Catchment Area Data Collection
Tesha Coleman, MSGeorgetown Lombardi Comprehensive Cancer Center
Brian C. Springer, MHAH. Lee Moffitt Cancer Center & Research Institute
Nathan L. Vanderford, PhD, MBAUniversity of Kentucky Markey Cancer Center
• Background
• Defining the catchment area
• Data collection
• Tracking impact
• Are there automated ways to collect this data?
Please discuss anything, anytime
Agenda
• Expectation to demonstrate impact of science in catchment area
• Expectation to match activities to needs of catchment areas
• Overall and special populations
Background
• Moffitt
• Markey
• Lombardi
Defining the Catchment Area
Charlotte Citrus De Soto Hardee Hernando Highlands Hillsborough Lake
Lee Manatee Pasco Pinellas Polk Sarasota Sumter
West Central Florida (15 counties)Current Population: 5,817,590
Rationale: Contiguous region 29.6% of the state’s population (19,653,079) Complements state efforts to develop other NCI CCCs Aligns with major traffic corridors (I-75, I-275, I-4, SR589)
≤2 hour driving distance Urban and rural populations 72.7% of Patients (Cancer Registry 2012, County at Presentation)
Moffitt
Overall Cancer Incidence RatesAge-Adjusted Rates,* All Ages
Catchment Area (1) Florida (1) United States (2)
Overall 467.7 462.1 438.1 Sex Female 425.3 421.1 491.8 Male 520.4 515.4 400.8
Age Groups
20–44 130.1 125.7 112.0 45–64 712.6 694.7 643.0 65+ 2,023.6 2,026.0 1,973.6 Race Black 447.4 434.6 466.3 White 445.3 440.3 448.7 Other 178.8 171.0 -- Ethnicity Hispanic 480.1 478.6 -- Non-Hispanic 325.3 364.5 345.6
*Incidence rates per 100,000Age-adjusted to the 2000 US standard population(1) FCDS Data, All Ages, 2008-2012(2) SEER, All Ages, 2011, 13 registries
Age and Race Distribution:Adults 20 years and older
Catchment FL US Catchment FL US Catchment FL US0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
33.1% 37.5% 42.3%53.0% 53.6% 51.8%
62.0% 60.9% 62.0%
36.3%36.4%
37.5%
34.2% 33.9% 35.3%28.6% 29.8% 29.0%
30.5% 26.0% 20.2%12.9% 12.5% 12.9% 9.4% 9.3% 9.1%
20 to 44 years 45 to 64 years 65+ years
White Alone Other Races*Black Alone
Source: United States Census, 2010, Tables P12A-P12G
Top 20 Incident CancersCatchment Area Overall^ Florida Overall^
Primary Cancer Site Rate* Rank Primary Cancer Site Rate*
Lung & Bronchus 96.72 1 Lung & Bronchus 90.76Breast 86.67 2 Breast 87.14Prostate Gland 76.30 3 Prostate Gland 77.34Colorectal 54.19 4 Colorectal 55.19Melanoma of the Skin 31.50 5 Urinary Bladder 28.18Urinary Bladder 30.11 6 Other 27.95Other 28.95 7 Melanoma of the Skin 27.61Non-Hodgkin's Nodal, Non-Hodgkin's Extra Nodal
24.25 8Non-Hodgkin's Nodal, Non-Hodgkin's Extra Nodal
24.92
Kidney & Renal Pelvis 20.03 9Benign/Borderline- Brain, Cranial Nerves Other Nervous System, Other Endocrine including Thymus (Benign/Border)
21.62
Head & Neck 19.10 10 Kidney & Renal Pelvis 19.51
Benign/Borderline- Brain, Cranial Nerves Other Nervous System, Other Endocrine including Thymus (Benign/Border)
18.63 11 Head & Neck 17.99
Corpus Uteri, Uterus, NOS 16.92 12 Corpus Uteri, Uterus, NOS 16.85Pancreas 16.49 13 Pancreas 16.49Thyroid Gland 13.89 14 Thyroid Gland 15.82Liver, Intrahepatic Bile Duct 9.32 15 Liver, Intrahepatic Bile Duct 9.61Ovary 9.27 16 Ovary 8.69Brain, Other Nervous System 8.48 17 Stomach 8.46
Acute Myeloid Leukemia, Chronic Myeloid Leukemia, Other Myeloid/Monocytic Leukemia, Acute Monocytic Leukemia
8.25 18Acute Myeloid Leukemia, Chronic Myeloid Leukemia, Other Myeloid/Monocytic Leukemia, Acute Monocytic Leukemia
8.20
