Need: Colorectal cancer screening is recommended because it is effective in reducing CRC incidence and mortality. Screening rates are suboptimal; Texas remains in the lowest performing quintile of states for colorectal cancer screening. Screening rates remain especially low among CPRIT priority populations, including uninsured, underinsured and socioeconomically disadvantaged individuals, those residing in rural or urban underserved areas, and those receiving care in Federally Qualified Health Centers (FQHCs). Screening rates remain suboptimal due to a range of barriers related to access, navigating the healthcare system and personal social and cultural challenges. In addition, rates are a...

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Need: Colorectal cancer screening is recommended because it is effective in reducing CRC incidence and mortality. Screening rates are suboptimal; Texas remains in the lowest performing quintile of states for colorectal cancer screening. Screening rates remain especially low among CPRIT priority populations, including uninsured, underinsured and socioeconomically disadvantaged individuals, those residing in rural or urban underserved areas, and those receiving care in Federally Qualified Health Centers (FQHCs). Screening rates remain suboptimal due to a range of barriers related to access, navigating the healthcare system and personal social and cultural challenges. In addition, rates are also low in the newly eligible 45- to 49-year-old age group. Consequently, there remains a strong and pressing need for maintenance and continuation of CRC screening programs. The Central Texas Colorectal Cancer Screening Program (CTX-CCSP) is award winning and is designed to comprehensively address colorectal cancer prevention and early detection in a nine-county area of Central Texas located within Public Health Region 7. This region has a population of over 2.8 million spanning across 8,000 square miles. Our service area extends across nine counties (Travis, Williamson, Bell, Burnet, Bastrop, Caldwell, Guadalupe, Fayette, and Gonzales). Overall Project Strategy: The CTX-CCSP utilizes an evidence-based mailed fecal immunochemical test-based approach that has been shown by our team and others to be effective and cost effective in improving screening completion among vulnerable individuals. The program is comprehensive, multimodal and integrates additional evidence-based approaches such as education and navigation to maximize screening completion. The program was established in 2017, expanded in 2020 and is delivered in the second and third largest federally qualified health center systems in Texas. These systems serve over 226,000 individuals across 70 clinics in Central Texas. To date almost 79,400 tests have been mailed, 18,811 screening tests and 737 colonoscopies have been completed. The multimodal program comprises no-cost screening, diagnostic services and patient navigation and is designed to specifically address the barriers experienced by individuals in this region. Program components include a clinic-wide mail out of fecal immunochemical test kits (FITs) to eligible individuals, education and dedicated bilingual navigation to ensure completion of care pathways to diagnostic colonoscopy and treatment if there is a cancer diagnosis. In this next cycle we propose to expand access and maximize impact through increased reach and effectiveness with data driven approaches. In this maintenance expansion we will: 1) expand access to services through addition of outreach and referral components; 2) add new clinical and community partners; 3) integrate tailored evidence-based education and health promotion to enhance overall screening and among groups with the highest risk or lowest participation in screening; 4) enhance navigation to improve longitudinal adherence for FIT and colonoscopy; and 5) expand colonoscopy capacity. Our new partners serve populations experiencing disparities such as safety-net populations, African Americans, refugee populations, recent immigrants and the uninsured. Specific goals: 1) Expand access to an effective multi-modal mailed FIT program serving Central Texas; 2) Integrate new evidence-based health promotion components to improve screening rates; 3) Maximize longitudinal colorectal cancer screening adherence; 4) All patients with abnormal screening results will be navigated to and receive diagnostic testing, and all patients diagnosed with cancer that requires treatment will be navigated into treatment. Achievable targets based on need, capacity, and prior experience are 13,555 total clinical services, 147,055 navigation services and 44,375 direct patient education services. Significance and Impact: Increasing CRC screening in vulnerable patients in Central Texas will reduce CRC incidence and mortality and decrease overall costs of care through reduction in treatment costs. Lessons learned from our expanded mailed FIT program will be used to develop plans for a state-wide CRC program to meet the needs of vulnerable patients throughout Texas. This work helps to move forward the goals of the Texas Cancer Plan to improve CRC screening rates and increase timely access to diagnostics and treatment through the implementation of sustainable and effective programs that prioritize the underserved and reduce cancer disparities throughout Texas.

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