Identifying Underserved Populations

At the Office of Cancer Health Equity (OCHE), our primary goal is to improve cancer outcomes for everyone in our community. But how do we define "community" and what metrics can we use to determine success? These are two of the toughest questions that we struggle with on a daily basis in our work at the Wake Forest Baptist Comprehensive Cancer Center (WFBCCC). A person's ability to prevent cancer, obtain screening, get treatment, enroll in a clinical trial, or survive cancer and survive it well should not be dependent on race, ethnicity, geography, or socioeconomic status. However, these characteristics and more, often impact care along the cancer continuum. In order to address these disparities in healthcare, it is critical to know where the deficits are and then to partner with communities most affected to seek out sustainable solutions. In this OCHE ECHO, we share some high-level data about some of the steps we take to identify the needs of the diverse communities we serve. And we welcome your thoughts about how we can be even more inclusive in our work.
Defining the Population we Serve
Catchment area (CA) is a term from the National Cancer Institute that we use to describe the primary geographic area of our Cancer Center. The CA of the Wake Forest Baptist Comprehensive Cancer Center (WFBCCC) consists of a contiguous 58 county, predominantly rural and Appalachian region in central and western North Carolina (NC), southwestern Virginia, West Virginia, and Tennessee. The CA was determined by evaluating where our patients come from. The CA includes the geographic area of origin of approximately 94% of our patient population ( see Figure ). Transportation and access to cancer care is a major issue for a significant number of the approximately 4.1 million residents. Demographics of the catchment area includes 13.3% African Americans and a growing Hispanic population (6.5%)
Cancer Disparities in WFBCCC Catchment Area
The region is characterized by high rates of poverty and limited access to health care and most catchment counties exceed the national average for smoking (92%). As a result, age-adjusted incidence of tobacco-induced cancers exceed national estimates (lung=+35.7%; head and neck=+6%; bladder=+6.1%). An overview of the top six cancers in the CA can be found in the table below:
Among African Americans (AAs), age-adjusted incidence rates exceed national estimates for bladder (+26%), colorectal (+14%), breast (+14%), lung (+11%), and prostate cancer (+16%). AA incidence rate is 13.9% higher than US. Incidence is 9.4% higher in AAs than whites and mortality is 39.5% higher in AAs than whites. Both the rural and urban underserved populations have higher rates of age-adjusted smoking, obesity, cancer incidence and mortality, compared with the rest of the U.S. Additional CA data comparisons can be found in the following table.
The greatest cancer health disparities are seen in the rural and African American populations within our catchment area with incidence and mortality rates for several cancers well above national rates. To begin understanding why we these disparities exists, OCHE has designed specific programs to engage the rural and African American communities in our CA. To complement the Rural Tobacco Outreach Program discussed in the July Newsletter , we were recently awarded funding to develop a program designed to build capacity for cancer survivorship in our rural communities. Additionally, OCHE identified 3 zip codes in East Winston that have the greatest cancer risk profiles and partnered with Gramercy Research Group to engage African Americans within those communities to gain insights into the perceptions of cancer risk & prevention and to assess any barriers that exist related to cancer care and health care in general.
Meet Our 2018-2019 Medical Students
Julia Cartledge, MS4
Barriers to Cancer Care for African Americans in East Winston

Julia first sparked an interest in health equity as an undergraduate majoring in “Medicine, Health and Society,” where she studied access to health care. She has worked as an interpreter at a local clinic and conducted research on the disparate rates of breast cancer mortality. During her rotation with OCHE, Julia worked with Gramercery Research Group to understand the barriers to cancer care for African Americans in East Winston. 

Jordan Freeman, MS4
Smoking Cessation for Low Income Patients at Downtown Health Plaza

Jordan's interest in health equity began as an undergraduate, majoring in “Medicine, Health, and Society.” He worked closely with patients as an interpreter at a free clinic and assisted them in navigating the complex medical system. During his rotation with OCHE, Jordan learned about programs for local residents interested in smoking cessation. He worked directly with Downtown Health Plaza to initiate implementation of a smoking cessation program tailored to its unique patient population.
Kaitlin Quallen, MS4
Qualitative Assessment of Hispanic Patient Navigation at WFBCCC

With a passion for global health, Kaitlin Quallen is interested in the social determinants of health and caring for underserved populations. Kaitlin has served on the leadership team for a local free clinic, and worked as an interpreter. During her OCHE rotation, Kaitlin observed the Hispanic Patient Navigation Program to assess its benefits to cancer care and differences in participation rates for clinical trials. 

Community Engagement
American Indian Round Table

On October 19-20, OCHE hosted the first annual American Indian Round Table on Cancer Health Equity. Representation from NC tribes gathered to discuss all aspects of health equity and how the Office of Cancer Health Equity can support the next generation of American Indian healthcare professionals and researchers in North Carolina. Donald Warne, MD, MPH, Associate Dean of Diversity, Equity and Inclusion and Indians Into Medicine (INMED) Program Director, at the University of North Dakota was the keynote speaker.
Upcoming Events
January 22: Medical Student Seminar

4:00 PM
Light Refreshments Provided

Join us for our annual Medical Student Seminar where our interns will present their equity projects.

March 9: Get Your Rear in Gear 2019

Quarry Park
1790 Quarry Rd 27107
Winston Salem, NC

Registration (Until March 6th): Adults: $25, Youth (12 and under): $15, Kids Fun Run (10 and under): $15 + processing fee
Staff Spotlight
Hispanic Patient Navigator, Maria Alejandra Combs Achieves National Certification

Maria Alejandra Combs, Hispanic Patient Navigator for the Office of Cancer Health Equity, passed the Academy of Oncology Nurse & Patient Navigators (AONN+) Oncology Patient Navigator Exam, making her a certified generalist in patient navigation.

Congratulations Maria!
Next Newsletter
Our next letter will share some results from an ongoing assessment of the cancer health equity needs of the African American community in East Winston. 

If you would like to volunteer with our office please email us at: [email protected] 

The Office of Cancer Health Equity Team

Director: Karen Winkfield, MD, PhD
Assistant Director: Jimmy Ruiz, MD
Assistant Director: Kathryn Weaver, PhD, MPH
Program Manager: Carla Strom, MLA
Hispanic Patient Navigator: Maria Alejandra Combs, JD, OPN-CG
Rural Patient Navigator: Emily Britt, MSW
Community Research Coordinator: Kelsey Shore, CCRC
Community Outreach Coordinator: Camry Wilborn, MA
P: 336-713-3665