Innovative efforts to reduce colorectal cancer disparities in Alaska Native population
March 06, 2012
"The last frontier: innovative efforts to reduce colorectal cancer disparities among the remote Alaska Native population"
Among the Alaska Native (AN) population, cancer is the leading cause of death, and colorectal cancer (CRC) is the second leading cause of cancer death. For the period 2004 to 2008, the AN age-adjusted CRC mortality and incidence rates were about twice those of the U.S. white population. The AN population also has the highest CRC incidence of all Native American groups, with a CRC incidence that is nearly five times higher than that of American Indians living in the U.S. Indian Health Services Southwest Region. The reasons for these regional disparities are unclear; nonetheless, the morbidity and mortality of CRC can be reduced in all regions by population-based screening and surveillance programs that include endoscopy (colonoscopy and flexible sigmoidoscopy) and fecal occult blood tests. Screening can detect advanced neoplasia (polyps and cancer) and, in the case of endoscopy, can even prevent cancer by removing precancerous polyps.
This study describes pilot projects conducted from 2005 to 2010 to increase CRC screening rates among AN populations living in rural and remote Alaska. Projects included training rural mid-level providers in flexible sigmoidoscopy, provision of itinerant endoscopy services at rural tribal health facilities in which an endoscopist from the Alaska Native Medical Center travelled to remote areas of Alaska to conduct CRC screenings at three regional hospitals, the creation and use of a CRC first-degree relative database to identify and screen individuals at increased risk, and support and implementation of screening navigator services. Patient navigator services include guiding patients through the screening process, encouraging them to obtain screening appointments, calling patients to remind them about upcoming appointments, ensuring transportation plans and answering questions about exam bowel preparation as well as tracking screening results to ensure that appropriate follow-up after the exam was completed.
As a result of these ongoing efforts, statewide Alaska Native CRC screening rates increased from 29 percent in 2000 to 41 percent in 2005 before the initiation of these projects and increased to 55 percent in 2010. The provision of itinerant CRC screening clinics increased rural screening rates, as did outreach to average-risk and increased-risk (family history) ANs by patient navigators. However, health care system barriers were identified as major obstacles to screening completion, even in the presence of dedicated patient navigators. Researchers noted study limitations including continuing challenges such as geography, limited health system capacity, high staff turnover, and difficulty getting patients to screening appointments.
They concluded that the projects described aimed to increase CRC screening rates in an innovative and sustainable fashion and may provide insight for others working to increase screening rates among geographically dispersed and diverse populations.
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