Transcript Cancer Council of the Pacific Islands Next Steps and

Lee Buenconsejo-Lum, MD
Neal A. Palafox, MD, MPH
Martina Reichhardt, Dr. Livinson Taulung, Dr. Johnny Hedson
60th PIHOA Executive Board meeting
Honolulu, August 30, 2016
Disclosure of Federal Support
This work was supported in part by:
CDC U58 DP000976 and U58 DP003906 Pacific Regional Central Cancer Registry
CDC U58 DP0058100 REACH CHIP
CDC U58 DP000777 American Samoa CCC/BCCEDP Programs
CDC U58 DP00847 CNMI CCC/BCCEDP Programs
CDC U58 DP000779 FSM National Comprehensive Cancer Control Program
CDC DP000781 Guam CCC/BCCEDP Programs
CDC U58 DP000826 RMI Comprehensive Cancer Control Program
CDC U58 DP003939 Palau CCC/BCCEDP Programs
The content in this presentation is the sole responsibility of the authors and does not
represent official views of the CDC or US Health and Human Services
Contents: please also refer to briefing packet for more detail
 Recap of the CCPI and Pacific Cancer Control Programs





Overview of Cancer in the USAPI
Regional CCC Program
Pacific Regional Central Cancer Registry
REACH Community Health Intervention Project
Pilot research projects:


Cervical cancer / HPV: U54 (UOG); Yap cervical cancer screening (UHCC/NCI);
Demonstration project planning – CNMI and Yap (CDC, HHS, HRSA, NCI)
eHealth communication (Univ. of Rochester GTHRN)
 CCPI Preliminary Priorities for 2017-2022 Strategic Plan and
competitive renewal applications for Cancer Registry and
CCC
 Research infrastructure development
CCPI
 Regional efforts started in 2002 with funding from the National Cancer
Institute. CDC funding since 2004.
 PIHOA Affiliate since Aug 3, 2006 (PIHOA Resolution 42-01)
 Two representatives designated by their Senior ranking health official: clinical
and public health
 Should be in a position to positively influence the health systems that impact
prevention and control of cancer
 CCPI oversees all of the Pacific Regional Cancer Programs
 Administered by the University of Hawaii (Palafox, Buenconsejo-Lum & team)
 Regional focus: cross-cutting issues that are necessary to improve jurisdiction
and regional capacity for cancer and NCD control
 Human resources for health development (HRH)
 Surveillance (cancer) and mortality reporting
 Training in certain areas (public health and clinical), including evaluation
 Prevention: policies and messages in congruence with other NCD
 Screening: working to ensure minimum standards
 Treatment: palliative care / survivorship
 PIHOA Endorsement of Regional CCC Plan and Program and the Pacific
Regional Central Cancer Registry program – Aug 3, 2006 (PIHOA Reso 42-05)
Cancer Council of the
Pacific Islands
(Advisory Board)
U.S. CCC
National
Partnership
Palau
RMI
Kosrae
Chuuk
Pohnpei
Yap
F
S
M
Pacific
Cancer
Coalition
U.S. Affiliated
Pacific
Island
(USAPI)
jurisdictions
American
Samoa
Guam
CNMI
Micronesian
Community Network
& Micronesian Health
Advisory Council
(Hawaii)
Pacific Islands Health
Officers Association
(PIHOA)
Overarching advisory
University of Hawaii
Dept. of Family
Medicine
International
Partners with
PIHOA
(SPC, WHO, BAG)
(administrative, technical
assistance)
Regional Comp
Cancer
Regional Cancer
Registry
Pacific Center of
Excellence in the
Elimination of
Disparities
(Pacific CEED)
Community
Health
Intervention
Project (REACH)
University of
Hawaii
Cancer Center
(technical assistance)
•U54 Partnership
with University of
Guam
•Hawaii Tumor
Registry
•Pacific Cancer
Research Group
University of
Hawaii
RTRN
Dept Geriatrics
Dept OB-Gyn
CTAHR / CHL
Top 13 Adult Cancers for all USAPI 2007 - 2013
Lung & Bronchus
18%
Breast
17%
Prostate
12%
Colon & Rectum
11%
Cervical Cancer, Invasive
7%
Liver
7%
Uterus
7%
Leukemia
5%
Thyroid
4%
Tobacco-related Oral
Cavity…
Ill-defined & unspecified
(unknown+misc)
4%
3%
Nasopharynx
3%
Stomach
3%
0%
N= 3573 adult cancers
Source: Pacific Regional Central Cancer Registry (PRCCR), 2007 - 2013(Chuuk data incomplete)
10%
20%
Top 13 cancers - Crude and age-standardized rates for age over 20
LIVER CANCER
USAPI almost 2x more than US
1.8x higher than US males
Palau: 3x higher than US
Yap: almost 3x higher
RMI, Guam: 2x higher
Higher than US:
Guam and Kosrae: leukemia
Palau, Yap, RMI, Guam: liver
RMI, Pohnpei, Yap and Palau: cervix
Tobacco related oral cavity and pharynx: 10.9 vs. 6.2 (Yap 3.5 x US)
Source: Pacific Regional Central Cancer Registry (PRCCR), 2007-2012
- All USAPI 2007-2013
CERVICAL CANCER
USAPI 2x US rate
RMI 7x
Pohnpei 4x
Yap & Palau 1.6x
Guam & AS slightly
higher
Contributions to overall NCD
Surveillance
 Cancer registries provided the first uniform (across all
jurisdictions) population-based surveillance system
throughout the USAPI
 Forces discussion, problem solving and improvements in
 Medical records / Health information systems
 Physician documentation
 Medical referral system
 Health insurance (related to referrals, mostly)

