In Oregon, 33% of the population resides in a rural or frontier area. For people living in those areas, getting access to health care can be difficult. According to the Oregon Office of Rural Health, the average travel time for an Oregonian to their nearest primary care facility is 13.6 minutes; the travel time for people in rural and frontier counties can be as long as 81 minutes.
So how to reach people in a state as large as Oregon with more than 96,000 square miles? Go to them. That's the goal of the OHSU Knight Cancer Institute's new mobile outreach van, designed to help end the burden of cancer across Oregon, one mile at a time.
"Our cancer institute is the only National Cancer Institute Comprehensive Cancer Center in Oregon, and we are committed to serving everyone in our catchment area," says Brian Druker, M.D., director of the OHSU Knight Cancer Institute. "Our goal is to reach underrepresented and underserved populations, and we want to make that as easy as possible — by showing up in their community."
On-the-ground perspective
Jackie Shannon, Ph.D., is associate director of community outreach and engagement at the OHSU Knight Cancer Institute and a professor in the Division of Oncological Sciences in the OHSU School of Medicine. She leads the Knight Cancer Institute's Community Outreach and Engagement team that is working to bring cancer education and prevention resources to people across Oregon.
Shannon recognizes that in a state as geographically diverse as Oregon, access to health care varies. She believes the health care system can play a role in bridging that gap by increasing access, providing engaging resources and sharing materials in multiple languages.
"When we talk about educating community members on cancer prevention and screenings, too often those discussions leave the burden of action on people that may not have access to the necessary resources required to take the recommended steps," she says. "Fostering a two-way dialogue with people across the state helps us gain an on-the-ground perspective as to what communities' current needs are, as well as an opportunity to gain a complete understanding of the environmental factors contributing to local health trends."
Since hitting the road in late 2022, the outreach van has traveled to county health fairs, street fairs, school career fairs and community events from Astoria on the coast to Prineville in the high desert and beyond.
Specific services shared at each event are determined by the community organizations, because they are the experts on their communities' interests and needs. Overall, the team aims to improve HPV, or the human papilloma virus, vaccination rates, increase colorectal cancer screening, deliver cancer screening education and increase diversity in clinical trial participation:
- HPV vaccines: HPV is a common virus that can cause six types of cancer, including cancers of the cervix, vulva, penis and oropharynx, or back of the throat. The HPV vaccine is able to prevent 90% of these cancers. Using teaching modules designed to increase awareness of the virus, knowledge of its risks and acceptance of the HPV vaccine as cancer prevention, the outreach team partners with local community organizations to bring evidenced-based information and resources in six different languages.
"The HPV vaccine has been around for 15 years, and the importance of the vaccine for cancer prevention is really overlooked," says Derrik Zebroski, mobile outreach coordinator for the OHSU Knight Cancer Institute. "Oregon has more than 10 counties in which the HPV vaccination rate is under 40%, and I believe we can improve that."
In collaboration with local health and dental providers, and local health departments, the team will host mobile vaccination events in the near future.
- Skin cancer screening: National Surveillance, Epidemiology and End Results Program data, or SEER data, shows that when melanoma is caught early, in stage 1 or 2, the five-year survival rate is extremely high at 98%. The rate of survival declines dramatically the later a melanoma is caught to approximately 60% for stage 3 and only 16% for stage 4. The mobile outreach team works with local partners to provide education and free-of-charge skin checks to members of the community. At a recent community event, the team provided more than 20 free skin checks to interested community members.
- FIT kits: Colorectal cancer is the third most common type of cancer for men and women in the U.S., with about 150,000 new cases occurring each year. Survival rates are 91% if the cancer is caught early, but drop to 17% once the cancer spreads.
Fecal immunochemical tests — or FIT kits — are take-home stool tests that detect early signs of cancer. At-home resources like FIT kits make it easier for people in rural and frontier communities to access cancer prevention care. The mobile outreach team will provide education, give out FIT kits and work with local partners on follow-up.
- Clinical trials: Clinical trials give patients ways to detect cancer early and try promising new therapies. But the patients who enroll in clinical trials are overwhelmingly white, younger and live in urban areas. The mobile outreach team will work with local partners to provide education and connect people to clinical trials such as the Pathfinder 2 early cancer detection study, and the Healthy Oregon Project, a no-cost research study offering genetic cancer risk screenings.
"Mobile outreach vehicles that bring cancer education and screening directly to people where they live and work are an important way of expanding the reach of lifesaving health care efforts," Zebroski says.
"Consistently showing up, getting to know them and listening to their needs are big steps in building trust in communities between the Knight Cancer Institute, as well as research and in science in general."
Team approach
The mobile outreach team has collaborated with a variety of local partners to provide resources to educate, prevent, detect and treat cancer, including: the OHSU Dermatology team; OHSU medical students; the Oregon Poison Center; East County Community Health; OHSU Community Relations; Crook County Public Health; Oregon Chinese Coalition; the OHSU Casey Eye Institute, whose Community Outreach Program celebrated its 10th anniversary in 2020; among others.
"It's not always easy and not every event is a success," Zebroski said in an interview with the OHSU Foundation on the mobile outreach van's efforts. "But I've never left an event and felt like there was nothing gained from it. I always meet at least one community partner or one individual who makes me see things in a new way.
"If we want to improve people's health care, we have to make it convenient for them, and I think mobile health care is a step in the right direction."
