University of Colorado at Denver

1. University of Colorado at Denver Cancer Prevention and Control research Network Colorado Site Activities Fall 2010 Advisors: Ginger Borges Tim Byers Lori Crane Jean Kutner Al Marcus Jack Westfall Investigators: Betsy Risendal Kristin Kilbourn Kathy Jankowski Bill Thorland Project Director: Andrea Dwyer

2. Overall Goal “Promote the long-term health and well-being of cancer survivors by facilitating the delivery and uptake of evidence-based, sustainable strategies at the patient, provider, system, and community level.”

3. Cancer Survivorship Cancer survivors are at increased risk for co-morbidities and new cancers Late and long-term side effects require ongoing surveillance Psychosocial morbidities are common in this population Specialty care needs such as fertility, genetic counseling, and physical therapy are also common Emerging evidence suggests that physical activity and weight management are important in reducing risk of recurrence and managing side effects

4. A time of opportunity…. Communication and coordination between the patient, provider, and community to properly address these issues are therefore of keen interest in cancer survivorship. Primary care well-situated to coordinate these health issues in this population, with input from Oncology Patient-centered medical home provide incentives and infrastructure for coordination of quality cancer survivorship care Self-management is a key component of both Patient-Centered Medical Home and Chronic Care Models (“How do I talk to my family doctor about my cancer diagnosis?” What do I need to know as a cancer survivor about my health and healthcare?”)

5. Chronic Disease Self-Management Program (CDSMP) Facilitating the translation, implementation, and dissemination of this evidence-based strategy to cancer survivors in Colorado. Key components: • Six week educational intervention • Peer-led • Produces measurable changes in self-efficacy, physical activity, and trend toward reduction in hospitalizations and cost effectiveness • Evidence-based, recommended by Surgeon General • Promotes physical activity through CDC recommended strategies such as goal setting and social support • Community-based and embedded in several healthcare systems (0ver 300 trainers in Colorado) • High fidelity (Master Trainer and Lay Leader, must be certified to deliver, manual)

6. Partnerships • Cancer survivors throughout Colorado • Dr. Kate Lorig (Professor, Stanford, creator of CDSMP) • Consortium for Aging and Wellness (holds state-wide license, multiple collaborators throughout state including 320 certified trainers) • Initial discussions with CDPHE, Texas A&M about dissemination

7. Plans and Activities Underway • First training of cancer survivor leaders in U.S. to take place in Colorado (Jan 2011) with Dr. Lorig and Dr. Rick Seidel (UVa, currently piloting the program) • CPCRN mini grant to COAW to recruit trainers and facilities • Randomized controlled trial of curriculum to demonstrate effectiveness in cancer survivor (new target population)

8. Project WIN (What is Next) – Cancer “Transition” Healthcare Delivery Partnership with healthcare providers and public health to facilitate transition care and health promotion strategies to cancer survivors Key components • Series of billable group medical visits led by primary care in partnership with oncology, with cancer survivor themes • Group medical visits as a model of care delivery has been successfully used in geriatrics, diabetes in primary care setting, with cancer patients such as with prostate cancer seed implementation • Deploys evidence-based strategies of goal setting, social support, and tailored one-on-one counseling for increasing physical activity • Emphasis on preventive/primary care including cancer prevention and control screenings • Patients will complete a Survivorship Care Plan • Multi-disciplinary, coordinated care delivery (PT, Psychology, Primary Care, Oncology, Nutrition providers) billable under high level provider • Uses social marketing theory and is “problem-focused” rather than “information driven”

9. Partnerships • Clinical “Champions” at the University of Colorado Cancer Center and Hospital as well as Providers throughout Colorado • Coordination with LAF Center of Excellence/THRIVE Clinical Team (Survivorship Clinic at UCH) • Area Health Education Centers and Practice Based Research Networks in Colorado (eventual) • Cancer survivors throughout Colorado

10. Plans and Activities Underway • Clinical leadership team sets goals and content for visits • Developing Facilitator Guide for high fidelity dissemination • Coordinate with Oncology to implement • Disseminate through Practice Based Research Networks in Colorado (High Plains Research Network – also leader in CRC dissemination)

11. Additional Efforts • R25 submitted 9/2010 to provide cancer survivorship education to primary care practice-based research networks in Colorado • Survivorship Survey and Scoping Study -Colorado site specific activity but based on interest in effort has grown to a workgroup activity.