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Lee HC, Ban LK, Tseng A, Hsing HC. Improving colorectal, oral, breast, and cervical cancer screening rates using an inreach approach. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_5_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Li X, Qian M, Zhao G, Yang C, Bao P, Chen Y, Zhou X, Yan B, Wang Y, Zhang J, Sun Q. The performance of a community-based colorectal cancer screening program: Evidence from Shanghai Pudong New Area, China. Prev Med 2019; 118:243-250. [PMID: 30412744 DOI: 10.1016/j.ypmed.2018.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 12/28/2022]
Abstract
Despite the rising disease burden of colorectal cancer (CRC), CRC screening has not yet been widely introduced as a large organized program in developing countries. To facilitate better delivery of screening in these areas, we investigated the performance of a large community-based CRC screening program implemented in Shanghai Pudong New Area during the period 2013-2016. We conducted a prospective cohort study by following up the screening behavior and results of tested participants in the program. Data from the program reporting system and monthly progress reports were collected. We used standard measures and indicators with modifications to evaluate the performance of the program. Disparities in CRC screening by age categories, primary screening results, and geographic areas were examined. A total of 403,098 individuals participated in the program, 25,764 of them were further screened by diagnostic colonoscopy (COL), and 505 people were eventually diagnosed with CRC as a result of the program. The program produced the following rates: participation (35.18%), primary screening positivity (24.89%), positive primary screening follow-up (26.26%), diagnostic COL (6.37%), and cancer detection (1.25‰). Vast variations in the quality of the program were observed across areas with different socioeconomic environments. The experience and lessons from the program suggest that incorporating the screening with other public health campaigns, using better-developed risk assessment tools, and allowing individual screening decisions for those aged above the target are possible practical ways to promote a better delivery of organized CRC screening programs.
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Affiliation(s)
- Xiaopan Li
- School of Public Health, Fudan University, Shanghai 200032, China; Center for Disease Control and Prevention, Pudong New Area, Shanghai 200136, China; Fudan University Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai 200136, China
| | - Mengcen Qian
- School of Public Health, Fudan University, Shanghai 200032, China; Fudan University Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai 200136, China
| | - Genming Zhao
- School of Public Health, Fudan University, Shanghai 200032, China.
| | - Chen Yang
- Center for Disease Control and Prevention, Pudong New Area, Shanghai 200136, China; Fudan University Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai 200136, China
| | - Pingping Bao
- Center for Disease Control and Prevention, Shanghai 200336, China
| | - Yichen Chen
- School of Public Health, Fudan University, Shanghai 200032, China; Center for Disease Control and Prevention, Pudong New Area, Shanghai 200136, China; Fudan University Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai 200136, China
| | - Xiaoyan Zhou
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Bei Yan
- Center for Disease Control and Prevention, Pudong New Area, Shanghai 200136, China; Fudan University Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai 200136, China
| | - Yingying Wang
- Center for Disease Control and Prevention, Pudong New Area, Shanghai 200136, China; Fudan University Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai 200136, China
| | - Jun Zhang
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Qiao Sun
- Center for Disease Control and Prevention, Pudong New Area, Shanghai 200136, China; Fudan University Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai 200136, China
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Huang JL, Fang Y, Liang M, Li STS, Ng SKC, Hui ZSN, Ching J, Wang HH, Wong MCS. Approaching the Hard-to-Reach in Organized Colorectal Cancer Screening: an Overview of Individual, Provider and System Level Coping Strategies. AIMS Public Health 2017; 4:289-300. [PMID: 29546218 PMCID: PMC5690455 DOI: 10.3934/publichealth.2017.3.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the proven effectiveness of colorectal cancer (CRC) screening on reduction of CRC mortality, the uptake of CRC screening remains low. Participation rate is one of determinants for the success of organized population-based screening program. This review aims to identify those who are hard-to-reach, and summarize the strategies to increase their screening rate from individual, provider and system levels. METHODS A systematic search of electronic English databases was conducted on the factors and strategies of uptake in CRC screening for the hard-to-reach population up to May 2017. DISCUSSION The coverage rate and participation rate are two indexes to identify the hard-to-reach population in organized CRC screening program. However, the homeless, new immigrants, people with severe mental illness, the jail intimates, and people with characteristics including lower education levels and/or low socioeconomic status, living in rural/remote areas, without insurance, and racial minorities are usually recognized as hard-to-reach populations. For them, organized screening programs offer a better coverage, while novel invitation approaches for eligible individuals and multiple strategies from primary care physicians are still needed to enhance screening rates among subjects who are hard-to-reach. Suggestions implied the effectiveness of interventions at the system level, including linkages to general practice; use of decision making tools; enlisting supports from coalition; and the continuum from screening to diagnosis and treatment. CONCLUSION Organized CRC screening offers a system access to approach the hard-to-reach populations. To increase their uptake, multiple and novel strategies from individual, provider and system levels should be applied. For policymakers, public healthcare providers and community stakeholders, it is a test to tailor their potential needs and increase their participation rates through continuous efforts to eliminate disparities and inequity in CRC screening service.
