Feature Interview
Melissa Wheeler,  Director Disparities & Outreach at Levine Cancer Institute 

This interview, conducted by by Nat Thomson, Simmons MSW Candidate, runs abridged in the January 2025 issue of the Simmons MPH Monthly. Melissa is the Director of Disparities & Outreach at Levine Cancer Institute, operating in the Charlotte metro and surrounding area of North Carolina. We thank Melissa so much for her time in talking with us.

Hi Melissa, it’s great to get to talk to you. I wanted to start off by asking what might have gotten you into or drawn you towards the field of oncology?

My first introduction into oncology was when a high school mentor of mine developed Kaposi's Sarcoma secondary to an HIV infection. This was in the ‘80s, when there was still very little understanding of AIDS/HIV, and as a result compassionate care was deeply lacking. It was at this point too that I was introduced to the concept of patient advocacy. I was immediately drawn to what would become a career of service to marginalized, under-resourced populations who needed support in lifting their voices and their stories. Years later, my father-in-law, a Vietnam Veteran who was exposed to Agent Orange, was diagnosed with metastatic gastric cancer. I was able to serve as his primary caregiver, helping him navigate a complex health system with limited resources and advocate for his comfort and care until he passed away at age 56.

Could you speak a bit about the Disparities & Outreach program at Levine Cancer Institute, which you created? 

The Atrium Health Levine Cancer (AHLC) Disparities and Outreach team reduces cancer health disparities and eliminates inequalities in care in medically under-served populations within the AHLC service area across North and South Carolina. Our mission is to improve the overall health and well-being of communities through targeted cancer prevention education, free screening services and the removal of barriers that can impede access to high-quality cancer care. We serve over 30,000 individuals each year, across a 30 county catchment area, through a wide variety of programming. We operate under a "whole human care" philosophy in which we assess all individuals for impediments to quality of life and stand ready to navigate to the appropriate resources. Common barriers we encounter are lack of adequate food and/or transportation, financial access barriers and a lack of trust. In the past 10 years we have provided over 20,000 free cancer screenings, connected those screened and their families to vital resources and developed more than 150 robust partnerships to create ecosystems of care. Our team is composed of an interdisciplinary group of community champions including clinical experts and public health "boots on the ground" resource experts.

Many Simmons public health students, past and present, have been involved in new and innovative programs and measures, so it would be great to hear a bit about your thoughts on innovation in public health. A significant one, of course. What have you learned along the way? What kind of attitude helped you push through some of the inherent challenges in innovating and changing the way things are approached? 

Innovation is incredibly important in overcoming public health challenges. If we don't innovate then we don't evolve and then we will be left with the same oftentimes life threatening disparities in health care. In 2017, recognizing the ever-increasing mortality rates for those with lung cancer in our country, our outreach team designed and launched the first mobile lung cancer screening bus in the country. Many said it could not be done, but 8 years later similar units have observed our outcomes and have begun launching their own programs. With this unit, capable of traveling to both urban and rural communities, we’re finding more than 60% of lung cancer cases in uninsured/underinsured individuals at an early stage, treatable with curative intent. We also offer high-touch tobacco cessation counseling and nicotine replacement therapy for entire households. It all started with just the idea alone, one that we couldn't walk away from despite there being many naysayers at the beginning. People were dying and if we stopped because it was too hard, lung cancer deaths would keep going. Public health is always challenging, but it requires a commitment to what we know to be true; that all individuals deserve equitable opportunities to receive high quality care. Aloso, if we become paralyzed by something which might be too big to tackle, then communities will suffer as a result. No cake is ever baked perfectly the first time. The only way to ever bake a great cake is to turn the oven on and go back and refine over time. So my message to those who want to make a difference in the field is that you can and you already have by just committing to it for your career.

When it comes to the intersection of public health and oncology, are there any perspectives you might share with our readers, some of whom may still be deciding where they might want to specialize in or even thinking about changing orientations?

For anyone seeking to enter the health field, regardless of specialty, I always recommend three key steps. 

First, take your own history of health access experience; what worked? what could have been better? how many times have you accessed the healthcare system? what resources did you have? what resources did you need? what did quality care feel like? what were your outcomes? Reflections on your own experiences can really help you when it comes time to inform others. 

