Comprehensive Cancer Alliance for Idaho (CCAI)

1. Comprehensive Cancer Alliance for Idaho (CCAI) WELCOME Stacey CarsonCancer Data Registry of Idaho Current President, CCAI scarson@teamiha.org

2. VISION Every Idahoan deserves the opportunity for proper cancer prevention and detection, state of the art cancer treatment, and the highest possible quality of life which we are committed to provide through a data driven, coordinated comprehensive cancer plan.

3. MISSION • Strengthen and coordinate efforts to address cancer issues along the continuum of cancer prevention and care. • Assess, define and monitor the burden of cancer in Idaho. • Resources will be identified or developed and will be networked through collaborative efforts. • Raise awareness among the general populations, health care professions, organizations, agencies and policymakers.

4. Comprehensive Cancer Alliance for Idaho (CCAI) Stakeholders and Partners

5. www.ccaidaho.org

6. Medical Advisory Committee

7. Purpose of Medical Advisory Committee • To guide the CCAI board’s strategic direction, professional education, and data distribution • To act in advisory capacity to programs: • Cancer Data Registry of Idaho (CDRI) • Women’s Health Check – Breast & Cervical Cancer Early Detection • Comprehensive Cancer Program • Engage your participation and find ways that we can be of value to you as you care for our communities

8. Composition & Time Commitment • WHO: Physicians with expertise and interest in cancer prevention, early detection, treatment, and quality of life • Locations: Meetings will be virtual • Time Commitment: 2 Web-based meetings (1 hour), and 2 Email responses per year

9. Potential Topics • New technology and how it relates to limited public funds for screening special populations • Review practice guidelines and quality assurance for screening and diagnostic services • Provide clinical consultation for guidelines relating to early detection and education • Provide input for professional development • Provide recommendations for data distribution

10. Cancer Data Registry of Idaho Chris Johnson, MPHEpidemiologistcjohnson@teamiha.org

11. Intro to Cancer Registries

12. Cancer Data Registry of Idaho • CDRI is a statewide cancer registry that collects incidence and survival data on all cancer patients who reside in the state of Idaho or who are diagnosed and/or treated for cancer in the state of Idaho. • CDRI was established in 1969 and became population-based in 1971. • Cancer is a reportable disease under state law, and operations of the registry are mandated by Idaho Code. • Funding comes from three sources: • <1% of the Idaho tobacco tax. • CDC • Grants & contracts

13. Cancer Registry Data Flow WHO IARC CI5 United States Cancer Statistics NAACCR CDC - NPCR SEER NCDB CDRI CoC Hospital Registries Other Hospital Registries Other Reporting Sources

14. Central Cancer Registries • Consolidate and Disseminate 2 Flavors • NCI – SEER – 10 states, 2 metro areas, 3 population groups • CDC – NPCR – 45 states, the District of Columbia, Puerto Rico, and the U.S. Pacific Island Jurisdictions

15. Quality of Idaho Cancer Data • NAACCR Gold Standard for Quality, Completeness, and Timeliness. • Because we produce high quality cancer incidence data, we have been included in the combined cancer incidence sections of all United States Cancer Statistics (USCS) and Cancer in North America (CINA) publications to date (1993-current for CINA; 1999-current for USCS).

16. (Some) Uses of Idaho Cancer Data • CDRI data are used for many purposes: • Surveillance of cancer incidence rates • Quality assurance of hospital registry data • Responding to requests for information from hospitals, media, and the public • Public health practice • Comprehensive Cancer Alliance for Idaho planning and evaluation • Comparative Effectiveness Research

17. CDRI Data Used in Population-Based Epidemiologic Studies

18. CDRI Data Used in Population-Based Epidemiologic Studies • ABHACUS Supplement • Journal CANCER, produced by American Cancer Society • 23 articles: • Baseline burden • Overview of HPV • Federal initiatives • Data from 39 states used in analysis • Human Papillomavirus Virus Vaccines • Gardasil – 2006 FDA approved Quadrivalent HPV Vaccine (HPV 6, 11, 16,18) • Prevents cervical, vaginal, vulvar precancers • Cervarix - Bivalent HPV Vaccine (HPV 16, 18) undergoing FDA approval

19. Comparative Effectiveness Research • “CER …compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care.” – IOM • 10 states funded as specialized registries • Expansion of electronic data collection • Develop datasets for researchers to address CER-related questions • 2011 cases, project ends Sept 2013

20. Examples of CER Questions • Are colorectal cancer patients tested for K-RAS and are the results used appropriately to determine treatment? What impact does K-RAS testing have on 2-3 year survival among colorectal cancer patients? • Are rectal cancer patients receiving radiotherapy and what is the timing of radiotherapy? Are disparities apparent in the appropriate neo-adjuvant use of radiotherapy among these patients?

21. Comprehensive Cancer Alliance for IdahoStrategic Plan Objectives 2011‐2015 Outcome Measures Used in Cancer Control * Outcome measures in decreasing order of utility for monitoring and evaluating components of cancer control. Adapted from: Armstrong BK. The role of the cancer registry in cancer control. Cancer Causes and Control 1992;3:569-579.

