1
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Colorectal neoplasia prevalence in a predominantly Hispanic community: Results from a colorectal cancer screening program in Texas. Am J Med Sci 2022; 364:394-403. [PMID: 35398033 DOI: 10.1016/j.amjms.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 03/07/2022] [Accepted: 03/31/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND A community-based, colorectal cancer (CRC) screening program for uninsured/underinsured individuals was successfully implemented in El Paso, Texas to increase CRC screening rates. Our aim was to determine the colorectal neoplasia prevalence among program participants and between screening groups. METHODS We retrospectively reviewed participant records from 2012 to 2017. Average-risk patients were first screened with a fecal immunochemical test (FIT) and included if positive. Above average-risk patients due to a family history of CRC were referred directly for screening colonoscopy. Patients were excluded if experiencing melena or hematochezia or had a personal history of colon polyps or CRC. RESULTS Of the 638 screening colonoscopies performed, 59.4% were in FIT-positive subjects and 40.6% were in subjects with a family history of CRC. Patients were predominantly female (72.9%), aged 50-65 years (84.2%), Hispanic (97.9%), and born in Mexico (92.4%). Overall, the detection rate for polyps, adenomas, and advanced adenomas was 46.2%, 34.3%, and 11.1%, respectively. Fifteen patients had adenocarcinoma (2.4%). Compared with colonoscopies in patients with a family history, FIT-positive patients demonstrated a higher prevalence of polyps (PR 1.39, 95% CI 1.09-1.78), adenomas (PR 1.55, 95% CI 1.15-2.07), advanced adenomas (PR 3.04, 95% CI 1.67-5.56). CONCLUSIONS This community-based CRC screening program in an enriched cohort of predominantly Mexican Americans was effective in identifying colorectal neoplasia and cancer. Additionally, there was an increased prevalence of colorectal neoplasia in average-risk, FIT-positive patients undergoing screening colonoscopy compared with above average-risk patients with a family history of CRC. Similar screening programs would likely benefit at-risk populations.
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2
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Azulay R, Valinsky L, Hershkowitz F, Elran E, Lederman N, Kariv R, Braunstein B, Heymann A. Barriers to completing colonoscopy after a positive fecal occult blood test. Isr J Health Policy Res 2021; 10:11. [PMID: 33573698 PMCID: PMC7879608 DOI: 10.1186/s13584-021-00444-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background Colorectal cancer leads to significant morbidity and mortality. Early detection and treatment are essential. Screening using fecal occult blood tests has increased significantly, but adherence to colonoscopy follow-up is suboptimal, increasing CRC mortality risk. The aim of this study was to identify barriers to colonoscopy following a positive FOBT at the level of the patient, physician, organization and policymakers. Methods This mixed methods study was conducted at two health care organizations in Israel. The study included retrospective analyses of 45,281 50–74 year-old members with positive fecal immunochemical tests from 2010 to 2014, and a survey of 772 patients with a positive test during 2015, with and without follow-up. The qualitative part of the study included focus groups with primary physicians and gastroenterologists and in-depth interviews with opinion leaders in healthcare. Results Patient lack of comprehension regarding the test was the strongest predictor of non-adherence to follow-up. Older age, Arab ethnicity, and lower socio economic status significantly reduced adherence. We found no correlation with gender, marital status, patient activation, waiting time for appointments or distance from gastroenterology clinics. Primary care physicians underestimate non-adherence rates. They feel responsible for patient follow-up, but express lack of time and skills that will allow them to ensure adherence among their patients. Gastroenterologists do not consider fecal occult blood an effective tool for CRC detection, and believe that all patients should undergo colonoscopy. Opinion leaders in the healthcare field do not prioritize the issue of follow-up after a positive screening test for colorectal cancer, although they understand the importance. Conclusions We identified important barriers that need to be addressed to improve the effectiveness of the screening program. Targeted interventions for populations at risk for non-adherence, specifically for those with low literacy levels, and better explanation of the need for follow-up as a routine need to be set in place. Lack of agreement between screening recommendations and gastroenterologist opinion, and lack of awareness among healthcare authority figures negatively impact the screening program need to be addressed at the organizational and national level. Trial registration This study was approved by the IRB in both participating organizations (Meuhedet Health Care Institutional Review Board #02–2–5-15, Maccabi Healthcare Institutional Review Board BBI-0025-16). Participant consent was waived by both IRB’s.
