There are two kinds of health literacy: personal health literacy and organizational health literacy. Personal health literacy describes the extent to which people have the capacity to locate, comprehend, and apply information and/or services that they have obtained to make informed health decisions and actions for themselves and others. Organizational health literacy is the extent to which organizations and associations equip individuals with what is necessary to draw conclusions and inferences that enhance their understanding and enable them to make informed health decisions and act for themselves and others.

Why is Health Literacy Important?

Health literacy is instrumental in influencing health disparities because it can serve as an essential barrier or bridge to comprehension of health education material. An impactful determinant of health, a person’s health literacy is more likely to accurately predict their behaviors when compared with economic status, age, or ethnic background. Health literacy also has a substantial effect on an individual’s health: those who lack health literacy are twice as likely to be hospitalized as those who possess satisfactory levels of health literacy. The most common cause for this could be: misinterpretation of information or incorrect dosage of self-administered medication or treatments. 

Those who lack health literacy may be ashamed and/or hesitant to open up about this issue with their healthcare providers for fear of judgment, and this may hinder their trust in the healthcare industry. This in turn may be pernicious towards their overall well-being.

How Can We Account for This When Developing Educational Materials?

There are an abundance of ways to make accommodations in health resources in order to account for differences in health literacy.

  • Use Plain Language
      • Avoid technical slang or jargon
        • If technical terms are used, be sure to define them in lay language and contextualize it so that the intended audience understands how and when it is utilized.
      • If the health resource is an article, include a plain language summary (this is something that the database Cochrane practices), a glossary of terms and words with phonetic pronunciation guides, and at least one example of how the term or phrase is used.
  • Be Aware of Appropriate Phrasing and Preferred Communication
      • Be sure to provide materials in the languages that are most often spoken in your area, and to interact with reliable translators to verify that the facts are coming across correctly and fully in all languages.
        • Brochures, forms, and other materials at health education events can be available in multiple languages
        • It is important to be aware of perception of words used in verbal and written communication
          • For instance, avoid the qualifier “disorders” when discussing mental health or the term “co-morbidities”, since they carry negative connotations. Instead, opt for terms such as “mental health conditions”, and “co-occurrences”. 
        • Identity-first vs person-first
          • Identity-first language puts a person’s condition before the person, and person-first language puts the person before their condition.
            • Preferences depend on the community, so it is important to consult a variety of sources and be receptive to your audience(s) and their input.
  • Visual Supplements for Written Materials 
    • Infographics
      • Can provide helpful imagery to highlight main ideas of the research
      • Assists people who may have trouble imagining what the text is conveying
    • Text, Font, and Contrast
      • Large text can be helpful for people with visual impairments
      • Fonts should be clear and legible
      • Colors, hues, or both for background and text should contrast in a way that does not obscure the information

Just as zip code is a salient social determinant of health, health literacy serves as an important indicator of potential health behaviors and outcomes. Being able to consume, understand, and disseminate health information will help people and those they care about immensely in that the decisions made and actions taken will be more robustly supported and informed. 

Reach out to us at info@coloncancerfoundation.org if you would like to collaborate and create accessible health materials pertaining to colorectal cancer, prevention, or another related topic!

 

Vanessa Seidner is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Photo credit: Alexander Grey on Unsplash.

Regular screening between the ages of 45 and 75 is an ideal strategy to lower the risk of colorectal cancer (CRC). However, one of the biggest obstacles to screening for people who want to get examined is the expense and wait time. ​​According to a 2022 study, the average cost of a colonoscopy screening in the U.S. was $2,125, with an out-of-pocket cost of $79. But there are other options to screen for CRC besides colonoscopy. 

The CDC recommends guaiac-based fecal occult blood test (gFOBT) stool testing, which is a test type that finds blood in the stool by using the chemical guaiac, and it’s performed once a year. 

Fecal immunochemical test (FIT) test, is a test type that looks for blood in the feces using antibodies. It is conducted annually in the same manner as a gFOBT. Additionally, there is the FIT-DNA test, which is performed every three years and combines the FIT with a test to identify altered DNA in the feces.

