How Can Gastric Cancer Patients in Rural Areas Access Specialists?

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How Can Gastric Cancer Patients in Rural Areas Access Specialists? from Patient Empowerment Network on Vimeo.

How can rural gastric cancer patients gain access to specialists? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses access to additional medical consults and a way to access more Asian and Hispanic patient groups.

[ACT]IVATION Tip

“…for challenges faced with timely access to Asian and Hispanic subgroups and all racial groups, in my opinion, is to seek…it’s always appropriate to seek second or third opinions particularly at larger comprehensive cancer centers for the availability of clinical trials or whether it’s about questions about standard of care therapies or actually just questions about can we have a supportive service that you may offer that our local community providers may not offer?”

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See More from [ACT]IVATED Gastric Cancer

Related Resources:

How Does Gastric Cancer Screening Differ for High-Risk Groups?

 Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

 What Gastric Cancer Challenges Do Asian and Hispanic Groups Face?

Transcript:

Lisa:

So there are maybe some patients who are in more rural communities or go to smaller cancer centers. You’re at a very large center that has a lot of these resources. Do you think there is some benefit to patients if they have the ability to have a consult done by a specialist like yourself who only see, or who sees mostly gastric cancer patients? Can they tap into that like as a one-time consult when they’re diagnosed, particularly if they have metastatic disease, and could they also tap into the resources of a larger center?

Dr. Jun Gong:

That is a great question, Lisa. And yes, we do do that. We, as part of a large urban medical center here, we have a great relationship with our community oncologist and primary care doctors and other subspecialists where we are often referred for a second opinion or a third opinion. Sometimes it’s really, is this the best treatment that I have? Or it’s simply a question of are there clinical trials because we would like to refer to an urban medical center, a larger comprehensive cancer center for clinical trial options.

And here what I would like to add is that the post pandemic period has really afforded, in my opinion, an easier way to do consultations. I know it’s specific to certain institutions and certain centers, but I actually am okay with virtual medicine consultations for those who are…who find it difficult to travel to an in-person visit, again, I can’t speak for all other cancer centers or oncologists, but we at least offer this ability to do that, to help with that barrier of transportation. And when they are connected with us sometimes if we are able to, we can even follow peripherally, almost like an extra care partner with the main local doctor who’s driving more of the day-to-day, and we’re providing our recommendations as an extension from an urban medical center.

Lisa:

Great. Thank you for that information. I know as a cancer patient and a patient advocate, I will always recommend seeking out a consult from another person just to have another set of eyes on, particularly if it’s a specialist like yourself who sees primarily that type of cancer. So, thank you.

Dr. Jun Gong:

My activation tip for challenges faced with timely access to Asian and Hispanic subgroups and all racial groups, in my opinion, is to seek…it’s always appropriate to seek second or third opinions – particularly at larger comprehensive cancer centers – for the availability of clinical trials or whether it’s about questions about standard of care therapies or actually just questions about can we have a supportive service that you may offer that our local community providers may not offer? Or can you help us in a later stage of our treatment? Not just a one-time consultation, really just raising awareness that we do have ancillary staff that are very, very, very helpful in terms of addressing a lot of these risk, healthcare access barriers.

The one thing I would’ve liked to add was I think involving church groups is a really, really great way for Asians and Hispanics, because they are so heavily invested in attending church services. And that’s one of the innovative approaches from the Cedars-Sinai perspective is that we actually have a disparity center, a center of community outreach where we are actually engaging both Asians and Hispanics and other racial groups with their leaders in the churches, the local churches, to actually educate and promote awareness.

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What Gastric Cancer Challenges Do Asian and Hispanic Groups Face?

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What Gastric Cancer Challenges Do Asian and Hispanic Groups Face? from Patient Empowerment Network on Vimeo.

 What kind of gastric cancer care barriers do Asian and Hispanic groups face? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses specific barriers that are experienced by some patient groups and some solutions to overcome barriers.

