Confronting Inequities in Cancer

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers
00:02 --> 00:03is provided by Smilow Cancer
00:03 --> 00:04Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:09with doctor Eric Winer.
00:10 --> 00:12Yale Cancer Answers features conversations
00:12 --> 00:14with oncologists and specialists who
00:14 --> 00:15are on the forefront of
00:15 --> 00:16the battle to fight cancer.
00:17 --> 00:18This week, it's a conversation
00:18 --> 00:20about disparities in cancer care
00:20 --> 00:22with doctor Tracy Battaglia.
00:22 --> 00:25Doctor Battaglia is associate cancer
00:25 --> 00:26center director for cancer care
00:26 --> 00:28equity at Yale Cancer Center.
00:29 --> 00:30Here's doctor Winer.
00:31 --> 00:33It's really a pleasure to
00:33 --> 00:34be here with you tonight.
00:34 --> 00:35And over the course of
00:35 --> 00:36the weeks ahead,
00:37 --> 00:38you'll hear me interview a
00:38 --> 00:41variety of different guests covering
00:41 --> 00:43a whole range of topics
00:43 --> 00:45related to cancer, cancer research,
00:46 --> 00:47and cancer treatment.
00:48 --> 00:49Tonight, we have
00:50 --> 00:51doctor Tracy Battaglia.
00:52 --> 00:53Tracy, welcome
00:54 --> 00:55It's really a pleasure to have you.
00:57 --> 00:58Thank you so much. It's
00:58 --> 00:59my pleasure to be here.
01:00 --> 01:01So first, could you just
01:01 --> 01:02tell us a little bit
01:02 --> 01:04about yourself and
01:04 --> 01:06your career
01:07 --> 01:08over the past
01:08 --> 01:10twenty or twenty five years?
01:10 --> 01:11Absolutely.
01:16 --> 01:17As you mentioned, I'm a
01:17 --> 01:19primary care physician by training
01:19 --> 01:21and health services researcher.
01:22 --> 01:23And like all of us,
01:24 --> 01:25my own lived experience
01:26 --> 01:27has really shaped the choices
01:27 --> 01:29of my academic career.
01:30 --> 01:31And so as you are
01:31 --> 01:31well aware,
01:33 --> 01:33I started
01:34 --> 01:35my medical career
01:36 --> 01:38with an interest in health
01:38 --> 01:39behavior and was a
01:39 --> 01:41psychology major as an undergraduate.
01:42 --> 01:43And during that
01:44 --> 01:45early part of my medical
01:45 --> 01:46training, I had my own
01:46 --> 01:48experience with cancer
01:49 --> 01:50as a survivor of stage
01:50 --> 01:51four Hodgkin's lymphoma.
01:52 --> 01:53And it was that experience
01:53 --> 01:55that really sort of motivated
01:57 --> 01:59me to be interested in oncology as
01:59 --> 02:00a field.
02:00 --> 02:02But I also realized that
02:02 --> 02:04my interest in oncology and
02:04 --> 02:05cancer was really more sort
02:05 --> 02:06of in the early stages
02:06 --> 02:07of prevention
02:08 --> 02:08and
02:10 --> 02:12early detection. And so I
02:12 --> 02:13pursued a career in
02:14 --> 02:16general medicine, primary care with
02:16 --> 02:18an early focus in women's
02:18 --> 02:18health,
02:20 --> 02:22and breast cancer prevention.
02:25 --> 02:26Early in my training, I
02:26 --> 02:26recognized
02:27 --> 02:28that my care experience was
02:28 --> 02:29very different than the patients
02:29 --> 02:31that I was caring for.
02:31 --> 02:32And so that was what
02:32 --> 02:33really sort of influenced me
02:33 --> 02:36to pursue an academic career,
02:36 --> 02:37really understanding
02:37 --> 02:38care delivery
02:39 --> 02:41and just differences in
02:41 --> 02:43care delivery between different people
02:43 --> 02:43and populations.
02:44 --> 02:46And so very early in
02:46 --> 02:47my career, I focused on
02:47 --> 02:50cancer disparities and was very
02:51 --> 02:51driven to try to make my NOTE Confidence: 0.9399783
02:54 --> 02:55own patients' experiences
02:55 --> 02:57as positive as my own
02:57 --> 02:58experiences were.
02:59 --> 03:00And so that's really how
03:00 --> 03:01I started in the field
03:01 --> 03:03of cancer disparities and care
03:03 --> 03:04delivery.
03:04 --> 03:06Well, I know there's been
03:06 --> 03:07much more to your career
03:08 --> 03:09beyond that start and we'll get to that.
03:11 --> 03:13But maybe we can start by
03:13 --> 03:14talking
03:14 --> 03:16a bit about what cancer
03:16 --> 03:17disparities
03:17 --> 03:17are.
03:19 --> 03:21It is known, of course that there are
03:24 --> 03:26differences in outcomes for people
03:26 --> 03:27by race.
