Embed Size (px)
Citation preview
Benefits of a Comprehensive Approach
ß Making coordination and cooperation the normal way of doing business in the cancer-fighting community
ß Giving everyone in the cancer-fighting community access to critical data, new ideas,examples of successful activities and resources that may not otherwise be available tothem
ß Helping to identify and address inefficient activities to make the most of existing cancerprevention resources
What a Comprehensive Approach to Cancer Control Is
The comprehensive approach to cancer control is an emerging strategy that seeks to ensure thatall of a state’s cancer-fighting resources—from government programs to private organizations—are working together to fight cancer in every community, on all fronts, from prevention and earlydetection to treatment, rehabilitation and end-of-life care.
Why the Comprehensive Approach Developed
Currently, the programs and organizations that work to pre-vent and control cancer typically focus on a particular can-cer site (breast, lung, prostate, etc.).
This “ b o d y - p a rt ” focus to the fight against cancer has grow nra p i d ly in the past 10 ye a rs and has achieved successes.
But cancer remains the second leading cause of death inthe United States, and fiscal constraints are driving states tofind smart e r, more effe c t i ve and more efficient ways to fi g h tthe disease.
Talking Points
The Financial Cost of Cancer
ß One of every four U.S. deaths is due to cancer.ß O ver 1.4 million new cases will be diagnosed
in 2005.ß Everyone is at risk of developing some form of
cancer.ß The top killing cancers for women are lung,
breast and colorectal. For men, they are lung,prostate and colorectal.
ß If current trends continue, one-third ofAmericans will be diagnosed with cancer in theirlifetimes.
ß With early screening and treatment, manycancer deaths can be prevented and thenumber of new cases can be reduced.
Sources: American Cancer Society,National Cancer Institute
Cancer Facts
ß Overall annual costs: $189.8 billionß Direct medical expense: $69.4 billionß Lost worker productivity due to illness: $16.9
billionß Lost productivity due to premature death:
$103.5 billion
Source: Estimated costs calculated in 2004,National Institutes of Health
Despite progress, cancer remains the second lead-ing cause of death in the United States.The diseasecontinues to exact a staggering toll both in terms ofhuman suffering and health care costs.Those pres-sures combined with tight fiscal constraints are driv-ing states to find smarter, more effective, more effi-cient strategies to fight the disease.
The emerging strategy of choice is to take a com-prehensive approach—an approach that bringstogether existing resources and programs under acommon plan. All 50 states have now taken stepstoward planning comprehensive approaches; manyalready are implementing plans.
I t ’s not difficult to understand why states arechoosing this approach. Under the tra d i t i o n a lapproach to cancer control, funding is typically cat-e g o ri c a l , directed to programs for specific fo rms ofcancer like lung cancer or colorectal cancer or torisk-factor programs like smoking or sun exposure.Planning is done within progra m s , and part n e r-ships with other programs or groups are limited.
For example, states have implemented successfulbreast and cervical cancer prevention and earlydetection programs.They also have launched effec-tive public awareness campaigns about the risks ofcancer from smoking. However, because these pro-grams often are built around organ-specific cancers orrisk-factors, the ability of states to fight the overall chal-lenge of cancer has been hampered by duplication ofefforts and missed opportunities for coordination.
States know that they are missing opportunities forcoordination, and they know this translates into missedopportunities to save lives.
The logic of the comprehensive approach is straight-forward: if states break down the barriers of the tradi-tional approach and get all the cancer stakeholders—including state programs and private and non-profitpartners—to collaborate on an ongoing basis they willmaximize the impact of limited resources and do a bet-ter job of saving lives and preventing cancer.
States that have used this logic to weave together
their cancer efforts are already seeing results. Somestates have marshaled the power of dozens and dozensof state cancer organizations to improve screening rates.Some are making sure that everyone can afford cancertreatments. Others are establishing close partnershipsamong programs that pay for cancer prevention andtreatment and community-based clinics to make surethat people in medically underserved areas have accessto care.
But whatever collaborative routes states are taking,they are positioning themselves to do a more effectivejob of preventing and treating cancer at a lower cost.
A Smarter, More Effective Way to Fight Cancer
Why States Are Taking a Comprehensive Approach toCancer Prevention and Control
Unequal Burdens
Cancer disparities are differences in the inci-d e n c e, p r e v a l e n c e, m o rt a l i t y, and the bu r d e nof cancer and related adve rse health condi-tions that exist among specific populationg r o u p s . These population groups may bec h a ra c t e ri zed by gender, a g e, e t h n i c i t y,i n c o m e, e d u c a t i o n , risk factors , d i f ferences inaccess to health serv i c e s , social class, d i s a b i l i-t y, g e o g raphic location or sexual ori e n t a t i o n .
Cancer incidence and death rates vary byrace and ethnicity, and some groups aremore susceptible to certain types of cancerthan are others .
ß Overall, African-Americans are more likelyto develop cancer than persons of anyother racialor ethnic group. Between 1996and 2000, the average yearly death rate per100,000 people for all cancers combinedwas 257 for African-Americans, 199 forwhites, 138 for Hispanics, 138 forAmerican-Indians and 125 for Asian-Americans.
ß African-American women have lowerincidence rates of breast cancer, butexperience higher death rates than otherwomen.
ß Cervical cancer incidence in Hispanicwomen has been consistently higher at allages than for other women.
ß People with health insurance are morelikely to have received appropriatepreventive care such as a recent Pap test.
ß Hispanic Americans have one of the highestuninsured rates.
ß American Indian and Alaska Natives havethe poorest survival from all cancerscombined in comparison with all otherracial and ethnic groups.
For additional information on health dispar-ities related to cancer, visit www.cdc.gov/can -cer/minorityawareness/index.htm.
Source: Centers for DiseaseControl and Prevention
ß One of eve ry four U. S . deaths is due to cancer.
ß O ver 1.4 million new cases will be diagnosed in 2005.
ß Everyone is at risk of developing some form of cancer.
ß The top killing cancers for women are lung, breast andc o l o r e c t a l . For men, they are lung, prostate and colorectal.
ß If current trends continu e, one-third of A m e ricans will bediagnosed with cancer in their life t i m e s .
ß With early screening and treatment, m a ny cancer deathscan be prevented and the number of new cases can ber e d u c e d .
S o u r c e s : A m e rican Cancer Society, National Cancer Institute
Cancer Facts At a Glance
2
ßCancer is the second lead-ing cause of death fo rA m e ri c a n s .
ßThe human cost is sub-stantial. In 2005, about 1.4million new cases of can-cer will be diagnosed, andmore than 563,700Americans—about 1,500people a day—will die ofthe disease.
ßThe financial cost of cancer also is huge.In 2004, the overall cost of cancer in theUnited States was $189.8 billion. Thatfigure includes $69.4 billion in directmedical expenses, $16.9 billion for lostworker productivity due to illness and$103.5 billion for lost worker productiv-ity due to premature death.
ßThe cancer burden—in terms of inci-dence and mortality—has been esti-mated in each state. To find out howlung, colorectal, breast and prostate can-cers affect your state, download the2004 State Cancer Burden Fact Sheetfrom CDC at www.cdc.gov/cancer/dbda -ta.htm or http://cancercontrolplanet.can -cer.gov.
The Centers for Disease Control andP r e ve n t i o n ’s (CDC’s) NationalC o m p r e h e n s i ve Cancer Control Progra mn ow provides support for designing andimplementing state comprehensive can-cer control plans in 49 states, the Distri c tof Columbia, fi ve tribal org a n i z a t i o n s , a n dsix U. S . Associated Pa c i fic islands and ter-ri t o ri e s .
