A Statewide Comprehensive Cancer Control Screening Program Shows Better Outcomes for Minority Patients in Delaware – No Increase of Overall Health System Costs

Colorectal cancer (CRC) is the third most common cancer diagnosed in man and women in the United States. According to estimates from the American Cancer Society, 102,480 new patients will be diagnosed with CRC in 2013. A further 40,340 patients will be diagnosed with rectal cancer. CRC is expected to cause about 50,830 deaths in the United States during 2013.

The same estimates show that the overall, the lifetime risk of developing colorectal cancer is about 1 in 20 (5.1%). This risk is slightly lower in women than in men.

Highly preventable
CRC is, however, also one of the few cancers that is highly preventable. Evidence has shown that routine screening help not only helps in diagnosing the disease, it can also prevent death resulting from CRC. An ongoing effort to increase routine screening has resulted in a drop of the death rate (this is the number of deaths per 100,000 people per year) from CRC in both men and women for more than 20 years.

Survival disparities
However, CRC is also one cancer that continues to demonstrate widening incidence and survival disparities between whites and African Americans. Although there are many reasons for these disparities, the available data shows that advanced stage at diagnosis explains up to 50% of the survival disparity.

Combined data from the National Program of Cancer Registries and from the Surveillance, Epidemiology and End Results (SEER) program submitted to the National Cancer Institute in November 2011 shows that African American men and women were more likely to die of CRC than any other race and ethnicity.

Delaware Cancer Consortium: Eliminating Disparities
A study analyzing the impact of the Delaware Cancer Consortium, Delaware’s cancer control program, reports a 41% reduction in colorectal cancer CRC) mortality rates for African Americans.

This reduction nearly eliminates racial disparities in outcomes. The study, published April 15, 2013 in the Journal of Clinical Oncology, a tri-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world’s leading professional society representing physicians who treat people with cancer, provides analysis on a novel design and approach used to eliminate colorectal cancer disparities for the first time by a state cancer control program.

These findings show the percentage of cases of CRC diagnosed at advanced and regional stages among African Americans declined from 79% to 40%. The data further shows that the Overall Incidence rates per 100,000 declined from 67% to 58% for African Americans and whites, respectively in 2002 to 45% for both groups in 2009.

“We can achieve tremendous progress when governments, insurers and providers work together to reduce disparities,” noted Stephen S. Grubbs, MD, lead co-author of the study and oncologist at Christiana Care’s Helen F. Graham Cancer Center. “Eliminating disparities in cancer screening, diagnosis, treatment, and mortality is an essential step toward improved health outcomes for all Americans with cancer.”

A new approach
The Delaware Cancer Consortium, originally formed as the Delaware Advisory Council on Cancer Incidence and Mortality in March 2001 to advise Delaware’s governor and legislature on the causes of cancer incidence and mortality and potential methods for reducing both, has been transferred in a comprehensive statewide colorectal cancer screening program. This screening program includes insurance coverage for screening, the use of nurse navigators to conduct screening outreach and recruitment, and ultimately treatment for those with a colorectal cancer diagnosis.

With funding from the state legislature, Delaware Governor Ruth Ann Minner (photo) developed the program in 2003. Delaware law tasked the Consortium with coordinating cancer prevention and control activities in the state. Members of the Consortium include representatives from the Delaware House of Representatives and State Senate, the Governor’s Office, the Secretary of the Department of Health and Social Services and physicians from cancer centers.

Unique results
“The results we achieved in Delaware can be replicated across the country,” said Congressman John Carney, a member of the Cancer Consortium’s Advisory Committee and former Chair of its Disparities Committee. “Forming strong partnerships, ensuring access to care for all, and focusing on prevention is what really makes the difference. I’m proud to be part of the Consortium and work with such dedicated members of our community to fight cancer in Delaware. We’ve made significant progress in recent years, and will continue working so that more Delawareans and their families can avoid the impact of this horrible disease.”

Screening
Using colonoscopy as the preferred screening method, the Delaware Cancer Consortium provided reimbursement for screening starting in 2002 for any uninsured Delaware resident with an income of up to 250 percent of the federal poverty level. Other residents were eligible for coverage through Medicaid, Medicare and private insurers. From its inception of the program through 2011, the program has provided over 5,000 colorectal cancer screenings.

A companion program, the Delaware Cancer Treatment program, was developed to cover the costs of cancer care for two years for the uninsured who are newly diagnosed. Combined, the Delaware Cancer Consortium and the Delaware Cancer Treatment program provided Delaware residents with universal colorectal cancer screening and treatment. “The Consortium demonstrated that racial disparities can be mitigated by providing equal care and equal access,” explained Blase N. Polite, MD, MPP, lead co-author and oncologist at University of Chicago Medical Center. “They were able to identify cancers at an earlier stage and likely found and removed precancerous lesions before they could become cancer.”

Long-term cost savings
The authors of the article in the Journal of Clinical Oncology also note the long-term financial savings produced through the state program. In the U.S., annual costs of colorectal cancer detection and treatment are estimated to total $14 billion. While the Delaware Cancer Consortium screening costs approximately $1 million annually, the increase in screening in Delaware through its expanded program saved approximately $8.5 million annually from reduced incidence of cancers that would have required aggressive therapy.

These annual savings more than offset the $6 million annual cost of the Cancer Treatment Program, which provided universal treatment for all cancers.

For more information:
Grubbs SS, Polite BN, Carney J Jr, Bowser W, Rogers J, Katurakes N, Hess P, Paskett ED. Eliminating Racial Disparities in Colorectal Cancer in the Real World: It Took a Village. Published online before print April 15, 2013, doi: 10.1200/JCO.2012.47.8412

JCO April 15, 2013 JCO.2012.47.8412

Photo courtesy:States government consulate, Amsterdam, The Netherlands.

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