Fight Continuing in Southwest Georgia Against Colorectal Cancer

Phoebe Putney Health System was recently recognized as one of the leading hospitals in the United States in the fight to end colorectal cancer when the National Colorectal Cancer Roundtable (NCCRT) named Phoebe as one of four honorees for this year’s “80 percent by 2018” National Achievement Awards.

The motivator, officials have said, is early intervention in a region of the U.S. impacted by limited health care access, poverty and other factors putting the people living in it at high risk by preventing expensive and potentially less effective intervention in the advanced stages of the disease.

“One thing we’ve tried to pride ourselves in is going upstream rather than float downstream,” said Phoebe CEO Joel Wernick.

A decade ago, Terrell County had the highest colorectal cancer death rate in the nation at 47.5 percent and Albany Area Primary Healthcare (AAPHC) was the only medical provider in the entire county. Phoebe officials said they joined AAPHC, the health department and several other regional hospitals and agencies to form what is now known of the Cancer Coalition of South Georgia to address the comprehensive cancer control needs of the region.

Cancer navigators working with the Cancer Coalition to identify those of high-risk who might not otherwise get the screenings are among the resources in place to change some of the Southwest Georgia statistics on colorectal cancer.

“One of the biggest predictors of success is access, or lack of access,” Wernick said. “This program is to increase access.”

Dr. Jim Hotz, clinical services director for AAPHC, said hundreds of lives in Southwest Georgia stand to be saved — and considering the screening rate has gone up in recent years from 26 percent to 73 percent (at AAPHC), getting above 80 percent is a reachable goal.

“Within the next one or two years, we can get there,” he said. “I think it is a doable thing … We are stretching our people to accomplish something they don’t ordinarily accomplish.”

Hotz, who lost a parent and uncle to colorectal cancer, has had several colonoscopies and more than a dozen polyps removed that might have otherwise threatened his health. From a mathematical standpoint, he said screening efforts for colorectal cancer have an impact not many other life-altering factors do.

“Of 1,000 (who go unscreened) after 50, 32 can die. We can take it down to 10,” he said. “No other cancer is close to that (impact). That’s the kind of information people need to know.

“This has been a problem nationwide. We we have found is a solution to the problem. We have all come together.”

According to NCCRT research and projections, reaching a screening rate of 80 percent in Phoebe’s service area would save an estimated 15 lives per year between now and the year 2030. AAPHC cared for 31,684 individuals in 2014, 22 percent of whom were uninsured.

While also treating a high-risk population, Hotz said another challenge has been that the tests done to detect colorectal cancer at an early stage have taken more than two decades to become a more common component of care.

“To me, it is not a stretchable goal. Why do we have to wait 25 years to get this out there? … It is a low-hanging fruit. You can go upstream and catch it before it goes downstream 70 percent of the time,” he said. “This is one of the strongest Public Health movements going on right now.

“We have chance to remove a significant burden.”

Robin Whitehurst, a 54-year-old woman in Blakely, was referred for screenings and scheduled several times last year, but was reluctant. This year her doctor had her do a fecal immunochemical test and it came back positive, putting her in a situation of getting a colonoscopy.

Whitehurst’s father had gone through a colonoscopy within the last year and suffered a complication. Her family has had a history of diverticulosis and stomach issues, so she was aware of her risks. She had heard horror stories from others, so she was terrified of the idea.

“I just had that in my head … Now my fears are over. I do not mind,” she said.

She was provided a gas reimbursement, since that was a barrier for her. Even though still weary of the colonoscopy procedure, she kept a positive outlook and ended up having two pre-cancerous polyps removed.

“I’m 54, and if I had waited 10 years, what would it have been then?,” Whitehurst said.

Now at the follow-up stage, she finds herself willing to talk to anyone or share her story to help others who are fearful.

“I didn’t know the Cancer Coalition would sponsor me through it,” Whitehurst said. “That’s what people need to know. There is help. I believe people don’t know there is an association that will help you.

“I hope anyone interested in that screening will ask their doctor if they are lacking the funds, because the help is out there. It’s a wonderful association. I had no idea it exists to help people.”

Dr. Ira Knepp, a physician with Phoebe Gastroenterology Associates, said about one case per day day per physician have come into the practice through the program over the last several years. He said that, because, the colon is a hollow organ, a problem is not often obvious until it is well advanced.

“Colorectal cancer is preventable in most cases, and when we rely on symptoms, it is too late … Success for a complete recovery is diminished,” he said.

When a colonoscopy is performed and a growth is removed at the polyps stage, the survival rate is 80-90 percent, Knepp said.

Knepp said that about 95 percent of the people identified as eligible for screening through the program show up, and of those, 90 percent have good preparations ahead of time.

“That allows for excellent colonoscopies … (The program) has allowed for 2,600 colonoscopies that would not have otherwise been done, and (the discovery of) 14 cancers that would not have been found,” he said.

In the process, Knepp said he has noticed that patients can gain more than just a clean bill of health. They also gain empowerment to change some of the risk factors that compromise their health.

“Patients realize they have control over themselves … It helps them develop a philosophy. We’ve noticed that in our patients,” the gastroenterologist said.

Reaching 80 percent by 2018 among the Southwest Georgia’s under served patient population means finding and removing polyps from more than 1,000 patients. Earlier in the month, Wernick, and Rhonda Green, program manager of community cancer screening for the Cancer Coalition, participated in a national webcast hosted by the American Cancer Society and NCCRT during which Wernick signed the “80 percent by 2018” Commitment Pledge, embracing the shared goal of reaching 80 percent screened for colorectal cancer by 2018.

Officials have said the effort has already made a big difference and maintained a decent amount of long-term momentum given the obstacles in place — and that the pace already achieved can be maintained.

“The socioeconomic status shows what we are up against,” said Knepp. “We don’t have the same means (to battle the problem) than in other districts. For a community this size and (its obstacles) it says a lot.

“The significance of the program speaks for itself. (The spike in screening rates) shows commitment of those involved … It’s a monumental task we’ve accomplished. It’s such an important issue.”

The effort in this endeavor is a collaboration between services offered by Phoebe, including gastroenterology, endoscopy, anesthesiology, pathology, radiology, surgical and oncology as well as several community organizations including the Cancer Coalition. On Wednesday, Phoebe will serve on the opening panel of Georgia’s first Colorectal Cancer Roundtable to challenge other hospitals to champion the care needed to have the populations they serve reach a screening rate of 80 percent by 2018.

The other NCCRT honorees included Coal Country Community Health Centers, Beulah, N.D.; Tina Kiser Cancer Concern Coalition, Cambridge, Ohio; Premier Medical Associates, Monroeville, Penn.; and South Carolina Public Employee Benefit Authority, Columbia, S.C.

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