CARES program aims to increase colorectal cancer screening in Cook County

Last year, the University of Chicago Medicine's new Center for Asian Health Equity received a $3.5 million grant from the Centers for Disease Control and Prevention to increase colorectal cancer screenings in Chicago's Cook County. The grant led to the formation of Cook County CARES (Colorectal Cancer Alliance to Reinforce and Enhance Screening), a partnership between the university and local community health organizations.

Science Life asked The Center's director Karen Kim, MD, professor of medicine, a few questions about the CARES program, and what she and her colleagues hope to accomplish. Kim also serves as director of the University of Chicago Medicine Comprehensive Cancer Center's Office of Community Engagement and Cancer Disparities (OCECD), and has been committed to tackling health disparities in Chicago for nearly two decades.

What is Cook County CARES and what are the program's goals?

The goal of Cook County CARES is to improve colorectal cancer screening in Cook County. Although efforts have been in place to improve colorectal cancer screening, the lack of coordination across different entities diminishes the impact of such efforts. Our organized approach to colorectal cancer screening partners the University of Chicago with community health clinics, public health departments, and insurers.

Through the CARES program, we hope to 1) raise public awareness and knowledge of colorectal cancer prevention; 2) use health information technology to promote colorectal cancer screening among individuals who are between the age of 50 and 75 years; 3) improve adherence to quality colorectal cancer screening and rescreening; 4) integrate population-level and clinical data to improve surveillance for colorectal cancer control and prevention in Cook County; and 5) coordinate resources to create a robust colorectal cancer control and prevention safety net that will significantly increase colorectal cancer screenings and reduce the incidence and mortality rates of colorectal cancer in Cook County.

Why is colorectal cancer screening important, and why are there disparities in screening in some Chicago communities?

Colorectal cancer is the second leading cause of cancer-related deaths in the U.S., when men and women are combined, yet it can be prevented or detected at an early stage through screening. Preventing colorectal cancer, or finding it early, doesn't have to be expensive. There are simple, affordable tests available.

Colorectal cancer screening can find precancerous polyps-abnormal growths in the colon or rectum-so they can be removed before progressing to cancer. Screening also helps reduce deaths due to colorectal cancer. The U.S. Preventive Services Task Force recommends colorectal cancer screening for men and women aged 50 to 75 using high-sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy.

Colorectal cancer disparities are particularly disturbing. Among African Americans, death from colorectal cancer is twice that of other populations, while screening rates are lowest among Asian Americans. Cook County CARES aims to address these disparities through education and targeted screening. It is so important to talk to your doctor about your individual risk and getting screened!

What community organizations are you working with, and how will you work together to achieve the program's goals?

Cook County CARES is housed within the University of Chicago Medicine's Center for Asian Health Equity and collaborates with three Federally Qualified Health Centers (FQHCs): Mile Square Health Center, Heartland Heath Centers, and Asian Human Services Family Health Center. Each health system partner offers a unique perspective, and reflects the diversity of the city. In addition, many serve the most vulnerable and under-screened/served populations.

Our team has worked with our partners to create a system for ongoing communication and feedback with partner leadership and staff. Our health systems and partners have provided baseline screening data. Together, we have developed a specific implementation strategy for each individual health system partner and their individual clinic sites.

What have you accomplished so far, and what is coming up?

We've had multiple planning meetings with project partners, and all partners are now focused on implementing screening interventions.

We hosted a Colorectal Cancer Steward Training Day at the University of Chicago on February 8 for staff from our three partner FQHCs. Training included colorectal education, and walk-throughs of the colorectal screening process, colonoscopy and radiation cancer treatment at UChicago.

On March 31, there will be an 80 by 2018 Colorectal Cancer Roundtable Kickoff Breakfast, which is co-sponsored by the American Cancer Society and held at the Gleacher Center in Chicago. This meeting will host colorectal cancer advocates, organization heads, and medical providers from local, state and national entities to discuss reaching the goal of 80 percent adherence to colorectal cancer screening by 2018 for the age-eligible population (50-75).

Cook County CARES will also oversee a series of workgroups that address different aspects of the colorectal screening initiative.

What data are you collecting and what do you hope it will reveal?

Our health systems and partners provided a year's worth of baseline colorectal cancer screening data, allowing for an accurate colorectal cancer screening baseline rate as a starting point. Regular collection, analysis, and monitoring of colorectal cancer screening rates with our partner health systems will help us understand how our efforts are affecting colorectal cancer screening rates.

Where do you hope to take the program in the future?

Our short-term goals are to decrease disparities, increase colorectal cancer prevention and early-stage colorectal cancer detection, and increase timely and effective treatment for colorectal cancer. Our long-term goals are to decrease disparities in colorectal cancer incidence and mortality in Cook County.

The Cook County CARES is laying the groundwork to form a Colorectal Coalition of Partnerships (CCOP) that will allow messaging to patients and providers as well as training and strategies for process change for providers and health systems beyond the Cook County area.

In year two, we plan to invite collaborators from across the state to join our discussion and share in training and dissemination activities, including:

1. Develop educational and implementation resources that can be shared based on current successes and lessons learned from grant work and our partners.
2. Work with Illinois Primary Health Care Association (IPHCA) to share materials with additional FQHC Health Systems.
3. Host first CCOP event to lay groundwork for messaging to patients and providers about colorectal screening.

In addition, across the three FQHC partner systems a consistent challenge has been the ability to access patient referral results from out-of-network providers. As a result it is hard to track patients with positive test results for follow-up care and access to additional testing if needed. Our CARES team is exploring options for our provider network to provide access to the information as well as follow-up care for the uninsured or underinsured populations.

Finally, one of the goals of our program is to develop a model program to provide equal access to screening and follow-up care for underserved and disadvantaged communities. We are excited to work with a variety of stakeholders to develop and implement programs to provide access to timely and quality colorectal cancer screening for all Illinois residents.