Data quality, tracking and reporting

Lab
 Radiology
 Primary Health Care / Outer Island health care system (Yap,
RMI, Chuuk, Pohnpei)
Civil Registration and Vital Statistics (Death Certification)

Cancer Surveillance Data: Program
Planning and Long-Term Evaluation
 Prioritizes need for certain programs (i.e., cervical cancer,
breast health)
 Programs / Activities depend on resources available in the
jurisdictions
 Survivor Programs – general and cancer-specific (in Guam,
American Samoa)
 Screening Programs – cervical, breast, prostate, colorectal,
oral
 Prevention programs – tobacco or obesity related
 Long term evaluation
 Changes in incidence of tobacco-, obesity-related, screenable
and those able to be detected at Stage 1 or 2 by good history and
physical examination
 Changes in proportion of stage 1 vs. later stage cancers
 Changes in proportion of cervical pre-cancer, Stage 1, Stage 2+
cervical cancers as HPV vaccination becomes more widespread
and screening improves
Pacific Cancer Programs
 Pacific Regional CCC (2004 – present)
 Currently back-funded from jurisdiction prime awards from CDC
National Comprehensive Cancer Control program
 Regional focus: cross-cutting issues that are necessary to improve
jurisdiction and regional capacity for cancer and NCD control;
leveraging of national and international resources for CCC
 See handout on the synergies and progression of the Pacific Cancer
Programs and benefits to the USAPI
 NCD Toolkit w/ PIHOA, Cervical cancer screening, various regional
assessments related to screening, diagnostic, treatment capacity, data
usage, surveillance
 Pacific Regional Central Cancer Registry (2007 – present)
 USAPI Racial and Ethnic Approaches to Community Health (REACH):
 Pacific CEED (2007-2012); STRIVE (Guam 2013-2014)
 USAPI REACH CHIP (2014-2018)
Regional CCC Strategic Plan: 2017-2022
 Competitive renewal applications for CCC, BCCEDP –
anticipated Feb or March 2017
 Each jurisdiction  regional
 Community-based, multi-sectoral coalitions coordinated
by the Health Dept Cancer Program
 Well coordinated with NCD programs
 Prevention (PSE), Screening/Early Detection, Treatment,
Survivorship
 PSE throughout, rigorous evaluation of outcomes (not just
# of outreach activities done)
 CDC priorities: Colorectal cancer, HPV (vaccination/cc
screening), survivorship
 Communication plan, probably also a sustainability plan
CCPI Regional Priorities –
infrastructure / prevention
 Intra- and inter-jurisdiction open communication, sharing,
networking around support of cancer/NCD. Facilitate
partnerships (CCPI, PIHOA, SAMHSA, others)
 Data, database management
 TA/training on health messaging and communications that
result in measurable behavior change
 Colorectal cancer, oral cancer, betel nut: education, PSE
 Strengthen HPV vaccination programs: provider education,
messaging, tailored intervention strategies appropriate for
resource context, cost reduction
CCPI Regional Priorities –
screening/early detection
 Screening/early detection: cervix, breast, colorectal
 Effective health messaging
 PSE interventions and/or policy revisions that are
resource-appropriate
 Provider education and PSE strategies to achieve
consistency/high quality practice
 TA on reminder systems or other methods to prevent
lost-to-follow up
 Leveraging resources to implement screening programs
