nci community-based cancer centers pilot program...61 major academic and research institutes making...
TRANSCRIPT
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John E. Niederhuber, M.D.
Presentation to the
National Cancer Advisory Board
September 6, 2006
NCI Community-Based
Cancer Centers Pilot
Program
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61 major academic and research institutes
making significant contributions each day
to advances in the understanding,
prevention and treatment of cancer
NCI-Designated Cancer Centers
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Presentation Overview •Context
•Program Development
•Proposed Program Components
•Program Assessment
•Research Questions
• Funding
•Next Steps
• Timeline
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Trends in community-based cancer care
•More well-trained cancer physicians
•State-of-the-art technology more
available
•Movement to physician offices and
“stand-alone” centers
•Growth in “niche” medical specialty
companies
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•Transportation/distance
•Economics/insurance
•Social support systems
•Qualified cancer specialists
•Age
•Reduced toxicity
Realities of treatment Why most cancer patients are treated
in hospitals in their communities:
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Mission: Enable the provision of
state-of-the-art multispecialty care
and early-phase clinical trials in
community-based locations to meet
the needs of the people
NCI Community Cancer Centers Program
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Bringing science to the people where
they live
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Goal: Anticipate sponsoring multiple
pilot sites for three years, to identify
critical factors to be incorporated
into a future RFA
(a nationally linked cohort of patients, from
screening through treatment of active
disease and survivorship)
NCI Community Cancer Centers Program
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“The Committee commends NCI for
its foresight in developing the
community cancer centers program,
which is a direct mechanism to
translate the most promising
advances in cancer treatment… to
community hospitals around the
country.” House Appropriations
subcommittee ’07 report
Congressional report
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Pilot program development Guiding Coalition: John Niederhuber, Mark
Clanton, Anna Barker, Ken Buetow, Norm
Coleman, and Donna O’Brien (healthcare
consultant)
CRCHD: Sanya Springfield, Nada
Vydelingum, Ken Chu, Jane Daye, and
Barbara Wingrove
DCCPS: Bob Croyle, Jon Kerner, Martin
Brown, Steve Taplin, Steve Clauser, Rachael
Ballard-Barbash, and Julia Rowland
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Pilot program development DCP: Leslie Ford and Lori Minasian
DCTD: Jim Doroshow, Michaele Christian,
Jeff Abrams, and Frank Govern
OCTR: Ernie Hawk, Jaye Viner, and Linda
Weiss
OD: Rochelle Rollins, Carolyn Compton, and
Julie Schneider
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Program development considerations
Community sites
• Early-stage programs with significant
outreach to racial/ethnic minorities that
address healthcare disparities
• Well-established programs with
successful accrual to clinical trials
• Programs with strong state funded
support
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Program development considerations
Community sites
• Public hospital programs that reach
large, uninsured populations
• Rural programs
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Program development considerations
• NCI-designated Cancer Center
Community networks
• Large physician network focused on
research partnership, improving quality
of cancer care at community cancer
programs, addressing health disparities
• National health systems to explore
knowledge transfer
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Baseline pilot program components
Community cancer center
Clinical trials
Disparities & community outreach
Information technology
Biospecimen initiatives
Hospice and palliative care
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Community Cancer Center
• Community hospital with:
– cancer program in a discrete center
– medical, surgical and radiation oncology
– one administrative/medical program structure
• Physician director (cancer expertise)
• Patient navigation support
• Multi-disciplinary disease specific planning
committees
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• Minimum 1,000 new cancer cases a year
• Existing programs for cancer screening
• Accreditation by the Commission on
Cancer of the American College of
Surgeons
• Appropriate staffing, technology, clinical
programs, and expertise
Community Cancer Center
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Clinical trials
• Minimum annual accrual of 25 patients
to clinical trials
Preference for more than 50 patients
Preference for experience with NCI-
sponsored clinical trials
• Established research function to
support clinical trials
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Disparities & community outreach
• Organized, sustainable approach for
community health outreach
relationships with other community-based
organizations
• Resources for care of the uninsured and
underinsured (direct financial and other)
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• Preference for a track record of
