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Center for Chronic Disease Outcomes Research


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Cancer Prevention and Screening

Background: Cancer is the leading cause of death in the United States in people aged 45-64 years and the second leading cause of death among those over age 65. CCDOR’s research in this area is focused on high value cancer screening and the development and evaluation of innovative approaches to enhance the reach and effectiveness of evidence-based tobacco cessation interventions.

• Dr. Wilt was a senior collaborator on two ground breaking manuscripts that define methods and frameworks for high value cancer screening. Involving an international multidisciplinary group, Dr. Wilt’s team conceptualized a framework and published recommendations for use of models in the development of clinical practice guidelines. This work is currently being incorporated into several national clinical guideline group processes.

• Russell P. Harris, MD, MPH; Timothy J. Wilt, MD, MPH; and Amir Qaseem, MD, PhD, MHA, for the High Value Care Task Force of the American College of Physicians.* A Value Framework for Cancer Screening: Advice for High-Value Care from the American College of Physicians. Annals of Internal Medicine 2015;162(10);712-717.

• The Veterans Victory over Tobacco Study, a randomized controlled trial, compared the effects of a proactive tobacco cessation care model versus a traditional cessation care model on the use of tobacco treatment and subsequent population-level smoking cessation rates.

• Dr. Partin completed a national study to identify organizational structures and processes associated with colonoscopy following positive fecal occult blood test (+FOBT) results. The findings (published in Cancer Epidemiology, Biomarkers and Prevention 2015;24(2):422-34) revealed that 30% of patients with +FOBT results received colonoscopy within 60 days and 49% within six months. They found directly notifying gastroenterology providers about +FOBT results, using guideline-concordant adenoma surveillance intervals, and using colonoscopy preparation instruction methods that provide both verbal and written information were associated with significantly higher six month follow-up rates. Significant predictors of 60-day follow-up rates included direct notification of gastroenterology providers about +FOBT results, adequate colonoscopy capacity, and frequent individual feedback to primary care providers. Some of these findings were incorporated as recommendations for optimizing colorectal cancer screening in the 12/30/2014 Veterans Health Administration colorectal cancer screening directive.

• The patient education pamphlet developed in collaboration with the VHA National Center for Health Promotion and Disease Prevention by a team led by Dr. Partin received the 2014 Silver Award in the "Government Brochure/Booklet" category of the National Mature Media Competition for the patient education brochure The PSA Test for Prostate Cancer Screening: Why Some Doctors No Longer Recommend Testing.  The National Mature Media Competition is the nation’s largest awards program that annually recognizes the best marketing, communications, educational materials and programs for adults age 50 and older. The pamphlet is available on the NCP website.

• Dr. Shaukat received the 2016 American Gastroenterology Association Young Investigator Award for her achievements in the area of colon cancer screening and prevention, including her work documenting long-term survival benefits after screening for colorectal cancer and demonstrating that longer withdrawal times are associated with a reduced incidence of interval cancer after screening colonoscopy (Gastroenterology 2015;149(4):952-957).

• Dr. Danan and colleagues analyzed the results of a large randomized controlled trial of VA smokers to see if calling all smokers and offering assistance to quit could increase successful quitting even among those without immediate plans to quit. The authors found that proactive outreach increased the use of evidence-based smoking cessation therapies such as counseling and medications by smokers in all three categories of readiness to quit. Proactive outreach increased successful abstinence among those in preparation (8% absolute increase), and among those in contemplation (4.5% absolute increase), but not among those in precontemplation (no significant difference). Journal of General Internal Medicine, 2016 August; 31(8): 878-87