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• W2007350547 abstract "Colorectal cancer (CRC) remains a major health issue in the United States and accounts for a staggering financial burden on the medical health care system.1Luo Z. Bradley C.J. Dahman B.A. et al.Colon cancer treatment costs for Medicare and dually eligible beneficiaries.Health Care Financ Rev. 2010; 31: 35-50PubMed Google Scholar, 2Lansdorp-Vogelaar I. van Ballegooijen M. Zauber A.G. et al.Effect of rising chemotherapy costs on the cost savings of colorectal cancer screening.J Natl Cancer Inst. 2009; 101: 1412-1422Crossref PubMed Scopus (150) Google Scholar We know the data. CRC represents the third most common cancer in the United States and is the second leading cause of cancer-related deaths. According to American Cancer Society data, in 2011, an estimated 141,000 new cases of CRC will be diagnosed, and of those approximately 50,000 will die of the disease.3Cancer facts & figures 2011-2013. American Cancer Society, Atlanta (Ga)2011Google Scholar The good news is that numerous studies have shown that adherence to screening protocols can lead to early detection and removal of precancerous polyps, thereby decreasing the incidence of CRC.4Edward B.K. Ward E. Kohler B.A. et al.Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening and treatment) to reduce future rates.Cancer. 2010; 116: 544-573Crossref PubMed Scopus (1490) Google Scholar Over the past 2 decades, the use of such screening modalities as fecal occult blood testing, sigmoidoscopy, double-contrast barium enema, and the criterion standard, colonoscopy, has contributed to a significant decrease in CRC. The bad news is that despite favorable strides in overall screening adherence rates and early detection and removal of precancerous polyps, less than 65% of average-risk individuals older than the age of 50 are getting screened.5Colorectal cancer screening-United States, 2002, 2004, 2006 and 2008.MMWR Morb Mortal Wkly Rep. 2011; 60: 884-889PubMed Google Scholar Even more disappointing is that numerous studies suggest that significant disparities in CRC screening rates continue to exist across racial/ethnic groups, educational levels, socioeconomic status, and geographic locations.3Cancer facts & figures 2011-2013. American Cancer Society, Atlanta (Ga)2011Google Scholar, 5Colorectal cancer screening-United States, 2002, 2004, 2006 and 2008.MMWR Morb Mortal Wkly Rep. 2011; 60: 884-889PubMed Google Scholar, 6Cancer mortality among American Indians and Alaska Natives—United States, 1994-1998.MMWR Morb Mortal Weekly Rep. 2003; 52: 704-707PubMed Google Scholar These trends translate into potentially higher CRC incidence and mortality in these populations. To a large degree, much of what we know about CRC screening disparities is based on more than a decade of studies that have shown low screening/high mortality rates among different racial/ethnic groups in the United States, particularly African American and Hispanic populations.3Cancer facts & figures 2011-2013. American Cancer Society, Atlanta (Ga)2011Google Scholar, 6Cancer mortality among American Indians and Alaska Natives—United States, 1994-1998.MMWR Morb Mortal Weekly Rep. 2003; 52: 704-707PubMed Google Scholar In this issue of Gastrointestinal Endoscopy, Redwood et al7Redwood D. Provost E. Perdue D. et al.The last frontier: innovative efforts to reduce colorectal cancer disparities among the remote Alaska Native population.Gastrointest Endosc. 2012; 75: 474-480Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar present interesting findings on the incidence and mortality of CRC in Alaska Natives (ANs). The authors' data are punctuated by their reporting of cancer as the leading cause of death among ANs, and, similar to national trends, CRC is the second leading cause of cancer-related deaths in this population.8Day L.W. Espey D.K. Madden E. et al.Screening prevalence and incidence of colorectal cancer among American Indian/Alaskan natives in the Indian Health Service.Dig Dis Sci. 2011; 56: 2104-2113Crossref PubMed Scopus (18) Google Scholar Consistent with previously published data on other minority populations, low screening rates are often at the forefront of high CRC incidence and mortality rates in ANs.5Colorectal cancer screening-United States, 2002, 2004, 2006 and 2008.MMWR Morb Mortal Wkly Rep. 2011; 60: 884-889PubMed Google Scholar, 9Burgess D. van Ryn M. Grill J. et al.Presence and correlates of racial disparities in adherence to colorectal cancer screening guidelines.J Gen Intern Med. 2010; 26: 251-258Crossref PubMed Scopus (34) Google Scholar, 10Schumacher M.C. Slattery M.L. Lanier A.P. et al.Prevalence and predictors of cancer screening among American Indian and Alaska native people: the EARTH study.Cancer Causes Control. 