The CDC program helps states, tribesand terri t o ries establish broad-basedcomprehensive cancer control coalitions,collect information about the burden ofcancer, and set priorities for a wide rangeof cancer prevention and control inter-ventions.
Other CDC funds suppor t colorectal,prostate and ov a rian cancer controlactivities within the fra m e wo rk of ac o m p r e h e n s i ve cancer control plan.
2004 CDC-funded ComprehensiveCancer Control Plans
The Human and Financial Costs of Cancer
3
CDC-funded ComprehensiveCancer Control Programs
“What Can I Do?”The State Legislator’s Role in Cancer Control
For state legislators looking for ways to advance a comprehensive approach to fightingcancer, there are many possible actions to take and roles to play, including:
ß Finding out what your state currently is doing about comprehensive cancercontrol. Contact your state health department and your American CancerSociety representative to learn more about cancer control efforts in your state.
ß Becoming a “champion” of comprehensive cancer control for your constituency.Support a resolution that identifies and promotes your state’s cancer plan andcoalition.
ß Joining your state’s cancer partnership, collaboration, or coalition. Participateyourself or dedicate staff members to participate.
ß Highlighting comprehensive cancer control in speeches and testimony. Use publicspeaking opportunities to underscore that this approach is one way your statecould improve its public health efforts.
ß Asking how any proposed new legislation relating to cancer fits in with yourstate’s cancer plan. When considering new cancer legislation, consult with yourstate’s cancer coalition to learn their perspective.
ß Sponsoring legislation that supports comprehensive cancer control efforts. Forexample, you could introduce legislation to establish a comprehensive cancercontrol program or to dedicate a portion of tobacco settlement funds to cancercontrol efforts or you could introduce a resolution to encourage state healthagencies to collaborate with other cancer stakeholders to improve overall ratesof screening, early diagnosis and treatment.
ß Participating in health fairs and other events that address cancer of all types.Distribute comprehensive cancer control materials to constituents andstakeholder groups. Again, be the recognizable “champion” in your state forfighting cancer. Put your “face” on the fight against cancer, and lead others tofollow you.
4
Implementing a Comprehensive Approach to Cancerin Your State:
Questions & Answers for State Policy-makers
What is a comprehensive approach to cancer control?
A comprehensive approach makes sure that all of a state’s cancer pre-vention resources are working together to fight cancer in every com-munity, on all fronts.The approach seeks to integrate and coordinatethe full range of cancer prevention and control activities to maximizethe impact of limited resources.
Taking a comprehensive approach means:
ß Uniting a state’s cancer stakeholders around a common plan toconquer cancer
ß Making sure there is a continuum of care, from prevention andearly detection to treatment, rehabilitation and palliative care
ß Setting program goals determined by the best available data,knowledge, and evidence of effectiveness
ß Selecting interventions and strategies based on the best scientificdata and knowledge
In practice, the approach involves getting a state’s various cancerprograms and efforts—including both public and private sectors—tocolaborate on a common plan to fight cancer.
For more information about the comprehensive approach to cancercontrol, please visit CDC’s National Comprehensive Cancer ControlProgram Web site at www.cdc.gov/cancer/ncccp.
What are the benefits of taking a comprehensiveapproach?
The potential benefits include:
ß Making coordination and cooperation the normal way of doingbusiness in the cancer-fighting community
ß Giving everyone in the cancer-fighting community access tocritical data, new ideas, examples of successful activities andresources that may not otherwise be available to them
ß Helping to identify and address inefficient activities to make themost of existing cancer prevention resources
A:
A:Q
Q
Why develop a comprehensive approach?
Even though remarkable progress has been made against the dis-ease in recent years, cancer remains the second leading cause ofdeath in the United States and fiscal constraints at the local, stateand national level are driving cancer-related programs and organ-izations to find smarter, more effective and more efficient way tofight the disease.
Since passage of the fi rst National Cancer Act in 1971, m o s tof the initiatives undert a ken to reduce the burden of cancerh ave been categori c a l , which means they focused on specifi co rg a n s , on a par ticular risk factor (such as smoking or sune x p o s u r e ) , or on one of more than 200 diseases that fall underthe heading of cancer.
Seeing an opportunity to combine fo r c e s , m a ny of themajor U. S . cancer organizations and programs came togethera decade ago to begin linking categorical programs in produc-t i ve way s . State cancer communities are now engaged in asimilar effo rt .
The continuing scarcity of public resources av a i l a ble for pub-lic health effo rts adds urgency to that effo rt . If a state’s cancerp r e vention stake h o l d e rs are able to org a n i zethemselves aroundan evidence-based state cancer plan, they are far better posi-tioned to make a compelling case to the public for adequatep u blic health funds. T h a t ’s what happened in Colora d o, w h e r ethe existence of a collabora t i ve ly developed and widely sup-p o rted statewide cancer plan made it easy for the state to ear-m a rk $28 million annu a l ly from reve nues generated by a newcigarette tax for cancer and cardiovascular disease preve n t i o n .
Where can I learn more about the burden of cancerin my state?
An excellent place to get a picture of the overall cancer burdenin your state is http://statecancerprofiles.cancer.gov/.This Web site,sponsored collaboratively by the National Cancer Institute,C D C, the Substance A buse and Mental Health Serv i c e sAdministration, and the American Cancer Society, offers individ-ual state cancer profiles that include death and incidence rates,historical trends and information about cancer burdens.
Other useful Web sites include:ß http://apps.nccd.cdc.gov/uscs/index.asp?Year=2001
This site contains official fe d e ral statistics on cancerincidence.
ß www.cdc.gov/cancer/dbdata.htm
This site contains state cancer burden data on lung cancer,colorectal cancer, breast cancer and prostate cancer and hasestimated numbers of new cancer cases and cancer deathsfor each state.
ß www.cdc.gov.cancer/natlcancerdata.htm
This site contains links to a number of other sources ofnational cancer data.
A:
A:Q
Q
2
Where can I find out more about cancer controlefforts in my state?
You can find out more by contacting the cancer control planningofficial in your state. See the Resources For Further Explorationguide for contact info rmation for your state or visithttp://apps.nccd.cdc.gov/CancerContacts/ncccp/contactlist.asp.
Most states have published their plans for comprehensive can-cer control. Ask your state health department leader for a copy,and ask what action steps are being taken. A number of statesprovide their cancer plans on their Web sites, which can beaccessed through the address above.
How are states taking a comprehensive approach?What are they doing?
In brief, the comprehensive approach to cancer control comes inas many varieties as there are states in the Union. But becausethe purpose is the same everywhere—to integrate and coordi-nate anti-cancer efforts—it’s not surprising that state efforts canbe grouped into general categories, including:
ß Measuring the burden of cancerß Bringing together information about cancerß Building broad, effective partnershipsß Ensuring a continuum of careß Expanding the reach of prevention and treatmentß Making cancer treatment affordable
This question is best answered through looking at the specificsof what states are doing. To do that, please review theComprehensive Approaches to Cancer Control in the States:Promising Practices insert in this tool kit.
What are some of the lessons learned from statesabout how best to implement a comprehensiveapproach?
States that were early adopters of the comprehensiveapproach learned four key lessons about how best to designand implement a comprehensive cancer control plan.The les-sons are:
ß Strong leadership in the state is essential to make the plana reality, provide vision, motivate partners, and sustainforward momentum
ß Effective public-private partnerships can generate resourcesto implement and evaluate activities
ß Decision making must be grounded in data and scientificevidence
ß Planning and implementation comprise a cycle; assessmentand evaluation of efforts lead to improved planning andimplementation activities.
