comprehensive cancer alliance for idaho data review: where we started, where we are, where we need...

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Data Review:Where we started,

Where we are,Where we need to go.

CCAI General MeetingOctober 28, 2009

Chris Johnson, MPHCancer Data Registry of Idaho

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Definitions

• Prevalence (of risk factors, screening)

• Incidence

• Stage

• Mortality

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Data Sources

• YRBSS

• ATS

• BRFSS

• SHEPS

• CDRI

• BVRHS

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Comprehensive Cancer Alliance for Idaho

Strategic Plan 2006-2010

Evaluation Progress Report

• Prevention

• Early Detection and Diagnosis

• Treatment

• Quality of Life and Survivorship

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Grading System

• Reached objective!!

• Showing improvement, progress towards meeting objective.

• Not showing improvement.

• Perhaps losing ground.

• Definitely losing ground, further away from target than at baseline.

• Still don’t have a data source.

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Prevention• Goal: Decrease the risks for developing

preventable cancers among Idahoans. – Tobacco Goal: Reduce the impact of tobacco

use and exposure on cancer incidence and mortality in Idaho.

– Nutrition Goal: Promote and increase dietary consumption of foods and nutrients known to decrease cancer risk.

– Physical Activity Goal: Increase Idahoan’s participation in regular physical activity, thus decreasing the risk of cancer.

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Prevention• Goal: Decrease the risks for developing

preventable cancers among Idahoans. – Overweight and Obesity Goal: Decrease the

prevalence of overweight and obesity as a means of cancer prevention and risk reduction.

– Sun and UV Light Exposure Goal: Reduce the incidence of skin cancer in Idaho.

– Environmental Exposure Goal: Reduce the cancer incidence and mortality in Idaho by addressing the impact of carcinogens in environmental and occupational settings.

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Tobacco Objectives

• Objective 1.1: By 2010, decrease to 13.4% the percentage of Idaho students in grades 9-12 who have used any form of tobacco during the previous 30 days.

Goal 2010 Baseline YRBS 2003

YRBS 2005 YRBS 2007

13.4 17.8 21.4 26.1

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Tobacco Objectives

• Objective 1.2: By 2010, decrease to 18.3% the percentage of Idaho adults exposed to second-hand smoke in their home, workplace or while riding in a car.

Goal 2010 Baseline ATS 2005

ATS 2007

18.3 24.4 21.7

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Tobacco Objectives

• Objective 1.3: By 2010, decrease to 6.8% the percentage of Idaho adult males who currently use smokeless tobacco.

Goal 2010 Baseline BRFSS 2003

BRFSS 2004 BRFSS 2005 BRFSS 2006

6.8 9.0 9.9 8.6 8.5

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Nutrition Objectives

• Objective 1.4: By 2010, increase to 30% the percentage of Idaho adults who consume at least five daily servings of fruits and vegetables.


BRFSS 2005 BRFSS 2007

30.0 20.4 23.2 22.3

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• Objective 1.5 By 2010, increase to 30% the percentage of Idaho high school students who consume at least five daily servings of fruits and vegetables.

Goal 2010 Baseline % YRBS 2003

YRBS 2007

30.0 19.0 17.4

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• Objective 1.6: By 2010, increase the promotion of whole grain consumption among Idahoans.

Goal 2010: To Be Est.

Baseline To Be Est.

To Be Established

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• Objective 1.7: By 2010, decrease to 3.6% the percentage of Idaho adults who are heavy drinkers.– Heavy drinking is defined for females as consuming

more than 30 alcoholic beverages in the last 30 days; for males, consuming more than 60 alcoholic beverages in the last 30 days.



3.6 4.2 4.9 5.0 4.6

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Physical Activity Objectives

• Objective 1.8: By 2010, increase to 65% the percentage of Idaho adults who accumulate 30 minutes or more per day of moderate physical activity on five or more days of the week or participate in 20 minutes or more of vigorous physical activity on three or more days of the week.

Goal 2010 Baseline % BRFSS 2003


65.0 56.0 54.0 55.8

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• Objective 1.9: By 2010, increase to 80% the percentage of Idaho high school students who accumulate 30 minutes or more per day of moderate physical activity on five or more days of the week or participate in 20 minutes or more of vigorous physical activity on three or more days of the week.


