Susan G. Komen NYC

Hi, my name is Kristie Kahl, editorial director of CURE magazine, the indispensable guide to every stage of the cancer experience. It's my pleasure to be joined with Dr. Klemp today, so that we can kind of recap what everybody has talked about today and kind of go over the highlights that everybody's learned. So, before we get into some of my questions, Jennifer, we actually have a question from the audience that says, I am a nurse practitioner leading a breast cancer navigation program. I would love your input and experience of advanced care providers taking on navigation roles with regards to care and reimbursement.

Klemp: So that question is a great question. And I think it's important to think about advancing APP roles in general. And as I think about an APP and their need, not really to sub specialize, but to have those concentrations that bring uniqueness to their role, whether it be navigation, whether it be genetics, or survivorship. They're really wasting To strengthen that expertise, and I think navigation because it is built in as an integral part to a lot of the alternative payment models, and so much of where we're going and healthcare, then I think that that can be a real advantage to taking on some of those roles, because the HPP is a billable provider. And so by taking the reimbursable pieces that are embedded with the navigation that right now, we don't get paid for. I think that that could be a real strength and advantage to the organization and to the patients that your survey.

Right, yeah. And so I kind of want to go back a little bit to this morning. So Dr. Gorgon had mentioned that there were four things that we've learned from COVID so far. So what do you think is the one of the main aspects that we've learned from COVID as patient navigators?

So Dr. Gorgan had a lot of insight and I think the thing that, you know, when I wrote in took my notes from him his talk, a lot of it obviously was about the power of transmission and a lot about sort of where we need to rapidly go. Based on the fact that this is a unique and pretty aggressive virus that we're dealing with. It's unlike others that have come before it. So I think the part that was important for navigation to take out of that, is that geographically where we do see these differences, whether it's what we see in the northeast or the southeast, which are different and different peaks in the end, when we are seeing exposures and preparing for kind of this next round. I think the important part for navigators is that pay attention to what we've just done. Let's learn from what worked and start preparing in our conversations for these potential next waves. Because the reinforcement, the expectation management for both ourselves, our staff and out patients will really be helpful as this does not seem to be something that's going to stop tomorrow. It's going to have a prolonged life. And let's use the lessons learned to help empower us for the next wave.

Definitely. And so you know, in cancer, we talk with a lot of patients and caregivers about the fact that a cancer diagnosis can be this new normal. But you know, with the pandemic, I think we are all facing a new normal now across the nation. And you know, and in Karen, Linda and Donna's talk that they had earlier this morning as well, they mentioned ways to kind of implement different strategies into their daily practice and how that's changed for them. So what are you hoping are the key takeaways for navigators to take away from this new reality so that they can start implementing different strategies into their day to day?

Yeah, I really liked that session and I felt like we had a lot of great insight from pretty innovative people that are also practical, right? You need innovation and practicality together to really make some solutions. So, I think we need to some of the lessons from Karen that I took away, we need to be surveying really our teams as well as our patients to what they can and can't do. Are they prepared or not prepared and address those lingering issues? technology is new for a majority of our patients in this capacity. So how do we build those kind of quick start guides and help them whether it's a you know, minute and a half YouTube video that their grandkid can help show them? You know, how do we help them leverage technology because that's not going away?

And then how do we really continue to provide professional education and push in a bidirectional really sort of conversation? What is needed? And then how do we push that perfect All education out to the field. And there really needs to be an ongoing not only repository, but ability to have that real time what you need to know, kind of conversation that happens every day and is relevant not here's the update for today. But here's what you need to know to help you do your job today.

I know you and Nicholas had also mentioned the fact that compassion fatigue and burnout is very real. And I can only imagine that during the pandemic, it's even more real than usual. So how can the navigation tool and the Academy of medicines toolkit address this navigator fatigue and burnout?

I think one of the biggest things it can do is brings organizational awareness. Right. So I think that, you know, a lot of times people will talk about issues they don't necessarily embrace or understand what the full scope of that is, in our town halls. I know at the University of Kansas Cancer Center. Some of our leadership have been pretty candid with the challenges they've had.

So that personalization, which we don't use very often you kind of use it sparingly as needed, but kind of PRN, that personalization would be really helpful, because how do you get the organization on board, which needs to support the staff and the people working from home and the people who are coming in and exposing themselves and their families. So, I think that if nothing else, we need more organizational awareness. And I'm hoping that some of those tools can really bring the evidence that's required for organizations to see this as a problem and to hopefully support not just by acknowledgment, but in action of preventing compassion, fatigue and burnout.

I know Nancy and spoke earlier about technology. So with that, how far would you say we've come with technology and breast cancer care? And what do we have to look forward to as patient navigators?

Technology has accelerated like a rocket ship, right? So I've seen organizations that had like 18 to 24 month plans, deploy them in two weeks. So it has been, you know, trial by fire. So the reality is, that's not going away. And I think that we need to number one, really streamline our utilization of technology. I am burnt out in the sense of being on zoom for like seven hours a day. So that's not you know, that's not healthy either. So we need to figure out that the balance of of using technology, we need to figure out the security of technology. We need to empower our our aging workforce in oncology. Aging, that's relative, but the fact is, is that not everybody is good with technology. So how do we kind of streamline some of the onboarding and quickstart so that people don't feel so overwhelmed and shut down, or the workforce we do have says, to heck with this, I'm done. I can't do anything. This is just, it's too much, which is also happening.

So, I think technology can help us. It also, though, has caused part of the epidemic, right? There's so much information, where do we go? How do we know that it's reliable? We did a cancer and COVID echo series in April, and one of the sessions we covered the infodemic of COVID. And that, you know, there's 700% increases, in fact checking, you know, so much is happening, but how does an average person or an average healthcare worker, keep up with what they should or shouldn't know. So I think we need to develop some some digestible information that is reliable because just you Too much out there. So technology overload is a concern. But technology is essential. So we need to do a cost benefit, kind of get the teeter totter back in check, and figure out how to support the workforce and our patients as we continue to to utilize technology, more and more.

Right, definitely. So, we actually have another question from the audience. Dr. Klemp, what influenced you to go into patient navigation? And what would you suggest to people who are considering going into this field?

I’m, by trade, and not a navigator I function in a role of supporting navigation and have navigated and have had hired navigators. So I'm like I'm, I grown in the process. But I will tell you a funny story, which I normally don't I don't normally personalize. But my mother was diagnosed with breast cancer back in 1984 when I was graduating from college and going to med school, and the interesting part is that she He was one of those people who had a bone marrow transplant for her breast cancer. So, I have lived through that. And I was her personal, you know, caregiver who took off time and, and that was my ROI is being with my mom. So when I was done with the acute part of the journey, I wrote my mentor of breast medical oncologist aka letter, and I described the role of a navigator, she still has this letter, and I described it to the tee, it didn't exist at that time. But I said, this is what we need for patients going through this intense type of journey.