Remember: State legislators, along with key partners and pub-lic health officials, can play essential roles in providing valuableleadership, as well as “visibility,” for promoting comprehensivecancer control activities.
A:
A:
A:Q
Q
Q
3
Q Who is involved with comprehensive cancer controlefforts?
A number of key national organizations are involved, includingthe Centers for Disease Control and Prevention, NationalCancer Institute, American Cancer Society, C-Change, ChronicDisease Directors, Intercultural Cancer Council, North AmericanAssociation of Central Cancer Registries, and American Collegeof Surgeons.
Are federal funds available to help states take acomprehensive approach?
Ye s . The CDC’s National Comprehensive Cancer ControlProgram provides funds to states for planning and implementingcomprehensive approaches to cancer control.Visit the NCCCPWeb site at www.cdc.gov/cancer/ncccp.
The program, which started in 1998 with funding for just fivestates and one tribal organization, now funds 61 programs—including 49 states, the District of Columbia, five tribes/tribalorganizations and six U.S. Associated Pacific islands/terriorities.Only Idaho currently lacks funding, and CDC anticipates Idahowill apply to participate in NCCCP this year.
With help from the NCCCP, states form broad-based com-prehensive cancer control coalitions, assess the burden of cancer,determine priorities for cancer prevention and control, anddevelop and implement statewide comprehensive approaches tocancer control.As programs mature, their ability to marshal theirown resources—and those of their partners—will help thembetter re-engineer cancer prevention activities to maximize effi-ciency and reach desired outcomes.
For more information, contact your state comprehensive can-cer official or contact the CDC at w w w.cdc.gov/cancer/com -ments.htm.
A:
A:Q
4
The comprehensive approach to cancer control comes in as many varieties asthere are states in the Union. But because the purpose of the comprehensiveapproach is the same everywhere—to integrate and coordinate anti-cancerefforts—one state’s experience and efforts are frequently valuable to other states.Following are six key practices commonly included in a comprehensive approachto cancer control planning:
ß Measuring the burden of cancerß Bringing information togetherß Building broad, effective coalitionsß Ensuring the continuum of careß Extending the reach of prevention and treatmentß Making cancer treatment affordable
These strategies can best be described in state-specific contexts. Examples from11 states—Te x a s , C o l o ra d o, M i c h i g a n , G e o rg i a , M i s s o u ri , D e l aw a r e, H aw a i i ,Kentucky, North Carolina, New York and Oregon—provide insights into practicesbeing used around the nation.
The Council of State Gove rnments does not endorse any par ticular state’sp ra c t i c e, method or progra m ; nor has it conducted independent evaluation ofa ny of the programs mentioned here. I n s t e a d , these examples are provided toi n fo rm state leaders about promising practices in cancer control being imple-mented by states.
Comprehensive Approaches toCancer Control in the States:Promising Practices
Texas
Measuring the burden of cancer
Highlighted State Examples:
ß Texas: Measuring the burdenof cancer
ß Colorado: Bringinginformation together
ß Michigan: Building broad,effective coalitions
ß Georgia: Ensuring thecontinuum of care
ß Missouri: Extending thereach of prevention andtreatment
ß Delaware: Making cancertreatment affordable
In Texas, one of the first things that the state’s cancercoalition did to advance the comprehensive approach tocancer control was to undertake a rigorous study of theannual costs of cancer in the Lone Star State.
According to study results, the estimated total costsdue to cancer in 1998 were about $14 billion. Of that,direct medical expenses accounted for $4.9 billion, a n dindirect costs and lost productivity accounted for $9.1 bil-l i o n . By major cancer types, the total direct costs included$2.2 billion for lung cancer, $1.2 billion for colorectal can-c e r, $1.2 billion for breast cancer, and $445 million fo rprostate cancer.
The report helped paint a vivid picture for state resi-dents and officials about the financial burden related tocancer and the need for continuing efforts to fight it.
The report can be accessed atwww.tdh.state.tx.us/tcccp/cancerdata.htm.
The state’s public health department and a statewide coalitionof cancer groups have collaborated on two important information-sharing projects.
In the first, the state is now able to use resources from the coali-tion of cancer groups to enhance its monitoring of cancer trends.The information-sharing already has led to improved targeting ofanti-cancer efforts. In particular, the state can now do a much bet-ter job of tracking trends in the cancer risk factors facing children.
In the second, the state and its partners created the ColoradoCancer Resource Guide, a central online location for cancerpatients and their families to find information about particulartypes of cancer, treatment options, financial assistance and links toother local, state and national resources.
Colorectal cancer has been killing nearly 2000 people a year inMichigan, making this type of cancer the second leading cause ofdeath in the state. Screening rates for colorectal cancer were lowstatewide.
In 2002, Michigan’s Cancer Consortium took aim at the prob-lem.The consortium, a group that includes more than 70 cancerorganizations throughout the state, created a special public/pri-vate network called the Colorectal Cancer Awareness Network,to develop and implement a strategy to fight this cancer.
Under the leadership of the American Cancer Society, the net-work grew to include more than 145 organizations.Together, thenetwork launched an aggressive campaign to promote awarenessabout colorectal cancer and the importance of screening.
In Georg i a , the state’s breast and cervical cancer program haswo rked to ensure the continuum of care is unbroken for eve ry-o n e.
The program began using client navigators to guide women inmedically underserved areas through a complex health care sys-tem so that they could get the care they need. The navigators,also called “lay health advisors,” come from the communities thatthey work in and receive specialized training in helping othersovercome health care system barriers.
The client navigators help women get needed breast and cer-vical cancer screenings and they help case managers conduct fol-low-up with patients.
They ensure a continuum of care because they build relation-ships of trust between patients and the health care system.Theyhelp dispel myths about cancer and help women overcome theirfears about the disease. With this support, more women getscreenings and follow through with their plan of care.
2
Colorado
Bringing information together
Michigan
Building broad, effective coalitions
Georgia
Ensuring the continuum of care
How do you make sure that the latest cancer screenings andtreatments are available to everyone in your state, including thoseliving in poor, rural areas?
Missouri answered that question by asking a number of partnersto join forces to offer a series of cancer screenings and follow-uptreatments to women in a large, poor rural area in the southeast-ern part of the state.The coalition that was built to do this includ-ed the state’s health department, a major state hospital, theAmerican Cancer Society, local women’s health support groupsand others.
Of the 459 women who were screened, 11 had breast cancerand were enrolled in the state’s breast and cervical cancer treat-ment and prevention program.
Missouri
Extending the reach of preventionand treatment
The Delaware Cancer Treatment Program is just one part of thestate’s $48.4 million anti-cancer plan, but it’s getting lots of atten-tion. The state’s plan helps people who might not have been ableto afford cancer treatment get the medical attention that couldsave their lives.
A $10 million program was created for residents of Delawarewho do not have health insurance and who are not eligible forMedicaid. Currently, the state estimates that 275 of the 3,800 adultsdiagnosed with cancer in Delaware are uninsured and have noother medical coverage.The program pays treatment costs for oneyear for patients with a newly diagnosed cancer.
Program eligibility requirements include:
ß Being a resident of Delawareß Having been diagnosed with cancer on or after July 1, 2004ß Not having comprehensive health insuranceß Having a household income that is under 650% of the
federal poverty level.
Delaware
Making cancer treatment affordable
3
Promising Practices in Comprehensive Approaches toCancer Control in Other States
HawaiiPassed resolution encouraging state health depart-ment to work with other government and non-gov-ernment partners to improve overall rates of screen-ing, early diagnosis, and treatment of cancer.
KentuckyDeveloped active Regional Cancer Partnerships tohelp involve more local cancer control partners incrafting statewide cancer plan priorities.
