CCSG Pilot: Kentucky-Cancer Community Awareness Research and Education (K-CARE)

Kentucky has the highest cancer morbidity and mortality in the nation. The state carries a heavy burden of lung cancer-the most deadly cancer. Poor health outcomes and high poverty levels are prevalent throughout the state. Residents of some western KY counties, such as Daviess experience higher lung cancer incidence and mortality than other KY counties. The National Lung Screening Trial demonstrated that screening high-risk individuals with low- dose computed tomography (LDCT) decreased relative lung cancer mortality by 20%. These findings offer hope that early detection will mitigate the dismal lung cancer 5-year survival rates and dramatically reduce lung cancer mortality once broadly implemented. The US Preventive Services Task Force now recommends annual LDCT screening for high-risk individuals. Unfortunately, only 2% of those eligible have taken advantage of this potentially life-saving screening. Racial/ethnic minority and the medically-underserved –two groups with high cancer morbidity and mortality- are known to be slow adopters of new cancer screening recommendations; these groups may be further challenged to adopt lung cancer screening because of the relative complexities of eligibility and the stigma associated with lung cancer. Community outreach with Community Health Workers (CHWs) is a proven method to reach harder to reach populations for cancer education, moreover CHWs may be effective in reducing lung cancer stigma. We propose expanding the successful c-CARE program that was conducted with the Georgia Cancer Center, Augusta Georgia. We will use the RE-AIM framework and a community-engaged approach to revise the Georgia program to the socio-cultural context of KY and train CHWs to recruit 100 participants and implement the lung cancer screening program in western Kentucky- a region with high lung cancer morbidity. We will leverage the established infrastructure of the Markey Cancer Center Affiliate Network (MCCAN), Owensboro Health, the KY LEADS Collaborative, the KY Cancer Consortium, and the KY Cancer Program and community organizations (e.g. churches, health clinics) to identify CHWs. The project builds on the previous work of the team and expands a successful ongoing lung cancer screening program (c-CARE). This proposal supports the MCCAN’s aim to enhance high-quality cancer services and programs through collaboration with state-wide community hospitals and expands MCC investment in western KY. Our long-term goal is to promote uptake of lung cancer screening, access to lung cancer care, and reduced lung mortality. Our expected outcomes from the proposed project include (1) acquiring data to refine the implementation strategies and (2) testing the effect of the intervention on participant knowledge, attitudes and beliefs regarding lung cancer screening and intent to obtain screening. We will use the data to inform an NIH proposal to test the implementation strategies of Kentucky- Cancer Community Awareness Research and Education (K-CARE), Utilizing a Community Health Worker Model to Reach Disparate Populations in Western Kentucky for Lung Cancer Screening in additional western KY counties. If the CHW model is successful, we will subsequently scale it and apply the model to other cancers that are amenable to treatment with early-detection (e.g. breast, colon). We will utilize the expertise of the following cores Behavioral and Community-Based Research Shared Resource Facility (BCBR SRF) and Biostatistics and Bioinformatics Shared Resource Facility.