Local Implementation of Cancer Control Efforts in Essex County

1. Local Implementation of Cancer Control Efforts in Essex County Livingston League of Women Voters Livingston Senior/Community Center Wednesday, February 15, 2006

2. Stanley H. Weiss, MD ProfessorUMDNJ-New Jersey Medical School and UMDNJ-School of Public Health Azadeh Tasslimi & Punam Parikh, MPH Essex County Cancer Coalition Co-Coordinators Tel: 973-972-4623 Email: tassliaz@umdnj.edu, parikhp1@umdnj.edu

3. 1) Background and Identifying Needs 2) Implementation of the New Jersey Comprehensive Cancer Control Plan 3) Capacity and Needs Assessment 4) Local Implementation in Essex County 5) Questions Overview

4. May January December    2000 2001 2002 20032004 2005 2006 2007 2008 First 5-year plan: 2003–2007 Background Executive Order 114: OCCP and the Governor’s Task Force established 1st New Jersey Comprehensive Cancer Control Plan released 1st Status Report to the Governor submitted (required biennially)

5. NJ-CCCP Organizational Structure

6. Background • Cancer ranked as the top health issue facing NJ residents in a State Health Issues Opinion Survey* (1999). • Yet no comprehensive capacity and needs assessment had ever been conducted in NJ • No inventory of cancer-related resources available on a statewide basis

7. Background • Began with 350 volunteers from various disciplines • Currently over 550 volunteers • These volunteers are stakeholders representing clinicians, public health officials, survivors and their families, community-based organizations, advocates, administrators, insurers, researchers

8. Governor’s Task Force Evaluation Committee • Serves to provide scientific oversight and expertise • Oversaw Cancer Capacity and Needs Assessment in all 21 counties • Submitted the first biennial Status Report to the Governor • Reviewed status of cancer burden and cancer control efforts • Proposed data-driven recommendations

9. Identifying Needs 1) Data and Data Systems: • Baseline capacity and needs assessment • To understand cancer burden and disparities in each county and statewide • To compare data from one county to each other and to the state as a whole • To understand current cancer-related services, resources, and gaps in New Jersey

10. Identifying Needs 2) Involve partners who have relevant expertise • Data and scientific expertise: • State Cancer Registry • State BRFSS Epidemiologist-Coordinator • NCI’s Regional Cancer Information Service • Public health, epidemiology, and statistical experts • Industry and academia • Workgroups and their Chairs • Health services and planning: • NJCEED Program • Cultural competency experts • Local health planners

11. Implementation of NJ-CCCP Multiple groups involved • Ten Workgroups • Local NJCEED programs and county cancer coalitions • Each group identifies areas of focus and strategies to address • Synergy among Workgroups and local cancer coalitions and other organizations encouraged

12. Capacity and Needs Assessment (C/NA) Baseline Capacity and Needs Assessment (C/NA) in each county was one of the first implementation steps of the NJ-CCCP Major components required for all reports: • Demographics and local infrastructure (e.g., transportation) • Resources (e.g., health care facilities, schools, community-based organizations, etc.) • Cancer statistics • Recommendations that integrate the first three components

13. Capacity and Needs Assessment (C/NA) Data Analyzed • Demographics and health status indicators • Cancer incidence and stage at diagnosis • Cancer mortality • Healthy New Jersey 2010 objectives • Staging of cancer • Prevalence • Estimates of medically underserved populations

14. Capacity & Needs Assessment • Local health planners - County Evaluators (CEs) • Already involved in local community • Experience with health services and planning • Responsible for conducting the C/NA and formulating recommendations for action for implementation at the county and state level

15. CANCER CONTROL IN ESSEX COUNTY

16. Essex County Cancer Coalition (ECCC) Priorities • Findings from the C/NA serve as the empirical basis for prioritizing local cancer control efforts • County demographic profile was created • Cancer issues not historically recognized as priorities in Essex emerged from the C/NA process