And it wasn't just for transplant, it was just cancer in general. And so, you know, I disclaimed multiple times that I play one on TV so I have not playing a navigator on TV, but I have been in oncology for 25 years, filling a lot of those roles and supporting that need, and hired one of the first survivorship navigators in the country back in the mid 2000s. So I think that the important part about what motivates us to either fill a role support a role, or be part of that team is that I do believe in team medicine and team science. And I believe that navigation, if any of you've ever seen the continuum of care map that I use as integral as part of my philosophy, navigation is the first piece and it continues through the entire cancer journey. So, you know, I would like to say that that navigation is a core of my philosophy, and that it's part of what I believe is how we achieve really better outcomes, better patient care and better quality and quantity of life for our patients living with cancer.

So, I want to shift gears back a little bit from the session this morning, how we can become a whole so Dr. Newman to discuss the racial disparities to having a Access to cancer care? How can we work to negate these disparities and help patients, you know, navigate their care? And moreover, are there any resources that we can offer to help bridge this gap?

Dr. Newman did a very beautiful job even using some analogies like the Titanic and showing, you know, access to care and those barriers that we need to tackle. We also on the flip side of that conversation had the CDC sitting there with programs like the early detection works in screening breast cancer, breast cancer and cervical cancer screening programs.

Most of the states that I interact with are underutilizing those types of screening programs. So how do we empower our local safety net clinics or community providers primary care, to know about how to use some of those programs to get patients in for screening, my colleagues and I in Kansas are working on developing a program not only to empower Local primary care, local family practice and our safety net clinics and our early detection work clinics is what we call it. But how do they utilize risk stratified screening? So, when do they start screening?

How often do they screen because there are so some conflicting messaging, depending on if you're getting screening recommendations from your professional organization, or from the US Preventive Task Force. So, I think the important part is that we need to better utilize existing programs, we need to identify where those gaps are and where the limitations are. And I think navigation can really help us fill in those gaps. But I always hate to build new things until we fully utilize the existing programs and services that we have. And I do think that many of those are underutilized because people don't know about them. People don't know how to access them, and they don't know how to use a lot of those programs that are out there.

And so during that same session, Dr. Farley had discussed, you know, integrating community health workers and navigators into the plan of care. So, up here we talk a lot about the multidisciplinary approach. So how can we help patient navigators make sure that they're integrating themselves into the multidisciplinary approach to cancer care.

I think that from that, that first touch point of the community health worker being in the community, they can match patients to those resources. They can be the conduit that a busy primary care or safety net clinic who doesn't navigate that process, well, they have a resource to help them help their patients access that resource. I think that that by us, utilizing community health workers to understand and maximize those opportunities to have us as providers be able to pull those types of individuals into our seminars, our discussions and our trainings would be ideal because then you're Bringing, like you talked about that multidisciplinary approach. But the circle of care has to all be informed and know how to communicate as well. And if we don't sort of foster the circle of care, then it will always be fragmented.

So, I think we need to, to bring in that entire, you know, family that's caring for that patient into the picture before we're going to really be able to maximize and leverage all those existing resources.

What do you think is next and where do we go from here for patient navigators?

I think in kind of summarizing the themes for today, there's some common threads, obviously, of education, scope of practice, the lanes that are filled, but there's also the need to come together to have these discussions to continue the conversation, because there are going to be speed bumps in the road, right?

So, we're going to lane with the speed bumps occur. And that could be COVID-19. It could be changes in someone's insurance status. There's lots of barriers that happen. And we have to be able to pivot as a healthcare delivery system as patients. And so, my two biggest sort of common themes that I took away from today are that we need to be better at having expectation management being sort of transparent with roles, responsibilities, expectations.

Then the other part of that is we do need to work on how we communicate and utilize that team and those resources. So, expectations, priorities, transparency, and then leveraging what's currently there, so that we can identify those gaps and then work towards that common goal of standards. accreditation reimbursement, which is really the next tier up, we have to kind of continue working on this tier before we can go to the next year. I think that we have a lot of work to do. But we have a lot of key stakeholders and bringing them together.

Videos

We answer your patient navigation questions at the 4th Annual Patient Navigation Town Hall "Empowering and Mobilizing Our Patient Navigation Workforce".

Answering Your Patient Navigation Questions

Stewart McKeough: This is going to be a great session. It's called Mobilize. We're pulling this from Empowering and Mobilizing our Patient Navigation Workforce. And you and I talked briefly about this on Friday, really having a better understanding of pay equity of certification training, how public policy can inform strengthening this workforce moving forward. So, we're going to hear from public policy experts, a great interview coming right up in a (second) with the New York Times, we will hear what Texas is doing. Texas has been at the forefront of community health worker certification for the past 20 years, we'll hear from a University of Texas health expert to talk about what they've learned and what they could do a better job at and how we in New York State and other states can replicate some of this good work. So, we're in for a good hour I think it is, hour and 15 minutes. But I first want to start by introducing our audience to Katie Engelhart and Kim Rockwood, I watched an interview that Katie had done with Kim on the New York Times in May. And immediately watched it because the headline was so grabbing these, essentially it was these people look after our most vulnerable populations, and yet their average pay is $16,200 a year. Are we okay with that? And of course, I thought, No, I'm not. And yet we hear these stories across the United States. And we hear them a lot with our community health workers. So, I wanted to introduce you to Katie and to Kim. We will replay the Times video that I saw and then I'll turn it over to you both so that Katie, you can update us with Kim on what's happened since that video ran on the Times and then Dr. Klemp and I will have some questions. Let me just formally introduce you though first. Katie Engelhart is a reporter and documentary film producer, who has worked as a correspondent for NBC News, and whose writing has appeared in The New York Times, The Guardian, the Atlantic and California Sunday. Her first book, The Inevitable Dispatches on the Right to Die will be published in 2021. And I'll just add in that Katie's a Canadian like I am, so I was immediately drawn to her and she's speaking with us today from her cottage in Northern Ontario, and I think we're all very jealous. And Kim Rockwood, oh my gosh, you've been working in health care since 1984. And you became a certified nursing assistant in 1987. And since that time, you've been Become a MAP Certified restorative aide certified assistant. And you've been trained in nonviolent crisis intervention and in supportive care for Alzheimer's. You're a remarkable individual Kim and I can't wait for our audience to get to know you a little bit more. Right after we play this video.

