Department of Health and Human Services Nevada Cancer Systems Overview

The Mission of the Health Division is to Promote and Protect the Wellbeing of Nevadans and Visitors to our State by Preventing Disease, Injury and Disability

Jim Gibbons, Governor Richard Whitley, MS, Administrator Michael J. Willden, Director Mary Guinan, MD, PhDPhD,, State Health Officer

Page 1 of 88 Table of Contents

Tab 1: Nevada Central Cancer Registry

Tab 2: Nevada Comprehensive Cancer Control Program

Tab 3: Nevada State Comprehensive Cancer Plan

Tab 4: Statewide and Community Partners

Page 2 of 88 For additional information on the programs highlighted in this document, please contact the following:

Nevada Central Cancer Registry Alicia Chancellor Hansen, MS Chief Biostatistician Office of Health Statistics and Surveillance Bureau of Health Statistics, Planning and Emergency Response Nevada State Health Division [email protected] (775) 684-4161

Nevada State Comprehensive Cancer Control Program Christine Wood, RDH, BS Chronic and Communicable Disease Manager Bureau of Child, Family and Community Wellness Nevada State Health Division [email protected] (775) 684-5953

Nevada Cancer Council Sheila Baez, RN, MN, AOCNS Chair [email protected] 775-722-8140

American Cancer Society Tom McCoy, JD Nevada Government Relations Director American Cancer Society [email protected] (775) 828-2206

Susan G. Komen for the Cure Stacey A. Gross MPH, CHES Community Programs Manager Southern Nevada Affiliate [email protected] (702) 822-2324

Governor’s Prostate Cancer Task Force Lew Musgrove Chairman [email protected] (702) 227-8028

Page 3 of 88 Nevada Central Cancer Registry

Alicia Chancellor Hansen, MS Chief Biostatistician

Juanamarie Harris Nevada Central Cancer Registry Program Manager

Page 4 of 88 What is a Cancer Registry?

„ “State-based cancer registries are data systems that collect, manage, and analyze data about cancer cases and cancer deaths. In each state, medical facilities (including hospitals, physicians' offices, therapeutic radiation facilities, freestanding surgical centers, and pathology laboratories) report these data to a central cancer registry.” http://www.cdc.gov/cancer/npcr/about.htm „ Population Based, Retrospective Data Collection Allows for capturing diagnosis, as well as initial treatment information „ National requirements for reporting Within 24 months from year of diagnosis „ Registries do not track incidence as diagnoses occur Cannot be used to identify cancer clusters Not real-time data

Page 5 of 88 Nevada Central Cancer Registry (NCCR)

„ Established and governed by NRS and NAC 457 „ Primary purpose Collect, register, and maintain a record of reportable cases of cancer occurring in the state „ Uses of the data Evaluate the appropriateness of measures for the prevention and control of cancer To conduct comprehensive epidemiological surveys of cancer and cancer related deaths „ De-identified data reported to Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries (NPCR) and North American Association of Central Cancer Registries (NAACCR) Reporting began in 1995 „ NCCR Website http://www.health.nv.gov/VS_NVCancerRegistry.htm

Page 6 of 88 How Data Is Collected

„ Abstracting State „ NCCR Cancer Registrars visit facilities and abstract cases Hospitals and Other Facilities „ Facility Cancer Registrars abstract cases and submit information to the NCCR Pathology Labs „ Pathology reports sent to NCCR for case finding and supporting information Information from all sources is consolidated „ Final comprehensive case is reported to NPCR and NAACCR „ Data sharing with other states Reports received from other state registries of diagnosis and treatment information for Nevada Residents Reports sent to other state registries for their residents who are diagnosed or treated in Nevada Formal written agreements with 11 states, including all surrounding states „ NPCR Data Exchange Requirements Written agreements Confidentiality Data transmitted securely

Page 7 of 88 Cancer Incidence: Consolidated Cases

Nevada Central Cancer Registry Total Consolidated Cases Calendar Year (CY) 2000-2007

12,000 11,118 10,702 10,753 10,695

10,000 10,316 10,035 8,000 7,733 6,000 7,265 4,000 2,000 Consolidated Cancer Cases Cases Cancer 0

0 1 2 3 4 5 6 7

0 0 0 0 0 0 0 0

Y Y Y Y Y Y Y Y

C C C C C C C C Cases

Page 8 of 88 National Standards for Data Quality and Completeness

„ NAACCR Gold Standard Certification for Past 6 Years! Gold Standard Requirements „ Percent completeness of case ascertainment: At least 95% „ Percent missing/unknown race: Less than 3% „ Percent missing/unknown sex, age and county: Less than 2% „ Percent of cases death certificate only: Less than 3% „ Duplicate cases: Less than 1 per 1,000 „ Percent passing quality control edits: 100% „ CDC NPCR In compliance with grant reporting requirements Goals „ 24 month completeness: 95% „ 12 month completeness: 90% „ Percent passing quality control edits: 100%

Page 9 of 88 Linkages With Other Programs

„ State Office of Vital Records Case finding „ Death Certificate Only Cases Survival Information Demographic information updates Grant requirement „ Hospital Discharge Data Case finding Supporting Information „ Women’s Health Connection (WHC) – Breast and Cervical Cancer Early Detection Program Benefits both programs „ Case finding for NCCR „ Treatment information for WHC „ Grant requirement „ Indian Health Services – US Department of Health and Human Services Improve estimates of cancer incidence among American Indian / Alaska Natives (AI/ANs) Improve the quality of cancer surveillance data for AI/ANs in NPCR registries Supports CDC goal to eliminate racial and ethnic health disparities Cancer incidence data for AI/ANs included in United States Cancer Statistics (USCS) annually Grant requirement

Page 10 of 88 Value of the Data

„ Identify areas where Nevada differs from the rest of the country Identify burden of disease and disparities „ Allows prevention programs to target interventions Information for policy development Evaluation of program outcomes „ Due to consistent high quality of Nevada data, information is included in nationally published statistics „ Research

Page 11 of 88 Accessing Cancer Data

„ Report on Cancer in Nevada: 2000-2004 „ http://www.health.nv.gov/CD_CancerReport2000-2004.htm „ CDC NPCR „ http://www.cdc.gov/cancer/npcr/ United States Cancer Statistics (USCS) „ http://apps.nccd.cdc.gov/uscs/ „ NAACCR „ http://www.naaccr.org/ Cancer in North America „ CINA+ Online http://www.cancer-rates.info/naaccr/ „ CINA Publications http://www.naaccr.org/index.asp?Col_SectionKey=11&Col_ContentID=50 „ National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) Program http://www.seer.cancer.gov/

Page 12 of 88 Data for Research

„ NAACCR Research Program Compiling a “multi-registry aggregated database from all NAACCR member registries” Researchers can submit proposals and request the use of the data Research proposals are evaluated “to determine scientific merit and provide constructive criticism to improve research designs.” Website: „ http://www.naaccr.org/index.asp?Col_SectionKey=11&Col_C ontentID=379

Page 13 of 88 Future Plans

„ Future Linkages National Death Index Social Security Death Index „ Web enabled reporting for facilities „ Geocoding of data „ Build infrastructure Information technology Data analysis Data quality control

Page 14 of 88 Lung Cancer and Smoking

„ Lung Cancer Incidence From 2000 to 2005, the incidence of invasive lung and bronchus cancer in Nevada declined from 85.2 to 70.6 per 100,000 (age-adjusted rate) „ Ranking improved from 3rd highest to 24th highest Source: United States Cancer Statistics (USCS)

Page 15 of 88 Smoking Prevalence

Adults Who Are Current Smokers In 1998, Nevada had Nevada BRFSS: 1998-2007 the 2nd highest 35 smoking rate in the 30 nation 25 „ 30.4% 20

In 2007, Nevada had % 15 th the 16 highest 10

smoking rate in the 5 nation 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 0 „ 21.5%

From 1998-2007, Nevada experienced the largest decrease in prevalence (8.9%) „ Of the 50 States and the District of Columbia

Sources: Morbidity and Mortality Weekly, Volume 58, No. 9, March 13, 2009; Behavioral Risk Factor Surveillance System

Page 16 of 88 Women, Lung Cancer, and Smoking

„ Lung Cancer In 2005, Nevada ranked 24th overall for Lung Cancer Incidence „ Male Incidence: ranked 31st „ Female Incidence: ranked 9th Source: United States Cancer Statistics (USCS)

„ This indicates a need to target prevention efforts towards women

„ Smoking Prevalence In 1998, 28.0% of women smoked In 2007, 19.5% of women smoked Source: Behavioral Risk Factor Surveillance System (BRFSS)

„ Although smoking prevalence among women has declined, lung cancer incidence remains high compared to other states

Page 17 of 88 Comparison of Nevada Cancer Incidence Rates to National Rates: 2001-2005

Source: USCS

Page 18 of 88 Colon and Rectum Cancer and Screenings

„ Colon and Rectum Cancer Incidence Rate for 2001-2005 49.7 per 100,000 people (age-adjusted) Ranked 37th highest Slightly less than national rate of 51.6 per 100,000 „ Source: USCS „ Colorectal Cancer Screenings Rate for 2004 46.7% Also, slightly less than national prevalence of 53.5% „ Source: BRFSS „ Screening rates are lower than national, but so are cancer rates „ Why? This example reveals a need for further investigation

Page 19 of 88 Comparison of Nevada Colorectal Cancer Screening Rates to National Rates: 2004 Respondents who ever had a colonoscopy or sigmoidoscopy

Source: Behavioral Risk Factor Surveillance System

Page 20 of 88 Future Opportunities

„ Further focused data analysis „ Integrate cancer data with other health related data in a Data Warehouse Allow additional queries revealing where public health efforts should be focused Existing programs can utilize information to target interventions Improve outcomes for Nevadans „ Many possibilities for what can be done with the data

Page 21 of 88 NEVADA STATE COMPREHENSIVE CANCER CONTROL PROGRAM

The Nevada State Comprehensive Cancer Control Program (CCCP) operates under the direction of the Nevada State Health Division (NSHD), Department of Health & Human Services. The CCCP is funded entirely by federal dollars through Centers for Disease Control and Prevention (CDC) National Comprehensive Cancer Control Program, CFDA# 93.283. (http://health.nv.gov/ComprehensiveCancer.htm)

Mission

To reduce the burden of cancer that results in risk reduction, early detection, better treatment, and enhanced survivorship.

Goals

To fulfill this mission, the CCCP adheres to the CDC National Comprehensive Cancer Control Program grant guidance and objectives for implementation programs:

• Develop and implement a statewide cancer plan that has broad support (See attached Framework for Comprehensive Cancer Control) • Implement the cancer plan • Conduct evaluation of the program and cancer plan • Effect policy change • Monitor changes in population-based measures • Conduct an NVCC membership satisfaction survey (See attached 2008 Nevada Cancer Council Member Satisfaction Survey Report)

Program Components

The CCCP meets these goals by developing, managing and supporting the following program components:

• Maintaining infrastructure for the CCCP at the Nevada State Health Division

• Maintaining effective communication and linkages between NSHD Comprehensive Cancer Control Program staff and partners actively involved in developing/implementing the comprehensive cancer control plan

• Providing the Nevada Cancer Council with administrative support, including assisting with meeting logistics and minutes

• Collecting and reporting data

• Creating a Cancer Control Plan Implementation Guide (an ongoing timeline of tasks and accomplishments of the Cancer Plan) for publication on the NVCC website: http://www.nevadacancercouncil.org/

• Develop a Nevada Cancer Council Membership Packet

Page 22 of 88 Framework for Comprehensive Cancer Control

What should be done? Phase 1—Setting Optimal Objectives (data– driven)

Data on: Needs Resources Data Data from: Process, outcome Impact evaluations Data on: Unmet needs Service gaps What is achieved? Knowledge Data gaps What could be done? Phase 4—Implementing for Phase 2 —Determining Effective Strategies Decision Possible Strategies (outcome– driven) Making (science-driven) Data on: Data on: Disease burden Basic and Target populations applied Utilization barriers research Data on: Societal influences Partner resources Fundraising possibilities

What can be done? Phase 3—Planning Feasible Strategies (capacity-driven)

NSHD 03-30-09 Source: Adapted from Journal of Public Health Management Practice 2000:6(2):67-78 Page 23 of 88 NEVADA STATE COMPREHENSIVE CANCER PLAN

The statewide Nevada Comprehensive Cancer Plan (attached) available at http://health.nv.gov/PDFs/canplan.pdf released on April 3, 2006, was compiled by a 56 member Cancer Council representing a cross-section of researchers, clinicians, advocates, hospitals, health plans and government representatives from 30 statewide organizations. Because of Nevada’s unique health care environment, the Council approached its cancer planning efforts by addressing five specific categories: • Prevention • Early Detection and Diagnosis • Treatment • Clinical Trials • Quality of Life and Palliative Care

The Nevada Cancer Plan has set six broad goals. The Nevada Cancer Council (NVCC) Implementation Plan Committees and Subcommittees are tasked to: • Reduce the risk for developing cancer • Increase early detection and appropriate screening for cancer • Increase access to appropriate and effective cancer treatment and care • Increase access to clinical trial initiatives • Address quality of life issues for health care consumers affected by cancer • Improve the coordination and collaboration among cancer control efforts

Plan Strategy that are accomplished: • Development of the Nevada Cancer Council (NVCC) webpage at http://www.nevadacancercouncil.org/ • Creation of an NVCC membership database; contact information includes organization affiliation and NVCC committee and task force involvement. Convened the first annual Nevada Cancer Control Summit • Incorporation of the EMAs (Extra Mile Awards) into the Annual Cancer Control Summit. December 8, 2008 marked the two-year anniversary of the Nevada Clean Indoor Air Act. To commemorate that event, Washoe County District Health Department (WCDHD) created the EMAs (a.k.a., the Extra Mile Awards) to honor local businesses that had gone the "extra mile" in terms of protecting their employees and customers from the dangers of secondhand smoke (i.e., banning smoking on outdoor patios, stand-alone bars that have banned smoking, smoke- free casino gaming areas, etc.). WCDHD has graciously donated their creative brainchild (the EMAs) to the NVCC to be awarded each year at the Annual Cancer Control Summit to commemorate legislators, agencies, programs, campaigns, individuals, etc. going the extra mile for all areas of cancer prevention. • Publication of The Stakeholder, NVCC’s quarterly newsletter • Development of NVCC Policy Statement on the 2009 Legislative Session (attached)

Page 24 of 88 united in the fight against cancer

State of Nevada Comprehensive Cancer Plan A GUIDE FOR COMP R E H E N S I V E CANCER CONTROL E FF O RTS IN THE STATE OF NEVADA

Nevada Cancer Council

Page 25 of 88 Funded by the Nevada State Health Division Through Cooperative Agreement Number U55/CCU922006 From the Centers for Disease Control and Prevention

The contents are solely the responsibility of the authors and do not necessarily reflect the views or imply an endorsement of the publication by the National Comprehensive Cancer Control Program, Centers for Disease Control and Prevention, or any other participating entity.