YRBS 2005 YRBS 2007

80.0 70.8 73.0 YRBS no longer asks-

new definition

coming

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• Objective 1.10: By 2010, increase the number of local communities that provide physical activity opportunities and/or adopt policies that promote physical activity.


Baseline To Be Est.

To Be Established

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Overweight and Obesity Objectives

• Objective 1.11: By 2010, increase to 45% the percentage of Idaho adults who are neither overweight nor obese (have a body mass index of less than 25.0).


BRFSS 2005 BRFSS 2006 BRFSS 2007 BRFSS 2008

45.0 41.8 38.7 40.3 36.9 37.8

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Overweight and Obesity Objectives

• Objective 1.12: By 2010, increase to 85% the percentage of Idaho high school students who are classified as neither overweight nor at risk for being overweight.


YRBS 2005 YRBS 2007

85.0 81.3 79.2 77.2

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Sun and UV Light Exposure Objectives

• Objective 1.13: By 2010, increase the proportion of Idahoans who use at least one of the following protective measures that may reduce the risk of skin cancer: 1) avoid the sun between 10 a.m. and 5 p.m.; 2) wear sun-protective clothing when exposed to sunlight; 3) use sunscreen with a sun-protective factor (SPF) of 15 or higher; and 4) avoid artificial sources of ultraviolet light.


Baseline To Be Est.

To Be Established

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Sun and UV Light Exposure Objectives

• Objective 1.14 By 2010, increase to 95% the percentage of secondary school health educators in Idaho who have included information on sun safety and skin cancer prevention in their classes.

Goal 2010 Baseline SHEPS 2004

SHEPS 2006

95.0 78.0 87.0

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Environmental Exposure Objectives

• Objective 1.15: By 2010, reduce population exposure to arsenic in soil, water, and chromated copper arsenate (CCA)-treated wood.


Baseline To Be Est.

To Be Established

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• Objective 1.16: By 2010, increase to 25% the number of homes that have been tested for radon.



25.0 15.0 17.9 18.2

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• Objective 1.17: By 2010, reduce population exposure to benzene.


Baseline To Be Est.

To Be Established

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• Objective 1.18: By 2010, reduce population exposure to dioxins and furans.


Baseline To Be Est.

To Be Established

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• Objective 1.19: By 2010, reduce population exposure to household and agricultural pesticides.


Baseline To Be Est.

To Be Established

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• Objective 1.20: By 2010, reduce exposure to carcinogenic chemicals in the work environment.


Baseline To Be Est.

To Be Established

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Early Detection and Diagnosis• Goal 1: Detect and diagnose cancer cases in

Idaho at an early stage in order to optimize treatment choices and the probability of cure and/or survival.

• Goal 2: Increase appropriate screening and early detection for cancer.

• Goal 3: Promote awareness of and implement early detection initiatives with evidence-based effectiveness.

• Goal 4: Reduce disparities in cancer screening services for uninsured, underinsured and underserved populations.

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Early Detection and Diagnosis– Breast Cancer Goal: Increase the appropriate utilization of

evidence-based and timely breast cancer screening and diagnosis.

– Cervical Cancer Goal: Increase the appropriate utilization of evidence-based and timely cervical cancer screening and diagnosis.

– Colorectal Cancer Goal: Increase the appropriate utilization of evidence-based and timely colorectal cancer screenings and diagnosis.

– Prostate Cancer Goals: • 1. Monitor prostate cancer research in primary, secondary, and tertiary

prevention and promote informed and shared decision making about screening and treatment for prostate cancer.

• 2. Decrease years of potential life lost among Idaho men with prostate cancer.

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Early Detection and Diagnosis– Skin Cancer Goals:

• 1. Increase the utilization of evidence-based skin cancer screening and diagnosis.

• 2. Reduce the rate of skin cancer/melanoma deaths among Idahoans.

– Oral and Pharyngeal Cancer Goals: • 1. Increase the appropriate utilization of evidence-based oral

and pharyngeal cancer screening and diagnosis. • 2. Reduce late stage diagnoses of oral and pharyngeal cancer

among Idahoans.

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Breast Cancer Objectives

• Objective 2.1: By 2010, increase to 70% the percentage of women age 40 and older who report having had a mammogram and clinical breast exam in the past two years. Increase to 74% the percentage of women age 50 and older who report having had a mammogram in the past two years.