Kim Rockwood in video: I mostly care for people in their homes. People like parents, grandparents, the most vulnerable population of our society, people who need help going to the bathroom, eating, taking their medications. This is for your bones. This is for your pain. We do everything for him, 'We're going to lift you up, alright.' I work seven days a week, but I love my job. I wouldn't do anything else. I've worked for over 30 years doing this, and I make just over $15 an hour. I live in Massachusetts and my salary is actually one of the highest in the country. 18% of us live below the poverty line. Nationally, we make just over $16,200 a year. And even though I work in health care, I cannot afford health insurance. I avoid going to the doctors. I have medical bills I haven't paid. My tattoo is: "We're all in this together. "And it is "the world has a heart." Since COVID, the federal government was giving out more than $100 billion emergency money to hospitals, nursing homes, long-term care facilities. That's great, but most of the money isn't going to people like me. I'm not a materialistic person and I'm not asking to make a million dollars, I don't mind doing hard work, but I need to make a living. I need to be able to pay my bills, especially now with Coronavirus. Most home givers aren't receiving hazard pay. I've had to pay for a lot of their PPE out of my own pocket. If we are essential workers, we need to be treated like essential workers. If I were to go on unemployment and stop working, I would make about the same amount of money if not more, and then there's not going to be anybody to take care of these people. And that's just crazy. It's a very broken system. These patients are sick, and they need to be cared for. Last Tuesday, Nancy fell, she basically sat on the floor until she was found. I would hate to have her end up in a nursing home or a long-term care facility. But that's what's gonna happen if she doesn't receive the care.

Kim Rockwood: [crying] I give her a quality of life that she deserves, and I don't want her to lose that. That's why I do what I do. If she falls, she loses all of that. I'm sorry. It doesn't have to be like this. The federal government, Department of Health and Human Services must require some of the money that is going out for relief to go to the frontline caregivers. States could also use the Medicaid to increase our pay, some states increased wages for all health workers, including home caregivers, Arkansas is doing it now. Even a few dollars more an hour would change our lives and make the health care system more sustainable and safer for our patients. But when this is all over and in a post COVID world and money shouldn't get taken away, caregivers will still be needed. We should be paid a living wage, we need help.

Katie Engelhart: I still find that piece very moving and I'd like to talk a little bit about how things are going for you (Kim). Now that were a few months on, but first, I thought it would be useful to just explain sort of how we got to know each other. So, I was working on a piece for the New York Times. And our idea was to find frontline workers, find essential workers and give them the ability and technical tools to author their own op ed to make their own case for what needed to be done in response to Coronavirus. And I guess I started thinking about how we defined frontline workers. And Kim and I, we've talked about this, but it became pretty clear that you know, while a lot of attention was rightly on the acute needs of COVID patients, there wasn't a whole lot of thought going to post-acute care to considering where these patients would go and how they'd be cared for after they got better. And this is even in, April and May as we were hearing warnings from Italy that homecare is going to be the next frontier of all of this. And as I did more research, it became very clear that you know, the homecare industry was already in crisis, there was an enormous shortage of homecare workers. A lot of workers didn't have the training and support they needed, underpaid, not protected, uninsured without paid sick leave all these things we now realize are really detrimental to the health of patients. And I think you know, the fact that this is work that's done largely by women, often women of color, immigrant workers hasn't escaped anyone who's been paying attention. What Coronavirus really showed us is that the health of caregiver population is closely tied to the health of the patient population. And I think that Kim, when we connected really saw that and really had ideas for how the situation could be improved. So, Kim, it would be useful to know I guess, to start how things have been going for you since we last spoke since this video was made.

Kim Rockwood: I'm still working seven days a week. I did move out of COVID-19 facility, and I'm working in a long-term care facility on top of working with Nancy and Brendan (from the video). I have a hospice couple that are living at home. And I lost two people who work for me with Nancy. And her needs are more than they could handle. So, I picked up more hours with her. Pretty much the same thing. nothing's really changed.

Kim Engelhart: Yeah, so it sounds like I mean, even before Coronavirus, we knew that turnover was a huge problem. A lot of healthcare agencies even in Massachusetts, which has either some of the highest rates in the country, if not the highest, you know some homecare agencies, we're finding a turnover rate of nearly 100% every year, and when I spoke with someone from the homecare industry, he said to me, you know, unfortunately our main competitors here are Burger King or McDonald's. Because those jobs sometimes pay better. They sometimes offer you know more in the way of benefits or support, there's room to advance, there's room to, you know, graduate to higher pay scales, and you're far more likely to get injured. Homecare workers are something like three or four times as likely to be injured on the job as other workers. And so Kim, I'm curious how you've seen that quick turnover and how you're finding it's affecting the care of your patients and I know you've also have a specific tide of fast food and have been able to see that comparison.

Kim Rockwood: I've worked with Nancy since last January, and in that time, I have been consistently working with her pretty much seven days a week. In the fall, when I went to school, I had people working with me, including my daughter, my daughter and I are the only one that are still with her. We've gone through five different PCAs. To be a PCA, you don't need to be certified, you honestly don't need to be trained. And once people come in and see the actual tasks that are involved in taking care of somebody who has been hospitalized, is trying to avoid going to any sort of long-term care facility or a hospital setting. It's work. And it's complicated. It's a lot more than making breakfast or putting out medicine. And, you know, they come in with the idea, well, I'm going to make this kind of money, but it'll be easy work. And it's not easy work. And Dunkin Donuts, took my daughter and she's now making $19 an hour as an assistant manager and I'm making $15.94 taking care of Nancy and Brendan, and my hospice couple who are dying.

Katie Engelhart: Well, I think a lot of people don't realize that, you know, Kim is, you know, as you've said, a certified nursing assistant, so able to work in long-term care settings, like nursing homes, and also a PCA, so personal care assistant working with people in their homes. The facilities require a certain level of training, it's not always very much sometimes, you know, 70 hours of training, depending on the state, but often to be a homecare worker, you know, for some reason, there's not that same criteria or same requirement of any sort of, you know, formal training and Kim, how do you find that that's affected the care of your patients because obviously, you know, you're very trained. I know, Kim's also, you know, paid to do a lot of additional certification, but you're sometimes trading off with people who are new on the job and aren't as experienced.

Kim Rockwood: I've had patients call me in the middle of the night because their catheter was clamped off and never released and the caregivers have left. I've had patients, clients get hurt while being transferred via a mechanical device such as wires. I've had patients not given the medication that they needed on time and ended up diabetic reactions. By going into somebody's home and caring for them in a health aspect, by not being trained, you're jeopardizing their safety. You're jeopardizing your health. You're jeopardizing your wellbeing. And you're jeopardizing the whole community of individuals living at home because it gets to that point where they can't be taken care of, it won't be an option to live at home, they will be mandated to go into long-term care or assisted living or whatever. Because, you know, I mean, how many lawsuits can there be or how many injuries because of PCA's not being trained before somebody says enough is enough.

