Cancer Prevention Programs in the Workplace: The Next Corporate Standard

Business of Aging Conference: Innovation Vignette

Toronto, April 30, 2011Dr. Alain Sotto, Hon B.Sc., MD, CCFP(E.M.), F.C.B.O.M.

Chief Physician of Ontario Power Generation (OPG)

and

Occupational Medical Consultant for Toronto Transit Commission (TTC) alain.sotto@opg.com / alain.sotto@ttc.ca

OBJECTIVES

• Review Canadian Cancer stats and costs

• Why implement cancer screening in the workplace?

• Are there any corporate cancer standards?

• Summary of OPG & TTC Colon Cancer screening program

• Sample of Colon Cancer workplace presentation

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Cancer in Canada for 2011

• Cancer surpassed Heart Disease as leading cause of death after 2007

• 4 most common cancers: Lung, Prostate, Breast, Colorectal account for over 50% of All cancers

• In 2011:est. 177,800 new cases: 75,000 deaths in Canada

• On average 487 diagnosed & 205 will die every DAY with cancer

• Over 1 in 3 will get cancer & Over 1 in 4 Canadians will die from it

• Cancer is still the biggest concern and yet only 41% of Canadians surveyed have gone for screening within the past year*

• 36% of Canadians also report never having been tested for cancer*

See cancer.ca *Sanofi-Aventis Healthcare Survey 2011

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Cancer Matters to Canadian Workplaces!!!!

• Cancer: 3rd highest cause of LTD & has longest duration of STD claims

• Expensive: lost productivity, disability, benefit costs & Newer drugs $$$$

• Cost of Biologics per patient per year: $1,000 – $70,000 !

• E.G. Avastin, Tarceva, Gleevac, Sutent, Tykerb etc..

• Canada ranks 13 out of 14 western countries for new Cancer treatments

• Ontario spends 46% of total budget on health care !!!

• Studies show 60 - 80% of cancer patients want to eventually RTW

• Estimated impact of cancer in Canada for next 30 years(2004 - 2033)1

– $543 B wage-based productivity costs to Canadian economy.

– $199 B reduction in corporate profits. 1- Risk Analytica - Life at Cancer Risk (2004 – 2033)

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Cancer Really Does Matter to Canadian Workplaces !!!

• 78% of Canadian employees surveyed in 2008 identified CANCER as their biggest health risk; however, few know how to prevent it.2

– Just 45% identified smoking cessation; 38% named diet; 28% said exercise.

– Cancer screening clinics @ work + Concern for Cancer was rated 1st out of the 5 conditions @ 8.4/ 10!!

{Cancer(8.4), Heart disease(8), DM(7.3), Mental Illness (6.7),Obesity (6)}

• 90% of Canadians believe their employer has a role to play in cancer prevention. 2

• With simple lifestyle- changes over 40 % of cancers could prevented!!!!

2 – Sanofi Aventis Healthcare Survey (2008)

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Why do Cancer Control Strategies in the Workplace??

• Workplace programs are ideal for 17 million working Canadians• Reduce mortality, morbidity (via Primary and Secondary prevention)• Enhances morale, loyalty, employee Engagement + employer image

( i.e. OPG--Top 100 in Canada / TTC--Top 75 in GTA).

• There is no integrated national worksite strategy for cancer control.

• Cancer agencies + other public health programs promote prevention and screening, but don’t target workplaces ??

• There are no workplace standards for cancer prevention / management.

• No incentives / recognition for companies that ‘get it right’. ISO’s, ACE

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Case Studies: Colon Cancer Screening Program at OPG &TTC

• Colon cancer is the number 2 cancer killer in Canada

• It is also 90 - 95% preventable!!

• I Approached Sr. HR Directors & Executives of why we need to do this. (Done within HR: OPG Wellness & TTC Occupational Health dept.)

• Basically:...ROI = 1.” if we can save one life- then it is the right thing to do”

• Wellness Goal: 4 E’s—Educate + Empower + Engage + Enable employees with Knowledge Transfer on Colon Cancer Screening

• Communication campaign - face to face presentations, posters, email messages, internal newsletters, brochures, video etc..

• Engaged Union support & Executive advocacy roles—key!

• Facilitate and improve access to Colonoscopy screening clinics

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Colon Cancer Screening Program--TTC

• Sr. HR Director, champion-- engaged Executive leadership team( top 6)

• TTC Union President and EVP asked to sign letter of endorsement for program

• Managers requested multiple face to face presentations to employees by Dr. Sotto - including shift workers

• Communication: TTC Colon Cancer Screening brochure & Referral forms attached to pay stubs & Coupler (internal) newsletter articles:

• Managers volunteered to be advocates/ ambassadors encouraging their staff to get screened via personal testimonials etc..

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Colon Cancer Screening Program--TTC

• TTC Management were surprised by employee interest and uptake

• Partnered with Colonoscopy clinics like Sunnybrook-WCH, North York Endoscopy & others Clinics

• Colon cancer program was open to spouses and family members

• Colonoscopy Referral forms sent with brochure and given at Dr. Sotto’s presentations & on TTC intranet website

• TTC Colon Cancer Awareness DVD + Forms were sent to 13,000 – March 2010

• Educational materials given in partnership with Colorectal Cancer Association of Canada (www.colorectal-cancer.ca): Barry Stein

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Colon Cancer Screening Program--OPG

• V.P. with colon cancer presented his story & I presented the medical

• Communication strategy: 12,000 email messages with brief 3-5 minute video on importance of colon cancer screening, Newsletter, Wellness intranet, Face to face presentations, Video with Darryl Sittler- advocate

• Very successful program!!!

