Colorectal cancer is the second leading cause of cancer death among Americans. There are 150,000 new cases and 57,000 deaths per year. While the lifetime risk of developing colorectal cancer is relatively low at 5-6%, that risk can climb to 20-25% with family history and/or other predisposing factors.
Screening tests for colorectal cancer have been clearly proven to decrease the incidence of the disease and facilitate the diagnosis at earlier stages. In fact, periodic screening colonoscopy for at-risk populations can prevent 75-90% of colorectal cancer cases.
But, it’s well-documented that regular screenings in at-risk populations remain below expected levels. Only 20 states mandate that insurance companies cover the cost of screening colonoscopies, and even individuals whose insurance will cover the testing fail to take advantage of these potentially life-saving exams.
The Ohio Cancer Incidence Surveillance System, administered by the Ohio Department of Health (ODH), identified several counties (23) in Ohio that showed higher percentages of late-stage diagnosis of colon and rectal cancer from data collected during 1999-2003. Our local numbers indicated a late-stage colon cancer diagnosis of nearly 60% – the second highest county in Ohio!
The ODH and the American Cancer Society (ACS) met with taskforces from each of these 23 counties in early 2005 to investigate techniques that might increase screening and earlier diagnoses in their communities. Each county taskforce would then go on to address the problem in the most efficient manner for their individual communities.
Guernsey County geographically sits on the edge of Appalachia, and six of the counties in our region have no local hospitals. Southeastern Med has 90 acute care beds, 75 physicians on staff and has become the regional medical center that serves this very rural area. Our Cancer Program has been accredited since 1991 and we are a Commission on Cancer (CoC) accredited Breast Care Center. Four general surgeons cover the trauma, oncology, vascular and thoracic services and also provide all endoscopic support for the hospital.
The Guernsey County Colorectal Taskforce was formed and began work early in 2006. The mission was to raise awareness of the significance of colorectal cancer and to enhance early detection by disseminating information and mobilizing community resources. The vision was to decrease colorectal cancer incidence and mortality in Southeastern Ohio and improve the quality of life for all colorectal cancer survivors. Team members included the Cancer Registrar and Cancer Program Administrator, nurses from various hospital departments, representatives from the American Cancer Society and local Health Department, local physicians and surgeons, a marketing department specialist and a cancer survivor, as well as two community support representatives from National City Bank. The Taskforce also included the CEO and the VP of Medical Affairs of Southeastern Med, signifying the importance local healthcare providers placed on the initiative.
The colorectal initiative received excellent community support in the form of grants and donations from the American Cancer Society, Wal-Mart, the Kiwanis Foundation, National City Bank, Ohio Department of Health and The OSU Department of Pathology, as well as physician- and citizen-donated time and services, including the production of an award-winning educational video.
The Taskforce concentrated its efforts in four general areas:
- Physician education
- Community education
- Legislative advocacy
- Concerted efforts to provide screening tests to the public in the form of free Hemawipe tests and reduced-cost and no-cost colonoscopies to patients with financial difficulties
We visited primary care offices to deliver ACS screening guidelines, posters and pamphlets, and instituted the Blue Sticky Note Project (ODH involvement) to encourage conversation about screening tests between physicians and patients.
Community education efforts included four billboards, radio spots, direct postcard mailings to 10,500 households in five counties, newspaper articles, and the distribution of the aforementioned video, which documented the hospital CEO undergoing an actual colonoscopy.
National City Bank allowed displays in their bank lobbies. The Taskforce made presentations to all local service clubs, sent brochures with the Senior Citizen Center Meals on Wheels. And a local theater ad reached 130,000 patrons in 12 months. In 2007, we also placed informational brochures in the local newspapers of Guernsey County and several surrounding counties.
All these initiatives prompted hundreds of calls to our cancer program administrator for more information, to acquire Hemawipes or to arrange an interview with our financial counselors for a reduced-cost or free colonoscopy. Since 2006, Southeastern Med and the Taskforce have provided more than 500 colonoscopies – most of which have been totally free, including physician, hospital and pathology fees – for individuals from 16 counties in Ohio.
In 2008, the taskforce rebranded, changing its name to the Tina Kiser Colorectal Cancer Coalition (TKC3) in honor of a member of the group who lost her long battle with Stage IV colon cancer.
