Download Hepatitis B and C - Northwest Portland Area Indian Health Board

Tribal Cancer Control Education
Eric Vinson
Northwest Tribal Comprehensive Cancer Program
May 29, 2013
Risky Business Training
Northwest Portland Area
Indian Health Board
Indian Leadership for Indian Health
Supported by CDC Grant #1 U58 DP000786-4
Organizational Chart
Northwest Portland Area Indian Health Board
Executive Committee Members
NPAIHB
Joe Finkbonner,
Executive Director
Northwest Tribal Epidemology Center
Victoria Warren-Mears,
Director
NTCCP & WTDP
Kerri Lopez,
Director
Northwest Diabetes Project
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NTCCP
& WHPP
National Diabetes Project
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Northwest Tribal Cancer
Control Project (NTCCP)
July 1998
Northwest Portland Area Indian
Health Board Delegates resolved to
form the Northwest Tribal Cancer
Coalition and the Northwest Tribal
Cancer Control Project
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NTCCP Mission
To envision and work toward cancerfree tribal communities by taking an
integrated and coordinated approach
to cancer control
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NTCCP 20 Year Plan
An integrated and coordinated approach
towards preventing and controlling
cancer in tribal communities
To reduce cancer incidence, mortality,
and morbidity among American Indians
and Alaskan Natives (AI/AN) in
Northwest tribal communities
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NTCCP Goals
• Facilitate a process for Northwest tribes to
promote cancer risk reduction strategies.
• Provide information on the most current early
detection, screening and treatment practices
through education and resource materials.
• Provide education regarding quality of life for
cancer patients, their families and caregivers.
• Coordinate and collaborate with local and national
cancer organizations and individuals.
• Improve Indian-specific cancer control data.
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Current news – May 19, 2014
www.cnn.com/2014/05/19/health/pancreatic-livercancer-deaths/
“Lung cancer is already the top killer overall, but
pancreatic and liver cancer will surpass the cancers
currently considered the second and third leading
causes of death, researchers say. Right now, second
most dangerous is breast cancer for women and
prostate cancer for men; and third is colorectal
cancer for both men and women.”
Article at: Projecting Cancer Incidence and Deaths to 2030: The Unexpected Burden of Thyroid, Liver, and
Pancreas Cancers in the United States, Lola Rahib, Benjamin D. Smith, Rhonda Aizenberg, Allison B. Rosenzweig, Julie M.
Fleshman, and Lynn M. Matrisian, Cancer Res Published OnlineFirst May 19, 2014; doi:10.1158/0008-5472.CAN-14-0155
News:
Projected Change Incidence
News:
Projected Change Mortality
Cancer in the NW AI/AN
#7
#8
Northwest Portland Area Indian Health Board. Cancer Among Northwest American Indians and Alaska Natives. Portland, OR: Northwest Tribal
Epidemiology Center, 2011.
Cancer Morality
#3
#7
Liver Cancer
From:
www.cancer.org/cancer/livercancer/detailedguide/livercancer-what-is-liver-cancer
A cancer that starts in the liver is called primary liver
cancer. There is more than one kind of primary liver
cancer.
Hepatocellular carcinoma (HCC)
• This is the most common form of liver cancer in adults.
• About 4 of 5 cancers that start in the liver are this
type.
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Liver cancer incidence, 20012005
n
Rate per 100,000 (95% CI)
51
8.2 (5.9, 11.3)*
AI/AN Male
31
9.7 (6.1, 15.7)*
AI/AN Female
20
7.0 (4.1, 11.3)*
1,831
3.6 (3.4, 3.8)
NHW Male
1,304
3.4 (5.2, 5.8)
NHW Female
527
1.9 (1.8, 2.1)
AI/AN
NHW
* AI/AN rate is significantly higher than corresponding NHW rate
Northwest Portland Area Indian Health Board
Northwest Tribal Registry Project, 2009
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Liver Cancer Risk Factors
Hepatitis B and C
• Chronic Infections
• Increased risk for people with both hepatitis B and C.