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Affiliation(s)
| | - Liora Valinsky
- Public Health Nursing, Ministry of Health, Jerusalem, Israel
| | | | - Einat Elran
- Maccabi Healthcare Services, Tel aviv, Israel
| | | | - Revital Kariv
- Maccabi Healthcare Services, Tel aviv, Israel.,Faculty of medicine University of Tel Aviv, Tel Aviv, Israel
| | | | - Anthony Heymann
- Meuhedet Health Care, 5 Pesach Lev, Lod, Israel.,Faculty of medicine University of Tel Aviv, Tel Aviv, Israel
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3
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Gwede CK, Sutton SK, Chavarria EA, Gutierrez L, Abdulla R, Christy SM, Lopez D, Sanchez J, Meade CD. A culturally and linguistically salient pilot intervention to promote colorectal cancer screening among Latinos receiving care in a Federally Qualified Health Center. HEALTH EDUCATION RESEARCH 2019; 34:310-320. [PMID: 30929015 PMCID: PMC7868960 DOI: 10.1093/her/cyz010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
Despite established benefits, colorectal cancer (CRC) screening is underutilized among Latinos/Hispanics. We conducted a pilot 2-arm randomized controlled trial evaluating efficacy of two intervention conditions on CRC screening uptake among Latinos receiving care in community clinics. Participants (N = 76) were aged 50-75, most were foreign-born, preferred to receive their health information in Spanish, and not up-to-date with CRC screening. Participants were randomized to either a culturally linguistically targeted Spanish-language fotonovela booklet and DVD intervention plus fecal immunochemical test [FIT] (the LCARES, Latinos Colorectal Cancer Awareness, Research, Education and Screening intervention group); or a non-targeted intervention that included a standard Spanish-language booklet plus FIT (comparison group). Measures assessed socio-demographic variables, health literacy, CRC screening behavior, awareness and beliefs. Overall, FIT uptake was 87%, exceeding the National Colorectal Cancer Roundtable's goal of 80% by 2018. The LCARES intervention group had higher FIT uptake than did the comparison group (90% versus 83%), albeit not statistically significant (P = 0.379). The LCARES intervention group was associated with greater increases in CRC awareness (P = 0.046) and susceptibility (P = 0.013). In contrast, cancer worry increased more in the comparison group (P = 0.045). Providing educational materials and a FIT kit to Spanish-language preferring Latinos receiving care in community clinics is a promising strategy to bolster CRC screening uptake to meet national targets.
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Affiliation(s)
- Clement K Gwede
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Enmanuel A Chavarria
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Brownsville Regional Campus, Brownsville, TX, USA
| | - Liliana Gutierrez
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Rania Abdulla
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Shannon M Christy
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Diana Lopez
- Suncoast Community Health Centers, Inc., Brandon, FL, USA
| | - Julian Sanchez
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Cathy D Meade
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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4
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Nadel MR, Royalty J, Joseph D, Rockwell T, Helsel W, Kammerer W, Gray SC, Shapiro JA. Variations in Screening Quality in a Federal Colorectal Cancer Screening Program for the Uninsured. Prev Chronic Dis 2019; 16:E67. [PMID: 31146803 PMCID: PMC6549419 DOI: 10.5888/pcd16.180452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Screening can decrease colorectal cancer incidence and mortality and is recommended in clinical practice guidelines. Poor quality of colorectal cancer screening can negate the benefit of screening. The objective of this study was to assess the quality of screening services provided by the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program from July 2009 through June 2015. Methods We collected data from the program’s 29 grantees, funded to provide colorectal cancer screening and diagnostic services to asymptomatic, low-income, and underinsured or uninsured adults aged 50 to 64. We collected data on the dates and results of all screening and diagnostic tests and, for colonoscopies, on whether the cecum was reached, whether bowel preparation was adequate, and endoscopists’ recommendations for the next test. Results Overall, 82.9% (range among grantees, 50.0%–97.2%) of positive FOBTs/FITs were followed up by colonoscopy; 95.2% of colonoscopies occurred within 180 days of the positive stool test. Cecal intubation rates ranged among grantees from 94.2% to 100%. Adenoma detection rates met recommended threshold levels for almost all grantees. Recommendations for rescreening and surveillance intervals deviated from guidelines in both directions. Of clients with normal colonoscopies, 85.3% (range, 37.7%–99.7%) were told to return in 10 years, as recommended in national guidelines. Of clients with advanced adenomas, 55.2% (range, 20.0%–84.6%) were told to return in 3 years as recommended, 25.4% (range, 3.8%–56.6%) in 5 or more years, and 18.6% (range, 0%–47.2%) in less than 3 years. Conclusion Although overall screening quality was good, it varied considerably. Ongoing monitoring to identify performance problems is essential for all colorectal cancer screening activities, so that efforts designed to improve performance can be targeted to individual clinicians.