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

How Does Gastric Cancer Screening Differ for High-Risk Groups?

 Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

 How Can Gastric Cancer Patients in Rural Areas Access Specialists?

Transcript:

Lisa:

What are the challenges faced by the Asian and Hispanic populations in accessing timely and appropriate treatment for stomach cancer and what strategies can be implemented to address these challenges?

Dr. Jun Gong:

There are several challenges that we see in our routine care of patients that are of Hispanic or Asian ethnicity with regards to access to treatment to stomach cancer. This often involves language barriers where, at least here geographically in Los Angeles, it’s a culturally diverse population, large metropolitan center where patients often speak non-English language. And this is often a barrier to communicating and getting timely access. Other concepts that we’ve come into as well is fear of insurance coverage denials in seeing the subspecialists or access to timely diagnostics and approval of treatments through insurance.

Other barriers include transportation. We have patients that actually have transportation issues. And although they try to take public transportation or whatever means necessary to get here, this still represents a formidable barrier to access. Other access related barriers that we often see is also caregiver support.

Here, patients are…stomach cancer is a quite complex illness. It can affect diet, it can affect strength. And so oftentimes these patients need more support to help with their daily activities as well. And so these are just a few of the growing kinds of risk factors or access related barriers that we’ve seen. How do we overcome this, is one of the major dilemmas right now in all of cancer care and medicine, in my opinion, not just exclusive to stomach cancer.

What I think is important here is advocacy groups. There are a lot of good stomach cancer advocacy groups such as the ones we’re participating under today. These can be accessed through public publicly available means either through word of mouth. They’re often health fairs that are a good place to distribute this.

I often think public libraries are also a great place for healthcare advocacy and connections. Obviously, the Internet is also one good means for doing this, but not all patients have internet access as well. So this is something that you also have to play into. As part of our clinical care team, we have our social worker and our case management teams that really comprise an important social, psychosocial resource to our patients where we do our best to connect them with advocacy support groups where we can connect them with resources such as transportation.

We certainly are more than happy to help with insurance related questions as well. And then another point I forgot to mention as well is that when you embark on treatment, sometimes patients are really debilitated and they’re not able to carry on their normal means of a living. And so here our supportive services teams within our cancer care team can really help with the financial impact of being on treatment such as chemotherapy for a period of time as well.

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Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

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Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities from Patient Empowerment Network on Vimeo.

 How can higher gastric cancer risks for Asian and Hispanic populations be overcome? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses H. pylori risk and screening and advice to patients to be proactive in their care.

[ACT]IVATION Tip

“…for the risk factors that are specific to the Asian and Hispanic populations is to understand the symptoms of H. pylori, which is one of the most common causes of stomach cancer, because they can be very effectively treated with antibiotics over a period of two weeks, oftentimes, and they’re very effective. This can be done at multiple provider levels from the primary care setting to the subspecialist setting. And also to know that symptoms, if they occur in family members that reside with the patient that is infected with h pylori or has stomach cancer, for them to be tested and the importance for their treatment as well.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

How Does Gastric Cancer Screening Differ for High-Risk Groups?

 What Gastric Cancer Challenges Do Asian and Hispanic Groups Face?

 How Can Gastric Cancer Patients in Rural Areas Access Specialists?

Transcript:

Lisa:

Dr. Gong, what can be done on an individual and systemic level to address the elevated risk for gastric cancer in the Asian and Hispanic populations?

Dr. Jun Gong:

To address the elevated risks for gastric cancer in Asian and Hispanic populations, I think it’s very important to understand what are probably some of the universal risks to both groups. And here, there’s been growing evidence that H. pylori infection affects both Asians and Hispanics and is one of the more pivotal risk factors to address on a systematic level. Here, there have been ongoing research where they’re just identifying H. pylori as a procedure and eradicating it with treatment.

