Community Partnerships Make a Difference: Free Cancer Clinics in Wyoming County

Cheryl McGovern, Valerie Bell, Regina Allen

Partnership HistoryThe Wyoming County Cancer/Tobacco Partnership was formed in November of 1998 by a group of agency representatives coming together to provide cancer control programs in Wyoming County. The mission of the Partnership is to educate the public and develop materials and interventions around breast, prostate, colorectal, and skin cancer, as well as smoke-free environments for children.

Wyoming County Facts: In 2004:

• the population was 28,168

• the median age was 38.5

• cancer was the second leading cause of death (Source - PA Department of Health, 2004 data)

• 6.7% of 15,727 adults aged 19-64 (1,054 persons) uninsured

(Source - PA Department of Insurance)

The event included a:• Brief Health Habits Survey, completed during scheduling• Medical history, obtained at event• Physical exam and laboratory testing• Skin exam, offered to all subjects• Pelvic exam, PAP test and breast exam, offered to women • Digital rectal, scrotal exams and PSA testing, offered to men• Fecal occult blood test (FOBT) kits distributed to all participants (telephone follow-up was conducted for FOBT)• Follow-up instructions given verbally and in writing

All results were forwarded to participants’ primary care or an assigned physician.

General Cancer Resource information was distributed to all participants, including: Sunscreen sample packets and sun safety information Community smoking cessation classes and Quitline information Prescription discount cards from local pharmacy

Evaluation methods included:• Participation rate• Post-event satisfaction/exit survey• Return rate for FOBT

ResultsOf 52 adults (14 men and 25 women) scheduling a screening appointment, 39 (75%) participated on one of two dates:

• 14 men had PSA tests (and DRE/scrotal exams) • 18 men and women had skin exams• 39 accepted FOBT kits • 23 women had pelvic exams and PAP tests performed

Of the 39 FOBT kits distributed, 27 (69%) were returned. None were positive. In addition as a result of the history and screening, the following referrals were made: 8 women to Healthy Women Program for mammograms, and 1 each for a testicular mass, an abnormal PSA, high blood pressure, diabetic counseling, and alcohol abuse counseling.

Intervention GoalTo increase cancer screenings among rural underserved residents of Wyoming County

Project Objectives• Register and provide free cancer screenings for up to 50 underserved, uninsured/underinsured Wyoming County residents• Obtain complete medical histories on each participant• Refer each participant to a provider for results and follow-up

MethodsA free Community screening/education event was held on two dates (February and April, 2007) and promoted by print and radio ads and church bulletins.

Pre-event Health Habits Survey responses among 52 registered participants:

All participants completed the exit survey. Survey results are as follows:• 31 (80%) learned about the clinic through print media• 8 of 14 men (57%) had not previously been screened, while most women (92%) had at least one cancer screening in the past 10 years• 33 (85%) cited lack of insurance as greatest obstacle to screening• 39 (100%) participants would take part in another clinic, if available

Lessons Learned• The target audience (underserved adults) was served.• Low turnout at the first clinic prompted a second event utilizing appointment reminders and thorough staff orientation, which enhanced attendance and performance during the second date.• Community partner participation was crucial to the project’s success. • Exit instructions and telephone follow-up likely contributed to the FOBT return rate. • Since the Department of Health and Bureau of Laboratories required participating physicians to accept laboratory results for patients without a physician, finding volunteer physicians was difficult. Some physicians required reminders to provide the necessary follow-up. • A Cancer Screening Clinic Procedure Manual, developed for this project, can be used by other community groups planning similar programs.

Acknowledgements• The screening was made possible with funding from a Appalachian Community Cancer Network Community Development Grant.• Additional in-kind community support and services were received from: American Cancer Society, American Lung Association, Luzerne/Wyoming County Drug and Alcohol, Migrant Education, Maternal Family Health Services, Northeast Regional Cancer Institute, Northern Appalachian Cancer Network, Pennsylvania Department of Health, Penn State Cooperative Extension, Tyler Memorial Hospital, Wyoming County Community Alliance, and Wyoming County United Way.

History

Total

Yes No. (%)

No No. (%)

Unknown No. (%)

Current smoker

52 26 (50) 26 (50) 0 (-)

Skin exam, ever

52 12 (23) 40 (77) 0 (-)

FOBT, ever1

52 8 (15) 43 (83) 1 (2)

Colonoscopy, ever1

51 5 (10) 46 (90) 0 (-)

PAP test, ever 2

32 32 (100) 0 (-) 0 (-)

Mammogram, ever3

28 20 (71) 8 (29) 0 (-)

PSA test, ever4

20 6 (30) 14 (70) 0 (-) 1Limited to participants 50 years and older; 2 Limited to women 18 years and older; 3 Limited to women 40 years and older; 4 Limited to men 50 years and older