March is National Colorectal Cancer Awareness Month

The USF College of Public Health’s (COPH) Florida Prevention Research Center (FPRC) in collaboration with Moffitt Cancer Center finished the second year of their FluFIT program to increase colorectal cancer (CRC) screening rates specifically using the fecal immunochemical test (FIT).

CRC is the second leading cause of cancer death in the US. Most of these deaths could be prevented with routine screening. FIT is the least invasive, least expensive form of screening involving a take-home kit with instructions on collecting a stool sample. During analysis, if blood is found there may be colon polyps or early stage CRC and a follow-up colonoscopy is scheduled.

In the FluFIT program, it has been shown that distributing the take-home FIT kits during the annual flu vaccine process increases CRC screening rates, thus the name FluFIT.

“When you opt for the FIT instead of the more invasive colonoscopy, you will have to do the FIT annually. Typically the flu vaccine is also done annually, so the FluFIT program is a way of pairing them up so that you can get them done at the same time,” said Dr. Dinorah Martinez Tyson, alumna and assistant professor of community and family health at the COPH.

In 2016, the FPRC’s Community Advisory Board selected working with employers as one of the ways to reach individuals over the age of 50 who are at a higher risk for developing colorectal cancer.

As a collaborator with Moffitt in the past years, the FPRC team reached out to Debra Cheek, Moffitt wellness coordinator, to talk about the FluFIT program. Moffitt team members are required to get the flu vaccine annually so they do not expose patients with compromised immune systems to the virus.

“The first time we met with Debra, we discussed ideas about promoting CRC screening and with the support of Linda Muñoz, director of benefits & wellness, they were ready to offer this new program,” said Tali Schneider, alumna and deputy director at the FPRC. An interdisciplinary team then formed a committee to design and develop the process, promotions and educational tools. Along with FPRC and Moffitt Wellness Program, the committee included the expertise of the following departments at Moffitt: health outcomes and behavior program, enterprise Imaging, GI tumor MMG, human resources, microbiology, occupational health, public relations, strategic marketing and the team member medical clinic.

Drs. Clement Gwede and Cathy Meade, health outcomes faculty members, were also very supportive of this initiative and played a critical role in the development of eligibility forms, educational materials, in-services, and recruitment of volunteer interns who assisted with the distribution process. 

“We worked almost a year on a monthly basis, but as we got closer to the start date, we met every other week,” Martinez Tyson said, “It was a true interdisciplinary effort that connected all the dots and put all the pieces into one puzzle.”

“While the FluFIT program has mainly been implemented in health care systems, such as community clinics, as far as we know, this is one of the first times the FluFIT has been implemented in the worksite setting,” Schneider said.

The FIT kits along with the flu vaccine were distributed through the months of September and October in both 2017 and 2018. FIT kits were only distributed to individuals who met eligibility, meaning they were at average risk to develop CRC, had not had a colonoscopy within the past 10 years and had not had a FIT screening within the last year. A more detailed questionnaire, including family history, was also provided during the flu vaccine process to further determine eligibility.

“The FluFIT program has been very successful – the process was very easy to understand and offered our team members an option to complete a cancer screening in the comfort of their own home.  Participants were also able to earn the wellness reward incentive, a medical premium discount for completing this cancer screening,” Cheek said. “For the last two years approximately 250 kits per year were distributed and there were 11 abnormal results overall. One of our team members who had been diagnosed with stage 4 colon cancer was our ‘poster child for poop’. She is very popular and well respected, so her testimonial encouraged others to get the screening done. Many of our executive team members also participated and helped to promote the program.”

Those who tested positive were then able to schedule colonoscopies and arrange for further testing.

Both Schneider and Cheek said that during a follow-up evaluation satisfaction survey, most team members were very pleased and stated that “If it weren’t for the FluFIT program, they wouldn’t have gotten screened for colorectal cancer.”  

Through their efforts, the interdisciplinary team won a Spirit of Moffitt Team Award and based on the results, the program is being institutionalized and will be offered annually.

“The FluFIT program has set the stage for other cancer screenings and outcome-based programs that benefit our team members at Moffitt. Thanks to the committee members who made this possible and to the participants who took advantage of this new program!” Cheek said.

Story by Caitlin Keough, USF College of Public Health