The Prostate Cancer Continuum

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The Prostate Cancer Continuum

• The Changing Face of Disparity Taking Health
  into Our Own Hands

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The real voyage of discovery consists not in
seeking new landscapes but in having new eyes.

• - Marcel Proust

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Pca is a Global Concern

• Highest incidence of male cancer in U.S. 2nd
  greatest cause of death declining overall but
  increasing in minority populations(2)
• 1 diagnosed cancer in Europe deaths have
  increased by 16 since 1995(1) despite
  widespread use of PSA testing...
• Sources (1) World Health Organization (2)
  American Cancer Society

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Why We Must Be Concerned

• 1 in every 6 men get Prostate Cancer
• 1 in every 4 Black men get Prostate Cancer
• Latinos have the 3rd highest incidence rate
• Blacks and Latinos are diagnosed at advanced
  disease stages at a 144 greater rate than whites
• The 5 year survival rate for Blacks and Latinos
  is worse than for whites and getting worse
• Black men die at a rate 240 higher than whites

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National Healthcare Quality Report - 2007

• Preventive healthcare lags significantly behind
  other gains in healthcare.
• Access to care and information varied widely
  between racial/ethnic groups and by
  socio-economic status
• Source www.ahrq.gov

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Healthcare Costs represent an increasing of
GDP- 650B more for Cancer Treatment
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U.S. - Worlds Best Medical Care? -
New York Times, 12 August 2007

• 37th in W.H.O. health system performance (France
  1, Italy 2)
• Last in overall quality lack of coordination of
  care/access for preventive and critically ill
• Only major industrialized country without
  universal health coverage
• Life expectancies near the bottom of other
  industrialized nations
• Worst Infant Mortality stats of any developed
  nation
• Sources Commonwealth Fund, Centers for Disease
  Control, W.H.O.

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Exacerbating the Problem

• Increasing employee cost burden
• Regulations on employers gt increasing costs gt
  decreasing competitiveness
• Insurance compensation standards
• Medicare reimbursement changes

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American Cancer Society Disparity Study - 2007

• Cancer patients with private insurance are much
  more likely to be diagnosed early, increasing
  their long-term survival
• Those uninsured patients or those with Government
  insurance are more likely to be diagnosed with
  advanced stage disease at first treatment

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Baby Boom Impact
Estimated Per Capita Health Expenditures by Age
and Sex, 1995
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Service Provider Impact

• Continuing nurse shortage
• Resistance to greater use of nurse practitioners
• Decline in doctors entering into Primary Care
  Medicine
• Resistance to Convenient Care clinics

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Population Impacts

• 12 million cancer survivors alive in the U.S.
  today
• 3 out of 4 American families will have a family
  member diagnosed with cancer
• 25 of American families living with cancer have
  children under the age of 18 living at home
• More than 28 of children in America will be
  living in poor households
• Sources American Cancer Society, Institute of
  Medicine, World Health Organization, The Policy
  Press

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Treatment Impact

• Skeletal impacts of ADT
• Cardiovascular issues related to hormone therapy
• Conflicting preventive therapeutic
  recommendations
• SELECT
• Finasteride
• PLCO Study
• Emerging technologies with minimal curative
  benefit
• Positive benefit of drug therapies
• Targeted disease management

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Lifestyle Impact

• Meat becoming more popular in diets globally
• 10.4 in the U.S.
• 25 more in Korea
• 49.7 in China
• gt2 in India
• Higher birth weights in emerging countries
• strong cancer association
• Sources Food Agriculture Organization of the
  United Nations, AICR

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Business of Medicine

• The System often has other issues
• Equipment investment
• Revenue production
• Pharmaceutical alliances
• Pay-for-Performance
• Patients MUST become their own advocates

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Complicating the Issue

• Women vs. Men
• Comparable incidence and mortality
• Research funds - 3X for breast cancer
• Public health staffing - inconsistent
• Government commitment - no agencies
• Media focus - inordinately female focus
• Men dont communicate

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Why Prostate Cancer Prevention?

