2016 Community Health Needs Assessment Results

December2016

Contactcommunityaffairs@mskcc.orgformoreinformation.

Community Health Needs Assessment Mandates per the IRS and NYS DOH

•  NYSDepartmentofHealth–  Hospitalsmustsubmita

ComprehensiveCommunityServicePlan(CSP)everythreeyears.

–  TheCSPmustincludeacommunityhealthneedsassessmentandrespondtospecificDOHhealthgoals,includingahealthdisparity.

•  InternalRevenueService–  Hospitalsmustconducta

communityhealthneedsassessment(CHNA)everythreeyears.

–  Incorporateinputfromthecommunityonhealthneedsandprioritization

–  Documenthospitalresponsetoneedsidentified

MSK’s CHNA Phases

DataAnalysis&Prepara(on•  Synthesizedcancer-relatedhealthdataandtrends

CommunityInput• Heldseriesofforumswithcommunityorganiza(onstaffandsurveyedonneedpriori(za(on

CHNA&CSPReports•  PreparedCHNA&CSPreportsforMSK’swebsite,submissiontoNYSDOH,andpublicdissemina(on

Data Analysis

•  Secondleadingcauseofdeath(591,699in2014)

•  About1.68millionnewcancercasesareexpectedtobediagnosedin2016

•  86%ofallcancersintheUnitedStatesarediagnosedinpeople50yearsofageorolder

America’s Cancer Landscape

•  IntheU.S.,thelifetimeriskofdevelopingcancerisapproximately42%(1in2)inmenand38%(1in3)inwomen

•  Morethan8%ofadultsdiagnosedwiththemostcommoncancerswilldevelopasecondformofprimarycancer–  Ofthesesecondprimarycancers,lungcanceristhemost

frequentlydiagnosedmalignancy

America’s Cancer Landscape

References •  TheStateofCancerCareinAmerica™2016.AmericanSocietyofClinicalOncology

•  AGuidetoOrganizingCommunityForums,July2002,CommunityCatalyst

•  1in12ChanceofSecondCancerinManySurvivors.Medscape.Jul21,2016

MSK’s NY/NJ/CT Catchment Area

MSK’s Care Locations MemorialHospital’sinpatienthospitalandseveraloutpatientfacilitiesarelocatedinManhattan,withadditionaloutpatienttreatmentcentersinBrooklyn,WestchesterCounty,LongIsland,andnorthernNewJersey.

MSK’s Counties Served

NewYork: • Bronx• Kings• Nassau• NewYork• Orange• Queens• Richmond• Rockland• Suffolk• Westchester

Connecticut:• Fairfield

NewJersey:• Bergen• Essex• Hudson• Hunterdon• Middlesex• Monmouth• Morris• Ocean• Passaic• Somerset• Union• Warren

Population

NewYork: 13,078,684

NorthernNewJersey: 3,866,532

Connecticut(FairfieldCounty):

948,053

Total: 17,893,269

PopulationrepresentsanestimateofthetotalnumberofresidentslivinginMSK’scatchmentarea.

Ourprimarycatchmentareaencompasses23countiesandnearly18millionpeople.

MSK Patient Demographics, 2015

Atotalof147,468pa(entswereseenatMSK’sfacili(es.

Gender Age

0-172%

18-252%

26-398%

40-4913%

50-5922%

60-6413%

65+40%60.9%

39.0%

Female

Male

U(Unknown)

MSK Patient Demographics, 2015

•  OfthetotalcancerincidenceinMSK’scatchmentarea,34%ofcancerincidenceisrepresentativeofmulticulturalconsumers

•  However,lessthan20%ofMSK’spatientpopulationismulticultural

90%

5%5%

EthnicityNon-Hispanic Hispanic Non-Hispanic

81%

7%

5%7%

Race

White Black Asian Other

Areas of Cancer-Related Health Need to Address: All Populations

Chronic Disease Prevention

NYSDOHPreventionAgendaGoal• Increasescreeningratesforcardiovasculardisease,diabetes,andbreast/cervical/colorectalcancer,especiallyamongdisparatepopulations

