Tag Archive for: Asian

Stomach Cancer Screening | How Asian and Latinx Patients Can Self-Advocate

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Stomach Cancer Screening | How Asian and Latinx Patients Can Self-Advocate from Patient Empowerment Network on Vimeo.

How can Asian and Latinx patients self-advocate for gastric cancer screening? Expert Dr. Joo Ha Hwang from Stanford Medicine shares advice for how patients can discuss gastric cancer screening with their provider and how providers should be engaging with patients for better care.

[ACT]IVATION TIP

“…especially if you come from Korea, Japan, where they actually have instituted national screening, with endoscopy, we actually have U.S. guidelines that state that if you come from a country whose guidelines state you should have endoscopy, then you should also have endoscopy, we should be following your home of origins guidelines for you and so, those patients should also have endoscopy.”

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Related Resources:

How Biomarkers Might Impact Future Stomach Cancer Care

How Biomarkers Might Impact Future Stomach Cancer Care

 What Are Key Risk Factors for Stomach Cancer?

What Are Key Risk Factors for Stomach Cancer?

 Potential Impact of Artificial Intelligence on Stomach Cancer Detection and CarePotential Impact of Artificial Intelligence on Stomach Cancer Detection and Care

Transcript:

Lisa Hatfield:

So in the United States, we do have many people from the Asian and Hispanic communities who may be at higher risk for gastric cancer, do you suggest that they talk to their provider about getting screened? And how might they phrase that question? Can I get screened for the H. pylorI? So if you had a patient who wanted to be screened or is interested in getting screened, how might they approach their provider in asking for the screening for gastric cancer or H. pylori?

Dr. Joo Ha Hwang:

I think the first step is to get tested for H. pylori, and pretty much, everyone who is, an immigrant to the U.S. is at much higher risk for having H. pylori, in the past, we used to say that the people from Asia, immigrants from Asia had an 80 percent risk of having H. pylori, from Mexico, it was more like around 60 percent, United States, it was in the 20 to 30 percent, it’s probably less than that now.

So worldwide, prevalence of H. pylori is certainly going down but again, providers should know this is something that is taught in medical school, is areas that are, endemic with H. pylori and providers should also know that, H. pylori is a carcinogen, and so if a patient just comes up in and says I’m worried about having H. pylori, I come from a high-risk population, it really shouldn’t be difficult to get tested for H. pylori, furthermore, if they have any symptoms, especially any epigastric pain what we call dyspepsia that should also trigger the provider to go ahead and test for H. pylori, because that’s part of the algorithm. So I think that all of these, it shouldn’t be difficult to engage a provider on that particular issue.

Lisa Hatfield:

So it is okay and appropriate for a patient to approach their provider and ask that question? So I appreciate that.

Dr. Joo Ha Hwang:

I think it’s important and I think that patients need to be their own advocates, because I have heard of instances where providers have been reluctant and in certain systems they’re discouraged from further testing, because it’s a capitated system. I think H. pylori testing is not that difficult, sometimes if patients want endoscopy, it can be, more challenging but again, especially if you come from Korea, Japan, where they actually have instituted national screening, with endoscopy, we actually have U.S. guidelines that state that if you come from a country whose guidelines state you should have endoscopy, then you should also have endoscopy, we should be following your home of origins guidelines for you and so, those patients should also have endoscopy.

But the challenge with that is that they’re going to end up paying for it, because it’s not typically covered by insurance or it’s not fully covered by insurance so you’d probably have to pay a copay, for something like that at this time.

Lisa Hatfield:

I have a friend who’s dealing with her father who lives in Korea, she’s from Korea, has been here about two, five years. He has stomach cancer. So we’ve been having this discussion, and that’s why I thought I’d ask that last question. She said she sometimes is afraid to approach her provider…

Dr. Joo Ha Hwang:

If you’re afraid to approach your provider, you need a different provider.

Lisa Hatfield:

Well, that’s a good suggestion too.

Dr. Joo Ha Hwang:

No, no. We’re supposed to work with you and listen to you and again, I go around and give a lot of talks to patient groups, and I like engaging in these types of activities, because I think the more information patients have, the more that they can talk with their physicians, and oftentimes patients know more than their physicians do, because they’ve done a lot more research. And hopefully you have a physician with some hubris who will listen to the patient and if they don’t know, they’ll kind of look things up, so yeah.