public/private partnership development
• Partnerships with national, regional and
state public health department
programs preferred
Disparities & community outreach
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Information technology • Information technology capacity that
includes:
plans for an electronic medical record
capacity to devote staff time and expertise
to assess the benefits, implications,
barriers, etc., to implementing relevant
caBIG infrastructure and components
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Biospecimen initiatives
Commitment and capability to describe
and assess implementation requirements
for the First-Generation Guidelines for
NCI-Supported Biorespositories for a
community-based cancer program
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Hospice and palliative care
•An organized program for referral
to hospice services as appropriate
•Palliative care programs and
survivorship plans are of interest
and will be explored during the
pilot
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Special areas of interest during the pilot
• Linkages with NCI Designated Cancer
Centers
• New community-based models to
address healthcare disparities
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Special areas of interest during the pilot
• National health system model in multiple
markets
– to study knowledge transfer methods,
rapid replication capability, or rapid
diffusion of best practices
• State funded cancer initiatives
• Special locations with high incidence/lack
of services
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• State or regional health information
technology initiatives
• Survivorship plans
• Experience with payer-supported clinical
initiatives
• Supplemental funding models to
accelerate achievement of pilot goals
Special areas of interest during the pilot
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• Experience in knowledge exchange
networks/activities
• Successful approaches for
multidisciplinary cancer care
• Successful approaches to increase
accruals to NCI-sponsored clinical trials
Special areas of interest during the pilot
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Pilot program assessment structure
An external — and independent — program
evaluator for this demonstration project
• Year 1: Infrastructure development; refinement
of the pilot program and research questions
– Colorectal cancer quality-of-care study to be
launched for screening, treatment and
follow-up care
• Years 2 and 3: implementation of the model and
evaluation of the metrics/research questions
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Research questions • What are the necessary components to insure a
comprehensive approach to cancer care?”
• What methods are effective to increase accrual of
patients into clinical trials?
• How can the benefits of a multi-disciplinary model
of cancer care best be demonstrated?
• Can the NCCCP model improve quality of care?
• What approaches can reduce healthcare
disparities?
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• How can the First-Generation Guidelines for NCI-
Supported Biorepositories be implemented in a
community hospital-based cancer program?
• How can community-based cancer programs
effectively participate in caBIG?
• How can a Knowledge Exchange Network support
the advancement of goals for NCI and NCCCP
Program?
Research questions
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Funding for pilot phase
• It is the intent to support, through
the NCI’s prime contract with
SAIC-F, multiple sites for a total of
$9M over a 3-year period
•Supplemental funding models to
be considered in support of pilot
goals (provider, state cancer plan,
etc.)
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Healthcare disparities…… 40%
Information technology… 20%
Biospecimen initiative….. 20%
Clinical trials……………… 20%
Funding for pilot phase
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Next Steps •NCCC Program Development Committee to
review comments obtained for Request for
Information sent out in mid-August
•Committee to advise in the drafting of the
Request for Proposal
•Strong communication effort to educate
and elicit feedback from the many
stakeholders in the cancer community
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Proposed timeline Mid-Aug. 2006…….…. Release Request for
Information/Interest (RFI)
RFI responses due
Release Request for
Proposal (RFP)
Pre-proposal conference
(if needed)
RFP responses due
Evaluation of RFP
responses completed
Mid-Jan. 2007…….…...
Mid-Dec. 2006…….…..
Mid-Nov. 2006………...
Mid-Oct. 2006…….......
Mid-Sept. 2006………..
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Proposed timeline
Mid-March 2007……
Site visits (if needed)
Pilot selections made and
announced
Preparations to launch
program; finalized pilot
requirements/ program
elements
Launch NCCCP pilot project
and program for ongoing
review and monitoring during
three-year pilot
April 30, 2007…..…..
April 2007………..…
Feb. 2007….………..
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RFI Posted
FedBizOpps:
http://www.fedbizopps.gov/
SAIC Frederick:
http://web.ncifcrf.gov/bizopps/
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Mission: Enable the provision of
state-of-the-art multispecialty care
and early-phase clinical trials in
community-based locations to meet
the needs of the people
NCI Community Cancer Centers Program
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