After a stage IIB breast cancer diagnosis and subsequent financial problems necessitated that Barbara Apkan MS, RN, leave her job in the emergency department, she embarked on a career as an advocate for low-income patients with breast cancer.

ADVANCE: How was your career sidetracked by your cancer diagnosis?

Apkan: I started at the University of Chicago Medical Center in the '80s as a research nurse. From there, I went to the emergency department where I worked from 1987-01. I was diagnosed with breast cancer in 2000. After 6 months of chemotherapy and 5 weeks of radiation, I was too tired from the harsh treatment to work in the ED. I had to go on long-term disability.

How did your personal experience on disability affect your "second career" in addressing healthcare disparities?

There was/is limited to no financial support available to bridge myself and many other survivors over from short-term disability until long-term disability starts. If it was out there, I didn't have it. Unless you have a lot of money saved, you're in a bind. I couldn't pay my mortgage and had to borrow money from my daughter.

Were there any other factors that inspired you to advocate for low-income women with breast cancer?

Yes, immediately after my diagnosis, upon speaking with women in the community and support groups, I realized there was an increased need in underserved communities of women for education, advocacy and patient navigation around breast cancer.

A few years ago, we had an access problem in the largest safety net hospital in Chicago, which resulted in numerous women not receiving much-needed diagnostic mammograms and procedures. Although many of the issues have been resolved, the entire healthcare system continues to be fragmented. As a result, the Metropolitan Chicago Breast Cancer Task Force's Quality Consortium, made up of 77 hospitals, is collaborating together in an effort to decrease the disparities of breast cancer.

When I was on the cancer committee with the Chicago chapter of the National Black Nurses Association and the Metropolitan Chicago Breast Cancer Task Force, I learned black women are dying of breast cancer at a rate 116 percent greater than whites. African-Americans in Chicago have the highest death rate nationwide.

You're involved with the Five vs. Twelve campaign, which advocates for generic versions of biologics. Can you tell us about your efforts to support generic biologics?

Biologic drugs are expensive. I know it takes years for drugs to go through clinical trials and to get them to market. However, many of the women I interface with who are, for example, diagnosed with HER 2 breast cancer also are uninsured or underinsured. The majority of them are not aware of the drug assistance programs and online breast cancer support hot lines. In contrast, women with better healthcare are guided through the drug assistance process and receive support as part of their navigational experience.

I am concerned pharmaceutical companies are not working on a more affordable generic biologic equivalent, considering the increased number of women dying from breast cancer, the state of the economy and the number of uninsured in the U.S. today.

I would like to see drug companies have more cultural sensitivity and visibility in their marketing strategies around drug assistance programs in underserved communities. My biggest challenge is getting women into the healthcare system and finding available resources.

How has your nursing background helped in your patient advocate work?

My 30+ years in nursing have taught me to look at people holistically. When women present with breast cancer, they're coming with spiritual woes, family problems and physical problems. "Nurses, I challenge you to be gatekeepers of the community's healthcare."