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Affiliation(s)
- Marion R Nadel
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop S107-4, Chamblee, GA 30341.
| | - Janet Royalty
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - William Helsel
- Information Management Services Inc, Calverton, Maryland
| | | | - Simone C Gray
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean A Shapiro
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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5
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Gingold-Belfer R, Leibovitzh H, Boltin D, Issa N, Tsadok Perets T, Dickman R, Niv Y. The compliance rate for the second diagnostic evaluation after a positive fecal occult blood test: A systematic review and meta-analysis. United European Gastroenterol J 2019; 7:424-448. [PMID: 31019712 DOI: 10.1177/2050640619828185] [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: 09/11/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction Only a minority of patients with a positive fecal occult blood test (FOBT) undergo a follow-up second diagnostic procedure, thus minimizing its contribution for colorectal cancer (CRC) prevention. We aimed to obtain a precise estimation of this problem and also assess the diagnostic yield of CRC and adenomas by colonoscopy in these patients. Methods Literature searches were conducted for "compliance" OR "adherence" AND "fecal occult blood test" OR "fecal immunohistochemical test" AND "colonoscopy." Comprehensive meta-analysis software was used. Results The search resulted in 42 studies (512,496 patients with positive FOBT), published through December 31, 2017. A funnel plot demonstrates a moderate publication bias. Compliance with any second procedure, colonoscopy, or combination of double-contrast barium enema with or without sigmoidoscopy in patients with a positive FOBT was 0.725 with 95% confidence interval (CI) 0.649-0.790 (p = 0.000), 0.804 with 95% CI 0.740-0.856 (p = 0.000) and 0.197 with 95% CI 0.096-0.361 (p = 0.000), respectively. The diagnostic yield for CRC, advanced adenoma and simple adenoma was 0.058 with 95% CI 0.050-0.068 (p = 0.000), 0.242 with 95% CI 0.188-0.306 (p = 0.000) and 0.147 with 95% CI 0.116-0.184 (p < 0.001), respectively. Discussion Compliance with diagnostic evaluation after a positive FOBT is still suboptimal. Therefore, measures to increase compliance need to be taken given the increased risk of CRC in these patients.
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Affiliation(s)
- Rachel Gingold-Belfer
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Leibovitzh
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nidal Issa
- Department of Surgery B, Rabin Medical Center, Hasharon Hospital, Petach Tikva, Israel
| | - Tsachi Tsadok Perets
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Niv
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Kwaan MR, Jones-Webb R. Colorectal Cancer Screening in Black Men: Recommendations for Best Practices. Am J Prev Med 2018; 55:S95-S102. [PMID: 30670207 DOI: 10.1016/j.amepre.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/30/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022]
Abstract
Screening for colorectal cancer has been demonstrated to reduce colorectal cancer mortality. Blacks have a higher mortality from this malignancy, particularly men, yet screening rates in this population are often found to be lower than in whites. A modest literature demonstrates effective interventions that can increase screening rates in blacks; however, results are not consistent and ongoing work is required. Most work has not addressed specific barriers to screening in black men. Given the lack of studies on black men only, this study evaluated the state of research in the black population using a PubMed search. The authors provide commentary that proposes increased (1) state and local government support for collaborative programs with healthcare organizations, including patient navigation; (2) augmented community-organizing efforts to generate more attention to the need for colorectal cancer screening in the black community, with a focus on black men; and (3) federal research funding to promote investigation into new interventions and evaluation of existing ones. Specific recommendations for black men include lowering the screening age to 45years, increasing access to health care, the use of patient navigators, and improved reporting and monitoring of colorectal cancer screening rates. SUPPLEMENT INFORMATION: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
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Affiliation(s)
- Mary R Kwaan
- Department of Surgery, University California, Los Angeles, Los Angeles, California.
