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Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer
Alliance for Idaho (CCAI)
WELCOME
Kari May
[email protected]
President, CCAI
Comprehensive Cancer Alliance for Idaho
Vision
Every Idahoan deserves the
opportunity for proper cancer
prevention and detection, state of the
art cancer treatment, and the highest
possible quality of life which we are
committed to provide through a data
driven, coordinated comprehensive
cancer plan.
Comprehensive Cancer Alliance for Idaho
MISSION
• Strengthen and coordinate efforts to address cancer issues along
the continuum of cancer prevention and care.
• Assess, define and monitor the burden of cancer in Idaho.
• Resources will be identified or developed and will be networked
through collaborative efforts.
• Raise awareness among the general populations, health care
professions, organizations, agencies and policymakers.
Comprehensive Cancer Alliance for Idaho
Cancer Data Registry of Idaho
Chris Johnson, MPH
Epidemiologist
[email protected]
Comprehensive Cancer Alliance for Idaho
Cancer Data Registry of Idaho
• CDRI is a statewide cancer registry that collects
incidence and survival data on all cancer patients who
reside in the state of Idaho or who are diagnosed
and/or treated for cancer in the state of Idaho.
• CDRI was established in 1969 and became populationbased in 1971.
• Cancer is a reportable disease under state law, and
operations of the registry are mandated by Idaho Code.
• Funding comes from three sources:
– <1% of the Idaho tobacco tax.
– CDC
– Grants & contracts
Comprehensive Cancer Alliance for Idaho
Thanks for Participating in the
MAC Survey!
1)What specific types of data or formats of
reports would be helpful to you and your
peers?
• “Incidence rates and survival rates per
county for each year and how this
compares to national rates.”
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance for Idaho
BRFSS Data – Gem County
Comprehensive Cancer Alliance for Idaho
Cancer Survival
• Methods development continues
– State life tables
– Pohar Perme net survival instead of relative
survival
• No US national cancer survival statistics
–yet…
• “Evaluation of NACCR Cancer in North
America Data for Use in PopulationBased Cancer Survival Studies” to be
published in JNCI survival monograph
(Fall 2013)
Comprehensive Cancer Alliance for Idaho
MAC Survey and Action Items
2) How should data reports be distributed to
health care professionals?
– “Electronic newsletter to all Idaho
physicians.”
• What CDRI will do:
– Idaho Disease Bulletin (Chris Hahn, MD,
State Epidemiologist)
• Utilizes IMA mailing list (not just members)
– IMAges (Idaho Medical Association)
Comprehensive Cancer Alliance for Idaho
MAC Survey and Action Items
3) Support for policy implementation –
clinical trials.
– “Utilize research assistant to screen new
patients to determine if they are eligible for
clinical trials and let physicians know who
may be a candidate.”
• CDRI concept:
– Utilize CDRI database for identifying patients
for clinical trial eligibility, statewide.
– Requires new data model of rapid case
reporting, something CDRI is exploring.
Comprehensive Cancer Alliance for Idaho
Women’s Health Check
Susan Bordeaux, RN
Clinical Coordinator
[email protected]
Comprehensive Cancer Alliance for Idaho
Women’s Health Check
• Serves nearly 5,000 low-income, uninsured
and underinsured women yearly
• Aged 50-64 for breast screening, aged 40-64
for cervical screening
• 138 women diagnosed with cancer in FY12
– 77 Breast, 3 Cervical, 58 Pre-cervical
• Most of these diagnosed women are
approved to BCC Medicaid for the duration
of their active treatment.
Comprehensive Cancer Alliance for Idaho
Women’s Health Check
• 10 contractors coordinate over 400 providers
• Program oversees quality assurance and
improvement for best care by national
standards
• Program promotes screening and early
detection for the general population, not
only WHC-eligible
• WHC currently has openings for screening
assistance statewide.
Comprehensive Cancer Alliance for Idaho
BCC Survey Action Item – Increase
Mammography Screening
• 67% Support campaign to increase primary
care provider referrals for mammography.
• What can CCAI impact?
