The Texas A&M Health Science Center School of Public Health is involved in groundbreaking cancer prevention programs and research. From piloting programs that screen and educate low-income patients at risk for colon cancer and breast cancer while training family medicine residents in cancer screening procedures, developing phone applications for cancer survivors, producing the CEO Cancer Gold Standard Accreditation Guidebook to help organizations seek accreditation and reduce the risk of cancer for their employees and families, and completing research that has the potential to significantly improve the ways state cancer control programs are developed and implemented around the country, Texas A&M is fighting cancer on multiple fronts.
Most recently, the Cancer Prevention and Research Institute of Texas (CPRIT) awarded Dr. Jane N. Bolin, professor at the Texas A&M School of Public Health and director of the Southwest Rural Health Research Center, a $300,000 grant to train community health workers (CHWs) for more effective cancer education and navigation. Bolin works in collaboration with Ms. Katy Nimmons, director of the National CHW Training Center, part of the Center for Community Health Development at the Texas A&M Health Science Center. They certify new CHW and new CHW instructors and offer continuing education courses.
There are over 3,000 certified CHW in Texas, and they do everything from door-to-door education about things like breast cancer to helping patients with every aspect of the screening. For example, instead of just telling women that they need to get a mammogram, they might help her find a provider and make the appointment, ensure she has transportation and childcare so she go to the appointment, and follow up with her afterward to see if she has any questions about the test or the results. It’s a growing field.
Dr. Bolin has received prior CPRIT funding, and this new award is only available to previous applicants who had successful CPRIT grants to scale up the projects. With the funding, they will be able to package materials for other training centers and community health worker programs across the state, from McAllen and Corpus Christi to Tyler, thereby reaching more people. They will also put the materials online for even more CHW instructors to be able to access to serve as a model nationally.
“There are a lot of disparities in the state in cancer screenings, and then cancer outcomes and mortality — not all Texans have the same chance,” Ms. Nimmons said. “CHWs, we’ve seen, are an effective strategy to reach people who are most at risk.”
“This is a very timely endeavor because of the Affordable Care Act, which envisions a greater role for navigators and community health workers,” Dr. Bolin said. “Health care organizations are now reimbursed for this type of service under an individual’s insurance.”
*INNOVATIVE COLORECTAL CANCER SCREENING PROGRAM MEETS QUALITY STANDARDS
New research from the Texas A&M Health Science Center indicates that colonoscopy in a family medicine residency met or exceeded recommended quality standards set forth by the American Society for Gastrointestinal Endoscopy and was therefore, comparable to those of specialists.
In the U.S., relatively few primary care physicians perform colonoscopies, and only a fraction of family medicine residencies train residents to conduct colonoscopies, though trust in a primary care physician is associated with patients adhering to Colorectal Cancer (CRC) screening compliance. CRC usually results from malignant transformation of polyps, unwanted growths that over time, develop into cancerous cells. Approximately 28 million Americans are not up to date on colorectal screenings though CRC remains the second most common cause of cancer mortality for both men and women combined.
Through an innovative partnership between the Texas A&M College of Medicine’s family medicine residency program and the Texas A&M School of Public Health, with funding from the Cancer Prevention and Research Institute of Texas (CPRIT), increased access to affordable colonoscopies for underinsured or uninsured residents was made available while providing colonoscopy training to family medicine resident physicians. Targeting seven counties in central Texas, six of which are rural, a total of 1155 colonoscopies were performed over a three-year period supervised by four board-certified family physicians. Polyps were discovered in 275 people and 11 cases of cancer were found, nine of which were rural residents.
CPRIT funding enabled the Texas A&M Family Medicine residency program to purchase equipment needed for training. The Texas A&M School of Public Health was responsible for grant administrative requirements and outreach to inform community members and health care providers about the available services. The partnership resulted in about 50 clinical partners who keep an eye out for patients who might need colorectal screenings. Over 200 community partners such as churches and social service agencies helped get the word out about the availability of the free colorectal screenings and bilingual community health workers were employed to provide culturally relevant community outreach and patient navigation services.
“Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program,” published in the Journal of the American Board of Family Medicine, reports quality indicators from colonoscopy procedures performed by family medicine physicians met or exceed the American Society for Gastrointestinal Endoscopy standards.
“It is our hope that this program will serve as a national model for reducing the incidence of colon cancer, as well as incorporating cancer prevention, screening and education into family medicine residency training programs,” said Dr. David McClellan, an assistant professor of family and community medicine in the Texas A&M College of Medicine and co-PI on the project.
The Centers for Disease Control and Prevention estimate that CRC-related mortality can be reduced by 60 percent if age-eligible adults adhere to screening recommendations.
“Since primary care physicians are more likely to practice in rural and less affluent areas than their specialist counterparts, training and equipping primary care physicians to perform colonoscopies should be explored as means of increasing colonoscopy capacity, especially among underserved populations,” said Dr. Jane Bolin, of the Texas A&M School of Public Health and co-PI on the project.
*MOBILE TECHNOLOGY INCREASING PHYSICAL ACTIVITY AMONG SENIOR CANCER SURVIVORS
The benefit of regular physical activity in cancer survivorship is well documented, though few older cancer survivors actually are exercising. Mobile technology may hold the key to increasing physical activity among older adults according to researchers at the Texas A&M School of Public Health.
The results of a pilot test of iCanFit, a mobile-enabled, web application among cancer survivors between the ages of 60-78 years of age showed improvement in the quality of life and engagement in regular physical activity. Findings of the study led by Dr. Yan Alicia Hong, associate professor at the Texas A&M School of Public Health, were published in the JMIR Cancer.