This is usually with antibiotic containing treatment for about two weeks. And this imposes what we call a primary prevention method if we can actually eradicate one of the primary causes of stomach cancer. Is this the best way to address the greatest risk factor on a systematic level for Asians and Hispanics and other ethnic groups at high risk? On an individual level, I think again, this comes to tailoring what the diagnosis is with the respect of ethnicity of the patient and their cultural and their background as well as their familial background. Here, H. pylori, dietary lifestyle, hereditary causes are important to address, to minimize risk for stomach cancer.

And it’s also important to know that on the individual level, that family members that are living with patients with stomach cancer may also have what we call H. pylori incidence around the entire family. So it’s important to advise that sometimes your family members, because of the close living facilities and the shared utilities and restroom and how we dine together, that this shares a familial risk. And oftentimes it may need to be that your family needs to be treated if H. pylori is detected within the family as well.

Lisa:

So if a patient comes in and their family members are concerned, would it be advised that maybe their family members can go see their primary care provider and say, “Hey, my family member has gastric cancer. Will you test me for H. pylori? Is that…would that be a valuable question to ask?

Dr. Jun Gong:

So I think that raises the big question about should we systematically test all high-risk subgroups for H. pylori? And I think the jury is still out on that. There has to be formalized guidelines. What I recommend is family members who are with another family member that’s diagnosed with H. pylori and/or stomach cancer, if they are having any concerning symptoms of H. pylori infection, this is usually abdominal discomfort. It can actually be gastritis type symptoms of acid reflux. If you have any of those symptoms, then those are certainly indications for you to be tested either at the primary care level for H. pylori.

My activation tip for the risk factors that are specific to the Asian and Hispanic populations is to understand the symptoms of H. pylori, which is one of the most common causes of stomach cancer, because they can be very effectively treated with antibiotics over a period of two weeks, oftentimes, and they’re very effective. This can be done at multiple provider levels from the primary care setting to the subspecialist setting. And also to know that symptoms, if they occur in family members that reside with the patient that is infected with h pylori or has stomach cancer, for them to be tested and the importance for their treatment as well.

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How Does Gastric Cancer Screening Differ for High-Risk Groups?

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How Does Gastric Cancer Screening Differ for High-Risk Groups? from Patient Empowerment Network on Vimeo.

 Is gastric cancer screening different for some high-risk groups? Expert Dr. Jun Gong from Cedar-Sinai Medical Center shares how screening guidelines are evolving for some high-risk patient groups and advice to patients to ensure essential screening occurs.

[ACT]IVATION Tip

“…understanding whether you are in a specific high-risk subgroup it’s important to ask, whether diet and lifestyle can contribute to these risk factors are important to ask, and whether there is a risk of familial or hereditary causes of stomach cancer is important to ask as well. For us as oncologists to guide you to our supportive services and down the right path to address all of these concerns.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

 What Gastric Cancer Challenges Do Asian and Hispanic Groups Face?

 How Can Gastric Cancer Patients in Rural Areas Access Specialists?

Transcript:

Lisa:

Are there any screening tests that are recommended for anyone who might be in a group that’s known to have a higher incidence of gastric cancer?

Dr. Jun Gong:

Screening for stomach cancer in the U.S. is very evolving. It’s somewhat controversial. Unlike in East Asia and parts of the world where they’ve actually implemented standard endoscopic screening protocols as young as 40 or age 50. Here in the U.S., there hasn’t been any formal screening guidelines implemented for stomach cancer.

However, a lot of consensus groups recognize the high-risk subgroups of stomach cancer and in these risk factor, high-risk factor groups, especially if you have a family member a first-degree family member with stomach cancer or you’re a part of one of these ethnic groups that are at high risk, they do encourage screening to be discussed with your provider. And this can entail endoscopy surveillance as well.

So my activation tip regarding risk factors is to always inquire whether from your provider or from ancillary staff.  It’s very common for us to refer our patients as well to cancer nutritionists, dieticians as well, in addition to going over what may be some possible familial or hereditary risk, if we sense that a strong family history is present.

