UNDERGRADUATE � SEMINAR SERIES� TOPIC-CANCER CARE DELIVERY SYSTEMS

SPEAKER NAME - SEHASREE MOHANTA

COURSE NAME-Integrated BS-MS Course (BIOLOGY MAJOR)

INSTITUTE NAME-INDIAN ASSOCIATION FOR THE CULTIVATION OF SCIENCE,KOLKATA

DATE-29/05/2022

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(Session- 2)

Picture Source-Harvard Gazette

Indian Association For The Cultivation of Science, Kolkata

DECLARATION OF INTENTIONS

• The field of quality assessment in cancer care is relatively new, and investigators are just beginning to identify meaningful indicators of quality for many aspects of cancer care.

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• Health services researchers have used established indicators to determine whether outcomes of care are affected by how care is delivered or who delivers care.

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• Several aspects of the health care delivery system have the potential to affect quality: the resources or capacity of facilities (e.g., volume of services, scope of services, access to technology, nurse staffing levels, academic affiliation);characteristics of health care providers and systems (e.g., level of training, specialization, certification); and the way in which services are financed, organized, and delivered (e.g., managed care versus traditional fee-for-service [FFS] care; regionalization of services).

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• The National Cancer Institute recently launched its Community Oncology Research Program, which includes a focus on this area of research.

Indian Association For The Cultivation of Science, Kolkata

CANCER- ANOTHER TERM OF MALIGNANCY

Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms.

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One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs; the latter process is referred to as metastasis.

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Widespread metastases are the primary cause of death from cancer.

Key facts-

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• Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths.
• The most common cancers are breast, lung, colon and rectum and prostate cancers.
• Around one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity.
• Cancer-causing infections, such as human papillomavirus (HPV) and hepatitis, are responsible for approximately 30% of cancer cases in low- and lower-middle-income countries.
• Many cancers can be cured if detected early and treated effectively.

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Data Source-WHO

Source-sciencedirect.com

CANCER CARE DELIVERY

• Cancer Care Delivery Research Program focuses on optimizing the quality of cancer care and cost-effectiveness of interventions that optimize patient-oriented outcomes, identifying barriers

to quality of cancer care, and ensuring effective allocation of health and social resources.

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• The number of cancer patients and survivors worldwide continues to grow as a result of our growing and aging population. In 2013, an Institute of Medicine report detailed a crisis of the cancer care delivery system resulting in larger numbers of cancer patients combined with increasingly complex treatments and rising costs associated with health care .

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• Since that time advances in genomics and a call for precision medicine have augmented these concerns and our expenditures on cancer care have continued to rise. Multiple factors within the health-care system impact the experience of the cancer patient and oncology provider. Cancer care delivery refers to the multiple layers of the health-care system that interact to affect outcomes for patients diagnosed with malignancies and the quality of that care.

Indian Association For The Cultivation of Science, Kolkata

ATTRIBUTES OF CANCER CARE DELIVERY

Source-Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology

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Indian Association For The Cultivation of Science, Kolkata

A High – Quality Cancer Care Delivery System

Charting a new course for a system in crisis

Indian Association For The Cultivation of Science, Kolkata

Source-nap.edu

IMPORTANCE OF DISSEMINATING THE EVIDENCE

• Scientific knowledge achieves its highest value and best purpose when that knowledge is used to advance the human condition.

Indian Association For The Cultivation of Science, Kolkata

THE CENTRAL GOALS OF HEALTHY PEOPLE 2010*

• Increase quality and years of healthy life.

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• Eliminate health disparities.

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• * USDHHS Healthy People 2010. Washington D.C. January 2000. Volume #1: page 2

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Indian Association For The Cultivation of Science, Kolkata

BURDEN OF CANCER IN U.S.

• U.S has the highest incident rate of cancer (Age standardized) i.e. 362.2*

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Cancer is the leading cause of death for American’s under 85 years of age.

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*https://www.medicalnewstoday.com/articles/cancer-rates-by-country

Indian Association For The Cultivation of Science, Kolkata

BURDEN OF CANCER IN U.S.

1,368,030 New Cancer Cases Projected in 2004

563,700 Cancer Deaths Projected in 2004

Indian Association For The Cultivation of Science, Kolkata

COST OF CANCER TREATMENT

• 1963 1972 1985 2002

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$1.2 billion

$3.8 billion

$18.1 billion

$60.9 billion

Indian Association For The Cultivation of Science, Kolkata

Data Source-

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CANCER : A DISEASE PROCESS

Indian Association For The Cultivation of Science, Kolkata

Indian Association For The Cultivation of Science, Kolkata

*NCI’S CHALLENGE: CLOSE THE GAP BETWEEN DISCOVERY AND DELIVERY

• There is a critical disconnect between research discovery and program delivery and this disconnect is a key determinant of the unequal burden of cancer in our society.

