Joni Reynolds, RN-CNS, MSN Director of Public Health Programs Winnable Battles: Cancer in Colorado

Freedom Sculpture by Zenos Frudakis Challengin g Disparities

CRC 5 Year Cause Specific Survival Rates 49% :: High Poverty Area 57% :: Medium Poverty Area 63% :: Low Poverty Area Source: Colorado Central Cancer Registry, September 2013 % of the population living in poverty :: less than 10% is low, 10% to less than 20% is medium, 20% or greater is high

“Early” Detection is percent in situ + localized of staged cases (unknowns excluded) Source: Colorado Central Cancer Registry, CDPHE, September 2013

Opportunities Freedom Sculpture by Zenos Frudakis for Change

Already over 900,000 Coloradans access the roughly 250 community clinics in the state An estimated 478,000 Coloradans will now be eligible for Medicaid

Baseline Screening Assessment Infrastructure & Resource Review EHR Updates Office Policy & Work Flow Development Staff Training

Taking the Leap Freedom Sculpture by Zenos Frudakis

Cancer and Prevention Guidelines Ned Calonge, MD, MPH

The ACA and the US Preventive Services Task Force

Lifetime impact of mammography for 1000 women at 40 years of age

Women who will die from breast cancer with no screening Lifetime impact of mammography for 1000 women at 40 years of age

Women who will not die from breast cancer because of screening Lifetime impact of mammography for 1000 women at 40 years of age

Lifetime impact of mammography for 1000 women at 40 years of age Women who will have a false positive mammogram requiring additional procedures

Breast cancer screening in Colorado Women age 50 and older with a mammogram in the past 2 years 63% 2009 incidence of breast cancer deaths from breast cancer 585

Cervical cancer screening in Colorado Women having a PAP test in the past 3 years 79% Annual incidence of cervical cancer 149 Annual deaths from cervical cancer 39

Colorectal cancer screening in Colorado Adults age 50 and older with visualization (ever) 67% 2009 incidence of colon cancer deaths from colon cancer 633

Lung cancer in Colorado Estimated number of smokers 676, incidence of lung cancer deaths from lung cancer 1590 Potential lives saved with screening 310 Potential lives saved with no smoking 1431

ACA and USPSTF recommendations Should there be a direct link between evidence of net benefit and coverage?

National Cancer Institute U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health eHealth for Behavioral Science: LEARNING AT THE SPEED OF TECHNOLOGY Michael Sanchez, MPH, CHES University of Colorado Cancer Center, October 2, 2013 Aurora, CO

2-10 years Grant Submitted Grant Awarded Develop & Pilot Test Recruit & Randomize Follow-upsAnalyze & Publish Replications, Reviews & Adoption Adapted from Bill Riley, NCI

SHOW ME THE EVIDENCE!

Fail quickly and often; think MINC Disseminate across platforms Implement in rapid learning health systems

Michael Sanchez

Patient Navigators Improve Health Outcomes Elizabeth Whitley, PhD, RN October 2013

Denver Health Patient Navigators

Patient Navigation Elizabeth Whitley, Ph.D., RN Patient Navigator Training Collaborative

18 Million Cancer Survivors Projected in 2022 Yrs since dx

Cancer Care Continuum

A Coordinated Cancer Care Team and family caregivers

Ideal survivorship care Supportive Oncology Care Team Courage Heart Brains