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A team approach emerges to boost upstate cancer screening

Earlier this year, an array of public health experts, doctors and hospitals set a national goal to raise the rate of colorectal screenings nationwide from 69 percent to 80 percent of those who should be tested for signs of the second-leading cancer killer in the U.S.

Western New York health care leaders signed on to the ambitious effort, including those painfully aware that screening rates for patients age 50 and older in the region’s federally qualified health centers was about 23 percent at the time.

The effort to substantially raise that rate has been part of the larger goal. Jason Coleman is a key figure in helping to get it done.

“It’s got to be more than a doctor handing these patients a business card as they walk out the door and saying, ‘Hey, you need to get screened. Make an appointment,’” said Coleman , primary care health systems manager for the American Cancer Society in Western New York.

Coleman, 46, came into his post after a work life that started in the hotel management business and morphed for a couple of decades into pharmaceutical and medical sales. For the last three years, he has worked with a dozen federally qualified health centers to help devise evidence-based strategies to boost the rates of colorectal, cervical and breast cancer screenings among low-income patients from Syracuse to Buffalo. The central New Jersey native and his wife, Jenn, who works for Harris Communications in Rochester, live in Wayne County with their sons, Nathan, 12, and Shane, 7.

Q. Why make the jump to the Cancer Society?

I saw a lot of disparity in health care, where some receive a real high level of care based on their circumstance, and found that my skills would lend themselves very well to working with underserved communities. The not-for-profit world doesn’t offer the same financial rewards as private industry ... but I felt I could make a great impact here. It’s the human part of things, to see the faces of cancer here in Western New York and the disparities that exist in many communities. In underserved communities, a higher percentage of cancer is caught farther down the line, in Stage 3 or 4, and as a result, they suffer a  higher degree of mortality due to cancer than the general population.

The trends and the costs of health care seemed to be driving a larger and larger wedge between the haves and have nots. In the area of cancer, that can mean the difference between life and death. I wanted to be part of the solution, not at the other end in driving costs.

Q. Have you dealt with cancer in your family life?

I watched my grandmother, Clara Brumfield, pass away in the early 1990s from stomach cancer. It was dramatic for my family. My grandfather, Wilbur, had Parkinson’s disease and she was always his caregiver. We always anticipated he would pass away first. My grandmother was always the rock of the family ... and within months of her diagnosis, see passed away and we were left caring for my grandfather. Cancer leaves an indelible mark on families.

Q. Why focus screenings in three areas?

Primarily because those are some of the areas most impacted through good screening protocols. We made the decision as an organization to try to move further upstream through early detection and diagnosis. We’re looking at a more comprehensive approach.

We work with both the survivor base on evidence-based strategies to better capture patients in their registry that are screening age ... so we can get them in for screening discussions. All too frequently, what happens at the community health centers is that staff are seeing these patients for acute visits but are having a difficult time engaging those people between visits to talk about preventative strategies that can help impact the cancer incident rates. ... We do our best to meet center staff where they are ... to help them identify the best way to impact their patient stream.

Q. How many folks do the centers treat and how do you split your time in a typical month?

As a whole, these centers treat 10,000 to 15,000 patients. We meet with quality improvement teams at the centers and identify through objective eyes areas of opportunity to increase cancer screening among their patient populations. Some quality improvement teams are heavily engaged in cancer screenings, others in areas that include blood pressure, diabetes and other health challenges. ... We had a $50,000 grant through Walgreen’s with the Community Health Center of Buffalo in 2015 focusing colorectal cancer. At the Chautauqua Center, we’re currently involved in a breast cancer screening program through a two-year $100,000 grant from the National Football League and the American Cancer Society. The center staff, based on their baseline rates, identified this as an area they would like to improve.

"We work frequently with other organizations that collaborate around these issues," Jason Coleman says.

Q. Why does screening matter?

Within the national average for federally qualified health centers, screening rates are in the neighborhood of 30, 35 percent. As a result of lower screening rates, these patients are being diagnosed at a later stage. With colorectal screening at these sites, we recommend the best test is the one that’s going to get done. Many physicians refer patients to colonoscopies year after year and year, and the patients don’t go. That can be for a variety of reasons: fear of the procedure, lack of transportation, lack of insurance coverage, preconceived notions as to what the screening entails and invasive testing as a whole.

We see that particularly evident in African-American populations with men who just don’t want a colonoscopy, period. So we work with centers to engage these patients in a screening discussion which offers patient choice early on, to include non-invasive testing options like fecal-immunochemical testing, FIT, and how to leverage the strengths of that testing to engage those patients in a screening discussion that will culminate in screening compliance.

