Maryland Comprehensive Cancer Control Plan


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Maryland Comprehensive Cancer Control Plan

  1. 1. Maryland Comprehensive Cancer Control Plan Oral Cavity and Oropharyngeal Cancer Prevention Committee
  2. 2. Methods <ul><li>Examined issues </li></ul><ul><li>Reviewed data </li></ul><ul><li>Identified problems and solutions </li></ul><ul><li>Developed flow chart </li></ul>
  3. 3. Risk Factors <ul><li>Tobacco </li></ul><ul><ul><li>Cigarettes </li></ul></ul><ul><ul><li>Cigars </li></ul></ul><ul><ul><li>Snuff </li></ul></ul><ul><ul><li>Spit tobacco </li></ul></ul><ul><ul><li>Pipes </li></ul></ul><ul><li>Alcohol </li></ul><ul><li>Sunlight – lip cancer </li></ul><ul><li>Lack of fruits and vegetables </li></ul><ul><li>Viruses – e.g., Human papilloma virus </li></ul>
  4. 4. The Problem
  5. 5. Oral Cancer in Maryland <ul><li>Maryland ranks 8th in mortality among all states </li></ul><ul><li>6th highest mortality rate in the US for African American men </li></ul><ul><li>5-year survival rate in Maryland for African Americans is 33% (whites - 55%) </li></ul><ul><li>Nearly a 15% higher death rate from oral cancer in Maryland than the US </li></ul><ul><li>Ries et. al. SEER Cancer Statistics review, 1973-1996 </li></ul>
  6. 6. Oral Cancer Mortality Rates Maryland
  7. 7. HP 2010 Oral Cancer Objectives <ul><li>Objective 21-6 – Oral Cancer Staging </li></ul><ul><li>Increase the proportion of oral and pharyngeal cancers detected at the earliest stage </li></ul><ul><ul><li>Target: 50 percent </li></ul></ul><ul><ul><li>Baseline: 35 percent of oral and pharyngeal cancers (stage I, local ) </li></ul></ul><ul><li>Objective 21-7 – Oral Cancer Examinations </li></ul><ul><li>Increase the proportion of adults who, in the past 12 months, report having an examination for oral and pharyngeal cancers </li></ul><ul><ul><li>Target: 20 percent </li></ul></ul><ul><ul><li>Baseline: 13 percent of adults aged 40 years and older </li></ul></ul><ul><li>Objective 3-6 - Oral Cancer Mortality Rate </li></ul><ul><li>Reduce the oral and pharyngeal cancer death rate </li></ul><ul><ul><li>Target: 2.7 deaths per 100,000 population </li></ul></ul><ul><ul><li>Baseline: 3.0 deaths per 100,000 population in 1998 (age adjusted to the year 2000 standard population) </li></ul></ul>
  8. 8. Oral Cancer Stage 1 Diagnosis Maryland
  9. 9. Oral Cancer Prevention The Maryland State Model <ul><li>Phase I - Needs Assessment </li></ul><ul><li>Phase II - Development and Pilot Testing of Educational Interventions </li></ul><ul><li>Phase III - Program Evaluation </li></ul>
  10. 10. Oral Cavity and Oropharyngeal Cancer Prevention Committee Proceedings and Recommendations
  11. 11. Oral Cancer Early Detection and Diagnosis <ul><li>Access to dental services disparity </li></ul><ul><ul><li>Limited for those populations at highest risk </li></ul></ul><ul><ul><ul><li>Poor </li></ul></ul></ul><ul><ul><ul><li>Adults </li></ul></ul></ul><ul><ul><ul><li>Older adults </li></ul></ul></ul><ul><li>More likely to visit a physician, family nurse practitioner or physician’s assistant than dentist </li></ul><ul><li>Oral cancer examination responsibility of all health care practitioners </li></ul>
