NEWARK, NJ -- It is a heart-wrenching scenario: A woman who is barely making ends meet and has no family or friends who she can rely upon, learns that she has breast cancer. The news is devastating, the latest blow in a long line of bad circumstances. She feels overwhelmed and has no idea how to get the care she desperately needs.
These are the conditions facing an alarming number of poor minority women living in Newark and its surrounding communities.
But a network of health care professionals, foundations dedicated to breast cancer care, education and research, and kind hearts in the community is working together to change the course for this special population of breast cancer patients.
At its center are breast cancer social worker Alyson Slutzky, MSW of Maplewood, and advanced practice nurse Nancy Paradis, APRN-BC of Jersey City, and the oncologists at Newark Beth Israel Medical Center's Frederick B. Cohen, MD, Comprehensive Cancer and Blood Disorders Center, where breast cancer is consistently the most prevalent cancer seen.
Their positions funded by grants from the Susan G. Komen Breast Cancer Foundation, North Jersey Affiliate and the Avon Foundation, Slutzky and Paradis use their unique skills and creativity to help women through the maze of health care and social services they need to carry on. The grants were awarded to Newark Beth Israel through the work of the medical center's Foundation.
According to cancer center Director Alice Cohen, MD, the funding that supports their work is essential. "Most of the time, services provided by the social worker, coordinator and advance practice nurse are non-reimbursable," Dr. Cohen said. "Their services have been critical to reaching the underserved, underinsured and those not knowledgeable about negotiating the complicated health care system."
Newark ranks as one of the poorest cities in New Jersey. The city has a per capita income of just $13,000, which is 50 percent lower than the statewide average.
Ms. Slutzky and Ms. Paradis, working closely with Dr. Cohen are pivotal to helping underprivileged women with breast cancer stay connected to their health-care team and navigate their way through the extremely difficult challenges of both their illness and daily life.
Their clients are a mix of newly diagnosed breast cancer patients and those who have relapsed. Many are in an advanced stage of their disease. Slutzky and Paradis work one-on-one with patients, Slutzky providing psychosocial counseling and Paradis her medical expertise. They also collaborate frequently to fill in gaps for patients. Both women are skilled at pulling together the right mix of people and resources to address a patient's concerns, whether it's a pharmaceutical company's discount program or a local cab driver who can provide reliable transportation for a woman with late-stage breast cancer.
"The common theme for these patients is that they all have breast cancer, but in my initial assessment of each woman I try to get a feel for who she is and what she's gone through in life," said Slutzky. "Health care treatment can be like a maze, and people don't know what to do. Our patients without insurance really need Nancy and me to help with things like applying for charity care. Together we walk them through it."
Slutzky's position is funded through a grant from the North Jersey Affiliate of the Susan G. Komen Breast Cancer Foundation, a global organization dedicated to fighting breast cancer through its support of innovative research and community-based outreach programs. She provides services including enrollment in prescription subsidy programs so women can receive low-cost prescriptions for needed cancer drugs, assistance with enrollment in social service programs, free prostheses and wigs for women who have no insurance, community outreach and education. "These women need help with a range of issues, from getting a security deposit for a place to live to applying for disability, to determining who their child's guardian will be," Slutzky said.
Paradis spends approximately half of her time seeing breast cancer patients clinically, but she also devotes significant effort to helping poor women navigate the health care system. That aspect of her role is a critical piece of the Avon Foundation grant that funds her position and that of part-time coordinator Alice Ramos, who works closely with her. The Avon Foundation provides funding and raises awareness for advancing access to care and finding a cure for breast cancer, with a focus on the medically underserved.
"There's a lot of negotiating and consideration of who I can pull into the team to help a specific patient. It is very individualized care, and it requires time," Paradis said. Through the Avon grant, she can fully or partially cover transportation costs for women in need. Fluent in Spanish and French, she spearheads an ongoing community outreach effort throughout Newark along with Ramos, adept in Portuguese, teaching breast health education and sharing screening information. She also serves as liaison to other hospital departments, particularly diagnostic areas like radiology, ultrasound, and nuclear medicine that routinely provide testing for breast cancer patients, and assists with charity care applications.
Among the cases Paradis and Slutzky have managed together was a woman in her 70s who lived alone and had no close family or friends. She'd been diagnosed with breast cancer in 2003, but stopped going for treatment after having a bad experience with chemotherapy at her doctor's office. By the time she came to the attention of the staff at Newark Beth Israel, her cancer had grown significantly.
"It took a long time to build trust and convince her to have a mastectomy," Paradis said. The woman eventually had the mastectomy, but that was only step one of her treatment. Next would be an intense course of radiation, and getting her to and from the hospital five days a week for six weeks would prove difficult. "The transportation she needed was not covered by Medicare, and she couldn't afford to take a taxi every day, plus her visual deficits precluded her from taking public transportation," said Paradis. When the woman said there was a local cab driver whom she trusted, Paradis located him and they made a pact. "I told him 'she needs serious treatment but it won't work unless you take her every day… can you do that'?" she recalled. The cab driver agreed, and they negotiated a fair price for his services that was covered by the Avon grant. "He became like member of family, and a big part of her treatment team."
When the woman confided that she missed going to her church, Paradis met with the pastor to discuss how they could bring her back. The pastor made arrangements for transportation to get her to and from church, even getting her new outfits to wear.
Today the woman is still taking the breast cancer drug Arimidex, and Paradis continues periodic home visits to assess her and confirm that she is taking her medication.
"The fact that this patient got through her treatments is a real credit to Nancy," said Slutzky. We both worked really hard with her. If we hadn't, she would have fallen through the cracks."
Both Slutzky and Paradis are in constant communication with the hospital oncologists, sharing their concerns and observations about their patients. "I feel great about our partnership with the doctors. They fill me in on specific patient issues before I see the patient, and when I hear of a problem from the patient's viewpoint I can report back to the doctors because it may help them to understand why the patient is acting a certain way," said Slutzky.
Paradis' collaborating physician is Dr. Cohen, and she also interacts regularly with the six other outpatient oncologists on staff at Newark Beth Israel. "I get called in to cases by the oncologists when they have breast cancer patients who have trouble accepting their diagnosis, are fearful or have cultural barriers to initiating treatment, or stop showing up all together," said Paradis.
Airing their concerns and understanding all the steps in their treatment helps these women stay the course.
"Women can become empowered to make good choices for themselves when they are given enough education and support," said Paradis. "A lot of our patients come in with advanced stage disease. We can help them to continue going on, enjoy what they have today, and not take away their hope. Current scientific research may lead to new treatments for patients with breast cancer and lead to improved quality of life and prolonged survival."
The Frederick B. Cohen, MD, Comprehensive Cancer and Blood Disorders
Center at NBIMC provides a multidisciplinary approach to the diagnosis
and management of patients with cancer and blood disorders, combining
compassion with the latest physician expertise, achievements and
clinical research. Under the direction of Alice Cohen, MD, the
center's staff includes 7 full-time medical oncologists, a surgical
oncologist, and a radiation oncology team, as well as oncology
nurses, social workers and support staff, all of whom collaborate
to guide patients through the physical and emotional challenges
that cancer presents. The Center is in the midst of a major expansion
that will increase its overall size by 67 percent and offer the
most advanced treatment tools, including two linear accelerators
and Intensity Modulated Radiation Therapy (IMRT) technology for
pinpoint delivery of radiation therapy.
Date: November, 2006
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