And this is where referrals to genetic counselors are available. But understanding whether you are in a specific high-risk subgroup it’s important to ask, whether diet and lifestyle can contribute to these risk factors are important to ask, and whether there is a risk of familial or hereditary causes of stomach cancer is important to ask as well. For us as oncologists to guide you to our supportive services and down the right path to address all of these concerns.

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Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

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Do Gastric Cancer Risk Factors Differ Among Hispanic Communities? from Patient Empowerment Network on Vimeo.

Are there gastric cancer risk factors that differ for Hispanic communities? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses risk factors for Hispanic and other higher risk stomach cancer groups.

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

What Early Phase Gastric Cancer Trials Are Showing Promise?

 Expert Guidance: Stomach Cancer Basics for Newly Diagnosed Patients

 How Is Gastric Cancer Screening and Care Impacted by Culture?

Transcript:

Lisa:

Are there any specific risk factors for gastric cancer that are more prevalent in Hispanic communities compared to other ethnic groups?

Dr. Jun Gong:

So this is an interesting question in terms of risk factors and certain ethnic groups. We’ve realized that actually gastric cancer is highly prevalent in East Asia. And there, the risk factors seem to be more diet-related. But then when you look on the Western side of the world, it’s different risk factors that exist for stomach cancer. You always have familial risk. These are genetic, ancestral, or hereditary causes of stomach cancer, which are fairly rare. And this is independent of geography.

But here on the West, we tend to see more of risk factors related to the Western lifestyle. Here, gastritis or chronic gastritis, heartburn, longstanding inflammation is a risk factor. Heavy smoking, heavy alcohol use, and obesity are emerging risk factors for stomach cancer as well. And also, we have a very unique risk factor in a bacteria called H. pylori that is known globally to be a risk factor for gastric cancer.

And we’ve done research on this in that although the demographics in the U.S. is very diverse, we do see that Asians and Hispanics and African Americans compose higher risk groups for stomach cancer when compared to non-Hispanic whites. And in certain ethnic groups such as the Koreans, it can be as much as five times the risk for non-Hispanic whites. And we think it is due to these unique variations in H. pylori risk across the different races. We’ve done research at Cedars-Sinai where we’re looking at the Hispanic population and we’ve seen over time that actually, in addition to Hispanic populations being at higher risk for stomach cancer, it seems to be affecting a younger group and in particular younger females.

So we’re looking into this kind of new epidemiologic evidence as to why stomach cancer in Hispanics is becoming younger in onset and tends to have a predilection for females. And these patients however, if they are afforded the correct treatment and the timely treatment, their outcomes are just as good as the non-Hispanic counterparts. So this is an emerging topic and a very important topic in my opinion.

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How Is Gastric Cancer Screening and Care Impacted by Culture?

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How Is Gastric Cancer Screening and Care Impacted by Culture? from Patient Empowerment Network on Vimeo. 

How can culture impact gastric cancer screening and care? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses solutions for improving screening rates and patient advice for reducing barriers.

[ACT]IVATION Tip

“I think one of the most important things is always for providers to be culturally aware that certain ethnic groups may have certain preferences with how news is delivered, how news is handled, how treatment is decided upon.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

What Early Phase Gastric Cancer Trials Are Showing Promise?

 Expert Guidance: Stomach Cancer Basics for Newly Diagnosed Patients

 Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Transcript:

Lisa:

Dr. Gong, how do cultural beliefs and practices impact the prevention, diagnosis, and treatment seeking behavior of individuals with stomach cancer? And how can healthcare providers better address the cultural barriers to care?

Dr. Jun Gong:

Cultural beliefs have a huge impact on access to care in stomach cancer, and I think we can do better with addressing cultural barriers to care. I think one of the innovations here at our center is that we have a center of community outreach and a disparities core here where we recognize that certain cultures and this can expand beyond Asians and Hispanics into all racial groups, that there’s a heavily…there’s an important influence of church in this sector here.

