Grants of up to $10,000 available for Kentucky communities to fight colon cancer; applications are due July 15

The Colon Cancer Prevention Project has a new "Project Innovation" grant program to help fund local innovative ideas to get more people screened for colon cancer in Kentucky and Southern Indiana.

Kentucky ranks first in colon-cancer diagnoses and fourth in colon-cancer deaths. It is estimated that 60 percent of deaths from colon cancer could be prevented if everyone were screened at age 50, according to the project's website.

The project, based in Louisville, is a partner in the national initiative to increase colon screening rates to 80 percent by 2018 and hopes to reach this goal by expanding into new communities through volunteer participation.

With this goal in mind, the project is offering up to $10,000 in grants to help individuals lead efforts to raise awareness in their communities about colon cancer and educate people about the importance of screening. The number of approved projects and the amount of funding will depend on the number of applications received and the perceived effectiveness of the project.

Anyone who creates a project to support the expansion of the Colon Cancer Prevention Project that will serve Kentucky or Southern Indiana can apply.

Projects should target African Americans or rural areas of Kentucky and Appalachia. Preference will be given to projects that focus on these counties: Whitley, Knox, Bell, Clay, Madison, Fleming, Morgan, Martin, Pike, Hopkins and Hardin. However, all applications will be considered.

Project requirements can be found online and applications will be accepted through July 15. For more information and access to the application, click here: http://coloncancerpreventionproject.org/help-kick-butt/project-innovation/

Free screenings of new Kentucky colon-cancer documentary, plus Q and A, are scheduled in Louisville, Lexington and Hazard

The Colon Cancer Prevention Project is premiering its new documentary, "Catching a Killer: Colon Cancer in the Bluegrass," in three select cities, before it starts airing on KET this summer.

The 30-minute film, which features stories from Kentuckians who have been affected by colon cancer, will be shown June 18 at the Clifton Center in Louisville; June 23 at the Central Library in Lexington; and July 20 at the Perry County Library in Hazard. It includes stories from residents of Appalachia and Louisville, two areas where colon cancer rates are the highest.

All three events will run from 7 to 8 p.m. and include a question-and-answer session with expert panelists after the film is over. Free food, music and photos will be offered before the start of the film, from 5:45 to 6:45 p.m.

The Colon Cancer Prevention Project is Kentucky and Southern Indiana’s only nonprofit focused solely on work to end the second leading cancer killer among men and women. Colon cancer strikes 2,600 Kentuckians each year – making Kentucky one of the worst states in the country for colon cancer incidence – but it is highly preventable with screening.

"Catching a Killer" not only shares the heartfelt stories of our neighbors, but also shares information about screening options and resources in our state.

“Our goal is to make sure people get screened for this disease and avoid ever hearing the words: You have cancer,” Andrea Shepherd, the project's executive director, said in a news release. “We hope that after viewing this documentary, people get on the phone and start talking with their physicians and families about colon cancer screening.”

The events are free and open to the public. More information and an RSVP form is available on the project's website.

Two weeks of high-fiber, low-fat diet brings changes that protect against colon cancer; high-fat diet brings changes with more risk

Two weeks is all it took for a change in diet to increase production of a substance in the gut that may reduce the risk of colon cancer, according to a recent study, published in Nature Communications.

The study asked 20 African Americans in Pittsburgh and 20 rural South Africans to switch diets for two weeks. The Americans were fed a high-fiber, low-fat diet, with plenty of fruits, vegetables, beans, cornmeal and very little meat, while the Africans were given a diet high in fat with lots of meat and cheese, Sindya N. Bhanoo reports for The New York Times.

“We made them fried chicken, burgers and fries,” Stephen J. D. O’Keefe, a gastroenterologist at the University of Pittsburgh and one of the study’s authors, told Bhanoo. “They loved it.”

After two weeks, colonoscopies on the volunteers found that the African Americans who ate the traditional African diet had "reduced inflammation in the colon and increased production of butyrate, a fatty acid that may protect against colon cancer," Bhanoo writes. Africans who ate the Western diet had changes in their gut bacteria "consistent with an increased cancer risk."

African Americans are disproportionately affected by colon cancer, while the disease affects few people in rural Africa, Bhanno notes.