Page 26 of 88 KENNY C. GUINN OFFICE OF THE GOVERNOR Governor

December 2, 2005

My fellow Nevadan:

With more than 11,000 individuals in our state diagnosed with cancer each year, and 4,600 more dying from the disease, it is imperative that health organizations coordinate efforts and resources in their fight against this often tragic condition. The Nevada Comprehensive Cancer Control Plan that I share with you today allows health care providers and health partners statewide to better accomplish this important objective.

As a cancer survivor myself, I understand the toll the disease can take on individuals, their family members and their friends. Those we love share our concerns upon detection, our anxieties during treatment, and our joy upon remission. Additionally, the entire state experiences significant economic and social impacts as a result of this deadly disease. Reduction in cancer rates is not only beneficial to us individually, but to the entire state as it lessens the burden on the health care systems we have in place.

In this plan you will uncover strategies Nevada can implement to reduce the incidence of cancer within our state. I encourage you to join with me, the Nevada Cancer Council, and the Nevada State Health Division’s Bureau of Community Health in the fight to gain better control of this disease through enhanced education and prevention efforts, earlier detection and improved treatment options for all those diagnosed with cancer.

Sincerely,

KENNY C. GUINN Governor

LF:SC

101 N. CARSON STREET • CARSON CITY, NEVADA 89701 • TELEPHONE: (775) 684-5670 • FAX: (775) 684-5683 555 E. WASHINGTON AVENUE, SUITE 5100 • LAS VEGAS, NEVADA 89101 • TELEPHONE: (702) 486-2500 • FAX (702) 486-2505 (O) 5089 Page 27 of 88 STATE OF NEVADA KENNY C. GUINN ALEX HAARTZ, MPH Governor Administrator

MICHAEL J. WILLDEN BRADFORD LEE, M.D. Director State Health Officer

DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH DIVISION 505 E. King Street, Room 201 Carson City, NV 89701-4797 Telephone: (775) 684-4200 • Fax: (775) 684-4211

Dear Colleague:

The Nevada State Health Division, Bureau of Community Health is pleased to share with you a copy of the State of Nevada Comprehensive Cancer Plan. The Nevada Comprehensive Cancer Control Program produced this plan, through funding from the Centers for Disease Control and Prevention. This plan addresses the burden of cancer and the strategies to reduce cancer incidence and mortality in Nevada.

Each year approximately 11,000 Nevadans are diagnosed with cancer and an additional 4,600 deaths are attributed to this disease. Reduction in the rates of cancer in Nevada will be accomplished through lifestyle changes that eliminate tobacco use, improve dietary habits, increase physical activity, maintain a healthy weight, avoid harmful ultraviolet light, increase early detection through cancer screening, and increase the receipt of appropriate and timely cancer treatment.

The Nevada Cancer Council is comprised of a diverse group of statewide organizations, partners, and advocates who are committed to the reduction of the cancer burden in our state. Through the hard work and dedication of each member, the Nevada Comprehensive Cancer Control Plan was developed. It is our hope this plan will become the driving force behind cancer control activities in the state.

The Nevada Department of Health and Human Services and Nevada State Health Division’s Bureau of Community Health extends its appreciation to all those individuals who helped prepare the plan. The information presented serves as a starting point in the effort to define and reduce the burden of cancer in Nevada.

Finally, I encourage you to become involved in reducing the cancer burden on Nevada residents. By working together, we can ensure a healthier future for the people of Nevada.

Sincerely,

Bradford Lee, MD State Health Officer Nevada State Health Division

Public Health: Working for a Safer and Healthier Nevada

Page 28 of 88 TABLE OF CONTENTS OF TABLE table of contents

EXECUTIVE SUMMARY 1

WHAT YOU CAN DO TO FIGHT CANCER IN NEVADA 2

CANCER IN NEVADA 4 Health Care and Cancer Rankings Most Common Cancers in Nevada Risk of Developing Cancer The Economic Burden

SETTING THE STAGE FOR CANCER CONTROL 8 Steering Committee, Subcommittees Choosing the Cancers Addressed in this Report Coordinating with Other Initiatives

ADDRESSING DISPARITIES, SURVIVORSHIP, GAPS, AND BARRIERS 13 Disparities Survivorship Gaps and Barriers

GOALS, OBJECTIVES, AND STRATEGIES 22 GOAL 1. Reduce the risks for developing cancer GOAL 2. Increase early detection and appropriate screening for cancer GOAL 3. Increase access to appropriate and effective cancer treatment and care GOAL 4. Increase access to clinical trial initiatives GOAL 5. Address quality of life issues for health care consumers affected by cancer GOAL 6. Improve coordination and collaboration among cancer control efforts

GLOSSARY 34

ACRONYMS 35

RESOURCES 36 Locating cancer control services in Nevada

Photography and copy for cancer patient stories generously provided by Joe Rubino.

Page 29 of 88 EXECUTIVE SUMMARY 1 Th e Plan identifi es areas of e Plan identifi Th received a grant from the Centers for Disease the Centers for Disease a grant from received

88 of 30 Th e Plan also addresses also addresses Plan e special issues: Th Addressing and special populations disparities survivorship, includes information about existing It in Nevada. and services,programs describes gaps and barriers orts, and eff cancer control that inhibit successful cancer control a vision for improving recommends goals for attaining the broad statewide. Strategies public and incorporate included in this Plan collaboration and coalition education, professional and surveillance.building, policy development, A road map for action: common ers interest a road andmap needto and off e goals areguide broad action. and are Th directed at improving the lives e of all Nevada residents. Th objectives and strategies included in this Plan are varied and intended to provide numerous “binding sites” with which interested partners can connect. Implementation will include local activities in communities across theorts state, collaborative eff among csmall areas groupsof interest, around specifi orts. Progressand towardstatewide meeting eff the goals in this plan will be evaluated annually, and a report will be distributed to the appropriate is plan willstakeholders. be regularly Th updated to meet the changing needs and capacities of our state. Page ada Cancer Council, with educing cancer incidence, tality through prevention, early early prevention, tality through

consumers aff ected by cancer cancer by ected aff consumers orts eff control cancer among collaboration screening for cancer for screening care and treatment cancer

morbidity and mor “Comprehensive cancer control is an integrated and is an integrated cancer control “Comprehensive to r approach coordinated In creating this Plan, the this Plan, creating In ning cancer control: Defi nition embraced the defi Cancer Council Nevada Control the Centers for Disease by developed cancer on a to help states address and Prevention scale: comprehensive Th e Nevada Cancer Council is dedicated to bringing Cancer Council is dedicated to bringing Nevada e Th early cancer prevention, together and coordinating orts to eff support, and research detection, treatment, the quality of life for everyone in Nevada. improve and collaboration coordination aim is to increase Its increase duplication, and to to reduce among programs, and control. opportunities for cancer prevention Control and Prevention’s National Comprehensive Cancer Control Program to develop a comprehensive cancer cancer a comprehensive develop to Program Cancer Control Comprehensive National and Prevention’s Control Comprehensive NSHD’s the a sub-grant from received Institute Cancer Nevada e Th plan for Nevada. control of the American Cancer Society, the resources and was joined by to facilitate the process Program Cancer Control survivors organizations, cancer centers, local hospitals, community-based advocates. and • • and coordination the Improve • • care health for issues life of quality Address • • ective eff and appropriate to access Increase • initiatives trial clinical to access Increase • • appropriate and detection early Increase • • cancer developing for risk the Reduce input from diverse community groups, approached approached community groups, diverse input from c specifi ve orts looking at fi by its cancer planning eff 2) early detection and categories: 1) prevention, 4) clinical trials; and 5) quality diagnosis, 3) treatment, this base model, the Using care. of life and palliative goals: has set six broad Cancer Plan Nevada Because of Nevada’s unique health of Nevada’s goals: Because broad Setting the Nev environment, care detection, clinical trial enrollment, and quality of life detection, clinical trial enrollment, care.” palliative

Th e Nevada State Health Division (NSHD) Division Health State Nevada e Th Executive Summary WHAT YOU CAN DO WHATCAN YOU

What You Can Do To Fight Cancer In Nevada

The Nevada Cancer Plan identifi es broad goals to reduce the burden of cancer. To accomplish these goals, everyone needs to be involved. What can you do?

If you are a Hospital…You can:  Include clinical trails information in meeting agendas.  Assure that your cancer cases are reported in a  Form speakers’ bureaus to provide cancer timely manner. education.  Provide meeting space for cancer support groups.  Train facilitators for survivor support groups.  Collaborate to sponsor community screening and education programs. If you are an Employer…You can:  Maintain American College of Surgeons membership.  Establish a smoke-free work place policy.  Encourage participation in cancer clinical trials.  Provide healthy foods in vending machines and cafeterias.  Encourage employees to increase physical activity. If you are a local Public Health  Collaborate with hospitals to host screening events. Department…You can:  Provide health insurance coverage.  Provide cancer awareness information and data to citizens and groups.  Collaborate with community-based coalitions. If you are a School or University…You can:  Work with physicians and other health care providers to promote screening programs and  Include cancer prevention messages in health classes. case management.  Provide healthy foods in vending machines  Provide space for community survivor support groups. and cafeterias.  Assess community needs and implement policy and  Increase physical education requirements. environmental changes to reduce cancer risks.  Make your entire campus a smoke-free environment.  Assure access to care for uninsured and underinsured.  Encourage participation in cancer clinical trials. If you are a Faith Based Organization…You can:  Provide cancer prevention information to members. If you are a Community Based  Collaborate with other community-based groups. Organization…You can:  Learn how to provide healthy potlucks and  Promote cancer awareness information to meeting meals. constituents.  Open your building for walking clubs.  Promote cancer screening.  Encourage members to get cancer-screening tests  Encourage participation in clinical trials. on time.  Collaborate to provide community prevention programs. If you are a Physician, Nurse, Social Worker, or other Health If you are a Professional Health Professional… Organization…You can: You can:  Provide continuing education credits on  Make sure patients get appropriate cancer cancer topics. information on screening tests. 2 Page 31 of 88 3 WHAT YOU CAN DO         You can: If you are aNevada Resident…      What You CanDoTo Fight Cancer InNevada Be sure your cancer cases are reported in a timely manner. Volunteer withyour hospital,healthdepartment, Show andcareforthosewhoare your support diagnosedwithcancer, considerenrollingina If smoke-free environments. Support Know whentobescreenedandobtain screenings Increaseyour dailyphysical activity. Eatanutritious andbalanced diet andmaintaina Avoid alltobaccoproductsandsecondhandsmoke. incancerclinicaltrials. participation Encourage life care. to hospice for end of Make earlier referrals Findouthow toenrollpatientsinclinicaltrials. Refer patientstosmokingcessationclassesand cancer controlefforts. whosupport faith community orlocalgroups diagnosed. clinical trial. on schedule. healthy weight. nutrition programs. Page 32 of 88 CANCER IN NEVADA IN CANCER

CANCER IN NEVADA

Stacy Marino knows more than any other 25 year old should know. Cancer has taught her. Two and a half years ago, when her daughter was two months old, Stacy was diagnosed with one of the most aggressive forms of Non-Hodgkin’s Lymphoma. She went through immediate, intensive chemotherapy and radiation, then more treatment, more chemotherapy, and more radiation. The cancer spread to her back and her brain. Finally, in the spring of 2002, Stacy went to the City of Hope, a comprehensive cancer center in Los Angeles for a Stem Cell Transplant that could not be performed in Las Vegas. Two hundred miles from home; she spent two months enduring one of the most diffi cult and debilitating treatments in medicine. She returned to Las Vegas last summer, and still the problems, the hospitalizations, the cancer, were not fi nished with her. Today, her future is uncertain. When you hear her story, you are forced to wonder about fairness and fate. You wonder when someone will fi nally cure this horrible disease. But when you are with her, you are pulled into her intensity and power. When she laughs, you feel the open, full joy associated with children. But it has a different quality. This joy has been soaked in pain and harrowing knowledge, and in absorbing those things; it burns brighter within this radiant, unyielding woman.