| | - Rhonda Jones-Webb
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
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7
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Chen ST, Wu MC, Hsu TC, Yen DW, Chang CN, Hsu WT, Wang CC, Lee M, Liu SH, Lee CC. Comparison of outcome and cost among open, laparoscopic, and robotic surgical treatments for rectal cancer: A propensity score matched analysis of nationwide inpatient sample data. J Surg Oncol 2017; 117:497-505. [PMID: 29284067 DOI: 10.1002/jso.24867] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/04/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Population-based studies evaluating outcomes of different approaches for rectal cancer are scarce. METHODS We conducted a retrospective cohort study using the Nationwide Inpatient Sample database between 2008 and 2012. We compared the outcomes and costs among rectal cancer patients undergoing robotic, laparoscopic, or open surgeries using propensity scores for adjusted and matched analysis. RESULTS We identified 194 957 rectal cancer patients. Over the 5-year period, the annual admission number decreased by 13.9%, the in-hospital mortality rate decreased by 32.2%, while the total hospitalization cost increased by 13.6%. Compared with laparoscopic surgery, robotic surgery had significantly lower length of stay (LOS) (OR 0.69, 95%CI 0.57-0.84), comparable wound complications (OR 1.08, 95%CI 0.70-1.65) and higher cost (OR 1.42, 95%CI 1.13-1.79), while open surgery had significantly longer LOS (OR 1.38, 95%CI 1.19-1.59), more wound complications (OR 1.49, 95%CI 1.08-1.79), and comparable cost (OR 0.92, 95%CI 0.79-1.07). There were no difference in in-hospital mortality among three approaches. CONCLUSIONS Laparoscopic surgery was associated with better outcomes than open surgery. Robotic surgery was associated with higher cost, but no advantage over laparoscopic surgery in terms of mortality and complications. Studies on cost-effectiveness of robotic surgery may be warranted.
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Affiliation(s)
- Szu-Ta Chen
- Division of Gastroenterology, Department of Pediatrics, National Taiwan University Hospital Yun-Lin Branch, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Meng-Che Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Chun Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Debra W Yen
- Department of Internal Medicine, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri
| | - Chia-Na Chang
- Department of Radiation Oncology, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
| | - Wan-Ting Hsu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Chun Wang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Shing-Hwa Liu
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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8
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Dhutia H, Malhotra A, Yeo TJ, Ster IC, Gabus V, Steriotis A, Dores H, Mellor G, García-Corrales C, Ensam B, Jayalapan V, Ezzat VA, Finocchiaro G, Gati S, Papadakis M, Tome-Esteban M, Sharma S. Inter-Rater Reliability and Downstream Financial Implications of Electrocardiography Screening in Young Athletes. Circ Cardiovasc Qual Outcomes 2017; 10:e003306. [DOI: 10.1161/circoutcomes.116.003306] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Harshil Dhutia
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Aneil Malhotra
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Tee Joo Yeo
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Irina Chis Ster
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Vincent Gabus
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Alexandros Steriotis
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Helder Dores
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Greg Mellor
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Carmen García-Corrales
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Bode Ensam
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Viknesh Jayalapan
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Vivienne Anne Ezzat
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Gherardo Finocchiaro
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Sabiha Gati
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Michael Papadakis
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Maria Tome-Esteban
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
| | - Sanjay Sharma
- From the Cardiology Clinical and Academic Group (H.D., A.M., G.F., S.G., M.P., M.T., S.S.) and Institute of Infection and Immunity (I.C.S.), St. George’s University of London, United Kingdom; Department of Cardiology, National University Heart Centre Singapore, Singapore, China (T.J.Y.); Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland (V.G.); Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (A.S., V.A.E.); Armed Forces
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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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10
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Tu C, Mojica W, Straubinger RM, Li J, Shen S, Qu M, Nie L, Roberts R, An B, Qu J. Quantitative proteomic profiling of paired cancerous and normal colon epithelial cells isolated freshly from colorectal cancer patients. Proteomics Clin Appl 2017; 11:10.1002/prca.201600155. [PMID: 27943637 PMCID: PMC5418098 DOI: 10.1002/prca.201600155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/03/2016] [Accepted: 12/06/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE The heterogeneous structure in tumor tissues from colorectal cancer (CRC) patients excludes an informative comparison between tumors and adjacent normal tissues. Here, we develop and apply a strategy to compare paired cancerous (CEC) versus normal (NEC) epithelial cells enriched from patients and discover potential biomarkers and therapeutic targets for CRC. EXPERIMENTAL DESIGN CEC and NEC cells are respectively isolated from five different tumor and normal locations in the resected colon tissue from each patient (N = 12 patients) using an optimized epithelial cell adhesion molecule (EpCAM)-based enrichment approach. An ion current-based quantitative method is employed to perform comparative proteomic analysis for each patient. RESULTS A total of 458 altered proteins that are common among >75% of patients are observed and selected for further investigation. Besides known findings such as deregulation of mitochondrial function, tricarboxylic acid cycle, and RNA post-transcriptional modification, functional analysis further revealed RAN signaling pathway, small nucleolar ribonucleoproteins (snoRNPs), and infection by RNA viruses are altered in CEC cells. A selection of the altered proteins of interest is validated by immunohistochemistry analyses. CONCLUSION AND CLINICAL RELEVANCE The informative comparison between matched CEC and NEC enhances our understanding of molecular mechanisms of CRC development and provides biomarker candidates and new pathways for therapeutic intervention.