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Affiliation(s)
- Jason Liwen Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Miaoyin Liang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shannon TS Li
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Simpson KC Ng
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zero SN Hui
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessica Ching
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Martin Chi Sang Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong
- State Key Laboratory of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong
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Kim B, Lairson DR, Chung TH, Kim J, Shokar NK. Budget Impact Analysis of Against Colorectal Cancer In Our Neighborhoods (ACCION): A Successful Community-Based Colorectal Cancer Screening Program for a Medically Underserved Minority Population. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:809-818. [PMID: 28577699 DOI: 10.1016/j.jval.2016.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 10/04/2016] [Accepted: 11/27/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Given the uncertain cost of delivering community-based cancer screening programs, we developed a Markov simulation model to project the budget impact of implementing a comprehensive colorectal cancer (CRC) prevention program compared with the status quo. METHODS The study modeled the impacts on the costs of clinical services, materials, and staff expenditures for recruitment, education, fecal immunochemical testing (FIT), colonoscopy, follow-up, navigation, and initial treatment. We used data from the Against Colorectal Cancer In Our Neighborhoods comprehensive CRC prevention program implemented in El Paso, Texas, since 2012. We projected the 3-year financial consequences of the presence and absence of the CRC prevention program for a hypothetical population cohort of 10,000 Hispanic medically underserved individuals. RESULTS The intervention cohort experienced a 23.4% higher test completion rate for CRC prevention, 8 additional CRC diagnoses, and 84 adenomas. The incremental 3-year cost was $1.74 million compared with the status quo. The program cost per person was $261 compared with $86 for the status quo. The costs were sensitive to the proportion of high-risk participants and the frequency of colonoscopy screening and diagnostic procedures. CONCLUSIONS The budget impact mainly derived from colonoscopy-related costs incurred for the high-risk group. The effectiveness of FIT to detect CRC was critically dependent on follow-up after positive FIT. Community cancer prevention programs need reliable estimates of the cost of CRC screening promotion and the added budget impact of screening with colonoscopy.
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Affiliation(s)
- Bumyang Kim
- University of Texas Health Science Center, School of Public Health, Houston, TX, USA
| | - David R Lairson
- University of Texas Health Science Center, School of Public Health, Houston, TX, USA.
