1. 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

2. Disclosure of Federal Support
This work was supported in part by: CDC U58 DP and U58 DP Pacific Regional Central Cancer Registry CDC U58 DP REACH CHIP CDC U58 DP American Samoa CCC/BCCEDP Programs CDC U58 DP00847 CNMI CCC/BCCEDP Programs CDC U58 DP FSM National Comprehensive Cancer Control Program CDC DP Guam CCC/BCCEDP Programs CDC U58 DP RMI Comprehensive Cancer Control Program CDC U58 DP 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

3. 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 Strategic Plan and competitive renewal applications for Cancer Registry and CCC
Research infrastructure development

4. 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)

5. 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

8. Guam & AS slightly higher LIVER CANCER USAPI almost 2x more than US
Top 13 cancers - Crude and age-standardized rates for age over All USAPI
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),

10. 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)

11. 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

12. 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 ( ); STRIVE (Guam )
USAPI REACH CHIP ( )

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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 incidence data in existing registries
** CDC funding – up for renewal, need to be prepared for reduced funding

20. 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

21. 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)

22. 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

23. For more information, please visit our website at:

24. 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
Olomwaay