translating research into practice: integrating science with service through comprehensive cancer...
TRANSCRIPT
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Translating Research into Practice: Integrating Science with Service through
Comprehensive Cancer Control
Jon F. Kerner, Ph.D.Deputy Director, Division of Cancer Control
& Population SciencesIndiana Cancer Consortium Fall Meeting
October 18, 2006
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The Central Goals of Healthy People 2010*
Increase quality and years of healthy life
Eliminate health disparities
* USDHHS Healthy People 2010. Washington D.C. January 2000. Volume #1: page 2
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Carcinogenesis as a Multi-Stage Process*
Normal Cell
Initiated Cell
Preneoplastic Lesion
MalignantTumor
ClinicalCancer
Metast.Disease
Initiation Promotion Conversion Progression
Support& Follow-up
Cancer Control as a Multi-Stage Process
Health Risk FactorBehaviors
Surveillance Follow-up Support
Prevention Early Detection Diagnosis & Treatment
TerminalCare
*Adapted from Shields PG, Harris CG. Principles of Carcinogenesis: Chemical. In: Devita VT, Hellman S, Rosenberg SA. Cancer Principles & Practice of Oncology. J.B. Lippencott Co. Philadelphia :1993.
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NCI’s Challenge: Close the Gap Between Discovery and Delivery
There is a critical disconnect between research discovery and program delivery and this disconnect is, in and of itself, a key determinant of the unequal burden of cancer in our society.
Barriers that prevent the benefits of research from reaching all populations, particularly those who bear the greatest disease burden, must be identified and removed.
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THE CANCER CONTROL CONTINUUM
Cancer Control Continuum
Prevention
Focus
• Tobacco Control• Diet• Physical Activity• Sun Exposure• Virus Exposure• Alcohol Use• Chemoprevention
Detection• Pap Test• Mammography• FOBT• Endoscopy• PSA Informed
Decision Making
Treatment• Health Services
and Outcomes Research
• Clinical Trials
Survivorship• Palliation• Coping• Health Promotion
Diagnosis• Informed
Decision Making
• Clinical Follow-up
• Imaging
Cross Cutting Issues
• Communications• Surveillance• Social Determinants and Health Disparities• Genetic Testing• Decision-Making• Evidence-Based Health Care• Quality of Cancer Care• Epidemiology
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Grant Awards by State - Fiscal Year 2005 Total Grants - $ in Thousands
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NCI Grants Awarded to the Institutions in the State of Indiana In (FY 05)
(n= 65, Total Dollars= $21 million)
DCCPS7 Grants (11%)
$1 million
DCB19 Grants (29%)
$5 million
DCP9 Grants (14%)
$4 million
DCTD21 Grants (32%)
$8 million
OD9 Grants (14%)
$3 million
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Cancer Centers by State (P30 Core Grants) Year 2005 All Types - All States
100.0%$21,004,10265Total
19.8%$4,162,42412Total for Other Nine Institutions
80.2%$16,841,67853Total for Two NCI-designated Cancer Centers
%Total Dollars
Total NCI Dollars
No. of Grants
Summary Distribution for NCI Grants for state of Indiana
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THE DISCOVERY-DELIVERY CONTINUUM
DiscoveryDiscovery DevelopmentDevelopment DeliveryDelivery
Public Public Health Health
PracticePractice
Primary Primary Care Care
PracticePractice
Disease Disease Specialty Specialty PracticePractice
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Reducing the cancer burden
Fundamental Research
Surveillance Research
Intervention Research
KnowledgeSynthesis
Application and Program Delivery
Dynamic Model of Cancer Research & Diffusion and Dissemination
Adapted from the Advisory Committee on Cancer Control, National Cancer Institute of Canada, 1994.
DisseminationDissemination
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Diffusion
… the passive process by which a growing body of information about an intervention, product, or technology is initially absorbed and acted upon by a small body of highly motivated recipients (Lomas, 1993).