17. Composition of Essex County, 2000(source: U.S. Census 2000) • 56% Minority population in Essex vs. only 27% in New Jersey • 1/3 of State’s total Black population lives in Essex Substantial Hispanic/Latino population - 16% of Essex vs.13% of NJ Other special populations (race, ethnicity, or language) exceeding 3% of county include: • Asians (29,429) • French- /French-Creole-speaking (24,874; incl. Haitians) • Portuguese (23,744) • Spanish-speaking, comprise 1/2 of linguistically isolated households

18. C/NA Findings: Essex County Among WOMEN Rates in Essex wereover 10% higherthan NJ for: • Breast ca mortality • Cervical ca incidence • Cervical ca mortality • Oral ca mortality Among MEN Rates in Essex wereover 10% higherthan NJ for: • Oral ca incidence • Oral ca mortality • Prostate ca incidence • Prostate ca mortality

19. C/NA Findings: Essex County Essex County had the highest cancer mortality rates of any county in NJ for: • Cervical • Oral • Prostate • Oral and prostate cancers emerged as newpriorities • Cervical cancer screening & treatment remains a priority, as it is preventable and highly treatable. High cervical cancer mortality rates indicate a need for increased education and detection.

20. Local Implementation:Essex County • Essex County Cancer Coalition (ECCC):One of 21 county cancer coalitions in NJ • GOALS • Implement the NJ Comprehensive Cancer Control Plan (NJ‑CCCP) (www.state.nj.us/health/ccp/ccc_plan.htm) • Prioritize cancer control efforts at the local level

21. Background Essex County Cancer Coalition: • Addresses all 7 cancers the NJ-CCCP identified as priorities: • Breast, cervical, colorectal, lung, melanoma, oral & prostate • County-wide focus, but dichotomous issues: • 4 contiguous inner-city municipalities with high proportions of medically underserved: Newark, Orange, East Orange, Irvington • Suburban areas with significant elderlypopulation

22. Inner-City • Cancers of Focus: • Cervical • Prostate • Oral • Disparities among Racial & Ethnic Minorities • Access to care, lack of insurance, language barriers • Low Clinical Trial Participation - Views on medical research

23. Suburban • Cancers of focus: • Lung • Colorectal • Breast • Prostate • Under-screened for many cancers relative to risk • Breast Cancer - Mammograms & Medicare coverage • Cervical Cancer - Pap Tests • Low Clinical Trial Participation - Lack of available clinical trial protocols (toxicity, comorbidities)

24. NJDHSS – Office of Cancer Control & Prevention NJDHSS – NJCEED Essex County Cancer Coalition Essex CEED Coalition Leadership Council Clinical Advisory Group Advocacy Committee Development Committee Education/Outreach Committee ECCC Organizational Structure

25. Mission Statement • Increase cancer awareness & reduce its impact on Essex residents through improved screening, access to treatment & follow-up • Promote awareness of and participation in cancer clinical trials • Support investigations that seek to find the causes of cancers, improve care, reduce health disparities, or increase access • Increase collaboration & communication among all stakeholders to maximize utilization/identification of resources • Examine and prioritize an expansion of cancer control efforts county-wide

26. ECCC is implementing the following NJ-CCCP Goals: • Promote collaboration with traditional and non-traditional partners to improve communication about access and resources for cancer education, detection, and prevention services, including research studies. NJ-CCCP strategy AC-2.1.6 • Disseminate information on cancer control efforts and services throughout Essex County. NJ-CCCP strategy AC-2.1.7 • Educate the public regarding the purpose and importance of participating in clinical trials for cancer, with special emphasis on addressing the concerns of minority populations. NJ-CCCP Objective AC-4.1.7 (other cancer-related BR-2.2.1, BR-5.1,CO-3.1). • Identify strategies to increase cancer service access and resources for all populations through public education. • NJ-CCCP Objective AC-4.1

