Abstract B67: Collaboration between Volunteers in Medicine, serving the working uninsured, and Mayo Clinic, an academic medical center, addresses breast cancer outcome disparities and increases minority representation in cancer clinical trials

Background: In 2003 the Volunteers in Medicine (VIM) clinic in downtown Jacksonville, Florida started providing free primary healthcare for low socio-economic status (income below 250% poverty level) working uninsured. VIM has now provided 18,000 patient evaluations and follows about 2,500 active patients. Volunteer physicians, ARNPs, nurses, and lay persons staff VIM to meet the needs of its patient population. VIM is funded through private and corporate donations, grants, and ongoing fundraising. Methods: VIM evaluates patients on a non-emergency appointment basis for basic care, laboratory testing, and medication dispensing. VIM partners with the community to provide free medical services: the University of North Florida (UNF) provides the ARNP Director of VIM, St. Vincent9s Health System provides free access to its extensive laboratory services and Mayo Clinic provides physician and nursing quality care as well as access to cancer clinical trials. VIM9s primary care services include mammograms, clinical breast examinations, pap smears, blood pressure testing, GI screenings, and basic laboratory testing. When results warrant further investigation, VIM refers patients to Mayo Clinic volunteer personnel for additional diagnostics and/or treatments. Results: Since 2005, 57 VIM patients were treated at Mayo Clinic: 33 patients were African American, 10 were Hispanic, 2 were of Asian descent, and 12 were Caucasian (77.2% minorities). Forty-three of the 57 (75.4%) patients were referred to Mayo Clinic because of abnormal mammogram screenings or abnormal breast examinations. Referred breast patients received chemotherapy, breast and reconstructive surgery, and radiation therapy. Overall, VIM9s referrals to Mayo Clinic generated 55 clinical trial entries in 7 separate trials. Twelve of these 57 patients were diagnosed with breast cancer and received diagnostic mammograms, ultrasounds, ultrasound-guided biopsies, stereotactic biopsies, breast MRIs, MRI-guided biopsies, and treatments as necessary at Mayo Clinic. Procedures were completed during initial visits to reduce the number of visits patients needed for diagnostic evaluations, based on feasibility. A Mayo Clinic-funded ARNP, who also volunteers at VIM, navigates the care of these patients and ensures timely patient evaluation and continuity of care at both VIM and Mayo Clinic. Conclusion: A partnership between an academic medical center and a volunteer medical clinic serving working uninsured patients can improve breast cancer disparities in a given community and increase minority representation in cancer clinical trials. Expansion and funding of similar programs will markedly ameliorate breast cancer care disparities and disparities in minority representation in cancer clinical trials.