Transcript Evaluation Report to the Governor’s Task Force on Cancer

Local Implementation of
Cancer Control Efforts in
Essex County
Livingston League of Women Voters
Livingston Senior/Community Center
Wednesday, February 15, 2006
Stanley H. Weiss, MD
Professor
UMDNJ-New Jersey Medical School
and UMDNJ-School of Public Health
Azadeh Tasslimi & Punam Parikh, MPH
Essex County Cancer Coalition
Co-Coordinators
Tel: 973-972-4623
Email: [email protected],
[email protected]
2
Overview
1) Background and Identifying Needs
2) Implementation of the New Jersey
Comprehensive Cancer Control Plan
3) Capacity and Needs Assessment
4) Local Implementation in Essex County
5) Questions
3
Background
May
January

2000
2001
2002

2003
December
2004

2005
2006
2007
2008
First 5-year plan: 2003–2007
Executive
1st New Jersey
1st Status
Order 114:
Comprehensive Report to the
Governor
OCCP and the Cancer Control
Plan
submitted
Governor’s
released
(required
Task Force
biennially)
established
4
NJ-CCCP Organizational Structure
5
Background
Cancer ranked as the top health issue
facing NJ residents in a State Health
Issues Opinion Survey* (1999).
 Yet no comprehensive capacity and
needs assessment had ever been
conducted in NJ
 No inventory of cancer-related
resources available on a statewide
basis

6
Background
Began with 350 volunteers from various
disciplines
 Currently over 550 volunteers
 These volunteers are stakeholders
representing clinicians, public health
officials, survivors and their families,
community-based organizations,
advocates, administrators, insurers,
researchers

7
Governor’s Task Force
Evaluation Committee
Serves to provide scientific oversight
and expertise
 Oversaw Cancer Capacity and Needs
Assessment in all 21 counties
 Submitted the first biennial Status
Report to the Governor

 Reviewed status of cancer burden and
cancer control efforts
 Proposed data-driven recommendations
8
Identifying Needs
1) Data and Data Systems:
 Baseline capacity and needs assessment
 To understand cancer burden and disparities in
each county and statewide
 To compare data from one county to each other
and to the state as a whole
 To understand current cancer-related services,
resources, and gaps in New Jersey
9
Identifying Needs
2) Involve partners who have relevant expertise
 Data and scientific expertise:







State Cancer Registry
State BRFSS Epidemiologist-Coordinator
NCI’s Regional Cancer Information Service
Public health, epidemiology, and statistical experts
Industry and academia
Workgroups and their Chairs
Health services and planning:
 NJCEED Program
 Cultural competency experts
 Local health planners
10
Implementation of NJ-CCCP
Multiple groups involved

Ten Workgroups
 Local NJCEED programs and county cancer
coalitions
 Each group identifies areas of focus and
strategies to address
 Synergy among Workgroups and local cancer
coalitions and other organizations
encouraged
11
Capacity and Needs Assessment
(C/NA)
Baseline Capacity and Needs Assessment (C/NA)
in each county was one of the first
implementation steps of the NJ-CCCP
Major components required for all reports:
1. Demographics and local infrastructure (e.g.,
transportation)
2. Resources (e.g., health care facilities, schools,
community-based organizations, etc.)
3. Cancer statistics
4. Recommendations that integrate the first three
components
12
Capacity and Needs Assessment
(C/NA)
Data Analyzed
 Demographics and health status indicators
 Cancer incidence and stage at diagnosis
 Cancer mortality
 Healthy New Jersey 2010 objectives
 Staging of cancer
 Prevalence
 Estimates of medically underserved
populations
13
Capacity & Needs Assessment

Local health planners - County Evaluators
(CEs)
 Already involved in local community
 Experience with health services and planning
 Responsible for conducting the C/NA and
formulating recommendations for action for
implementation at the county and state level
14
CANCER CONTROL IN
ESSEX COUNTY
Essex County Cancer Coalition
(ECCC) Priorities

Findings from the C/NA serve as the
empirical basis for prioritizing local
cancer control efforts
 County demographic profile was created
 Cancer issues not historically
recognized as priorities in Essex
emerged from the C/NA process
16
Composition of Essex County, 2000
(source: U.S. Census 2000)
Asian
4%
Black
41%
Other
11%
White
44%