4 Page 33 of 88 CANCER IN NEVADA 5 . 2) as the second common 88 of 34 cancer (fi rst among women) and accounted for rst among women) cancer (fi 15.9% of 1) (Fig. all cancer cases. the percentage of Cancer in Lung and Bronchus cantly higher than the signifi (18.0%) was Nevada nation (12.9%). On the other hand the percentage of Breast Cancer in Nevada those who developed than the nation considerably lower (15.9%) was (Fig (18.2%) during the 1997-2001 period. African Americans had the highest age-adjusted cancer in Nevada from 1997-2001. This cancer in Nevada cancer accounted for 18% of during this all cancer cases period. Breast Cancer w (1997-2001) When compared to the national average Among all racial/ethnic minorities in Nevada, the most common was Cancer Lung and Bronchus Page   Incidence Highlights Incidence  er a life ed hospitals Analysis, Epidemiology . The Henry J. Kaiser Family Foundation Foundation Family Kaiser J. Henry The ada has 14 federally qualifi 10,000 residents 1,000 residents of 44th in the total number 38th in total health care employment Nev 48th in the number of doctors per 100,000 residents• of 43rd in the number rural health clinics • of 50th in the number per nurses registered • Source: 2005, American Cancer Society, Inc. Surveillance Surveillance Inc. Society, Cancer American 2005, Source: 1969-2002, Tapes, Data Use Public Mortality US Research; Disease for Centers Statistics, Health for Center National 2004. Prevention, and Control ending disease. It is estimated that 1,990 men will be diagnosed with Prostate Cancer in 2005 and 260 will die from ifit. Prostate Cancer, is no long caught early, It is estimated that 11,120 new cancer cases will be this year and about 4,620 residents diagnosed in Nevada will die of this disease in 2005. Cancer incidence and age, gender, depending on the site, mortality rates vary, and other factors. access to health care, ethnicity, Most Common In Nevada Cancers Sources: Sources: Health of Department States United statehealthfacts.org, and Control Disease for Centers Services, and Human (CDC), National Center for Healthcare Prevention ce of Statistics (NCHS), Offi File Mortality Compressed and Health Promotion, 1999-2001. (CMF) compiled from Report on Cancer In Nevada, 1997-2001, Source: • • Out of ranks: Nevada states, the 50 • of 14th in the number adults who smoke • 9th in cancer mortality rates • 48th in the number of hospital beds per Health Care and Care Health Rankings Cancer CANCER IN NEVADA health centers • 6 CANCER IN NEVADA   HighlightsDischarge Inpatient Hospital NEVADA IN CANCER   Mortality Highlights ColorectalCancer was thesecondleading cancer Lung andBronchus Cancerwas theleadingcause LungandBronchus CancerandColorectal LungandBronchus Cancerwas theleadingcancer percentage estimates remainedconstant.) percentage cancer deathsduringthisperiod. (Fig. 3-2003-2005 all cancertypesaccountedfor 32.0%of These inNevadafor cancermortality from1997to2001. disc in billedamountsforcancerinpatienthospital thetotal1billiondollars accounted for32.8%of amounts inNevada from1997to 2001.This accounted for305.2milliondollarsintotalbilled duringthisperiod. discharges allcancerinpatient which accountedfor7.6%of cancerwas ColorectalCancer, leading typeof all cancerinpatienthospitaldischarges. second The canceraccountedfor14.9%of 1997 to2001.This inNevadafor inpatienthospitaldischarges from 0.40 respectively forNevada in1997to2001. 0.49,0.46and Americans hadcomparisonratiosof African Americans. Asians, HispanicsandNative we may expecttohave 94newcancercasesamong 100newcancercasesamongCaucasians,for every cancer incidenceratewas means; just0.94.This age-adjusted rates amongCaucasians, theratioof cancer. comparedto When incidence rateof harges duringthisperiod. harges Page 35 of 88 Modifiable Risks into two categories: modifiable and non-modifiable. Similar to other chronic diseases, cancer risks are defined deathamongadultsinNevada. the leadingcauseof diseaseas through 2001,cancerissecondonlytoheart With atleast3,400individuals dyingannually from1997 cancers inNevada 55orolder. arediagnosedatage middleandolderage. About78%of disease of Although cancermay strike atanyage,itismostlya Anyone inNevada isatriskfordeveloping cancer. Risk of Developing Cancer       we includebutarenotlimitedto: cancontrol.They Modifiable risksarethosethatdefi ned assomething human immunodefi (HIV),and helicobacter ciency virus (HPV), (HBV),human papillomavirus Bvirus hepatitis cancersrelatedtoinfectiousexposures,Certain such as by tobacco use. in 2005 more than 180,000 cancer deaths will be caused completely. The American Cancer Society estimates that smoking and heavy alcohol use could of be prevented prevented. In addition, all cancers caused by cigarette or obesity and other lifestyle factors and thus could be will be related to nutrition, physical inactivity, overweight the 570,280of cancer deaths expected to occur in 2005 Scientific evidence suggests that as many as 50% to 75% decreases in lung cancer death rates in men. and, more recently, decreases in smoking followed by followed by dramatic increases in lung cancer death rates mirrored smoking patterns, with increases in smoking that lung cancer death rates in the United States have this association. Further support comes from the fact epidemiologicHundreds of studies have confirmed association between tobacco use and developing cancer. consistent finding, over research, decades of is the strong According to the National Cancer Institute, the most

Accesstopreventive heathcareservices Overweight orobesity Physical Activity Nutrition Environmental Exposureincludingsunand Tobacco Use chemical aswell asinfectiousexposures estimates remainedconstant.) cancer deaths. (Fig. 3 -2003-2005percentage all deathandaccountedfor10.8%of cause of all CANCER IN NEVADA 7

1.9 ada, the economic cost for cancer in cost ada, the economic ve treatment modalities for each type of treatment modalities for each ve 88 of 36 personal and family history of disease and genetic testing; testing; genetic and of disease history family and personal history family when only undertaken generally is latter the of as early such disease or other clinical characteristics, onset of of likelihood indicate a substantial cancer, an to cancer. inherited predisposition also seek genetic may affected with cancer People and survivors diagnosed individuals testing; both newly ne of to defi be desired may Testing earlier cancers. to clarify risk to offspring, to personal cancer etiology, ne the appropriateness of particular surveillance defi about risk- or to aid in decision-making approaches, surgery. reducing prophylactic been reported for breast cancer, have Gene mutations and renal cell cancer, thyroid, melanoma, leukemia, other and scientists are closing in on genes for several gene predisposes a The mutation BRCA1 cancers. cancer. person to hereditary breast cancer and ovarian responsible for about 5 is probably BRCA1 A mutant percent of of the 182,000 cases breast cancer predicted many as a quarter and as offor a single year, the cases agesoccurring 45 and younger. in women Early detection of through age and gender cancer, halfappropriate screening, accounts for about of screening Regular all newly detected cancer cases. a health care professional can result in examinations by the detection of cancers of colon, rectum, the breast, skin at earlier stages, and cervix, oral cavity, prostate, to be successful. when treatment is more likely more expensi of development the continuing cancer, new therapies ofand the increasing numbers elderly population our the cost is expected to increase substantially in Nevada, the next decade. over The Economic Burden Burden Economic The In Nevada Cancer of While the most important cost of cancer is the loss of and oflives quality of the huge life, economic burden of cancer cannot be ignored. The Centers for Disease estimates that the direct (CDC) Control and Prevention and indirect cost of States in 2004 cancer in the United $189 billion. Thiswas estimate includes about $69.4 billion in medical costs and $120 billion for indirect With a population of costs and lost productivity. $1.1 billion or $585 approximately in 2002 was Nevada per person. Due to the emergence of And it does not end here. million in Nev Page Genetic Predisposition Age Race Gender In depth information on these topics can be found in the Disparities Section of this report. The best able risks is to adhere to to managed non-modifi way with your work recommended screening guidelines and primary to ensure that all risk factors are care provider determining when considered screenings. recommended (Source: The National Institutes of Health Cancer Information Services) genesAltered or mutated trigger Genes all cancers. that control the orderly replication of cells become damaged, the cell to reproduce without allowing to spread into neighboring restraint and eventually tissues and set up growths throughout the body. just a small portion ofHowever, cancer is inherited. es people with a moderately historyFamily often identifi increased risk of Less often, family history cancer. indicates the presence of an inherited cancer high lifetime risk predisposition conferring a relatively of DNA-based testing can be In some cases, cancer. as the cause ofc mutation rm specifi a used to confi the inherited risk, and to determine whether family inherited the mutation. members have of cancer risk increased an with person a Identifying clinical through of cancer occurrence the reduce can cancer, breast for tamoxifen (e.g., strategies management person’s that improve or cancer) colon for ts colonoscopy benefi intrinsic through of life quality or outcome health predisposition). genetic no (e.g., itself for plan to information of the ability better include may ts benefi Intrinsic other or retirement career, children, (having future the risk. cancer about knowledge improved with decisions) of assessment include assessment risk of genetic Methods The Role of Genetics in in Genetics of Role The Cancer Developing     Non-modifi able risks are defi ned as risks that we are defi able risks Non-modifi cannot control. They include but are not limited to: Non-Modifiable Risks Non-Modifiable CANCER IN NEVADA vaccines, changes, behavioral through prevented be could ofthan many more the addition, In antibiotics. or in diagnosed be to estimated cancers skin million one sun’s the from protection by prevented be could 2005 rays. ultraviolet CANCER CONTROL CANCER SETTING THE STAGE FOR CANCER CONTROL

Lynn Wiesner holds her granddaughter Tommi Stockham. With them are Lynn’s children: Tommi’s mother, Kari Stockham and Kurt Wiesner. These are the people Tom Wiesner left behind. Tom Wiesner was a great bright light in Las Vegas, and the state of Nevada. Businessman, county commissioner, community leader, Regent of the University and Community College System of Nevada, he loved many things passionately – his family, his city, his state, the UNLV Rebels. When Tom was diagnosed with leukemia in November 2001, it took all of the persuasion of his friends, his doctors and even the health secretary of the United States to convince him to leave Nevada for the treatment and care he needed. Tom and Lynn went to Fred Hutchinson Cancer Research Center in Seattle. For eight months, they were forced to live away from their family and their friends. They missed baby showers for Kari and even the birth of their fi rst granddaughter. Their children and family made the long trip to Seattle as often as possible, while Tom and Lynn rode the roller coaster of optimism and despair, days of pain and pain-free days. The distance, the separation, was a weight added to the burden they all carried. Tom died in Seattle on June 25, 2002. More than 2500 people attended his memorial service in Las Vegas to acknowledge a large, generous life of meaning, service, and laughter. THESE PEOPLE, these pieces of his huge heart remain – his wife, his son, his daughter, and the effervescent Tommi, carrying his name into the promise of her life.

8 Page 37 of 88 CANCER CONTROL 9 s Regional Medical Center s Regional y’ The Nevada Cancer The Nevada y’s Regional Medical Center Regional y’s / Summerlin Hospital / Southern Nevada Cancer Research / Southern Cancer Research Nevada / Sierra Health Services, Inc. / American Cancer Society-Nevada Cancer / American Cancer Society-Nevada / Washoe Health System Health / Washoe / UsTOO / St. Mar / Carson Tahoe Cancer Services / Carson Tahoe / Sisters Network / Summerlin Hospital / Susan G. Komen Foundation Komen / Susan G. / Ovarian Cancer Alliance of / Ovarian Nevada / Nevada Cancer Center / Nevada 88 obinson of oundation / CCOP 38 Irene Battle / Access on Demand McHale Jack Brown Jackie /Saint Mary’s Regional Medical Center Regional Clemons /Saint Mary’s Jan Health System / Washoe Johnson Jan Hospital Durham / Mountainview Jane Beatty Jeanne CurryJennifer Martinsen Jennifer System Health Jim Hiney / Washoe Central Cancer Registry / Nevada Karen Power Wagenen Kathy Van F Kristin Astrom Lew Musgrove Liz Williams Hospital O’Callaghan Federal Lorene Noble / Mike Inc. Centers, Health / Nevada Guzman Paula Cancer Centers of Sennes / Comprehensive Paula Nevada Sally DeLipkau Sandy Lahr Stacey Lee-Harrington Sue McNutt Susan R Institute (NVCI) Susen Speth-Briganti / Saint Mar Page ram, Nevada State Health Division State Health Division ram, Nevada , Nevada Cancer Institute Cancer , Nevada / Sierra Health Services, Inc. National Cancer Institute’s Cancer Information Service National Cancer Institute’s / Southwest Cancer Clinic / Southwest / NCI-CIS-NVCI / Quest Diagnostics Quest / / University Medical Center / University / Emy’s Boutique / Emy’s / Nevada State Health Division Health State Nevada / Nevada Health Centers, Inc. Health Centers, Nevada / Nevada State Health Division State / Nevada Planning Director, American Cancer Society American Cancer Society Planning Director, / Southern Nevada Research Foundation Research Nevada Southern / / National Black Leadership Initiative on Cancer on Initiative Leadership Black National / / Sunrise Hospital & Medical Center Medical & Hospital Sunrise / / HEREIU / University of Nevada Cooperative Extension of Cooperative Nevada University / Director, Outreach and Education, Nevada Cancer Institute Education, Nevada and Outreach Director, / University of / University Reno Nevada / Nevada State Health Division Health State Nevada / American Cancer Society Cancer American Manager, Nevada Central Cancer Registry, Nevada State Health Division State Health Division Nevada Central Cancer Registry, Nevada Manager, / Hotel Employees and Restaurant Employees Restaurant and Employees Hotel / / Sunrise Hospital & Medical Center Medical & Hospital Sunrise /

/ Carson Tahoe Cancer Resource Center Resource Cancer Tahoe Carson / / lene Herst lene r International Union (HEREIU) Union International Council led the development ofCouncil led the development up of Plan and the steering committee made Cancer the Nevada 12 experts from identifying the areas of and guidance in oversight elds provided focus and setting medical fi the cancer control and composed of Subcommittees, goals. overall 30 organizationsfrom the representing over more than 50 individuals The Steering Committee attaining the goals. and strategies for drafted objectives met and sector, public and private a draft of and approved reviewed and strategies and and amended these objectives reviewed the plan. / Carson Tahoe Cancer ServicesEdythe Garvey / Carson Tahoe Emelda Ekpoudia Emilia Guenechea Geoffrey Leigh Dominican Hospital / St. Rose Holly Lyman Dr. Daniel Kirgan Dr. Ihsan Azzam Dr. Jerry Reeves Dr. Larry Gamell Dr. Institute Cancer , Nevada Bray-Ward Patricia Dr. Institute Cancer , Nevada Ward David Dr. Nicholas Vogelzang Dr. Christine Belle Christine McBride Deborah Shamoon Ahmad Dr. Carla Brutico Brutico Carla Bell Carolyn Cha Morneault Diana Nangano Dianne Johnson Dorothy Cancer Centers of / Comprehensive Arnold Wax Dr. Nevada Christine Petersen Dr. Subcommittee Members Subcommittee Bond Bobbette Vanderharten Carol Paula Guzman, Paula and Education Program Prevention and Charlene Herst, Tobacco Manager, Prog Cancer Control Comprehensive Steering Committee Steering Merle Berman, Advocate Emilia Guenechea, SETTING THE STAGE FOR CANCER mountains through sifting the and many minds of thinking the It takes CONTROL plan. cancer a comprehensive create to information of Buffy Martin Buffy Manager, Environmental Public Health Tracking System, Nevada State Health Division State Health Division System, Nevada Public Health Tracking Environmental Manager, MPH, Ihsan Azzam, MD, Bureau of Chief, McBride, MBA, Deborah Division State Health Health, Nevada Community Daniel Kirgan, MD, American College ofDaniel Kirgan, MD, of University Surgeons, of School Nevada Medicine Leland, Tricia Perez, Veronica Sierra Services,cer, Health Inc. Chief MD, Christine Peterson, Medical Offi Karen Power, SETTING THE STAGE FOR CANCER CONTROL

