Local Implementation of Cancer Control Efforts in Essex County

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Local Implementation of Cancer Control Efforts in
Essex County

• Livingston League of Women Voters
• Livingston Senior/Community Center
• Wednesday, February 15, 2006

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Stanley H. Weiss, MD ProfessorUMDNJ-New Jersey
Medical School and UMDNJ-School of Public Health
Azadeh Tasslimi Punam Parikh, MPH Essex County
Cancer Coalition Co-Coordinators Tel
973-972-4623 Email tassliaz_at_umdnj.edu,
parikhp1_at_umdnj.edu
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Overview

• 1) Background and Identifying Needs
• 2) Implementation of the New Jersey Comprehensive
  Cancer Control Plan
• 3) Capacity and Needs Assessment
• 4) Local Implementation in Essex County
• 5) Questions

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Background

• Executive Order 114
• OCCP and the Governors Task Force
• established

1st New Jersey Comprehensive Cancer Control
Plan released
1st Status Report to the Governor
submitted (required biennially)
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NJ-CCCP Organizational Structure
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Background

• Cancer ranked as the top health issue facing NJ
  residents in a State Health Issues Opinion
  Survey (1999).
• Yet no comprehensive capacity and needs
  assessment had ever been conducted in NJ
• No inventory of cancer-related resources
  available on a statewide basis

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Background

• Began with 350 volunteers from various
  disciplines
• Currently over 550 volunteers
• These volunteers are stakeholders representing
  clinicians, public health officials, survivors
  and their families, community-based
  organizations, advocates, administrators,
  insurers, researchers

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Governors Task Force Evaluation Committee

• Serves to provide scientific oversight and
  expertise
• Oversaw Cancer Capacity and Needs Assessment in
  all 21 counties
• Submitted the first biennial Status Report to the
  Governor
• Reviewed status of cancer burden and cancer
  control efforts
• Proposed data-driven recommendations

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Identifying Needs

• 1) Data and Data Systems
• Baseline capacity and needs assessment
• To understand cancer burden and disparities in
  each county and statewide
• To compare data from one county to each other and
  to the state as a whole
• To understand current cancer-related services,
  resources, and gaps in New Jersey

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Identifying Needs

• 2) Involve partners who have relevant expertise
• Data and scientific expertise
• State Cancer Registry
• State BRFSS Epidemiologist-Coordinator
• NCIs Regional Cancer Information Service
• Public health, epidemiology, and statistical
  experts
• Industry and academia
• Workgroups and their Chairs
• Health services and planning
• NJCEED Program
• Cultural competency experts
• Local health planners

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Implementation of NJ-CCCP

• Multiple groups involved
• Ten Workgroups
• Local NJCEED programs and county cancer
  coalitions
• Each group identifies areas of focus and
  strategies to address
• Synergy among Workgroups and local cancer
  coalitions and other organizations encouraged

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Capacity and Needs Assessment (C/NA)

• Baseline Capacity and Needs Assessment (C/NA) in
  each county was one of the first implementation
  steps of the NJ-CCCP
• Major components required for all reports
• Demographics and local infrastructure (e.g.,
  transportation)
• Resources (e.g., health care facilities, schools,
  community-based organizations, etc.)
• Cancer statistics
• Recommendations that integrate the first three
  components

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Capacity and Needs Assessment (C/NA)

• Data Analyzed
• Demographics and health status indicators
• Cancer incidence and stage at diagnosis
• Cancer mortality
• Healthy New Jersey 2010 objectives
• Staging of cancer
• Prevalence
• Estimates of medically underserved populations

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Capacity Needs Assessment

• Local health planners - County Evaluators (CEs)
• Already involved in local community
• Experience with health services and planning
• Responsible for conducting the C/NA and
  formulating recommendations for action for
  implementation at the county and state level

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CANCER CONTROL IN ESSEX COUNTY
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Essex County Cancer Coalition (ECCC) Priorities

• Findings from the C/NA serve as the empirical
  basis for prioritizing local cancer control
  efforts
• County demographic profile was created
• Cancer issues not historically recognized as
  priorities in Essex emerged from the C/NA process

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Composition of Essex County, 2000(source U.S.
Census 2000)

