Comprehensive Cancer Alliance for Idaho Data Review: Where we started, Where we are, Where we need to go. CCAI General Meeting October 28, 2009 Chris Johnson, MPH Cancer Data Registry of Idaho

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3 Definitions Prevalence (of risk factors, screening) Incidence Stage Mortality

Comprehensive Cancer Alliance for Idaho 4 Data Sources YRBSS ATS BRFSS SHEPS CDRI BVRHS

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6 Comprehensive Cancer Alliance for Idaho Strategic Plan Evaluation Progress Report Prevention Early Detection and Diagnosis Treatment Quality of Life and Survivorship

Comprehensive Cancer Alliance for Idaho 7 Grading System Reached objective!! Showing improvement, progress towards meeting objective. Not showing improvement. Perhaps losing ground. Definitely losing ground, further away from target than at baseline. Still don’t have a data source.

Comprehensive Cancer Alliance for Idaho 8 Prevention Goal: Decrease the risks for developing preventable cancers among Idahoans. –Tobacco Goal: Reduce the impact of tobacco use and exposure on cancer incidence and mortality in Idaho. –Nutrition Goal: Promote and increase dietary consumption of foods and nutrients known to decrease cancer risk. –Physical Activity Goal: Increase Idahoan’s participation in regular physical activity, thus decreasing the risk of cancer.

Comprehensive Cancer Alliance for Idaho 9 Prevention Goal: Decrease the risks for developing preventable cancers among Idahoans. –Overweight and Obesity Goal: Decrease the prevalence of overweight and obesity as a means of cancer prevention and risk reduction. –Sun and UV Light Exposure Goal: Reduce the incidence of skin cancer in Idaho. –Environmental Exposure Goal: Reduce the cancer incidence and mortality in Idaho by addressing the impact of carcinogens in environmental and occupational settings.

Comprehensive Cancer Alliance for Idaho 10 Tobacco Objectives Objective 1.1: By 2010, decrease to 13.4% the percentage of Idaho students in grades 9-12 who have used any form of tobacco during the previous 30 days.

Comprehensive Cancer Alliance for Idaho 11 Tobacco Objectives Objective 1.2: By 2010, decrease to 18.3% the percentage of Idaho adults exposed to second- hand smoke in their home, workplace or while riding in a car.

Comprehensive Cancer Alliance for Idaho 12 Tobacco Objectives Objective 1.3: By 2010, decrease to 6.8% the percentage of Idaho adult males who currently use smokeless tobacco.

Comprehensive Cancer Alliance for Idaho 13 Nutrition Objectives Objective 1.4: By 2010, increase to 30% the percentage of Idaho adults who consume at least five daily servings of fruits and vegetables.

Comprehensive Cancer Alliance for Idaho 14 Nutrition Objectives Objective 1.5 By 2010, increase to 30% the percentage of Idaho high school students who consume at least five daily servings of fruits and vegetables.

Comprehensive Cancer Alliance for Idaho 15 Nutrition Objectives Objective 1.6: By 2010, increase the promotion of whole grain consumption among Idahoans.

Comprehensive Cancer Alliance for Idaho 16 Nutrition Objectives Objective 1.7: By 2010, decrease to 3.6% the percentage of Idaho adults who are heavy drinkers. –Heavy drinking is defined for females as consuming more than 30 alcoholic beverages in the last 30 days; for males, consuming more than 60 alcoholic beverages in the last 30 days.

Comprehensive Cancer Alliance for Idaho 17 Physical Activity Objectives Objective 1.8: By 2010, increase to 65% the percentage of Idaho adults who accumulate 30 minutes or more per day of moderate physical activity on five or more days of the week or participate in 20 minutes or more of vigorous physical activity on three or more days of the week.

Comprehensive Cancer Alliance for Idaho 18 Physical Activity Objectives Objective 1.9: By 2010, increase to 80% the percentage of Idaho high school students who accumulate 30 minutes or more per day of moderate physical activity on five or more days of the week or participate in 20 minutes or more of vigorous physical activity on three or more days of the week.

Comprehensive Cancer Alliance for Idaho 19 Physical Activity Objectives Objective 1.10: By 2010, increase the number of local communities that provide physical activity opportunities and/or adopt policies that promote physical activity.

