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The Prostate Cancer Continuum. The Changing Face of Disparity: Taking Health into Our Own Hands. The real voyage of discovery consists not in seeking new landscapes but in having new eyes. - Marcel Proust. Pca is a Global Concern. - PowerPoint PPT Presentation
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The Prostate Cancer Continuum
The Prostate Cancer Continuum
The Changing Face of Disparity:
Taking Health into Our Own Hands
The Changing Face of Disparity:
Taking Health into Our Own Hands
The real voyage of discovery consists not in seeking new
landscapes but in having new eyes.
The real voyage of discovery consists not in seeking new
landscapes but in having new eyes.- Marcel Proust- Marcel Proust
Pca is a Global ConcernPca is a Global Concern•Highest incidence of male cancer in
U.S.; 2nd greatest cause of death; declining overall but increasing in minority populations(2)
•#1 diagnosed cancer in Europe; deaths have increased by 16% since 1995(1) ”despite widespread use of PSA testing...”
• Sources: (1) World Health Organization; (2) American Cancer Society
•Highest incidence of male cancer in U.S.; 2nd greatest cause of death; declining overall but increasing in minority populations(2)
•#1 diagnosed cancer in Europe; deaths have increased by 16% since 1995(1) ”despite widespread use of PSA testing...”
• Sources: (1) World Health Organization; (2) American Cancer Society
Why We Must Be ConcernedWhy We Must Be Concerned
1 in every 6 men get Prostate Cancer 1 in every 4 Black men get Prostate Cancer Latinos have the 3rd highest incidence rate Blacks and Latinos are diagnosed at advanced disease
stages at a 144% greater rate than whites The 5 year survival rate for Blacks and Latinos is
worse than for whites and getting worse Black men die at a rate 240% higher than whites
1 in every 6 men get Prostate Cancer 1 in every 4 Black men get Prostate Cancer Latinos have the 3rd highest incidence rate Blacks and Latinos are diagnosed at advanced disease
stages at a 144% greater rate than whites The 5 year survival rate for Blacks and Latinos is
worse than for whites and getting worse Black men die at a rate 240% higher than whites
National Healthcare Quality Report - 2007
National Healthcare Quality Report - 2007
•“Preventive healthcare lags significantly behind other gains in healthcare.”
•Access to care and information varied widely between racial/ethnic groups and by socio-economic status
• Source: www.ahrq.gov
•“Preventive healthcare lags significantly behind other gains in healthcare.”
•Access to care and information varied widely between racial/ethnic groups and by socio-economic status
• Source: www.ahrq.gov
Healthcare Costs represent an increasing % of GDP
- $650B more for Cancer Treatment
Healthcare Costs represent an increasing % of GDP
- $650B more for Cancer Treatment
U.S. - World’s Best Medical Care?- New York Times, 12 August 2007
U.S. - World’s Best Medical Care?- New York Times, 12 August 2007
• 37th in W.H.O. health system performance (France #1, Italy #2)
• Last in overall quality: lack of coordination of care/access for preventive and critically ill
• Only major industrialized country without universal health coverage
• Life expectancies near the bottom of other industrialized nations
• Worst Infant Mortality stats of any developed nation• Sources: Commonwealth Fund, Centers for Disease Control, W.H.O.
• 37th in W.H.O. health system performance (France #1, Italy #2)
• Last in overall quality: lack of coordination of care/access for preventive and critically ill
• Only major industrialized country without universal health coverage
• Life expectancies near the bottom of other industrialized nations
• Worst Infant Mortality stats of any developed nation• Sources: Commonwealth Fund, Centers for Disease Control, W.H.O.
Exacerbating the ProblemExacerbating the Problem
• Increasing employee cost burden
• Regulations on employers => increasing costs => decreasing competitiveness
• Insurance compensation standards
• Medicare reimbursement changes
• Increasing employee cost burden
• Regulations on employers => increasing costs => decreasing competitiveness
• Insurance compensation standards
• Medicare reimbursement changes
American Cancer Society Disparity Study - 2007
American Cancer Society Disparity Study - 2007
•Cancer patients with private insurance are much more likely to be diagnosed early, increasing their long-term survival
•Those uninsured patients or those with Government insurance are more likely to be diagnosed with advanced stage disease at first treatment
•Cancer patients with private insurance are much more likely to be diagnosed early, increasing their long-term survival
•Those uninsured patients or those with Government insurance are more likely to be diagnosed with advanced stage disease at first treatment
“Baby Boom” Impact“Baby Boom” Impact
Estimated Per Capita Health ExpendituresEstimated Per Capita Health Expendituresby Age and Sex, 1995by Age and Sex, 1995
Service Provider ImpactService Provider Impact
•Continuing nurse shortage
•Resistance to greater use of nurse practitioners
•Decline in doctors entering into Primary Care Medicine
•Resistance to “Convenient Care” clinics
•Continuing nurse shortage
•Resistance to greater use of nurse practitioners
•Decline in doctors entering into Primary Care Medicine
•Resistance to “Convenient Care” clinics
Population ImpactsPopulation Impacts 12 million cancer survivors alive in the U.S.