Choosing the Cancers Breast cancer is most common among women over age 55; however, we continue to see increasing rates of Addressed in this Report diagnosis among women 45 years of age and under. The 5-year relative survival rate for breast cancer Cancer sites for this Plan were determined by (all stages) is about 84%. If all breast cancers were incidence rates and by the availability of evidence- diagnosed at a localized stage through regular cancer base interventions for prevention, early detection, screenings, 5-year survival would increase to about 95%. and effective treatments. In Nevada, the four leading cancers in order of incidence are: 1) lung, 2) breast, Most of the known risk factors for breast cancer such 3) colorectal; and 4) prostate. These four cancers as age, gender, and family history, cannot be changed. accounted for 57% of all cancers in Nevada. (Fig. 4) The good news is that breast cancer is curable if caught early. There are several screening programs that are Lung and Bronchus Cancer active in our communities. Lung and bronchus cancer is the second most commonly diagnosed cancer in the United States Colorectal and in Nevada. It is the number one killer among It is estimated that, in 2005, 1,240 colorectal cancers both men and women when all racial and ethnic will be diagnosed in Nevada and 480 Nevada residents groups are combined. Lung cancer mortality rates will die from this disease. Nevada’s age adjusted for non-Hispanic men and women have increased. incidence rate of 53.1 for colorectal cancer is slightly Overall, more women die from lung cancer than lower than the national average of 54.9. from breast cancer. Some 1,450 individuals in Nevada Risk factors include age, diet, polyps (benign growths are estimated to die from this disease in 2005, on the inner wall of the colon and rectum), personal contributing heavily to Nevada’s ranking of 9th in the and family medical history, and ulcerative colitis. country for cancer mortality. Early detection has shown to be effective in reducing It is estimated that 1,570 new cases of lung cancer were both the incidence and mortality of colorectal diagnosed in Nevada during 2004. The biggest risk cancer. Screening with fecal occult blood test cards, factor for lung and bronchus cancer is smoking. It is colonoscopy, fl exible sigmoidoscopy or air-contrast also worth noting that Nevada ranks 14th in the nation barium enema can detect early stage cancers and pre- for adults who use tobacco products. cancerous polyps; these growths can be removed during Early detection of lung and bronchus cancer is diffi cult colonoscopy or during more extensive surgery. because the disease is usually far advanced by the time it is diagnosed. Survival rates vary by the stage of the cancer at the time of diagnosis. Those diagnosed at the Prostate Cancer localized level have the highest one and fi ve year relative Prostate cancer is the most frequently diagnosed survival rates, 76.1% and 38.3% respectively. This was cancer among men in Nevada of all racial and ethnic followed by those with regional and with distant levels, groups. It is estimated that 2,000 new cases of with rates of 52.1% and 18.5% for the one-year period prostate cancer will be diagnosed in 2005 and that and 9.2% and 2.2% for the fi ve-year period. 230 men will die from this disease. It is worth noting that African American men in Nevada have higher Breast Cancer mortality rates than any other race in the state, a trend Breast cancer is the most common form of cancer in that is also observed nationally. women in Nevada, as well as in the United States. It is Most signifi cant risk factors for developing prostate estimated that there will be 1,620 new cases of breast cancer, such as gender, age, race/ethnicity and family cancer diagnosed in Nevada in 2005. Approximately, history, cannot be changed. Because prostate cancer three hundred of Nevada women identifi ed with cancer occurs at an age when other medical conditions and will die in 2005. major causes of death such as heart disease, stroke and diabetes mellitus are very frequent, it is hard to measure Source: 2005, American Cancer Society, Inc. Surveillance the actual number of prostate cancer patients who die Research; US Mortality Public Use Data Tapes, 1969-2002, CANCER CONTROL National Center for Health Statistics, Centers for Disease as a direct result of this disease. Control and Prevention, 2004 10 Page 39 of 88 CANCER CONTROL

1) rams Cancer 11 promotes and ws and regulations pertaining to hrough the Bureau of Community to eliminate health disparities among to eliminate health disparities among 2) he goal of the number for cancer is to decrease is one of 2010. People 28 focus areas for Healthy T different segments of the population. The Nevada State Health Division The Nevada protects the health of and visitors to all Nevadans the state through its leadership in public health and enforcement of la public health. T new cancer cases as well as the illness, disability, disability, as the illness, new cancer cases as well sets The initiative cancer. and death caused by including in 15 categories, targets for improvements c death rates from specifi cancer deaths, overall types of and screening methods, prevention cancer, cancer survival. ve-year surveillance, and fi within the chronic disease section have been disease section have within the chronic added or enhanced, and include Arthritis and and Control, Diabetes Prevention Prevention Public Health Tracking, Control, Environmental Cancer Control, and Tobacco Comprehensive and Education. Prevention Health, the Division offers numerous programs offers numerous Health, the Division control, and ultimately designed to prevent, disease in and chronic eradicate communicable in population and caseload has Growth Nevada. affected many of the programs of this Bureau, resulting in an increased need for collaborations Prog and partnerships within the community. to help individuals ofto help individuals all ages increase life their quality ofexpectancy and improve life, and major goals: 2010 has two People Healthy 88   Coordinating with Coordinating Initiatives Other and programs ongoing have Several initiatives in the Plan. contributed to the goals and objectives health 2010, a They People range from Healthy project of prevention promotion and disease the Department ofU.S. and Human Services, Health to as such c to Nevada, are specifi projects which several Governor’s tobacco control efforts, comprehensive community and several Cancer, on Prostate Force Task as such coalitions focusing on minority populations, En for a Better Health and Salud Partners Community Accion. Many of the set by the goals and objectives ect goals members of Cancer Council refl the Nevada these national and already set through and objectives local programs. of 40 Page SETTING THE STAGE FOR CANCER but at an early stage, can be diagnosed Prostate cancer CONTROL of about the value there is controversy widespread growing and, cancer is often slow Prostate screening. become a serious the disease will never in many cases, is a disease ofhealth problem. It Many men aging. die from another more will likely with prostate cancer despite the Thus, life threatening age-related disease. t of diagnosing the benefi fact that screening offers if it is unknown early stage, prostate cancer at an this outcomes. results in improved In addition, current detection prostate cancer generate of a high rate techniques results, false positive lead to unnecessary may biopsies and which prostate culties and stress diffi physical cause undue worry, may Aggressive prostate cancer for men and their families. consequences, adverse serious treatments also can have problems. impotence and bowel including incontinence, to determineStudies are underway whether widespread Also needed lives. prostate cancer screening can save are methods to determine types of which prostate be cancer require aggressive would treatment and which waiting.” better treated with “watchful In spite of the disagreement as to whether to screen major organizationsor not to screen, several in the recommended that have prostate cancer community at agemen begin to establish a baseline PSA 45 or age if40 relatives bloodline with those or African-American American Urological had prostate cancer. who have had agesAssociation and American Cancer Society It is important 50 and 45 as their recommendations. is as change in that number number the PSA to watch more important itself. than the number SETTING THE STAGE FOR CANCER CONTROL

 Designated by the state legislature as the Cancer-related coalitions and offi cial cancer institute for the State of Nevada, other formalized cooperative the Nevada Cancer Institute (NVCI) is a efforts play a significant role in collaborative, statewide effort involving concerned cancer prevention and control citizens, the oncology community, academic leaders, in Nevada. Among the more legislators, corporations, health care advocates, and active groups: cancer patients and their families. NVCI is wholly committed to offering the residents of Nevada  American Cancer Society – provides support and a facility that offers the most current and most information to cancer survivors and their families. advanced cancer treatment options. As a non-profi t  Susan G. Komen Foundation – offers research research center, an essential part of the Institute’s and community based outreach programs. mission is to ensure that cancer patients and their families, regardless of their geographic location,  Candlelighters of Southern Nevada – makes have access to the latest in cancer prevention, parent-run support groups available for families of education, detection, and treatment options. children with cancer.  Ovarian Cancer Alliance Network – provides support Three cancer-related programs and awareness for those affected by ovarian cancer. within the Nevada State Health  Nevada Tobacco Prevention Coalition – involves Division exist to prevent chronic a community-based coalition, which is helping to medical conditions that adversely reduce tobacco use in Nevada. affect the health of Nevadans.  Nevada Childhood Cancer Foundation – raises  The Tobacco Prevention and Education awareness and support for children’s cancer initiatives. Program provides funding to county health  Leukemia Lymphoma Society – serves in improving authorities; technical assistance to the tobacco the quality of life for cancer patients and their families. prevention coalitions, including the statewide  develops Nevada Tobacco Prevention Coalition; works with Nevada Cervical Cancer Coalition – policies to promote, protect, maintain, and improve the coalition members in the development of tobacco health of women in Nevada. prevention plans and strategies; and provides technical assistance to communities interested in implementation  UsTOO – is the largest Prostate Cancer support of tobacco control policies and initiatives. organization in the world with over 330 chapters worldwide.  The Breast and Cervical Cancer Early  Nevada Prostate Cancer Task Force – This Detection Program, through the Women’s Health legislative mandated task force is also a member of the Connection, assesses public and professional National Alliance of Prostate Cancer Coalitions. needs related to breast and cervical cancer; provides screening, tracking, follow-up services and treatment referral; provides public education regarding breast and cervical cancer to high risk groups; and provides professional education regarding diagnostic and therapeutic standards for breast and cervical cancer.  The Nevada Central Cancer Registry obtains and summarizes information on trend predictions about cancer cases in Nevada; provides information that allows investigation of the distribution and causes of avoidable cancer; and assists in establishing the effectiveness of cancer prevention programs, and pinpointing problem areas that need further study and evaluation. CANCER CONTROL

12 Page 41 of 88 DISPARITIES, SURVIVORSHIP,

ADDRESSING DISPARITIES, SURVIVORSHIP, GAPS AND BARRIERS GAPS, AND BARRIERS

Sally DeLipkau helps people with cancer see over the rough, high walls of fear, despair, and pain. A Cancer Information Representative for Washoe Medical Center in Reno, she spends her days with patients and their families, giving them information, encouragement, and hope. When she speaks to them her words come from years of experience in this work and from another, deeper place within her: the place where her own fondest ideas about her life were rubbed raw by the sudden diagnosis, the long treatment, the trauma of cancer. She knows what chemotherapy is, and radiation. She knows the fear that comes when everything you care about in your life is rushing away from you at once. In 23 years, she has had cancer four times. She has been told to take a trip she always wanted to take, to buy her Christmas presents because Christmas was so many months away and her life might not stretch that far. But Sally has survived it all. If you speak with her, she will tell you she is doing just fi ne. That’s the kind of woman she is. There is lightness to her and a kindness that envelops everyone who enters the warm circle of her presence. This woman must be a wonderful comfort, a gift to a fearful young mother about to have her 22nd radiation treatment in 27 days, to a middle-aged man wondering if he will see his grandchildren grow up.

13 Page 42 of 88 DISP

ADDRESSING DISPARITIES, SURVIVORSHIP, GAPS AND BARRIERS ARITIE

DISPARITIES AND BARRIERS Many different demographic and socioeconomic characteristics are associated with health-related disparities. Income, race/ethnicity, culture, geography, age, gender, sexual orientation, and literacy are just some of the factors. Poverty is the most critical factor. Socioeconomic status infl uences the prevalence of underlying risk factors for cancer, such as tobacco use and obesity, access S, to appropriate early detection and cancer treatment, general medical care, and palliative care. (Source: American Cancer Society Cancer Facts & Figures 2004)

Nevada residents face some of the highest cancer SU mortality rates in the nation. A signifi cant factor in cancer care outcomes in Nevada is the inadequacy in addressing health care needs of minority populations. A Cancer General Facts review of population data demonstrates that minority – Hispanics populations are among the fastest growing segments RVIVORSHIP,GAPS,  of Nevada’s population. This growth has brought an Education levels, which are associated with increased diversity of cultures and languages, increased economic levels and health status, are lower social and public welfare issues, increased stratifi cation among Hispanics than other populations. in income and increased demand for health and public For example, Hispanics are less likely to have services. Nevada’s public health system and health a high school diploma than non-Hispanic policy makers have begun to recognize the need for Whites. In 1999, approximately 56.1% of long-range planning to meet the health needs of the Hispanics age 25 and older had fi nished state’s increasingly diverse populations. In the 2001 high school, compared to about 87.7% of report, “The State of Public Health in Nevada,” non-Hispanic White adults. (Source: Hispanic Cultures, Latinos, Central Americans, AG Ramirez, minority health disparities was cited among the top ten L. Suarez, 2000 in press) planning issues shaping the future design of Nevada’s public health system and services.  The most prevalent cancers for Hispanic men and women are the same as for Whites: prostate, The burden of cancer is not borne equally by all breast, lung, and colorectal. (Source: American population groups in Nevada. Low income and Cancer Society Cancer Facts & Figures 2005) medically underserved populations have higher risks  of developing cancer and poorer chances of early Only 38% of Hispanic women, age 40 and diagnosis, optimal treatment, and survival. Moreover, older, have regular screening mammograms these populations have not benefi ted equally from before symptoms develop. (Source: US Census Bureau. The Hispanic population in the United States, recent improvement in cancer prevention, early 1999. Current Population Reports, Series -20-527. detection, and treatment. Washington, DC, 2000.) Eliminating health disparities is a key goal of the  Hispanics experience the highest invasive cervical Nevada Cancer Plan, as well as national organizations cancer incidence rates (16.2 per 100,000) of any and agencies, including the American Cancer Society group other than Vietnamese, and twice the and the U.S. Department of Health and Human incidence rates of non-Hispanic White women Services’ Healthy People 2010 initiative. (7.9 per 100,000). (Source: American Cancer Society Statistical Cancer Facts for Minority Groups: Cancer Facts & Figures 2004) The unequal burden is exemplifi ed by differences in  Low screening participation rates make cancer incidence and mortality as a function of race, Hispanic women more likely to be diagnosed ethnicity, gender, and socioeconomic status. at a more advanced stage of the disease 14 Page 43 of 88 ADDRESSING DISPARITIES, SURVIVORSHIP, GAPS AND BARRIERS