03:27 --> 03:29And that, for example, if
03:29 --> 03:30you are a twenty year old
03:31 --> 03:33Black woman in the United
03:33 --> 03:33States,
03:34 --> 03:35you have twice the chance
03:35 --> 03:37of dying from breast cancer
03:37 --> 03:38by the time you're fifty
03:38 --> 03:39compared to a twenty year
03:39 --> 03:40old white woman.
03:42 --> 03:43But maybe the
03:43 --> 03:45most prominent example of a
03:45 --> 03:46disparity,
03:46 --> 03:48and we can talk about
03:48 --> 03:49why that exists,
03:49 --> 03:51but there are many, many
03:51 --> 03:53other disparities as well. And
03:53 --> 03:55we know that in our
03:55 --> 03:56country with
03:56 --> 03:58sometimes great medical care,
03:58 --> 03:59there are also instances
04:00 --> 04:01where there just isn't great
04:01 --> 04:02medical care.
04:03 --> 04:04So can you comment on
04:06 --> 04:08the various ways that disparities
04:08 --> 04:09occur?
04:12 --> 04:13I want to just sort of take
04:13 --> 04:14a moment to reflect on
04:14 --> 04:16the statistic that you just
04:16 --> 04:17shared about young Black women.
04:19 --> 04:20I just want to point
04:20 --> 04:21out that I've been doing
04:21 --> 04:23this work for twenty five
04:23 --> 04:23years
04:24 --> 04:25and that statistic hasn't changed
04:27 --> 04:28in the twenty five years
04:28 --> 04:29that I've been doing this work.
04:30 --> 04:32I think that we should
04:32 --> 04:33really reflect on that and
04:33 --> 04:34sort of think about that
04:34 --> 04:35as we have this conversation.
04:36 --> 04:36Because
04:37 --> 04:39even though we have an
04:39 --> 04:40increased recognition
04:40 --> 04:42of disparities, which are these
04:42 --> 04:44sort of differences in outcomes by
04:46 --> 04:47different groups and populations,
04:48 --> 04:50we haven't made a whole
04:50 --> 04:51lot of progress in
04:52 --> 04:53reducing those differences.
04:53 --> 04:54And so,
04:56 --> 04:58now maybe we should just
04:58 --> 04:59talk about what health
04:59 --> 05:01equity means.
05:01 --> 05:02Can I just interrupt for one
05:02 --> 05:03second and ask,
05:04 --> 05:06isn't it the case also
05:06 --> 05:08that as cancer care gets
05:08 --> 05:09more expensive,
05:10 --> 05:11more complicated,
05:12 --> 05:14and very often more effective
05:15 --> 05:17that those disparities could increase?
05:17 --> 05:19Yes. Thank you for pointing
05:19 --> 05:20that out because I think
05:20 --> 05:21it helps answer the first
05:21 --> 05:23question you posed,
05:23 --> 05:24which is, what
05:24 --> 05:25are other examples of
05:26 --> 05:28cancer disparities and inequities?
05:28 --> 05:29I mean, I think it's
05:29 --> 05:30this notion that
05:34 --> 05:35as care becomes more complex
05:36 --> 05:36and
05:37 --> 05:39really frankly, sort
05:39 --> 05:41of tailored to the individual
05:41 --> 05:42person and the individual
05:42 --> 05:44cancer type and tumor,
05:44 --> 05:46as we learn and understand
05:46 --> 05:47more that cancer
05:47 --> 05:48is not one disease,
05:48 --> 05:50it's many, many, many different
05:50 --> 05:51types of diseases,
05:53 --> 05:54that complexity makes
05:55 --> 05:58disparities and inequities
05:59 --> 06:01more likely. And that is
06:01 --> 06:01because,
06:02 --> 06:04a major root cause of
06:04 --> 06:06cancer disparities and
06:06 --> 06:07inequity
06:08 --> 06:09is this lack of equal
06:09 --> 06:10access.
06:11 --> 06:12And so that goes back
06:12 --> 06:13to the definition of what
06:13 --> 06:15health equity is and health
06:15 --> 06:16equity is actually when
06:16 --> 06:17we all
06:18 --> 06:19have an equal opportunity to
06:19 --> 06:20be as healthy as possible.
06:20 --> 06:22So when we're talking about
06:22 --> 06:23cancer, specifically,
06:24 --> 06:25equity is when everyone has
06:25 --> 06:27an equal opportunity to prevent
06:27 --> 06:27cancer,
06:28 --> 06:29find it early
06:29 --> 06:31and get proper treatment and
06:31 --> 06:33follow-up after treatment is completed.
06:33 --> 06:33And so
06:34 --> 06:36with advances in cancer prevention
06:36 --> 06:37options,
06:37 --> 06:39early detection options,
06:40 --> 06:40treatments,
06:41 --> 06:43and even access to
06:43 --> 06:44cutting edge treatments through
06:44 --> 06:45clinical trials,
06:46 --> 06:47we have to have equal
06:47 --> 06:48access to all of those
06:48 --> 06:50things for equity to be
06:50 --> 06:52accomplished. And the truth is
06:52 --> 06:53the way that our health
06:53 --> 06:55system is set up,
06:56 --> 06:57we don't have equal access.
