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Because of the wide variety of known cancers, prevention and early detection efforts must be carefully targeted, taking into account both the disease and the specific needs of the population you target. The following are three successful approaches already implemented to reduce risk factors for cancer:
• Spectrascan Health Services.
Spectrascan, a disease management company based in Windsor, CT, features a program targeted at breast cancer patients. Administrators there claim that breast cancer was a good candidate for disease management because treatment costs tend to be lower when the disease is detected early.
"Breast cancer is unique in that you have a really good shot at detecting 80% to 90% of the cancers at an early stage, which has tremendous cost implications," says Michael Krieger, senior project manager at Spectrascan.
Spectrascan uses the new Atlanta-based American Cancer Society guidelines, which recommend annual mammographic screening for women over the age of 40, Krieger says. The problem is that, nationally, fewer than 40% of women comply with those guidelines. To encourage regular screening, Spectrascan case managers send out monthly reminder cards to women who haven’t scheduled screening appointments. Women who can’t be reached by mail are contacted by telephone. By phone, case managers assess the factors discouraging the woman from getting a mammogram, such as problems with transportation or a language barrier.
• The Medical College of Virginia (MCV).
At MCV’s women’s health care division in Richmond, case managers have focused their efforts on physician education, particularly in the area of smoking cessation, says Judith Collins, RNC, director of the division. The 32 physicians who care for patients at the center are counseled to inquire about the smoking habits of their patients and to provide smokers with an information packet about smoking cessation. The packet contains:
• a two-page article about smoking cessation copied from a consumer publication;
• a list of symptoms experienced by smokers when they quit;
• a smoking cessation contract stating the quit date and rewards the patient can give herself each week, month, and year of not smoking;
• a worksheet on reasons to quit and reasons to continue smoking.
The packet also contains the name and phone number of an adult nurse practitioner at the center who specializes in smoking cessation. Women who call receive individual counseling or may be referred to a more intensive group cessation program in the community, Collins says.
• Fox Chase Cancer Center.
Fox Chase Cancer Center in Philadelphia focuses on broader prevention issues through its three research divisions: basic science, medical science, and population science, says Paul Engstrom, MD, senior vice president for population science at Fox Chase. It’s also a participant in the Bethesda, MD-based National Cancer Institute’s (NCI) Breast Cancer Prevention Trial, which includes more than 12,000 women in the United States ages 35 to 59 with a family history of breast cancer. The trial is designed to test whether the cancer drug Tamoxifen can lower the risk of breast cancer among high-risk women. Fox Chase is also part of a similar NCI study regarding the prevention of prostate cancer.
To ensure that physicians affiliated with Fox Chase are adequately educating their patients about cancer prevention, Engstrom personally conducts seminars at surrounding community hospitals to educate caregivers.
"Merely having brochures in the waiting room has little effect on most patients," says Engstrom. "Surveys have shown that if a doctor doesn’t take time to talk to the patient about smoking cessation or diet or screening, then generally, the patient doesn’t get the message."
[For more information about prevention programs, contact:
Michael Krieger, senior project manager, Spectrascan Health Services, 200 Day Hill Road, Windsor, CT 06095. Telephone: (860) 285-0545.
Judith Collins, RNC, director of the division of Women’s HealthCare, Medical College of Virginia, 9000 Stony Point Parkway, Richmond, VA 23235. Telephone: (804) 560-8150.
Paul Engstrom, MD, senior vice president for population science at Fox Chase Cancer Center in Philadelphia. Telephone: (215) 728-2986.]