when fewer treatment options are available, Cancer General Facts resulting in poorer outcomes and higher mortality. (Source: Cervical cancer screening in regional Hispanic - Native American / Populations. AG Ramirez, A McAlister, R. Villarreal, E Trapido, GA Talavera, E. Perez-Stable, J. Marti, American Alaskan Native Journal of Health Behavior, 2000)  Cancer rates, which were previously reported to be lower among American Indian/ Alaska Natives has shown increasing rates over the past twenty years. Cancer General Facts - (Source: US Department of Health and Human Services, Indian Health Services. Trends in Indian health, 1998- African American 99. Rockville, MD: Department of Health and Human Services, Indian Health Services; 2000)  Surpassed only by unintentional injuries and homicides, cancer ranks as the third leading cause  Cancer is the second leading cause of death among of death among African American children, ages American Indians and Alaska Natives ages 45 and 1-14 years. (Source: Cancer Facts & Figures for African older. (Source: US Department of Health and Human Americans 2005-2006) Services, Indian Health Services. Trends in Indian health, 1998-99. Rockville, MD: Department of Health and  Lung cancer accounts for the largest number of Human Services, Indian Health Services; 2000) cancer deaths among both African American men (30%) and women (21%), followed by prostate  The types of cancer experienced within Native cancer in men (19%) and breast cancer in women American communities vary signifi cantly by the (19%). (Source: Cancer Facts & Figures for African geographic region with some unusual patterns Americans 2005-2006) (e.g., colon and lung cancer among Alaska Natives, lung, cervical, breast, and prostate cancer among  Cancer of the colon and rectum and cancer of the Northern Plains tribes, and stomach and gallbladder pancreas rank third and fourth as leading causes cancer among Southwestern Tribes). (Source: of cancer death for African American men and Patterns of cancer mortality among Native Americans, women, (Source: Cancer Facts & Figures for African N. Cobb, RE Paisano, L. Burhansstipanov, Cancer 1998; Americans 2005-2006) 83(11):2377-83, Cancer) 2000)  The most commonly diagnosed cancers in 2002  Lung cancer is the most common cause of cancer among African American men were prostate cancer death among eight of the nine Indian Health (37%), followed by cancers of the lung (15%), and Service (IHS) Areas (three IHS Areas not included of the colon and rectum (9%). (Source: Cancer Facts & due to signifi cant statistical errors). (Source: Cancer Figures for African Americans 2005-2006) Mortality Among American Indians and Alaska Natives  The most common cancers among African in the United States: regional differences in Indian health 1989-1993. Rockville, MD: Indian Health Services; 1997. American women in 2002 were breast cancer (31%), HIS Pub. No. 97-615-23.) followed by lung (12%) and colorectal cancers (12%). (Source: Cancer Facts & Figures for African  While common cancers in the general population Americans 2005-2006) are also common among American Indian/Alaska Native communities, there are some rarer cancers  During the period 1989-1994, Whites experienced that are disproportionately seen among American higher 5-year relative survival rates for all cancers Indians/Alaska Natives in different geographic than African Americans, regardless of stage at time regions of the country. Such cancers include:

GAPS, AND BARRIERS AND GAPS, of diagnosis. (Source: Cancer Facts & Figures for African Americans 2005-2006) a. Elevated incidence rates of stomach and  Cancers among African Americans are more gallbladder observed among Arizona and New frequently diagnosed after the cancer has Mexico American Indians. metastasized and spread to regional or distant sites. b. High incidence rates of lung, colorectal, uterine (Source: Cancer Facts & Figures for African Americans cervix, prostate, kidney and stomach cancers 2005-2006) among Alaska Natives. . Elevated lung, prostate and uterine cervix cancer DISPARITIES, SURVIVORSHIP, DISPARITIES, c 15 Page 44 of 88 GAPS, AND BARRIERS DISPARITIES, SURVIVORSHIP,

ADDRESSING DISPARITIES, SURVIVORSHIP, GAPS AND BARRIERS

among Northern Plains American Indians. affl uent communities. Culturally sensitive and culturally (Source: Cancer Mortality Among American appropriate effective cancer education, prevention, Indians and Alaska Natives in the United States: screening, early detection, case management, appropriate regional differences in Indian health 1989-1993. treatment, and good quality of life following diagnosis Rockville, MD: Indian Health Services; 1997. HIS Pub. No. 97-615-23.) requires involvement and actions at various levels, including community groups, health care providers,  In comparison to the general population the educators, employers, and the individuals affected. prevalence rate of cigarette smoking is higher among American Indian tribes (41.7% for men and Although documenting socioeconomic disparities in 38.1% for women). However, American Indian cancer is clearly important in order to target specifi c women in Arizona are the exception with a smoking underserved population subgroups and thereby reduce prevalence rate of 16.7% (prevalence rate among disparities, educational level, occupation, and income American Indian men in Arizona is 23.6%). (Source: are not routinely gathered for cancer patients in Centers for Disease Control and Prevention. State specifi c Nevada. As an alternative, the county-specifi c poverty prevalence of current cigarette smoking among adults rate (the percentage of population who live at or – United State 1998. MMWR Morb Mortal Wkly Rep below the poverty level) will be used as a surrogate 2000; 49 (39):881-4.) measure for the economic deprivation and the uneven Nevada conducted a Native American specifi c distribution of economic resources. Behavior Risk Factor Surveillance System (BRFSS) over sampling survey in 2004. There were 652 completed interviews among the 18 federally Gender Disparities recognized tribes and 1 Urban Indian Center In Nevada, and in the United States, cancer in Nevada. Thirty-one percent of respondents burden varies by gender. According to the Report on reported current smoking; 34.4% among men and Cancer in Nevada 1997-2001, males had a statistically 29.1% among women. signifi cant higher age-adjusted cancer incidence rate, 496.7 over the female rate of 423.0. Nevada rates are signifi cantly lower than the national rates of 554.3 and Socioeconomic status 424.4, respectively. For all cancers during the report period (SES) is an overriding factor closely tied to health (1997-2001) Nevada females had a higher one-year relative status. People with higher income and SES have better survival rate (75.7%) than males (70.2%). The trend was health than those with a lower income and SES. SES similar for the fi ve-year relative survival rate with females also appears to be a strong force behind differences and males at 54.5% and 47.2% respectively. in health among racial and ethnic groups. Poverty affects health outcomes in part by limiting access to needed resources. Other factors of SES, such as education, geographic location, and occupation, also affect health. Often poorer neighborhoods are “economically segregated.” This means that there may be a limited number of health care facilities available, as well as transportation problems in accessing the facilities. Despite the fact that many cancers can be prevented by taking advantage of current knowledge of primary or secondary prevention, minority and disadvantaged groups are less likely to benefi t from knowledge about cancer prevention and early detection. Lower educational attainment and poverty translate into reduced opportunities in many ways beyond just a lack of knowledge. For example, low-income communities are less likely to have access to healthy foods and facilities for recreational physical activity than more 16 Page 45 of 88 ADDRESSING DISPARITIES, SURVIVORSHIP, GAPS AND BARRIERS

Age Disparities According the per month of traveling throughout these counties. The staff has earned a reputation of reliability and is Report on Cancer in Nevada 1997-2001, cancer incidence differed signifi cantly by age groups. Among a trusted source for health care for the working poor, children age 0-14 years the most common cancer was uninsured, indigent, and rural populations within Leukemia (39.4%), followed by head and neck cancers Nevada. CHN clinics operate on a sliding fee scale (18.2%). Thyroid cancer (14.5%) was most common in depending on income, but do not deny services due the age group 15-24, followed by Hodgkin’s Lymphoma to inability to pay. When specialized care is needed (11.5%). Thyroid cancer was also most common among residents in these counties have to travel to one of the young adults ages 25-34, followed by breast cancer urban centers in Nevada, or out of state, which can (12.3%). Breast cancer was the most common among cause additional burdens, including transportation and adults ages 35-54 and it was the second most common housing costs and lost days of pay for themselves and among adults ages 55-64. Lung and Bronchus cancers their families. were most common diagnosed cancer among adults ages 55-75+, and the second frequent cancer in the age group 45-54. During the reporting period, Lung and Developing Bronchus cancer was the most commonly diagnosed cancer in Nevada reaching 18.0% of all cancer cases, Interventions followed by Breast cancer at 15.9%. Addressing disparities requires a multifaceted approach because the underlying factors producing disparities are complex. Disparate health outcomes Geographic Disparities are not primarily due only to one pathologic agent or a genetic factor. Instead, a broad range of social, With a total of 110,540 square miles, Nevada is the economic and community conditions interplay with 7th largest state in the country. It is 485 miles long individual risk factors to intensify susceptibility and and 315 miles wide. According to the Nevada State provide less protection and affect unhealthy behaviors. Demographer the population of the state in 2003 These conditions, such as deteriorated housing, poor was 2,296,566. Approximately 71% of the population education, limited employment opportunities, limited resides in southern Nevada (Las Vegas metropolitan household resources, readily available cheap and area), 18% in northern Nevada (Reno and Carson) inadequate high-fat/low fi ber foods, and limited access with the other 11% living in the other 14 rural to parks and recreational facilities are particularly and frontier counties. About 87% of state land is exacerbated in neighborhoods where the racial/ethnic federally controlled. minorities and low-income groups live. The Nevada State Health Division’s Community Health It is the relationship between place, race, and poverty Nursing Clinics, the sole provider of public health that can lead to the greatest disparities. Research nursing in Nevada’s 14 frontier and rural counties, has shown that even after adjusting for individual endeavors to promote optimal wellness through the risk factors neighborhood differences in cancer delivery of public health nursing, preventive health care, screening, incidence, treatment, and survival rates and health education. persist. Reducing such disparities requires community Community Health Nursing (CHN) Clinics provide mobilization and actions at several levels. many health care services that include family planning, The Nevada Cancer Council is committed to working health education, cancer screening, and the diagnosis with researchers, health care professionals, community

GAPS, AND BARRIERS AND GAPS, and treatment of sexually transmitted diseases. They organizations, and others to better determine the needs also provide essential public health services such and priorities of our special populations, including as immunizations, serve as school nurses in school our aging population, and to develop interventions districts that do not have one, and provide identifi cation to address these issues across the cancer continuum and treatment for communicable diseases such as of care ranging from education, prevention, early Tuberculosis. With an area of responsibility of over detection, diagnosis, treatment, survival, quality of life, 96,000 square miles, the nurses average 1,000 miles and end-of-life care. DISPARITIES, SURVIVORSHIP, DISPARITIES, 17 Page 46 of 88 DISPARITIES, SURVIVORSHIP,

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SURVIVORSHIP National initiatives are underway to address cancer GAPS, AND BARRIERS survivorship issues and develop a more comprehensive The following information is taken from national approach to long-term survivorship. Key to addressing databases. Unfortunately, Nevada has limited data in the needs of survivors is gaining understanding of their the area of survivorship. This data gap is identifi ed in unique needs and concerns during the time following the Quality of Life goals and objectives section. diagnosis. These needs and concerns span the physical, psychological, social-economical, emotional, and A vital component of comprehensive cancer planning spiritual domains. Examples of survivor issues include identifi ed by the Centers for Disease Control and concerns regarding quality of life, late-term and long- Prevention, and also recognized by the National Cancer term effects of cancer treatment, re-employability and Institute, is the growing cancer survivor population. insurability, and fear of recurrence. The number of cancer survivors (cancer prevalence) continues to increase. As of January 2000, there were The Nevada Cancer Council will work to address the an estimated 9.4 million cancer survivors nationally needs of the growing survivor population through (about 3% of the population). Among National Cancer activities that span the cancer control consortium, Institute’s Surveillance, Epidemiology, and End Results including palliation and quality of life. It will take a (SEER) programs, the overall 5-year survival rate for concerted effort to obtain better and more accurate all cancers combined among adults is 65% (1995- data to describe the needs of survivors and to develop 2001), and the overall 5-year survival rate for children the means to appropriately and adequately address with cancer is 77%. While three out of every four those needs. The Nevada Cancer Institute is developing Nevada families will be affected by cancer, the death a cancer survivorship program made possible by a rate for all cancers combined has been declining since donation from the Lance Armstrong Foundation. 1990 and the proportion of patients alive fi ve years This gift will allow Nevada to have a program that will after diagnosis has been increasing since 1975. Family work towards collecting information and developing members, friends, and caregivers are also impacted by meaningful programs that will address issues of cancer the survivorship experience. survivorship.

18 Page 47 of 88 ADDRESSING DISPARITIES, SURVIVORSHIP, GAPS AND BARRIERS GAPS AND BARRIERS insured individuals. In addition, many other health care reimbursement systems match There are both gaps and barriers in our present Medicare rates, further limiting the pool of cancer programs and services that need to be resources to recoup extra costs. Medicare addressed in implementing this Plan. Some will reimbursement rates are calculated by the require the development of new infrastructure and Centers for Medicare & Medicaid Services additional resources. Other will require changes (formerly the Health Care Financing in public policy. Several gaps and barriers can be Administration) based on a national formula. addressed by improving access to existing programs. A change in legislation would be required to increase the rates to better refl ect the cost of Gaps providing health care in Nevada.  SERVICE TO RURAL AREAS Some experts Need for additional infrastructure or resources: in the home health care fi eld believe that  COLORECTAL CANCER Although colorectal metropolitan areas in the state have adequate cancer is the second leading cause of cancer numbers of service agencies. However, there is death in Nevada and regular screening has been a shortage of agencies serving rural areas. Even shown to be effective in lowering mortality in rural areas close to metropolitan centers, and morbidity from the disease, screening rates such as Pahrump and Tonopah (75 miles and are still low in Nevada, as they are nationally. 210 miles away from Las Vegas respectively), However, before there can be public education there is a shortage of services. This problem campaigns to increase the number of Nevadans is exacerbated by the fact that agencies cannot seeking screening for colorectal cancer, an afford to service those areas. assessment of the state’s capacity will be needed to determine if additional infrastructure is Need for improved education: required such as more trained professionals, facilities, and equipment.  CHANGING PERCEPTIONS There are opportunities to address gaps that do not  BREAST AND CERVICAL CANCER necessarily require new services, signifi cant Women’s Health Connection Program has increases in resources, or changes in policy. In proven to be effective in reaching low income, some cases, education that changes perceptions underinsured or uninsured older women across of the public and/or providers about existing the state for breast and cervical cancer early services could narrow gaps. For example, even detection and screening; however, additional though hospice reimbursement covered six resources are needed to maintain and expand months of care in 2001, the average length this program, in order to reach more women of stay in hospice nationally was two months. of younger age groups that are not currently This limitation to optimum end-of-life care is eligible for this program. believed to be primarily the result of negative attitudes and mistaken beliefs about hospice Need for policy changes: on the part of patients, family members, and  REIMBURSEMENT RATES The delivery health care providers. Frequently, physicians of health care in Nevada is adversely affected do not refer to hospice soon enough. by Medicare reimbursement rates that Furthermore, patients and families usually do