Comprehensive Cancer Alliance for Idaho 20 Overweight and Obesity Objectives Objective 1.11: By 2010, increase to 45% the percentage of Idaho adults who are neither overweight nor obese (have a body mass index of less than 25.0).

Comprehensive Cancer Alliance for Idaho 21 Overweight and Obesity Objectives Objective 1.12: By 2010, increase to 85% the percentage of Idaho high school students who are classified as neither overweight nor at risk for being overweight.

Comprehensive Cancer Alliance for Idaho 22 Sun and UV Light Exposure Objectives Objective 1.13: By 2010, increase the proportion of Idahoans who use at least one of the following protective measures that may reduce the risk of skin cancer: 1) avoid the sun between 10 a.m. and 5 p.m.; 2) wear sun- protective clothing when exposed to sunlight; 3) use sunscreen with a sun-protective factor (SPF) of 15 or higher; and 4) avoid artificial sources of ultraviolet light.

Comprehensive Cancer Alliance for Idaho 23 Sun and UV Light Exposure Objectives Objective 1.14 By 2010, increase to 95% the percentage of secondary school health educators in Idaho who have included information on sun safety and skin cancer prevention in their classes.

Comprehensive Cancer Alliance for Idaho 24 Environmental Exposure Objectives Objective 1.15: By 2010, reduce population exposure to arsenic in soil, water, and chromated copper arsenate (CCA)-treated wood.

Comprehensive Cancer Alliance for Idaho 25 Environmental Exposure Objectives Objective 1.16: By 2010, increase to 25% the number of homes that have been tested for radon.

Comprehensive Cancer Alliance for Idaho 26 Environmental Exposure Objectives Objective 1.17: By 2010, reduce population exposure to benzene.

Comprehensive Cancer Alliance for Idaho 27 Environmental Exposure Objectives Objective 1.18: By 2010, reduce population exposure to dioxins and furans.

Comprehensive Cancer Alliance for Idaho 28 Environmental Exposure Objectives Objective 1.19: By 2010, reduce population exposure to household and agricultural pesticides.

Comprehensive Cancer Alliance for Idaho 29 Environmental Exposure Objectives Objective 1.20: By 2010, reduce exposure to carcinogenic chemicals in the work environment.

Comprehensive Cancer Alliance for Idaho 30 Early Detection and Diagnosis Goal 1: Detect and diagnose cancer cases in Idaho at an early stage in order to optimize treatment choices and the probability of cure and/or survival. Goal 2: Increase appropriate screening and early detection for cancer. Goal 3: Promote awareness of and implement early detection initiatives with evidence-based effectiveness. Goal 4: Reduce disparities in cancer screening services for uninsured, underinsured and underserved populations.

Comprehensive Cancer Alliance for Idaho 31 Early Detection and Diagnosis –Breast Cancer Goal: Increase the appropriate utilization of evidence-based and timely breast cancer screening and diagnosis. –Cervical Cancer Goal: Increase the appropriate utilization of evidence-based and timely cervical cancer screening and diagnosis. –Colorectal Cancer Goal: Increase the appropriate utilization of evidence-based and timely colorectal cancer screenings and diagnosis. –Prostate Cancer Goals: 1. Monitor prostate cancer research in primary, secondary, and tertiary prevention and promote informed and shared decision making about screening and treatment for prostate cancer. 2. Decrease years of potential life lost among Idaho men with prostate cancer.

Comprehensive Cancer Alliance for Idaho 32 Early Detection and Diagnosis –Skin Cancer Goals: 1. Increase the utilization of evidence-based skin cancer screening and diagnosis. 2. Reduce the rate of skin cancer/melanoma deaths among Idahoans. –Oral and Pharyngeal Cancer Goals: 1. Increase the appropriate utilization of evidence-based oral and pharyngeal cancer screening and diagnosis. 2. Reduce late stage diagnoses of oral and pharyngeal cancer among Idahoans.

Comprehensive Cancer Alliance for Idaho 33 Breast Cancer Objectives Objective 2.1: By 2010, increase to 70% the percentage of women age 40 and older who report having had a mammogram and clinical breast exam in the past two years. Increase to 74% the percentage of women age 50 and older who report having had a mammogram in the past two years.

Comprehensive Cancer Alliance for Idaho 34 Cervical Cancer Objectives Objective 2.2: By 2010, increase to 90% the percentage of women, age 18 and older, who report having had a Pap smear in the prior three years.

