Outreach

Claudia Barajas recently put on headphones at El Jefe, a Nashville-based Hispanic radio station, to moderate an information-packed discussion about lung cancer prevention and the importance of screenings for individuals at higher risk of developing lung cancer. 

Her Spanish-speaking guest was Rafael Paez, MD, a clinical fellow in the Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt University Medical Center. The pair shared information tailored for the Hispanic community and fielded questions from El Jefe on-air personality Alex Jantes. 

Barajas, manager of Community Engagement for Vanderbilt-Ingram Cancer Center (VICC), hosts La Hora de la Salud or the Hour of Health, a new, monthly radio show for the ethnically diverse Hispanic community living and working in Middle Tennessee and beyond. Barajas invites health experts, particularly those specializing in the areas of cancer prevention, early detection and risk factors associated with cancer, to appear with her on the show. The station’s signal on 96.7 FM, 105.3 FM and 810 AM is heard throughout Middle Tennessee, and listeners anywhere in the world can tune in via the station’s website and app.

Barajas joined VICC in 2015, after 17 years of directing similar outreach programs for the Hispanic/Latino and African American communities in Oklahoma City. Nashville’s Hispanic/Latino community is largely from Mexico but also includes significant populations from Central America, Cuba, Puerto Rico and Colombia, where Barajas was born before moving to the United States more than 30 years ago.

For six years, Barajas shared health-centric information for Hispanic listeners during a local radio program hosted by Nuestra Comunidad (Our Community), but her new show is solely sponsored by VICC. Barajas said while the content will often be focused on cancer and cancer prevention, she is already booking guests to speak on related health topics such as mental health and obesity. 

“I think the campaign will be a success because so many from the Latino and the African American communities, as well as people living in rural areas, are considered essential workers, as we often heard during the pandemic,” she said. “They do a lot of manual labor, and they use the radio as a primary source of getting information. This is not new but has been increasing through the pandemic.”

Service Area

Barajas is part of the VICC Community Outreach and Engagement (COE) Office, a group whose responsibilities include meeting the needs of all populations living in the Cancer Center’s geographic catchment area. That immense area includes 123 counties encompassing all of Tennessee, western Kentucky and northern Alabama. Through COE, VICC’s mission is not isolated within clinical walls; it instead takes place at community gatherings, church socials, community health council meetings, local festivals — and at least one radio station.

Cancer affects everyone, but its burden is often much higher in certain ethnic and socioeconomic populations. The COE Office serves as a critical part of the Cancer Center’s mission to address the needs of the catchment area and promote cancer health equity.

According to the National Cancer Institute (NCI), death rates from cancer are higher in African Americans, particularly African American males, compared to any other racial or ethnic groups. Hispanics and Latinos have the highest rates for cancers associated with infection (such as liver, stomach and cervical cancers) and are more likely to be diagnosed with advanced stages of the most common cancers than non-Hispanic whites.

Community outreach and engagement has been a fundamental activity of NCI-designated Cancer Centers since the Cancer Centers program began in 1971. However, since 2016, community outreach and engagement has been expanded to all aspects of the centers’ programs, including basic, clinical, translational and population research.

“We’re an NCI-designated Comprehensive Cancer Center so our mission is to serve our community,” said Debra Friedman, MD, MS, E. Bronson Ingram Chair of Pediatric Oncology and associate director for Community Science and Health Outcomes at VICC. “What that means is understanding the community, getting community input on how we serve them and then making sure our services reach the community. And community outreach engagement is bidrectional. We reach out to the community for their perspective on what’s important to them. It can be prevention, early detection, availability of treatment, access to research, access to services, education, advocacy — the whole gamut. 

“We know not everybody will be able to walk through the doors of the Vanderbilt-Ingram Cancer Center for everything they need. When we design research here, develop educational tools, design advocacy efforts, and when we deliver clinical services, we want to make sure that we are bringing that to our communities. That can be done obviously through satellite programs, and they can be done virtually now. It can also be working with primary care practices and with subspecialty practices in communities. What we don’t want to be is that ivory tower sitting here in Nashville on our campus where, if you can’t get here easily, you can’t benefit from all that we have to offer.”

The Numbers

From July 2021 until July 2022, VICC’s Community Outreach and Engagement Office held 104 events, reaching more than 17,247 people, including 42 community education programs focused on cancer education, prevention and screening that reached 11,847 people. 

The majority of the events (91) were targeted to diverse populations, including 27% for rural communities, 19% for Hispanic/Latino communities, 30% for African American communities, and 5% for faith-based groups. Of these events, 24% focused on general cancer, 14% on breast, 7% on colorectal, 5% on cervical, 5% on pancreatic and 2% on lung. Other topics presented at events included cancer survivorship (7%) and clinical research trials (14%). 