| | - Tong Han Chung
- University of Texas Health Science Center, School of Public Health, Houston, TX, USA
| | - Junghyun Kim
- University of Texas Health Science Center, School of Public Health, Houston, TX, USA
| | - Navkiran K Shokar
- Texas Tech University Health Science Center, Family and Community Medicine and Biomedical Sciences, Lubbock, TX, USA
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Wacher NH, Reyes-Sánchez M, Vargas-Sánchez HR, Gamiochipi-Cano M, Rascón-Pacheco RA, Gómez-Díaz RA, Doubova SV, Valladares-Salgado A, Sánchez-Becerra MC, Méndez-Padrón A, Valdez-González LA, Mondragón-González R, Cruz M, Salinas-Martinez AM, Garza-Sagástegui MG, Hernández-Rubí J, González-Hermosillo A, Borja-Aburto VH. Stepwise strategies to successfully recruit diabetes patients in a large research study in Mexican population. Prim Care Diabetes 2017; 11:297-304. [PMID: 28343902 DOI: 10.1016/j.pcd.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/24/2017] [Accepted: 02/26/2017] [Indexed: 11/24/2022]
Abstract
AIMS Describe stepwise strategies (electronic chart review, patient preselection, call-center, personnel dedicated to recruitment) for the successful recruitment of >5000 type 2 diabetes patients in four months. METHODS Twenty-five family medicine clinics from Mexico City and the State of Mexico participated: 13 usual care, 6 specialized diabetes care and 6 chronic disease care. Appointments were scheduled from 11/3/2015 to 3/31/2016. Phone calls were generated automatically from an electronic database. A telephone questionnaire verified inclusion criteria, and scheduled an appointment, with a daily report of appointments, patient attendance, acceptance rate, and questionnaire completeness. Another recruitment log reviewed samples collected. Absolute number (percentage) of patients are reported. Means and standard deviations were estimated for continuous variables, χ2 test and independent "t" tests were used. OR and 95% CI were estimated. RESULTS 14,358 appointments were scheduled, 9146 (63.7%) attended their appointment: 5710 (62.4%) fulfilled inclusion criteria and 5244 agreed to participate (91.8% acceptance). Those accepting participation were more likely women, younger and with longer disease duration (p<0.05). The cost of the call-center service was $3,010,000.00 Mexican pesos (∼$31.70 USD per recruited patient). CONCLUSIONS Stepwise strategies recruit a high number of patients in a short time. Call centers offer a low cost per patient.
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Affiliation(s)
- Niels H Wacher
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico.
| | - Mario Reyes-Sánchez
- División de Medicina Familiar, Unidad de Atención Primaria, IMSS, Mexico City, Mexico
| | | | - Mireya Gamiochipi-Cano
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | | | - Rita A Gómez-Díaz
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Svetlana V Doubova
- Unidad de Investigación en Epidemiología y Servicios de Salud, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Adán Valladares-Salgado
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Martha Catalina Sánchez-Becerra
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Araceli Méndez-Padrón
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Leticia A Valdez-González
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Rafael Mondragón-González
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Miguel Cruz
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | | | | | - Jaime Hernández-Rubí
- Departamento de Ingeniería en Sistemas Computacionales y Automatización, Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Arturo González-Hermosillo
- Departamento de Ingeniería en Sistemas Computacionales y Automatización, Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Chou CK, Chen SLS, Yen AMF, Chiu SYH, Fann JCY, Chiu HM, Chuang SL, Chiang TH, Wu MS, Wu CY, Chia SL, Lee YC, Chiou ST, Chen HH. Outreach and Inreach Organized Service Screening Programs for Colorectal Cancer. PLoS One 2016; 11:e0155276. [PMID: 27171410 PMCID: PMC4865222 DOI: 10.1371/journal.pone.0155276] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 04/26/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Outreach (i.e., to invite those who do not use, or who under use screening services) and inreach (i.e., to invite an existing population who have already accessed the medical system) approaches may influence people to increase their use of screening test; however, whether their outcomes would be equivalent remains unclear. METHODS A total of 3,363,896 subjects, 50-69 years of age, participated in a colorectal cancer (CRC) screening program using biennial fecal immunochemical tests; 34.5% participated during 2004-2009 when the outreach approach alone was used, and 65.5% participated from 2010-2013 when outreach was integrated with an inreach approach. We compared the outcomes of the two approaches in delivery of screening services. RESULTS Coverage rates increased from 21.4% to 36.9% and the positivity rate increased from 4.0% to 7.9%, while referral for confirmatory diagnostic examinations declined from 80.0% to 53.3%. The first period detected CRC in 0.20% of subjects screened, with a positive predictive value (PPV) of 6.1%, and the second detected CRC in 0.34% of subjects, with a PPV of 8.0%. After adjusting for confounders, differences were observed in the PPV for CRC (adjusted relative risk, 1.50; 95% confidence interval [CI], 1.41-1.60), cancer detection rate (1.20; 95% CI, 1.13-1.27), and interval cancer rate (0.72; 95% CI, 0.65-0.80). When we focused on the comparison between two approaches during the same study period of 2010-2013, the positivity rate of fecal testing (8.2% vs. 7.6%) and the PPV for CRC detection remained higher (1.07; 95% CI, 1.01-1.12) in subjects who were recruited from the inreach approach. CONCLUSIONS Outcomes of screening were equivalent or better after integration of outreach and inreach approaches. IMPACT The results will encourage makers of health-care policy to adopt the integration approach to deliver screening services.
