joni reynolds, rn-cns, msn director of public health programs

Joni Reynolds, RN-CNS, MSNDirector of Public Health Programs

Winnable Battles: Cancer in Colorado

Freedom Sculpture by Zenos Frudakis

Challenging

Disparities

CRC 5 Year Cause Specific Survival Rates49% :: High Poverty

Area57% :: Medium Poverty Area63% :: 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 CRC0

10

20

30

40

50

60

70

80

Breast, Cervix, CRC % Detected Early by Poverty Level

HighLow

“Early” Detection is percent in situ + localized of staged cases (unknowns excluded)Source: Colorado Central Cancer Registry, CDPHE, September 2013

Opportunities

Freedom Sculpture by Zenos Frudakis

for Change

Already over 900,000 Coloradans access the

roughly 250 community clinics in the state

An estimated 478,000 Coloradans will now be eligible for Medicaid

Baseline Screening Assessment

Infrastructure & Resource Review

EHR Updates

Office Policy & Work Flow Development

Staff Training

Taking the

LeapFreedom 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

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

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 years79%

• Annual incidence of cervical cancer149

• Annual deaths from cervical cancer 39

Colorectal cancer screening in Colorado

• Adults age 50 and older with visualization (ever) 67%

• 2009 incidence of colon cancer1705

• 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?

National Cancer InstituteU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of Health

eHealth for Behavioral Science: LEARNING AT THE SPEED OF TECHNOLOGY

Michael Sanchez, MPH, CHESUniversity of Colorado Cancer Center, October 2, 2013

Aurora, CO

2-10 years

Grant Submitted

Grant Awarded

Develop & Pilot

Test

Recruit & Randomize

Follow-ups Analyze &

Publish

Replications, Reviews & Adoption

Adapted from Bill Riley, NCI

2005 2006 2007 2008 2009 2010 2011 2012

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 sanchezgarciama@mail.nih.gov

Patient Navigators Improve Health Outcomes

Elizabeth Whitley, PhD, RNOctober 2013

Denver Health Patient Navigators

Patient Navigation

Elizabeth Whitley, Ph.D., RNPatient Navigator Training Collaborative

www.patientnavigatortraining.org

18 Million Cancer SurvivorsProjected in 2022

Yrs since dx

Cancer Care Continuum

A Coordinated Cancer Care Team

and family caregivers

Ideal survivorship care

Supportive Oncology Care Team

Courage

Heart

Brains