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Affiliation(s)
- Chengjian Tu
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
- New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
| | - Wilfrido Mojica
- Department of Pathology, State University of New York at Buffalo, State University of New York, Buffalo, NY 14260 USA
| | - Robert M. Straubinger
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
- New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
| | - Jun Li
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
- New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
| | - Shichen Shen
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
- New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
| | - Miao Qu
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
- Beijing University of Chinese Medicine, Beijing, China, 100029
| | - Lei Nie
- School of pharmaceutical sciences, Shandong University, 44 Wenhua West Road, Jinan, China, 250012
| | - Rick Roberts
- Department of Structural Biology, State University of New York at Buffalo, State University of New York, Buffalo, NY 14260 USA
| | - Bo An
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
- New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
| | - Jun Qu
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14260 USA
- New York State Center of Excellence in Bioinformatics and Life Sciences, 701 Ellicott Street, Buffalo, NY 14203 USA
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Shokar NK, Byrd T, Salaiz R, Flores S, Chaparro M, Calderon-Mora J, Reininger B, Dwivedi A. Against colorectal cancer in our neighborhoods (ACCION): A comprehensive community-wide colorectal cancer screening intervention for the uninsured in a predominantly Hispanic community. Prev Med 2016; 91:273-280. [PMID: 27575314 DOI: 10.1016/j.ypmed.2016.08.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/17/2016] [Accepted: 08/25/2016] [Indexed: 12/14/2022]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Screening is widely recommended but underutilized, particularly among the low income, the uninsured, recent immigrants and Hispanics. The study objective was to determine the effectiveness of a comprehensive community-wide, bilingual, CRC screening intervention among uninsured predominantly Hispanic individuals. This prospective study was embedded in a CRC screening program and utilized a quasi-experimental design. Recruitment occurred from Community and clinic sites. Inclusion criteria were aged 50-75years, uninsured, due for CRC screening, Texas address and exclusions were a history of CRC, or recent rectal bleeding. Eligible subjects were randomized to either promotora (P), video (V), or combined promotora and video (PV) education, and also received no-cost screening with fecal immunochemical testing or colonoscopy and navigation. The non-randomly allocated controls recruited from a similar county, received no intervention. The main outcome was 6month self-reported CRC screening. Per protocol and worst case scenario analyses, and logistic regression with covariate adjustment were performed. 784 subjects (467 in intervention group, 317 controls) were recruited; mean age was 56.8years; 78.4% were female, 98.7% were Hispanic and 90.0% were born in Mexico. In the worst case scenario analysis (n=784) screening uptake was 80.5% in the intervention group and 17.0% in the control group [relative risk 4.73, 95% CI: 3.69-6.05, P<0.001]. No educational group differences were observed. Covariate adjustment did not significantly alter the effect. A multicomponent community-wide, bilingual, CRC screening intervention significantly increased CRC screening in an uninsured predominantly Hispanic population.
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Affiliation(s)
- Navkiran K Shokar
- Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States.
| | - Theresa Byrd
- Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th Street STOP 9430, Lubbock, TX 79430-9430, United States.
| | - Rebekah Salaiz
- Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States.
| | - Silvia Flores
- Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States.
| | - Maria Chaparro
- Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States.
| | - Jessica Calderon-Mora
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Office of Diversity Affairs, 5001 El Paso Drive, El Paso, TX 79905, United States
| | - Belinda Reininger
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Regional Brownsville Campus, 80 Fort Brown, Brownsville, TX 78520, United States.
