Taplin Tackles Equitable Treatment in Prostate Cancer

Mary-Ellen Taplin, MD

Despite advances in treatment, prevailing health care disparities remain alarmingly high within the management of prostate cancer, according to Mary-Ellen Taplin, MD, who applauded Mass General Brigham’s United Against Racism initiative which seeks to provide equitable access to health care services in the community.

The Prostate Cancer Outreach Clinic, which falls under the initiative, was cofounded by Quoc-Dien Trinh, MD, MBA, of Mass General Brigham, and Adam Feldman, MD, MPH, of Massachusetts General Hospital. Central to the clinic’s operational framework is its reliance on community engagement, supported by community health care workers who play a pivotal role in facilitating patient interactions and streamlining access to health care services, particularly for individuals presenting with elevated prostate-specific antigen (PSA) levels or in need of screening.

After a year of operation, the clinic has yielded promising outcomes, serving a considerable patient cohort and achieving notable rates of successful visit scheduling and cancer diagnoses. Collaborative endeavors with an array of stakeholders, including institutional partners, patient advocacy groups, and health care insurers have been pivotal in achieving these outcomes, according to Taplin.

In an interview with OncLive®, Taplin discussed how the clinic’s initiatives exemplify a pragmatic approach to mitigating health care disparities in prostate cancer care and detailed future directions for the center. Taplin is the chair of the Executive Committee for Clinical Research and

institute physician at Dana-Farber Cancer Institute, and professor of medicine at Harvard Medical School in Boston, Massachusetts.

OncLive: What are some of the main elements that create health care disparities in prostate cancer? How has the prostate cancer outreach clinic in Boston helped combat these issues?

Taplin: Health care inequities in prostate cancer are a well-established challenge for us in the field. [There are] many barriers to equitable health care, including access to health insurance, access to medical centers, and access to physicians. But in addition to access, there’s also inequities in care delivery. To combat that barrier to care delivery in Boston, my colleagues in urology, Dr Quoc-Dien Trinh and Dr Adam Feldman, have worked for several years with many stakeholders to build a clinic for men who are at risk for prostate cancer, because of elevated PSA or who need PSA screening. The key to the success of that clinic is [community engagement]. To facilitate community engagement, community health care workers were trained and integrated into this clinic.

So, when patients are referred for prostate cancer screening, or because they have an elevated PSA, the first introduction is to a community health care worker, who then works with the patient to evaluate [whether] their insurance is consistent with getting care at one of the Mass General Brigham [MGB] hospitals. Then the community health care worker takes the next step and schedules the appointment and helps the patient get to the appointment. If the insurance is not compatible with an MGB institution, then the community health care worker will work with the financial assistance teams that are available to get the patient health care or an appropriate referral. This clinic has been in operation for about 1 year, but they’ve had over 220 patients within the system and almost 100 new referrals. Moreover 54% of patients were successfully scheduled for visits and of the patients with an elevated PSA 25% were diagnosed with prostate cancer.

I am very proud of my colleagues. Working with many stakeholders, from the institutions to patient advocacy groups, community practices, and health care insurers they were able to make a practical approach to breaking down the barriers to equitable care. Many important initiatives are underway, including working on improving access to getting to the medical practice because of issues with public transportation and how far away from the hospitals some patients live, as well as building bigger and more comprehensive coalitions, which will set the priorities for continuing this work and extending its outreach.

Which populations of patients are most vulnerable to these disparities?

[The population of patients who are most vulnerable to health care disparities] will differ by region. Patients who live in rural communities, patients who have poor health care literacy, patients who have no or poor health insurance, patients of different ethnic groups, especially if they have other risk factors, such as being far from medical practices [may be more at risk of not receiving adequate care]. It really depends on the area of the country. Since prostate cancer is very common in black men, we are concerned that black men are not getting equitable care, and that’s been shown in Dr Trinh’s research and others.

Could this clinic serve as a blueprint for other institutions nationwide?

I do think that [this outreach clinic] could be a model, and that was one of the reasons I wanted to discuss it so I could spread the word. In talking to Dr Trinh, part of his success was that he’s been with MGB for 15 years, so he had developed relationships with new people in many pockets of a very big health care system. That was key to being able to work with the different components to set this up.

Also, Dr Trinh, 10 years ago, approached it from an academic standpoint and had funding from the Department of Defense, the American Cancer Society, and the Prostate Cancer Foundation. [Because of that] he was able to, through academic work and publications and training, develop key metrics that then could be applied in a practical way with consensus from many listening sessions and by being open to taking the community feedback and engaging with the community. His team is not just going to show up once and talk about prostate cancer. [By] going [to] event after event after event, you develop a trust with the community that allows you to then open avenues of referrals for patients at risk, because you’ve met the community health care workers and the advocates [who are part of] running different groups and community practices. I think it can be used as a model, but it has to come with a deep commitment to breaking down the barriers, which are long established and sometimes unrecognized.

Did your colleagues face any challenges in getting the clinic off the ground?

Yes, many. Establishing trust within the communities at risk was a challenge [because we are] working with different aspects of a large healthcare system where people turn over in their jobs. You may have had a meeting six months ago with a group and then six months later, the people that you met with are gone, so you have to start over with new employees in that part of the group. So, [there are] lots of challenges.

The first year [the clinic was open], the number of patients who had a follow-up appointment scheduled was less than ideal, [it] was about 54%. [There are] a lot of reasons for that, such as transportation, unstable housing, and medical literacy. A future goal is to increase the proportion of patients who come to the initial [appointment] and then follow through with the follow-up appointments. But this is just the first year and I think it’s a tremendous accomplishment.

We’ve had other Dana-Farber initiatives, such as PSA screening vans that go into the community that have had some success, but this practice of establishing streams of referrals for patients who might otherwise go unconnected to health care is not going anywhere.

Are there any other prospective avenues that are being considered to improve the success of the clinic?

It’s been identified that black men in Massachusetts are five times more likely to take public transportation to the practice and four times more likely to live at extended distances from the practice. Developing a program with rideshare vouchers is one of the future initiatives that [the clinic] has. Other future initiatives are going to come from the community, [so that we can continue to] develop this coalition and expand it and listen to the voices of the communities. Expanding the community health care worker network and program [has] proven successful and impactful. [I think we’ve shown that] was a missing link to the hospital systems and the practitioners.

Reference

Prostate cancer outreach clinic. Mass General Brigham. Accessed March 22, 2024. https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/prostate-cancer-outreach-clinic