Learning Collaborative #6 October 2016 National Immunization Partnership with the Academic Pediatric Association (NIPA) Wave 2 CDC Grant # 1H23IP000950

Agenda Attendance Review CORNET Data Oropharyngeal Cancer Data Collection Reminder LC schedule & Data Submission Dates Any questions? Contact Information

CORNET Data

Intervention: Prompts

Intervention: Standing Orders

Intervention: Reminder-Recall

Total Missed Opportunities

Missed Opportunities by Dose - Ask Rachel

Missed Opportunities by Gender

Missed Opportunities by Visit Type

Reason Not Vaccinated

Oropharyngeal Cancer

HPV Cancer Survivor Videos Head & Neck Surgeon https://www.youtube.com/watch?v=YVEAtc3clqg&list=PLRu0uHzo7TdKdq1TstwyNbSn0KMI8L4--&index=12 Other Survivor Videos http://bit.ly/2aO4yrb

HPV Types Differ in their Disease Associations Mucosal sites of infection Cutaneous ~ 80 Types “Common” Hand and Foot Warts ~40 Types Genital Warts Laryngeal Papillomas Low Grade Cervical Disease Low risk (non-oncogenic) HPV 6, 11 most common High risk (oncogenic) HPV 16, 18 most common Cervical Cancer Anogenital Cancers Oropharyngeal Cancer Cancer Precursors HPV types differ in their tendency to infect cutaneous and mucosal or genital epithelium. More than 150 HPV types have been identified, including approximately 40 that infect the genital area. Genital HPV types are categorized according to their epidemiologic association with cervical cancer. High-risk types (e.g., types 16 and 18) can cause low-grade cervical cell abnormalities, high-grade cervical cell abnormalities that are precursors to cancer, and cancers. In addition to cervical cancer, HPV infection also is the cause of some cancers of the vulva, vagina, penis, and anus, as well as cancer of the oropharynx. Low-risk types like 6 and 11 can cause benign or low-grade cervical cell changes, genital warts, and recurrent respiratory papillomatosis.

Cancers Caused by HPV, U.S.   Cancer site Average number of cancers per year probably caused by HPV Percentage per year Male Female Both Sexes Anus 1,600 3,000 4,600 91% Cervix 10,700 Oropharynx 9,100 2,000 11,100 70% Penis 700 63% Rectum 200 500 Vagina 600 75% Vulva 2,400 2,200 69% TOTAL 11,600 19,200 30,800 Here you can see the distribution of HPV cancers at the various anatomic sites, with about 11,600 HPV cancers occurring in men, and 19,200 HPV cancers occurring in women, in the US, annually. CDC, United States Cancer Statistics (USCS), 2006-2010

New Cancers Caused by HPV per Year United States 2008-2012 Rectum n=500 3% Men (n = 11,600) Anus n=1,600 14% Oropharynx n=9,100 78% Penis n=700 6% Rectum n=200 2% Anus n=3,000 16% Cervix n=10,700 56% Vagina n=600 3% Vulva n=2,400 13% Oropharynx n=2,000 10% This is another way of looking at the same information, and we can clearly see that the predominant HPV cancer in women is cervical cancer and the predominant HPV cancer in males is oropharyngeal. Women (n = 19,200) CDC, United States Cancer Statistics (USCS), 2008-2012

Number of HPV-Associated Cancer Cases Probably Caused by HPV per Year in the United States, 2008–2012 Data are from population-based registries participating in CDC’s National Program of Cancer Registries or NCI’s Surveillance, Epidemiology, and End Results Program, meeting USCS publication criteria quality for all years 2008–2012, and cover about 99% of the US population. HPV-associated cancers were defined as cancers at specific anatomic sites with specific cellular types in which HPV DNA frequently is found. All cancers were confirmed histologically. Cervical cancers (ICD-O-3 site codes C53.0–C53.9) were limited to carcinomas (ICD-O-3 histology codes 8010–8671, 8940–8941). Vaginal (ICD-O-3 site code C52.9), vulvar (ICD-O-3 site codes C51.0–C51.9), penile (ICD-O-3 site codes C60.0–60.9), anal (ICD-O-3 site code C21.0–C21.9), rectal (ICD-O-3 site code C20.9) and oropharyngeal (ICD-O-3 site codes C01.9, C02.4, C02.8, C05.0, C05.1, C05.2, C05.8, C05.9, C09.0, C09.1, C09.8, C09.9, C10.0, C10.1, C10.2, C10.3, C10.4, C10.8, C10.9, C14.0, C14.2 and C14.8) cancers were limited to squamous cell carcinomas (ICD-O-3 histology codes 8050–8084, 8120–8131). Adapted from: Viens et al. Human Papillomavirus- Associated Cancers—United States, 2008–2012. MMWR 2016;65(26):661-666.

Rates of HPV-Associated Cancer and Median Age at Diagnosis Among Males in the United States, 2008–2012 Rates are per 100,000 persons and age-adjusted to the 2000 US standard population. Data are from population-based registries participating in CDC’s National Program of Cancer Registries or NCI’s Surveillance, Epidemiology, and End Results Program, meeting USCS publication criteria for all years 2008–2012, and cover about 99% of the US population. Rates are not shown for some cancer sites and age groups because there were fewer than 16 cases. HPV-associated cancers were defined as cancers at specific anatomic sites with specific cellular types in which HPV DNA frequently is found. All cancers were confirmed histologically. Cervical cancers (ICD-O-3 site codes C53.0–C53.9) were limited to carcinomas (ICD-O-3 histology codes 8010–8671, 8940–8941). Vaginal (ICD-O-3 site code C52.9), vulvar (ICD-O-3 site codes C51.0–C51.9), penile (ICD-O-3 site codes C60.0–60.9), anal (ICD-O-3 site code C21.0–C21.9), rectal (ICD-O-3 site code C20.9) and oropharyngeal (ICD-O-3 site codes C01.9, C02.4, C02.8, C05.0, C05.1, C05.2, C05.8, C05.9, C09.0, C09.1, C09.8, C09.9, C10.0, C10.1, C10.2, C10.3, C10.4, C10.8, C10.9, C14.0, C14.2 and C14.8) cancers were limited to squamous cell carcinomas (ICD-O-3 histology codes 8050–8084, 8120–8131). Adapted from: Viens et al. Human Papillomavirus- Associated Cancers—United States, 2008–2012. MMWR 2016;65(26):661-666.

Notice: Overdue Data All overdue data must be submitted ASAP. Overdue Data includes: - Baseline Chart Reviews - Prior Monthly Chart Reviews - PDSA Self-Assessments - Baseline and Monthly Tally Forms In order for your study team members to receive MOC credit and the participation stipend, all data must be submitted by the end of day, November 5th.

Next Learning Collaboratives: October 2016 Data Due: October Monthly Chart Review Data is due November 5th! Final Learning Collaborative Call Schedule: Tuesday 11/29 @ 8am ET/ 7am CT/ 6am MT/ 5am PT Tuesday 11/29 @ Noon ET/ 11am CT/ 10am MT/ 9am PT Friday 12/02 @ Noon ET/ 11am CT/ 10am MT/ 9am PT **If you would like calendar appointments for the final LC calls, please send Holly your preferred date.

Any questions?

Contact Information Please contact: Holly Tyrrell, MSSW Phone: 703/556 9222 x113 I Fax: 703/556 8729 Email: hollyce@academicpeds.org