Multiple Myeloma 7.72 19 Multiple Myeloma 8.07Stomach 7.37 20 Brain, Other Nervous System 7.85
^Adults 20 years and older*Incidence rates per 100,000Age-adjusted to the 2000 US standard populationSource: Florida Cancer Data System
Markey - Appalachian Kentucky
Cancer
Obesity
Smoking
Poverty
Appalachian county economic status (2013-14)
73% rural 25.1% below poverty level 26.3% without high school diploma
ILLINOIS
INDIANA
OHIO
WESTVIRGINIA
VIRGINIA
NORTH CAROLINA
TENNESSEE
UK
Markey Catchment Area
96% of patient population 93% clinical trial accruals
Significant Burden of Cancer in Kentucky
1st in the nation in overall cancer mortality rate
1st in the nation in incidence rate for all cancer sites
- Lung and bronchus (1st); colon and rectum (1st); larynx (1st); kidney and pelvis (2nd); oral cavity and pharynx (3rd); brain (7th); non-Hodgkin’s lymphoma (7th); skin (8th); cervix (9th)
Cancer incidence and mortality are highest in Appalachia
Age-adjusted cancer mortality rates, 2006 - 2010
All Cancers
Lung Colorectal
Larynx
U.S. 180.2 51.3 16.8 1.2
Kentucky† 209.5 73.2 19.3 1.5
Appalachian Kentucky*
227.9 83.4 21.2 1.7
† p<0.01 vs U.S. as a whole; * p<0.05 vs non-Appalachian Kentucky. SEER and Kentucky Cancer Registry.
Lombardi - Background
Capital Breast Care Center (CBCC) was founded in 2004 to ensure that all women in the Washington, D.C. area have access to needed breast health services.
Washington, D.C. has the highest rates of breast cancer mortality in the nation.
Mission: Provide culturally sensitive breast cancer screening services and health and wellness education guided by evidence-based practices to all women in the Washington, DC area, regardless of their ability to pay.
Catchment Area
3.9 million individuals
District of Columbia & adjacent counties
41% cancer patients in Lombardi’s catchment area are underrepresented minorities
• Markey
• Lombardi
• Moffitt
Data Collection - Examples
Markey - Catchment Area Data Collection
Manual surveillance of:- Grants- Manuscripts
Automated surveillance of:- Clinical trial accruals
Catchment Area Data Collection - Grants
Appalachian-Focused Projects – Currently Funded
APPALACHIA
NCIMark Dignan$1,088,516
Appalachian CommunityCancer Network II
NIEHSEllen Hahn$420,326
FRESH home screeningfor lung cancer prevention
NCATS / UK CCTSBin Huang$41,200
Relative survival rates – Appalachia vs. non
KLCRTadahide Izumi
$75,000DNA damage biomarkersrelated to tobacco use
NCMHHDAnn Coker$273,116
Violence against womenand cancer care disparities
Department of DefenseSusanne Arnold
$64,630Lung cancer and
environmental carcinogens
NCCDPHPIRichard Crosby
$750,000Rural Cancer
Prevention Center
Foundation for Healthy Ky.Ellen Hahn
$50,000Smoke and tobacco free
policy adoption
ARCMark Dignan
$305,513Patient navigator training
in Appalachia
KLCREric Durbin
$75,000Automated identification of
lung cancer trial recruits
NIDCRJamie Studts
$173,573Dental point-of-care
smoking cessation tool
KLCRIsabel Mellon
$75,000Nucleotide excision repair
and lung cancer
NCI / U. of MiamiJamie Studts
$44,991Lung cancer screening
decision aid
NIDABrady Reynolds
$357,563Web-based managementfor adolescent smoking
BMSFJamie Studts$4,057,881
Kentucky lung cancersurvivorship program
NCIJessica Burris
$153,747Smoking Cessation
after Cancer Diagnosis
Catchment Area Data Collection – PublicationsAndrykowski MA, Steffens RF, Bush HM, Tucker TC. Disparities in mental health outcomes among lung cancer
survivors associated with ruralness of residence. Psycho-Oncology 23:428-436, 2014.
