Commission on Cancer Community Needs Assessment · The Cancer Management Committee met periodically...
Transcript of Commission on Cancer Community Needs Assessment · The Cancer Management Committee met periodically...
2017
Commission on Cancer Community Needs Assessment
ACKNOWLEDGEMENTS
This Community Needs Assessment (CNA) was developed by Mount Auburn Hospital’s (MAH)
Community Health Department on behalf of the Mount Auburn Hospital Cancer Center and the
Hoffmann Breast Center under the auspices of the MAH Cancer Management Committee. The MAH
Community Health Department would like to acknowledge the great work and commitment of the MAH
Cancer Management Committee. The Cancer Management Committee met periodically throughout the
assessment in order to develop the assessment’s approach, oversee progress, provide feedback, and
review the final report of findings. This assessment would not have been possible without their guidance
and support.
The MAH Community Health Department would also like to thank the dozens of individuals and
organizations who participated in this assessment by completing surveys or sharing information through
interviews and focus groups. The information gathered as part of these activities was critical to the
assessment, as it allowed the MAH Community Health Department to engage stakeholders and gain a
better understanding of the burden of cancer, service system capacity, strengths, and challenges as well
as barriers to care and underlying determinants of health. Please accept our heartfelt appreciation and
thanks for your participation in this effort.
In addition, the Community Health Department would like to thank John Snow, Inc. (JSI) for their efforts
to compile quantitative and qualitative information for the assessment and for help in developing the
final report. JSI is a public health management consulting and research organization dedicated to
improving the health of individuals and communities throughout the world. JSI helped to ensure that a
rigorous and comprehensive assessment was conducted and we appreciate their assistance.
Finally, Mount Auburn Hospital would like to thank Mary Johnson, RN, Director of Community Health at
Mount Auburn Hospital and Mary DeCourcey, MS, Community Health Specialist. This assessment would
not have been possible without their considerable efforts and guidance.
MOUNT AUBURN HOSPITAL CANCER MANAGEMENT COMMITTEE
John Bridgeman Russell Nauta, M.D. Susan Pories, M.D.
Lisa Weissmann, M.D. Chair Thomas Caughey, M.D. Anthony Abner, M.D.
Mary McCullough Elzbieta Griffiths, M.D.
John Perry, M.D. Jeremy Schiller, M.D.
Paula Falzone, RN Kathy Willey, RN
Beth Loomis Nickie McNally
Beth Roy Meredith Hobson Jennette Paskell
Wei Kwan Margaret Sandin, M.D.
Karen Viscariello Mary Johnson
Michael O’Connell Meg Lotz
Tom Caughey, M.D.
Carol McKenna Emily Lotterhand Sarah Slater, M.D. Lisa Asmar-Abdien Matt Fickie, M.D
Prudence Lam, M.D. Ellen Nason
Nicole Sanders O’Toole Sarah Collins Rita Cosgrove Leslie Joseph
1
TABLE OF CONTENTS
About Mount Auburn Hospital ............................................................................................... Page 2
Assessment Purpose and Approach ....................................................................................... Page 4
Community Characteristics .................................................................................................... Page 8
Patient Population ............................................................................................................... Page 16
Burden of Cancer ................................................................................................................. Page 20
Key Findings Related to Barriers to Prevention, Screening, and Navigation ....................... Page 24
Emerging Recommendations ............................................................................................... Page 28
Proposed Strategic Initiatives .............................................................................................. Page 29
Appendices
Appendix A: Data from US Census Bureau & Massachusetts Department of Public Health ........ Page 30
Appendix B: Data from Mount Auburn Hospital Cancer Registry .............................................. Page 41
Appendix C: Review of Current Cancer Management Activities .. .............................................. Page 55
2
ABOUT MOUNT AUBURN HOSPITAL
Mount Auburn Hospital is a 217 bed acute-care, Harvard-affiliated community teaching hospital serving
the healthcare needs of residents in Arlington, Belmont, Cambridge, Somerville, Watertown, and
Waltham. Mount Auburn, Incorporated in 1871, was Cambridge’s first hospital, and is a not-for-profit,
charitable teaching hospital whose primary purpose is to maintain the good health of the residents in its
service area by providing high-quality medical services and programs as a means to prevent and cure
disease and to relieve suffering. Medical education and clinical research play an important part in the
hospital’s mission and are considered necessary to maintain high-quality care for patients. The Hospital
offers comprehensive inpatient and outpatient medical, surgical, obstetrical, and psychiatric services as
well as specialized care in bariatrics, cardiology, cardiac surgery, orthopedics, neurology, vascular
surgery, and oncology. In addition, Mount Auburn offers a network of satellite primary care practices in
several surrounding communities, as well as a range of community-based programs, including Mount
Auburn Home Care, outpatient specialty services, and occupational health. Mount Auburn’s dual mission
is to provide excellent and compassionate health care and to teach students of medicine and the health
professions.
MOUNT AUBURN CANCER CENTER AND HOFFMAN BREAST CENTER
Mount Auburn’s dedication to excellent and compassionate care is exemplified in the Hoffman Breast
Center and the Hospital’s Hematology/Oncology and Radiation Oncology departments. Cancer
specialists provide a broad range of outreach, education, prevention, diagnostic, treatment, and disease
management services for those with blood diseases and many different cancers. Thousands of patients
have been expertly cared for and compassionately treated by an extraordinary team of physicians,
nurses, technicians and staff. Patients from the communities the hospital serves benefit from a
multidisciplinary team approach to coordinate the best available treatment options for many cancers
including: blood cancers (chronic leukemia, lymphoma and myeloma, breast, colorectal, gynecological,
lung, pancreatic, prostate, and stomach.
Over the years, as the treatment modalities for cancer have rapidly expand, Mount Auburn Hospital’s
Cancer Center has enhanced the healing environment and further supported the very special level of
care that physicians and nurses provide to patients and families. The care provided by the Cancer Center
is augmented by services and resources provided by the Hospital’s Herzstein Wellness Center, which
provides a broad range of services and resources for patients and their families such as mind-body
medicine, workshops and support groups, integrative therapies, nutrition counseling and education. The
Cancer Center is also supported by the Cancer Genetics and Prevention Program, which supports
patients through genetic testing and treatments as well as counseling on cancer prevention strategies.
The Cancer Genetics and Prevention Program works closely with patients and their caregivers to create
collaboratively-designed, personalized treatment plans and reviews genetic testing possibilities.
Mount Auburn’s Cancer Center is also supported by the Hospital’s Palliative Care Program, which
provides specialized medical care for people with serious illnesses, including cancer. Mount Auburn’s
Oncology Department led the effort to establish the Palliative Care Program, which focuses on providing
3
patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis.
The program includes specialized doctors, nurses, social workers and chaplains, who work with the staff
at the Cancer Center to help patients and families to evaluate their goals, understand treatment options
and make informed decisions about their care.
Finally, the Cancer Center works closely with the Hospital’s Hoffman Breast Center, which provides
convenient, personalized and supportive preventive, diagnostic, counseling and coordination services
specifically for women, including plastic and reconstructive surgery and support for those diagnosed
with breast cancer.
4
ASSESSMENT PURPOSE AND APPROACH
PURPOSE AND BACKGROUND Since 1987, Mount Auburn Hospital has been accredited by the American College of Surgeons
Commission on Cancer. The Commission on Cancer (CoC) recognizes cancer care programs around the
Country for their commitment to providing comprehensive, high-quality, and multidisciplinary patient
centered care. The CoC is dedicated to improving survival and quality of life for cancer patients through
standard-setting, prevention, research, education, and the monitoring of comprehensive quality care.
Through the CoC, cancer programs have access to reporting tools to aid in benchmarking and improving
outcomes as well as educational and training opportunities, development resources, and advocacy. Only
a select group of facilities receive this distinguished accreditation through a rigorous evaluation and
review of 36 quality standards. Accreditation by the Commission on Cancer assures patients that they
are receiving the highest quality care in a multidisciplinary setting with advanced services and treatment
options.
In order to maintain this accreditation, the Commission on Cancer requires that oncology departments
conducted a community needs assessment (CNA) at least once every three years. The goal of this
assessment process is to identify the needs of the population being served with respect to: 1)
Community Education and Prevention, 2) Screening, and 3) Navigation Services as a way of ensuring that
the facility is working to improve patient services and reduce health disparities.
APPROACH, METHODS, AND DATA LIMITATIONS The CNA was conducted in two phases, which allowed Mount Auburn Hospital to: 1) Compile
quantitative and qualitative data; 2) Engage and involve key stakeholders - including clinical and
administrative staff, other community based service providers, and the community at-large; 3) Develop
a report, including a summary of the assessment’s approach/methods, key findings, emerging
recommendations and proposed strategic initiatives, and; 4) Comply with all CoC requirements.
FIGURE 1: CHNA APPROACH AND METHODS
5
Data sources included a broad array of existing secondary data drawn primarily from the Massachusetts
Department of Public Health, key informant interviews, and focus groups. In parallel to this process, the
Cancer Management Committee also explored the impact and effectiveness of the hospital’s cancer
outreach, prevention, screening, and navigation services that it has implemented over the past three
years so that this experience could inform its strategic activities moving forward.
The goal of Phase I was to gain an understanding of health-related characteristics of the region’s
population, including demographic, socio-economic, geographic, health status, care seeking, and access
to care characteristics. This involved quantitative and qualitative data analysis from existing secondary
data, a survey of internal staff, interviews with key stakeholders, and a series of focus groups. The main
objectives of Phase II of the assessment were to: 1) Review the assessment’s major findings, 2) Review
the Cancer Center’s existing strategies to improve outreach/prevention, screening, and navigation
services, 3) Determine the strategies that should be implemented over the coming years to augment
what the Cancer Center currently does to reduce the burden of cancer, raise awareness, educate, and
reduce barriers to screening and navigation services. During Phase II, JSI reviewed the Cancer Center’s
prior activities, facilitated discussions at the Cancer Committee’s December 2017 meeting, and
developed this report of findings and recommendations.
COMMUNITY SPECIFIC SECONDARY (QUANTITATIVE) DATA JSI characterized the community population, health status/cancer burden, and community need at the
municipal and state levels, as well as for the service area overall when possible. A number of data
sources were utilized to ensure a comprehensive understanding of the issues. JSI produced a series of
tables and graphs to summarize and draw out key findings (see Appendix A). Sources of secondary data
include:
U.S. Census Bureau, American Community
Survey 5-Year Estimates, 2011-2015
Behavioral Risk Factor Surveillance System
(BRFSS), 2007-2009 (CHNA level data)
Massachusetts Hospital Inpatient Discharges
(MA Department of Public Health), 2008-2012
Mount Auburn Hospital Cancer Registry, 2016
Massachusetts Hospital ED Discharges (MA
Department of Public Health), 2008-2012
Massachusetts Cancer Registry (MA
Department of Public Health), 2013
Massachusetts Vital Records (MA Department
of Public Health), 2014
Internal Staff Survey. The Cancer Center conducted internal staff survey with clinical and other patient
support staff at the Center. In total, surveys were collected from 30 clinicians and other patient support
staff, which provided important information related to the burden of cancer and the barriers and service
gaps that the Hospital patient’s face.
Key Informant Interviews. JSI conducted 26 interviews with a representative group of key internal and
external stakeholders with experience and insight on the burden of cancer as well as the barriers to
education, screening, and navigation services that the residents of Mount Auburn’s service area face.
Interviews were conducted using a standard interview guide. Interviews focused on pressing cancer
6
concerns related to cancer burden, barriers to care, and service/resource gaps, as well as possible
strategies to address the concerns identified.
Resource Inventory. To understand community need and underlying risks as well as to appropriately
target strategies, JSI worked with staff at the Cancer Center to understand and take stock of the existing,
cancer-related resources in Mount Auburn’s service area. In this regard, JSI reviewed the hospital’s prior
cancer needs assessment and the hospital community benefits needs assessment produced for the MA
Attorney General, which included a listing of partners and other cancer-related resources. The goal of
this process was to identify gaps in resources as well as key partners who may or may not be already
partnering with the hospital.
COMMUNITY INPUT (QUALITATIVE DATA) JSI conducted a series of informal focus groups/community meetings to gather critical community input
from patients/family members, service providers, community leaders, and residents from Mount
Auburn’s service area. These focus groups were organized with a number of the Cancer Center’s
partners to leverage their community connections and help to ensure good participation. During these
focus groups, JSI discussed findings of the data and posed a range of questions that solicited input on
community ideas, perceptions and attitudes, including: 1) Does the data reflect what you see as the
major needs and health issues in your community? Are the identified gaps the right ones? What
segments of the populations are most at-risk? What are the underlying social determinants of health
status? 2) What strategies would be most effective to improving health status and outcomes in these
areas?
Overall, 5 focus groups were conducted.
TABLE 1: FOCUS GROUPS/COMMUNITY MEETINGS
Event Audience(s)
CHNA 17
September 14, 2017
Community Leaders and Advocates
Patient Family Advisory Council
September 27, 2017
Mount Auburn Internal Staff
Mount Auburn Patients and Family
Members
Elder Services
November 8, 2017
Mount Auburn Internal Staff
Community Leaders and Advocates
SCALE
December 4, 2017
Community Leaders and Advocates
Community Residents
Waltham Family School
December 8, 2017
Community Leaders and Advocates
Community Residents
DATA LIMITATIONS Assessment activities of this nature nearly always face data limitations with respect to both quantitative
and qualitative data collection. With respect to the quantitative data compiled for this project, the most
7
significant limitation is the availability of timely data. Relative to most states and commonwealths
throughout the United States, Massachusetts is at the forefront of making comprehensive data available
at the commonwealth-, county- and municipal-level. This data is made available through the
Massachusetts Cancer Registry as well as the Commonwealth’s Behavioral Risk Factor Survey System
and Vital Records system. The breadth of demographic, socio-economic, and epidemiologic data that
was made available was more than adequate to facilitate an assessment of community health need and
support the development of recommendations for the Cancer Center. One major challenge was that
much of the epidemiologic data that is available, particularly at the sub-county, municipal-,
neighborhood-, or zip code-level data was up to 5 years old. The list of data sources included in this
report provides the dates for each of the major data sets provided by the Commonwealth. The data was
still valuable and allowed the identification of health needs relative to the Commonwealth and specific
communities. However, older datasets may not reflect recent trends in health statistics. The age of the
data also hindered trend analysis, as trend analysis required the inclusion of data that may have been up
to ten years old, which challenged any current analysis.
With respect to qualitative data, information was gathered through a staff survey as well as a series of
stakeholder interviews and focus groups/community meetings, which engaged service providers,
community leaders/advocates, and community residents. These interviews and focus groups provided
invaluable insights on cancer-related concerns, barriers to care, service gaps, and at-risk target
populations. However, given the relatively small sample size and the nature of the questioning the
results are not necessarily generalizable to the larger population. While every effort was made to
promote the focus groups/community meetings to the community and to identify a representative
sample of interviewees the selection or inclusion process was not very large, scientific, or random.
8
COMMUNITY CHARACTERISTICS
Population characteristics such as age, gender identity, race, ethnicity, and language were examined
to characterize community composition, needs, and health status. Social, economic, and
environmental factors that impact health status and health equity, like income, education, and
housing were also examined. Finally, epidemiologic and morbidity/mortality related data was used to
characterize disease burden and health inequities, identify target populations and health-related
priorities, and to target strategic responses.
The following is a summary of key findings of this review. Conclusions were drawn from
quantitative data and qualitative information collected from through the staff survey, interviews
and focus groups/community meetings. Summary data tables and graphs are included below.