Lisa Hatfield:

Yeah. I appreciate that, thank you.

Dr. Joo Ha Hwang:

My pleasure.

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Potential Impact of Artificial Intelligence on Stomach Cancer Detection and Care

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Potential Impact of Artificial Intelligence on Stomach Cancer Detection and Care from Patient Empowerment Network on Vimeo.

What role might artificial intelligence take in stomach cancer detection and care? Expert Dr. Joo Ha Hwang from Stanford Medicine shares his perspective on how AI might be most impactful in stomach cancer detection and care, how the FDA will be involved in AI use, and protections that must be put in place to safeguard patient interests.

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Related Resources:

How Biomarkers Might Impact Future Stomach Cancer Care

How Biomarkers Might Impact Future Stomach Cancer Care

 Stomach Cancer Screening | How Asian and Latinx Patients Can Self-Advocate

Stomach Cancer Screening | How Asian and Latinx Patients Can Self-Advocate

 Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?

Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?

Transcript:

Lisa Hatfield:

Dr. Hwang, what is the current role of artificial intelligence or AI in gastric cancer care? And how do you envision the role of AI in the future management of gastric cancer?

Dr. Joo Ha Hwang:

Yeah, it’s a great question, very early day for AI but AI is really the hot topic, in the field of medicine, and AI will definitely play a role in, the detection of gastric cancer on probably many fronts, obviously the most straightforward one is during endoscopy, we can use AI to help identify early gastric cancer, and one of the issues in the United States is, since gastric cancer is a relatively rare finding, and it can be very subtle on endoscopy, a lot of endoscopists can miss an early gastric cancer or a precancerous lesion, and so we’re hoping to use AI to better identify, these lesions, since they’re not super common, and we’re really not taught to look for these lesions, this is an area that AI can be helpful. But the other, probably easier implementations of AI would be through just medical records and just using AI to help identify people who are at high risk.

And then flagging these patients for physicians to say, “Hey, this patient should be considered for H. pylori testing, this patient should be considered for endoscopic screening.” So I think that’s actually a simpler implementation of AI. So I think that AI will definitely help, it should help with outcomes, the challenge really is, working with the FDA to allow AI to be implemented in the clinical setting, that’s not a really simple task, because AI can also potentially be used for nefarious reasons and so we certainly have to protect patients’ identities, we have to protect patients’ information.

And so, there’s a lot of steps and a lot of responsibility that comes with AI. But I would say stay tuned, it will definitely, you’ll see more and more AI implementation over the years to come, and overall it should be very positive for patients for all disease processes, including gastric cancer.

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What Stomach Cancer Care Obstacles Do Asian and Latinx Patients Face?

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What Stomach Cancer Care Obstacles Do Asian and Latinx Patients Face? from Patient Empowerment Network on Vimeo.

What kind of gastric cancer care barriers do some patient groups face? Expert Dr. Joo Ha Hwang from Stanford Medicine discusses key factors that impact gastric cancer care access, and recommendations for patients and providers to reduce disparities.

[ACT]IVATION TIP

“…if you have any influence with the members of Congress, kind of bring up the issues related to minority health and access to healthcare. I know there’s a, within the Department of Health and Human Services, there is a Department of Minority Health, this is something that I think that they’re working on, which is access to healthcare, but it’s a real problem.”

See More from [ACT]IVATED Gastric Cancer

Related Resources:

How Biomarkers Might Impact Future Stomach Cancer Care

How Biomarkers Might Impact Future Stomach Cancer Care

 What Are Key Risk Factors for Stomach Cancer?

What Are Key Risk Factors for Stomach Cancer?

 Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?
Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?

Transcript:

Lisa Hatfield:

Dr. Hwang, what are the challenges faced by the Asian and Hispanic populations in accessing timely and appropriate treatment for stomach cancer? And what strategies could be implemented to address these challenges?

Dr. Joo Ha Hwang:

There are several questions or several challenges. Number one, I think, is patient awareness is educating these communities that they actually are at higher risk of developing gastric cancer. Number two, their access to healthcare oftentimes, is difficult sometimes because of language barriers, sometimes due to cultural issues, sometimes just due to regional geographic issues, and access to healthcare also insurance. A lot of the immigrant population, they even if they’re very successful and work quite a bit, oftentimes they’re, small business owners and they have high deductible, insurance plans. I had a friend who was an immigrant from Asia, and I told him you’re at high risk for developing gastric cancer, and you should have an endoscopy, we did an endoscopy on him and this was at a county hospital in Seattle.