And so what we do is we actively engage leaders in the churches, in the local churches for Asians, Hispanics, and a lot of different other subgroups. And we find this a great, great relationship and partnership to have for promoting awareness and educating patients about resources that we have within a culturally specific location where patients and family members find a great deal of trust in the church.

And we also have other innovations as well. So this is more from…more of a day-to-day lifestyle from a clinical trial, a research perspective here at Cedars, we also have a designated specialist from a diversity and inclusion research group where we actually move along the disease groups from stomach cancer to colon cancer to other cancer types.

And we have this specialist sit in, usually in our weekly meetings. And whenever there is a new study, a new clinical trial, this diversity inclusion specialist will raise the question, what racial groups, ethnic groups will be of interest to hear? And how can we expand outreach and participation in these clinical trials? So these are some of the innovations that I think we can do to address cultural barriers to care.

Lisa:

Dr. Gong, do you have an activation tip?

Dr. Jun Gong:

So, my activation tip is that yes, there are growing and emerging concepts to address cultural barriers. I think one of the most important things is always for providers to be culturally aware that certain ethnic groups may have certain preferences with how news is delivered, how news is handled, how treatment is decided upon.

And additionally, I think it’s important for patients and providers to promote awareness and education in a setting where patients and family members are very comfortable with. This can be the church setting as we recognize the importance of this in the day-to-day lives of many patients and family members across multiple cultures.

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What Early Phase Gastric Cancer Trials Are Showing Promise?

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What Early Phase Gastric Cancer Trials Are Showing Promise? from Patient Empowerment Network on Vimeo.

What are the latest gastric cancer clinical trial developments in early phases? Expert Dr. Jun Gong from Cedar-Sinai Medical Center shares updates about early phase clinical trials and advice to patients for being proactive in their care.

[ACT]IVATION Tip

“…it’s never wrong to ask if there is any available clinical trial no matter what setting or stage of disease. Whether it’s early stage or advanced stage, it’s always appropriate to ask every provider, ‘Is there a clinical trial that you see may be eligible for me or that you believe to be a better option than certain standard of care options?”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

Expert Guidance: Stomach Cancer Basics for Newly Diagnosed Patients

 How Is Gastric Cancer Screening and Care Impacted by Culture?

 Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Transcript:

Lisa:

Dr. Gong, can you speak to any early phase trials that have shown encouraging results for stomach or gastric cancer and in particular any of those related to metastatic disease?

Dr. Jun Gong:

So the exciting part about research in stomach or gastric cancer is that there are a lot of ongoing exciting developments in new treatment diagnostics almost every year. And so I think in terms of advanced or metastatic stomach cancer, some of the more exciting trials that have been ongoing and for which results are eagerly anticipated include novel targeted therapies. Here beyond HER2, MSI, EBV PD-L1. We’re looking at novel targets such as claudin. In fact, it is highly anticipated that the first claudin antibody will be available soon for all corners in the U.S. with the FDA approval of such a drug. The compound in question is called zolbetuximab, and here, it requires patients to be tested for claudin on their tumor biopsies. And this is a targeted therapy that’s able to be added to chemotherapy for patients with metastatic gastric cancer.

There are other novel targets such as FGFR2, which is a new target that has…also a targeted therapy that can be added to chemotherapy. This recently demonstrated exciting benefit in a Phase I/II clinical trial. Then we also have novel immunotherapies. We have early phase trials that are now investigating CAR T therapies targeting stomach cancer and specific markers of stomach cancer, including claudin as well. So those are some of the more exciting Phase I ongoing trials in the advanced stomach cancer setting. In the non-advanced or non-metastatic stomach cancer setting, they’re really trying to…the trials have really focused on trying to improve upon chemotherapy, leading up to surgery to derive better cures for stomach cancer. And here, the addition of immunotherapy to chemotherapy is an eagerly anticipated concept that is now playing out in clinical trials and in larger clinical trials and their final results are eagerly anticipated as well.