Most of the community events conducted via virtual platforms were also recorded and posted on the VICC YouTube channel. In addition, in the same time span, members of the COE team participated in 26 rural health council meetings, representing 16 Tennessee counties to discuss needs, initiatives and collaborative efforts with local government, business and community leaders.

In an unexpected bonus, virtual COE programming also drew participants from Texas, Oklahoma, Maryland and internationally in Mexico, Colombia, United Arab Emirates, Ecuador, Hungary, Argentina, Germany, Great Britain and Canada. 

Being out in the communities, asking directly how needs can best be met in that area rather than just assuming a cookie-cutter approach will do, has paid off in significant wins for the Cancer Center as new initiatives and research are planned, Friedman said. But listening has also paid off in ways that might at first seem minor. 

For example, when meeting with a federally qualified community health center in rural Tennessee, Friedman asked the best way to provide educational materials. She was imagining the answer might be videos that could be looped or fliers to hand out at clinics. A director of a rural community health center instead suggested that information be printed on “paper fans that people fan themselves with when it’s hot.”

“That would never have occurred to me in a million years,” Friedman said. “They explained that many of their clients lived in very poor areas where air conditioning is not common, and when it is hot, they come into clinics fanning themselves. Now when they take out that fan, they’ll have information on lung cancer screenings.” 

Recognizing from the start that community members know their populations and their needs establishes an invaluable rapport that benefits everyone, Barajas said, something she’s seen time and time again throughout her years of working in this field. 

“We have to recognize the expertise of the members of the communities,” she said. “They know how information should be presented, and they know how they can be more receptive to the information we have to share. So, it’s very important to be there in the communities not only to share resources and information, but also to be receptive to their feedback and to take that feedback into consideration for new projects.”

Community health educators are members of the COE team who help everyone at VICC — from the research teams in their laboratories to the clinical staff providing care — stay attuned with what’s going on in far-lying communities and specific patient populations. They’re the boots on the ground when it comes to listening to concerns at a church’s potluck fellowship or staffing an informational booth at a county’s annual strawberry festival. Because the community health educators are likely to hear about concerns or needs first, they are active participants when it comes to planning the Cancer Center’s research initiatives, Friedman said. 

Health Educators

LaNese Campbell was leading health-related initiatives for the congregation at Second Missionary Baptist Church in Nashville when she first met Barajas.

“I was the wellness person for my church, and I would bring people in to do seminars and workshops,” Campbell said. “Claudia and I kept collaborating on events, and finally she asked me if I wanted to work with her. I said, ‘Yeah!’”

Campbell had returned to Nashville to care for her aging parents after living in Texas for many years. As she navigated the health care system for her mother and brought wellness programs to her church, her eyes were opened to disparities that impacted access to care she had not realized existed.

“I became passionate about it,” she said. “I could see a lot of the disparities, and it kind of blew my mind. Once I really started looking at the incidence rates of certain cancers and survival rates for certain populations, I realized that this is stuff that people just didn’t know. And it’s important.

“In the Black community cancer is just a bad word. I remember when my sister had lung cancer, and my mom didn’t want anyone to know. There was such a stigma to it. Then when I started realizing how much people just didn’t know, I thought, ‘We need to break this.’ I said, ‘Let’s talk about the Big C.’”

And she does. Campbell travels to meet with members of both African American and rural communities to deliver facts about cancer, to dispel myths, to promote preventive measures and screenings, and to answer even the most unexpected questions. She said nothing she hears surprises her, and she feels like meeting people in their own communities builds trust so they open up more than they might otherwise. 

Campbell and Barajas both present to groups and attend health fairs and other events to promote women’s health screenings and the importance of doing breast self-exams. They utilize 3D models that mimic breast tissue with masses inside that illustrate how a tumor and a cyst might feel.

“As women touch the breast models, it sparks their questions,” Barajas said. “Often when women feel a lump, they open their eyes wide and say, ‘Oh! Is that how they are? I didn’t know!’ I say, ‘Bingo! This is wonderful, and this is why we are here!’”

Campbell has presented in churches and countless community events, and she was once asked to talk about clinical trials at a family reunion that wasn’t even her own. 

“Wherever you let me talk, I’ll talk,” she laughed. 

Campbell remembered when a person who had attended several online educational events called following an event. The woman was highly educated and in her mid-60s. When Campbell asked if she was up to date on her health screenings, the caller admitted that she’d never once had a Pap smear, mammogram or colonoscopy. 

Campbell talked with her about the importance of all of the screenings and what to expect, and she realized the woman had based her decisions on incorrect hearsay and myths that had caused her to be fearful. The woman soon had all of her screenings, and Campbell said she is now staying on schedule. 

“One of the things we like to tell people is to share the information,” Campbell said. “It’s not something you sit on. I think the more we get out into the community and the more we break down these barriers and let people know that cancer is not a death sentence, then we will start seeing more progress of people getting in to see their doctors regularly, taking preventive measures and having their screenings done.”