Need Despite the availability of effective primary and secondary prevention interventions, the morbidity and mortality related to colorectal and cervical cancer remain high. In Harris County, Texas, a county with over 4 million residents, colorectal cancer (CRC) is the second leading cause of cancer-related mortality for men and women combined and has an incidence of 49.3 per 100,000 in 2009 (slightly higher than the statewide incidence of 48.9 per 100,000). Cervical cancer (CxC) has an incidence of 11.1 per 100,000 (significantly higher than the incidence of 10.4 per 100,000 for Texas as a whole), despite the fact that there is a highly effective screening tool.

For both CRC and CxC, the bu...

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Despite the availability of effective primary and secondary prevention interventions, the morbidity and mortality related to colorectal and cervical cancer remain high. In Harris County, Texas, a county with over 4 million residents, colorectal cancer (CRC) is the second leading cause of cancer-related mortality for men and women combined and has an incidence of 49.3 per 100,000 in 2009 (slightly higher than the statewide incidence of 48.9 per 100,000). Cervical cancer (CxC) has an incidence of 11.1 per 100,000 (significantly higher than the incidence of 10.4 per 100,000 for Texas as a whole), despite the fact that there is a highly effective screening tool.

For both CRC and CxC, the burden of disease is highest among the medically underserved, who lack access to critical screening, diagnostic, and therapeutic services. This population represents a large proportion of Harris County’s population, with 31% of the adult population lacking health insurance in 2010.

To address CRC and CxC disparities in Harris County, in 2010 we proposed to establish a joint collaboration of key institutions to empower medically underserved residents to seek and obtain CRC and CxC screening and follow-up diagnostic and therapeutic services. In Harris County, the Harris Health System (HHS) operates an integrated health system that provides quality healthcare to the county’s large population of uninsured and underinsured residents. However, while HHS provided CRC and CxC screening and diagnostic services prior to 2010, 71% of CRC screening-eligible and 62% of CxC screening-eligible patients did not receive the recommended screening tests. Furthermore, follow-up rates for necessary diagnostic and therapeutic procedures among screen-positive patients were sub-optimal, with over 50% of patients with abnormal CRC screening tests and 40% of patients with abnormal CxC screening tests being lost-to-follow-up.

The Community Network for Cancer Prevention (CNCP) established with the initial CPRIT award used an innovative strategy to drive dramatic improvements in CRC and CxC screening in Harris County. The strategy included a community theater program to conduct outreach and education within the larger community, evidence-based point-of-care videos and didactic materials at HHS community health clinics to effectively educate the patient population, and a comprehensive patient navigation system to increase uptake of CRC and CxC screening tests and improve follow-up to diagnosis and treatment among screen-positive patients. Over the project period, the proportion of eligible HHS patients who completed CRC and CxC screening increased by 250% and 130%, respectively, while the loss-to-follow-up rate dropped to 0% through the diligent efforts of the CNCPs’ Patient Navigation Team.

In the proposed Expansion Project, we will to continue the highly successful model of the CNCP and expand its reach to include new venues within HHS and new collaborating charitable and community-based institutions. The goals of the expansion project are to 1) provide outreach and education regarding CRC and CxC prevention and screening guidelines and services to medically underserved residents of Harris County, Texas; 2) increase access to and utilization of CRC and CxC screening services for Harris County residents who obtain healthcare services through HHS and collaborating institutions; 3) expand the referral and follow-up system for patients with abnormal CRC and CxC screening tests to additional sites within HHS and to collaborating charitable institutions; and 4) promote continuous performance improvement through ongoing process evaluation and reporting.

The proposed expansion will entail the development of new cancer education tools and materials to better suit the needs of specific collaborators and sectors within the served population. Additionally, we propose key programmatic changes that will improve the CNCP’s potential for long-term sustainability, including a shift to a more sustainable Theater Outreach Program for community outreach and education and a smaller but more efficient Patient Navigation Team. Through the project’s Theater Outreach Program, deployment of point-of-care videos and educational materials, and comprehensive patient navigation system, we will serve over 340,000 Harris County residents.

The expansion of the CNCP’s target audience and programmatic materials will lead to a significant increase in the number of medically underserved residents who obtain CRC and CxC screening and subsequent diagnostic and therapeutic procedures as needed. These efforts will contribute to the CPRIT’s goals to reduce deaths and number of new cases of CRC and CxC through screening and early detection. Most importantly, it will help reduce the unjust cancer health disparities that continue to hinder Texas’ and the nation's commitment to health equality.

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