Arias A, Rigalli JP, Villanueva SSM, Ruiz ML, Luquita MG, Perdomo VG, Vore M, Catania VA, Mottino AD. Regulation of expression and activity of multidrug resistance proteins MRP2 and MDR1 by estrogenic compounds in Caco-2 cells. Role in prevention of xenobiotic-induced cytotoxicity. Toxicology 320:46-55, 2014.
Burikhanov R, Shrestha-Bhattarai T, Hebbar N, Qiu S, Zhao YM, Zambetti GP, Rangnekar VM. Paracrine Apoptotic Effect of p53 Mediated by Tumor Suppressor Par-4. Cell Reports 6:271-277, 2014.
Burikhanov R, Sviripa VM, Hebbar N, Zhang W, Layton WJ, Hamza A, Zhan CG, Watt DS, Liu C, Rangnekar VM. Arylquins target vimentin to trigger Par-4 secretion for tumor cell apoptosis. Nature Chemical Biology 10:924-926, 2014.
Butler KM, Begley K, Riker C, Gokun Y, Anderson D, Adkins S, Record R, Hahn EJ. Smoke-Free Coalition Cohesiveness in Rural Tobacco-Growing Communities. Journal of Community Health 39:592-598, 2014.
Butler KM, Rayens MK, Adkins S, Record R, Langley R, Derifield S, McGinn C, Murray D, Hahn EJ. Culturally-specific Smoking Cessation Outreach in a Rural Community. Public Health Nursing 31:44-54, 2014.
Heidary DK, Glazer EC. A Light-Activated Metal Complex Targets both DNA and RNA in a Fluorescent in Vitro Transcription and Translation Assay. Chembiochem 15:507-511, 2014.
Elliott VA, Rychahou P, Zaytseva YY, Evers BM. Activation of c-Met and Upregulation of CD44 Expression Are Associated with the Metastatic Phenotype in the Colorectal Cancer Liver Metastasis Model. Plos One 9:e97432, 2014.
Hollis CP, Weiss HL, Evers BM, Gemeinhart RA, Li TL. In Vivo Investigation of Hybrid Paclitaxel Nanocrystals with Dual Fluorescent Probes for Cancer Theranostics. Pharmaceutical Research 31:1450-1459, 2014.
Catchment Area Data Collection – Clinical Trials
Automated surveillance of:- Grants- Manuscripts- Clinical trial accruals
Catchment Area Data Collection – Desired State
Lombardi - CBCC-Data CollectionMethods
Foundation Grants Avon Foundation CareFirst
Research Studies/Publications Clinical Service Data
Patient Demographics Screening Behaviors Clinical Outcome
Percentage of patients returning for annual screening
Median time to follow-up
Time intervals between the screening and diagnostic workup (additional imaging and biopsies)
CBCC-Data Collection
Tools• National Breast & Cervical Cancer Program Guidelines• Electronic Medical Record Audit• Community Needs Assessment
Resources• Community Partnerships• Membership with Community Coalitions & Networks• Community Setting Screening Services
Moffitt - Catchment Area Data Collection
•Grants•Publications•Clinical trial accruals•Queries by program leaders
•Program meetings/presentations
•Retreats/symposia
Moffitt – Publication Tracking Tools (similar to this)
Moffitt – Meetings/Retreats
• Lombardi
• Moffitt
• Markey
Tracking Impact
Sample Data CollectionCBCC Patient Demographics 2014
Ethnicity
AsianOtherWhiteBlackHispanic
Insurance
UninsuredCommercial InsuranceMedicareMedicaid Programs
N=1703
23%
39%
38%
State
VirginiaMarylandDC
Age
39 & Under40-4950-5960-6970 & Over
N=1703
Sample Data CollectionCBCC Patient Demographics 2014
Tracking Impact-Example
Tracking Impact-Example
CBCC “Clients”Demographic & Socioeconomic
Characteristics
• 40% between 40-50 years of age• 90% minorities (45% Black, 45%
Hispanic)• >50% uninsured, 25% on Medicaid
Research Coordinators
CBCC as a Resource for Enrolling Minority Participants in Research Studies
Cancer Prevention and Control Program
Cancer Prevention and Control Program
Cancer Prevention and Control Program
Cancer Prevention and Control Program
Breast Cancer Program Cancer Prevention and Control Program
Molecular Oncology Program
