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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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15

16

17

SM

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Methods (4)Methods (4)

HCP Interventions• Didactic Presentations

– Grand Rounds– Continuing Ed.

• Academic Detailing– PCPs

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20

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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

0

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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