| | - Alok Dwivedi
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, United States
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12
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Joseph DA, Meester RG, Zauber AG, Manninen DL, Winges L, Dong FB, Peaker B, van Ballegooijen M. Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity. Cancer 2016; 122:2479-86. [PMID: 27200481 PMCID: PMC5559728 DOI: 10.1002/cncr.30070] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/21/2016] [Accepted: 03/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 2014, a national campaign was launched to increase colorectal cancer (CRC) screening rates in the United States to 80% by 2018; it is unknown whether there is sufficient colonoscopy capacity to reach this goal. This study estimated the number of colonoscopies needed to screen 80% of the eligible population with fecal immunochemical testing (FIT) or colonoscopy and determined whether there was sufficient colonoscopy capacity to meet the need. METHODS The Microsimulation Screening Analysis-Colon model was used to simulate CRC screening test use in the United States (2014-2040); the implementation of a national screening program in 2014 with FIT or colonoscopy with 80% participation was assumed. The 2012 Survey of Endoscopic Capacity (SECAP) estimated the number of colonoscopies that were performed and the number that could be performed. RESULTS If a national screening program started in 2014, by 2024, approximately 47 million FIT procedures and 5.1 million colonoscopies would be needed annually to screen the eligible population with a program using FIT as the primary screening test; approximately 11 to 13 million colonoscopies would be needed annually to screen the eligible population with a colonoscopy-only screening program. According to the SECAP survey, an estimated 15 million colonoscopies were performed in 2012, and an additional 10.5 million colonoscopies could be performed. CONCLUSIONS The estimated colonoscopy capacity is sufficient to screen 80% of the eligible US population with FIT, colonoscopy, or a mix of tests. Future analyses should take into account the geographic distribution of colonoscopy capacity. Cancer 2016;122:2479-86. © 2016 American Cancer Society.
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Affiliation(s)
- Djenaba A. Joseph
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Brandy Peaker
- Office of Public Health Scientific Services, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
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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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14
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Developments in Screening Tests and Strategies for Colorectal Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:326728. [PMID: 26504799 PMCID: PMC4609363 DOI: 10.1155/2015/326728] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/19/2015] [Accepted: 04/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second most common in women. It is the fourth most common cause of cancer mortality. In the United States, CRC is the third most common cause of cancer and second most common cause of cancer mortality. Incidence and mortality rates have steadily fallen, primarily due to widespread screening. METHODS We conducted keyword searches on PubMed in four categories of CRC screening: stool, endoscopic, radiologic, and serum, as well as news searches in Medscape and Google News. RESULTS Colonoscopy is the gold standard for CRC screening and the most common method in the United States. Technological improvements continue to be made, including the promising "third-eye retroscope." Fecal occult blood remains widely used, particularly outside the United States. The first at-home screen, a fecal DNA screen, has also recently been approved. Radiological methods are effective but seldom used due to cost and other factors. Serum tests are largely experimental, although at least one is moving closer to market. CONCLUSIONS Colonoscopy is likely to remain the most popular screening modality for the immediate future, although its shortcomings will continue to spur innovation in a variety of modalities.
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15
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Knobf M, Cooley M, Duffy S, Doorenbos A, Eaton L, Given B, Mayer D, McCorkle R, Miaskowski C, Mitchell S, Sherwood P, Bender C, Cataldo J, Hershey D, Katapodi M, Menon U, Schumacher K, Sun V, Ah D, LoBiondo-Wood G, Mallory G. The 2014–2018 Oncology Nursing Society Research Agenda. Oncol Nurs Forum 2015; 42:450-65. [DOI: 10.1188/15.onf.450-465] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Gwede CK, Koskan AM, Quinn GP, Davis SN, Ealey J, Abdulla R, Vadaparampil ST, Elliott G, Lopez D, Shibata D, Roetzheim RG, Meade CD. Patients' perceptions of colorectal cancer screening tests and preparatory education in federally qualified health centers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:294-300. [PMID: 25249181 PMCID: PMC4372499 DOI: 10.1007/s13187-014-0733-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study explored federally qualified health center (FQHC) patients' perceptions about colorectal cancer screening (CRCS) tests, including immunochemical fecal occult blood tests (iFOBT), as well as preferences for receiving in-clinic education about CRCS. Eight mixed gender focus groups were conducted with 53 patients. Findings centered on three thematic factors: (1) motivators and impediments to CRCS, (2) test-specific preferences and receptivity to iFOBTs, and (3) preferences for entertaining and engaging plain language materials. Results informed the development of educational priming materials to increase CRCS using iFOBT in FQHCs.