Breast Cancer Program
Cancer Prevention and Control program
FIERCE Focused Intervention on
Exercise to Reduce CancEr
RCT on exercise among obese, metabolically unhealthy Black women at high-risk of breast
cancer
[NIMHD P60MD006920; PI: Adams-Campbell]
POWER Preventing Obesity in Women
with Exergaming Routine
RCT on the effects of exergaming among overweight /
obese Black women
[NCI R21CA165067; PI: Adams-Campbell]
ENGAGED ExperieNces With
MammoGrAphy ScreeninG and BrEeast Density]
A survey among women who have had a recent screening mammogram
regarding their awareness of mammographic breast
density as a breast cancer risk factor and their awareness of their
personal breast cancer risk
[Prevent Cancer Foundation, PCF Grant #1105; PI: O’Neill]
HPV Health Communication
Intervention Study
Educational intervention among Black mothers with
daughters aged 9-17 years about Human
Papilloma Virus (HPV) and the HPV vaccine
[NCI K01 CA155417; PI: Wallington]
Minority Biospecimen / Biobanking
Survey
Survey on biospecimen
knowledge and donation intent
among minorities
[NCI GMap/BMaP 3P30CA051008-17S3; PI: Adams-Campbell]
Time to Diagnosis After
Abnormal Mammogram
Analysis of factors affecting time to
diagnostic imaging and biopsy after an abnormal screening
mammogram
[Avon Foundation for Women 05-2012-012;
Komen Foundation NR-11-33344; CareFirst
BlueCross BlueShield 2011, 2012; PI: Oppong]
QUIT & FIT
A 12-week RCT among Black women
to investigate the effectiveness of an
exercise intervention in addition to nicotine
patches on smoking cessation
[Lombardi institutional support, PI: Adams-
Campbell]
Lombardi’s Office of
Minority Health and Health Disparities Research
Capital Breast Care
Center The “Research Corner” with a
dedicated hotline
Potential Research Participants at CBCC
Information On Ongoing Studies
Participants Enroll in Ongoing Research
Studies at the Lombardi
Comprehensive Cancer Center
Women (And Their Relatives / Partners) Present At CBCC for
Screening
2012 Opening of Office of Minority Health & Health
Disparities Research in SE DC
DC Mayor Gray, Congresswoman Holmes Norton, GU President DeGioia, Adams-Campbell & Weiner
CBCC Magazine
Tracking Impact-Example
Task Force 1: Educate & Enhance Knowledge Base of Local Referring Physicians & Partners on Clinical Intervention Trials, to foster patient accruals at MoffittHammon (VP Planning), Adkins (Planning), Soliman (Faculty CBMM)
Map Key: 51% - 90% 25% - 50% 13% - 24% 6% - 12% 1% - 5% Minority catchment area by zip code
Task Force 2: Patient Navigation at Moffitt Cancer Center Gwede (Faculty HOB), Newman (Dir. Patient Relations), Morehouse (CTO), Wadhwa (CTO)
FY09 Percent FY09 Percent FY09 PercentBMT 1.9 3.9 2.3CUTANEOUS 13.2 2.8 0.8ENDOCRINE 3.0 6.7 5.4GI 12.5 11.0 12.3GU 11.2 15.2 13.4HEAD & NECK 5.9 3.5 3.4MALIGNANT HEME 7.2 8.1 7.7MOFFITT SOUTH 7.7 7.1 11.9NEURO 4.0 2.5 2.7RADIATION ONCOLOGY 3.1 3.5 1.9SARCOMA 4.6 4.9 6.1SENIOR ADULT 2.3 1.8 0.8THORACIC 6.9 2.8 4.6WOMENS - BREAST 7.4 13.4 11.1WOMENS - GYN 8.5 12.4 15.7
Total New Pts Hispanic New Pts AA New PtsMOFFITT CLINICAL PROGRAM
Sandra MorehouseMinority Patient
Navigator
Task Force 3: Enhancing Moffitt’s Communication with Minority Communities Antonia (Faculty CBE), Quinn (Faculty HOB), Meade (Faculty HOB), Hice (VP PR&M)
Markey - Environmental Factors and Cancer
Xianglin Shi, PhD(RR)
Zhou Zhang, PhD(CP)
>25% of Appalachians get drinking water from wells or streams
Funding sources: RO1 ES015518; RO1 ES020870; RO1 ES018883; RO3 CA171604
David Orren, PhD(RR)
Bituminous coal beds insoutheastern Kentucky
0 - 100100 - 250
250 - 2200
Arsenic ppm
KY
WV
VA
OH
TN
As, Cd, Cr
Mary Vore, PhD(RR)