2008; 19: 725-737Crossref PubMed Scopus (67) Google Scholar In this issue, Redwood et al present data from 3 pilot projects conducted between 2005 and 2010 that aimed at increasing CRC screening rates among a large population of ANs living in rural and remote areas. The motivation for the programs arose from a retrospective review of medical records at the Alaska Native Medical Center in the late 1990s that revealed a 10% CRC screening rate for average-risk individuals. The pilot projects focused on 3 different modes of intervention: endoscopy, first-degree relative outreach, and patient navigation. The study cohorts were members of the AN population, which includes members of the Eskimo, Aleut, and American Indian ethnic groups. The authors used lower endoscopy as the preferred screening method because the high prevalence of Helicobacter pylori–associated hemorrhagic gastritis presented interpretation challenges with the routine use of fecal occult blood testing. Recognizing that limited access to remote areas of Alaska (reachable only by small aircraft, snow mobiles, and boats) posed a major obstacle for both patient and provider transportation to service those clinics, efforts were made to implement endoscopic training of mid-level health care providers to perform screening flexible sigmoidoscopies at small clinics and regional hospitals that comprised parts of the Alaska Native Tribal Health Consortium (ANTHC). Redwood et al report a fivefold increase in AN screening rates from 10% to 47% between 2000 and 2003. They further report that subsequent growth of the program led to the development of a successful screening colonoscopy program in rural field clinics. Redwood et al further present data from an outreach program initiated in January 2007, aimed at first-degree relatives of CRC patients identified in the ANTHC. A systematic process was initiated in which CRC patients were asked during hospital or follow-up visits for a contact list of first-degree relatives in need of screening. The information was maintained in a computerized database and used to contact relatives by phone or mailings. A listing of first-degree relatives was also sent annually to regional tribal medical directors for additional outreach from their facilities. As of March 2011, the database consisted of 588 CRC patients and 1446 first-degree relatives. The authors present several interesting findings. First, of the 655 first-degree relatives due for screening, 465 had already been screened, 202 were too young for screening, and 124 had missing contact information. Second, 236 first-degree relatives were screened for CRC as a result of the outreach program. In this latter group, approximately 35% were found to have precancerous polyps or CRC. Finally, the authors report data from an 11-month patient navigation program implemented in April 2009. In partnership with a regional tribal health organization, the ANTHC developed the CRC Screening Patient Navigator Demonstration Project. A patient navigator was instrumental in performing phone screening of average-risk, asymptomatic patients and assisting with all aspects of screening logistics including appointment scheduling, addressing questions related to the colon preparation and procedure, arranging transportation, and tracking screening results to ensure proper follow-up. The authors observed patient navigator outreach to 336 individuals via a combination of phone calls, letters, e-mails, and provider contacts. At the end of the program, only 46 patients (14%) underwent CRC screening as a result of navigator assistance, and 22 referrals (6%) were still pending. Redwood et al7Redwood D. Provost E. Perdue D. et al.The last frontier: innovative efforts to reduce colorectal cancer disparities among the remote Alaska Native population.Gastrointest Endosc. 2012; 75: 474-480Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar present an observational study of pilot programs aimed at increasing the rate of CRC screening in the AN populations living in remote, difficult-to-reach areas of the state. Perhaps the most important element of their study is the grassroots approach in which they chose to address the major health concern of disparities in the rate at which ANs were getting screened for CRC compared with the study benchmark of the U.S. white population. The authors identified 3 key barriers to screening for the rural AN population: paucity of trained endoscopists, poor transfer of family history information, and logistically challenging navigation through the local health care system. The endoscopy pilot project sought to train mid-level health care providers to perform a service (ie, lower endoscopy) that few could provide in the rural geographic setting. The first-degree family outreach program aimed to contact and educate families of CRC survivors of the increased importance of screening for the disease. Last, the patient navigator