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Appendix

Fulfilling the Potential of Cancer Prevention and Early Detection

Institute of Medicine and American Cancer Society Symposium

June 30, 2003,

National Academy of Sciences,

2100 C Street, N.W.

Washington, B.C., 20418

8:30–9:00

Continental Breakfast in the Great Hall

9:00–9:05

Plenary Session—The Lecture Room

Introduction of Symposium and Dr. von Eschenbach Harvey Fineberg, M.D., Ph.D., President, Institute of Medicine

9:05–9:25

“Cancer Prevention and Early Detection: Key Strategies for Challenge Goal 2015”

Andrew von Eschenbach, M.D., Director, National Cancer Institute

9:25–9:45

“View from the ACS: Fulfillment of the Potential of Cancer Prevention”

John Seffrin, Ph.D., CEO, American Cancer Society, President, UICC



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Fulfilling the Potential of Cancer Prevention and Early Detection: An American Cancer Society and Institute of Medicine Symposium Appendix Fulfilling the Potential of Cancer Prevention and Early Detection Institute of Medicine and American Cancer Society Symposium June 30, 2003, National Academy of Sciences, 2100 C Street, N.W. Washington, B.C., 20418 8:30–9:00 Continental Breakfast in the Great Hall 9:00–9:05 Plenary Session—The Lecture Room Introduction of Symposium and Dr. von Eschenbach Harvey Fineberg, M.D., Ph.D., President, Institute of Medicine 9:05–9:25 “Cancer Prevention and Early Detection: Key Strategies for Challenge Goal 2015” Andrew von Eschenbach, M.D., Director, National Cancer Institute 9:25–9:45 “View from the ACS: Fulfillment of the Potential of Cancer Prevention” John Seffrin, Ph.D., CEO, American Cancer Society, President, UICC

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Fulfilling the Potential of Cancer Prevention and Early Detection: An American Cancer Society and Institute of Medicine Symposium 9:45–9:55 “How Many Lives Can Be Saved?” Tim Byers, M.D., M.P.H., IOM report co-editor Professor of Preventive Medicine and Associate Director University of Colorado Comprehensive Cancer Center 9:55–10:05 “Harnessing the Power of Cancer Prevention and Early Detection” Susan Curry, Ph.D., IOM report co-editor Director, Health Research and Policy Centers Professor, University of Illinois, Chicago 10:05–10:45 Q&A 10:45–11:00 BREAK 11:00–11:20 “Reducing Disparities in Cancer” Harold Freeman, M.D., Department of Surgery, North General Hospital, New York Director, Center to Reduce Cancer Health Disparities National Cancer Institute 11:20–11:40 “Delivering Quality Cancer Prevention” Hugh Straley, M.D., Medical Director for Quality and Research Group Health Cooperative 11:40–12:00 “Private Sector Perspectives on Cancer Prevention and Early Detection” Lew Sandy, M.D., Executive Vice President for Clinical Strategies and Policy UnitedHealthCare 12:00–12:30 Q&A 12:30–1:15 LUNCH in the Great Hall Speakers and Attendees 1:15–2:30 Simultaneous group discussions with invited speakers Facilitators—Clement Bezold, Ph.D., Institute for Alternative Futures, Len Lichtenfeld, M.D., American Cancer Society, Reporters—Susan Curry, Ph.D., University of Illinois, Chicago, Tim Byers, M.D., University of Colorado Comprehensive Cancer Center.

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Fulfilling the Potential of Cancer Prevention and Early Detection: An American Cancer Society and Institute of Medicine Symposium Group Discussion I Policy in Tobacco and Obesity (Lecture Room) Tobacco use and obesity are major contributors to the cancer burden. Initiatives to increase the adoption, reach, and impact of evidence-based cancer prevention interventions need to occur at multiple levels across multiple behavioral targets. The policy recommendations in the IOM National Cancer Policy Board report reflect similarities and differences in the state of the science for tobacco compared to obesity interventions. Progress in both areas will be enhanced when all states have comprehensive cancer control plans that include public and private partnerships for community-based programs (Recommendation #3). There is sufficient evidence to recommend enactment and enforcement of federal and state initiatives that reduce tobacco use (e.g., increased excise taxes, clean indoor air acts—Recommendation #1). Still needed is a coordinated, national strategy to address obesity, unhealthy diet, and physical inactivity (Recommendation #2). In light of these similarities and differences, group discussion topics include: What opportunities are there to link and create synergies between policy initiatives for tobacco and obesity? Particularly important is avoiding competition between the two targets, as would happen if we concluded that we’ve fixed tobacco and need now to turn to obesity. Where and how can tobacco policy successes pave the way for timelier implementation of obesity-related policies as new evidence emerges? What policy initiatives have the greatest potential to address and help eliminate health disparities related to tobacco and obesity? Harvey Fineberg, M.D., Ph.D., President Institute of Medicine Bob Croyle, Ph.D., Acting Director, Division of Cancer Control and Population Sciences, National Cancer Institute Bill Corr, J.D., Executive Director, National Center for Tobacco-Free Kids Bill Dietz, M.D., Ph.D., Director, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention

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Fulfilling the Potential of Cancer Prevention and Early Detection: An American Cancer Society and Institute of Medicine Symposium Group Discussion II Payer/Provider/Managed Care Issues (Board Room) A vital role of the health care system in filling the gap between what we know and what we do for cancer prevention and early detection is to ensure universal access to evidence-based prevention interventions. The IOM National Cancer Policy Board recommends: that public and private insurers consider such evidence-based services as essential benefits (Recommendation #4); that support be increased for programs that provide primary care to uninsured and low income people (Recommendation #5); that existing national programs such as CDC’s National Breast and Cervical Cancer Early Detection Program receive adequate support and be expanded for colorectal cancer screening (Recommendation #6); and that the USDHHS conduct a comprehensive review to assess whether evidence-based preventive services are being offered and successfully delivered in federal health programs (Recommendation #7). umping off from these recommendations, group discussion topics include: What are the optimal leverage points for improving access to proven prevention interventions? Of the recommendations noted by the IOM, what opportunities are there for timely and early successes in their implementation? What types of decision making strategies and benefit policies may be needed with regard to access to, and coverage for, cancer prevention interventions that generate high demand, but have uncertain or even unproven evidence to support them? What policy initiatives have the greatest potential to address and help eliminate cancer-related health disparities? Lew Sandy, M.D., Executive Vice President for Clinical Strategies and Policy UnitedHealthCare Sean Tunis, M.D., M.Sc., Chief Medical Officer Centers for Medicare and Medicaid Services Helen Darling, M.A., President, Washington Business Group on Health 2:30–2:45 BREAK

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Fulfilling the Potential of Cancer Prevention and Early Detection: An American Cancer Society and Institute of Medicine Symposium 2:45–4:00 Simultaneous group discussions with invited speaker Facilitators—Clement Bezold, Ph.D., Institute of Alternative Futures, Len Lichtenfeld, M.D., American Cancer Society. Reporters—Susan Curry, Ph.D., University of Illinois, Chicago, Tim Byers, M.D., University of Colorado Comprehensive Cancer Center Group Discussion III Aplied Research (Lecture Room) Estimates are that it takes an average 17 years for a clinical innovation to move from research into practice. Strategies to minimize this lag include timely assessment and synthesis of emerging evidence and rapid dissemination of the resulting evidence-based recommendations (Recommendation #9) as well as increased attention to building the evidence base for effective strategies to disseminate evidence-based prevention interventions (Recommendation #12). Discussion of these recommendations by the group can focus on the following issues: How can we change the current process of funding, reporting, and disseminating research results in cancer prevention to decrease the time it takes to get information on effective cancer prevention strategies into clinical practice and public awareness? What new research funding initiatives are needed to increase the number of studies that apply rigorous scientific methods to evaluate dissemination strategies, and what opportunities are there for shared funding of such research across NIH and other federal agencies, as well as through government-private funding partnerships? Ralph Coates, Ph.D., Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention Jon Kerner, Ph.D., Assistant Deputy Director for Research Dissemination & Diffusion, Division of Cancer Control and Population Sciences, National Cancer Institute Peter Greenwald, M.D., Dr.P.H., Director, Division of Cancer Prevention, National Cancer Institute Bob Graham, M.D., Acting Deputy Director, Agency for Healthcare Research and Quality

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Fulfilling the Potential of Cancer Prevention and Early Detection: An American Cancer Society and Institute of Medicine Symposium Group Discussion IV Prevention Through Education and Primary Care (Board Room) Primary care providers in health care settings are effective agents of behavioral change. However, maximizing their effectiveness requires programs to improve education and training, monitor adherence to evidence-based guidelines, and enhance practice environments to support provision of cancer prevention and early detection services (Recommendation #8). Key discussion issues for this group include: Who is accountable for ensuring that graduate curricula and continuing education programs include adequate coverage of cancer prevention and early detection? How can professional organizations and academic medical centers be encouraged to have this as an educational priority? What leverage points are there for monitoring the performance not only of health care providers but also of the systems of health care delivery, to ensure infrastructure and accountabilities for delivering evidence-based prevention interventions? How can state health departments and federal agencies such as CMS advance this priority? Ron Davis, M.D., Trustee, American Medical Association, Director, Center for Health Promotion & Disease Prevention, Henry Ford Health System Robert Smith, Ph.D., Director of Cancer Screening, American Cancer Society Hal Sox, M.D., Editor, Annals of Internal Medicine 4:00–4:30 Summary of sessions and wrap-up with reporters, Susan Curry and Tim Byers 4:30 Adjourn