Shawna Hudson, PhD:
Answering the Unanswered Questions on Cancer Care
words by eve jacobs / photography by john emerson
s sociology a vital component of cancer care? Undoubtedly yes, according to The Cancer Institute of New Jersey (CINJ), where Shawna Hudson’s work in this field promises to shine a light on some of the more complex issues concerning access to healthcare in our State. While the traditional instruments of science, such as test tubes and microscopes, do not figure in her day’s work, Hudson’s tools of the trade focus on the wider-scoped laboratory of human behavior in sickness and in health, informing medical science in ways that are crucial to its everyday workings.
The sociologist has taken no detours on her professional path. Perhaps growing up in a military family that uprooted every few years — living in Maryland, Kansas, Germany, Belgium and Rhode Island — readied her to put down roots and “dig in.” Lucky for New Jersey that she chose Rutgers for her undergraduate degree, liked it immensely, and stayed in the State for her graduate work and beyond. It is where she now lives with her husband and two children.
Her doctoral studies focused on health disparities in the aging population; and her postdoctoral research — funded by the NJ Commission on Cancer Research — looked at impediments to accessing clinical trials. A large part of her efforts over the past few years have been “making sure different groups know their options and can make informed choices.”
Several years ago, she became part of a partnership with IMPACT NJ (Improve Participation and Access to Clinical Trials in NJ) to raise awareness of clinical trials among minority populations. As part of this effort, she is evaluating pilot programs funded by the Susan G. Komen Breast Cancer Foundation North Jersey Affiliate that provide patient navigators at Newark’s UMDNJ-University Hospital and Beth Israel Hospital to help patients understand the available treatments.
“More people are now considering clinical trials as an option,” Hudson says. “We are starting to break down the barriers of Tuskegee.”
Research “based on hard outcomes” is what she strives for. She is currently venturing into the world of cancer survivors to gather data on what happens years after cancer treatment is finished.
Her work with the Sisters Network of Central NJ — an African American breast cancer survivors’ group — provided her with important insights for this research. “When black women get breast cancer, it tends to be more aggressive. They may have different long-term follow-up needs and quality of life issues. There are lots of anecdotes but little research in this area,” she explains.
Her current cancer survivors’ study aims to answer such questions as: Is the healthcare system set up to assess who should be screened more frequently, or at younger ages, based on higher risk? What is the role of primary care in this process?
She is also looking at long-term decision-making: Who is providing care two to five years after the final cancer treatment, and 10 to 15 years later? Are patients receiving treatment for the late effects of cancer treatment, such as cardiovascular disease and osteoporosis? Are men and women treated differently? Are treatment decisions cancer-based, gender-based, or are there other factors? Elderly patients and those from ethnic/minority groups are her primary focus.
Hudson and her team are asking interviewees to tell them their stories about treatment and their disease: “We say: ‘If you were doing it over, would you do anything differently?’ We are trying to get at patients’ expectations and how they think about the issues.”
Her long-term goal is to determine the best places for intervention. “We want to understand who’s not getting care and who is. How do we make care better? Where can we step in to make a difference in the process?”
Following interviews for the pilot study of 40 participants, the team will analyze the data for six to eight months. When they have narrowed down the issues, Hudson plans to do a larger survey — including 300 participants.
Among her findings to date are:
- Many cancer survivors are seeing primary care doctors for testing and screening when their cancer treatment is completed but do not consider these visits cancer follow-up.
- Early on in their survivorship, patients have a better sense of the effects of cancer therapies. Later on, they do not make a connection between these “late effects” and their cancer treatment.
- The majority of cancer survivors want to remain with their oncologists for follow-up care.
So far, her research indicates there is little difference between black and white, but there are differences between elderly and young people.
“We don’t know how much of the difference is because of the digital divide,” she comments. “Are those online more hooked in?”
Her schedule calls for the team to start the large survey in the spring of 2011 and to analyze the quantitative data in 2012. “This will give us leads for an even bigger study,” she says, “and will indicate whether we should be focusing efforts on educational interventions or on survivorship clinics.”
She hopes to gain from the initial study “enough to understand what’s going on,” and following the larger one, “to set appropriate interventions going in New Jersey; and if it works here, see if this can work as a national model.”
New Jersey “does not have an easy-to-navigate healthcare delivery system,” she says. “What do people do when they get caught in complex systems? They get lost. We want to help avoid this.”
As most of us know through our own experiences or those of friends and family, determining the best treatments for cancer and where to get them is often confusing. If Hudson’s work can smooth the paths of cancer patients, even a little, she will have accomplished a great thing.