Flexible sigmoidoscopy involves the insertion of a small, flexible, lighted tube into the rectum by the doctor. The doctor does an examination to look for polyps or cancer in the bottom portion of the colon and the rectum. It is done every 5-10 years.

CT colonography (virtual colonoscopy) uses X-rays and computers to produce images of the entire colon, which are displayed on a computer screen for the doctor to analyze; it is done every 5 years. 

Why Is This Important?

The choice to get screened has never been easy, particularly for older adults, especially since evidence-based tailored screening guides for average-risk individuals have been developed for those between the ages of 76 and 85, while a personalized approach is yet to be developed for those between 45 and 75 years of age. The population is exposed to a variety of preventive screening measures, often a part of the annual physical or wellness visit. Therefore, clinicians guiding average-risk patients between the ages of 45 and 75 sometimes find it difficult to explain why screening should  CRC screening should be stopped, since there are no evidence-based studies to back up their claim. 

Individualized awareness of the advantages and disadvantages of screening by providing alternative forms of support was found to reduce the likelihood that patients would use screening altogether and increase the likelihood that they would receive screening orders that were in line with the benefits of screening, based on a recent study involving 436 older patients (70-75 years).

Conclusion

In order to support average-risk patients (45–75 years old) in making individualized decisions, policies and screening protocols should be designed, similar to those for adults 75 years of age and above. A multi-level intervention that provides personalized information about the benefits and risks of screening, along with patient education and system-level support, can potentially lower overall screening use and align screening orders with benefits, while also cutting down on screening costs and wait times all over the country without compromising benefits. 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

By Parker Lynch

One cannot deny the importance of considering an individual’s risk of colorectal cancer (CRC) on the basis of their diet, exercising habits, and genetic predispositions. However, many other demographic factors can influence the likelihood of being diagnosed with CRC, as well as subsequent quality of life and survival outcomes. 

Lower socioeconomic status, for instance, is associated with a very high risk of developing CRC. Most of these community members are uninsured, which makes it difficult for them to receive the screenings that are otherwise readily accessible for those with insurance plans. A colonoscopy (one of the most important preventative screening measures for CRC) can cost anywhere from $500 to $6,000 without insurance, depending on the site where the procedure is conducted. For those on tight budgets, paying such amounts out-of-pocket every 5-10 years (depending on their personal risk of CRC) is quite unrealistic.

Tampa Bay Study

In a retrospective study conducted in 2021 by the CDC, researchers analyzed 13,982 uninsured patients with CRC who had received services at various free clinics in the Tampa Bay area between 2016 and 2018. These patients’ demographics are as follows: 

  • 5,139 (36.8%) were aged 50 years or older
  • Most were female (56.8%)
  • A large majority were non-Hispanic White (41.1%)
  • Majority were unemployed (54.9%)

Less than 7% of these patients had received any sort of preventive colorectal screening in their lives. 22.7% of these patients were smokers, and another 28.3% had diabetes. Not only are these patients more at risk for CRC because of their predisposed comorbidities, but they also don’t have the means to receive proper preventative screenings.

Bridging the Gap: Free Clinics

This study is one of many that sheds light on the healthcare treatment discrepancies among people of different socioeconomic statuses in America. The concerning statistics presented by these retrospective studies have motivated healthcare professionals and non-profit organizations to provide free clinics across the U.S. to make screening accessible to those who wouldn’t be able to otherwise afford it.

The NYC Health Department’s NYC Community Cares Project, for instance, provides free colonoscopies for uninsured residents referred from primary care sites. This program collaborates with various endoscopy centers and allows patients to work with primary care physicians, while also receiving free anesthesia and pathology services. Other interventions, such as the ColonoscopyAssist program, assists uninsured individuals in 30 states with the fees associated with CRC screening. This organization strives to eradicate a lot of the costs that are accumulated when someone gets preventative screening done, and reduces a colonoscopy’s cost to around $1,000 for a patient. Though this program doesn’t entirely eradicate colonoscopy costs, it still helps patients by significantly reducing the price, inherently making them much more feasible. 