56% Minority
population in Essex vs.
only 27% in New Jersey
 1/3 of State’s total Black
population lives in Essex
Substantial Hispanic/Latino population - 16% of Essex vs.13% of NJ
Other special populations (race, ethnicity, or language)
exceeding 3% of county include:
• Asians (29,429)
• French- /French-Creole-speaking (24,874; incl. Haitians)
• Portuguese (23,744)
• Spanish-speaking, comprise 1/2 of linguistically isolated households
17
C/NA Findings: Essex County
Among WOMEN
Rates in Essex were over
10% higher than NJ for:
 Breast ca mortality
 Cervical ca incidence
 Cervical ca mortality
 Oral ca mortality
Among MEN
Rates in Essex were over
10% higher than NJ for:
 Oral ca incidence
 Oral ca mortality
 Prostate ca incidence
 Prostate ca mortality
18
C/NA Findings: Essex County
Essex County had the highest cancer
mortality rates of any county in NJ for:



Cervical
Oral
Prostate
 Oral and prostate cancers emerged as new
priorities
 Cervical cancer screening & treatment remains a
priority, as it is preventable and highly treatable.
High cervical cancer mortality rates indicate a
need for increased education and detection.
19
Local Implementation:
Essex County
Essex County Cancer Coalition (ECCC):
One of 21 county cancer coalitions in NJ
 GOALS

 Implement the NJ Comprehensive Cancer
Control Plan (NJ-CCCP)
(www.state.nj.us/health/ccp/ccc_plan.htm)
 Prioritize cancer control efforts at the local
level
20
Background
Essex County Cancer Coalition:

Addresses all 7 cancers the NJ-CCCP identified as
priorities:
 Breast, cervical, colorectal, lung, melanoma, oral &
prostate

County-wide focus, but dichotomous issues:
 4 contiguous inner-city municipalities with high
proportions of medically underserved:
Newark, Orange, East Orange, Irvington
 Suburban areas with significant elderly population
21
Inner-City

Cancers of Focus:
 Cervical
 Prostate
 Oral

Disparities among Racial & Ethnic Minorities

Access to care, lack of insurance, language
barriers

Low Clinical Trial Participation - Views on medical
research
22
Suburban

Cancers of focus:





Lung
Colorectal
Breast
Prostate
Under-screened for many cancers relative to risk
 Breast Cancer - Mammograms & Medicare coverage
 Cervical Cancer - Pap Tests

Low Clinical Trial Participation - Lack of available
clinical trial protocols (toxicity, comorbidities)
23
ECCC Organizational Structure
NJDHSS – Office of Cancer
Control & Prevention
Essex County Cancer Coalition
Leadership
Council
Advocacy
Committee
NJDHSS –
NJCEED
Essex CEED
Coalition
Clinical Advisory
Group
Development
Committee
Education/Outreach
Committee
24
Mission Statement





Increase cancer awareness & reduce its impact on
Essex residents through improved screening, access
to treatment & follow-up
Promote awareness of and participation in cancer
clinical trials
Support investigations that seek to find the causes of
cancers, improve care, reduce health disparities, or
increase access
Increase collaboration & communication among all
stakeholders to maximize utilization/identification of
resources
Examine and prioritize an expansion of cancer control
efforts county-wide
25
ECCC is implementing the following
NJ-CCCP Goals:

Promote collaboration with traditional and non-traditional
partners to improve communication about access and resources
for cancer education, detection, and prevention services,
including research studies. NJ-CCCP strategy AC-2.1.6

Disseminate information on cancer control efforts and
services throughout Essex County. NJ-CCCP strategy AC-2.1.7

Educate the public regarding the purpose and importance of
participating in clinical trials for cancer, with special emphasis
on addressing the concerns of minority populations. NJ-CCCP
Objective AC-4.1.7 (other cancer-related BR-2.2.1, BR-5.1,CO-3.1).

Identify strategies to increase cancer service access and
resources for all populations through public education.
NJ-CCCP Objective AC-4.1
26
Diverse Membership

Members include:
 Cancer Survivors
 Healthcare Providers
 Educators
 Outreach Workers
 Cancer Advocates
 Public Health Workers
& Researchers
 People Personally
Affected by Cancer

Organizations represented:
 Community-based
organizations
 County & Local health
departments
 National & Local Cancer
Organizations
 Health Centers, Hospitals,
& Clinics
 Faith-based Organizations
 Corporations
 Academia
 Foundations
27
For Example…

The Coalition is partnering with the following
organizations to address the three cancers
that were identified as priorities in Essex
County through the C/NA:
 The Prostate Net
 Oral Cancer Consortium
 Essex “Communities Against Tobacco” (CAT)
Coalition
 Essex Cancer Education & Early Detection
(CEED) Program
28
Communication Methods
Quarterly ECCC Meetings
 Email list-serve (free using Yahoo!Groups)
for:

 Entire Coalition
 Leadership Council and Each Committee
Monthly Community Health Calendar that
focuses on cancer
 Coalition Website:
www.umdnj.edu/EssCaWeb

