TCCAP: a Targeted Awareness Program to Address Colorectal Cancer Disparities in Northeast Pennsylvan...
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TCCAP: a Targeted Awareness Program to Address Colorectal Cancer Disparities in Northeast Pennsylvania. Samuel M. Lesko, MD, MPH Regina Schmid-Allen, MHA Laura Toole, LCSW Northeast Regional Cancer Institute, Scranton, PA. Acknowledgement.

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Samuel m lesko md mph regina schmid allen mha laura toole lcsw

TCCAP: a Targeted Awareness Program to Address Colorectal Cancer Disparities in Northeast Pennsylvania

Samuel M. Lesko, MD, MPH

Regina Schmid-Allen, MHA

Laura Toole, LCSW

Northeast Regional Cancer Institute,

Scranton, PA


Acknowledgement
Acknowledgement Cancer Disparities in Northeast Pennsylvania

Supported by grants from:The Harry & Jeanette Weinberg Foundation, Scranton Area Foundation, Blue Ribbon Foundation, Margaret Briggs Foundation, Sordoni Foundation, Inc., Procter & Gamble Fund, Southern Union Co., Pennsylvania Department of Health, Pennsylvania Department of Community & Economic Development, and In-kind Support


Northeast regional cancer institute
Northeast Regional Cancer Disparities in Northeast PennsylvaniaCancer Institute

Non-profit, community based organization with a commitment to ease the burden of Cancer in Northeast Pennsylvania.

  • Cancer Registry

  • Research

  • Education and Support

  • Cancer Risk


Partner hospitals
Partner Hospitals Cancer Disparities in Northeast Pennsylvania

Community Medical CenterGeisinger South Wilkes-BarreMarian Community HospitalMercy Health PartnersMoses Taylor Hospital/Mid-Valley HospitalWayne Memorial Health SystemWyoming Valley Health Care System


Appalachia community cancer network accn appalachian areas of 7 states ky md ny oh pa va wv
Appalachia Community Cancer Network (ACCN): Appalachian Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)


Background
Background Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

Colorectal cancer

  • 4th most common Ca in US

  • 2nd leading cause of Ca deaths in US

  • Screening can prevent CRCa deaths

  • Colorectal cancer in NEPA

  • Most commonly diagnosed Ca

  • 2nd leading cause of Ca death


Cancer cases nepa 1998 02
Cancer Cases, NEPA 1998-’02 Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)


Crca sirs both sexes 1998 02
CRCa SIRs, Both Sexes, Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)1998-’02


Crca stage at diagnosis both sexes
CRCa, Stage at Diagnosis, Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)Both Sexes

Percent


Goals
Goals Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

  • To improve colorectal cancer screening rates

  • To improve the stage at which new colorectal cancer cases are diagnosed

  • To decrease colorectal cancer mortality rates


Methods 1
Methods (1) Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

Awareness Program

  • Multi-faceted

  • Community

  • Healthcare Providers

  • 3-year (2004-2006)


Methods 2 community advisory council

Ellen Althouse, RN Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

William Auriemma, MD

Joseph Bannon, MD

Michael Barrett, MD

Valerie Bell, RN

Maureen Besancon

Derry Bird

M.R. Chowdhury, MD

Edward Dzielak, MD

Mary Erwine, RN, MSN

Pat Finan

Marcie Grello, BS

Linda Gutierrez, MD

Mrs. Ceil Hughes

Rita Ives, RN, AOCN

David Kalinoski

Jamie Kane

Robert Kearns

Susan Kennedy

Doug Klamp, MD

Michael Kondash, MD

Lisa Kuter

Bob Lamson

Pat Lawless, MHA

Ina Lubin

Gail Matisko, RN, BSN

John McGeehan, MD

Sally McGuire

Judge Carmen Minora

Erin Moskel

Peter C. Olden, PhD

Stacey Ondik

Dipti Pancholy, MD

Bharat Patel, MD

Paul Remick, MD

Methods (2)Community Advisory Council

David D. Reynolds, MD

Judy Rogers, CRN

David Rutta, MD

Marie Santilli

Karen Saunders

Nayan C. Shah, MD

Eileen Sharp, PhD

Beth Taylor, RN, OCN

Kristin Tigue

Michael Turock, MD

Kim Vangarelli

Vera Walline, MPH, CHES

Ann Ward

Gloria Watson

Barbara L. Winters, PhD

Robert E. Wright, MD

Eileen Zuber


Methods 3
Methods (3) Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

Community Interventions

  • Advertisements

    • Print, Billboards, Broadcast

  • Direct Mail

    • Screen for Life

  • Printed Materials

  • Educational Programs

  • CASUAL Day


Samuel m lesko md mph regina schmid allen mha laura toole lcsw

SM Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)


Methods 4
Methods (4) Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

HCP Interventions

  • Didactic Presentations

    • Grand Rounds

    • Continuing Ed.

  • Academic Detailing

    • PCPs


Evaluation
Evaluation Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

  • Questionnaires

  • HCP Follow-up Calls

  • Population Survey

  • Cancer Registry Data


Results community 1
Results: Community (1) Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

Community

  • 206 total community programs - 8,017 attendees

  • 46,510 targeted mail pieces

  • 59,725 total pieces of educational materials

  • 38,712,582 total individual market impressions


Results community 2
Results: Community (2) Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

Programs

97% Reported Knowledge Gain

96% Planned to Change Behavior

Direct Mail

65% Reported Knowledge Gain

86% Planned to be Screened


C a s u a l day 2004 2006
C.A.S.U.A.L. Day Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)2004-2006

  • Team Captains – more than 400 businesses engaged

  • Participants – more than 12,000

  • Money Raised – more than $124,000 raised to support Cancer Institute colon cancer awareness programming


Results hcp 1
Results: HCP (1) Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

Health Care Professionals

  • 21 hospital-based CME accredited programs - 852 attendees

  • 9 non-hospital programs - 250 attendees

  • 38 non-physician healthcare groups - 876 attendees

  • 230 physician “detailing” sessions


Results hcp 2
Results: HCP (2) Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

CME Programs

98% Reported Knowledge Gain

95% Planned to Change Behavior

Detailing Sessions

44% Requested Additional Materials

75% Reported increased Patient Request

for Screening

70% Reported Increased Screening


Prevalence of screening lower endoscopy by year 2001 2006
Prevalence of Screening Lower Endoscopy* by Year, 2001-2006 Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

Endoscopy

Percent

* Proportion of Adults Reporting Having Had a Screening Lower Endoscopy in the Previous Five Years


Colorectal cancer stage at diagnosis by year 1998 2007
Colorectal Cancer Stage at Diagnosis Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)by Year*, 1998-2007

* NEPA, 6 counties


Results mortality
Results: Mortality Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

Too Early to Tell!


Implications
Implications Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

Based on:

  • Change in Stage @ Dx

  • Stage-specific Survival

  • Stable Incidence

    13 Fewer Deaths per Year

  • $4,102/Year of Life Saved


Discussion
Discussion Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

  • Sustainable – Cost/YOLS Modest

  • Community Effort – Media, CASUAL Day

  • Limitations – No Control

    – FOBT Use

  • Long Term Effects - Unknown