More people die from cancer in El Paso County than any other cause but heart disease, mirroring rates for Texas and the United States.
But the challenges facing doctors, patients and caregivers, while not unique, are often more acute in El Paso where people tend to be poorer and sicker on average than Texas or the U.S. as a whole.
Far fewer patients have health insurance. And while the physicians who treat cancer in El Paso are top notch, there just aren’t enough of them.
That means cancer is sometimes diagnosed at a later stage and wait times can be longer. Sometimes patients’ primary concern is not the cancer but paying for treatment.
Those are some of the findings of a new community cancer needs assessment commissioned by the Rio Grande Cancer Foundation. It is the first of its kind to be conducted in El Paso in more than a decade.
Next year, the foundation turns 20 years old. A lot has changed in El Paso – and oncology – over the past two decades.
Walking into the foundation’s headquarters on the Eastside feels like walking into a bookstore, calm and cozy. The foundation’s executive director, Patty Tiscareño, has a way of putting people at ease, which may go a long way toward explaining why she has had the job for almost 20 years.
The foundation works to reduce the burden of cancer in El Paso. It provides grants to local non-profits and operates a number of programs of its own.
The $80,000 assessment was conducted by Boston-based non-profit Health Resources in Action and published a few weeks ago. It was funded by the cancer foundation, Paso del Norte Health Foundation and the Sierra Providence Health Network.
According to the assessment, more people are being successfully treated for cancer in El Paso, as they are nationwide. More than 91 percent of survivors and caregivers rate the quality of oncology care in El Paso as excellent or good, and the overwhelming majority of people stay in El Paso for treatment.
Tiscareño, 61, was born in Long Beach, California. She was 3 when her family moved to El Paso. Her dad was an educator – one of the first employees of the Socorro Independent School District.
“He would park in our driveway a little yellow school bus that sat eight. He would pick up kids on Lee Boulevard, teach classes in the morning, do the books in the afternoon and then drive the students home at night,” Tiscareño said.
She has been singing “since the cradle” and is the “PT” in PT and the Cruisers, a local classic rock band.
“When I was 15, I was a folk singer – had long hair like Cher and a POW bracelet,” Tiscareno said.
Tiscareño worked as a banker for 15 years for State National Bank. She was recruited away from the bank by one of its customers, the director of the El Paso Cancer Treatment Center, where she served as director of development.
When the center was sold in 1996, she was asked if she would like to be the director of a new foundation.
The Rio Grande Cancer Foundation was formed by the proceeds of the sale of the cancer center, $11.7 million, and Tiscareno has been executive director ever since.
She sat down with El Paso Inc. and talked about what the foundation is doing in response to the assessment’s findings, how the foundation’s focus has changed and why war may not be the best metaphor to describe the effort to cure cancer.
Q: Did anything in the assessment surprise you?
I was surprised by the incidence of cancer. Having seen more women come in to use our services and avail themselves of information, I was a little surprised that the men’s cancers are No. 1.
First and foremost is prostate cancer and after that is breast cancer, a close second.
Q: One respondent quoted in the assessment said, “Everybody has someone in their family that has diabetes… They’re more concerned about that than getting cancer.”
We live in a community that does have a very large diabetic prevalence – huge. But there is a different mindset.
When you say the word “cancer” to someone, automatically you start thinking about “it’s a war,” “it’s a battle,” “I have to fight this.” Somebody tells you you have diabetes, the mindset is managing the disease.
Diabetes is a chronic disease, and cancer is just now being recognized by people as a chronic disease, which simply means that there is no cure but there is treatment and there is survivability. But we may be about a generation away from that.
I can remember my mother coming home and getting on the phone, a wall phone, and talking to somebody, “Oh, my God, so and so has (lowering her voice to a whisper) breast cancer.” You didn’t talk about it.
Those hushed tones have gone away and people now wear shirts saying, “Save the Tatas.”
We are in your face about it now, but the mindset is just starting to change that cancer is not a death sentence, but a chronic disease.
Q: That said, one doctor quoted in the assessment said, “(One of my patients) wanted the message to be that not everyone… gets cured. She said that she keeps hearing about people being cured, so maybe she did something wrong because she still has cancer.”
That was a particularly poignant comment to me. The bottom line is not all cancers are curable, and there are some that are particularly heinous.
I read an article recently that said, today, war is still the No. 1 metaphor used in describing the effort to cure cancer. In war there are winners and losers, and a person who dies from cancer is described as having “lost their battle.” But that’s not really appropriate, because it suggests that maybe if they had just fought harder, they may have won.
Q: What are the barriers to cancer care services in El Paso identified by the assessment?
One is the low physician to patient ratio; that is a big one. And I really want to emphasize that it is not the quality of physicians.
Our oncology physicians are stellar; there are just not enough of them.
But the financial burden was probably the biggest issue. For a lot of folks who are diagnosed, they have to put down a significant down payment in order to receive services and that is very hard on people.
Q: Really? A down payment?
So many people are underinsured or uninsured in El Paso, and they’re required to come up with a deposit for their treatment services.
Q: I was surprised to learn that those who are uninsured are more likely to get diagnosed with cancer at a later stage.
