60th PIHOA Executive Board meeting Honolulu, August 30, 2016 Lee Buenconsejo-Lum, MD Neal A. Palafox, MD, MPH Martina Reichhardt, Dr. Livinson Taulung, Dr. Johnny Hedson 60th PIHOA Executive Board meeting Honolulu, August 30, 2016

Disclosure of Federal Support This work was supported in part by: CDC U58 DP000976 and U58 DP003906 Pacific Regional Central Cancer Registry CDC U58 DP0058100 REACH CHIP CDC U58 DP000777 American Samoa CCC/BCCEDP Programs CDC U58 DP00847 CNMI CCC/BCCEDP Programs CDC U58 DP000779 FSM National Comprehensive Cancer Control Program CDC DP000781 Guam CCC/BCCEDP Programs CDC U58 DP000826 RMI Comprehensive Cancer Control Program CDC U58 DP003939 Palau CCC/BCCEDP Programs The content in this presentation is the sole responsibility of the authors and does not represent official views of the CDC or US Health and Human Services

Contents: please also refer to briefing packet for more detail Recap of the CCPI and Pacific Cancer Control Programs Overview of Cancer in the USAPI Regional CCC Program Pacific Regional Central Cancer Registry REACH Community Health Intervention Project Pilot research projects: Cervical cancer / HPV: U54 (UOG); Yap cervical cancer screening (UHCC/NCI); Demonstration project planning – CNMI and Yap (CDC, HHS, HRSA, NCI) eHealth communication (Univ. of Rochester GTHRN) CCPI Preliminary Priorities for 2017-2022 Strategic Plan and competitive renewal applications for Cancer Registry and CCC Research infrastructure development

CCPI Regional efforts started in 2002 with funding from the National Cancer Institute. CDC funding since 2004. PIHOA Affiliate since Aug 3, 2006 (PIHOA Resolution 42-01) Two representatives designated by their Senior ranking health official: clinical and public health Should be in a position to positively influence the health systems that impact prevention and control of cancer CCPI oversees all of the Pacific Regional Cancer Programs Administered by the University of Hawaii (Palafox, Buenconsejo-Lum & team) Regional focus: cross-cutting issues that are necessary to improve jurisdiction and regional capacity for cancer and NCD control Human resources for health development (HRH) Surveillance (cancer) and mortality reporting Training in certain areas (public health and clinical), including evaluation Prevention: policies and messages in congruence with other NCD Screening: working to ensure minimum standards Treatment: palliative care / survivorship PIHOA Endorsement of Regional CCC Plan and Program and the Pacific Regional Central Cancer Registry program – Aug 3, 2006 (PIHOA Reso 42-05)

Pacific Cancer Control Programs & Partners U.S. CCC National Partnership Cancer Council of the Pacific Islands (Advisory Board) Pacific Islands Health Officers Association (PIHOA) Overarching advisory Palau International Partners with PIHOA (SPC, WHO, BAG) University of Hawaii Dept. of Family Medicine (administrative, technical assistance) RMI Pacific Cancer Coalition Kosrae FSM Guam University of Hawaii Cancer Center (technical assistance) U54 Partnership with University of Guam Hawaii Tumor Registry Pacific Cancer Research Group Chuuk Regional Comp Cancer Regional Cancer Registry Pacific Center of Excellence in the Elimination of Disparities (Pacific CEED) Community Health Intervention Project (REACH) U.S. Affiliated Pacific Island (USAPI) jurisdictions Pohnpei CNMI Yap Since 2002, the Cancer Council of the Pacific Islands has been the regional infrastructure to address cancer and cancer risk factors in the USAPI. Among the main goals of the regional cancer programs is -to advocate at US National and International levels, -“speak with one voice” regarding cancer control, capacity, barriers and strengths in the region and -to seek resources to augment each jurisdictions’ CCC programs -address cross-cutting issues that impact each CCC program: training, technical assistance, policies, data and surveillance, evaluation The Pacific Regional Cancer Programs are administered by the Department of Family Medicine at the University of Hawaii and work synergistically with others in the University, other academic institutions, the US National CCC Partnership, Regional and International Partners, as well as PIHOA (The health ministers / directors of each USAPI) to support CCC and Chronic Disease control efforts. American Samoa University of Hawaii RTRN Dept Geriatrics Dept OB-Gyn CTAHR / CHL Micronesian Community Network & Micronesian Health Advisory Council (Hawaii) 5 5

Guam & AS slightly higher LIVER CANCER USAPI almost 2x more than US Top 13 cancers - Crude and age-standardized rates for age over 20 - All USAPI 2007-2013 CERVICAL CANCER USAPI 2x US rate RMI 7x Pohnpei 4x Yap & Palau 1.6x Guam & AS slightly higher LIVER CANCER USAPI almost 2x more than US 1.8x higher than US males Palau: 3x higher than US Yap: almost 3x higher RMI, Guam: 2x higher Higher than US: Guam and Kosrae: leukemia Palau, Yap, RMI, Guam: liver RMI, Pohnpei, Yap and Palau: cervix Tobacco related oral cavity and pharynx: 10.9 vs. 6.2 (Yap 3.5 x US) Source: Pacific Regional Central Cancer Registry (PRCCR), 2007-2012

Contributions to overall NCD Surveillance Cancer registries provided the first uniform (across all jurisdictions) population-based surveillance system throughout the USAPI Forces discussion, problem solving and improvements in Medical records / Health information systems Physician documentation Medical referral system Health insurance (related to referrals, mostly) Data quality, tracking and reporting Lab Radiology Primary Health Care / Outer Island health care system (Yap, RMI, Chuuk, Pohnpei) Civil Registration and Vital Statistics (Death Certification)