• The longer the hepatitis infection lasts (especially hepatitis C),
the greater the risk.
Cirrhosis
• A disease in which healthy liver tissue is replaced by scar tissue.
• Chronic alcoholism and chronic hepatitis C are the most common
causes of cirrhosis.
Aflatoxin
• Increased risk by eating foods that contain aflatoxin (poison from
a fungus that can grow on foods, such as grains and nuts, that
have not been stored properly).
From: www.cancer.gov/cancertopics/pdq/prevention/hepatocellular/Patient/page3
Liver Cancer Risk Reduction
Hepatitis B vaccine
• Preventing hepatitis B infection has been shown
to lower the risk of liver cancer in children.
Diet
• In a study of patients with chronic hepatitis C,
those who were treated to lower their iron
levels by having blood drawn and eating a lowiron diet were less likely to develop liver
cancer than those who did not have this
treatment.
From: www.cancer.gov/cancertopics/pdq/prevention/hepatocellular/Patient/page3
New Hepatitis C Treatment
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Hepatitis C Treatment Assistance
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Hepatocellular carcinoma (HCC)
• This is the most common form of
liver cancer in adults.
• About 4 of 5 cancers that start in the
liver are this type.
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Who gets screened for HCC?
Selected AASLD Recommendations
Chronic Hepatitis B (HBV)
Population Group
Incidence of HCC
All HBV carriers with family history of HCC
Incidence higher than those without
family history
All Cirrhotic Patients with chronic HBV
3-8% per year
Other Groups
Population Group
Incidence of HCC
Hepatitis C cirrhosis
3-5% per year
State 4 Primary biliary cirrhosis
3-5% per year
Genetic hemochromatosis and Cirrhosis
Unknown, but probably > 1.5%/year
Alpha-1 antitrypsin deficiency and Cirrhosis
Unknown, but probably > 1.5%/year
All other causes of Cirrhosis including alcohol Unknown
From: Jeremy Holden MD, The Oregon Clinic- Portland Gastroenterology, March 2013, Presentation
and: www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/HCCUpdate2010.pdf
How to Screen for HCC
• Current American Association for the Study
of Liver Diseases (AASLD) guidelines
recommend screening at risk patients with
ultrasound alone at 6-month intervals
• Alpha-fetoprotein (AFP) is no longer used
as a screening assay due to its poor
sensitivity and specificity
From: Jeremy Holden MD, The Oregon Clinic- Portland Gastroenterology, March 2013, Presentation
and: www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/HCCUpdate2010.pdf
Where to get screened?
• Cancer Centers
• List of Cancer Centers available at:
 datalinks.facs.org/cpm/CPMApprovedHospitals_Search.htm
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Liver Cancer Resources
American Liver Foundation (ALF) - www.liverfoundation.org
•
HELPLINE: The national ALF Helpline is available to answer questions about liver
disease and liver wellness. This resource provides emotional support to patients at
their point of crisis and information on local resources including physician referrals.
To reach our Helpline, call 1-800-GO-LIVER (1-800-465-4837).
•
SUPPORT GROUPS: Support programs assist patients who have a diagnosed liver
disease, provide education and information on resources in their areas, and offer
emotional support to them and their family members and caregivers. Locate a support
group near you.
•
SUPPORT GUIDES: Information on clinical trials and financial resources. More guides
coming soon.
National Cancer Institute:
www.cancer.gov/cancertopics/types/liver
And Cancer Information Service: www.cancer.gov/aboutnci/cis/page3
800-422-6237
Pancreatic Cancer
From: www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient
Pancreatic cancer is a disease in which malignant (cancer)
cells form in the tissues of the pancreas.
The pancreas is a gland about 6
inches long that is shaped like a
thin pear lying on its side. The
wider end of the pancreas is
called the head, the middle
section is called the body, and
the narrow end is called the
tail. The pancreas lies between
the stomach and the spine.