SERVICE AREA Mount Auburn Hospital’s
primary service area includes
the quasi- urban cities of
Cambridge and Somerville and
adjacent towns of Arlington,
Belmont, Watertown and
Waltham. While great efforts
are made to improve the health
status, provide diagnostic
screening, and address access
barriers of all of the residents
of these communities, special
attention is given to address
the needs of diverse and/or low
income, vulnerable segments of
these populations living in
these communities. The
assessment found that the
majority of the residents living
in Mount Auburn’s primary
service area, relative to the
Commonwealth, had few barriers to care and were more likely to be insured, were more affluent,
and were more likely to have a personal vehicle. However, census data and qualitative information
from interviews and focus groups showed that these cities/towns have significant proportions of
low income, racially and ethnically diverse, foreign born, and/or geographically isolated residents.
The challenges that these cohorts face with respect to social determinants of health and access to
care are often intense and are at the root of the challenges and poorer health outcomes faced in
these communities.
FIGURE 2: MOUNT AUBURN HOSPITAL SERVICE AREA
9
AGE AND GENDER Age and gender are fundamental factors to consider when assessing individual and community health
status, as the risk for some cancer is related to gender; women are more at risk for breast cancer
and only men have a risk of prostate cancer. Additionally, the risk for many cancers, including
those with identified screening recommendations such as breast, prostate and colorectal cancers,
increases with age. Men tend to have a shorter life expectancy and more chronic illnesses than
women, and older individuals typically have more physical and mental health vulnerabilities and are
more likely to rely on immediate community resources for support compared to young people.1,2 In
Mount Auburn’s service area, gender breakdowns in each of the municipalities mirror that of the
Commonwealth.
Among municipalities in the primary service area, there is variation in demographic make-up. Compared
to Massachusetts and the service area overall, Arlington and Belmont have a higher proportion of
residents under 18 and residents over the age of 65.
FIGURE 3: POPULATION UNDER 18/OVER 65, 2011-2015
Source: US Census Bureau, American Community Survey 2011-2015 5-Year Estimates
RACE/ETHNICITY, LANGUAGE, AND CULTURE There is an extensive body of research that illustrates the complex factors that contribute to cancer
disparities in certain racial/ethnic populations. In most cases, these disparities, which include less
screening and higher rates of cancer incidence, advanced diagnoses, and mortality, are associated
1 Lyons L. Age, religiosity, and rural America. Gallup Web site. March 11, 2013. http://www.
gallup.com/poll/7960/age-religiosity-rural-america.aspx. 2 Harvard Men’s Health Watch. Mars vs. Venus: The gender gap in health. Harvard Health Publications Web
site. January 2010. http://www.health.harvard.edu/newsletter_article/ mars-vs-venus-the-gender-gap-in-health.
10
with low socioeconomic status, lack of insurance coverage, and living conditions.3 Cultural beliefs
are also barriers that prevent individuals from obtaining effective care. In the United States, African
Americans/Blacks suffer the greatest burden; for all cancers combined, mortality rate is 25% higher
compared to Whites. Looking specifically at breast cancer, White women are more likely to be
diagnosed, though African American/Black women are more likely to die from the disease. African
American/Black men have the highest incidence of prostate cancer among all racial/ethnic groups,
and are twice as likely as Whites to die of the disease. Though genetic factors may account for
some of these differences in survival, research suggests that barriers to early detection and
screening and unequal access to treatment technology are the major factors contributing to these
differences in survival.4
These disparities illustrate the unfair, disproportionate, and often avoidable inequities that exist
within communities and reinforce why it is important to understand the demographic makeup of a
community to identify population segments that are more likely to experience adverse health
outcomes.
Looking at the service area:
Approximately 1 in 4 residents are Non-white; 12% of individuals in the service area are
Asian (unspecified); 7% are Black or African American; and 5% identify as some other
race/two or more races.
Approximately 9% of those in the service area are Hispanic/Latino (of any race).
Compared to the Commonwealth (7%), the percentage of Black or African American
residents is significantly high in Cambridge (11%).
Compared to the Commonwealth (6%), the percentage of Asian residents is significantly
high in all municipalities, with the exception of Watertown.
Research suggests that language barriers contribute to poor health communication and disparities
in health care use and outcomes.5 Individuals with LEP may have lower levels of medical
comprehension, which lead to higher rates of complications attributable to limited understanding
about treatments and side effects, lack of informed consent, and poor comprehension of follow-up
care plans.6,7 Due to the complex nature of cancer care, LEP patients diagnosed with cancer may be
particularly vulnerable to adverse outcomes as a result of communication barriers.
3 Cancer Health Disparities Research. National Cancer Institute Web site. Updated July 24, 2017.
https://www.cancer.gov/research/areas/disparities 4 Cancer Health Disparities. National Cancer Institute Web site. Updated March 11, 2008.
https://www.cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet#q2 5 Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical
cancer screening in a multiethnic population. Am J Public Health. 2005; 95(8): 1410-1416. Doi:
10.2105/AJPH.2004.041418 6 Wilson E, Chen AH, Gumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician
language on health care compression. J Gen Intern Med. 2005; 20(9): 800-806. Doi: 10.1111/i.1525-
1497.2005.0174.x 7 Coren JS, Filipetto FA, Weiss LB. Eliminating barriers for patients with limited English proficiency. J. Am.
Osteopath. Assoc. 2009; 109(12): 634-640.
11
According to quantitative data:
Among all municipalities in the service area, over 2% of the population speaks Spanish or
Spanish Creole; in Somerville, Waltham, and Watertown, over 2% of the population speaks
Spanish at home and have limited English proficiency (LEP).
In Somerville, 6% of the population speaks Portuguese or Portuguese Creole, with 3% of this
population having limited English proficiency.
In Belmont, 6% of the population speaks Chinese (unspecified), with 3% of this population
having limited English proficiency.
FIGURE 4: SPANISH LANGUAGE/LEP, 2011-2015
Source: US Census Bureau, American Community Survey 2011-2015 5-Year Estimates
Broader issues of immigration status and culture were major themes in interviews or community
forums, and many interviewees identified immigrant populations as a cohort that require specialized
health care services and resources; Central and South Americans, Haitians, Chinese (Mandarin),
Russians, Armenians, and those from Arabic speaking countries were referenced specifically.
Immigrants are less likely to visit doctor’s offices and emergency rooms than low-income native
12
residents.8 According to the Centers for Disease Control and Prevention (CDC), immigrants are less
likely than the general population to receive breast, cervical, and colorectal cancer screenings due
to limited access to care and cultural barriers.9 Prejudice and discrimination, mistrust, and cultural
differences deter many immigrants and refugees from seeking health services, and it is common for
immigrants and refugees to self-isolate due to trauma and stress.10
According to quantitative data:
The percentage of the population that is foreign born is significantly high in all
municipalities compared to the Commonwealth (15.5%). Rates were highest in Cambridge
(27%), Waltham (26%), and Somerville (25%).
SOCIAL DETERMINANTS OF HEALTH The quantitative and qualitative data show clear geographic and demographic differences related to the
leading social determinants of health (e.g. socioeconomic status, housing, and transportation). These
issues influence and define quality of life for many segments of Mount Auburn’s service area. A
dominant theme from key informant interviews and focus groups was the tremendous impact that
underlying social determinants, particularly housing, poverty, and transportation, have on low-income
and vulnerable segments of the population.
Socioeconomic Status
Socioeconomic status, as measured by education, income and poverty, employment, and the extent
to which one lives in areas of economic disadvantage, is closely linked to morbidity, mortality, and
overall well-being. According to research, individuals in low-education and low-income groups have
higher incidence and mortality rates than affluent individuals, with excess risk particularly marked
for lung, colorectal, cervical, stomach, and liver cancer.11
Education
Higher education is associated with improved health outcomes and social development at the
individual and community level.12 Compared to individuals with more education, people with lower
educational attainment are more likely to experience a number of health issues, including obesity,
8 Ku L, Jewers M. Health care for immigrant families: Current policies and issues. Migration Policy Institute Web
site. http://www.migrationpolicy.org/research/health-care-immigrant-fami-lies-current-policies-and-issues.
Published 2013. 9 Cancer Screening. Centers for Disease Control and Prevention Web site. Updated June 21, 2016.
https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/general/discussion/cancer-screening.html 10 Lake Snell Perry Mermin/Decision Research. Living in America: Challenges facing new immigrants and refugees.
Sponsored by the Robert Wood Johnson Foundation. Published January 2006.http://www.rwjf.org/content/dam/farm
/reports/reports/2006/rwjf3807 11 Singh GK, Jemal A. Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the
United States, 1950-2014: Over six decades of changing patterns and widening inequalities. J Environ Public
Health. 2017. Doi: 10.1155/2017/2819372 12 Zimmerman EB, Woolf SH, Haley A. Population health: Behavioral and social science insights – Understanding
the relationship between education and health. Agency for Healthcare Research and Quality Website. Agency for
Healthcare Research and Quality, https://www.ahrq.gov/professionals/education/curriculum-tools/ population-
health/ zimmerman.html. Published September 2015.
13
substance misuse, and injury.13 The health benefits of higher education typically include better access
to resources, healthier and more stable housing, and better engagement with providers. Proximate
factors associated with low education that affect health outcomes include the ability to navigate the
health care system, educational disparities in personal health behaviors, and exposure to chronic
stress.14 It is important to note that while education affects health, poor health status may also be a
barrier to education.
FIGURE 5: EDUCATIONAL ATTAINMENT, 2011-2015
Source: US Census Bureau, American Community Survey 2011-2015 5-Year Estimates
Despite the overall service area population being highly educated compared to the
Commonwealth, there is slight variation among municipalities: Somerville (89%) and Waltham
(90%) are the only two municipalities that do not have a significantly higher percentage of residents
with a high school degree or higher compared to the Commonwealth (90%).
Employment, Income, and Poverty
All towns in the service area have a high median income compared to the Commonwealth, and the
civilian labor force unemployment is about the same, or significantly lower (Arlington, Cambridge,
and Somerville). However, we know from qualitative findings that there are small but significant
pockets within the service area that live in poverty, are unemployed, and struggle to afford food
and other household items.
The percentage of residents that live below the federal poverty line is significantly high in
Cambridge (14%) and Somerville (15%) compared to the Commonwealth (12%).
13 Health disparities. Centers for Disease Control and Prevention Web Site. Published September 1,
2015.https://www. cdc.gov/healthyyouth/disparities/. 14 Zimmerman EB, Woolf SH, Haley A. Understanding the relationship between education and health: A review of
the evidence and an examination of community perspectives. Agency for Healthcare Research and Quality Web site.
Published 2014.
14
Compared to the Commonwealth (24%), a significantly high percentage of residents live
below 200% of the federal poverty line in Somerville (28%).
In Somerville, the percentage of families (10%), those under 18 (23%), and those over 65
(14%) living below the federal poverty line was significantly high compared to the
Commonwealth (8%, 15%, and 9%, respectively).
FIGURE 6: POPULATION LIVING BELOW 200% OF THE FEDERAL POVERTY LEVEL, 2011-
2015
Source: US Census Bureau, American Community Survey 2011-2015 5-Year Estimates
Housing, Transportation, and Food Access
A large body of evidence suggests that poor housing is associated with a range of health conditions,
including asthma and other respiratory conditions, exposure to environmental toxins, injury, and the
spread of communicable diseases.15 These health issues are more common among low-income
segments of the population who struggle to find safe and healthy housing. In Somerville, substantial
numbers of people are “house-poor,” with housing costs that exceed 30% of income. Cambridge
and Somerville are the only municipalities in the service area with overnight homeless shelters,
and have substantial numbers of people that are homeless or unstably housed.
Transportation is a common concern for cancer patients, as treatment often requires many visits.
For example, a course of radiation therapy may require a patient to come to the hospital daily for
many weeks. Research shows that cancer patients may forego treatments in the absence of
available and affordable means of transportation; this issue is perceived more often for
racial/ethnic minorities than for whites.16
15 Hughes HK, Matsui EC, Tschudy MM, Pollack CE, Keet CA. Pediatric asthma health disparities: Race, hardship,
housing, and asthma in a national survey. Acad Pediatr. 2017; 17(2): 127-134. 16 Guidry JJ, Aday La, Zhang D, Winn RJ. Transportation as a barrier to cancer treatment. Cancer Pract. 1997; 5(6):
361-366.
15
Key informants and individuals at community forums frequently identified transportation as a major
barrier to care, especially for those that live outside of Cambridge and Somerville and have limited
access to forms of public transport. Transportation significantly impacts one’s ability to access health
resources, but also determines whether an individual or family has the ability to access the basic
resources that allow them to live productive and fulfilling lives, such as work, school, grocery stores,
recreational facilities, and other community resources.17
Issues related to food insecurity, food scarcity, hunger, and the prevalence and impact of obesity are at
the heart of the public health discourse in urban and rural communities across the United States.
Research consistently produces evidence that compared to normal weight individuals, those that
are obese and overweight are at an increased risk for many forms of cancer, including breast, liver,
kidney, pancreatic, colorectal, esophageal, endometrial, and meningioma.18 A 2012 study showed
that approximately 3.5% of new cancer cases in men, and 9.5% of new cancer cases in women,
were due to overweight or obesity.19 While there is limited quantitative data on food access, lack of
access to healthy foods was a common theme in interviews and community forums, particularly for
low-income individuals and families.
17 Syed ST, Gerber BS, Sharp LK. Traveling towards disease: Transportation barriers to health care access. J
Community Health. 2013; 38(5): 976-993. 18 Obesity and Cancer. National Cancer Institute Web site. Reviewed January 17, 2017.
https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet 19 Arnold M, Pandeya N, Byrnes G, et al. Global burden of cancer attributable to high body-mass index in 2012: a
population-based study. Lancet Oncology 2015; 16(1): 36-46.
16
PATIENT POPULATION THOSE WHO MADE FIRST CONTACT WITH CANCER CENTER IN 2016
DEMOGRAPHICS, LANGUAGE, AND INSURANCE STATUS Of those who made first contact with Mount Auburn’s Cancer Center in 2016:
Approximately 37% of patients were between the ages of 60-69; 23% were between the ages of
70-79, and; 17% were between the ages of 50-59 at age of diagnosis.
Approximately 87% were white; 7% were black, and 3% were Asian (not-specified).
MAH provided over 1000 interpretation encounters to cancer patients: 37% Spanish, 28%
Armenian, 11% Portuguese, 8% Korean, 7% Russian, 6% Mandarin, 2% American Sign Language,
and 1% Haitian Creole
Approximately 48% were privately insured; 47% were covered under Medicare; and 4% were
covered under Medicaid. Approximately 0.3% were uninsured.
PATIENT ORIGIN Looking strictly at the municipalities in Mount Auburn’s primary service area, most patients are from
Cambridge (16.2%), and the fewest are from Waltham (5.5%) (See Table 2). Table 3 (below) lists the top
ten patient origins by zip code, inclusive of municipalities from outside of Mount Auburn’s primary
service area.
TABLE 2: PERCENTAGE OF TOTAL PATIENTS FROM PRIMARY SERVICE AREA, 2016
Municipality Percentage of Patients
Cambridge 16.2%
Arlington 11.1%
Watertown 10.3%
Somerville 7.7%
Belmont 6.0%
Waltham 5.5%
Source: Mount Auburn Hospital Cancer Registry
TABLE 3: TOP 10 PATIENT ORIGINS BY ZIP CODE, 2016
Zip Code/Municipality Percentage of Patients
Watertown (02472) 10.31%
Arlington (02474) 7.33%
Medford (02155) 6.11%
Belmont (02478) 5.97%
Cambridge (02139) 5.83%
Cambridge (02138) 4.61%
Cambridge (02140) 4.34%
Arlington (02476) 3.80%
Somerville (02144) 2.99%
Somerville (02143) 2.44%
Source: Mount Auburn Hospital Cancer Registry
17
DIAGNOSTIC CHARACTERISTICS The top 10 Cancer diagnoses at Mount Auburn Hospital are shown below in Figure 7; the most common
diagnoses was breast cancer, accounting for 42% of all diagnoses in 2016. When looking at the top 10
diagnoses by sex, among female patients who made first contact with MAH in 2016, the top sites were
breast (62%), bronchus/lung (10%), and corpus uteri (8%) (Figure 8); among male patients, the top sites
were prostate (26%), bladder (22%), and bronchus/lung (21%) (Figure 9).