• Significant public health risk
• 186,000 new cases and 29,000 deaths yearly (2008)
  
• Risk factors (age, race, genes) are not
  modifiable
• Benefit of screening on mortality is
  controversial
• Therapy is associated with morbidity
• That Leaves Prevention

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Phase III Chemoprevention Trials
RRR 22.5
RRR 23.5
PCPT
REDUCE
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5ARIs for Biochemical Recurrence
Andriole et al, Urology 45491, 1995
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PCPT and REDUCEWhat did we learn?

• Consistency of effect
• Similar magnitude of risk reduction across all
  risk groups
• No longer any grade issues
• Conclusion
• Use of 5-alpha reductase inhibitors is an
  effective primary prevention strategy

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Healthcare Disparity

• Disaffected classes
• racial/ethnic minorities
• high risk populations
• Socio-economic impact
• lack of/limited insurance
• breaking the social contract
• Equal Access
• education
• preventive mechanisms
• care

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• Moving the Bar Forward
• Success Stories and Templates for Change

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Technology for Change

• 71 of the people in North America are online
• 113 million Americans seek health information
  online
• Almost half of adult users and 84 of teens will
  be on social sites
• 40 of self-classified non-users became direct
  or indirect users after a cancer diagnosis
• Sources Internet World Stats, Pew Internet
  American Life Project

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Social Network Integration

• Credible peer-to-peer communications
• New Prostate Cancer Infolink
• Pints for Prostate
• Prostate Cancer Internet Alliance
• FaceBook

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Opciones de Tratamiento Investigación
Traslacional Toma de Decisión Informada Hormonas G
leason 7 Una Nueva Categoría de
Riesgo? Diagnósticos Terapia Citotóxica Está
considerando un Ensayo Clínico? Quimioterapia Medi
cina Alternativa / Complementaria Espera
Alerta Terapias de Ataque Soluciones
Quirúrgicas Manejo de Efectos Colaterales Solucion
es Oncológicas de la Radiación Cuidado
Paliativo Manejo del Dolor Fuentes de
Información Servicios de asistencia pacientes
Este sitio se ha producido con la ayuda de la
familia de Roberto "Tito" Warat y una concesión
educativa de la oncología de Sanofi-Aventis
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Reinforcing the Message

• In The Know newsletter
• Hard Copy - 29M circulation
• Online supplement - gt 100M
• Broad spectrum content
• Audience diversification
• consumers/patients
• advocates
• professionals
• researchers
• international

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Media Syndication

• Mass impressions
• Minimal cost
• Increase reach

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PodCasting for Health

• Reinforce the print message
• Portability for consumers
• Viability for diverse situations
• personal
• public health
• clinical
• research

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Cell Casting for Health

• Enhanced consumer interactivity
• Opt-in network
• 1.877.2CHECKNOW
• Customized content
• Applications for
• clinicians
• researchers
• public health

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Going to the Barbershop Empowering Communities
Through Risk Communication
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Barbershop based Health Awareness Initiative

• Project BHAI (Brother)
• 48 shops in Jharkhand and Orissa Provinces -
  India
• cancer prevention and tobacco control
• enhance knowledge
• enhance healthy behavior
• create a sustainable environment
• build on existing networks and partnerships
• expand to co-morbid disease

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Research Partnerships
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Creating a New Network
The Prostate Net

• Core Distribution
• 80,000 Website visits/month
• 1,200 Patient Support Group Leaders
• 1,000 Public Health Workers
• 6,000 Medical Oncologists
• gt 4,000 Urological Specialists
• gt 2,000 Cancer Researchers

American/National Medical Assns. gt 5,000 Doctors
Sponsors
National Assn. of Barber Boards of America
200,000 Barbers
Participating Medical/Research Centers gt 300
Community
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Create Heroes

• Meet James
• He came to a Health Fair
• On HIS BIRTHDAY!!
• To give himself The Gift of Life!!

• Warren brought his son to a Pca screening
• To educate him about being responsible for his
  health

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Why is all this needed?! To Eliminate the
Suffering and Death from Cancer
If Youre Not the Lead Dog, the View Never
Changes - Mike Ditka
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Thank You!
WWW.THEPROSTATENET.ORG 1.888.477.6763