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)