today 3 out of 4 American families will have a family
member diagnosed with cancer 25% of American families living with cancer
have children under the age of 18 living at home More than 28% of children in America will be
living in poor households
Sources: American Cancer Society, Institute of Medicine, World Health Organization, The Policy Press
12 million cancer survivors alive in the U.S. today
3 out of 4 American families will have a family member diagnosed with cancer
25% of American families living with cancer have children under the age of 18 living at home
More than 28% of children in America will be living in poor households
Sources: American Cancer Society, Institute of Medicine, World Health Organization, The Policy Press
Treatment ImpactTreatment Impact
Skeletal impacts of ADT Cardiovascular issues related to hormone therapy Conflicting preventive therapeutic recommendations
SELECT Finasteride PLCO Study
Emerging technologies with minimal curative benefit Positive benefit of drug therapies
Targeted disease management
Skeletal impacts of ADT Cardiovascular issues related to hormone therapy Conflicting preventive therapeutic recommendations
SELECT Finasteride PLCO Study
Emerging technologies with minimal curative benefit Positive benefit of drug therapies
Targeted disease management
Lifestyle ImpactLifestyle Impact
Meat becoming more popular in diets globally 10.4% in the U.S. 25% more in Korea 49.7% in China >2% in India
Higher birth weights in emerging countries strong cancer association
Sources: Food & Agriculture Organization of the United Nations, AICR
Meat becoming more popular in diets globally 10.4% in the U.S. 25% more in Korea 49.7% in China >2% in India
Higher birth weights in emerging countries strong cancer association
Sources: Food & Agriculture Organization of the United Nations, AICR
Business of Medicine Business of Medicine
The System often has other issues: Equipment investment Revenue production Pharmaceutical alliances Pay-for-Performance
Patients MUST become their own advocates
The System often has other issues: Equipment investment Revenue production Pharmaceutical alliances Pay-for-Performance
Patients MUST become their own advocates
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Complicating the IssueComplicating the Issue
Women vs. Men Comparable incidence and mortality Research funds - 3X for breast cancer Public health staffing - inconsistent Government commitment - no agencies Media focus - inordinately female focus Men don’t communicate
Women vs. Men Comparable incidence and mortality Research funds - 3X for breast cancer Public health staffing - inconsistent Government commitment - no agencies Media focus - inordinately female focus Men don’t communicate
Why Prostate Cancer Prevention?Why Prostate Cancer Prevention?
Significant public health risk
186,000 new cases and 29,000 deaths yearly (2008)
Risk factors (age, race, genes) are not modifiable
Benefit of screening on mortality is controversial
Therapy is associated with morbidity
That Leaves Prevention
Significant public health risk
186,000 new cases and 29,000 deaths yearly (2008)
Risk factors (age, race, genes) are not modifiable
Benefit of screening on mortality is controversial
Therapy is associated with morbidity
That Leaves Prevention
Phase III Chemoprevention TrialsPhase III Chemoprevention Trials
RRR = 22.5% RRR = 23.5%
PCPT REDUCEREDUCE
5ARIs for Biochemical Recurrence5ARIs for Biochemical Recurrence
Andriole et al, Urology 45:491, 1995
PCPT and REDUCEWhat did we learn?
PCPT and REDUCEWhat did we learn?