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Affiliation(s)
- Chu-Kuang Chou
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan
| | | | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shu-Lin Chuang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tsung-Hsien Chiang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Yuan Wu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shu-Li Chia
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- * E-mail: (YCL); (STC)
| | - Shu-Ti Chiou
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- * E-mail: (YCL); (STC)
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Underwood JM, Lakhani N, Finifrock D, Pinkerton B, Johnson KL, Mallory SH, Migliore Santiago P, Stewart SL. Evidence-Based Cancer Survivorship Activities for Comprehensive Cancer Control. Am J Prev Med 2015; 49:S536-42. [PMID: 26590649 PMCID: PMC7894748 DOI: 10.1016/j.amepre.2015.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION One of six priorities of CDC's National Comprehensive Cancer Control Program (NCCCP) is to address the needs of cancer survivors within the local population served by individually funded states, tribes, and territories. This report examines cancer survivorship activities implemented in five NCCCP grantees, which have initiated evidence-based activities outlined in A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies (NAP). METHODS NCCCP action plans, submitted annually to CDC, from 2010 to 2014 were reviewed in February 2015 to assess implementation of cancer survivorship activities and recommended strategies consistent with the NAP. Four state-level and one tribal grantee with specific activities related to one of each of the four NAP strategies were chosen for inclusion. Brief case reports describing the initiation and impact of implemented activities were developed in collaboration with each grantee program director. RESULTS New Mexico, South Carolina, Vermont, Washington state, and Fond Du Lac Band of Lake Superior Chippewa programs each implemented activities in surveillance and applied research; communication, education, and training; programs, policies, and infrastructure; and access to quality care and services. CONCLUSIONS This report provides examples for incorporating cancer survivorship activities within Comprehensive Cancer Control programs of various sizes, demographic makeup, and resource capacity. New Mexico, South Carolina, Vermont, Washington state, and Fond Du Lac Band developed creative cancer survivorship activities that meet CDC recommendations. NCCCP grantees can follow these examples by implementing evidence-based survivorship interventions that meet the needs of their specific populations.
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Affiliation(s)
- J Michael Underwood
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Naheed Lakhani
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - DeAnna Finifrock
- Fond du Lac Human Services Division, Community Health Services Department, Cloquet, Minnesota
| | - Beth Pinkerton
- New Mexico Comprehensive Cancer Program, New Mexico Department of Health, Albuquerque, New Mexico
| | - Krystal L Johnson
- Division of Cancer Prevention and Control, Bureau of Community Health & Chronic Disease Prevention, South Carolina Department of Health & Environmental Control, Columbia, South Carolina
| | - Sharon H Mallory
- Vermont Comprehensive Cancer Control Program, Vermont Department of Health, Burlington, Vermont
| | - Patricia Migliore Santiago
- Washington State Comprehensive Cancer Control Program, Office of Healthy Communities, Washington State Department of Health, Olympia, Washington
| | - Sherri L Stewart
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Verma M, Sarfaty M, Brooks D, Wender RC. Population-based programs for increasing colorectal cancer screening in the United States. CA Cancer J Clin 2015; 65:497-510. [PMID: 26331705 DOI: 10.3322/caac.21295] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Answer questions and earn CME/CNE Screening to detect polyps or cancer at an early stage has been shown to produce better outcomes in colorectal cancer (CRC). Programs with a population-based approach can reach a large majority of the eligible population and can offer cost-effective interventions with the potential benefit of maximizing early cancer detection and prevention using a complete follow-up plan. The purpose of this review was to summarize the key features of population-based programs to increase CRC screening in the United States. A search was conducted in the SCOPUS, OvidSP, and PubMed databases. The authors selected published reports of population-based programs that met at least 5 of the 6 International Agency for Research on Cancer (IARC) criteria for cancer prevention and were known to the National Colorectal Cancer Roundtable. Interventions at the level of individual practices were not included in this review. IARC cancer prevention criteria served as a framework to assess the effective processes and elements of a population-based