PMC 2014 Community Needs Assessment by Piedmont Medical Center

Community Needs Assessment Community Needs Assessment with a Focus on Oncology

By: Piedmont Medical Center

WITH A FOCUS ON ONCOLOGY

TABLE OF CONTENTS INTRODUCTION AND OVERVIEW-------------------------------------------------------------------------------------------------------------------------- 3 PMC Awards and Recognition -------------------------------------------------------------------------------------------------------------------------------------------- 4

PURPOSE OF COMMUNITY ASSESSMENT--------------------------------------------------------------------------------------------------- 6 HEALTH PROFILE --------------------------------------------------------------------------------------------------------------------------------------------------------------- 7 Demographics ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 7 Socioeconomic --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 9 Education ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 17 Cancer Incidence Rates ------------------------------------------------------------------------------------------------------------------------------------------------------------ 9

Death Rates -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 19

Occurances --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 21

HEALTH BEHAVIORS AND RISK FACTORS ------------------------------------------------------------------------------------------------- 23 Chronic Disease ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 23 Nutrition/Obesity ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 24 Access to Care --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 29 Insurance Coverage --------------------------------------------------------------------------------------------------------------------------------------------------------------------- 33

CANCER SURVIVOR SURVEY ---------------------------------------------------------------------------------------------------------------------------------- 34 Methodology --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 34 Results ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 34

HEALTH NEEDS PRIORITIZATION ----------------------------------------------------------------------------------------------------------------------- 39 Cancer Prevention ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 39 Active Cancer Treatment ---------------------------------------------------------------------------------------------------------------------------------------------------------- 41 Survivorship/Wellness ---------------------------------------------------------------------------------------------------------------------------------------------------------------- 43

REFERENCE LIST --------------------------------------------------------------------------------------------------------------------------------------------------------------- 46 APPENDIX A --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 47 APPENDIX B --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 52

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INTRODUCTION AND OVERVIEW

Introduction and Overview

This report presents an overview of the current community conditions for the following areas:

This report presents an overview of the current community conditions for the following areas: • • •

• Chester County, South Carolina • Lancaster County, South Carolina Chester County, South Carolina Lancaster County, South South Carolina • York County, Carolina

York County, South Carolina

Piedmont Medical Center inSouth RockCarolina Hill, South Carolina and has been serving Piedmont Medical Center is locatedisinlocated Rock Hill, and has been serving York, Chester, Lancaster and surrounding counties for over 30 years. The hospital is 288 bed acute care facility that offers York, Chester, Lancaster and surrounding counties for over 30 years. The hospital is a comprehensive medical variety from, advanced heart, stroke, Cancer and orthopedics care to an array of a 288-bed, care facility that offers a variety of comprehensive medical services specialized womenacute and children’s services. from advanced cardiac and stroke care, cancer care, and orthopedics to an array of Piedmont Medical has been recognized specialized womenCenter and children’s services.for multiple healthcare awards throughout the state

including American College of Surgeons Commission of Cancers Accreditation with Commendations, which is issued in 3 year increments from has last date of survey. Piedmont has heldawards the Oncology Piedmont Medical Center been recognized for Medical multipleCenter healthcare throughout accreditation for 9 consecutive years, with the next accreditation being held in 2015.

the state, including American College of Surgeons Commission of Cancers Accreditation with Commendations, which is issued in three-year increments from the last3 date of survey. Piedmont Medical Center has held the Oncology accreditation for 9 consecutive years, with the next accreditation being held in 2015.

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PMC PRESTIGIOUS AWARDS & ACKNOWLEDGEMENTS

SCORE

Scan the QR code to download the Hospital Safety Score App and see the scores of other nearby hospitals. You can also see this hospital’s complete dataset at www.hospitalsafetyscore.org

Named the 2010 & 2013 South Carolina Distinguished Hospital of the Year by the South Carolina Department of Health and Environmental Control.

National Accreditation Outpatient Diabetes Management by the AADE.

RECOGNIZED FOR HOSPITAL SAFETY

South Carolina State Level III Trauma Center by the SCDHEC.

Awarded “A” Grade (Fall 2013/Spring 2014) by the Hospital Safety Score/The Leapfrog Group.

RECOGNIZED FOR GYNECOLOGICAL SURGERY

RECOGNIZED FOR EMERGENCY MEDICINE

Designated as a Center of Excellence in Minimally Invasive Gynecology (COEMIG)™ by the AAGL

Certified Zero Harm Award (For Surgical Site Infection Hip) by the South Carolina Hospital Association.

RECOGNIZED FOR DEDICATED LACTATION SUPPORT PROGRAM

National Accreditation with Commendations by the American College of Surgeons Commission on Cancer.

: Cs CL

TECTING, PR OM PRO OT IN UPPORTING BR DS EA AN ST

Recognized International Board Certified Lactation Consultant Care Facility by IBCLC.

RECOGNIZED FOR CANCER CARE

HOSPITAL

PIEDMONT MEDICAL CENTER SAFETY The Hospital Safety Score issues A, B, C, D or F grades to all U.S. hospitals based on how safe they are for patients. During the Fall 2013 grading period, the publicly available data showed that this hospital had patient safety procedures in place that exceeded the standards of other medical institutions.

RECOGNIZED FOR DIABETES MANAGEMENT

WORLDWIDE ING ED FE

FALL 2013 SPRING 2014 FALL 2014

RECOGNIZED FOR EXCEPTIONAL CARE

IBLCE®

International Board of Lactation Consultant Examiners

RECOGNIZED FOR IMAGING CARE Accreditation Nuclear/PET Imaging Services by the IAC.

RECOGNIZED FOR CARDIAC CARE

ACR Accredited Facility (Breast MRI, Computed Tomography, MRI Breast Ultrasound, Mammography and Ultrasound) by the ACR. RECOGNIZED FOR ORTHOPAEDIC CARE ®

Designated as a Blue Distinction Center for Knee and Hip Replacement by BCBS of SC. RECOGNIZED FOR PNEUMONIA PREVENTION 2013 Center of Excellence (Pneumonia) by Cigna.

Get With The Guidelines Gold Plus Achievement Award for Heart Failure by the AHA/ASA.

RECOGNIZED FOR STROKE CARE

Mission: Lifeline STEMI-Receiving Hospital Designation Bronze by the AHA.

Get With The Guidelines Gold Plus and Target: Stroke Achievement Award by the AHA/ASA.

Accredited Chest Pain Center, Cycle IV with PCI (Percutaneous Coronary Intervention) by the SCPC.

Advanced Primary Stroke Center Certification by The Joint Commission.

Joint Commission Disease Specific Care Certification in Heart Failure by The Joint Commission.

2013 Center of Excellence (Stroke) by Cigna.

Accredited Facility in Vascular Testing (accredited in: Extracranial Cerebrovascular, Peripheral Venous and Peripheral Arterial Testing) by the IAC.

RECOGNIZED FOR SURGICAL CARE

Nationally Certified Cardiac Rehabilitation Program by the AACVPR.

2013 Center of Excellence (Gall Bladder Removal and Laparoscopy) by Cigna.

Designated as a Blue Distinction® Center for Cardiac Care by BCBS of SC.

RECOGNIZED FOR WORKSITE HEALTH AND PREVENTION

2013 Centers of Excellence (Heart Attack, Irregular Heartbeat, Heart Failure, Cardiac Care) by Cigna.

WorkHealthy America Excellence Recognition by Working Well and Prevention Partners.

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PMC PRESTIGIOUS AWARDS & ACKNOWLEDGEMENTS AACVPR: AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION Nationally Certified Cardiac Rehabilitation Program The AACVPR Cardiac and Pulmonary Rehabilitation Program Certification process is the only peer-review accreditation process designed to review individual facilities for adherence to standards and guidelines developed and published by AACVPR and other professional societies.

AADE: AMERICAN ASSOCIATION OF DIABETES EDUCATORS AAGL: ADVANCING MINIMALLY INVASIVE GYNECOLOGY WORLDWIDE Designated as a Center of Excellence in Minimally Invasive Gynecology (COEMIG)™ AAGL Center of Excellence in Minimally Invasive Gynecology™ and the COEMIG seal are trademarks of the AAGL. All rights reserved.

ACR: AMERICAN COLLEGE OF RADIOLOGY AHA/ASA: AMERICAN HEART ASSOCIATION AND AMERICAN STROKE ASSOCIATION ®

1) Get With The Guidelines Gold Plus Achievement Award for Heart Failure The American Heart Association and American Stroke Association recognize this hospital for achieving 85% or higher adherence to all Get With The Guidelines® Heart Failure Performance Achievement indicators for consecutive 12 month intervals and 75% or higher compliance with 4 of 9 Get With The Guidelines Heart Failure Quality Measures to improve quality of patient care and outcomes.

2) Mission: Lifeline® STEMI-Receiving Hospital Designation Bronze The American Heart Association recognize this hospital for achieving 85% or higher composite adherence to all Mission: Lifeline STEMI Referral Center Performance Achievement indicators for consecutive 90-day intervals and 75% or higher compliance Mission: Lifeline STEMI Referral Center quality measures to improve the quality of care for STEMI patients.

3) Get With The Guidelines® Gold Plus and Target: Stroke Achievement Award The American Heart Association and American Stroke Association recognize this hospital for achieving 85% or higher adherence to all Get With The Guidelines® Stroke Performance Achievement indicators for consecutive 12 month intervals and 75% or higher compliance with 5 of 8 Get With The Guidelines Stroke Quality Measures to improve quality of patient care and outcomes in addition to achieving Time to Intravenous Thrombolytic Therapy ≤ 60 minutes in 50% or more of applicable acute ischemic stroke patients (minimum of 6) during one calendar quarter.

BCBS of SC: BLUECROSS BLUESHIELD OF SOUTH CAROLINA Designated as a Blue Distinction® Center for Cardiac Care BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

IAC: INTERSOCIETAL ACCREDITATION COMMISSION IBCLC: INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT Recognized IBCLC Care Award Facility The IBCLC Care Directory lists recognized hospitals, birthing facilities, birthing services, and community-based health agencies that hire currently certified International Board Certified Lactation Consultant (IBCLC) certificants and have a dedicated lactation support program.

SCDHEC: SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL 1) Named the 2010 & 2013 South Carolina Distinguished Hospital of the Year 2) South Carolina State Level III Trauma Center SCPC: SOCIETY OF CARDIOVASCULAR PATIENT CARE FORMERLY KNOWN AS THE SOCIETY OF CHEST PAIN CENTERS Accredited Chest Pain Center, Cycle IV with PCI (Percutaneous Coronary Intervention)

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PURPOSE OF COMMUNITY ASSESSMENT Piedmont Medical Centerâ&#x20AC;&#x2122;s mission is to deliver exceptional healthcare to every person we have the privilege to serve, and we do so by addressing barriers to treatment and services provided. After the barriers are identified specialized quality improvement measures are developed to improve the previously established services to the community. Piedmont Medical Center also takes pride in addressing areas of treatment that may be an opportunity for services, and developing those new service lines to improve the care of the patient population within the tri-county area; when appropriate. Following the recommendations of the American College of Surgeons is one of the many ways that the hospital provides exemplary cancer care. The accreditation with American College of Surgeons provides set guidelines with goals and benchmarks to help those hospitals achieve exceptional cancer care for the community. The accreditation addresses the following but is not limited to: prevention of cancer, screening, diagnosis, treatment and survivorship. Standard 3.1: The Patient Navigation Process requires that a Community Needs Assessment be performed to ascertain the needs of the population served by Piedmont Medical Center, and to identify ways to improve cancer health disparities and gaps in resources. This assessment is to be done once every 3 years.

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Population specific Profile for York, Chester, Lancaster

POPULATION SPECIFIC PROFILE

Population Profile: Age and Gender Demographics

YORK, CHESTER, LANCASTER: Age and Gender Demographics

Population by gender within the 3 county areareport is shown in is Table 1. According 2008-2012 Population by gender within the 3report county area shown in Table to 1. ACS According to 5 year population estimates for the report area, the female population comprised 51.65% of the report area, 2008-2012 5 year population estimates for the report area, the female population whileACS the male population represented 48.35%.

comprised 51.65% of the report area, while the male population represented 48.35%.