project worked directly with average-risk patients to educate them about the benefits of screening colonoscopy and then further assist them with a series of steps to complete the process of screening and follow-up. Common to each of these efforts was an attempt to connect directly with the patient and family and delivery of the desired service (lower endoscopy) to the target population. The study encountered familiar roadblocks previously described in other rural and urban settings.6Cancer mortality among American Indians and Alaska Natives—United States, 1994-1998.MMWR Morb Mortal Weekly Rep. 2003; 52: 704-707PubMed Google Scholar They include high staff turnover, difficulty transporting patients to appointments, system-level inefficiencies that turned patients away, and variability in patient follow-up. Overall, Redwood et al set out to improve adherence to CRC screening rates among the AN population and accomplished that goal through a series of hands-on, grassroots programs focused on the patient and family. Although the positive intent and outcome of the programs are noted, it is disappointing that the success of the programs, like many of their kind, relied heavily on funding for manpower. The initial sigmoidoscopy screening project dwindled after losing all but one of the program's endoscopy-trained nurse practitioners who ran the clinic. The take-off colonoscopy screening program that followed used itinerant endoscopists who were incentivized to perform a respectable 290 colonoscopies on age-appropriate adults who perhaps would not otherwise have been screened. A 2-tiered payment schedule is described, but brings to mind the question: what if funding had not been available? Like most service-based industries, capital generally begets service. But does not the honor of being a physician command more than simple reliance on a fee-for-service structure? What if we as gastroenterologists challenged ourselves to be less focused on the next health care reimbursement and considered volunteering a small amount of time and endoscopic talent to programs such as the one described by Redwood et al? Perhaps the most successful outcome of the program is continued use, to this day, of itinerant endoscopists to further the colonoscopy screening program. The authors mention that funding is essentially left to the individual health care systems. Hypothetically, if 10 gastroenterologists in nearby major metropolitan areas in Alaska volunteered a half day of colonoscopy screening per month (assuming 8 patients per half days of colonoscopies), 80 additional patients per month, or 960 additional underserved patients could be screened per year. The existing funding could then be used for more patient education and community-based outreach programs. When viewed from the perspective of the larger, national GI community, the numbers could be even more impactful. The American Society for Gastrointestinal Endoscopy boasts a membership of more than 11,000 members. If half this number of gastroenterologists donated 1 half day per year to screening at-risk, low-income individuals, as many as 44,000 individuals could be screened for CRC. To say that disparities in screening and other aspects of medicine are problematic and in need of change is one thing. I would assert that looking from the paradigm of choosing service over reimbursement has the ability to make a change that is exponentially impactful. Certainly, the road to becoming a physician is a long and arduous educational path, fraught with long hours, delayed financial gratification, time away from family and friends, psychosocial stressors, and the huge burden of educational debt.11West C.P. Shanafelt T.D. Kolars J.C. Quality of life, burnout, educational debt and medical knowledge among internal medicine residents.JAMA. 2011; 306: 952-960Crossref PubMed Scopus (425) Google Scholar, 12Hendrie H.C. Clair D.K. Brittain H.M. et al.A study of anxiety/depressive symptoms of medical students, housestaff and their spouses/partner.J Nerv Ment Dist. 1990; 178: 204-207Crossref PubMed Scopus (51) Google Scholar Understandably, all of these factors portend the expectation of reward at the end of the journey. This we call a good solid job with financial security. Therefore, in a climate of decreasing health care reimbursements, the notion of volunteering a small amount of one's time and service, at a glance, appears idealistic, archaic, and perhaps reminiscent of the ancient days of the Father of Medicine, Sir William Osler.13Osler W. A note on the teaching of the history of medicine.Br Med J. 1902; 2: 93Crossref PubMed Scopus (14) Google Scholar The current and ever-changing health care environment is obviously worlds apart from that observed during the era of Osler; however, the basic tenet and challenge to physicians to serve remains the same. I do not propose that physicians