Local Implementation of Cancer Control Efforts in

Essex County

Livingston League of Women VotersLivingston Senior/Community Center

Wednesday, February 15, 2006

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Stanley H. Weiss, MD Professor

UMDNJ-New Jersey Medical School and UMDNJ-School of Public Health

Azadeh Tasslimi & Punam Parikh, MPHEssex County Cancer Coalition

Co-Coordinators Tel: 973-972-4623

Email: tassliaz@umdnj.edu, parikhp1@umdnj.edu

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Overview1) Background and Identifying Needs2) Implementation of the New Jersey

Comprehensive Cancer Control Plan3) Capacity and Needs Assessment4) Local Implementation in Essex County5) Questions

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Executive Order 114:

OCCP and the Governor’s Task Forceestablished

1st New Jersey Comprehensive Cancer Control

Planreleased

1st Status Report to the

Governor submitted(required biennially)

2000 2001 2002 2003 2004 2005 2006 2007 2008

First 5-year plan: 2003–2007

May January December

Background

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NJ-CCCP Organizational Structure

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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

Background

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Began with 350 volunteers from various disciplines

Currently over 550 volunteersThese volunteers are stakeholders

representing clinicians, public health officials, survivors and their families, community-based organizations, advocates, administrators, insurers, researchers

Background

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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

Governor’s Task Force Evaluation Committee

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Identifying Needs1) 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

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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

Identifying Needs

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Implementation of NJ-CCCPMultiple 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

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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 statistics4. Recommendations that integrate the first three

components

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Data AnalyzedDemographics and health status indicatorsCancer incidence and stage at diagnosisCancer mortalityHealthy New Jersey 2010 objectivesStaging of cancerPrevalenceEstimates of medically underserved

populations

Capacity and Needs Assessment (C/NA)

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Capacity & Needs AssessmentLocal 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

CANCER CONTROL IN ESSEX COUNTY

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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

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Composition of Essex County, 2000(source: U.S. Census 2000)

56% Minority population in Essex vs. only 27% in New Jersey

1/3 of State’s total Black population lives in EssexWhite

44%

Asian4%

Black41%

Other11%

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

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C/NA Findings: Essex County

Among WOMENRates in Essex were over 10% higher than NJ for:

Breast ca mortalityCervical ca incidenceCervical ca mortalityOral ca mortality

Among MENRates in Essex were over 10% higher than NJ for:

Oral ca incidenceOral ca mortalityProstate ca incidenceProstate ca mortality

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Essex County had the highest Essex County had the highest cancercancermortality ratesmortality rates of any county in NJ for: of any county in NJ for:

CervicalCervical Oral Oral ProstateProstate

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.

C/NA Findings: Essex County

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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

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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

Background

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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

Inner-City

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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)

Suburban

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LeadershipCouncil

Development Committee

Education/OutreachCommittee

Clinical AdvisoryGroup

Essex County Cancer Coalition

NJDHSS – Office of Cancer Control & Prevention

NJDHSS –

NJCEED

Essex CEEDCoalition

AdvocacyCommittee

ECCC Organizational Structure

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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

Mission Statement

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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-2.1.6NJ-CCCP strategy AC-2.1.6

Disseminate information on cancer control efforts and services throughout Essex County. NJ-CCCP strategy AC-2.1.7NJ-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 NJ-CCCP Objective AC-4.1.7 (other cancer-related BR-2.2.1, BR-5.1,CO-3.1).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-4.1NJ-CCCP Objective AC-4.1

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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

Diverse Membership

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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

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Quarterly ECCC MeetingsEmail 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

Communication Methods

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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

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American Cancer Society (ACS) Web Site: www.cancer.org

– Type in zip code to find local resources and events Local Office: Metro NJ Region-

Address: 767 Northfield Ave, West Orange 07052Tel: 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

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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…

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Essex CEED SitesConduct 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: marciacp@umdnj.edu