06:57 --> 06:58So we have to make
06:58 --> 07:00a conscious effort to
07:02 --> 07:03think about how to change
07:03 --> 07:05that, our healthcare delivery system
07:05 --> 07:06to ensure everyone has equal
07:06 --> 07:07access. And that's
07:08 --> 07:09a very tall order.
07:12 --> 07:15Who else other than people of color
07:20 --> 07:22face disparities in cancer care?
07:25 --> 07:26So I think you have
07:26 --> 07:27to think about
07:31 --> 07:31different populations
07:32 --> 07:34and sort of identities. So,
07:35 --> 07:37populations that are at risk
07:37 --> 07:39are those populations that have
07:39 --> 07:39historically
07:40 --> 07:42been marginalized for some reason,
07:44 --> 07:46root causes of structural,
07:47 --> 07:49sometimes race, but it's
07:49 --> 07:50also by
07:50 --> 07:53language and income and
07:53 --> 07:54gender identity.
07:55 --> 07:57Where you live matters, if
07:57 --> 07:59you're rural versus in an
07:59 --> 08:00urban setting. And so
08:01 --> 08:02we see disparities and
08:02 --> 08:03inequities
08:03 --> 08:05when we look at populations
08:06 --> 08:07through all of those lenses,
08:07 --> 08:08whether it be
08:09 --> 08:11white, nonwhite race,
08:13 --> 08:14or ethnicity,
08:15 --> 08:17coming from low income background,
08:18 --> 08:20not having health insurance or
08:20 --> 08:21having public health insurance,
08:22 --> 08:23not speaking English as your
08:23 --> 08:24primary language,
08:26 --> 08:27you know, unhoused
08:27 --> 08:28populations,
08:28 --> 08:29people who have
08:29 --> 08:29housing insecurity are more at
08:29 --> 08:29risk. All the populations that
08:29 --> 08:30we know,
08:31 --> 08:32security are more at risk.
08:33 --> 08:34All the populations that we
08:34 --> 08:35know,
08:37 --> 08:40don't have access to social
08:40 --> 08:41support.
08:42 --> 08:43It sounds to me like
08:44 --> 08:46probably half of the US
08:46 --> 08:47population is at risk.
08:48 --> 08:50Well, you know, it's true.
08:50 --> 08:52Every population and every community
08:52 --> 08:53has
08:54 --> 08:56people who are at risk.
08:56 --> 08:57And so it really depends
08:57 --> 08:58on where you live. And part of
08:59 --> 09:00the work that I have
09:00 --> 09:01always done
09:02 --> 09:03is sort of taking this
09:03 --> 09:04health equity lens
09:05 --> 09:06which really is
09:10 --> 09:12just asking critical questions around not
09:12 --> 09:13who is getting care, but
09:13 --> 09:15who isn't getting care. And
09:15 --> 09:17that may look very different
09:17 --> 09:18depending on what community or
09:18 --> 09:20health system that you're in.
09:20 --> 09:22So for example,
09:22 --> 09:23twenty five years in Boston,
09:24 --> 09:26the populations that I worked
09:26 --> 09:27with in Boston and the
09:27 --> 09:29health systems that I worked
09:29 --> 09:31in in Boston, the social
09:31 --> 09:32systems and the
09:32 --> 09:34public systems in terms of
09:34 --> 09:35insurance and
09:36 --> 09:37Medicaid expansion,
09:38 --> 09:39the populations at risk were
09:39 --> 09:40different than they are here
09:40 --> 09:42in Connecticut. And
09:42 --> 09:43I've been here
09:43 --> 09:45a few months now and
09:45 --> 09:46I'm starting to understand
09:46 --> 09:47the health system,
09:48 --> 09:49which is very complex.
09:50 --> 09:51I'm starting to understand sort
09:51 --> 09:53of the state
09:53 --> 09:55and the social systems.
09:56 --> 09:57And the populations are a
09:57 --> 09:59little bit different. And so
09:59 --> 10:00the approaches need to be
10:00 --> 10:01tailored and different to address
10:01 --> 10:03those inequities. And so I think
10:04 --> 10:05cancer equity really starts with
10:05 --> 10:07asking the question of who
10:07 --> 10:09is getting care and who
10:09 --> 10:10is not. And that really
10:10 --> 10:11gets at the root cause
10:11 --> 10:11of inequity.
10:12 --> 10:13And it sounds to me
10:13 --> 10:14like there are just so many
10:15 --> 10:17reasons for it.
10:17 --> 10:18For example,
10:19 --> 10:21for somebody who may not
10:21 --> 10:23have a lot of financial
10:23 --> 10:25resources and is the
10:25 --> 10:27single mother of three children,
10:28 --> 10:29that woman is going to,
10:30 --> 10:31in most cases, be more
10:31 --> 10:33concerned about getting food on
10:33 --> 10:34the table for her three
10:34 --> 10:35kids,
10:36 --> 10:38and less concerned about figuring
10:38 --> 10:39out how to pay for
10:40 --> 10:41the transportation to get to
10:41 --> 10:43a doctor's appointment to get
10:43 --> 10:44her cancer treatment.