29
Cancer Services & Resources
•Many
Coalition members work for organizations
that serve as resources for cancer education,
screening/early detection, and support services
•Coalition
promotes services provided by
members and non-members throughout Essex
County
30
American Cancer Society (ACS)

Web Site: www.cancer.org
– Type in zip code to find local resources and events

Local Office: Metro NJ RegionAddress: 767 Northfield Ave, West Orange 07052
Tel:
973-736-7770

National Call center: 1-800-ACS-2345
Patients and others can obtain referrals to local
cancer resources and to a local “patient and
family services director/coordinator” who may be
able to help
 Broad range of cancer education materials
available
31
NJ Cancer Education &
Early Detection (CEED) Programs
www.state.nj.us/health/cancer/njceed/
The NJCEED Program offers funding to
all 21 counties for comprehensive
breast, cervical, prostate & colorectal
cancer education, outreach &
screening.
 There are 2 CEED sites in Essex…

32
Essex CEED Sites
Conduct education/outreach and screenings at churches,
health departments & community centers:

UMDNJ - “S.A.V.E. Women & Men of Essex County”
CEED Program
 For more information contact:
Ms. Catherine Marcial, SAVE Women & Men Project Coord.
Tel: (973) 972-0308, email: [email protected]

St. Michael’s Medical Center-"In The Pink" CEED
Program
 For more information contact:
Ms. Aretha Hill-Forte, "In the Pink" Project Coordinator
Tel: (973) 877-2989, email: [email protected]
33
Cancer Care www.cancercare.org

National non-profit
organization providing
free professional
support services to:





people living with cancer,
caregivers,
children & loved ones
the bereaved

Trained oncology
social workers provide:
 free counseling
 24-hr online support groups,
 face-to-face,
 telephone
 financial assistance
Telephone Education Workshops
Expert-led programs on a variety of cancer-related topics
More than 50 Workshops per year
Participants can listen to and ask questions of cancer experts
To register: call 1-800-813-HOPE or at
www.cancercare.org/education.html
For more information, please contact:
Kathy Nugent, LCSW, Director of Social Services
Tel: 201-301-6809, Email: [email protected]
34
NJ Cancer Clinical Trials Connect
www.njctc.org

Innovative electronic tool to match patients to cancer
clinical trials statewide
 Patients create a confidential medical profile online
 Informational resource to educate people about clinical
trials, provides links to other resources
 Website available in Spanish
 Toll-free information line 866-788-3929, Monday through
Friday, 9 am-5 pm
 Supported by CINJ, RWJ Medical School, & NJ-DHSS
For more information, contact:
Susan Goodin, PharmD
Tel: 732-235-6783, Email: [email protected]
35
The Prostate Net www.prostate-online.org
National non-profit organization which
aims to increase awareness of prostate
cancer especially among minority men in
medically underserved areas
 Barbershop Initiative:

 National program to increase prostate cancer
awareness among minority men by training barbers
to deliver health messages and involving local
medical centers to provide education coupled with
free prostate cancer screenings & treatment.

Cancer Education Literature
36
Oral Cancer Consortium www.oral-cancer.org




Comprised of 26 metropolitan healthcare institutions
and professional societies in NY, NJ & PA.
Recognize that oral cancer is an under- publicized
issue and aim to raise awareness & the importance
of prevention and early detection.
Sponsoring Oral Cancer Screening Day
(April 20, 2006)
For more information about where to receive a free
oral cancer screening, call the Oral Cancer Screening
Information Line at 1-877-263-3401.
37
Dental Clinics near Essex that
Provide Reduced-Cost Oral Cancer
Screenings
1.
2.
3.
4.
UMDNJ-New Jersey Dental School
Newark Beth Israel Medical Center
Newark Community Health Centers
Mountainside Hospital
Accept Medicaid, charity care, and sliding
scale fees
38
The Essex Communities Against
Tobacco (CAT) Coalition

Part of a statewide group of anti-tobacco, communitybased coalitions that promote tobacco-free
environments.

Supports tobacco prevention education programs
and participates in anti-tobacco advocacy
efforts/activities
 Advocate for passage of “Clean Indoor Air” Bill in NJ

Tobacco strongly linked with lung, oral and cervical
cancers
 For more information contact:
Ms. Michele Grippaldi, Essex CAT Coalition Coordinator
Tel: 973-571-2324, [email protected]
39
Sisters Network www.sistersnetworkinc.org

Addresses the breast health needs of African American
women, through affiliate chapters & partnerships with
existing service providers

Chapters are organized by breast cancer survivors
committed to establishing community breast health services
 Successful community outreach programs:
"The Gift for Life Block Walk"
The Pink Ribbon Awareness Campaign
STOP THE SILENCE: Changing the Face of Early Breast Health
Intervention

Local Chapter: Sisters Network, Newark
 For more information contact:
Ms. Charlotte Munnerlyn
Tel: 973 926-5535, [email protected]
40
Current ECCC Activities

Cancer Prevention & Early Detection Health Fair
- April 20, 2006
 In conjunction with Oral Cancer Screening Day at New
Jersey Dental School
 Health fair was proposed by Coalition members
 Participants include:
Essex County Cancer Coalition
CancerCare
The Prostate Net
Essex CEED
Sisters’ Network
Essex CAT Coalition
41
Current ECCC Activities (cont.)

