Cancer Survivorship Research-The Public Health and PopulationBased ApproachAndrea (Andi) Dwyer, Program DirectorCancer Prevention and Control Research NetworkUniversity of Colorado Center
Bench to BedsideBasic Preclinical Translational Clinical Dissemination Adoption Research Research ResearchManyIdeas Population Affected by Cancer
Cancer Prevention & Control Research Network• The CPCRN was initiated in October 2002, with funding from the Centers for Disease Control and Prevention (CDC) & National Cancer Institute (NCI)• It is a thematic research network of the CDC Prevention Research Centers (PRCs)• The mission of CPCRN is to accelerate the adoption, implementation, translation, and dissemination of evidence-based cancer prevention/control strategies• Several workgroups; Marcia Ory-Texas, Betsy Risendal and Andrea Dwyer Survivorship Workgroup co-chairs-Colorado
Examples of Public Healthand Population BasedSurvivorship Research1. Transitioning from active cancer treatment to survivorship2. Managing long term cancer symptoms and side effects in the community3. Registry of colorectal cancer survivors
A Novel Primary Care CLINICAL Group Visit Intervention for Cancer Survivors: What Is Next (WIN)
WIN Pilot Series Results• Group visit model provides strategy to focus on targeted health behaviors• Group visits are feasible and acceptable to survivors (and caregivers)-80% Retention• Engages primary care providers/practices into survivorship phase of care• Dissemination planned to other areas/clinic sites• Improvements in physical activity, nutrition and communication with providers and family
Cancer-Thriving and Surviving (CTS) Wait-Listed Randomized Control Trial1. Self-management is one of the few evidence-based strategies for self- management support is the Chronic Disease Self-Management Program (CDSMP).2. The CDSMP is a six week, NOT MEDICALLY BASED - community-led, high fidelity group problem-solving/ educational intervention delivered through trained peer leaders (Stanford Patient Education Center).Research Goal:1. Describe the adaptations made to the CDSMP for the CancerThriving and Surviving Program, and evaluate the perceivedsatisfaction and utility of these adaptations among survivors. 2. Demonstrate the feasibility/ acceptability of the deliveryand evaluation of the Cancer Thriving and Surviving Program
Recruitment Goal: 300 peopleCurriculum Revision Achievement: 323!!! What It Took: 2 Years (6 months longer than planned) • Community partner who actively recruited for trial at $70,000 • Television-Radio and Newspaper • Flyer distribution and outreach at physician offices and treatment centers Interim Results: • Improvements in Outcomes (pending as not final analysis) • Able to reach recruitment goals • 15% Colorectal Cancer Survivors
*Family Cancer Registries *Cancer is a reportable disease and in most US States Tumor Registries are funded by CDC• Colon Cancer Family Registry (CCFR)• Cancer Genetics Network (CGN)• Rare Cancer Genetics Registry (RCGR) • NCI-funded • Multi-institutional • Population and clinic-based recruitment • Central data collection • Multiple Outcomes • Long-term follow-up • Consent for re-contact • Goal: facilitate research
Colon Cancer Family Registries Table 6. Survey Data Collected by Participant TypeSince 1997 Participant Type Baseline 5-yr follow-up 10-yr follow-up survey (to date)* (to date)*• 35,300 enrolled – 12 centers• 10,225 families Colorectal Cancer 11,635 6,233 (7,224) 2,539 (2,973)• Status: long-term follow-up Sub-cohort Other Cancer Sub- 3,629 2,361 (2,805) 992 (1,062)Data available cohort• Family cancer history Unaffected Sub- 20,033 13,370 (16,048) 4,726 (6,077) cohort• Risk factors – diet, exercise, hormone use, alcohol, screening TOTAL 35,297 21,964 (26,077) 8,257 (10,112) history, NSAIDs• Clinical data – tumor stage, grade, histology• Biospecimens – blood, tumor – MSI, IHC, methylation, BRAF, MMR sequencing
As An Advocate…• Find a Trial• Join a Trial• Spread the Word• Research Does NOT Stop after Treatment Agencies and Organizations to Contact for Population and Public Health- Survivorship Research LIVESTRONG: Programs and Partnerships www.livestrong.org NCI: Office of Cancer Survivorship www.dccps.nci.nih.gov ACS: Survivorship Trials and Behavioral Research www.cancer.org Community Cancer Centers-Research http://ncccp.cancer.gov NCI Designated Cancer Centers http://www.cancer.gov
What Does a Budget Cut Mean... Does Even A 10% Cut Make a Difference? Total CPCRN Budget $300K CCFR Funding Was Decreased for the Colon Cancer Family Minus 10%=$270K Registry Project During Biggest Phase of Reaching Rural Communities in $30,000 Less Colorado – this impactedrepresentation of populations. Research Assistant time reduced from 100% to 40% CTS Wait List Opportunity Might Not Be WIN Program Possible in CTS halted for several months-was Trial…Changing the only survivorship program Research Design available at time at University of Colorado Cancer Center
Opportunities… Patient Protection and Affordable Care Act• Better accessibility to health care• Person centered care-improved coordination• Emphasis on primary care• Greater Attention to Survivorship The Message!• There are nearly 13 million Cancer Survivors in the United States… • Survivorship Research and Improving Care is vital for the health of our nation!
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