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Outcomes/Effectiveness Research

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Subsidized multiphasic mobile cancer screening units may not be a cost-effective way to reduce cancer morbidity and mortality

Subsidized mobile multiphasic (multi-cancer) cancer screening facilities may have the potential to reduce cancer morbidity and mortality. However, to realize this potential, they need to target hard-to-reach unscreened and underscreened groups in the age and risk groups where cancer is most likely to develop. They also need to maintain a high volume, coordinate with local primary care services to ensure continuity of care and not duplicate existing resources, and build on a strong infrastructure for providing diagnostic and treatment services, regardless of the patient's ability to pay.

At this time, it is not clear whether the large investment required to sustain such mobile units will translate into a reasonable cost per year of life saved, according to a recent study supported in part by the Agency for Healthcare Research and Quality (HS08395). Ultimate decisions about resource allocation will depend on regional health care needs and priorities, says lead author, Ann S. O'Malley, M.D., M.P.H., of Georgetown University Medical Center.

Dr. O'Malley and her colleagues reviewed research studies on mobile cancer screening units and interviewed directors of mobile units, van staff, health care providers, and program administrators working in conjunction with mobile vans in Washington DC, and Tampa, FL. They examined the positive and negative aspects of mobile vans providing mammography services and feelings about the feasibility of adding other cancer screening services to the vans, such as prostate, cervical, and colorectal cancer screening. They also calculated the costs of each screening type and yearly van operating costs.

Most of those interviewed agreed that advance promotion and scheduling was necessary to ensure a reasonable volume of screened patients. A substantial ongoing subsidy would be needed to maintain van operations, even when the target population included a large portion of insured individuals. In addition, space limitations would make it difficult to conduct multiple screening activities in the same van.

More details are in "Feasibility of mobile cancer screening and prevention," by Dr. O'Malley, William Lawrence, M.D., M.Sc., Wenchi Liang, Ph.D., and others in the Journal of Health Care for the Poor and Underserved 13(3), pp. 298-319.

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