Abstract A35: Reducing lung cancer mortality in disparate populations through cancer-Community Awareness Access Research and Education (c-CARE)
Authors: Williams Lovoria B. , Tingen Martha , McCall Amber , Khleif Samir N. 
Published: May 2016

Introduction: Lung cancer is the leading cause of cancer death in the US. Only 15% are diagnosed at early stage, resulting in a 5-year survival of 17%. Disparities exist among racial/ethnic minorities and the medically underserved and regionally. High mortality is in part due to the prior absence of a lung cancer screening guideline. The National Lung Screening Trial confirmed that screening individuals at high risk of lung cancer with an annual low-dose computed tomography reduced lung cancer mortality by 20%. The US Preventive Services Task Force now recommends lung cancer screening for high-risk asymptomatic adults. c-CARE is a new model of academic cancer center-community engagement to improve cancer health literacy and outcomes in disparity populations. The purpose of this c-CARE project is to increase community awareness of lung cancer risk factors and screening criteria, and to connect high-risk individuals to lung cancer screening and tobacco cessation services.

Methods: The study approach was Community-based Participatory Research (CBPR). Formative development involved vetting the study design with the Community Advisory Board (CAB) to ensure community priorities and concerns were addressed. Curriculum development and intervention evaluation were guided by the Health Belief Model. Community members who were similar to the target population of racial/ethnic minorities and medically underserved as well as Community Health Workers unassociated with the current project were recruited to participate in focus groups and semi-structured interviews to review the curriculum and guide refinement of the data collection instruments. All focus groups and interviews were held in community settings. Twelve community sites will be included in study implementation: 7 African- American churches; 4 community clinics that serve the medically underserved, and a community recreation center. Researchers will train four Community Health Workers from within each community site to deliver four 90-minute long education sessions and to recruit 50 English-speaking adults aged 21-80 years (target enrollment 500). High-risk individuals will be connected to lung cancer screening programs and tobacco cessation. Pre- and post-intervention outcome measures will be collected with surveys to assess changes in participant knowledge, attitudes and beliefs regarding cancer, perceived barriers and self-efficacy to obtain lung cancer screening. A site-level survey will be conducted at each site during project Year 1 to obtain a baseline measure of the population's cancer screening and prevention behaviors pre intervention; the site-level survey will be repeated in Year 3 to measure the impact of the intervention on the same measures.

Results: Researchers have currently enrolled 100% of the community sites (n=12) and 50% of the Community Health Workers (n=24). The CAB perceived the project aims as addressing a priority community health concern. Findings from four focus groups and three semi-structured interviews of Community Health Workers and community members indicated consensus with findings regarding cultural and local relevancy of the curriculum and the need to modify specific survey questions to improve flow, clarity and sensitivity to the social context.

Conclusions: CBPR methods engendered community relations and buy-in of the project, enhanced the study design and development of a culturally acceptable curriculum. The data derived from the focus groups and interviews facilitated the refinement of the curriculum and data collection instruments. Training Community Health Workers to recruit participants and to deliver the curriculum facilitates access to a hard-to-reach population, builds community capacity, ensures curriculum delivery within the social context of the setting and may increase program sustainability.

Citation Format: Lovoria B. Williams, Martha Tingen, Amber McCall, Samir N. Khleif. Reducing lung cancer mortality in disparate populations through cancer-Community Awareness Access Research and Education (c-CARE). [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A35.