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Affiliation(s)
- Clement K Gwede
- Division of Cancer Prevention and Control, Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA,
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17
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Shokar NK, Byrd T, Lairson DR, Salaiz R, Kim J, Calderon-Mora J, Nguyen N, Ortiz M. Against Colorectal Cancer in Our Neighborhoods, a Community-Based Colorectal Cancer Screening Program Targeting Low-Income Hispanics. Health Promot Pract 2015; 16:656-66. [DOI: 10.1177/1524839915587265] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background. Colorectal cancer is the second leading cause of cancer-related death in the United States. Despite universal screening recommendations, screening rates in the United States remain suboptimal, especially among the poor, the uninsured, recent immigrants, and Hispanics. This article describes the development of a large community-based colorectal cancer screening program designed to address these disparities. Method. The Against Colorectal Cancer in our Neighborhoods program is a bilingual, evidence-based, theory-guided, multicomponent community screening intervention, targeting the uninsured and developed using a systematic planning process. It combines community health worker–led outreach, bilingual and culturally tailored community education, and no-cost screening with provision of the fecal immunochemical test or colonoscopy and navigation services. A detailed process and outcome evaluation is planned. Program development cost calculated prospectively (in 2011 dollars) using a societal perspective and micro-costing methods was $243,278, of which $180,344 was direct cost. Discussion. The detailed description of the development processes and costs of this health promotion program targeting low-income Hispanics will inform health program decision makers about the resource requirements for planning and developing new programs to reduce disease burden in communities.
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Affiliation(s)
| | - Theresa Byrd
- Texas Tech University Health Sciences Center, El Paso, TX, USA
| | | | - Rebekah Salaiz
- Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Junghyun Kim
- University of Texas Health Science Center at Houston, TX, USA
| | | | | | - Melchor Ortiz
- Texas Tech University Health Sciences Center, El Paso, TX, USA
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18
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Impact of Project SCOPE on Racial/Ethnic Disparities in Screening Colonoscopies. J Racial Ethn Health Disparities 2014. [DOI: 10.1007/s40615-014-0016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Phillips-Angeles E, Song L, Hannon PA, Celedonia M, Stearns S, Edwards K, Feest S, Shumann A. Fostering partnerships and program success. Cancer 2014; 119 Suppl 15:2884-93. [PMID: 23868483 DOI: 10.1002/cncr.28157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/19/2012] [Accepted: 10/05/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Fostering partnerships was critical to the success of the Colon Health Program (CHP) in Greater Seattle. The CHP was built on the Breast and Cervical Health Program (BCHP) framework. A replicable system to provide quality colorectal screening services for individuals with limited incomes and no health insurance was developed. METHODS Partners were recruited and engaged during 3 programmatic phases: 1) development and start-up, 2) implementation, and 3) sustainability planning. Several tactics were used to develop trust and build bridges among the partners and to create an effective work group. RESULTS The partners were critical to developing clinic policies, procedures, and systems to increase colorectal screening and improve follow-up; expanding access to colonoscopies; and initiating statewide dissemination of training and systems as well as policy change. The fecal occult blood test completion rate was 61%, and the colonoscopy completion rate was 78%. The colonoscopy navigation system was effective with a low "no show" rate (8%). The partners were instrumental in helping Washington State obtain funding from the Centers for Disease Control and Prevention to continue the CHP statewide. CONCLUSIONS During implementation, key elements for success included: building the project on the successful BCHP framework, meticulous training of clinic staff about colorectal cancer and screening methods, frequent consultation to identify and solve problems, active support of the clinic administration, and the presence of a CHP champion in the clinic. Institutionalization of the CHP depended on: assessing progress after the first year, documenting experience with the program, disseminating lessons learned, engaging new partners, and determining steps to expand the program.
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20
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Nadel MR, Royalty J, Shapiro JA, Joseph D, Seeff LC, Lane DS, Dwyer DM. Assessing screening quality in the CDC's Colorectal Cancer Screening Demonstration Program. Cancer 2014; 119 Suppl 15:2834-41. [PMID: 23868477 DOI: 10.1002/cncr.28164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 03/12/2013] [Accepted: 08/16/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gaps in screening quality in community practice have been well documented. The authors examined recommended indicators of screening quality in the Centers for Disease Control and Prevention's Colorectal Cancer Screening Demonstration Program (CRCSDP), which provided colorectal cancer screening and diagnostic services between 2005 and 2009 for asymptomatic, low-income, underinsured, or uninsured individuals at 5 sites around the United States. METHODS For each client screened in the CRCSDP, a standardized set of colorectal cancer clinical data elements was collected. Data regarding client age, screening history, risk level, screening test indication, results, and recommendation for the next test were analyzed. For colonoscopies, data were analyzed regarding whether the cecum was reached, bowel preparation was adequate, and identified lesions were completely removed. RESULTS Overall, 53% of the fecal occult blood tests (FOBTs) (2295 tests) distributed were completed and returned. At the 2 sites with adequate numbers of FOBTs, 77% and 97%, respectively, of clients with positive results received follow-up colonoscopies. Site-specific cecal intubation rates ranged from 90% to 98%. Adenoma detection rates were 32% for men and 21% for women. For approximately one-third of colonoscopies, the recommended interval to the next test was shorter than recommended by national guidelines. At some sites, endoscopists failed to report on the adequacy of bowel preparation and completeness of polyp removal. CONCLUSIONS Cecal intubation rates and adenoma detection rates met recommended levels. The authors identified the need for improvements in the follow-up of positive FOBTs, documentation of important elements in colonoscopy reports, and recommendations for rescreening or surveillance intervals after colonoscopy. Monitoring quality indicators is important to improve screening quality.