St. Michael’s Medical Center-"In The Pink" CEED Program

For more information contact:Ms. Aretha Hill-Forte, "In the Pink" Project CoordinatorTel: (973) 877-2989, email: ahillforte@cathedralhealth.org

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Cancer Care www.cancercare.org Trained oncology social workers provide:

free counseling 24-hr online support groups, face-to-face, telephone

financial assistance

For more information, please contact:Kathy Nugent, LCSW, Director of Social ServicesTel: 201-301-6809, Email: knugent@cancercare.org

National non-profit organization providing free professional support services to: people living with cancer, caregivers, children & loved ones the bereaved

Telephone Education WorkshopsExpert-led programs on a variety of cancer-related topicsMore than 50 Workshops per year Participants can listen to and ask questions of cancer expertsTo register: call 1-800-813-HOPE or at

www.cancercare.org/education.html

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NJ Cancer Clinical Trials Connectwww.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, PharmDTel: 732-235-6783, Email: goodin@umdnj.edu

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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

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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.

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Dental Clinics near Essex that Provide Reduced-Cost Oral Cancer

Screenings

1. UMDNJ-New Jersey Dental School2. Newark Beth Israel Medical Center3. Newark Community Health Centers4. Mountainside Hospital

Accept Medicaid, charity care, and sliding scale fees

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The Essex Communities Against Tobacco (CAT) Coalition

Part of a statewide group of anti-tobacco, community-based 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 CoordinatorTel: 973-571-2324, EssexCountyCAT@yahoo.com

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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 CampaignSTOP THE SILENCE: Changing the Face of Early Breast Health

Intervention

Local Chapter: Sisters Network, Newark For more information contact:

Ms. Charlotte MunnerlynTel: 973 926-5535, munnemann@aol.com

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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 CancerCareThe Prostate NetEssex CEED Sisters’ NetworkEssex CAT Coalition

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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

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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

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

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SUPPLEMENTAL SUPPLEMENTAL SLIDESSLIDES

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General Cancer Risk FactorsGeneral Cancer Risk FactorsRisk factors you Risk factors you cannot cannot

change:change:

Gender: (Males – Oral)(Females – Breast)

Age Genetics Family History Personal history Race/Ethnicity

(White Females – Breast) (Black Males – Prostate, Oral)

Socioeconomic Status (Cervical)

Lifestyle choices and Lifestyle choices and behaviors you behaviors you cancan change: change: Smoking Alcohol (1 > drink per day) Healthy Diet Infectious Agents (HPV, HIV) Exposure to UV Light Oral Contraceptive Use

Protective factors:Protective factors: Early Detection Breastfeeding Low-fat diet ExerciseExercise Safe Sex PracticesSafe Sex Practices

Sources: American Cancer Society; National Cancer Institute

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Screening GuidelinesCancer TypeCancer Type AgeAge Type of Type of

ScreeningScreeningGeneral General FrequencyFrequency

BREAST >40yrs20s & older

MammogramClinical Breast Exam

1-2 yrs20s-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 >50yrsNote: *Men at high risk-45yrs

PSA blood testDRE

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.

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TestTest Mandatory Mandatory OfferOffer

Mandatory Mandatory CoverageCoverage

AgeAge FreqFreq Other Other ContingenciesContingencies

Breast Cancer:Mammography

X >40yrs Annual Younger in women w/ family history

Cervical Cancer:Pap Test

X X >20yrs Biennial Physician Referral Required

Colorectal Cancer: X >50yrs Varies: Younger if high risk and/or

physician referralFOBT AnnualSigmoidoscopy 5yrs

Colonoscopy 10yrsProstate Cancer: X >50yrs Annual <40yrs if high risk

and/or physician referralPSA

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.

Insurance Coverage Overview for Common Cancer Screenings

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Key Health and Economic Key Health and Economic IndicatorsIndicators

(source: U.S. Census 2000)(source: U.S. Census 2000)Essex County New Jersey

Population Density (people per square mile)

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

% Population Below Poverty LevelIndividuals (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

Median Household Income1989 $34,518 $40,927

1999 $44,944 $55.146