GAPS, AND BARRIERS AND GAPS, are lower than rates in many other states. not know enough about the scope and value of Compounding this is the high percentage hospice services and may not be open to facing of Nevadans relying on Medicare and the reality of end-of-life situations. Because Medicaid (23%) and those who are uninsured feelings and beliefs about death and dying are (22%). When the cost of providing care as deeply held as any religious beliefs, health exceeds the amount Medicare reimburses, care providers must be sensitive to different the cost is passed along to health care ways patients and their families approach end- organizations, providers, and privately DISPARITIES, SURVIVORSHIP, DISPARITIES, 19 Page 48 of 88 DISPARITIES, SURVIVORSHIP,

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of-life issues. Educational efforts to inform the underinsured with coverage that does not GAPS, AND BARRIERS public about the benefi ts of hospice care may include the full continuum of cancer care. For improve utilization of these services. the working poor, many of whom are also uninsured or underinsured, leaving work for  CULTURAL SENSITIVITY Another medical care adds to their fi nancial burden. educational approach that could signifi cantly narrow gaps that affect the welfare of  Native Americans are eligible to receive health Nevada’s diverse population groups is care provided by the Indian Health Service enhancing culturally and linguistically either within IHS-owned facilities or at the appropriate information and programs along expense of IHS through the Contract Health the continuum of care, from health education, Services (CHS) Program, depending on the prevention and risk reduction to screening and patient’s eligibility status for CHS. Most of the diagnostic follow-up, treatment, survivorship 26 tribes in Nevada have a health care clinic programs, and end-of-life care. At the and/or hospital, but must travel to Arizona for screening and diagnosis stages alone, this certain specialized health care services. Services could positively impact the unequal burden are hard to fi nd for Native Americans not that Hispanics and American Indians bear as a affi liated with a Nevada tribe. result of late stage diagnoses. TRANSPORTATION TO AND HOUSING AT TREATMENT CENTERS Transportation in this Barriers largely rural state is a signifi cant barrier to cancer care, with many of the state’s residents living hundreds A number of practical barriers sometimes prohibit of miles from metropolitan areas where most of or delay cancer care for some Nevadans. Practical the cancer care services are offered. The Disabled problems can also affect treatment decisions and American Veterans organization operates an extensive, make compliance with regular screening, treatment volunteer, statewide transportation system for Veterans plans, and follow-up care diffi cult. Administration patients, and the American Cancer Society (ACS) offers its Road to Recovery program FINANCIAL BARRIERS Financial limitations create in some areas. Nevertheless, for many Nevadans signifi cant barriers to cancer care for many Nevadans. transportation issues pose major problems to Research has demonstrated that poverty has a negative accessing cancer care. When a treatment plan requires impact on cancer survival rates. In 1990, the American regular, sometimes daily, appointments at a cancer Cancer Society estimated low income Americans had a treatment facility far from their homes, housing 10% to 20% lower rate of cancer survival than others in presents major problems to some rural cancer patients the U.S. Source: Singh GK, Miller BA, Hankey BF, Edwards and family members. BK. Area socioeconomic status variations in US incidence, mortality, stage, treatment and survival 1975-1999, National Cancer Institute, 2003, NIH Pub. No. 03-547. SOCIAL BARRIERS Psychological and social barriers to cancer care affect all patient groups to some  Ten percent of all Nevadans live below the degree, regardless of culture, income level, or age. federal poverty level, according to the 2000 These barriers have been shown to lower screening U.S. Census, and a national ranking of 19th rates, delay follow-up of abnormal screening results, (Maryland is ranked fi rst with 7.3% living infl uence choices in treatment options, compliance with below the federal poverty level). It is below the treatment, and create emotional distress throughout the national average of 11.9%. Unfortunately, nearly continuum of care. one half of Native Americans and one quarter of Hispanics living in Nevada are at or below  One of the most prevalent psychological poverty level. barriers is fear. Fear of the medical procedure itself can be a deterrent, but probably more  In 2001, 22% of adults and 17% of children in the state had no health coverage for all or part of the year. Many other Nevadans are 20 Page 49 of 88 ADDRESSING DISPARITIES, SURVIVORSHIP, GAPS AND BARRIERS

common is fear of discovering the disease and many residents who do not speak English, the its potential, real or perceived, for a devastating dominant language in the medical system. impact on the lives of the patient and family members. For some patients, mistrust of  Differences in communication styles also vary physicians, western medicine, and the health care from culture to culture. Simple translation from establishment contributes signifi cantly to fear. one language to another is often inadequate for clear communication. Some Native American  Embarrassment and anxiety about loss of languages in the state do not even have a word privacy are also issues for people of all cultures, for cancer. although they may be more commonplace in some cultures and some age groups. Depression  Beliefs about illness in general, and cancer and shock are common emotional responses to specifi cally, also vary signifi cantly. In some groups, a cancer diagnosis that can be serious deterrents cancer may be defi ned as a death sentence, to receiving care, contributing to lack of follow- believed to be contagious, or carry a stigma that up and confusion about decisions affecting makes talking about the disease diffi cult. medical care. For patients and family members  who are isolated and without adequate social Decisions about health care are always made support, these common psychological barriers within a cultural context. In Nevada, the rich can be particularly troublesome. diversity of cultures requires that providers and health care systems be knowledgeable about  Lack of information and knowledge about cultural differences and fl exible about the many cancer and the health care system can be a different approaches that patients bring into signifi cant impediment to care for all groups health care settings. of people. This may be more prevalent among patients with low socioeconomic status who tend to have lower education levels. Some public health specialists believe that low socioeconomic status is the most important risk factor for inadequate health care, regardless of culture or race/ethnicity.  Age also can be a barrier. Generally speaking, elderly patients from all cultures are less comfortable than younger patients with the culture of high technology that is so much a part of modern medical care, and they are also more uncomfortable with the loss of privacy. In addition, older people from minority groups are less likely to be acculturated to the dominant culture.

CULTURAL BARRIERS Although none of the ethnic/racial groups in Nevada is homogeneous, and

GAPS, AND BARRIERS AND GAPS, barriers to care vary widely within any group, some barriers to cancer care are more prevalent in certain population groups.  Language may be the easiest barrier to identify. It is a very real problem in a state that has two major languages (English and Spanish), numerous Native American languages, and DISPARITIES, SURVIVORSHIP, DISPARITIES, 21 Page 50 of 88 GOALS, OBJECTIVES 22

AND STRATEGIES 88 Ruben Rivero Ruben shouldn’t be alive. The long be alive. shouldn’t string of his life should now. by been broken have He thanks four physicians of 51 Page in Las Vegas, and cutting edge technology in Los Angeles for the miracle ofin Las Vegas, Shops at at the Forum in maintenance working years ago, Four these days. pain. His internist stomach began severe to experience Ruben Palace, Caesar’s an appointment made cancer, suspecting sent him to a gastroenterologist who, The pancreatic cancer. diagnosed with with an oncologist. He was for Ruben not goodprognosis was surgery and for survival. The his only chance was that surgerysurgeon told Ruben itself that it could but rife with danger, was be attempted without the most precise informationnot even about the size and location of Because the necessary imaging technology the tumor. did not The procedure to the UCLA Medical Center. went Ruben exist in Las Vegas, It was in an area where surgery tumor was that the be possible. showed would to beat tremendous continues in October 2001. Ruben performed in Las Vegas when his and decisively acted quickly in Las Vegas odds because his physicians in immediate jeopardy. life was GOALS, OBJECTIVES AND STRATEGIES GOALS, OBJECTIVES

AND STRATEGIES 23 es. GOAL 1: GOAL TOBACCO USE TOBACCO 88 DEVELOPING CANCER DEVELOPING of REDUCE THE RISKS FOR REDUCE THE RISKSFOR , some objectives are identifi ed to highlight identifi are , some objectives 52 er wev gnifi cant positive impact on reducing cancer rates rates cancer reducing on impact positive cant gnifi Page i s over time. over cause of use is the most preventable Tobacco death in It is responsible for and in the United States. Nevada 87% of all lung cancers and is a contributing factor Cancer prevention is a proactive approach to keeping to keeping approach is a proactive Cancer prevention therefore reducing the risks for the population healthy, a long-term commitment cancer involve developing including of levels society, all at efforts continuous and policy, public mobilization, and development community choices. personal informed and initiatives, health public and behaviors Cancer risks include “unhealthy” hereditary, exposures, environmental negative lifestyles, of and the lack aging, public health policies, access to as age While risk factors such and family health care. cantly history can signifi cannot be altered, individuals modifying some behaviors. risks by reduce their own an Business policies and government regulations play important for larger segments role in cancer prevention of the population. Scientists estimate that as many as 50% to 75% of all cancer deaths in the United States are caused by as smoking, physical such “risky” human behaviors Eliminating tobacco and poor diet choices. inactivity, practices, eating and activity incorporating healthy use, have would radiation ultraviolet to exposure and limiting a their importance in cancer control, even though their importance in cancer control, even sources for data collection or no there are no existing agencies currentlyaddressing those objectiv in include local activities Implementation will efforts collaborative across the state, communities c areas of interest, among small groups around specifi meeting the Progressand statewide efforts. toward and a reportgoals annually in this Plan will be evaluated will be distributed to the appropriate stakeholders. ect This Plan will be updated on a regular basis to refl the progress in cancer control and to ensure that it and capacities of needs to meet the changing continues our state. all of the state’s diverse populations, and to addressing and to addressing all of populations, diverse state’s the possible, Wherever disparities. health cancer-related strategies are measurable and time- and the objectives the source for collecting data. bound, and indicate Ho

opriate and or cancer. eening f e cancer treatment and care. ease access to appr e consumers affected by cancer. by affected consumers e laboration among cancer among laboration l r effectiv Reduce the risks for developing cancer. developing for risks the Reduce Improve the coordination and and coordination the Improve co Incr clinical trial participations in Nevada. health for issues of life quality Address ca Increase early detection and appropriate scr

he goals are broad and are directed at

GOAL 2. 2. GOAL GOAL 1. 1. GOAL • Prevention • early Screening, detection and diagnosis • Treatment • Clinical trials • Quality of care life and palliative GOAL 6. GOAL efforts. control 3. GOAL of and diversity Increase number the 4. GOAL 5. GOAL

given to servinggiven all geographic parts of the state and interested partners can connect. Attention has been and provide numerous “binding sites” with which “binding sites” with which numerous and provide and control. The objectives and strategies are varied strategies are varied and and control. The objectives expected resources available for cancer prevention for cancer prevention expected resources available strategies that are realistic given the state’s current and the state’s strategies that are realistic given The Committees have emphasized objectives and emphasized objectives The Committees have recommendations under each goal.recommendations under each included in the form of general policy or research part of been Others have and strategies. the objectives identifi ed during community meetings. Some became meetings. ed during community identifi Many important issues (needs and priorities) were improving the lives of the lives improving residents. all Nevada

has set six broad goals: Based on the above categories Cancer Plan Nevada Based on the above looking at fi ve major and specifi c categories: ve major and specifi looking at fi decided to approach cancer planning efforts by diverse community input, the Steering Committee realistic, practical. After an extremely rich and Comprehensive Cancer Plan that is scientifi c, Plan Cancer Comprehensive that is scientifi commitment to create an inclusive Nevada Nevada an inclusive commitment to create showed sustainable involvement and fi rm and fi sustainable involvement showed From the very partners early stagesFrom community GOALS, OBJECTIVES AND STRATEGIES and control. T community members in all areas of members community cancer prevention Nevada Cancer Plan offers a road map for use by the Cancer Plan offers a road map for use by Nevada GOALS, OBJECTIVES AND STRATEGIES

in other cancers, including head and neck cancer, Objective 1.2: Promote quitting among young esophageal, bladder, pancreatic, uterine cervix, and people and adults kidney cancers. Each year, more than 2,000 Nevadans die from smoking-related causes. Strategies: To address the negative effects of smoking on health,  Increase awareness, availability, and access to the Centers for Disease Control and Prevention (CDC) nicotine dependence treatment and tobacco use formed the National Tobacco Control Program and by cessation resources. 1999 all 50 states were funded. The four goals of this  Increase tobacco excise tax. program are: 1) preventing initiation among young  Integrate tobacco dependence referral and people, 2) eliminating exposure to second hand smoke, treatment interventions into routine health care. 3) promoting quitting among adults and young people, and 4) identifying and eliminating disparities among populations. Objective 1.3: Eliminate non-smoker’s exposure Because most adult current smokers started smoking to second hand smoke before the age of 18, preventing young people from becoming smokers is a critical piece of any tobacco Strategies: control plan. Of Nevada adults who smoke every  Educate the public, including community leaders, day, 72% report having started when they were 18 about the harmful effects of secondhand smoke. or younger.  Eliminate state laws that preempt strong tobacco control laws and promote the positive health Objective 1.1: Prevent the Initiation of Tobacco and economic impacts of laws and policies that Use Among Young People restrict smoking. Baselines: • High School Youth Smoking  Increase enforcement of federal and state Previous 30 days – Baseline 19.6% secondhand smoke laws and regulations, and • High School Youth Using Chewing corporate voluntary policies. Tobacco Previous 30 days – Baseline 3.6% • Adults Currently Smoking – Baseline 23.2% • Adults Attempts to Quit – Baseline to be determined Data Source: Centers for Disease Control and Prevention; Healthy People 2010 Report; Youth Risk Behavior Survey (YRBS 2003), Nevada Behavior Risk Factor Surveillance System (BRFSS 2004)

Strategies:  Increase counter marketing to youth under age 18 and to young adults age 18-24.  Increase participation in school and community AND STRATEGIES AND based activities by organizations and individuals serving and/or infl uencing youth to prevent youth tobacco use. GOALS, OBJECTIVES GOALS,  Engage the public and political leaders in activities promoting policy change to reduce tobacco use by youth.  Provide technical assistance to local and statewide partners for the wide use of evidence-based effective interventions promoting non-use of tobacco products by youth.

