Winnable Battles:
Cancer in Colorado
Joni Reynolds, RN-CNS, MSN
Director of Public Health Programs
Challenging
Disparities
Freedom Sculpture by Zenos Frudakis
CRC 5 Year Cause
Specific Survival Rates
49% :: High Poverty Area
57% :: Medium Poverty Area
63% :: Low Poverty Area
Source: Colorado Central Cancer Registry, September 2013
% of the population living in poverty :: less than 10% is low, 10% to less than 20% is medium, 20% or greater is high
Breast, Cervix, CRC
% Detected Early by Poverty Level
80
70
60
50
40
High
Low
30
20
10
0
Breast
Cervix
“Early” Detection is percent in situ + localized of staged cases (unknowns excluded)
Source: Colorado Central Cancer Registry, CDPHE, September 2013
CRC
Opportunities
for
Change
Freedom Sculpture by Zenos Frudakis
An estimated 478,000
Coloradans will now be eligible for
Medicaid
Already over 900,000
Coloradans access the roughly
250 community clinics in the state
Baseline Screening Assessment
Infrastructure & Resource
Review
EHR
Updates
Office Policy &
Work Flow
Development
Staff Training
Taking
the
Leap
Freedom Sculpture by Zenos Frudakis
Cancer and Prevention
Guidelines
Ned Calonge, MD, MPH
The ACA and the US Preventive
Services Task Force
Lifetime impact of mammography for
1000 women at 40 years of age
Lifetime impact of mammography for
1000 women at 40 years of age
Women who will die from breast cancer with no screening
Lifetime impact of mammography for
1000 women at 40 years of age
Women who will not die from breast cancer because of screening
Lifetime impact of mammography for
1000 women at 40 years of age
Women who will have a false positive mammogram requiring additional procedures
Breast cancer screening in Colorado
• Women age 50 and older with a mammogram
in the past 2 years
63%
• 2009 incidence of breast cancer
3465
• 2012 deaths from breast cancer
585
Cervical cancer screening in Colorado
• Women having a PAP test in the past 3 years
79%
• Annual incidence of cervical cancer
149
• Annual deaths from cervical cancer
39
Colorectal cancer screening in Colorado
• Adults age 50 and older with visualization (ever)
67%
• 2009 incidence of colon cancer
1705
• 2012 deaths from colon cancer
633
Lung cancer in Colorado
• Estimated number of smokers
676,000
• 2009 incidence of lung cancer
2292
• 2012 deaths from lung cancer
1590
• Potential lives saved with screening
310
• Potential lives saved with no smoking
1431
ACA and USPSTF recommendations
• Should there be a direct link between
evidence of net benefit and coverage?
eHealth for Behavioral Science:
National Cancer Institute
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
LEARNING AT THE SPEED OF TECHNOLOGY
Michael Sanchez, MPH, CHES
University of Colorado Cancer Center, October 2, 2013
Aurora, CO
2-10 years
2005
Grant
Submitted
2006
2007
Grant
Awarded
Develop
& Pilot
Test
2008
2009
Recruit &
Randomize
2010
2011
Follow-ups
2012
Analyze
&
Publish
Replications,
Reviews &
Adoption
Adapted from Bill Riley, NCI
SHOW ME THE
EVIDENCE!
http://www.wired.com/wired/issue/16-07
Fail quickly and often; think MINC
Disseminate across platforms
Implement in rapid learning
health systems
Michael Sanchez
[email protected]
Patient Navigators Improve
Health Outcomes
Elizabeth Whitley, PhD, RN
October 2013
Denver Health Patient Navigators
Patient Navigation
Elizabeth Whitley, Ph.D., RN
Patient Navigator Training Collaborative
www.patientnavigatortraining.org
18 Million Cancer Survivors
Projected in 2022
Yrs since dx
Cancer Care Continuum
A Coordinated Cancer Care Team
and family caregivers
Ideal survivorship care
Courage
Heart
Brains
Supportive Oncology Care
Team
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