that can achieve population targets
CCPI priorities - treatment
 Breast, cervix, colorectal, endometrial, lung
 Provider education and PSE strategies to achieve consistency/high
quality practice and/or appropriate referral recommendations
 Provider and patient resources to help decide on realistic treatment
options, including palliation
 Curriculum on cancer communication, including Goals of Care
 Resource-appropriate policies and guidelines
 Explore telemed links to consultants who can give resource-
appropriate advice or at least understand the context
 Guidance for off-island referral committees
 TA to decide if you have the capacity to provide on-island
maintenance or palliative chemo
CCPI Priorities – QOL / survivorship
 Increase multi-level support to increase access to
palliative care services, including pain management
 CCPI to PIHOA
 WHO Guidelines – institutionalize selected guidelines
 (FSM has a new national procurement policy /
legislation)
 Additional priorities TBD after the Pt Navigation /
Health System Readiness assessment is complete
CCPI Priorities – evaluation
capacity building
 Build capacity to evaluate PSE, Programs and projects
 how to build eval into the planning of projects and
programs … so that the success stories have data
 how to report more effectively
 Opportunity to share how different Programs /
Projects are being evaluated
CCPI Priorities: Data mgmt and
cancer surveillance
 TA on better data harmonization / flow /
communication between programs
 cervical cancer screening registry/database
 Continue to improve cancer registry completeness,
quality and efficiency
 Work to include 2002-2006 incidence data in existing
registries
** CDC funding – up for renewal, need to be prepared
for reduced funding
Build research capacity infrastructure
 Long term: Address the uneven global burden and impact
NCDs on LMICs in the Pacific
 strengthen the focus on cancer and other NCDs in Pacific
LMICs by LMICs
 develop research infrastructure to support priority research
needs, including (mentoring, training, pipeline programs)
 build an evidence base for effective NCD prevention and
control in the jurisdiction- and regional-specific context of
resources, partnerships and needs
 increase the number of Pacific Islander researchers from
LMICs --focused on NCDs through global health career
tracks
Situational assessments
 Administrative support
 Fiscal and grants management
 Information and Communications Technology (ICT)
regulatory capacity structures and data systems.
 Assets mapping of the current and future partners
(current programs, capacity, expansion capability)
 Community needs and assets
 existing NCD/Ca & other strategic plans
 direct community input – CBPR model
 Other partners (UOG,UHCC, JABSOM, U54, CHL)
Considerations for PIHOA
 Registry / Surveillance capacity / HIS improvement
 Intra- / inter-jurisdiction open communication,
sharing, networking around cancer/NCD.
 Facilitate partnerships (CCPI, PIHOA, SAMHSA, )
 Data, database management
 PIHOA : interweave with other programs
 Registry
 REACH
 Research
For more information, please visit our website at:
www.pacificcancer.org
Si Yu`os Ma`ase
Kulo
Malulap
Kalangan
Msuulaang
Komagar
Fa`a Fetai Tele Lava
Olomwaay
[email protected]
www.pacificcancer.org
Kinisou
Chapwur
Kommol
Tata
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