10:45 --> 10:46And yet on the other
10:46 --> 10:48hand, there may be problems
10:50 --> 10:52on the medical side
10:52 --> 10:53of the equation as well where
10:55 --> 10:57certain patient populations just don't
10:58 --> 10:59get the same attention
10:59 --> 11:00that others do.
11:02 --> 11:03Yeah. I think all those
11:03 --> 11:04things are true.
11:06 --> 11:08Often when I talk about cancer
11:08 --> 11:09equity I share
11:10 --> 11:11two case studies
11:12 --> 11:13at the hospital that I
11:13 --> 11:15worked at Boston medical center.
11:20 --> 11:21One of a middle aged white woman in
11:21 --> 11:22her late forties,
11:23 --> 11:26who is a professional physician
11:26 --> 11:28who felt a breast lump
11:28 --> 11:29and got in and had her
11:30 --> 11:31mammogram
11:31 --> 11:33and biopsy within twenty four
11:33 --> 11:34hours and was diagnosed with
11:34 --> 11:35a stage one cancer.
11:36 --> 11:37And the other patient
11:38 --> 11:40was a younger forty two
11:40 --> 11:42year old woman, Haitian immigrant,
11:42 --> 11:44non English speaking, on public
11:44 --> 11:45health insurance. In fact, was
11:45 --> 11:47uninsured at the time because
11:47 --> 11:49she had lost her insurance
11:49 --> 11:50after she had her last child.
11:52 --> 11:52Suffered from
11:54 --> 11:56housing insecurity after a fire
11:56 --> 11:57in her home and was
11:57 --> 11:58living in a shelter,
11:59 --> 12:00felt a mass
12:00 --> 12:02months ago, but
12:02 --> 12:04frankly that wasn't the most
12:04 --> 12:05pressing issue in her life.
12:05 --> 12:07So she put off getting
12:07 --> 12:07care
12:07 --> 12:09and it wasn't until ten
12:09 --> 12:10months later that she was diagnosed
12:10 --> 12:11with a ten centimeter
12:12 --> 12:13stage three cancer.
12:13 --> 12:15That was at my institution
12:16 --> 12:18where I was seeking care.
12:18 --> 12:19In fact, that first patient
12:19 --> 12:20was me.
12:20 --> 12:22So I'm providing
12:22 --> 12:23care to a population.
12:24 --> 12:25And despite having access to a
12:25 --> 12:27large academic
12:27 --> 12:29medical center with
12:29 --> 12:31Medicaid expansion and
12:32 --> 12:34medical insurance coverage, patients
12:35 --> 12:36have a lot of barriers
12:37 --> 12:39getting them into care because
12:39 --> 12:40cancer, frankly, is not the
12:40 --> 12:41worst thing that they're dealing
12:41 --> 12:42with in their life. They're
12:42 --> 12:44dealing with their three kids,
12:45 --> 12:46getting food on the table
12:46 --> 12:47and making sure they have
12:47 --> 12:48safe housing.
12:49 --> 12:51And so it's those sort
12:51 --> 12:52of root causes we need
12:52 --> 12:53to be thinking about as
12:53 --> 12:54we design our care delivery
12:54 --> 12:56systems and have these amazing
12:56 --> 12:58new scientific discoveries,
12:59 --> 13:01that, you know, are
13:01 --> 13:02helping people live longer, but
13:02 --> 13:04we're not letting everyone access
13:04 --> 13:05them equally.
13:06 --> 13:08And it's
13:08 --> 13:09not always just about our
13:09 --> 13:11healthcare system. It's really
13:11 --> 13:12about our
13:12 --> 13:14social system. And
13:14 --> 13:15I think that
13:16 --> 13:17the future of cancer equity
13:17 --> 13:19really has to lie in
13:20 --> 13:22an intersection between social care
13:22 --> 13:23and healthcare.
13:23 --> 13:24And I think there's a
13:24 --> 13:26movement towards that, but there's
13:26 --> 13:27a lot of work that
13:27 --> 13:28we need to continue to
13:28 --> 13:30do to really realize that.
13:30 --> 13:31Well, we're going to take
13:31 --> 13:33just a brief break at
13:33 --> 13:34the moment and we'll be
13:34 --> 13:37back with doctor Tracy Battaglia
13:37 --> 13:39to talk more about how
13:39 --> 13:41we're going to figure out
13:41 --> 13:42a way to deliver cancer
13:42 --> 13:43care
13:43 --> 13:45to everyone who needs it.
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14:38 --> 14:40You're listening to Connecticut Public Radio.
14:42 --> 14:43Good evening again. This is
14:44 --> 14:46Eric Winer, and I'm here
14:46 --> 14:47interviewing
14:48 --> 14:49Tracy Battaglia.
14:49 --> 14:50We're talking about
14:52 --> 14:53cancer care disparities
14:54 --> 14:56and the challenges that exist
14:56 --> 14:57and how we hope
14:57 --> 14:59to change that in the
14:59 --> 15:00years ahead.
