Barbara K. Rimer, DrPH Chair, President’s Cancer Panel

Update to the National Cancer Advisory Board

September 9, 2014

Mission

The Panel shall monitor the development and execution of the activities of the National Cancer Program, and shall report directly to the President.

Any delays or blockages in the rapid execution of the Program shall immediately be brought to the attention of the President.

Authority: 42 U.S.C. 285a-4; Sec. 415 of the Public Health Service Act, as amended

Members

Barbara K. Rimer, DrPH Univ. of North Carolina at Chapel Hill

Hill Harper, JD Cancer Survivor, Actor, and Best-Selling Author

Owen N. Witte, MD University of California Los Angeles

A key criterion for topics

Actionable recommendations

Overview 2012-2013 Report to the President – UPDATE

Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer

June 13, 2014 Planning Workshop Cancer Communication in the Digital Era: Opportunities & Challenges

2014-2015 Series Connected Health: Improving Patients’ Engagement and Activation for Cancer-Related Health Outcomes

Accelerating HPV Vaccine Uptake:

Urgency for Action to Prevent Cancer

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• • • • • • • • • • ' ''''''''' A Report to the President of the United States

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The President's Cancer Panel

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ACCELERATING HPV VACCINE UPTAKE:

URGENCY FOR ACTION TO PREVENT CANCER

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HOW TO ACCELERATE HPV VACCINE UPTAKE IN THE U.S.

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INCREASE GLOBAL HPV VACCINATION CONDUCT HIGH-PRIORITY RESEARCH

2012-2013 Report to the President – ACTION UPDATE

HPV Report Presentations

National Vaccine Advisory Committee (February 2014): Drs. Rimer & Lowy

NIH Office of Research on Women’s Health (March 2014): Dr. Sandler

Policy session at AACR Annual Meeting (April 2014): Drs. Witte and Sandler

Webinar for the National Foundation for Infectious Diseases (May 2014): Drs. Rimer and Noel Brewer

Accepted poster for APHA Annual Meeting (November 2014) – J. Sienko/L. Paradis

Research to Reality R2R: Oyber-Seminar Series

Upcoming NCI “Research to Reality” Cyber-Seminar

Accelerating HPV Vaccine Uptake: What is Working and Why

Tuesday September 23, 2014 2:00-3:00 pm ET

For more information and to register: http://researchtoreality.cancer.gov

Speakers include Abby Sandler, PhD, Executive Secretary, President’s Cancer Panel.

Dr. Toin Frieden 0

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Clinicians Clinical s1rategies in #H PVReport to accelerate HPV vax uptake & end cancers for our kids' fu1ure. 1.usa.govi 1 eADjt5

Ao o i/canccr ourvivor , it 'o vita l to protect yout h from future cancers . C heck o ut @PresC;inr.erPane l' s II HPVReport 1 .usa.g ov/ 1 eADj15 .. ~>t, '" (I,,>:- * ............ $ 1 .. , .. . ...

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Social Media Engagement

#HPVReport We created & disseminated a

comprehensive hashtag to magnify reach, engage stakeholders, and monitor online sentiment.

Tweets and Facebook posts revealed strong support for report.

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Social Media Engagement

@PresCancerPanel Monthly Network Growth Jan 2014–Feb 2014

Promotional efforts, partner engagement, and report acclaim boosted monthly Twitter network and engagement numbers, enhancing online visibility and reinforcing the role of the Panel.

Report Release Week Analytics (Feb. 10-17, 2014) Reach: Over 4 million Twitter users Engagement activity: 170 Followers: 65 new followers

@PresCancerPanel Monthly Engagement Levels Dec 2013–Mar 2014

2250

2200

2150

2100

2050

2000

1950

Jan-14 Feb-14 Dec 2013 Jan 2014 Feb 2014 Mar 2014

2013 HPV Vaccination Coverage for Adolescents

In 2013: 37.6% of girls ages 13-17 completed

three-dose series (compared to 33.4% in 2012).*

13.9% of boys ages 13-17 completed three-dose series (compared to 6.8% in 2012).

*Healthy People 2020 goal: 80 percent of girls ages 13-15 complete HPV vaccine series.

CDC. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years – United States, 2013. MMWR 2014;63(29):625-33. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6329a4.htm

Implementation of Panel Recommendations – NCI

NCI announced one-year grant supplements: Promote collaborations between NCI-designated cancer centers and state/local cancer coalitions and HPV immunization programs.

Release date: July 17, 2014; Request Receipt date: August 4, 2014; Earliest Anticipated Start Date for Awards: September 10, 2014.

Implementation of Panel Recommendations – CDC

CDC announced funds Develop and administer national

network of cancer prevention organizations.

Goal: improve HPV vaccination delivery for prevention of HPV-related cancers.

CDC-RFA-IP14-1410PPHF14 PPHF 2014: Immunization - HPV Roundtable: Creating a National Network of Partners to Promote Cancer Prevention through Human Papillomavirus (HPV) Vaccination financed solely by 2014 Prevention and Public Health Funds.

