1. 1 TCCAP: a Targeted Awareness Program to Address Colorectal Cancer Disparities in Northeast Pennsylvania Samuel M. Lesko, MD, MPH Regina Schmid-Allen, MHA Laura Toole, LCSW Northeast Regional Cancer Institute, Scranton, PA

2. 2 Acknowledgement Supported by grants from: The Harry & Jeanette Weinberg Foundation, Scranton Area Foundation, Blue Ribbon Foundation, Margaret Briggs Foundation, Sordoni Foundation, Inc., Procter & Gamble Fund, Southern Union Co., Pennsylvania Department of Health, Pennsylvania Department of Community & Economic Development, and in-kind support

3. 3 Northeast Regional Cancer Institute Non-profit, community based organization with a commitment to ease the burden of Cancer in Northeast Pennsylvania. Cancer Registry Research Education and Support Cancer Risk

4. 4 Appalachia Community Cancer Network (ACCN): Appalachian Areas of 7 States (KY, MD, NY, OH, PA, VA, WV)

5. 5 Background Colorectal cancer 4 th most common Ca in US 2 nd leading cause of Ca deaths in US Screening can prevent CRCa deaths Colorectal cancer in NEPA Most commonly diagnosed Ca 2 nd leading cause of Ca death

6. 6 Cancer Cases, NEPA 1998-’02

7. 7 CRCa SIRs, Both Sexes, 1998-’02

8. 8 CRCa, Stage at Diagnosis, Both Sexes Percent

9. 9 TCCAP Goals 1.To improve colorectal cancer screening rates 2.To improve the stage at which new colorectal cancer cases are diagnosed 3.To decrease colorectal cancer mortality rates

10. 10 Methods (1) Awareness Program Multi-faceted Community Healthcare Providers 3-year (2004-2006)

11. 11 Methods (2) Community Advisory Council Ellen Althouse, RN William Auriemma, MD Joseph Bannon, MD Michael Barrett, MD Valerie Bell, RN Maureen Besancon Derry Bird M.R. Chowdhury, MD Edward Dzielak, MD Mary Erwine, RN, MSN Pat Finan Marcie Grello, BS Linda Gutierrez, MD Mrs. Ceil Hughes Rita Ives, RN, AOCN David Kalinoski Jamie Kane Robert Kearns Susan Kennedy Doug Klamp, MD Michael Kondash, MD Lisa Kuter Bob Lamson Pat Lawless, MHA Ina Lubin Gail Matisko, RN, BSN John McGeehan, MD Sally McGuire Judge Carmen Minora Erin Moskel Peter C. Olden, PhD Stacey Ondik Dipti Pancholy, MD Bharat Patel, MD Paul Remick, MD David D. Reynolds, MD Judy Rogers, CRN David Rutta, MD Marie Santilli Karen Saunders Nayan C. Shah, MD Eileen Sharp, PhD Beth Taylor, RN, OCN Kristin Tigue Michael Turock, MD Kim Vangarelli Vera Walline, MPH, CHES Ann Ward Gloria Watson Barbara L. Winters, PhD Robert E. Wright, MD Eileen Zuber

12. 12 Methods (3) Community Interventions Advertisements –Print, Billboards, Broadcast

13. 13

14. 14

15. 15 Methods (3) Community Interventions Advertisements –Print, Billboards, Broadcast Direct Mail –Screen for Life

16. 16

17. 17 Methods (3) Community Interventions Advertisements –Print, Billboards, Broadcast Direct Mail –Screen for Life Printed Materials Educational Programs CASUAL Day

18. 18 SM

19. 19 Methods (4) Healthcare Provider Interventions Didactic Presentations –Grand Rounds –Continuing Ed. Academic Detailing –PCPs

20. 20

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22. 22 Evaluation Questionnaires HCP Follow-up Calls Population Survey Cancer Registry Data

23. 23 Results: Community (1) Community 206 total community programs - 8,017 attendees 46,510 targeted mail pieces 59,725 total pieces of educational materials 38,712,582 total individual market impressions

24. 24 Results: Community (2) Programs 97% Reported Knowledge Gain 96% Planned to Change Behavior Direct Mail 65% Reported Knowledge Gain 86% Planned to be Screened

25. 25 C.A.S.U.A.L. Day 2004-2006 Team Captains – more than 400 businesses engaged Participants – more than 12,000 Money Raised – more than $124,000 raised to support Cancer Institute colon cancer awareness programming

26. 26 Results: HCP (1) Healthcare Professionals 21 hospital-based programs - 852 attendees 9 non-hospital programs - 250 attendees 38 non-physician provider programs - 876 attendees 230 physician “detailing” sessions

27. 27 Results: HCP (2) CME Programs 98% Reported Knowledge Gain 95% Planned to Change Behavior Detailing Sessions 44% Requested Additional Materials 75% Reported increased Patient Request for Screening 70% Reported Increased Screening

28. 28 Prevalence of Screening Lower Endoscopy in NEPA by Year, 2001-2006 Endoscopy < 5 yrs Percent

29. 29 Colorectal Cancer Stage at Diagnosis in NEPA by Year, 1998-2005 Percent

30. 30 Results: Mortality Too Early to Tell!

31. 31 Discussion Community Effort – Media, CASUAL Day 13 Fewer Deaths per Year –Change in Stage @ Dx –Stage-specific Survival –Stable Incidence Duration of effects - Unknown Limitations – –No Control –FOBT Use

32. 32 Implications Sustainable – Cost Modest –$4,102/Year of Life Saved Replicable

33. 33