  12. 12. Addressing Oral Cancer Prevention Main Issues <ul><li>Lack of oral cancer literacy </li></ul><ul><ul><ul><li>Awareness </li></ul></ul></ul><ul><ul><ul><li>Behavior </li></ul></ul></ul><ul><li>Disparities </li></ul><ul><ul><ul><li>Education and awareness </li></ul></ul></ul><ul><ul><ul><li>Mortality </li></ul></ul></ul><ul><ul><ul><li>Survival </li></ul></ul></ul><ul><ul><ul><li>Access </li></ul></ul></ul>
  13. 13. Addressing Oral Cancer Prevention Main Focus <ul><li>Direct oral cancer literacy for: </li></ul><ul><ul><li>Public </li></ul></ul><ul><ul><li>Healthcare Providers </li></ul></ul><ul><ul><li>Media </li></ul></ul><ul><ul><li>Policy Makers </li></ul></ul><ul><li>Address disparities </li></ul><ul><ul><li>Intertwined with lack of literacy </li></ul></ul><ul><ul><li>Access to services </li></ul></ul>
  14. 14. Oral Cancer Literacy What Everyone Needs to Know <ul><li>Public, health care providers, policymakers and media </li></ul><ul><ul><li>Risk assessment and risk reduction </li></ul></ul><ul><ul><li>Risk factors </li></ul></ul><ul><ul><li>Signs and symptoms </li></ul></ul><ul><ul><li>Behavior modification </li></ul></ul><ul><ul><ul><li>Public to request oral cancer examination </li></ul></ul></ul><ul><ul><ul><li>Providers to incorporate adequate oral cancer examination into standard of care </li></ul></ul></ul><ul><ul><li>Adequacy of oral cancer examination </li></ul></ul><ul><ul><li>Frequency of oral cancer examination </li></ul></ul>
  15. 15. Public <ul><li>Educational interventions </li></ul><ul><ul><li>Schools </li></ul></ul><ul><ul><li>Workplace </li></ul></ul><ul><ul><li>Hospitals </li></ul></ul><ul><ul><li>Faith-based institutions </li></ul></ul><ul><ul><li>Recreational and sports organizations </li></ul></ul><ul><li>Develop messages targeted to different needs and values of the community </li></ul><ul><ul><li>Those engaged in risk behaviors </li></ul></ul><ul><ul><li>Those not engaged in risk behaviors </li></ul></ul><ul><ul><li>Culturally appropriate </li></ul></ul><ul><ul><li>Age and gender appropriate </li></ul></ul><ul><li>Literacy to lead to use of appropriate screening, referral, follow-up & treatment services </li></ul>
  16. 16. Healthcare Providers <ul><li>Provider education specific to primary care providers (PCP) and dental health professionals </li></ul><ul><ul><li>No dental coverage for Maryland adults under Medicaid </li></ul></ul><ul><ul><li>Medicare does not cover dental services </li></ul></ul><ul><ul><li>Maryland adults have medical coverage under Medicaid and Medicare and will visit PCP </li></ul></ul><ul><li>Curriculum Change </li></ul><ul><ul><li>Make oral cancer exams part of standard of care and practice for all health care providers </li></ul></ul><ul><li>CME/CEUs </li></ul><ul><li>Lead to appropriate screening, referral, treatment and follow-up services </li></ul>
  17. 17. Media <ul><li>Plays key role in increasing awareness of both healthcare providers and the public </li></ul><ul><li>Immediate access to mass population </li></ul><ul><li>Public service announcements </li></ul><ul><li>Paid advertisements </li></ul><ul><li>Explore what is the best form of communication to reach specific communities </li></ul><ul><ul><li>Talk radio </li></ul></ul><ul><ul><li>Television </li></ul></ul><ul><ul><li>Print </li></ul></ul>
