1. Translating Research into Practice: Integrating Science with Service through Comprehensive Cancer Control Jon F. Kerner, Ph.D. Deputy Director, Division of Cancer Control & Population Sciences Indiana Cancer Consortium Fall Meeting October 18, 2006

2. The Central Goals of Healthy People 2010*  Increase quality and years of healthy life  Eliminate health disparities * USDHHS Healthy People 2010. Washington D.C. January 2000. Volume #1: page 2

3. Carcinogenesis as a Multi-Stage Process* Normal Cell Initiated Cell Preneoplastic Lesion Malignant Tumor Clinical Cancer Metast. Disease InitiationPromotion Conversion Progression Support & Follow-up Cancer Control as a Multi-Stage Process Health Risk Factor Behaviors Surveillance Follow-up Support PreventionEarly Detection Diagnosis & Treatment Terminal Care *Adapted from Shields PG, Harris CG. Principles of Carcinogenesis: Chemical. In: Devita VT, Hellman S, Rosenberg SA. Cancer Principles & Practice of Oncology. J.B. Lippencott Co. Philadelphia :1993.

4. NCI’s Challenge: Close the Gap Between Discovery and Delivery  There is a critical disconnect between research discovery and program delivery and this disconnect is, in and of itself, a key determinant of the unequal burden of cancer in our society.  Barriers that prevent the benefits of research from reaching all populations, particularly those who bear the greatest disease burden, must be identified and removed.

7. THE CANCER CONTROL CONTINUUM Cancer Control Continuum Prevention Focus Tobacco Control Diet Physical Activity Sun Exposure Virus Exposure Alcohol Use Chemoprevention Detection Pap Test Mammography FOBT Endoscopy PSA Informed Decision Making Treatment Health Services and Outcomes Research Clinical Trials Survivorship Palliation Coping Health Promotion Diagnosis Informed Decision Making Clinical Follow-up Imaging Cross Cutting Issues Communications Surveillance Social Determinants and Health Disparities Genetic Testing Decision-Making Evidence-Based Health Care Quality of Cancer Care Epidemiology

8. Grant Awards by State - Fiscal Year 2005 Total Grants - $ in Thousands

10. Cancer Centers by State (P30 Core Grants) Year 2005 All Types - All States 100.0%$21,004,10265Total 19.8%$4,162,42412Total for Other Nine Institutions 80.2%$16,841,67853Total for Two NCI-designated Cancer Centers %Total Dollars Total NCI Dollars No. of Grants Summary Distribution for NCI Grants for state of Indiana

11. THE DISCOVERY-DELIVERY CONTINUUM DiscoveryDevelopment Delivery Public Health Practice Primary Care Practice Disease Specialty Practice

12. Reducing the cancer burden Fundamental Research Surveillance Research Intervention Research Knowledge Synthesis Application and Program Delivery Dynamic Model of Cancer Research & Diffusion and Dissemination Adapted from the Advisory Committee on Cancer Control, National Cancer Institute of Canada, 1994.Dissemination

13. Diffusion … the passive process by which a growing body of information about an intervention, product, or technology is initially absorbed and acted upon by a small body of highly motivated recipients (Lomas, 1993).

14. Publication Bibliographic databases Submission Reviews, guidelines, textbook Negative results variable 0.3 year 6. 0 - 13.0 years 50% 46% 18% 35% 0.6 year 0.5 year 9.3 years Dickersin, 1987 Koren, 1989 Balas, 1995 Poynard, 1985 Kumar, 1992 Poyer, 1982 Antman, 1992 Negative results Lack of numbers Expert opinion Inconsistent indexing It takes 17 years to turn 14 per cent of original research to the benefit of patient care to the benefit of patient care 17:14 Original research Acceptance Implementation E.A. Balas, 2000

15. Dissemination Active process through which target groups are made aware of, receive, accept and use information and other interventions.

17. TRANSLATION Evidence-based Knowledge “The transfer of evidenced-based knowledge into routine or representative practice” Clinical Practice Glasgow, R SBM (2005) 26 th Annual SBM Meeting, Symposium #22: Disseminating Behavioral Medicine Research: Making the Translational Leap.

18. What is Evidence…..?  Surveillance Data  Systematic Reviews of Multiple Intervention Research Studies  An Intervention Research Study  Program Evaluation  Word of Mouth/Marketing  Personal Experience OBJECTIVE SUBJECTIVE

19. INTEGRATION Explicit Evidence- Based Knowledge Informed Application Tacit Clinical and Contextual Knowledge “The informed combination of evidence-based knowledge and local contextual knowledge into community applications.” Adapted from Glasgow, R SBM (2005) 26 th Annual SBM Meeting, Symposium #22: Disseminating Behavioral Medicine Research: Making the Translational Leap.

20. T RIO TRIO T ranslating R esearch into I mproved O utcomes ( TRIO )  Use and communicate cancer and behavioral surveillance data to identify needs, track progress and motivate action.  Collaboratively develop tools for accessing, and promoting adoption of, evidence-based cancer control interventions.  Support regional and local partnerships to develop models for identifying infrastructure barriers, expanding capacity and integrating science into comprehensive cancer control planning and implementation.

37. A Modest Proposal – More Focused Accrual & Reimbursement by Government?

38. A Modest Proposal – More Focused Accrual (when case fatality & disparities are high)?

39. What % of Diagnosed IN Patients on Protocol?

40. Protocols within 100 miles for 46260

42. What else can be done to reduce lung cancer deaths and to support CCC plan implementation?

51. "Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein (1879-1955) Source: Harvard Report on Cancer Prevention, Cancer Causes and Control, November/December, 1996

58. Source: M Peck ScD, UNMC, adapted from J Richmond

59. Tacit & Contextual Knowledge From Experience Explicit Knowledgefrom Knowledge from Research Evidence Integrating Science with Service: Do We Have the Right Stuff?

60. “To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications.” ~Louis Pasteur Our goal is to turn knowledge into applications that benefit people.