become martyrs to their field and forgo the prospect of enjoying the financial fruits of many years of labor. I do propose, however, that if we as a GI community are truly committed to making a difference in the financial and access aspects of health care disparities, giving a small amount of time and effort to combat the problem has long-reaching implications and life-saving potential. It is clear that volunteerism is only part of the story. This is but 1 way to change the deck of the cards. The approach to addressing disparities on any level of health care deliverance is multitiered by design and necessity. On a legislative policy level, it is important that organizations such as the American Society for Gastrointestinal Endoscopy continue to have a presence on Capitol Hill and lobby for provisions such as the Colorectal Cancer Screening, Prevention, Early Detection and Treatment Act and the Preventive Services Provision of the Affordable Care Act. From a public health perspective, the Centers for Disease Control and Prevention must continue to be instrumental in providing funding for a host of community programs targeted at removing financial barriers to screening, such as funding more screening programs across the country. These legislative and public health efforts are indeed essential, imperative, and not to be undermined; however, the million dollar question is whether the resources are trickling down adequately to the key people for whom they are intended? The findings reported by Redwood et al lend credence to the utility and potential success of reaching out to low-screening/high-mortality groups on the most local of levels.14Coombes J.M. Steiner J.F. Bekelman D.B. et al.Clinical outcomes associated with attempts to educate patients about lower endoscopy: a narrative review.J Community Health. 2008; 33: 149-157Crossref PubMed Scopus (14) Google Scholar Would more effort focused on building alliances with grassroots organizations such as community churches and civic organizations, which have key positions of influence and access to minority populations, make CRC understandable, tangible, personal, and, most important, preventable? Research reported by vast health care systems such as the Veterans Affairs hospitals and Medicare have taught us that screening disparities persist despite presumably equal access to health care for all members.6Cancer mortality among American Indians and Alaska Natives—United States, 1994-1998.MMWR Morb Mortal Weekly Rep. 2003; 52: 704-707PubMed Google Scholar, 15Lasser K.E. Murillo J. Lisboa S. et al.Colorectal cancer screening among ethnically diverse, low-income patients.Arch Intern Med. 2011; 171: 906-912Crossref PubMed Scopus (161) Google Scholar Negative cultural opinions about the CRC screening process and the health care system as a whole may taint desires to comply with screening recommendations, even in the best of circumstances.16Anathakrishnan A.N. Schellhase K.G. Sparapani R.A. et al.Disparities in colon cancer screening in the Medicare population.Arch Intern Med. 2007; 167: 258-264Crossref PubMed Scopus (110) Google Scholar No doubt there are many strides to be made in addressing the complexity of reasons why disparities in CRC screening still exist across several ethnic/minority groups in this country. So where do we go from here? The observational study presented by Redwood et al, like others before it, highlights the success that can come out of well-organized grassroots programs aimed at reaching screening-eligible adults across all ethnic/racial, sex, and socioeconomic backgrounds. On a small scale, Redwood et al provide evidence that even in the setting of global health care changes, large-scale impacts are often best effected one patient at a time. At the end of the day, it is a team effort—physician volunteerism, organization-sponsored legislative initiatives, research, and grassroots community efforts. Are you choosing to be in the game and play a key part in how the end plays out or to sit on the bench turning a blind eye? Now is the time to be impactful. The author disclosed no financial relationships relevant to this publication. The last frontier: innovative efforts to reduce colorectal cancer disparities among the remote Alaska Native populationGastrointestinal EndoscopyVol. 75Issue 3PreviewThe Alaska Native (AN) population experiences twice the incidence and mortality of colorectal cancer (CRC) as does the U.S. white population. CRC screening allows early detection and prevention of cancer. Full-Text PDF" @default.
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• W2007350547 cites W2069162375 @default.
• W2007350547 cites W2072063446 @default.
• W2007350547 cites W2089300758 @default.
• W2007350547 cites W2105313216 @default.
• W2007350547 cites W2132251912 @default.
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