– Provider script pads (50%)
– Provider impact reports (for WHC providers)- 25%
• Develop Mammogram script pad for use in
medical offices and clinics
– Design and production stages completed by 6/7/13
– Announced in newsletters, distributed throughout Idaho
via WHC contractors, IAFP, other partners
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer
Control Program
Patti Moran, MHS
Program Manager
[email protected]
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Action
• Promotion of screening: Confusion on
what works/doesn’t work
• Educate partners on evidence-based
promotion strategies
www.thecommunityguide.org
• Continue to watch impacts of healthcare
reform
Comprehensive Cancer Alliance for Idaho
Sample: Task Force Recommendations & Findings
Interventions
Breast Cancer
Cervical Cancer
Colorectal
Cancer
Client Reminders
Recommended
July 2010
Recommended
July 2010
Recommended
July 2010
Client Incentives
Insufficient
Evidence
July 2010
Insufficient
Evidence
July 2010
Insufficient
Evidence
July 2010
Small Media
Recommended
December 2005
Recommended
December 2005
Recommended
December 2005
Mass Media
Insufficient
Evidence
October 2009
Insufficient
Evidence
October 2009
Insufficient
Evidence
October 2009
Group Education
Recommended
October 2009
Insufficient
Evidence
October 2009
Insufficient
Evidence
October 2009
One-on-One
Education
Recommended
March 2010
Recommended
March 2010
Recommended
March 2010
Reducing
Structural
Barriers
Recommended
March 2010
Insufficient
Evidence
March 2010
Recommended
March 2010
Reducing Client
Out-of-Pocket
Costs
Recommended
October 2009
Insufficient
Evidence
October 2009
Insufficient
Evidence
October 2009
Comprehensive Cancer Alliance for Idaho
• Continue to educate stakeholders on the
effectiveness of policy, systems, and
environmental change interventions
– Clinical trials
– Tanning restrictions for teens
– Shade policies
• Survivorship- not included on survey but
CCCP is now required to address, e.g.:
– Survivorship Plan/Treatment summaries
– Referral to post treatment community QOL
programs (physical activity, support, prevent
secondary cancers, cessation)
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance for Idaho
Strategic Plan Objectives 2011‐2015
Outcome Measures Used in Cancer Control
* Outcome measures in decreasing order of utility for monitoring and
evaluating components of cancer control. Adapted from: Armstrong BK.
The role of the cancer registry in cancer control. Cancer Causes and
Control 1992;3:569-579.
Comprehensive Cancer Alliance for Idaho
Version History – May 13, 2013
• Recalculation of all cancer mortality baseline
data, targets, and rankings using revised
intercensal population estimates released from
the National Center for Health Statistics in
October 2012.
• Updates to SEER cancer incidence through
2010; US mortality through 2010; Idaho
mortality data through 2011; and Idaho
incidence data through 2010.
Comprehensive Cancer Alliance for Idaho
Version History – May 13, 2013
• Update of US data for Objective 27 - Reduce
the proportion of adolescents in grades 9
through 12 who report using artificial sources of
ultraviolet light for tanning.
• When 2010 US cancer incidence data are
made available (expected July 2013), all cancer
incidence baseline data, targets, and rankings
will need to be recalculated using the revised
intercensal population estimates released from
the National Center for Health Statistics in
October 2012.
Comprehensive Cancer Alliance for Idaho
Melanoma Mortality
Comprehensive Cancer Alliance for Idaho
Cancer Conference Discussion
• Applied for funds to support statewide
cancer meeting tailored to professionals.
• May 2014
• How important are CMEs?
• General or breakouts with specific tracks?
– Ideas for tracks? (dermatology, clinical
research, survivorship)
• Speaker volunteers or suggestions?
Comprehensive Cancer Alliance for Idaho
Clinical Guidelines Discussion
• Which sources do you rely on for clinical
guidelines?
Comprehensive Cancer Alliance for Idaho
Clinical Practice Guidelines in
Oncology
• National Comprehensive Cancer Network
(NCCN)
• National Cancer Institute (NCI)
• American Society of Clinical Oncology
(ASCO)
• Agency for Healthcare Research and
Quality (AHRQ) National Guideline
Clearinghouse
• Others??
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance for Idaho
Comprehensive Cancer Alliance for Idaho
NCI
• Positive for BCR/ABL 
– Imatinib
– Nilotinib
– Dasatinib
• The preferred initial treatment for newly diagnosed
patients with chronic-phase CML could be any of these
specific inhibitors of the BCR/ABL tyrosine kinase.
– [Wei G, Rafiyath S, Liu D: First-line treatment for chronic
myeloid leukemia: dasatinib, nilotinib, or imatinib. J Hematol
Oncol 3: 47, 2010.]
Comprehensive Cancer Alliance for Idaho
ASCO
Summary of Postmastectomy Radiotherapy Guidelines
(Recht et al, 2001)
1. Patients With Four or More Positive Axillary Lymph Nodes
– PMRT is recommended for patients with four or more positive axillary lymph
nodes.
2. Patients With One to Three Positive Axillary Lymph Nodes
– There is insufficient evidence to make recommendations or suggestions for the
routine use of PMRT in patients with T1/2 tumors with one to three positive
nodes.
3. Patients With T3 or Stage III Tumors
– PMRT is suggested for patients with T3 tumors with positive axillary nodes and
patients with operable stage III tumors.
(Many more)
Comprehensive Cancer Alliance for Idaho
Discussion Topics
• CDRI is planning to use our CER dataset
(2011 cases) to measure patterns of care
in Idaho against clinical guidelines for
breast, colon, rectum, and CML cases.
• Do you have comments regarding
granularity of reports?
• Routes of dissemination to medical
community?