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Q&A
Cancer screening and support services in the H+H system
0:48:21
·
6 min
Council Member Narcisse inquires about cancer screening and support services in the H+H system. Dr. Katz discusses available services, challenges in patient navigation, and the most common types of cancer among H+H patients.
- Request for $500,000 to add two nurse practitioners as navigators for high-risk cancer patients
- Discussion of primary care-based cancer prevention and screening efforts
- Challenges in patient navigation for follow-up procedures and treatments
- Most common cancers in H+H system: colorectal, breast, prostate, and lung
- Need for earlier screening ages, especially for Black male patients
Mercedes Narcisse
0:48:21
It should be enough to write it on the note.
0:48:24
Okay, cancer screening and support continues to be a pressing issue for the system and desperately needs more funding.
0:48:33
In one of our recent conversations with our team it was stated that the system was looking for a request of half a million dollars for the addition of two nurse practitioners to serve as navigators for high risk cancer patients.
0:48:50
We know cancer is hitting home federal level everywhere.
0:48:53
Has this request been made?
0:48:56
If yes, what is the status of this request to OMB?
Mitchell Katz
0:49:01
We've requested it.
0:49:03
OMB hasn't yet determined if they can or cannot fund it, But we certainly see it as pressing.
0:49:11
I think the field recognizes that unless you have cancer navigation, people do not follow through.
0:49:19
It's just too difficult.
0:49:21
It's emotionally stressful for people.
0:49:23
People are afraid of the Some of the things like colonoscopy are fairly difficult procedures to get done because of the requirements of taking medications to flush the system ahead of time.
0:49:37
Navigation makes a huge difference.
0:49:39
So we will keep working with our OMB colleagues to see if they're able to fund it.
Mercedes Narcisse
0:49:45
Yeah.
0:49:45
Can you please describe the available services for cancer patients that HNH cares for, including prevention care?
Mitchell Katz
0:49:53
Certainly.
0:49:54
So I mean the largest amount of cancer prevention care occurs in primary care, and we do very well, much better than other systems in New York City in primary care.
0:50:08
Because we are much more a primary care system.
0:50:12
So we all receive when I was in clinic last night, you know, for every single patient, my epic chart tells me when she is due for a pap smear, who's due for a mammogram, who needs a pneumovax, right.
0:50:30
All the things are on the left hand corner.
0:50:33
And we do very well.
0:50:35
I think where the challenge comes in is the navigation that's required.
0:50:40
Let's say a woman has the mammogram.
0:50:44
Generally, we're very successful at that.
0:50:47
Where it's more difficult is the mammogram has an abnormality.
0:50:52
Now the process is not simple.
0:50:55
To go for the mammogram, pretty simple.
0:50:58
We have people who call, don't forget your appointment, Tuesday 10:30, people come.
0:51:05
We run into problems is it's an abnormality.
0:51:10
We're not sure.
0:51:11
Next step is a diagnostic mammogram.
0:51:14
Then you probably need an ultrasound.
0:51:17
Then you may need a stereotactic biopsy.
0:51:21
And multiple steps.
0:51:24
Many of those steps can't happen if you're at a clinic.
0:51:27
They can only happen at a hospital.
0:51:29
Some things have to be guided by ultrasound.
0:51:32
And so that's really where the navigation is needed.
0:51:37
Same thing with colon cancer screening.
0:51:41
Very high rates of people doing the tests for blood in the stool.
0:51:46
We do super well.
0:51:48
Getting people who are positive on that test to do the correct procedure prior to the colonoscopy.
0:51:56
If you don't flush the system then the colonoscopy is not accurate.
0:52:01
Making sure they come.
0:52:03
It's something people don't want to.
0:52:05
You have to have a ride to get home because of the medication.
0:52:08
One of my own patients had an appointment.
0:52:11
His ride fell out.
0:52:13
Right, and so he couldn't do it.
0:52:16
I mean if I needed the test then my ride didn't work, I would be able to take an Uber, I would take a bicycle, I would that wasn't available.
0:52:26
Didn't have the money for those other things.
0:52:28
So that's where the navigation is so critical.
Mercedes Narcisse
0:52:31
And not only that too, people in denial when they first learn they have cancer.
0:52:36
So they need that support to walk them through.
0:52:38
Or you don't see them, they go and pray.
0:52:41
Pray is good but the doctor
Carmen de Leon
0:52:42
follow-up is Works
Mitchell Katz
0:52:44
better with treatment.
0:52:45
Yeah.
Mercedes Narcisse
0:52:45
What is the most recurring type of cancer and what demographic constitutes most of the H and H cancerous patient?
Mitchell Katz
0:52:54
Well because of who we take care of, almost we have a very high proportion of black and brown patients in all of health and hospitals.
0:53:05
So that's what our data reflects is the rates of cancer which are very high.
Mercedes Narcisse
0:53:14
Which cancer is very high?
Mitchell Katz
0:53:15
Well so the ones that are most common in us, and I can't honestly say I could tell you which is the highest, highest.
0:53:23
It's colorectal, breast and prostate that run the highest in general.
0:53:31
Lungs too.
0:53:32
Lungs.
Mercedes Narcisse
0:53:33
And there is an increase in black male early age that getting diagnostic tests done Yeah, they
Mitchell Katz
0:53:41
drop the screening ages because of those increases.
Justin L. Brannan
0:53:46
That's
Mercedes Narcisse
0:53:47
right.
0:53:47
Instead of 45 you have to bring them early.
0:53:49
Exactly.
0:53:50
What
Mitchell Katz
0:53:50
age?
0:53:51
44 is when we start talking about mammograms.
0:53:56
Forty five is when we talk about colon cancer.
0:53:59
But we'll go even younger if there's a family history.
Mercedes Narcisse
0:54:04
Much younger now because I have some that I'm hearing from doctors in the under Yeah, me too.
0:54:11
That's scary for
Mitchell Katz
0:54:12
black Yes, we
Mercedes Narcisse
0:54:14
need to do more.
0:54:15
How can the council I know it's not too sexy to talk about health.
0:54:18
Right?
0:54:19
How can the council further advocate for the creation of new cancer related programs or services within the system?
Mitchell Katz
0:54:30
Well, I think part of what we've tried to do is by doing the navigation, we think that we also can save some money because especially for higher level procedures, if someone doesn't show,
Justin L. Brannan
0:54:44
it's
Mitchell Katz
0:54:44
paying for the doctor and the technologist, but there's no revenue because the person didn't show.
0:54:52
So we think using navigation actually can help us to be more efficient.
0:54:59
But beyond that, we appreciate the city council support of these programs and recognition that many of our patients need a little extra help.
0:55:09
But they often don't have the same level of family support that people who are financially better off have.