TABLE 1. POPULATION BY GENDER, 2008 - 2012

Table 1. Population by Gender, 2008 - 2012

GEOGRAPHIC

00toTO 44

Geographic AREA Area

TO1717 55to

18 64 18 TO to 64

Chester County, hester South CCarolina County, SC Lancaster L ancaster County, South County, SC Carolina York County, York County, SouthSC Carolina

1,057

1,063

3,065

2,765

Report AreaArea R eport South South Carolina Carolina United States

1,057

2,704

1,063

2,314

3,065

9,761

10,392

2,765

9,761

10,392

2,015

F 2,818

2,818

6,216

23,459

23,183

4,959

2,704

2,314

6,435

6,216

23,459

23,183

4,959

6,815

7,821 7,821

7,632 7,632

21,544 21,544

20,672 20,672

68,687 68,687

74,329 74,329

10,359 10,359

14,705 14,705

11,582 11,582

11,009 11,009

31,044 31,044

29,653 29,653

101,907 101,907

107,904 107,904

17,333 17,333

24,338 24,338

381,455 1,426,186 1,486,245

255,686

152,199 147,620 152,199

147,620

6,435

OVER Over64 64

396,548

381,455

1,426,186

1,486,245

255,686

6,815

363,133

10,291,12 9,846,76 27,554,02 26,287,95 96,618,00 97,869,40 15,754,42 23,115,79 4 0 27,554,024 4 26,287,952 2 96,618,0000 97,869,4088 15,754,421 1 23,115,796 6 10,291,124 9,846,760 U nited States

Source: U.S. Census Bureau, American Community Survey, 2012 Data Release, December 2013. The 2012 American Community Survey 5-year data is a 5-year average of data collected from 2008 through 2012. Source: U.S. Census Bureau, American Community Survey, 2012 Data Release, December 2013. The 2012 American Community Survey 5-year data is a 5-year average of data collected from 2008 through 2012.

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POPULATION SPECIFIC PROFILE YORK, CHESTER, LANCASTER: Race Demographics

Population Profile: Race Demographics

Population by race and gender within the 3 county report area is shown in Table 2. According to and the gender American Community 5 year averages, white population Population by race within the 3 countySurvey report area is shown in Table 2. According to the American Community Survey 5 year averages, white population comprised 74.32% of the report area, black comprised 74.32% of the report area, black population represented 22%, and other population 22%, and otherPersons races combined were 1.75%. Persons themselves as races represented combined were 1.75%. identifying themselves asidentifying mixed race made up mixed race made up 1.93% of the population. 1.93% of the population.

TABLE 2. POPULATION BY RACE, 2008 - 2012 GEOGRAPHIC AREA

Geograph ic Area

C hester Chester County, County, SC South L ancaster Carolina Lancaster County, SC County, South York Carolina County, SC York County, South R eport Carolina Area Report Area S outh

South Carolina Carolina U nited United States States

Table 2. Population by Race, 2008 - 2012

WHITE

White

9,708

27,568

83,858

83,858 121,134

AMERICAN INDIAN American

BLACK

Black

10,001

28,205

88,245

88,245 126,451

5,870

9,048

19,497

19,497 34,415

121,13 126,451 34,415 4 1,528,029 1,580,437 605,309 1,528,0 1,580,43 605,30 29 7 9 113,15 116,139, 18,509, 113,159,432 116,139,472 18,509,428 9,432 472 428

6,662

9,274

161

22,953

22,95 3

38,889

Asian

Indian M F M F 83

161

113

149

709

709 953

M 113

149

276

865

NATIVE MIXED RACE HAWAIIAN Native Mixed Race

ASIAN

1,317

1,127

F 70

276

F 6

196

1,317

Hawaiian M F M F 6

196

1,821

1,821 1,663

28 2,023

209

381

13 33

2,573 35

F 209

381

256

310

2,573

F 256

310

2,696

2,696 3,163

3,262

38,88 953 1,127 1,663 2,023 33 35 3,163 3,262 9 685,395 7,754 7,368 26,424 31,211 870 921 39,405 42,017 685,3 7,754 7,368 26,42 31,21 870 921 39,405 42,017 95 4 1 20,31 1,258, 1,270, 7,055, 7,804, 257,7 256,6 4,128, 4,167, 20,316,420 1,258,126 1,270,974 7,055,679 7,804,116 257,706 256,696 4,128,988 4,167,303 6,420 126 974 679 116 06 96 988 303

Source: U.S.U.S. Census Bureau, Community Survey, 2012 Release, December 2013. Source: Census Bureau,American American Community Survey, 2012 DataData Release, December 2013. The 2012 American CommunitySurvey Survey 5-year is is a 5-year average of data from 2008 2012. The 2012 American Community 5-yeardata data a 5-year average of collected data collected fromthrough 2008 through 2012.

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Income and Poverty POPULATION SPECIFIC PROFILE Population Profile: Poverty, 2012

YORK, CHESTER, LANCASTER: Poverty 2012

2012 poverty estimates show a total of 53,389 persons living below the poverty rate in the report area. In poverty estimates show ahad total 53,389poverty persons thewhile poverty in the 2012,2012 Chester County, South Carolina, theofhighest rateliving (24.8 below percent), York rate County, South Carolina, had the lowest poverty rate (13 percent). report area. In 2012, Chester County, South Carolina, had the highest poverty rate (24.8

percent), while York County, South Carolina, had the lowest poverty rate (13 percent).

TABLE 3. POVERTY, 2012

Table 3. Poverty, 2012

GEOGRAPHIC AGES AGE0-17 0-17 AGE 5-17 5-17 Geographic AreaAREA AllALL Ages Age Age Number of Poverty Number of Poverty Number of Poverty Number of Rate Poverty Persons Number of Poverty Number Persons Rate Persons of Poverty Rate Persons Rate Persons Rate Persons Rate Chester County, 8,019 24.8 2,740 36.5 1,785 32.8 South CCarolina 8,019 24.8 2,740 36.5 1,785 32.8 hester County, SC Lancaster County, 15,295 19.9 5,162 29.2 3,269 25.6 15,295 19.9 5,162 29.2 3,269 25.6 ancaster County, SC South LCarolina York County, South 30,075 13.0 10,006 17.2 6,895 16.1 30,075 13.0 10,006 17.2 6,895 16.1 York County, SC Carolina Report Area 53,389 15.7 17,908 21.5 11,949 19.6 53,389 15.7 17,908 21.5 11,949 19.6 R eport Area South Carolina 837,327 18.3 285,674 26.8 192,338 24.9 United S outh States 48,760,123 15.918.316,396,863 22.6 21.0 837,327 285,674 26.8 11,086,537 192,338 24.9 Carolina 48,760,123 16,396,863 (SAIPE), 2012. 22.6 Estimates 11,086,537 Source: U.S. Census Area Income and 15.9 Poverty Estimates for 2012 were21.0 U nited States Bureau, Small released in December 2013. Source: U.S. Census Bureau, Small Area Income and Poverty Estimates (SAIPE), 2012. Estimates for 2012 were released in December 2013.

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POPULATION SPECIFIC PROFILE Population Profile: Households in Poverty by Family YORK, CHESTER, LANCASTER: Households in Type Poverty

by Family Type

Table 4 shows the number of households in poverty by type in the 3 county report area.

Table 4 shows the number of households in poverty by type in the 3 county report area. At 1,031 households, At 1,031 households, Chester County, had the households lowest number of femaleChester County, South Carolina, had the lowest South numberCarolina, of female-headed in poverty while York headed poverty York County, Southhouseholds Carolina, in had the largest number County, Southhouseholds Carolina, hadinthe largestwhile number of female-headed poverty. The U.S. Census Bureau estimates that there were 11,227 households living in poverty within the report area. of female-headed households in poverty. The U.S. Census Bureau estimates that there

were 11,227 households living in poverty within the report area.

TABLE 4. HOUSEHOLDS IN POVERTY BY FAMILY TYPE, 2008 - 2012

Table 4. Households in Poverty by Family Type, 2008 - 2012

GEOGRAPHIC AREA

Geographic Area

TOTAL HOUSEHOLDS,

HOUSEHOLDS IN POVERTY

Total 2007-2011 Households in Poverty Households, Overall Married Male Female Married Householder Male Female 2007-2011 Couples Householder Overall Couples Householder Householder Chester County, 8,569 1,758 519 208 1,031 8,569 1,758 519 208 1,031 hester County, SC South CCarolina Lancaster County, 20,501 3,208 986 290 1,932 20,501 3,208 986 290 1,932 ancaster County, SC South LCarolina York County, ork County, SC South YCarolina Report Area R eport Area South Carolina United S outh States Carolina

61,167

90,237 1,192,051 76,595,552

6,261

61,167

11,227 157,553 8,363,024 1,192,051 90,237

6,261

1,967

3,472 3,472 47,988 3,031,161 157,553 47,988 11,227

697

3,597

697

1,195 1,195 14,688 873,067 14,688

3,597

6,560 6,560 94,877 4,458,796 94,877

76,595,552 3,031,161 873,067The 20124,458,796 U nited States Bureau, American Community Source: U.S. Census Survey, 8,363,024 2012 Data Release, December 2013. American Community Survey 5-year data is an average of data collected from 2008 through 2012. U.S. Census Bureau, American Community Survey, 2012 Data Release, 2013. 2012 American type. Community Note:Source: The poverty rate for Household type is based on the total number of December households forThe that household Survey 5-year data is an average of data collected from 2008 through 2012.

Note: The poverty rate for Household type is based on the total number of households for that household type.

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INCOME INCOME LEVELS, 2008 - 2012 Income

Income: Income Levels, 2008 - 2012

Two common measures of income are Median Household Income and Per Capita Income,

Two common measures of income are Median Household Income and Per Capita Income, based on U.S. based on U.S. Census Bureau estimates. Both measures are shown for the 3 county Census Bureau estimates. Both measures are shown for the 3 county report area in Table 13. Household report areafrom in Table 13.inHousehold incomes ranged from $32,718ininYork Chester County, incomes ranged $32,718 Chester County, South Carolina, to $52,571 County, South Carolina. The average Per Capita income for the 3 county report area is $21,725 as compared to a national South Carolina, to $52,571 in York County, South Carolina. The average Per Capita average of $28,051. income for the 3 county report area is $21,725, as compared to a national average of

$28,051.

TABLE 13. INCOME LEVELS BY COUNTY, 2008 - 2012

Table 13. Income Levels by County, 2008 - 2012

GeographicAREA Area GEOGRAPHIC Chester County, South C hester County, SCCarolina Lancaster County, South Carolina L ancasterSouth County, SC York County, Carolina Report Area York County, SC South Carolina United States Report Area

MEDIAN HOUSEHOLD INCOME,

Median Household Income, 2012 2012 32,718 32,718 42,107 42,107 52,571 42,465 52,571 44,623 60,119 42,465

Per CAPITA Capita Income, 2012 PER INCOME, 2012 17,927 20,899 26,350 21,725 23,906 29,733

17,927 20,899 26,350 21,725

South 44,623 23,906 Source: U.S.Carolina Census Bureau, American Community Survey, 2012 Data Release, December 2013. The 2012 American Community Survey 5-year data is a 5-year average of data collected from 2008 through 2012. United States

60,119

29,733

Source: U.S. Census Bureau, American Community Survey, 2012 Data Release, December 2013. The 2012 American Community Survey 5-year data is a 5-year average of data collected from 2008 through 2012.

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INCOME HOUSEHOLD INCOME Income: Household Income Median annual household incomes in the 3 county report area are shown in Table 14.

Median annual household incomes in the 3 county reportHousehold area are shown in Table 14. According to the According to the U.S. Census, Median Annual Incomes ranged from a low of U.S. Census, Median Annual Household Incomes ranged from a low of $33,718 in Chester County, South $33,718 in Chester County, South Carolina, to a highin of $51,427 in York County, South Carolina, to a high of $51,427 in York County, South Carolina, 2012.