Cancer Surveillance Data: Program Planning and Long-Term Evaluation Prioritizes need for certain programs (i.e., cervical cancer, breast health) Programs / Activities depend on resources available in the jurisdictions Survivor Programs – general and cancer-specific (in Guam, American Samoa) Screening Programs – cervical, breast, prostate, colorectal, oral Prevention programs – tobacco or obesity related Long term evaluation Changes in incidence of tobacco-, obesity-related, screenable and those able to be detected at Stage 1 or 2 by good history and physical examination Changes in proportion of stage 1 vs. later stage cancers Changes in proportion of cervical pre-cancer, Stage 1, Stage 2+ cervical cancers as HPV vaccination becomes more widespread and screening improves

Pacific Cancer Programs Pacific Regional CCC (2004 – present) Currently back-funded from jurisdiction prime awards from CDC National Comprehensive Cancer Control program Regional focus: cross-cutting issues that are necessary to improve jurisdiction and regional capacity for cancer and NCD control; leveraging of national and international resources for CCC See handout on the synergies and progression of the Pacific Cancer Programs and benefits to the USAPI NCD Toolkit w/ PIHOA, Cervical cancer screening, various regional assessments related to screening, diagnostic, treatment capacity, data usage, surveillance Pacific Regional Central Cancer Registry (2007 – present) USAPI Racial and Ethnic Approaches to Community Health (REACH): Pacific CEED (2007-2012); STRIVE (Guam 2013-2014) USAPI REACH CHIP (2014-2018)

Regional CCC Strategic Plan: 2017-2022 Competitive renewal applications for CCC, BCCEDP – anticipated Feb or March 2017 Each jurisdiction  regional Community-based, multi-sectoral coalitions coordinated by the Health Dept Cancer Program Well coordinated with NCD programs Prevention (PSE), Screening/Early Detection, Treatment, Survivorship PSE throughout, rigorous evaluation of outcomes (not just # of outreach activities done) CDC priorities: Colorectal cancer, HPV (vaccination/cc screening), survivorship Communication plan, probably also a sustainability plan

CCPI Regional Priorities – infrastructure / prevention Intra- and inter-jurisdiction open communication, sharing, networking around support of cancer/NCD. Facilitate partnerships (CCPI, PIHOA, SAMHSA, others) Data, database management TA/training on health messaging and communications that result in measurable behavior change Colorectal cancer, oral cancer, betel nut: education, PSE Strengthen HPV vaccination programs: provider education, messaging, tailored intervention strategies appropriate for resource context, cost reduction

CCPI Regional Priorities – screening/early detection Screening/early detection: cervix, breast, colorectal Effective health messaging PSE interventions and/or policy revisions that are resource-appropriate Provider education and PSE strategies to achieve consistency/high quality practice TA on reminder systems or other methods to prevent lost-to-follow up Leveraging resources to implement screening programs that can achieve population targets

CCPI priorities - treatment Breast, cervix, colorectal, endometrial, lung Provider education and PSE strategies to achieve consistency/high quality practice and/or appropriate referral recommendations Provider and patient resources to help decide on realistic treatment options, including palliation Curriculum on cancer communication, including Goals of Care Resource-appropriate policies and guidelines Explore telemed links to consultants who can give resource-appropriate advice or at least understand the context Guidance for off-island referral committees TA to decide if you have the capacity to provide on-island maintenance or palliative chemo

CCPI Priorities – QOL / survivorship Increase multi-level support to increase access to palliative care services, including pain management CCPI to PIHOA WHO Guidelines – institutionalize selected guidelines (FSM has a new national procurement policy / legislation) Additional priorities TBD after the Pt Navigation / Health System Readiness assessment is complete

CCPI Priorities – evaluation capacity building Build capacity to evaluate PSE, Programs and projects how to build eval into the planning of projects and programs … so that the success stories have data how to report more effectively Opportunity to share how different Programs / Projects are being evaluated

CCPI Priorities: Data mgmt and cancer surveillance TA on better data harmonization / flow / communication between programs cervical cancer screening registry/database Continue to improve cancer registry completeness, quality and efficiency Work to include 2002-2006 incidence data in existing registries ** CDC funding – up for renewal, need to be prepared for reduced funding

Build research capacity infrastructure Long term: Address the uneven global burden and impact NCDs on LMICs in the Pacific strengthen the focus on cancer and other NCDs in Pacific LMICs by LMICs develop research infrastructure to support priority research needs, including (mentoring, training, pipeline programs) build an evidence base for effective NCD prevention and control in the jurisdiction- and regional-specific context of resources, partnerships and needs increase the number of Pacific Islander researchers from LMICs --focused on NCDs through global health career tracks

Situational assessments Administrative support Fiscal and grants management Information and Communications Technology (ICT) regulatory capacity structures and data systems. Assets mapping of the current and future partners (current programs, capacity, expansion capability) Community needs and assets existing NCD/Ca & other strategic plans direct community input – CBPR model Other partners (UOG,UHCC, JABSOM, U54, CHL)

Considerations for PIHOA Registry / Surveillance capacity / HIS improvement Intra- / inter-jurisdiction open communication, sharing, networking around cancer/NCD. Facilitate partnerships (CCPI, PIHOA, SAMHSA, ) Data, database management PIHOA : interweave with other programs Registry REACH Research

For more information, please visit our website at: www.pacificcancer.org

www.pacificcancer.org lbuencon@hawaii.edu Si Yu`os Ma`ase Kulo Malulap Kalangan Msuulaang Komagar Kinisou Chapwur Fa`a Fetai Tele Lava Kommol Tata lbuencon@hawaii.edu Olomwaay www.pacificcancer.org