In 2013, The Medical Center Cancer Committee selected Colorectal Cancer Screening as the primary cancer screening to reduce mortality. According to the American Cancer Society, colorectal cancer is the third most common cancer in both men and women. In Kentucky, it is projected that 2,300 new cases would be discovered and 880 people would die from colorectal cancer in 2013.
The American Cancer Society reports the incidence of colorectal cancer has decreased over the past 20 years as a direct result from increased use of colorectal cancer screenings for detection and polyp removal before advancing to cancer. But, there are disparities. Indigent patients with no insurance, who are at high risk for colorectal cancer, may not have the means to screen early, therefore decreasing the ability for early detection and treatment.
A grant funded by the Kentucky General Assembly was awarded to the Barren River District Health Department to provide colon screens via fecal immunochemical test (FIT) and colonoscopies to indigent patients. The Medical Center agreed to provide outpatient use of the hospital facilities for colonoscopies at the variable cost. If tumor(s) or poly(s) are found, The Medical Center will also provide use of the facility and equipment for removal and pathology. The services are performed according to American Medical Association guidelines and include the colonoscopy and lab work prior to procedure. Gastroenterologists, anesthesiologists and many other departments of The Medical Center work with the Barren River District Health Department to provide this service.
To be eligible for the screening, participants must meet certain criteria including: annual household income less than 250 percent of the Federal Poverty Level; no insurance coverage for colon cancer screenings (note: high deductible or out of pocket is not considered "no insurance coverage"); not eligible for Medicaid or Medicare; age 50-65 for people at average risk (age 45-65 for African Americans because of increased risk or age 18-49 if high risk); meets screening guidelines; US citizen or qualified alien; and, a resident of Kentucky.
The American Cancer Society, Kentucky Cancer Program and The Medical Center Health & Wellness Center collaborated with the Barren River District Health Department to provide outreach and education to the target population.
If cancer is found, the provider follows protocol to ensure that indigent patients seek follow-up care and treatment as appropriate. The patient navigator works with the provider and patient to explore all potential sources of treatment including hospital indigent care, physician donated care, and/or non-profit and charitable organizations that assist with patient care and treatment services.
The goal was set to reach 469 patients, including FIT screenings and colonoscopies as appropriate, by June 30, 2014 and outreach to counties in the Barren River District with the greatest need – Hart, Warren, Barren, Metcalfe, Logan, Edmonson, Butler and Simpson.
In 2013, 260 referrals were made. Of those, 29 have completed a FIT, 59 have completed a colonoscopy. Fifty-nine individuals were not eligible for the program because they did not meet eligibility guidelines and 50 dropped out for various reasons. The remaining 63 referrals were in progress at year end.