Carolina, in 2012.

TABLE 14. 2012 MEDIAN ANNUAL HOUSEHOLD INCOME Table 14. 2012 Median Annual Household Income Geographic Area GEOGRAPHIC AREA

Chester County, South Carolina Lancaster County, South C hester County, SC Carolina York County, South Carolina ancaster County, SC South LCarolina United York States County, SC

Median MEDIAN HOUSEHOLD INCOME ($) Household Income ($)

33,718 43,479 51,427

33,718 43,479 51,427 43,290 51,371

Source: U.S.Carolina Census Bureau, Small Area Income and Poverty Estimates (SAIPE), 2012. Estimates for 2012 were South 43,290 released in December 2013.

United States

51,371

Source: U.S. Census Bureau, Small Area Income and Poverty Estimates (SAIPE), 2012. Estimates for 2012 were released in December 2013.

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COMMUNITY NEEDS ASSESSMENT â&#x20AC;&#x201C; ONCOLOGY 12

INCOME CURRENT UNEMPLOYMENT

Current Unemployment

Labor force, employment, and unemployment data for each county in the 3 county report area is provided in Table 6. According to the U.S. Department of Labor in December Labor force, employment, and unemployment data for each county in the 3 county report area is provided in 2013, unemployment inDepartment the report of area varied from 6.9 unemployment percent in York County, Table 6. According to the U.S. Labor in December, in the reportSouth area varies fromCarolina 6.9 percent in York County, South Carolina to 9.3 percent in Chester County, South Carolina. to 9.3 percent in Chester County, South Carolina. Overall, the report area Overall, the report area experienced an average 7.3 percent unemployment in December 2013. experienced an average 7.3 percent unemployment rate rate in December 2013.

TABLE 6. EMPLOYMENT/UNEMPLOYMENT INFORMATION, DECEMBER 2013

Table 6. Employment/Unemployment Information, December 2013

GEOGRAPHIC AREA

Geographic Area

Chester County, C hester County, South South Carolina Carolina Lancaster County, L ancaster County, South Carolina South Carolina York County, ork County, South South YCarolina ReportCarolina Area South Report Carolina Area United States South Carolina

LABOR FORCE Labor Force

EMPLOYMENT Employment

UNEMPLOYMENT Unemployment

UNEMPLOYMENT Unemployment RATE Rate

14,525 14,525

13,179 13,179

1,346 1,346

9.3 9.3

31,908 31,908 112,945

29,464 29,464 105,132

2,444 2,444 7,813

7.7 7.7 6.9

112,945 159,378 2,138,614 159,378 155,613,662 2,138,614

105,132 147,775 2,004,540 147,775 145,443,949 2,004,540

7,813 11,603 134,074 11,603 10,169,713 134,074

6.9 7.3 6.3 7.3 6.5 6.3

Source: U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics, February 5, 2014.

United States

155,613,662

145,443,949

10,169,713

6.5

Source: U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics, February 5, 2014.

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INCOME EMPLOYMENT: Thirteen Month Unemployment Rates Unemployment change theUnemployment 3 county report Rates area from December 2012 to Employment: Thirteenwithin Month

December 2013 is shown in the chart below. According to the U.S. Department of Labor, unemployment for this thirteen month period 11.3 percent to 7.28 percent. For in Unemployment change within the 3 county report areafell fromfrom December 2012 to December 2013 is shown the chart below. According to the U.S. Department of Labor, unemployment for this thirteen month period December, the thirteen month unemployment change for the report area varies from 3.9 fell from 11.3 percent to 7.28 percent. For December, the thirteen month unemployment change for the report percent in Chester County, South Carolina to 4.1 percent in York County, South Carolina. area varies from 3.9 percent in Chester County, South Carolina to 4.1 percent in York County, South Carolina.

Table 8. Change in Unemployment Rates, December 2012 - December 2013

TABLE 8. CHANGE IN UNEMPLOYMENT RATES, DECEMBER 2012 - DECEMBER 2013

Geograp Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec hic Area 2012 DEC 2013 JAN 2013 FEB 2013 MAR 2013 APR 2013 MAY 2013 JUN2013JUL2013 GEOGRAPHIC AUG 2013 SEP 2013 OCT 2013 NOV 2013 DEC Chester 13.20 14.60 13.50 12.20 11.30 11.80 12.50 11.90 11.50 10.40 10.20 9.40 9.30 AREA 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 County, South C hester Carolina 13.20 14.60 13.50 12.209.9011.30 11.80 12.5010.20 11.9010.00 11.50 9.10 10.40 8.80 10.20 8.10 9.40 7.70 9.30 Lancaster 10.20 10.80 County, SC11.60 12.40 11.50 10.20 County, L ancaster South 11.60 12.40 11.50 10.20 9.90 10.20 10.80 10.20 10.00 9.10 8.80 8.10 7.70 Carolina County, SC York 11.00 12.50 11.70 9.90 9.60 9.70 9.10 8.50 8.20 7.70 7.70 6.90 6.90 York County, 11.00 12.50 11.70 9.90 9.60 9.70 9.10 8.50 8.20 7.70 7.70 6.90 6.90 South County, SC Carolina Report 11.30 11.30 12.68 12.68 11.8211.82 10.1910.19 9.82 9.82 9.98 9.989.79 9.799.149.14 8.87 R eport Area 8.87 8.25 8.25 8.16 8.16 7.40 7.40 7.28 7.28 Area South 8.80 9.30 8.70 7.90 7.40 7.80 8.70 8.10 8.10 7.50 7.20 6.60 6.30 South 8.80 9.30 8.70 7.90 7.40 7.80 8.70 8.10 8.10 7.50 7.20 6.60 6.30 Carolina Carolina 7.70 United 8.60 8.10 7.70 7.20 7.30 7.80 7.70 7.40 7.10 7.00 6.70 6.50 States U nited

States

7.70

8.60

8.10

7.70

7.20

7.30

7.80

7.70

7.40

7.10

7.00

6.70

6.50

Source: U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics, February 5, 2014. Source: U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics, February 5, 2014.

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14 COMMUNITY NEEDS ASSESSMENT â&#x20AC;&#x201C; ONCOLOGY

Housing

HOUSING Housing: Housing Age

HOUSING AGE

housing units, median and median in 2012 for the 3 county report Total Total housing units, median year builtyear andbuilt, median age in 2012age for the 3 county report areas are shown in Tableareas 11. According to the U.S. Census Bureau, the median age of housing ranged from 21 years in York are shown in Table 11. According to the U.S. Census Bureau, the median age of County, South Carolina to 35 years in Chester County, South Carolina. housing ranged from 21 years in York County, South Carolina to 35 years in Chester County, South Carolina.

TABLE 11. MEDIAN HOUSING UNIT AGE, 2012

Table 11. Median Housing Unit Age, 2012

GEOGRAPHIC AREA Geographic Area Chester County, South C hester County, Carolina South Carolina Lancaster County, South Carolina L ancaster County, York County, South South Carolina Carolina York County, Report Area South Carolina South Carolina United Report StatesArea South Carolina

TOTAL HOUSING Total Housing UNITSUnits 14,706

MEDIAN Year YEARBuilt BUILT Median 1977

MEDIAN AGE Median (IN Age 2012)(in 2012) 35

14,706 32,381

1977 1984

32,381 94,007

1984 1991

28 21

141,094 94,007 2,134,456 141,094 131,642,456

1984 1991 1985 1984 1975

21 28 27 28 37

1985

2,134,456

Source: U.S. Census Bureau, American Community Survey, 2012 Data Release, December 2013. The 2012 American data is a 5-year average of data collected United StatesCommunity Survey 5-year131,642,456 1975 from 2008 through 2012. 37 Source: U.S. Census Bureau, American Community Survey, 2012 Data Release, December 2013. The 2012 American Community Survey 5-year data is a 5-year average of data collected from 2008 through 2012.

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HOUSING NUMBER OF UNSAFE, UNSANITARY HOMES

Housing: Number of Unsafe, Unsanitary Homes units without plumbing are shown The number and percentage of occupied housing in the 3 county report area in Table 12. U.S. Census data shows 411 housing units in number and percentage occupied housing units without plumbing shown in theestimates 3 county report show 864 the report The area were without ofplumbing in 2000, and ACSarefive year area in Table 12. U.S. Census data shows 411 housing units in the report area were without plumbing in housing units in ACS the five report area were plumbing in 2012. 2000 and year estimates show 864without housing units in the report area were without plumbing in 2012.

TABLE 12. HOUSING UNITS PLUMBING, 2000 2000 ANDand 2008 2012 TableWITHOUT 12. Housing Units without Plumbing, 2008 --2012 Geographic Occupied HOUSING Housing Percent Occupied Housing HOUSING Percent PERCENT Housing OCCUPIED PERCENT Area OCCUPIED Housing Units without Units without UNITS UNITS GEOGRAPHIC HOUSING WITHOUT HOUSING WITHOUT Units, 2000 WITHOUT without Plumbing, Units, without WITHOUT Plumbing, AREA UNITS, PLUMBING, UNITS, PLUMBING, Plumbing, 2000 2008-2012 Plumbing, 2008-2012 PLUMBING, PLUMBING, 2000 2000 2008-2012 2008-2012 2000 2008-2012 2008-2012 2000 Chester 12,880 93 0.65 14,706 24 0.19 C hester County, 12,880 93 0.65 14,706 24 0.19 County, SCSouth L ancaster Carolina 23,178 106 229 0.79 23,178 106 0.420.42 32,381 32,381 229 0.79 County, SCLancaster County, York County, South 61,051 212 0.32 94,007 611 0.71 SC Carolina 61,051 212 0.320.42 94,007141,094 611 0.71 Report AreaYork County, 97,109 411 864 0.61 South Carolina 1,533,854 South Carolina 9,521 0.54 2,134,456 8,012 0.45 Report Area 97,109 411 0.42 141,094 864 0.61 United States 1,737,080 11,005 2,172,6478,012 9,528 0.52 South 1,533,854 9,521 0.540.562,134,456 0.45 Carolina Source: U.S. Census Bureau, 2000 Census of Population and Housing, Summary File 3, 2000.; U.S. Census Bureau, American United2012 Data Release, 1,737,080December 11,005 0.56American 2,172,647 9,528 5-year data0.52 Community Survey, 2013. The 2012 Community Survey is a 5-year average of data collected from 2008 through 2012. States and Housing, Summary File 3,ASSESSMENT 2000.; U.S. Census Bureau, myPMC.com Source: U.S. Census Bureau, 2000 Census of Population COMMUNITY NEEDS â&#x20AC;&#x201C; ONCOLOGY

The 2012 American Community Survey 5-year data is a 5-year average of data collected from 2008 through 2012.

LITERACY AND EDUCATION Literacy and Education

Education: Educational Attainment

EDUCATIONAL ATTAINMENT

9 shows the distribution of educational in the 3 county regions. Table 9Table shows the distribution of educational attainmentattainment levels in thelevels 3 county regions. Educational Educational attainment is calculated forispersons overfor 25, is an for the attainment is calculated for persons over 25, and an average theand period of average 2008 to 2012. period of 2008 to 2012.

TABLE 9. PERCENT ATTAINING EDUCATIONAL LEVELS, 2008 - 2012 Table 9. Percent Attaining Educational Levels, 2008 - 2012 % NO HIGH% High % HIGH % Some % GRADUATE Geographic % No High % Graduate GEOGRAPHIC % SOME %% %% SCHOOL SCHOOL OR or Area School School Only College Associates Bachelors AREA COLLEGE ASSOCIATES BACHELORS DIPLOMA ONLY PROFESSIONAL Diploma Professional Chester C hester 22.67 39.0 18.1 9.2 7.9 3.2 22.67 39.0 18.1 9.2 7.9 3.2 County, County, South SC Carolina L ancaster Lancaster 18.35 18.35 33.7 21.3 33.7 21.3 8.28.2 12.912.9 5.6 5.6 County, SC County, South Carolina York County, 13.01 28.4 21.4 9.3 18.8 9.0 SC York County, 13.01 28.4 21.4 9.3 18.8 9.0 South Report Area 15.25 30.7 21.1 9.0 16.3 7.6 Carolina South Carolina 15.25 15.94 30.3 20.6 8.69.0 15.816.3 8.8 7.6 Report Area 30.7 21.1 South 15.94 30.3 20.6 8.6 15.8 8.8 Carolina Source: U.S. Census Bureau, American Community Survey, 2012 Data Release, December 2013. The 2012 American Community Survey 5-year data is a 5-year average of data collected from 2008 through 2012.

