University of Rochester Medical Center, Dept. of Urology
Introduction: Racial and socioeconomic disparities in the incidence, treatment, and outcomes of urologic cancers are well documented; solutions to these inequities are not. The purpose of this study was to assess the feasibility and effectiveness of integrating a urologic specialty care clinic into an existing primary care infrastructure. We also aimed to increase trainees’ awareness of health inequities in urologic cancer care. Methods: St. Joseph’s Neighborhood Center (SJNC) is a Catholic charity organization that provides health care and social services to individuals without health insurance. University of Rochester Medical Center (URMC) has a long-standing partnership with SJNC through a student-led primary care clinic. In February 2021, URMC residents organized bi-monthly urology clinics at SJNC staffed by attending, resident, and student volunteers. A preliminary analysis of clinic records was conducted. Qualitative data was obtained through direct observation of program processes and informal feedback with volunteers. Results: Twelve clinics have been held. Four to 6 patients referred by SJNC’s primary care team were seen in each 2-hour evening clinic. Patients were evaluated by student/resident teams, followed by discussion with an attending urologist. Approximately 40% of patients were referred for suspected genitourinary malignancy. Multiple barriers to oncologic diagnostics were identified (Table 1). Hematuria evaluations were the most difficult to coordinate due to cost and logistics of imaging and procedures. Trainees reported an increased awareness of cancer care disparities and the practical challenges of overcoming access to specialty care in a medically underserved community. Conclusions: Comprehensive cancer care is routinely fragmented or unavailable to medically underserved populations. Despite a nationally recognized cancer center in Rochester, NY, many individuals living within the urban area struggle to obtain routine cancer screening and evaluations for potentially treatable or curable cancers. We outlined a feasible model of integrating access to uro-oncologic care into a primary care system with sustainable buy-in from local partners. Future directions are to increase the frequency of clinics, access to clinical trials, and decreasing the financial burdens of care. SOURCE OF Funding: NA
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