Chapter 13: Grant-Funded Projects in the Office of Health Policy: Screening for Colorectal Cancer and Breast Cancer

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Chapter 13: Grant-Funded Projects in the Office of Health Policy: Screening for Colorectal Cancer and Breast Cancer

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In this segment, Dr. Foxhall talks about projects that support screening for colorectal cancer and for breast cancer (via a mobile unit). The Office of Health Policy “provides the infrastructure,” identifying an opportunity and partners who can help accomplish goals that fit with MD Anderson’s mission. He provides additional information about both of these screening programs.

Identifier

FoxhallLE_03_20140311_C13

Publication Date

3-11-2014

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - An Institutional Unit; Overview; MD Anderson History; MD Anderson Impact; MD Anderson and the Texas Legislature; Education; Information for Patients and the Public; Institutional Mission and Values; Beyond the Institution

Transcript

Lewis Foxhall, MD:

The other couple projects we’re working with are actually directed from our office. One is going to be for screening women for breast cancer with mobile mammography, so we’ve purchased a new mobile van, and we’ll be able to deploy that out across the region here in the next few months. And we’ve started a colorectal cancer screening program which we’ve also just started in the rural counties all around Houston, and we’ll be moving into the Harris County region this summer. So that will get us kind of plugged in there. So that’s been, I think, a positive thing. We see a lot of the partner—you know, we work with partners and clinics that actually arrange for and provide the services. We’re really providing the infrastructure and paying for getting the tests done. So that’s been very gratifying to see their interest, and I think that’s a positive thing.

Tacey Ann Rosolowski, PhD:

I’m trying to—you know, I’m putting together that statement with what you said even in our first session, where you said that it was a process of figuring out how primary care people could be involved in cancer care.

Lewis Foxhall, MD:

Right.

Tacey Ann Rosolowski, PhD:

And that just seems like a really interesting shift, maybe even in MD Anderson’s understanding of the role, providing infrastructure and support rather than directly providing physicians who would do the work. Is that true? I mean, am I hitting it, or was there some other change that had to take place in order for MD Anderson to begin doing this?

Lewis Foxhall, MD:

Well, I mean, that’s, you know, an opportunity for us, and I think that’s part of the broader policy analysis is to say, “Here’s the work that needs to be done. Who else can help us in this?” And to try to understand who those entities might be, whether they’re clinicians in the community or they’re state agencies or funding partners or others that can help us accomplish our goals. So we’ve got a pretty broad mission of eliminating cancer, and we do a pretty darn good job of treating patients and doing research about how to cure cancer, but there’s a lot of community work that we’re not necessarily all that well suited for, and finding partners and helping with our expertise and knowledge and ability to attract funding is a way to achieve those goals. Collaboration with others, that really makes a big difference.

Tacey Ann Rosolowski, PhD:

Now, am I correct in assuming that this look outside the institution really began with Joseph Painter and with you coming on and kind of saying, “Okay—”?

Lewis Foxhall, MD:

Dr. Painter was an advocate of that approach and that’s how he got in touch with me, was reaching out to primary care physicians with educational programming and got me interested in this stuff. So it’s all his fault. (Rosolowski laughs.) And Dr. LeMaistre, who was president at the time, was very supportive of prevention interventions, and they’d been involved in the tobacco program and worked for many years and was part of the initial Surgeon General’s team that really provided our first knowledge about the link with lung cancer and tobacco. So there’s sort of a lineage of folks that are interested in prevention and interested in connecting with the community beyond the hallowed halls to really figure out how we can make all this stuff happen in the real world.

Tacey Ann Rosolowski, PhD:

And, you know, they had an effect not only on what MD Anderson does, but also what it looks like as an institution, in terms of organization and the complexity of it. I’m sort of getting the feel for that. Is there more you’d like to tell me about the breast cancer and colorectal cancer screening programs? I mean, why is that suddenly possible now? Because it seems like those would be needs that had existed for a long time. What happened to make it possible to address this now?

Lewis Foxhall, MD:

Well, it’s federal funding. This is federal funding. Yes, there’s been a need for a long time, but there’s very little opportunity to get funding for these sorts of projects. So for the mammography, we really needed another van. We have one, but it’s already used all the time, so we had to buy another van, which is close to a million dollars. So to do that, we have to have some sort of way to pay for it besides the institution writing a check for it. So that was very important. And then the colon screening involves colonoscopies and some fairly expensive procedures that when people don’t have insurance, they just can’t pay for them, so it doesn’t happen. But it’s an almost totally avoidable condition if we can get people screened on a regular basis, so that’s the opportunity here. There’s a chance to really reach out to clinics that serve those populations and help them do what they need to do to get them screened.

Tacey Ann Rosolowski, PhD:

What are the numbers you expect to use, or have you started getting the numbers at this point?

Lewis Foxhall, MD:

We’re just barely getting started, but we’ve had good results. Some of the clinics have been very, very active. They’re screening at fairly high rates, almost 80, 90 percent screening. In general, most of these clinics have been screening at 25, 30 percent for eligible people, so it’s a big jump. Some are having a little more challenge getting organized, getting started, but this is really just our first pass at it, and I think over time more of them will be screening at higher rates. But the financial barrier is a big one. I mean, they know what to do, they want to do it, but if your patients can’t afford the test, then they can’t afford the test. So there’s not much you can do about that. So it’s been exciting to see them get engaged, and really just helping them along a little bit has been very, very rewarding. So that’s good.

Tacey Ann Rosolowski, PhD:

Yeah. I mean, that’s a huge jump in numbers when you think about how that translates to the number of individuals who’ve had potential problems identified. Yeah, that’s pretty amazing.

Lewis Foxhall, MD:

Sure.

Tacey Ann Rosolowski, PhD:

Wow. So the investment in this van is sort of a one-time investment, and then you expect that project to run for how long on these funds?

Lewis Foxhall, MD:

Well, we have about two and a half more years of the project at this point. It’s possible it might be renewed, but we don’t know for sure. But we at least have that period of time to see what we can do [unclear]. C

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Chapter 13: Grant-Funded Projects in the Office of Health Policy: Screening for Colorectal Cancer and Breast Cancer

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