FIGURE 7: TOP 10 CANCER DIAGNOSES, 2016
Source: Mount Auburn Hospital Cancer Registry
FIGURE 8: TOP 10 SITES BY SEX (FEMALE), 2016
Source: Mount Auburn Hospital Cancer Registry
Colon
6%
Bronchus/Lung
14%
Hema/Reti
3%
Breast
42%
Corpus Uteri
6%
Prostate
8%
Kidney
5%
Bladder
10%
Thyroid
3%
Unknown
3%
Colon
5%
Bronchus/Lung
10%
Hema/Reti
2%
Breast
62%
Corpus Uteri
8%
Prostate
0%
Kidney
2% Bladder
5%
Thyroid
4% Unknown
2%
18
FIGURE 9: TOP 10 SITES BY SEX (MALE), 2016
Source: Mount Auburn Hospital Cancer Registry
Figure 10 compares the stage of cancer (all sites) of those diagnosed at Mount Auburn in 2015 to the
stage of cancer (all sites) of those diagnosed across Massachusetts in the same year. According to this
figure, Mount Auburn saw nearly 50% more patients with Stage 0 diagnoses and 3% less patients with
Stage IV diagnoses. A breakdown of stage at diagnoses for all sites, breast, lung, colorectal, and prostate
cancer at Mount Auburn is shown in Table 4. Through this data we see that, across sites, most patients
are diagnosed at Stage 0, I, or II. We also can glean that among these four cancer types, lung/bronchus
and colorectal cancer tend to be diagnosed at later stages (Stages III and IV).
FIGURE 10: STAGE AT DIAGNOSIS, 2015
Source: Mount Auburn Hospital Cancer Registry
Colon
9%
Bronchus/Lung
21%
Hema/Reti
5% Breast
0%
Prostate
26%
Kidney
10%
Bladder
22%
Thyroid
2%
Unknown
5%
0
5
10
15
20
25
30
35
0 I II III IV NA Unknown
Per
cen
t (%
) D
iag
no
sed
Stage at Diagnosis
MAH
Other
19
Table 4: PERCENT OF DIAGNOSES BY SITE AND STAGE, 2015
Stage 0 Stage I Stage II Stage III Stage IV 88 Unknown
All Sites 14% 37% 14% 9% 13% 6% 7%
Lung/Bronchus 2% 37% 6% 13% 37% 0 5%
Breast 23% 51% 13% 6% 0 0 7%
Colon/Rectal 8% 20% 16% 20% 26% 0 10%
Prostate 0 2% 67% 6% 19% 0 6% Source: Mount Auburn Hospital Cancer Registry
20
BURDEN OF CANCER
RISK FACTORS An important aspect of the CNA is characterizing the extent to which population segments and
communities participate in activities that are considered “high-risk.” It is well understood that certain
health risk factors, such as obesity, tobacco use, lack of physical exercise, poor nutrition, and alcohol use
have effects on the burden of cancer, physical chronic conditions, and behavioral health.
Across indicators, Mount Auburn’s service area fares similarly or better than the Commonwealth. The
rates of current smokers, exposure to environmental tobacco smoke, and overweight/obesity are all
significantly lower than the Commonwealth, and people reported significantly more leisure time
physical activity.
TABLE 5: RISK FACTORS, 2007-2009
Community Health Network Area
(CHNA) 17
Commonwealth of
Massachusetts
Current Smoker
(Currently smokes
some days or
everyday)
10.9 15.8
Former Smoker
(More than 100
cigarettes in lifetime,
but no longer smoke)
26.2 28.3
Exposed to
environmental
tobacco smoke at
their home, work, or
other places
31.8 37.5
Binge Drinking (In
past month : 5+
drinks in one occasion
for men; 4+ drinks
for women in one
occasion for women)
15.8 17.6
Overweight/Obese
(BMI >25) 48.8 58.2
Leisure Time Physical
Activity (Any physical
activity other than
regular job in past
month)
83.6 78.7
Source: Massachusetts Department of Public Health, Health Survey Program
* The MA Department of Public Health no longer reports cancer screening rates at the municipal-level. The most recent data
aggregated at the CHNA level is 2007-2009; this includes all towns in the primary service area with the exception of Waltham.
21
INCIDENCE Looking across Mount Auburn’s service area, the summary incidence rate (SIR) was significantly high in
only two municipalities for two types of cancer: for liver cancer among females in Somerville, and
stomach cancer among females in Watertown. The summary SIR was significantly low in several towns,
for several cancer types (see Table 2 below). For further detail, please see Summary Incidence sheets for
each municipality in the primary service area (Appendix A).
TABLE 5: SUMMARY INCIDENCE RATE (SIR)** HIGHER/LOWER THAN EXPECTED, 2009-2013
Summary Incidence Higher Than
Expected
Summary Incidence Lower Than
Expected
Arlington None None
Belmont None All Sites/Types (Males)
Lung/Bronchus (Males)
Oral Cavity/Pharynx (Males)
Cambridge None All Sites/Types (Males & Females)
Lung & Bronchus (Males and Females)
Kidney/Renal Pelvis (Female)
Colon/Rectum (Female)
Breast (Female)
Bladder (Males and Females)
Somerville Liver (Females) All Sites/Types (Females)
Testis (Males)
Breast (Females)
Melanoma (Females)
Waltham None Prostate (Males)
Melanoma (Females)
Watertown Stomach (Females) None
Source: Massachusetts Cancer Registry, 2009-2013
**A standardized incidence ratio is an indirect method of adjustment for age and sex that describes in
numerical terms how a city/town’s cancer experience in a given time period compares with that of the
state as a whole. For more information, please see pages 2-7 of Massachusetts’ Cancer Incidence Report.
22
HOSPITALIZATIONS Of the six towns in Mount Auburn Hospital’s service area, all-cancer hospitalization rates were
significantly lower than the Commonwealth in Cambridge. Table 6 includes hospitalization rates for all
cancers, and the four leading cancer sites.20 Rates of hospitalization due to lung cancer were significantly
lower than the Commonwealth in Arlington and Belmont, and hospitalizations due to breast cancer
were significantly lower in Somerville.
TABLE 6: AGE-ADJUSTED HOSPITALIZATION RATES (PER 100,000), 2008-2012
All Cancer Lung* Breast Colorectal Prostate
MA 371.30 47.86 39.08 38.41 47.15
Arlington 353.59 33.20 46.17 35.59 59.32
Belmont 305.49 29.51 33.28 30.54 60.69
Cambridge 327.80 41.63 33.53 33.44 51.13
Somerville 382.30 54.19 26.40 34.97 43.39
Waltham 372.43 53.07 38.92 36.38 36.42
Watertown 388.97 52.38 32.24 43.73 47.15
Source: Massachusetts Department of Public Health (Hospitalizations), 2008-2012
EMERGENCY DEPARTMENT (ED) DISCHARGES The rate of ED Discharge related to all cancers and lung cancer were significantly higher in Waltham
compared to Massachusetts. Rates of ED Discharge related to all cancers were significantly lower in
Arlington, Cambridge, and Somerville compared to the Commonwealth.
TABLE 7: AGE-ADJUSTED EMERGENCY DEPARTMENT DISCHARGES (PER 100,000), 2008-2012
All Cancer Lung Breast Colorectal Prostate
MA 15.58 2.66 1.93 0.83 1.18
Arlington 6.58 NA NA NA NA
Belmont 15.01 0.00 0.00 0.00 NA
Cambridge 7.31 NA NA 0.00 NA
Somerville 10.69 0.00 NA NA NA
Waltham 36.83 10.45 NA NA NA
Watertown 15.75 NA NA NA 0.00
Source: Massachusetts Department of Public Health (ED Discharges), 2008-2012
20 American Cancer Society, Cancer Facts and Figures 2017, https://www.cancer.org/content/dam/cancer-
org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf
23
MORTALITY Of the six towns in Mount Auburn Hospital’s service area, the all cancer mortality rate is significantly
high in Somerville (194.2) compared to the Commonwealth. Looking at the four leading cancer sites,
service area mortality rates were significantly lower than the Commonwealth in several municipalities.
The colorectal cancer mortality rate was significantly high in Arlington (29.8) compared to the
Commonwealth overall (12.6).
TABLE 8: AGE-ADJUSTED MORTALITY RATES (PER 100,000), 2014
All Cancer Lung* Breast Colorectal Prostate
MA 155.6 47.86 10.2 12.6 7.4
Arlington 150.6 33.20 --1 29.8 --1
Belmont 117.7 29.51 0.0 --1 15.0
Cambridge 137.9 41.63 12.2 7.7 6.1
Somerville 194.2 54.19 --1 10.1 --1
Waltham 176.8 53.07 10.5 8.5 9.1
Watertown 137.7 52.38 --1 --1 --1
Source: Massachusetts Department of Vital Statistics, 2014, *Massachusetts Department of Vital Statistics 2008-2012
SCREENING According to Behavioral Risk Factor Surveillance Survey data on cancer screening for colorectal and
breast cancer, the screening rates in MAH’s service area mirror that of the Commonwealth. However,
qualitative findings suggest that there are major barriers to access and disparities in screening rates for
certain racial/ethnic and enculturated segments of the population.
TABLE 9: CANCER SCREENING RATES (PERCENTAGE OF SURVEY RESPONDENTS), 2007-2009*
Community Health Network Area
(CHNA) 17
Commonwealth of
Massachusetts
Adults 50+ with
Colonoscopy or
Sigmoidoscopy in past
5 years
62.0% 63.5%
Women 40+ with
Mammogram in past 2
years
84.4% 84.5%
Source: Massachusetts Department of Public Health, Health Survey Program (BRFSS
* The MA Department of Public Health no longer reports cancer screening rates at the municipal-level. The most recent data
aggregated at the CHNA level is 2007-2009; this includes all towns in the primary service area with the exception of Waltham.
24
KEY FINDINGS RELATED TO BARRIERS TO PREVENTION, SCREENING, AND NAVIGATION
PATIENT-CENTERED BARRIERS
Insurance Status (No insurance/Under-insured) Access to health insurance that helps to pay for needed preventive, acute, and disease management
services, as well as access to comprehensive, timely accessible primary care has shown to have a
profound effect on one’s ability to prevent disease and disability, increase life expectancy, and perhaps
most importantly, increase quality of life.21 Nationally, disparities in access and health outcomes exist
for many population segments, including those in low income brackets, immigrant populations
(especially new arrivals without permanent resident status), racial/ethnic diverse segments, and LGBT
populations, just to name a few. Due to a range of mostly social factors, these groups are less likely to
have a usual source of primary care, less likely to have a routine check-up, and less likely to be screened
for illnesses, such as breast cancer, prostate cancer, or colon cancer. Data also suggests that those that
face disparities are more likely to use hospital emergency departments and inpatient services for care
that could be avoided or prevented altogether with more accessible primary care services. 22
While Massachusetts has had the lowest rates of uninsurance in the nation for years, reported at 2.8%
in September 2016 based on US Census Bureau estimates, considerable numbers of people still struggle
due to lack of health insurance or health insurance with adequate coverage. This was cited as the
leading barrier by nearly all of the clinical and support staff that participated in the assessment. There
are still large numbers of people in the service area who are uninsured or under-insured with limited
benefits. Charles River Health Center, for example, is a federally qualified health center (FQHC) with
sites in Alston and Waltham that serves large number of low income, underserved residents from Mount
Auburn’s service area. In 2015, approximately 40% of Charles River’s patients were uninsured, which
was the highest rate among all of Massachusetts’ FQHCs.
For the Cancer Center, this is particularly problematic when staff are trying to ensure that patients,
particularly those at high-risk, are able to obtain the diagnostic tests or other personalized services they
need so that they can identify cancer early and obtain appropriate, routine screening and diagnostic
services. Once diagnosed, lack of insurance or adequate coverage is less of an issue but prior to
diagnosis it can difficult, time-consuming, and sometimes impossible to provide certain vital screening
and diagnostic services for patient in need. If the Cancer Center is to make strides to reduce disparities
for the area’s most vulnerable (e.g., low income, certain racial/ethnic segments, non-English speakers,
recent immigrants), than they must be able to screen and provide personalized diagnostic services so
that patients can be diagnosed and provided appropriate treatments in a timely manner.
21 Healthy People 2020. Access to Health Services. https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-
topics/Access-to-Health-Services Accessed 6/2/16 22 Institute of Medicine. Coverage Matters: Insurance and Health Care.
http://iom.edu/~/media/Files/Report%20Files/2003/Coverage-Matters-Insurance-and-Health-Care/Uninsurance8pagerFinal.pdf
Accessed 6/2/16
25
Low-Income/Poverty Status (Individuals/Families) Socio-economic status, as measured by income, employment status, and education, has long been
recognized as a critical determinant of health. Research shows that communities with lower socio-
economic status bear a higher disease burden, including cancer burden, and have lower life
expectancy.12 Low income populations, as defined as those living at below 200% of the federal poverty
level (FPL), are less likely to be insured, less likely to have a usual source of primary care for urgent,
routine, and preventive services (including cancer screenings), more likely to delay health care services,
and more likely to use emergency department for both emergent and non-emergent care. Moreover,
children born to low income families are, as they move into adulthood, are less likely to be formally
educated, less likely to have job security, and less likely to rise and move up to higher socio-economic
levels, this perpetuating the barrier.
As discussed above, while residents in the service area are more likely to be in middle- and upper-
income brackets compared to residents of the County and the Commonwealth overall, there are still
substantial segments of the population across all of the service area’s communities that are in low
income brackets, are on fixed-incomes, or who are considered “house poor”, who struggle to pay for
safe housing, transportation, health care services, food, utilities, and other essential items. This issue
was brought up as a major factor and barrier to care in nearly every key informant interview and focus
group. This issue was generally considered to be more important than issues of racism and was often
cited as the underlying issue with respect to some of the other social determinants such as
transportation, education, appropriate child-care, and housing.
Specifically, poverty or low income status, as well as lack of gainful, reliable employment was cited as a
barrier as it was linked to a range of underlying factors such lack of health insurance, inability to pay
health care co-pays, inability to pay for needed medications, inability to pay for childcare service so that
individuals/family members can access health care services, inability to pay for transportation. Cancer
Center clinicians and staff, clearly cited that these issues hindered patient’s ability to access the primary
care, screening, prevention, navigation, and treatment services that they needed to take care of
themselves or their families.
Race/Ethnicity, Immigration Status, and Language While data is not readily available to assess this issue among residents of Mount Auburn’s service area
specifically, national and Commonwealth data shows that there are substantial disparities in health
outcomes for those in certain racial and ethnic categories, for recent immigrants, and for those who do
not speak English or do not speak English well. While these factors can be inter-related they also have
their own unique characteristics that lead to specific challenges and barriers. For example, it is has be
shown that even if you control for other factors such as employment, income, and language status,
African Americans face disparities in access and outcomes relative to their white, Caucasian
counterparts. Racism is a factor in and of itself and has been shown to be at the heart of issues of
access, including access to cancer outreach, preventive, screening and navigation services. Foreign born
residents, especially recent immigrants or refugees and even more specifically those who are not
permanent residents or who are not specifically authorized to be in the United States, face enormous
barriers. These segments struggle to access services due sometimes to lack of health insurance, limited
26
understanding of the local culture, lack of trust, or lack of understanding of the health care system.
Finally, those who speak or read a language other than English or who do not speak or read English well
struggle to access services. These segments struggle because they cannot easily learn about or navigate
the health care system or communicate with staff or clinicians at their service sites.