Q: One person quoted in the assessment said, “(Patients) are thinking about ‘how am I going to pay for this?’ They’re not even focusing on treatment; it’s payment.’” Is that a sentiment you hear often?
Absolutely. In fact, I think it is probably the primary concern. A lot of doctors will tell you that when you first get the cancer diagnosis, your brain shuts down and everything else that comes after that is garbled.
You start thinking, “How am I going to pay for this?”
We do have programs to help. We have made some adjustments to our transportation program, for example. We used to help people with airfare, and now we simply do a pre-paid Visa card and give those to people for the purpose of transportation. That could be from Fabens to El Paso for radiation five days a week. It could be for lodging. It could be for a copay.
Q: The assessment broaches a topic that is tough to talk about: the quality of treatment being determined by how much a patient can pay – by their socioeconomic status. What are your thoughts on that?
That was a distressing thing for me to read about when the assessment did come back. I wish I could offer something concrete to say, “Let’s fix this.” I’m curious how our insurance and health care systems will approach this problem.
If you don’t have the funds, you are at the mercy of a system that is already overburdened. And to come up with a $2,500 or $3,000 deposit for your chemotherapy, for some people, is absolutely like coming up with $2 million or $3 million.
So they are first or foremost not going to go to the doctor when they have symptoms until it is at a stage that is late and less treatable.
Q: Do many have to go out of town for cancer treatment these days?
The majority of the people stay here. People will go to M.D. Anderson for a second opinion and come back here. Would you rather spend six weeks in a hotel room in Houston getting your radiation or would you rather stay here where your support network and pillow is?
There are some cancer treatments and there are things like bone marrow transplants that are done exclusively in other centers.
Q: A cancer diagnosis is always tough, but the assessment suggests some of the challenges are more acute in El Paso. How well is the cancer system in El Paso handling those challenges?
There is a lot of opportunity to improve on what we are doing. I look at cancer and cancer treatment from two aspects. One is the physical treatment – the surgery, the chemotherapy, the radiation, bloodwork, imaging and mammograms.
The other side is that most of these people work. How do I get to my treatment six days a week? What do I do with my kids? How do I handle my fatigue? What am I going to do about all of these ancillary sorts of things?
The physicians and oncology treatment community, their days are so long and they are so overwhelmed with the treatment of that cancer that the support stuff sometimes gets left behind.
There are wonderful cancer organizations in town, but there are just too many people for these to support. We do a great job on the treatment end, but we have a lot of work to do on the survivorship end.
Q: Is the number of people surviving cancer increasing?
Absolutely. By 2022, the number of people who will have lived at least five years is estimated to increase by 37 percent in the U.S.
Q: Is that largely due to the steady improvement in treatment and care over the years?
That’s a huge component. Another one is you have a much more knowledgeable public, because things are so much in your face; there are pink ribbons everywhere.
But there also does seem to be a return in your generation, the millennial generation, to a simpler lifestyle and healthier eating. This is not fact-based, but just something I have observed.
Whole Foods is coming into El Paso; Sprouts is thriving and there are community gardens. People are aware that some of the things that have caused cancer in the past – pesticides, polluted air – that we have control over them.
So I really think that this next generation, your generation, is going to make great strides in reducing the incidences of cancer through prevention.
Q: Is demand growing for support groups?
Absolutely. One of the top things people asked for in the assessment was support groups. When I first started in this business, support groups were pretty much the norm, but they have virtually gone away.
My feelings on why they have gone away are twofold. Some of the national organizations like the American Cancer Society or Susan J. Komen have moved up to regional efforts, so the grass roots presence has declined.
Second, the support groups were typically handled by nurses and social workers, but they are now overwhelmed; they are the hardest-working people.
So the people who would say, “Yeah, I’ll run that support group for you after hours,” can’t.
The foundation has just started training sessions for support group facilitators. It is a free, six-week support group course.
Right now, we are building our arsenal of facilitators. We are not looking for people who are experts on cancer; we are looking for teachers – people who will facilitate and help people feel comfortable.
Q: What else is the foundation doing as it heads into its 20th year?
We have a corpus and a certain amount we can spend each year, but the foundation is going to be doing more fundraising and donor development in its 20th year – special projects to help us raise funds to augment what we are already putting into the community.
Q: The foundation hasn’t focused on fundraising as much in the past.
Yeah. Unsolicited, with little effort, we raise about $200,000 a year. It’s necessary that we do more to meet the needs because they are just burgeoning.
Q: The assets of all the foundations in El Paso plunged with the stock market in 2008. The cancer foundation’s assets fell from $12.6 million to $10.5 million. Where are you now?
We are at $13.5 million.
Q: How much did the foundation give out last year?
Last year, our grants were down significantly, and there are two reasons for that. One, our board has adopted a very tight spending policy to help build our corpus.
And, secondly, there aren’t as many grant seekers in our field as their used to be. We probably put $600,000 back into the community last year compared to $750,000 the year before.
Email El Paso Inc. reporter Robert Gray at email@example.com or call (915) 534-4422 ext. 105. Twitter: @ReporterRobby.