Colorectal cancer is the second most common cancer in both men and women in the U.S. and is expected to cause about 49,700 deaths during 2015, according to the American Cancer Society. Kentucky leads the nation in both incidences and deaths from colorectal cancer, with 51.4 cases per 100,000 people and 18.7 deaths per 100,000, according to the Kentucky Cancer Registry.

New health-related laws deal with heroin, dating violence, end-of-life care, prescriptions, colon-cancer and newborn screening

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The Kentucky General Assembly passed several health-related bills this session, including high-profile measures on heroin and dating violence. It did not pass many others, including one that would have a great influence on the state's health: a statewide smoking ban, which passed the House for the first time ever, but never got out of an unfavorable committee in the Senate. Here's a roundup:

Heroin: Kentucky's heroin-overdose epidemic was caused partly by a 2012 legislative crackdown on prescription painkillers, which steered users to the illegal drug. Last year's bill died because of deadlock over sentences for traffickers and needle-exchange programs for addicts, and Gov. Steve Beshear and legislators gave this year's bill top priority. It was not finally negotiated until a few hours before passage, but Beshear signed Senate Bill 192 into law less than 12 hours after it passed so that its emergency clause could put it into effect immediately.

SB 192 includes both a needle-exchange program and harsher penalties against traffickers, the main points of contention between the House and Senate, but requires local governments to approve needle exchanges and allows judges to be lenient in sentencing addicts, to help them get treatment. It allocates money for drug-treatment programs, allows increased access to Naloxone, a drug that reverses the effects of an overdose, and allows jailers to provide medically assisted treatment for inmates with opiate addiction.

Dating violence: After 10 years of lobbying and debate, the dating violence bill will allow dating partners to get interpersonal protective orders from a judge if they have been the victim of dating violence, sexual abuse or stalking. This year's bill largely dissolved social conservatives' opposition by creating a new chapter in the law for dating violence, with the same protections as the domestic-violence law. Kentucky is the last state to offer protection to dating-violence victims. House Bill 8 was sponsored by Rep. John Tilley, D-Hopkinsville, who also sponsored the House heroin bill.

Beshear has signed these bills into law:

Prescription synchronization: SB 44, sponsored by Sen. Julie Raque Adams,R -Louisville, will allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

Medical order scope of treatment: SB 77, sponsored by Sen. Tom Buford, R-Nicholasville. will create a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care.

Colorectal cancer screening: SB 61, sponsored by Sen. Ralph Alvarado, R-Winchester, will require that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The governor also signed a similar measure, HB 69, sponsored by Rep. Tom Burch, D-Louisville, which contains an amendment by Sen. Julian Carroll, D-Frankfort, for a Medicaid savings study.

Newborn screenings for fatal disease: SB 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, will require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur.

Spina bifida: SB 159, sponsored by Adams, will require medical providers to supply written, up-to-date, accurate information to parents when their unborn child is diagnosed with spina bifida so they can make informed decisions on treatment.

Emergency care for strokes: SB 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, requires that local emergency services have access to a list of stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky. Emergency medical providers will set their own protocols for assessment, treatment and transport of stroke patients.

Alcohol and drug counselors: HB 92, sponsored by Rep. Leslie Combs, D-Pikeville, creates an enhanced licensing program to recognize three levels of certified alcohol and drug counselors, with different levels of education. The goal is to increase the number of counselors in the state.

UK cancer research center: HB 298, sponsored by Rep. Rick Rand, D-Bedford, revises the state budget to authorize $132.5 million, half of the cost, for a new medical research center at the University of Kentucky. The university says it will raise money to cover the other half.

These health bills awaited the governor's signature Monday morning:

Physician assistants: HB 258, sponsored by Rep. Denver Butler, D-Louisville, to allow physicians to supervise up to four physicians at the same time, rather than two.

In-home care: HB 144, sponsored by Burch, to establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services.

Pharmacist-practitioner collaboration: HB 377, sponsored by Rep. Dean Schamore, D-Hardinsburg, to allow collaboration between pharmacist and practitioners to manage patients' drug-related health needs.

