| The Avon-MGH Breast Care Program
The Avon-MGH Breast Care Program. was launched in 2001 with a $500,000 grant
from the Avon Products Foundation. Over the years, the foundation has given
more than $12 million to create the Avon Foundation Comprehensive Breast Evaluation
Center, which is at the forefront of the hospital’s efforts to support
research and improve the diagnosis, treatment, and prevention of breast cancer
in underserved populations throughout the Boston metropolitan area.
 The
outreach initiative is under way at three Boston-area health centers that
serve primarily low-income patients. The MGH-Chelsea Health Center serves
mostly Latino and immigrant patients. The Geiger Gibson Community Health
Center serves patients from a variety of ethnic
backgrounds. The Mattapan
Community Health Center provides care for African-Americans, Caribbean-Americans,
and Haitians in a community that has one of the highest breast cancer death
rates in Boston.
A Commitment to the Underserved
Low-income minority patients often face significant barriers to care. For example,
communication is a major barrier for individuals whose primary language
is not English. Other challenges include lack of transportation and child
care, employment in jobs that pay hourly wages with no allowance for doctors’ visits,
and—for
people who are not US citizens—the fear that they will be deported.
Cultural attitudes about medical care also vary, which further complicate
matters.
 The
Avon-MGH Breast Care Program seeks to overcome such barriers by creating a strong
partnership between community providers in local health centers, who understand
their patients’ cultures and challenges, and a multidisciplinary team
of specialists at the hospital’s main campus, whose expertise is treating
breast cancer.
Primary care providers at the health centers refer a patient to the program
on the basis of an abnormal mammogram or an abnormal finding on a clinical breast
exam. Since the program started, more than 450 patients have been referred for
evaluation and follow-up services; 32 have been diagnosed with breast cancer.
“Each participant in this program receives the same top-quality care that
any other patient receives,” says Bruce A. Chabner, MD, clinical director
of the Cancer Center.
A key component of the program is a weekly session held exclusively for outreach
patients at Avon Foundation Breast Evaluation Center. Recognizing that participants
in the outreach program already face enough challenges in their lives, a multidisciplinary
team of experts is available so that, in most cases, a patient can undergo a
complete medical evaluation and testing in one day.
Breast surgeon Kevin Hughes, MD, oversees the weekly session. He works closely
with medical oncologist Lidia Schapira, MD, a native Spanish speaker who is
sensitive to cultural issues for Hispanic patients, and nurse practitioner Connie
Roche, NP, who acts as liaison between the clinic and the health centers. Because
about half of the patients participating in the program are Hispanic, a Spanish
interpreter is available at the clinic every week. Appointments may be scheduled
up to a day before the session and all patients are seen within a week. After
each session, Roche contacts referring physicians with results so they are kept
in the loop.
Each of the participating health centers employs staff to help patients overcome
obstacles to care by offering individual advice and access to resources such
as food vouchers, funds for transportation, and grants for child care. Kristen
Mason, manager of Community Benefit Partnerships at Partners HealthCare System,
oversees the initiative and monitors progress at the three sites.
Maria’s experience provides an example of how essential teamwork is to
the process. A patient at the MGH-Chelsea Health Center, Maria was referred
to the program after she told her physician that she had noticed discharge from
one of her nipples. Maria underwent a biopsy at the Avon Clinic and was scheduled
for a follow-up appointment to discuss the results. She never showed up.
“Many patients are coming from situations where survival is the first
order of the day,” explains Roche. “Putting food on the table or
keeping a job is more important to them than something like a follow-up appointment,
especially if they don’t feel sick.”
An Approach that Works
Roche contacted MGH-Chelsea Health Center patient navigator Atala
Esquilin, who helps reduce barriers to care and ensure that patients get to
their appointments. After calling several times and getting no response, Esquilin
went to Maria’s
home and left a note urging her to call. The approach worked. Maria contacted
Esquilin, who persuaded her to come back to Massachusetts General Hospital
for her follow-up appointment, so that she could learn her diagnosis and discuss
treatment options.
At the MGH-Chelsea Health Center patients like Maria also benefit from the
efforts of social worker Sheila Jewett, LICSW, who runs weekly Spanish language
support group. (An English-language support group is also available.) Sarah
Oo serves as program director, working closely with Mason to coordinate the
center’s outreach program. Primary care physician Stacy Engel, MD, is
the clinical advisor for the program at this location.
This outreach program is expected to have an impact beyond Boston, thanks
to Massachusetts General Hospital’s emphasis on education and research.
Surgical residents who are training at hospital are exposed to the complexities
of cancer care in underserved populations. Also, some patients in the program
are participating in research studies aimed at developing strategies to
improve access to care.
“It is vitally important as a society that we increase access to care
and improve health outcomes for the underserved,” Chabner says. “This
program has enabled Massachusetts General Hospital to do that for our own patients
while creating a model of care for other institutions.”
Source: Synergy: Winter 2004, Volume 2.
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