Session
Promoting Education and Awareness Across the Cancer Continuum
APHA 2022 Annual Meeting and Expo
Abstract
Evaluation of an implementation support program to build the capacity of rural community-based organizations to implement Cancer Prevention and Control Intervention.
APHA 2022 Annual Meeting and Expo
Background: Evidence-based interventions (EBIs) increase cancer screening rates, but the implementation of EBIs is low in rural communities due to lack of capacity for implementation. Rural community-based organizations (CBOs) show great potential for implementing EBIs because they can serve as a link between the community and the healthcare system by providing screening referrals and home health education and by connecting community members to social services. We created an implementation support program to build the capacity of rural CBOs to implement EBIs. The purpose of this study was to deliver and evaluate implementation support program among staff members of rural CBOs.
Methods: Fourteen staff members from two CBOs completed the program. The program consisted of two parts. The first part was an 8-hour didactic focusing on building knowledge and ability to find, select, adapt, and implement EBIs. During the training, the staff at CBOs applied their knowledge to select an EBI for cancer screening and adapt to their community as well as develop an implementation plan for future implementation. The second part was provision of technical assistance while the CBOs implemented the adapted EBI to their clients. The program was delivered either in English or Spanish based on CBOs’ preference. We assessed knowledge and ability to implement EBI pre/post participating in the first part of the program with surveys.
Findings: The CBO staff were all Hispanics and women; slightly over half were English language dominant vs Spanish only (56% vs 44%). The majority had a high school degree (54%) and reported an income of $50,000 or lower (70%). Pre/post participation in the program, participants showed a greater degree of knowledge in EBIs (pre: 31% to post: 100%) and implementation plans (pre: 50% to post: 100%). CBOs ability to select, adapt and implement also increased respectively: select EBI (pre: 65% to post: 100%), adapt EBI (pre: 50% to post: 100%), and use EBI (pre: 57% to post: 92%). The participants also reported that the training was a good learning experience (strongly agree: 100%) and they could apply in their workplace (agree: 18% and strongly agree: 82%).
Conclusion: An implementation support program focused on training and technical assistance for rural CBOs, has potential to build the capacity of rural CBOs to accelerate implementation of cancer prevention and control EBIs in rural communities.
Abstract
Evaluating Academic-community Partnership to Address Cancer Disparities
APHA 2022 Annual Meeting and Expo
Background: The cancer incidence rate is strikingly high in 27 counties identified in upstate New York as our catchment area (CA), at 508.1 cases per 100,000 residents. This is significantly higher than state and national rates (483 and 450.5 cases per 100,000, respectively).
Objective: Describe the Logic Model of an Academic-Community partnership between the Office of Community Outreach and Engagement (COE) and the Community Cancer Action Council (CCAC) of the Wilmot Cancer Institute to reduce cancer disparities among 27 counties in upstate New York.
Methods: Using a community-based logic model, we inform the planning, implementation, and monitoring of academic-community partnership impact on cancer disparities. The logic model components were structured with four aims: 1) Define catchment areas; 2) Foster community engagement; 3) Integrate community with research and clinical trials; 4) Disseminate programs and education. A CCAC was convened to develop community-driven partnerships to inform the Wilmot Cancer Center leadership, strategic planning, outreach, education, and disparities research. The CCAC implements academic-partnership initiatives on voted priority groups: 1) Cancer Prevention and Risk Reduction; 2) Community-Driven Cancer Research; 3) Access to Cancer Care; and 4) Cancer Care and SurvivorshipThe COE team report to the CCAC on our progress using quantitative and qualitative data.
Results: According to the four aims, the impact results are: 1) 85 reports provided, six population-based and internal databases, and two geomapping dashboards; 2) Expansion to 54 CCAC members, 26 bidirectional education sessions, four CCAC community initiatives, and five satellite community offices; 3) 46 projects consulted with COE, six Community Advisory Boards, four COE pilot projects funded and ten translations with community input; and 4) 46 organizations, 23 counties represented, and 80,000 hours in the community. The logic model facilitated collaborative work and made explicit the impact through the academic-community partnership to reduce the cancer burden in our CA.