Participants completed a baseline survey and then began use of the iCanFit interactive website, where they could set physical activity goals, receive personalized feedback, and track progress. In a follow-up survey 2-3 months later, study participants indicated a general affinity towards the key function “Goals” in the program, which motivated continued activity. They also provided suggestions to further improve the application including adding a reminder functionality and easier or alternative ways of entering activities.
“Mobile tools have been widely used by younger individuals, but few such programs have been designed specifically for seniors, especially older cancer survivors,” Dr. Hong said. “iCanFit is one such initiatives and we are working on more mHealth projects benefiting older adults.”
*TEXAS A&M RELEASES CEO CANCER GOLD STANDARD ACCREDITATION GUIDEBOOK
In an effort to help organizations seek accreditation and reduce the risk of cancer for their employees and families, the Texas A&M School of Public Health and Texas A&M AgriLife Extension Service have produced the Going for the Gold: Achieving CEO Cancer Gold Standard™ Accreditation Guidebook.
Eradicating cancer is the goal of the CEO Cancer Gold Standard™, a workplace wellness initiative. The CEO Roundtable on Cancer, a nonprofit organization of chief executive officers of major U.S. companies founded by former President George H.W. Bush, developed this initiative in collaboration with the National Cancer Institute.
“I am very proud that Aggies initiated this guidebook, which will become an important tool for companies wanting to be part of the CEO Gold Standard,” said Bush.
“Beginning with President and Mrs. Bush, we thank everyone in Aggieland, and notably the authors of this valuable guide, for creating such a clear, comprehensive and inviting roadmap that will encourage employers to work with and on behalf of their employees to lower the risk of cancer, detect it early, and ensure access to high-quality care,” said Dr. Martin Murphy, chief executive officer, CEO Roundtable on Cancer.
To earn Gold Standard accreditation, an organization must establish programs to reduce cancer risk by eliminating tobacco use; encouraging physical activity; promoting healthy diet and nutrition; detecting cancer at its earliest stages; and providing access to quality care, including participation in clinical trials. The Gold Standard calls for organizations to evaluate their health benefits and corporate culture and take extensive, concrete actions in areas of health and wellness to reduce the risk of cancer in the workplace.
The accreditation process resulted in the creation of a very active Health and Wellness Committee at the Texas A&M School of Public Health and a strong partnership with the Texas A&M AgriLife Extension Service.
“Going beyond our experience, we are now ready to share lessons learned more broadly within the Health Science Center, Texas A&M University and The Texas A&M University System at large. The health and wellness activities outlined in this guidebook can have a great benefit to Aggie employees and their families,” said co-author and Regents and Distinguished Professor Dr. Marcia Ory, of the Texas A&M School of Public Health.
“Strongly committed to promoting a healthy workforce, AgriLife Extension Service exemplifies an organization that supports the values of the CEO Cancer Gold Standard,” said co-author Dr. Ninfa Pena-Purcell, of the Texas A&M AgriLife Extension Service. “This most recently was exemplified by our launching wellness programs across all agency offices in Texas.”
The Cancer Alliance of Texas (CAT) introduced the Texas A&M School of Public Health to the opportunity to become CEO Gold Standard Accredited and was extremely helpful during the process.
“We will be sharing the guidebook with other CAT members and providing guidance on how state-wide organizations might seek accreditation,” said co-author Dr. Samuel Towne, Jr., assistant professor at the Texas A&M School of Public Health and a CAT member.
*TEXAS CANCER PLAN SERVES AS A GOOD MODEL FOR OTHER STATES
A study lead by the Texas A&M School of Public Health has the potential to significantly improve the ways that state cancer control programs are developed and implemented around the country.
Researchers affiliated with the Cancer Prevention and Control Research Network (CPCRN) analyzed 40 different state cancer prevention plans funded by the Centers for Disease Prevention and Control in order to determine how they incorporated community capacity building and sustainability into their plan.
Research findings published in Frontiers in Public Health demonstrate the importance of including detailed methods for obtaining and implementing funding as well as proposed strategies for increased community involvement in state plans for cancer prevention programs.
In “Promoting Public Health through State Cancer Control Plans: A Review of Capacity and Sustainability,” researchers indicated community capacity was addressed in just over half the plans with few specifics on roles and responsibilities, timelines for action, and measurements for evaluation. Almost all 40 state cancer prevention plans addressed sustainability on a least a cursory level, but with few details on how these strategies would be implemented.
In contrast, the Texas Cancer Plan was selected as a case study of how to incorporate capacity and sustainability, which included highly detailed plans for increasing community participation, capital, and resources as well as plans for gaining and implementing continued funding.
“It is essential that state cancer control plans specifically identify how states will incorporate community involvement, allocate organizational resources, and leverage existing community capital to establish credibility and legitimacy,“ said lead author Dr. Marcia Ory, of the Texas A&M School of Public Health. “Plans must address both community capacity building and sustainability in a concrete and realistic manner to assure the success of the important work being undertaken by cancer control and prevention agencies.”
“The initial Texas Cancer Plan was published in 1986, making Texas one of the first states to have a state cancer plan. Texas’ plans are designed to engage stakeholders and their communities from plan initiation through implementation of goals and objectives for cancer control,” said Dr. Deborah Vollmer Dahlke, co-author and Cancer Alliance of Texas member.
With the release of these findings, study investigators are hopeful that there will be greater attention to these key concepts as they are critical to plans intended to better serve communities. When local cancer prevention programs work together to combine their collective community resources, they increase participation, reinforce a strong chain of leadership, and increase gained capital.