Katie Engelhart: For someone who does want training for someone who joins the field, and you know, they're working at home care, and they want to get better and they want to improve their skills. What kind of options are available to them? Are there options to get new certifications with, you know, some government assistance to increase that pay scale.

Kim Rockwood: If you go into like a department of transitional Assistance Program, you can go into a certified nursing assistant program through community colleges. I know that Red Cross offers programs. However, unless you're going through a transitional program, because you are getting state funding for whatever to sustain your own life, you have to pay out of pocket. I have been certified basically through any job that I've ever been, I grabbed the opportunity and I take it where I go, or I pay for it. I'm $24,000 in student loan right now, finishing up my associate as an RN.

Katie Engelhart: It seems like culturally, we've, you know, we've moved away from an institutional model. People don't want to be in the hospital longer than they need to be. It's expensive. They don't want to be in nursing homes or other kind of rehab facilities and yet, the infrastructure is still back in the old days, right. Yeah, it sounds like you're still operating pretty much in the same setting that you did in the '80s.

Kim Rockwood: Right now, in Massachusetts more than 36,000 people are living at home independently receiving home services. And they're not getting paid, you know?

Stewart McKeough: Dr. Klemp and I just popped up the minute we heard you talking about certification training and we're about to move into our next segment of this session to hear from our UT Health advocate and subject matter experts. So wanted to wrap some things up with you but Dr. Klemp, I think what we're hearing from Katie and Kim is how important it is to find the best way to sync up our training and certification and accreditation wherever you fall in the continuum. What do you think?

Dr. Jennifer Klemp: Right, and I also heard from Kim kind of (that) there's not a lot of standardization or sort of, you know, it works a lot better to demonstrate your value which you have listed off. I mean, I the empathy I have for the role that you're filling, but also, the complicated nature of your patients, right? So, we're talking about a lot of skills that people have, how do we demonstrate that competency? How do we make sure that there's some standards around that, and there's that need to have it be a little more universal, versus all these one offs or a lack of sort of certification? So the way that we move towards that and move towards increasing value is to put that into a story, right. And the story usually includes outcomes and metrics that can then be taken to payers where payers say, okay, yes, this is part of a bundle, this has to happen. So, this is a very complicated picture that you've described through your experience. And it really goes to kind of the bigger society challenges we have, and dealing with, with policy, the accreditation, the billing, like this is a really big and complicated issue. And that human experience, I think just highlights the need to push this forward so we can start putting more value on a very necessary service and, you know, tool for our patients and providers and organizations.

Stewart McKeough: Katie and Kim, thank you both very, very much. Any more thoughts? Any before we move on to the next segment?

Katie Engelhart: I think just as I said before, you know, I think we're really seeing in nursing homes what happens when the lowest level of caregivers not offered, you know, support such as a paid sick day, the ability to stay home and to not spread infection to residents and, you know, all signs point to homecare being the next place where we're going to see these outcomes if nothing's done.

Dr. Jennifer Klemp: Yeah, the compassion, fatigue and burnout is there, and I commend you and thank you for what you do, Kim because you are amazing and your resilience is amazing.

At the 4th Annual Patient Navigation Town Hall "Empowering and Mobilizing Our Patient Navigation Workforce", experts discuss how navigators can mobilize for equity in their field. 

Mobilizing For Equity

: Okay, Dr. Klemp. We are going to hear from Rosalia Guerrero from the University of Texas School of Public Health, and I'll let you do the intro and set up this segment.

: Great. Well, thank you so much, Stuart and Dr. Rosalia Guerrero. Rosalia is, as Stuart said from the University of Texas School of Public Health. And she's currently the project manager for the community health worker program, but also serves as adjunct professor for Texas Southern University Health Management Department, and really has been part of the dialogue in Texas for a long time. And I'm hoping today that we can learn a little bit more about that experience. Because one of the things that is happening, and there is sort of that movement, is sort of state-by-state, tackling the need for accreditation and putting this level of standard on our community health work, navigators and workforce. But do we tackle that as one-offs, do we learn from the lessons of Texas and other states? So, I'm hoping we learn from you today and we look forward to your discussion.

 Hi. And thank you for having me. This is great. I hear there's a lot of community health workers and patient navigators out there. So, greetings to all of you. I'm very excited to be here. I will say one of my most treasured titles is that of certified community health worker instructor, which we're able to have here in Texas. So, I'll be speaking about that today briefly. If you go to the next slide?

As I mentioned, my job here today was to talk about the history of certification for community health workers in Texas. But I would like to start by saying that community health workers have been around for a very, very long time. Texas certainly did not invent them. The United States didn't invent them. They've been around for a time in different types of communities. So we just want to keep that in mind as we're moving forward: every community is different, so every community health worker program will be different. But (here’s) a little bit about how we got started here in Texas. Please move to the next slide.

There's a little timeline. Texas is an interesting case in the South because our model for community health workers actually came from Mexico, where they were called promotoras de salud, which is basically health promoters, people who promote health, and we see them in all areas of Mexico and Latin American countries in the 1970s. And really in the 1960s, when we had farmworkers come up into the United States, in the agricultural industry, they also brought all their health issues, which would be - people still got pregnant and people still had diabetes, people get hurt, still needed their vaccines.

And what we saw in the healthcare industry is that many times they came with one of these promotoras, which was usually a family member, but someone who, along the migrant stream from Texas all the way to Yakima, Washington, would educate themselves on healthcare in that particular community. And that way, helping their community, just like they did back home.

In the 80s, this led way to the migrant health promotion. It's a program sponsored by the federal government that’s still around today to provide health care to migrant farmworkers and also pay for some of the work that the community health workers were doing. By this time, they were starting to call them community health workers. One of the early sponsors of community health workers, oddly enough, maybe not, was Blue Cross Blue Shield. They offered all community health workers who would go along in the migrant stream with the farmworkers, they would offer them pay and also health insurance for $8 a year. This was in the 80s and 90s. They still continued with that program until they went from being a non-profit to for profit.

In the 1990s, and up until this time, community health workers are basically minding their own business, literally the business of health, and they would be with the foreign workers and all along the border, they were very well integrated into the health care system and no one really paid them any mind, outside of that. But when NAFTA came around in the 90s, Clinton famously went to the border to talk about all these great promotoras and the economy. And what he was faced with was, again, migrant farmworkers living in less than substandard housing. By this time, we had colonias, which are basically shanty towns outside of town. And he saw that we had these community health workers that would go out there and he's like, what is this, we need to support this more, and really do something with the border communities.

So, at this time is when there was the start of the talk about who are these community health workers and how should we best support them? Or on the opposite end, maybe regulate them? We don't know who these people are. They don't come from a traditional educational system. Some of them don't even have papers. So, how is it that they're working within our health care industry?