He got a bill for $6,000 for his endoscopy, and I was personally appalled at that, and that’s actually kind of what got me into this field, was because I felt that that was very unfair, that this person who worked very hard and had insurance, but had a high copay, because he had high deductible insurance, was being treated like this when someone with Medicare, we’re charging only $200 for an endoscopy. And then if we had screening guidelines from the USPSTF such as for colon cancer, breast cancer, it would be completely free. And so there’s a huge disparity, and it is the Hispanic, it’s the Asian population, it’s the immigrant population that are at higher risk for gastric cancer.

And this is completely uncovered, and so, these are all inequities, in the system that we’re trying to address, what I would say, is that, if my activation tip for this would be, if you have any influence with the members of Congress, kind of bring up the issues related to minority health and access to healthcare. I know there’s a, within the Department of Health and Human Services, there is a Department of Minority Health, this is something that I think that they’re working on, which is access to healthcare, but it’s a real problem. The other side of it also is the education side and the empowerment side, and I think that we have to do a better job in terms of educating the populations who are at high risk for gastric cancer to go see their primary care physician to talk to them about what they need to do.

The other challenge really, actually is on the physician side, because, and I’ve been working at this as well, physicians don’t know, we’re taught in medical school that gastric cancer is rare, and it’s almost like an afterthought and we spend very little time on gastric cancer, but gastric cancer isn’t rare, and there are high risk populations, and there is something that we can do about it. So we really have a long way to go, but the good news is there is progress to be made, so if we just put in the effort, we can make a huge dent in outcomes for gastric cancer.

Lisa Hatfield:

Are there any efforts underway right now to develop guidelines for those communities in the U.S. to do screening? Do you know?

Dr. Joo Ha Hwang:

Yeah. We’re actively involved on a national level to work with societies and working with societies to make guidelines. This helps educate providers and whatnot, the challenge really in terms of getting insurers to cover this. This is really cost-effective, but oftentimes when insurers look at something they need to see an immediate return, they want to say within one year, this is cost beneficial, where this is a long….Gastric cancer prevention, any cancer prevention is really a long-term, outlook and that’s why the USPSTF plays such an important role because their guidelines have immediate implications on insurers and what they need to pay for, and so really we need, guidelines from the USPSTF, to make a true impact on the outcomes of gastric cancer.

But this is proving to be challenging because, the population that’s affected is a relatively small population in the United States. But again, in this era of precision medicine and equitable medicine, my view is it shouldn’t matter, in terms of the size of the population, that’s at risk, it should be data that says these particular patients are at high risk, and this intervention should work to decrease the risk of gastric cancer, and so I think we need to start having dialogue and changing the way we think about, patient care and make this more personalized, precision individualized medicine as opposed to population-based medicine.

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What Are the GAPS Study Key Findings About Gastric Precancer?

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What Are the GAPS Study Key Findings About Gastric Precancer? from Patient Empowerment Network on Vimeo.

What have been key findings on gastric precancer from the GAPS Study? Expert Dr. Joo Ha Hwang from Stanford Medicine discusses the GAPS Study, patient groups at risk of H. pylori and gastric intestinal metaplasia, and proactive patient advice for early detection of gastric cancer.

[ACT]IVATION Tip

“…talk with your physician on whether or not you’re at high risk and you should have endoscopic screening or if you have gastric intestinal metaplasia (GIM). So let’s say you’ve had endoscopy and you have been diagnosed with gastric intestinal metaplasia, there are some guidelines out there that actually are deceptive.”

 

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What Is the Role of Biomarker Testing in Stomach Cancer?

 What Key Ways Is Early Detection of Stomach Cancer Delayed?

 How Can Public Policy Measures Reduce Gastric Cancer in High-Risk Populations?

Transcript:

Lisa Hatfield:

Dr. Hwang, can you tell us more about the gastric precancerous condition study, the GAPS Study and its key findings so far? And how do you combine clinical and endoscopic data with bio-specimens in the GAPS Study to improve early cancer detection?