15:01 --> 15:02I think it's fair to
15:02 --> 15:03say, Tracy, that it's going to
15:03 --> 15:05take a long time before
15:05 --> 15:06we are able to provide
15:07 --> 15:08equal access to care to
15:08 --> 15:09everyone.
15:09 --> 15:10But along
15:11 --> 15:13that path, it seems that
15:13 --> 15:14there's a lot of progress
15:14 --> 15:15that can be made in
15:15 --> 15:17a stepwise fashion. Would you
15:17 --> 15:17agree?
15:18 --> 15:19I would agree. I'm excited
15:19 --> 15:21to change our conversation from
15:21 --> 15:23talking about the differences
15:23 --> 15:24and the disparities and what
15:24 --> 15:25actions we can take to
15:25 --> 15:26overcome them.
15:27 --> 15:28Well, good.
15:29 --> 15:30So can we talk a
15:30 --> 15:32little bit about
15:33 --> 15:34the use of
15:34 --> 15:37navigation, whether it's nurse navigators
15:37 --> 15:38or lay navigators,
15:40 --> 15:42to help with some of
15:44 --> 15:46the challenges that exist in
15:46 --> 15:47cancer care for so many
15:47 --> 15:48people?
15:49 --> 15:51Absolutely. So I think we
15:51 --> 15:52just spent
15:52 --> 15:52a good
15:54 --> 15:55few minutes
15:55 --> 15:56describing
15:56 --> 15:58the inequities and the differences
15:58 --> 16:00in care and care delivery.
16:00 --> 16:02And despite that, and
16:02 --> 16:04despite the persistence of these
16:04 --> 16:06inequities, there actually are very
16:06 --> 16:07few proven
16:08 --> 16:09interventions that actually over
16:10 --> 16:11come those inequities.
16:12 --> 16:13And so what I'm talking
16:13 --> 16:15about is how
16:15 --> 16:16can we, what can we
16:16 --> 16:17do to intervene
16:18 --> 16:20to ensure equal access to
16:20 --> 16:20care,
16:21 --> 16:22to ensure
16:23 --> 16:25the same good outcomes for
16:25 --> 16:26all patients? How
16:26 --> 16:27do we do that?
16:28 --> 16:28Well,
16:29 --> 16:31there is a very
16:31 --> 16:32large and
16:33 --> 16:33scientifically sound
16:35 --> 16:36base of evidence for the
16:36 --> 16:38use of patient navigation to
16:38 --> 16:40improve care, cancer care delivery
16:40 --> 16:41across the entire spectrum of
16:41 --> 16:43cancer care, From cancer screening,
16:43 --> 16:45to early diagnosis,
16:45 --> 16:47and timely quality
16:47 --> 16:47treatment.
16:48 --> 16:50Patient navigation is a term
16:50 --> 16:51that was coined in the
16:51 --> 16:521990s by
16:52 --> 16:54Doctor Harold Freeman, who
16:54 --> 16:56was a surgical oncologist
16:56 --> 16:58in Harlem where he recognized,
16:59 --> 17:00as I have recognized in
17:00 --> 17:02my own practice,
17:02 --> 17:04that young Black women were
17:04 --> 17:06dying much more
17:06 --> 17:08than the white patients he
17:08 --> 17:09was caring for in Harlem
17:09 --> 17:10in large part, because they
17:10 --> 17:12were showing up much later
17:12 --> 17:13in their disease state.
17:16 --> 17:18And he asked the question,
17:19 --> 17:20why is that the case?
17:20 --> 17:21And it was in large
17:21 --> 17:23part because they were not
17:23 --> 17:25accessing care because of all
17:25 --> 17:26these barriers to care we
17:26 --> 17:27talked about before,
17:28 --> 17:29cancer wasn't necessarily
17:30 --> 17:31the priority for the patient
17:31 --> 17:32because they had all these
17:32 --> 17:34other social barriers or social
17:34 --> 17:35drivers
17:36 --> 17:37to their care, whether it was
17:38 --> 17:40housing insecurity or food insecurity
17:41 --> 17:42or employment
17:43 --> 17:43challenges,
17:43 --> 17:45insurance challenges,
17:46 --> 17:48language challenges,
17:48 --> 17:48transportation,
17:49 --> 17:50getting to care. All of
17:50 --> 17:52those things were impeding the
17:52 --> 17:54access to services. And
17:54 --> 17:56he designed a program in
17:56 --> 17:57partnership with the community. And
17:57 --> 17:58he said, well,
17:59 --> 18:01who else to better help
18:01 --> 18:03patients get into our hospital
18:04 --> 18:05walls, but patients from the
18:05 --> 18:07community who they know and
18:07 --> 18:07trust.
18:08 --> 18:09And so he hired what
18:09 --> 18:11were now called patient navigators
18:11 --> 18:12who are culturally and linguistically
18:13 --> 18:15congruent with the patient population
18:15 --> 18:16to be the liaison between
18:16 --> 18:17the health system and the
18:17 --> 18:18patient.
