How Fox Chase’s Evelyn González Is Fighting Cancer Care Disparities in Philly

As Fox Chase Cancer Center’s senior director of community outreach, Evelyn González works to address cancer health disparities in Philly. Photograph courtesy Fox Chase Cancer Center

In a recently published paper about improving cancer care on a national level, experts zeroed in on the “inequities in healthcare that exist across the entire cancer care continuum and are disproportionately affecting medically underserved populations who may encounter cultural, linguistic, economic, and other barriers to care.” According to the authors, these disparities exist for a variety of reasons: social determinants of health, provider implicit bias, insurance coverage, and lack of standardized care.

To help increase quality cancer care in historically underserved communities, the co-authors — one of whom was Evelyn González, senior director of community outreach at Fox Chase Cancer Center — developed a framework of strategies and recommendations for both addressing and decreasing cancer care disparities nationwide. We spoke with González about her involvement with the research initiative, her team’s key findings, and steps the healthcare system (both locally and nationally) can take to improve cancer care equity.

NextHealth: What does your role as a community outreach director for a top cancer center involve?
González: My job involves community outreach and engagement. Specifically, I work to create a network of partnerships that help address cancer health disparities across the Great Philadelphia area. Our partners are both traditional — like other healthcare providers or community-based groups — but we also work with alternative-based organizations because our communities work in all kinds of settings. In this way, my goal is to help Fox Chase and our network better understand community needs.

But my role also centers on educating community members on cancer-related information, so that together, we can determine ways we can mitigate the risks that put people at greater peril [for developing cancer]. Oftentimes, people are aware of what cancer is, but they’re not aware that their specific community has a higher cancer burden. So, I am the person who initiates approaches and solutions that engage the community in order to address and decrease any burden or barrier they face when it comes to cancer care.

What does that work look like in action?
The work is done in a variety of ways, mainly because it depends on what the community needs. It’s not a one-size-fits-all — nor an ivory tower — approach. I might organize our team to go into a specific community-based organization to deliver cancer education in a format that is easily digestible — as in, the language isn’t all medical jargon. Or, it might be sitting on a planning committee to plan a specific event within a community, or engaging community members in discussions about research. We also bring our mobile cancer screenings directly into communities so that residents don’t have to come to us.

Overall, though, the work is grounded in developing mutual goals with community members, so that we can create an impactful network. We strive to establish actual relationships, listen to people and their needs, build trust, and meet folks where they are.

Can you talk more about the approach you and the co-authors took to develop an actionable framework for addressing and decreasing cancer care disparities?
We conducted an environmental scan to determine what was already being done about cancer care disparities, and figure out effective solutions for the cancer care continuum (which encompasses prevention, screenings, early detection, treatment, survivorship, and end-of-life issues). What we found is that many patients get lost along the way, resulting in further disparities. Thus, our central question became, “How can we prevent people from falling through the cracks?” We then surveyed the country and identified leaders in the field and patient organizations. We invited 50 experts to participate in a round-table discussion (33 attended) about what’s working and what’s not in order to address the areas in which we’re losing our patients.

It’s important to note that disparities aren’t just genetic. They’re also based on social determinants of health like housing, poverty, and education among others. We wanted to figure out recommendations that could help make the cancer care continuum more patient-centric.

What were some of your key findings from the environmental scan?
In addition to community engagement, we found barriers in the areas of patient navigation and implementation of changes within the healthcare system. Traditionally, patient navigation is executed by a nurse navigator (though, not all institutions have one). What we propose in the paper is that in addition to nurse navigators, there needs to be lay navigators — that is, folks who are aware of resources and cultural understandings within the community from where the patient is coming. Having a lay navigator could help build trust and minimize the “get to know me” time and also aid patients in navigating the system, understanding medical information in order to make informed decisions, and asking for help when necessary. Lay navigators can also help nurse navigators better understand the cultural and linguistic barriers patients might face when trying to access cancer care.

It’s important to note that disparities aren’t just genetic. They’re also based on social determinants of health like housing, poverty, and education among others. We wanted to figure out recommendations that could help make the cancer care continuum more patient-centric.

What do you propose the healthcare system can do more of in order to improve health outcomes for cancer patients?
We’ve proposed several recommendations in the paper for the healthcare system, including having a standardized approach to implement best practices across the field, finding alternative ways to communicate with patients, and collaborating with patient advocacy groups.

When it comes to education, I think more medical staff needs to be trained in community life, culture, and diversity. They are trained to know the clinical side of things, but oftentimes they aren’t educated on the community itself. Physicians and researchers should be brought into actual communities where their patients are coming from so they have a first-hand view of patients in their primary environments, and can build relationships and trust from there.

Healthcare professionals should also engage their communities so that more inclusive advancements can be made. For example, I trained a group of community ambassadors (cancer survivors, caregivers, and folks simply interested in the field) on the importance of research participation. The reason we have 17 million cancer survivors is because we have more answers and treatment options. The problem that still exists, though, is that research studies lack diversity when it comes to participants. Right now, the data is incomplete and doesn’t represent the population either because some folks don’t participate in trials or trials are limiting in their eligibility criteria. (For example, most trials rule out folks who live with high blood pressure or diabetes, or are classified as obese.) Overall, medical professionals should educate people on lowering their cancer risks, and make research findings more representative of underserved or traditionally excluded groups.

What can Philadelphia’s healthcare system/professionals do to increase health equity across the cancer care continuum?
Though Philadelphia has a very rich healthcare environment, these challenges occur on a national level — Philadelphia is not immune to them. Our community health needs assessment had close to 200 respondents, many of whom said they needed increased access to preventative cancer services and education on screening guidelines. More patient centers could implement mobile screening units in order to bring those screenings directly to communities, especially those living in medically underserved or vulnerable areas. Making this and general health services available and accessible to everyone, particularly those who are either uninsured or under-insured, would help improve health outcomes. Additionally, medical professions have already started taking a kind of regional approach to cancer care, which means they’re using data to identify cancer “hot spots.” If our shared goal is to rule out cancer or identify cancer at an early-stage, then we need to do everything possible to reduce the cancer burden by preventing risks and serving communities, especially those that need it most.

Philadelphia magazine is one of more than 20 news organizations producing Broke in Philly, a collaborative reporting project on solutions to poverty and economic mobility in the city. Read all our reporting here.