At its core, Huntsman Cancer Institute (HCI) is dedicated to creating an environment that not only promotes—but insists upon—equity, diversity, and inclusion. Here are a few highlights of noteworthy programs and research from the Cancer Control and Population Sciences Program that advance HCI’s quest to create a cancer-free frontier for all communities, no matter their location, income, or insurance status.
Huntsman at Home™ Program Provides Value through Patient-Centered Care
When HCI launched the Huntsman at Home™ program in 2018 to deliver clinical-level care to patients in their homes, no one could have guessed just how vital the program would become in 2020. HCI’s desire to improve care to cancer patients outside the walls of its facilities was validated because of precautions due to the global pandemic.
"A group of us were intrigued when we first learned about the hospital-at-home concept, which is more common in other countries, especially those with a single-payer health system," says Kathi Mooney, PhD, RN, co-leader of the Cancer Control and Population Sciences Program at HCI and distinguished professor of nursing at the University of Utah (U of U). "It had yet to be tried in the cancer population, but we knew that many of the supportive care needs of patients could be provided at home on an acute-level basis rather than through emergency department visits and hospitalizations."
The Huntsman at Home™ program was developed by a team of dedicated clinicians and researchers at HCI. It is currently available to those who live within a 20-mile radius. Specifically designed for cancer patients, the program was started to test whether acutely ill patients—some recovering from chemotherapy and others dealing with the effects of cancer progression—could avoid emergency room visits and unplanned hospital stays.
Through the Huntsman at Home™ program, nurse practitioners with acute care oncology expertise and palliative care skills partnered with registered nurses from Community Nursing Services to regularly make home visits to patients to monitor their symptoms and help them manage their illnesses.
Visits through the Huntsman at Home™ program have been covered by HCI and Huntsman family funding in hopes of demonstrating to insurance companies that such programs can save them money by preventing prolonged hospital stays or expensive emergency department visits. Utah was among the first six institutions to receive a Centers for Medicare and Medicaid (CMS) waiver during the pandemic to allow reimbursement for acute level, hospital at home care at the same rate as hospitalization.
Huntsman at Home™ care has shown significant reductions in unplanned hospitalizations and emergency departments visits, as well as lower health care costs. Cambia Health Foundation supported this evaluation. Huntsman at Home™ is funded by HCI and Huntsman Cancer Foundation. An expansion of the program to three rural counties is expected in early summer 2021, supported by the Huntsman Foundation and the Rita & Alex Hillman Foundation.
CDC Awards Huntsman Cancer Institute $3 Million to Increase Colorectal Cancer Screening Rates
HCI was awarded a five-year, $3 million grant from the Centers for Disease Control and Prevention (CDC) to improve Utah’s colorectal cancer screening rates. The program builds on an ongoing partnership between HCI’s Center for Health Outcomes and Population Equity (HOPE) led by David Wetter, PhD, professor of population health sciences; the U of U’s Department of Biomedical Informatics; and the Association for Utah Community Health (AUCH). The goal is to deliver health information technology to residents across the state who are most in need, including those who are uninsured and those living in poverty.
"Lower screening rates directly contribute to higher death rates from colorectal cancer," says Guilherme Del Fiol, MD, PhD, a member of HCI’s Cancer Control and Population Sciences Program and associate professor of biomedical informatics at the U of U. "This funding ensures more Utahns will have access to lifesaving colorectal cancer screening, regardless of income, insurance status, or location. We have an enormous opportunity to improve access to preventive care through statewide collaboration and the optimal use of electronic health record systems."
Despite strong evidence that colorectal cancer screening saves lives, only 72% of Utahns report being up to date with colorectal cancer screening. That rate is much lower for more economically disadvantaged populations. Currently, only 59% of individuals living below the federal poverty level and 28% of individuals who are uninsured report being up to date with screening.
The new project will include three customized interventions: provider reminders, provider assessment and feedback, and patient reminders. The project will partner with dozens of community health centers and primary care clinics across the state to provide preventive care to more than 30,000 underserved patients.
"Each of these interventions is evidence-based, building on years of expertise that has demonstrated real-world impact in clinical settings," says Del Fiol. "We are eager to adapt this work and screen as many individuals as possible."
Research Shows Disparities between Cancer Patients in Urban and Rural Settings
Research shows people who live in small towns and sparsely populated areas have poorer cancer outcomes than those who live in bigger cities. Population science researchers at Huntsman Cancer Institute (HCI) formed a rural working group to understand why these disparities exist and how to achieve health equity for all communities HCI serves.
Kathi Mooney PhD, RN, co-leader of the Cancer Control and Population Sciences Program at HCI and distinguished professor of nursing at the University of Utah (U of U), and Neli Ulrich, PhD, HCI Comprehensive Cancer Center executive director and professor of population health sciences at the U of U, initiated the rural working group. In July 2020, Mia Hashibe, PhD, an investigator in the Cancer Control and Population Sciences program at HCI and professor of family and preventive medicine at the U of U, received a grant to focus on long-term adverse health outcomes among rural cancer survivors in Utah.
A rural area is defined as having fewer than 100 people per square mile. That’s 96% of Utah. Rural areas in the United States have higher rates of obesity and smoking, lower health insurance coverage rates, and decreased access to primary care. These factors contribute to higher rates of chronic diseases among rural cancer survivors.
Hashibe is investigating whether rural prostate, breast, and colorectal cancer patients are more often diagnosed with heart disease, depression, diabetes, and other health problems.
"Our study is the first large-scale population-based cohort in Utah and of the elderly in the nation," Hashibe says. "We would like to understand whether distances to health care contribute to adverse health outcomes, which may in turn contribute to lower survival. Ultimately, we would like to prevent cancer survivors from having any difficulty receiving the treatment they deserve."
As part of her work, Hashibe and her team will also evaluate the risk of opioid use among rural breast, prostate, and colorectal cancer patients in comparison to urban cancer patients. They want to identify possible solutions such as tobacco cessation programs and access to care through telemedicine.