Moving Forward

These public health interventions are vital to treating patients that suffer from America’s healthcare inaccessibility issues that run rampant throughout the country. Even though the U.S. spends more money on healthcare than any other wealthy country in the world, we have struggled to match other countries in patient satisfaction, accessibility, and life expectancy. 

Movements like the Community Cares Project in NYC, ColonoscopyAssist program, and other free/reduced-cost screening resources across the country are making huge strides in the CRC community. Should these endeavors continue to be subsidized by non-profit organizations, philanthropies, donations, and government support, uninsured individuals can receive timely preventative screenings. Increased access to these resources can ensure that patients from all socioeconomic backgrounds can receive the care that they need. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

By the ASCENDS team, University of Alabama at Birmingham

In the dynamic realm of cancer treatment, one persistent challenge demands our attention: the accessibility of care is far from straightforward.

Factors such as geographical location, income, employment status, and demographics can significantly influence the quality of care received. It’s high time we reshape this narrative, particularly for those colon cancer patients who face barriers to optimal cancer care.

And here’s the exciting part – you can be a driving force behind this transformation by simply sharing your story.

ASCENDS, an acronym for Advancing Surgical Care and Equity in the Deep South, is an initiative designed to revolutionize cancer care, especially for individuals in rural and minority communities who live in the states of Mississippi and Alabama.

ASCENDS is led by Dr. Maria Pisu and Dr. Daniel Chu, is funded by the National Institutes of Health, and is based at the University of Alabama at Birmingham.

How Can You Participate?

If you reside, or were treated, in the states of Mississippi or Alabama, we invite you to share your name and contact information. A member of the ASCENDS team will reach out to you for a one-time phone survey. And if you weren’t treated in these states but know someone who was, please consider sharing this opportunity!

ASCENDS is eager to hear about your experiences, triumphs, and even the challenges you’ve encountered. Why?

Because your voice can stir conversations, instigate change, and construct bridges within the landscape of cancer care. Your stories can influence policies, shape healthcare practices, and bridge long-standing gaps in the delivery of care.

 

There is also a little extra incentive – participants in the survey will be compensated for their time!

While the results of the study will drive the direction of the implementation, your results will be compiled into a plan of care recommendation that will be shared with healthcare providers in the deep South. Participants will be able to receive the study results once they are compiled. All personal information will be excluded.

Curious to Learn More?

Visit our website or connect with us on Facebook. Let’s work together to make a lasting impact on the world of cancer care!

 

This was an invited commentary from the ASCENDS team at the University of Alabama at Birmingham.

Photo credit: Tumisu on Pixabay.

Systemic racism remains an impediment  for the progress of public health in the U.S. Racial disparities continue to reduce access to quality healthcare in the country, as was confirmed by a recently published study. 

The study, published in the Journal of Clinical Oncology (JCO), found that young Black individuals (18-49 years) in the U.S. diagnosed with colorectal cancer (CRC) have a higher death rate than their White counterparts. The authors suggest that young Black patients with CRC are less likely to receive timely and guideline-concordant care (guideline-concordant is the minimal treatment patients should receive according to the National Comprehensive Cancer Network standards), which may be responsible for the increased mortality in that population. Specifically, the study found that Black CRC patients had longer times to receive adjuvant chemotherapy for colon cancer and neoadjuvant chemoradiation for rectal cancer compared to White patients. 

Racial disparity has a long and profound history in the U.S., affecting everything from the housing sector to the criminal justice system to the healthcare system and the economy. But when it comes to healthcare, it becomes even more worrisome and disturbing because the system’s ongoing inequities are impeding the progress made through years of public health effort. As a national goal, the Agency for Healthcare Research and Quality is dedicated to reducing racial disparities in health outcomes across the country. 