  18. 18. Policy Makers <ul><li>Education targeted to policy makers and advocates </li></ul><ul><li>Issues to be addressed: </li></ul><ul><ul><li>Coverage of medically necessary dental procedures </li></ul></ul><ul><ul><li>Mandating CME/CEU in oral cancer prevention for re-licensure (model after CPR) </li></ul></ul><ul><ul><li>Uniform dental coverage for Medicaid adults </li></ul></ul><ul><ul><li>Management of uninsured/undocumented individuals </li></ul></ul><ul><ul><li>Funding for research such as practice patterns (PCP v. Dental), screening effectiveness and evaluation of existing programs </li></ul></ul><ul><ul><li>Continuation of existing programs targeted towards oral cancer (i.e., Office of Oral Health program) </li></ul></ul><ul><ul><li>Oral cancer competency module for medical and dental licensure </li></ul></ul>
  19. 19. Oral Cancer Literacy Provider* <ul><li>Funding for Research </li></ul><ul><li>Covering of medically necessary dental procedures </li></ul><ul><li>Uniform adult dental coverage that includes preventive services as well as emergency care </li></ul><ul><li>Management/incorporation uninsured and undocumented populations </li></ul><ul><li>CME/CEU </li></ul><ul><li>Medical & Dental Board Licensure and Re-licensure </li></ul><ul><li>Oral Cancer Competency Module on Licensure Exams </li></ul>Provider Education PCP Dental Health Professionals Curriculum Change CME/CEUs Curriculum Change CME/CEUs Use and provide appropriate screening, referral, follow-up, and treatment Educational interventions, such as: Schools/agencies, Workplace, Hospitals, Faith-based institutions, Service organizations, Sports and recreation, Website Government, Providers <ul><li>*What everyone needs to know: </li></ul><ul><li>Risk assessment and risk reduction </li></ul><ul><li>Risk factors </li></ul><ul><li>Signs and symptoms </li></ul><ul><li>Oral cancer exam- steps </li></ul><ul><li>Frequency of oral cancer exam </li></ul>Awareness Oral Cancer Prevention, Early Detection, and Treatment Model Public* Media* Policy Makers*
  20. 20. Disparities <ul><li>Main issues </li></ul><ul><ul><li>Lack of access </li></ul></ul><ul><ul><li>Lack of oral health literacy </li></ul></ul><ul><li>Ultimate Goal </li></ul><ul><ul><li>Reduce disparities in oral cancer mortality and morbidity </li></ul></ul>
  21. 21. Oral Cavity and Oropharyngeal Prevention Committee Members Thank You! <ul><li>Albert Bedell, PhD - Maryland Academy of General Dentistry </li></ul><ul><li>Joe Califano, MD - Johns Hopkins Dept. of Otolaryngology- Head and Neck Surgery </li></ul><ul><li>Catherine Carroll, CRNP - Chase Brexton Health Services, Inc. </li></ul><ul><li>Harry Goodman, DMD - University of Maryland Dental School </li></ul><ul><li>Alice M. Horowitz, PhD – National Institute of Dental and Craniofacial Research </li></ul><ul><li>Robert D. Jones, DDS - Maryland Association of Community Dental Programs and Maryland State Dental Association </li></ul><ul><li>Fred Magaziner, DDS - American Academy of General Dentistry and American College of Dentists </li></ul><ul><li>Ilise Marrazzo, MPH (Chairperson) – Dept. Health and Mental Hygiene, Office of Oral Health </li></ul><ul><li>Kelly Sage, MS – Dept. Health and Mental Hygiene, Office of Oral Health </li></ul><ul><li>Yale Stenzler, EdD - Oral Cancer Survivor </li></ul><ul><li>Sheryl L. Ernest Syme, RDH, MS - Maryland Dental Hygienists' Association </li></ul><ul><li>Rodney Taylor, MD - University of Maryland Department of Otolaryngology </li></ul><ul><li>Brooks Woodward, DDS - Chase Brexton Health Services, Inc. </li></ul><ul><li>David Zauche - American Cancer Society </li></ul>
  22. 22. Questions?