The Long Road to Recovery, Part I: Cancer Screening in the U.S. (Mary Bird Perkins Cancer Center, Louisiana)

Early in the first U.S. COVID-19 surge of 2020, National Cancer Institute (NCI) Director Norman Sharpless warned that the pandemic could, over time, have substantial consequences for cancer outcomes. The NCI’s initial modeling suggested that delayed or missed cancer screening and treatment for breast and colorectal cancers could, during the next decade, account for an approximate 1 percent increase in deaths (i.e., an additional 10,000 deaths) from these two cancers.

A year and a half later, as the U.S. healthcare system continued to grapple with COVID-19 spikes and pandemic fallout, Debra A. Patt, FASCO, MD, PhD, MBA, presented her perspective on the road to recovery from the pandemic at the ACCC 38^th [Virtual] National Oncology Conference. Dr. Patt is the lead author of a study examining the impact of the pandemic on cancer screening rates and E&M services among older adults in the U.S. At the time of the study’s publication (November 2020), the authors noted that disruptions in cancer screenings had continued for a minimum of six months, and most screening rates remained “diminished.” In her remarks, Dr. Patt stressed the critical need for continued focus on cancer screenings and outreach education as the oncology care community continues to strive to bring screening rates back to pre-pandemic levels.

To obtain an on-the-ground perspective of how cancer programs’ screening and outreach education efforts are recovering from pandemic pressures, ACCCBuzz spoke to four cancer programs across the country that will be featured in four separate blog posts in January 2022. For the first blog in the series, we spoke to Renea Duffin, MPA, vice president of cancer support and outreach at Mary Bird Perkins Cancer Center, an ACCC member organization located in Baton Rouge, Louisiana.

About Mary Bird Perkins

The Mary Bird Perkins Cancer Center has weathered much since the onset of COVID-19. During the past two years, Louisiana has experienced four significant COVID-19 spikes. By July 2021, Louisiana had one of the worst COVID-19 infection rates in the country, pushing the state’s healthcare resources to the limit. Then, in August 2021, Hurricane Ida hit southeastern Louisiana hard, with some of the storm’s worst devastation occurring in Terrebonne, Orleans, Jefferson, and St. John Parishes. Areas adjacent to Baton Rouge (where the cancer center is located) also suffered extreme damage.

During the pandemic, Mary Bird Perkins has continued to deepen its ties with local communities. For 20 years, Mary Bird Perkins has been strengthening its education, prevention, and early detection programs to bring information and care access to people in their home communities. In 2016, Mary Bird Perkins’ early detection program for the medically underserved received an ACCC Innovator Award. This long-standing program brings education about cancer prevention and screening services to underserved Louisiana communities—a critical service in a state with the fifth-highest rate of cancer mortality in the U.S.  

The early detection program currently serves 30 of the state’s parishes. Features of the program include:

• A community-based, year-round delivery model
• Patient navigation that streamlines processes and ensures follow-up for abnormal findings
• The use of national tools that monitor health outcomes by ZIP Code
• Partnerships that minimize duplication and maximize smooth transitions along the care continuum

In addition to the cancer center’s robust schedule of community events, Mary Bird Perkins’ two mobile medical clinics offer year-round free screenings for five different cancer types. When an abnormal finding is identified, each patient receives follow-up care from a patient navigator who helps eliminate barriers along the care path.

In 2016, Mary Bird Perkins Cancer Center expanded the reach of its cancer prevention education program by bringing its two mobile screening units into the workplace through its “Prevention on the Go” program, funded by an employer grant. In 2020, the program received a three-year grant from the Blue Cross and Blue Shield of Louisiana Foundation to provide community screening and education to 12 parishes in very rural northeast Louisiana. All of these services are provided by a relatively small staff that includes a director, nurse navigator, two outreach coordinators, two regional managers, and one workplace program coordinator.

Pandemic Deters Early Detection Efforts

ACCCBuzz spoke with Renea Duffin, MPA, vice president of cancer support and outreach at the Mary Bird Perkins Cancer Center, in late October 2021.

Like other healthcare facilities the country, in mid-March 2020, Duffin says the Mary Bird Perkins Cancer Center quickly adapted to COVID-19 public health emergency restrictions and requirements. As a consequence, the outreach and screening program was paused, the mobile medical units were closed, and community events were cancelled. During this period, when program staff could not travel out into the community, they regrouped and planned how best to adapt their services so both providers and patients would be as safe as possible when screening could resume.

