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A hospital partnership that has provided residents in Wards 7 and 8 with basic cancer care will end in approximately 90 days, leaving people east of the Anacostia River with a dearth of options for oncology services in their neighborhood.
In 2013, Sibley Memorial Hospital submitted an application for a certificate of need for a Proton Therapy Center at their facility in Northwest D.C. The center was projected to cost nearly $157 million. One of the terms for gaining approval for their certificate was offering local oncology services in wards 7 and 8. Those services began in 2015 with the opening of the Sibley Oncology Clinic at United Medical Center.
The clinic at UMC provided patients suspected of having cancer with a timely diagnosis, a treatment plan, and a referral to oncology services at a hospital that could provide medical and radiation oncology, which are not available at UMC. Once a patient had a treatment plan, they traveled to Howard, Sibley, or another hospital in the District depending upon the availability of appropriate services and patient preference.
A Sibley spokesperson explains that a nurse practitioner at the UMC clinic offered “navigation” services, ensuring that patients had reliable transportation to appointments and access to healthy food. The navigator worked through social barriers that could prevent people from completing treatment, and also addressed side effects. An oncologist either on site or at Sibley consulted with patients.
Howard University oncologist Dr. Melvin Gaskins saw patients at the UMC cancer clinic twice a week. At the height of the program the clinic was serving over 200 patients a year.
But the process for getting service beyond the typical check up was complicated. Gaskins describes a convoluted process that was less than popular with his patients. “We saw between four and six patients on clinic days,” he says. “Some were new patients and others were follow up. Typically someone would see me there [at UMC], go to Howard to get their therapy, and then come back to UMC for follow up. The patients that we saw weren’t interested in going all over the city for treatment. I’m sure they would have been happy to have therapy at the hospital. They weren’t too enthused about traveling over to Howard to get their chemotherapy.”
Gaskins retired in July 2017. Sibley Memorial did not replace him with another oncologist, but with an oncology nurse practitioner. Dr. Dennis Haghighat, Chief Medical Officer at United Medical Center, explains via email that the change in providers caused patient referrals to drop.
“After his retirement the number of referrals to the program dropped sharply and never recovered,” says Haghighat. “Our local physicians wanted an onsite oncologist present who could also see patients in the hospital not just in the clinic. Due to low patient volumes, our relationship with Sibley Hopkins ended on the last day of 2018. Approximately 40 patients from the program will continue to receive care here through the end of June to assure that they can finish their care close to home. We currently have no oncologist on staff at UMC.”
UMC asked Sibley to end their services at the Southern Avenue SE hospital by June 30, 2019. The nurse navigator will no longer serve patients there after this date.
Haghighat explains that the physicians at UMC are reluctant to admit patients with newly diagnosed cancer given that there is no cancer expert available to see them. When UMC receives these cases, it transfers the patients to other hospitals where a cancer expert is available. In addition, he says that continuing the agreement wouldn’t have been practical given the attendance and scope of other health issues facing their patient community.
(Meanwhile, Sibley Memorial still hasn’t opened its proton beam machine center. It had to renew its certificate of need because of unforeseen delays in construction and installation. A spokesperson for the hospital confirmed that the proton beam machine will begin accepting patients in October 2019.)
In certain cancers, the District leads the nation in incidences and deaths. In 2015, the most recent year for which Centers for Disease Control and Prevention data are available, D.C. surpassed the national average in new prostate cancer cases (103.2 per 100,000 versus a 99.1 national average) and prostate cancer deaths (27.4 per 100,000 versus a 18.9 national average). Breast cancer deaths in D.C. average 28.5 per 100,000 as opposed to 20.3 nationally. Colorectal deaths are also above the national average with D.C.’s number coming in at 16.6 versus 14.0 nationally.
According to the Department of Health, the top four cancers in D.C. in 2012 were prostate, breast, colorectal, and lung and bronchus. (The agency tells City Paper they are currently working on updating all fact sheets, and will post them online “as soon as they are available.”)
The District of Columbia Cancer Registry, Cancer and Chronic Diseases Bureau published a burden of cancer report in 2014. It stated that there were 36 cases of colorectal cancer in Ward 8 in 2013, while Ward 2 had 16 cases. Ward 7 had 61 cases of lung cancer—the highest that year—while Ward 8 was the leader in lung cancer deaths at 39. Ward 5, home of MedStar Washington Hospital Center, had the highest rates of breast and prostate cancers at 66 and 93, respectively, that year.
Barriers to care, such as poor transportation, can lead to delays in getting both a diagnosis and treatment. These delays leave time for an early stage cancer to advance. Dr. Gaskins says that he was surprised by the number of young people he saw with advanced lung cancer during his time at UMC. “If you have a couple of wards in D.C. where all you’re doing is diagnosing cancer late, it ends up being much more expensive these days and everyone has to bear the burdens of health care at some point with Medicaid and Medicare.”
Some organizations have made an effort to step in and ease the burden of screening and treatment. Breast Care for Washington opened in 2012 inside the Conway Health and Resource Center on Atlantic Street SW in Ward 8. They provide mammograms, biopsies, and patient navigation services along with numerous support services.
Also in 2012, Thelma D. Jones founded the Thelma D. Jones Breast Cancer Fund. She survived HER2 breast cancer, an aggressive form in which the breast cancer cells have a higher than normal level of human epidermal growth factor receptors. Her nonprofit provides advocacy, support groups for women with breast cancer, and SmarTrip cards for clients in need.
She explains how insufficient transportation can keep people from getting treatment. “The women in public housing are farther away from the Metro,” says Jones. “Some as many as four blocks from the Metro. That may not sound like a long way but if you’re not feeling well and you have the weight of the world on your shoulders, four blocks in the winter or in the hot summer sun or in the rain can be very taxing. You don’t want to have to stand up on a crowded Metro to go across town.”
Natalie Williams, who publicly battled with breast cancer in 2012, started the Natalie Williams Breast Care Foundation. Williams, the former Corporate Secretary and Hospital spokesperson for UMC is disappointed to hear that the partnership between UMC and Sibley Hopkins is ending. “You don’t really want to send people off to other places to find support, to find education. In a ward where you’re already dealing with issues of transportation and finances, you would think folks would be making it as easy as possible,” she says.