Joining Forces to Save Lives in Appalachia

COLLABORATION LEADS TO STRATEGIES
FOR STEMMING CERVICAL CANCER

Cervical cancer rates in Appalachia are some of the highest in the country. Researchers at the UK Markey Cancer Center wanted to change that through Take CARE (Improving Uptake of Cervical Cancer Prevention Services in Appalachia).

This multistate project looked at ways to prevent cervical cancer in an area of the country where women face challenges accessing healthcare and where there are lower rates of screening. It’s the kind of large-scale research that requires years of effort and millions of dollars, and it wouldn’t be possible without federal funding.

The hope is that the lessons learned here will make a difference for women in Appalachia and beyond.

Cervical Cancer Prevention in Appalachia

Reversing the rates of cervical cancer in Appalachia has proved challenging due to a variety of factors, including limited healthcare access, lack of awareness about prevention and screening, and the region’s high rates of tobacco use.

Take CARE looked at ways to make a difference. The recently completed project was a collaboration among UK, the Ohio State University, the University of Virginia and West Virginia University. The National Cancer Institute (NCI) provided an $11 million grant to fund the research, which began in 2018 and ran until 2024.

The core of the Take CARE project included working with regional healthcare systems to integrate evidence-based cancer prevention approaches. Markey researchers partnered with two Appalachian healthcare systems in Kentucky — Big Sandy Health Care based in Prestonsburg and White House Clinics based in Richmond — on three targeted prevention programs:

• Smoking cessation: Smoking is a major risk factor for cervical cancer. To help patients, providers connected them with a tobacco treatment specialist for counseling. Patients could also get nicotine replacement therapy if they needed it.
   
• HPV vaccination: Certain types of human papillomavirus (HPV) can cause cervical cancer. Clinic staff counseled parents about the importance of getting the HPV vaccine for their children. They also provided educational materials and reminder magnets to encourage families to return for the next dose of the vaccines.
   
• Cervical cancer screening: Detecting cervical cancer early with a Pap smear makes it much easier to treat, but screening rates are low in Appalachia. Clinics provided women with mailbased, self-collection kits. The kits made it simple for women to collect their own sample at home without a doctor’s office visit.

Training for the Clinics

An important part of the research project involved collaborating with the health systems and their staff. Markey researchers provided training and refreshers on screening guidelines and tips for communicating with patients. The providers in the clinics were the ones on the front lines, talking with patients and working directly with them.

Providers at Big Sandy Health Care and White House Clinics were eager to participate, said Markey researcher Mark Dignan, PhD, MPH. Dignan had worked with Big Sandy on previous projects, so he leveraged those connections for Take CARE. “We had a good response from the clinics and strong partnerships throughout the process,” he said.

“The clinics were enthusiastic about it,” research protocol manager Mark Cromo said. “They are constantly looking for ways to improve their HPV screening rates and lower smoking rates.”

The Importance of Community-based Cancer Prevention

Effective cancer prevention begins in the community, Dignan said. He has based his career in doing that work in communities throughout Kentucky.

Take CARE researchers published their results in the journal “Cancer Epidemiology, Biomarkers and Prevention.” Their research found that the mail kits led to more cervical cancer screenings. Cromo said clinics also saw an increase in HPV vaccinations over the course of the project, and a number of people quit or cut down on smoking.

There were other positive outcomes from the project. Part of the training encouraged providers to talk about HPV vaccination as a cancer prevention vaccine. “One of the health systems really took that to heart and incorporated that language when talking to parents. They found that to be very beneficial,” Cromo said.

Even though the project is complete, the health systems are continuing with pieces of it. One even hired a dedicated smoking cessation specialist.

The Take CARE experience will also help Markey researchers on future community-based projects. “We learned so much from working with these health systems,” Cromo said. “It really was a valuable project to learn more about how they operate and how we can try to fit in and help them to better serve their patients.”

The Value of Collaboration

Partnering with universities in neighboring Appalachian states broadened the participant pool. The universities worked closely together to ensure consistency across the project and the various states. The collaboration also distributed the work and brought in fresh ideas from different perspectives, making the whole project stronger, Dignan said.

The research also has potential value outside of Appalachia. “It probably has some utility, particularly for rural populations and perhaps populations that have high rates of poverty and low educational levels,” Dignan said. “I think our results would be useful to healthcare providers serving those populations.”

Federal Funding Matters

NCI grants like the one for Take CARE are critical for cancer prevention research. The grants are the sole source of funding for this type of research. The funding covered investigator salaries, educational materials, testing kits and lab tests, nicotine replacement therapy, and more. “Ultimately, the grants support the university, which then supports the research,” Dignan said. “It’s just so important to have that funding,” Cromo said. “We could not do this type of project without it.”