Cancer is a significant health problem in Virginia, impacting the physical, emotional, economic, and social well-being of individuals, their families, and communities. An average of 32,769 Virginia residents are diagnosed with cancer annually, with an average of 13,891 succumbing to their disease. Cancer was the leading cause of death in Virginia in 2007, surpassing heart disease. Virginia is poised to combat this disease with healthcare institutions, cancer care centers, state education and research institutions, city and state governments, non-profit organizations, and grass-roots community groups working to reduce the cancer burden in the State. In addition, a statewide network of partners, the Cancer Action Coalition of Virginia (CACV), has developed a State five year cancer plan since 2001 to help unify and direct the efforts of these organizations in combating cancer.
Virginia is a highly diverse state in geography, population demographics, economics and access to healthcare. With a land mass of 40,000 square miles that spans from the shores of the Atlantic to the hills of the Appalachian Mountains, there are varying degrees of knowledge of and access to healthcare. For cancer prevention and control efforts to be effective they, “must be complete, comprehensive, sustainable, community-specific, and culturally and linguistically appropriate.” To accomplish this, a comprehensive cancer needs assessment specific to four communities defined by health district was performed by VCU Massey Cancer Center in collaboration with the Virginia TICRC.
Cancer needs assessments of the four communities are available at the links below:
- Crater Health District
- Piedmont Health District
- Pittsylvania/Danville Health District
- Mount Rogers Health District
These districts have a relatively high cancer burden and large medically-underserved areas. The comprehensive assessment of cancer needs specific to each community will be used to develop a holistic strategy to improve cancer outcomes, and will utilize strategies that are culturally appropriate to these communities. As part of this strategy, funding is being offered to research scientists at VCU for research projects that address one or more of the needs identified in the needs assessments. Project activities must occur within one or more of the four health districts, and engage community resources in the research.
Cancer needs were assessed in three broad categories:
- Deficiencies in cancer detection and treatment services, both facilities and healthcare personnel, in the health district
- Community resources needed for preventive health education and support of cancer patients and caregivers
- Primary care physician needs related to continuing education and continuity of care during and after patient cancer treatment.
The findings from each health district revealed some similarities of need, as well as needs distinct to the individual district. A brief description of the distinctive demographic characteristics of each and a synopsis of needs is provided below.
Demographics by health districts
- Mount Rogers Health District is composed of six counties and two cities. It has a population of 183,442 that is predominantly white (95%). Average median household income is lower than the State, as is attainment of a Bachelor’s degree or above (14% vs. 29.5%). All counties and the City of Bristol are designated Medically Underserved by the US Department of Health and Human Services. All counties are designated “rural localities,” except Washington County/Bristol, which is designated a “Rural Urban Commuting Area.”
- Pittsylvania/Danville is a single county and the city of Danville. It has a population of 63,506 in the county and 43,055 in the city with a racial mix of 66% white and 31% black. Average median household income is lower in the city than the county, and both are lower than the State average. Both the county and city lag behind the State in attainment of a college degree (13% & 15.7% respectively). The county is considered mixed rural: census tracts south of Chatham are non-rural; north of Chatham is a Rural Urban Commuting Area (RUCA).
- Piedmont Health District is composed of seven counties. It has a population of 104,609 with a racial mix of 65% white and 33% black. Average median household income is lower than the State, as is attainment of a Bachelor’s degree or above (12% vs. 29.5%). Percent of the population without a high school education is at 28%. All seven counties are designated Medically Underserved,v and all but Amelia county and parts of Cumberland county are designated rural.
- Crater Health District is composed of five counties and three cities. It has a population of 122,193 with a racial mix of 47% white and 48% black. Average median household income is lower than the State, with the cities of Petersburg and Emporia having the lowest incomes, as well as the highest unemployment (12.8% & 11.9%). The health district has both a higher percentage of adults without a high school education, and a lower percentage of adults with Bachelor’s degree or above, compared to the State. The county of Greensville has the greatest disparity in both these measures of educational attainment (34.9% & 4.8%). Three quarters of the health district is designated as Medically Underserved, and one quarter are designated rural.
Needs identified across all four health districts
- Oncologist services. Shortage of oncologists treating in the area was universally expressed. In the case of Mount Rogers, the need was for oncology specialists. Piedmont had the greatest need, with no oncologists living in the health district; oncologists travel there 3 days a week to provide chemotherapy. Pittsylvania/Danville is understaffed with oncologists, resulting in long waits for appointments and treatment.
- Primary care physicians. Consistent with the Medically Underserved Designation of these health districts, a need for additional PCP services was expressed universally, particularly in the more rural areas of the health districts.