70% (40 +) 74% (50 +)

59.3 (40+) 67.5 (50+)

62.2 (40+) 72.0 (50+)

63.2% (40+) 76.2% (50+)

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Cervical Cancer Objectives

• Objective 2.2: By 2010, increase to 90% the percentage of women, age 18 and older, who report having had a Pap smear in the prior three years.



90.0 79.0 77.5 76.9

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Colorectal Cancer Objectives

• Objective 2.3: By 2010, increase to 50% the percentage of adults age 50 and over who report having received a colonoscopy/ sigmoidoscopy within the past five years.



50.0 37.9 41.7 45.4

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Colorectal Cancer Objectives

• Objective 2.4: By 2010, increase to 33% the percentage of adults age 50 and over who report having a fecal occult blood test (FOBT) in the past two years.



33.0 21.9 20.5 18.7

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Prostate Cancer Objectives

• Objective 2.5: By 2010, increase the number of men age 45 and older who have talked with their provider about prostate cancer screening.


Baseline To Be Est.

To Be Established

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Prostate Cancer Objectives

• Objective 2.6: By 2010, reduce the prostate cancer death rate to 28.8 per 100,000 (age-adjusted).

Goal 2010 Baseline 2000-2004 ID

Mortality

ID Mortality Data 2005



28.8 30.2 28.5 24.6 26.2

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Skin Cancer Objectives

• Objective 2.7 By 2010, increase the number of Idahoans who reported having had a visual examination of the skin, including both self-examination and clinical exam.


Baseline To Be Est.

To Be Established

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Oral and Pharyngeal Cancer Objectives

• Objective 2.8 By 2010, increase to 50% the percentage of oral and pharyngeal cancers detected at the earliest stage.

Goal 2010 Baseline % SEER local stage CDRI 1999-2003 Incidence

% SEER localized, 2003-2005 Incidence



50.0 45.1% 39.2% 41.9% 41.1%

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Oral and Pharyngeal Cancer Objectives

• Objective 2.9 By 2010, increase the percentage of adults who, in the past 12 months, report having had an examination to detect oral and pharyngeal cancers.– 2007 BRFSS question added: At your last dental

visit, did the dentist or dental hygienist tell you that they were examining you for signs of oral cancer?


25.1

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Treatment• Goal: All Idahoans diagnosed with

cancer will receive quality cancer care.

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Treatment Objectives

• Objective 3.1 By 2010, increase provider utilization of evidence-based treatment guidelines.


Baseline To Be Est.

To Be Established

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• Objective 3.2: By 2010, increase access and referral to specialized cancer care services, including clinical trials.


Baseline CDRI 2007

CDRI 2008

Clinical Trial Participation

Rate

2.0% 3.2%

Ages 0-19 36.7% 43.8%Ages 20+ 1.7% 2.7%

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• Objective 3.3: By 2010, increase the availability of resources and educational materials to help cancer patients make informed decisions regarding their care.


Baseline To Be Est.

To Be Established

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Treatment Objectives• Objective 3.4 By 2010, reduce racial, ethnic, socioeconomic and

other disparities in access to cancer treatment and care.– Objective based on adults without health care coverage. Race=

(Black or African American, Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaskan Native, Other Race); Ethnicity=Hispanic; Socioeconomic= (less than high school education, or annual household income less than $25,000, or Medicaid is health care coverage used for most medical care, or no health care coverage. Excluded are those with a household income greater than $50,000 or those with a 4-year college education. Analysis includes those aged 25-64).


Baseline 2005 BRFSS


2005-2007 NHW 25-64

15.5

Race (35.4) Ethnicity (54.6) Socioeconomic (58.8)




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Quality of Life and Survivorship• Goal: Ensure that all cancer survivors,

families and caregivers have access to services that enhance quality of life throughout all phases of their cancer experience.

– Note: BRFSS Survivorship Module being developed and tested by CDC.

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Quality of Life and Survivorship Objectives

• Objective 4.1 By 2010, develop an infrastructure for the identification and dissemination of Idaho specific cancer resources.


Baseline To Be Est.

To Be Established

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• Objective 4.2: By 2010, increase the knowledge of health professionals and lay health leaders regarding quality of life and survivorship issues such as support groups, symptom management, pain management, palliative care, emotional and long-term effects and end-of-life-care services.