Tax refund donations: SB 82, sponsored by Sen. Max Wise, R-Campbellsville, to put an income tax check-off box on tax forms to allow people the option of donating a portion of their tax refund to support pediatric cancer research, rape crisis centers or the Special Olympics.

Health related bills that were left hanging:

The smoking ban, HB 145, sponsored by Rep. Susan Westrom, D-Lexington, never got a hearing in the Senate Veterans, Military Affairs and Public Protection Committee, and neither did the Senate companion bill, SB 189, sponsored by Adams.

Three bills challenged Medicaid managed-care companies. SB 120, sponsored by Alvarado, would have created a process for health-care providers to appeal the companies' decisions to the state passed the Senate, but not the House.  And the following two bills that never got out of the Senate: SB 88, also sponsored by Alvarado, which challenged the $50 "triage fees" MCOs pay for emergency-room visits that they conclude were not emergencies, and would have required them to pay contracted fees instead and SB 31, sponsored by Buford, which would limited the amount of co-payments. Also not getting House action was Alvarado's SB 6 would have created review panels for lawsuits seeking damages from health-care providers.

State Senate passes bills to lower a barrier to colon-cancer screening and allow patients to synchronize their prescriptions

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Two health-related bills, one to remove a financial barrier for colorectal cancer screenings and the other to allow consumers to synchronize prescriptions so they can get all of their medications on the same day, passed the state Senate Feb. 19.

Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, would clarify that a fecal test to screen for colon cancer, and any follow-up colonoscopy, are preventive measures that federal health reform require to be covered by insurance. It went to the House on a vote of 31-3.

"The purpose of this bill is to identify and correct ongoing discrepancies in the coding and billing portion of this screening and prevention continuum," said Alvarado, who is a physician.

The two primary ways to screen for colon cancer are colonoscopy or a non-invasive fecal blood test.

This bill was prompted because patients are being charged for a diagnostic procedure instead of a preventive one if they do a non-invasive fecal test that comes back positive, and then get a follow-up colonoscopy. The non-invasive fecal test is coded as a preventive screening, which is covered by insurance, but the colonoscopy is coded as a diagnostic procedure, which comes with a hefty price-tag, sometimes upwards of $1,000, Alvarado said.

Patients are also being charged for a diagnostic procedure if lesions are removed during the screening process, which is standard procedure to do so, since the patient would otherwise have to return for a second colonoscopy to remove them.

This is ironic, Alvarado said in a news release, because if the patient had chosen the more expensive and invasive colonoscopy initially, the insurance company would have paid for it.

This is a "barrier to screening," he said, in a state that leads the nation in colorectal cancer and until recently led the nation in deaths caused by it.

A sister bill, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, passed the House Feb. 9 and was assigned to the Senate Health and Welfare committee Feb. 12.

By a 34-0 vote, the Senate passed SB 44, sponsored by Sen. Julie Raque Adams, R-Louisville. It would allow patients with multiple prescriptions, in consultation with their health care provider and their pharmacist, to synchronize them so that they may be picked up from the pharmacy at the same time.

"This bill will allow patients to refill and pick up their prescribed medications for chronic conditions on the same day of the month instead of making multiple trips to the pharmacy," Adams said.

"This bill is not just about convenience," Adams said, but also helps make sure patients take their medication, "improving health outcomes and lowering health care cost overall." She cited a study that found patients who participated in a med-synchronization program at their pharmacy were 30 percent more likely to take their medicine as prescribed.

Some are concerned about the front-end cost of this program, "but fail to see the potential cost savings to the health care system overall," Adams said, saying a Medicare Part D cost-benefit analysis found there was an estimated savings of $1.8 billion to the system, and also showed improved medication adherence.

A sister bill, House Bill 140, sponsored by Rep. Addia Wuchner, R-Florence, was assigned to the House Banking and Insurance Committee on Jan. 9.

Kentuckians rank high in colorectal cancer deaths; study will use emergency rooms to promote screening to save lives

University of Kentucky College of Nursing Associate Professor Jennifer Hatcher has received a two-year $359,528 grant for her project, “Promoting Colorectal Cancer Screenings in Rural Emergency Departments.”

The grant, given by the National Cancer Institute, will be used to study how effective motivational interventions are in helping non-emergency patients in rural Appalachian emergency departments to get screened for colorectal cancer, Hatcher said in an interview. Patients' companions in the emergency rooms can also participate in the interviews.