North CarolinaLaunched a successful pilot program to raise aware-ness about the importance of early detection of col-orectal cancer among low-income women with littleor no health insurance.
NewYorkImplemented an emergency rescreening for breastcancer after unusually low rates of breast cancercases were discovered at a mammography screeningfacility.
OregonDeveloped a “cluster buster” protocol to morepromptly respond to citizen concerns that cancerrates are high in particular neighborhoods and toreduce the duplication of efforts among state agen-cies in responding to citizen concerns.
•
•
••
•
See inside for: Colorado, Delaware, Michigan,Texas, Georgia, and Missouri.
4
StateDateEnacted
Bill Number/EnactmentNumber Description
California 8/24/2002 SB1632/2002-266 Requires every school site to allow pupils to use sun-screen during the school day without a physician’s noteor prescription and authorizes school sites to set a policyrelated to use of sunscreen.
Florida 6/17/2004 SB2138/2004-329 Provides funding for public education regarding cancerprevention under the Jessie Trice Cancer PreventionProgram.
NorthCarolina
8/2/2004 SB657/ 2004-157 Requires that opera t o rs of tanning bed equipment posthealth risks of tanning beds and not allow persons underthe age of 13 to use the equipment without prescri p t i o nfrom a healthcare profe s s i o n a l .
StateDateEnacted
Bill Number/EnactmentNumber Description
Mississippi 3/25/2002 HB891/02/HR12/1771
Creates Mississippi Healthcare Coordinating Council toestablish a comprehensive preventive health care plan;includes expanding Medicaid coverage for breast andcervical cancer screenings and treatment.
Hawaii 5/30/2003 SB1241/321-45 Establishes that screening, early diagnosis and treatmentof cancer be part of a statewide comprehensive cancercontrol plan to be developed by the health department.
NorthCarolina
6/19/2003 SB887/SL 2003-223
Mandates insurance coverage for surveillance tests forwomen aged twenty-five and older, at risk for ovariancancer.
Georgia 5/15/2002 SB1100/2002-24 Requires health benefit policy coverage for colorectalcancer screening.
New York 8/3/2003 SB6206/2003-326 Allows taxpayers to make a gift to prostate cancerresearch and detection.
Early Detection/Screening
Primary Prevention
The Continuum of CareThe comprehensive approach to cancer is about making sure that all of a state’s cancer prevention resources—from governmentprograms to private organization—are working together to fight all cancers in every community, on all fronts.This includes ensur-ing that the full scope of cancer care—ranging from primary prevention, early detection, and treatment and rehabilitation to painrelief and patient and family care during survivorship—is addressed.
This table provides recent examples of legislation from the states that seek to enhance particular stages of the continuum.TheCouncil of State Governments does not endorse any of these approaches; nor has it conducted independent evaluation of any ofthe programs or legislation mentioned here. Instead, the legislation listed is intended to give state leaders an idea of some of theapproaches being taken to build the continuum of care.
5 continuum of care 6/1/05 10.44 AM Page 1
StateDate Enacted
Bill Number/EnactmentNumber Description
Hawaii 6/25/2001 HB118/2001-321 Establishes a breast and cervical cancer treatment pro-gram to provide funding for uninsured and underinsuredpersons in the state with breast or cervical cancer, orboth.
Arkansas 4/10/2001 HB2508/1455 Establishes a program to raise awareness concerningprostate and testicular cancer and to increase the avail-ability of diagnosis and treatment of prostate and testicu-lar cancer.
California 8/1/2003 HB429/2003-140 Requires department of health to award one or morecontracts to provide prostate cancer treatment throughprivate or public nonprofit organizations.
Missouri 7/2/2002 SB1026/4183 Allows physicians to refer patients who have been newlydiagnosed with cancer to a specialist for a second opin-ion; requires insurance coverage.
StateDateEnacted
Bill Number/EnactmentNumber Description
Hawaii 7/9/2004 HB1839/189 Authorizes doctors to prescribe medically necessarydoses of controlled substances to treat intractable pain,including treatment of acute and chronic pain originatingfrom cancer.
NewHampshire
5/28/2003 HB831/03-1017 Ch.78
Requests Committee on Health and Human Servicesstudy access to palliative care services in all areas of thestate.
Virginia 2/25/2005 HJR605 Encourages Virginia’s health care community to increasethe education and training of health care professionals inthe techniques and benefits of palliative care, and toincrease patient awareness regarding palliative care.
StateDateenacted
Bill Number/EnactmentNumber Description
Connecticut 4/28/2004 HB 5464/ 04-34 Requires health insurance coverage for wigs for cancerpatients who suffer hair loss from chemotherapy whensuch wig is prescribed by an oncologist.
Indiana 2/14/2002 SCR 12 Honors participants of the American Cancer Society’sRelay for Life, of whom 6,136 were cancer survivors.
Maine 5/19/2003 SB314/1407 Ensures comprehensive cancer control will includepatient and family education on how to manage the dis-ease and the treatment of the disease.
Treatment/Rehabilitation
Pain Relief
Patient and Family Care/Survivorship
5 continuum of care 6/1/05 10.44 AM Page 2
State Legislation Description
Alabama 2002 SJR 72 Recognizes the Alabama Comprehensive Cancer Control Coalitionand urges the adoption of a cancer control plan and creation of aComprehensive Cancer Control Task Force
Pennsylvania 2004 SR 195 Commends the members of the Pennsylvania Cancer ControlConsortium for their leadership in the development of theComprehensive Cancer Control Plan
Maine 2003 SB 314/ LD 973 Ensures Comprehensive Cancer Control in Maine
Washington 2003 HR 4622 Supports the Comprehensive Cancer Control Partnership
Washington 2003 SR 8619 Recognizes the Comprehensive Cancer Control Partnership
Utah 2005 SJR 16 Recognizes the Department of Health and the Utah Cancer ActionNetwork for taking the lead in formulating the Comprehensive CancerControl Plan
Comprehensive Approaches to Cancer:A Table of Sample Legislation
This table includes examples of legislation from the states relating to or establishing comprehensive approaches to cancer control.The Council of State Governments does not endorse any of these approaches; nor has it conducted independent evaluation of anyof the programs or legislation mentioned here. The examples are provided to give state leaders an indication of how other statesare beginning to implement a comprehensive approach to cancer.
6 table of legislation 6/1/05 10.45 AM Page 1
Sample Legislation on Comprehensive Cancer ControlThe Council of State Governments does not necessarily endorse this legislation; nor has it conducted independent evaluation of any ofthe legislation reprinted here. Instead, the sample legislation reprinted here is offered to illustrate how some states are approaching com-prehensive cancer control.
Legislation Creates Comprehensive Control Program in Maine
In 2003, Maine enacted this law (2003 SB 314) establishing a program to coordinate cancer prevention, research and treatment activitiesin the state.The text of the statute is reprinted below.
Title 22: HEALTH AND WELFARE Subtitle 2: HEALTHPart 3: PUBLIC HEALTHChapter 255: CANCER
§1407. Cancer prevention, research and treatment
1. Program established.The Bureau of Health shall establish a cancer prevention and controlprogram to provide leadership for and coordination of cancer prevention, research andtreatment activities.The program may include, but is not limited to:
A. Monitoring cancer prevalence at the state and community levels through the cancer-incidence registry under section 1404 and other means;
B. Education and training of health professionals on the current methods of diagnosingand treating cancer;
C. Patient and family education on how to manage the disease and the treatment of thedisease; and
D. Consultation with and support of community-based cancer prevention, research andtreatment programs.
2. Consultation. In implementing the program established in subsection 1, the Bureau of Healthshall consult with the Medicaid program administered by the department and with theDepartment of Education. In addition, the bureau shall seek advice from other organizationsand private entities concerned with cancer prevention, research and treatment.