As a healthcare provider, we urge you to improve the strength and consistency of your recommen­dation fur HPV vaccination to your patients. Your recommendation is the number one reason why someone will get the HPV vaccine and be protected from HPV-associated cancers and disease.

Signed:

~ ~ 0 ~<:::!. - ,.. ' 0 REID B. BLACKWHDIR, MD

President American Academy of Family Physicians

,~ [(· ~ President American College of Obstetricians and Gynecologists

T HOMAS FR1£DE N, MD

Director Centers for Disease Control and Prevention

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President American Academy of Pediatrics

MOLLY COOKE, MD

President American College of Physicians

~;Juf~ DIBORAH WEXLER, MD

Executive Director lmmmization Action Coalition

Implementation of Recommendations – Immunization Action Coalition (IAC)

IAC issued “Dear Colleague” letter encouraging strong HPV vaccine recommendations

Signed by:

AAFP ACP AAP CDC ACOG IAC

2014 Planning Workshop

Cancer Communication in the Digital Era:

Opportunities & Challenges

2014-2015 Series

Connected Health: Improving Patients’ Engagement and

Activation for Cancer-Related Health Outcomes

Improve communication, health care, health & reduce costs

“The participation of patients in their own healthcare could substantially improve their care...Access to electronic personal health information and interfaces that make it easy for public and private clinical organizations to share health information with each other and with patients could enable healthcare providers and patients to collaborate in informed decision-making.” P. 17, PCAST, Realizing Potential of Health IT, 2010

Exhib it 4: Changes in Adoption of Basic and Comprehensive EHRs, 2008-2013

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Source: /\uthoro' calculationc of do.to from the /\mcrico.n Hospit::i.l /\noocio.tion Anrual Suivcy Information Technology Supplement Note: All analyses were statistically weqhted for potential nmresponse bias.

Medicine’s Move to Electronic Connectivity: The Supply Side (Robert Wood Johnson Foundation Annual Report)

Robert Wood Johnson Foundation: Report on Health Information Technology (2014)

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The Public’s Move to Electronic Connectivity: The Demand Side (NCI’s Health Information National Trends Survey [HINTS])

mpa ct of t ra ck ing he a lt h Among trackers, the 96 who say tracking their health has had the follo w ing imp a cts, by chronic condi t ion status

Changed overa ll! approach to ow n heal th or heal t h of someone e lse

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so u rce: P,ew Internet Health T rack i ng Survey, August 07 - September 06, . 2012 . N=3,014 adults ages 18+. Interviews were conducted in English and Spanis h and on landline and cell phones. Margiin of error is+/- 2 percentage points for results based on a ll adults.

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People with Chronic Conditions Are Highly Likely to Track Their Symptoms

Patients Who Are More Act ively Engaged in Their Care Have Lower Costs

Than Pat ients Who Are Less Engaged Predicted per capita billed costs In dollars. January-June 2011. by patient act ivation method (PAM) level

$1,000

$800

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$400

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N01es· 1npa11enI anel pnannacy coslS no11ne1UC1eel 00I1ar amounts are a(ljl!Slecl ror a111erenccs 1n <JSease seventy ana aemograpnlCS Source· AOap1eel trom J H. Hlllbarcl, J. Greene, anCl v. OYerton. "Patients wiln Lower Activation Associated With H1!;11er Costs; Delivery Systems Stloulel Know Their Patients· 'Scores,· Health Affaif5, Feb. 2013 32(2):21 &--22.

Highly Engaged and Activated Patients Have Lower Healthcare Costs

"People who are disengaged in their health are the toughest group to manage and account for a disproportionate share of healthcare costs.

Joseph Kvedar, MD Director Center for Connected Health Partners HealthCare System

Intelligent devices: potentially powerful new tools for health

Intelligent devices include remote sensors, wearables, digital cameras, and mobile phone apps.

What is HealthKit? How the iPhone wi ll get you fit

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How Apple HealthKit is go ing to keep th e doctor aw ay

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On the 9t h of September , App le will lau nch th e iPhone 6, w hich means that i t will a lso be launching a new ve rsion of iOS.

Apple Announces HealthKit Today

Connecting Health Data to Clinical Systems Through Sensors, Wearables & Other Devices

Robert Wood Johnson Foundation: Personal Data for the Public Good (2014)

“Quantified Self” movement spurs new interest in prevention and healthy behaviors relevant to cancer control. “Meaningful Use” incentives to

health care providers focus on requirement to demonstrate “patient engagement” through health information technology (Phases 2 & 3).

Connected health may improve medication adherence.

Non-adherence is a problem fororal cancer medications.

Increased resource use, incl. ER visits, costs, reduced regimenefficacy

Connected health could improveadherence. Tailored reminders to patients Feedback re: barriers to

adherence Live chats with pharmacists &

others Portals for easier medication

refills Social support from other

patients

Darkow et al. (Pharmacoeconomics, 2007): 31% of patients had Rx interruptions that led toincreases in medical costs for patients on imatinib. Decrease in med persistence betw 4 & 14 months of Rx.

Hohneker et al. (JOP, 2011): 54% to 80% of breast cancer patients receiving hormone therapy adhere to Rx.