Abstract
Addressing Lung Cancer Biomarker Testing Through Project ECHO: Results of a Three-State Pilot Project and Early Lessons in Replication
APHA 2022 Annual Meeting and Expo
Despite an unprecedented acceleration of new treatment options for non-small cell lung cancer (NSCLC) that target specific biomarkers, many patients face challenges receiving comprehensive biomarker testing. Many cancer treatment facilities, particularly in community practice settings and in rural communities, are limited in their ability to offer biomarker testing. Often overlapping, these barriers can be categorized as clinician barriers, patient barriers, and system barriers. Stemming from the foundational work identified by the National Lung Cancer Roundtable’s (NLCRT) Biomarker Initiative to optimize the use of NSCLC biomarkers in practice and utilizing the Extension for Community Healthcare Outcomes (ECHO) model, the ACS and NLCRT led a three-state pilot in May 2021 through February 2022. The curriculum addressed these multi-factorial barriers and aimed to help equip learners to implement NSCLC comprehensive biomarker testing in a multidisciplinary setting at their respective institutions.
The project utilized a state-based approach in Kentucky, Georgia, and Mississippi and featured a mix of collective sessions with all three states participating together and sessions that were solely comprised of institutions within each state. The state-based approach allowed each state to customize elements of the curriculum, focusing on their respective unique cultural or payer landscape. More importantly, the state-based approach aimed to foster collaboration and facilitate continued state-wide activities to improve lung cancer biomarker testing, after the ECHO Series concluded.
The project recruited 18 expert faculty members who represent the critical multi-disciplinary stakeholders in biomarker testing, along with recruiting one lead institution in each state to help with recruitment and post-ECHO efforts. Comprised of 21 spoke sites, the spokes mainly represented community cancer programs and rural centers. Additionally, each spoke was instructed to build multidisciplinary ECHO team, with the suggested team including one oncologist, one pathologist, one navigator, one pharmacist, and one proceduralist responsible for tissue acquisition.
The evaluation, which will be completed late summer, will use a mixed methods approach of both quantitative and qualitative and will explore the knowledge and confidence gain, the application of learnings, and the value of state-based approach, including if/how it helped to facilitate continued state-wide activities. Initial results suggest the project was successful in building partnerships both within and across states, and has catalyzed new state and spoke level lung cancer projects. Presently, this project is expanding into nine-states, launching in fall 2022.
Using our real-word experiences, participants will learn the below learning objectives, along with early lessons learned in our project replication.
Abstract
Supporting Cancer Screening and Prevention at Hospital Systems Through the Development of Communities of Practices Teams and a Multipronged Capacity Building Approach
APHA 2022 Annual Meeting and Expo
Background. Cancer is the second most common cause of death in the United States, exceeded only by heart disease. The Hospital System Capacity Building (HSCB) Initiative aims to decrease cancer morbidity by increasing cancer screening and prevention efforts across the United States. The initiative engages representatives from hospital systems, health departments, the American Cancer Society (ACS), and selected community organizations to form Communities of Practice (COP) teams. The COP approach utilizes multi-sector partnerships and the implementation of Evidence Based Interventions (EBIs) to incorporate cancer screening and prevention into each hospital systems’ mission, priority setting, quality standards and investment practices. The initiative supports coordination and collaboration across partners, improves access to care, and leads to comprehensive approaches to cancer screening and prevention. Since the project began in 2019 ACS has recruited and provided capacity building assistance (CBA) to 21 COP teams.
Methods. COP work is grounded by collaborative action plans (CAPs) updated annually by COP teams, and supported and reviewed by ACS staff and subject matter experts (SMEs). CAPs include the project aim, EBIs and activities, and how partners will collaborate to implement work. The work of each COP team is supported by a multipronged CBA approach provided through our national office, regional staff that sit on each COP team, and SMEs. CBA is conducted through quarterly calls with SMEs, monthly calls with national staff, resources to support EBI implementation, webinars, and peer to peer learning including project ECHO. Project evaluation includes tracking and monitoring EBI implementation, measuring system-level cancer screening and vaccination rates, and other key partnership related outcomes.
Results. Seventeen sites implemented 148 activities in support of 61 EBIs in 2021. Sixty-seven percent of the 15 sites for whom we have screening data saw increases in their cancer screening or HPV vaccination rates. This is especially significant given the ongoing impact of COVID-19 on cancer prevention and screening rates.
