Dutchess County Comprehensive Cancer Control Plan … · Dutchess County Comprehensive Cancer Control ... facilitated the development of a county comprehensive cancer control plan

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Dutchess County Comprehensive Cancer

Control Plan 2010—2020

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Page 3 DC Comprehensive Cancer Control Plan

Dutchess County Comprehensive Cancer Control Plan

2009-2020

Introduction

Cancer is the second leading cause of death in Dutchess County. Our Community experiences an average of 550 cancer-related deaths annually representing one quarter of all deaths recorded in the county. The American Cancer Society estimates 27 people are diagnosed with cancer and 11 die each week in Dutchess County. According to the NYS Department of Health, the years between and including 2000 and 2004, the incident rate of cancer and percentage of death from cancer in the county were higher than the state’s rate.

In 2006 County Executive William R. Steinhaus announced and funded a Comprehensive Cancer Control Initiative. He asked the Dutchess County Department of Health under the leadership of Dr. Michael Caldwell to bring together the local cancer service providers to form a Cancer Consortium and begin dialogue on the issue of cancer. In 2007 a cancer needs assessment was conducted by JSI Research and Training Institute. Information obtained from the assessment was gathered through a comprehensive epidemiologic profile of cancer in Dutchess County, key informant interviews, resource inventory and focus groups. This data facilitated the development of a county comprehensive cancer control plan.

Through this comprehensive cancer control plan, the Dutchess County Cancer Consortium hopes to communicate their vision for Dutchess County as a community that works together to ensure that every resident has the ability to decrease their chances of developing cancer or, if diagnosed with cancer, have access to the quality care they need for a positive outcome.

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Key Points from the 2007 Cancer Needs Assessment

In Dutchess County, four cancers have the highest cancer rate, higher than the state and nation. They are lung, female breast, prostate and colorectal cancers. Other cancers that stand out are melanoma and cancer of the liver and bile duct.

Lung Cancer

Although lung cancer death rates in males have decreased, Dutchess County has a higher male lung cancer death rate than the state. The female lung cancer death rate in Dutchess County is higher than the state and has shown an increasing trend during the years from 1984 to 1994 and leveling off during 1994-2004.

Breast Cancer

Both the incidence and mortality from breast cancer in Dutchess County have decreased but still remain higher than the state.

Prostate Cancer

Prostate cancer is the second leading cause of cancer death among men in the United States. The detection of prostate cancer is on the rise most likely due to increased screening. The mortality rate from prostate cancer has decreased due to early detection and advanced treatment options; however the mortality rate is higher in Dutchess County than in the state.

According to the National Cancer Institute (NCI), prostate cancer death rate is higher among African American men than for any other racial or ethnic group. During the 1990s the death rate from prostate cancer decreased almost twice as much in Caucasians and Asians than for African Americans.

Colorectal Cancer

The incidence rate of colorectal cancer in both genders in Dutchess County is lower than in the state. The mortality rate from colorectal cancer in females is slightly higher than the state. Colorectal screening for both genders 50 years and older remains only 50%.

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Disparities

Disparities in cancer morbidity and mortality by race and ethnicity are substantial in Dutchess County as in the nation as a whole. African American males were found to have the highest cancer rate of any subgroup by race and gender. African American females have lower cancer rates than American white females. Both African American males and females have significantly higher cancer death rates despite black females having lower cancer rates.

Risk Factors

Risk factors are individual characteristics that increase a person’s chances of developing cancer. Risk factors associated with cancer include family history, overweight/obesity, sedentary lifestyle, using tobacco, poor dietary habits, alcohol consumption and exposure to the sun and environmental toxins.

According to the 2003-2004 NYS Behavioral Risk Factor Surveillance System, the percentage of the Dutchess County population with risk factors associated with cancer are:

● 23.4% of Dutchess County Adults smoked cigarettes

● 37% of youth ages 9-18 years had tried smoking and about 13% smoked in the last 30 days.

● Overall 64.9% of the adult population can be classified as overweight or obese in Dutchess County

● 61% of the adult population in Dutchess do not eat 5 fruits and vegetables per day.

● 21% of the population has a sedentary lifestyle.