NYSDOHPreventionAgendaGoal• Promoteuseofevidence-basedtobaccodependencetreatmentamongthosewhousetobaccoandaddressdisparityamongadultswithincome<$25k

Modifiable Risk Factors • Anestimated20%ofallcancerdiagnosedintheUSarerelatedtomodifiableriskfactors,andcanbeprevented

• Increasingevidencedemonstratesalinkbetweenbehavioralfactorsandcertaintypesofcancer,including:

• Excessbodyfat,• Physicalinactivity,• Smoking,and

• Poornutrition• Effectivepopulation-widebehaviorchangemustutilizeresourcesthatimprovethepublic’shealth:

• Smokingbansandregulations• Improveequitableaccesstofruitsandvegetables

Accessibility Barriers

PatientBarrierstoCancerCare

Transportation

FinancialConcernsandInsuranceCoverage

WaitTimetoStart

Treatment

LackofSocialSupport

AccesstoDesiredProvider

HealthcareEnvironment

LanguageandHealthLiteracy

AnxietyAboutCancer

Diagnosis&Treatment

Clinical Trial Awareness and Participation

BarrierstoCTParticipation:•  Uncertaintiesabouttreatment

sideeffectsandsafety

•  Possibilityofreceivingaplacebo

•  ConvenienceofCTlocation

•  Insurancecoverage

BenefitsofParticipation:

• Accesstoleading-edgetreatment

• Improvedhealthoutcomesandsurvivalrates

• Empowereddecision-makingaboutpersonalcancercare

• Changedattitudetowardsclinicalresearch

DriversofCTParticipation:•  Patientexhaustedallstandard

treatmentoptionsavailable

•  Noadditionalout-of-pocketcosts

•  LocalizingCTenrollmentandparticipation

Improve Cancer Survivorship Program Use ThenumberofcancersurvivorsintheUSisexpectedtogrowfrom14.5millionin2014to19millionby2024dueto:

• Advancesindetectionandtreatment• Agingpopulation• Coordinationoffollow-upcare• Caregiversupport

However,cancersurvivorshipplansareunderutilizedbyhealthcareprofessionalsinNYS

• OnlyhalfofNYSadultsdiagnosedwithcancereverreceivedasurvivorshipplan

ResourcesavailableatMSK:• CounselingandEmotionalSupport• ScreeningServices• TobaccoTreatment• SurvivorshipStudies• BridgesNewsletter&Events

PercentofNYSAdultsWhoEverReceivedanIndividualizedCarePlan

CarePlans

0–10yearssincefirstcancer

diagnosis

>10yearssincefirstcancer

diagnosis

WriVenSummaryofTreatments

57.6

30.8

Instruc(onsaboutFollow-upAppointments

88.7

79.2

Both(SurvivorshipCarePlan)

51.1

27.5

Areas of Cancer-Related Health Need to Address: Multicultural Populations

Population Trends

4in10personsintheUSarenon-White AndtheyarethemajorityinNYalready

2+Races,2% Other,1%

Hispanic,17%

Asian,5%

Black,12%

Non-HispanicWhite,62%

2+Races,1% Other,1%

Hispanic,24%

Asian,11%

Black,16%

Non-HispanicWhite,47%

Over Time the Multicultural Population Increases

Cancer Health Disparities

•  TheNationalCancerInstitutedefines"cancerhealthdisparities"asadversedifferencesthatexistamongspecificpopulationgroupsin:–  Incidence,–  Prevalence,–  Mortality,–  Survivorship,and–  Burden

•  Socialfactorscontributingtodifferencesincancerratesandtreatmentinclude:–  Lackofaccesstoqualityhealthcare–  Languageandliteracybarriers–  Financialconcerns

–  Poverty

Cancer Health Disparities, U.S.

