Eduardo Miranda, MD, FACP, is a board-certified specialist in medical oncology, hematology, and internal medicine. Dr. Miranda operates a community cancer center in Laredo, Texas, and is the chairman of the Cancer Committee at Doctor’s Hospital Laredo. Since 1999, Dr. Miranda and his staff have worked to improve care for people with cancer in Laredo and the surrounding communities of Webb, Hebbronville, Zapata, and Hidalgo.
“Caring for every patient. Learning from every patient.” For ASCO President Dr. Monica Bertagnolli, this is more than just a presidential theme. To put action to words, she is heading to local communities to speak with patients, caregivers, and oncology professionals. She and other ASCO members are responding to patients’ concerns and, at the same time, they are learning more about the challenges that exist in getting quality cancer care. These sessions are called “ASCO in the Community: Listening and Learning from Our Patients.” In October 2018, Dr. Bertagnolli visited Laredo, Texas, to join a public breast cancer forum and fashion show to celebrate breast cancer survivors and raise breast cancer awareness. In this post, local medical oncologist Dr. Eduardo Miranda shares the key issues discussed by the community.
What was your role in the Laredo events?
The participating cancer survivors wanted to have their doctors join them, their family members, and friends at the forum and fashion show. I treated most of the survivors, so it was important for me to be there to greet them. I wanted to share their moments of celebration and be by their side during the conversation on getting quality cancer care.
What is the cancer experience like in Laredo?
Laredo is located on the Mexican border in southern Texas. About 90% of people who live here are Hispanic, and many families have a history in this area that dates back 300 years. It’s a really young community; the median age is 27. Here, people with cancer tend not to feel alone or neglected because family ties are very strong and they often have a very supportive circle of friends. In general, there’s a great respect for the doctors who provide cancer treatment. Our patients trust that we’re always doing our best to help them. However, there are close to 300,000 people in Laredo and only 3 medical oncologists. Two are employed by a hospital, and I’m an independent medical oncologist.
Each of the 2 hospitals here has a radiation center, but we rely heavily on surgical specialists from San Antonio, Texas, 160 miles away, to perform many cancer-related procedures. Another challenge we face regarding access to care is that many people don’t have health insurance. In addition, it’s tough getting insurance authorizations for tests and treatments that patients need. Despite these challenges, working as an oncologist in this community has a very special meaning. Our patients place all of their hopes on us for a good outcome because they want to stay here and be close to their loved ones during treatment. I always feel compelled to find the best strategies to deliver the same quality cancer care they may find in larger centers.
What communication and cultural barriers exist in Laredo?
In many areas of the United States, cultural and language barriers can make it hard for Hispanic people to get quality cancer care. In Laredo, however, most people are bilingual, speaking Spanish and English. So the language barrier isn’t an issue. Also, the great support many patients have from family and friends that come with them to appointments lessens any cultural barriers. These supporters often take notes and help our patients follow our recommendations. This is very helpful in making sure that the most important information is recorded. There are also many other ways family and friends can help, including providing comfort, asking follow-up questions, and helping to describe any symptoms the patient is experiencing from cancer and its treatment.
Based on the experiences of people with cancer in Laredo, what information do you think people with cancer need to know?
Everyone deserves quality cancer care. In my office waiting room, you’ll find patients from all walks of life sitting next to each other. They all share something in common—their desire to fight a difficult disease. You should never feel intimidated if you don’t have the best insurance plan or no insurance. Help can come from other sources. Talk with your doctor about the different financial resources available. To start a conversation about your finances, you might want to say: “I’m worried about the costs related to cancer treatment. Can we talk about my concerns?”
In Laredo, people without insurance can be directed to our county-run health care program. If they qualify for the program, they’re given vouchers to cover doctor’s visits, tests, and treatments at Medicaid rates. In addition, our staff helps people apply for free or reduced-cost medications through pharmaceutical companies’ patient assistance programs. Undocumented patients are seen at a local Catholic institution staffed by nurse practitioners. We also see those patients and help them apply for assistance from a wide range of national service organizations that help people with cancer address medical and nonmedical costs.
Why is it important for people to participate in events about cancer care?
In Laredo, events like the forum and fashion show help our community see how well people with cancer are doing after going through cancer treatment here. They’re also an opportunity to find out where more support is needed. No matter what community you’re in, adding your voice to the conversation, whether you’re a patient, caregiver, or provider, can help bridge gaps in cancer care.
In 2018 to 2019, ASCO is holding a series of ASCO Presidential Town Halls with local groups across the United States to hear from patients, providers, and the general public about real-world barriers to quality cancer care and to talk about ways to provide the best care to every person diagnosed with cancer. These events are free and open to everyone; pre-registration is necessary. Check back on Cancer.Net for additional locations and dates to be announced soon.
Whether you will be able to attend an ASCO Presidential Town Hall near you or not, we welcome comments from patients and caregivers about your experiences with cancer.