Slide 1

Assessing the Catchment Area to Identify and Pursue Unmet Research Needs Maryann Donovan, PhD, MPH Associate Director for Research Administration University of Pittsburgh Cancer Institute

Slide 2

PAR 11-005 Stage II, Community Service, Outreach and Dissemination: Process for evaluation of the impact of outreach and dissemination activities on clinical and public health systems within the centers catchment area PAR 12-298 and 13-386 Six Essential Characteristics, Organizational Capabilities: In addition to research/scientific questions of broad applicability, [a Center] should use its available expertise and resources to address cancer research within the catchment area. Senior Leadership: Discuss how the senior leaders have worked together to: Enable a focus on cancer problems applicable to the catchment area served by the Center Research Strategy (Research Programs): For each program briefly discuss the following: In addition to questions of broader applicability, and as appropriate to the type of Program, briefly describe how the cancer research relevant to the catchment area is addressed. This may include, for example, a discussion of research focused on cancer health disparities (e.g., problems affecting racial and ethnic minorities, rural residents, women, children, elderly, persons of low socioeconomic status), cancer sites of high incidence/mortality, environmental exposures, behavioral factors, or other issues. Changing CCSG Requirements: Focus is Now on Research, Not Outreach UPCI Outreach Activities Community Cancer Screening Clinics Health & Wellness Events Cultivation of Community Navigators for the Medically Underserved Healthcare for the homeless Primary Prevention Education Healthy Choices for Students during School Year and Summer

Slide 3

UPCIs Response to Changing Requirements: A New Internal Advisory Committee Committee for Cancer Research in Western PA (CCRwPA) Established in 2013 to identify needs and plan and monitor research Meets monthly Chaired by the UPCI Director and includes: UPCI Deputy Director UPCI Associate Director for Cancer Control and Population Sciences Leader of UPCIs Biobehavioral Oncology Program UPCI Associate Director for Health Equity, Education, and Advocacy UPCI Associate Director for Research Administration Technical and administrative support provided by PhD scientists from UPCIs Office of Research Administration

Slide 4

UPCIs Catchment Area 29 Western Pennsylvania Counties (shown in green)

Slide 5

UPMC CancerCenter Network

Slide 6

Sources for Defining the Cancer Problems in UPCIs Catchment Area Public Websites: NCI-CDC State Cancer Profiles (http://statecancerprofiles.cancer.gov) Pennsylvania Department of Health PubMed Intra-Institutional: Department of Environmental and Occupational Health Department of Behavioral & Community Health Sciences UPMC CancerCenter Registry

Slide 7

Tools on http://statecancerprofiles.cancer.gov Demographics Screening and Risk Factors Cancer Knowledge Prevalence Mortality

Slide 8

Sample Interface on http://statecancerprofiles.cancer.gov Age-adjusted Incidence of All Cancers (2006-2010) Lung Cancer Mortality (2006-2010) Ever Smoking Rate (2000-2003) Incidence of Breast Cancer in African American Women (2006-2010) Data for Preparing Maps Tools on http://statecancerprofiles.cancer.gov

Slide 9

Tools on State Department of Health Website Detailed Maps

Slide 10

Examples of What Was Learned Highest Incidence Cancers (per 100,000) Lung: 17/29 counties > US (65) Breast: 15/29 counties > US (120) Colorectal: 27/29 counties > US (44) Prostate: 16/29 counties > US (144) Cancer Risk Factors Smoking prevalence: 22/29counties > US (19.0%) Obesity: 27/29 counties > US (27.9%) Aging (> 65 years): 29/29 counties > US (13.0%)

Slide 11

BOP: Regulated Reduction of Cigarette Nicotine Content BOP: Strategies to Avoid Returning to Smoking (STARTS) Randomized clinical trial of an intensive support program to prevent post- partum smoking relapse through cognitive-biobehavioral techniques focused on mood, stress, and weight 300 local women (target of 40% African American) who stop smoking for at least 1 month during pregnancy Cancer Problem: Smoking-related Lung Cancer Smoking is the causative factor in approximately 90% and 80% of lung cancer deaths in men and women, respectively. In 22 of the 29 counties in UPCIs catchment area, smoking prevalence is higher than the U.S. average. Lung and bronchus cancer mortality is higher than the national average in 19 of the counties. LCP: Pittsburgh Lung Screening Study (PLuSS) Screened 3,642 smokers with low-dose CT in western PA and found 275 lung cancer cases (36% early stage) Resource for biomarker discovery and validation for early detection Supported by Lung Cancer SPORE Contributed to new USPSTF Screening Guidelines Cancer Biomark, 2011; J Thorac Oncol, 2011; J Thorac Oncol, 2012; Clin Proteomics, 2014 Nic Tob Res, 2013, 2014 Lung Cancer Mortality (2006-2010) Ever Smoking Rate (2000-2003) Lung Cancer Incidence (2006-2010)

Slide 12

Cancer Problem: Using the UPMC Network to Reduce Melanoma Mortality by Early Detection 2014: Trained >500 primary care clinicians throughout the network via UPMC uLearn CME system Target: 86,000 patients 35 years will be screened 50,000 screened in first 8 months Research Plan: Thickness-specific melanoma incidence and mortality will be compared for screened group vs. overall thickness-specific incidence in an 18-county area Melanoma Incidence (2006-2010) MP: Primary Care Physicians Taught Melanoma Screening

Slide 13

Cancer Problem: HPV+ Cancers HNCP: Extent of regional increase in HPV+ head and neck cancer over the last 50 years HPV P16 staining of oropharyngeal squamous cell carcinomas tissue blocks from UPMC pathology archives from 1956-1969 (n=43) vs. 2007-2009 (n=53) revealed an increase in the proportion of HPV+ cases (from 35% to 72%) CEPP: Quality of life in 177 UPMC CancerCenter patients with HPV+ head and neck cancer HPV16+ head and neck cancer patients have better overall quality of life (both before and after treatment) BOP: Knowledge and health behaviors related to HPV infection Assessing knowledge of HPV infection and prevention measures and documenting health and personal behaviors of individuals in underserved areas Implementing low-literacy educational sessions about HPV Partnering with Jewish Healthcare Foundation to increase HPV vaccination rates Laryngoscope, 2014 Hum Pathol, 2012

Slide 14

Cancer Problem: Care and Survival Disparities in African American Patients CEPP: Race-based Disparities in Head and Neck Cancer Survival African Americans are more likely than Whites to be diagnosed with late stages of oral cavity and laryngeal cancer African American patients with laryngeal cancer, showed a significant difference in relapse-free survival BOP/BOCP: Attitudes, Communication, Treatment, and Support (ACT) Intervention led by an African American breast cancer survivor Improved initiation of chemotherapy, adherence, and completion of total dose BOP: Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) Collaboration with University of North Carolina Intervention to improve completion of treatment for early stage breast/lung 138/150 patients enrolled in Pittsburgh (31% African American) Head and Neck, 2011 ACT Intervention Wins a 2014 Pittsburgh YMCA Racial Justice Award Oncology Nurses Forum, 2011

Slide 15

Committee for Cancer Research in Western PA at Work: Planning New Research Initiatives BRAINSTORMING SESSIONS PILOT FUNDING OPPORTUNITIES NEW COLLABORATIONS Mitochondria, Aging and Metabolism Request for Pilot Proposals 2014-2015