Comprehensive Cancer Control: Can We Practice What We Preach?

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Comprehensive Cancer Control Can We Practice
What We Preach?

• Jon F. Kerner, Ph.D.
• Division of Cancer Control and Populations
  Sciences

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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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NCIs Challenge Health Disparities Present
Scientific, Moral and Ethical Dilemmas

• Profound advances in biomedical science have
  occurred over the last several decades, which for
  many Americans, have contributed to increased
  longevity and improved quality of life.
• Despite this progress, a heavier burden of
  disease is borne by some population groups in
  the United States, particularly the poor and
  underserved.
• The unequal burden of disease in our society is a
  challenge to science as well as a moral and
  ethical dilemma for our nation.

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Executive Summary
Chapter 3 Cancer Disparities   Goal Reduce
cancer health disparities in Maryland.
Target for Change   By 2008, develop a system to
monitor and document cancer disparities in
Maryland.
Objective 1 Increase public and community
awareness about cancer health disparities and
cancer prevention, screening, and treatment in
Maryland.
Objective 2 Develop and implement health care
programs designed to reduce cancer disparities
among targeted populations in Maryland.
Objective 3 Increase cancer disparities
documentation and intervention on a systematic
basis in Maryland.
Objective 4 Increase provider education and
reimbursement aimed at reducing cancer
disparities
Objective 5 Improve access to, and utilization
of, cancer screening and treatment options for
underserved populations.
Objective 6 Improve the quality of cancer care
received by racial/ethnic minorities.
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NCI Map of Grants by State FY 2002
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6/21 (28.6) grants and 26.6 of grant funds
focus on health disparities research
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Executive Summary
Chapter 5 Tobacco-Use Prevention and Cessation
Lung Cancer   Goal Substantially reduce tobacco
use by Maryland adults and youth.
Targets for Change By 2008, reduce lung
cancer mortality to a rate of no more than 57.3
per 100,000 persons in Maryland. Maryland
Baseline 59.5 per 100,000 in 2000 (age-adjusted
to the 2000 U.S. standard population). Source
Maryland Division of Health Statistics By 2008,
reduce the proportion of Maryland middle school
youth that currently smoke cigarettes to no more
than 6.2. Maryland Baseline 7.3. Source
Maryland Youth Tobacco Survey (2000) By 2008,
reduce the proportion of Maryland high school
youth that currently smoke cigarettes to no more
than 20.3. Maryland Baseline 23.7. Source
Maryland Youth Tobacco Survey (2000) By 2008,
reduce the proportion of Maryland adults that
currently smoke cigarettes to no more than 15 .
Maryland Baseline 17.5. Source Maryland Adult
Tobacco Survey (2000) By 2008, increase the
proportion of Maryland adults that would support
a proposal to make all restaurants in their
community smokefree to 72.1. Maryland Baseline
63.0. Source Maryland Adult Tobacco Survey
(2000)
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CDC Office of Smoking Health State Highlights
2002 report Maryland
38.08 per capita in, 6.04 per capita out.
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NCIs Challenge Close the Gap Between Discovery
and Delivery

• There is also 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 DISCOVERY-DELIVERY CONTINUUM
Development
Delivery
Discovery
How do we model Interagency partnership across
the continuum?
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Bench to Bedside
1 NCI-designated Cancer Center 0
CCOPs 35 ACoS
Bench to Trench
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Dynamic Model of Cancer Research Diffusion and
Dissemination
Intervention Research
Surveillance Research
Fundamental Research
Knowledge Synthesis
Application and Program Delivery
Reducing the cancer burden
Adapted from the Advisory Committee on Cancer
Control, National Cancer Institute of Canada,
1994.
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Original research
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variable
Negative results
Dickersin, 1987
Submission
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0.5 year
Kumar, 1992
Koren, 1989
Acceptance
Negative results
0.6 year
Kumar, 1992
Publication
Expert opinion
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0.3 year
Poyer, 1982
Balas, 1995
Lack of numbers
Bibliographic databases
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6. 0 - 13.0 years
Antman, 1992
Poynard, 1985
Reviews, guidelines, textbook
9.3 years
Inconsistent indexing
Implementation
E.A. Balas, 2000
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Translating Research into Improved Outcomes (TRIO)

• 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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http//cancercontrol.cancer.gov/d4d/
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cancercontrolplanet.cancer.gov
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Working Together To Make the WholeGreater Than
the Sum of Its Parts
How about Maryland?
National Partnership Model in Comprehensive
Cancer Control
Dissem. Diffusion
R D
Synthesis
Direct Service
Dissem. Diffusion
Synthesis
RD
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Research-Practice Partnerships?
Getting a new idea adopted, even when it has
obvious advantages, is often very difficult. --
Everett Rogers, Diffusion of Innovations
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P30/P50 Review Committee Report Recommendation 2

• Make better use of centers as entrepreneurial
  resources for planning, innovation and
  dissemination

2.2 Use existing resources of centers as
cost-effective sites for piloting new research
and dissemination programs
2.6 Provide support via P30 to centers making
links with state agencies, health departments,
CDC, etc. 2.7 Modify the P30 award to encourage
novel methods and infrastructure for
disseminating new knowledge in early detection,
prevention, cancer control and clinical research
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Observations about Centers Interest in
Dissemination and Diffusion

• Few cancer centers articulate a specific interest
  in dissemination based on information from Web
  sites.
• There are few population sciences shared
  resources and none are specifically focused on D
  and D.
• There are few people already within cancer
  centers with the skill set needed to develop the
  D and D area.
• If it is an unfunded mandate, D and D will not
  occur on the appropriate scale.

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Potential Partners for All Cancer Centers and
Academic Medical Centers in Comprehensive Cancer
Control

• Schools of public health
• Schools of allied health professionals
• Schools of communication
• Business schools
• Health departments
• Voluntary health organizations
• Private sector, e.g. advertising agencies

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Application of DD Models in Cancer Centers

• Create Knowledge Transfer TeamsProvide support
  for people whose role is to assess the
  appropriateness of discoveries in different areas
  for dissemination (perhaps as part of a
  Dissemination Core).
• New Associate Director position?

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Application of DD Models in Cancer Centers

• Knowledge Synthesis ModelEncourage cancer
  centers to seek training opportunities for people
  in knowledge synthesis (KS), actively encourage
  more KS prior to grant funding as part of grant
  evaluation, more aggressively promote existing
  knowledge syntheses to cancer centers.
• Discourage cancer center PR departments to
  promote the study finding du jour?

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Our goal is to turn knowledge into applications
that benefit people.
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