By 2000, this led to the establishment of the US Mexico Border Health Commission, which really started to work, very focused on community health work and the model and how it should be best dealt with. And by 2001, community health worker certification is legislated in the state of Texas, which makes it unique. I think it's the only one in the United States, where it's actually legislated, it's a law that promotes and protects community health workers, provides for their education, and this is directed by the Texas Department of State Health Services, our state health department, which provides certification for community health workers. And that department still exists. And, and community health workers were still being used in a lot of the health care industry in Texas. But still, you found them more along the border, and then came along the Affordable Care Act in 2010. And what's interesting about the Affordable Care Act, they mention community health workers, specifically, more than a dozen times, and in 2010, there's a resurgence of this conversation around certification.

And when I say community health workers, I'm really talking about an umbrella. Today we're talking about patient navigators and the indigenous communities, you have community health representative. So, the community health worker certification basically encompasses everybody. If you want to move to the next slide.

What certification basically got us was a department, which is one of the pros that I'll talk about. One of the support mechanisms was actually having a program carved out within the state health department. So that means the staff, that means programs, that means activities. So, when I talk to community health workers, I provide a training, a certified training. I'm through the University of Texas School of Public Health, I make sure to always remind them, I'm not certifying you I'm just providing this training. Who certifies you is the state health department. And community health workers receive a license with a unique number and their picture on it. And this has been a source of professional pride for community health workers in Texas, which number a little bit over 5,000 today throughout the state.

To be certified in the state of Texas, you had to have gone through a 160-hour course in the eight core competencies of community health work. You have to take it from a certified Training Center, and certified training instructors, and all those different phases are certified by the state of Texas.

Another nice thing about the program is that every year they keep statistics, so you can go on to the state website and you'll get a report every year: How many community health workers there are, what's their education, what's your background, age, all these demographics. So that's really nice to have as well. If you want to move on to the next slide.

What I wanted to spend some time on is what I was asked when Stuart first called me: what has worked in the state of Texas? I will say I've been around a community health workers since before they were certified. And at that time, I was living on the border. And there was a state commission that came and said, let's call you certified community health workers and we're going to be professionals. And I wasn't too keen on that. I was actually one of the people with like the little sign, you know: no certification in Texas. This is terrible, community health workers are beautiful and organic, they come from the community, we're going to lose all that.

And what happened was like the community health workers are saying, Hey, we like this idea of being called professionals. We've been doing the work. We go out there, we work shoulder to shoulder with nurses and doctors. So why shouldn't we be labeled as professionals? Why shouldn't we get a wage? Sometimes, most during that time, community health workers were usually volunteers. I still remember sometimes they get gifts or something. And those were now days gone by, of course, the models spread beyond the border after certification.

There was an educational system that was set up. I think that's one of the primary products that came out of this is for the first time, community health workers had access to training that they did not have access to. Training centers were set up just to provide this education.

It supported research out in the community was very difficult for universities to do research in rural areas. So, basically, they would do research at college universities, you know, they basically researched themselves. But once community health workers were certified, they were able to be hired to go and interact with their own community and ask what their community needs are.

And then, of course, the state office was created, which is very important, because they're the ones that support all the activities of the community health workers here in Texas.

So all in all, it's been a good run. We're now coming on our 20th year of certification in Texas. So, I got a chance to look back and say, well, what could we have done differently or how can it have improved? If we knew then what we know now, what would we do different?

One of the things I noticed is that there's very little support for healthcare organizations, or hospitals of people who employ community health workers. And that might seem counterintuitive, like why they need support their employers? It's that they don't get a lot of support in integrating community health workers. I've seen great community health worker programs within healthcare organizations, and I've seen very bad community health worker programs within organizations. And a lot of that has to do it with the lack of education of the employer. So, more support to organizations letting them know how to integrate community health workers, would be a great service that the program could provide or under new legislation, but does not currently.

In the previous talk, there was mention of this lack of standardization. That's true. If you've seen one community health worker training program, you've seen one community worker training program. Besides the eight core competencies, training programs are provided no guidance as to what a curriculum should be. That was done purposefully for good reason, because the training program should reflect the community that it is in. So, if you would like to have a training program that is based more on breast health navigation, you can do that here in Texas. So, to a certain degree, that lack of standardization, again was done on purpose, but for the same reason, sometimes it's very difficult to gauge quality of education.

There’s also still a big need for community health worker associations, the professional associations, which are very important, but they're unlike like, let's say nursing or physician medical associations. They're able to advocate for themselves quite well, but community health workers are usually on the lower spectrum of the pay grade. So again, working long hours, not a lot of pay, so they don't have the resources to go to Las Vegas and get together and talk about how they're going to further their profession. So, it would be great if the state could support that as well.

One of the things that is not traditionally a part of the community health worker program in Texas, is to talk about so how will community health workers be financed? Having the training that's all well and good, promoting their profession? That's great. But still in Texas, there is, and in many, many states, there’s not a way to reimburse programs that are actually paying, employing community health workers and sometimes that's why pay is so low because they can't get reimbursed for that. So sometimes that comes out of the administration pool, which is very small. So not that the state should pay for community health workers, but they should leave the conversation around round reimbursement for community health workers.

And then the other thing: the community health worker program at the state is very siloed. Just like a lot of them, but community health workers touch so many parts of health, that they should really reach out into the other programs. And that's it for me.

 Great, I think that you provided a lot of context. And I think that last slide, there's a couple of questions I'd like to ask you because I feel like you've definitely showed both sides of the coin, right? There's the pro of standardization. But there's the con of standardization. So you want to be able to have the breast health educators or the screening and outreach coordinators, have that sub specialty. But there's still the need to have some of that standardization because that all will lead to, hopefully, the reimbursement of the service, as now we've shown sort of an aggregate of what value it provides.

So, as you look at that kind of both sides of the coin, what's your sense of where this should go based on your experience? Or where do you feel from different agencies of where they want that to go?

 Well, definitely, the Community Health Worker Program is here in the state of Texas still very much so wanted, and people are still excited about it. It's growing, if it's anything, but at the same time, it needs to change.

Just recently, we started working groups within the state of Texas to talk about, through the advisory board because it has an advisory board, let's talk about financing. Let's talk about how we're going to modernize using technology. We started talking about telehealth and community health workers.

So, the idea is to always be keeping it new, and advancing community health work and supporting them in that way. So it's not so much okay, well, it could be better, let's do something different. Well, it's more of let's keep what we have, just let's just make it better by engaging more people and more importantly, more community health workers.

: So I just want to weigh in, Dr. Klemp and Dr. Guerrero, hearing what has worked well in Texas, and Dr. Guerrero, thank you very much for also sharing where you think you can move forward, we hope in the short term. So, where does that leave us, Dr. Klemp, in New York State? What's a good baseline or a good starting point for community health workers? Not to – I know it's a loaded question, but I know you're going to give us an overview of the scope of practice survey we did with navigators here, and we'll hear it from two public policy experts. But what do you think, just to get us started, and also we'll want to hear from our audience what they think as well because this is important work.