Dr. Joo Ha Hwang:

So, the GAPS study is a study that we started at Stanford when I first got there about six years ago. This is a prospective study where we enroll patients who we feel are at high risk for developing gastric cancer and then follow them longitudinally. And we do endoscopy and we do biopsies, we do systematic biopsies using something called the Sydney Protocol, where we basically map the stomach and take biopsies. And then with those biopsies, we run several different analysis on them.

And our goal is to identify biomarkers that would help to identify patients who are particularly high risk. So the thing that we’re looking for in particular, there’s a condition called gastric intestinal metaplasia. And that’s the pre-cancerous condition. That’s a change in the lining of the stomach, typically from chronic inflammation, and most commonly due to chronic H. pylori infection.

So unfortunately it’s quite prevalent. If you look at the Asian population, it can be over 30 percent of the population of Asians, East Asians can have gastric intestinal metaplasia, but not all of those patients will then go on to gastric cancer. And so, there’s a cost, especially in the U.S. the cost is pretty high to do endoscopic screening and surveillance. And so what we’re trying to do is further identify those patients who are at particularly high risk, who have gastric intestinal metaplasia, who would warrant ongoing surveillance given their risk of developing gastric cancer in the future.

So, this is going to take many, many years because it takes a long time for this to evolve. And so, we’re hoping to follow hundreds of patients longitudinally and determine what biomarkers, what other clinical factors may help to predict the progression onto gastric cancer so that we can detect gastric cancer early in those patients and cure them of gastric cancer.

So my activation tip for this particular question or for this particular topic would be that, again, talk with your physician on whether or not you’re at high risk and you should have endoscopic screening or if you have gastric intestinal metaplasia (GIM). So let’s say you’ve had endoscopy and you have been diagnosed with gastric intestinal metaplasia, there are some guidelines out there that actually are deceptive. And if you are in the group that is at higher risk of developing gastric cancer, you should talk to your physician about how having endoscopic surveillance and what that interval should be for having endoscopic surveillance to make sure that you don’t progress onto developing gastric cancer.

Lisa Hatfield:

And just out of curiosity, with this GAPS Study, trying to identify biomarkers that might be used in the future to track that, are these biomarkers something that you find in the tissue from the biopsy, are they biomarkers you might find in the blood or saliva? So people can have less invasive means to have surveillance for gastric cancer?

Dr. Joo Ha Hwang:

We’re investigating all of that. So when we enroll a patient in GAPS, we collect saliva, we collect blood, serum. So ideally it would be a noninvasive biomarker, but the best biomarker is something that wouldn’t require endoscopy. But we are also looking at the tissue itself. So all of these things are being investigated. So stay tuned.

Lisa Hatfield:

And my last question about that, in case if a patient is watching this in the Bay Area, is your study currently enrolling participants?

Dr. Joo Ha Hwang:

Yes, we are actively enrolling and we welcome anyone’s participation.

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Novel AML Therapy Use | Impact of Socioeconomic Status and Other Factors

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Novel AML Therapy Use | Impact of Socioeconomic Status and Other Factors from Patient Empowerment Network on Vimeo.

How do socioeconomic status and other factors impact novel acute myeloid leukemia (AML) therapy use? Expert Dr. Andrew Hantel from Dana-Farber Cancer Institute and Harvard Medical School  discusses major factors that impact novel AML therapy use, solutions to decrease the disparities in novel therapy use, and support resources for patients.

[ACT]IVATION TIP

“…for patients who are newly diagnosed and considering different treatment options that may be available to them to say working with both your clinical team and looking outside the clinical team to other well-known support services like Leukemia & Lymphoma Society to see if there are additional financial and other resources that can be obtained in order for you to be able to avail yourself of any treatment option that’s available, would be very helpful.”

Download Resource Guide | Descargar guía de recursos

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Why Is Shared Decision-Making Important for AML Patients?

Transcript: 

Lisa Hatfield:

Dr. Hantel, in your study focusing on sociodemographic associations with uptake of novel therapies for AML, can you describe those findings and what they might mean for patients from diverse backgrounds, particularly those with lower socioeconomic status?

Dr. Andrew Hantel:

So in our study of sociodemographic associations with the uptake of novel therapies for AML, we found that patients from diverse backgrounds, particularly those with lower socioeconomic status and those who identified as Black, Asian, or other in this case, non-Hispanic minoritized groups actually face disparities in accessing some of the new treatments that we have for AML. And we know that there are a number of new treatments for this disease, but that many of these treatments are more expensive and are given as outpatients.