Consistency of effect Similar magnitude of risk reduction across all
risk groups No longer any grade issues
Conclusion Use of 5-alpha reductase inhibitors is an effective
primary prevention strategy
Consistency of effect Similar magnitude of risk reduction across all
risk groups No longer any grade issues
Conclusion Use of 5-alpha reductase inhibitors is an effective
primary prevention strategy
Healthcare DisparityHealthcare Disparity
•Disaffected classes• racial/ethnic minorities• high risk populations
•Socio-economic impact• lack of/limited insurance• breaking the “social contract”
•Equal Access:• education• preventive mechanisms• care
•Disaffected classes• racial/ethnic minorities• high risk populations
•Socio-economic impact• lack of/limited insurance• breaking the “social contract”
•Equal Access:• education• preventive mechanisms• care
Moving the Bar Forward:
Success Stories and Templates for Change
Moving the Bar Forward:
Success Stories and Templates for Change
Technology for ChangeTechnology for Change
71% of the people in North America are online 113 million Americans seek health information
online Almost half of adult users and 84% of teens will
be on social sites 40% of self-classified “non-users” became direct
or indirect users after a cancer diagnosis Sources: Internet World Stats, Pew Internet & American
Life Project
71% of the people in North America are online 113 million Americans seek health information
online Almost half of adult users and 84% of teens will
be on social sites 40% of self-classified “non-users” became direct
or indirect users after a cancer diagnosis Sources: Internet World Stats, Pew Internet & American
Life Project
Social Network IntegrationSocial Network Integration
Credible peer-to-peer communications “New” Prostate Cancer Infolink “Pints for Prostate” Prostate Cancer Internet Alliance FaceBook
Credible peer-to-peer communications “New” Prostate Cancer Infolink “Pints for Prostate” Prostate Cancer Internet Alliance FaceBook
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Este sitio se ha producido con la ayuda de la familia de Roberto "Tito" Warat y una concesión educativa de la oncología
de Sanofi-Aventis
Opciones de TratamientoInvestigación TraslacionalToma de Decisión InformadaHormonasGleason 7: ¿Una Nueva Categoría de Riesgo?DiagnósticosTerapia Citotóxica¿Está considerando un Ensayo Clínico?QuimioterapiaMedicina Alternativa / ComplementariaEspera AlertaTerapias de AtaqueSoluciones QuirúrgicasManejo de Efectos ColateralesSoluciones Oncológicas de la RadiaciónCuidado PaliativoManejo del DolorFuentes de InformaciónServicios de asistencia pacientes
Reinforcing the MessageReinforcing the Message
“In The Know” newsletter Hard Copy - 29M circulation Online supplement - > 100M Broad spectrum content Audience diversification
consumers/patients advocates professionals researchers international
“In The Know” newsletter Hard Copy - 29M circulation Online supplement - > 100M Broad spectrum content Audience diversification
consumers/patients advocates professionals researchers international
Media SyndicationMedia Syndication
Mass impressions Minimal cost Increase reach
Mass impressions Minimal cost Increase reach
PodCasting for Health
•Reinforce the print message
•Portability for consumers
•Viability for diverse situations:•personal•public health•clinical•research
Cell Casting for Health
•Enhanced consumer interactivity
•Opt-in network
1.877.2CHECKNOW
•Customized content
•Applications for:cliniciansresearcherspublic health
Going to the Barbershop: Going to the Barbershop: Empowering Communities Through Empowering Communities Through
Risk CommunicationRisk Communication
Barbershop based Health Awareness Initiative
Barbershop based Health Awareness Initiative
Project BHAI (Brother): 48 shops in Jharkhand and Orissa Provinces - India cancer prevention and tobacco control
enhance knowledge enhance healthy behavior create a sustainable environment build on existing networks and partnerships expand to co-morbid disease
Project BHAI (Brother): 48 shops in Jharkhand and Orissa Provinces - India cancer prevention and tobacco control
enhance knowledge enhance healthy behavior create a sustainable environment build on existing networks and partnerships expand to co-morbid disease
Research PartnershipsResearch Partnerships
Creating a New NetworkCreating a New Network
The Prostate Net
Core Distribution:80,000+ Website visits/month
1,200 Patient Support Group Leaders1,000+ Public Health Workers
~ 6,000 Medical Oncologists> 4,000 Urological Specialists> 2,000 Cancer Researchers
Sponsors
National Ass’n. of Barber Boards
of America~ 200,000 Barbers
ParticipatingMedical/Research
Centers> 300
American/National MedicalAss’ns.
> 5,000 Doctors
Community
Create HeroesCreate Heroes Meet James He came to a Health Fair On HIS BIRTHDAY!! To give himself The Gift
of Life!!
Meet James He came to a Health Fair On HIS BIRTHDAY!! To give himself The Gift
of Life!!
•Warren brought his son to a Pca screening•To educate him about being responsible for his health
•Warren brought his son to a Pca screening•To educate him about being responsible for his health
Why is all this needed?!Why is all this needed?!To Eliminate the Suffering and Death from To Eliminate the Suffering and Death from
CancerCancer
“If You’re Not the Lead Dog, the View Never Changes”
- Mike Ditka