24 Page 53 of 88 GOALS, OBJECTIVES

AND STRATEGIES 25 tifi cial sources of light ultraviolet tifi 88 Nutrition and Diet and Nutrition of oid ar rting, including c sun advice on what specifi 54 15 or higher Av o • factor of a sun-protective Use sunscreen with • safe behaviors should be used to reduce UV exposure, and develop and promote a media-based UV warning system similar to the (green/red drop day) used for water conservation. transportation that provide covered bus shelters. transportation covered provide that a year. resident 8-12 times the average reaching programoutreach modeled after the successful Sun program. protection outreach sun Smart, Australia’s monitoring network already in place to provide the public with practical guidelines for reducing by a factor of two the annual cumulative exposure to UV radiation. media outlets to add UV radiation intensity level rep ofthe number who use at least one Nevadans measure to reduce the risk ofprotective skin cancer. refl ect sun-safe behaviors, including the provision the provision including ect sun-safe behaviors, refl of areas and policies allowing/ shaded play ofencouraging the use hats outdoors. in regards behaviors to sun promote healthy clothing. exposure and protective education programs to encourage that have workers protection from sun exposure. Page of Increase the number with public communities messagessafety, sun about marketing social Promote Explore the applicability of a statewide sun safety UV Protection Agency’s Use the Environmental mass with meteorologists in the state’s Work a surveillance Develop source for determining policies that to develop schools with public Work of Increase the number care centers that day of Increase the number with outdoor employers Healthy eating habits and practices, including reduced eating habits and practices, Healthy and increased consumption offat intake fruits, offer protection from may and whole grains, vegetables, certain types of In addition, limiting foods cancer. in some that are high in nitrates (used as a preservative or heavily smoked, meats) and foods that are pickled, salted can reduce the risk of Using cancer. stomach alcohol in moderation, if at all, can reduce the risk for       Data Source: CDC Behavioral Risk Factor Surveillance CDC Data Source: System (2003) Strategies:    the sun erexposure m ov y out of s (basal cell and severe, blistering severe, SUN EXPOSURE disparities relateddisparities to tobacco use and its effects among different population groups skin cancer: serious form of skin cancer. squamous cell carcinomas) arehighly curable.

to sunlight Non-melanoma cancer

partners use of for the wide evidence-based interventions promoting non-use ofeffective targettobacco products by populations with tobacco related disparities. populations of communities tobacco use in their the tobacco tactics used by and the marketing and representatives industry involving by organizations in state and local coalitions. • is the less common but more Melanoma • • 10:00 a.m. and 4:00 p.m. the sun between Avoid • Wear sun-protective clothing when exposed

statewide assistance to local and technical Provide in target Increase knowledge and awareness o reduce the risk of skin cancer sta to UV radiation. Episodes of associated and increased with long-ter measures to reduce the risk of skin cancer: The strongly risk for squamous cell carcinoma is T using at least one of the following protective basal cell carcinoma. 1.5: Objective of Increase the number Nevadans sunburn for both melanoma and are a major risk factor protection behaviors. (SPF) of to other sun 15 should be used in addition Sunscreen with a minimum sun protection factor Sunscreen with a minimum clothing, including a wide brimmed hat and sunglasses. clothing, including a wide brimmed hat and sunglasses. between 10:00 a.m. and 4:00 p.m. and wear protective protective and wear 10:00 a.m. and 4:00 p.m. between categories of Sun safe behaviors can protect against the two children is critical. children by the ageby of and caregivers, 18, educating parents, person’s lifetime skin damageoccurs from sun exposure person’s known cancer risk factor. Because more than half Because cancer risk factor. known of a Exposure to the sun’s ultraviolet (UV) radiation is a ultraviolet Exposure to the sun’s   Objective 1.4: Objective the Identify and eliminate Strategies: GOALS, OBJECTIVES AND STRATEGIES 26 GOALS, OBJECTIVES (unweighted data from 2003 Youth Risk female adolescents, 27% of ages 13-17 male adolescents, 44% of ages 13 – 17 adults 20.4% of all youth, 45% of ages 13 - 17 Baseline: adults 25% of Target: thenumber By2006,increase of Objective 1:6: for developing cancer. indicationsthatthesemay reducetherisk because of vegetables aday, wholegrains, andlow-fat foods a dietincludingfi and fruits of ve ormoreservings obesity. NationalCancerInstituterecommends The deaths areassociatedwithnutritional factorsand allcancer thatsomeone-thirdof Research suggests prostatecancer. saturated fat,may reducetheriskof oral cancer;andeatingadietlow infat,especiallylow in STRATEGIES AND OBJECTIVES GOALS, activity may reducetheriskfor developing colon mortality. thatregular physical Research suggests demonstrated to benefit healthanddecrease overall Regular, moderatephysical activity hasbeen  AND    STRATEGIESStrategies: System, 2003Youth RiskBehaviorSurvey Data Source: CDCBehavioralRiskFactorSurveillance Provide counselingtomothersintheWomen, socialmarketing messages Increasethenumber of Exploreimplementingevidence-based programs evidence-based, Exploreexpandingtheuseof Work withtheNevada AllianceforChronicDisease vegetables, andwholegrains. fruits, fatandincreasingconsumptionof dietary reducing of on theimportance (WIC) Program Infants, andChildrenSupplementalNutrition about thebenefi healthy eating. ts of that useyouth advisorsandpeerleaders. improve school food. comprehensive such asPathways* programs that foodsandbeverages inschools. quality of workers,service andschool boardstoimprove the Prevention, dieteticorganizations, school food Behavior Survey) Physical Activity and vegetables perday eating fi fruit of ve servings ormore guidelinesthat recommend dietary 13andolderfollowing aged persons Page 55 of 88

betv .: y20,ices h ubro thenumber By2006,increase of Objective 1.7: tobaccouse. the prevalence of cancer. Inaddition,physical activity toreduce may serve 62.5 % of youth, ages 13 - 17, participate youth, 13-17,participate ages 62.5%of youth, 13–17 ages 75%of adultsexercise atleast20 Baseline: 50.8 %of adults 55 %of Target: System, 2003,1999Youth RiskBehaviorSurvey Data Source: CDCBehavioralRiskFactorSurveillance cancer willbe diagnosed inNev breast In 2005,anestimated 1,620newcasesof detection and treatmentthese and of other cancer types. to identify new and more efficient methods for early lung, ovarian andprostate cancer. Research continues somecancers, such as rates of to increasesurvival population-based screeninghasnotyetbeenshown cancerand are notavailable formanyothertypesof Unfortunately, routine adequatescreeningmethods rates from breast, cervix, and colon/rectum. screening guidelines was able to significantly lower death shown that following age and gender-appropriate cancer approach to cure or cancer. control of Studies have scr regular population-based screening or high risk targeted thesecancers, factors forsomecancers. For manyof and behavioral changes, therearenoknown risk Although manycancerscouldbeprevented by lifestyle   Strategies: Work and withthestateandlocalagencies Exploreimplementingevidence-basedprograms e worksite physical activity programs. inschool and toincreaseparticipation organizations that useyouth advisorsandpeerleaders. ening, and early detection could provide a good AND APPROPRIATE SCREENING INCREASE EARLY DETECTION from 1999Youthfrom RiskBehavior Survey) daysperweekmore (unweighted data physicalin vigorous activity or three minutes perday, daysperweek three participating in regular exercise inregular participating 13andolder aged persons BREAST CANCER FOR CANCER GOAL 2: ada, according tothe GOALS, OBJECTIVES

AND STRATEGIES 27 omen – 65.3% facilitate access for women agefacilitate access for women 40-49 who desire screened to be for breast cancer and increase the rate of minority/ ethnic/rural and other certain disparate subgroups of age women a received who have 50 and over years in the past two mammogram by 5% 88 mammogram within the past two years the past two within mammogram African American Women – 71% African American Women Hispanic W of 56 programs that educate diverse populations of populations programs that educate diverse and the importance on breast health ofwomen mammography screening. materials. educational/marketing about mammogram results in a form that is comprehensible and culturally appropriate. to inform of women and/ their need for follow-up or re-screening. up for abnormal mammogram results. underserved audiences. programs on mammography clinical breast and exam techniques. state-of-the-art for breast cancer teach techniques tests. screening exams and Foundation. Komen G. Society and the Susan Page Identify c to marketing channels specifi funding sources to facilitate Explore potential Support existing programs new and develop and linguistically appropriate culturally Provide cation for prompt notifi Promote mechanisms Promote the use of systems reminder and tracking cation follow- Increase the use of aggressive notifi education provider periodic continuing Provide training programs with health professional to Work Support of activities the the American Cancer Objective 2.3: Objective resources and By 2008, Develop Target: Baseline 75% had a aged 40+ who have 69.2% women Strategies: Objective 2.2: Objective By 2008, reducedisparity gap the Baseline:  Data Source: Behavioral Risk Factor Surveillance System, 2002 System, Surveillance Factor Risk Behavioral Source: Data Strategies:          cluding cancers of the . (ex women age 50 and older reportingwomen in the had a mammogram having years past two System, 2002. urces and screening services during o

located in rural areas through the promotion of promotion the the through areas rural in located Nevada. for (Mammovan) unit mammography mobile homelessness and mental health systems, and nursing nursing and systems, health mental and women. to homelessness screening promote and advocate to homes the importance of regular mammography screening. screening. mammography of regular importance the risk assessment services through health care professionals and organizations. organizations, and businesses to utilize available res informing of women the need for breast cancer screening and the importance of their role in recommending screening to women. Medicare coverage for payment of for payment Medicare coverage mammography screening for eligible parties. Women’s Health Connection Breast and Cervical Women’s Cancer Education Program in order to increase and to women, mammography in low-income 40 services between provide for uninsured women and 64 years of age. community events.

schools, groups, civic Encourage churches, Inform cancer public about available the Educate primary on strategies for care providers Increase public knowledge of of the availability regarding public education and outreach Continue Promote access to and increased services in women women in services increased and to access Promote Develop partnerships with correctional, domestic abuse, abuse, domestic correctional, with partnerships Develop Continue outreach efforts to all women in Nevada about about Nevada in women all to efforts outreach Continue       

 among women in the U.S among women Figures cancer is the most common . Breast cancer American Cancer Society’s 2005 Cancer Facts & Facts 2005 Cancer Cancer Society’s American GOALS, OBJECTIVES AND STRATEGIES

Data source: Surveillance Risk Factor Behavioral Strategies: Baseline: 80.0% Target: Target: 85% Objective 2.1: Objective increaseBy 2006, the proportion of atypia), and fi agerst pregnancy after 30. atypia), and fi breast disease (fi bro cystic changes with biopsy proved bro cystic changes with biopsy proved breast disease (fi therapy, never had pregnancy and delivery, benign pregnancy and delivery, had never therapy, oral contraceptive use, history use, oforal contraceptive estrogen replacement include: family history, early menarche, late menopause, late menopause, early menarche, include: family history, breast cancer, followed by age. Other risk factors Other risk factors age. by followed breast cancer, skin). Female gender primary is the factor for risk skin). Female 28 GOALS, OBJECTIVES    access: of state current of Strategies: Afterdetermination To bedetermined. Baseline: stateof current Determine Objective 2.4: Data Source: Behavioral Risk Factor Surveillance System, 2004 STRATEGIES AND OBJECTIVES GOALS, aeie 8.%o women 84.7% in Nevada of report having Baseline: to90percent By 2006,increase Objective 2.5: the vaccine have not been determined yet. (FDA). Requirements and protocols for administering the approval process by the Federal Drug Administration restriction. A HPV vaccine is currently going through HPVtesting without Medicaid offerscoverage of in women 30 andolderisnow available. age Nevada cancer (HPV). OnlyHPVinfectionthatpersistscanleadto always causedby thecommonhuman papillomavirus by cancerisalmost asmuch as75percent.Cervical cancerandcanreducemortality screening forcervical studieshave foundthatthePap testiseffective in of duetoinvasivemortality cancer. cervical Anumber reducemorbidityand test hasthepotentialtofurther thePap cancer. cervical Increaseduseof detection of 1980’ inthe1970’s, cancermortality decline incervical The ANDwidespread useof STRATEGIES Support AmericanCancerSociety’s Support tomake efforts networks andlinkages Endorsetheestablishmentof resourcesatdiverse Maintainreferral geographic women 40-49. age for access toscreeningordiagnosticmammography in rural areas.in rural more readilyavailable tocancerpatients, particularly such services, asRoadtransportation toRecovery, Nevada residents. andcareareavailable torural screening services providers andurbancenterssothat among rural breast abnormalities. towomen with on diagnosisandtreatmentservices locations toprovide comprehensive information s, and1990’ . Atest,approv had a pap smear within the past 3 years CERVICAL CANCER Nevada. inrural Nevada, particularly of mammography accessinthestate smear intheprior3years havingolder, hada Pap reporting women, 18and age the number of s isthoughttobedueprimarilythe thePapanicolaou (Pap) testforearly ed b y theFDA, todetectHPV Page 57 of 88 nationally incidence ratesmarginallydeclinedb both inmenandw Colorectal canceristhethirdmostcommon  Strategies: Data Source: Behavioral Risk Factor Surveillance Survey - 2004 60% Baseline: Target:     Strategies: Data source: Behavioral Risk Factor Surveillance System, 2004 than 1,240Nev Society’ (BRFSS). 50 neverage hadacolonoscopyorsigmoidoscopy Nevadans over invasive of cancers. In2004,over half precancerouspolypsto of preventing progression duetoincreasedscreeningandpolypremoval,in part  Objective 2.6: rectum cancerin2005. Continue to support andpromotetheWomen’s Continue tosupport Nevada’s Through self-insuredhealthplans, clinics toextendclinicalhoursbeyond Encourage careproviders onstrategiesfor Educateprimary Promote colorectalscreeningthrough public Develop partnerships with correctional, domestic domestic correctional, with partnerships Develop systems. systems. health mental and homes nursing homeless, abuse, fage. of income, uninsuredwomen between 40and64years forlow- toprovide services Detection Program CancerEarly Health ConnectionBreastandCervical their membership. covered screeningsfor theutilizationof encourage those clinicswithextendedhours. traditional businesshours. of Compileadirectory recommending screeningtowomen. theirrolein of screening andtheimportance cancer theneedforcervical women of informing awareness campaigns. s “CancerFacts andFigur . Research suggests thatthisdeclinemay. Research be suggests According totheAmericanCancer report having exam aproctoscopic report 67 fNev 46.7% of COLORECTAL CANCER adans willbediagnosedwithcolonand Incr years to60%by2007 fibarium enemaevery ve toten tenyears ordoublecontrast every fievery ve years or colonoscopy received aflexible sigmoidoscopy 50andolderwhohaveaged aetepooto fpeople of ease theproportion omen. From 1998to2000, adans a ged 50andolder y 3%peryear es 2005,” more GOALS, OBJECTIVES