So, my first disclaimer is that I am going to play one on TV, right? So, I'm not an expert in accreditation, I am obviously on the Leadership Council of AONN and have been for about eight years, so I've been watching this movement, and I'm a provider, right. And luckily, in my practice, I'm director of the survivorship program, which I do have a very rural footprint, but my practice has been telehealth for years. So, I work in where I definitely see the need. And but I do not want to own being an expert in accreditation.

So, having done my disclaimer, I feel like I'm torn with two sides, kind of like we just discussed. I feel like there needs to be accreditation and standards around a discipline, because that is what allows us to move the needle forward in oncology, where if we're talking about cancer screening, we're talking about breast cancer, we're moving that forward.

I think the importance of where cancer care is going is something called alternative payment models, which is a bunch of services, navigation being a core piece of that bundle, right? It's sort of the thread that ties on how patients access care. So, if we're going to build into payment models, the need for navigation, care coordination, the community health worker model, then how do we demonstrate that that is done with any consistency if we don't have any standards or accreditation around?

So, I feel like we have to move in that direction in order for people to get paid accordingly and organizations can't just afford to eat all that cost like we talked about. They have to have a budget where that that fits into that. So, putting my business cap on and my clinical cap on I think that's one way to achieve that.

: What do you think Dr. Guerrero, because Dr. Klemp makes a really good point. We can talk about how we achieve greater pay equity for community health workers, certainly, and for patient navigators, but in order to talk about the cost effectiveness, we still need to, particularly for community health workers, talk about the efficacy. And you can't really talk about efficacy unless there are some certification and training standards. I think we would agree that that's important. You’ve got some standards in place and yet you showed us, Dr. Guerrero, the umbrella of the different disciplines within community health workers. So even in the community health worker lane, there are multiple functions, different roles. And so how can we streamline those roles, achieve greater certification, and then we can talk about

 Right. What well, certification really isn't the solution. It's actually the start of something, you have to start with certification. And then you can move towards things like pay equity, and standardization and growth.

And here in Texas, and I think it's very important to note, that just because we have certification, we do not undervalue at all the community health workers that choose not to be certified. That's perfectly fine. There are people that love to work out in the community. They're working with their church and their schools and this is a calling for them.

Certification allows for the community health worker to move into a space where the healthcare field is very special. You have rules and regulations, and they want to move into that space, so, once you pass your certification, then you can start talking about reimbursement. And one of the things about reimbursement that I learned over the years is that for to get reimbursement from insurance, whether it be Medicaid or Medicare or private insurance, basically there's two types of caps. There's the administration cap, which is basically just like 10% to pay, for like the CEO because we don't want the CEO to be making $5 million, and things like that. And then the other 90% is for reimbursement.

Community health workers, because they don't have that financing and they’re not in that reimbursement model, you have to pay them out of that 10%. And so, until you have certification, and then move forward to talk about reimbursement, and you can't talk about reimbursement without certification, then you can move into that 90% of finance and get out of that 10% admin.

 And can I just follow up with that too, real quick before we transition to the scope of practice? How do your advocates feel? So you know, if you talk about it from the stakeholder of the community health worker, and then let's talk about it from the stakeholder of maybe our advocacy groups or professional organizations, what is their feeling in Texas? And how do they either help push things or, you know, kind of what's their role in this?

 Well, again, talking about community health worker associations, it's important that we help community health workers advocate for themselves, because then after a while advocates are really talking about what their interests are, which, community health worker is, is a part of that but again, I go back to my history when I was like, we love community health workers, they’re so natural, they come from the community, you know. But then the community health workers were like hey, we're not getting paid, you know?

So, I think it's important that community health workers speak for themselves. And that advocates, that's the best way they can help is to support community health workers, that they use their own voice, and at the same time, educate them as to how the health industry works.

When we talk about these financing models, you might think that well, community health workers, they're not going to understand, that they 

 if you spend the time, so they have to be at the table.

And that's why here in Texas, the advisory board for the state, a community health worker program passed to consist of 51% community health workers, because we never want to lose that we can't lose that voice, or else we'll get lost and all the financing lingo and things like that, and so we definitely don't want to lose that. We want to protect that original and keep the spirit of the community health worker, no matter what model gets chosen, because it's no good if we find a great financing model, but we've basically washed away everything that makes a community health worker, a community health worker.

At the 4th Annual Patient Navigation Town Hall "Empowering and Mobilizing Our Patient Navigation Workforce", we provide you insight into how to get properly certified as a patient or nurse navigator.

Certification For Community Health Workers

Patient navigators are the vaunted “healthcare emissaries” for patients with breast cancer and can help navigate their journey a great deal. In this conversation from the Susan G. Komen Greater New York City “Empowering and Mobilizing Our Patient Navigation Workforce” virtual conference experts highlight the results of a survey of patient navigators.

This is actually a good segue to the scope of practice survey that Komen Greater New York City conducted with 250 patient navigators of all stripes earlier this year, and Dr. Klemp is going to give us a snapshot of where patient navigation stands in our service area and in Greater New York City. So over to you, Dr. Klemp.

 Well, as we talked about metrics are very important. And when Stewart described the survey, that's part of knowing your community. And I think the important part about these snapshots - and there's a lot of information I know that the Greater New York City affiliate will share more of this information - but we took out some of the key highlights that we thought were helpful and important, and the first was really, what type of navigators were out there and responded to the survey?

So about 41% have listed themselves as community health workers, and another 22% (identified as) lay navigators in a hospital setting. So about 65% were more of the lay or patient navigator of working more in the field, or not in a specialty or having a nursing background.

We also saw nurse navigation being a small piece, but when we go to the third bar down, so down here, we still see that a lot of this group is undergoing the different certifications that are available. So, we know through AONN and NCBC, you have certification for both nurse and non-nurse, or licensed or non-licensed, and there's a lot of different discussions around semantics. And I think that as we just heard, many community health workers, maybe they don't want to go through certification. That, I think, has the same semantics as the licensed and non-licensed. So, I don't want to speak on behalf of community health workers or lay navigators, but I think these are important semantics to be mindful of, because it shows that that a large percentage of respondents do have some sort of certification, do have some sort of degree that really supports their role and their scope of practice, but there are some, I think, nuances of how that fits into how they view themselves and the role that they play.