Baseline To Be Est.

To Be Established

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• Objective 4.3: By 2010, support the dissemination of existing, or the development and delivery of, patient advocacy/navigator training programs for rural/frontier hospitals (local hospital based support system using hospital and/or American Cancer Society volunteers) to increase the knowledge, the availability and the use of psychosocial services for newly diagnosed patients.


Baseline To Be Est.

To Be Established

*American Cancer Society Study of Cancer Survivors may be able to provide some information.

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• Objective 4.4: By 2010, educate survivors about, and improve access to, quality of life services such as support groups, symptom management, pain management, palliative care, emotional and long-term effects and end-of-life-care services.


Baseline To Be Est.

To Be Established

*American Cancer Society Study of Cancer Survivors may be able to provide some information.

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• Objective 4.5: By 2010, increase patient, healthcare provider and institutional awareness of the use, efficacy, risks and benefits of complementary cancer therapies.


Baseline To Be Est.

To Be Established

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• Objective 4.6: By 2010, identify, develop (if needed) and disseminate physical activity programs that are appropriate for cancer patients and survivors.


Baseline To Be Est.

To Be Established

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Report Card – Overall Grade = ?

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Report Card – Overall Grade = ?

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A few thoughts…

• CCAI thought we would find data sources to measure some of the objectives that didn’t have data.– That hasn’t happened.

• For some objectives, the target may need to be reassessed.– Mammography among 50+ reached target,

but Idaho still has among the lowest screening in the US.

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A few thoughts…

20 - Prevention

9 - Early Detection and Diagnosis

4 - Treatment

6 - Quality of Life and Survivorship

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Other Measures We Might Consider…

• CDRI has been recognized since 1995 as a “Gold Standard” population-based cancer registry, yet few objectives use CDRI data.– For goals having to do with incidence, consider

measuring incidence.– Survival– Cancer prevalence

• YPLL• Costs• More on disparities• Trends in cancer mortality

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Other Measures We Might Consider…

• Comprehensive Cancer Control Program (IDHW, CDC-funded)– Incidence of invasive cervical cancer– Incidence of early stage breast cancer– Incidence of advanced stage breast cancer– Incidence of advanced stage colorectal

cancer– Health care coverage source at diagnosis

• Gaps

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Access to Care and Resources

• Goal: Ensure access to quality comprehensive and coordinated care from the time of a suspected diagnosis of cancer and throughout the cancer continuum.– Objective 1: By 2010, at least ten agencies,

health care facilities, and/or non-profit organizations will partner to hold at least six community events to raise awareness about childhood and adolescent cancer.

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Access to Care and Resources

– Objective 2: By 2010, work with Idaho third party payers to improve and streamline the approval process for evidence-based treatment protocols for child cancer patients.

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Patient and Family Quality of Life

• Goal: Focus on issues related to the quality of life of childhood cancer survivors and their families including social and emotional needs, family economic concerns, school re-entry issues, and access to psychosocial support programs.– Objective 3: By 2010, implement at least two

methods that will reduce the financial and/or emotional impacts on the families of children with cancer.

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Long Term Care and Survivorship

• Goal: Improve long-term care and the assessment and management of the late effects of childhood cancer.– Objective 4: By 2010, develop at least two

strategies to coordinate oncology and community care. Address the unique needs of childhood cancer survivors and the need for continuity of care between primary care, the pediatric oncologists, and subsequent healthcare providers.

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Advocacy

• Goal: Address advocacy concerns to strengthen work in the area of childhood cancer. This includes advocacy on behalf of patients and families for legislation and public policy.– Objective 5: By January 2010, establish a

child and adolescent cancer advocacy network to link Idahoans to national childhood cancer efforts.

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Environmental

• Goal: Reduce exposure of Idahoans to known carcinogens.– Objective 6: By 2010, conduct at least two

campaigns to increase awareness about ways to reduce pediatric and adult exposure to known carcinogens.

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To consider…

• How many goals and objectives should the CCAI plan include?

• Process versus outcome measures?

• What are the characteristics of a “good” objective?

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comprehensive cancer alliance for idaho data review: where we started, where we are, where we need...

Documents

comprehensive cancer

cancer incidence

cancer risk

risk of cancer

percentage of idaho

percentage of idaho

idaho data review

means of cancer prevention