27. Diverse Membership • Organizations represented: • Community-based organizations • County & Local health departments • National & Local Cancer Organizations • Health Centers, Hospitals, & Clinics • Faith-based Organizations • Corporations • Academia • Foundations • Members include: • Cancer Survivors • Healthcare Providers • Educators • Outreach Workers • Cancer Advocates • Public Health Workers & Researchers • People Personally Affected by Cancer

28. For Example… • The Coalition is partnering with the following organizations to address the three cancers that were identified as priorities in Essex County through the C/NA: • The Prostate Net • Oral Cancer Consortium • Essex “Communities Against Tobacco” (CAT) Coalition • Essex Cancer Education & Early Detection (CEED) Program

29. Communication Methods • Quarterly ECCC Meetings • Email list-serve (free using Yahoo!Groups) for: • Entire Coalition • Leadership Council and Each Committee • Monthly Community Health Calendar that focuses on cancer • Coalition Website: www.umdnj.edu/EssCaWeb

30. Cancer Services & Resources • Many Coalition members work for organizations that serve as resources for cancer education, screening/early detection, and support services • Coalition promotes services provided by members and non-members throughout Essex County

31. American Cancer Society (ACS) • Web Site: www.cancer.org – Type in zip code to find local resources and events • Local Office: Metro NJ Region- Address: 767 Northfield Ave, West Orange 07052 Tel: 973-736-7770 • National Call center: 1-800-ACS-2345 Patients and others can obtain referrals to local cancer resources and to a local “patient and family services director/coordinator” who may be able to help • Broad range of cancer education materials available

32. NJ Cancer Education & Early Detection (CEED) Programswww.state.nj.us/health/cancer/njceed/ • The NJCEED Program offers funding to all 21 counties for comprehensive breast, cervical, prostate & colorectal cancer education, outreach & screening. • There are 2 CEED sites in Essex…

33. Essex CEED Sites Conduct education/outreach and screenings at churches, health departments & community centers: • UMDNJ - “S.A.V.E. Women & Men of Essex County” CEED Program • For more information contact: Ms. Catherine Marcial, SAVE Women & Men Project Coord. Tel: (973) 972-0308, email: marciacp@umdnj.edu • St. Michael’s Medical Center-"In The Pink" CEED Program • For more information contact: Ms. Aretha Hill-Forte, "In the Pink" Project Coordinator Tel: (973) 877-2989, email: ahillforte@cathedralhealth.org

34. Cancer Care www.cancercare.org • National non-profit organization providing free professional support services to: • people living with cancer, • caregivers, • children & loved ones • the bereaved • Trained oncology social workers provide: • free counseling • 24-hr online support groups, • face-to-face, • telephone • financial assistance • Telephone Education Workshops • Expert-led programs on a variety of cancer-related topics • More than 50 Workshops per year • Participants can listen to and ask questions of cancer experts • To register: call 1-800-813-HOPE or at www.cancercare.org/education.html For more information, please contact: Kathy Nugent, LCSW, Director of Social Services Tel: 201-301-6809, Email: knugent@cancercare.org

35. NJ Cancer Clinical Trials Connectwww.njctc.org • Innovative electronic tool to match patients to cancer clinical trials statewide • Patients create a confidential medical profile online • Informational resource to educate people about clinical trials, provides links to other resources • Website available in Spanish • Toll-free information line 866-788-3929, Monday through Friday, 9 am-5 pm • Supported by CINJ, RWJ Medical School, & NJ-DHSS For more information, contact: Susan Goodin, PharmD Tel: 732-235-6783, Email: goodin@umdnj.edu

36. The Prostate Net www.prostate-online.org • National non-profit organization which aims to increase awareness of prostate cancer especially among minority men in medically underserved areas • Barbershop Initiative: • National program to increase prostate cancer awareness among minority men by training barbers to deliver health messages and involving local medical centers to provide education coupled with free prostate cancer screenings & treatment. • Cancer Education Literature

37. Oral Cancer Consortium www.oral-cancer.org • Comprised of 26 metropolitan healthcare institutions and professional societies in NY, NJ & PA. • Recognize that oral cancer is an under- publicized issue and aim to raise awareness & the importance of prevention and early detection. • Sponsoring Oral Cancer Screening Day (April 20, 2006) • For more information about where to receive a free oral cancer screening, call the Oral Cancer Screening Information Line at 1-877-263-3401.

