U-M Comprehensive Cancer Center works to eliminate racial, ethnic health disparities
Regina Kelley and Vanessa Smith take turns leading the Saturday morning exercise class in the Ann Arbor Bethel A.M.E. Church multipurpose room. They wear matching red T-shirts, bedazzled by rhinestones spelling "GAP," shorthand for "God Answers Prayers." They call out the steps choreographed to a mix of rhythm and blues and gospel music. While other exercise teachers might remind their classes to breathe, Kelley and Smith don't need to. The class quietly sings along to the music, punctuating grapevines with claps and snaps.
The class is an extension of Body & Soul, a program designed by the National Institutes of Health to encourage African-American churches to help the members of their congregations adopt healthier lifestyles to prevent cancer and other diseases. Ann Arbor Bethel A.M.E. is one of 14 churches that partner with the University of Michigan Comprehensive Cancer Center through Body & Soul.
"It's part of our duty as Christians to stay healthy," said Bonita Cowan-Tucker, a coordinator of the Health and Wellness Ministry at Ann Arbor Bethel A.M.E. "We tell our members, 'You can't help anyone else if you need help because you're sick.'"
The Body & Soul program is one of many activities under way at the U-M Comprehensive Cancer Center that seek to address health disparities. Cancer statistics show that African-Americans, Asian-Americans, Latinos and Native Americans are at higher risk for certain cancers and suffer disproportionately high death rates. The reasons for these disparities are complex. But through a combination of community outreach and research, the Cancer Center seeks to better understand these trends and reverse them. Here's a look at some of the work under way.
CONNECTING THE COMMUNITY
For Bonita Cowan-Tucker of Ann Arbor Bethel A.M.E. Church, the goal is to encourage members of her church to make gradual changes to improve their health. Body & Soul has helped by providing structure for the church's health initiatives, she said. In addition to the exercise class, the ministry prints educational information in the church bulletin, organizes an annual five-mile walk, conducts regular blood pressure checks and hosts speakers.
That's just the kind of work that Body & Soul is designed to foster, said Aisha Langford, director of community outreach for the U-M Comprehensive Cancer Center. Since 2005, the Cancer Center has provided training for church coordinators as well as educational materials and support through quarterly meetings. A regular Men's Fellowship Breakfast that aims to promote prostate cancer screening among African-American men has also evolved through collaboration with area churches.
"Our health ministry teams say health education is becoming more engrained in churches," Langford said. "Health behavior is slow to change, but there definitely has been some progress. Conventional wisdom says that men don't pay attention to their health and that African-American men won't turn out for health events. Our Men's Fellowship Breakfast has proved that wrong."
The U-M Cancer Center's Community Outreach team hosts a number of other events designed to include minorities, including cancer screenings and Da de la Familia, an event to promote cancer awareness among Latinos.
SPEAKING UP ABOUT PAIN
For minorities, women and older adults, cancer pain is less likely to be assessed, according to Carmen R. Green, M.D., a professor at the U-M Medical School and a pain medicine physician at the U-M Cancer Center. And even if it is, minorities and women are more likely to receive suboptimal treatment.
Green says the reasons for this are unclear: Are minorities, women and older adults less likely to complain about pain to providers? Do myths about pain prevent them from seeking treatment? Do they have less access to care? Are providers dismissing their complaints? One study has suggested that pharmacies in minority neighborhoods may be less likely to carry prescription pain medications, but more research is necessary to understand the full nature of the problem.
In the meantime, Green is seeking to educate people about the importance of pain management. Pain robs patients of their health and well-being, but many treatment options are available, from physical therapy to nerve blocks. Green encourages patients to talk to their providers about pain.
"We also need to be engaged in public policy at a national level," Green said. "Our country only spends a small percentage of research dollars on pain, and with more people surviving cancer, we're likely to see a pain epidemic. As a society, we need to hear firsthand from patients why this is an important issue."
As Green's research indicates, communication breakdowns may be occurring between minority patients and their healthcare teams. Sarah Hawley, Ph.D., M.P.H., an associate professor of internal medicine at the U-M Comprehensive Cancer Center, has surveyed breast cancer patients to determine how much they understand about concepts related to their diagnosis.
Her study found that all patients had gaps in understanding, but it was worse among African-Americans and Latinas. In addition, a separate study of Hawley's has shown that Latina women -- many of whom primarily spoke Spanish -- who were less integrated into American society were more likely to be dissatisfied or regret treatment decisions.
"To make an informed decision about surgery or other treatment options, you have to be able to understand the risks and benefits," Hawley said. "We know that people of different cultures receive information differently. We know there are opportunities to improve the way healthcare providers communicate, even among the general population."
Hawley's group is piloting a Web-based intervention that will help patients at the U-M Cancer Center and the Karmanos Cancer Institute in Detroit consider the risks and benefits of treatment options. She is also working on another study to record doctor-patient conversations to analyze differences in communication styles among white, African-American and Latina patients.
What Can You Do?We asked our researchers what patients can do to help prevent health disparities. Here's what they said.
- If you don't understand something -- or you want to understand something better -- ask your doctor to explain it again. If you're feeling rushed, ask your doctor to slow down.
- Bring someone with you to your appointment so you can compare notes and discuss your situation later.
- Speak up about how you're feeling. If you're experiencing pain, make sure you tell your doctor.
- Join an advocacy group to help educate members of your community about cancer.
- Participate in a U-M Comprehensive Cancer Center Community Outreach event.
SMALL CHANGES, BIG GAINS
Arden Morris, M.D., M.P.H., associate professor of surgery at the U-M Comprehensive Cancer Center, conducted a study of Medicare patients with colorectal cancer that showed that African-Americans were 23 percent less likely than whites to receive chemotherapy after surgery. All had access to care through Medicare. Whites and African-Americans were equally likely to see an oncologist after surgery, but African-Americans did not go on to receive chemotherapy.
Morris conducted a focus group in Detroit with African-Americans and whites, and preliminary results show that even though neither group fully understood why chemotherapy was recommended, whites were more likely to go ahead with it anyway. African-Americans wanted to understand why they needed more treatment before deciding to proceed with chemotherapy.
With this new information, Morris said, a simple intervention can be developed. Doctors could be trained to have patients repeat back their recommendations after a conversation to prevent misunderstandings. Over time, this may help doctors improve the way they communicate with patients.
"I think a lot of providers would be stunned to hear what patients believe," Morris said. "I really believe providers want to provide the best care. The problem is, they don't realize how little patients are taking away from the conversation."