These issues were discussed as major barriers in all of the interviews and focus groups that were
conducted for this assessment. These issues were particular said to be problematic in Cambridge,
Somerville, Waltham, and Watertown where there are substantial portions of racial/ethnic minorities,
recent immigrants, and non-English speakers. The most frequent comments related to this segment
were related to challenges for recent immigrants who were not acculturated, had limited ability to
communicate in English, often struggled with low income status, did not trust their service providers,
and simply struggled to navigate the health care system. A small number of interviewees said that race
was not a major factor in accessing appropriate cancer services, while others disagreed. One
interpretation of this discrepancy could be that those who are “in care” and are already accessing
primary care services are obtaining cancer-related services but that many are not in care or well
engaged in services.
Transportation Lack of transportation was a theme from the assessment’s key informant interviews and focus groups.
Lack of transportation was cited not only for having a significant impact on access to health care
services, but also as a determinant of whether an individual or family had the ability to access the basic
resources that allowed them to live productive and fulfilling lives; access to affordable and reliable
transportation widens opportunity and is essential to addressing poverty, unemployment, and goals
such as access to work, school, healthy foods, recreational facilities and a myriad of other community
resources, including health care services. Many focus group participants and interviewees identified
transportation issues for those living in Mount Auburn’s service area. While there was variation in the
nature of the issue depending on where you lived and your circumstances, transportation was identified
as an issue by people throughout the service area. Even those living in Cambridge and Somerville, who
have access to a strong public transit system expressed that transportation can be a major barrier to
accessing care; the primary issue being the expense of public transportation, followed by lack of timely,
reliable, flexible, or convenient services. In the more suburban towns in the Cancer Center’s service
area, residents are much more likely to have access to personal cars but there are still large numbers of
people in these communities, especially older adults and low income segments of the population, that
face transportation barriers. In this case, most often people cited the lack of affordable, convenient,
and flexible public transportation, particularly for those who don’t have a personal car, cannot drive
themselves, and don’t always have strong support systems.
It’s important to note that most clinicians or support staff at the Center expressed that transportation
for those who were in care was not an insurmountable problem, in fact, the navigators and case
management staff interviewed said that it was rare that they were not able to address their patient’s
transportation barriers but for those not in care or for those trying to access routine primary care and
preventive services this can hinder access to appropriate and timely care.
27
Other Patient-Related Factors (i.e., Mental Health, Substance Use, Homeless/Unstably Housed, LGBT) According to numerous interviewees many people residents throughout all of the cities/towns in the
service area face life-challenges or have to deal with stigma in the community that can greatly challenge
their ability to access services or to be treated in the same way as other segments of the population. The
segment of the population most often cited in this regard, according to interviewees and focus group
participants was those in the service area who were mentally ill or who were substance users. These
segments were said to face enormous barriers and did not have adequate support networks or
advocates who made sure that they received the care they needed, including cancer education,
screening and navigation services. In this regard there was a great need to provide tailored and
targeted services to ensure adequate access. Similarly, the homeless face tremendous stresses and
challenges that need to be addressed in careful, thoughtful, and proactive ways. Other interviewees
mentioned LGBTQ populations. According to the American Cancer Society, compared to heterosexual
individuals, LGBT people are at a greater risk of late-stage cancer diagnoses due to issues of
discrimination, stigma, and isolation that may hinder access to routine health care services and
screening tests.23
Low Literacy/Limited Health Literacy (Limited Education, Immigrants) Another frequently cited issue was the challenges that many experienced related to low literacy or
specifically low health literacy that challenged many residents ability to navigate the system, learn about
important cancer risk and protective factors, and obtain appropriate screening and treatment services.
PROVIDER-CENTERED BARRIERS
High Patient No-Show Rates and Low Payment Rates Numerous interviewees cited provider or health system barrier related to high no show rates and low
payment rates that indirectly served to limit access for those being seen at outpatient clinics. This was a
significant issue in the high risk/genetics clinic and particularly problematic for the segments of the
population who are most at-risk who tend to underserved (e.g., low income, recent immigrants, non-
English speakers). These populations have higher no-show rates and are more likely to be Medicaid
insured, which has on average lower payment rates. These are just the segments of the population who
are likely to be the target of cancer outreach, prevention, and screening efforts. In order to address
these issues, practices need to reduce no-show rates and explore how to increase payment rates or
somehow increase subsidies so that they can more easily sustain programs or services for these
segments.
Challenges related to Information Sharing and Health Information Technology (HIT) Many interviewees cited challenges related to information sharing between different components of the
health care system which limited their ability to coordinate care and/or to identify those in need of
screening and diagnostic services. Interventions targeted at enhancing communication, enhancing
provider’s ability to identify and manage care through their electronic medical record systems could
help to increase access, address barriers, and reduce the burden of cancer.
23 American Cancer Society: 2016 LGBT Communities Engagement Guide
28
EMERGING RECOMMENDATIONS
Once all of the assessment’s findings were compiled, the Cancer Management Committee participated
in a strategic planning process (December 15, 2017) that integrated data findings from the full breadth
of quantitative and qualitative sources, including information gathered from census data, the
Massachusetts Department of Public Health, the staff survey, key informant interviews, and focus
groups. Based on this review, the Cancer Management Committee agreed on the following series of
emerging recommendations that the Committee believed should guide their subsequent efforts to
identify the Cancer Center’s strategic initiatives moving forward.
TARGET EDUCATION, NAVIGATION, AND SCREENING
Recent Immigrants at SCALE, Cambridge Learning Center, Waltham Family School, and Charles
River Health Center
Persons with mental health issues, substance users, and/or developmentally disabled with local
partners (e.g., Transitional housing partners, peer recovery coaches, Springwell, outpatient
providers)
Homeless with Cambridge/Somerville Health Care for the Homeless partners
Older adults with elder service providers (e.g., Councils on Aging, Springwell, nursing homes,
assisted-living)
ENHANCE USE OF ELECTRONIC MEDICAL RECORDS
Develop red flags and monitoring tools that allow MAH’s employed/ affiliated providers to
identify and follow-up with those most at-risk
USE TELEMEDICINE FOR GENETIC COUNSELING
Pilot would allow MAH and CHA to perfect operations and explore if program is sustainable and
capable of reducing burden of cancer on at-risk target population
Telemedicine would enhance access and reduce no-show rates, which would promote
sustainability of program
ENHANCE LANGUAGE SERVICES FOR GENETIC COUNSELING CLINIC
Translation of materials would increase understanding of need for genetic counseling to prevent
cancer.
Utilization of interpreter services for appointment reminders would decrease no-show rate for
non-English speaking community members.
PROMOTE SMOKING CESSATION PROGRAMS
Recent immigrants at SCALE, Cambridge Learning Center, Waltham Family School, and Charles
River Health Center
Mentally ill, substance users, and/or developmentally disabled with local partners (e.g.,
Transitional housing partners, peer recovery coaches, Springwell, outpatient providers)
Homeless with Cambridge/Somerville Health Care for Homeless Orgs.
Older adults with elder service providers (e.g., Councils on Aging, Springwell, nursing homes,
assisted living.
29
PROPOSED STRATEGIC INITIATIVES
Once the emerging recommendations were agreed on, the Cancer Management Committee reviewed
the effectiveness of strategic initiatives implemented by the Cancer Center since the last assessment in
2014 (Appendix C). Based on this review and the emerging recommendations outlined above, the
Cancer Management Committee proposed the following three strategic initiatives.
Given the breadth, depth, and complexity of the assessment’s findings, the Cancer Management
Committee was charged with identifying initiatives that would be: 1) Feasible given resource constraints;
2) Effective based on based past experience; and 3) Impactful in light of the assessment findings related
to cancer burden, barriers to care, and target populations most at-risk.
1) Evidence-based smoking cessation programs in Waltham or Somerville targeting at risk groups
such as racial/ethnic minorities, recent immigrants, and other at-risk groups in partnership with
our community partners.
2) Mammography with at risk groups such as racial/ethnic minorities, recent immigrants, and non-
English speakers in Waltham in partnership with Charles River Community Health Center and
the Waltham Senior Center.
3) Multi-facetted, evidence-informed strategies to improve patient engagement in appropriate
genetic screening/counseling targeting at-risk segments of the population (e.g., racial/ethnic
minorities, recent immigrants, non-English speakers) through strategies such as enhanced care
coordination, patient navigation, and remote counseling technologies (e.g., skype-counseling,
telemedicine).
30
APPENDIX A: DATA FROM US CENSUS BUREAU AND MASSACHUSETTS
DEPARTMENT OF PUBLIC HEALTH
KeyStatistically higher than statewide rateStatistically lower than statewide rate
MA Arlington Belmont Cambridge Somerville Waltham Watertown
DemographicsPopulation 6,705,586 44128 25337 107916 78595 62438 33350
Age under 18 (%) 20.8 21.6 24.4 11.8 12.6 13.7 17.3
Age over 65 (%) 14.7 16.1 16.3 10.7 9.4 13.2 14.4
Race / Ethnicity / CultureWhite alone (%) 79.6 84.2 82.9 76.7 75.5 75.3 84.8
Black or African American alone (%) 7.1 2.2 1.8 10.6 7.6 6 3
Asian alone (%) 6.0 9.5 12.6 15 10.1 11.1 7.1
Native Hawaiian and Other Pacific Islander (%) 0 0 0 0.1 0 0 0
American Indian and Alaska Native (%) 0.2 0.3 0 0.2 0.1 0.1 0.2
Some Other Race (%) 4.2 0.8 0.8 2.2 3.3 4.3 2.6
Two or More Races (%) 2.9 3 1.8 4.3 3.3 3.1 2.3
Hispanic or Latino of Any Race (%) 10.6 3.4 5.3 8 9.8 13.3 11.5
Foreign Born (%) 15.5 17.9 21.5 27.1 24.7 26.2 23.1
Language Spoken at Home by Population 5 Years and Older (detailed language data on separate tab)
Speak another language at home and speak English less than "very well" (%) 8.9 5.9 8.4 7.8 11.8 11.7 10.5
Speak Spanish at home (%) 8.4 2.2 5 6.5 7.4 10.5 8.6
Other Indo-European languages (%) 8.8 13.3 13.3 16.8 12.5 14.3
Asian and Pacific Islander Languages (%) 4.0 5.7 9.2 8.7 4.5 7.2 4.5
HouseholdTotal households 2,549,721 18643 9504 43801 32181 24248 14357
Family households (families) (%) 63.6 60.1 70.1 42.2 43.4 52.4 53.8
In married couple family (%) 46.9 50.9 60.2 31.4 29.9 39 42.7
Average family size 3.2 3.02 3.18 2.78 2.97 3.01 3.05
Income and Employment (past 12 months)
Unemployment Rate among Civilian Labor Force (%) 7.6 4.6 4.7 5 5.5 6.1 7.4Median household income (dollars) 68,563.0 93,787 110,685 79416 73,106 75205 87,409Below 200% 24% 12% 10% 21% 28% 20% 19%
Below federal poverty line - all residents (%) 11.6 5 4.5 14 14.7 10 8.5
Below federal poverty line - families (%) 8.2 2.5 3.5 9 10.4 6 6.2
Below federal poverty line - under 18 years (%) 15.2 2.2 4.5 14.9 22.7 11.9 10.6
Below federal poverty line - age 65+ (%) 9.2 10.5 4.6 12.5 14.2 8.3 9.2Below federal poverty line - female head of household, no husband present (%) 25.5 2.1 9.3 22.9 26.8 20.6 34With cash public assistance income (%) 3.0 1.5 1.3 2.1 1.6 1.4 1.5With Food Stamp/SNAP benefits in the past 12 months (%) 12.5 4.6 3.9 7.7 9.3 7.6 6.3Free and Reduced Lunch Enrollment (%) 44.0 12 9 43 64 51 28
Educational Attainment (Population 25 Years and Older)
High school degree or higher (%) 89.8 95.9 97 94.3 89.3 90.1 94
Bachelor's degree or higher (%) 40.5 67.6 73.3 75.1 57.3 48.7 59.6
HousingVacant housing units (%) 9.8 5 6 9.5 3.4 6.3 5.7Owner-occupied (%) 62.1 61 63.5 37.1 34 50.3 52.1
Avg household size of owner occupied 2.7 2.63 2.85 2.2 2.51 2.5 2.32Monthly owner costs exceed 30% of household income (%) 34.5 30.6 30.9 30 40 35.2 36.7
Renter-occupied (%) 37.9 39 36.5 62.9 66 49.7 47.9Avg household size of renter occupied 2.3 1.91 2.27 2 2.27 2.04 2.28
Gross rent exceeds 30% of household income (%) 50.6 39.4 44.2 46.2 39.7 42.5 40.9
Primary Service Area
Source: US Census Bureau, American Community Survey 5-Year Estimates, 2011-2015
31
KeyStatistically higher than statewide rateStatistically lower than statewide rate
Source: Behavioral Risk Factor Surveillance System 2007-2009* (MDPH)
*2007-2009 was the last years for which the Massachusetts Department of PublicHealth collected BRFSS data at the Community Health Network Area level
Mass. CHNA 17
Behavioral Risk Factors (percent of respondents)Had a checkup in past year 76.7 73.9Fair/poor health 12.3 8.9
With a disabilityII** 21.3 19.3
Unable to see Doctor due to cost (past 12 months) 6.7 3.1
Current smoker 15.8 10.9
Former smoker 28.3 26.2
Exposed to environmental tobacco smoke 37.5 31.8
Binge drinking 17.6 15.8
Overweight/Obese 58.2 48.8
Any leisure time physical activity in past month 78.7 83.6
Consume 5+ servings of fruit and vegetables/day 26.9 33.5
Had cholesterol checked in past 5 years 84.3 85.4
Adults 65+ with flu vaccine in past 12 months 74.6 81.6
Ever told they had diabetes 7.5 5.9Current asthma 10.1 8.8Ever told they had arthritis 26.2 20.8Ever told they had cardiovascular disease (Adults 35+) 7.7 7.1Had colonoscopy/sigmoidoscopy in past 5 years (Aduls 50+) 63.5 62Had mammogram in past 2 years (Women 40+) 84.5 84.4Ever tested for HIV (Adults 18-64) 42.5 50.1Unintentional fall in past 3 months (Adults 65+) 16.1 13.5Uninsured 4 1.5
Notes:All above estimates are crude prevalence rates. No age-adjusting was done
p g y y y g q1. Are you limited in any way in any activities because of physical, mental, or emotional problems?2. Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, aspecial bed, or a special telephone?3. Are you blind or do you have serious difficulty seeing, even when wearing glasses?4. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering ormaking decisions?5. Do you have serious difficulty walking or climbing stairs?6. Do you have difficulty dressing or bathing?