● 15% stated they were at risk for binge drinking (having 4-5 or more drinks on one occasion and 4% reported they were heavy drinkers (2 or more drinks per day.)

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KEY ISSUES

In order to identify the strengths, gaps and barriers of cancer services in the areas of prevention, screening, treatment and support in Dutchess County, JSI Research and Training Institute conducted not only a cancer epidemiological profile of Dutchess County but key informant interviews and two focus groups. The results of the interviews and focus groups are summarized here.

Cancer prevention activities were identified as insufficient by the key informants. If there are prevention services, there is a lack of knowledge about them. Key informants also identified the lack of tobacco cessation services for youth. Literacy and cultural beliefs about cancer prevention that are not evidenced based was an identified theme in the focus groups.

Screening for breast, cervical, colorectal, skin and prostate cancer are all available in Dutchess County and are offered free or at discounted rates for those who are eligible. Lack of insurance and lack of knowledge about screening services was identified as a barrier.

While cancer treatment services in Dutchess have increased enabling residents to receive their treatments locally, there are still some gaps. Two areas that stand out are pediatric oncology and GYN specialty care. Transportation to cancer screening and treatment for those in need is limited.

The biggest challenge a resident faces when they have been diagnosed with cancer is knowing where to go and what one’s options are for treatment and support in Dutchess County.

A notable recommendation from the cancer needs assessment was to improve communication, coordination of services and collaboration between organizations providing cancer services relating to prevention, screening and support services.

To review the 2007 Dutchess County Cancer Needs Assessment in its entirety please go to www.cancerfreedutchess.net

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DUTCHESS COUNTY COMPREHENSIVE CANCER CONTROL PLAN 2009- 2020

Health Promotion and Disease Prevention

Tobacco use is the leading cause of preventable death in the U.S. According to the American Cancer Society, tobacco use damages nearly every organ in the body and is linked to approximately 15 types of cancer. Lung cancer is the leading cause of cancer death in both men and women in New York State and in Dutchess County. Tobacco use is responsible for roughly 30% of all cancer deaths. The Center for Disease Control (CDC) states, cigarette smokers die 13-14 years earlier than nonsmokers and cigarette smoking increases the length of time that a person lives with a disability by 2 years. According to the Campaign for Tobacco Free Kids, the total national annual public and private health care expenditures caused by smoking is $96 billion. Preventing and cessation of tobacco use in the population will substantially lower cancer incidence and its burden of cost on our health care system.

Goal: Reduce Tobacco use in Dutchess County

Objective: By 2020 Reduce Adult Tobacco Use to 10% and youth tobacco use to 6%.

Baseline is 19% of adults smoke and 12% youth smoke in Dutchess County. Source SFD 2007 Area Poll, DCDOH 2008 Youth Tobacco Use Survey.

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Strategies:

■ Collaborate with tobacco control advocates, already operating in the county, to decrease the social acceptability of tobacco use by actively supporting policies promoting decreases in tobacco advertising in the community, smoke free multiple dwellings, smoke free parks and play grounds, and high cigarette taxes.

■ Collaborate with tobacco control advocates and other community organizations to increase the number and the utilization of tobacco cessation services in Dutchess County and the use of the NYS Smokers’ Quitline.

■ Collaborate with the tobacco control advocates to encourage smoke free hospital and college campuses.

■ Collaborate with the tobacco control advocates in promoting health provider education and reminder systems to assess all patients for tobacco use and referral to the NYS Smokers’ Quitline.

■ Encourage Dutchess County employers to have benefit plans that meet the CEO Cancer Gold Standards for tobacco cessation which include 100% coverage for physician counseling and medications both prescription and over the counter.

■ Support efforts in reducing the cost of over the counter (OTC) nicotine replacement therapy and efforts to make it available in convenient stores where tobacco products are sold.

■ Increase smoking cessation services to youth in the schools and community.

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Skin Cancer

According to the CDC, skin cancer is the most common form of cancer in the United States. The two most common forms of skin cancer are basal cell and squamous cell which develop either on the surface or base of the skin and are highly curable. The third most common type of skin cancer is melanoma. This type develops in the skin cells that are responsible for pigment. It can spread to other parts of the body quickly. It is responsible for 75% of all the deaths from skin cancer. When detected early, it is very curable.