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Source: U.S. Census Bureau, American Community Survey, 2012 Data Release, December 2013. The 2012 American Community Survey 5-year data is a 5-year average of data collected from 2008 through 2012.

LITERACY AND EDUCATION Education: Adult Literacy ADULT LITERACY The National Center for Education Statistics (NCES) produces estimates for adult literacy

The National Center for Education Statistics (NCES) produces estimates for adult literacy based on based on educational attainment, factors in each county. Estimated educational attainment, poverty, and other poverty, factors in and eachother county. Estimated literacy rates for the 3 county literacy rates from for the 3 county reportSouth areaCarolina ranged to from in YorkCounty, County, South Carolina report area ranged 11 in York County, 20 in11Chester South Carolina in 2003.

to 20 in Chester County, South Carolina in 2003.

Table 10. Persons Lacking ProseSKILLS, Literacy Skills, 2003 TABLE 10. PERSONS LACKING BASIC PROSEBasic LITERACY 2003 Geographic Area Chester County, South GEOGRAPHIC AREACarolina Lancaster County, South Carolina York County, South Carolina C hester County, SC Report Area South L ancaster Carolina County, SC United States York County, SC

Estimated Population over 16 ESTIMATED POPULATION 25,437 OVER 16 46,770 133,140 25,437 205,347 46,770 3,098,822 15,058,111 133,140

Percent Lacking Literacy Skills PERCENT LACKING LITERACY 20 SKILLS 17 2011 13 1715 22 11

Source: U.S. Area Department of Education, Institute of Education Sciences, National Center for Education Statistics, 13 State Report 205,347 and County Estimates of Low Literacy, 2003.

South Carolina

3,098,822

United States

15,058,111

Source: U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, State and 18 County Estimates of Low Literacy, 2003.

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CANCER RELATED STATISTICS DEATH RATE RELATED TO ALL CANCERS IN 2012 Based on Department of Health and Environmental Control, Bureau of Community Health and Chronic Disease Prevention, the 3 county area shown on the table below includes deaths associated with cancer in 2012, ranging from 86 deaths in Chester County, to 449 deaths in York County. The age adjusted report ranges from 144.4 per 100,000 deaths in Lancaster County, to 207.1 per 100,000 deaths in Chester County. In 2012, South Carolina had a total of 9668 cancer related deaths, with an average age adjusted death rate of 177.7 per 100,000. By comparison, the cumulative 3 county report area had 676 cancer related deaths, with an average age adjusted death rate of 180.3 per 100,000.

TABLE 11. DEATH RATE RELATED TO CANCER, 2012 GEOGRAPHIC AREA C hester County, SC

NUMBER OF DEATHS RELATED TO CANCER, 2012

AGE ADJUSTED DEATH RATE (PER 100,000), 2012

207.1

L ancaster County, SC

141

144.4

York County, SC

449

189.5

676

180.3

9668

177.7

Report Area South Carolina

State of South Carolina, Department of Health and Environmental Control, Bureau of community Health and Chronic Disease Prevention, County Chronic Disease Fact Sheet November 2013 http://scdhec.gov/hs/epidata/county_reports.htm

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CANCER RELATED STATISTICS DEATHS RELATED TO CANCER CLASSIFIED ACCORDING TO RACE/SEX Based on Department of Health and Environmental Control, Bureau of Community Health and Chronic Disease Prevention, The 3 county area shown on Table 3 shows deaths related to cancer classified according to race/sex. In the 3 county report area, Whites experienced the highest rate of death related to cancer with 533 deaths, compared to 138 for Blacks. The male population experienced the highest rate of death related to cancer with 359 deaths, compared to 317 for females. According to the 2010 United States Census Bureau Report1, there are 246,761 Whites and 73,115 Blacks in the 3 county report area, or 3.47 Whites per 1 Black.

TABLE 12. DEATHS RELATED TO CANCER CLASSIFIED ACCORDING TO RACE/SEX GEOGRAPHIC AREA

BLACKS

WHITES

FEMALES

MALES

C hester County, South Carolina

L ancaster County, South Carolina

103

Y ork County, South Carolina

377

213

236

Report Area

138

533

317

359

US Department of Commerce, United States Census Bureau, American Fact Finder. Community facts 2010 http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml

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CANCER RELATED STATISTICS Table 13 shows age adjusted specific cancer occurrences within the 3 county report area. Table 14 shows how cancer impacts the 3 county report area in relation to all 46 South Carolina Counties. The highest rate of cancer is 1, the lowest is 46. These findings are based on studies released in 2012 from data obtained during the years 2005-2009.

TABLE 13. AGE ADJUSTED, SPECIFIC CANCER OCCURRENCES IN SERVICE AREA, 2005-2009 GEOGRAPHIC AREA

BREAST

PROSTATE

COLON/ RECTAL

LUNG

ALL CANCERS

C hester County, South Carolina

115.0

148.7

54.4

101.3

503.4

L ancaster County, South Carolina

101.7

145.9

45.3

78.2

443.5

Y ork County, South Carolina

115.9

159.7

44.1

76.2

470.9

South Carolina

122.0

160.2

45.0

72.3

471.5

Source: State of South Carolina, Department of Health and Environmental Control, County Cancer Profiles, 2012 http://www.scdhec.gov/Health/docs/SCYorkCountyCancerProfile.pdf, http://www.scdhec.gov/Health/docs/ SCLancasterCountyCancerProfile.pdf , http://www.scdhec.gov/Health/docs/SCChesterCountyCancerProfile.pdf,

TABLE 14. COUNTY RANKINGS WITHIN STATE, BY CANCER OCCURRENCES IN SC, 2005-2009 GEOGRAPHIC AREA

BREAST

PROSTATE

COLON/ RECTAL

LUNG

ALL CANCERS

C hester County, South Carolina

L ancaster County, South Carolina

Y ork County, South Carolina

Source: State of South Carolina, Department of Health and Environmental Control, County Cancer Profiles, 2012 http://www.scdhec.gov/Health/docs/SCYorkCountyCancerProfile.pdf, http://www.scdhec.gov/Health/docs/ SCLancasterCountyCancerProfile.pdf, http://www.scdhec.gov/Health/docs/SCChesterCountyCancerProfile.pdf

Chester County is ranked number 6 overall in SC for cancer occurrences and number 1 in lung cancers.

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CANCER RELATED STATISTICS Cancer and heart disease are the major causes of death within the 3 county service area of Piedmont Medical Center. causes of death.

TABLE 15. TOP TEN LEADING CAUSES OF DEATH IN CHESTER, LANCASTER AND YORK COUNTIES, 2012 Table 15. Top Ten Leading Causes of Death Chester, Lancaster and York Counties, 2012 Malignant Neoplasms Diseases of Heart Chronic Lower Respiratory Disease Accidents Cerbrovascular Disease Alzheimers Nephritis, Nephrotic Syn and Nephrosis Pneumonia and Influenza Septicemia Diabetes Homicide Chronic Liver Disease and Cirrhosis 0

Chester County

100

200

Lancaster County

300

400

500

York County

Source: SCDHEC Vital Statistics; Chronic Disease Epidemiology. Nov 2013 http://www.scdhec.gov/health/epidata/docs/ epitechnotes.pdf

Source:

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SCDHEC Vital Statistics; Chronic Disease Epidemiology. Nov 2013 http://www.scdhec.gov/health/epidata/docs/epitechnotes.pdf

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CHRONIC DISEASE FINDINGS Chronic disease within the 3 county service area impacts morbidity and mortality among the residents. Chronic diseases are among the leading causes of death and hospitalizations in South Carolina. Common behavioral risk factors contribute to chronic diseases, and have a tremendous impact on the local and national health of communities. According to The Campaign to End Obesity, obesity is linked to more than 60 chronic diseases.

TABLE 16. RISK FACTORS FOR CHRONIC DISEASE RISK FACTORS

REGION 3 INCLUDING SERVICE AREA*

STATE

Current smoking %

21.62

22.5

Sedentary Lifestyle

21.60

25.10

Overweight or Obese

65.05

66.10

39.8

41.63

High Cholesterol

*DHEC Health Region 3: Chester, Fairfield, Lancaster, Lexington, Newberry Richland and York State of South Carolina, Department of Health and Environmental Control, Bureau of community Health and Chronic Disease Prevention, County Chronic Disease Fact Sheet November 2013 http://scdhec.gov/hs/epidata/county_reports.htm

Over 75 percent of hypertension cases are directly linked to obesity. Approximately twothirds of U.S. adults with type 2 diabetes are overweight or have obesity.2

TABLE 17. CHRONIC DISEASE PREVALENCE CHRONIC DISEASE PREVALENCE Hypertension % Heart Disease Stroke Diabetes

REGION 3 INCLUDING SERVICE AREA*

STATE

38.54

39.01

4.83

5.13

2.4

3.7

10.3

11.6

"The Campaign to End Obesity." The Campaign to End Obesity. Campaign to End Obesity, n.d. Web. 29 July 2014. http://www. obesitycampaign.org/obesity_facts.asp

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CHRONIC DISEASE FINDINGS Obesity is a significant public health concern in the United States. If current trends continue, 103 million American adults will be considered obese by 2018.3

TABLE 18: NUTRITION, PHYSICAL ACTIVITY, AND OBESITY State of South Carolina, Department of Health and Environmental Control, Division of Nutrition, Physical Activity and Obesity.

OBESE

NOT MEETING PHYSICAL ACTIVITY RECOMMENDATIONS

NOT MEETING FRUIT AND VEGETABLE RECOMMENDATIONS

hester County, C South Carolina

29.9%

51.0%

86.1%

L ancaster County, South Carolina

30.0%

58.9%

85.3%

Y ork County, South Carolina

28.7%

52.5%

86.4%

South Carolina

30.3%

54.6%

82.6%

United States

27.7%

49.4%

76.6%

LOCATION

Bureau of Community Health and Chronic Disease Prevention, 2010 County Profiles http://www.scdhec.gov/Health/docs/Epi/ obesity/York.pdf http://www.scdhec.gov/Health/docs/Epi/obesity/Lancaster.pdf http://www.scdhec.gov/Health/docs/Epi/obesity/Chester.pdf

The results in a recent major study out of the United Kingdom, showed that every 5.5 kg (about 11 lb.)/m² increase in BMI was associated with increases in the risk for the following cancers;4 cervical, colon, gallbladder, kidney, leukemia, liver, ovarian, postmenopausal breast cancer, thyroid, and uterine cancers.

