Remote interventions, particularly a mailed tailored DVD plus telephonic patient navigation, improved adherence to breast, cervical, and colorectal cancer screenings among women living in rural counties in the United States, according to the results of a randomized controlled clinical trial conducted by Electra D. Paskett, PhD, Professor and Marion N. Rowley Chair in Cancer Research, The Ohio State University College of Medicine, Columbus, and colleagues.1 The findings demonstrate the need to focus on geographic areas with higher economic deprivation to increase cancer screening adherence. The study was presented during the Union for International Cancer Control (UICC) World Cancer Congress, held in October in Geneva.
“This is the first study to compare interventions to simultaneously increase adherence to three screening tests in rural women, a medically underserved population with higher cancer mortality.”— Electra D. Paskett, PhD
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Studies have shown that rural populations experience greater cancer disparities across the cancer control continuum, from prevention and incidence to survivorship and mortality, compared with their urban counterparts.2 Those living in rural parts of the United States also tend to have lower cancer screening rates compared with individuals living in urban centers, as well as higher incidence rates of potentially preventable cancers. The barriers to cancer care in rural settings are many, including an oncology workforce shortage, longer travel times to access care, and higher out-of-pocket medical costs.2
In this study, 983 women (aged 50–74) were randomly assigned to one of three groups: (1) a mailed tailored DVD intervention (DVD); (2) a DVD intervention plus telephonic patient navigation (DVD/PN); and (3) usual care. The study authors compared the effectiveness of these interventions in simultaneously increasing adherence to any breast, cervical, and colorectal cancer screening that was not up to date at baseline. The participants lived in 98 rural counties in Ohio and Indiana.
The interventions focused on constructs associated with cancer screening, including knowledge, perceived personal risk for cancer, and benefits and self-efficacy, as well as resolving barriers to obtaining the needed tests. Of the 983 women enrolled in the trial, 19% needed all three screening tests, 29% needed two of the screening tests, and 52% needed one of the screening tests. Most of the participants were married, insured, and White, with 84% reporting educational attainment past high school. The national percentile of adjusted area-level deprivation index was 66 (range, 1–100), with higher scores indicating higher economic deprivation.
The researchers found that at 12 months, the percentage of women having all the needed screenings was 10% for those receiving the usual care intervention; 15% for those receiving the mailed DVD intervention; and 30% for women receiving the combined DVD/PN intervention (odds ratio [OR] = 1.9 and 5.8, respectively vs usual care, P < .001). A total of 25% of participants in the usual-care arm, 29% in the DVD arm, and 49% in the DVD/PN arm received any needed screenings (OR = 3.8 for DVD/PN vs usual care, P < .001).
The adjusted area-level deprivation index was significantly related to receiving both all or any needed screenings at 12 months, with those in higher deprivation areas having lower adherence (P = .004 and P = .031, respectively) in adjusted models. No interaction of this index with the interventions was found.
“This is the first study to compare interventions to simultaneously increase adherence to three screening tests in rural women, a medically underserved population with higher cancer mortality. Results demonstrate the value of these remote interventions, especially patient navigation, in rural areas, and point to the need to focus on areas with higher economic deprivation to increase cancer screening adherence,” concluded the study authors.
DISCLOSURE: This study was supported by a grant from the National Institutes of Health and the National Cancer Institute. Dr. Paskett has received grant funding from Merck Foundation, Pfizer, and Genentech.
1. Paskett E, Champion V, Stump T, et al: Impact of area-level deprivation on interventions to increase adherence to cancer screening among rural women. Presented at the Union for International Cancer Control World Cancer Congress, October 18, 2022.
2. Zahnd W, Ganai S: Access to cancer care in rural populations: Barriers and solutions. ASCO Daily News, April 3, 2019. Available at https://dailynews.ascopubs.org/do/access-cancer-care-rural-populations-barriers-and-solutions. Accessed November 15, 2022.