I think another important piece that you highlighted in your needs assessment is how young the field of navigation still is. If you look at those of us who work in oncology, we're an old workforce, right? We are an aging, shrinking workforce. And so, I didn't know when I converted that bucket, but apparently I have. So, I'm in the older bucket now. And so, when you think about those of us who've been in practice 20+ years, that's a shrinking percentage and a smaller piece of the workforce, whereas many of those drawn to fields of navigation or community health work, they're younger, and they're newer in their practice. Or, we see a lot of transition from someone who worked in a particular field or scope, and then they convert over. So, I think that these are important things to think about because we can always reinvent ourselves, but the other important piece is, well, what are the tools that we have available to help them as they sort of, reinvigorate their careers or start their careers in navigation or community health workers?

We do see a lot of across the board range in salary. This usually is a component of years in practice versus amount of education versus the type of employment. So, I think you're always going to have, as we said, sort of a pretty big range when it comes to salary. And I think that a lot of individuals work in a variety of types of organizations. Many, because probably responding to a common survey, are going to work in breast health outreach and screening. We also know that a lot of work for other community or hospital-based organizations extending that reach and care. We had a nice distribution. I probably I think our previous speaker, Karen, had something to do with your Westchester County response or, or maybe you had a bigger presence. But this is, you know, a nice distribution of respondents based on the counties that they work in and overlap.

And then, I think the other piece is do they follow any standards or reporting? So majority, a significant majority, almost 70% said yes, that they do follow some standards. So, I think the interesting part would be, okay, where do those standards come from? Are they from the employer? Are they from a professional organization they do align with? Is it from the discipline that they work within the scope of practice? So, there are some standards being followed. And I think when you already have that precedent, kind of, like we heard, from the previous discussion, then that really sets the foreground for the need for that standardization, because that's what helps people build their scope of practice, guide their principles, and help achieve the goals laid out for patient care.

And then the other piece that I think is a common problem for all of us, and even more so, by this pie chart in the top left, is how do people report this? How are they documenting? Documentation Is the bane of our existence oftentimes, right? So maybe we're documenting in a health record, but then we have to keep track in an Excel spreadsheet or a database. So there's often this duplicative sort of role of how we document something for direct patient care, versus where are we documenting the outcomes, and the metrics we need to document and it sure would be nice if they were the same, but that that's not often the case. And so that goes to that piece we talked about with compassion fatigue, which is increasing administrative duties, where we're spending more time doing documentation, then we are often sometimes doing that direct patient care.

Who do they share data with? You see a variety of where those metrics are being shared: from agencies, probably funders, obviously health insurance companies are a large group of that. With the care team, the oncologist the medical patient physician's assistant, PNPs. And so I think the important piece is that we do need to know what is required and why we're collecting the data. I assume because there's only a small percentage that required patient consent, that most of this is de-identified or it had better be, right? De-identified data, which is going to these entities, but maybe to a health insurance company, it's not it's actually identified data, or if it's to the healthcare team, it's identified data. So what are the metrics or standards around that? You know, do we have a standard of how we get consent from patients, whether that'd be oral or written? I think that's an interesting question and something to flesh out.

We also see a variety of types of professional training or formal programs from sort of self-taught classes that we take online to internships, on the job, and we do know that most of the of the experience that we get in healthcare is still on the job, right? You can be trained, and you can have a degree, but what you're going to learn is on the job, and with a younger workforce in navigation and community health workers, we don't have as many seasoned or experienced professionals that are part of that ‘train the trainer’. So I think that that could be enhanced as part of this. But it's, it's once again buried.

And then how do they get updates? And we talked about this with, with I think, our third session today, where we really asked, how are we pushing out this professional development and updated need to know information? And where are we getting these updates and how often are we getting updates for training? This is pretty varied as well. So, the accreditation standard maybe every two years, but that still means we have an online need for professional development. So where are we getting that? Are we getting it through organizations like AONN or other nursing or professional organizations? This is an important piece to think about too.

And then lastly, I think as we start thinking about, you know, how are we communicating?

So, we look at how we're communicating with our patients. A lot is already, you know, sort of phone contact telehealth. But now we're converting to more video-based, requiring more training of our patients and our staff.

The social determinants of health, I think are really important. What are the issues influencing our ability to support patients and economic stability, education. There's some consistent messages that we see, but these are pretty high bars. And so, what we realize is that there's some common barriers. And those social determinants to health are really important factors. Some of those we can help with, some we can't. And, you know, control is a big piece of us being able to support our constituents. And I think the important part about that slide is there some pretty big barriers in regard to economics, insurance, and so forth, that really are influencing that access.

And then lastly, this insurance status which also is pretty varied, shows a lack - under insurance or lack of insurance. And so that requires obviously utilizing a variety of different sources, from helping people onboard to programs that would be available to organizations that will support those who are under or uninsured. And so this requires a real community approach to access to screening and other types of services that are necessary in direct patient care.

So I think you know, as we look at that needs assessment, that Komen undertook, I think that we learn a lot about the community that you're serving, we learn a lot about the struggles and the challenges that the workforce is having, and I think it's very informative as individuals or organizations are watching this, whether you'd be from New York or other areas, of how this type of information can really empower and inform the strategies we need to take together.

And as we heard from Rosalia, you know, communities have different needs. And you've seen one program, you've seen one program. So, the importance of knowing your community is huge. The importance of having some standards is also huge because it helps us with those, those greater goals of reimbursement and so forth. So, we still have the need for individual community understanding and deployment, while we have the need for this standardization. I think that that balance is something that we'll continue to work on. But I appreciate this data and the effort that went into collecting this to help us really understand this picture and paint that picture for us. So Stuart, did you want to make any additional comments, or Rosalia on, you know, the data we just saw?

Thank you Dr. Klemp, really appreciate it. Speaking of data, I just want to get your thoughts. Both of your thoughts, briefly, about data collection process improvements for data collection navigators are there at every intervention, from the first proactive encounter through to diagnosis and beyond? I know that electronic medical record portability is always an issue. Any thoughts on what we can do, since we're talking about process improvements and standards, specifically for this workforce, on what we can be doing to better track patients throughout the care continuum?

: I would say one thing that I've seen in programs across the country and that's one advantage I've had lately as I get to see how people are really delivering care, is that oftentimes if they're using a separate software, or even if we're in the same health record, you know, it's not always evident to the provider what interactions happen.

And so, just to give an example, whether you're using one of the largest EMRs, like we use, you know, there's different permissions for different types of people. So, to give you an example, our navigators, were doing a distress screener, but the providers couldn't see the distress screener. So, it doesn't do a whole lot of good to do a needs assessment or an intake, and then the people who are caring for the patient on this other side, can't even see what happened. So there's a need for permissions within the EMR so that we can see what other people are doing.

And then the documentation if you're using another maybe navigation or health worker-type software, if your other care team can't see that, they don't know what you did. And just sending a note over here doesn't work. Because people never get to see, it seems like it gets lost in the abyss. So, I think that there has to be some place where everybody who cares for a patient will ultimately be able to see what the other person's doing. And Rosalie, I don't know why you thought that either?