Incidence

•  AfricanAmericanmenhadthehighestcancerincidenceratefollowedbywhiteandHispanicmales,respectively

•  Amongwomen,whitewomen

hadthehighestrateofnewcancercases,followedbyAfricanAmericanandHispanicwomen

Mortality

•  Amongmen,AfricanAmericanswerealsomorelikelytodieofcancerthananyotherrace/ethnicgroup

•  Thoughwhitewomenwerediagnosedwithcancerathigherrates,AfricanAmericanandHispanicwomensufferedagreaterburdenofcancerdeathsamongrace/ethnicgroups

*Incidenceandmortalityratesfrom2013

Cancer Health Disparities, NYC

•  Despiteasignificantreductionincancerdeathsinthelastdecade,notallNewYorkershavebenefitedequallyfromadvancesinscreening,earlydiagnosis,andtimelytreatment

•  Minoritypopulationshavethehighesttotaldeathratefromlung,prostate,andbreastcancers

–  Ofthe51,704deathsinNYCin2014,24%wereduetocancer–  AfricanAmericansandHispanicsaccountedforamajorityofthese

cancerdeaths

Health Literacy and Communication Needs •  Approximately80millionAmericanshavelimitedhealthliteracy

–  Strongassociationbetweenlowhealthliteracyandsociodemographicfactors

–  Adultsaged65+andminoritiesaretwiceaslikelytolackadequatehealthliteracy

•  Healthliteracymaybeanimportantpredictorofincreasedcancerrisk–  Individualswithlowhealthliteracyretainlessinformationfromcancer-

relatedmediamessagingandwritteneducationalmaterials

–  Cancerscreeninginformationisalsolesseffectiveduetolimitedknowledgeofmedicalterms

Patient Navigation

CancerCare

Pa(entNaviga(on

Outreach:Linktosocialservices

Screening:Improve

accessanduseofpreven(on

services

Diagnosis:Ensure(melyfollowupandtreatment

Treatment:Reduceactual/

perceivedbarrierstocare

1.   Overcominghealthsystembarriers•  Gainingaccesstoappointmentsand

actualutilizationofthehealthcaresystem

2.   Deliveringhealtheducation

•  Informationalsupportthroughwrittenmaterials,forums,andpreventionscreenings

3.   Addressingpersonalbarrierstocare

•  Connectiontosocialservices

4.   Providingpsychosocialsupport•  Culturallyappropriateemotional

supportforpatientsandfamilies

Cancerpa(entnaviga(onhelpstoaddressdispari(esinfourmajorareas:

Systemic Challenges TobaccoUse•  CigarettesmokingishighestamongNewYorkerswithanincomeoflessthan$25K

•  Productsareadvertisedandpromoteddisproportionatelytoracial/ethnicminoritycommunities

Obesity&Nutrition•  InNYC,morethanhalfofalladultsareoverweight(34%)orobese(22%),

withahigherprevalenceamongHispanicandBlackadults•  Needtocreateenvironmentsthatpromotehealthyfoodandbeverage

choicesandeliminatefoodinsecurity,particularlyinminoritycommunitiesPhysicalInactivity•  Morethan1in4NYCadults(28.9%)donotparticipateinmonthlyphysical

activity•  Needtoimproveaccesstoadequateandsafeexercisespacesinminority

communities

Community Input

Community Forums

Threeforumsheld:•  CityCollegeofNewYork(9/15)•  BrooklynInfusionCenter(9/23)•  Webinar(10/4)

Community Forums Agenda

•  Introductions•  PresentationofMSK’s2016CommunityHealthNeedsAssessmentdataanalysis

•  Requestparticipantinputonthefollowing:–  Criticalcancer-relatedhealthconcernsfacingresidentsin

