Comprehensive Program for Improving Cervical and Colorectal Cancer Screening among the Medically Underserved
Introduction
Colorectal cancer (CRC) and cervical cancer (CxC) remain significant causes of morbidity and mortality in Texas and both cancers are marked by stark racial and ethnic disparities. The Community Network for Cancer Prevention (CNCP) is an academic-community partnership established through CPRIT Prevention grants to empower medically underserved Harris County residents to seek and obtain cancer prevention, screening, and follow-up services to address barriers that exist at multiple stages within the cancer continuum of care.
Methods
The CNCP network includes Harris Health System, the county’s safety-net system and the third largest safety-net health system in the U.S., and other safety-net providers: San Jose Clinic and Tomagwa Healthcare Ministries. The CNCP uses a comprehensive, evidence-based approach to address barriers that exist at multiple stages within the cancer care continuum. Pillars of the program are: 1) an effective patient education program to educate patients about cancer screening and motivate them to complete the test; 2) a tiered tracking, reminder, and patient navigation model to ensure diagnostic follow-up among patients with an abnormal screening test; and 3) an innovative Theater Outreach Program (TOP) to increase cancer screening intentions in medically underserved, minority communities. Additionally, in our current project period, we are implementing a mailed Fecal Immunochemical Test (FIT) program whereby FIT kits are mailed to patients.
Results
During Project Year 1 (August 31, 2021 – August 30, 2022), the proportion of active primary patients who completed a colorectal screening was 65.01% for Harris Health, an increase over the 2020 screening rate of 43.4% but short of the 2019 baseline rate of 69.6%. From March to August 2022, we distributed 37,411 FIT bags with test patient instructional sheets (45,450 in English/Spanish and 2,950 in English/Vietnamese) and 6,075 colonoscopy prep sheets (4,625 in English/Spanish and 1,450 in English/Vietnamese) to Harris Health clinics and hospitals. There were 32,116 FITs distributed at Harris Health, with an average return rate of 70.8%. The mailed home-based FIT kits were sent to 716 patients. From those patients, 103 (14.4%) completed their FIT test. Our navigators navigated 3,650 patients with a positive FIT test. For cervical cancer screening, during Project Year 1, the proportion of eligible patients ages 21 to 65 who completed cervical cancer screening was 67.04% for Harris Health, a slight decrease from the 2020 rate (68.1%) and the 2019 baseline rate (68.3%). We navigated all 3,915 patients with a positive Pap or Pap/HR-HPV test. Due to the decrease in in-person visits, the number of views for the point-of-care videos was lower than previous years. The colorectal and cervical cancer screening point-of-care videos were viewed by an average of 352 and 269 patients per month, respectively. Through TOP, we delivered 15 virtual and hybrid performances, reaching a total audience of 344 individuals. Among audience members attending colorectal cancer performances (n = 168), the proportion of participants indicating a higher intention to screen increased from 58.1% pre-performance to 77.1% post-performance. For cervical cancer performance audience members (n = 82), the proportion of participants indicating a high intention to screen was similar pre- and post-performance (63.9% to 62.5%).
Conclusion
Our current maintenance expansion program provides critical activities to promote colorectal and cervical cancer screening and ensure that patients are not lost to follow-up. While we have indicated an increase in colorectal cancer screening in the previous year, it has not reached our 2019 baseline rate. In addition, decreases in cervical cancer screening rates are troublesome, albeit consistent with national trends. We are considering implementing additional activities to attain further increases in screening participation.