Erasing the cancer screening deficit

Six years after launching its Cancer Moonshot program, the White House has announced revised national goals in battling the disease: (1) reduce the death rate from cancer by at least 50 percent over the next 25 years, and (2) improve the experience of people and their families living with and surviving cancer.

The federal call to action urges the U.S. healthcare system to “get back on track” with preventative measures after 9.4 million patients missed cancer screenings as a result of the COVID pandemic. Missed screenings translate to delayed cancer-detection opportunities; in those instances, cancer will be more advanced when it’s eventually diagnosed.

The government will convene federal departments and agencies to focus cancer-fighting efforts and promote more screenings. However, the initiative lacks specific funding, leaving hospitals and health systems on their own in trying to erase the screening deficit.

“Hospitals across the country need to devote effort to contact patients to reschedule canceled screening tests in order to minimize the delay in screening and cancer diagnoses from the missed tests,” explained Ronald Chen, MD, author of the study that uncovered the shortfall in breast, colon and prostate screenings.

The American Cancer Society (ACS) advises that convincing patients to get screened will require effective and trustworthy messaging. Priority should be placed on identifying patients at increased cancer risk due to genetic, personal or family history. Additionally, patients with a history of an abnormal screening or those with new or concerning symptoms should be evaluated sooner than asymptomatic average-risk individuals.

ACS reports that patients’ most trusted sources for cancer-screening information are doctors and healthcare organizations, while preferred communication channels are direct conversation with their provider, followed by patient portals, websites and email. A positive and brief message, such as “catch cancer early when it’s easier to treat,” would work well in patient-facing tweets, banners and pop-up notifications.

Ramping up technology 

Aside from outbound messaging and communication considerations, experts recommend information technology oversight that promotes appropriate cancer risk assessment and screening while incorporating the following properties:

• Eligibility. Screenings must be repeated on a regular basis to improve outcomes. At the same time, recommendations based on risk factors and health history change over time. Algorithms should be customized as treatment guidelines evolve so that data can be efficiently mined to identify patients eligible or overdue for screening.
• Complexity. Screening guidelines continually add new factors, such as breast density for breast cancer. Providers and patients should collaboratively weigh the pros and cons of available screening modalities for a specific form of cancer. Clinical decision support (CDS) systems should integrate person-specific information from multiple sources to facilitate assessment and shared decision-making.
• Coordination. Cancer screening often involves appointments at outside facilities. Provisions must be made for appropriate follow-up and evaluation based on the result of each screen. Health IT tools should monitor initiation and completion of each step in the screening process. Again, CDS should be able to handle multiple sets of screening and follow-up guidelines to ensure seamless care management.
• Standardization. Cancer-screening guidelines that use open-access data standards are platform-agnostic in terms of deployment. While guidelines are being translated to computable formats, focus should be on ensuring that programmed terminology and logic are accurate and valid for downstream applications.

Taken together, aggressive messaging and embedded evidence-based processes will help patients re-engage in cancer screening and care.

Frank Irving is a Philadelphia-based content writer and communications consultant with specialties in healthcare, technology and sports. When not following those beats, he writes creative fiction.