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Patient Navigation in

Cancer Survivorship and

the Roles of CHWs

Chavely Conde, BHS

Kyla Alsman RN, BSN

Objectives

Understand how cancer is a chronic

disease and the impact cancer has

on long term health

Understand how CHW can help

cancer survivors and education on

available resources

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A Cancer Survivor is….

…. anyone who has been diagnosed with cancer – from the time of diagnosis and for the balance of his or her life.

NCCN: National Coalition for Cancer Survivorshiphttp://www.canceradvocacy.org/

What Does a Cancer Survivor

Look Like? Living cancer-free for the

remainder of life

Living cancer-free for many years but experiencing one or more serious, late complications of treatment

Living cancer-free for many years, but dying after a late recurrence

Living cancer-free after the first cancer is treated, but developing a second cancer

Living with intermittent periods of active disease requiring treatment

Living with cancer continuously without a disease-free period

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Survivors Are Not One Size

Fits All

Some draw closer to

family and friends –

Some are

abandoned by family

and friends

Some are young –

some are old

Some are able to

resume normal

activity – some

might benefit from

physical therapy

Some struggle with

depression, anxiety,

fear

MDHHS Focus Groups, 2017

What is a Community Health

Worker (CHW)?

Trusted member of the community

Service to community members regardless of race, age, gender, culture, or religion.

Provide one-on-one tailored services to address health and social needs

Guide and connect community members to needed resources and services

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Understanding Community

Health Workers

Serve as liaison for patients

Provide educational information, emotional support,

and advocacy

Empower community members

Engage with community members at local events

Raise prevention awareness for cancers

Navigate community members to screening

resources

CHWs working and engaging

with their community

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Estimated and projected number of cancer survivors in the United States from 1977 to

2022 by years since diagnosis.

de Moor J S et al. Cancer Epidemiol Biomarkers Prev 2013;22:561-570

Ongoing Survivor Needs

• Monitoring for late effects

• What are late effects?

• Health problems that happen because of cancer and/or treatment

• Can be both physical or psychological

• May not develop until many years after cancer treatment if finished

• Financial Toxicity:

– Medical Bills

– Supportive Care Services are not often a

covered benefit or require specialist copays.

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Survivorship care

Risk of having late effects of treatment is

influenced by multiple factors

– Treatment received

– Health behaviors (both good and bad)

– Pre-existing problems

– Genetics

Physical Consequences of Cancer

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Health Behaviors

• Diet

• Exercise

• Sun

• HPV

• Tobacco

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Programs and Resources

What resources are available

to CHWs for cancer survivors?

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Health Eating Resources

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Truman Medical Center

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Show Me Healthy Women

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LIVESTRONG at the YMCA

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• 12-week program with two 75-90-minute sessions per

week

• Includes cardiovascular conditioning, strength training,

balance, and flexibility exercises

• Evaluation includes fitness and quality of life assessments

before and after participation

• Facilitated by YMCA-certified instructors

• Requires referral and medical clearance from a physician

Genetics

Some cancers are genetic (example: breast cancer in

adults, retinoblastoma in children)

– Could increase risk of developing secondary cancer

Family history

– Example: patient has family history of heart disease and

then receives cancer treatment that increases the risk for

heart problems

Previvor-

– A survivor of a predisposition ( or increased risk) for a

disease such as cancer

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Ongoing Survivors Needs

Physical Well Being

Diet and Exercise

Fatigue/ Pain

Fertility

Monitoring for late effects

Psychological Well Being

Anxiety

Depression

Fear of Recurrence

Cognition/ Attention

Survivor Guilt

Social Well Being

Family Distress

Roles and

Relationships

Isolation

Finances/Work

Spiritual Well Being

Meaning of Illness

Hope

Uncertainty

Inner Strength

Cancer Survivorship

Roles of CHWs

Health care providers can not measure

patient outcomes once they leave the office

CHWs can follow up with patient and

monitor their care plan.

CHWs motivate community members to:

Exercise

Eat healthy

Follow prescription directions

Find ways to help with financial

barriers

Make lifestyle changes

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Community Health Workers

aren’t all alike

Paid CHWs

Hired as CHW- full or part time

Certification

Specific training (extensive)- per hiring organization

Skillsets vary per job description

Volunteer CHWs

Volunteer their time

Limited hours to

serve/work*

Trainings by outreach

organizations

Train the Trainer model

for retention

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Certification

Some states require certification

Certification is necessary for payment

purposes

MO- certification program: 160 hours, 60

service

Kansas

Kansas does not have a certification program

KS Community Health Worker Coalition

Education committee

Symposium committee

Advocacy committee

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Case Study JJ

30 year old woman with a history of Hodgkin’s Lymphoma at the age of 15.

Past treatment includes history of chest radiation and chemotherapy that increases risk for heart problems.

Patient presents with no health insurance and concern for a lump in her breast.

History of smoking 1 pack per day

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Survivorship care is multidisciplinary and take the

whole community to provide care

Follow Up

Based off JJ’s past treatment she would be due for the

following:

– Echocardiogram (ultrasound of heart to check

function)

– Education on Diet and Exercise

– Sun Safety- education

– Smoking cessation Education

– Breast Mammogram and Breast MRI every year

Needs education about resources due to lack of

insurance

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CHW role before, during and

after cancer treatment

BeforeListen to needs of community members

Guide to screening resources

Address barriers to getting screened

Help enroll eligible women into the state Breast and Cervical

Cancer Program/Navigate them to the resource

Show Me Healthy Women in Missouri

Early Detection Works in Kansas

CHW role before, during and

after cancer treatment

During

Assist with medical appointments

Follow-up to ensure they get to their appointment

Transportation needs/ issues

Find medical interpreting services when needed for

diagnostics, and treatment

Connect to social worker if needed

Talk to family about issues and follow-up

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CHW role before, during and

after cancer treatment

After

Follow-up with appointments

Follow-up with family members to see if any issues

Refer to social worker for financial assistance and

psychosocial needs

Guide them to appropriate resources to continue positive

health behaviors

Hispanic Women’s

Survivorship Discussion on

Barriers

Barriers described-

Language

Financial issues

Health Insurance

Emotional Support

Lack of education in

the community/family

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Barriers that CHW try to

eliminate

Social determinants of health

Socioeconomic

Academic/education

Language

Physical

Psychological

Geographical

Cultural

Benefits of CHWs

Health services

Increase access to care

Less ER visits

Decrease no-show appointments

Help to gather data for research projects

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Questions?

Thank you