Community Health Center / Cancer Control Project

In 1991, the Community Health Centers/Cancer Control Project (CHC/CCP) was funded by the National Cancer Institute (NCI Grant No. CA-54300).  The CHC/CCP was a multi-centered randomized clinical trial set in 67 C/MHCs (in New York, New Jersey, and Connecticut) to disseminate and evaluate the adoption and implementation of cancer early detection practice guidelines developed by the NCI.  This was a collaborative effort among CDN, Dartmouth Medical School and Albert Einstein College of Medicine.  This four-year project evaluated physician recommendations, and performance of Pap tests, mammograms, stool occult blood tests, sigmoidoscopy, breast self-examination and clinical examination of the oral cavity, breast and colon/rectum.  These are all recommended methods to find cancer at an early stage when it is most easily treated.  The Medical Directors and other clinical and office staff at the participating health centers received special training in the design and implementation of office systems to help foster early detection activities.  The project also assisted this group of physicians in motivating their patients to be more receptive to early detection services.

Project Outcome:

The outcome of this project contained mixed results.  Overall, seven of the eight early-detection services increased across all of the participating sites.  However, for those sites that were specifically targeted by the intervention, only breast self-examination services appeared to improve statistically.  The mixed results appear to be due to the a number of factors including: 1) the large number of sites that were targeted; 2) high variability in staff size among the sites; and 3) high staff turnover at some of the sites.  The project confirmed that an office system is able to improve cancer early detection services in complex CHCs which have stable clinical leadership.  On the other hand, if a CHC is experiencing high staff turnover and other major changes, such an intervention will most likely not be successful.