Download Maryann Donovan - Markey Cancer Center

Assessing the Catchment Area to Identify
and Pursue Unmet Research Needs
Maryann Donovan, PhD, MPH
Associate Director for Research Administration
University of Pittsburgh Cancer Institute
Changing CCSG Requirements:
Focus is Now on Research, Not Outreach
PAR 11-005
PAR 12-298 and 13-386
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Six Essential Characteristics, Organizational
Capabilities: In addition to research/scientific
questions of broad applicability, [a Center] should
use its available expertise and resources to
address cancer research within the catchment
area.
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Senior Leadership: Discuss how the senior
leaders have worked together to: …Enable a
focus on cancer problems applicable to the
catchment area served by the Center
•
Research Strategy (Research Programs): For
each program briefly discuss the following: … In
addition to questions of broader applicability, and
as appropriate to the type of Program, briefly
describe how the cancer research relevant to the
catchment area is addressed. This may include,
for example, a discussion of research focused on
cancer health disparities (e.g., problems affecting
racial and ethnic minorities, rural residents,
women, children, elderly, persons of low
socioeconomic status), cancer sites of high
incidence/mortality, environmental exposures,
behavioral factors, or other issues.
Stage II, Community Service, Outreach
and Dissemination: … Process for
evaluation of the impact of outreach and
dissemination activities on clinical and public
health systems within the center’s catchment
area
UPCI Outreach Activities
• Community Cancer Screening
Clinics
• Health & Wellness Events
• Cultivation of Community
Navigators for the Medically
Underserved
• Healthcare for the homeless
• Primary Prevention Education
• Healthy Choices for Students
during School Year and Summer
UPCI’s Response to Changing Requirements:
A New Internal Advisory Committee
Committee for Cancer Research in Western PA (CCRwPA)
• Established in 2013 to identify needs and plan and
monitor research
• Meets monthly
• Chaired by the UPCI Director and includes:
─ UPCI Deputy Director
─ UPCI Associate Director for Cancer Control and Population Sciences
─ Leader of UPCI’s Biobehavioral Oncology Program
─ UPCI Associate Director for Health Equity, Education, and Advocacy
─ UPCI Associate Director for Research Administration
• Technical and administrative support provided by PhD
scientists from UPCI’s Office of Research Administration
MCCC Counties
Allegheny
Armstrong
Beaver
Bedford
Blair
Butler
Cambria
Cameron
Centre
Clarion
Clearfield
Craw ford
Elk
Erie
Fayette
Forest
Greene
Huntingdon
ndiana
Jefferson
Law rence
McKean
Mercer
Potter
Somerset
Venango
Warren
Washington
Westmoreland
UPCI’s Catchment Area
29 Western Pennsylvania Counties
(shown in green)
UPMC CancerCenter Network
Sources for Defining the “Cancer Problems”
in UPCI’s Catchment Area
Public Websites:
• NCI-CDC State Cancer Profiles
(http://statecancerprofiles.cancer.gov)
• Pennsylvania Department of Health
• PubMed
Intra-Institutional:
• Department of Environmental and Occupational Health
• Department of Behavioral & Community Health Sciences
• UPMC CancerCenter Registry
Tools on http://statecancerprofiles.cancer.gov
• Demographics
• Screening and Risk
Factors
• Cancer Knowledge
• Prevalence
• Mortality
Tools on http://statecancerprofiles.cancer.gov
Sample Interface on
http://statecancerprofiles.cancer.gov
Age-adjusted Incidence of
All Cancers (2006-2010)
Incidence of Breast Cancer in
African American Women (2006-2010)
Ever Smoking Rate (2000-2003)
Data for Preparing Maps
Lung Cancer Mortality (2006-2010)
Tools on State Department of Health Website
Detailed Maps
Examples of What Was Learned
Highest Incidence Cancers (per 100,000)
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Lung: 17/29 counties > US (65)
Breast: 15/29 counties > US (120)
Colorectal: 27/29 counties > US (44)
Prostate: 16/29 counties > US (144)
Cancer Risk Factors
• Smoking prevalence: 22/29counties > US (19.0%)
• Obesity: 27/29 counties > US (27.9%)
• Aging (> 65 years): 29/29 counties > US (13.0%)
Cancer Problem: Smoking-related Lung Cancer
Smoking is the causative factor in approximately 90% and 80% of lung cancer deaths in men and women,
respectively. In 22 of the 29 counties in UPCI’s catchment area, smoking prevalence is higher than the U.S.
average. Lung and bronchus cancer mortality is higher than the national average in 19 of the counties.
