Breast
cancer is a disease that knows no ethnic, socioeconomic,
age, gender or cultural boundaries. Surviving breast
cancer, however, is a more uneven experience.
In 1999, an estimated 19,910 women and
145 men in California were diagnosed with the disease. Among
the estimated 4,640 people who died from breast cancer in
California in 1999, a disproportionate number were poor,
older women with inadequate or no medical insurance;
Latinas and African-American women were over-represented in
this group.
Source: American Cancer Society, 1999.
A wide range of factors contribute to
the high rate of mortality among economically disadvantaged
women:
Low Access to Preventive Health Care:
Medically uninsured women typically have low access to
preventive health care, including information on breast
self-examination, cancer screening and nutrition/healthy
lifestyles. They often seek medical care only under extreme
conditions and in emergency room settings. Once an indigent
woman is diagnosed with breast cancer, it is more likely to
be at an advanced stage of the disease, when prognosis is
poor and treatment options are limited.
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Barriers to Timely Treatment and
Support: Indigent women who receive their medical
care at overcrowded, understaffed county clinics and
hospitals must frequently endure long delays between the
clinical discovery of a suspicious mass and the
scheduling of a biopsy and/or definitive treatment.
Discouraged and afraid, many women do not return for
treatment. Follow-up is often difficult due to patients'
lack of telephone service and/or a permanent address.
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Language and Cultural Barriers:
Low-income patients who may be immigrants or members of
racial/ethnic minority groups often do not receive
breast cancer education and treatment information in
their preferred language, at an appropriate literacy
level and/or in a culturally sensitive format. Without
fully understanding their treatment options, these women
are significantly challenged to arrive at prudent and
timely decisions regarding their medical care. Health
care practitioners may also lack awareness, skill and
experience to address the unique cultural issues which
breast cancer patients and their families face.
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A Unique Set of Fears: While a
breast cancer diagnosis is devastating news to anyone,
it may evoke particular fear in poor, immigrant women
from less developed countries where breast cancer
survival rates are considerably lower. Undocumented
immigrants may also be reluctant to enter breast cancer
treatment, fearing they will be reported to the INS and
deported. Indigent women may lack experience as
self-advocates and be reluctant to ask their health care
providers questions, seek second opinions and play an
active role in their treatment and recovery process.
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Lack of Psychosocial Support:
Poor women with breast cancer are frequently isolated
from reliable sources of social and psychological
support, making it difficult for them to arrive at
decisions regarding treatment options and follow through
with treatment regimens. Concerns about missing work,
not being able to care for their children during and
after surgery and the lack of transportation may
influence treatment decisions and compromise patients'
timely medical care and compliance with treatment
protocols. 
The Need for a Comprehensive Program
of Information, Advocacy and Peer Support for Medically
Underserved and Indigent Breast Cancer Patients
Strategic relationships are in place at
the state level between WIN Against Breast Cancer (WIN ABC)
and the California Department of Health Services (DHS)
Breast Cancer Early Detection Program (CA BCEDP), Breast and
Cervical Cancer Control Program (BCCCP) the California
Health Collaborative/Breast Cancer Treatment Fund (CA BCTF)
and the American Cancer Society (ACS) in efforts to increase
access to high quality screening, care and treatment
services for breast cancer patients, regardless of their
ability to pay. WIN ABC's Breast Buddy Breast Care Program
for the Indigent and Underserved is a product of this
collaborative alliance and will involve these entities and
their local affiliates.
The California Department of Health
Services Breast Cancer Early Detection Program offers new
hope for the reduction of breast cancer mortality among
uninsured, underinsured and low-income women. Together with
the federally funded Breast and Cervical Cancer Control
Program, BCEDP provides breast cancer screening and
diagnostic services, free of charge. In addition, 14
California DHS-funded Regional Partnerships throughout the
state have launched programs to develop resources for
women's breast care in their communities through local
networks of medical care, public education and support
service providers. An estimated 1,200 women will be
diagnosed with breast cancer in each year of these combined
programs.
California is taking a leadership role in
the fight against breast cancer by emphasizing a triad of
services -- early detection, treatment and psychosocial
support. While funding is in place for breast cancer
screening and medical treatment through the CA BCEDP and CA
BC Treatment Fund, interviews with key public health
administrators reveal that there is no statewide program to
meet the informational and psychosocial needs of underserved
and indigent patients diagnosed with breast cancer in
California. Given the critical role that timely, accurate
information and psychosocial support play in a patient's
fight against breast cancer, a comprehensive program of
information, advocacy, self-help and peer support is
urgently needed.
WIN Against Breast Cancer is committed to
collaborating with the CA BCEDP, its 14 Regional
Partnerships, the CA BC Treatment Fund and the American
Cancer Society in an initiative that will extend WIN ABC's
successful Breast Buddy Breast Care Program to medically
underserved and indigent breast cancer patients throughout
California. Due to the diversity and size of its low-income
population, Los Angeles County was selected as the locus of
the two-year pilot program.