3. Funding.The Bureau of Health may accept federal funds and grants for implementing the pro-gram established in subsection 1 and may contract for work with outside vendors or individ-uals.
HOUSE RESOLUTION NO. 2003-4622
WHEREAS, One out of every four deaths in Washington state is caused by cancer; and
WHEREAS, Cancer is the second leading cause of death in Washington state for all residents; and
WHEREAS, Cancer is the leading cause of death among adults 45–74 years of age in Washingtonstate; and
WHEREAS, One out of every two men and one out of every three women will get cancer in theirlifetime; and
WHEREAS,Approximately 30,000 people in Washington state will get cancer in 2003; and
WHEREAS, Over 10,000 people in Washington state will die from cancer in 2003; and
WHEREAS, Comprehensive Cancer Control is an integrated and coordinated approach to reducingcancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation, and palliation; and
WHEREAS,The Washington State Comprehensive Cancer Control Partnership is a voluntarystatewide, multidisciplinary group working to develop a state plan by June 2003;
NOW,THEREFORE, BE IT RESOLVED,That the House of Representatives recognize theComprehensive Cancer Control Partnership and its goal to reduce the burden of cancer on thepopulation of Washington state; and
BE IT FURTHER RESOLVED,That copies of this resolution be immediately transmitted by the chiefclerk of the House of Representatives to the governor and to Rep. Paul Sanders, chairman of theWashington State Prostate Cancer Coalition.
Washington Recognizes Work of State’s Comprehensive Cancer Control Partnership
In 2003, the state of Washington’s House of Representatives adopted this resolution recognizing the importance of the Comprehensive CancerControl Partnership’s goal to reduce the burden of cancer.
Alabama
Cancer Prevention DivisionAlabama Department of Public HealthRSA Tower
201 Monroe StreetMontgomery, AL 36104(334) 206-5316
Web site: www.adph.orgCancer plan:www.adph.org/administration/comcancerctl.pdf
Alaska
Comprehensive Cancer Control Program3601 C Street, Suite 540
P.O. Box 240249 Anchorage, AK 99524 (907) 269-8092
Arizona
Arizona Department of Health Services
150 North 18th AvenueSuite 310 Phoenix, AZ 85007
(602) 542-2808
Arkansas
Comprehensive Cancer Control
Arkansas Department of Health4815 West Markham Street, MS 11Little Rock, AR 72205-3866
(501) 661-2495Web site: www.healthyarkansas.comCancer plan: www.healthyarkansas.com/disease/cancer -plan.pdf
California
Cancer Control BranchCalifornia Department of Health Services1616 Capitol Avenue, Suite 74-456
Sacramento, CA 94234-7320(916) 449-5400Web site: www.dhs.ca.gov/ps/cdic/cpns/default.htm
Colorado
Comprehensive Cancer ProgramColorado Department of Public Health andEnvironment
4300 Cherry Creek Drive, South Denver, CO 80246 (303) 692-2519
Web site: www.cdphe.state.co.us/pp/ccpc/CCPCHom.aspCancer plan:www.cdphe.state.co.us/pp/ccpc/CancerPlan.html
Connecticut
Cancer UnitConnecticut Department of Public Health
410 Capitol Avenue, MS #13 PHIHartford, CT 06134-0308 (860) 509-8098
Delaware
Cancer Prevention and Control Program
Division of Public HealthDelaware Health and Social ServicesBlue Hen Corporate Center, Suite 200
655 South Bay Road Dover, DE 19901 (302) 739-4651
Web site: www.state.de.us/dhss/dph/dpc/cancer.html
District of Columbia
Comprehensive Cancer Control Program
District of Columbia Department of Health825 North Capitol Street, N.E., 3rd FloorWashington, DC 20002
(202) 442-9139
FloridaComprehensive Cancer Control ProgramBureau of Chronic Disease Prevention and HealthPromotion
Florida Department of Health4052 Bald Cypress Way, Bin A18Tallahassee, FL 32399-1744
(850) 245-4444, ext. 3808Web site: www.doh.state.fl.us/family/cancer/index.htmlCancer plan:www.doh.state.fl.us/family/cancer/plan/default.html
Resources for Further Exploration
American Cancer Society
National Home Office1599 Clifton Road, N.E.
Atlanta, GA 30329-4251(800) 227-2345 (800-227-2345)www.cancer.org
Centers for Disease Control and Prevention
Division of Cancer Prevention and Control National Center for Chronic Disease Prevention andHealth Promotion 4770 Buford Highway, N.E., MS K-64 Atlanta, GA 30341-3717
(770) 488-4751Email: [email protected]/cancer
National Cancer Institute
Public Inquiries Office
Suite 3036A6116 Executive Boulevard, MSC8322Bethesda, MD 20892-8322
(800) 422-6237 Email: [email protected]://www.cancer.gov
C-Change
1776 Eye Street, N.W.Suite 900
Washington, DC 20006 (800) 830-1827 or (202) 756-1600 Fax: (202) 756-1512
Email: [email protected]
Intercultural Cancer Council
6655 Travis, Suite 322Houston,TX 77030-1312
713-798-4617 E-mail: [email protected]://iccnetwork.org/
Cancer Resources State by StateNational Organizations
8 resources 6/1/05 10.48 AM Page 1
Georgia
Cancer Control SectionDivision of Public Health
Georgia Department of Human Resources2 Peachtree Street, 16th FloorSuite 16.295
Atlanta, GA 30303-3142 (404) 657-6604Web site: www.georgiacancer.org/
Hawaii
Chronic Disease Management and Control Branch
Hawaii Department of Health1250 Punchbowl Street, Room 205Honolulu, HI 96813
(808) 692-7464
Idaho
Bureau of Health Promotion
Idaho Department of Health and WelfareP.O. Box 83720 Boise, ID 83720-0036
(208) 334-5933
Illinois
Comprehensive Cancer Control ProgramDivision of Chronic Disease Prevention and ControlIllinois Department of Public Health
535 West Jefferson Street, 2nd FloorSpringfield, IL 62761-0001 (217) 785-5243
Indiana
Comprehensive Cancer Control Program2 North Meridian Street, 6B
Indianapolis, IN 46204-3006 (317) 233-3819
Iowa
Comprehensive Cancer Control ProgramBureau of Chronic Disease Prevention and Management
Iowa Department of Public HealthLucas State Office Building321 East 12th Street
Des Moines, IA 50319-0075 (515) 281-4535Web site:www.idph.state.ia.us/hpcdp/comp_cancer_control.aspCancer consortium’s web site: www.canceriowa.org/Cancer plan:www.idph.state.ia.us/common/pdf/publications/ccc_2003.pdf
Kansas
Cancer Prevention and Control Program
Bureau of Health PromotionKansas Department of Health and Environment1000 Southwest Jackson, Suite 230
Topeka, KS 66612 (785) 296-5868Cancer plan:www.kdhe.state.ks.us/bhp/download/ccc_part1.pdf
Kentucky
Kentucky Cancer ConsortiumCommunity Programs Division
University of Kentucky Markey Cancer Control Program2365 Harrodsburg Road, Suite A-230Lexington, KY 40504-3381
(859) 219-0772 Ext. 249Web site: www.kentuckycancerconsortium.org/index.phpCancer plan: www2.kcr.uky.edu/kcp/cancerplan.htm
Louisiana
Louisiana State University Health Sciences Center
School of Public HealthDepartment of Public Health and Preventive Medicine1600 Canal Street, Suite 1100
New Orleans, LA 70112 (504) 568-2231Cancer plan: www.lcltfb.org/CC-Plan/default.html
Maine
Bureau of HealthMaine Department of Human Services
11 State House Station Key Bank Plaza, 4th FloorAugusta, ME 04333
(207) 287-5387Web site: www.mainecancerconsortium.org/welcome.htmlCancer plan: www.mainecancerconsortium.org/images/can -cerplan.pdf
Maryland
