where do we go from here?

Lisa C. Richardson, MD, MPHDirector, Division of Cancer Prevention and Control,

Centers for Disease Control and Prevention

Where Do We Go From Here?

Michigan Cancer ConsortiumNovember 9, 2016

All slides in this presentation are the property of the presenter. Please do not duplicate slides without the written permission of the presenter.

The Golden Circle

Simon Sinek, 2009 TedTalkAll slides in this presentation are the property of the presenter. Please do not duplicate slides without the written permission of the presenter.

CDC’s Cancer Prevention and Control Appropriations

CANCERREGISTRIES

OVARIAN & JOHANNA’S

BREAST CANCER IN YOUNGWOMEN

COMPREHENSIVECANCER

PROSTATE BREAST AND CERVICAL

CANCERSURVIVORSHIP and

SKIN CANCER

COLORECTAL

What Is Driving the Future?

Health MarketTransformation

Growth of Exponential Technology

Changes in Populations and Cancers

Consumer Preferences and Expectations

Kaiser Family Foundation (2016); Deloitte Healthcare Convergence (2015); Deloitte Healthcare Consumer Engagement (2015); Deloitte Healthcare Current (2015); Deloitte Global Mobile Consumer Survey (2015); CDC (2015); Congressional Budget Office (2015)

Why CDC for Cancer Prevention and Control?

Uniquely Positioned toDrive Outcomes

Translation and Evaluation

Partnerships

Our Guiding Principles

Address Health DisparitiesConsider populations facing health inequities and how to reach them and improve their outcomes. Who might get left out of a program? How do we address and overcome barriers?

Define Expected Outcomes UpfrontConsider the purpose and expected outcomes during the initial planning phases. How will you know when you’ve been successful? What data do we need and how will we get it?

Collaborate Consider each partner’s strengths, capabilities, and assets as they relate to the strategic priorities. How might they add value to the work? How might they derive value from it?

Communicate: Tailor to a Specific Audience Consider who is the recipient of the work and who is impacted by the messaging. What do they value? How do they receive and use information?

CDC has an active and growing presence on social mediaSharing the message about Cancer Prevention and Control

15,665The CDC Breast Cancer

Facebook page received more than 15k likes since

August 2014.

@CDC_Cancer has more than 90k followers and is averaging more than 1k new followers a month.

7.9M+In 2016, CDC Cancer’s web

pages had more than 14.9 million page views from

4 million unique visitors.

4,850+CDC Breast Cancer’s

Pinterest Board has more than 95 pins and more

than 4.8k followers.

1.4MThe 85 videos on the cancer playlist have been viewed

more than 5.6 million times.

91,000

CDC’s Cancer Aspirations and Strategic Priorities

• Reduce incidence of vaccine-preventable cancers by promoting system and policy changes

Elimination of preventable cancers

• Increase the impact and return on investment (ROI) of screening programs, and scale screening best practices within and beyond DCPC

All people get the right screening at the right

• Improve the integration of clinical and public health data to support data-driven decisions by providers and state health department

People have the best possible cancer care

and outcomes

• Improve health outcomes for cancer survivors through the execution of a unified survivorship agenda

Cancer survivors live longer, healthier lives

CDC’s Framework and Priorities

• Elimination of preventable cancers

• All people get the right screening at the right time

• People have the best possible cancer care and outcomes

• Cancer survivors live longer, healthier lives

Why DCPC?• Existing collaboration with NCIRD, NCHHSTP, and NCEZID• Enables powerful data-driven insights, reinforces messaging, and expands reach• Every Branch and OD are already working in this space, and with a more

coordinated approach, progress can be accelerated and impact can be greater • Currently fund National HPV Roundtables for ACS

• Reduce incidence of vaccine-preventable cancers by promoting system and policy changes

Elimination of preventable cancers

HPV & COMPREHENSIVE CANCER CONTROL DCPC-NCIRD CoAgImproving HPV Vaccination Rates Together (HPV Roundtable)

NCI Supplemental HPV FundingUp to $2.7 Million for 18 Cancer Centers

Skin Cancer Prevention

From 2009-2015, 1.3 million fewer teenagers reported using indoor tanning devices.

Why DCPC?• Unique role and long history of funding and delivering impactful, national-level

screening programs• Established programming expertise and partner networks and relationships• Cadre of economists and evaluators with expertise in cost effectiveness research

and evaluation activities• Opportunity to measure impact and ROI to demonstrate value and importance of

programming• Opportunity to take lessons learned and scale beyond DCPC

Increase the impact and return on investment (ROI) of screening programs, and scale screening best practices within and beyond DCPC

All people get the right screening at the right

Supporting Organized Approaches to Colorectal Cancer Screening: FY 2015-FY 2020

Component 1: Health System Change to improve and increase CRC Screening•All 30 grantees are partnering with health systems to

implement priority strategies

Component 2: Direct Screening• 6 grantees are also being funded to support direct

screening for low-income adults age 50-64.