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Pancreatic Cancer- Risk Factors
• Smoking: Smoking tobacco is the most important risk factor for
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pancreatic cancer. People who smoke tobacco are more likely
than nonsmokers to develop this disease. Heavy smokers are
most at risk.
Diabetes: People with diabetes are more likely than other
people to develop pancreatic cancer.
Family history: Having a mother, father, sister, or brother
with pancreatic cancer increases the risk of developing the
disease.
Inflammation of the pancreas: Pancreatitis is a painful
inflammation of the pancreas. Having pancreatitis for a long
time may increase the risk of pancreatic cancer.
Obesity: People who are overweight or obese are slightly more
likely than other people to develop pancreatic cancer.
From: www.cancer.gov/cancertopics/wyntk/pancreas/page4
Pancreatic Cancer Symptoms
www.cancer.gov/cancertopics/wyntk/pancreas/page5
Early cancer of the pancreas often doesn’t cause symptoms. When the
cancer grows larger, you may notice one or more of these common
symptoms:
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Dark urine, pale stools, and yellow skin and eyes from jaundice
Pain in the upper part of your belly
Pain in the middle part of your back that doesn’t go away when you shift your
position
Nausea and vomiting
Stools that float in the toilet
Also, advanced cancer may cause these general symptoms:
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Weakness or feeling very tired
Loss of appetite or feelings of fullness
Weight loss for no known reason
These symptoms may be caused by pancreatic cancer or by other health
problems. People with these symptoms should tell their doctor so that
problems can be diagnosed and treated as early as possible.
Pancreatic Cancer Resources
Pancreatic Cancer Action Network - 877-272-6226
www.pancan.org/section-facing-pancreatic-cancer/find-support-resources/
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Connect with other survivors and caregivers
In-person support and networking groups
Telephone support groups
Online support groups
Educational events
Survivor Stories
National Cancer Institute:
www.cancer.gov/cancertopics/types/pancreatic
And Cancer Information Service: www.cancer.gov/aboutnci/cis/page3
800-422-6237
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Cancer Communication
• www.vitaltalk.org
Has resources such as: http://vimeo.com/91963432
Created by:
Anthony Back, MD- (Principal investigator) is Associate Professor
of Medicine at the University of Washington in Seattle. He is Director of the
Program in Cancer Communication at the Seattle Cancer Care Alliance (SCCA)
and Fred Hutchinson Cancer Research Center (FHCRC). He is a board-certified
medical oncologist whose primary research interests are doctor-patient
communication and palliative care, and he practices gastrointestinal oncology.
Dr. Back was a Faculty Scholar on the Project on Death in America and is a
member of the ASCO Communication Task Force. He is the Principal Investigator
the Oncotalk communication skills training program for Medical Oncology fellows
(R25 CA 92055), and is an investigator on other NIH-funded observational studies
of doctor-patient communication about hope and information (R01 PI J.R.
Curtis) and prognosis in hematologic malignancies (R01 P.I. Stephanie Lee).
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Health Education Materials
Native CIRCLE
www.nativeamericanprograms.net/native-circle/
Print/DVD/CD - Topics
• Women’s Health – Breast, GYN,
• General Health and Wellness - Men and Women
• Colon, Stomach and Pancreatic Cancer
• Friend/Family Support and Caregiving and Cancer
• Men’s Health
• Smoking/Smoking Cessation
• Youth
• Diabetes
• Nutrition
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Arthritis
www.cdc.gov/chronicdisease/resources/publications/AAG/arthritis.htm
• Includes more than 100 different rheumatic
diseases and conditions, the most common of
which is osteoarthritis.
• Other forms of arthritis that occur often are
rheumatoid arthritis, lupus, fibromyalgia, and
gout.
• Symptoms include pain, aching, stiffness, and
swelling in or around the joints. Some forms of
arthritis, such as rheumatoid arthritis and
lupus, can affect multiple organs and cause
widespread symptoms.
Arthritis Risk Factors
Sex: Women make up nearly 60% of arthritis cases.
Age: Nearly 60% of the elderly population has arthritis. Risk
increases with age.