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Publication
Bibliographic databases
Submission
Reviews, guidelines, textbook
Negative results
variable
0.3 year
6. 0 - 13.0 years50%
46%
18%
35%
0.6 year
0.5 year
9.3 years
Dickersin, 1987
Koren, 1989
Balas, 1995
Poynard, 1985
Kumar, 1992
Kumar, 1992
Poyer, 1982
Antman, 1992
Negative results
Lack of numbers
Expertopinion
Inconsistentindexing
It takes 17 years to turn 14 per cent of original researchIt takes 17 years to turn 14 per cent of original research to the benefit of patient careto the benefit of patient care
17:14
Original research
Acceptance
Implementation
E.A. Balas, 2000
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Dissemination
Active process through which target groups are made aware of, receive, accept and use information and other interventions.
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Translational Research vs. Research Translation
"Cutting-Edge" "State-Of-The-Art" "Resource-Limited"
Academic Cancer& Medical Centers
CCOPs & ACoSApproved CancerPrograms
Municipal & RuralHospitals & Clinics
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TRANSLATION
Evidence-basedKnowledge
“The transfer of evidenced-basedknowledge into routine
or representative practice”
ClinicalPractice
Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22:Disseminating Behavioral Medicine Research: Making the Translational Leap.
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What is Evidence…..?Surveillance DataSystematic Reviews of Multiple
Intervention Research StudiesAn Intervention Research StudyProgram EvaluationWord of Mouth/MarketingPersonal Experience
OBJECTIVE
SUBJECTIVE
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INTEGRATION
Explicit Evidence-Based Knowledge
InformedApplication
Tacit Clinicaland
Contextual Knowledge
“The informed combination of evidence-basedknowledge and local contextual knowledge
into community applications.”
Adapted from Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22:Disseminating Behavioral Medicine Research: Making the Translational Leap.
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TTranslating RResearch into IImproved OOutcomes (TRIOTRIO)
Use and communicate cancer and behavioral surveillance data to identify needs, track progress and motivate action.
Collaboratively develop tools for accessing, and promoting adoption of, evidence-based cancer control interventions.
Support regional and local partnerships to develop models for identifying infrastructure barriers, expanding capacity and integrating science into comprehensive cancer control planning and implementation.
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A Modest Proposal – More Focused Accrual & Reimbursement by Government?
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A Modest Proposal – More Focused Accrual (when case fatality & disparities are high)?
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What % of Diagnosed IN Patients on Protocol?
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Protocols within 100 miles for 46260
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Protocols within 100 miles for 46260
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What else can be done to reduce lung cancer deaths and to support CCC plan implementation?
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"Not everything that can be counted counts, and not everything that counts can be counted."
- Albert Einstein (1879-1955)
Source: Harvard Report on Cancer Prevention, Cancer Causes and Control, November/December, 1996
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What else do we need to know to motivate action?
“Cancer statistics are people with the tears wiped away.”
Why did Joanne die?
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Models for Systems Change
Circles of Influence/Circles of Impact
Source: M Peck ScD, UNMC
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“Joanne”
Joanne’s Family
Joanne’s Health Care Providers
Joanne’s Workplace
Transportation
Community Programs
ACS
Health Department
Local Officials & Policy Makers
State & National Policy Makers
Media
So Many Forces Influence Her Life …and Death
Source: M Peck ScD, UNMC
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“Joanne”
Joanne’s Family
Joanne’s Health Care Providers
Joanne’s Workplace
Transportation
Community Programs
ACS
Health Department
Local Officials & Policy Makers
State & National Policy Makers
Media
Circles of Influence
Source: M Peck ScD, UNMC
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Insert circles of influence slides here …n=6
“Joanne”
Joanne’s Family
Joanne’s Health Care Providers
Joanne’s Workplace
Transportation
Community Programs
ACS
Health Department
Local Officials & Policy Makers
State & National Policy Makers
Circles of Impact
Source: M Peck ScD, UNMC
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When “Joanne” dies…Circles of Influence, Circles of Impact
Source: M Peck ScD, UNMC
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Source: M Peck ScD, UNMC, adapted from J Richmond
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Tacit & ContextualKnowledge
From Experience
ExplicitExplicitKnowledgeKnowledge from from
Research EvidenceResearch Evidence
Integrating Science with Service: Do We Have the Right Stuff?
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“To him who devotes his life to science, nothing can give
more happiness than increasing the
number of discoveries, but his cup of joy is full when the results of his studies
immediately find practical applications.”
~Louis Pasteur
Our goal is to turn knowledge into applications that benefit people.