Improvement in CRC Screening Rates Shown Following Covid-19 Pandemic


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In an interview with Targeted Oncology, Narissa Nonzee, PhD, discussed a study which focused on increasing colorectal screening rates among patients in ethnic minority communities.

Narissa Nonzee, PhD

Narissa Nonzee, PhD

Colorectal cancer (CRC) screening rates increased across Federally Qualified Health Centers (FQHCs) that were partnered with City of Hope, according to Narissa Nonzee, PhD.

During the COVID-19 pandemic, CRC screening substantially declined. Additionally, screening for patients with CRC is underutilized by ethnic minorities and in safety-net systems. To improve screening rates in medically underserved communities, City of Hope partnered with FQHCs and community and faith-based organizations.

A multi-component intervention was implemented and included community outreach and education, as well as clinic-based interventions. Findings showed that the multi-ethnic multimedia campaign reached 35.4 million impressions, and the NCI Screen2Save education training reached 300 diverse community members. Provider and staff training also reached 150 medical providers.

Over 80% of the 100 providers surveyed felt confident they could get their patients to complete their CRC screening test and follow-up care. Overall, findings revealed that screening rates for patients with CRC increased before vs after the intervention implementation period from 45% to 52%.

“We're hoping to take these findings and feed it back to our partners and develop strategies to help improve not only colorectal cancer screening rates, but other cancer screening rates within their health centers,” Nonzee, assistant professor, Division of Health Equities, Department of Population Sciences, City of Hope, told Targeted OncologyTM in an interview.

In the interview, Nonzee further discussed the study which focused on increasing colorectal screening rates among patients in ethnic minority communities.

Targeted Oncology: Can you discuss some of the disparities seen in the colorectal cancer space regarding screening?

Nonzee: We see many disparities in CRC screening and outcomes by race, education, insurance, status, immigration, and even regionally across the United States, Black African Americans are about 20% more likely to get colorectal cancer, and about 40% more likely to die from it than other racial and ethnic groups. We also see that Latino adults are more likely to be diagnosed at later stages compared with White adults. This is why it may be attributed in part to lower cancer screening rates.

In 2018 for example, 69% of age eligible adults were up to date with colorectal cancer screening in the United States compared with only 56% among Latinos, 40% among uninsured, and 44% within qualified health centers, which serves as the backbone to our primary care safety net system in the United States. This is why it was so important for us to really tackle this issue in conjunction with our community partners.

Can you provide a brief overview of the study you worked on related to the disparities in CRC?

Colorectal cancer is largely preventable with screening yet remains a second leading cause of cancer deaths in the United States. Moreover, screening had substantially declined during the COVID-19 pandemic and remains underutilized by racial and ethnic minorities and within safety net systems. This was the issue that we were trying to tackle with the study. The purpose of our study was to improve colorectal cancer education and screening rates among medically underserved communities.

To accomplish this goal, what we did at City of Hope was partner with federally qualified health centers, community, and faith-based organizations in our diverse area. We are lucky to have dedicated partners within our cancer center. What we did was we implemented a multicomponent intervention that included a couple different components. One was a community outreach and education component which involved a multiethnic media campaign and community training that was adapted from an NCI Screen2Save program, and clinic-based intervention components, which involves dissemination of patient education, provider, and staff training, primarily at the Community Health Center partners that we partnered with.

What findings were concluded from the study?

We're looking at 2 main things for this study. One was about the reach to different populations, and a second outcome we were looking at was whether there were changes in screening rates in the community health centers that we were working with. For the first part of it, we found that our intervention had broad reach, our multiethnic multimedia campaign reached over 35 million impressions. This is thanks to the bilingual City of Hope clinicians who promoted screenings of 4 languages that are commonly found within our catchment area, including Spanish, Korean, Mandarin, and English. This was across multiple media platforms, including TV, radio, and newspaper. Then, our Screen2Save education component reached 300 diverse community members, and our provider and staff training reached 150 medical providers in the community. Again, all possible due to our highly valued community partners, who have been dedicated to improving the health and wellness of their communities.

Secondly, for the clinic-based component of the intervention, we observed that yes, screening rates did improve before vs after the intervention implementation period from 45% to 52%. Even when we looked further into our adjusted analyses, this meant that the intervention was associated with over a 9% increase in cancer screening rates over this very short time period, which was an amazing success for this program.

What are the next steps for research regarding screening disparities in CRC?

We have been building collaborations with our community partners, especially with our federally qualified health centers. We're hoping to take these findings and feed it back to our partners and develop strategies to help improve not only colorectal cancer screening rates, but other cancer screening rates within their health centers. We currently partner with 1 who we have a HRSA grant with. That involves a partnership between an NCI designated Comprehensive Cancer Center Center and an FQHC. This is all about improving cancer screening rates through patient navigation, as well as creating more of a community oncology unit of care within our catchment area.

What unmet needs still exist in the space?

There are many unmet needs. We know from the literature, for example, about the multidimensional, multilevel barriers that exist within various communities, whether it's knowledge and awareness at the personal level or mistrust of the healthcare system, or structural and access barriers to care. One other thing that comes to mind are health policies to promote equitable access to cancer care, because insurance also doesn't always have equal access. Thankfully, within City of Hope they've done a lot within this space in promoting the Cancer Care Equity Act. It recently took into effect the first of this year and this law expands access to NCI designated comprehensive cancer centers for Medicare beneficiaries with complex cancer. This would mean accessing oncology specialists, precision medicine, and clinical trials, that could be life-saving. These sort of incremental changes to address these unmet needs are important within our community.

What should a community oncologist take away from this study?

We were fortunate to see improvements in screening rates itself within the primary care and the community health centers that we were working with. From the community oncologist perspective, even knowing that colorectal cancer screening rates and colorectal cancer screening remains underutilized. Although it wasn't assessed in our study, we know from the literature that delays in screening may contribute to late-stage diagnosis in the community oncology setting. It's important to be mindful of these multidimensional, multilevel obstacles to completing cancer related screening and care. Be mindful of all the potential factors that could create delays in care within the community oncology setting.

To improve cancer screening within our communities, it relies on listening, collaborating, building trust, identifying assets within our community partners to collaborate on this initiative together. This couldn't have been done without the collaboration of our community partners.

Ashing K, Garcia M, Kidambi T, et al. Community outreach and engagement to increase colorectal cancer screening in ethnic minority communities. Presented at: 2023 AACR Annual Meeting; April 14-19, 2023; Orlando, FL
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