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Affiliation(s)
- Marion R Nadel
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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21
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Subramanian S, Tangka FKL, Hoover S, Beebe MC, DeGroff A, Royalty J, Seeff LC. Costs of planning and implementing the CDC's Colorectal Cancer Screening Demonstration Program. Cancer 2014; 119 Suppl 15:2855-62. [PMID: 23868480 DOI: 10.1002/cncr.28158] [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: 07/12/2012] [Revised: 08/17/2012] [Accepted: 08/20/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) initiated the Colorectal Cancer Screening Demonstration Program (CRCSDP) to explore the feasibility of establishing a large-scale colorectal cancer screening program for underserved populations in the United States. The authors of the current report provide a detailed description of the total program costs (clinical and nonclinical) incurred during both the start-up and service delivery (screening) phases of the 4-year program. METHODS Tailored cost questionnaires were completed by staff at the 5 CRCSDP sites. Cost data were collected for clinical services and nonclinical programmatic activities (program management, data collection, and tracking, etc). In-kind contributions also were measured and were assigned monetary values. RESULTS Nearly $11.3 million was expended by the 5 sites over 4 years, and 71% was provided by the CDC. The proportion of funding spent on clinical service delivery and service delivery/patient support comprised the largest proportion of cost during the implementation phase (years 2-4). The per-person nonclinical cost comprised a substantial portion of total costs for all sites. The cost per person screened varied across the 5 sites and by screening method. Overall, economies of scale were observed, with lower costs resulting from larger numbers of individuals screened. CONCLUSIONS Programs incur substantial variable costs related to clinical services and semivariable costs related to nonclinical services. Therefore, programs that serve large populations are likely to achieve a lower cost per person.
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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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Boehm JE, Rohan EA, Preissle J, DeGroff A, Glover-Kudon R. Recruiting patients into the CDC's Colorectal Cancer Screening Demonstration Program: strategies and challenges across 5 sites. Cancer 2014; 119 Suppl 15:2914-25. [PMID: 23868486 DOI: 10.1002/cncr.28161] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/05/2012] [Accepted: 11/05/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In 2005, the Centers for Disease Control and Prevention (CDC) funded 5 sites as part of the Colorectal Cancer Screening Demonstration Program (CRCSDP) to provide colorectal cancer screening to low-income, uninsured, and underinsured individuals. Funded sites experienced unexpected challenges in recruiting patients for services. METHODS The authors conducted a longitudinal, qualitative case study of all 5 sites to document program implementation, including recruitment. Data were collected during 3 periods over the 4-year program and included interviews, document review, and observations. After coding and analyzing the data, themes were identified and triangulated across the research team. Patterns were confirmed through member checking, further validating the analytic interpretation. RESULTS During early implementation, patient enrollment was low at 4 of the 5 CRCSDP sites. Evaluators found 3 primary challenges to patient recruitment: overreliance on in-reach to National Breast and Cervical Cancer Early Detection Program patients, difficulty keeping colorectal cancer screening and the program a priority among staff at partnering primary care clinics responsible for patient recruitment, and a lack of public knowledge about the need for colorectal cancer screening among patients. To address these challenges, site staff expanded partnerships with additional primary care networks for greater reach, enhanced technical support to primary care providers to ensure more consistent patient enrollment, and developed tailored outreach and education. CONCLUSIONS Removing financial barriers to colorectal cancer screening was necessary but not sufficient to reach the priority population. To optimize colorectal cancer screening, public health practitioners must work closely with the health care sector to implement evidence-based, comprehensive strategies across individual, environmental, and systems levels of society.
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Affiliation(s)
- Jennifer E Boehm
- 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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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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27
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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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