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• Barriers that prevent the benefits of research from reaching all populations, particularly those who bear the greatest disease burden, must be identified and removed.

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• *NCI=National Cancer Institute.

Indian Association For The Cultivation of Science, Kolkata

THE DISCOVERY-DELIVERY CONTINUUM

Discovery

Development

Delivery

Basic Science

Translational

Science

Community

Health

Practice

Primary Care

Practice

Oncology

Practice

Indian Association For The Cultivation of Science, Kolkata

Discovery to Development

Discovery to Delivery

Indian Association For The Cultivation of Science, Kolkata

RESEARCH-PRACTICE PARTNERSHIPS?

• “Getting a new idea adopted, even when it has obvious advantages, is often very difficult.” -- Everett Rogers, Diffusion of Innovations

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Indian Association For The Cultivation of Science, Kolkata

PARTNERSHIP MODELS

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• State Cancer Plans (ACS, CDC, C-Change, ACoS, ICC, NAACCR, LAF)

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• Collaborate with partners to support and expand the Cancer Control PLANET for Community Health Practice

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Indian Association For The Cultivation of Science, Kolkata

Indian Association For The Cultivation of Science, Kolkata

https://changingthepresent.org/collections/planet-cancer

Indian Association For The Cultivation of Science, Kolkata

DEVELOPMENT OF CLINICAL PLANET

Indian Association For The Cultivation of Science, Kolkata

SCREENING IMPLEMENTATION IS COMPLICATED

Process of Care

OUTCOMES

Risk Assessment

Age

Family Hx

Exposure Hx

Genetics

Lifestyle

Detection

Screening

• CBE/Mammography
• Pelvic/Pap
• FOBT/sigmoidoscopy

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Symptomatic

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Diagnosis

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Mammography

Ultrasound

Colposcopy

Biopsy

Repeat Exams

Treatment

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Surgery

Radiation

Adjuvant

Chemo

Palliative Care

Morbidity

Mortality

Quality of Life

Satisfaction

Quality of

Death

Indian Association For The Cultivation of Science, Kolkata

SYSTEMS CHANGE IS CRITICAL

• Systematic implementation of evidence based medicine
• Guidelines are necessary but not sufficient
• IOM report
• Systemic change is needed
• The chronic care model
• An implementation guide for teams

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Indian Association For The Cultivation of Science, Kolkata

ORGANIZING THE CHAOS OF CHANGE

• Conceptual organization
• The chronic care model

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Indian Association For The Cultivation of Science, Kolkata

Source-nature.com

MOVING SCIENCE INTO ONCOLOGY PRACTICE

• Food and Drug Administration (FDA) Collaboration
• Centers for Medicare and Medicaid Services (CMS) Collaboration

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Indian Association For The Cultivation of Science, Kolkata

WE HAVE BEEN TALKING ABOUT DISSEMINATION FOR QUITE A LONG TIME

• When the NCI was first authorized in 1937, Congress mandated that "NCI promote the useful application of research results."
• "The Cancer Control section of the National Cancer Act of 1971 is designed to ensure more rapid and effective communication of research results to medical practitioners and, as appropriate, to the general public...“

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Dialogue to Action!

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Indian Association For The Cultivation of Science, Kolkata

CONCLUSION

• Changes across the board urgently are needed to improve the quality of cancer care. All participants and stakeholders, including cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS (United States Department of Health and Human Services), other federal agencies, and industry, must reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality cancer care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

Indian Association For The Cultivation of Science, Kolkata

REFERENCES

1. “ Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis “- Levit LA, Balogh E, Nass SJ, Ganz P.

Washington, DC: National Academies Press (2013).

2. “Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology “ – Erin E Kent, Sandra A Mitchell , Kathleen M Castro-J clin Onco.

2015 Aug 20; 33(24): 2705–2711.

Published online 2015 Jul 20. doi: 10.1200/JCO.2014.60.6210

3.“The Anatomy and Physiology of Teaming in Cancer Care Delivery: A Conceptual Framework ” –NCI: Journal of the National Cancer Institute, Volume 113, Issue 4, April 2021, Pages 360–370, https://doi.org/10.1093/jnci/djaa166 Published: 27 October 2020

4. http://www.iom.edu/qualitycancercare

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Indian Association For The Cultivation of Science, Kolkata