Adventist Health for several years has been rolling out a genetic testing and cancer risk-assessment program to sites across the Roseville, Calif.-based system. Now, the program is playing a part in Adventist’s efforts to get patients in need of cancer screenings back into its facilities despite fears over COVID-19.
In the wake of the pandemic, patients have deferred or canceled preventive care appointments out of concern they’ll be exposed to the virus. That could have long-term consequences for cancer care, since fewer patients screened could make it harder to catch cancer cases at an early stage.
Staff at Adventist hope to avoid that by proactively reaching out to patients at high risk for cancer.
Dr. Candace Westgate, an obstetrician-gynecologist and now medical director of the cancer risk-assessment program at the system, began developing the Adventist Health Early All-Around Detection program—abbreviated as AHEAD—in 2016 for OB-GYN services. It’s since expanded to more than two dozen primary-care and specialty sites across Adventist.
Front desk staff ask patients to fill out an online questionnaire from software company CancerIQ about their family history. The software program determines whether the patient might benefit from genetic testing, based on guidelines from medical societies.
Information from family history and the genetic tests is used to stratify patients as low-, medium- or high-risk for various cancers. That informs subsequent care plans, such as more frequent screenings, referrals to specialists or even risk-reducing surgery for some patients.
That risk stratification also can identify patients that doctors want to be sure aren’t skipping cancer screenings.
Recently, due to COVID-19, “patients are scared or concerned about coming in,” Westgate said.
So, to encourage patients with cancer risk factors not to miss screenings, Adventist staff have been calling patients flagged as high-risk to offer reassurance and remind them about upcoming appointments.
Mammograms, colonoscopies and other screenings that require patients to visit a healthcare facility have experienced a sizable drop this year. That was expected when facilities closed their doors for non-emergency care in the early days of the pandemic, but since April, industry experts had hoped to see screenings rebound as patients rescheduled preventive care.
However, as of July, breast, colon, lung and prostate screenings were still down 8.9%, 37.5%, 58.7% and 19.1% year-over-year, respectively, according to a study analyzing data from a Medicare claims clearinghouse. A Health Care Cost Institute analysis of data from various payers found mammograms were down 24% and colonoscopies were down 33% as of August.
NorthShore University HealthSystem in Evanston, Ill., is building tools in its electronic health record system to help make sure patients don’t miss steps in care plans after genetic testing. NorthShore launched its genetic testing program in early 2019 with genomics company Color to offer testing as part of primary care. Patients, who pay $175 to receive genetic testing through the program, can undergo screenings related to hereditary cancer, cardiovascular risks and pharmacogenomics.
NorthShore is working on creating care pathways in its EHR that match patients to care plans—and subsequently monitor progress—based on their risk factors. That way, the system could automatically push reminders and decision-support alerts to patients or care teams if a patient is due for a screening.
NorthShore started building pathways for some patient populations, such as those at high-risk for breast cancer. But the system’s personalized medicine staff is still validating the tools so they haven’t been deployed into patient care, said Dr. Peter Hulick, director of the system’s Mark R. Neaman Center for Personalized Medicine.
“This will be important, especially in COVID, but really at any time the health system wants to know: Are people getting the screening or prevention that they need?” Hulick said.
While targeted outreach can be helpful, it’s important to keep in mind that most cancers aren’t caused by inherited genetic mutations, said Dr. Richard Schilsky, chief medical officer at the American Society of Clinical Oncology. So while people with genetic factors are at high risk for developing a particular cancer, patient outreach shouldn’t stop with this population.
“While those people are high-risk, and you do want to get them in for screening when they’re scheduled for a screening, you don’t want to neglect the other … lower-risk people who might also be due for screening,” Schilsky said.