The CDC has listed general risk factors that increase a person’s risk for developing skin cancer. These are if a person has:

A lighter natural skin color

A family history

A personal history

A history of sunburns early in life

Having exposure to the sun because of work or play

Having skin that buns, freckles, reddens or becomes painful in the sun.

Having blue or green eyes

Having blonde or red hair

Having certain types of moles or a large number of moles on the skin

According to the US Preventive Services Task Force, most skin cancers can be prevented if children, adolescents and adults protect themselves from UV radiation either from the sun or artificial sources. The CDC has found tanning beds and sunlamps emit rays that are just as dangerous as the sun.

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In order to successfully prevent skin cancer, organizations, should be encouraged to adopt sun protective policies. Public education and policies should include sun protective behaviors in combination, not just using a single one. Those behaviors are; covering up by wearing protective clothing, using shade, avoiding sun during peak hours, wearing a hat with a wide brim, wearing sunglasses and the use of sun screen that block both UV-A and UV-B rays.

Goal: Reduce the incidence of skin cancer.

Objective: By 2020 increase the proportion of county residents who use at least two sun protective measures to prevent excessive sun exposure to 80%

National baseline according to Healthy People 2010 is 47%. National objective for 2010 was 75%

Strategies:

■ Educate new parents on the importance of sun protection of their infants and young children.

■ Educate and encourage adoption of sun protection policies at schools, day care centers, camps, recreation centers and scouting organizations.

■ Promote and educate the general population of the benefits of sun protection.

■ Educate the public of the dangers of artificial sun tanning.

■ Organize community events to educate and screen for skin cancer especially in the spring before the summer season starts

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■ Partner with municipalities, sporting venues and other organizations who promote outdoor activities in the community to distribute educational materials and hold screening events.

■ Educate Healthcare providers on the USPSTF recommendations on skin cancer.

■ Develop a mass media campaign to educate and remind the public on skin cancer protective measures.

Prevention and Risk Reduction of Cancer

The American Cancer Society states that except for quitting smoking, maintaining a healthy weight, being physically active and making good dietary choices is the best way to prevent cancer. According to the American Institute for Cancer Research, in the US approximately one third of the most common cancers like colorectal and breast cancer can be prevented through a healthy diet, regular physical activity and maintaining a healthy weight. Tobacco use is not included in this figure which is said to be responsible for causing another third of cancers.

According to the ACS, obesity increases a person’s cancer risk by causing the body to produce and circulate hormones like estrogen and insulin that can stimulate cancer growth. Being physically active helps to control weight, control hormone levels and strengthens the immune system. Eating more fruits and vegetables instead of high calorie, high fat foods supplies our bodies with the vitamins, minerals and antioxidants needed to prevent and fight against cancer.

If the community does not smoke and adopts a healthy lifestyle approximately two thirds of cancer deaths can be prevented. (ACS)

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Goal: Prevent and reduce the risk of cancer through a healthy life style.

Objective 1: Increase the proportion of Dutchess County residents to 50% who consume five or more servings of fruits and vegetables per day by 2020.

Objective 2: By 2020 reduce the proportion of Dutchess County residents who can be classified as overweight or obese to 35%.

Objective 3: Increase the proportion of Dutchess County residents who do not have a sedentary lifestyle to 90% by 2020.

Baseline as mentioned earlier from the 2007 Cancer Needs Assessment:

● Overall 64.9% of the adult population can be classified as overweight or obese in Dutchess County

● 61% of the adult population in Dutchess do not eat 5 fruits and vegetables per day.

● 21% of the population has a sedentary lifestyle.

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Strategies:

■ Increase the promotion of existing community programs that encourage the increase intake of fruits and vegetable per day such as; farmer’s markets and community gardens.

■ Collaborate with community organizations (community centers, senior centers, churches, etc.) and other stakeholders (master gardeners, garden centers) to increase the number of community gardens in the community.

■ Encourage adoption of policies in worksites to offer healthy foods choices (low fat, low sugar, whole grain, high fiber foods) at meetings and conferences in cafeterias and vending machines.