32
KeyStatistically higher than statewide rateStatistically lower than statewide rate
Source: Massachusetts Hospital Inpatient Discharges and ED Discharges, 2008-2012 (Accessed through Massachusetts Department of Public Health)
MA Arlington Belmont Cambridge Somerville Waltham Watertown
All Types (invasive) 371.3 353.59 305.49 327.8 382.3 372.43 388.97Breast (female only) 39.08 46.17 33.28 33.53 26.4 38.92 32.24Lung 47.86 33.2 29.51 41.63 54.19 53.07 52.38Colorectal 38.41 35.59 30.54 33.44 34.97 36.38 43.73Prostate 58.15 59.32 60.69 51.13 43.39 36.42 47.15
All Types (invasive) 15.58 6.58 15.01 7.31 10.69 36.83 15.75Breast (female only) 1.93 NA 0 NA NA NA NALung 2.66 NA 0 NA 0 10.45 NAColorectal 0.83 NA 0 0 NA NA NAProstate 1.18 NA NA NA NA NA 0
Cancer ED Discharges (per 100,000)
Primary Service Area
Cancer Hospitalizations (per 100,000)
33
KeyStatistically higher than statewide rateStatistically lower than statewide rate
Source: Massachusetts Vital Statistics, 2014
MA Arlington Belmont Cambridge Somerville Waltham Watertown
Cancer Mortality (Age-adjusted per 100,000), 2014All Types (invasive) 155.6 150.60 117.70 137.90 194.20 176.80 137.70Bone 0.4 0 0 -1 0 0 0Brain and Central Nervous System 4.3 -1 0 5.8 -1 -1 -1Breast (invasive, female) 10.2 -1 0 12.2 -1 10.5 -1Bladder 4.5 -1 -1 -1 -1 -1 -1Cervical (Cervix Uteri) 0.7 0 0 0 0 0 0Colorectal 12.6 29.8 -1 7.7 10.1 8.5 -1Esophagus 4.8 -1 -1 -1 -1 -1 -1Kaposi's Sarcoma 0.0 0 0 0 0 0 0Kidney & Renal Pelvis 3.5 -1 0 -1 -1 -1 0Larynx 0.8 0 -1 -1 0 -1 0Leukemia 6.0 -1 -1 -1 -1 8.8 -1Liver & Intrahepatic Bile Ducts 6.5 -1 -1 9.8 -1 -1 -1Lymphoma, Hodgkin Disease 0.2 -1 0 0 0 0 0Lymphoma, Non Hodgkin Disease 5.3 -1 0 -1 -1 8.2 -1Melanoma of Skin 2.7 0 -1 -1 -1 0 -1Multiple Myeloma 3.6 -1 0 -1 14.9 -1 0Oral Cavity & Pharynx 2.3 -1 -1 -1 -1 -1 0Ovary 3.8 -1 -1 -1 -1 -1 0Pancreas 11 8.3 18.5 7.7 7.9 25.7 14Prostate 7.4 -1 15 6.1 -1 9.1 -1Soft Tissues 1.1 -1 0 -1 -1 0 0Stomach 3.1 -1 -1 -1 -1 -1 -1Testis 1 0 0 0 0 0 0Thyroid 0.5 0 0 -1 -1 -1 -1Uterine (Corpus Uteri) 2.5 -1 -1 0 -1 -1 0
Primary Service Area
34
Arlington Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013
Obs Exp SIR 95% CI Obs Exp SIR 95% CI
Bladder, Urinary Melanoma of Skin
Male 43 45.9 93.7 (67.8-126.2) Male 25 29.8 83.9 (54.3-123.8)
Female 16 17.8 89.9 (51.3-145.9) Female 26 25.4 102.3 (66.8-149.9)
Brain and Other Nervous System Multiple Myeloma
Male 8 9.0 89.1 (38.4-175.7) Male 10 9.3 107.8 (51.6-198.2)
Female 9 7.7 117.1 (53.4-222.3) Female 4 8.0 nc (nc-nc)
Breast Non-Hodgkin Lymphoma
Male 0 1.6 nc (nc-nc) Male 19 26.7 71.2 (42.8-111.2)
Female 212 195.0 108.7 (94.6-124.4) Female 33 24.9 132.4 (91.1-185.9)
Cervix Uteri Oral Cavity & Pharynx
Male 19 21.3 89.4 (53.8-139.6)
Female 2 6.9 nc (nc-nc) Female 15 10.5 142.9 (79.9-235.8)
Colon / Rectum Ovary
Male 43 50.2 85.7 (62.0-115.4)
Female 45 54.8 82.1 (59.9-109.9) Female 16 17.4 91.8 (52.4-149.1)
Esophagus Pancreas
Male 13 12.0 108.5 (57.7-185.5) Male 18 16.1 111.8 (66.2-176.8)
Female 2 3.5 nc (nc-nc) Female 21 18.2 115.5 (71.5-176.6)
Hodgkin Lymphoma Prostate
Male 3 3.5 nc (nc-nc) Male 149 149.8 99.5 (84.1-116.8)
Female 5 2.8 175.9 (56.7-410.5)
Kidney & Renal Pelvis Stomach
Male 29 25.3 114.7 (76.8-164.8) Male 9 10.9 82.9 (37.8-157.5)
Female 13 15.3 84.8 (45.1-145.1) Female 5 7.1 70.4 (22.7-164.3)
Larynx Testis
Male 4 7.0 nc (nc-nc) Male 8 6.6 120.8 (52.0-238.0)
Female 3 2.3 nc (nc-nc)
Leukemia Thyroid
Male 16 18.6 85.9 (49.1-139.5) Male 12 11.8 101.6 (52.5-177.6)
Female 11 14.5 75.6 (37.7-135.3) Female 35 36.9 94.7 (66.0-131.7)
Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS
Male 17 15.7 108.0 (62.9-173.0)
Female 2 5.6 nc (nc-nc) Female 49 43.8 112.0 (82.8-148.0)
Lung and Bronchus All Sites / Types
Male 69 80.8 85.4 (66.4-108.1) Male 554 599.8 92.4 (84.8-100.4)
Female 87 90.7 95.9 (76.8-118.3) Female 670 663.6 101.0 (93.5-108.9)
Obs = observed case count; Exp = expected case count;
SIR = standardized incidence ratio ( (Obs / Exp) X 100);
95% CI = 95% confidence intervals, a measure of the statistical significance of the SIR;
Shading indicates the statistical significance of the SIR at 95% level of probability;
nc = The SIR and 95% CI were not calculated when Obs < 5;
35
Belmont Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013
Obs Exp SIR 95% CI Obs Exp SIR 95% CI
Bladder, Urinary Melanoma of Skin
Male 26 26.9 96.6 (63.1-141.6) Male 16 16.9 94.6 (54.1-153.7)
Female 5 9.9 50.4 (16.3-117.7) Female 8 14.1 56.7 (24.4-111.8)
Brain and Other Nervous System Multiple Myeloma
Male 7 5.1 137.8 (55.2-284.0) Male 6 5.3 113.7 (41.5-247.6)
Female 4 4.4 nc (nc-nc) Female 5 4.4 112.6 (36.3-262.8)
Breast Non-Hodgkin Lymphoma
Male 2 0.9 nc (nc-nc) Male 16 15.2 105.3 (60.1-171.0)
Female 130 109.9 118.3 (98.8-140.5) Female 10 13.9 72.2 (34.5-132.7)
Cervix Uteri Oral Cavity & Pharynx
Male 5 11.8 42.5 (13.7-99.1)
Female 1 3.9 nc (nc-nc) Female 6 5.8 103.5 (37.8-225.3)
Colon / Rectum Ovary
Male 21 28.8 73.0 (45.2-111.6)
Female 25 30.3 82.5 (53.4-121.8) Female 10 9.6 103.7 (49.7-190.8)
Esophagus Pancreas
Male 5 6.8 73.1 (23.6-170.6) Male 10 9.3 107.3 (51.3-197.3)
Female 4 1.9 nc (nc-nc) Female 8 10.0 80.1 (34.5-157.7)
Hodgkin Lymphoma Prostate
Male 2 1.9 nc (nc-nc) Male 84 85.2 98.6 (78.6-122.0)
Female 2 1.7 nc (nc-nc)
Kidney & Renal Pelvis Stomach
Male 13 14.2 91.5 (48.7-156.5) Male 4 6.2 nc (nc-nc)
Female 5 8.7 57.5 (18.5-134.2) Female 5 3.9 128.2 (41.3-299.1)
Larynx Testis
Male 1 3.9 nc (nc-nc) Male 4 3.4 nc (nc-nc)
Female 0 1.3 nc (nc-nc)
Leukemia Thyroid
Male 4 10.8 nc (nc-nc) Male 7 6.3 110.4 (44.2-227.4)
Female 5 8.2 61.1 (19.7-142.6) Female 26 20.7 125.5 (81.9-183.8)
Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS
Male 2 8.6 nc (nc-nc)
Female 2 3.1 nc (nc-nc) Female 28 24.3 115.1 (76.5-166.4)
Lung and Bronchus All Sites / Types
Male 32 47.1 68.0 (46.5-95.9) Male 293 342.3 85.6 (76.1-96.0)
Female 41 51.6 79.5 (57.0-107.8) Female 354 371.7 95.2 (85.6-105.7)
Obs = observed case count; Exp = expected case count;
SIR = standardized incidence ratio ( (Obs / Exp) X 100);
95% CI = 95% confidence intervals, a measure of the statistical significance of the SIR;
Shading indicates the statistical significance of the SIR at 95% level of probability;
nc = The SIR and 95% CI were not calculated when Obs < 5;
36
Cambridge Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013
Obs Exp SIR 95% CI Obs Exp SIR 95% CI
Bladder, Urinary Melanoma of Skin
Male 46 74.4 61.8 (45.3-82.5) Male 56 51.6 108.5 (81.9-140.8)
Female 17 30.0 56.7 (33.0-90.9) Female 44 49.7 88.5 (64.3-118.8)
Brain and Other Nervous System Multiple Myeloma
Male 20 17.6 113.8 (69.5-175.7) Male 18 15.0 119.7 (70.9-189.2)
Female 12 15.2 78.9 (40.7-137.8) Female 7 13.6 51.5 (20.6-106.2)
Breast Non-Hodgkin Lymphoma
Male 4 2.5 nc (nc-nc) Male 42 46.1 91.2 (65.7-123.2)
Female 299 338.6 88.3 (78.6-98.9) Female 34 43.8 77.6 (53.7-108.4)
Cervix Uteri Oral Cavity & Pharynx
Male 37 35.3 104.7 (73.7-144.4)
Female 9 13.7 65.5 (29.9-124.4) Female 16 18.2 88.0 (50.3-142.9)
Colon / Rectum Ovary
Male 71 80.9 87.7 (68.5-110.7)
Female 69 90.6 76.1 (59.2-96.3) Female 21 31.2 67.3 (41.7-102.9)
Esophagus Pancreas
Male 14 19.7 71.1 (38.9-119.4) Male 32 26.1 122.5 (83.8-172.9)
Female 5 5.9 85.4 (27.5-199.3) Female 26 30.1 86.5 (56.5-126.7)
Hodgkin Lymphoma Prostate
Male 7 10.2 68.5 (27.4-141.1) Male 247 250.3 98.7 (86.7-111.8)
Female 3 8.9 nc (nc-nc)
Kidney & Renal Pelvis Stomach
Male 33 42.4 77.8 (53.6-109.3) Male 11 17.6 62.5 (31.2-111.9)
Female 14 27.1 51.6 (28.2-86.6) Female 8 11.7 68.2 (29.4-134.4)
Larynx Testis
Male 4 11.4 nc (nc-nc) Male 26 22.7 114.7 (74.9-168.1)
Female 1 4.0 nc (nc-nc)
Leukemia Thyroid
Male 26 32.8 79.2 (51.7-116.1) Male 27 23.3 115.7 (76.2-168.4)
Female 18 26.6 67.8 (40.1-107.1) Female 78 80.6 96.8 (76.5-120.8)
Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS
Male 18 25.5 70.5 (41.7-111.4)
Female 13 9.7 133.8 (71.2-228.9) Female 67 76.7 87.3 (67.7-110.9)
Lung and Bronchus All Sites / Types
Male 106 132.7 79.9 (65.4-96.6) Male 901 1018.5 88.5 (82.8-94.4)
Female 103 158.1 65.1 (53.2-79.0) Female 940 1176.9 79.9 (74.8-85.1)
Obs = observed case count; Exp = expected case count;
SIR = standardized incidence ratio ( (Obs / Exp) X 100);
95% CI = 95% confidence intervals, a measure of the statistical significance of the SIR;
Shading indicates the statistical significance of the SIR at 95% level of probability;
nc = The SIR and 95% CI were not calculated when Obs < 5;
37
Somerville Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013
Obs Exp SIR 95% CI Obs Exp SIR 95% CI
Bladder, Urinary Melanoma of Skin
Male 38 49.9 76.2 (53.9-104.6) Male 30 35.8 83.9 (56.6-119.8)
Female 19 19.7 96.3 (58.0-150.5) Female 20 34.6 57.8 (35.3-89.2)
Brain and Other Nervous System Multiple Myeloma
Male 8 12.5 64.1 (27.6-126.3) Male 11 10.2 107.7 (53.7-192.7)
Female 13 10.5 124.4 (66.2-212.7) Female 11 8.9 123.0 (61.3-220.2)
Breast Non-Hodgkin Lymphoma
Male 0 1.7 nc (nc-nc) Male 40 31.9 125.2 (89.5-170.5)
Female 176 227.3 77.4 (66.4-89.8) Female 21 29.4 71.5 (44.2-109.3)
Cervix Uteri Oral Cavity & Pharynx
Male 25 24.0 104.3 (67.5-154.0)
Female 10 10.1 99.3 (47.5-182.7) Female 11 12.0 91.7 (45.7-164.0)
Colon / Rectum Ovary
Male 52 56.1 92.6 (69.2-121.5)
Female 48 61.4 78.2 (57.7-103.7) Female 23 20.7 110.9 (70.3-166.5)
Esophagus Pancreas
Male 11 12.9 85.6 (42.6-153.1) Male 19 17.3 109.7 (66.0-171.3)
Female 5 3.8 130.7 (42.1-304.9) Female 21 19.8 106.1 (65.6-162.2)
Hodgkin Lymphoma Prostate
Male 11 7.5 146.9 (73.3-262.9) Male 144 157.2 91.6 (77.2-107.8)
Female 4 6.2 nc (nc-nc)
Kidney & Renal Pelvis Stomach
Male 36 29.1 123.8 (86.7-171.3) Male 15 12.0 125.1 (70.0-206.3)
Female 24 18.3 131.5 (84.2-195.7) Female 14 7.9 178.0 (97.3-298.7)
Larynx Testis
Male 11 7.6 145.6 (72.6-260.5) Male 7 17.5 40.1 (16.1-82.6)
Female 2 2.5 nc (nc-nc)
Leukemia Thyroid
Male 16 22.7 70.5 (40.3-114.5) Male 14 17.0 82.2 (44.9-137.9)
Female 20 18.1 110.2 (67.3-170.2) Female 50 58.7 85.1 (63.2-112.3)
Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS
Male 26 17.1 152.4 (99.5-223.3)
Female 16 6.3 252.3 (144.1-409.8) Female 48 49.4 97.2 (71.7-128.9)
Lung and Bronchus All Sites / Types
Male 105 87.5 120.0 (98.1-145.2) Male 669 683.0 97.9 (90.7-105.7)
Female 100 103.8 96.3 (78.4-117.1) Female 723 792.0 91.3 (84.8-98.2)
Obs = observed case count; Exp = expected case count;
SIR = standardized incidence ratio ( (Obs / Exp) X 100);
95% CI = 95% confidence intervals, a measure of the statistical significance of the SIR;