18:18 --> 18:20To help understand what their
18:20 --> 18:22specific barriers to care are,
18:22 --> 18:23and then connect them with
18:23 --> 18:25community resources to overcome them.
18:25 --> 18:26Whether that be helping them
18:26 --> 18:27enroll
18:27 --> 18:29for public insurance,
18:29 --> 18:30get transportation,
18:31 --> 18:33support around housing or food
18:33 --> 18:33insecurity,
18:34 --> 18:35so that they could deal
18:35 --> 18:36with those issues
18:37 --> 18:38as a means to make
18:38 --> 18:40sure that they were also
18:40 --> 18:40able to
18:41 --> 18:42comply with their medical
18:44 --> 18:45treatment and care.
18:46 --> 18:47And so fast
18:47 --> 18:48forward twenty years now, we
18:52 --> 18:53have good evidence
18:54 --> 18:56using randomized clinical trials, which
18:56 --> 18:58is the best scientific evidence
18:58 --> 18:59we have that shows if
18:59 --> 19:00you insert these
19:01 --> 19:02patient navigators into the health
19:02 --> 19:04system to support patients through
19:04 --> 19:05their care,
19:05 --> 19:07they are more likely to
19:07 --> 19:08get into their screening,
19:08 --> 19:10get a timely diagnosis,
19:10 --> 19:12and get into timely treatment
19:12 --> 19:14and have quality treatment and
19:14 --> 19:16complete that treatment. And ultimately
19:16 --> 19:17we know
19:17 --> 19:18if we can do that,
19:18 --> 19:20we're going to improve outcomes
19:20 --> 19:22and start to get to
19:22 --> 19:24a place where everyone has
19:24 --> 19:26the opportunity for optimal health.
19:28 --> 19:29It's so important,
19:29 --> 19:31and it's more important than
19:31 --> 19:32ever before.
19:32 --> 19:33I know that when
19:34 --> 19:35I try to access
19:35 --> 19:36the health care system,
19:37 --> 19:39and I'm about as connected
19:39 --> 19:41as a person can be,
19:41 --> 19:42being the cancer center director and
19:43 --> 19:44having
19:44 --> 19:46adequate education and resources,
19:47 --> 19:48but I find it impossible
19:49 --> 19:50to navigate the system.
19:50 --> 19:52I share that experience.
19:53 --> 19:55And if you don't have that
19:56 --> 19:57inner knowledge,
20:01 --> 20:03and particularly if there are
20:03 --> 20:04reasons why you want to run
20:04 --> 20:06away from the health care
20:06 --> 20:08system to begin with, it's
20:08 --> 20:09just too easy for that
20:09 --> 20:10to happen.
20:10 --> 20:12And you can see how
20:12 --> 20:15the assistance of a navigator,
20:15 --> 20:16of someone to just
20:16 --> 20:18help guide you through the
20:18 --> 20:19experience could make such a
20:19 --> 20:20huge difference.
20:21 --> 20:23Yeah, you know in some
20:23 --> 20:23respects,
20:23 --> 20:24patient navigation,
20:26 --> 20:27the fact that we need
20:27 --> 20:28patient navigation
20:29 --> 20:30suggests that our health system is
20:32 --> 20:32inadequate.
20:33 --> 20:34Right.
20:34 --> 20:36It's a complex system even for us
20:44 --> 20:46and our medical literacy and health
20:46 --> 20:47literacy is higher and we are
20:51 --> 20:52care providers ourselves.
20:54 --> 20:55And we speak the language and
20:56 --> 20:59the people we work
20:59 --> 21:00with are like us, right?
21:02 --> 21:02So for all of those
21:02 --> 21:04reasons, and people want to
21:04 --> 21:05take care of us. Absolutely.
21:08 --> 21:09When I had my
21:09 --> 21:10cancer diagnosis
21:11 --> 21:13as a professional, you know,
21:13 --> 21:14people called me.
21:15 --> 21:16I didn't have to
21:16 --> 21:16call to get into care.
21:16 --> 21:18People called me to help
21:18 --> 21:19me get into care. That
21:19 --> 21:20was not my patient experience.
21:22 --> 21:23And so until
21:23 --> 21:25we have a just system
21:25 --> 21:27that supports everyone equally, we're
21:27 --> 21:29always going to have inequities.
21:29 --> 21:30And so I don't think
21:30 --> 21:32health equity or cancer equity
21:34 --> 21:35work will ever go away
21:35 --> 21:37because we're human by
21:37 --> 21:38nature.
21:40 --> 21:41From a social
21:41 --> 21:43sort of system, we
21:43 --> 21:45set ourselves up for
21:45 --> 21:46inequity. And so we always
21:46 --> 21:47have to be asking
21:47 --> 21:49that critical question, who in
21:49 --> 21:50our community right now is
21:50 --> 21:51not being served? That might
21:51 --> 21:53look different in ten, twenty
21:53 --> 21:54years. It might be a
21:54 --> 21:55different group or population,
21:56 --> 21:57but there will always be
21:57 --> 21:59those who are
21:59 --> 21:59doing
22:01 --> 22:02better than others. And
22:02 --> 22:03so we always have to
22:03 --> 22:05have this critical
22:05 --> 22:06health equity lens
22:06 --> 22:08as we approach our work.