■ Support and promote existing programs in schools that are working toward modifying school breakfast and lunch programs to healthier nutritious foods.

■ Support policy changes that encourage healthier food and drink choices in the local community.

■ Promote the use of existing walking trails and bike paths and participation in community walks like the Heart Walk, Walk for Autism, Relay for Life, etc.

■ Work with City, Town, and Village officials to provide additional walking trails, bike paths and sidewalks.

■ Encourage and support worksites in Dutchess County to provide their employees opportunities to participate in weight loss programs and exercise programs either through a benefit plan or onsite.

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■ Encourage political, business and community leaders to set positive healthy life examples for their constituents.

■ Educate Dutchess County residents on the CDC’s Physical Activity Guidelines and the benefits of physical activity through paid and unpaid forms of media.

■ Educate the community on proper portion sizes.

■ Encourage restaurants to serve food in proper serving sizes or display calorie and nutritional information on their menus.

Environment

Cancer can be linked from exposure to certain chemicals, biological agents, such as viruses, and physical agents such as radiation. According to the EPA, each year billions of pounds of synthetic chemicals and heavy metals are released in the environment as a result of industrial production, processing, use or disposal. Potential carcinogens are used in and around the home in the form of pesticides, solvents and other products. Some carcinogens are found naturally in the environment such as radon and arsenic. Toxic chemicals are found throughout the environment and everyone is involuntarily exposed every day to low levels of these contaminants in the air, water and food. There is now growing scientific evidence that low level exposure to chemicals in the general environment contributes to society’s cancer burden. Taking steps to reduce exposure to harmful environmental agents can assist in preventing this cancer burden.

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Goal: Reduce the risk of cancer associated with exposure to toxic chemicals in the environment and around the home.

Objective: At least 80% of residents will know what Hazardous Household Waste (HHW) is and when and where community recycling is held in Dutchess County.

Strategies:

■ Educate the residents of what Hazardous Household Waste (HHW) is and its risk to the environment and health.

■ Increase awareness and promote programs that assist residents to decrease their use of hazardous chemicals in and around the home (pesticides, solvents, etc.)

■ educate DC residents of and use community recycling events for the proper elimination of HHW.

■ Encourage radon testing in the home.

■ Support public policies decreasing chemicals in the environment.

■ Develop media to educate the community on what and how to reduce toxic chemicals in and around the home.

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Early Detection/Screening

According to the CDC, cancer screening is detecting cancer before signs and symptoms of disease occur or at the earliest stage possible. Screening is important because it may find many cancers early when treatment is the most effective. The US Preventive Services Task Force has found supporting evidence that screening for certain cancers saves lives and has recommended specific guidelines in the screening for breast, cervical, and colorectal cancer.

Goal: To detect cancer in DC residents at its earliest stage for the best prognosis and treatment.

Objective: Increase the percentage of women over 40 years of age who had a mammography in the past 2 years to 90% by 2020

Objective: Increase the percentage of women who have had a Pap test in the past 3 years to 95% by 2020.

Objective: Increase the early detection of colon and rectal cancer to 50% in men and to 46% in women by 2020.

Baseline Data - In Dutchess County 83.4 % women over 40 years of age had a mammography in the past 2 years. 88% of women between the ages of 35-54 and over 65 had a pap test in the past 3 years. Source 2008 BRFSS

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Between 2002 – 2006 40.4% of men and 36% of were women diagnosed with colorectal cancer at an early stage in Dutchess County. Source: NYSDOH Cancer registry.

Strategies:

■ Educate Dutchess County residents on the age appropriate, evidence based recommended screenings for all cancers especially breast cancer and colorectal cancer through all types of paid and unpaid media.

■ Educate and increase utilization among Dutchess County residents, especially disparate populations, the underinsured and uninsured of the recommended cancer screenings and free or reduced cost screening services in Dutchess County.

■ Ensure all Dutchess County cancer community service providers have their services registered with the 211 system.

■ Encourage Dutchess County cancer community services providers to network, share resources and collaborate to provide educational material and screening services/events within the communities where residents reside.

