Assessing the Effectiveness of Cancer Screening Interventions Targeting Appalachian Populations: A Systematic Review

Abstract

Purpose Appalachian residents have higher cancer prevalence and invasive cancer incidence in almost all cancer types relative to non‐Appalachian residents. Public health interventions have been carried out to increase preventive cancer screening participation. However, no studies have evaluated the effectiveness of existing interventions targeting cancer screening uptake in this high‐risk population. The main objective of this study is to assess the effectiveness of interventions aimed at increasing uptake and/or continuing participation in screened cancers (breast, cervical, colorectal, lung, and prostate) in Appalachia. Methods We conducted a systematic review of electronic databases and gray literature using a combination of MeSH and free‐text search terms related to breast, cervical, colorectal, lung, and prostate cancer; mass screening; health promotion; and Appalachia. We identified 3,014 articles of which 15 articles were included. We assessed methodological quality using validated tools and analyzed findings using narrative synthesis. Findings Fifteen studies reported uptake and/or continued participation in screening interventions; these focused on cervical (n = 7), colorectal (n = 5), breast (n = 2), and lung (n = 1) cancers in Appalachia. Interventions included diverse components: mass media campaigns, community outreach events, community health workers, interpersonal counseling, and educational materials. We found that multi‐strategy interventions had higher screening uptake relative to interventions employing 1 intervention strategy. Studies that targeted noncompliant populations and leveraged existing community‐based organization partnerships had a substantial increase in screening participation versus others. Conclusions There is an urgent need for further research and implementation of effective cancer prevention and screening interventions to reduce disparities in cancer morbidity and mortality in Appalachian populations.

Impact of the COVID-19 Pandemic on Cancer Screening Delays

“…2 Black individuals. [7][8][9][10] Delays in cancer screenings among these diverse and underserved populations may worsen preexisting disparities in cancer care and outcomes. Identifying populations that are most likely to delay cancer screenings can provide valuable guidance to enhance cancer screening and diagnosis strategies (such as at home cancer screening-fecal immunochemical test [FIT], mobile screening units) for different populations.…”

Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

“…Where specified, the total number of participants included in primary studies in each review ranged from 307 to 187,613. Twenty quantitative or mixed‐methods reviews included solely primary studies that were conducted in the United States, 6,36,39,44,55,56,58,60,65–70,72–77 whereas 32 reviews included primary studies from various countries, 15,29–31,35,37,38,40–43,45,53,54,57,59,61–64,71,78–88 which included the United States, the US Territory of American Samoa, Belgium, the United Kingdom (unspecified), China, Korea, Botswana, Turkey, Netherlands, Scotland, England, Sweden, Taiwan, Australia, New Zealand, Germany, Switzerland, Denmark, France, Italy, Canada, Guatemala, Brazil, India, Kenya, Nigeria, Mexico, Malaysia, Iran, Pakistan, Bangladesh, Thailand, Singapore, and Hong Kong. Two reviews 89,90 did not report the countries of their primary studies.…”

“…Interventions that met the criteria of this umbrella review, and were considered to be navigation , were referred to by other terms in their reviews, such as case management, 38,43,45,54,59,81,86,87 care management, 87 coordination, 59 community‐based health worker interventions, 61,78 peer counselling, 60 interpersonal counselling, 67 telephone counselling, 81 and nurse‐led follow‐up care 43 . Some interventions involved culturally tailored components 6,29,40,42,55,56,60,74 .…”

Extranodal Extension Improves AJCC‐8 Accuracy in HPV+ Oropharyngeal Cancer in a High‐Risk Population

“…3B). This seems to contradict the belief that patients with Medicaid/self‐pay status may forgo regular cancer screening and, therefore, may present with advanced disease 26,27 . Instead, patients with these insurance plans may be more likely to miss treatments or follow‐up visits or have factors affecting their overall nutrition due to financial restrictions.…”

“…This seems to contradict the belief that patients with Medicaid/self-pay status may forgo regular cancer screening and, therefore, may present with advanced disease. 26,27 Instead, patients with these insurance plans may be more likely to miss treatments or follow-up visits or have factors affecting their overall nutrition due to financial restrictions. Our analysis did indicate that patients from rural populations are more likely to present with a high initial staging compared to patients from non-rural populations (see Fig.…”