MSK’scatchmentarea

–  SpecificstrategiestoreachHispanicandAfricanAmericanpopulations

–  OpportunitiesforMSKtopartnerwithcommunity-basedorganizations

Forum Participants

•  AmericanCancerSociety•  ArabAmericanFamilySupportCenter

•  BronxHealthREACH•  BrooklynCommunityServices•  CancerandCareers•  CancerCare•  CoaliciónMexicana•  CommunityActionNetwork-HealthyStartBrooklyn

•  TheCreativeCenter•  FriendsofKaren

•  Gilda’sClub•  HarlemUnited•  HispanicFederation•  TheLeukemia&LymphomaSociety

•  MaketheRoadNewYork•  MexicanConsulate•  NationalOvarianCancerCoalition

•  NYCFamilyJusticeCenter•  SHARE•  QueensLibrary

23communityrepresenta8vesfrom22community-basedorganiza8ons

Perceptions of MSK

Positive•  Excellentreputation•  Highlevelofkindness,goodcommunication•  Clean,safe,welcoming•  Greatpatientexperience

Negative•  “Exclusivity”•  Insurancebarriers•  Location

Areas of Need Expressed by Forum Participants Inputfromforumpar8cipantswascategorizedinto20areas(inalphaorder):

Clinicaltrialaccess Patient/Providercommunicationtechniques

Collaborativeinitiativeswithtrustedcommunity-basedorganizations

Politicaladvocacy

Community-basedintegratedcare Preventionprograms

Educationmaterialsinmultiplelanguages Promotioninculturallyrelevantmedia

Financialinformation/assistance Rolemodels/spokespeople

Hospitalaccessprograms Socialservices

Integrativemedicine Supportservices

Languageassistance Survivorship/cancertransitionplans

Legaladvocacy Targetedoutreach

Patientnavigation/casemanagement

Transportation

Top 5 Needs Ranked by Forum Participants

ParticipantsprioritizedthetopfivecategoriesofneedforMSKtoaddressthroughaSurveyMonkeyquestionnaire.(74%responserate)

8

8

7

7

7

CollaborativeInitiatives

FinancialInformation/Assistance

PreventionPrograms

Transportation

PatientNavigation

Top5RankedCommunityHealthNeeds

MSK Response Plan

High-Level Recommendations

GeneralRecommendations

•  IncreaseinternalandexternalawarenessaroundcurrentMSKinitiativesthatrespondtoareasofneed

•  Increasecollaborationandcoordinationinternallytorespondtoareasofneedandmeasureeffectivenessofeffort

Areas of Health Need Identified Through the 2016 CHNA Process AreaofNeed EnhancedMSKEffortsin2017and2018

Greatercollaborationwithcommunity-basedorganizations

1)DesigntargetedoutreachstrategiestoreachtheHispaniccommunityinNorthernBrooklyn.2)Advancesystemsandguidelinestobettertrack,measure,andcoordinatepartnershipswithcommunity-basedorganizationsacrossMSK.

KnowledgeGatheringonMul(culturalPopula(ons

Deepeninsightsintothecancer-relatedhealthbeliefs,attitudes,anddecision-makingpracticesofmulticulturalpopulationswithinitialresearchintheHispanicpopulation.

FinancialAssistanceAwareness

IncreaseawarenessinternallyandexternallyofMSK’sFinancialAssistanceProgram,initiativestoscreenpatientsforfinancialdistress,andtoassistpatientswithresourcesfornon-treatmentrelatedsupport.

Educa(onalMaterialsforMul(culturalAudiences

IncreasethepercentageofMSK’spatienteducationmaterialsavailableonourwebsiteinSpanishandRussianfrom62%to100%in2017,andpromotetheavailabilityoftheseresourcesinternallyandexternally.