Comprehensive Cancer Alliance for Idaho 35 Colorectal Cancer Objectives Objective 2.3: By 2010, increase to 50% the percentage of adults age 50 and over who report having received a colonoscopy/ sigmoidoscopy within the past five years.

Comprehensive Cancer Alliance for Idaho 36 Colorectal Cancer Objectives Objective 2.4: By 2010, increase to 33% the percentage of adults age 50 and over who report having a fecal occult blood test (FOBT) in the past two years.

Comprehensive Cancer Alliance for Idaho 37 Prostate Cancer Objectives Objective 2.5: By 2010, increase the number of men age 45 and older who have talked with their provider about prostate cancer screening.

Comprehensive Cancer Alliance for Idaho 38 Prostate Cancer Objectives Objective 2.6: By 2010, reduce the prostate cancer death rate to 28.8 per 100,000 (age- adjusted).

Comprehensive Cancer Alliance for Idaho 39 Skin Cancer Objectives Objective 2.7 By 2010, increase the number of Idahoans who reported having had a visual examination of the skin, including both self- examination and clinical exam.

Comprehensive Cancer Alliance for Idaho 40 Oral and Pharyngeal Cancer Objectives Objective 2.8 By 2010, increase to 50% the percentage of oral and pharyngeal cancers detected at the earliest stage.

Comprehensive Cancer Alliance for Idaho 41 Oral and Pharyngeal Cancer Objectives Objective 2.9 By 2010, increase the percentage of adults who, in the past 12 months, report having had an examination to detect oral and pharyngeal cancers. –2007 BRFSS question added: At your last dental visit, did the dentist or dental hygienist tell you that they were examining you for signs of oral cancer?

Comprehensive Cancer Alliance for Idaho 42 Treatment Goal: All Idahoans diagnosed with cancer will receive quality cancer care.

Comprehensive Cancer Alliance for Idaho 43 Treatment Objectives Objective 3.1 By 2010, increase provider utilization of evidence-based treatment guidelines.

Comprehensive Cancer Alliance for Idaho 44 Treatment Objectives Objective 3.2: By 2010, increase access and referral to specialized cancer care services, including clinical trials.

Comprehensive Cancer Alliance for Idaho 45 Treatment Objectives Objective 3.3: By 2010, increase the availability of resources and educational materials to help cancer patients make informed decisions regarding their care.

Comprehensive Cancer Alliance for Idaho 46 Treatment Objectives Objective 3.4 By 2010, reduce racial, ethnic, socioeconomic and other disparities in access to cancer treatment and care. –Objective based on adults without health care coverage. Race= (Black or African American, Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaskan Native, Other Race); Ethnicity=Hispanic; Socioeconomic= (less than high school education, or annual household income less than $25,000, or Medicaid is health care coverage used for most medical care, or no health care coverage. Excluded are those with a household income greater than $50,000 or those with a 4-year college education. Analysis includes those aged 25-64).

Comprehensive Cancer Alliance for Idaho 47 Quality of Life and Survivorship Goal: Ensure that all cancer survivors, families and caregivers have access to services that enhance quality of life throughout all phases of their cancer experience. –Note: BRFSS Survivorship Module being developed and tested by CDC.

Comprehensive Cancer Alliance for Idaho 48 Quality of Life and Survivorship Objectives Objective 4.1 By 2010, develop an infrastructure for the identification and dissemination of Idaho specific cancer resources.

Comprehensive Cancer Alliance for Idaho 49 Quality of Life and Survivorship Objectives Objective 4.2: By 2010, increase the knowledge of health professionals and lay health leaders regarding quality of life and survivorship issues such as support groups, symptom management, pain management, palliative care, emotional and long-term effects and end- of-life-care services.

Comprehensive Cancer Alliance for Idaho 50 Quality of Life and Survivorship Objectives Objective 4.3: By 2010, support the dissemination of existing, or the development and delivery of, patient advocacy/navigator training programs for rural/frontier hospitals (local hospital based support system using hospital and/or American Cancer Society volunteers) to increase the knowledge, the availability and the use of psychosocial services for newly diagnosed patients. *American Cancer Society Study of Cancer Survivors may be able to provide some information.