Shading indicates the statistical significance of the SIR at 95% level of probability;
nc = The SIR and 95% CI were not calculated when Obs < 5;
38
Waltham Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013
Obs Exp SIR 95% CI Obs Exp SIR 95% CI
Bladder, Urinary Melanoma of Skin
Male 61 52.5 116.2 (88.9-149.3) Male 25 35.8 69.9 (45.2-103.2)
Female 21 20.2 104.0 (64.3-158.9) Female 14 30.7 45.6 (24.9-76.6)
Brain and Other Nervous System Multiple Myeloma
Male 15 11.4 132.0 (73.8-217.8) Male 9 10.7 83.8 (38.3-159.1)
Female 13 9.5 136.8 (72.8-233.9) Female 4 9.1 nc (nc-nc)
Breast Non-Hodgkin Lymphoma
Male 2 1.8 nc (nc-nc) Male 26 31.7 82.0 (53.5-120.1)
Female 234 221.2 105.8 (92.7-120.2) Female 32 28.6 111.8 (76.4-157.8)
Cervix Uteri Oral Cavity & Pharynx
Male 16 25.4 63.1 (36.0-102.4)
Female 9 8.2 109.7 (50.1-208.3) Female 8 11.9 67.0 (28.9-132.1)
Colon / Rectum Ovary
Male 60 57.2 104.8 (80.0-134.9)
Female 56 60.8 92.1 (69.6-119.6) Female 18 20.1 89.4 (52.9-141.3)
Esophagus Pancreas
Male 13 14.1 92.1 (49.0-157.4) Male 21 18.7 112.5 (69.6-171.9)
Female 3 3.9 nc (nc-nc) Female 25 20.4 122.8 (79.4-181.2)
Hodgkin Lymphoma Prostate
Male 4 5.6 nc (nc-nc) Male 146 181.6 80.4 (67.9-94.5)
Female 5 4.8 104.2 (33.6-243.1)
Kidney & Renal Pelvis Stomach
Male 36 30.1 119.6 (83.7-165.5) Male 18 12.5 144.2 (85.4-227.9)
Female 16 17.8 89.9 (51.4-146.1) Female 9 7.9 114.2 (52.1-216.9)
Larynx Testis
Male 5 8.3 60.1 (19.4-140.2) Male 12 11.3 105.8 (54.6-184.8)
Female 2 2.6 nc (nc-nc)
Leukemia Thyroid
Male 19 22.2 85.5 (51.4-133.5) Male 17 15.2 112.1 (65.3-179.5)
Female 13 17.3 75.3 (40.1-128.8) Female 53 46.6 113.7 (85.1-148.7)
Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS
Male 19 18.6 102.0 (61.4-159.3)
Female 5 6.4 77.6 (25.0-181.2) Female 41 50.5 81.2 (58.3-110.2)
Lung and Bronchus All Sites / Types
Male 93 95.6 97.3 (78.5-119.2) Male 667 715.5 93.2 (86.3-100.6)
Female 109 105.4 103.4 (84.9-124.7) Female 750 765.7 98.0 (91.1-105.2)
Obs = observed case count; Exp = expected case count;
SIR = standardized incidence ratio ( (Obs / Exp) X 100);
95% CI = 95% confidence intervals, a measure of the statistical significance of the SIR;
Shading indicates the statistical significance of the SIR at 95% level of probability;
nc = The SIR and 95% CI were not calculated when Obs < 5;
39
Watertown Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013
Obs Exp SIR 95% CI Obs Exp SIR 95% CI
Bladder, Urinary Melanoma of Skin
Male 35 33.3 105.2 (73.2-146.3) Male 14 21.7 64.6 (35.3-108.5)
Female 9 13.1 68.7 (31.4-130.4) Female 21 19.0 110.8 (68.5-169.3)
Brain and Other Nervous System Multiple Myeloma
Male 10 6.5 153.1 (73.3-281.7) Male 5 6.7 74.3 (23.9-173.4)
Female 9 5.6 161.1 (73.5-305.7) Female 5 5.9 85.2 (27.4-198.7)
Breast Non-Hodgkin Lymphoma
Male 0 1.1 nc (nc-nc) Male 20 19.3 103.7 (63.3-160.1)
Female 149 141.2 105.5 (89.2-123.9) Female 21 18.4 114.4 (70.8-174.9)
Cervix Uteri Oral Cavity & Pharynx
Male 15 14.8 101.5 (56.8-167.4)
Female 8 5.1 155.8 (67.1-307.0) Female 3 7.6 nc (nc-nc)
Colon / Rectum Ovary
Male 45 36.2 124.3 (90.6-166.3)
Female 38 39.0 97.5 (69.0-133.8) Female 15 12.7 118.3 (66.2-195.1)
Esophagus Pancreas
Male 9 8.4 106.9 (48.8-202.9) Male 12 11.4 105.4 (54.4-184.1)
Female 1 2.5 nc (nc-nc) Female 18 13.1 137.1 (81.2-216.8)
Hodgkin Lymphoma Prostate
Male 4 2.8 nc (nc-nc) Male 92 102.0 90.2 (72.7-110.7)
Female 2 2.4 nc (nc-nc)
Kidney & Renal Pelvis Stomach
Male 23 17.9 128.2 (81.2-192.3) Male 8 7.8 102.4 (44.1-201.8)
Female 4 11.4 nc (nc-nc) Female 11 5.0 220.3 (109.8-394.3)
Larynx Testis
Male 5 5.0 100.8 (32.5-235.2) Male 5 5.8 86.4 (27.9-201.7)
Female 1 1.7 nc (nc-nc)
Leukemia Thyroid
Male 12 13.4 89.3 (46.1-156.0) Male 12 8.6 139.2 (71.9-243.2)
Female 10 10.4 95.8 (45.8-176.1) Female 24 28.1 85.5 (54.8-127.2)
Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS
Male 10 11.0 90.8 (43.5-167.1)
Female 6 4.1 146.0 (53.3-317.7) Female 26 31.9 81.5 (53.2-119.4)
Lung and Bronchus All Sites / Types
Male 52 58.7 88.7 (66.2-116.3) Male 417 427.2 97.6 (88.5-107.4)
Female 61 70.1 87.1 (66.6-111.8) Female 470 487.1 96.5 (88.0-105.6)
Obs = observed case count; Exp = expected case count;
SIR = standardized incidence ratio ( (Obs / Exp) X 100);
95% CI = 95% confidence intervals, a measure of the statistical significance of the SIR;
Shading indicates the statistical significance of the SIR at 95% level of probability;
nc = The SIR and 95% CI were not calculated when Obs < 5;
40
41
APPENDIX B: DATA FROM MOUNT AUBURN HOSPITAL CANCER REGISTRY
12/1
9/2
017
3:3
5 P
M
Su
mm
ary
by
Bo
dy
Sy
ste
m a
nd
Be
st
CS
/AJ
CC
Sta
ge
Re
po
rt
MO
UN
T A
UB
UR
N H
OS
PIT
AL
Filte
r(s):
Q
uic
k F
ilte
r: Y
ear:
DIA
GN
OS
IS Y
EA
R 2
016-2
016 A
ND
( C
aseS
tatF
lag
= `
C`
):
Pri
mary
Sit
eS
tg 0
Stg
IS
tg II
Stg
III
Stg
IV
88
Un
kB
lan
k/In
vT
ota
l%
%%
%%
%%
%%
1.2
%O
RA
L C
AV
ITY
& P
HA
RY
NX
0 2
0 4
0 1
2 0
90.0
%0.7
%1.0
%0.0
%4.1
%0.0
%3.8
%
Tongue
0.1
% 0
0 0
1 0
0 0
0 1
0.0
%0.0
%0.0
%0.0
%1.0
%0.0
%0.0
%
Saliv
ary
Gla
nds
0.3
% 0
1 0
0 0
0 1
0 2
0.0
%0.4
%0.0
%0.0
%0.0
%0.0
%1.9
%
Naso
phary
nx
0.1
% 0
0 0
0 0
1 0
0 1
0.0
%0.0
%1.0
%0.0
%0.0
%0.0
%0.0
%
Tonsi
l0.4
% 0
1 0
2 0
0 0
0 3
0.0
%0.0
%0.0
%0.0
%2.0
%0.0
%1.9
%
Hyp
ophary
nx
0.3
% 0
0 0
1 0
0 1
0 2
0.0
%0.4
%0.0
%0.0
%1.0
%0.0
%0.0
%
12.3
%D
IGE
ST
IVE
SY
ST
EM
0 1
0 2
32
17
10
15
4 9
03.8
%5.6
%9.9
%27.0
%32.7
%4.5
%18.9
%
Eso
phagus
0.8
% 0
2 0
1 2
0 1
0 6
0.0
%0.4
%0.0
%3.2
%1.0
%0.0
%3.8
%
Sto
mach
1.0
% 0
0 0
4 1
0 2
0 7
0.0
%0.7
%0.0
%1.6
%4.1
%0.0
%0.0
%
Sm
all
Inte
stin
e0.3
% 0
1 0
0 1
0 0
0 2
0.0
%0.0
%0.0
%1.6
%0.0
%0.0
%1.9
%
Colo
n E
xclu
din
g R
ectu
m4.9
% 0
3 0
10
7 7
8 1
36
1.0
%3.0
%6.9
%11.1
%10.2
%0.0
%5.7
%
4C
ecu
m 0
0 0
0 1
2 1
0
1A
ppendix
0 0
0 0
1 0
0 0
9A
scendin
g C
olo
n 0
1 0
1 2
2 3
0
2H
epatic
Fle
xure
0 0
0 2
0 0
0 0
3T
ransv
ers
e C
olo
n 0
0 0
2 0
0 1
0
4S
ple
nic
Fle
xure
0 0
0 2
1 1
0 0
1D
esc
endin
g C
olo
n 0
0 0
1 0
0 0
0
12
Sig
moid
Colo
n 0
2 0
2 2
2 3
1
Rect
um
& R
ect
osi
gm
oid
1.9
% 0
2 0
3 3
1 2
3 1
42.9
%0.7
%1.0
%4.8
%3.1
%0.0
%3.8
%
7R
ect
osi
gm
oid
Junct
ion
0 0
0 2
1 0
1 3
7R
ect
um
0 2
0 1
2 1
1 0
Anus,
Anal C
anal &
Anore
ctum
0.3
% 0
0 0
0 1
1 0
0 2
0.0
%0.0
%1.0
%1.6
%0.0
%0.0
%0.0
%
Liv
er
& Intr
ahepatic
Bile
Duct
0.8
% 0
1 2
0 1
0 2
0 6
0.0
%0.7
%0.0
%1.6
%0.0
%4.5
%1.9
%
Gallb
ladder
0.4
% 0
0 0
1 1
1 0
0 3
0.0
%0.0
%1.0
%1.6
%1.0
%0.0
%0.0
%
Oth
er
Bili
ary
0.1
% 0
0 0
1 0
0 0
0 1
0.0
%0.0
%0.0
%0.0
%1.0
%0.0
%0.0
%
Pancr
eas
1.6
% 0
1 0
11
0 0
0 0
12
0.0
%0.0
%0.0
%0.0
%11.2
%0.0
%1.9
%
Retr
operito
neum
0.1
% 0
0 0
1 0
0 0
0 1
0.0
%0.0
%0.0
%0.0
%1.0
%0.0
%0.0
%
11.8
%R
ES
PIR
AT
OR
Y S
YS
TE
M 0
5 0
30
12
5 3
2 2
86
1.9
%12.0
%5.0
%19.0
%30.6
%0.0
%9.4
%
Lary
nx
0.5
% 0
1 0
0 1
0 2
0 4
0.0
%0.7
%0.0
%1.6
%0.0
%0.0
%1.9
%
Lung &
Bro
nchus
11.2
% 0
4 0
30
11
5 3
0 2
82
1.9
%11.2
%5.0
%17.5
%30.6
%0.0
%7.5
%
0.8
%S
OF
T T
ISS
UE
0 2
0 0
1 2
1 0
60.0
%0.4
%2.0
%1.6
%0.0
%0.0
%3.8
%
Soft T
issue (
inclu
din
g H
eart
)0.8
% 0
2 0
0 1
2 1
0 6
0.0
%0.4
%2.0
%1.6
%0.0
%0.0
%3.8
%
2.1
%S
KIN
EX
CLU
DIN
G B
AS
AL &
SQ
UA
MO
US
0 2
0 2
1 0
6 4
15
3.8
%2.2
%0.0
%1.6
%2.0
%0.0
%3.8
%
Mela
nom
a -
- S
kin
1.9
% 0
2 0
2 0
0 6
4 1
43.8
%2.2
%0.0
%0.0
%2.0
%0.0
%3.8
%
Oth
er
Non-E
pith
elia
l S
kin
0.1
% 0
0 0
0 1
0 0
0 1
0.0
%0.0
%0.0
%1.6
%0.0
%0.0
%0.0
%
34.5
%B
RE
AS
T 0
18
0 0
14
33
129
58
252
55.8
%48.3
%32.7
%22.2
%0.0
%0.0
%34.0
%
Bre
ast
34.5
% 0
18
0 0
14
33
129
58
252
55.8
%48.3
%32.7
%22.2
%0.0
%0.0
%34.0
%
6.7
%F
EM
ALE
GE
NIT
AL S
YS
TE
M 0
3 2
7 5
4 2
8 0
49
0.0
%10.5
%4.0
%7.9
%7.1
%4.5
%5.7
%
Cerv
ix U
teri
0.3
% 0
0 1
0 0
0 1
0 2
0.0
%0.4
%0.0
%0.0
%0.0
%2.3
%0.0
%
42
12/1
9/2
017
3:3
5 P
M
Su
mm
ary
by
Bo
dy
Sy
ste
m a
nd
Be
st
CS
/AJ
CC
Sta
ge
Re
po
rt
MO
UN
T A
UB
UR
N H
OS
PIT
AL
Pri
mary
Sit
eS
tg 0
Stg
IS
tg II
Stg
III
Stg
IV
88
Un
kB
lan
k/In
vT
ota
l%
%%
%%
%%
%%
Corp
us
& U
teru
s, N
OS
4.7
% 0
1 0
4 4
1 2
4 0
34
0.0
%9.0
%1.0
%6.3
%4.1
%0.0
%1.9
%
33
Corp
us
Ute
ri 0
1 0
4 3
1 2
4 0
1U
teru
s, N
OS
0 0
0 0
1 0
0 0
Ova
ry1.5
% 0
2 0
3 1
2 3
0 1
10.0
%1.1
%2.0
%1.6
%3.1
%0.0
%3.8
%
Oth
er
Fem
ale
Genita
l O
rgans
0.3
% 0
0 1
0 0
1 0
0 2
0.0
%0.0
%1.0
%0.0
%0.0
%2.3
%0.0
%
7.8
%M
ALE
GE
NIT
AL S
YS
TE
M 0
3 0
9 3
34
8 0
57
0.0
%3.0
%33.7
%4.8
%9.2
%0.0
%5.7
%
Pro
sta
te6.7
% 0
3 0
9 3
33
1 0
49
0.0
%0.4
%32.7
%4.8
%9.2
%0.0
%5.7
%
Test
is1.0
% 0
0 0
0 0
1 6
0 7
0.0
%2.2
%1.0
%0.0
%0.0
%0.0
%0.0
%
Oth
er
Male
Genita
l Org
ans
0.1
% 0
0 0
0 0
0 1
0 1
0.0
%0.4
%0.0
%0.0
%0.0
%0.0
%0.0
%
12.9
%U
RIN
AR
Y S
YS
TE
M 0
6 0
9 3
8 3
2 3
6 9
434.6
%12.0
%7.9
%4.8
%9.2
%0.0
%11.3
%
Urinary
Bla
dder
8.5
% 0
0 0
8 2
5 1
6 3
1 6
229.8
%6.0
%5.0
%3.2
%8.2
%0.0
%0.0
%
Kid
ney
& R
enal P
elv
is3.8
% 0
6 0
1 1
3 1
6 1
28
1.0
%6.0
%3.0
%1.6
%1.0
%0.0
%11.3
%
Ure
ter
0.5
% 0
0 0
0 0
0 0
4 4
3.8
%0.0
%0.0
%0.0
%0.0
%0.0
%0.0
%
0.3
%B
RA
IN &
OT
HE
R N
ER
VO
US
SY
ST
EM
0 0
2 0
0 0
0 0
20.0
%0.0
%0.0
%0.0
%0.0
%4.5
%0.0
%
Bra
in0.3
% 0
0 2
0 0
0 0
0 2
0.0
%0.0
%0.0
%0.0
%0.0
%4.5
%0.0
%
2.9
%E
ND
OC
RIN
E S
YS
TE
M 0
1 1
0 6
3 1
0 0
21
0.0
%3.7
%3.0
%9.5
%0.0
%2.3
%1.9
%
Thyr
oid
2.7
% 0
1 0
0 6
3 1
0 0
20
0.0
%3.7
%3.0
%9.5
%0.0
%0.0
%1.9
%
Oth
er
Endocr
ine in
cludin
g T
hym
us
0.1
% 0
0 1
0 0
0 0
0 1
0.0
%0.0
%0.0
%0.0
%0.0
%2.3
%0.0
%
1.4
%LY
MP
HO
MA
0 0
1 4
0 1
4 0
10
0.0
%1.5
%1.0
%0.0
%4.1
%2.3
%0.0
%
Non-H
odgkin
Lym
phom
a1.4
% 0
0 1
4 0
1 4
0 1
00.0
%1.5
%1.0
%0.0
%4.1
%2.3
%0.0
%
7N
HL -
Nodal
0 0
0 3
0 1
3 0
3N
HL -
Extr
anodal
0 0
1 1
0 0
1 0
1.1
%M
YE
LO
MA
0 0
8 0
0 0
0 0
80.0
%0.0
%0.0
%0.0
%0.0
%18.2
%0.0
%
Mye
lom
a1.1
% 0
0 8
0 0
0 0
0 8
0.0
%0.0
%0.0
%0.0
%0.0
%18.2
%0.0
%
1.2
%LE
UK
EM
IA 0
0 9
0 0
0 0
0 9
0.0
%0.0
%0.0
%0.0
%0.0
%20.5
%0.0
%
Lym
phocy
tic
Leukem
ia1.0
% 0
0 7
0 0
0 0
0 7
0.0
%0.0
%0.0
%0.0
%0.0
%15.9
%0.0
%
Mye
loid
& M
onocy
tic
Leukem
ia0.3
% 0
0 2
0 0
0 0
0 2
0.0
%0.0
%0.0
%0.0
%0.0
%4.5
%0.0
%
1A
cute
Mye
loid
Leuke
mia
0 0
1 0
0 0
0 0
1C
hro
nic
Mye
loid
Leuke
mia
0 0
1 0
0 0
0 0
0.4
%M
ES
OT
HE
LIO
MA
0 1
0 1
1 0
0 0
30.0
%0.0
%0.0
%1.6
%1.0
%0.0
%1.9
%
Meso
thelio
ma
0.4
% 0
1 0
1 1
0 0
0 3
0.0
%0.0
%0.0
%1.6
%1.0
%0.0
%1.9
%
2.6
%M
ISC
ELLA
NE
OU
S 0
0 1
9 0
0 0
0 0
19
0.0
%0.0
%0.0
%0.0
%0.0
%43.2
%0.0
%
Mis
cella
neous
2.6
% 0
0 1
9 0
0 0
0 0
19
0.0
%0.0
%0.0
%0.0
%0.0
%43.2
%0.0
%
Tota
l 7
30
104
267
101
63
98
44
53
0
43
44
Stag
e of
All
Site
s Can
cer D
iagn
osed
in 2
015
Mou
nt
Au
bu
rn H
osp
ital
, C
amb
rid
ge
MA
vs
. A
ll Ty
pes
Hos
pit
als
in A
ll S
tate
s A
ll D
iag
nos
is T
ypes
- D
ata
from
13
90
Hos
pit
als
#St
age
My
(N)
Oth
. (N
)M
y (%
) O
th.
