Maximizing Access to Cancer Care: Sparking Change Together Dave Barbour, PharmD Field Medical Director June 22, 2017

Maximizing Access to Cancer Care: Sparking Change Together Dave Barbour, PharmD Field Medical Director June 22, 2017

Leading Sites of New Cancer Cases and Deaths Estimated New Cases Estimated Deaths 19% Prostate 30% Breast 27% Lung & bronchus 25% Lung & bronchus 14% Lung & bronchus 12% Lung & bronchus 9% Colon & rectum 14% Breast 9% Colon & rectum 8% Colon & rectum 8% Prostate 8% Colon & rectum 7% Urinary bladder 7% Uterine corpus 7% Pancreas 7% Pancreas Rebecca L. Siegel, MPH; Kimberly D. Miller, MPH; Ahmedin Jemal, DVM, PhD. Cancer Statistics, 2017. CA CANCER J CLIN 2017;67:7–30

5-year Relative Survival Breast Cancer: Diagnosis and Survival Stage at Diagnosis 5-year Relative Survival In Situ 100% Localized 98.8% Regional 85.2% Distant 26.3% Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2013, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2013/, based on November 2015 SEER data submission, posted to the SEER web site, April 2016.

Metastatic Breast Cancer: By the Numbers Berman AT, Thukral AD, Hwang WT et al. Incidence and patterns of distant metastases for patients with early-stage breast cancer after breast conservation treatment. Clin Breast Cancer. Apr 2013;13(2):88-94.; Brockton NT, Gill SJ, Laborge SL et al. The Breast Cancer to Bone (B2B) Metastases Research Program: a multi-disciplinary investigation of bone metastases from breast cancer. BMC Cancer. 2015;15:512.; Herrinton LJ, Barlow WE, Yu O et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol. 2005;23(19):4275-86.; O’Shaughnessy J. Extending survival with chemotherapy in MBC. The Oncologist. 2005;10:20-29. http://theoncologist.alphamedpress.org/content/10/suppl_3/20.long. Accessed May 2017. Mariotto AB, Etzioni R, Hurlbert M, et al. Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. May 2017; DOI: 10.1158/1055-9965.EPI-16-0889.

Disparities in Outcomes Between Ethnicities American Cancer Society. Cancer Facts & Figures 2017. Available at https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2017.html. Accessed June 14, 2017.

State Policy Focus: Support Early Detection and Treatment Programs Joint Federal/State Programs Federal laws created program options for states to screen and provide treatment for certain uninsured and underinsured women with breast and/or cervical cancer Screening: National Breast & Cervical Cancer Early Detection Program (NBCCEDP) Treatment: Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) However, these programs can be underfunded, and many states have policies in place that create barriers to screening and treatment

Many Women Lack Access to Screening Deaths from these diseases occur disproportionately among women who are uninsured or underinsured Uninsured women are half as likely to have had a mammogram in the last year compared to the general population In 2016, the program served fewer than one in ten eligible women, down from one in five in 2010. CDC website on the National Breast and Cervical Cancer Early Detection Program, http://www.cdc.gov/cancer/nbccedp/about.htm. American Cancer Society’s Cancer Prevention & Early Detection Facts & Figures; Ku L, et al “Health Reform and the Implications for Cancer Screening. Report to the American Cancer Society Cancer Action Network and the National Colorectal Cancer Roundtable, February 2, 2016.

Screening and Treatment Programs are an Important Source of Care Key Facts Mammography screening can reduce breast cancer mortality by 38% by detecting cancer at an earlier stage1 Screening program provides important patient navigation and case management services if a woman has a suspicious finding Patient navigation improves stage at diagnosis: one study reports a 108% increase in stage 0 breast cancer diagnoses and a decrease of almost 79% in stage IV breast cancer diagnoses2 Earlier treatment of breast cancer leads to reduced mortality and significantly lower costs for treatment Late-stage breast cancer treatment is twice the cost of early-stage disease management and costs fall over time3 1. Paci E. Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet. Journal of Medical Screening, 2012; 2 Gabram SG, Lund, MJ, Hatchett N, et al. Effects of an outreach and internal navigation program on breast cancer diagnosis in an urban cancer center with a large African-American population. Cancer. 2008; 113(3): 602-607. 3 Lopes G. Investing in Cancer Prevention and Control to Reduce Global Economic Burden. ASCO. Website: https://am.asco.org/investing-cancer-prevention-and-control-reduce-global-economic-burden. May 30, 2015. Blumen H, Fitch K, and Polkus V. Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service. Am Health Drug Benefits. 2016; 9(1): 23-32.

State Policy Solutions Include… Increase Access to Screening Protect and increase funding for the program: Expand state eligibility guidelines for age, underinsurance so they meet federal criteria at a minimum Increase Access to Treatment Allow all eligible women to access Medicaid, regardless of where they received screening Increase Awareness of Screening and Treatments Programs, Cancer Support resolutions, hold hearings, learn community needs

Resolutions recognizing Metastatic Breast Cancer Day (October 13th) Support Awareness and Engagement Resolutions recognizing Metastatic Breast Cancer Day (October 13th) Voiceover to include that Komen and American Cancer Society, as well as other patient advocacy groups, often lead the efforts to secure support for these resolutions. 2017 Resolutions to Date 2016 Resolutions 2016 & 2017 Resolutions

The Time To Take Action is Now! Support your state’s breast and cervical cancer screening programs Introduce a resolution or memorial to draw attention to MBC and the need for more research and support for patients Support MBC research through appropriations, collaborations and supporting participation in clinical trials Join a cancer caucus or start a cancer caucus Conduct an informational hearing

Thank you!

Appendix

What is the NBCCEDP? Local NBCCEDP programs offer the following services at no or low-cost for eligible women: Federal Eligibility Criteria For Screening Women must: Be between 40 and 64 years of age for breast cancer screening Be between 21 and 64 years of age for cervical cancer screening Have no insurance, or insurance that does not cover screening exams Have a yearly income at or below 250% of the federal poverty level (approximately $60,000 for a family of 4) Clinical breast examinations Mammograms Pap tests Pelvic examinations Human papillomavirus (HPV) tests Diagnostic testing if results are abnormal Referrals to treatment CDC website on the National Breast and Cervical Cancer Early Detection Program, http://www.cdc.gov/cancer/nbccedp/about.htm.

Screening Dictates Treatment Source of Screening in NBCCEDP Affects Eligibility for Coverage of Treatment Under BCCTPA States have discretion in determining eligibility for Medicaid enrollment (and access to treatment) as a result of a screening for breast or cervical cancer States have adopted three different standards of eligibility requirements to access Medicaid: Level 1) Most restrictive: only screening or diagnostic services paid for with CDC funds For example, the state provides funds only to county health departments and women must be screened or diagnosed at the health department in order to be Medicaid-eligible. Level 2) Mid-level restrictiveness: screening or diagnostic services provided by a CDC- funded provider For example, the state requires providers to enroll in a screening program and women must be screened or diagnosed by providers who are enrolled in the state program in order to be Medicaid- eligible. Level 3) Least restrictive: screening or diagnostic services provided by either CDC- or non- CDC-funded providers The state partners with private entities to provide screening and diagnostic services and any provider in the state can screen or diagnose women for breast or cervical cancer for her to be Medicaid-eligible. Expansion of Eligibility for the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA), https://ww5.komen.org/Issues-to-Monitor.aspx#expansion