Q. How do the evidence-based practices come into play?

There’s good data out there that shows that client reminders with appropriate messaging makes a difference in patients. If patients receive messages they don’t understand, we try to help identify very specific characteristics for that particular center, and find messaging that will resonate.

Q. What’s the ideal care team engagement?

It can be the team within the walls of a health center comprised of an MD, medical assistants, RNs, educators, patient navigators. That care team would help a patient through structural barriers to screening, identify transportation options, identify how to utilize insurance, how to connect them to free cancer programs. It could help arrange child care if that’s what they need. These centers, in order to get patients to screen need to have more than just the MD involved in this process to begin that conversation.

Q. How does this benefit everybody?

Uninsured patients show up for emergency care at the hospital. The hospitals write off a lot of these treatments if patients have no insurance or ability to pay, and that cost has to come from someplace. It usually trickles down in the form of increased insurance premiums for those who are insured, and increased taxation through the state Medicaid program. So we pay for Medicaid and the uninsured whether we choose to or not. The model of health care really needs to take that into consideration. And it really goes without saying that these patients deserve the same level of care that we all get. Their concerns are just like all of ours.

Q. What do you expect to see under a new presidential administration?

There are concerns as one would guess with a lot of media attention to the incoming Republican administration looking to pull away from the Affordable Care Act, but I believe it’s too early for us to make a determination as to what that’s going to look like. We have millions and millions of Americans that have taken advantage of the Affordable Care Act and the safety net that’s built into it when it comes to pre-existing conditions and free screenings for cancer as baselines for policies offered within the marketplace. My hope is that they’ll have a viable alternative for these patients that are the most needy among us before they pull the carpet out from under them. We at the American Cancer Society are going to give this administration our whole support, as we wish every American would, to find a viable alternative for these patients.

Q. As you’ve said, the bottom line is that these patients are going to be cared for and somebody’s going to have to pay for it.

The problem is where the money comes from. People still get sick, whether they have insurance or not. Getting to the core of our work with the American Cancer Society, there’s a human side of it, too. We don’t want people to be diagnosed at the late stage because outcomes and prognosis are poorer and the human toll is greater. We want the impact of cancer to be as minimal as possible.

Q. Are there any other testing initiatives on the horizon in the Buffalo area for 2017, 2018?

We’re very excited about the opportunity with human papillomavirus (HPV) vaccination and its impact on cervical cancer rates. There’s another area for 11- and 12-year-old boys and girls who are not vaccinating at the same rate as other key measures such as TDAP and meningitis. Frequently, human papillomavirus hovers around 50 percent nationwide compared to over 90 percent for mandatory vaccines. Previously, the indication was for a three-shot succession. The centers would get the first shot and then they’d have a very difficult time having patients get the second or third shot. Phones get disconnected, addresses change, so the communication can be much more difficult. First vaccinations were better than 50 percent but the second and third vaccination rates were much, much lower. We’re going to work with the centers and providers to implement standardized protocols so they can schedule that next appointment at checkout and turn on those alerts within their systems – and change perception, too. The general public sometimes falls victim to social media around this particular issue and turns the discussion into a discussion about sex, where it really is just a question about cancer prevention.

Q. Is this an effort that’s going to be taking place system wide in Western New York?

We work frequently with other organizations that collaborate around these issues, such as the Cancer Services Program, the P2 Collaborative, the Department of Health. We identify areas where we can collaborate to have an even greater impact. We pool our dollars when given the opportunity.

Q. Are the risk factors for some of these cancers a little different in some of the federal centers and, if so, how are they addressed?

Smoking is a risk factor for every cancer and the smoking incidence among underserved populations are greater due to a number of factors that are sometimes within our control and are sometimes not. We work mostly with the Tobacco Coalition and other partners is order to affect policy change. Tobacco 21 was a victory this past year, when the legal age for purchasing tobacco products was raised to 21 years of age. We also try to work against some of the powers of Big Tobacco in targeting some of these underserved communities with advertising. We’re looking to put a national face on this and say, “This isn’t right.” We also work on nutrition and physical activity programs because obesity is also a risk for almost every cancer. Some of these communities are classified as food desserts. They can’t get healthy foods – fresh foods, fresh vegetables – and if they do, the cost is outside of their reach. We work nationally to try to change this landscape.


Twitter: @BNrefresh, @ScottBScanlon

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