Interestingly, the American Cancer Society reports that, with the exception of pancreatic and kidney cancer, Black people had lower survival rates than White people for all cancer types. 

Barriers to CRC Screening and Treatment

Back to the JCO study – the authors found that access to CRC screening is difficult for Black people in the U.S. for a number of reasons, including:

  • Health insurance coverage: Often your health insurance determines the type of healthcare you receive. However, obtaining quality private health insurance is primarily dependent on having a job. But when it comes to employment, a substantial percentage of Black people are disadvantaged. Compared to White people, Black people have the highest unemployment rate in the country and are more likely to work in blue-collar jobs. Consequently, Black individuals have lower rates of private insurance coverage. 
  • Facility type: Black people are more likely to receive treatment at facilities with limited resources and are less likely to have access to high-performing facilities like teaching hospitals and cancer centers with a National Cancer Institute designation. However, research indicates that there could be a 5% reduction in the disparity in the provision of guideline-concordant care if Black and White patients were treated in the same healthcare facilities. 
  • Access to specialists/Lack of diversity in the medical workforce: For Black patients with metastatic CRC, fewer consultations with specialists and subsequent multimodality therapy treatments are provided. Nonetheless, even in cases when the rates of specialist visits are comparable to those of White patients, Black people are less likely to undergo treatment for CRC. A lack of cultural sensitivity and diversity in the medical workforce erodes good patient-provider communication, including the kind and caliber of information that clinicians deliver to patients, and makes the health care system appear less trustworthy. Disparities in patients’ access to high-quality care can be made worse by this, which can result in clinicians making insufficient treatment recommendations and creating obstacles to treatment adherence for patients from marginalized populations.

Over the years, a lot of work has been done to boost access to healthcare and remove barriers that might prevent it. Despite that, racial disparities in healthcare in the U.S. remain. However, no one should be denied access to high-quality healthcare due to the color of their skin or race. More work is needed to eradicate the disparities that Black Americans and other minority races face throughout the country.

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

 

Photo credit: Nathan Dumlao on Unsplash

By Parker Lynch

There are several known risk factors for colorectal cancer (CRC): genetic predisposition, age, poor diet, lack of regular physical activity, high alcohol consumption, etc. Recent research is further indicating that other health conditions could also influence an individual’s risk for developing CRC. One such condition is type 2 diabetes, was previously discussed by Emma Edwards (an intern colleague at the Colon Cancer Foundation) in a previous blogpost.

Someone with type 2 diabetes typically has hyperinsulinemia, meaning that they have too much insulin in their blood. Research shows that these higher levels of insulin and sugar in one’s body creates an environment in which CRC can develop more readily. Additionally, higher levels of sugar in the bloodstream typically contributes to more inflammation, which also increases CRC risk. The two factors together mean that someone with type 2 diabetes has a 27% greater chance of developing CRC. 

Severity and Oncological Outcomes

Knowing that there is a link between diabetes and CRC, researchers wanted to specifically hone in on patients with both conditions to understand whether severe diabetes has an impact on CRC survival. 

In a Taiwanese study published in October 2023, data from the country’s Cancer Registry Database was retrospectively analyzed for the period between 2007 and 2015. The 59,202 patients included in this study had diabetes and had undergone curative radical resection for their CRC (stages Ⅰ-Ⅲ), meaning that they had surgery to completely remove their cancerous tumors. The study split the population into three groups: 

  • CRC patients with diabetic complications
  •  CRC patients without diabetic complications
  • CRC patients without diabetes

After conducting the retrospective research, it was found that those with uncomplicated diabetes had an insignificantly worse CRC survival (better survival rates), whereas those with complicated diabetes had a significantly higher risk of poor survival. Women with diabetes, in particular, suffer from more negative CRC outcomes than their male counterparts. These findings indicate that patients who don’t experience diabetic complications will have better CRC outcomes in terms of survival.

