Gateway to Hope

Gateway to Hope believes that if women have access to affordable, quality and timely care, sufficient health literacy, strong support relationships, and adequate financial resources, then we will see improved breast cancer health outcomes among low income women and women of color.

As costs continue to rise for cancer patients, the healthcare community recognizes that the financial burden, or “financial toxicity,” facing patients ultimately has a dramatic effect on treatment outcomes. Financial toxicity is comprised of the objective financial burden as well as subjective distress resulting from cancer treatment. Similar to the effects of physical toxicity of treatment, the emotional, mental and physically debilitating financial side effects of treatment can reduce quality of life and hinder delivery of care:
• 40% of all cancer patients are in debt after treatment.
• More than 1/3 of patients skip treatment or medication to save money
• Those with more resources to afford and access care survive 5 years longer than those without.
• Individuals with incomes at or below 200% of the federal poverty level (FPL) report financial toxicity scores twice as high as those with incomes greater than 800% of the FPL.

By 2022, Gateway to Hope seeks to serve 450 patients annually. Representing a thoughtful and strategic pivot toward better addressing community need with our program, we will prioritize our outreach efforts to reach women who have the highest level of need. We also will modify our program to be even more patient-centric than it is today; without compromising our quality standards and fiscal responsibility, we will address the unique needs of individual patients and increase the amount of time we spend with them – providing emotional support and helping them navigate treatment. As the direct result of our work with patients, our ultimate goals are to ensure 100% of program recipients are adhering to their treatment plan, maintaining health coverage, and have a sustained living situation during treatment. These are among the leading indicators of whether a patient will effectively access the treatment they need to survive their diagnosis. Through our work with patients directly, and as the result of our leadership within various community coalitions, we seek to be a leader in community-wide efforts to reduce breast cancer outcome disparities among black and white women in St. Louis.

To receive support from Gateway to Hope, individuals must be undergoing active breast cancer treatment and meet our financial eligibility requirement of annual income at or below 4.5 times the federal poverty rate (for a single individual that is approximately $56,000 a year.) Gateway to Hope provides financial assistance and emotional support during active treatment. Up to $5,000 is provided to individuals receiving care in Missouri or Southern Illinois to cover health insurance premiums, basic living expenses (rent/mortgage, utilities, vehicle payments and insurance, and telephone), and gas reimbursements for trips to and from treatment. Additionally, each patient receives the support of a program staff member who provides guidance throughout treatment. The staff provides emotional support, education, and help understanding the complexities of health insurance coverage and their treatment. Referrals to community and national resources are provided to alleviate barriers and distress that may arise during and after treatment.
Gateway to Hope’s program team consists of the following key staff members who work directly with breast cancer patients:

Keri Koehler, LMSW, Program Manager: With extensive experience in program development, evaluation, research, health behavior and policy, Keri Koehler joined Gateway to Hope in 2015. Koehler received her Master of Social Work from Washington University, and Bachelor of Arts from the University of Arkansas. She is a current member of the Association of Oncology Social Work and Social Work Leaders in Healthcare of Metro St. Louis, Inc.

Wendy Behnke, Patient Navigator: Wendy is a candidate for graduation in May 2019 from the Brown School at Washington University. She has found a passion for medical social work and breast cancer advocacy efforts. Wendy has a strong commitment to work towards ending health disparities in the St. Louis community and she believes in access to excellent health care for all and that individuals are more than their diagnosis. 

Heather Burns, LMSW, Patient Navigator & Outreach Coordinator: Heather has always been passionate about supporting those in need. She is particularly interested in addressing the health and wellness issues faced by women. The majority of her social work career has been in the medical field. Heather received her Bachelor’s in Psychology and Sociology from Maryville University and her Master’s in Social Work from University of Missouri St. Louis. Some of her graduate work involved participating in a pilot research project with Forward Through Ferguson.

In addition to Gateway to Hope staff, support for these efforts will be provided by master’s social work practicum students, volunteers and our Clinical Advisory Council, comprised of community health experts: Lannis Hall, MD, MPH; Debbie Wadsworth, MD; Becky Lynn, MD; Denise Meckler, MD; Christine Ekenga, PhD; Jane Weiss, RN, BSN; and Christine Lyss, RN.

In 2018, Gateway to Hope served 346 women. In 2019, we are on track to serve more than 375 women. These patients live in Missouri or Illinois, fall at or below 450% of the Federal Poverty Guidelines, and receive treatment in Missouri. We have experienced more than 60% growth in the number of patients served over the last 6 years. Services are provided across the state of Missouri and Southern Illinois. 53% of our patients resided in St. Louis City and St. Louis County in 2018, and 75% resided in the St. Louis region. While eligibility extends to households with incomes up to 450% of the Federal Poverty Level, nearly 90% of patients in 2018 were at 250% or below. Patients at all stages of breast cancer are accepted, including stage IV metastatic breast cancer, which accounted for 20% of patients in 2018. Approximately 53% of Gateway to Hope patients are white, 40% are black, and the remaining are other ethnicities.

In 2018, Gateway to Hope staff had more than 2,700 forms of contact with patients. We also provided more than $400,000 of financial assistance to patients. As a result of these efforts:
• 88% of patients report they focused more on their treatment, 84% were better able to cope with their diagnosis, and 83% worried less about finances because of GTH assistance.
• Patients were more aware of available resources (84%) and overall quality of life improved (81%).
• Only 12% of Gateway to Hope patients reported skipping their medication compared to 18% of all cancer patients in a survey conducted by Cancer Care.
• Only 12% reported skipping appointments, compared to 22% in a national survey conducted by Cancer Care.
• 100% of patients with health insurance at time of diagnosis maintained their coverage throughout treatment.
• Patients experienced on average a 35% decrease of overall level of distress.
• Patients received gas cards or reimbursements to cover over 33,000 miles traveled to and from treatment.