• 56 Minority population in Essex vs. only 27 in
  New Jersey
• 1/3 of States total Black population lives in
  Essex

• Substantial Hispanic/Latino population - 16 of
  Essex vs.13 of NJ
• Other special populations (race, ethnicity, or
  language)
• exceeding 3 of county include
• Asians (29,429)
• French- /French-Creole-speaking (24,874 incl.
  Haitians)
• Portuguese (23,744)
• Spanish-speaking, comprise 1/2 of
  linguistically isolated households

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C/NA Findings Essex County

• Among WOMEN
• Rates in Essex were over 10 higher than NJ for
• Breast ca mortality
• Cervical ca incidence
• Cervical ca mortality
• Oral ca mortality

• Among MEN
• Rates in Essex were over 10 higher than NJ for
• Oral ca incidence
• Oral ca mortality
• Prostate ca incidence
• Prostate ca mortality

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C/NA Findings Essex County

• Essex County had the highest cancer
• mortality rates of any county in NJ for
• Cervical
• Oral
• Prostate
• Oral and prostate cancers emerged as new
  priorities
• Cervical cancer screening treatment remains a
  priority, as it is preventable and highly
  treatable. High cervical cancer mortality rates
  indicate a need for increased education and
  detection.

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Local ImplementationEssex County

• Essex County Cancer Coalition (ECCC)One of 21
  county cancer coalitions in NJ
• GOALS
• Implement the NJ Comprehensive Cancer Control
  Plan (NJ-CCCP) (www.state.nj.us/health/ccp/ccc_pla
  n.htm)
• Prioritize cancer control efforts at the local
  level

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Background

• Essex County Cancer Coalition
• Addresses all 7 cancers the NJ-CCCP identified as
  priorities
• Breast, cervical, colorectal, lung, melanoma,
  oral prostate
• County-wide focus, but dichotomous issues
• 4 contiguous inner-city municipalities with high
  proportions of medically underserved
• Newark, Orange, East Orange, Irvington
• Suburban areas with significant elderly population

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Inner-City

• Cancers of Focus
• Cervical
• Prostate
• Oral
• Disparities among Racial Ethnic Minorities
• Access to care, lack of insurance, language
  barriers
• Low Clinical Trial Participation - Views on
  medical research

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Suburban

• Cancers of focus
• Lung
• Colorectal
• Breast
• Prostate
• Under-screened for many cancers relative to risk
• Breast Cancer - Mammograms Medicare coverage
• Cervical Cancer - Pap Tests
• Low Clinical Trial Participation - Lack of
  available clinical trial protocols (toxicity,
  comorbidities)

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ECCC Organizational Structure
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Mission Statement

• Increase cancer awareness reduce its impact on
  Essex residents through improved screening,
  access to treatment follow-up
• Promote awareness of and participation in cancer
  clinical trials
• Support investigations that seek to find the
  causes of cancers, improve care, reduce health
  disparities, or increase access
• Increase collaboration communication among all
  stakeholders to maximize utilization/identificatio
  n of resources
• Examine and prioritize an expansion of cancer
  control efforts county-wide

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ECCC is implementing the following NJ-CCCP Goals

• Promote collaboration with traditional and
  non-traditional partners to improve communication
  about access and resources for cancer education,
  detection, and prevention services, including
  research studies. NJ-CCCP strategy AC-2.1.6
• Disseminate information on cancer control
  efforts and services throughout Essex County.
  NJ-CCCP strategy AC-2.1.7
• Educate the public regarding the purpose and
  importance of participating in clinical trials
  for cancer, with special emphasis on addressing
  the concerns of minority populations. NJ-CCCP
  Objective AC-4.1.7 (other cancer-related
  BR-2.2.1, BR-5.1,CO-3.1).
• Identify strategies to increase cancer service
  access and resources for all populations through
  public education.
• NJ-CCCP Objective AC-4.1

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Diverse Membership

• Members include
• Cancer Survivors
• Healthcare Providers
• Educators
• Outreach Workers
• Cancer Advocates
• Public Health Workers Researchers
• People Personally Affected by Cancer