Lisa:

And do you have an activation tip, Dr. Gong?

Dr. Jun Gong:

My activation tip for this is it’s never wrong to ask if there is any available clinical trial no matter what setting or stage of disease. Whether it’s early stage or advanced stage, it’s always appropriate to ask every provider, “Is there a clinical trial that you see may be eligible for me or that you believe to be a better option than certain standard of care options?” And we as oncologists are always more than happy to look into these clinical trials and really give you guys a breakdown of what trials may or may not be considered.

Sometimes clinical trials, it’s important to realize that for a particular treatment setting, may not be available at our institution, but there are other institutions within the geography. If you are not geographically limited, even across the country where unavailable clinical trials may be available. We generally refer to what we call a master website. It’s called clinicaltrials.gov. And here it’s a very, in my opinion, patient friendly search engine where you can search your diagnosis and look at available clinical trials. And it’s very easy to have this streamlined approach and even filter out some trials that may not be eligible in collaboration with your doctor.

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Expert Guidance: Stomach Cancer Basics for Newly Diagnosed Patients

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Expert Guidance: Stomach Cancer Basics for Newly Diagnosed Patients from Patient Empowerment Network on Vimeo.

What are stomach cancer basics for newly diagnosed patients to know? Expert Dr. Jun Gong from Cedar-Sinai Medical Center explains stomach cancer staging, where the cancer occurs, and advice for patients.

[ACT]IVATION Tip

“…ask the physician or care provider, ‘What is my stage of stomach or gastric cancer?’ and we will do our best to explain the stage.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

What Early Phase Gastric Cancer Trials Are Showing Promise?

 How Is Gastric Cancer Screening and Care Impacted by Culture?

 Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Transcript:

Lisa:

Dr. Gong, how do you explain stomach cancer to your newly diagnosed patients and care partners? And really important too, how do you explain disease staging to them?

Dr. Jun Gong:

So the way I explain stomach cancer or gastric cancer, is another term for this disease, to my patients is that we all are familiar somewhat with our organ that is the stomach. This is the organ that helps digest and process our foods. And it’s the organ that connects to the esophagus and then to the small bowel. And unfortunately, cancers can arise from this organ. And this is where it’s a little bit unique in the sense that unlike other cancers, the stomach is almost like a tube. It’s a hollow structure.

Unlike breast cancer, for example, where you can have a discrete mass where you can actually draw on a caliper and say this is 2 centimeters or 3 centimeters in dimension, stomach cancer tends to grow along the walls of this tube infiltrating to the inside of the lumen. Or it can even spread to the outside of the stomach as well. 

And so this is how the staging is a little bit different for stomach or gastric cancer. And the way, instead of measuring by size, we measure how the depth of the infiltration of the tumor is along the thickness of the wall. And so the staging is similar to other cancer types where there’s a stage I, II, III, or IV connotation. And stage IV means that the cancer has spread outside the stomach and into distant sites such as the liver or lungs, while tumors of the stomach that are confined to the stomach and even to the lymph nodes around the stomach are still classified as I, II, or III. So this is a little bit about, a background, about how we explain what stomach cancer is and how the staging system works.

My activation tip for patients and care partners who are newly diagnosed with gastric or stomach cancers and are unsure about their stage is that it is always more than appropriate to ask the physician or care provider, “What is my stage of stomach or gastric cancer?” and we will do our best to explain the stage. And, of course, this is dependent oftentimes on the availability of information from a diagnostic workup. And how we stage the patient is usually dependent on imaging such as CT or MRIs or PET scans. And it’s often combined with ultrasound or endoscopic procedures such as an upper endoscopy or an endoscopic ultrasound, which is a specialized procedure that allows you to look within the thickness of the stomach to see how deep or how depth of the invasion of the stomach cancer is.

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