■ Encourage Dutchess County cancer community service providers to collaborate and make provisions to provide appropriate reading level and cultural cancer educational material and counseling.

■ Encourage and support Dutchess County employers to offer benefit plans that include cancer screening provisions that follow the American Cancer Society (ACS) Guidelines or the US Preventive Services Task Force (USPSTF) Guidelines.

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■ Encourage Dutchess County employers to offer benefit plans that eliminate cost as a barrier to accessing preventive screening test and exams for cancer.

■ Communicate the need for health insurance providers to provide DC businesses affordable health benefit plans that cover preventive cancer screening and exams free of co- payments

■ All community cancer service providers collaborate to conduct educational, screening, events all month long using the Cancer Awareness Calendar Example: If May is skin cancer month do education, screening, events, and media around skin cancer for the whole month throughout the county

Treatment - Quality of Care – Access to Care

The goal of cancer treatment is to cure the person with cancer or to stop

the progression of cancer while maintaining quality of life. Having access

to quality cancer treatment can mean the difference between life and death and temporary or permanent disability. To assure Dutchess County residents receive quality and equitable care, the CDC recommends, health care professionals utilize nationally recognized treatment guidelines that provide guidance to standardized cancer treatments. In addition, having access to clinical trails provides innovative therapies and treatments that are strictly monitored and evaluated.

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Goal: All Dutchess County residents diagnosed with cancer will have equal access to seamless, quality, coordinated cancer care throughout the care continuum.

Objective: By 2020 increase the number of community based organizations who employ staff that received patient navigation training and who are implementing a patient navigation program to 10.

Objective: Residents diagnosed with cancer will report they received care and treatment desired and satisfaction with their care.

Baseline data – 4 organizations have employees who received patient navigation training and who are doing some type of programming.

Strategies:

■ Support efforts to expand one – on – one advocacy such as companion peer programs or patient navigation in non-traditional sites within the communities in which residents live.

■ Educate Dutchess County residents on patient navigation and how and where to access a patient navigator in Dutchess County through paid and unpaid media.

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■ Encourage cancer treatment organizations to develop a system for cancer patients to communicate their satisfaction with their treatment and care.

■ Increase access to interpretation services at all levels of cancer treatment and care

■ Establish a physicians committee, to research and recommended clinical guidelines (using the national comprehensive cancer network and other resources) and outcomes for best treatment options and communicate findings to other cancer treatment providers.

■ Conduct a cancer forum each year of cancer survivors to provide feedback on all aspects of their care.

■ Increase awareness and access to clinical trails in cancer treatment for residents diagnosed with cancer.

■ Educate the importance and support Dutchess County employers to offer benefit plans that provide access to cancer care at Commission on Cancer-approved facilities and/or National Cancer Institute-approved cancer centers.

■ Encourage cancer treatment/hospitals centers to seek accreditation through the American College of Surgeons Commission on Cancer.

■ Educate the importance and encourage Dutchess County employers to offer benefit plans that provide access and eliminate cost as a barrier to cancer clinical trials.

■ Encourage the increase of oncology certification among health care professionals.

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■ Eliminate barriers to existing services by enrolling all who are eligible into Medicaid, Family Health Plus and Child Health Plus.

■ Promote and increase the number of medical interpreters and bilingual healthcare providers and workers employed in Dutchess County.

■ Promote and develop patient navigation services that are representative of underserved communities with a high degree of cultural competence.

■ Collaborate with higher education institutions to encourage careers in the oncology field and medical interpretation.

■ Investigate ways of providing cancer transportation services to residents who need it.

■ Organize a community forum with the underserved/disparate communities annually in order to understand how to better serve these communities and or evaluate if they are being reached.

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Palliative Care and Pain Management

The CDC states palliative care is a type of medical care that focuses on the treatment of symptoms a person manifest when they are living with a chronic disease or illness such as cancer. The World Health Organization (WHO) describes it as a type of care that seeks relieve from symptoms without curing the underlying disease. Its goal is to provide the best quality of life possible before someone becomes terminally ill. It focuses not only on the physical problems like pain, nausea, loss of appetite and fatigue but also emotional and spiritual problems as well. It is delivered by a multidisciplinary team of physicians, nurses, social workers chaplains and others. The whole person and family are included in the care. It relieves suffering and assists the family in receiving the support it needs including bereavement. It should intensify as the illness becomes progressive. According to WHO, in and ideal situation, palliative care should be provided throughout the continuum of cancer care from diagnosis, through treatment, survivorship and end of life

Goal: Residents diagnosed with cancer will achieve a comfort level of their choice to maintain quality of life.