Thorpe, Kenneth E., PHD. The Future Costs of Obesity. N.p., n.d. Web. 30 July 2014. www.fightchronicdisease.org/sites/ fightchronicdisease.org/files/docs/CostofObesityReport-FINAL.pdf 4

Bhaskaran, Krishnan, Ian Douglas, Harriet Forbes, Isabel Dos-Santos-Silva, David Leon, and Liam Smeeth. "Body-mass Index and Risk of 22 Specific Cancers: A." The Lancet 384 (2014): 755-65. 14 Aug. 2014. Web. 17 Sept. 2014. http://download. thelancet.com/pdfs/journals/lancet/PIIS0140673614608928.pdf?id=aaajAKIByn4Rg5ZshWfGu

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NUTRITION Nutritional Resources for the Adult population within the 3 county service area

YORK COUNTY Pilgrims’ Inn 236 West Main Street Rock Hill, SC 29731 803-327-4227 Rock Hill Health Center 1070 Heckle Boulevard Rock Hill, SC 29732 803-909-7300

York County Council on Aging 917 Standard Street Rock Hill, SC 29730 803-327-6694

York County Health Department 116 North Congress Street York, SC 29745 803-684-7004

York County Department of Social Services 933 Heckle Boulevard Rock Hill, SC 29732 803-684-2315

Piedmont Medical Center Outpatient Nutrition Services 803-329-6886

LANCASTER COUNTY Lancaster County Council on Aging 309 South Plantation Road Lancaster, SC 29720 803-285-6956

Lancaster County Department of Social 1837 Pageland Highway Lancaster, SC 29721 803-286-6914

CHESTER COUNTY Senior Services, Inc. of Chester County 1197 Armory Road Chester, SC 29706 803-385-3838

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NUTRITION Fresh Air Markets available in the areas include but are not limited to:

LANCASTER COUNTY Griswold’s Family Produce

Lancaster County Farmers Market

803-286-4191

803-283-3302

CHESTER COUNTY Chester County Farmer and Artisan Market 803-444-4320

York Road Market 803-581-1436

Chester Market - Cotton Hills Farm 803-385-4545

YORK COUNTY Blacks Farm

Boyd Farm

Bryant's Peaches

Bush & Vine

803-684-2333

803-329-4900

803-684-7310

803-684-2732

The Market at Inman Farms Market

Old Town Market

Peach Stand

Rock Hill Farm

803-329-5562

803-547-7563

803-328-3746

803-206-6682 York County Farmers Market 803-324-2984

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EXERCISE There are many opportunities for people to exercise in our service area. There are a multitude of gyms, beautiful parks, and peaceful walking trails for everyone to enjoy. In general, these are the areas identified as dedicated to encouraging exercise and wellness for the general public in the 3 county service area.

YORK COUNTY York County has over 50 public parks, public areas on Lake Wylie, River Walk areas, and exercise classes offered for a fee. Kings Mountain State Park has over 6,500 acres of open air beauty available to explore. Multiple areas throughout the county have dedicated biking trails and lanes. York County Parks and Recreation 803-684-3742 YMCA is an active presence within York and Chester counties. There are 9 locations offering a multitude of different opportunities and educational classes for wellness. Charlotte Avenue Branch

Good Hill Branch

York Branch YMCA

803-329-9622

803-684-2247

Chester County Branch

Clover Branch

803-581-9622

803-222-9622

Rock Hill Acquatics Center

Carolina Crossing

Wellness Center

803-628-9622

803-366-9622

803-817-Pool

There are approximately 8 gyms in York County offering fee active based services.

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EXERCISE LANCASTER COUNTY Lancaster County has an active Parks and Recreation Department. There are 4 recreation centers including gyms, pools, fitness programs, and wellness programs, etc. Multiple outdoor public parks are managed through this agency as well. Lancaster Parks and Recreation 803-684-3742 There are approximately 5 fitness centers offering fees for services opportunities.

CHESTER COUNTY Chester County offers a variety of public opportunities for fitness and wellness. Most are found within the City of Chester and Town of Great Falls. Wylie Park Activity Center

Chester County State Park

803-581-7429

803-385-2680

Landsford Canal State Park

Sumter National Forest

803-789-5800

803-276-4810

There are 4 gyms/fitness centers within Chester county offering fee for service opportunities.

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ACCESS TO HEALTHCARE HOSPITALS CHESTER COUNTY – Chester Regional Medical Center LANCASTER COUNTY – Springs Memorial Hospital YORK COUNTY – Piedmont Medical Center

URGENT CARE CENTERS CHESTER COUNTY – None LANCASTER COUNTY – at least 5 total YORK COUNTY – at least 6 total

FREE OR UNDERINSURED CLINICS CHESTER COUNTY North Central Family Medicine

Good Samaritan Medical Clinic

803-581-0574

803-385-6332

LANCASTER COUNTY Care Net of Lancaster

Kershaw Family Medicine

803-285-2273

803-475-4701

YORK COUNTY York County Free Clinic

North Central

803-366-6337

803-325-7744

Catawba Care 877-647-6363

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ACCESS TO HEALTHCARE SCREENING AND CANCER RELATED PROGRAMS BEST CHANCE NETWORK – 1-800-277-2345 State screening program in cooperation with the American Cancer Society, for breast and cervical health for uninsured and indigent SC residents. Mammography Screenings available same day, along with weekend and extended hour clinics offered throughout the calendar year. BREAST SCREENING SOURCE OF YORK COUNTY – Non-For-Profit service for York County residents who are uninsured or indigent to obtain financial assistance with breast screening. LUNG SCREENING – Piedmont Medical Center—criteria driven, low out of pocket expense. OPEN COLONOSCOPY SCREENING – 803-324-7607 Program available in Rock Hill and Lancaster for patients who qualify medically.

TRANSPORTATION No public transportation currently exists in 3 county service area, including buses, trains, light rail or subway service lines. A small taxi service is available but is limited to the urban areas only. All services noted below require multiple days advance notice to obtain services. York County Access

Chester County Connector

Lancaster Area Ride Service

803-327-6694

803-385-3838

Offered by York County Council On Aging.

Offered by Senior Services Inc.

Offered by Council on Aging-

Rates range from $1.50-$3.50 one way

Rates range from $2 one way for local, up to $10 one way for Charlotte

Operates M-F for $2.50 one way

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American Cancer Society Road to Recovery 800-227-2345 Free for cancer patients. Limited availability

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PROVIDERS BY SPECIALTY SPECIALTY

YORK

CHESTER

LANCASTER

Anesthesiology

Family Medicine

Gastroenterology

General Dentistry

Geriatric Medicine

Gynecology

Infectious Disease

Medical Oncology

Nephrology

Neurology

Neurosurgery

Obstetrics and Gynecology

Ophthalmology

Oral and Maxillofacial Surgery

Orthopedic Surgery

Otolaryngology

Pain Management

Palliative Care

Psychiatry

Pediatrics

Pulmonary Disease

Radiation Oncology

Rheumatology

Surgery, General

Thoracic and Cardiac Surgery

Urology

Vascular Surgery

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TOBACCO CESSATION Tobacco Cessation Organizations available in the areas include but are not limited to:

STATEWIDE RESOURCES American Lung Association

SC DHEC

1-800-LUNG-USA

1-800-QUIT-NOW 1-800-784-8669

Resource for questions about health questions or smoking cessation American Lung Association – Freedom from Smoking

Smoking cessation SC will pay for nicotine replacement for patients without medical insurance.

www.lungusa.org Online smoking cessation

CHESTER COUNTY

Chester Regional Medical Center – Smoking cessation

LANCASTER COUNTY YORK COUNTY

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None

Piedmont Medical Center Quit Smart – 803-985-4651

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INSURED/UNINSURED STATUS According to Market Expert, the most recent data obtained in 2014 shows the 3 county service area has the following coverage.

GEOGRAPHIC AREA

UNINSURED

MEDICARE

MEDICAID

PRIVATE INSURANCE

C hester County, South Carolina

19.11%

15.42%

22.22%

38.98%

L ancaster County, South Carolina

14.95%

11.56%

14.67%

56.53%

York County, South Carolina

12.48%

13.46%

12.06%

59.77%

South Carolina

14.39%

13.98%

15.01%

53.92%

According to “The South Carolina Indicators, Projects for Health”, lack of insurance compromises the health of the uninsured because they receive less preventive care, and are diagnosed at more advanced disease stages. After diagnoses occur for this at risk population, they tend to receive less therapeutic care and have higher mortality rates than the insured.5

http://www.ipspr.sc.edu/scip/pubhealth/afford.asp#_edn1

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CANCER PATIENT AND SURVIVOR SURVEY RESULTS METHODOLOGY Patient and Survivor Survey Results

.Cancer

Oncology Services at Piedmont Medical Center conducted a cancer patient and survivor survey as part Methodology of a community needs assessment. The requirement for the survey was that those who completed it be a survivor of cancer or currently under treatment for ervices at Piedmont Medical Centerdid conducted a cancer patient and to survivor survey as within this 3 cancer. The survey not require the respondents have been treated mmunity needscounty assessment. requirement forwas the requested survey wasthat for those completing serviceThe area, however, it they be a resident with in this service a survivor of cancer or currently under treatment for cancer. The survey did not require area at the time of the survey. ents to have been treated within this service area, however, it was requested that they be Thearea following graphs are survey. the results of the community questionnaire that was distributed th in this service at the time of the throughout the tri-county area. The questionnaire was assembled to help determine g graphs are the results of the were community thatwithin was distributed throughout which services being questionnaire utilized the most the 3 county service area and to nty area. The questionnaire was assembled to assist in determining which services were were available establish how to improve the oncology service line. The questionnaires d the most within the service area establish how to improve the oncology service at various Relay forand Lifetoevents, grocery stores, drugstores, YMCAs and doctor’s offices estionnaires were placed at various Relay for Life events, grocery stores, drugstores, throughout the tri-county, as well as online through social media and the Piedmont doctor’s offices throughout the tri-county, Medical Center’s website. as well as placed online through social media mont Medical Center’s website. Over 430 surveys were returned to Oncology Services over the 90 days span that the surveytowas conducted. rveys were returned Oncology Services over the 90 days span that the survey was

Each of the graphs is a compilation of all the replies by the respondents. The answers to the questions from the questionnaire have been in to either a bar graph or pie chart graphs is a compilation of all the replies by the respondents. Theplaced answers the questions sobeen it canplaced clearly responses. Whileso theit can results show oncology services have stionnaire have in demonstrate either a bar graph or pie chart clearly beenthe providing patient servicesservices effectively, graphs also bring responses. While results show oncology havethe been providing patientawareness to areas that still need further improvement according the oncology patient population. A sample ctively, the graphs also bring awareness to areas that stilltoneed further improvement of the full survey that was distributed to the community is available at the end of this the oncology patient population. A sample of the full survey that was distributed to the assessment Appendix A. s available at the end of thisasassessment as Appendix A.

RESULTS

Results Q1 – AGE

Q2 – COUNTY OF RESIDENCE

Q2.Q2. County County of Residence of Residence

Q1. AGE 70-99+

27%

50-69

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Chester Chester

51%

30-49 18-29

2% 2% 4% 4%

19%

12% 12% 82% 82% AGE

Lancaster Lancaster YorkYork

Other Other

COMMUNITY NEEDS ASSESSMENT – ONCOLOGY

Q3.Q3. Gender Gender

82%

York

Male

30%

Female

Other Other

CANCER PATIENT AND SURVIVOR SURVEY RESULTS Q3 – GENDER

Q4 – EDUCATION

Gender Q3.Q3. Gender

Q4. Education

Q4. Annual Income

Doctural 24

Masters/Other Graduate

70%70%

MaleMale

30% 30%

12%

Bachelors

Less than 40K

40K-70K 17%

179

Associate

Female Female

70K-110K

Educa

110K-139K

Some College 112 High

25%

Greater than 139K

School

29%

Some High School

Q7. Treatment

Q4.Q5 Education – Education ANNUAL INCOME Q4. Q4. Annual Income Q4. Annual Income

Doctural Doctural0 Masters/Other Graduate Masters/Other Graduate

70%

York

200

12% 12%

Associate 61 Associate Some College Some College

9% 9%

179

HighHigh School School Some High School Some High School

160 140

Education Education 40K-70K

120

25%40K-70K 25%

100 80

70K-110K

70K-110K 29% 29%

110K-139K

Greater than 139K

112

Q7 – TREATMENT

38 9

Q6.16% Types of Cancer

25%

Surgery & Radiation Surgery & Radiation

Chemotherapy Chemotherapy & & Radiation Radiation

25%

100

10 13

Chemoth

15%

16%

Rate

Oral forms of

Oral Chemotherapy forms of Chemotherapy

17%

Chemotherapy Only

44 5

44 myPMC.com 5

40 3

10 13

Chemotherapy Only

Q8. Rate 12 Health 4 Your 3

Oral form Chemoth

31%

Surgery & Radiation Surgery & Radiation && Chemotherapy Chemotherapy

35%

Surgery Only

160

1204%

Q8 – RATE YOUR HEALTH

Surgery Only

16%

12%

181 140

Q8. Rate Your Health

181 Types of Cancer Q6.

180 12%

44 5 5 17%

Q7. Treatment

200

Chemoth Radiation

25%

Greater than 139K

Q7. Treatment

Surgery & Chemoth

110K-139K

7% 7%

Surgery &

12%

Less than 40K

112

16%

181

180

17% 17%

Surgery O

Q6. Types of Cancer

24 16 24 16 Bachelors Bachelors

Q6 – TYPES OF CANCER

COMMUNITY NEEDS ASSESSMENT – ONCOLOGY

Greater than 60 minutes

20-40 minutes 20-40 minutes

Distance of Travel for Treatment Treatment 45%

45% 35%

12% Less than 20 minutes

35% Less than 20 minutes Distance of Travel for SURVEY RESULTS CANCER PATIENT AND SURVIVOR Treatment 41-60 minutes

20-40 minutes

45%

Less than 20 minutes Q9 – DISTANCE OF TRAVEL FOR35% TREATMENT

Q10 – TRANSPORTATION BARRIERS

Q10. Transportation Barriers Q10. Transportation Barriers Q9. Distance of Travel for Treatment Q9. Distance of Travel for Treatment

Greater than 60 minutesQ10.

