Breaking Down Barriers
to Cancer Care
words by carole walker /
photograph by dan katz
rimary care physician Ana Natale Pereira, MD, MPH, pays attention to the cultural, linguistic, and healthcare barriers impacting the medical care of Latinos and African-Americans. She’s intent on eliminating these obstacles.
A 1996 graduate of UMDNJ-New Jersey Medical School (NJMS) and UMDNJ-School of Public Health in 2005, she completed her internal medicine residency at UMDNJ-University Hospital in 1999, served as chief resident in 2000, and has worked to prevent and control cancer in minorities through community-based research, education and outreach.
The physician struggles with challenges faced by all clinical researchers, including finding participants who can meet the stringent eligibility criteria for research studies, as well as issues particular to urban environments, such as negative perceptions of human subjects research. “For the most part, Latinos approach this kind of research with distrust. Educating the community about research is very important and requires building trustworthy partnerships,” she says.
Her first major project funded by the National Cancer Institute aimed to increase knowledge and awareness of the importance of colorectal cancer screening and to improve early detection rates. Through organized community focus groups, four major barriers to cancer care were identified — language, lack of insurance, undocumented status, and lack of knowledge of the disease — as well as other concerns, including low perceived risk, fear, denial, fatalism, and making healthcare a low priority.
The groups suggested strategies to address these issues, and as a result, two other projects were initiated. Through funding from the UMDNJ-Institute for the Elimination of Health Disparities-Project EXPORT, in collaboration with Marielos Vega, RN, Natale-Pereira focused on educating Latino community-based organization leaders about colorectal cancer, so they, in turn, could educate others in the community. Simultaneously, she received funding from the Centers for Medicare and Medicaid Services (CMS) to evaluate knowledge of this disease among older African-Americans, Hispanics, and community leaders in Newark, and developed a teaching module that would convey the needed information.
In 2006, NJMS became one of six national sites funded by CMS for its Cancer Prevention and Treatment Demonstration project. Under the leadership of Natale-Pereira, the project aims to reduce cancer health disparities among elderly Latinos in the Newark metro-area and communities in Union, Bergen and Hudson counties. It helps them to navigate the healthcare system and complete breast, cervical, prostate and colon cancer screenings, as well as offer support for treatment, including lung cancer.
This randomized intervention study uses a MATCH (Multilevel Approach to Community Health) planning model, which integrates community outreach, education, access to screening, and patient assistance programs using community health workers and patient navigators. It aims to recruit 1,384 participants. Currently, more than 670 have been enrolled with more than 300 in intervention.