Letters to the Editor to be published in
local newspapers in Essex County
 Intent is to highlight local cancer issues in
conjunction with national health observances

Cancer education for Essex firefighters
 Coordinators will give an overview of cancer
issues at March meeting of fire chiefs
42
Current ECCC Activities (cont.)

Creator of NJ Cancer Trials Connect educated
Coalition members
 Member who educates the community about
clinical trials though his personal experiences
 Coalition has helped to initiate a Working Group
to:
 Further understand barriers to participation in cancer
clinical trials
 Formulate effective educational approaches
 Identify appropriate funding opportunities
43
How Can You and/or Your
Organization Contribute to Cancer
Control Efforts in Essex County?
We strongly encourage YOUR participation on the Essex
County Cancer Coalition to:
Educate yourself about the cancer burden in Essex
County and the cancer issues affecting the
communities you work with
Expand awareness and promote the importance of
cancer prevention & early detection
Help reduce the number of cancer deaths and
alleviate the overall cancer burden in the County
SUPPLEMENTAL
SLIDES
45
General Cancer Risk Factors
Risk factors you cannot
change:
Lifestyle choices and
behaviors you can change:
 Gender:








(Males – Oral)
(Females – Breast)
Age
Genetics
Family History
Personal history
Race/Ethnicity
(White Females – Breast)
(Black Males – Prostate, Oral)
Socioeconomic Status
(Cervical)




Smoking
Alcohol (1 > drink per day)
Healthy Diet
Infectious Agents (HPV, HIV)
Exposure to UV Light
Oral Contraceptive Use
Protective factors:
 Early Detection
 Breastfeeding
 Low-fat diet
 Exercise
 Safe Sex Practices
Sources: American Cancer Society; National Cancer Institute
46
Screening Guidelines
Cancer Type
Age
Type of
Screening
General
Frequency
BREAST
>40yrs
20s & older
Mammogram
Clinical Breast
Exam
1-2 yrs
20s-30s: every 3 years;
annually after 40yrs
CERVICAL
Within 3yrs of 1st
sexual intercourse or
21yrs old
Pap Smear
Annually
COLORECTAL*
>50yrs
Colonoscopy
Every 10 yrs
PROSTATE
>50yrs
Note: *Men at high
risk-45yrs
PSA blood test
DRE
Annually
*Shared decision
making with physician
ORAL
Should ask dentist to examine you for oral
cancer as part of annual dental check-up
Annually
*Other tests commonly used to detect colorectal cancer are: fecal occult blood test (FOBT) and flexible sigmoidoscopy.
47
Insurance Coverage Overview for Common
Cancer Screenings
Test
Breast Cancer:
Mammography
Cervical Cancer:
Pap Test
Mandatory Mandatory Age
Offer
Coverage
X
>40yrs
X
Colorectal Cancer:
X
X
Other
Contingencies
Annual Younger in women
w/ family history
>20yrs Biennial Physician Referral
Required
>50yrs
FOBT
Sigmoidoscopy
PSA
Varies:
Annual
5yrs
Colonoscopy
Prostate Cancer:
Freq
Younger if high
risk and/or
physician referral
10yrs
X
>50yrs
Annual
<40yrs if high risk
and/or physician
referral
DRE
Phase I, II & III
approved cancer clinical trials
Members in NJ Association of Health Plans (NJAHP) –
represents the state's nine largest health insurers.
48
Key Health and Economic Indicators
(source: U.S. Census 2000)
Essex County
New Jersey
6,285.4
1,134.4
Median Age (years)
34.7
36.7
% Adults ≥25 years without high school
diploma
24.4
17.9
% Linguistically Isolated Households
7.5
6.3
% Unemployed
9.3
5.8
% Estimated Uninsured
17.0
13.0
Individuals (all ages)
15.6
8.5
Children (<18 years)
22.1
11.1
Single, female householders
28.3
19.4
Elderly (65 years and older)
12.2
7.8
1989
$34,518
$40,927
1999
$44,944
$55.146
Population Density (people per square
mile)
% Population Below Poverty Level
Median Household Income
49