22:09 --> 22:10And so I think that since
22:12 --> 22:14COVID and sort of
22:15 --> 22:16all of the
22:16 --> 22:17social sort of
22:19 --> 22:21unearthing of
22:21 --> 22:22what we've always known around
22:23 --> 22:24social inequity,
22:25 --> 22:27we've been challenged as
22:28 --> 22:29a society to
22:30 --> 22:31do something about it. And
22:31 --> 22:32so I think that's a
22:32 --> 22:33good thing, but I don't
22:33 --> 22:34think we can ever let
22:34 --> 22:36that guard down. It needs
22:36 --> 22:37to continue. We're already seeing
22:37 --> 22:38the pendulum swing in some
22:38 --> 22:40respects about the focus on
22:40 --> 22:41health equity and
22:43 --> 22:45the disinvestment in health equity,
22:46 --> 22:47after there was such a
22:47 --> 22:49strong investment in health equity
22:49 --> 22:50post COVID. We can't
22:50 --> 22:52let our guard down.
22:53 --> 22:54And I respect your leadership
22:54 --> 22:56as a cancer center director
22:56 --> 22:59and prioritizing this conversation because
22:59 --> 23:00it suggests that you recognize
23:00 --> 23:01that it's important.
23:02 --> 23:03And if we can just
23:03 --> 23:05step away from the professional
23:05 --> 23:07and into the personal for
23:07 --> 23:07a second.
23:08 --> 23:10So you had Hodgkin's disease
23:10 --> 23:11when you
23:11 --> 23:13were twenty. In your early
23:13 --> 23:14twenties
23:14 --> 23:16and breast cancer in
23:16 --> 23:18the last
23:18 --> 23:18decade.
23:21 --> 23:23To what extent has that
23:24 --> 23:24lived experience
23:25 --> 23:26fueled
23:27 --> 23:29your desire to pursue this
23:29 --> 23:30career?
23:34 --> 23:35As I started out our conversation,
23:37 --> 23:38it's our lived experience. It's
23:38 --> 23:40our stories, it's our history.
23:40 --> 23:41It's what shapes us.
23:45 --> 23:46And I think
23:49 --> 23:50that my first cancer experience
23:52 --> 23:53motivated me to go into
23:53 --> 23:54this field.
23:55 --> 23:57And my second cancer experience
23:58 --> 24:00challenged me to think
24:00 --> 24:02critically about what we've
24:02 --> 24:04done to get to
24:04 --> 24:05where we are and how
24:05 --> 24:06much further we need to go.
24:08 --> 24:10For me personally, it's just fueled
24:10 --> 24:11my desire and
24:12 --> 24:14commitment to doing this work,
24:15 --> 24:16but it also helps me
24:16 --> 24:18understand where we're falling short.
24:19 --> 24:20I see myself
24:20 --> 24:22as an advocate to continue to
24:24 --> 24:26ensure that the
24:26 --> 24:27leaders of our health systems
24:31 --> 24:31and our government
24:32 --> 24:34really prioritize this work because
24:35 --> 24:36I can tell you from
24:36 --> 24:37my own experience
24:38 --> 24:39that
24:41 --> 24:41we have a long way
24:41 --> 24:42to go.
24:42 --> 24:43We have a long way
24:43 --> 24:45to go and you know,
24:45 --> 24:47what's really remarkable is
24:48 --> 24:49not that cancer care is
24:49 --> 24:51by any means close to
24:51 --> 24:51perfect
24:52 --> 24:54for even those who can
24:54 --> 24:54get
24:54 --> 24:56the very best care.
24:56 --> 24:58But we've made so much
24:58 --> 25:00progress in the last three
25:00 --> 25:01decades and
25:02 --> 25:03the progress
25:03 --> 25:05feels like it's exponential at
25:05 --> 25:06this point with
25:07 --> 25:07newer
25:08 --> 25:09drugs being approved at a
25:09 --> 25:11rate that is really
25:12 --> 25:13unprecedented
25:13 --> 25:15and other kinds of
25:15 --> 25:16therapies as well.
25:17 --> 25:18But
25:19 --> 25:20that's if you can
25:20 --> 25:21get it, and it's just
25:22 --> 25:23so critical at this point.
25:24 --> 25:25What would you say to
25:25 --> 25:26someone
25:26 --> 25:27or to
25:28 --> 25:29a health care system that
25:29 --> 25:30says,
25:30 --> 25:32well, this navigation thing sounds
25:32 --> 25:33okay,
25:33 --> 25:35but how are we gonna
25:35 --> 25:37afford it? How can we
25:37 --> 25:37possibly
25:38 --> 25:38consider
25:39 --> 25:41covering the costs for navigation?