• Brief videos sent to ALL employees by email with message on Breast, Prostate, Colon cancers

• Able to see how ees’ many watched video i.e.. over 5000 hits in 3-4 weeks for each video

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Colorectal Cancer 2011 -- The Number 2 Cancer Killer!

• 22, 200 Canadians Diagnosed: 12,500 Men + 9,700 Women

• 9,100 Canadians will die of it: 5,000 Men + 4,100 Women

• Accounts for 12% of all new cancer cases and 12 % of all cancer deaths

• 61 Diagnosed every Day!!

• 24 will Die every Day!!

• Life-Time Risk of Developing Colorectal Cancer (CRC)• Men: 1/13 (7.7%)

• Women: 1/16 ( 6.25%)

• 1/ 28 for M & 1/ 32 F will Die*Canadian Cancer Society, 2011

• 5- year Survival is 63% M & 64% F

Audrey Hepburn(1929-1993)

Happy 50th Birthday !!!!!!!!!!

WomenWomen

MammogramMammogram

Breast Breast ExamExam

PAPPAP

FOBTFOBT

ColonoscopColonoscopyy

MenMen

PSA + DREPSA + DRE

FOBTFOBT

ColonoscopyColonoscopy

0020-2420-2430-3430-34

AgeAge 40-4440-4450-5450-5460-6460-6470-7470-7480-8480-84

100100

200200

300300

400400

500500

Rate

per

10

0,0

00

Rate

per

10

0,0

00

New Cases of Colorectal Cancer

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What are the symptoms of Colon Cancer ?• Most often, NONE!!

It is silent but deadly!!

• Usual symptoms:• Rectal bleeding• Anemia • Abdominal discomfort• Change in bowel habit• Unexplained Wt. loss

You are at Average Risk, if > 50 and healthy!

and You are at High Risk if Age >40: AND

• If Family history of Polyps / Colon, Uterine, Ovarian, or Inherited Breast Cancers

• If has Ulcerative or Crohn’s colitis

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• 95% colon cancers develop from Adenomatous polyps, which grow slowly, usually over a period of 10-15 years!!.

• 2/3 of polyps are Adenomas which are pre-cancerous & • 1/3 are Hyperplastic (i.e. Low risk for Cancer)• Screening tests play a key role in detecting and removing polyps

before they become cancerous• Diagnosis of Early stage colorectal cancer--- improves your 5 yr-

survival to 90 %

ColonCancer

Workplace Screening is Ideal: Now That’s Prevention!!!!

• Doing the screening test when:

Everything works well & Feeling fine!!No complicating problems!!Employees are usually at Work—so can prevent disability & reduce costs!

SCREENING SAVES LIVES!!

Polyp in the Colon

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How Common Are Polyps?

Age (yr)Age (yr)5050 6060 7070 8080

1010%%

30%30%

50%50%

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COLONOSCOPY

• For Average risk > 50 years old:1st FOBT and then Colonoscopy if blood (MOH)

• If High risk : age > 40 or 10 years earlier than the age of 1st degree relative’s Dx of Colon cancer-whichever is first!

• Checks for polyps + any abnormalities of ENTIRE large bowel/ colon

• Invasive; under mild sedation

• Needs bowel prep –KLEEN-PREP/ PICO-SALX

• “Gold standard” for finding Colon Cancer and Polyps

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Katie Couric Effect: 20% increase in Colonoscopy rate

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Sunnybrook & Women’s College Health Sciences CentreIn Partnership with TTC

Physician Referral FormFor Colon Cancer Screening Program

Patient last name: Patient first name: D.O.B:

Address: City: Postal Code:

Home Phone: Work Phone: Cell Phone: Health Card Number:

Referring Physician: Referring Physician #:

Reason for Referral:□ Screening Colonoscopy: If your patient is 50 years old or older and has no bowel symptoms. (This requires a screening colonoscopy as per the

Canadian Association of Gastroenterology).Relevant Past Medical History:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Medications:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Physician Name:________________________________Physician’s Signature:___________________________Date: __________________________________________Stamp:

Colon Cancer and Wine: Red or White?

Does drinking red wine reduce your risk of Colon Cancer?

• >3 g/ week of red wine reduced the incidence of colon cancer by 67%!!!!!!

• Colon Cancer Rates: 9.9% Abstainers;8.8% White wine;3.4% Red wine

• Red wine has the more Resveratrol

Colon Cancer : Fish & Calcium/ Vit. D

A: Does eating fish 5X’s / week reduce your risk of Colon Cancer?(Harvard PH)

• Men who ate fish >5 X’s / week reduced risk of Colon Cancer by 40%!

B:Does Calcium and Vit D reduce the risk of Colon CA?

• >800 mg of Calcium /day reduced it by 26- 46%

• Vit D 1000 IU per day

SUMMARY: Key Points and ACTIONS for ALL!• Cancer affects All employers: STD/ LTD, Drugs & Benefits, etc.

• CDN. employees believe their employer has role in prevention- 90%

• Prevention programs are well received in workplace & at low cost!

• Cancer screening advocates very helpful! e.g. Darryl Sittler

• Check: www.yourdiseaserisk.wustl.edu – Online Cancer assessment tool

• Need executive endorsement for workplace programs

• Need corporate cancer Tool-kits for Managers

• Need a Corporate Cancer Prevention Standard: www.controlcancer.ca

• Check Ontario site: www.coloncancercheck.ca

• Check CCAC: www.colorectal-cancer.ca

• Watch my Colon cancer DVD: Just do it!!!!!!!!!!!!!!!!!!!!!!!

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