(%)
1.0
135
99251
16.94%
7.98%
2.I
251
360065
31.49%
28.94%
3.II
129
215942
16.19%
17.35%
4.II
I92
159909
11.54%
12.85%
5.IV
100
210172
12.55%
16.89%
6.O
C1
178
0.13%
0.01%
7.N
A48
147711
6.02%
11.87%
8.U
NK
4151093
5.14%
4.11%
Col
. TO
TAL
7
97
12
44
32
11
00
%1
00
%
©2017 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / Wednesday, December 20, 2017
45
To
p 1
0 S
ite
s b
y S
ex
1:0
6P
M11/3
0/2
017
MO
UN
T A
UB
UR
N H
OS
PIT
AL
Filte
r(s):
Q
uic
k F
ilte
r: Y
ear:
1S
T C
ON
TA
CT
YE
AR
2016-2
016 A
ND
( C
aseS
tatF
lag
= `
C`
):
Colo
nB
ronch
us &
Lung
Hem
ato
poie
ti
c &
Retic
ulo
endo
Sys
tem
Bre
ast
Corp
us
Ute
riP
rost
ate
Gla
nd
Kid
ney
Bla
dder
Thyr
oid
Gla
nd
Unkn
ow
n
Prim
ary
Site
Tota
l
117
8.7
6
45.9
5
41
21.1
3
50.0
0
10
5.1
5
50.0
0
1 0.5
2
0.3
9
0 0.0
0
0.0
0
50
25.7
7
100.0
0
19
9.7
9
70.3
7
43
22.1
6
69.3
5
4 2.0
6
20.0
0
9 4.6
4
50.0
0
194
220
4.8
3
54.0
5
41
9.9
0
50.0
0
10
2.4
2
50.0
0
257
62.0
8
99.6
1
34
8.2
1
100.0
0
0 0.0
0
0.0
0
8 1.9
3
29.6
3
19
4.5
9
30.6
5
16
3.8
6
80.0
0
9 2.1
7
50.0
0
414
Tota
l37
82
20
258
34
50
27
62
20
18
608
Count (N
)R
ow
%C
olu
mn %
46
11/3
0/2
017
1:0
9 P
MM
OU
NT
AU
BU
RN
HO
SP
ITA
L
Su
mm
ary
by
Bo
dy
Sy
ste
m a
nd
Pri
ma
ry P
ay
er
Re
po
rt
Filte
r(s):
Q
uic
k F
ilte
r: Y
ear:
1S
T C
ON
TA
CT
YE
AR
2016-2
016 A
ND
( C
aseS
tatF
lag
= `
C`
):
Pri
mary
Sit
eT
ota
l (%
)
No
t
Insu
red
Insu
red
NO
S
Pri
vate
Insu
ran
ce
Med
icaid
Med
icare
Fed
Go
v`t
Bla
nk
/Un
k
OR
AL C
AV
ITY
& P
HA
RY
NX
1 0
3 4
0 0
8 (
1.1
%)
Tongue
0 0
0 1
0 0
1 (
0.1
%)
Saliv
ary
Gla
nds
0 0
1 1
0 0
2 (
0.3
%)
Naso
phary
nx
0 0
0 1
0 0
1 (
0.1
%)
Tonsi
l 0
0 1
1 0
02 (
0.3
%)
Hyp
ophary
nx
1 0
1 0
0 0
2 (
0.3
%)
DIG
ES
TIV
E S
YS
TE
M 1
0 6
1 2
8 0
090 (
12.2
%)
Eso
phagus
0 0
4 2
0 0
6 (
0.8
%)
Sto
mach
0 0
3 4
0 0
7 (
0.9
%)
Sm
all
Inte
stin
e 0
0 1
1 0
02 (
0.3
%)
Colo
n E
xclu
din
g R
ect
um
0 0
29
7 0
036 (
4.9
%)
4C
ecu
m 0
0 2
2 0
0
1A
ppendix
0 0
1 0
0 0
9A
scendin
g C
olo
n 0
0 8
1 0
0
2H
epatic
Fle
xure
0 0
1 1
0 0
3T
ransv
ers
e C
olo
n 0
0 3
0 0
0
4S
ple
nic
Fle
xure
0 0
4 0
0 0
1D
esc
endin
g C
olo
n 0
0 1
0 0
0
12
Sig
moid
Colo
n 0
0 9
3 0
0
Rect
um
& R
ect
osi
gm
oid
0 0
8 6
0 0
14 (
1.9
%)
7R
ect
osi
gm
oid
Junct
ion
0 0
5 2
0 0
7R
ect
um
0 0
3 4
0 0
Anus,
Anal C
anal &
Anore
ctum
0 0
3 0
0 0
3 (
0.4
%)
Liv
er
& Intr
ahepatic
Bile
Duct
0 0
4 2
0 0
6 (
0.8
%)
Gallb
ladder
0 0
2 1
0 0
3 (
0.4
%)
Oth
er
Bili
ary
0 0
1 0
0 0
1 (
0.1
%)
Pancr
eas
1 0
5 5
0 0
11 (
1.5
%)
Retr
operito
neum
0 0
1 0
0 0
1 (
0.1
%)
RE
SP
IRA
TO
RY
SY
ST
EM
2 0
59
25
0 0
86 (
11.7
%)
Lary
nx
0 0
3 1
0 0
4 (
0.5
%)
Lung &
Bro
nch
us
2 0
56
24
0 0
82 (
11.1
%)
SO
FT
TIS
SU
E 1
0 2
3 0
06 (
0.8
%)
Soft T
issu
e (
inclu
din
g H
eart
) 1
0 2
3 0
06 (
0.8
%)
SK
IN E
XC
LU
DIN
G B
AS
AL &
SQ
UA
MO
US
1 0
7 7
0 0
15 (
2.0
%)
Mela
nom
a -
- S
kin
1 0
7 6
0 0
14 (
1.9
%)
Oth
er
Non-E
pith
elia
l S
kin
0 0
0 1
0 0
1 (
0.1
%)
BR
EA
ST
11
0 8
8 1
59
0 0
258 (
35.0
%)
Bre
ast
11
0 8
8 1
59
0 0
258 (
35.0
%)
47
11/3
0/2
017
1:0
9 P
MM
OU
NT
AU
BU
RN
HO
SP
ITA
L
Su
mm
ary
by
Bo
dy
Sy
ste
m a
nd
Pri
ma
ry P
ay
er
Re
po
rt
Pri
mary
Sit
eT
ota
l (%
)
No
t
Insu
red
Insu
red
NO
S
Pri
vate
Insu
ran
ce
Med
icaid
Med
icare
Fed
Go
v`t
Bla
nk
/Un
k
FE
MA
LE
GE
NIT
AL S
YS
TE
M 1
0 1
4 3
4 0
150 (
6.8
%)
Cerv
ix U
teri
0 0
0 2
0 0
2 (
0.3
%)
Corp
us &
Ute
rus,
NO
S 1
0 1
0 2
3 0
135 (
4.7
%)
34
Corp
us U
teri
1 0
10
22
0 1
1U
teru
s, N
OS
0 0
0 1
0 0
Ova
ry 0
0 4
7 0
011 (
1.5
%)
Oth
er
Fem
ale
Genita
l Org
ans
0 0
0 2
0 0
2 (
0.3
%)
MA
LE
GE
NIT
AL S
YS
TE
M 3
1 3
3 2
1 0
058 (
7.9
%)
Pro
sta
te 3
1 3
2 1
4 0
050 (
6.8
%)
Test
is 0
0 0
7 0
07 (
0.9
%)
Oth
er
Male
Genita
l Org
ans
0 0
1 0
0 0
1 (
0.1
%)
UR
INA
RY
SY
ST
EM
3 1
48
42
0 0
94 (
12.8
%)
Urinary
Bla
dder
3 1
33
25
0 0
62 (
8.4
%)
Kid
ney
& R
enal P
elv
is 0
0 1
3 1
5 0
028 (
3.8
%)
Ure
ter
0 0
2 2
0 0
4 (
0.5
%)
BR
AIN
& O
TH
ER
NE
RV
OU
S S
YS
TE
M 0
0 1
0 0
01 (
0.1
%)
Bra
in 0
0 1
0 0
01 (
0.1
%)
EN
DO
CR
INE
SY
ST
EM
0 0
7 1
4 0
021 (
2.8
%)
Thyr
oid
0 0
7 1
3 0
020 (
2.7
%)
Oth
er
Endocr
ine in
cludin
g T
hym
us
0 0
0 1
0 0
1 (
0.1
%)
LY
MP
HO
MA
0 0
5 4
0 1
10 (
1.4
%)
Non-H
odgkin
Lym
phom
a 0
0 5
4 0
110 (
1.4
%)
7N
HL -
Nodal
0 0
3 4
0 0
3N
HL -
Ext
ranodal
0 0
2 0
0 1
MY
ELO
MA
0 0
5 3
0 0
8 (
1.1
%)
Mye
lom
a 0
0 5
3 0
08 (
1.1
%)
LE
UK
EM
IA 2
0 3
5 0
010 (
1.4
%)
Lym
phocy
tic L
euke
mia
2 0
3 3
0 0
8 (
1.1
%)
7C
hro
nic
Lym
phocy
tic
Leuke
mia
2 0
3 2
0 0
1O
ther
Lym
phocy
tic L
euke
mia
0 0
0 1
0 0
Mye
loid
& M
onocy
tic
Leukem
ia 0
0 0
2 0
02 (
0.3
%)
1A
cute
Mye
loid
Leuke
mia
0 0
0 1
0 0
1C
hro
nic
Mye
loid
Leuke
mia
0 0
0 1
0 0
ME
SO
TH
ELIO
MA
0 0
3 0
0 0
3 (
0.4
%)
Meso
thelio
ma
0 0
3 0
0 0
3 (
0.4
%)
MIS
CE
LLA
NE
OU
S 0
0 1
0 8
1 0
19 (
2.6
%)
Mis
cella
neous
0 0
10
8 1
019 (
2.6
%)
Tota
l 7
37
2 1
357
349
2 2
6
0.3
%0.3
%47.4
%3.5
%48.4
%0.1
%
48
49
Race 1
1:26PM11/30/2017MOUNT AUBURN HOSPITAL
Filter(s): Quick Filter: Year:1ST CONTACT YEAR 2016-2016 AND ( CaseStatFlag = `C` ):
Count (N) Percent (%)Race 1
640(01) **INVALID** 86.84%
53(02) **INVALID** 7.19%
2(04) **INVALID** 0.27%
2(06) **INVALID** 0.27%
2(08) **INVALID** 0.27%
1(10) **INVALID** 0.14%
1(14) **INVALID** 0.14%
3(15) **INVALID** 0.41%
2(17) **INVALID** 0.27%
17(96) **INVALID** 2.31%
3(98) **INVALID** 0.41%
11(99) **INVALID** 1.49%
Total 100.00% 737
50
Postal Code at Diagnosis
12:54PM11/30/2017MOUNT AUBURN HOSPITAL
Filter(s): Quick Filter: Year:1ST CONTACT YEAR 2016-2016 AND ( CaseStatFlag = `C` ):
Count (N) Percent (%)Postal Code at Diagnosis
7602472 10.31%
5402474 7.33%
4502155 6.11%
4402478 5.97%
4302139 5.83%
3402138 4.61%
3202140 4.34%
2802476 3.80%
2202144 2.99%
1802143 2.44%
1702145 2.31%
1502148 2.04%
1502452 2.04%
1401801 1.90%
1402453 1.90%
1302421 1.76%
1202149 1.63%
1102176 1.49%
1002141 1.36%
1002451 1.36%
702458 0.95%
601730 0.81%
601803 0.81%
601876 0.81%
501821 0.68%
501890 0.68%
502151 0.68%
502152 0.68%
502459 0.68%
402420 0.54%
402465 0.54%
301742 0.41%
302129 0.41%
302131 0.41%
302135 0.41%
302136 0.41%
302174 0.41%
302178 0.41%
302445 0.41%
302467 0.41%
201460 0.27%
201701 0.27%
201720 0.27%
201749 0.27%
201773 0.27%
201778 0.27%
201810 0.27%
201843 0.27%
201844 0.27%
201863 0.27%
201867 0.27%
201906 0.27%
201940 0.27%
201960 0.27%
202026 0.27%
202111 0.27%
51
Postal Code at Diagnosis
12:54PM11/30/2017MOUNT AUBURN HOSPITAL
202119 0.27%
202124 0.27%
202127 0.27%
202128 0.27%
202130 0.27%
202150 0.27%
202169 0.27%
202180 0.27%
202190 0.27%
202215 0.27%
202493 0.27%
101226 0.14%
101462 0.14%
101463 0.14%
101478 0.14%
101532 0.14%
101702 0.14%
101719 0.14%
101731 0.14%
101752 0.14%
101754 0.14%
101760 0.14%
101772 0.14%
101775 0.14%
101776 0.14%
101830 0.14%
101832 0.14%
101835 0.14%
101845 0.14%
101851 0.14%
101862 0.14%
101864 0.14%
101880 0.14%
101887 0.14%
101902 0.14%
101945 0.14%
101950 0.14%
101969 0.14%
102021 0.14%
102043 0.14%
102045 0.14%
102050 0.14%
102072 0.14%
102090 0.14%
102108 0.14%
102109 0.14%
102110 0.14%
102113 0.14%
102114 0.14%
102118 0.14%
102121 0.14%
102132 0.14%
102134 0.14%
102142 0.14%
102156 0.14%
102172 0.14%
102194 0.14%
102210 0.14%
102333 0.14%
52
Postal Code at Diagnosis
12:54PM11/30/2017MOUNT AUBURN HOSPITAL
102352 0.14%
102368 0.14%
102375 0.14%
102446 0.14%
102454 0.14%
102461 0.14%
102468 0.14%
102482 0.14%
102536 0.14%
102543 0.14%
102563 0.14%
102720 0.14%
103051 0.14%
103060 0.14%
103103 0.14%
103244 0.14%
103801 0.14%
103833 0.14%
103841 0.14%
104348 0.14%
104444 0.14%
117837 0.14%
185375 0.14%
Total 100.00% 737
53
Age at Diagnosis (in years)
12:52PM11/30/2017MOUNT AUBURN HOSPITAL
Filter(s): Quick Filter: Year:1ST CONTACT YEAR 2016-2016 AND ( CaseStatFlag = `C` ):
Count (N) Percent (%)Age at Diagnosis (in years)
6 0 - 29 0.81%
1530 - 39 2.04%
8040 - 49 10.85%
12750 - 59 17.23%
22660 - 69 30.66%
16670 - 79 22.52%
9980 - 89 13.43%
1790+ 2.31%
1Unknown 0.14%
Total 100.00% 737
Range:
Mean:
22 to 93
65
54
APPENDIX C: REVIEW OF CURRENT CANCER MANAGEMENT ACTIVITIES
55
Appe
ndix
Cur
rent
Can
cer M
anag
emen
t Act
iviti
es
Stan
dard
CYPr
ogra
m
Can
cer M
anag
emen
t Goa
lsC
ance
r Man
agem
ent E
valu
atio
n of
Effe
ctiv
enes
sC
omm
ents
Prev
entio
n20
15Sm
okin
g Ce
ssat
ion
At le
ast 1
0 Co
mm
unity
Mem
ber A
tten
d.
