Samuel M. Lesko, MD, MPH Regina Schmid-Allen, MHA Laura Toole, LCSW
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Transcript of Samuel M. Lesko, MD, MPH Regina Schmid-Allen, MHA Laura Toole, LCSW
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TCCAP: a Targeted Awareness TCCAP: a Targeted Awareness Program to Address Colorectal Cancer Program to Address Colorectal Cancer Disparities in Northeast PennsylvaniaDisparities in Northeast Pennsylvania
Samuel M. Lesko, MD, MPH
Regina Schmid-Allen, MHA
Laura Toole, LCSW
Northeast Regional Cancer Institute,
Scranton, PA
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AcknowledgementAcknowledgement
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
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Northeast RegionalNortheast RegionalCancer InstituteCancer 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
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Partner HospitalsPartner Hospitals
Community Medical CenterGeisinger South Wilkes-BarreMarian Community Hospital
Mercy Health PartnersMoses Taylor Hospital/
Mid-Valley HospitalWayne Memorial Health System
Wyoming Valley Health Care System
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Appalachia Community Cancer Network Appalachia Community Cancer Network (ACCN): Appalachian Areas of 7 States (ACCN): Appalachian Areas of 7 States
(KY, MD, NY, OH, PA, VA, WV)(KY, MD, NY, OH, PA, VA, WV)
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BackgroundBackground
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
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Cancer Cases, NEPA 1998-’02Cancer Cases, NEPA 1998-’02
0
500
1000
1500
2000
2500
3000
3500
Colon/Rectum Breast Lung Prostate Bladder NH Lymphoma Uterus
Ca
se
s
Women
Men
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CRCa SIRs, Both Sexes, CRCa SIRs, Both Sexes, 1998-’021998-’02
Monroe
Luzerne
Wyoming
Lackawanna
Pike
Wayne
Susquehanna131
139
74
136
95
126
123
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CRCa, Stage at Diagnosis,CRCa, Stage at Diagnosis,Both SexesBoth Sexes
0
10
20
30
40
50
60
Local Regional Distant
Lackawanna county 1998-2002
SEER 1995-2000
0
10
20
30
40
50
60
Local Regional Distant
Lackawanna county 1998-2002
SEER 1995-2000
Per
cen
t
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GoalsGoals
1.To improve colorectal cancer screening rates
2.To improve the stage at which new colorectal cancer cases are diagnosed
3.To decrease colorectal cancer mortality rates
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Methods (1)Methods (1)
Awareness Program• Multi-faceted• Community• Healthcare Providers• 3-year (2004-2006)
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Methods (2)Methods (2)Community Advisory CouncilCommunity Advisory Council
Ellen Althouse, RNWilliam Auriemma, MDJoseph Bannon, MDMichael Barrett, MDValerie Bell, RNMaureen BesanconDerry BirdM.R. Chowdhury, MDEdward Dzielak, MDMary Erwine, RN, MSNPat FinanMarcie Grello, BSLinda Gutierrez, MDMrs. Ceil HughesRita Ives, RN, AOCNDavid KalinoskiJamie KaneRobert Kearns
Susan Kennedy Doug Klamp, MDMichael Kondash, MDLisa KuterBob LamsonPat Lawless, MHAIna LubinGail Matisko, RN, BSNJohn McGeehan, MDSally McGuireJudge Carmen MinoraErin MoskelPeter C. Olden, PhDStacey OndikDipti Pancholy, MDBharat Patel, MDPaul Remick, MD
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
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Methods (3)Methods (3)
Community Interventions• Advertisements
– Print, Billboards, Broadcast• Direct Mail
– Screen for Life• Printed Materials• Educational Programs• CASUAL Day
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SM
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Methods (4)Methods (4)
HCP Interventions• Didactic Presentations
– Grand Rounds– Continuing Ed.
• Academic Detailing– PCPs
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EvaluationEvaluation
• Questionnaires• HCP Follow-up Calls• Population Survey• Cancer Registry Data
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Results: Community (1)Results: Community (1)
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
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Results: Community (2)Results: Community (2)
Programs
97% Reported Knowledge Gain
96% Planned to Change Behavior
Direct Mail
65% Reported Knowledge Gain
86% Planned to be Screened
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C.A.S.U.A.L. Day C.A.S.U.A.L. Day 2004-20062004-2006
• 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
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Results: HCP (1)Results: HCP (1)
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
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Results: HCP (2)Results: HCP (2)
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
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Prevalence of Screening Lower Prevalence of Screening Lower Endoscopy* by Year, 2001-2006Endoscopy* by Year, 2001-2006
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10
20
30
40
50
60
2001 2002 2003 2004 2005 2006
Endoscopy
Pe
rce
nt
Pe
rce
nt
* Proportion of Adults Reporting Having Had a Screening Lower Endoscopy in the Previous Five Years
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Colorectal Cancer Stage at DiagnosisColorectal Cancer Stage at Diagnosisby Year*, 1998-2007by Year*, 1998-2007
0
1 0
2 0
3 0
4 0
5 0
6 0
1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7
Pe
rce
nt
% l o c a l % r e g i o n a l % d i s t a n t
* NEPA, 6 counties* NEPA, 6 counties
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Results: MortalityResults: Mortality
Too Early to Tell!
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ImplicationsImplications
Based on:• Change in Stage @ Dx• Stage-specific Survival• Stable Incidence
13 Fewer Deaths per Year• $4,102/Year of Life Saved
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DiscussionDiscussion
• Sustainable – Cost/YOLS Modest• Community Effort – Media, CASUAL Day• Limitations – No Control
– FOBT Use • Long Term Effects - Unknown
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