Achieving Equity Through Outreach

Ronald Chen, MD, MPH, chair of the Department of Radiation Oncology and associate director for health equity at The University of Kansas Cancer Center, knew his study of the pandemic’s impact on cancer screening may unearth concerning news. But the research team was astonished by the findings: Nearly 10 million cancer screenings in the United States failed to happen in 2020 because of the COVID-19 pandemic. The study examined data on three cancers that are most impacted by early screenings: breast, colorectal and prostate. 

Dr. Chen’s findings were published in JAMA Oncology in April 2021. More studies have since confirmed the pandemic’s catastrophic impact on cancer screenings. As a result of missed or delayed screenings, more cancers will be diagnosed at later stages. For example, when breast cancer is caught early, the survival rate is nearly 100%. The National Cancer Institute (NCI) predicts that over the next decade, nearly 10,000 additional breast and colorectal cancer deaths will occur due to pandemic-related delays in cancer screening and treatment. This estimate does not account for other cancer types. Actual excess deaths could be much higher. What’s more, the drop in cancer screenings is more dramatic in some minority communities. The trend only stands to deepen existing health inequities.

Certain procedures can help find cancer earlier when it may be easier to treat and cure. They are a vital part of comprehensive healthcare. But simply telling people to schedule their routine screenings is not enough. NCI-designated cancer centers like The University of Kansas Cancer Center must do more. A fundamental element of the designation means working with communities and tailoring solutions based on their unique needs. Community outreach and engagement specialists work intimately with communities.

Meet them where they are

In the United States, African American men and women are 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups. Angela works to reduce these disparities one interaction at a time. Whether it’s a 5K run raising awareness of cancer, a group counseling session or a one-on-one conversation in a beauty salon, Angela uses each opportunity to educate individuals about the importance of colorectal cancer screening. She provides them with take-home fecal immunochemical tests (FIT), a simple and noninvasive test that indicates hidden blood in the stool. Of the more than 180 FITs handed out by the cancer center outreach team in 2021, a few have come back positive requiring follow-up care.

“In some cases, I helped individuals schedule a follow-up colonoscopy,” Angela said. “I am so proud of them for taking an active role in their health.”

Personal interactions give Angela better insight into the types of screening barriers African Americans face. For example, Angela learned that some people feel a visit to the doctor may just invite more trouble. She also regularly refutes the argument that clinical trial participants are human guinea pigs.

“It’s about having an honest, transparent conversation about their fears,” Angela said. “I’m a previvor, which means I am at high risk for cancer. I share my story. I share my husband’s cancer story. Cancer doesn’t discriminate. If you’re not getting screened on a regular basis, this could be you.”

Eliminate barriers

Chavely Conde is a research associate for MCA. She enrolls women in the Early Detection Works (EDW) program, which is funded by the Centers for Disease Control’s National Breast and Cervical Cancer Early Detection Program. Kansas’ EDW program helps Kansas women reduce their risk of death from breast and cervical cancers through education, screening, diagnosis and referral for treatment. The program is open to women who are uninsured or underinsured and meet certain income guidelines. Most women Chavely enrolls to the EDW program are non-English speaking.

An immigrant from the Dominican Republic, Chavely is familiar with the challenges of navigating healthcare in a foreign language. Latina women tend to be diagnosed with more advanced breast cancers than non-Latino white women. This may be due to delays in follow-up care after an abnormal mammogram. Chavely helps by working one-on-one with women to determine eligibility, proceed with enrollment, navigate to referral clinics and answer any questions they may have. 

She partners with an ever-growing network of organizations. For example, she trained El Centro Inc. patient navigators to assess eligibility and enroll women into the EDW program. El Centro provides educational, social and economic services for Latino families in Kansas City. Following the training, El Centro hosted four successful mobile mammogram screening events in 2021. The number of people reached grows exponentially with each interaction.

“Once you connect with someone, the chain continues,” Chavely said. “I get calls from friends of the women I helped, asking if I can do the same thing for them.”

Chavely also serves as program manager for Healthy Living Kansas, an outreach program started by the Department of Population Health at the University of Kansas Medical Center. Latinos make up the majority of people in three southwest Kansas counties. She partners with MCA to train local community health workers, called Promotores de Salud, on an array of topics including cancer prevention, awareness, cancer screening and medical interpretation. With every touchpoint, Chavely hopes more women will take the steps needed to catch cancer early. 

“Sometimes people feel they are not worth it, or they are intimidated by the process,” Chavely said. “EDW and Healthy Living Kansas empowers them to be in control of their own health.”