38. Dental Clinics near Essex that Provide Reduced-Cost Oral Cancer Screenings • UMDNJ-New Jersey Dental School • Newark Beth Israel Medical Center • Newark Community Health Centers • Mountainside Hospital Accept Medicaid, charity care, and sliding scale fees

39. The Essex Communities Against Tobacco (CAT) Coalition • Part of a statewide group of anti-tobacco, community-based coalitions that promote tobacco-free environments. • Supports tobacco prevention education programs and participates in anti-tobacco advocacy efforts/activities • Advocate for passage of “Clean Indoor Air” Bill in NJ • Tobacco strongly linked with lung, oral and cervical cancers • For more information contact: Ms. Michele Grippaldi, Essex CAT Coalition Coordinator Tel: 973-571-2324, EssexCountyCAT@yahoo.com

40. Sisters Network www.sistersnetworkinc.org • Addresses the breast health needs of African American women, through affiliate chapters & partnerships with existing service providers • Chapters are organized by breast cancer survivors committed to establishing community breast health services • Successful community outreach programs: • "The Gift for Life Block Walk" • The Pink Ribbon Awareness Campaign • STOP THE SILENCE: Changing the Face of Early Breast Health Intervention • Local Chapter: Sisters Network, Newark • For more information contact: Ms. Charlotte Munnerlyn Tel: 973 926-5535, munnemann@aol.com

41. Current ECCC Activities • Cancer Prevention & Early Detection Health Fair - April 20, 2006 • In conjunction with Oral Cancer Screening Day at New Jersey Dental School • Health fair was proposed by Coalition members • Participants include: • Essex County Cancer Coalition • CancerCare • The Prostate Net • Essex CEED • Sisters’ Network • Essex CAT Coalition

42. Current ECCC Activities (cont.) • Letters to the Editor to be published in local newspapers in Essex County • Intent is to highlight local cancer issues in conjunction with national health observances • Cancer education for Essex firefighters • Coordinators will give an overview of cancer issues at March meeting of fire chiefs

43. Current ECCC Activities (cont.) • Creator of NJ Cancer Trials Connect educated Coalition members • Member who educates the community about clinical trials though his personal experiences • Coalition has helped to initiate a Working Group to: • Further understand barriers to participation in cancer clinical trials • Formulate effective educational approaches • Identify appropriate funding opportunities

44. How Can You and/or Your Organization Contribute to Cancer Control Efforts in Essex County? We strongly encourage YOUR participation on the Essex County Cancer Coalition to: • Educate yourself about the cancer burden in Essex County and the cancer issues affecting the communities you work with • Expand awareness and promote the importance of cancer prevention & early detection • Help reduce the number of cancer deaths and alleviate the overall cancer burden in the County

45. SUPPLEMENTAL SLIDES

46. General Cancer Risk Factors Lifestyle choices and behaviors you can change: • Smoking • Alcohol (1 > drink per day) • Healthy Diet • Infectious Agents (HPV, HIV) • Exposure to UV Light • Oral Contraceptive Use Risk factors you cannot change: • Gender: (Males – Oral) (Females – Breast) • Age • Genetics • Family History • Personal history • Race/Ethnicity (White Females – Breast) (Black Males – Prostate, Oral) • Socioeconomic Status (Cervical) Protective factors: • Early Detection • Breastfeeding • Low-fat diet • Exercise • Safe Sex Practices Sources: American Cancer Society; National Cancer Institute

47. Screening Guidelines *Other tests commonly used to detect colorectal cancer are: fecal occult blood test (FOBT) and flexible sigmoidoscopy.

48. Insurance Coverage Overview for Common Cancer Screenings

49. Key Health and Economic Indicators (source: U.S. Census 2000)