Radiation Therapy Oncology Group (RTOG) Semi-Annual Meeting

1. Radiation Therapy Oncology Group (RTOG)Semi-Annual Meeting Tampa, Florida February 3, 2007

2. Urban Latino African American Cancer (ULAAC) Disparities Project Michael L. Steinberg, MD, FACR Principal Investigator David Huang, MD Co-Investigator Nicole Harada, CCRC, CCRP Clinical Trials Coordinator/Data Manager

3. Component Updates • Administrative • Navigation • Clinical Trials • Telesynergy/Telemedicine • Quality Assurance • Publications, Articles, and Presentations • Work in Progress

4. Administrative Component

5. Our Partners • Centinela Freeman Regional Medical Center • Michael L. Steinberg, MD, FACR, Principal Investigator • David Khan, MD, Co-Investigator • David Huang, MD, Co-Investigator • RAND Corporation • Allen Fremont, MD, PhD • Nell Forge, PhD , Co-Investigator • USC Norris Comprehensive Cancer Center • Oscar Streeter, MD , Co-Investigator • UCSF Comprehensive Cancer Center • Mack Roach, MD , Co-Investigator

6. Infrastructure Project Staff: • Debbie Karaman, MPH, Community Health Educator • Erika Cobb, Program Administrative Assistant • Herschel Knapp, PhD, MSSW • Nicole Harada, Clinical Trials Coordinator • Susan Richardson, RN, Oncology Nurse • Keith Andre, MA, Project Administrator

7. Community Liaison • Community Advisory Board • Meets two times per year • Investigators’ Meeting • Meets two times per year • Medical Advisory Board • Meets 6 times per year

8. Navigation Component

9. Our Patients

10. Cancer Disparities Research Partnership (CDRP) Patient Navigation Model Patient Navigation Rehabilitation Outreach Cancer Diagnosis Resolution Abnormal Finding AbnormalResults Diagnosis Treatment ConcludeNavigation Freeman, et.al., Cancer Practice, 1995. Diagnosis Treatment Abnormalresults ConcludeNavigation

11. Patient Navigator Training Program • The 9-hour navigator training course emphasizes: • Investigating and implementing resources for patients in a timely fashion • Listening compassionately and non-judgmentally • Completing appropriate records of all interactions on behalf of patient • Empowering patients to self-advocate in the healthcare realm

12. Training Program

13. Active Navigators

14. Reasons for Navigator Attrition

15. Gender of Active Navigators

16. Ethnicity of Active Navigators

17. Cancer Survivor Status of Active Patient Navigators

18. Patient Data

19. Patients Offered Navigation By Project Year

20. Ethnicity of Patients Offered Navigation

21. Percentage of each Ethnicity Accepting Navigation * Small sample size

22. Percentage of Patients Accepting NavigationBy Ethnicity

23. Measuring the Effectiveness of Barrier Solution Identification • Patient-specific barriers to care are identified during the patient intake conducted by a navigator • Records are maintained and audited to determine number of days to barrier solution identification • Barrier solution includes assigning a navigator (psychosocial barriers) and identifying community resources (functional barriers)

24. Premise • Barriers to care increase the likelihood that the patient will not be able to comply with treatment and follow-up regimens • Barriers to care increase the likelihood that the patient will not participate in a clinical trial • Addressing barriers to care will increase compliance and likelihood of clinical trials participation

25. 6 Most Common Barriers

26. Barriers to Care: Chart Audit

27. Mean Number of Days to Barrier Solution Identification

28. Percentage of Barriers Solutions Identified in One Day

29. Clinical Trials

30. Trials Open for Accrual

31. Trials Closed to Accrual

32. Patients Accrued to Trial

33. Accrual to Trial by Ethnicity

34. Clinical Trial Accrual/Navigation

35. Telesynergy/Telemedicine

36. Telesynergy Telemedicine

37. Telesynergy Usage • Tumor Boards • Meetings with partners and mentoring institutions • Meetings with CDRP sites

38. Quality Assurance

41. Instruments • *Patient Satisfaction Survey • *Cancer Post Treatment Survey • *Clinical Trial Questionnaire • Rand Process Instrument – In Process

42. 1. The patient navigator was courteous. 2. The patient navigator was sensitive. 3. The patient navigator was respectful. 4. The patient navigator was friendly. 5. The patient navigator was thorough. 6. I valued working with the navigator. 7. The education materials I received were helpful. 8. Support services referrals met my needs. 9. I received financial information (if needed).10. I would recommend this service to others.Response: 5 point Likert Scale Strongly Agree = 5, Strongly Disagree = 1 N/A option offered on each question Patient Satisfaction Survey

43. Sample method Each month, 10% of patients are randomly selected for telephone navigator service satisfaction survey.

44. Q: Does the navigator’s cancer history predict patient satisfaction? In other words: Do you have to have had cancer in order to provide effective cancer navigation?

45. Navigators without a hx. of CA outperformed navigators w/ CA hx. on 60% of patient satisfaction metrics.

46. Statistically Significant Differences Individual ANOVA test revealed a statistically significant difference on question 7 (only).

47. Overall patient satisfaction exceeds 90% with navigator services regardless of navigator’s cancer history (p = .953). Note: 5-point Likert scale scores presented as satisfaction percentages

48. Final Question on Survey Would you like to continue with the Patient Navigator Program?  I would like to continue working with my navigator.  I would like to have a different navigator assigned to me.  I would like to discontinue receiving navigation.

49. 94.7% of patients surveyed chose to continue navigation. Navigator’s CA hx. does not predict patient satisfaction (X2: p = .329.)

50. Provisional Findings Overall, there is no statistically significant difference in patient satisfaction when comparing navigators who have had cancer to navigators who have not had cancer. In other words: All helping hands are good hands and 95% of patients were satisfied and wished to continue navigation