Abstract B105: Addressing colorectal cancer disparities in rural Appalachia
Authors: Dignan Mark , Schoenberg Nancy , Shelton Brent , Pearce Kevin , Tolle Cheri 
Published: December 2010

Colorectal cancer, a disease that is both preventable and detectable in early stages, is currently the third leading cause of cancer death in the U.S. In Kentucky, this disease is the second leading cause of cancer death. The elevated rates of colorectal cancer are a concern because they have increased in recent decades and because of low rates of use of available screening modalities. Low screening rates are particularly concerning for rural populations because of limited access to colonoscopy as well as diagnostic and treatment facilities for colorectal cancer. This concern is particularly acute in Appalachia, a region with a long history of pronounced cancer health disparities.

This NCI-funded study is designed to increase colorectal cancer screening by providing outreach and education to primary care physicians practicing in rural, medically underserved areas in Appalachian Kentucky. The intervention is delivered using academic detailing in partnership with Area Health Education Centers (AHEC). General practice, family medicine, and general internal medicine practices in Appalachian Kentucky were identified and invited to participate. A practice representative, usually the lead health care provider, completed a survey describing the practice characteristics and the colorectal cancer screening testing that they provided and/or recommended. Medical record reviews of a sample of 60 asymptomatic patients age 50 and older were conducted to establish baseline screening rates. Practices were then randomized to early or delayed intervention groups. The intervention was delivered at the practices. After an introductory visit, the academic detailer made up to four subsequent visits to the practices to present information on screening efficacy, patient counseling, reimbursement, and practice management. Evaluation data were collected through medical record reviews at 6 and 18 months after the final intervention visit. Medical record reviews collected data on screening recommended and/or provided (fecal occult blood testing (FOBT) in the past year, flexible sigmoidoscopy in the past 5 years, and colonoscopy in the past 10 years).

A total of 66 practices we enrolled. Baseline data from 3906 patient records indicated that health care providers had recommended screening by FOBT in the past year for 18.5% of the eligible patients seen during the period covered by the medical record review. The review also showed that 10.5% of records included documentation of results of FOBT. For flexible sigmoidoscopy in the past 5 years 0.4% had a recommendation and 0.3% results. For colonoscopy in the past 10 years, rates of recommendation and results documentation were 43.7% and 29.7%, respectively. Data from medical record review conducted 6 months after the intervention revealed small changes in FOBT, and a substantial increase in documentation of results from colonoscopy, (p&lt;.05). Medical record review at 18 months post intervention revealed a sharp decline in FOBT and slight increases in colonoscopy. Qualitative interviews with project personnel and participants suggest that a pattern of rapid abandonment of FOBT as a screening modality and increased emphasis on colonoscopy may be competing explanations for intervention effects.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B105.