National Colorectal Cancer Roundtable

Expand colorectal cancer screening efforts

• National Colorectal Cancer Roundtable (NCCRT)’s 80% by 2018 Initiative – American Cancer Society, CDC, NCI, HRSA, other

stakeholders

From 2013-2015, 2.9 Million more adults reported being up-to-date with colorectal cancer screening

CDC’s Colorectal Cancer Control Program

*Of the clinics reporting an EHR-calculated screening rate, 77% reported somewhat or very confident in the accuracy of the screening rate; 15% reported not confident, and 8% did not report a confidence level

CDC’s Colorectal Cancer Control Program

77% of clinics are Patient Centered Medical Home-recognized

Why DCPC?

DCPC is one of the only organizations that manages a national-level data source; Expertise and ongoing analysis around registry/surveillance data

Unique position in the cancer ecosystem through its relationship with state health departments, providers, and national organizations

Ability to leverage public health data, along with other data, to demonstrate public's health value in reducing cost and improving quality and overall population health

Improve the integration and use of clinical and public health data to support data-driven decisions by providers and state health departments

People have the best possible cancer care

and outcomes

PCORTF Collaborative Project – CDC and FDA

• Two Year Project• Project Goals:

–Develop a Natural Language Processing (NLP) Web Service for structuring and standardizing unstructured clinical information

–Pilot for use in cancer registries and safety surveillance domains

–Will be expandable to meet other domain requirements

Literature Review and Evaluation

Engage Stakeholders, Requirement

Gathering, and Technical

Design

Prototype Development

Pilot NLP Web Service

NLP Web Service

Published

Overview of Project Activities

Potential Challenges

Dependencies on open source software

Availability of large test datasets

Limitations of open source NLP software and tools

Inclusion of stakeholders from different domains

Prioritization of requirements

Why DCPC? Deep expertise and capabilities across surveillance, research, and

program to identify and address emerging survivor needs Unique position to translate the science around survivors into state-level

public health programs and interventions Experience with coalitions and CBO’s that can connect survivors with a

broad array of health and social resources DCPC is embedded in NCCDPHP which provides great opportunities to

address co-morbidities

• Improve health outcomes for cancer survivors through the execution of a unified survivorship agenda

Cancer survivors live longer, healthier lives

16.9 17.1 15.4 15.6 16.813.8 12.1

0.05.0

10.015.020.025.030.0

2009 2010 2011 2012 2013 2014 2015 2017

Cancer Survivors Who Are Current Smokers

Smoking in Cancer Survivors

From 2009-2015 overall, the number of cancer survivors who are current smokers has decreased from 2.3 million people to 1.9 million people.

Comprehensive Cancer Control Plan for Michigan, 2009–2015

Genomics GoalIncrease availability of cancer-related genetic

information to the Michigan public and decrease barriers to risk-appropriate services

Ovarian Cancer GoalImprove understanding of, and access to, genetic

counseling services for women who may be at high risk for developing ovarian cancer

michigancancer.org/

Promoting Evidence-based Cancer Screening Polices Among Insurers

Enhancing Breast Cancer Genomics Best Practices and Policies, 2011–2014

Goals● Promote adoption of health plan policies to increase coverage of BRCA clinical services● Increase healthcare provider knowledge and use of BRCA clinical practices● Expand surveillance of BRCA clinical practices

1. Record family and personal

history of cancer

2. Perform cancer genetic risk

evaluation referral and counseling

3. Perform BRCA testing and

interpret results

4. Provide recommended BRCA related

clinical service

BRCA counseling, testing, and clinical services

Promoting Evidence-based Cancer Screening Policies Among Insurers

Michigan Department of Health and Human Services, unpublished data

Members from specific health plan receiving BRCA counseling and testing, October 1, 2007–September 30, 2013

Lynch Syndrome Screening Network (LSSN)

LSSN Mission● Promote Lynch syndrome screening on all newly

diagnosed colorectal and endometrial cancers● Facilitate the ability of institutions to implement

appropriate screening through network collaboration● Investigate universal screening for other

Lynch syndrome-related malignancies Institutional membership

● Over 120 leading cancer institutions are members● Over 20,000 newly diagnosed cancers screened● Membership data assisting to measure

Healthy People 2020 Lynch syndrome objective http://www.lynchscreening.net/

“I plan to do two things: 1) Increaseresources—both private andpublic—to fight cancer. 2) Breakdown silos and bring all the cancerfighters together —to work together,share information, and end canceras we know it. And the goal of thisinitiative is simple—to double therate of progress. To make a decade’sworth of advances in 5 years.”

Vice President Joe BidenFebruary 2016

To make a decade worth of advances in cancer prevention, diagnosis, and treatment, in five years …

… coming together of science, technology, advocacy, social science, and big data to solve cancer’s greatest challenges.

Free Trapped Data

Support Patients

Increase Access to Treatment

Improve Care

Help Find a Cure

Unleash New Breakthroughs

Vice President’s Cancer Moonshot To …..