Clas
ses
Yes,
Apr
il - 1
0 en
rolle
d, S
epte
mbe
r -12
en
rolle
d
Onl
y pr
ogra
m in
are
a. S
mal
l enr
ollm
ent
how
ever
com
mun
ity m
embe
rs e
xpre
ss
desir
e to
con
tinue
.
Prev
entio
n20
15Ed
ucat
iona
l Ses
sions
at E
SOL
prog
ram
s and
hom
eles
s sh
elte
rs
Offe
r bre
ast p
reve
ntio
n an
d ea
rly
dete
ctio
n in
form
atio
n to
at l
east
30
stud
ents
at l
ocal
ESO
L pr
ogra
ms a
nd
hom
eles
s she
lters
.
Yes,
Ove
r 130
com
mun
ity m
embe
rs
reac
hed
Valu
ed b
y co
mm
unity
par
tner
s.
Nav
igat
ion/
Bar
riers
2015
Tran
spor
tatio
n As
sista
nce
Prov
ide
tran
spor
tatio
n w
hen
it is
a ba
rrie
r for
scre
enin
g or
trea
tmen
t.
Yes,
tra
nspo
rtat
ion
to c
ance
r tr
eatm
ents
pro
vide
d th
roug
h co
mm
unity
reso
urce
s.
Cont
inue
Nav
igat
ion/
Bar
riers
2015
Tran
slatio
n of
New
Bre
ast
Dens
ity L
ette
r
Tra
nsla
tion
into
Spa
nish
, Por
tugu
ese,
W
este
rn A
rmen
ian
and
Kore
an
lang
uges
.Ye
sCo
mpl
eted
Nav
igat
ion/
Bar
riers
2015
Hoffm
an B
reas
t Cen
ter a
nd
Inte
rpre
ter S
ervi
ces
Com
mun
icat
ion
Wor
k Gr
oup
Iden
tify
path
way
of c
omm
unic
atio
n be
twee
n Ho
ffman
Bre
ast C
ente
r (HB
C)
Staf
f and
Inte
rpre
ter S
ervi
ces
Yes,
Pat
hway
com
plet
ed.
Inte
rpre
ters
w
ill p
riorit
ize H
BC c
ases
whe
n po
ssib
le.
Com
plet
ed
Nav
igat
ion/
Bar
riers
2015
Acce
ss o
ver-
the-
phon
e in
terp
rete
rs in
Hof
fman
Bre
ast
Cent
er
Hoffm
an B
reas
t Can
cer s
taff
com
plet
e co
mpe
tenc
y on
util
izing
ove
r-th
e-ph
one
inte
rpre
ter
Yes,
incr
ease
d ov
er-t
he-p
hone
ut
iliza
tion.
Com
plet
ed
Nav
igat
ion/
Bar
riers
2015
Lung
Can
cer S
cree
ning
Eval
uate
nee
d fo
r lun
g ca
ncer
scre
enin
g pr
ogra
m
Low
rate
of L
ung
Canc
er S
cree
ning
id
entif
ied.
De
velo
ped
Lung
Nod
ule
Prog
ram
Scre
enin
g20
15Ba
rron
Cen
ter M
en's
Clin
ic
Prov
ide
at le
ast 3
free
clin
ics f
or Jo
seph
M
. Sm
ith C
omm
unity
Hea
lth C
ente
r pa
tient
s (no
w) C
harle
s Riv
er C
omm
unity
He
alth
(CRC
H) re
quiri
ng p
rost
ate
canc
er
scre
enin
g/ev
alua
tion.
Yes
, 5 c
linic
s hel
d w
ith n
avia
gtio
n fo
r 3
patie
nts.
Jose
ph M
. Sm
ith C
omm
unity
Hea
lth
(CRC
H) h
as id
entif
ied
path
way
to
urol
ogy
depa
rtm
ents
at o
ther
hos
pita
ls to
mee
t thi
s nee
d.
Scre
enin
g20
15
Hoffm
an B
reas
t Cen
ter
Colla
bora
tion
With
Jose
ph M
. Sm
ith C
omm
unity
Hea
lth
Cent
er (C
RCH)
Prov
ide
brea
st c
ance
r scr
eeni
ng a
nd
follo
w u
p di
agno
sitc
eval
uatio
n fo
r Jo
seph
M. S
mith
Com
mun
ity H
ealth
(C
RCH)
pat
ient
s.
Yes,
174
scre
enin
g m
amm
ogra
ms a
nd
116
diag
nost
ic m
amm
ogra
ms p
rovi
ded
Jose
ph M
. Sm
ith (C
RCH)
staf
f con
tinue
to
iden
tify
need
for t
hese
serv
ices
.
56
Appe
ndix
Cur
rent
Can
cer M
anag
emen
t Act
iviti
es
Stan
dard
CYPr
ogra
m
Can
cer M
anag
emen
t Goa
lsC
ance
r Man
agem
ent E
valu
atio
n of
Effe
ctiv
enes
sC
omm
ents
Prev
entio
n20
16Ed
ucat
iona
l Ses
sions
at E
SOL
prog
ram
s and
hom
eles
s sh
elte
rs
Offe
r bre
ast p
reve
ntio
n an
d ea
rly
dete
ctio
n in
form
atio
n to
at l
east
30
stud
ents
at l
ocal
ESO
L pr
ogra
ms a
nd
hom
eles
s she
lters
.
Yes,
ove
r 200
com
mun
ity m
embe
rs
reac
hed
Valu
ed b
y co
mm
unity
par
tner
s.
Nav
igat
ion/
Bar
riers
2016
Tran
slatio
n of
Hof
fman
Bre
ast
Cent
er d
ocum
ents
. T
rans
latio
ns o
f at l
east
the
top
10
docu
men
ts i
nto
Span
ish.
16 d
ocum
ents
tran
slate
d.
Com
plet
ed
Scre
enin
gs20
16
Hoffm
an B
reas
t Cen
ter
Colla
bora
tion
With
Cha
rles
Rive
r Com
mun
ity H
ealth
(fo
rmer
ly) J
osep
h M
. Sm
ith
Com
mun
ity H
ealth
Cen
ter
Prov
ide
brea
st c
ance
r scr
eeni
ng a
nd
follo
w u
p di
agno
sitc
eval
uatio
n fo
r Ch
arle
s Riv
er C
omm
unity
Hea
lth
(form
erly
) Jos
eph
M. S
mith
Com
mun
ity
Heal
th p
atie
nts.
Yes,
41
scre
enin
g m
amm
ogra
ms a
nd
37 d
iagn
ostic
mam
mog
ram
s pro
vide
d
Char
les R
iver
Com
mun
ity H
ealth
staf
f ha
ve id
entif
ied
decr
ease
d v
olum
e ho
wev
er th
ese
serv
ices
are
still
nee
ded.
Nav
igat
ion/
Bar
riers
2016
Tran
slatio
n of
Dist
ress
Sca
le T
rans
latio
n in
to S
pani
sh, P
ortu
gues
e,
Wes
tern
Arm
enia
n an
d Ko
rean
la
ngug
es.
Yes
Com
plet
ed
Nav
igat
ion/
Bar
riers
2016
Lung
Can
cer S
cree
ning
Hire
RN
Nav
igat
orN
avig
ator
Hire
dCo
mpl
eted
Prev
entio
n20
16Sm
okin
g Ce
ssat
ion
Goal
: At l
east
10
Com
mun
ity M
embe
rs
to a
tten
d cl
asse
sYe
s, J
anau
ary
12 e
nrol
led,
Apr
il 6
enro
lled
Plan
to c
hang
e m
odel
to p
ilot m
ontly
se
ssio
ns w
hich
had
low
enr
ollm
ent.
Prev
entio
n20
16Pr
osta
te C
ance
r Disp
artiy
Su
ppor
t Cam
brid
ge H
ealth
Alli
ance
's ef
fort
s to
addr
ess P
rost
ate
Canc
er
inci
dece
in B
lack
Men
Yes,
supp
ort p
rodu
ctio
n an
d tr
ansla
tion
of c
omm
unity
edu
catio
n vi
deos
.Co
ntin
ue
Nav
igat
ion/
Bar
riers
2016
Tran
spor
tatio
n As
sista
nce
Prov
ide
tran
spor
tatio
n w
hen
it is
a ba
rrie
r for
scre
enin
g or
trea
tmen
t.
Yes,
tran
spor
tatio
n to
can
cer
trea
tmen
ts p
rovi
ded
thro
ugh
com
mun
ity re
sour
ces.
Cont
inue
and
doc
umen
t whe
re p
atie
nts
are
bein
g se
en.
Prev
entio
n20
17Sm
okin
g Ce
ssat
ion
Pilo
t Fre
edom
from
Sm
okin
g Cl
ass.
At
leas
t 10
com
mun
ity m
embe
rs to
att
end.
Yes,
2 st
aff t
rain
ed a
s lea
ders
8
atte
nded
the
first
cla
ss.
Low
att
enda
nce.
Con
tinue
to e
valu
ate.
Prev
entio
n20
17Pr
osta
te C
ance
r Disp
artiy
Pr
ovid
e at
leas
t tw
o ou
trea
ch e
vent
s to
incr
ease
aw
aren
ess a
bout
pro
stat
e ca
ncer
in B
lack
men
Yes,
2 e
vent
s com
plet
ed a
nd g
rant
pr
ogra
m fo
r mor
e pr
ogra
ms i
n Ca
mbr
idge
and
Som
ervi
lle d
esig
ned
Eval
uate
d ef
fect
iven
ess o
f Cam
brid
ge
and
Som
ervi
lle g
rant
pro
gram
.
Prev
entio
n20
17Br
east
Can
cer C
omm
unity
Ed
ucat
ion
Wor
k w
ith im
mig
rant
wom
en in
So
mer
ville
to d
esig
n ed
ucat
ion
prog
ram
ab
out e
arly
det
ectio
n of
bre
ast c
ance
r.
Yes,
Bre
ast H
ealth
Aw
arne
ss v
ideo
cr
eate
d an
d re
cord
ed in
Eng
lish
and
Span
ishCo
mpl
eted
57
Appe
ndix
Cur
rent
Can
cer M
anag
emen
t Act
iviti
es
Stan
dard
CYPr
ogra
m
Can
cer M
anag
emen
t Goa
lsC
ance
r Man
agem
ent E
valu
atio
n of
Effe
ctiv
enes
sC
omm
ents
Nav
igat
ion/
Bar
riers
2017
Lung
Nod
ule
Nav
igat
ion
Desig
n a
prog
ram
to c
onne
ct to
prim
ary
care
pat
ient
s ide
ntifi
ed w
ho h
ad l
ung
nodu
le fi
ndin
g on
a C
T in
201
6 an
d do
no
t hav
e a
prim
ary
care
phy
sicia
n.
Yes,
pro
gram
des
igne
d an
d be
ing
impl
emet
ed.
Cont
inue
nav
igat
ion.
Nav
igat
ion/
Bar
riers
2017
Tran
spor
tatio
n As
sista
nce
Prov
ide
tran
spor
tatio
n w
hen
it is
a ba
rrie
r for
scre
enin
g or
trea
tmen
t.
Yes,
tran
spor
tatio
n to
can
cer
trea
tmen
ts p
rovi
ded
thro
ugh
com
mun
ity re
sour
ces.
59%
to M
D ap
poin
tmen
ts, 3
7% to
can
cer
trea
tmen
ts.
Cont
inue
Prev
entio
n20
17O
utre
ach
to L
GBT
Com
mun
ity
Prov
ide
smok
ing
educ
atio
n to
LGB
T yo
uth.
N
o, 2
sess
ions
pro
vide
d in
com
mun
ity
sett
ings
with
low
enr
ollm
ent.
Disc
ontin
ue
Prev
entio
n20
17Ed
ucat
iona
l Ses
sions
at E
SOL
prog
ram
s and
hom
eles
s sh
elte
rs
Offe
r bre
ast
and
lung
can
cer p
reve
ntio
n an
d ea
rly d
etec
tion
info
rmat
ion
to a
t le
ast 3
0 st
uden
ts a
t loc
al E
SOL
prog
ram
s an
d co
mm
unity
mem
bers
at h
omel
ess
shel
ters
.
Yes o
ver 1
20 c
omm
unity
mem
bers
re
ache
d Va
lued
by
com
mun
ity p
artn
ers.
Nav
igat
ion/
Bar
riers
2017
Lung
Nod
ule
Surv
ellie
nce
Prog
ram
Deve
lop
Nod
ule
Net
pro
gram
to tr
ack
patie
nts w
ith p
oten
tial b
arrie
rs to
car
e.Ye
s, p
rogr
am in
itiat
edCo
ntin
ue
Scre
enin
g20
17
Hoffm
an B
reas
t Cen
ter
Colla
bora
tion
With
Cha
rles
Rive
r Com
mun
ity H
ealth
Ce
nter
Prov
ide
brea
st c
ance
r scr
eeni
ng a
nd
follo
w u
p di
agno
sitc
eval
uatio
n fo
r Ch
arle
s Riv
er C
omm
unity
Hea
lth
patie
nts.
Data
not
ava
ilabl
e un
til Ja
nuar
y 20
18TB
D
Scre
enin
g20
17Fr
ee M
amm
ogra
phy
Even
t
Prov
ide
brea
st c
ance
r scr
eeni
ng a
nd
follo
w u
p of
dia
gnos
itc e
valu
atio
n fo
r m
amm
ogra
phy
to G
reek
and
Arm
enia
n po
pula
tions
Yes,
eve
nt h
eld
with
supp
ort o
f loc
al
Gree
k an
d Ar
men
ian
chur
ches
and
co
mm
unity
gro
ups.
Low
vol
ume.
Host
nex
t yea
r with
incr
ease
d ou
trea
ch.
58