Kondryn et al. (Lancet Onc, 2011): 63% of teens & young adults do not adhere to cancer Rx regimens.

Consistent with other findings re: non-adherence to oral regimens

Communication Problems Significant in Cancer Care

Interviews with 416 cancer patients across 3 clinical sites (Mazor, et al, 2012)

Asked about events where something “went wrong,” the event could have been prevented, and the event could have caused significant harm

Results 28%: problems with medical care

47%: communication problems

24%: problems with communication & medical care

Mazor KM, Roblin DW, Greene SM, et al. Toward patient-centered cancer care: patient perceptions of problematic events, impact, and response. J Clin Oncol. 2012;30:1784-1790.

PROGRESS AGAINST CANCER

ASCO's Blueprint for Transforming Clinical and Translational Cancer Research

Envisioning the Future of Patient Care in Oncology: The 2011 ASCO Blueprint

“You will receive a saliva reader that plugs into your smart phone, together with a few mobile applications that allow you to record your symptoms” (p. 3, line 8).

“Every eight hours, your phone will buzz to remind you to take your medicine and answer a short series of questions about how you are feeling” (p. 3, line 10).

ASCOQ CANCER•LINQ~

Learning Intelligence Network for Quality

Creating a Connected Cancer Care Platform

CancerLinQ provides real-time quality feedback to providers.

Real-time clinical decision support can inform discussions between patients and physicians & choice of therapy.

Powerful analytic tools help uncover patterns that can lead to improved care.

1Tgov* 8/12/2013 in 8ict echrolc<1v & Oiomedicioe, People S Technoicqy, Pu,i ic Service, ltade rshit Sc P:,licy,

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MyJourney Compass: National Pilot Project Uses Information to Improve Cancer Treatment

An ex perimental hec.lth Informatio n exchange be ng tested In the north CEorgla city of

Rnmf' is. hP.lping Knn~r ~innoc k kte-p ht:r t rr1:vel r l;ms.. A hrea~t r.ance r pat ient. Sinnock had

been reluctan: to travel very far from her doctors unti l the ne'I\' pro·~ram prom ised to

pr ovide access to her mec ical records from anywhere she might happen to be - i1cluding

the beach.

"I: gives me a sense of freedom that I can

r.ctually IE"ave town t1nd knnw th ac I c:;u,

have medical info rmat ion related to my

cancer wit~ me," she said." 'm exc ited to

be part of creating ;orrethi ng t1at other

p eop le across t he cuu ntr ·,1 m ight us1::."

• Watch a video desc ribing t l-,is project

Providing e,.sy access to medical histories

r.nd tr PatmP.nt rec:ord.s is. jus t nn P ,npe. Ci of

MyJourney Com~ass, a pib t project

designed co help patients navigate the

comple.)( cancer ueacmen i::rocess and

becurr e more invol•1ed the ir health car e

decisions. Operated though th• Gcorgja Department of Corrmu nity Health , the

Ko,:::n S nnoc< i~ sho.•m w;ing ;:he NcxJ~ 7 tJbl:::t comp ute " provided :o pa tl~ncs: throug h t!le

1\1\·J:,1..m EY Cctlll:i.SS pi lot proj ect, l he ccn1i:u1er pro'/dc$ ncd ic.il inform.n on1 a:cc:.:. tc 1c.11th 1nfcrma.t1cn ncorjs .1.nd a synpt :)ro tra.c<er fer regular :.umrnunicetiu·1 vvilh phy:>ilian'.I, (C it< imagt ror l"igh-rescl ution 'version. c ,edi!: :\ob re10

Pilot Program Uses “Connected Health Technologies” to Improve Cancer Care

Navigator programs increase 5-year survival rates for breast cancer patients—are expensive.

ONC funded pilots to improve navigation through connected technology.

GA Tech computer scientists creating computational model with triggers for improving patient navigation/health outcomes.

Cancer-Related Connected Health: Key Questions

Does connected health improve patients’ activation, engagement & patient-provider communication?

What cancer-related outcomes can be achieved through connected health?

Are there negative consequences for patients or the system?

Is cancer-related connected health being developed at the right pace?

Cancer-Related Connected Health: Key Questions

Does providing computationally-tailored information to patients improve cancer care & care outcomes?

Barriers to connected health? What would accelerate the process? Impact of connected health on diverse patients? Transformative processes, ideas, intelligent

devices & technologies on the horizon with potential to improve cancer-related connected health care?

Research needs?

Connected Health Series Workshops (working titles)

Workshop 1: Engaging Patients with Connected Health Technologies December 2014: Boston, MA Connected health landscape and potential cancer applications

Workshop 2: The Personal Health Data Revolution, Connected Health & Cancer March 2015: San Francisco, CA area Role of health data in promoting health, consumer and patient

activation, optimizing self-management, and supporting insight-driven healthcare leading to optimal outcomes

Workshop 3: Imagining the Future of the Connected Cancer Patient TBD Recommendations to accelerate progress re: connected health

technologies in cancer

Contact Us

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(301) 451-9399 pcp-r@mail.nih.gov

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