Promoting Colon Cancer Screening New York City Health and Hospitals Corporation

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Promoting Colon Cancer Screening New York City
Health and Hospitals Corporation

• Colorectal Cancer Summit
• Ramanathan Raju, MD, MBA
• June 2008

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Who We Are

• 11 acute care hospitals
• Four Long-Term Care Facilities
• Six Diagnostic and Treatment Centers
• Over 80 Community Health Clinics
• Home care agency (Health and Home Care
• Managed care (MetroPlus)

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Who Do We Serve

• 1.3 million individuals annually
• 1 out of 6 New Yorkers
• 435,000 uninsured patients
• 43 Hispanics, 35 African Americans, 6 Asian,
  6 Caucasian, and 10 Other Minorities
  
• 240,000 patients - age 50 - 75 yrs

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Who Do We Serve

• Ambulatory Care FY 2007
• Total Patients 879,882 5M visits
• - 44 Hispanics 35 African Americans 8
  Asian 6 White 7 Other
  
• - 60 Females 30 aged 45 -
• - 25 Self Pay 46 Medicaid 8 Medicare 8
  Commercial 13 others.

5
Colorectal Cancer Burden

• 1,500 colon cancer deaths each year in NYC
• Significantly higher mortality rates among
  African Americans
  
• 59 of New Yorkers report ever having colonoscopy
  or sigmoidoscopy

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Health Hospitals Corporation Colon Cancer
Screening Guidelines

• Colonoscopy every 10 years is the screening test
  of choice.
  
• Any colon cancer screening is better than no
  test.
  
• FOBT annually or
• Flexible sigmoidoscopy every 5 years or
• Annual FOBT plus flexible sigmoidoscopy every 5
  years or
  
• Double contrast barium enema every 5 years

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Colorectal Cancer Control Initiative

• Four Point Plan to Promote Colonoscopy
• Enhance capacity and improve access
• Enhance provider knowledge and skills
• Enhance public awareness, patient literacy
• Evaluate outcome performance monitoring

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Colorectal Cancer Screening Initiative

• Begun in March 2003
• Colorectal Cancer Screening Workgroup
• Central Office and Facility Leadership
• Colonoscopy as gold standard for the colorectal
  cancer screening
  
• Goal to triple number of screening colonoscopies

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Colorectal Cancer Control Initiative

• Enhancing Capacity
• Personnel
• Gastroenterologists hourly sessions
• Endoscopy Nurse training
• Patient navigator
• Physical Plant and Equipment
• Endoscopy suites
• Recovery suites
• Endoscopes
• Computer hardware and software

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Colorectal Cancer Control Initiative

• Provider Education
• Forums, grand rounds
• Individual detailing
• Redesign of the Colonoscopy Process
• Direct Endoscopy Referral System

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Colorectal Cancer Control Initiative

• Public Awareness and Community Outreach
• Take Care NY multimedia campaign
• Colon Cancer Awareness Month
• Collaboration with NYCDOHMH and ASC
• Patient Education
• Limited English Proficiency
• Focus Group discussion

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Total Colonoscopies Performed
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Patients with Colon Polyps Removed2003 - 2007

• Patients with Colon Polyps Removed2003 - 2007

Patients with Colon Polyps Removed2003 - 2007
Hospital-Specific Data                         
                                                  
                                       
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Screening Guidelines

• Tests that find polyps and cancer
• flexible sigmoidoscopy every 5 years 
• colonoscopy every 10 years 
• double contrast barium enema every 5 years 
• CT colonography (virtual colonoscopy) every 5
  years
  
• Tests that mainly find cancer
• fecal occult blood test (FOBT) every year,
• fecal immunochemical test (FIT) every year,
• stool DNA test (sDNA), interval uncertain
• Colonoscopy should be done if test results are
  positive.For FOBT or FIT used as a screening
  test, the take-home multiple sample method should
  be used. A FOBT or FIT done during a digital
  rectal exam in the doctor's office is not
  adequate for screening.

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Challenges Ahead

• Access to Screening
• Colonoscopy GI specialists trained
  colonoscopists
  
• New technology - CTC FIT Stool DNA testing

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Challenges Ahead

• Provider training
• Primary care providers
• Residency and fellowship training in GI
• Radiological procedure for virtual colonoscopy
• Laboratory directors, pathologists and
  technicians
  

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Challenges Ahead

• Patient literacy and community norms
• Myths about colon cancer
• Acceptable colon cancer screening procedure

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Challenges Ahead

• Performance monitoring
• penetration in the target population
• colonoscopy
• yield of procedure
• time of conducting procedure
• caecal intubation

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Conclusions

• Increased screening colonoscopy
• Increased identification of patients with
  adenomatous polyp (cancer prevented)
  
• Confront old and new challenges
• Lack of trained providers
• Community knowledge, attitude and behaviour
  towards colonoscopy
  
• New technology

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Thanks!

• American Cancer Society
• New York City Council
• NYC Department of Health Mental Hygiene
• New York Community Trust