And in these cases, this can be great, because it allows people to not have to remain in the hospital like some of our old therapies, but also means that really this is putting more of the like logistical burden on families and on patients. Meaning you have somebody who’s potentially more sick at home rather than in the hospital where there’s nursing and a lot of other caregivers that isn’t on the caregiver at home.

And then we also have the increased burden of actually bringing the person back and forth to the hospital, taking more time off work, and all of the money also that’s involved in that. And so this can translate into some disparities by socioeconomic status, which means that people with less means are less likely to get these medications. And these same groups are also less likely to be seen in practices where these newer drugs are likely to get prescribed.

And so together, some of the study findings that we saw were more that these drugs were being less taken up by people with those backgrounds and by practices that see those patients. And in the end, we know that these novel therapies are being approved, because they offer something new, either that’s better or that expands the treatments to newer groups who are unlikely to have as great options before.

And so we want to really provide these treatments to everybody who’s eligible for them. And we shouldn’t think that that eligibility requires really different amounts of money, or different types of personal characteristics could be equitably available to everybody.

And addressing these disparities kind of involves a very complex set of considerations, such as making sure that patients who are stable enough to do so they can go see AML specialists and consider more of these novel therapies that all patients are educated about, their treatment options and the logistics of different treatment choices and that they’re provided with all the avenues of support available to them.

Some of these can be through societies like The Leukemia & Lymphoma Society, which can connect patients with a variety of support services, including more informational services as well as direct financial support to be able to either obtain these drugs or work with companies and other places to figure out how to maintain or how to obtain these drugs.

So my activation tip for this question would be for patients who are newly diagnosed and considering different treatment options that may be available to them to say working with both your clinical team and looking outside the clinical team to other well-known support services like Leukemia & Lymphoma Society to see if there are additional financial and other resources that can be obtained in order for you to be able to avail yourself of any treatment option that’s available, would be very helpful.

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How Are Cultural and Language Barriers to CAR T Therapy Being Addressed?

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How Are Cultural and Language Barriers to CAR T Therapy Being Addressed? from Patient Empowerment Network on Vimeo.

How are CAR T therapy barriers of cultural and language nature being addressed? Expert Dr. Sikander Ailawadhi from Mayo Clinic discusses research study results on access barriers and ways to create solutions that address language and cultural issues.

[ACT]IVATION TIP

“…having a culturally sensitive discussion and a system that approaches the patients for complex treatments like CAR T or clinical trials. And personally, I’ve seen that it makes a big difference to the patient’s consideration of those treatment options.”

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 Roadblocks for Black and Latinx Patients From CAR T Trial Access

Roadblocks for Black and Latinx Patients From CAR T Trial Access

Transcript:

Lisa Hatfield:

Dr. Ailawadhi, we know cultural or language barriers may hinder access to information about CAR T-cell therapy. How are you and your colleagues addressing this barrier?

Dr. Sikander Ailawadhi:

It’s very important to think about cultural or language barriers and how they may affect our way we deliver the care and the way the patients consume that healthcare. A few years ago we had done a study looking at just electronic medical record usage and how patients participate in their EMRs, for example. And we realized that for patients who are non-white, language barrier was a big issue because frankly, majority of our EMRs are English. They don’t provide a lot of Spanish or other language support.

Similarly, clinical trials and education material for CAR T, et cetera, they are very frequently in English. There is an increasing number of Spanish documents that are becoming available. So how we try to overcome these barriers, I think we have started, utilizing an approach in our institution where our research staff, we are trying to hire a diverse population.

There is data that based on studies, it has been very clearly shown before that, a patient is more likely to consider favorably a clinical trial or a treatment if it is being offered by someone who look and speak like them. So an African American patient is more likely to accept or consider a treatment, I would say, not even accept, but consider a treatment if it is being offered by an African American physician, an African American clinical research coordinator, et cetera.

While I’m not African American, I can’t change that, but we have African American, Hispanic, Asian clinical research coordinators in our teams, and we have noticed a clear difference in the patient’s understanding their ability to ask questions, their willingness to ask questions and clear out their barriers if it is given to them in a culturally sensitive, culturally appropriate manner.  So my activation tip for this question would be, having a culturally sensitive discussion and a system that approaches the patients for complex treatments like CAR T or clinical trials. And personally, I’ve seen that it makes a big difference to the patient’s consideration of those treatment options.

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