State Council on Cancer ControlDepartment of Health and Mental Hygiene 201 West Preston Street, 4th Floor
Baltimore, MD 21201(410) 767-1617
Massachusetts
Comprehensive Cancer Control and Prevention ProgramDivision of Health Promotion and Disease PreventionMassachusetts Department of Public Health
250 Washington Street,Boston, MA 02108 (617) 624-5484
Web site: www.mass.gov/dph/cancerct/home.htmCancer plan: www.mass.gov/dph/cancerct/plan.pdf
Michigan
Comprehensive Cancer Control ProgramMichigan Department of Community Health
3423 N. Mar tin Luther King Jr. Blvd.Lansing, MI 48909(517) 335-9620
Web site: www.michigan.gov/mdch/0,1607,7-132-2940_2955_2975---,00.htmlCancer plan:www.michigan.gov/documents/MCCIPlan_6718_7.pdfCancer consortium’s web site: www.michigancancer.org/
Minnesota
Comprehensive Cancer PlanningHealth Promotion and Chronic Disease Division
Minnesota Department of HealthP.O. Box 9441 Minneapolis, MN 55440-9441
(612) 676-5220Web site: www.health.state.mn.us/divs/hpcd/compcancer/Cancer plan: www.cancerplanmn.org/
Mississippi
Comprehensive Cancer Control Program
Division of Health Promotion570 East Woodrow WilsonP.O. Box 1700
Jackson, MS 39215-1700 (601) 576-7781
Missouri
Cancer Control UnitMissouri Department of Health and Senior Services920 Wildwood
Jefferson City, MO 65109 (573) 522-2845
Montana
Chronic Disease Prevention and Health PromotionMontana Department of Public Health and HumanServicesP.O. Box 202951Helena, MT 59620-2951
(406) 444-9020
Nebraska
Comprehensive Cancer Control Program
Nebraska Department of Health and Human ServicesP.O. Box 95044 Lincoln, NE 68509-5044
(402) 471-0369
Nevada
Comprehensive Cancer Control ProgramNevada State Health Division505 East King Street, Room 103
Carson City, NV 89701-4774 (775) 684-5914Web site: http://health2k.state.nv.us/cccp/
New Hampshire
Comprehensive Cancer Control ProgramDivision of Public Health Services
Department of Health and Human Services29 Hazen DriveConcord, NH 03301-6504
(603) 271-4886Fax (603) 271-4827
2
8 resources 6/1/05 10.48 AM Page 2
New Jersey
Office of Cancer Control and PreventionNew Jersey Department of Health and Senior Services
P.O. Box 369 Trenton, NJ 08625-0369 (609) 588-7681
Web site: www.state.nj.us/health/ccp/Cancer plan: www.state.nj.us/health/ccp/ccc_plan.htm
New Mexico
Comprehensive Cancer ProgramNew Mexico Department of Health
625 Silver Southwest, Suite 325Albuquerque, NM 87102 (505) 841-5847
Web site: www.cancernm.org/ccp/Cancer plan:www.cancernm.org/docs/pdf/nm_cancer_plan_02-06_bm.pdf
New York
Comprehensive Cancer Control ProgramDivision of Chronic Disease Prevention and Adult Health
New York State Department of HealthEmpire State PlazaCorning Tower, Room 515
Albany, NY 12237-0675 (518) 474-3276Web site: www.health.state.ny.us/nysdoh/cancer/center/can -cerhome.htmCancer plan:www.health.state.ny.us/nysdoh/cancer/cancer_control/index.htm
North Carolina
Comprehensive Cancer Control ProgramDivision of Public HealthNorth Carolina Department of Health and HumanServices1915 Mail Service CenterRaleigh, NC 27699-1915
(919) 715-0121Web site: www.nccancer.org/Cancer plan: www.nccancer.org/ccplan06.htm
North Dakota
Division of Cancer Prevention and ControlNorth Dakota Department of Health
600 East Boulevard Avenue, Department 301Bismarck, ND 58505-0200 (701) 328-2333
Ohio
Comprehensive Cancer Control
Ohio Department of HealthP.O. Box 118Columbus, OH 43215
(614) 752-2464Web site:www.odh.state.oh.us/ODHPrograms/cancer/Cancer1.htmCancer plan: www.cancer.org/downloads/com/ohiocancer -plan2010.pdf
Oklahoma
Comprehensive Cancer Control ProgramChronic Disease Division
Oklahoma State Department of Health1000 Northeast 10th StreetOklahoma City, OK 73117-1299
(405) 271-4072
Oregon
Oregon Partnership for Cancer ControlOregon Health ServicesOregon Department of Human Services
800 NE Oregon Street, Suite 730Portland, OR 97232-2162 (503) 731-4273
Web site: www.ohd.hr.state.or.us/cancer/
Pennsylvania
Cancer Prevention and Control Programs
Cancer Prevention and Control SectionPennsylvania Department of HealthPO Box 90
Harrisburg, PA 17108 (717) 787-5251Website:www.dsf.health.state.pa.us/health/cwp/browse.asp?a=174&bc=0&c=35535&healthPNavCtr=|#4451Cancer plan: www.dsf.health.state.pa.us/health/lib/health/can -cer/2002/CancerAnnualReport01-02.pdf
Rhode Island
Cancer Control ProgramRhode Island Department of Health3 Capitol Hill, Room 408
Providence, RI 02908 (401) 222-3497Web site: www.health.ri.gov/disease/cancer/index.phpCancer plan:www.health.ri.gov/disease/cancer/controlplan.php
South Carolina
Division of Cancer Prevention and ControlSouth Carolina Department of Health and EnvironmentalControl
2600 Bull StreetColumbia, SC 29201(803) 545-4114
Cancer plan: www.scdhec.net/cancer/cancer_plan.htm
South Dakota
Breast and Cervical Cancer ControlOffice of Health PromotionSouth Dakota Department of Health
615 East 4th StreetPierre, SD 57501-1700 (605) 773-5728
Fax (605) 773-5509
Tennessee
Comprehensive Cancer Control ProgramPolicy, Planning and Analysis, Office of Cancer Surveillance
Tennessee Department of HealthCordell Hull Building, 6th Floor North425 Fifth Avenue North
Nashville,TN 37247 (615) 741-1638
Texas
Bureau of Chronic Disease and Tobacco PreventionTexas Department of Health
1100 West 49th Street, Room T-406Austin,TX 78756-3199 (512) 458-7111, Ext. 3439
Web site: www.texascancercouncil.org/Cancer plan: www.texascancercouncil.org/tcplan/cover.html
Utah
Utah Cancer Control ProgramUtah Department of HealthP.O. Box 142107
Salt Lake City, UT 84118-2107 (801) 538-9495Web site: www.utahcancer.org/
Vermont
Planning for Cancer Control in Vermont
Division of Health ImprovementVermont Department of Health108 Cherry Street
PO Box 70 Burlington,VT 05401-0070 (802) 865-7706
Web site: www.healthyvermonters.info/cancer/
Virginia
Comprehensive Cancer Prevention and Control Project
Division of Chronic Disease Prevention and ControlVirginia Department of Health109 Governor Street, 10th Floor West
Richmond,VA 23219 (804) 864-7879Web site: www.vahealth.org/cancerprevention/Cancer plan: www.vahealth.org/cancerprevention/cancer -plan01.pdf
Washington
Comprehensive Cancer ControlWashington State Department of Health
P.O. Box 47855 Olympia,WA 98504-7855 (360) 236-3853
Web site: www.doh.wa.gov/CCC/default.htm
West Virginia
West Virginia Comprehensive Cancer Control Program
350 Capitol Street, Room 319Charleston,WV 25301-3715 (304) 558-6262
Web site: www.wvdhhr.org/bph/oehp/cancer/default.htm
3
8 resources 6/1/05 10.48 AM Page 3
Wisconsin
Comprehensive Cancer Control ProgramDepartment of Health and Family Services
1 West Wilson StreetP.O. Box 2659 Madison,WI 53701-2659
(608) 261-6857Web site: http://dhfs.wisconsin.gov/health/cancer/index.htm
Wyoming
Wyoming Cancer Surveillance ProgramWyoming Department of Health
6101 Yellowstone Road, Room 259ACheyenne,WY 82002 (307) 777-8609
Web site: http://wdh.state.wy.us/wcsp/index.asp
For updated information about state contacts, please visit http://apps.nccd.cdc.gov/CancerContacts/ncccp/contactlist.asp
Information current as of May 2005.