Genetic predisposition: Certain genes are known to be
associated with a higher risk of some types of arthritis.
Lyme disease: Approximately 60% of patients with untreated
Lyme disease will develop Lyme arthritis.
Obesity: Obesity is associated with gout in men16 and
osteoarthritis of the knee, hip and hand in women.
Joint injuries: Sports injuries, occupation-related injuries and
repetitive use joint injuries can increase the risk of arthritis.
Occupations such as farming, heavy industry, and occupations
with repetitive motion are associated with arthritis.
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Arthritis across the USA
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Arthritis in Oregon
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Arthritis Resources for Individuals
CDC Arthritis Program Interventions
The Arthritis Toolkit ($43.96)
www.bullpub.com/catalog/the-arthritis-toolkit/
Walk With Ease ($11.95)
www.arthritistoday.org/tools-and-resources/walk-with-ease-program/program.php
Better Choices Better Health® for Arthritis (Free)
• Online only: www.arthritistoday.org/arthritis-self-management-program/
Fitness & Exercise for People with Arthritis ($?)
Susan S. Levy [email protected]
From: http://www.cdc.gov/arthritis/interventions/program_lists.htm
PROGRAM DEVELOPMENT
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Tribal Cancer Action Planning
Cancer Control in Northwest Tribal
Communities
 Prevention
 Screening & Early Detection
 Treatment
 Survivorship
• Rehabilitation
• Palliation
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Cancer Prevention through
Education and Outreach
Women’s Health Example
Objective
Increase the awareness of
women aged 40 and older
about the importance of
annual mammograms.
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Strategy
Develop a community
awareness campaign
Plan a “women’s health
day” to distribute
information about breast
health
Plan an activity in
connection with Breast
Cancer Awareness Month
(October)
Evaluation
Record activities of awareness
campaign·
Record number of persons served at
community health day
Measure awareness of importance
of screening
Survey community for change in
level of awareness of importance of
screening
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Tribal Action Plans
Planning to achieve a specific objective.
Includes:
• Who will conduct each component of the activity
• When actions are to be carried out
• What resources need to be allocated
• What outcomes are anticipated
• What evaluation is needed to determine success
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Sample Tribal Action Plan
Activity: Cancer Mural Walk
Action Steps
Accountability
Primary
Register to Use Park
Jensen Thayer, WA
BCCP
Get Tables for Park
ONCS
Wagon Rental
Jensen Thayer, WA
BCCP
T-Shirts
Pat Ike/ONCS
Cancer Pins/Tape Measures
Jensen Thayer, WA
BCCP
Juice
Ellen
Doublerunner/ONCS
Mural Walk Posters
Others
Schedule
Start
May 7,
2007
Dollars
Feedback
Mechanism
Time
(hrs)
$25
0.3
$195
0.3
$600
8
$50
0.60
Yakama Juice
$108
0.60
Ellen
Doublerunner/ONCS
Yakama Legends
Casino
$200
8
Mural Walk Maps
Jensen Thayer, WA
BCCP
Mural Society
.15
Cancer Literature
Yakama Navigator
ACS
.30
Total
May 7,
2007
Complete
Resources
ACS
WA BCCP
$1,188
18.25
Sign-In
Sheets
Yakama ONCS Mural
Walk/Ride 2005
Successful Strategies for
Developing Partnerships
• Use partnerships to extend resources and
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delivery
Partner with providers and other clinical
staff
Consult with other tribal programs
Partner with state programs for services and
training
Use advisors to provide clinical guidance
and test new ideas
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Partners
Foundations and Non-Profits
American Indian and Alaska Native Organizations
State and Federal Organizations
Contact Information
Northwest Tribal Comprehensive Cancer Program
Kerri Lopez (Tolowa), Project Director
Eric Vinson (Cherokee), Project Coordinator
Tom Becker, MD, PhD, Medical Epidemiologist
Improving Data & Enhancing Access - NW (IDEA-NW) Project
Sujata Joshi, MPH, Project Director
Phone: 503-416-3301
Email: [email protected]
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