• Organizations represented
• Community-based organizations
• County Local health departments
• National Local Cancer Organizations
• Health Centers, Hospitals, Clinics
• Faith-based Organizations
• Corporations
• Academia
• Foundations

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For Example

• The Coalition is partnering with the following
  organizations to address the three cancers that
  were identified as priorities in Essex County
  through the C/NA
• The Prostate Net
• Oral Cancer Consortium
• Essex Communities Against Tobacco (CAT)
  Coalition
• Essex Cancer Education Early Detection (CEED)
  Program

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Communication Methods

• Quarterly ECCC Meetings
• Email list-serve (free using Yahoo!Groups) for
• Entire Coalition
• Leadership Council and Each Committee
• Monthly Community Health Calendar that focuses on
  cancer
• Coalition Website www.umdnj.edu/EssCaWeb

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Cancer Services Resources

• Many Coalition members work for organizations
  that serve as resources for cancer education,
  screening/early detection, and support services
• Coalition promotes services provided by members
  and non-members throughout Essex County

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American Cancer Society (ACS)

• Web Site www.cancer.org
• Type in zip code to find local resources and
  events
• Local Office Metro NJ Region-
• Address 767 Northfield Ave, West Orange 07052
• Tel [phone]
• National Call center 1-800-ACS-2345
• Patients and others can obtain referrals to
  local cancer resources and to a local patient
  and family services director/coordinator who may
  be able to help
• Broad range of cancer education materials
  available

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NJ Cancer Education Early Detection (CEED)
Programswww.state.nj.us/health/cancer/njceed/

• The NJCEED Program offers funding to all 21
  counties for comprehensive breast, cervical,
  prostate colorectal cancer education, outreach
  screening.
• There are 2 CEED sites in Essex

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Essex CEED Sites

• Conduct education/outreach and screenings at
  churches,
• health departments community centers
• UMDNJ - S.A.V.E. Women Men of Essex County
  CEED Program
• For more information contact
• Ms. Catherine Marcial, SAVE Women Men Project
  Coord.
• Tel [phone], email marciacp_at_umdnj.edu
• St. Michaels Medical Center-"In The Pink" CEED
  Program
• For more information contact
• Ms. Aretha Hill-Forte, "In the Pink" Project
  Coordinator
• Tel [phone], email ahillforte_at_cathedralhe
  alth.org

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Cancer Care www.cancercare.org

• Trained oncology
• social workers provide
• free counseling
• 24-hr online support groups,
• face-to-face,
• telephone
• financial assistance

• National non-profit organization providing free
  professional support services to
• people living with cancer,
• caregivers,
• children loved ones
• the bereaved

• Telephone Education Workshops
• Expert-led programs on a variety of
  cancer-related topics
• More than 50 Workshops per year
• Participants can listen to and ask questions of
  cancer experts
• To register call 1-800-813-HOPE or at
  www.cancercare.org/education.html

For more information, please contact Kathy
Nugent, LCSW, Director of Social Services Tel
201-301-6809, Email knugent_at_cancercare.org
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NJ Cancer Clinical Trials Connectwww.njctc.org

• Innovative electronic tool to match patients to
  cancer clinical trials statewide
• Patients create a confidential medical profile
  online
• Informational resource to educate people about
  clinical trials, provides links to other
  resources
• Website available in Spanish
• Toll-free information line 866-788-3929, Monday
  through Friday, 9 am-5 pm
• Supported by CINJ, RWJ Medical School, NJ-DHSS
• For more information, contact
• Susan Goodin, PharmD
• Tel [phone], Email goodin_at_umdnj.edu

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The Prostate Net www.prostate-online.org

• National non-profit organization which aims to
  increase awareness of prostate cancer especially
  among minority men in medically underserved areas
• Barbershop Initiative
• National program to increase prostate cancer
  awareness among minority men by training barbers
  to deliver health messages and involving local
  medical centers to provide education coupled with
  free prostate cancer screenings treatment.
• Cancer Education Literature

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Oral Cancer Consortium www.oral-cancer.org

• Comprised of 26 metropolitan healthcare
  institutions and professional societies in NY, NJ
  PA.
• Recognize that oral cancer is an under-
  publicized issue and aim to raise awareness the
  importance of prevention and early detection.
• Sponsoring Oral Cancer Screening Day
• (April 20, 2006)
• For more information about where to receive a
  free oral cancer screening, call the Oral Cancer
  Screening Information Line at 1-877-263-3401.