Greater Barriers than 60 Transportation

minutes

12%

41-60 minutes 20-40 minutes

Treatment

45%

20-407% minutes 92% Less than 20 minutes

Yes

35%

Yes

No Distance of Travel for Treatment

92% Distance 12% of Travel for 41-60 minutes92%

45%

35%

Less than 20 minutes

Q11. of Forms of Insurance Q11. Forms Insurance

Q11 – FORMS OF INSURANCE Q12 – INSURANCE CONCERNS Q10. Transportation Barriers EFFECTConcerns TREATMENT DECISIONS Q12. Insurance Effect Treatment Employer-Based Private 57% Employer-Based Private 57% Q11. Forms of InsuranceQ10. Transportation Decisions Barriers 10% Medicaid 10% Medicaid Q12. Insurance Concerns Effect Treatment Employer-Based Private 57% Decisions 7% Yes 27% Medicare Medicare 97% 27% 92% 10%

Medicaid

Self-Pay Forms of Insurance 6% Self-Pay 92%

27%

97% Medicare

Yes

Self-Pay

Forms of Insurance Forms of Insurance

Yes

No 3%

Q11. Forms of Insurance Q13 – ENVIRONMENT Employer-Based Private

OF CARE

Q13. Environment of Care 10%

Medicaid

Hospital Infusion Center

Q13.of Environment Q11. Forms Insuranceof Care 37 Q14. Information Q14. Information Received Received at Diagnosis at Diagnosis

27%

10% Home

Medicare 66% 66% Inpatient Hospital 6% Self-Pay

18%

Environment of Care

13%

Hospital Infusion Center Outpatient Clinic

25%

27%

Not Enough Not Enough Forms of Insurance Too Much Too Much 9%

18%

Environment of Care Just Right Just Right

13%

64%

Oupatient Clinic

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57%

Other

Medicaid

Self-Pay 3% Home

Q14 – INFORMATION RECEIVED AT DIAGNOSIS

57%

Forms of Insurance Employer-Based Private 3%

3% Other Medicare

Hospital Inpatient

64%

Q15. Education Q15. Education as Treatment as Treatment Progressed Progressed COMMUNITY NEEDS ASSESSMENT – ONCOLOGY 36 37 Not Applicable Not Applicable 11%

11%

Fair

25%

Not Enough

Good

66%

28%

Too Much

Education Progressed

Very Good

33%

CANCER PATIENT AND SURVIVOR SURVEY RESULTS Excellent 20% Just Right

Q15 – EDUCATION AS TREATMENT PROGRESSED Q16 – INDIVIDUALIZED CARE Q17A.Q17A. GivenGiven Advance Advance Directives Directives Q15. Education as Treatment Progressed

Q16. Individualized Care

11%

Not Applicable

38%

Good Very Good

25%

Was NotWas Given NotForms Given Forms

27%

25%

Always

33%

Excellent

Health Care Health POA Care POA

Sometimes Education as Treatment Progressed Usually

28%

Living Will Living Will

Rarely

Fair

41% 1% 41%

Never

Poor

Individu

63%

20%

Q18. Types of Support Utilized 9% Online Support Q17A – GIVEN ADVANCE DIRECTIVES Care Q17B – WOULD HAVE DONE ADVANCE DIRECTIVES Q16. Individualized

Q18. Types of Support Utilized

11% Q17A. Q17A. Given Given Advance Advance Directives DirectivesIndividual Q17B. Counseling Q17B. Would Would Have Have DoneDone Advance Advance Directives Directives

Never

Rarely

1% 8%

Sometimes 38% 38%

Individual Counseling

35% 16% Community Individualized Care 35%

41% 41%27%

Usually

Online Support 12% Hospital Based

12%

Hospital Based

19%

Other

LivingLiving Will Will

Always

63%

Health Health CareCare POA POA Was Not WasGiven Not Given FormsForms 25% 25%

Types of Support Utilized

11%

None

30%

Types of Support Utilized 16%

Community

36% 19%

Other

30%

None

35%

Yes

Maybe Maybe 36%

Q18 – TYPES OF SUPPORT UTILIZED

Q19 – ENOUGH SUPPORTIVE GROUPS/FUNCTIONS

Q19. Enough Supportive Groups/Functions Q19. Enough Supportive Groups/Functions

Q18. Types of Support Utilized

Q17B. Q17B. Would Would Have Have Done Done Advance Directives Directives 9%Advance Online Support Individual Counseling

35% 35%

Hospital Based

Other

30% 30%

11% Yes

12%

28.41%

Types of Support Utilized 79.94% Community

16%

Yes Yes

35% 35%

19%

28.41%

Yes No

79.94%

Maybe Maybe None

36% 41

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COMMUNITY NEEDS ASSESSMENT – ONCOLOGY 41

would you like to a see offered the service area?”. Some choose to say interested in quite few, whileinothers decided to write personal notes of they whatwould wouldbe have been mo quite a few, while others decided to write notes of what would have been more helpful to them as they battled cancer, andpersonal a few choose not to answer this question at all. Eleven them as they battled cancer, and a fewavailable, choose not to answer this question at all. Eleven options were the respondents were asked to pick 4. available, the respondents were asked to pick 4. The perception and opinion of the patient is vital in understanding what is needed by th The perception and opinion of the patient is vital in understanding what is needed by the community Support services can have a direct impact of the total well-being of cancer patients d Support services can have a direct impact of the total well-being of cancer patients during and following active treatment. Knowing which services our cancer patients feel would hav treatment. Knowing which services our cancer patients feel would have benefitted For the Communityfollowing Needs active Assessment, this question was of particular as in our area. them is paramount to improvinginterest cancer care them is paramount to improving cancer care in our area.

CANCER PATIENT AND SURVIVOR SURVEY RESULTS

we look to improve the cancer services within our 3 county service area. In Q20, the question was written as: What other services would you More like toServices see offered in the service Q20. Desired-Pick 4 Q20. More Services Desired-Pick 4 area?” Some chose to say they would be interested in quite a few, while others decided to write personal notes of what would have been more helpful to them as they61battled Genetic Counseling 61 Genetic Counseling 84 Transportation Services Treatments cancer, and a few chose not Transportation to answer this question atfor all. Eleven options 84 were available, Services for Treatments 88 Caregiver Support and the respondents were asked to pick 4.Caregiver Support 88 Individual Financial Advice re Cost of Individual Financial Advice re Cost of

The perception and opinion of the patient is vital in understanding by95the Theraputic Exercisewhat is needed 95 Theraputic Exercise 100 community. Support services can have a directSpiritual impact on the total well-being 100 of cancer CareSpiritual Care For the Community Needs Assessment, this question was of particular interest as we look to improve 103 Social Support Groups patients and following active treatment. Knowing which services our 103 cancer patients the cancer services within our during service area. In Q20, the question was written as: What other services Social Support Groups would you like to see offered in the service area?”. Some choose to say they would be interested in Individual Counseling 122 122 feel would have benefitted them is paramount to Counseling improving cancer care in our area. Individual quite a few, while others decided to write personal notes of what would have been more helpful to

Classes of Specific Cancers them as they battled cancer, and a few choose not to answer this question at Educational all. Eleven of options were Cancers Educational Classes Specific available, the respondents were asked to pick 4. More Information of Treatment Options

130

Q20 – MORE SERVICES DESIRED-PICK 4

138

More Information of Treatment Options The perception and opinion of the patient is vital in understanding what is needed by the community. Nutritional Couseling Nutritional Couseling

Support services can have a direct impact of the total well-being of cancer patients during and following active treatment. Knowing which services our cancer patients feel would have benefitted them is paramount to improving cancer care in our area.

130

193

0 80 20 100 40 60 140 80 160 100180 120200 140 160 180 200 0 60 120 Q2120– 40 RECEIVED QUALITY

SURVIVORSHIP/FOLLOW UP CARE

Q20. More Services Desired-Pick 4

Q21. Received Quality Survivorship/Follow Q21. Received Quality Survivorship/Follow Up Care Up Care

Genetic Counseling

Transportation Services for Treatments

Caregiver Support Individual Financial Advice re Cost of

Theraputic Exercise

Spiritual Care

100

Social Support Groups

103

68.27%

18.53% 122

Individual Counseling

13.20% 18.53%

Yes

Not Applicable Not Applica

130

Educational Classes of Specific Cancers

68.27% 13.20%

138

More Information of Treatment Options

193

Nutritional Couseling 0

20 40 60 80 100 120 140 160 180 200

Q21. Received Quality Survivorship/Follow Up Care 68.27%

13.20% 18.53%

Yes No Not Applicable

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COMMUNITY NEEDS ASSESSMENT – ONCOLOGY

COMMUNITY HEALTH NEEDS PRIORITIZATION This Assessment focuses predominantly on cancer patients, care, and services in the tri-county service area. Taking all of the information available and extracting it in an objective fashion should give the surveyors a better understanding of where we excel and where we need to focus future endeavors to improve cancer care to our patients in this area. Cancer care can be addressed in 3 broad areas: Prevention, Treatment, and Survivorship/ Wellness. These are not compartmentalized areas and frequently patients will move among these arenas throughout the care continuum.