Conclusion. 2021 screening rates and evaluation data demonstrate the success of the COP approach in supporting hospital systems in incorporating cancer prevention and screening interventions. The partnerships developed, and EBIs implemented supported most systems in increasing rates despite COVID-19. Results indicate that the COP approach and CBA model used could be 1) adopted by other hospital systems across the country to support cancer screening and prevention efforts and 2) applied across different systems and topic areas to support the development of multi-sector partnerships and implement EBIs.
Abstract
Combating Cancer in the Maasai Mara: Sustainable Clinics & Homesteads
APHA 2022 Annual Meeting and Expo
To fight the growing cancer epidemic among the XX Conservancy of southern Kenya, we are currently launching a culturally competent program, the Allied Response against Cancer (ARC), that works hand-in-hand with conservancy members to implement practical solutions. Our program is tripartite: 1) launch an educational campaign on awareness of cancer risk factors, 2) develop a conservancy-wide cancer screening and prevention clinic, and 3) implement novel sustainable homesteads to combat environmental, behavioral, and nutritional risk factors. The educational portion of our initiative tackles the issue at an individual and interpersonal level and lays the groundwork for our other two solutions. Topics for education include HPV vaccination to avoid cervical cancer, learning how to perform quick, non-invasive self-testing procedures, and teaching local medicine men and women, who primarily use herbal interventions, more about basic modern medicine techniques. Then, we aim to establish a mobile pop-up clinic that can perform annual and low-cost screenings based on the American Society of Clinical Oncology resource stratified guidelines for prostate, cervical, colorectal, esophageal, and lung cancers, the most prevalent types in this area. HIV vaccinations would also be available through the clinic. Finally, we would like to introduce a slightly modified homestead with the following features: ventilation by adding windows and raising the ceiling to avoid biomass carcinogens, a keyhole garden that allows for the growth, consumption, and selling of nutritionally fortified crops, and a way to collect potable water. We aim to measure the outcomes of this program by conducting community interviews for the educational portion, vaccination and screening results from the clinic, and by measuring the rate of adoption of the homesteads and indoor carcinogen levels. This project, recently accepted and funded by the Clinton Global Initiative and backed by our home institution, has required considerable international collaboration. The design and implementation process of this program offers key new insight into how to implement effective international cancer prevention strategies, particularly in rural, low-resource communities.
Abstract
Diversification of the research workforce utilizing community-engaged research pipeline programs for underrepresented minority (URM) students
APHA 2022 Annual Meeting and Expo
Diversifying the cancer workforce is critical for addressing cancer inequities. One opportunity to achieve this is by creating educational and training opportunities for underrepresented minority (URM) students. The Outreach Core of the U54 Partnership between the Dana-Farber/Harvard Cancer Center and the University of Massachusetts Boston offered URM students a 12-week paid internship on community outreach and/or community-engaged research from 2015-2021. The program included journal clubs, professional development, networking opportunities, and long-term mentoring.
We interviewed 17 of 28 internship participants from October 2020 to February 2021. Students shared details of achievements, challenges faced, skills developed, career goals, and aspirations. Professionally transcribed interviews were managed with Nvivo 12 and analyzed using a reflexive thematic analysis approach.
Almost all interns identified as women and as first-generation college students. Participants described several benefits, including exposure to a new field and potential career paths, increased confidence, expanded personal and professional networks, and enhanced professional skills. Key program elements highlighted as critical included flexibility around other personal commitments, accommodating travel, and paying interns enough to allow for participation. The multi-level mentoring model (including peers, U54 faculty and staff, and program alumni) was seen as core to program success.
The opportunity for URM students to participate in community engagement and outreach internships can help support the diversification of the cancer research workforce, but only if program offerings sufficiently account for the strengths and needed supports of the early career individuals participating.
Abstract
Undergraduate Gaining Research Opportunities to increase the
APHA 2022 Annual Meeting and Expo
Pipeline programs have shown promise in helping students from groups underrepresented in science access research careers. However, basic science pipeline programs far outnumber socio-behavioral and epidemiological-related pipeline programs. Undergraduates Gaining Research Opportunities for the Cancer Workforce (U-GROW) fills this gap. The new year-long program, a partnership between Cedars-Sinai Cancer Center (CSC) and seven Los Angeles-area California State University (CSU) campuses, facilitates undergraduate training in socio-behavioral cancer research for a population that identifies as 78% students of color and a little over 50% first-generation.