The second step is to take time to ask others in your circles of influence (whether it be family members, friends, fellow students, professors or community members) about their health journey. It doesn’t have to be someone with a complex health issue. In fact, we have much to learn from all consumers of health products and services, regardless of diagnosis. This process helps provide a foundation for understanding how people interact with health systems, including ourselves and our loved ones, before we embark on a career path to influence that same experience. It can also uncover unconscious biases we might have, we all have them, and awareness is key to healing those blind spots. 

The third step I always recommend is to shadow any and all facets of both health services and community services that you can. When you open your ears, your mind, and your experience to what the real world looks like, it offers priceless information for future directions, where gaps currently exist and the potential solutions. It also connects you to colleagues whose resources you may need in the future.

Could you talk a bit about Project PINK, another Charlotte metro program of yours, as well?

Project PINK increases access to life-saving mammography exams for uninsured and underinsured women, ages 40 and above. The program offers a comprehensive approach to early breast cancer detection, providing community education, free mammograms, and follow-up care. Project PINK utilizes Charlotte Radiology‘s Mobile Breast Center to bring mammography expertise and screening exams to under-resourced communities in Mecklenburg, Iredell, Catawba Indian Nation and Union counties. In Anson and Cleveland counties, women are screened at free-standing locations with free transportation provided. Similar to other screening programs, we conduct assessments for barriers to care and provide immediate resources, such as food cards and bus passes, then help navigate women into longer term community based support. We also offer free colorectal cancer screening via FIT cards given away at the event. Recognizing the importance of culturally tailored care, we further designed Proyecto Rosa, which is free mammogram screening events hosted by our bilingual, bicultural staff exclusively for the Latina community, offering tailored education, resources and support.

A fair amount of your work in public health and oncology includes mobile units; could you talk a bit about the strategy and benefits of these interventions and programs? My father was a hospital executive and did some mobile work as well and they would use the term “press a breast” in regards to mobile mammography, which always made us giggle when he would take us on site here and there.

Well, I consider "press a breast" very health literate [terminology], although it may not sound super clinical to health systems, but you would be surprised at how many individuals misunderstand their results or the need for testing. Several years ago, we had a young surgical fellow accompany our team to educate on breast health in a women's shelter. Several times during a presentation she referred to "dense breast tissue" as increasing the risk for breast cancer. Close to the end of the presentation I observed one participant turn to another and say "I'm good, I got no dents in mine." That was a health literacy aha moment that I carry with me to this day. And yes, we did clear up the misunderstanding. But it was a lesson that we have to be mindful of thinking that "everyone knows what we know" or that people translate information the same way we might.

But to answer your question on mobile health and the benefits, we have to think about the human experience. There can be obvious tangible barriers like transportation that mobile units avoid. But when we think about the human experience, we have to consider why companies like Amazon and DoorDash have become increasingly cornerstone. Most people prefer to receive care, services and support in an environment they are familiar with, where they feel safe,where they feel seen, where they feel known. We park our mobile unit off the bus line or at community free clinics, churches, grocery stores or other community service organizations where people have been accessing other important resources or navigating the environment. It also normalizes cancer screening and accessing health care like nothing else can because individuals can organically walk up and ask our team "what are y'all doing in our neighborhood?" And we always stand ready to respond to the questions and address the needs.

You mentioned that you did your undergrad degree in social work - I'd be curious to hear about what aspects of social work may have informed your public health work?

I often tease that I was born a social worker. I was always the kid on the playground making sure others had milk money or that their shoes were tied. I was the high school friend that all the others would call for "counseling" or dating advice. I have always been a helper. But, in all seriousness, the training I received in social work for my undergraduate degree became core to every other function I would carry out in my career and directly led me to the path of public health. Social work is built on concepts of service, dignity, inherent self-worth, human relationships and justice, which is a direct mirror to what should be foundational to every health experience. Social work also taught me to be super resource savvy; I often say it helped me become a professional beggar, because if someone has a dollar to give I can turn it into two and find someone who needs it and will multiply it. Later in my career I went back for a Master's in Health Administration so I could be a "bleeding heart with a business plan", and could skillfully demonstrate to higher level decision-makers that reactive health support leaves everyone behind. Proactive, preventive and community engaged/ community driven health support lifts us all.

We thank Melissa so much for her time in speaking with us!