PREVENTION The data regarding chronic disease, smoking, and obesity in the service area (see Tables 16, 17, and 18) supports the continued need focus on cancer prevention, education, and wellness programs. According to the American Cancer Society, 572,000 Americans die of cancer each year, about one-third of these cancer deaths are linked to excess body weight, poor nutrition, and/or physical inactivity.6 Smoking continues to be the number one cancer causing risk factor across our population. In our service area 21.62% are still smoking, compared to 22.5% in the state. Education on the effects of smoking and smokeless tobacco use is vast and readily available, however, direct support for those trying to stop is minimal. State programs are free, but scripted support is not well received by patients dealing with the challenges of withdrawal and behavior abstinence. The social stigma related to smoking appears to have a strong consequence for some smokers. Direct human support is minimal in the tri-county area. No programs at the local level were found in Lancaster County and only 2 small programs exist in York and Chester counties. Nutritional Services in the service area, especially government run systems, seem to be primarily related to obtaining food as opposed to addressing obesity. Nutritional education programs are available through SC public offices, however these are predominantly focused on children and adolescents, not the adult population. 65.05% of Region 3 in SC, which includes our service area, is considered obese. 85% of citizens in our area admit that they do not receive the recommended fruits and vegetables daily. As obesity continues to escalate to near public health crisis levels across the country, research is proving the direct impact on increasing cancer risks. Second only to smoking, weight control must be addressed as assertively as tobacco cessation if we are to see cancer risks in the area decrease. 6 Diet

and Physical Activity: Whatâ&#x20AC;&#x2122;s the Cancer Connection?" Diet and Physical Activity: What's the Cancer Connection? American Cancer Society, n.d. Web. 21 Sept. 2014 http://www.cancer.org/cancer/cancercauses/dietandphysicalactivity/dietand-physical-activity

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COMMUNITY NEEDS ASSESSMENT â&#x20AC;&#x201C; ONCOLOGY

COMMUNITY HEALTH NEEDS PRIORITIZATION There is little to no nutrition education for wellness programs in the service area. Outpatient nutrition counseling has limited availability and is utilized predominantly in the face of illness. It currently is not available to the general public for prevention and wellness. The availability for exercise or to simply participate in activities that can add to wellness through physical activity is significant in our tri-county service area. Bike riding and walking trails and parks are widely available. Gyms are plentiful; however these include a financial obligation that many may not be able to afford. Lifestyle choices impact our health as well as increase or decrease cancer risks. Hypertension, diabetes, obesity, smoking, sedentary lifestyles, and poor nutrition all negatively impact mortality and morbidity for our service area. Being aware of and developing plans to address lifestyles that may lead to previously mentioned health issues can help lower the occurrence of cancers in the population. To help compensate for these negative facts, screenings can be utilized. Screenings can help our population by enhancing the early detection rates of cancers and hopefully increase the survival rates for our area by detecting cancers while still in a stage where cure is a realistic goal. Currently breast and cervical screening programs are readily available in the service area for both insured and uninsured. Other screening opportunities are more limited and do not have financial assistance. A large part of preventative medicine revolves around the primary care physician (PCP). The primary care physician can be of incredible importance to the individual’s health, especially in the outlying areas. York and Lancaster counties appear to have at least an adequate number of primary care physicians (at this time). However, Chester County seems to be quite lacking. The PCP is on the forefront of preventative medicine including screening for disease, nutrition, weight management, hypertension, and diabetes management, etc. all begin with him/her. The physician’s education, interventions, monitoring, and referrals to the appropriate next level of care are vital in the health management process. The lack of PCP presence in Chester County is worrisome, with only 5 publicly listed in the county. Many citizens who are under insured or uninsured utilize Urgent Cares and even the emergency room systems for their primary care needs throughout the state. Chester County unfortunately does not have an urgent care office. All patients must either go to the ED in Chester or leave the county to find medical care. Add the lack of oncology services in Chester County to previously mentioned deficits in patient care and the problem mounts.

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COMMUNITY HEALTH NEEDS PRIORITIZATION Active Treatment/Services Most active oncologic therapy is now performed in the outpatient setting. The benefit to outpatient services is it improves the patient’s quality of life while also attributing to a decrease in financial costs by controlling health care costs for patients as well the State and Federal governments. However, to ensure the best possible outcomes, more therapies historically reserved for the inpatient setting need to move to the outpatient setting as well. There are far more barriers to patient care for patients under active treatment. The barriers to treatment begin to mount as patients continue to live longer with their cancers and strive for some sort of normalcy as they undergo treatment. Access to Care is the predominant factor when addressing outpatient care. Availability to oncologic services is paramount. As noted in the physician listings there are only 6 Oncologists and 2 Radiation Oncologists in York County, 5 Oncologists in Lancaster County and 0 in Chester County. In the rural service areas, all of which are without public transportation, the simple chore of getting to the doctor can be problematic. According to the survey completed within the service area, 45% of respondents stated they traveled 20-40 minutes to their medical appointments. Only 7% of those surveyed cited that transportation impacted their care, however health care providers note transportation is a daily struggle for many patients, especially those noted to be below the poverty level, without a vehicle, or unable to afford the cost of fuel. Transportation services are limited, with only one organization per county to assist some patients to and from appointments. Patients that require physical assistance are unable to use these services. These fee based services have an impact on the Counties and the State. American Cancer Society does offer “Road to Recovery” for the service area, which is free transportation provided by volunteers. “Road to Recovery” has limited availability and patients cannot require physical assistance greater than needing a driver. Independent distance travel is a deterrent for many cancer patients due to disease and/or treatment symptoms. Traveling long distances when ill can be exceptionally challenging for the severely fatigued, weak and those afflicted with nausea/vomited or diarrhea. Integrative services are growing in importance as medical research reinforces the benefits of nutrition, exercise, and emotional support while on active treatment. Therapies like physical and occupation therapy are widely utilized within the service areas and benefit the patient. The availability of integrative services in the outpatient setting is vital to improving patient care. With physician orders some therapies are covered by insurance such as physical, occupational, and nutritional counselling. However, for patients who do not have an active symptom to ‘justify’ such referrals, access to many of these services are limited. The Survey respondents cited Nutritional Counseling as the number one service that

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COMMUNITY HEALTH NEEDS PRIORITIZATION could improve their care. (Survey, Q20) at 193 of 430. Access to this is extremely limited in the entire service area as noted in the Preventative section of this survey. Support groups with different approaches were also noted high on the list of services desired by respondents along with therapeutic exercise. Patients or their families, facing life threatening illnesses, will often take an active role in their health. This is encouraged and can have a positive impact on outcomes. The availability of these services without an MD order, or where insurance will off-set cost, such as therapeutic yoga, cancer support groups for patients and caregivers, and counselling, is quite limited. York County has only 4 groups for support of cancer patients; one for prostate cancer, one for breast cancer and two general cancer support group offered through Rock Hill Churches. No support groups could be found in Chester or Lancaster counties. Individual counseling services are available throughout the service area, most at significant cost or are dependent upon insurance benefits. Catawba Mental Health does accept Medicaid patients but is saturated with a high patient load. Yoga is readily available through independent businesses, however this can be cost prohibitive and may not be in an environment comfortable for a patient actively receiving treatment. There are support programs available in York County through the American Cancer Society. Reach to Recovery is specifically designed for support for breast cancer patients. Look Good Feel Better is offered to females dealing with chemotherapy. In York County this is offered every other month. Spiritual care for patients and families facing life threatening illness can be a significant need. Of the over 430 surveyed, 100 noted the increased need for this service. Piedmont Medical Center is actively developing a chaplaincy program for inpatients. Currently, there is no formal community or theological organization designated to address spiritual care for cancer patients in the service area, although, many individual churches offer this for their congregations. Patients or families not affiliated with a church family may not have access to spiritual care in the outpatient setting. Education throughout the care continuum is a well-documented need for patients and families. Patients and caregivers who understand their disease, and why a treatment is recommended, are far more likely to be compliant with the regimen, and be actively involved with the plan of care. Patient and family teaching is only effective when properly taught. The literacy rates in our service area vary, and teaching must be geared toward the individual patients and their learning ability. Awareness of the literacy barrier in our population is paramount to meeting the needs of the patient population. According to data obtained, 20% of Chester County residents have low literacy skills, and 22.67% did not complete high school. Lancaster County has a lower index with 17% low literacy skills, and York County is at a mere 11%. For comparison sake, SC as a whole has 15% of the population with low literacy. In the Survey, (Q20) 138 out of 430 respondents cited the desire for more education regarding treatment options, and 130 out of 430 cited

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COMMUNITY NEEDS ASSESSMENT â&#x20AC;&#x201C; ONCOLOGY

COMMUNITY HEALTH NEEDS PRIORITIZATION the need for more education about their specific cancers. In Q14 of the Survey, 25% of respondents cited not receiving enough education at the time of diagnosis regarding their cancer.

Survivorship/Wellness More patients are beating cancer than ever before. According to the American Cancer Society, by January 1, 2024, it is estimated that the population of cancer survivors will increase to almost 19 million: 9.3 million males and 9.6 million females.7 The recognition of the needs of survivors is relatively new in the world of cancer treatment. Survivors, whether just diagnosed or having completed treatment months or many years ago often have many common concerns. They include the risk of recurrence or the development of a new cancer, the impact that treatment has had on their bodies going forward, and how to take control of their own health to help avoid another diagnosis of cancer. The American College of Surgeons has recommended the application of a survivorship plan of care for survivors, and the development of survivorship clinics to enhance the long term follow up of cancer patients. Piedmont Medical Center and oncology groups in the area are developing a program to meet these new standards. According to the survey respondents, only 13% of the 430 stated that they did not receive adequate follow up or survivorship services. Survivors of cancer should be monitored by the medical community for possible recurrence, side effects of therapy, possible long term complications or secondary cancers. This involves not only the oncology community but their primary care physicians and other medical professionals. Many times patients go from an environment of intensive therapy with tremendous support, in a ‘fight for their life,’ and then back to “normal” very quickly. The lack of transition can be difficult for some. Lymphedema can be a lifelong reminder and hurdle for patients to contend with. Physical therapy may be necessary to assist these patients. Lymphedema clinics are available in York and Lancaster Counties. Emotional support is frequently needed to help patients learn to live as a Survivor. Education and support are frequently needed to help patients learn to monitor their bodies and make the lifestyles changes desired. Many patients become strong advocates of their own heath once they have dealt with a cancer diagnosis. Therefore many wellness programs benefit this group: Nutrition classes, exercise, yoga, and other integrative services. The instituting of these programs in the service area, including outlying areas, will be a benefit to our citizens for all three areas: Prevention, Active Treatment and Survivorship.

7 American

Cancer Society. Cancer Treatment and Survivorship Facts & Figures 2014-2015. Atlanta: American Cancer Society; 2014 http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-042801.pdf

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COMMUNITY HEALTH NEEDS PRIORITIZATION Special Attention Area Overall interpretation of the data from Lancaster and York counties are typical of the state in most areas. Recommendations have been made to improve cancer care to the entire service area. However, Chester County is a special area of concern and warrants special attention. The needs of this county seem to be well above the rest of the service area. While there have been recent health care improvements in Chester County, gaps in care continue to exist. The following is an assessment and a plan to assist this special attention area. As noted in the 2012 data, Chester County was ranked 6th out of South Carolina's 46 counties for cancer occurrences. The county ranks number one in lung cancers and number nine in colorectal cancers. For comparison of cancer data, York County was ranked number 20 and Lancaster County was ranked 39 out of 46 counties. These figures alone are enough to elicit a closer look at the data. Chester County has a history of agriculture and texile producton. It is considered rural. According to the census in 2012 it had 32,936 residents. The poverty level is 24.8%, compared to 15.7% for the report area. Household income averages $33,718/year versus $43,290/year for the state. 20% of Chester County is rated as having low literacy skills versus 13% in the report area. 22.67% of Chester County residents do not have a high school diploma compared to 15.85% in the report area. Unemployment in Dec 2012 was 9.3% in Chester County versus 6.3% in the state. The latest data obtained from 2014 shows medical coverage in Chester County differs as well vastly from the state with 19.11% uninsured versus 14.39%, 22.2% on Medicaid versus 15.01%, Medicare 15.42% versus 13.98% and private insurance 38.98% versus 53.92%. Chester County is home to Chester Regional Medical Center, an 82 bed hospital. There are no urgent care facilities in the county and only one group of (5) primary care physicians and two clinics for indigent or underinsured patients. There are no oncologists or radiation oncologists within the county. There is one mammography screening facility. Integrative services for wellness, nutritional counselling, education, etc. are profoundly limited in the area. For many years, race has been a known disparity in health care. Close inspection of the data within York, Lancaster and Chester County, revealed that although Chester County has much higher numbers with regards to its cancer diagnosis and deaths, in general, this does not appear to be related to race. Table 20 shows the data supports a disparity for all residents within Chester County regardless of race.

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COMMUNITY NEEDS ASSESSMENT â&#x20AC;&#x201C; ONCOLOGY

COMMUNITY HEALTH NEEDS PRIORITIZATION GEOGRAPHIC AREA

WHITE

CANCER DEATHS

% WHITE

BLACK

CANCER DEATHS

% BLACK

C hester County, SC

19,709

0.27%

12,532

0.26%

L ancaster County, SC

55,773

103

0.18%

18,322

0.21%

York County, SC

172,103

377

0.22%

42,450

0.15%

As noted in the beginning of this work, the goal of this assessment is to bring together the data regarding the service area, identify gaps in resources and to identify potential ways to improve cancer health disparities and gaps in resources. In general, Chester County appears to be an area of great potential for improvement. Those looking for ways to improve the health and welfare of the area would do well to assist the citizens of Chester County.