program. Eight programs were included in this review. Half of the programs met all IARC criteria, and all programs led to improvements in screening rates. The rate of colonoscopy after a positive stool test was heterogeneous among programs. Different population-based strategies were used to promote these screening programs, including system-based, provider-based, patient-based, and media-based strategies. Treatment of identified cancer cases was not included explicitly in 4 programs but was offered through routine medical care. Evidence-based methods for promoting CRC screening at a population level can guide the development of future approaches in health care prevention. The key elements of a successful population-based approach include adherence to the 6 IARC criteria and 4 additional elements (an identified external funding source, a structured policy for positive fecal occult blood test results and confirmed cancer cases, outreach activities for recruitment and patient education, and an established rescreening process).
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Affiliation(s)
- Manisha Verma
- Research Scientist, Einstein Healthcare Network, Philadelphia, PA
| | - Mona Sarfaty
- Director, Program for Climate and Health, George Mason University, Fairfax, VA
| | - Durado Brooks
- Director, Cancer Control Intervention, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
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Ganepola GAP, Nizin J, Rutledge JR, Chang DH. Use of blood-based biomarkers for early diagnosis and surveillance of colorectal cancer. World J Gastrointest Oncol 2014; 6:83-97. [PMID: 24734154 PMCID: PMC3981973 DOI: 10.4251/wjgo.v6.i4.83] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 03/08/2014] [Accepted: 03/17/2014] [Indexed: 02/05/2023] Open
Abstract
Early screening for colorectal cancer (CRC) holds the key to combat and control the increasing global burden of CRC morbidity and mortality. However, the current available screening modalities are severely inadequate because of their high cost and cumbersome preparatory procedures that ultimately lead to a low participation rate. People simply do not like to have colonoscopies. It would be ideal, therefore, to develop an alternative modality based on blood biomarkers as the first line screening test. This will allow for the differentiation of the general population from high risk individuals. Colonoscopy would then become the secondary test, to further screen the high risk segment of the population. This will encourage participation and therefore help to reach the goal of early detection and thereby reduce the anticipated increasing global CRC incidence rate. A blood-based screening test is an appealing alternative as it is non-invasive and poses minimal risk to patients. It is easy to perform, can be repeated at shorter intervals, and therefore would likely lead to a much higher participation rate. This review surveys various blood-based test strategies currently under investigation, discusses the potency of what is available, and assesses how new technology may contribute to future test design.
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Tangka FKL, Subramanian S, Beebe MC, Hoover S, Royalty J, Seeff LC. Clinical costs of colorectal cancer screening in 5 federally funded demonstration programs. Cancer 2014; 119 Suppl 15:2863-9. [PMID: 23868481 DOI: 10.1002/cncr.28154] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/05/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention initiated the Colorectal Cancer Screening Demonstration Program (CRCSDP) to explore the feasibility of establishing a large-scale colorectal cancer (CRC) screening program for underserved populations in the United States. The authors of this report assessed the clinical costs incurred at each of the 5 participating sites during the demonstration period. METHODS By using data on payments to providers by each of the 5 CRCSDP sites, the authors estimated costs for specific clinical services and overall clinical costs for each of the 2 CRC screening methods used by the sites: colonoscopy and fecal occult blood test (FOBT). RESULTS Among CRCSDP clients who were at average risk for CRC and for whom complete cost data were available, 2131 were screened by FOBT, and 1888 were screened by colonoscopy. The total average clinical cost per individual screened by FOBT (including costs for screening, diagnosis, initial surveillance, office visits, and associated clinical services averaged across all individuals who received screening FOBT) ranged from $48 in Nebraska to $149 in Greater Seattle. This compared with an average clinical cost per individual for all services related to the colonoscopy screening ranging from $654 in St. Louis to $1600 in Baltimore City. CONCLUSIONS Variations in how sites contracted with providers and in the services provided through CRCSDP affected the cost of clinical services and the complexity of collecting cost data. Health officials may find these data useful in program planning and budgeting.