One Step At a Time

Managing diabetes alone is a lot of work. Patients must constantly manage their diet, blood glucose levels, physical activity levels, etc. Dealing with CRC on top of diabetes seems impossible. However, patients are encouraged to take their afflictions one step at a time, with the support of their healthcare team by their side, composed of both oncology specialists and endocrinologists. 

Maintaining blood sugar levels and minimizing possible diabetic complications can have a positive impact on CRC outcomes. Though colon cancer and diabetes seem like vastly different conditions, they can go hand-in-hand and should be considered together when developing a treatment plan. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

 

Photo credit: Towfiqu barbhuiya on Unsplash.

Image credit: Gordon Johnson from Pixabay

 

There have been moments where we have experienced a symptom and attributed it to a completely different disease or condition than it ended up being. There are infographics to help acknowledge the similarities and simultaneously clarify distinct differences across the common cold, flu strains, and COVID-19. Since there is much overlap and potentially confusion that can arise regarding symptoms of Crohn’s disease, ulcerative colitis, and colorectal cancer, we have created infographics to help visualize commonalities as well as distinguish their disparate characteristics. 

We hope that these graphics will provide a clearer picture of symptoms that are unique to specific conditions and diseases and where and how they manifest in our body.

 

 

Sources:

  1. Colon cancer vs. ulcerative colitis (UC) symptoms & signs. eMedicineHealth. April 2, 2020. Accessed November 8, 2023. https://www.emedicinehealth.com/colon_cancer_symptoms_vs_ulcerative_colitis/article_em.htm.
  2. Crohn’s disease and colon cancer: What you need to know. HealthMatch. October 15, 2021. https://healthmatch.io/colon-cancer/crohns-disease-and-colon-cancer#overview.
  3. Colon cancer. Mayo Clinic. July 27, 2023. https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669.
  4. Colorectal cancer – symptoms and signs. Cancer.Net. June 1, 2022. https://www.cancer.net/cancer-types/colorectal-cancer/symptoms-and-signs.
  5. Colorectal cancer signs and symptoms: Signs of colorectal cancer. Signs of Colorectal Cancer | American Cancer Society. June 29, 2020. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/signs-and-symptoms.html.
  6. Colorectal cancer: Symptoms and diagnosis. Colon Cancer Foundation. December 1, 2022. https://coloncancerfoundation.org/colorectal-cancer-symptoms-diagnosis-and-treatment/.

 

Vanessa Seidner is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

The Network for Excellence in Health Innovation (NEHI) conducted research to shine a spotlight on disparities in colorectal cancer (CRC) screening and has proposed short-term and long-term recommendations to address these disparities. The report, Addressing Persistent Disparities in Colorectal Cancer Screening Among Racially and Ethnically Diverse Populations, proposes solutions that would help close existing gaps and legislative involvement for long-term resolutions.

By Parker Lynch

We all know that exercise is healthy. However, the extent to which a patient with colon cancer could improve their prognosis through exercising is something that was previously unknown, and is still being researched. Authors of one such research study published their findings after analyzing how physical activity impacted individuals with Stage III colon cancer.

Does Exercise Improve Colon Cancer Outcomes?

In collaboration with the National Cancer Institute, two groups of patients with Stage III colon cancer (one of them being a placebo or control group) were randomly assigned to various community and academic centers throughout the U.S. and Canada to be evaluated during the duration of their treatment. Patients were then instructed to report the average weekly time that they spent exercising.                                                                                                                                                                                                                                                                       

Each physical activity was assigned a specific metabolic equivalent (MET). The MET values were then multiplied by the hours that each patient reported spending each week, which were then categorized as:

  • <6 METs (light- to moderate-intensity physical activities) 
  • ≥6 METs (vigorous-intensity activities) 

Patients’ METs were evaluated throughout their chemotherapy treatments as well as six months after treatment completion. 

