In West Virginia, where colorectal cancer is the second-deadliest type of cancer, half of all colorectal cancers elude diagnosis until they have already grown beyond the colon. With Medicaid expansion, more West Virginians now have health insurance for cancer screening, yet many barriers to screening persist.
West Virginia University researchers are working to improve screening rates for the state, which has one of the highest incidences of colorectal cancer and one of the lowest screening rates in the nation.
“For patients who decline colonoscopy, the cost of the procedure is not always the issue. It is the non-procedure-related costs,” said Mary Ellen Conn, assistant director of WVU’s Cancer Prevention and Control Program.
Some patients may not be able to get time off from work to get screened. Others may lack transportation or childcare. And in West Virginia’s most rural counties, months-long waitlists can be a deterrent.
Conn and her colleague Stephenie Kennedy-Rea, director of the WVU Cancer Prevention and Control Program, lead a team that works with healthcare providers at 34 primary care clinics across West Virginia to implement research-proven interventions to increase their colorectal cancer screening rates.
This effort is part of the West Virginia Program to Increase Colorectal Cancer Screening, known as WV PICCS. Funded by the Centers for Disease Control and Prevention, the goal of the program is to increase colorectal cancer screening rates and create systems change for long-lasting impact. The program will receive a total of $2.65 million in CDC funding over its five-year run.
One of the first steps in working with clinics is to train providers and staff on the current colorectal cancer screening guidelines. Unlike with other cancers that call for just one screening method, several approved tests are available for colorectal.
In addition to colonoscopy, there are newer stool-based screening methods, including the fecal immunochemical test, which requires no fasting, no medication or diet restrictions, and no scoping procedures at distant facilities. The patients collect their own samples in privacy and take-;or mail-;the kit to the clinic.
Research shows that some patients will forego screening altogether if they are not offered an alternative to colonoscopy. But even if a patient accepts a fecal immunochemical test in a doctor’s exam room, there is no guarantee the patient will complete the test.
The WV PICCS team works with participating clinics to intervene when patients do not submit their fecal immunochemical test for analysis. They help clinics implement tailored reminder calls to the patients-;scripting the calls, determining the number and frequency of the calls and taking into account each clinic’s workload and staffing level.
Conn says that after reminder calls they are seeing an average 42 percent return rate on the tests.
“Keep in mind that these are tests that would not have come back into the clinic on their own,” Conn said. “We basically help the clinic move a zero rate of return to a higher percentage.”
As a result of working with WV PICCS, clinics completing the first year of intervention saw their average overall clinic screening rate increase from 27 percent to 50 percent.
The Clay-Battelle Community Health Center serving Blacksville and Burton is a participating clinic that currently receives training and technical assistance.
“Medicine is an always-changing, always-evolving thing,” said Megan Moore, a physician assistant who practices at the Blacksville clinic. “I think taking the time to re-educate all of us revitalizes our interest in educating our patients. Sometimes you may learn some new little tidbit, and that tidbit can be the thing you can tell a patient to make them go, ‘Hey, this is a good idea. This is going to help my overall health.'”
WV PICCS gathers data on participating clinics’ screening rates and reports the data to the clinics every quarter. Screening rates for individual providers are also shared through a process of provider assessment and feedback as studies show provider recommendation is the number one reason patients get screened.
“Some clinics invite us to provider meetings to present these data and discuss them,” Conn said. “This spurs a lot of discussion among the providers themselves. They question each other, like, ‘Well, Dr. Smith, you have a 70 percent screening rate. What are you saying to your patients?’ This really increases meaningful dialogue among providers where they can learn from one another.”
Colorectal cancer survival rates underscore the importance of screening and early detection. Out of 10 patients whose cancers are treated before they break through the colon wall, nine will be alive in five years. But for every 10 patients whose cancer has spread to other parts of the body, just one will reach the five-year mark.
“This program provides a unique opportunity to enhance physicians’ knowledge of screening options for their patients, create systems change to improve clinic screening rates and work in partnership to address one of the most preventable cancer killers in our state,” Kennedy-Rea said. “By working together, we can move the needle on colorectal cancer.”