Shift Happens: The Impact of Change on Health Care Delivery

Len Lichtenfeld, MD, MACP

Deputy Chief Medical Officer

Impact Conference

June 18, 2009

Total Number of Deaths Avoided from 1991-1992 to 2005

Cancer Remains a Formidable Challenge in 2009

•1.48 million new cases

•More than 1 million cases of non-melanoma skin cancer

•62,280 cases of in situ breast cancer and 53,120 cases of in situ melanoma

•562,340 deaths

Early detection technologies will offer an improved ability to predict risk and detect disease at the molecular level, and will result in the emergence of a “pre-cancer” survivor population

Trends Affecting Cancer In 2020

The PreventionTherapy Convergence

Clinical symptoms*Clinical

detection*Microscopic disease

LESION, TUMORdeath

0 10 102 104 105 106 107 108 109 1010 1011 1012

(1 mm3/1 mg) (1 cm3/1 g) (1 l/1 kg) Number of cells (volume/mass)

Lippman, Heymach

TherapyPreventionInterventionConvergence

Molecular targeting

Molecular/cellular changes

Genetic/epigenetic 3p, 9p, p16, p53 EGFR, K-ras, PI3K...

Metastases

Invasion/angiogenesis

ProliferationApoptosis

Microneoplasia IEN microcancer

Expanding size, subclones

Clonal patches/field *CancerMicroneoplasia

Neoplasia Risk/precancer *CancerNo man’s land

Trends Affecting Cancer In 2020

The survivor population will nearly double by 2020, driven by the aging of the baby-boomer population and improved cancer survival rates

Estimated Number of Cancer Survivors in the United States from 1971 to 2005

U.S. 2005 cancer prevalence counts are based on 2005 cancer prevalence proportions from the SEER 9 registries and 1/1/2005 U.S. population estimates based on the average of 2004 and 2005 population estimates from the U.S. Census Bureau.Source: Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisner MP, Reichman M, Edwards BK (eds). SEER Cancer Statistics Review, 1975–2005, National Cancer Institute. Bethesda, MD, based on November 2007 SEER data submission, posted to the SEER Web site, 2008.

Previvor

From Cancer Patient to Cancer Survivor: Lost inTransition

Maria Hewitt, Sheldon Greenfield, and Ellen Stovall,Editors, Committee on Cancer Survivorship: ImprovingCare and Quality of Life, Institute of Medicine andNational Research Council

2006

Prevention of recurrent and new cancers, and of other late effects;

Surveillance for cancer spread, recurrence, or second cancers; assessment of medical and psychosocial late effects;

Intervention for consequences of cancer and its treatment, for example: medical problems such as lymphedema and sexual

dysfunction; symptoms, including pain and fatigue;psychological distress experienced by cancer survivors and their caregivers; and concerns related to employment, insurance, and

disability; and

Coordination between specialists and primary care providers to ensure that all of the survivor’s health needs are met.

Essential Components of Survivorship Care

New delivery models will continue to proliferate (such as mini-clinics) amidst a shortage of oncologists, PCPs, and nurses, leading to further fragmentation of the delivery system

Trends Affecting Cancer In 2020

Health Care Reform

The Unknowns

•Prevention

•Regional Variation

•Health Information Technology

•Comparative Effectiveness