Colorectal cancer (CRC) is the second most common cancer among African American (AA) women and the third most common for AA men. The AA community also bears a disproportionate CRC burden, with the highest mortality of any racial/ethnic group. Much of the disparity in mortality is likely due to later stage at diagnosis, which in turn depends on the method of detection (symptoms vs. screening) and delays from initial detection to surgical intervention. Disparities in treatment may contribute to disparities in mortality. Early detection of CRC through screening is the best way to diagnose CRC at an early stage, when chances of survival are highest; nonetheless, utilization of CRC screening is low overall and tends to be lower in AAs than in whites. In addition, effectiveness of CRC screening in detecting CRC before symptoms develop varies widely by screening modality, which includes tests for blood in the stool, as well as procedures to image the colon, such as sigmoidoscopy and colonoscopy. Patient delay in presenting symptoms for medical evaluation (presentation delay), and the amount of time spent in the system before beginning treatment may also contribute to later stage at diagnosis and less treatable cancer. In addition, adjuvant chemotherapy can increase survival for patients with later-stage disease, yet many patients for whom chemotherapy should be part of their standard of treatment do not receive chemotherapy, and prior studies provide evidence for both socioeconomic and racial disparities in receipt of chemotherapy. The overall goals of this study are to identify factors that could be intervened upon to improve adequacy of care and reduce the stage at which CRC is diagnosed. We will interview 500 African American patients with newly diagnosed CRC, and abstract medical records for information on the process of screening, diagnosis and treatment, as well as comorbidity and stage at diagnosis. Potential elements for intervention will be assessed and include patient barriers such as knowledge, cultural beliefs about cancer, social support, transportation, housing, literacy, perceived stress, fear, medical trust; and health care access barriers (health insurance status, provider recommendations for screening, proximity to providers and facilities). The design and implementation of this study will be informed in collaboration with the Community, Training and Research Cores. We will work with the Community Core on interpreting of results and dissemination strategies, and this project will serve as a place for trainees from the Training Core to gain and apply knowledge and skills in disparities research.
Study results will identify potential intervention points for improving adequacy of care and reducing stage at diagnosis for colorectal cancer, and will provide information on what types of future interventions are likely to have the greatest impact. These might include policy changes, community-based interventions to increase awareness and knowledge, and facility-based navigator interventions to reduce barriers to care.
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