: Yes, I agree. I think technology is great, as long as it's used correctly, what it's being used for. Another thing I would add, is also here in Texas, we work a lot of integrating community health workers on health care teams. So, I think a lot of us would like to say that, oh, yeah, community health care workers are part of our team, but we really need to make sure that we, again, hear their voice and teach our providers how to put value on the stories that community health workers talk about. They're very powerful, and can lead to better quality of care if we listen to the folks that are working most intimately with our patients.

So yes, it's technology. But also listening to community health workers, getting their feedback and making sure that they're an essential part of that of that healthcare team.

And so, Dr. Guerrero, is technology starting to capture those stories in a way that can impact care overall?

 Well, I think it's hard, especially when you're dealing with so many patients, and sometimes we get used to saying that, well, someone fell between the cracks. And that's not acceptable because especially when it's your mom or your sister or somebody you don't like to hear that.

But I think community health workers, they are ultimately advocates, and they're the ones when they see someone falling, they will speak up, we just have to listen to them. And sometimes, yeah, technology sometimes can't capture everything, but bbsolutely, it's important that be used wisely.

Dr. Klemp, any more thoughts? This has been fascinating.

: It has been. I think it shows that we need to learn from some of those who've gone before us, but there's also an enormous amount of work to do. And I think that's one reason that that, I know one of your goals, Stuart, and one of the greater NYC affiliates’ goals of this town hall, is to sort of put some frame or some sort of next steps on what could happen or should be happening. And I commend you for bringing this discussion together, because it really shows that this conversation needs to continue, and it needs some structure to do that.

Articles

Patient navigators are the vaunted “healthcare emissaries” for patients with breast cancer and can help navigate their journey a great deal. In this conversation from the Susan G. Komen Greater New York City “Empowering and Mobilizing Our Patient Navigation Workforce” virtual conference experts highlight the results of a survey of patient navigators.
 

Knowing Your Community of Patient Navigators

Susan G. Komen Greater NYC is dedicated to connecting with our community during this challenging period of isolation. We are providing a weekly newsletter filled with virtual resources, new developments, events, articles, and valuable information that keeps our community members linked and up to date!

Stay connected during these challenging times and keep up with all the news and updates from Susan G. Kommen Greater NYC by signing up for our latest newsletter! 

Stay Connected During COVID-19

Breast cancer treatment today is no longer “one size fits all”—what is best for one woman may not be right for another. It’s important to learn as much as possible about your individual breast cancer diagnosis when making a treatment decision. For some patients, a genomic test can help determine whether chemotherapy is necessary in addition to hormone therapy to treat breast cancer and help prevent future recurrences.

Numerous studies, including the landmark TAILORx trial of over 10,000 women using the Oncotype DX® genomic test, demonstrate that the vast majority of women with early-stage, hormone-receptor-positive, HER2-negative breast cancer do not need chemotherapy, according to research from

. These types of tests have been available for more than a decade, but some breast cancer patients aren’t offered this important tool.

A recent study from the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) Registry looked at how often early-stage breast cancer patients were receiving a genomic test to help guide their treatment decisions. With more than 44,600 patients in the SEER study, results revealed that age was a factor influencing whether or not a woman received a genomic test. In fact, genomic testing rates decreased 1.5-fold in younger (under 40) patients and 3-fold in older (over 70) patients when compared to the “typical” age breast cancer patient (ages 40-70), according to 

Traditional assumptions about age, breast cancer aggressiveness, and health may have impacted these patient’s treatment plans — assumptions that all younger breast cancer patients have more aggressive disease and that older breast cancer patients either can’t tolerate or don’t need chemotherapy – resulting in the potential over-treatment or under-treatment of a patient’s breast cancer. It is important to recognize that not all cancers are the same.

No Matter My Age was created to help educate and raise awareness about the need for all breast cancer patients — regardless of their age – to get as much information as they can before making a treatment decision.

This means learning how to self-advocate and to ask questions about care options, including whether a genomic test may help determine the best treatment plan. To learn more, visit No Matter My Age. 

Know your cancer before making a treatment decision.
 

Age Bias is a Problem for Patients With Breast Cancer

&#8203;Susan G. Komen Greater NYC will host the first annual Westchester Metastatic Breast Cancer Conference in conjunction with Pace University on Saturday, November 9, 2019, from 8:15 am to 3:15 pm at the &#8203;Kessel Student Center, GottesmanRoom, PaceUniversity,&#8203;&#8203;8&#8203; 61BedfordRoad, Pleasantville, NY10570.

The &#8203;Westchester Metastatic Breast Cancer Conference&#8203;will provide patients living with stage IV/metastatic breast cancer with critical information on new and emerging treatments, integrative therapies and how to live well with advanced breast cancer. Attendees will enjoy a day of making connections, expanding resources, feeling empowered and being part of a caring community of breast cancer thrivers. &#8203;Patrick Borgen, MD,&#8203;&#8203;Maimonides Medical Center, and Northwell Health, is Conference Chair.

The distinguished conference faculty includes&#8203;&#8203;Barry Boyd, MD,&#8203;Yale Health System, &#8203;Chau Dang, MD,&#8203;&#8203;Memorial Sloan Kettering Cancer Center, Michelle C. Espinoza, MD,&#8203;&#8203;Northwell Health,&#8203;&#8203;Anna Komorowski, MD,&#8203;Northwell Health,&#8203;&#8203;Alice Police, MD,&#8203;&#8203;Northwell Health, &#8203;Joseph Sparano, MD,&#8203;&#8203;Montefiore Medical Center, and &#8203;Linda Vahdat, MD,&#8203;&#8203;Memorial Sloan Kettering Cancer Center.

Attendance is free.&#8203;&#8203;Advanced registration is required.&#8203;Register at k&#8203;omennyc.org/wmbcc.&#8203;

The Westchester Metastatic Breast Cancer Conference is made possible by &#8203;&#8203;Amgen Oncology,&#8203; Athenex Oncology,&#8203;&#8203;Genentech&#8203;&#8203;and &#8203;Pace University.&#8203;

About Susan G. Komen Greater New York City

Founded in 1990, Susan G. Komen Greater NYC invests in medical research to find the cures and empowers a wide range of community-based programming to provide critical breast cancer services to medically underserved communities.

Susan G. Komen NYC works to remove disparities in access to care to help ensure that where you live and the color of your skin does not determine whether you live. For more information, please visit&#8203;&#8203;www.komennyc.org.&#8203; 

&#8203;A first of its kind in Westchester, this conference will provide patients, caregivers and medical professionals with critical information on treatments and living well with advanced breast cancer.

Komen Greater NYC to Host Daylong Conference or Patients With Metastatic Breast Cancer at Pace University Featuring Renowned Breast Cancer Researchers and Clinicians