The Breast Buddy® Program for Indigent and Underserved
has Been Designed To:
1) Define a new standard of care, education and support
for underserved breast cancer patients.
2) Build strategic community relationships.
3) Develop effective community outreach strategies.
4) Develop culturally sensitive, linguistically
appropriate patient education materials.
5) Strengthen hospital leadership to improve the capacity
and functioning of systems that impact breast cancer care.
6) Change the culture in which breast cancer care is
delivered to underserved patients by creating an integrated
and seamless system of services.
Completed Planning Process
WIN ABC laid the necessary groundwork for
the proposed program through a planning grant from Blue
Cross of California's California HealthCare Partnerships.
Critical planning activities included:
Key informant interviews with
state and local Los Angeles County representatives of the
Department of Health Services, the CA BCED Program and CA BC
Treatment Fund to identify significant areas of need,
barriers to care and opportunities for collaboration to
improve breast cancer treatment, support and follow-up care
for medically underserved and indigent individuals.
Site visits and planning meetings
with key staff at the four hospital facilities that provide
breast cancer screening and treatment services to indigent
patients in Los Angeles County for the BCEDP Regional
Partnership and CA BCTF: 1) Martin Luther King (MLK) Drew
Medical Center, 2) Harbor-UCLA Medical Center, 3) Los
Angeles County-University of Southern California (LAC USC)
Medical Center and 4) Olive View Medical Center.
Program Design
The Breast Buddy Breast Care Program is a
comprehensive, innovative approach to overcoming barriers to
breast cancer care and enhancing the survival of breast
cancer patients. During the two- year pilot period, WIN ABC
is adapting the program model to meet the needs of indigent
and underserved breast cancer patients and communities
through a specially developed program based at MLK Drew and
Harbor-UCLA Medical Centers. The pilot project will enable
WIN ABC to refine the model, build strategic community
relationships, develop community outreach strategies and
establish improved standards of care which will then be
replicated and sustained for indigent and underserved breast
cancer patients throughout California and beyond.
Program goals and implementation activities are detailed
below:
Goal 1: To develop a pilot of the
Breast Buddy Breast Care Program to reach underserved and
indigent patients diagnosed with breast cancer in Los
Angeles County.
Emphasis is being placed on developing an
internal communication system that promotes ongoing
dialogue, planning, education and evaluation among a
multi-disciplinary team of breast care providers who work to
improve the pathways of care at each site. Another key
objective is to integrate evaluation procedures into the
program, so as to regularly measure patient, volunteer and
provider-related outcomes.
To accommodate the evaluation design, the
Breast Buddy Breast Care Program was implemented at one
medical site in the first year and a second medical site in
the second year. This will allow for internal controls
(e.g., Site 1 compared to Site 2 at various stages of
implementation).
Goal 2: To build strategic community
relationships to provide the necessary resources to support
and sustain the development and implementation of the Breast
Buddy Program for indigent and underserved breast cancer
patients in Los Angeles County.
To promote community ownership and the
long-term sustainability of the Breast Buddy Breast Care
Program, WIN ABC is building strategic relationships with
key stakeholders in the communities serviced by the BCEDP
treatment sites. Strategic partners will include, but not be
limited to, health care professionals, community-based
organizations and clinics, local government agencies and
officials and businesses within the service area. Lessons
learned about community resource development will be applied
to a strategic replication effort within other poor and
underserved communities across the state of California.
Goal 3: To develop and implement
community outreach strategies to link underserved and
indigent breast cancer patients to the California Breast
Cancer Early Detection Program, California Breast Cancer
Treatment Fund and the Breast Buddy Breast Care Program.
WIN ABC staff is conducting community
outreach activities to link breast cancer patients with the
medical, legal and psychosocial support available through
the Breast Cancer Early Detection Program, Breast Cancer
Treatment Fund, the Breast Buddy Program and the California
Women's Law Center. Within the two-year pilot project, WIN
will develop a community outreach campaign with these main
objectives: 1) Promote personal health responsibility and
increase awareness about the importance of breast cancer
early detection. 2) Increase the number of patients who
access breast cancer screening, treatment and support
services, including the Breast Buddy Breast Care Program. 3)
Teach patients how to make informed health care decisions,
linking them with the resources necessary to accomplish this
goal. 4) Recruit breast cancer survivors in the community to
serve as Breast Buddy patient mentor volunteers and Program
ambassadors.
WIN Against Breast Cancer will host
presentations about the benefits of the BCEDP, BCTF and
Breast Buddy Breast Care Program at community-based sites
accessible to the target population, including local
churches, synagogues, schools, YWCAs and clinics. A
representative from the local chapter of the American Cancer
Society and program sites' Breast Cancer Coordinators will
join WIN ABC staff to recruit breast cancer survivors to be
trained as Breast Buddy volunteers.