25:44 --> 25:44I mean, I think that's
25:44 --> 25:46easy. Right? We can't not
25:46 --> 25:48afford to do it. We
25:48 --> 25:49can't not afford to do
25:49 --> 25:50it. Like we have to
25:50 --> 25:52do it because it's going
25:52 --> 25:53to improve. It's going to
25:53 --> 25:54save lives.
25:54 --> 25:56It's actually ultimately going to
25:56 --> 25:57improve costs
25:57 --> 25:59because we're going to get
25:59 --> 26:01people in earlier with
26:01 --> 26:02an earlier diagnosis so
26:02 --> 26:04that they have less morbidity
26:04 --> 26:06and less complications and less
26:06 --> 26:07complicated treatment regimens.
26:10 --> 26:12Care in the
26:12 --> 26:13emergency room when you're
26:13 --> 26:15super sick is not the
26:15 --> 26:16answer. It's the
26:16 --> 26:19most expensive approach.
26:26 --> 26:27And what would you say to
26:27 --> 26:28someone
26:29 --> 26:30who says, this is
26:30 --> 26:31really
26:31 --> 26:33horrific what I'm hearing.
26:33 --> 26:35How can I help?
26:37 --> 26:38Do you think there are
26:38 --> 26:39things that
26:40 --> 26:42non doctors, non nurses,
26:43 --> 26:45people who just have friends
26:45 --> 26:46with cancer can do
26:48 --> 26:49to somehow
26:50 --> 26:52help with this problem of
26:52 --> 26:53cancer disparities?
26:54 --> 26:55Yeah. I mean, I think
26:55 --> 26:56we all have to
26:57 --> 26:57become advocates
27:02 --> 27:04in health equity. And I
27:04 --> 27:05think it starts with asking
27:05 --> 27:07the difficult questions. Sometimes
27:07 --> 27:08I am that person in
27:08 --> 27:10the room that asks a
27:10 --> 27:12difficult question of who's not
27:12 --> 27:13here. Who's actually not in
27:13 --> 27:14the room right now? And
27:14 --> 27:16we're making decisions, but the
27:16 --> 27:17people who we're making decisions
27:17 --> 27:18for are not represented.
27:19 --> 27:20So I think we can,
27:20 --> 27:22each one of us, sort
27:22 --> 27:23of hold ourselves accountable in
27:23 --> 27:25whatever spaces we are in.
27:25 --> 27:27Our communities, in our schools,
27:27 --> 27:27in our work,
27:28 --> 27:30with our doctors as a
27:30 --> 27:31patient, if you're a provider,
27:31 --> 27:32as a provider.
27:33 --> 27:35And ask the question, who's
27:35 --> 27:36not being served and why?
27:37 --> 27:38Because we make decisions
27:39 --> 27:41ourselves and within
27:43 --> 27:44the role as leaders
27:44 --> 27:46and administrators that
27:47 --> 27:49inadvertently leave people out. So
27:49 --> 27:50I think it just really
27:50 --> 27:52starts with that first
27:52 --> 27:54critical question of who's not
27:54 --> 27:55here and who's not being
27:55 --> 27:56served and why.
27:56 --> 27:57And I guess if when
27:57 --> 27:59we hear someone has cancer
27:59 --> 28:00and we know they're,
28:01 --> 28:03for example, somebody without health
28:03 --> 28:03insurance
28:04 --> 28:04who
28:05 --> 28:07does not have financial resources
28:08 --> 28:10or health literacy or education,
28:11 --> 28:12who's in the LGBTQ
28:13 --> 28:14plus community, who lives in
28:14 --> 28:16a rural environment, who for
28:16 --> 28:17that matter has mental health
28:17 --> 28:17issues,
28:19 --> 28:20and, of course, people who
28:20 --> 28:21are of color,
28:22 --> 28:23we must ask
28:23 --> 28:25ourselves whether they're gonna get
28:25 --> 28:27adequate cancer care and do
28:27 --> 28:28our best to help
28:28 --> 28:30in any way we can.
28:30 --> 28:32And that's where patient navigation
28:32 --> 28:33can come in, for sure.
28:34 --> 28:36Doctor Tracy Battaglia is associate
28:36 --> 28:38cancer center director for cancer
28:38 --> 28:39care equity at Yale Cancer
28:39 --> 28:40Center.
28:40 --> 28:42If you have questions, the
28:42 --> 28:43address is canceranswersatyale
28:44 --> 28:44dot edu,
28:45 --> 28:46and past editions of the
28:46 --> 28:48program are available in audio
28:48 --> 28:49and written form at yale
28:49 --> 28:51cancer center dot org.
28:51 --> 28:52We hope you'll join us
28:52 --> 28:53next time to learn more
28:53 --> 28:54about the fight against cancer.
28:55 --> 28:56Funding for Yale Cancer Answers
28:56 --> 28:58is provided by Smilow Cancer
28:58 --> 28:59Hospital.

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Confronting Inequities in Cancer with guest Tracy Battaglia July 21, 2024

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Tracy Battaglia, MD, MPH

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