1. Presented by: Liz M. Baker, CHES NC Comprehensive Cancer Program 1

2. Goals 1. Increase knowledge of Flu-FIT Program. 2. Understanding of Flu-FIT Program available resources. 3. Increase participation of Flu-FIT program and sign the 80 by 18 pledge. 2

3. N.C. Breast and Cervical Cancer Control Program N.C. WISEWOMAN Project N.C. Comprehensive Cancer Control Program http://publichealth.nc.gov/chronicdiseaseandinjury/cancerpreventionandcontrol/index.htm 3

4. 4 Partnerships Time Resources Cancer Burden https://www.surveymonkey.com/r/80by2018pledge

5. Colon Anatomy and Colorectal Cancer 5 What is Colorectal Cancer? Photo courtesy: http://www.cdc.gov/cancer/colorectal/basic_info/what-is-colorectal-cancer.htmhttp://www.cdc.gov/cancer/colorectal/basic_info/what-is-colorectal-cancer.htm

6. Colorectal Cancer (CRC) Statistics CRC is the 2 nd leading cause of cancer death in NC from 2009-2013 when men and women are combined. Ninety-percent of CRC is preventable and detected at an early stage through screenings. CRC Incidence rate in NC: 36.3 per 100,000 1 CRC Mortality rate in NC: 14.2 per 100,000 2 http://www.schs.state.nc.us/schs/CCR/incidence/2013/gender.pdf http://www.schs.state.nc.us/schs/CCR/mort2014s.pdf 6

7. When to Screen for CRC? Types of screenings 1.Colonoscopy 2.Flexible Sigmoidoscopy with Fecal Occult Blood Test (FOBT) 3.Fecal Immunochemical Test (FIT) 4.Double Contrast Barium Enema, 5.Virtual Colonoscopy 6.DNA stool sampling Frequency of Screenings 1.Every 10 years 2.Every 5 years 3.Annually 4.As recommended 5.As recommended 6.Every 3 years (ACS guidelines) 7 October 2008 Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services./ In March 2008, the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology released a consensus guideline for colorectal cancer screening./ In November 2014 the NC Advisory Committee on Cancer Coordination and Control approved these recommendations and will re-examine as scientific evidence is available. Comparison of 2008 ACS/USMSTF/ACR Guidelines with those of the USPSTF http://www.cancer.org/healthy/informationforhealthcareprofessionals/colonmdclinicansinformationsource/colorectalcancerscreeningandsurveillanceguidelines/comparison-of-colorectal-screening-guidelines Recommendations for CRC screening for average risk patient 50-75 years old; High risk patients with (family history) are encouraged to start earlier and work with their provider to identify the best test method.

8. Fecal Occult Blood Test (FOBT) is a Colorectal Cancer (CRC) screening test method to find CRC early in patients 50 years and older at normal risk. 8 What is Fecal Occult Blood Test? TypesNotes Guaiac based FOBTPatient completes the test in the privacy and comfort of their home. Immunochemical FOB or FIT (Fecal Immunochemical Test) Test is positive a colonoscopy is required to determine the source of bleeding. Test is only a screening tool not a diagnostic tool for colorectal cancer Complete annuallyEstimated cost $20

9. Flu – FIT Program  Available through medical practices, clinics, and pharmacies  Eligible patients offered Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT) at the time of their Flu shot.  Patient completes FOBT/FIT at home and returns kit to doctor’s office or mails to lab for processing.  Results are shared with Doctor and Patient.  Follow up with Doctor if test is positive. 9

10. Why do a FLU-Fit Program? 1. A Flu‐FIT Program is feasible to implement in a clinic with a high volume of influenza vaccinations 2. Many flu shot recipients are over the age of 50 and due for colorectal cancer screening 3. Increases colorectal cancer screening 4. Reinforces the message to patients that just like a flu shot, you need an annual FIT test. 10

11. Flu-FIT Program Initiative Timeline Time frame SpringSummerFall/Winter Flu Season Action items 1. Use ACS tool to gather baseline screening data 2. Introduce and assemble Flu-FIT intervention team. 3. Connect with ACS staff and identify 1‐2 key clinic staff responsible for FluFIT initiative. 4. Develop a collaborative activities checklist (timeline; roles; responsibilities; data sharing). 5. Conduct an initial one‐hour training between mid‐June and mid‐July. 6. Provide additional trainings at regular clinic staff meetings and reinforce the importance of CRC screening (get all providers on board with FIT). 7. Implement Flu –FIT program. 8. Evaluate by gathering data and input for system review. 11

12. CRC Screening Eligibility 12 1. Patient is between 50 and 75 years old. 2. Patient has not had a colonoscopy in the last 10 years. 3. Patient has not had a FIT test in the past year. 4. Patient who has a personal or family history of colorectal issues.

13. How to Set up Flu-FIT Program Put your Flu-Fit team together. Train your team. Choose times and locations for your program. Advertise the program. Design a patient flow and management plan. Offer the Fit/FOBT first before giving the flu shot. Assess eligibility for Flu shot and FIT/FOBT screening. Develop systems to support follow up. Get started, implement your Flu-Fit program. Make sure to follow-up when a test is not sent back in. 13

14. Resources in Flu-FIT tool kit Flu-FIT Logic Model Flu-FIT Flow Chart FIT Brands Checklist for running Flu-FIT Program CRC screening recommendations Reminder call telephone script Educational flyer Reminder post card Advertising posters 14

15. Considerations for FIT Many sites use Flu-FIT to begin process of incorporating FIT into routine practice outside of flu season. It’s a great way to incorporate in-practice registration. FIT as another screening modality- The best test is the one that gets done. Options are important. Gather baseline data to measure program success. Develop systems to support follow up for those patients who receive FIT kit. 15

16. Key Talking Points to remember about CRC CRC and FIT screening is important. Patients need to complete and return FIT kit. Send patients reminder. CRC is 2 nd leading cause of cancer death in U.S. 70% of patients have no symptoms. CRC is 90% preventable. The best test is the one that gets done. 16

17. Colorectal Cancer Prevention CRC is 90% preventable. Eat a healthy diet. Get regular physical activity. Quit tobacco use. Limit alcohol use. Get screened! 17

18. Flu-FIT programs 18

19. Resources on Colorectal Cancer American Cancer Society cancer.org, Anna Jones 919-334-5232cancer.org Colon Cancer Alliance http://www.ccalliance.org/http://www.ccalliance.org/ Untied States Preventive Services Task Force http://www.uspreventiveservicestaskforce.org/Page/Document/draft- recommendation-statement38/colorectal-cancer-screening2 http://www.uspreventiveservicestaskforce.org/Page/Document/draft- recommendation-statement38/colorectal-cancer-screening2 National Cancer Institute http://www.cancer.gov/types/colorectalhttp://www.cancer.gov/types/colorectal FluFIT.org NCCHCA Clinical Conference on Quality and Chronic Disease (formerly the Janet Reaves Memorial Conference on Quality and Chronic Disease) NCCHCA Clinical Conference on Quality and Chronic Disease 19

20. 80% by 2018 pledge 20 How can an organization be a part of the 80% by 2018? Join over 600 organizations across the nation who have committed to substantially reducing colorectal cancer as a major public health problem for those 50 and older! Sign up online at: https://www.surveymonkey.com/r/80by2018pledge https://www.surveymonkey.com/r/80by2018pledge

21. QUESTIONS For More Information: N.C. Cancer Prevention & Control Branch Liz M. Baker, BS,CHES, Hed. Main Line: (919) 707-5300 Elizabeth.Mumm@dhhs.nc.gov 21