Colorectal Cancer Trends Increasingly Younger at Age of Diagnosis, Making Effective Early Intervention Critical

Pharmacy Times® interviewed Kimlin Tam Ashing, PhD, a professor and founding director of the Center of Community Alliance for Research & Education (CCARE) at City of Hope, who is a leader in examining health disparities, cancer inequities, survivorship, and quality of life in oncology care and presented her research at the 114th Annual Meeting of the American Association for Cancer Research (AACR). Ashing presented at AACR on how interventions in ethnic minority communities elucidate strategies for increasing colorectal cancer screenings, and how community outreach and engagement increases colorectal cancer screening in ethnic minority communities.

Pharmacy Times: Why was colorectal cancer screening a particular focus for your team at City of Hope?

Kimlin Tam Ashing, PhD: Colorectal cancer has been on the increase across the US and actually globally. So, it's critically important to address prevention. In particular, it's one of the cancers in the sense that we have screenings that actually could detect the cancer before it spreads. We can detect even cellular changes before it becomes cancer, which is the colonoscopy. So, it's one of the cancers that we can really make an impact on in terms of prevention, early detection, and screening and saving lives. We see a trend for earlier stage of diagnosis if we screen appropriately.

Unfortunately, it’s one of the cancers where we see a trend in increasing younger age of diagnosis. So, we are particularly excited that the US Preventive Task Force has reduced the age from 50 to 45. And so, we want to make that very much a part of the public awareness and domain for cancer prevention.

Pharmacy Times: Could you tell me more about the multi-component intervention between October 2020 and October 2022?

Ashing: Yes, so understanding that there multi-level factors that influence colorectal cancer screening, as well as other cancer screenings, right? So, we understand that the system level factors are critically important. We looked at Federally Qualified Health Centers [FQHCs], which are federally qualified health clinics, to provide much of the preventive care for our medically underserved populations. So, that was one of the target groups in terms of working with workflows and physician recommendation that has been deemed as evidence-based increased colorectal cancer screening.

We know that public awareness is critically important, so we leveraged our ethnically focused media because our population who tend to be more likely to be not up to date with screening or lacking access to care—we promoted this through several media campaigns that target various Asian communities, the African American community, the Latinx community, through radio, local television, as well as social media to reach those populations so that there is increased awareness of colorectal cancer, colorectal cancer screening, and the importance of early detection and screening. So, we implemented also the multimedia campaign.

We also worked with community leaders in the various organizations that we partner with, including nurse associations and local advocacy organizations. So, we were able to train and activate their community advocates, their community leaders so that they can spread the word about colorectal cancer screenings. So, it’s multi-component, addressing the different aspects of the clinic system, the provider communication, activating applicants to spread the word, and also public media campaigns, so capturing people where they are to activate them into screening.

Pharmacy Times: Would these interventions be possible to implement without partnership with FQHCs and community and faith-based organizations?

Ashing: I think as cancer centers, we can make some impact alone, but we can go much further together. We really need to include those who are boots-on-the-ground, who have trust and credibility and trustworthiness in the community. So, partnering with the organizations that can help us do the important work of addressing cancer burden and disparities in our communities, I think it’s critically important, these partnerships. As comprehensive cancer centers, we are doing an incredibly good job of working in communities as community outreach and engagement staff and experts, but we need the partnerships in order to reach are very, very hard to reach population and those communities for whom there are various, including lack of awareness of cancer screening.

There may be beliefs around cancer that needs to have someone who is a community gatekeeper to, you know, actually challenge some of those beliefs. The fact that many communities still tend to think that cancer screening is looking for cancer, so that if you screen, you're actually gonna find something that doesn't exist. And so, there may be these beliefs that need to be appropriately respected but challenged, and say, that cancer screening actually detects changes that could become cancer or are already cancerous. And that this can allow you to have timely treatments, preventive treatments if it's pre-cancerous, as well as reduce the burden and the challenge and the human impact of extended cancer treatments if we find it early, and extend lives and improve quality of life. So, we need these trusted community partners to also work with us to address the cultural as well as the community barriers. And we also need the systems to address the system barriers, just looking at the importance of physician reminders, that every opportunity for an in-person visit or virtual visit is an opportunity to recommend cancer screening that’s due.

Pharmacy Times: What were the results of the multi-component interventions during the 2-year study period, and how were these results assessed?

Ashing: Yes, so we found that our multi-prong intervention was effective in addressing the physician priority of recommending cancer screening, that these health systems were very much welcoming and realized that there are opportunities for improvement, right—quality improvements in terms of cancer screening recommendations. And so, we found that, based on this intervention, that we were able to screen an additional almost 600 persons that would not have been screened without the intervention. And so, we were very rigorous and conservative in our analyses. And we also found that, of course, where you would find that the community clinics that were really challenged to address colorectal cancer screening, that they had important improvements, but that there are system changes, right, and system differences that need to be recognized, because not all clinics start at the same point. And some clinics may need longer intervention, additional support for workflows to increase the cancer screening, so that it gets to be at least the Healthy People recommendation.

Pharmacy Times: For organizations interested in establishing similar interventions to improve colorectal cancer screening, how would you recommend they start this process and find the right partnerships to have a significant impact in their communities?

Ashing: It's important to partner with community organizations. I think making contact—most community organizations in our experience are ready and willing to partner. Our community leaders recognize that cancer screening and prevention is under-addressed and understudied in our marginalized and minoritized communities. So, they are ready and willing. It just takes the brave step of reaching out to community partners. I think organizations such as the American Cancer Society, is a great partner to introduce cancer centers and researchers to community partners who are willing.

Also, our FQHC partners are also very open to quality improvement. These are important metrics for these centers to report, so they are very, very willing to partner. And, I think, an openness to dialogue—so before we started, we actually worked with these community partners in developing the project and developing the protocol. In terms of responding to what the needs are, I think it's important to reach out and get feedback and input from all of the sectors who are going to be impacted by the intervention and have them at the table so that we are both listening and responding to the needs of the community.