Of cancers that affect both men an women, colorectal cancer is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and in women, according to the Centers for Disease Control and Prevention.

Kentucky leads the way in these national health statistics.  It has the highest rate of colorectal cancer in the nation at 55.1 per 100,000 and is the fourth highest in the nation for deaths caused by colorectal cancer at 19.8 per 100,000. And those in Kentucky's Appalachian counties have a higher incidence rate than the rest of the state and nation overall at 57.2 percent, according to a Kentucky Colon Cancer Screening Program annual report.

“Residents of rural Appalachia have a higher incidence and mortality rate from colorectal cancer than residents of any other region of the country," Hatcher said in the release. "In light of the fact that colorectal cancer is one of the few cancers that can actually be prevented by screening, this grant presents a tremendous opportunity for us to address one of the key factors affecting this disparity for rural Appalachians—limited access to the health care system."

The interventions for the study will be conducted by lay health workers, trained local people who are interested in the health of the community and helping their neighbors get screened. They will talk to the patients or their companions about their perceived barriers related to colorectal screening and help them work toward resolving those barriers. All interactions are voluntary, Hatcher said in an inteview.

The lay health workers act as connections between the patients and whatever resources they may need to get screened, or helps alleviate fears they may have about colorectal screening. They are also trained to provide education on what types of screenings are available and discuss what is best for each individual.

Patients who agree to the intervention will get a follow-up call one week after the emergency room intervention to see if they need further assistance in setting up a screening and will receive yet another call in three month.

The project will be the first to address the disproportionate incidence and mortality from colorectal cancer in rural Appalachia utilizing the emergency department as an access point, says the release.

"We believe that using an emergency department as an access point for this project will allow us to reach more individuals who are at risk for developing colorectal cancer, thereby reducing the disparate mortality rates that rural Appalachians suffer from this disease,” Hatcher said in the release.

UK receives $3.75 million from CDC to use for colorectal cancer screening in Kentucky River's headwater counties

The University of Kentucky Rural Cancer Prevention Center has received a $3.75 million, five-year grant renewal from the Centers for Disease Control and Prevention to use toward the prevention of colorectal cancer in Central Appalachia and other rural areas.

The UK Center is one of 26 CDC-funded Prevention Research Centers in the country, Mallory Powell reports for UKNow. It works with a team of community members, public health professionals and researchers to conduct and support community-based, participatory prevention research toward rural cancer prevention in the Kentucky River Area Development District.

Over the next five years, this $3.75 million grant will allow Dr. Richard Crosby, director of the RCPC and his team to develop, implement, and disseminate an at-home colorectal screening test that has the potential to drastically increase annual colorectal cancer screenings in rural areas, Powell reports.

Kentucky has the nation's highest rates of cancer incidence and death, with more people from Appalachian Kentucky dying from colorectal cancer than those diagnosed with the same cancer in other regions of the state.

"This is about serving Kentuckians, and we are targeting an area of rural Appalachia that has extremely high rates of colorectal cancer morbidity," Crosby told Powell. "We're focusing on a project that engages people at a point when we can still do something to prevent their death."

The at-home colorectal screening test will allow the person to collect a small stool sample per instruction in the privacy of their home and mail it in the provided kit to the lab for testing, Powell notes. The lab will then determine if there are any potentially cancerous cells. If the test comes back positive, the RCPC staff will assist the participant with further testing and treatment as needed.

Colorectal cancer is usually a slow growing cancer and has a higher survival rate if detected and treated early. Late diagnosis because of delayed or lack of screening causes the chance of survival rate to significantly drop.

Delayed or lack of screening for colorectal cancer is often a problem for people living in rural areas like Appalachia because of healthcare access, Powell notes. The Kentucky River ADD falls into this category, since all eight counties in the district are classified as health-care professional shortage Areas by the Health Services and Resources Administration. This district is also one of the poorest in the nation.

The colorectal screening work of the RCPC will build on the successes of its previous prevention program for cervical cancer prevention and screening, which is now being used in 18 local Kentucky health departments and has also been adapted for use in 30 local health departments in North Carolina.