Comprehensive Cancer Alliance for Idaho 51 Quality of Life and Survivorship Objectives Objective 4.4: By 2010, educate survivors about, and improve access to, quality of life services such as support groups, symptom management, pain management, palliative care, emotional and long-term effects and end- of-life-care services. *American Cancer Society Study of Cancer Survivors may be able to provide some information.

Comprehensive Cancer Alliance for Idaho 52 Quality of Life and Survivorship Objectives Objective 4.5: By 2010, increase patient, healthcare provider and institutional awareness of the use, efficacy, risks and benefits of complementary cancer therapies.

Comprehensive Cancer Alliance for Idaho 53 Quality of Life and Survivorship Objectives Objective 4.6: By 2010, identify, develop (if needed) and disseminate physical activity programs that are appropriate for cancer patients and survivors.

Comprehensive Cancer Alliance for Idaho 54 Report Card – Overall Grade = ?

Comprehensive Cancer Alliance for Idaho 55 Report Card – Overall Grade = ?

Comprehensive Cancer Alliance for Idaho 56 A few thoughts… CCAI thought we would find data sources to measure some of the objectives that didn’t have data. –That hasn’t happened. For some objectives, the target may need to be reassessed. –Mammography among 50+ reached target, but Idaho still has among the lowest screening in the US.

Comprehensive Cancer Alliance for Idaho 57 A few thoughts… 20 - Prevention 9 - Early Detection and Diagnosis 4 - Treatment 6 - Quality of Life and Survivorship

Comprehensive Cancer Alliance for Idaho 58 Other Measures We Might Consider… CDRI has been recognized since 1995 as a “Gold Standard” population-based cancer registry, yet few objectives use CDRI data. –For goals having to do with incidence, consider measuring incidence. –Survival –Cancer prevalence YPLL Costs More on disparities Trends in cancer mortality

Comprehensive Cancer Alliance for Idaho 59 Other Measures We Might Consider… Comprehensive Cancer Control Program (IDHW, CDC-funded) –Incidence of invasive cervical cancer –Incidence of early stage breast cancer –Incidence of advanced stage breast cancer –Incidence of advanced stage colorectal cancer –Health care coverage source at diagnosis Gaps

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Comprehensive Cancer Alliance for Idaho 61 Access to Care and Resources Goal: Ensure access to quality comprehensive and coordinated care from the time of a suspected diagnosis of cancer and throughout the cancer continuum. –Objective 1: By 2010, at least ten agencies, health care facilities, and/or non-profit organizations will partner to hold at least six community events to raise awareness about childhood and adolescent cancer.

Comprehensive Cancer Alliance for Idaho 62 Access to Care and Resources –Objective 2: By 2010, work with Idaho third party payers to improve and streamline the approval process for evidence-based treatment protocols for child cancer patients.

Comprehensive Cancer Alliance for Idaho 63 Patient and Family Quality of Life Goal: Focus on issues related to the quality of life of childhood cancer survivors and their families including social and emotional needs, family economic concerns, school re-entry issues, and access to psychosocial support programs. –Objective 3: By 2010, implement at least two methods that will reduce the financial and/or emotional impacts on the families of children with cancer.

Comprehensive Cancer Alliance for Idaho 64 Long Term Care and Survivorship Goal: Improve long-term care and the assessment and management of the late effects of childhood cancer. –Objective 4: By 2010, develop at least two strategies to coordinate oncology and community care. Address the unique needs of childhood cancer survivors and the need for continuity of care between primary care, the pediatric oncologists, and subsequent healthcare providers.

Comprehensive Cancer Alliance for Idaho 65 Advocacy Goal: Address advocacy concerns to strengthen work in the area of childhood cancer. This includes advocacy on behalf of patients and families for legislation and public policy. –Objective 5: By January 2010, establish a child and adolescent cancer advocacy network to link Idahoans to national childhood cancer efforts.

Comprehensive Cancer Alliance for Idaho 66 Environmental Goal: Reduce exposure of Idahoans to known carcinogens. –Objective 6: By 2010, conduct at least two campaigns to increase awareness about ways to reduce pediatric and adult exposure to known carcinogens.

Comprehensive Cancer Alliance for Idaho 67 To consider… How many goals and objectives should the CCAI plan include? Process versus outcome measures? What are the characteristics of a “good” objective?

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