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Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
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Glover-Kudon R, DeGroff A, Rohan EA, Preissle J, Boehm JE. Developmental milestones across the programmatic life cycle: implementing the CDC's Colorectal Cancer Screening Demonstration Program. Cancer 2014; 119 Suppl 15:2926-39. [PMID: 23868487 DOI: 10.1002/cncr.28166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/28/2012] [Accepted: 08/31/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND In 2005 through 2009, the Centers for Disease Control and Prevention (CDC) funded 5 sites to implement a colorectal cancer screening program for uninsured, low-income populations. These 5 sites composed a demonstration project intended to explore the feasibility of establishing a national colorectal cancer screening program through various service delivery models. METHODS A longitudinal, multiple case study was conducted to understand and document program implementation processes. Using metaphor as a qualitative analytic technique, evaluators identified stages of maturation across the programmatic life cycle. RESULTS Analysis rendered a working theory of program development during screening implementation. In early stages, program staff built relationships with CDC and local partners around screening readiness, faced real-world challenges putting program policies into practice, revised initial program designs, and developed new professional skills. Midterm implementation was defined by establishing program cohesiveness and expanding programmatic reach. In later stages of implementation, staff focused on sustainability and formal program closeout, which prompted reflection about personal and programmatic accomplishments. CONCLUSIONS Demonstration sites evolved through common developmental stages during screening implementation. Findings elucidate ways to target technical assistance to more efficiently move programs along their maturation trajectory. In practical terms, the time and cost associated with guiding a program to maturity may be potentially shortened to maximize return on investment for both organizations and clients receiving service benefits.
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Seeff LC, DeGroff A, Joseph DA, Royalty J, Tangka FKL, Nadel MR, Plescia M. Moving forward: using the experience of the CDCs' Colorectal Cancer Screening Demonstration Program to guide future colorectal cancer programming efforts. Cancer 2014; 119 Suppl 15:2940-6. [PMID: 23868488 DOI: 10.1002/cncr.28155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/06/2012] [Accepted: 11/07/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) established and supported a 4-year Colorectal Cancer Screening Demonstration Program (CRCSDP) from 2005 to 2009 for low-income, under- or uninsured men and women aged 50-64 at 5 sites in the United States. METHODS A multiple methods evaluation was conducted including 1) a longitudinal, comparative case study of program implementation, 2) the collection and analysis of client-level screening and diagnostic services outcome data, and 3) the collection and analysis of program- and patient-level cost data. RESULTS Several themes emerged from the results reported in the series of articles in this Supplement. These included the benefit of building on an existing infrastructure, strengths and weakness of both the 2 most frequently used screening tests (colonoscopy and fecal occult blood tests), variability in costs of maintaining this screening program, and the importance of measuring the quality of screening tests. Population-level evaluation questions could not be answered because of the small size of the participating population and the limited time frame of the evaluation. The comprehensive evaluation of the program determined overall feasibility of this effort. CONCLUSIONS Critical lessons learned through the implementation and evaluation of the CDC's CRCSDP led to the development of a larger population-based program, the CDC's Colorectal Cancer Control Program (CRCCP).
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Affiliation(s)
- Laura C Seeff
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA.
