Winnable Battles: Cancer in Colorado. Joni Reynolds, RN-CNS, MSN Director of Public Health Programs

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1 Winnable Battles: Cancer in Colorado Joni Reynolds, RN-CNS, MSN Director of Public Health Programs

2 Challenging Disparities Freedom Sculpture by Zenos Frudakis

3 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

4 80 Breast, Cervix, CRC % Detected Early by Poverty Level High Low Breast Cervix CRC Early Detection is percent in situ + localized of staged cases (unknowns excluded) Source: Colorado Central Cancer Registry, CDPHE, September 2013

5 Opportunities for Change Freedom Sculpture by Zenos Frudakis

6 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

7 Baseline Screening Assessment Infrastructure & Resource Review EHR Updates Office Policy & Work Flow Staff Training Development

8 Taking the Leap Freedom Sculpture by Zenos Frudakis

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13 Cancer and Prevention Guidelines Ned Calonge, MD, MPH

14 The ACA and the US Preventive Services Task Force

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16 Lifetime impact of mammography for 1000 women at 40 years of age

17 Lifetime impact of mammography for 1000 women at 40 years of age Women who will die from breast cancer with no screening

18 Lifetime impact of mammography for 1000 women at 40 years of age Women who will not die from breast cancer because of screening

19 Lifetime impact of mammography for 1000 women at 40 years of age Women who will have a false positive mammogram requiring additional procedures

20 Breast cancer screening in Colorado Women age 50 and older with a mammogram in the past 2 years 63% 2009 incidence of breast cancer deaths from breast cancer 585

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22 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

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24 Colorectal cancer screening in Colorado Adults age 50 and older with visualization (ever) 67% 2009 incidence of colon cancer deaths from colon cancer 633

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26 Lung cancer in Colorado Estimated number of smokers 676, incidence of lung cancer deaths from lung cancer 1590 Potential lives saved with screening 310 Potential lives saved with no smoking 1431

27 ACA and USPSTF recommendations Should there be a direct link between evidence of net benefit and coverage?

28 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

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31 2-10 years Grant Submitted Grant Awarded Develop & Pilot Test Recruit & Randomize Follow-ups Analyze & Publish Replications, Reviews & Adoption Adapted from Bill Riley, NCI

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33 SHOW ME THE EVIDENCE!

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35 Fail quickly and often; think MINC Disseminate across platforms Implement in rapid learning health systems

36 Michael Sanchez

37 Patient Navigators Improve Health Outcomes Elizabeth Whitley, PhD, RN October 2013

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41 Denver Health Patient Navigators

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45 Patient Navigation Elizabeth Whitley, Ph.D., RN Patient Navigator Training Collaborative

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47 18 Million Cancer Survivors Projected in 2022 Yrs since dx

48 Cancer Care Continuum

49 A Coordinated Cancer Care Team and family caregivers

50 Ideal survivorship care Courage Heart Brains Supportive Oncology Care Team