1. Comprehensive Cancer Control: Can We Practice What We Preach? Jon F. Kerner, Ph.D. Division of Cancer Control and Populations Sciences

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. NCI’s Challenge: Health Disparities Present Scientific, Moral and Ethical Dilemmas  Profound advances in biomedical science have occurred over the last several decades, which for many Americans, have contributed to increased longevity and improved quality of life.  Despite this progress, a heavier burden of disease is borne by some population groups in the United States, particularly the poor and underserved.  The unequal burden of disease in our society is a challenge to science as well as a moral and ethical dilemma for our nation.

4. Target for Change: By 2008, develop a system to monitor and document cancer disparities in Maryland. Objective 1: Increase public and community awareness about cancer health disparities and cancer prevention, screening, and treatment in Maryland. Chapter 3: Cancer Disparities Goal: Reduce cancer health disparities in Maryland. Objective 2: Develop and implement health care programs designed to reduce cancer disparities among targeted populations in Maryland. Objective 3: Increase cancer disparities documentation and intervention on a systematic basis in Maryland. Objective 4: Increase provider education and reimbursement aimed at reducing cancer disparities Executive Summary Objective 5: Improve access to, and utilization of, cancer screening and treatment options for underserved populations. Objective 6: Improve the quality of cancer care received by racial/ethnic minorities.

5. NCI Map of Grants by State – FY 2002

7. 6/21 (28.6%) grants and 26.6% of grant funds focus on health disparities research

8. Chapter 5: Tobacco-Use Prevention and Cessation & Lung Cancer Goal: Substantially reduce tobacco use by Maryland adults and youth. Executive Summary Targets for Change: By 2008, reduce lung cancer mortality to a rate of no more than 57.3 per 100,000 persons in Maryland. Maryland Baseline: 59.5 per 100,000 in 2000 (age- adjusted to the 2000 U.S. standard population). Source: Maryland Division of Health Statistics By 2008, reduce the proportion of Maryland middle school youth that currently smoke cigarettes to no more than 6.2%. Maryland Baseline: 7.3%. Source: Maryland Youth Tobacco Survey (2000) By 2008, reduce the proportion of Maryland high school youth that currently smoke cigarettes to no more than 20.3%. Maryland Baseline: 23.7%. Source: Maryland Youth Tobacco Survey (2000) By 2008, reduce the proportion of Maryland adults that currently smoke cigarettes to no more than 15 %. Maryland Baseline: 17.5%. Source: Maryland Adult Tobacco Survey (2000) By 2008, increase the proportion of Maryland adults that would support a proposal to make all restaurants in their community smokefree to 72.1%. Maryland Baseline: 63.0%. Source: Maryland Adult Tobacco Survey (2000)

9. MD Target: 57.3 Maryland Baseline: 59.5 per 100,000 in 2000 (age-adjusted to the 2000 U.S. standard population). US Target: 44.9 U.S. Baseline: 56.1 per 100,000 in 2000 (age-adjusted to the 2000 U.S. standard population).

10. CDC Office of Smoking Health State Highlights 2002 report Maryland

11. NCI’s Challenge: Close the Gap Between Discovery and Delivery  There is also 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.

12. THE DISCOVERY-DELIVERY CONTINUUM Discovery Development Delivery Policy How do we model Interagency partnership across the continuum? How do we increase investment in the development process?

13. 1 NCI-designated Cancer Center 0 CCOPs; 35 ACoS

14. 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

15. 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

16. T RI OTRIO Translating Research into Improved Outcomes (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.

17. http://cancercontrol.cancer.gov/d4d/

19. Working Together To Make the Whole Greater Than the Sum of Its Parts National Partnership Model in Comprehensive Cancer Control ACS NCI CDC R&D Synthesis Direct Service R & D Dissem.& Diffusion R & D Synthesis Dissem. & Diffusion Direct Service

20. Research-Practice Partnerships? “Getting a new idea adopted, even when it has obvious advantages, is often very difficult.”-- Everett Rogers, Diffusion of Innovations

21. Maryland Grantee Institutions No. of Grants Total Dollars % of Dollars Comp. Cancer Center 141$68,906,16578.1% 30 Other Institutions 97$19,347,96121.9% Total238$88,254,126100%

22. P30/P50 Review Committee Report Recommendation #2 2.Make better use of centers as entrepreneurial resources for planning, innovation and dissemination 2.6 Provide support via P30 to centers making links with state agencies, health departments, CDC, etc. 2.7 Modify the P30 award to encourage novel methods and infrastructure for disseminating new knowledge in early detection, prevention, cancer control and clinical research 2.2 Use existing resources of centers as cost-effective sites for piloting new research and dissemination programs

23. Observations about Centers’ Interest in Dissemination and Diffusion  Few cancer centers articulate a specific interest in dissemination based on information from Web sites.  There are few population sciences shared resources and none are specifically focused on D and D.  There are few people already within cancer centers with the skill set needed to develop the D and D area.  If it is an “unfunded mandate,” D and D will not occur on the appropriate scale.

25. Potential Partners for All Cancer Centers and Academic Medical Centers in Comprehensive Cancer Control  Schools of public health  Schools of allied health professionals  Schools of communication  Business schools  Health departments  Voluntary health organizations  Private sector, e.g. advertising agencies

26. Application of D&D Models in Cancer Centers  Create Knowledge Transfer Teams— Provide support for people whose role is to assess the appropriateness of discoveries in different areas for dissemination (perhaps as part of a Dissemination Core).  New Associate Director position?

27.  Knowledge Synthesis Model—Encourage cancer centers to seek training opportunities for people in knowledge synthesis (KS), actively encourage more KS prior to grant funding as part of grant evaluation, more aggressively promote existing knowledge syntheses to cancer centers.  Discourage cancer center PR departments to promote the study finding “du jour?” Application of D&D Models in Cancer Centers

28. “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.