Here’s What They Found

During a median follow-up of 5.9 years, the study found the following relation between the status of a patient’s health and their corresponding physical activity levels: 

  • For light-intensity to moderate-intensity activities, the 3-year disease-free survival (DFS) was 65.7% with 0.0 hour/wk
  • For vigorous-intensity activity, the 3-year DFS was 76.0% with 0.0 h/wk and 86.0% with ≥ 1.0 h/wk

These results strongly indicate that more frequent, high-intensity recreational activities can improve DFS.

Implications for Patients 

Nothing is ever directly causational, and there are never guarantees that one specific lifestyle change will influence treatment outcome. However, studies like this are vital because they provide information that could change one’s quality of life while going through cancer treatment. If a patient with colorectal cancer picks up running as a new hobby because of this study and it makes them feel better in their day-to-day life, then that is a real-world influence of research studies. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

By Vanessa Seidner

The Colon Cancer Foundation and the 2024 Early-Age Onset Colorectal Cancer (EAO-CRC) Chair, Dr. Cathy Eng of the Young Adult Cancer Program at Vanderbilt-Ingram Cancer Center, will be hosting the 8th Annual EAO-CRC Summit in Nashville, Tennessee, which will provide the grounds for discussions about the latest technological and medical advances, how to build community, and about what actions can be taken at various levels to address the rise in EAO-CRC. 

Colorectal cancer (CRC) is the third most common cancer among men and women. This cancer occurs more often in the older population, yet there has been a rapid rise in CRC incidence among young people. Early-Age Onset (EAO) CRC refers to cases of colon or rectal cancer that occur in people under the age of 50 years. There has been an annual increase in these cases of approximately 2% since 2011.

Some of the best ways to prevent CRC or avoid unfavorable outcomes include on-time screening (starting at age 45 years – earlier if there are symptoms or family history), knowing the risk factors and family history, and consulting medical professionals when potential symptoms arise. One of the most effective ways to increase awareness of these solutions is through health education.

How Can We Encourage Health Education on EAO-CRC for College Students?

There are several opportunities to host educational events. The implementation of peer educators in colleges and universities is a cost-effective approach that allows students to impart valuable knowledge to their peers about meaningful and healthy lifestyle changes. While health outlooks differ, health education can be tailored to specific audiences to increase the likelihood that someone can reach and maintain their concept of optimal health. 

Health education events can appear as presentations, panels, tabling, and expositions. 

  • Presentations
      • Longer, more information-dense messaging
        • Can incorporate interactive questions and activities and pre/post surveys that allow participants to think critically about what they have learned and about how they will apply it to their lives moving forward. Information pamphlets and giveaways can also bolster interactivity. 
      • Key takeaways: Elaborate and in-depth, allows for active participation, and allows for future action to be taken.
  • Panels
      • Question and answer sessions. These can allow for an increased sense of closeness.
        • Panelists can provide a variety of perspectives germane to their topic
        • They can share anecdotes and experiences – personal, occupational, or both 
        • Specific contact information can be provided in case an audience member wishes to reach out to a panelist.
      • Key takeaways: Allows sharing of diverse viewpoints, opportunity for an open dialogue 
  • Tabling Events 
    • Drop-by event; can give quick overviews
    • Opportunity to share information pamphlets and giveaways
    • Can host activities to engage visitors in discussion and have giveaways
    • Key takeaways: Cost- and time-effective, succinct, and engaging – tabling events are a popular health education method                                                                                                   

Colleges and universities can host one or more of these events to increase awareness on risk factors, symptoms, the need to consult a medical professional if symptoms occur, and the importance of regular screening. As for timing, it is best to do so on days where there are not as many classes, in populous areas, and during a time of day when there is a higher influx of people, such as around a mealtime or when a certain timeblock for classes commonly ends. 

March is Colorectal Cancer Awareness Month. Consider a tabling event with information about the disease and with some free merchandise. Students can also be encouraged to wear dark blue to increase awareness of CRC.

Reach out to us at info@coloncancerfoundation.org if you would like to partner on an information event in March or any other time!

 

Vanessa Seidner is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Photo Source: Naassom Azevedo on Unsplash