C5 Summit 2003: Citywide Colon Cancer Control Coalition Summit, 2003 Public Education

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C5 Summit 2003(Citywide Colon Cancer Control
Coalition Summit, 2003)Public Education

• Mark B. Pochapin, MD
• Director, Jay Monahan Center for Gastrointestinal
  Health
• Chief, Gastrointestinal Endoscopy
• Associate Professor of Clinical Medicine
• Weill Cornell Medical Center / New York -
  Presbyterian Hospital

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Can you Identify this picture?
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Can We Prevent Cancer?
Yes
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Colorectal Cancer Prevention

Polyp
Cancer
No Polyp No Cancer
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Natural History Polyp - Cancer
10 years


A series of molecular changes transforms normal
colonic epithelial cells into colorectal
carcinoma through the intermediate step of an
adenomatous polyp
Normal
Adenoma
Carcinoma
25 of the general population have polyps by age
50 years
Centers for Disease Control and Prevention. A
Call to Action Prevention and Early Detection of
Colorectal Cancer. Available at
http//www.cdc.gov/cancer/colorctl/calltoaction/sl
ides/slide07.htm.
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US Preventive Services Task Force 2002 Summary

• Colorectal cancer screening reduces death
• Grade A Recommendation

Pignone M et al. Ann Intern Med. 2002137132141.
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Public Education

• Examples of effective colon awareness campaigns
  or ads
• Lessons learned from other similar campaigns
• Which audiences to target?
• How do we segment the market?
• Which messages should be used?
• What venues/outlets should we target?
• What funding sources are available?

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Examples of effective colon cancer awareness
campaigns or ads

• How do we define effective?
• Discussed later (Evaluation Surveillance)
• Who has campaigns/ads currently?
• Medical societies (AGA, ACG, ASGE)
• Patient advocacy societies (CCA, CCN)
• Cancer societies (ACS)
• Colorectal cancer organizations (NCCRA)
• New York City Dept of Health
• Media (NBC)
• Who has the largest audience?
• The Media National Television
• Today Show audience 6 -10 million people at
  any one time

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The Couric Effect
Did you have your colonoscopy yet?
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Couric Effect

• Studied at Univ of Michigan health system
• P Cram, S Vijan, J Inadomi, ME Cowen, D
  Carpenter, AM Fendrick
• 400 endoscopists nationwide
• CORI (Clinical Outcomes Research Initiative)
• Midwestern managed care organization
• 44,000 adult members
• Looked at number of colonoscopies before and
  after the Today Shows Confronting Colon Cancer
  segment 3/00
• Dramatic increase in colonoscopies by 19 that
  was sustained x 40 weeks

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Couric Effect CORI Data
P Cram, AM Fendrick, J Inadomi, M Cowen, D
Carpenter, S Vijan, "THE IMPACT OF A CELEBRITY
PROMOTIONAL CAMPAIGN ON THE USE OF COLON CANCER
SCREENING THE KATIE COURIC EFFECT" Archives of
Internal Medicine, 2003, in press.
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Couric Effect HMO Data
P Cram, AM Fendrick, J Inadomi, M Cowen, D
Carpenter, S Vijan, "THE IMPACT OF A CELEBRITY
PROMOTIONAL CAMPAIGN ON THE USE OF COLON CANCER
SCREENING THE KATIE COURIC EFFECT" Archives of
Internal Medicine, 2003, in press.
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Demographics of Increased Colonoscopies

• Trends consistent with demographics of Today Show
  viewers
• 60 Women
• Median age - 47.5 years old

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Lessons

• Appropriate advocate
• Utilize medical expertise / science
• Understandable to the average person
• Sincere (No hidden agenda)
• Trusted by the public
• Large audience
• Interested in information that could improve
  their health
• Message focused on wellness not illness
• Colon cancer can be prevented
• Intervention must occur when you are well

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Audiences to Target5 Segments

• 1) General Well Public
• Discuss CRC with health care practitioner during
  routine visit
• Many options are available
• 2) High Risk Individuals
• Symptoms
• Personal or family history of colon cancer /
  polyps
• Inflammatory Bowel Disease
• Genetic syndromes (FAP, HNPCC)

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Audience to Target5 Segments

• 3) Underserved
• African Americans
• Increased mortality
• More right-sided polyps
• 4) Uninsured
• Are resources available?
• Which Screening tests can be offered?

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Audience to Target5 Segments

• 5) Medical Community
• Must initiate prevention and screening
• Must assure follow-up after polyp removal
• Understand that CRC screening is at least as
  effective as Breast Ca
• Recognize that printed materials cannot replace a
  discussion
• Can enhance understanding and shorten discussion
  time
• Understand the medical-legal implications of not
  following recommended guidelines

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Messages

• Any screening is better than no screening
• Colon cancer can be prevented
• This is in contrast to other cancers such as
  breast or prostate cancer which cannot be
  prevented (they can only be detected early)
• There is an important difference between
  prevention and screening
• Take responsibility for your own health when you
  are feeling well
• Take the initiative (empower yourself) Ask your
  provider about CRC prevention and screening
• Know your family history
• Dont die of embarrassment

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Venues or Outlets to Target

• Comprehensive Academic Centers
• Prevention and Education
• Comprehensive humanistic care
• Academic research
• Groups interested in public health education and
  outreach
• Common goals for professional organizations,
  patient advocacy groups, cancer societies, and
  Dept of Health
• Need to link efforts
• Medical Professionals
• Conferences
• Professional Meetings
• Media
• News
• Public Service Announcements (Education / Get
  Screened)

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(No Transcript)
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The Jay Monahan Center for Gastrointestinal Health
Business As Usual
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The Jay Monahan Center for Gastrointestinal Health

• A comprehensive treatment center
• New York - Presbyterian Hospital / Cornell
  Medical Center
• Access to a team of specialists to navigate
  patients through the health care system
• Seamless, multidisciplinary care with emphasis on
  humanism.
• Education and access to information regarding
  preventative care and treatment options for GI
  cancers
• Patients
• Public
• Medical community
• Clinical research with focus on the most
  promising clinical trials

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Funding

• Federal Government
• NCI Grants Research, Education and Outreach
• Mandatory insurance coverage for screening
• Medicare coverage since 7/01
• Eliminate Colorectal Cancer Act
• State sponsored programs
• Emily Couric (VA) Mandatory screening coverage
• New York State Colorectal Cancer Screening and
  Prostate Cancer Education Initiative
• Private Foundations and Organizations
• Cancer Societies
• Professional Organizations

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RecommendationsNext Steps

• 1) Develop a city sponsored public relations plan
  for media support to increase awareness. This
  can be a cooperative effort with all groups
  interested in CRC
• Television and Radio
• News
• Commercials / Public Service Announcements (PSAs)
• Billboards
• Bus, Subway
• Signs
• Printed Material
• Articles
• Brochures
• Ads
• Dedicated Day/Week in March for NYC CRC awareness
• Unified Slogan, Pin, Mascot

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Next Steps

• 2) Develop and support innovative comprehensive
  centers that include prevention and education
  within the academic medical environment.

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Next Steps

• 3) Legislative support for programmatic
  development and funding
• New York City Department of Health leading the
  way
• Annual symposium such as this one
• Evaluation
• Progress Report
• Expansion

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Remember this picture?
MOO