Simultaneous to this community outreach
effort, WIN ABC is organizing focus groups among breast
cancer patients who receive their care at the BCEDP
treatment facilities and breast cancer survivors residing in
the community. Focus group participants provide important
feedback on key content areas of the existing Breast Buddy
Volunteer Curriculum and suggest ways in which it may be
adapted to best meet their needs and address cultural
issues. Focus groups are being conducted in English and
Spanish and engage representatives of Los Angeles County's
major ethnic groups. Based on the data from these focus
groups and community meetings, WIN ABC has begun to modify
and develop culturally sensitive and linguistically
appropriate educational materials for breast cancer patients
and their families.
Goal 4: To build statewide support for
the Breast Buddy Breast Care Program and develop strategies
for its replication within California's 14 Regional BCEDP
Partnerships.
The two-year pilot of the Breast Buddy
Breast Care Program in Los Angeles County will lay the
groundwork for the extension of the Program to other
indigent and underserved communities throughout California.
In Year 2, WIN ABC is further developing its ties to the
California BCEDP, Breast Cancer Treatment Fund, California
Department of Health Services and the American Cancer
Society in order to develop a plan for the statewide
replication of the Breast Buddy Program.
The results of the program evaluation
will be disseminated to planning partners and will inform
and facilitate the statewide replication process. Statewide
replication of the Breast Buddy Breast Care Program is
scheduled to commence in Year 3. Two other Los Angeles
County BCEDP facilities (LA County-USC and Olive View
Medical Centers) will be among the first replication sites.
ANTICIPATED IMPACT ON THE POPULATION TO BE SERVED
WIN Against Breast Cancer's Breast Buddy
Breast Care Program for underserved and indigent breast
cancer patients is designed to have an impact on three
target populations: 1) breast cancer patients, 2) their
health care providers and 3) breast cancer survivors who
serve as Breast Buddy patient mentor-volunteers.
Anticipated Outcomes for Breast Cancer Patients
1) Increased participation in treatment decisions.
2) Increased ability to make informed health care
decisions.
3) Enhanced abilities to cope with breast cancer.
4) Greater compliance with treatment protocols and
follow-up care.
5) Increased knowledge about personal health
responsibility and adoption of healthy lifestyles.
6) Increased confidence in accessing resources within
their health care system and wider community.
7) Greater satisfaction with their breast cancer
treatment and health care.
8) Improved quality of life.
9) Reduction of negative health impacts, including
morbidity and mortality from breast cancer.
Anticipated Outcomes for Health Care Providers
1) Increased teamwork, integrated services and defined
pathways of care for breast cancer patients.
2) Increased understanding of the needs of underserved
and indigent breast cancer patients and their families.
3) Increased sensitivity to the patients' unique cultural
issues concerning their health care.
4) Improved provider/patient relations.
5) Increased commitment to providing high quality,
comprehensive breast cancer care.
6) Enhanced job satisfaction and quality of work life.
Anticipated Outcomes for Breast Cancer Patient Mentors
(Survivor-Volunteers)
1) Increased self-esteem and sense of value to their
lives.
2) Increased ability to make informed health care
decisions.
3) Enhanced problem-solving skills.
4) Enhanced communication skills.
5) Increased knowledge about breast cancer and their own
breast health and follow-up care.
6) Increased ability to assume personal health
responsibility.
Anticipated Outcomes for Breast Cancer
Survivor-Volunteers
6) Increased ability to be an advocate for themselves and
others within their healthcare system.
7) Increased involvement in their community.
Anticipated Benefits to Medical Centers
1) State-of-the-art breast cancer care and support for
patients.
2) Client service and public image will be substantially
enhanced with the establishment of breast cancer care that
is already the standard of patient care in the medical
community.
3) Increased patient satisfaction with a common disease
will result in increased client loyalty.
4) Increased provider satisfaction with the diagnosis and
treatment of breast cancer patients.
5) Recognition as an innovative leader in breast cancer
treatment and management.
6) Utilization of untapped volunteer resources, fostering
a partnership with clients who are breast cancer survivors.
7) Efficient utilization of physician time while
maximizing patient support. Using volunteer patient mentors
will extend the productivity of paid staff and clinic time.
8) Complimentary to the goals to decrease cancer
morbidity, to increase patient satisfaction and compliance
with screening and breast cancer care.
9) Direct linkage to WIN Against Breast Cancer, the
American Cancer Society and other major community based
organizations and to the resources that they offer.
Compliance with SB 697 with this community linkage and with
the identified needs met by the Breast Buddy Breast Care
Program.
10) Increased budget allocations (e.g., from the County)
to support Program infrastructure and improved pathways of
care.
Anticipated Benefits to the Community
1) Availability of WIN Against Breast Cancer's newsletter
and comprehensive Breast Health and Breast Cancer Resource
Guide (English and Spanish editions.)
2) Trained volunteers available to provide support to the
community-at-large and public education at local events
(e.g., religious, community health fairs).
3) Increased public awareness and knowledge about the
importance of early detection, healthy lifestyle choices,
informed health care decisions and personal health
responsibility.
Last Updated: 02/12/2003
