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Tracy Battaglia was about to begin her junior year of college when two things happened that would profoundly shape her life: she earned an early acceptance to medical school and she was diagnosed with cancer.
"When I faced cancer, cancer was my number one priority," recalled Battagalia. "It was the worst thing in my life that I was dealing with."
Now a doctor at Boston Medical Center, Battaglia’s come to see the way she dealt with her own cancer as a kind of privilege, one she says many of her patients, often women of color, simply can’t afford.
“Breast cancer’s not necessarily the worst thing in their life. They’re challenged with making decisions day to day about going to work so they can get a paycheck, so they can put food on their table and so they don’t get evicted from their apartment," said Battaglia. "And when you’re going through chemotherapy or radiation therapy and you need to be there every day, sometimes you have to make hard decisions.”
And she said, it’s not just race, but income and language barriers that put women at an increased risk of missing cancer treatment.
Charmaine Brumant spent much of last year being treated for breast cancer at Boston Medical Center. It’s only a few miles from her Mattapan apartment, but getting there was a conundrum. Given the side effects of cancer drugs — nausea, fatigue, a compromised immune system — navigating public transit wasn’t realistic.
So, she took a taxi — a luxury made possible only because the hospital picked up the tab.
Brumant benefited from a patient navigator — someone who works at the hospital and helps patients overcome obstacles that could get in the way of treatment. It can be as simple as providing taxi vouchers or as complex as helping a patient find stable housing. Battaglia says patient navigators are a proven way to make sure at-risk patients get treatment. She says Boston hospitals all offer some version of this service, but many patients switch hospitals during their care and navigators lose track of them.
"We don’t have a safety net in the city to put our arms around that population of patients, to make sure they’re getting the care they need," said Battaglia.
But that’s about to change. Normally competitors, the city’s hospitals are launching a five-year test of cooperation. Patient navigators from Boston Medical Center, Mass General Hospital, Beth Israel Deaconess Medical Center, Tufts Medical Center, Brigham and Women’s Faulkner Hospital and Dana-Farber Cancer Institute will create a city-wide registry. It's designed to track 1,100 women at risk of missing breast cancer treatments. The goal is to make sure there’s always a point person helping the patient navigate not just the healthcare system, but also life challenges.
“If we can demonstrate the ability to do this in breast cancer care," said Battaglia, "the sky’s the limit for disseminating this model outside of Boston to other cities for breast cancer care."
And if this model works, Battaglia said it could also be adopted to treat other conditions — from diabetes to heart disease — in which race and income influence outcome.