Bridging the Gap: Translating Research into Comprehensive Cancer Control

1. Translating Research into Practice: Integrating Science with Service through Comprehensive Cancer Control Jon F. Kerner, Ph.D. Deputy Director, Division of Cancer Control & Population Sciences Indiana Cancer Consortium Fall Meeting October 18, 2006

2. The Central Goals of Healthy People 2010* • Increase quality and years of healthy life • Eliminate health disparities * USDHHS Healthy People 2010. Washington D.C. January 2000. Volume #1: page 2

3. Metast. Clinical Malignant Normal Cancer Disease Tumor Cell Cancer Control as a Multi-Stage Process Terminal Diagnosis Prevention Early Detection Care & Treatment Support Risk Factor Surveillance Support Health Follow-up & Follow-up Behaviors Carcinogenesis as a Multi-Stage Process* Progression Conversion Initiation Promotion Initiated Preneoplastic Cell Lesion *Adapted from Shields PG, Harris CG. Principles of Carcinogenesis: Chemical. In: Devita VT, Hellman S, Rosenberg SA. Cancer Principles & Practice of Oncology. J.B. Lippencott Co. Philadelphia :1993.

4. NCI’s Challenge: Close the Gap Between Discovery and Delivery • There is a critical disconnect between research discovery and program delivery and this disconnect is, in and of itself, a key determinant of the unequal burden of cancer in our society. • Barriers that prevent the benefits of research from reaching all populations, particularly those who bear the greatest disease burden, must be identified and removed.

7. Tobacco Control • Diet • Physical Activity • Sun Exposure • Virus Exposure • Alcohol Use • Chemoprevention Focus • Communications • Surveillance • Social Determinants and Health Disparities • Genetic Testing • Decision-Making • Evidence-Based Health Care • Quality of Cancer Care • Epidemiology Cross Cutting Issues THE CANCER CONTROL CONTINUUM Cancer Control Continuum Prevention Detection Diagnosis Treatment Survivorship • Informed Decision Making • Clinical Follow-up • Imaging • Pap Test • Mammography • FOBT • Endoscopy • PSA Informed Decision Making • Health Services and Outcomes Research • Clinical Trials • Palliation • Coping • Health Promotion

8. Grant Awards by State - Fiscal Year 2005 Total Grants - $ in Thousands

10. Cancer Centers by State (P30 Core Grants) Year 2005 All Types - All States Summary Distribution for NCI Grants for state of Indiana No. of Grants Total NCI Dollars %Total Dollars Total for Two NCI-designated Cancer Centers 53 $16,841,678 80.2% Total for Other Nine Institutions 12 $4,162,424 19.8% Total 65 $21,004,102 100.0%

11. Counts Context Public Health Practice Primary Care Practice Disease Specialty Practice What about the Public/Patients? THE DISCOVERY-DELIVERY CONTINUUM Delivery Discovery Development Translational Research Research Translation

12. Dynamic Model of Cancer Research & Diffusion and Dissemination Diffusion Diffusion Diffusion Dissemination Intervention Research Diffusion Fundamental Research Surveillance Research Knowledge Synthesis Application and Program Delivery Reducing the cancer burden Adapted from the Advisory Committee on Cancer Control, National Cancer Institute of Canada, 1994.

13. Diffusion … the passive process by which a growing body of information about an intervention, product, or technology is initially absorbed and acted upon by a small body of highly motivated recipients (Lomas, 1993).

14. 17:14 It takes 17 years to turn 14 per cent of original research to the benefit of patient care Original research 18% variable Negative results Dickersin, 1987 Submission 46% 0.5 year Kumar, 1992 Koren, 1989 Acceptance Negative results 0.6 year Kumar, 1992 Publication Expert opinion 35% 0.3 year Poyer, 1982 Balas, 1995 Lack of numbers Bibliographic databases 50% 6. 0 - 13.0 years Antman, 1992 Poynard, 1985 Reviews, guidelines, textbook 9.3 years Inconsistent indexing Implementation E.A. Balas, 2000

15. Dissemination Active process through which target groups are made aware of, receive, accept and use information and other interventions.

16. Bench to Bedside Bench to Trench

17. TRANSLATION Evidence-based Knowledge Clinical Practice “The transfer of evidenced-based knowledge into routine or representative practice” Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22: Disseminating Behavioral Medicine Research: Making the Translational Leap.

18. What is Evidence…..? OBJECTIVE SUBJECTIVE • Surveillance Data • Systematic Reviews of Multiple Intervention Research Studies • An Intervention Research Study • Program Evaluation • Word of Mouth/Marketing • Personal Experience ...like beauty, it's in the eye of the beholder

19. INTEGRATION Explicit Evidence- Based Knowledge Informed Application Tacit Clinical and Contextual Knowledge “The informedcombination of evidence-based knowledge and local contextual knowledge into community applications.” Adapted from Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22: Disseminating Behavioral Medicine Research: Making the Translational Leap.

20. TranslatingResearchintoImproved Outcomes (TRIO) • Use and communicate cancer and behavioral surveillance data to identify needs, track progress and motivate action. • Collaboratively develop tools for accessing, and promoting adoption of, evidence-based cancer control interventions. • Support regional and local partnerships to develop models for identifying infrastructure barriers, expanding capacity and integrating science into comprehensive cancer control planning and implementation.

21. http://cancercontrolplanet.cancer.gov

24. Why 7th highest for Ca mortality and 26th for Ca incidence?

35. http://cancercontrol.gov/d4d

37. A Modest Proposal – More Focused Accrual & Reimbursement by Government? 57% Industry, 33% Government, 10% Private

38. A Modest Proposal – More Focused Accrual (when case fatality & disparities are high)?

39. What % of Diagnosed IN Patients on Protocol?

40. Protocols within 100 miles for 46260

41. Protocols within 100 miles for 46260

42. What else can be done to reduce lung cancer deaths and to support CCC plan implementation?