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Breaking Down Barriers to Care

Telephone proves valuable tool for cancer screening

Exploring ways to increase cancer screening for minority and low-income women in New York City, researchers found that the telephone could be a powerful weapon in the fight against cancer. The study, appearing in the April 18 online edition of Annals of Internal Medicine, showed that telephone calls delivered by trained personnel helped women overcome barriers to screening and improved screening rates for breast, cervical, and colorectal cancer.

Allen Dietrich
Allen Dietrich

"This study represents a promising step toward addressing the clear-cut disparity in cancer screening rates and death rates for certain low-income and minority groups," says lead author Allen Dietrich, associate director for population sciences at Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, professor of community and family medicine at Dartmouth Medical School (DMS), and a family physician. "Our team found that telephone support can increase the historically low cancer screening rates for minority women. We are hopeful that this model can be transferred to other populations who could benefit from this type of outreach."

The randomized, controlled trial was funded by the National Cancer Institute (NCI) and enrolled 1,413 women ages 50 to 69 who were patients of 11 Community Health Centers in New York City, and whose medical records indicated they were overdue for cancer screening tests. The women were randomly assigned to receive either telephone calls from prevention care managers or to simply continue with their doctors' usual care. Eighteen months later, the researchers found that screening rates increased 12 percent for mammograms, 7 percent for Pap tests, and 13 percent for colorectal screenings when they compared the rates for women who received the phone calls to those who had not.

"What makes this study so exciting is that we reached women with difficulties accessing needed care and we showed that with the right attention and support, we were able to substantially reduce their barriers to cancer screening," says study coauthor Jonathan N. Tobin, an epidemiologist and president/CEO of Clinical Directors Network (CDN), a clinical research network in New York City.

Women who were assigned to the intervention group received an average of four telephone support calls from a bilingual prevention care manager. These managers were trained to provide information on screenings and to respond to a number of common barriers that each patient could face that could delay her screenings.
Dietrich and his research team at DMS, along with CDN, will begin a larger NCI-funded study to be conducted in partnership with Medicaid managed care organizations this month.

The study's findings could have several implications in the medical community, according to the authors. In addition to potentially saving lives through earlier detection of cancer and reducing health care disparities, they note that other preventive services such as smoking cessation could be incorporated into telephone support to increase the value of the outreach.


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Last Updated: 12/17/08