By July 2020, the mobile screening program was back in business—but on a more limited scale. COVID-19 safety precautions included limiting the screenings to breast, colorectal, prostate, and skin cancers. Oral cancer screenings were halted as a safety precaution. The program transitioned from a first-come, first-served basis to appointments only. When scheduling an appointment, staff would help participants complete the necessary paperwork electronically. Through the use of a wait-list app, patients would stay in their cars until the app notified them to come to the mobile clinic unit for their appointment.

Duffin says that the cancer center continues to permit no more than three individuals in a mobile unit at one time: the patient, a nurse practitioner, and a patient navigator. The mobile medical units are equipped with air purifiers and PPE for staff, and everyone is required to be masked. To allow for thorough cleaning between each patient screening, more time is allotted between patient appointments. As a result, fewer patients can be screened per day.

Screening Rates Drop

Duffin says that, in 2020, the Mary Bird Perkins Cancer Center saw a 30 percent decline in screening events and a 47 percent decline in screening participation. The cancer center conducted 6,710 cancer screenings in 2019, a number that dropped to 3,585 in 2020. Today, screening numbers are beginning to recover, Duffin says. As of October 2021, year-to-date cancer screenings at Mary Bird Perkins totaled 3,786.

Regarding breast cancer screenings, in 2019, the mobile outreach clinics performed 2,322 screenings and diagnosed 68 new cases of breast cancer. In 2020, the outreach and screening program screened 1,321 patients for breast cancer. As of October 2021, breast cancer screenings had climbed to 1,359. “So the numbers are slowly beginning to tick back up,” affirms Duffin.

“The interesting thing is that our number of cancer diagnoses did not diminish, even though the number of participants diminished,” says Duffin. “In 2019, we diagnosed 68 [breast] cancers. In 2020, even though we only screened 3,585 [individuals], we diagnosed 42 cancers. Thus far in 2021 [October], we’ve already diagnosed 31 cancers, with a number of other screening participants with abnormal findings still in follow-up.”

Engaging the Community

Duffin praises the work of the cancer center’s marketing and communications team for “doing an outstanding job of helping us promote our screening events … through social media, digital billboards, print ads, radio spots, and even television.” The cancer center held three large-scale “Live Well” events in September and October 2021. “We did billboards for those as well as early morning news shows to make people aware,” says Duffin. “That really gets the message out to people.”

“On November 6, 2021, we held our Live Well Bayou event in Houma,” Duffin continues, “which was hard hit by Hurricane Ida this year.” Duffin explains that the hurricane and its aftermath resulted in the cancellation of several screening events for that area, as “people were focused on trying to rebuild their lives.” But by getting the word out about the rescheduled screening event, Duffin says her team did 193 screenings on that one day alone.

Mary Bird Perkins uses communication strategies to cast a wide net for its screening events. “A multi-channel approach is your best option when it comes to trying to reach as many people as possible,” says Scott Miller, the communications director at the cancer center. “We are targeting the underserved, but we also know there are people who have insurance who are not getting screened because of different barriers, so while we work to target communications as much as possible, we often take a mass media approach. We use all of the channels at our disposal for messaging.”

Duffin emphasizes that relationship-building and commitment over time are integral to community engagement and establishing trust. “Because we have been doing this for so long, people know who we are,” says Duffin. “They recognize us and trust us to do it [cancer screening] for them. We have so many of our participants that come year after year. And some members of our team have been doing this for so long, participants look for them. They know them by name when they call to schedule their appointment.”

Grassroots and word-of-mouth outreach is invaluable, Duffin says: “Once you become a trusted provider and you have reached influencers within the local communities, people are going to come to you. And the fact that we go out to them is even more meaningful. They don’t have to come to a brick-and-mortar facility for screening. We go into their communities and provide the service to them.” Since 2002, Mary Bird Perkins has provided 100,000 free cancer screenings—thanks to generous community support.

Since the final months of 2021, the pandemic has taken another turn with the dawn of the omicron variant. Much more transmissible than the once-dominant delta variant, omicron is sweeping through communities and packing hospitals worldwide. Mary Bird Perkins’ early detection program for the medically underserved will continue to navigate the rocky terrain of the evolving pandemic to bring early detection services to as many vulnerable people as possible.

Next: ACCCBuzz learns about the pandemic’s impact on cancer screening rates at St. Elizabeth Healthcare in Fort Mitchell, Kentucky.