Cancer touches all of our lives. These words ring true yet offer little to describe the sadness, isolation and fear that many of us feel when faced with a cancer diagnosis – our own or that of a loved one.
Knowing that, what can we do to prevent cancer? Quit smoking. Eat healthier foods. Limit alcohol. Use sunscreen. Exercise. Maintain a healthy weight. Get preventive screenings.
Screenings check for early signs of disease. Some, like a prostate exam, take place in a doctor’s office. Others involve appointments and high-tech equipment or procedures.
Cancer screenings are among medicine’s best tools to improve health outcomes. They lead to early diagnosis, and often more and better treatment options. Yet many people put off or skip screenings entirely. Penn Medicine's Abramson Cancer Center (at the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center and Pennsylvania Hospital) aims to improve the health of the community by promoting screening for several cancers that are prevalent in the Greater Delaware Valley – colon, breast, lung and cervical. This three part series offers an update on a few of those efforts.
Read on for the first part of the Let's Get Screened series on colonoscopies.
Why Colon Cancer Screenings Are Widely Avoided
Colonoscopy saves lives. The test debuted in 1969 and became a regular part of preventive health care in the 1970s. More than 15 million colonoscopies are performed in the U.S. each year.
This powerful test not only finds cancer, it identifies polyps or groups of cells that may become cancer in the future. Doctors remove them during the procedure. Most patients opt for anesthesia, making the procedure entirely painless.
Despite these selling points, many people avoid or delay colonoscopies. This is especially so in some parts of the Abramson Cancer Center’s service area where studies show lower than average rates of colon cancer screening participation.
Why is this? One reason is that the procedure comes with a homework assignment. It’s not enough to show up for the day of the test. This screening requires test prep, and not the kind you can buy from a college test prep service like Stanley Kaplan or Princeton Review. For many people, the prep is the hardest part.
The prep begins days before the procedure when you start to change your diet. The final day requires a liquid diet consisting of drinks laced with a laxative. Patients must purchase supplies and follow a strict eating/drinking schedule. Adherence is critical. Patients who show up for a colonoscopy without completing the prep are sent home and rescheduled.
Two Penn doctors recognized the challenges patients face in completing the screening. People don’t always understand the value of the test. Others do but are unable to complete it. They have difficulty making or keeping appointments. They may not be able to take time off from work or have a friend or relative to escort them home. The cost of prep supplies can be a major barrier for those on a tight budget.
Addressing the Colonoscopy Problem
In 2012, Carmen Guerra MD, MSCE, FACP, Ruth C. and Raymond G. Perelman Professor in Internal Medicine, and Michael Kochman, MD, Wilmott Family Professor of Medicine, teamed up to address the problem. Dr. Guerra is a primary care doctor and health services researcher who studies access to care. Dr. Kochman is a gastroenterologist and surgeon with expertise in GI diagnostic screenings.
They started the West Philadelphia Colorectal Screening Navigation Program. The program first focused on five zip codes near Penn. The area was chosen for its lower rate of screening. Grant funding evolved into donor support. The renamed Colonoscopy Outreach Navigation Project now draws residents of 11 zip codes around the city.
The effort relies on a nurse navigator who provides one-on-one service. Health records are used to identify people who have received an order for the screening but have not completed the appointment. Contact begins with a phone call. Some of those called appreciate the reminder and proceed on their own. Others politely decline. Many are grateful for a little help.
Help is tailored to patient needs. It may include:
- Free prep supplies
- Reminder phone calls
- Help making appointments
- Transportation coordination or assistance
Helping Unscreened Patients Get Screened
Since 2012, calls to 2,440 people have led to 763 screenings. Nearly 43 percent of the screenings revealed at least one polyp. The polyps are not cancer but could become cancer in the future. On five occasions, colon cancer was found.
Most participants (72 percent) earn below $30,000/year. 90 percent are African American. Both women and men benefit from the program.
Oncology Nurse Navigator Diann Boyd, BSN, RN, OCN, staffs the effort. She notes that fear of the prep is a key barrier for many people who put off colonoscopy. Just the idea of fasting can be scary. She calls patients at key points in the process to answer questions and offer support and reminders.
Over the years, the program has seen an increase in the number of completed colonoscopies. Boyd says, “It is rewarding to see patients complete a screening, especially when they come from a place of hesitation. There is a sense of accomplishment when you feel you’ve made a connection and had an impact on someone’s life.” She describes the sigh of relief she hears when people hear about the service. Perhaps most gratifying are the thank you calls she receives after.
Dr. Guerra too is encouraged by the program’s success. She adds, “In the U.S., only about two-thirds of people 50 and older have completed a colorectal cancer screening test as recommended by the screening guidelines. We need to find ways of helping unscreened patients get screened, especially in under-served populations which often bear a greater burden of cancer.”
Read part 3 on lung cancer screening