Resources on the Web
National Comprehensive Cancer Control Program
www.cdc.gov/cancer/ncccp/
Maintained by the CDC’s Division of Cancer Prevention and Control, this Web site has detailed information about comprehensive cancer control, national leadership efforts andfuture CDC initiatives in the area.The site also includes a link to state-by-state information about cancer burdens at www.cdc.gov/cancer/dbdata.htm.
Cancer Control PLANET
http://cancercontrolplanet.cancer.gov/
Provides access to Web-based resources that can assist in assessing the cancer and/or risk factor burden within a given state: identifying potential partner organizations that may alreadybe working with high-risk populations, understanding the current research findings and recommendations, accessing and downloading evidence-based programs and products and find-ing guidelines for planning and evaluation. The site is sponsored by the National Cancer Institute, the Centers for Disease Control and Prevention, American Cancer Society, theSubstance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality.
American Cancer Society Statistics
www.cancer.org/docroot/stt/stt_0.asp
Contains a wealth of statistical information for present and past years; also includes statistics specific to African-Americans, and state-specific data.
National Cancer Institute Cancer Statistics
www.nci.nih.gov/statistics/
Contains links to national databases, glossaries of cancer terms and detailed state cancer profiles.
United States Cancer Statistics (USCS): 2001 Incidence and Mortality report:
http://apps.nccd.cdc.gov/uscs/index.asp?Year=2001
The Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), in collaboration with the North American Association of Central Cancer Registries(NAACCR), have combined their data sources to produce official federal statistics on cancer incidence from registries having high quality data. Statistics on death data from CDC’sNational Vital Statistics System are also included.
Understanding and Using the USCS report:
www.cdc.gov/cancer/npcr/uscs/2001/users_guide/index.htmwww.cdc.gov/cancer/npcr/uscs/2001/users_guide/figures.htm
The Centers for Disease Control and Prevention (CDC) has produced special companion materials using data from the United States Cancer Statistics: 2001 Incidence and Mortalityreport (USCS).These materials are designed for use by the media, researchers, policy makers, state health department officials, cancer control planners, and others interested in U.S.cancer data. State-specific information is included.
4
8 resources 6/1/05 10.48 AM Page 4
By Dan Lorentz
“Like every other state, we’ve got a tight budget so we have to be smart in how we fightcancer. And that means getting all the stakeholders and programs working together on acomprehensive plan so that we don’t duplicate efforts or miss opportunities.The bottom lineis: in fighting cancer we have to make sure that every dollar spent goes as far as it can tosave lives.”
—Delaware Gov. Ruth Ann Minner
States are taking a comprehensive approach
Attacking Canceron All Fronts
ince taking office in 2001, Delaware Gov. RuthAnn Minner has launched one ambitious anti-cancer initiative after another. Delaware is nowspending $10 million a year for increased cancerawareness, screening and treatment. It has creat-ed a cancer registry to identify cancer “hotspots.” And the “First State” has just started apioneering program to pay for cancer treatment
for those who can’t afford it.These efforts are not just a grab bag of popular programs.
Anyone who knows about how Minner’s husband died in 1991of lung cancer, and about how Delaware’s cancer risk and death
rates are among the highest in the United States, also knowsthat Minner is far too serious about combating cancer to settlefor that.
Minner is in earnest; she wants the fight against cancer tobe one of her administration’s major legacies. If you lookbeyond the names of the various initiatives she has launched,you’ll see that Delaware is taking a comprehensive approachto fighting cancer.
Simply put, the comprehensive approach is about makingsure that all of a state’s anti-cancer resources—from govern-ment programs to private organizations—are workingtogether to fight cancer in every community on all fronts,
S
from prevention and early detection to treatment, reha-bilitation and end-of-life care.
While some states have yet to pursue the comprehensiveapproach with Delaware’s aggressiveness, all are at leastplanning to implement it. It’s not hard to understand why.
Why the Comprehensive Approach?The twin pressures of the costs of cancer—in terms of
death, suffering and lost productivity—and fiscal constraintsare important factors driving states to find smarter, moree ffective strategies to combat the disease.
M i n n e r, whose state ranks sixth in cancer cases anddeaths, says the logic of the comprehensive approach to can-cer control is compelling to states.
“Most people in Delaware are like me: they knowsomeone or are related to someone who has been touchedby cancer,” said Minner. “That helps explain why we areso motivated to fight the disease.”
“But like every other state, we’ve got a tight budget so wehave to be smart in how we fight cancer. And that meansgetting all the stakeholders and programs working togetheron a comprehensive plan so that we don’t duplicate eff o r t sor miss opportunities. The bottom line is: in fighting cancerwe have to make sure that every dollar spent goes as far asit can to save lives.”
Although fiscal constraints and the continuing cancer tollare important spurs toward a comprehensive approach, therapid growth of cancer prevention and control programswithin state health departments itself highlights the need tobetter coordinate cancer control activities to maximizeresources and outcomes.
For example, while states have implemented successfulbreast and cervical cancer prevention and early detectionprograms and have launched effective public awarenesscampaigns about the risks of cancer from smoking, theyoften have failed to integrate their cancer eff o r t s .
Because these programs often are built around specific cancersor risk factors, states’ ability to fight the overall challenge of can-cer can be hampered by duplicated efforts and missed opportuni-ties for coordination.
According to Susan True, program services branch chief in theDivision of Cancer Prevention Control of the Centers for DiseaseControl and Prevention, state officials know they are missingopportunities for coordination, which translates into missedopportunities to save lives. “That’s why the interest in comprehen-sive cancer control approach is rapidly spreading through thestates,” she explains.
States Move ForwardUnder the traditional approach to cancer control, funding is typ-
ically categorical—that is, funding streams go to programs forspecific forms of cancer like lung cancer or colorectal cancer, orrisk factors like smoking or sun exposure. Planning is usuallydone within programs, and collaboration with other programs orprivate and nonprofit organizations is limited. The continuum of
anti-cancer interventions is often fragmented; prevention andearly detection efforts are programmatically isolated from treat-ment, rehabilitation and palliation efforts.
As states move toward a comprehensive approach, those tradi-tional barriers are breaking down.