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REFERENCES American Cancer Society. Cancer Treatment and Survivorship Facts & Figures 2014-2015. Atlanta: American Cancer Society; 2014 http://www.cancer.org/acs/groups/content/@research/documents/ document/acspc-042801.pdf “Awards and accreditation: Nationally recognized,” retrieved from Piedmont Medical Center website. 2014 July: http://www.piedmontmedicalcenter.com/en-us/aboutus/pages/awards.aspx Bhaskaran, Krishnan, Ian Douglas, Harriet Forbes, Isabel Dos-Santos-Silva, David Leon, and Liam Smeeth. "Body-mass Index and Risk of 22 Specific Cancers: A." The Lancet 384 (2014): 75565. 14 Aug. 2014. Web. 17 Sept. 2014. http://download.thelancet.com/pdfs/journals/lancet/ PIIS0140673614608928.pdf?id=aaajAKIByn4Rg5ZshWfGu "Diet and Physical Activity: What’s the Cancer Connection?" Diet and Physical Activity: What's the Cancer Connection? American Cancer Society, n.d. Web. 21 Sept. 2014 http://www.cancer.org/cancer/ cancercauses/dietandphysicalactivity/diet-and-physical-activity “Historical/trend analysis, percent of population without Health insurance” South Carolina Health indicators project health: Retrieved from University of South Carolina Website; 21 Sept. 2014 http:// www.ipspr.sc.edu/scip/pubhealth/afford.asp#_edn1 "Local Area Unemployment Statistics”; retrieved from United states department of labor website; 2014, July : U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics, February 5, 2014. Thorpe, Kenneth E., PHD. The Future Costs of Obesity. N.p., n.d. Web. 30 July 2014. www. fightchronicdisease.org/sites/fightchronicdisease.org/files/docs/CostofObesityReport-FINAL.pdf “State and County estimates of low literacy”. Retrieved from National center for education statistic website 2014 June from : U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, State and County Estimates of Low Literacy, 2003. State of South Carolina, Department of Health and Environmental Control, Bureau of community Health and Chronic Disease Prevention, County Chronic Disease Prevention, County Chronic Disease Fact Sheet November 2013 retrieved http://www.scdhec.gov/hs/epidata/county_reports.htm State of South Carolina, Department of Health and Environmental Control, County Cancer Profiles, 2012 retrieved 2014, April from http://www.scdhec.gov/Health/docs/SCYorkCountyCancerProfile.pdf, http://www.scdhec.gov/Health/docs/SCLancasterCountyCancerProfile.pdf http://www.scdhec.gov/Health/docs/SCChesterCountyCancerProfile.pdf State of South Carolina, Department of Health and Environmental Control, Bureau of community Health and Chronic Disease Prevention, County Chronic Disease Fact Sheet November 2013 retrieved from http://scdhec.gov/hs/epidata/county_reports.htm US Department of Commerce, United States Census Bureau, American Fact Finder. Community facts 2010, retrieved from United states Census Bureau website, 2014, June from: http://factfinder2.census. gov/faces/nav/jsf/pages/index.xhtml “2012 American Community Survey 5- Year data collected from 2008 to 2012 . Retrieved from United States Census Bureau website; 2014 July. : U.S. Census Bureau, 2000 Census of Population and Housing, Summary File 3, 200; U.S. Census Bureau, American Community Survey, 2012 Data Release, December 2013.

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COMMUNITY NEEDS ASSESSMENT – ONCOLOGY

APPENDIX A Appendix A is the survey created for cancer patients and cancer survivors. It was placed strategically throughout the 3 county report area.

CANCER PATIENTS and SURVIVORS SURVEY Community Needs Assessment

If you are currently a cancer patient or a cancer survivor, please consider completing this survey. This survey is for ALL cancer patients and survivors—regardless of where they were treated. The information you provide will be kept confidential and only used for the purposes of this survey. All completed surveys will be collected by July 31, 2014. Thank you so very much for taking the time to give us this very important information!

DEMOGRAPHIC INFORMATION 1. Age:

 18-29

 30-49

 50-69

 70-99+

2. County you currently live in: □

 York

 Lancaster  Chester

 Other (please specify):____________

3. Gender:

 Male

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 Female

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APPENDIX A 4. Education:

 Some High School

 High School Diploma

 Some College

 Associate Degree

 Bachelor’s Degree

 Doctoral Degree

 Master’s/Other Graduate Degree

5. Household income:

 less than $40,000

 $40,000-$70,000

 $110,000-$139,000

 greater than 139,000

 $70,000-$110,000

GENERAL HISTORY/HEALTH 6. Type of Cancer Have Currently/Have Had (check all that apply):

 Bladder

 Leukemia

 Pancreatic

 Uterus

□

 Brain

 Lymphoma

 Prostate

 Breast

 Melanoma

 Sarcoma

 Colorectal

 Myeloma

 Stomach

 Kidney

 Ovarian

 Thyroid

 Other (Please specify) : _______________________

7. Treatment:

 Surgery Only

 Surgery + Radiation

 Chemotherapy Only

 Surgery + Radiation + Chemotherapy

□

 Oral (pill) forms of chemotherapy used at any time during treatment

 Chemotherapy + Radiation

8. Rate how you feel your health is currently:

 Excellent

 Very Good

 Good

 Fair

 Poor

IMPACTS ON TREATMENT 9. How far did you travel for the majority of your treatment?

 less than 20 mins

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 20-40 mins

 41-60 mins

 more than 60 mins

COMMUNITY NEEDS ASSESSMENT – ONCOLOGY

APPENDIX A 10. Was transportation a problem for you to get to and from treatments?

 Yes

 No

11. During treatment, what form of insurance did you have?

 Self-Pay

 Medicare

 Medicaid

 Employer-based/private

12. Did insurance concerns or problems affect your treatment decisions or choices?

 Yes

 No

13. In what environment did you receive the majority of your treatment?

 Outpatient Clinics (i.e. doctor’s office)

 Hospital Infusion Center

 Hospital (as an inpatient)

 Home

 Other (please specify):________________________________

□

14. At the time of your initial diagnosis, how much information about the disease, treatments, and available resources do you feel was given to you?

 Not enough (I had to find more information myself)

 Too much (I was overwhelmed by information)

□

 Just right

15. As your treatment progressed, how would you rate the education you received about your chemotherapy regimen and medications (the effects, side-effects and goals of each)?

 Excellent

 Very Good

 Good

 Fair

 Poor

 Not applicable

16. Do you feel you were given individualized, personalized care? □

 Always

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 Usually

 Sometimes

 Rarely

 Never

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APPENDIX A 17. Were you given forms for Advance Directives (i.e. Living Will, Power of Attorney) at any time during your treatment process?

 Living Will

 I was not given any forms about Advance Directives

If you had been given these forms, would you have been more likely to complete an Advanced Directive?

□

 Yes

 Health Care Power of Attorney

 No

 Maybe

19. What types of support do you utilize if any? (check all that apply)

 Community Support Groups

 Online Support

□

 Individual Counseling

 Other (please specify):_________________

 Hospital-Based Support Groups

 None

20. Do you feel that there were enough supportive groups/functions/meetings and other support resources available to you?

 Yes

 No

21. What services would you like to see more of for cancer patients and their family? (select your top 4)

 Nutritional Counseling

 Transportation Services for Treatments

 Social Support Groups

 More Information About Treatment Options

 Individual Counseling

 Spiritual Care

□

 Caregiver Support Groups

 Educational Classes on Specific Cancers

 Therapeutic Exercise Groups

 Genetic Counseling

 Individual Financial Advice Regarding Cost of Care

22. After your treatment was completed, did you feel you had adequate follow-up from your healthcare team for monitoring the risks of cancer recurrence and/or possible long-term side effects of cancer treatments?

 Yes

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 No

 Not applicable at this time

COMMUNITY NEEDS ASSESSMENT – ONCOLOGY

APPENDIX A OPTIONAL: Please share with us any comments, ideas or suggestions you have to improve the lives of the cancer patients in our community: _______________________________________________________________________________________________________

Once again, Piedmont Oncology Services thanks you for your time and opinions. They are extremely important to us as we actively strive to improve our cancer services to meet the needs of the people in our community. Who better to ask, than the ones who have been walking this path and know the journey personally?

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APPENDIX B POSSIBLE INTERVENTIONS TO CONSIDER The data gathered and analyzed for this Community Needs Assessment identified problems and potential solutions. The following is a summary of ideas that could benefit the communites in our 3 county report area. The service area of York, Chester and Lancaster counties is predominately rural, therefore outreach is vital. Transportation and distance are contributing barriers to success. The collaboration with and utilization of community locations such as community centers, YMCAs, schools and churches, etc. could help increase the success of many of these ideas.

PREVENTION Smoking: Assistance with other wellness focused groups could enhance the availability of programs to decrease tobacco use. 1. Support groups 2. Behavior therapy 3. If appropriate, nicotine replacement could be an effective smoking cessation tool. Nutrition: There is a well-documented connection to poverty and obesity. Education, counseling, and support should be made available for free or at a reduced fee to help ensure that this population is able to participate. Nutrition and/or weight management educational classes could be offered across the service area. 1. Community ‘Gardens For Health’ 2. S tate programs/classes on weight control and nutrition as part of SNAP, and independent programs not only emphasizing infant/child but adults as well. Exercise: 1. P ublic campaigns on the benefits of even minimal exercise and weight control could be beneficial. Access to Care: 1. I ncreased PCPs in the service area, particularly in Chester County, could improve care on the “front-lines” for citizens. 2. I ncreased Urgent Care facilities, particularly in Chester County, which has no such resource. 3. I ncreased free or sliding scale operations that emphasize preventative care and wellness. 4. I ncreased Oncology specialists in all 3 counties could benefit patients. Easier access improves compliance and therefore improves outcomes. myPMC.com

COMMUNITY NEEDS ASSESSMENT – ONCOLOGY

APPENDIX B Screening Services: 1. E ducate the public about the most recent screening recommendations and payment options. Include information targeting those with low literacy. 2. I ncreased Breast Cancer Screening programs, special events, education and payment programs like Best Chance and Breast Screening Source of York County. 3. L ung Cancer Screening pilot program launched this year at Piedmont Medical Center. Education, advertising in the community as well as in the medical circles is needed to advance the program. 4. C olorectal Screening programs, more special events, and education. Payment programs are needed for the indigent or uninsured. 5. P rostate Cancer Screening special programs and education. Payment programs are needed for the indigent or uninsured. 6. Cervical Screening 7. Skin Screening

ACTIVE TREATMENT/SERVICES Access to Care: Specialty Physician 1. Recruitment of Oncologist to Piedmont Medical Center 2. Recruitment of more Oncologists to service area in general, particularly Chester County 3. Satellite oncology office in Chester County for cancer care Access to Care: Transportation 1. Increased transportation services with handicap or wheelchair assistance 2. Increased volunteers especially in outlying areas with Road To Recovery Integrative Therapies: 1. N utrition classes for patients or caregivers currently under cancer care offered throughout the service area 2. Yoga programs designed and exclusively offered to cancer patients 3. General cancer support groups offered throughout service area 4. Specialty exercise programs offered for patients currently under cancer care 5. D evelopment in the theological community for spiritual support to cancer patients in the outpatient setting. Outreach in the rural setting for patients and caregivers Education: 1. Specific cancer classes, with treatment options discussed 2. Integrative therapy education 3. Written material education geared toward low literacy groups

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COMMUNITY NEEDS ASSESSMENT â&#x20AC;&#x201C; ONCOLOGY

APPENDIX B SURVIVORSHIP/WELLNESS Access to care: 1. Development of disease specific lifetime clinics 2. Recruitment of Nurse Practitioner to assist in clinic Integrative Therapies: 1. Nutritional Classes 2. Exercise and wellness 3. Support groups Education: 1. Quarterly disease specific meetings and education for survivorship/wellness 2. C ommunity outreach to churches and community groups for supportive educational opportunities

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