22. Where did we get these objectives? • Healthy People 2020 Cancer Objectives • “Healthy People provides science-based, 10-year national objectives for improving the health of all Americans.” • Agency for Healthcare Research and Quality (AHRQ) • “the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans.” • Idaho Comprehensive Cancer Strategic Plan 2006-2010

23. A Tale of Two Cities

24. Cancer Mortality • Cancer is #1 cause of death in Idaho. • 2,559 cancer deaths in 2011.

25. Female Breast Cancer Mortality

26. Melanoma Mortality

27. Colorectal Cancer Incidence

28. Clinical Trial Participation

29. Cancer Screening

30. Tobacco Use

31. CDRI and MAC • What we can do for you: • Provide information for decision making • What you can do for us: • Provide guidance for measuring treatment • Comparative Effectiveness Research

32. Questions/Discussion • In terms of information on cancer burden in Idaho/statistics, was any of this news to you? • If yes, what ideas do you have for disseminating this information to Idaho’s medical community?

33. Women's Health Check Susan Bordeaux, RNClinical CoordinatorBordeauS@dhw.idaho.gov

34. Women’s Health Check • Program serves nearly 5,000 women yearly. • Low-income, uninsured and underinsured, aged 50-64 for breast screening, aged 40-64 for cervical screening • 138 women diagnosed with cancer in FY12 • 77 Breast, 3 Cervical, 58 Pre-cervical • Most of these diagnosed women are referred to BCC Medicaid for the duration of their active treatment. • 10 contractors coordinate over 400 providers • Program oversees quality assurance and improvement for best care by national standards

35. Medical Advisory Committee (MAC) • Professional Education – • Idaho Ranks 51st in mammography screening • Promote early detection through increasing physician mammography referrals • Best format, methods, CME strategies • Clinical Breast Exam (CBE) – • Importance in breast cancer screening • Colorectal Cancer Screening Program (future) – Consider issues for Idaho, pros and cons

36. Professional Education • Prevention – physical activity, diet, tobacco cessation, public education- backed by professional recommendations • Early detection– support clinical breast exams and screening mammography • Increase referrals = increase mammograms, increase regular Pap testing

37. Operation Pink B.A.G.(Bridging the Access Gap)

38. Breast Cancer in Idaho Screening and Diagnostic Referral Guidance May 2012 Caroline Sobota, MD Gem State Radiology http://www.ccaidaho.org/docs/B%20Ca%20in%20ID%20lectureW07.pdf

39. www.ccaidaho.org

40. Cervical Cancer Screening Update May 2012 Lee Parsons, MD OB/GYN Associates Boise and Treasure Valley, Idaho http://www.ccaidaho.org/professional.html

41. Cancer Screening Intervals, Algorithms, and Information Breast Cancer • http://www.operationpinkbag.org/Professional.cfm • California State Breast Cancer Algorithms • Mammography screening intervals comparison fact sheet • Breast Cancer in Idaho fact sheet Cervical Cancer • http://www.ccaidaho.org/ resources.htm • New USPSTF cervical cancer screening intervals • ASCCP, ACOG, ACS • Cervical diagnostic algorithms follow ASCCP

42. Professional Education for Referral Promotion • Professional development targets • Who refers?, How do we reach them? • Algorithms, resources – posted to CCAI and Operation Pink B.A.G. websites, other ideas? • Format • Webinars w/ CME’s • Brown bags, conference calls • Best format w/ limited $

43. Clinical Breast Exam (CBE) • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.Grade: Insufficient Evidence • CDC requires CBE as part of a “complete breast screening exam” • Not offered at all mammography centers • USPSTF recommendation may influence future direction/cost-cutting measures • What does this mean? – • MAC opinions • Possible statement of support for CBEs Questions to MAC on first survey in early 2013

44. Colorectal Cancer Screening Program(not funded at this time)ranks 2nd among cancer mortality (2011 = #222) Pros • Increase early detection Idaho screening ranked 47th • Decrease late-stage dx’s • Decrease mortality • Use WHC as a model for data recovery, reporting, and QA • Increase quality cancer preventive/patient navigation services Cons • No $ for treatment costs • Screen using FOBT or FIT • Colonoscopy only after suspicious results • Questions to MAC on first survey in early 2013

45. MAC Discussion • What can we do to educate and encourage primary care providers to refer for mammograms? • Survey early in 2013 (CBE and Colorectal Program) Contacts: Susan Bordeaux, RN, Idaho Women’s Health Check • bordeaus@dhw.idaho.gov • Phone (208) 334-5971 Minnie Inzer Muniz, MEd, Idaho Women’s Health Check • inzerm@dhw.idaho.gov • Phone (208) 332-7311

46. Idaho Comprehensive Cancer Program (ICCCP) Patti Moran, MHS Manager 208-332-7344 moranp@dhw.idaho.gov

47. Population Based Program • No funds allowed for research, screening or other clinical services • CCC Cancer Spectrum: Prevention, Early Detection, Diagnosis, Tx, Quality of Life (Palliative Care, Survivorship), End of Life • Priorities: Colorectal and skin cancer; some breast & cervical cancer and oral cancer partnership promotion work

48. ICCCP, cont. • Surveillance, Public Education, Awareness/Communication/Outreach, Professional Education, Some Policy • Contract with the seven local health districts to maintain a local cancer coalition and do promotion and education

49. CDC DirectionDomain 2: Policy and Environmental Supports • Policy Note: Policy here refers to organizational level, local level, or legislative policy. Examples: • Increase tobacco tax • Coverage for care if enrolled in a clinical trial • Tanning bed restrictions • Physical education in schools • Smoke free environments- parks, housing, worksite, etc. • Sun safety policies- schools

50. Policy/Environment, cont. Environmental Support Strategies • Creating conditions that promote health and support and reinforce healthful behaviors (statewide in schools, worksites, and communities). Examples: • Nutrition standards • Accessible foods • Pricing strategies • Built environments- walkability, sun safety