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Dental Clinics near Essex that Provide
Reduced-Cost Oral Cancer Screenings

• UMDNJ-New Jersey Dental School
• Newark Beth Israel Medical Center
• Newark Community Health Centers
• Mountainside Hospital
• Accept Medicaid, charity care, and sliding
• scale fees

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The Essex Communities Against Tobacco (CAT)
Coalition

• Part of a statewide group of anti-tobacco,
  community-based coalitions that promote
  tobacco-free environments.
• Supports tobacco prevention education programs
  and participates in anti-tobacco advocacy
  efforts/activities
• Advocate for passage of Clean Indoor Air Bill
  in NJ
• Tobacco strongly linked with lung, oral and
  cervical cancers
• For more information contact
• Ms. Michele Grippaldi, Essex CAT Coalition
  Coordinator
• Tel [phone], EssexCountyCAT_at_yahoo.com

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Sisters Network www.sistersnetworkinc.org

• Addresses the breast health needs of African
  American women, through affiliate chapters
  partnerships with existing service providers
• Chapters are organized by breast cancer survivors
  committed to establishing community breast health
  services
• Successful community outreach programs
• "The Gift for Life Block Walk"
• The Pink Ribbon Awareness Campaign
• STOP THE SILENCE Changing the Face of Early
  Breast Health Intervention
• Local Chapter Sisters Network, Newark
• For more information contact
• Ms. Charlotte Munnerlyn
• Tel [phone], munnemann_at_aol.com

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Current ECCC Activities

• Cancer Prevention Early Detection Health Fair
  - April 20, 2006
• In conjunction with Oral Cancer Screening Day at
  New Jersey Dental School
• Health fair was proposed by Coalition members
• Participants include
• Essex County Cancer Coalition
• CancerCare
• The Prostate Net
• Essex CEED
• Sisters Network
• Essex CAT Coalition

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Current ECCC Activities (cont.)

• Letters to the Editor to be published in local
  newspapers in Essex County
• Intent is to highlight local cancer issues in
  conjunction with national health observances
• Cancer education for Essex firefighters
• Coordinators will give an overview of cancer
  issues at March meeting of fire chiefs

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Current ECCC Activities (cont.)

• Creator of NJ Cancer Trials Connect educated
  Coalition members
• Member who educates the community about clinical
  trials though his personal experiences
• Coalition has helped to initiate a Working Group
  to
• Further understand barriers to participation in
  cancer clinical trials
• Formulate effective educational approaches
• Identify appropriate funding opportunities

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How Can You and/or Your Organization Contribute
to Cancer Control Efforts in Essex County?

• We strongly encourage YOUR participation on the
  Essex County Cancer Coalition to
• Educate yourself about the cancer burden in Essex
  County and the cancer issues affecting the
  communities you work with
• Expand awareness and promote the importance of
  cancer prevention early detection
• Help reduce the number of cancer deaths and
  alleviate the overall cancer burden in the County

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SUPPLEMENTAL SLIDES
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General Cancer Risk Factors

• Risk factors you cannot change
• Gender
• (Males Oral)
• (Females Breast)
• Age
• Genetics
• Family History
• Personal history
• Race/Ethnicity
• (White Females Breast)
• (Black Males Prostate, Oral)
• Socioeconomic Status
• (Cervical)

• Lifestyle choices and
• behaviors you can change
• Smoking
• Alcohol (1 drink per day)
• Healthy Diet
• Infectious Agents (HPV, HIV)
• Exposure to UV Light
• Oral Contraceptive Use

• Protective factors
• Early Detection
• Breastfeeding
• Low-fat diet
• Exercise
• Safe Sex Practices

Sources American Cancer Society National
Cancer Institute
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Screening Guidelines
Other tests commonly used to detect colorectal
cancer are fecal occult blood test (FOBT) and
flexible sigmoidoscopy.
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Insurance Coverage Overview for Common Cancer
Screenings
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Key Health and Economic Indicators (source U.S.
Census 2000)