In Colorado, for example, the state’s public health departmentand a statewide coalition of cancer groups have collaborated ontwo important projects. In the first, the state is now able to useresources from the coalition to enhance its monitoring of cancertrends. The information-sharing has already led to more targ e t e danti-cancer efforts. In particular, the state can now do a much bet-ter job of tracking trends in the cancer risk factors facing children.
The state and its partners also created the “Colorado CancerResource Guide,” a central online location for cancer patients andtheir families to find information about particular types of cancer;treatment options; financial assistance; and local, state and nation-al resources. (Visit the resource guide at w w w. c c rg o n l i n e . o rg .)
In Georgia, the state’s breast and cervical cancer program usesclient navigators to help make sure care is accessible for everyone.The navigators, also called “lay health advisors,” come from thecommunities in which they work, and receive specialized training
n If current trends continue, one-third of Americans will bediagnosed with cancer in their lifetimes.
n E ve ryone is at risk of developing some fo rm of cancer.
n More than 1.3 million new cases will be diagnosed in 2005.
n Cancer is now the leading cause of death in the UnitedStates among Americans 85 or younger, causing one in fourdeaths each year.
n The top killing cancers for women are lung, breast and col-orectal. For men, the top killers are lung, prostate and col-orectal cancer.
n Many cancer deaths can be prevented with earlyscreening and treatment.
n Many new cases of cancer can be stopped from everdeveloping with the right lifestyle choices.
n Cancer incidence varies by race and ethnicity, with somegroups being more susceptible to certain types of cancersthan others.
Sources: American Cancer Society, National Cancer Institute
Fact File
in helping others overcome health care system barriers. T h u sthey are able to guide women in medically underserved areasthrough a complex health care system so they can get the care theyn e e d .
In Michigan, the state’s cancer consortium—a group thatincludes more than 70 cancer organizations—created a specialpublic/private network to address the state’s low rates of colorec-tal cancer screening. Under the leadership of the American CancerS o c i e t y, the network grew to include more than 145 org a n i z a t i o n s ,all of which contributed to an aggressive outreach campaign pro-moting colorectal screening.
In Missouri, the state health department, a major state hospital,the American Cancer Society, local women’s health supportgroups and others formed a coalition to offer a series of cancerscreenings and follow-up treatments to women in a large, poor,rural area in the Southeastern part of the state. Eleven of the 459women screened had breast cancer and were enrolled in the state’sbreast and cervical cancer treatment and prevention program.
In Texas, one of the state cancer coalition’s first undertakingswas a rigorous study of the annual cost of cancer in the Lone StarState. The study estimated that in 1998, the total cost due to can-cer was about $14 billion. Of that, direct medical expensesaccounted for $4.9 billion and indirect costs and lost productivityaccounted for $9.1 billion. The report painted a vivid picture forstate residents and officials of the need for continuing efforts tofight cancer.
The National ComprehensiveCancer Control Program
Many of the state-level efforts have been seeded with fundsfrom the CDC’s National Comprehensive Cancer ControlProgram.
The program, which started in 1998 with funding for just sixstate plans, grew by fiscal year 2004 to a $12 million programthat funds 61 plans serving programs in 49 states, the Districtof Columbia, tribes and United States territories. With helpfrom this program, states form broad-based coalitions, assessthe burden of cancer, determine priorities for cancer preventionand control, and develop and implement statewide comprehen-sive approaches to cancer control.
“The National Comprehensive Cancer Control Program ishere to help states,” True said. “The CDC can provide cus-
tomized, state-specific technical assistance. We have a wealthof written guidance materials available, and we offer leader-ship institutes where state policy-makers and health depart-ment officials can learn in depth about how to plan and imple-ment the comprehensive approach.”
Within the comprehensive control framework, the CDC sup-ports colorectal, prostate and ovarian cancer control activities,as well as activities targeted at more publicized cancers such asthose of the breast and lung.
C u r r e n t l y, 21 states are being funded to plan comprehensiveapproaches. Twenty-eight states are already beginning toimplement their statewide plans. By July, every state will be inthe planning stages—if not already in action—for comprehen-sive cancer control.
What State Legislators Can DoI t ’s easy to see how a governor like Delaware’s Minner can
play a pivotal leadership role in pushing a state to take a com-prehensive approach to cancer. It’s also not hard to see thatnational programs, state health departments and private andnonprofit cancer organizations are key parts of makingstatewide collaborative efforts against cancer work. But dostate legislators have a role to play?
Yes, they most definitely do, according to Gary Gurian of C-Change, a national cancer collaborative composed of leadersfrom 130 public, private and non organizations chaired by for-mer President George Bush and his wife, Barbara Bush.
Gurian, whose organization has worked closely with theCDC, the American Cancer Society and the National CancerInstitutes to help many states plan and implement comprehen-sive approaches, says it would be a mistake for national cancero rganizations and programs to take the contributions of statelegislators for granted.
“Comprehensive cancer control plans are an importantlinchpin in our efforts to eliminate cancer as a public healthproblem,” Gurian said. “What state-based comprehensive can-cer plans do—and this is particularly important—is make surethat the full continuum of cancer care is in place from preven-tion and early detection through treatment and palliative care.From providing political support and pressure to allocatingresources, state legislators are critical to helping make surethese plans are implemented.”
For more information about the CDC’sNational Comprehensive Cancer ControlProgram for states, visit the program’s Website at www.cdc.gov/cancer/ncccp/index.htm.
Cancer Control PLANET’s Web site atcancercontrolplanet.cancer.gov offers links tocomprehensive cancer control resources forpublic health policy-makers.You can accessindividual state cancer profiles from this siteas well.
To learn more about C-Change, thenational cancer collaborative organization, goto www.ndoc.org/default.asp.
The Council of State Governments’Healthy States Initiative will release a tool kiton the comprehensive approach to cancercontrol.The tool kit will be designed to givestate policy-makers the resources they needto understand and become involved in com-prehensive cancer control policies. Look forit at www.healthystates.csg.org this summer .
Comprehensive CancerTool Kit from the HealthyStates Initiative
Internet Resources
For state legislators who want to become involved in theirs t a t e ’s comprehensive cancer control efforts, Gurian has theser e c o m m e n d a t i o n s :
n S t a rt by learning about your state’s effort s. The first step for astate legislator is to get in touch with his or her state’s com-prehensive cancer control program director. A complete list ofstate contacts can be found at a p p s . n c c d . c d c . g o v / c a n c e rc o n -t a c t s / n c c c p / c o n t a c t s . a s p . Ask to see a copy of the state’s com-prehensive plan for cancer control, and ask about eff o r t salready underway. For information about cancer activities inyour community, visit this page on the American CancerS o c i e t y ’sWeb site: w w w. c a n c e r. o rg / d o c root/COM/COM_ 0.asp.
n Learn from what other states are doing. Do you want to findan innovative approach to comprehensive cancer control? A r eyou looking for ways to tackle a particular cancer- r e l a t e dproblem in your state? The best source of policy inspiration is
to learn about what other states are doing. You can find can-cer plans for every state on Cancer Control Planet’s Web site:c a n c e rc o n t ro l p l a n e t . c a n c e r. g o v / s t a t e _ p l a n s . j s p .
n Make the case for the comprehensive approach. Convincedthat comprehensive cancer control will help save lives andstretch resources? Then make the case for comprehensivecancer control in speeches, in newsletters, at town hallmeetings and on your legislative Web site. The CDC’sDivision of Cancer Control and Prevention provides awealth of background information about the comprehen-sive approach as well as compelling statistics about theburden of cancer. Find links to these resources and more atwww.cdc.gov/cancer/ncccp/index.htm.
—Dan Lorentz is a health policy analyst at the The Council ofState Governments.
This article was reprinted from the April 2005 issue of State News.