Moonshot Initiative

Federal Task Force

Deputies Working Committee

Science

Therapies

Prevention & Diagnosis

Access & Care

Blue Ribbon Panel

*Blue Ribbon Panel has seven work groups not reflected in diagram: Cancer Immunology and Prevention, Tumor evolution and Progression, Precision prevention and early detection, Expanding Clinical Trials, Pediatric Cancer, Enhanced data sharing, and Implementation Sciences

Cancer Moonshot: Organization

Cancer Moonshot: Key Activities

5/31/2016 Prevention and Diagnosis Work Group Kick-Off

January-February March-April May-June July-August September-October

1/28/16White House

MemorandumLate April:

CDC Engaged

9/7/16Blue Ribbon Panel Report Released

10/17/16Task Force

Report Released

6/29/16Moonshot Summit

Recommendations:

– Establish a network for direct patient involvement– Create a clinical trials network devoted exclusively to

immunotherapy– Develop ways to overcome resistance to therapy– Build a national cancer data ecosystem– Intensify research on the major drivers of childhood cancers– Minimize cancer treatment’s debilitating side effects– Expand use of proven prevention and early detection strategies– Mine past patient data to predict future patient.– Develop a 3D cancer atlas– Develop new cancer technologies

Cancer Moonshot: Blue Ribbon Panel

Cancer Moonshot: Cancer Moonshot Task Force Report Priority Areas

Catalyze New Scientific

Breakthroughs

Unleash the Power of Data

Accelerate Bringing New Therapies to

Patients

Strengthen Prevention and

Diagnosis

Improve Patient Access and Care

FDA’s Oncology Center of Excellence

Expedite and integrated

development and evaluation of drugs,

biologics, and devices

Shift away from conventional phase

1, phase 2, and phase 3 paradigm

Use common control trials

Encourage use of large simple trials

NCI’s Cancer Clinical Trials

• Re-design how patients and oncologists locate information about NCI-supported cancer clinical trials

• New API allows researchers and patient groups to tailor information from the site, in real time, to identify trials relevant to individual communities and specific cancers

• Easier for researchers to recruit new participants and for patients to find trials that make a difference for them

trials.cancer.gov

Prevention and Diagnosis Work Group Priorities

Increase Outreach and Funding for Adopting Effective Prevention

Strategies

HPV vaccination

Tobacco control

Improve the Cancer Screening Continuum

Colorectal cancer screening

Colorectal Cancer Legislation

Enhance Understanding of Environmental

Determinants of Cancer

Radon risk

Screening assays of carcinogens (Tox21

Interagency Agreement)

Prevention and Diagnosis Work Group Priorities: HPV Vaccination

Strategy: Promote HPV as Cancer Prevention

• National HPV Vaccination Roundtable– American Cancer Society, CDC (DCPC and NCIRD), and

other partners

• Expand reach of current CDC Immunization and Comprehensive Cancer Control programs

• Establish HPV Vaccination State Affinity Groups (CMS, CDC, and HRSA)

Prevention and Diagnosis Work Group Priorities: Colorectal Cancer

Strategy: Expand colorectal cancer screening efforts

• National Colorectal Cancer Roundtable (NCCRT)’s 80% by 2018 Initiative – American Cancer Society, CDC, NCI, HRSA, other

stakeholders

Strategy: Remove barriers that limit access to colorectal cancer screening

• President’s Fiscal Year 2017 budget proposes legislation to waive co-payments when polyps removed during screening colonoscopy

• CMS to provide technical assistance as needed

Unleash the Power of Data Work Group

Enable a seamless data environment

Unlock scientific advances with open computational

and storage platforms

Develop a workforce capable of

using the open and connected

…. we will come.

…. make it easy and relevant to use ….

If you build it ….

Cancer Moonshot: Alignment

Blue Ribbon Panel Federal Task ForceResearch and Science – Network for direct patient engagement

(clinical trials)

Data – Data ecosystem– Human tumor atlas

– Genomic Data Commons– APPOLLO– Shared resources of linked clinical

data sets

Therapies – NIH Public-Private Partnership for accelerating new therapies

Prevention and Diagnosis

– Evidence-based approaches to prevention: Tobacco control Colorectal cancer HPV vaccination

– Promote tobacco control– Increase colorectal cancer

screening– Improve HPV vaccination

Access and Care – Minimize cancer treatment’s debilitating side effects

Comprehensive Cancer Control National PartnershipAmerican Cancer Society

American College of SurgeonsCommission on Cancer

Association of State and Territorial Health Officials

American Cancer Society Cancer Action Network

Centers for Disease Control and Prevention

Health Resources Services Administration

Intercultural Cancer Council

LIVESTRONG Foundation

North American Association of Central Cancer Registries

National Association of Chronic Disease Directors

National Association of County and City Health Officials

National Cancer Institute

Susan G. Komen for the Cure

Cancer Support Community

Leukemia & Lymphoma Society

The George Washington University Cancer Center

Truth Initiative

YMCA of the USA

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Chronic Disease Prevention and Health Promotion

Division of Cancer Prevention and Control

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