NEED Texas ranks second in the nation in number of individuals diagnosed with liver cancer and fifth in the nation in number of deaths caused by liver cancer. Liver cancer is the most rapidly increasing cancer in both men and women, with incidence rates more than tripling and death rates doubling since 1980. Additionally, Texas ranks 41st in number of individuals diagnosed with lung cancer and 40th in the number of deaths caused by lung cancer. Lung cancer is the number one cause of cancer-related mortality for both men and women. In Texas, only 17.3 percent of lung cancer cases are detected early, when survival rates can be as high as 55 percent; detection at later stage yields only a 4.5 p...

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NEED Texas ranks second in the nation in number of individuals diagnosed with liver cancer and fifth in the nation in number of deaths caused by liver cancer. Liver cancer is the most rapidly increasing cancer in both men and women, with incidence rates more than tripling and death rates doubling since 1980. Additionally, Texas ranks 41st in number of individuals diagnosed with lung cancer and 40th in the number of deaths caused by lung cancer. Lung cancer is the number one cause of cancer-related mortality for both men and women. In Texas, only 17.3 percent of lung cancer cases are detected early, when survival rates can be as high as 55 percent; detection at later stage yields only a 4.5 percent survival rate nationally. Liver cancer, although less prevalent than several other cancers, has low survival rates and incidence of liver cancer is on the rise – particularly in regions of Texas. In fact, Texas has a higher rate of mortality from liver cancer than any other state.7 There are also racial and ethnic disparities in liver cancer outcomes, with Hispanics and Blacks less likely to get early diagnosis and treatment.8 Rural and medically underserved counties in Texas with lower socioeconomic status have additional barriers to diagnosis and treatment, such as access and transportation. These statistics indicate that there is need to develop statewide strategies to promote cancer education, improve screening rates, and increase early stage diagnoses. OVERALL PROJECT STRATEGY This project proposes to continue and expand dissemination activities previously funded as CPRIT PP160048. Our proposed project utilizes CHWs and the CHW model to conduct both active and passive dissemination and implementation strategies to improve cancer education, navigation, and outreach throughout the state of Texas. Utilizing community health workers (CHWs) is a nationally recognized, evidence-based, culturally competent approach for improving population health. CHWs are defined as frontline public health workers who are trusted members of a community. The use of CHWs for prevention education, outreach and/or navigation has been shown to increase patient knowledge, increase referrals, improve screening rates, and improve screening guidelines adherence for some types of cancer. Dissemination strategies for this proposal build upon CHW training tools from six successful CPRIT-funded prevention projects related to breast, cervical, and colorectal cancer (CRC). However, this proposal expands further to include packaging and disseminating CHW CEUs on liver and lung cancer prevention-detection, treatment, and survivorship, as well as message tailoring for underserved populations. Additionally, the project will develop products for promotion of best practices for implementation with a particular focus on vulnerable populations. Additional implementation strategies proposed include consultation and the provision of training and technical assistance to CHWs, CHW Instructors, organizations, and providers across the state (dissemination partners). SPECIFIC GOALS The specific goals of this project are to: 1) train 450 CHWs to disseminate resources from CPRIT-funded TAMU SPH prevention, detection, treatment, survivorship, and navigation projects for breast, cervical, colorectal, liver, and lung cancers over 2 years; 2) train 50 CHW Instructors on message tailoring, dissemination skills, and cancer resources for underserved populations over 2 years; and 3) equip at least ten programs and/or organizations promoting the CHW model with best practices to implement resources related to prevention, detection, treatment, survivorship, and navigation for breast, cervical, colorectal, liver and lung cancers over two years. SIGNIFICANCE AND IMPACT This proposal will disseminate successful models for CHW cancer prevention-detection, treatment, survivorship, and message tailoring. CHW programs and CHWs trained can effectively diffuse culturally competent education and navigation strategies to others in their communities. The project’s online component will further disseminate the training and materials for other organizations and CHWs to utilize, even beyond the targeted geographic regions. Additionally, training CHWs in message tailoring and best practices for vulnerable populations has the potential to impact large numbers of low-income and underserved persons across Texas.

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