Through private donations, the group designed and ordered an inflatable walk-through colon, dubbed “The Supercolon,” that we use for public education events. These events have been so successful, in fact, that we have rented “The Supercolon” to organizations throughout Ohio for their own education efforts. A van displaying a picture of the colon is used to transport the exhibit. The “Supercolon” has been such an effective educational tool that the Taskforce has since acquired an inflatable Breast Education Torso.
The Taskforce efforts resulted in a 28% increase in colonoscopies by the end of 2008 and community polyp detection increased by 65% since the beginning of the taskforce efforts.
The total number of cases of colorectal cancer diagnosed rose 50% in one year (2005-27 cases, 2006-40). Our community has on average 30 cases of colorectal cancer found yearly. More than double the previous number of Stage I cases were found in 2006.
Within the first three years of Taskforce initiatives, the number of late-stage cancers fell significantly, and Guernsey County improved to the best statistical category in Ohio, instead of the worst. Our statistics have also shown a consistent decrease in late-stage diagnoses with most years in the 40% range. The 2011 numbers revealed an incredibly low 29% of late-stage diagnoses and the 2013 rate was even lower!
Over the last 9 years, the initiatives have continued. The Taskforce received additional grant money from the American Cancer Society for multiple educational initiatives, which were, in part, used to provide 200 primary care physicians in Southeastern Ohio with a flash drive containing an educational presentation on colorectal cancer and the benefits of appropriate screening.
After nearly 10 years of these efforts, we have seen a decrease in the total number of colon cancer cases with only 16 total cases in 2014 and only 2 late stage cases (12%). The average late-stage rate for other counties in Ohio is 51%.
Colonoscopy numbers continue to trend upward, as do the numbers of polyps being removed in comparison to 2005 – before the colorectal cancer Taskforce began its work.
Our efforts and results have been recognized at local, state and national gatherings. Our initiatives and data have been presented at:
- Commission on Cancer National Meeting
- Colon Cancer Conference at the CDC
- Community Cancer Control in Appalachia Conference
- Prevent Cancer Foundation National Meeting
- Several state meetings
We’ve also received several awards, including:
- American Hospital Association Charitable Services Award of Excellence
- National Colon Cancer Roundtable Blue Star Award
- 80% by 2018 National Achievement Award
Our program has also received the sole Excellence in Mission Award from the East-Central Division of the American Cancer Society for the last three years.
From an advocacy standpoint, the Taskforce has been very involved in efforts to support legislation to improve coverage for colorectal screening by private insurance companies. Taskforce members participated in 2008 American Cancer Society Lobby Day and gave testimony in support of Senate Bill 328, which mandated colorectal screening coverage. The primary care community and the public have responded dramatically to our efforts to increase screening, too.
The educational component to any screening program must be complemented by competent care during the screening process and state-of-the-art treatment of those individuals found to have colon cancer. Our Cancer Program has earned American College of Surgeons Commission on Cancer (CoC) Accreditation for over 20 years.
We monitor quality assurance benchmarks that include:
- Withdrawal time during colonoscopy
- Adenoma detection rates at colonoscopy
- Appropriate follow-intervals for colonoscopy
- Number of lymph nodes harvested at colon resection
- % of colon cancer patients that receive appropriate adjuvant or neo-adjuvant radiation and chemotherapy
Our CoC benchmarks regularly exceed local, state and national levels. This focus on quality care has resulted in a local five-year survival rate for all-stage colon cancer patients of 60.7% (national average 55.2%). More telling, perhaps, is the fact that 96% of all colon cancer patients choose to remain in our community for their care.
Clearly, our small community has shown a definitive improvement in awareness of colorectal cancer screening and real progress in decreasing late-stage diagnoses.
These improvements have been accomplished with minimal resources, without governmental funding, and by fostering relationships with local primary care providers and the American Cancer Society.
Our hope and intent is that our modest efforts could be expanded to state and national initiatives that would:
- Increase public and physician education about the value of screening
- Mandate screening coverage by insurers
- Obtain funding to provide screening and diagnostic colonoscopies to at-risk populations
Each of these initiatives would benefit the total population in preventing many colorectal cancer cases and limiting most to early-stage, more easily treated cancers.
To that end, we have recently renamed our Taskforce the Tina Kiser Cancer Concern Coalition and expanded our cancer education efforts across multiple disciplines.