U-GROW began with a week-long Summer Symposium (SS) focused on developing student scientist identity. At the SS, faculty members presented their research and explained how they navigated the “hidden curriculum of academia as people from minority backgrounds. Trainees then participated in a mentored, paid internship in cancer socio-behavioral research with CSC and CSU faculty. Throughout the summer, U-GROW engaged and educated students’ support networks, by inviting family members to events to meet internship mentors and celebrate trainees’ accomplishments. Training and outreach will continue year-round, through science communication coursework and individual mentoring, as U-GROW’s pilot cohort applies to graduate school.
Preliminary results show measurable increases in perceived confidence in scientist identity, increased knowledge about research into health education and promotion as a result of immersive internships, and improved intent to pursue a graduate degree.
The next steps include conducting and evaluating the rest of the year-round curriculum: monthly science communication workshops and quarterly webinars, and applying lessons from the evaluation of all program components to next year’s plans.
Abstract
Insights for Early Detection and Prevention of Stomach Cancer among At-Risk Asian Americans: Results from Qualitative Interviews with Healthcare Providers
APHA 2022 Annual Meeting and Expo
Background: Asian Americans are experiencing disparities in stomach cancer mortality and incidence, with Chinese, Korean, and Vietnamese (CKV) American immigrants at particularly high risk when compared to non-Hispanic white Americans. Insufficient stomach cancer screening guidelines in the United States (U.S.) may contribute to lack of clarity for healthcare professionals around when and how to recommend stomach cancer screening and prevention practices for their at-risk patients.
Objective: To examine how healthcare professionals serving CKV American communities navigate offering stomach cancer and Helicobacter pylori (H. pylori) (a risk-factor for stomach cancer) screening to their patients.
Methods: This qualitative study drew on key informant interviews with healthcare providers and community leaders (n=14) serving CKV communities in Southern California. Interview guides were developed based on existing literature and the Health Belief Model. Analysis involved thematic analysis of transcripts to determine major and minor themes.
Results: Healthcare providers mainly considered symptoms and family history, although some considered other risk factors related to ethnicity and education when considering when to recommend H. pylori and stomach cancer screening. Major barriers to recommending stomach cancer screening for CKV individuals included lack of national guidelines and, concurrently, challenges with insurance coverage. Physicians suggested more widespread H. pylori testing, culturally relevant education, and updated screening guidelines for stomach cancer prevention for Asian Americans.
Discussion: Updated guidelines for stomach cancer screening and prevention that are specific to high-risk racial and ethnic groups are likely necessary to lower the burden of stomach cancer incidence and mortality among CKV Americans and reduce disparities.
Abstract
Cancer resources and needs assessment of immigrant communities in New York
APHA 2022 Annual Meeting and Expo
Background: Immigrants and foreign-born individuals, many with limited English proficiency (LEP) and low socio-economic status, account for over a third of the population in New York City. While data on cancer incidence and mortality are widely available, information on cancer-related social and behavioral priorities, knowledge, and resources among immigrant, low-income, LEP communities is sparse.
Methods: Through a health resources and needs assessment survey, our project engages community stakeholders to identify multilevel determinants surrounding cancer disparities, as well as to assess resources available to adults within NYU Langone’s Perlmutter Cancer Center (PCC), an NCI-funded Comprehensive Cancer Center, catchment area focusing on racial/ethnic minority and immigrant populations. The survey questionnaire was informed by community input and includes harmonized measures across questionnaires from other NCI-designated Centers; surveys are translated into 8 languages: Arabic, Bangla, Chinese, Haitian Creole, Korean, Spanish, Russian, Urdu. Data collection is ongoing through paper survey and Open REDCap (n≈2000). Participant recruitment strategies are tailored to survey hard-to-reach, LEP communities engaging a team of Community Health Workers with strong community connections and cultural knowledge.
Results: A majority of participants are female (63%), foreign-born (72%), and speak a language other than English at home (79%). Over half of participants are on public insurance (53%) and 16% have no health insurance. Preliminary data suggest lack of insurance and food insecurity are associated with lower adherence to cancer screening guidelines. Additional analyses will explore cancer screening attitudes and behaviors, medical mistrust, and the impact of COVID-19 on cancer screening and care. Data collection is expected to conclude in July 2022. The presentation will include the full data collected.
Conclusions: Results from this survey will help to determine community-driven cancer-related priorities and available resources among under-resourced immigrant communities and will contribute to strategic planning for the PCC to meet the needs of this population.