Need: Malignant Neoplasms routinely rank as the second leading cause of death for Texans according to mortality data published by the Texas Department of State Health Services. Breast Cancer is the most commonly diagnosed cancer in women. Lung and colorectal cancers are the second and third most commonly diagnosed cancers in women and men. The age adjusted incidence rate of breast cancer for the Harris and Jefferson Counties (113.2 and 100.9) exceeded that of Texas (111.7). These rates are higher with African American (121.4, 115.5) subpopulations of Harris and Jefferson Counties. The age adjusted incidence rate of colorectal cancer for the Harris and Jefferson Counties (38.8 and 40.7) exce...

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Need: Malignant Neoplasms routinely rank as the second leading cause of death for Texans according to mortality data published by the Texas Department of State Health Services. Breast Cancer is the most commonly diagnosed cancer in women. Lung and colorectal cancers are the second and third most commonly diagnosed cancers in women and men. The age adjusted incidence rate of breast cancer for the Harris and Jefferson Counties (113.2 and 100.9) exceeded that of Texas (111.7). These rates are higher with African American (121.4, 115.5) subpopulations of Harris and Jefferson Counties. The age adjusted incidence rate of colorectal cancer for the Harris and Jefferson Counties (38.8 and 40.7) exceeded that of Texas (38.1). These rates are higher within African American (49.9, 43.9) subpopulations of Harris and Jefferson Counties. Legacy’s population census when compared to incidence data demonstrates need for a proactive cancer control and prevention program. On average, primary care providers at FQHCs across the United States have so many competing health care issues to manage, they often do not have the time to consistently order appropriate screenings. In addition, the episodic nature of care at a FQHC further compounds this issue, as many patients visit Legacy for services on an acute or as needed basis, leaving preventive healthcare by the wayside. The importance of addressing these missed opportunities is critical to addressing the need for cancer screening. While screening offers the ability for secondary prevention by detecting cancer before symptoms appear, the cost, structural, emotional and cultural burdens of cancer screenings are considerable, and often present serious barriers to initiating and completing screening services; especially for low income, uninsured, and underinsured clients, and their providers. Overall Project Strategy: Legacy Community Health Services, a Federally Qualified Health Center, proposes to increase breast, and colorectal cancer prevention screening rates for patients who meet USPTF screening guidelines regardless of their ability to pay, through a unique combination of evidence-based system-level and patient-level intervention strategies that aim to link patients to and see them through the completion of appropriate screenings. The combined interventions include Standing Orders, Reducing Client Out-of-Pocket cost, Patient Reminders and Recalls, and Patient Education strategies in an effort to deliver USPTF recommended screening to a primarily low-income, uninsured FQHC population spread across the combined thirteen-county Houston-Sugar Land- Woodlands and Beaumont-Port Arthur-Orange Metropolitan Statistical Areas. The intervention strategies will be paired with Legacy’s Cancer Control and Prevention (CCP) team. The team will be comprised of a nurse and 3 prevention coordinators The CCP team functions independent but supplementary of the primary care clinic. In essence, the CCP team becomes an extension of each patient’s medical care team. Specific Goals: The overall goal of the project is to increase screening rates for breast and colorectal cancers. The project will serve approximately 100,000 people over three years. Innovation: Legacy’s project creatively combines system and patient-level intervention strategies geared toward improving screening rates, access to a large multi-county patient pool, expansive man power, and extensive information technology capabilities, and leverages them within the unique clinical setting of a Federally Qualified Health Center. This has not been achieved based on research conducted by Legacy staff in preparation of this proposal. Legacy’s project takes action to operationalize a system of care buttressed by evidence-based practices that actually get people screened. Significance and Impact: Imagine a Texas that stops spending hundreds of millions in dollars on the direct costs of cervical, breast, and colorectal cancers; imagine the opportunity to erode the racial disparities of cervical cancer in the most racially diverse city in America; imagine a year when thousands of Texans do not hear the life-altering diagnosis of cancer; finally, imagine a project that holds the potential to link thousands of low income and uninsured patients to and see them through completion of USPTF recommended preventive screening for breast, cervical, and colorectal cancer. Legacy’s project, if funded by CPRIT, promises these unique and major impacts on cancer prevention and control.

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