LCP: Pittsburgh Lung Screening Study (PLuSS)
• Screened 3,642 smokers with low-dose CT in western PA and found 275
lung cancer cases (36% early stage)
• Resource for biomarker discovery and validation for early detection
• Supported by Lung Cancer SPORE
→ Contributed to new USPSTF Screening Guidelines
Ever Smoking Rate (2000-2003)
Cancer Biomark, 2011; J Thorac Oncol, 2011; J Thorac Oncol, 2012; Clin Proteomics, 2014
BOP: Regulated Reduction of Cigarette Nicotine Content
Lung Cancer Incidence (2006-2010)
Nic Tob Res, 2013, 2014
BOP: Strategies to Avoid Returning to Smoking (STARTS)
• Randomized clinical trial of an intensive support program to prevent postpartum smoking relapse through cognitive-biobehavioral techniques
focused on mood, stress, and weight
• 300 local women (target of 40% African American) who stop smoking
for at least 1 month during pregnancy
Lung Cancer Mortality (2006-2010)
Cancer Problem: Using the UPMC Network to
Reduce Melanoma Mortality by Early Detection
MP: Primary Care Physicians
Taught Melanoma Screening
Melanoma Incidence (2006-2010)
• 2014: Trained >500 primary care clinicians throughout the
network via UPMC uLearn CME system
• Target: 86,000 patients ≥ 35 years will be screened
 50,000 screened in first 8 months
• Research Plan: Thickness-specific melanoma incidence
and mortality will be compared for screened group vs.
overall thickness-specific incidence in an 18-county area
Cancer Problem: HPV+ Cancers
HNCP: Extent of regional increase in HPV+ head and neck cancer over the last 50 years
• HPV P16 staining of oropharyngeal squamous cell carcinomas tissue blocks from
UPMC pathology archives from 1956-1969 (n=43) vs. 2007-2009 (n=53) revealed
an increase in the proportion of HPV+ cases (from 35% to 72%)
Hum Pathol, 2012
CEPP: Quality of life in 177 UPMC CancerCenter patients with HPV+ head and neck
cancer
• HPV16+ head and neck cancer patients have better overall quality of life (both
before and after treatment)
Laryngoscope, 2014
BOP: Knowledge and health behaviors related to HPV infection
• Assessing knowledge of HPV infection and prevention measures and
documenting health and personal behaviors of individuals in underserved areas
• Implementing low-literacy educational sessions about HPV
• Partnering with Jewish Healthcare Foundation to increase HPV vaccination rates
Cancer Problem: Care and Survival
Disparities in African American Patients
CEPP: Race-based Disparities in Head and Neck Cancer Survival
• African Americans are more likely than Whites to be diagnosed with late
stages of oral cavity and laryngeal cancer
• African American patients with laryngeal cancer, showed a significant
difference in relapse-free survival
Head and Neck, 2011
BOP/BOCP: Attitudes, Communication, Treatment, and Support (ACT)
• Intervention led by an African American breast
cancer survivor
• Improved initiation of chemotherapy, adherence,
and completion of total dose
Oncology Nurses Forum, 2011
ACT Intervention Wins a
2014 Pittsburgh YMCA Racial Justice Award
BOP: Accountability for Cancer Care through Undoing Racism and Equity
(ACCURE)
• Collaboration with University of North Carolina
• Intervention to improve completion of treatment for early stage breast/lung
• 138/150 patients enrolled in Pittsburgh (31% African American)
Committee for Cancer Research in Western PA at
Work: Planning New Research Initiatives
BRAINSTORMING
SESSIONS
PILOT FUNDING
OPPORTUNITIES
Mitochondria, Aging and Metabolism
Request for Pilot Proposals 2014-2015
NEW
COLLABORATIONS