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An Overview of Colorectal Cancerin Delaware

Delaware Health Care Commission

November 3, 2011

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Delaware’s Approach

In 2002, Delaware Cancer Consortium said: Create a comprehensive statewide colorectal cancer screening and advocacy program. Reimburse for colorectal cancer screening of uninsured and underinsured Case manage every Delawarean with an abnormal colorectal cancer screening test.

Resulted in Screening for Life (began paying for CRC in 2002) Delaware Cancer Treatment Program (began in 2004) Cancer Screening Nurse Navigator and Cancer Care Coordinator Programs (began in

2005)

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Cancer Screening Program

Began screening for CRC in 2002 Reimburses providers for CRC screening and diagnostic services Eligibility – uninsured/underinsured, DE resident, between 100% and

250% FPL, and meets age requirements or is at increased/high risk

To Date more than 5,000 CRC screenings have been provided through the

program

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Cancer Treatment Program

Established in Delaware regulations in 2004 Provides free cancer treatment to Uninsured Delawareans for up to 24

months Household income up to 650% of FPL Diagnosed with any cancer

To Date More than 1,000 people have received services through the program More than $38 million spent on treatment

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Cancer Screening Nurse Navigator and Cancer Care Coordinators Screening Nurse Navigators

At least one Nurse Navigator at each Delaware acute care hospital Recruit insured and uninsured to obtain CRC, breast and cervical cancer screening Assist patients navigate the health care system and overcome barriers to obtaining

cancer screening and case manage all abnormal screenings Over 10,000 people have received navigation services Statewide Cancer Screening Nurse Navigator database to collect screening

information on those who have received navigation services

Care Coordinators At least one Care Coordinator at each Delaware hospital Assist cancer patients with care coordination, including social service needs as well as

healthcare coordination, so patient only has to concentrate on treatment Statewide Network – all Care Coordinators know each other and work together to

ensure patients needs are met

Initially funded by the State until 2011 – due to budget cuts state discontinued funding, BUT – hospitals picked up funding

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Screening Data

In Delaware, in 2010, African Americans were significantly more likely than Caucasians to have had a sigmoidoscopy or colonoscopy within the last 12 months (33.6% vs. 23.7%, respectively).

From 2002-2010, Delaware’s rate of increase in CRC screening prevalence exceeded that of the U.S. for African Americans. Delaware’s CRC screening rate for African Americans increased nearly 57%

compared to the nation’s increase by 49.6%.

Between 2002 and 2010, CRC screening prevalence increased significantly in each of Delaware’s three counties.

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In 2010, 74.0% of Delawareans age 50 and older reported ever having

had a sigmoidoscopy or colonoscopy.

Percentage of Adults Ages 50+ Who Have Ever Had a Sigmoidoscopy/Colonoscopy, U.S. vs. DE, 2002 - 2010

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In 2010, DE’s CRC screening rate for males was 14% higher than

the U.S. DE’s female screening rate was 13% higher than the U.S.

Percentage of Adults Ages 50+ Who Have Ever Had a Sigmoidoscopy/Colonoscopy, U.S. vs DE, by Gender, 2002 - 2010

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In Delaware, from 2002-2010, CRC screening rates increased 28% among

Caucasians and 57% among African Americans.

Percentage of Adults Ages 50+ Who Have Ever Had a Sigmoidoscopy/Colonoscopy, U.S. vs DE, by Race, 2002 - 2010

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In 2010, DE’s CRC screening rate for Caucasians was 10% higher than the

U.S. For African Americans, DE’s rate was 18% higher than the U.S.

Percentage of Adults Ages 50+ Who Have Ever Had a Sigmoidoscopy/Colonoscopy, U.S. vs DE, by Race, 2002 - 2010

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Are we having an impact on CRC Incidence and Mortality?

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2001 2009

Colorectal Cancer by Stage of Diagnosis, All Races, Delaware 2001 and 2009

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Colorectal Cancer by Stage of Diagnosis, African Americans, Delaware 2001 and 2009

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Colorectal Cancer by Stage of Diagnosis, Caucasians, Delaware 2001 and 2009

2001 2009

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How have we done?

Between 2001 and 2009, the percentage of CRC cases diagnosed in the local stage increased by 40%.

The magnitude of this increase differed substantially between races: Among Caucasians, 23% increase in CRC cases diagnosed in local stage Among African Americans, 225% increase in CRC cases diagnosed in local stage

CRC Incidence:1999 – 2009

“Slow, Steady Declines”

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CRC Mortality:1999 – 2008

“Shrinking Disparities”

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