- Patient navigation. All health districts expressed a need for a system to provide patient navigation from screening to resolution of disease for all cancers.
- Central cancer information center. All health districts expressed the need for a central information center to which both healthcare providers, patients, and the general public could refer to get information related to cancer resources of all kinds in the community, and cancer information. This is being partially met in Pittsylvania/Danville with the newly established Cancer Resource Center.
- Cancer support groups. There was an expressed need for support groups for cancer patients and caregivers. There were two areas of need, development of a support group structure that meets the needs of the rural community in which they would function, and training of local individuals on the steps to establishing and maintaining an effective support group.
- Strategies to effectively address systemic barriers to healthy living. Barriers to healthy diet and exercise identified included the ready access to fast food and lack of access to healthier food choices (financial and access barriers), lack of affordable and safe areas for exercise, lack of community campaigns and local laws to promote smoking cessation.
- Development and implementation of education programs that are integrated into the school curriculum. All health districts emphasized the need to begin education for healthy lifestyles early in life, and that it should continue across the age spectrum.
- Primary care physician continuing education. Physicians from all health districts requested continuing education about cancer screening guidelines, particularly ovarian, colorectal, breast and lung.
- Additional areas of continuing education need included pain management, surveillance of cancer recurrence, and long-term effects of cancer treatment. Piedmont and Pittsylvania/Danville had a particular need for continuing education related to pain management and palliative care.
- Effective oncologist to primary care physician communication. Only 30% of physicians indicated that they received satisfactory communication “almost always” from oncologists treating their patients. Types of communication found to be most helpful were the initial treatment plan, follow up care guidelines, and the end of treatment notes.
Needs specific to particular health districts
- Additional cancer screening and treatment facilities. The Piedmont Health District has very limited cancer screening and treatment services available. Mount Rogers Health District requires additional services in the rural areas of the district – Grayson, Carroll, Bland counties, and Galax city.
- Systems for coordination of cancer care between local treating physicians. The Crater Health District has a specific need for improved collaboration between treating physicians within the health district.
- Improved patient to physician communication. The Crater Health District identified a general lack of understanding between the patient population and their treating physicians. Education of both the patients and physicians to improve communication was expressed as a need.
- Promotion of cancer services available locally. Both the Crater Health District and Mount Rogers Health Districts felt that services available were being underutilized.
- Education about hospice services and timing of utilization. Crater, Pittsylvania/Danville, and Piedmont Health Districts have hospice services available, however the culture within these health districts has resulted in under utilization or inappropriate timing of usage. Education of both the population and healthcare providers about hospice to correct incorrect perceptions was identified as a need.
- Societal behavioral change interventions. Mount Rogers, Pittsylvania/Danville and Piedmont Health Districts identified the need for aggressive campaigns to change a societal attitude about preventive dietary, exercise, and tobacco use behaviors.
- Coordination of community organization activities related to cancer. The Crater Health District recognized a need to unite community organizations in existence that were providing services to cancer patients and caregivers, to collaborate on these services for maximal utilization of resources.
- Innovative solutions to transportation difficulties. The long distance required to travel for residents of the Piedmont Health District to get cancer screenings and receive cancer treatment represents a substantial barrier to care. The difficulties posed in terms of cost, as well as adverse effects on employment and, consequently, health insurance is substantial.
- Skin cancer prevention awareness campaigns. The high incidence of skin cancer in the Mount Rogers Health District was identified as an area of concern. Due to the large at risk population in this district, education campaigns on the prevention of skin cancer were identified as a need particular to this district.
- Community engagement in cancer clinical research and increased availability. The Mount Rogers and Piedmont Health Districts were particularly in need of both community education around cancer clinical research and the development of systems to make cancer clinical trials available to cancer patients.
From the results identified above, the following priority areas in response to the current call for proposals have been identified:
- Development and/or evaluation of models of effective community cancer information resource systems
- Development and/or evaluation of cancer support group models specific for the rural setting
Continuing cancer education systems that meet the needs of community physicians
- Implementation/testing of systems of communication between treating oncologists and community physicians
- Innovative approaches to the physician shortage in rural and economically stressed communities
- Innovations in preventive health public education across the age spectrum. Emphasis on tobacco use, nutrition/obesity, physical activity, and cancer screening
Development and/or evaluation of community-based models for meeting the practical needs of cancer patients and caregivers (i.e. transportation, medical expenses, daily living, etc.)
- Projects addressing the community concerns related to cancer causing toxins in the environment
- Development of strategies to increase clinical trial access in underserved communities