Cancer in Rural Areas最新文献

{"title":"Abstract IA29: Overcoming barriers to screening in rural areas: No bus, no taxi, no services","authors":"B. Thompson, E. Carosso, K. Briant, Genoveva Ibarra","doi":"10.1158/1538-7755.DISP17-IA29","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA29","url":null,"abstract":"Background: Cancer screening in rural areas is hampered by numerous barriers; among these are systemic factors such as access to care in the rural area, lack of culturally appropriate physicians, and lack of screening systems. These barriers are often accompanied by structural impediments such as lack of transportation to distant clinics and screening settings, lack of child care, and inconvenient times for appointments. New and innovative approaches to dealing with rural populations are needed to overcome some of these barriers. In Eastern Washington State, the many rural areas are served by a Federally Qualified Health Center (FQHC) system. A number of their clinics are spread throughout the region, and we collaborated with them to work on two innovative cancer prevention strategies in the rural area. Methods: Using a giant inflatable colon, we brought fecal occult blood test (FOBT) kits to 300 individuals who were over the age of 50 at regularly scheduled health fairs in the area. Individuals went through a brief educational tour of the colon, then received the kits, which were returned to us via mail or drop-off. A local hospital analyzed the kits and results were returned to participants. In a second study, women who were nonadherent with Pap testing were identified by the FQHC; after HIPAA consent, they were randomized to receive one of three intervention arms: a usual care arm, a video arm, or a promotora outreach arm. Adherence after seven months was assessed via medical records. Results: For the colon study, we received a return rate of 75.6%. Of these, seven were abnormal and those participants received free or low-cost colonoscopies. For the cervical cancer study, the rates of adherence after seven months were 34% (usual care), 38.7% (video arm), and 53.4% (promotora outreach). In both studies, knowledge and intention to be screened were significantly increased. Discussion: Rural areas suffer unique barriers to obtaining cancer prevention screening. Our approach of “meet the people where they are” has been positive in increasing screening rates. Whether it is participation at local community health fairs or collaboration with an FQHC, it is clear that “going to the people” is a method that works. More emphasis should be put on such methods in rural areas. Citation Format: Beti Thompson, Elizabeth Carosso, Kathy Briant, Genoveva Ibarra. Overcoming barriers to screening in rural areas: No bus, no taxi, no services [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA29.","PeriodicalId":440243,"journal":{"name":"Cancer in Rural Areas","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115747580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract IA28: Rural disparities in uptake of well visits and access to cancer screening in Medicare under the Affordable Care Act","authors":"Roger T Anderson, F. Camacho, Aaron Yao","doi":"10.1158/1538-7755.DISP17-IA28","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA28","url":null,"abstract":"Background: Under the Affordable Care Act (ACA), Medicare beneficiaries can receive annual wellness visits (AWV) to configure or update a personalized prevention plan. Previous data show the use of AWVs rose from about 7 percent overall (3.2 million visits) in 2011 to 20 percent (10.4 million visits) in 2016, but patterns of rural uptake of AWV have not been examined nor their potential to reduce rural disparities in cancer screening. Methods: We examined physician and outpatient claims for rural and urban beneficiaries enrolled in Medicare 5% FFS (“Fee for Service”) from 2011-2014 among beneficiaries with >1 year prior enrollment. Beneficiaries were classified into three groups based on previous care patterns: patients with annual health care visits but no AWV (controls); those without previous screening but who attended a subsequent AWV; and those with a previous screening episode with a subsequent AWV. Confounders considered included beneficiary race (white, black, other), gender, age category at reference, Charlson comorbidity score, reference date, National County Economic Distress from Appalachian Regional Commission, and NCHS rural urban status. Outcomes included receipt of colorectal (CRC) and breast (BC) cancer screenings, as well as a bundle of 7 recommended preventative services relating to cardiovascular disease, cancer, diabetes, and bone density. Results: Per beneficiary, AWVs were more likely to occur in metropolitan regions and regions with higher socioeconomic indices, along with individual characteristics such as white ethnicity, female gender, and older age groups. By 2014, the AWV utilization rates in metropolitan residents were 60% higher than rural residents. For both urban and rural US populations, screening access for those without an AWV was significantly lower than with an AWV. For CRC and BC screening, having an AWV was associated with a greater than two-fold increase screening compared to controls (p 80% of the other patient groups. We examine evidence of the impact of ACA on access to screening in rural Appalachia to identify policy and implementation research solutions for the well-documented higher late-stage cancer burden in this region. Conclusions: Our findings strongly suggest that AWVs can be used to reduce disparities in preventive services, such as cancer screenings and vaccinations, especially in disadvantaged groups that tend to lack prior preventive services. However, rural beneficiaries have fewer opportunities to have an AWV. Policies to increase AWV penetration may involve increasing access through community health workers, practice-based supports, and increased financial incentives. Given the size of the screening effects found in this study together with the underutilization of AWV by rural populations, we believe policy seeking to expand the use of AWVs may help with early detection of cancer to improve survival. Citation Format: Roger T. Anderson, Fabian Camacho, Aaron Yao. Rural disparities in upta","PeriodicalId":440243,"journal":{"name":"Cancer in Rural Areas","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114469446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}