Objective: 100% of residents in Dutchess County who are diagnosed with cancer will receive information on palliative care and how to access it by 2020.

Strategies:

■ Make provisions for all community cancer service providers to have access to information on palliative care.

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■ All community cancer services organizations will distribute information on what palliative care is and how to access it to their clients.

■ Encourage all cancer patient navigators to include palliative care in all their contacts with people diagnosed with cancer.

■ Support efforts in facilitating dialogue between physician and cancer patient to consider palliative care at the beginging of treatment.

■ Promote the use of best practices for palliative care among health professionals.

Survivorship

The American Cancer Society states cancer survivors are those who have been diagnosed with cancer and the family and friends affected by the diagnosis. According to the CDC, as of 2005 there were 11.1 million Americans living with a previous diagnosis of cancer. Because more people are surviving with a diagnosis of cancer, survivors and their families are faced with other challenges. These challenges involve the physical, psychological, social and financial burdens from the diagnoses. Steps need to be taken to promote health, prevent secondary disease and maintain the well being of the survivor and the family.

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Goal: Cancer survivors and their families will receive the services needed to maintain their quality of life and live productive lives.

Objective: All cancer survivors and their families will continue to receive treatment, support and preventative services they need not only during but after completion of their cancer treatment.

Strategies:

■ Conduct focus groups of cancer survivors, physicians, and advocates to access knowledge, utilization and needs/gaps in services.

■ Promote communication of survivorship services

■ Encourage communication between healthcare providers and cancer survivors about a follow-up plan of care for future screenings and test, care for delayed side effects of treatment, and which provider is responsible.

■ Develop a mechanism to provide all cancer survivors with a follow up plan after completion of cancer treatment.

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■ Develop or encourage survivorship peer programs for survivors just completing treatment.

■ Ensure cancer survivors receive financial support if eligible and needed.

■ Develop a mechanism for access to genetic counseling for survivor families who will benefit.

■ Support efforts to educate cancer survivors of the importance of good nutrition and being physically active.

■ Celebrate national cancer survivorship day.

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Evaluation

A comprehensive approach to combating cancer in Dutchess County is relatively new. This approach will provide opportunities for community organizations to think and problem solve collectively and work together in a new way to have the greatest impact on our community. Evaluating what we do, how we do it and to whom will contribute to what works best in Dutchess County.

After the County Executive funded the Dutchess County Cancer Control initiative in 2006 a consortium was formed consisting of community leaders and cancer service providers. In 2007 a County Cancer Needs Assessment was done. This assessment identified needs and gaps in services. As a result, transportation and the need for patient navigation services were identified as priorities by the consortium. Two requests for applications were announced and awarded. One grant was awarded to the American Cancer Society (ACS) in Dutchess County to increase access to cancer related services by providing transportation to residents in need. The second grant was awarded to the Harold B. Freeman Institute for Patient Navigation to provide training to staff in community based organizations.

There were 12 clients who had an increase in access to cancer related services because of the grant received by ACS. One hundred ten (110) rides were provided. All but one of the clients was over 62 years of age.

Six staff from four community based organizations received the patient navigation training. A follow up for feedback on the training and how it is being implemented within the agency’s programming will be done in late summer 2009.

Also in the summer of 2009, it is anticipated that the Dutchess County comprehensive cancer control plan will be adopted by the consortium. At that time

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the consortium will begin to organize and engage in program planning. Evaluation will focus on refining program plans, improve operations and then measuring outcomes against the data and needs identified in the initial cancer needs assessment. We will use the CDC’s “Framework for Program Evaluation in Public Health” to meet evaluation goals.

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Dutchess County Comprehensive Cancer Control Plan … · Dutchess County Comprehensive Cancer Control ... facilitated the development of a county comprehensive cancer control plan