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Drive-by FluFIT Clinics May Increase Colorectal Cancer Screening Rates During the COVID-19 Pandemic

PHILADELPHIA – Administering colorectal cancer screening kits through a socially distant drive-by flu vaccination clinic increased access to colorectal cancer screening among Black Americans, according to results presented at the AACR Virtual Meeting: COVID-19 and Cancer, held February 3-5.

“Black Americans are about 40 percent more likely to die from colorectal cancer,” said Carmen Guerra, MD, an associate professor of medicine in the Perelman School of Medicine at the University of Pennsylvania. While routine screening for colorectal cancer can improve survival, the COVID-19 pandemic—which has disproportionately impacted Black Americans—has led to a dramatic reduction in colorectal cancer screening due to economic hardships and fears of virus exposure, Guerra explained.  

“We wanted to address the decline in colorectal cancer screening during the pandemic in communities of color,” she said.

Guerra and colleagues partnered with Einstein Medical Center and the Rev. Leroy Miles of Enon Tabernacle Church in Philadelphia to establish a socially distant drive-by FluFIT clinic to simultaneously administer flu vaccines and fecal immunochemical tests (FITs) for colorectal cancer screening to eligible individuals.

“Inspired by the death of actor Chadwick Boseman from metastatic colorectal cancer, Reverend Miles called upon us to help improve access to colorectal cancer screening in his community,” Guerra noted. “He proposed using the same drive-by model that the church had already been using to distribute food and school supplies throughout the pandemic.”

Guerra, Miles, and colleagues recruited local health care workers and members of the Chi Eta Phi Sorority Inc., to administer flu vaccines donated by the Philadelphia Public Health Department and FITs donated by Polymedco Inc. They established an online registration site, which included a survey to determine screening eligibility and a link to an educational video about colorectal cancer. Participants were asked to complete a questionnaire before and after watching the video to assess their pre- and post-intervention knowledge on colorectal cancer and likelihood of undergoing screening. Drive-by flu vaccination and FIT retrieval was available on three separate dates, and participants had the option to return their completed FITs at a church drop box.

Of the 335 individuals who registered for the event, 192 (57.3 percent) were eligible for screening, attended, and received a FIT. The mean age of participants was 58.9 years. Among the 192 participants who received a FIT, 93.8 percent identified as Black, 1.6 percent identified as Hispanic, and 60.4 percent were female.

Guerra and colleagues found that the video intervention led to significant increases in knowledge about colorectal cancer and intent to undergo screening. To date, 154 participants (80.3 percent) have completed and returned the FIT. Positive FIT results potentially indicative of colorectal cancer were observed in 13 participants; these patients were referred to colonoscopy.

“Despite the restrictions posed by the pandemic, the drive-by FluFIT model allowed us to successfully engage community members to educate and screen for colorectal cancer in a safe and effective manner,” said Guerra. “This research demonstrates that we can mitigate the significant decline in colorectal cancer screening that has occurred during the pandemic and help reduce the burden of colorectal cancer in diverse communities.”

Guerra and colleagues plan to adapt their model and evaluate a drive-by COVID-19 vaccine-FIT program this spring.

A limitation of the study is that the impact on cancer diagnoses and outcomes cannot be determined yet, as colonoscopy results are still pending.

The study was supported by the National Cancer Institute. Guerra is on advisory boards for Freenome Inc., and Guardant Health, and receives grant funding from the Bristol Myers Squibb Foundation.