Transcript Shift Happens - Impact of Change

Shift Happens:
The Impact of Change on Health Care Delivery
Len Lichtenfeld, MD, MACP
Deputy Chief Medical Officer
Impact Conference
June 18, 2009
Total Number of Deaths Avoided from 1991-1992 to 2005
Cancer Remains a Formidable
Challenge in 2009
•1.48 million new cases
•More than 1 million cases of non-melanoma
skin cancer
•62,280 cases of in situ breast cancer and
53,120 cases of in situ melanoma
•562,340 deaths
Trends Affecting Cancer In 2020
Early detection technologies will offer an improved
ability to predict risk and detect disease at the molecular
level, and will result in the emergence of a “pre-cancer”
survivor population
The PreventionTherapy Convergence
Microscopic disease
0
10
Neoplasia
102
104
No man’s land
*Cancer
Clonal patches/field
Microneoplasia
*Cancer
Proliferation
Apoptosis
Intervention
105
106
107
108 109 1010 1011 1012
(1 mm3/1 mg)
(1 cm3/1 g)
(1 l/1 kg)
Number of cells (volume/mass)
Risk/precancer
Microneoplasia
Molecular/cellular
changes
Clinical
detection*
death
Clinical
symptoms*
Genetic/epigenetic
3p, 9p, p16, p53
EGFR, K-ras, PI3K...
Prevention
IEN
microcancer
Expanding size,
subclones
Metastases
Invasion/angiogenesis
Convergence
Molecular targeting
Therapy
Lippman, Heymach
Trends Affecting Cancer In 2020
The survivor population will nearly double by 2020,
driven by the aging
of the baby-boomer population and improved cancer
survival rates
Estimated Number of Cancer Survivors in the
United States from 1971 to 2005
U.S. 2005 cancer prevalence counts are based on 2005 cancer prevalence proportions from the SEER 9 registries and 1/1/2005 U.S. population
estimates based on the average of 2004 and 2005 population estimates from the U.S. Census Bureau.
Source: Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L,
Eisner MP, Reichman M, Edwards BK (eds). SEER Cancer Statistics Review, 1975–2005, National Cancer Institute. Bethesda, MD, based on
November 2007 SEER data submission, posted to the SEER Web site, 2008.
Previvor
2006
From Cancer Patient to Cancer Survivor: Lost in
Transition
Maria Hewitt, Sheldon Greenfield, and Ellen Stovall,
Editors, Committee on Cancer Survivorship: Improving
Care and Quality of Life, Institute of Medicine and
National Research Council
Essential Components of Survivorship Care
Prevention of recurrent and new cancers, and of other late
effects;
Surveillance for cancer spread, recurrence, or second
cancers; assessment of medical and psychosocial late
effects;
Intervention for consequences of cancer and its treatment,
for example: medical problems such as lymphedema and
sexual dysfunction; symptoms, including pain and fatigue;
psychological distress experienced by cancer survivors
and their caregivers; and concerns related to employment,
insurance, and disability; and
Coordination between specialists and primary care
providers to ensure that all of the survivor’s health needs
are met.
Trends Affecting Cancer In 2020
New delivery models will continue to proliferate (such as miniclinics) amidst a shortage of oncologists, PCPs, and nurses, leading
to further fragmentation of the delivery system
Health Care Reform
The Unknowns
•Prevention
•Regional Variation
•Health Information Technology
•Comparative Effectiveness