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Rohan EA, Boehm JE, DeGroff A, Glover-Kudon R, Preissle J. Implementing the CDC's Colorectal Cancer Screening Demonstration Program: wisdom from the field. Cancer 2013; 119 Suppl 15:2870-83. [PMID: 23868482 PMCID: PMC5389376 DOI: 10.1002/cncr.28162] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/24/2012] [Accepted: 10/18/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colorectal cancer, as the second leading cause of cancer-related deaths among men and women in the United States, represents an important area for public health intervention. Although colorectal cancer screening can prevent cancer and detect disease early when treatment is most effective, few organized public health screening programs have been implemented and evaluated. From 2005 to 2009, the Centers for Disease Control and Prevention funded 5 sites to participate in the Colorectal Cancer Screening Demonstration Program (CRCSDP), which was designed to reach medically underserved populations. METHODS The authors conducted a longitudinal, multiple case study to analyze program implementation processes. Qualitative methods included interviews with 100 stakeholders, 125 observations, and review of 19 documents. Data were analyzed within and across cases. RESULTS Several themes related to CRCSDP implementation emerged from the cross-case analysis: the complexity of colorectal cancer screening, the need for teamwork and collaboration, integration of the program into existing systems, the ability of programs to use wisdom at the local level, and the influence of social norms. Although these themes were explored independently from 1 another, interaction across themes was evident. CONCLUSIONS Colorectal cancer screening is clinically complex, and its screening methods are not well accepted by the general public; both of these circumstances have implications for program implementation. Using patient navigation, engaging in transdisciplinary teamwork, assimilating new programs into existing clinical settings, and deferring to local-level wisdom together helped to address complexity and enhance program implementation. In addition, public health efforts must confront negative social norms around colorectal cancer screening.
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Affiliation(s)
- Elizabeth A Rohan
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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14
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Seeff LC, Rohan EA. Lessons learned from the CDC's Colorectal Cancer Screening Demonstration Program. Cancer 2013; 119 Suppl 15:2817-9. [DOI: 10.1002/cncr.28165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 08/16/2012] [Indexed: 12/15/2022]
Affiliation(s)
- Laura C. Seeff
- Division of Cancer Prevention and Control; Centers for Disease Control and Prevention; Atlanta Georgia
| | - Elizabeth A. Rohan
- Division of Cancer Prevention and Control; Centers for Disease Control and Prevention; Atlanta Georgia
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Seeff LC, Royalty J, Helsel WE, Kammerer WG, Boehm JE, Dwyer DM, Howe WR, Joseph D, Lane DS, Laughlin M, Leypoldt M, Marroulis SC, Mattingly CA, Nadel MR, Phillips-Angeles E, Rockwell TJ, Ryerson AB, Tangka FKL. Clinical outcomes from the CDC's Colorectal Cancer Screening Demonstration Program. Cancer 2013; 119 Suppl 15:2820-33. [DOI: 10.1002/cncr.28163] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/05/2012] [Accepted: 11/06/2012] [Indexed: 12/13/2022]
Affiliation(s)
- Laura C. Seeff
- Division of Cancer Prevention and Control; Centers for Disease Control and Prevention; Atlanta Georgia
| | - Janet Royalty
- Division of Cancer Prevention and Control; Centers for Disease Control and Prevention; Atlanta Georgia
| | | | | | - Jennifer E. Boehm
- Division of Cancer Prevention and Control; Centers for Disease Control and Prevention; Atlanta Georgia
| | - Diane M. Dwyer
- Maryland Department of Health and Mental Hygiene; Baltimore Maryland
| | - William R. Howe
- Information Management Services, Inc; Silver Spring Maryland
| | - Djenaba Joseph
- Division of Cancer Prevention and Control; Centers for Disease Control and Prevention; Atlanta Georgia
| | | | - Melinda Laughlin
- Missouri Department of Health and Senior Services; Jefferson City Missouri
| | - Melissa Leypoldt
- Nebraska Department of Health and Human Services; Lincoln Nebraska
| | | | | | - Marion R. Nadel
- Division of Cancer Prevention and Control; Centers for Disease Control and Prevention; Atlanta Georgia
| | | | | | - A. Blythe Ryerson
- Division of Cancer Prevention and Control; Centers for Disease Control and Prevention; Atlanta Georgia
| | - Florence K. L. Tangka
- Division of Cancer Prevention and Control; Centers for Disease Control and Prevention; Atlanta Georgia
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