Areas of Health Need Identified Through the 2016 CHNA Process

AreaofNeed EnhancedMSKEffortsin2017and2018

Preven(onPrograms

1)IncreasethenumberofunderservedindividualsscreenedforcancerandcardiovasculardiseasebyMSK’sImmigrantHealthandCancerDisparitiesService’scommunityprogramsby5%in2017andby5%againin2018,inkeepingwithMSK’sgoalstoaddressNewYorkStateDepartmentOfHealthPreventionAgendapriorities.2)IncreasethenumberofparticipantsinMSK’sTobaccoTreatmentProgramby5%in2017andby5%againin2018,inkeepingwithMSK’sgoalstoaddressNewYorkStateDepartmentOfHealthPreventionAgendapriorities.

Areas of Health Need Identified Through the 2016 CHNA Process

AreaofNeed HowAddressedbyExistingMSKEfforts

Clinicaltrialaccess

CancerHealthEquityResearchProgram,ClinicalTrialSurvey,OfficeofClinicalResearch,OfficeofDiversityPrograms,Promo(ngImmigrantMinorityEquityinCancerResearch

Community-basedintegratedcare(co-locatedprimaryandspecialtycareservices)

TheRalphLaurenCenterforCancerCare

Hospitalaccessprograms(facilitytoursandwelcomehouses,referralprograms)

MSKDirect,MyMSK,presenta(onstocommunitygroups,par(cipa(onatcommunityevents

Integra(vemedicine(accessandsupporttocoveroutofpocketcost)

ExpandingIntegra(veMedicineservicestoMSKregionalsites,CommunityAcupunctureprogram

Languageassistance LanguageAssistanceProgram

Pa(entnaviga(on/casemanagement

Pa(entRepresenta(on,Pa(entandCaregiverSupportProgram

Areas of Health Need Identified Through the 2016 CHNA Process

AreaofNeed HowAddressedbyExistingMSKEffortsPa(ent/Providercommunica(ontechniques

Comskil:Communica(onSkillsTrainingProgram,ImmigrantHealthandCancerDispari(esService’sLanguageIni(a(ves

Rolemodels/spokespeople Pa(entstories,Pa(entandCaregiverSupportProgram

Socialservices(artsprograms,counseling,supportgroups)

TheCounselingCenter,Spiritual&ReligiousCare,Pa(entandCaregiverSupportProgram,Pa(entRecrea(on.ResourcesforLifeAjerCancer,SocialWork

Survivorship/cancertransi(onplans

SurvivorshipCenter,ResourcesforLifeAjerCancer

Targetedoutreach(tozipcodeswithhighercancerincidence/prevalence)

BreastExamina(onCenterofHarlem,ImmigrantHealthandCancerDispari(esService,RalphLaurenCenterforCancerCare

Transporta(on(financialsupporttotransportpa(entstocaresitefromhome)

SocialWorkandCaseManagement

Areas of Health Need Identified Through the 2016 CHNA Process

AreaofNeed BeyondMSK’sScopetoAddressLegaladvocacy(tohelppa(entswithworkplacebarriers,housingconcerns,insurancecoverageandlapses,immigra(onissues)

Pa(entsarereferredexternallyforsupport.

Poli(caladvocacy(foraccesstoqualityfood,physicalac(vityresources,andhealthyenvironment)

MSKisaleaderinenvironmentalstewardshipandfocusesouradvocacyeffortsonhealthcarerelatedconcerns.

Supportservices(casemanagementforpa(entswhoneedhelpwithdomes(cviolenceconcerns,food/housingcrises,chronicpsychiatriccare)

Pa(entsarereferredexternallyforsupport.

Summary of MSK’s 2016 CHNA

ü Identifiedandreceivedinputfromthebroadcommunityoncancer-relatedhealthneedsinourservicearea

ü RecommendedstrategiesforMSKtorespondtokeyhealthneedsin2017and2018

ü Strengthenedandformednewrelationshipswithwell-respected,community-basedorganizations

ü Prepared2016CHNAReportand2016-2018ComprehensiveCommunityServicePlanaddressingkeyhealthneedsandcommunitybenefitgoals,availableat:www.mskcc.org/communityserviceplans.