AND STRATEGIES 29 mined that are knowledgeable regarding that are knowledgeable quality cancer care in Nevada that participatein Nevada in the ofAmerican College Surgeons ProgramsCommission on Cancer (ACoS) 88 To be deter To of 58 participating in ACoS surveys. surveys. participating in ACoS administrators. such as the Nevada Oncology as the Nevada such and Society Oncology Nursing Society to offer educational seminars and collaborate regarding education of non-oncology providers. treating cancer patients to ensure quality of life issues are being addressed. this objective. this objective. Cancer Institute and the cancer the Nevada clinicians throughout our state. residency program in partnership in Nevada with of and the University NVCI of School Nevada radiologists, This will require oncologists, Medicine. and radiation oncologist in surgeons, pathologists, cant numbers. signifi Page Encourage professional oncology organizations guidelines for home health agencies Establish Determine of number the hospitals currently ts of to hospital approval ACoS Promote the benefi data collection methods to set baseline for Develop a video teleconference tumor board between Pilot the establishment of Promote a medical oncology Objective 3.2: Objective of Increase the number providers Baseline: be determined To     exists for this objective data source No current Data Source: Strategies:    Data Source: No current data source exists for this objective data source No current Data Source: Strategies: counseling, relaxation sessions, support and groups, relaxation sessions, counseling, American c patient. specifi tailored to a cancer education an Cancer Society programs I Can Cope, as such a service Better, Good Feel educational series; Look to and Reach beauty techniques; women to teach a support program cancer patients, for breast Recovery, treatment facilities. at some are also provided 3.1: Objective of Increase the number hospitals Baseline:

orce was created, passed and created, passed and orce was GOAL 3: GOAL vernor Kenny C. Guinn. In June 2003 Guinn. In June C. vernor Kenny Go INCREASE ACCESS TO TO ACCESS INCREASE pleteness of this Profi le allowed it to become a a become to it allowed le of Profi this pleteness

Nevada State Health Division in collaboration collaboration in Division Health State Nevada ck to run on which will help the Nevada Statewide Statewide Nevada the help will which on run to ck m APPROPRIATE AND EFFECTIVE AND EFFECTIVE APPROPRIATE e a

CANCER TREATMENT AND CARE TREATMENT CANCER Prostate Cancer Task F Prostate Cancer Task signed by by signed a published and prepared force task the with The of state Nevada. the for le Profi Cancer Prostate co th Cancer Registry and the SEER registry. SEER the and Registry Cancer template for the statistics of all cancers; a consistent consistent a of cancers; all statistics the for template tr cation of prostate cancer among men in Nevada. Nevada. in men among cancer of prostate cation encourageuse screening and diagnostic people to services with an emphasis on high-risk, underserved residing in rural Nevadans and areas. populations, screening and diagnostic services. screening and diagnostic providers to supportproviders regular education and patient screenings. bjective 2.7: 2.7: and bjective awareness the Increase u

of During the 2001 session a Legislature, the of the effectiveness Evaluate that strategies the geographic Evaluate of distribution cancer for primary professional education Develop care

O ed oncology These services care. include individualized by professionals such as social workers dedicated to as social workers such professionals by services for patients and family members provided elsewhere in the state. Some also have supportive supportive Some also have elsewhere in the state. unique diagnostic or treatment options not available unique diagnostic or treatment options not available dedicated to research. Some facilities and practices offer dedicated to research. including clinical trials, and have departments and have or staffincluding clinical trials, Carson City, provide a variety of a variety provide Carson City, treatment options, in the larger communities, Las Vegas, Reno, and Reno, Las Vegas, in the larger communities, Most of the treatment facilities and oncology practices patient’s fi ofnal months or days life. fi patient’s or cancer treatment, or providing comfortor cancer treatment, or providing during a alleviating discomfort cancer or suffering caused by the cancer, managing the disease as a chronic illness, illness, managing the disease as a chronic the cancer, include removing a precancerous lesion or polyp, curing a precancerous lesion or polyp, include removing treatment vary to patient. They from patient may to standard treatment options. The goals to standard treatment options. of cancer modifi ers and monoclonal antibodies have been added ers and monoclonal antibodies have modifi recent years, new approaches such as biologic response as biologic such new approaches recent years, long been the mainstays oflong been the mainstays cancer treatment. In more Surgery, chemotherapy, and radiation therapy have and radiation therapy have chemotherapy, Surgery,

 Strategy:   

GOALS, OBJECTIVES AND STRATEGIES

30 GOALS, OBJECTIVES aeie To bedetermined Baseline: accesstooptimal By2007,increase Objective 3.5:     Strategies: Data Source: Nocurrent datasource existsforthisobjective   Strategies: Data Source: Nocurrent datasource existsforthisobjective guidelines Objective 3.3: theuseof Increase STRATEGIES AND OBJECTIVES GOALS,  Strategies: Data Source: Nocurrent datasource existsforthisobjective aeie To bedetermined Baseline: thenumber By2007,increase of Objective 3.4: AND STRATEGIES To bedetermined Baseline: Implement acomprehensive to statewide program providers whoarefully Increasethenumber of Educateproviders onhow anddiscuss tointerpret physicians trainedincancer Increasethenumber of Identifyandutilizeexistingprocessestoeducate Develop andimplementprofessionaleducationon Work withpublicandprivate andthe organizations address transportation barriers tocare. barriers address transportation the use of guidelines. the useof guidelines withproviders. University systeminNevada topromotetheuseof treatment-related disorders. on provide appropriatefollow-up andinformation treatmentandwho aboutlateeffectsof informed screening resultswithpatients. detection techniques andpractices. forcancercare. screeningandreferral regarding providers onthemost recentpracticeguidelines areas themajormetropolitan outside of Nevadans for cancer care living Comprehensiv compiled bytheNational optimal cancer screening andcare optimal cancerscreening knowledgeablewho are about otherthanoncologistsproviders in Nevada providers among cancertreatment cancercare organizations, for recognizedor othernationally e CancerNetw Page 59 of ork, ork, 88 Data Source: Nocurrent datasource existsforthisobjective    Cancer Research Foundation on Cancer, CancerInformationServices,SouthernNevada Data source: NationalCancer Institute,NevadaReport in Lessthan5%adult participation Baseline: thenumber Increase anddiversity Objective 4.1:      Strategies: aeie To bedetermined Baseline: services of fragmentation Decrease Objective 3.6:

Increase screening and support programs being programs Increasescreeningandsupport homehealthandhospice Increasethenumber of thatprovide existingservices Promoteandsupport Createstatewidecancerresourceguideforall Educatepatients, communities, andclinicians homehealthcareandend- Increasethenumber of forhealthcare Provide educationalopportunities training onend-of-lifecare Increasetheamountof to treatmentfacilities. developed for rural residents.developed forrural communities andremoteareas. thatreach Nevadans livingservices insmall staying aw family memberswhenoptimaltreatmentrequires housing forpatientsincancertreatmentandtheir related services in the state of Nevada. inthestateof related services availableregarding services. communities andremoteareas. thatreach Nevadans livingof-life services insmall diverse populations. thestate’s forallof appropriate end-of-lifeservices providers incancer relatedfields onculturally professions. forcancer-relatedfor studentspreparing healthcare DIVERSITY OFDIVERSITY CLINICAL TRIAL INCREASE THENUMBER AND PARTICIPANTS INNEVADA clinical trials. a y fromtheirhomesincommunities closer per year starting in2006. per year starting by5% clinicaltrialparticipation of existing services for allNevadans. for existing services and improve coordinationof GOAL 4:

GOALS, OBJECTIVES

AND STRATEGIES 31 utilization and mined mers, including available resources, resources, available including mers, u inform affected those by cancer of their right to participate fully in their care and encourage them to participate as fully as they are comfortable inform of quality the public about life issues related to cancer and resources addressing the available those needs o be deter T 88 of 60 hanges in quality of life. information to locate additional local and on how national resources. c health care cons I two least at to resources and of issues quality life Council. Cancer Nevada the to and classes Cope Can including the resources to health care providers regular updating and distribution of community resource guides. and end-of-life services residents for all Nevada particularly those in underserved areas. for home health care in rural areas can be more communities. culturally appropriate for diverse but not limited to, cancer programs at hospitals, cancer programs at hospitals, but not limited to, oncology American cancer centers, practices, support rural providers, health Cancer Society, and hospices. rehabilitation centers, organizations, and Nevada, in patients cancer to available resources monitor patternswhen possible, of on quality of presentations Develop life issues for year on presentations each Beginning in 2006, make information quality of Provide on available life care on palliative Promote educational initiatives the policies regulating reimbursement Explore how Gather resource information from groups including, update all inventory and routinely Develop Page Objective 5.2: Objective to By 2006, increase activities be determined To Baseline: Data Source: No current data source exists for this objective data source No current Data Source: Strategies: presentations on patient By 2006, develop      Objective 5.1: Objective to By 2006, increase activities Baseline: exists for this objective data source No current Data Source: Strategies:   hile pain

hospice care, it is hospice care, GOAL 5: GOAL ey aspect of AFFECTED BY CANCER BY AFFECTED FOR HEALTH CARE CONSUMERS CARE CONSUMERS HEALTH FOR utilization of cancer clinical trails options for racial/ethnic minorities and other underserved populations in Nevada. based oncology increase recruitment of practices, Cancer to the Nevada oncologists research-focused of the number cantly increase Institute to signifi open protocols in our state. edge therapies by increasing the number of the number edge increasing therapies by all as clinical trials in Nevada participants in approved stipulated in the objective. insurance efforts that promote provisions for ofcoverage Institute-approved the National Cancer clinical trials and state-of-the-art therapies. physicians/providers’ support and participationphysicians/providers’ need of to the critical to increase awareness their in medical research. role active ADDRESS QUALITY OF LIFE ISSUES QUALITY OF ADDRESS In addition to increasing enrollment in community and information Improve about, access to, c knowledge and offer cutting scientifi Improve current health insurance legislation and Review enlisting the trials by Increase enrollment in clinical

important during any stage of cancer treatment when methods ofpain is present. Various relief are available, ofdepending on the source and severity the pain. options include medication with non-opioids Treatment as as acetaminophen or ibuprofen), opioids (such (such and local anesthetics. codeine or morphine), steroids, radiation Other treatments for pain include surgery, and chemotherapy. therapy, Quality of Life is a concept that encompasses spiritual, spiritual, encompasses that well-being. concept a is physical of and Life Quality nancial, fi urban/ emotional, orientation, sexual psychological, gender, age, by uenced of education, infl level is It status, socioeconomic and care. health location, to rural access and culture, status, immigration ofThe diversity population exceptional Nevada’s presents both a challenge and an asset to addressing quality of into quality of Research life issues. life issues preclude offering it should not is encouraging; however, services to address the needs of people dealing with cancer in their daily lives. care addresses relieving pain and other Palliative symptoms associated with cancer or its treatment, especially as patients are nearing death. W management is a k      GOALS, OBJECTIVES AND STRATEGIESStrategies: 32 GOALS, OBJECTIVES Strategies: By2006,identifyandpromote Objective 5.3:   including: consumers, healthcare for empowerment STRATEGIES AND OBJECTIVES GOALS,  AND STRATEGIES        Convene an annual meeting of lay healthworkers Convene anannual meetingof Provide easyaccesstoconsumerinformation usingpatientguides/ Explorethepossibilityof Develop anddeliver acampaigntoeducatethe Make presentationseach yearonpatient on How tolocateevidence-basedinformation Homehealthcare, palliative care, andend-of-life aboutthelong-term learning of importance The How consumerscanadvocate forthemselves and How toempower patientstoconsiderawidevariety How decisions consumerscanmake well-informed The need for appropriate and effective follow- effective and appropriate for need The implement the strategiesidentified. and areas;publishareport; communities andrural members, especiallythosewhoareisolatedinsmall andfamily survivors lifeof improve thequalityof an existingannual conference todiscussstrategies and publichealthemployees within thecontextof facilities. through agencies, web sites, andcancercare the medicalsystem. advocates atclinicalsitestohelppatientsnavigate services. publicaboutpalliativegeneral careandend-of-life beginning in2006. Can Cope classes and to the Nevada Cancer Council issuesandresourcestoat least twoempowerment I healthy lifestylesandreducingrisksforcancer. andavailable services. information access thisinformation. cancerandtreatmenthow to and lateeffectsof thehealthcaresystem. navigate life. optionstoimprove qualityof of up care. up ftherapies. of alternative therapies, differentkinds andintegrating and about medicaltreatment,complementary resources where needed where resources new of thecreation and support populations;defiunderserved ne accessible tothestate’smore liferesources existing qualityof thatmakesuccessful approaches Page 61 of 88          Objective 5:4 Assist cancerpatientsinidentifying and create quality care and referrals to support services. that are sensitive to patient’s culture and language reimbursementratesoncancertreatment. Nevada residents. remoteareas, andundocumented residents. groups, residentsliving insmallcommunities and by low income toservices toreducebarriers Strategies: Create and distribute materials and programs low Medicare Review literatureontheimpactof Studycancercareissuesforundocumented research onanddevelop Gathercurrent methods anexistingconference, Withinthecontextof Support theAmericanCancer Society’s Support Patient distributiontocancer information Support Maintainanup-to-date, computerizedinventory freecancerinformation Publicizetheavailability of followed upwithdefinitive diagnosticprocedures. screeningtestresultsbuthave notyet abnormal thosewhoreceive addressing fearandanxietyof develop aworkshop onspecific strategiesfor area hospitals. Lifecentersin andQualityof programs Services cancer. type andstateof clinical trialoptionsthatmay beavailable fortheir locallyavailableconcerning treatmentresourcesand centers,hotlines, andmedicalfacilities information patients andtheirfamiliesthroughtelephone aboutproviders information that iseasilyaccessibletothepublicandcontains Nevada CancerInstitute. Society, theNationalCancerInstitute, andthe theAmericanCancer such asthoseof services services andsupport and usingcancercare , ser vices, andfacilities. GOALS, OBJECTIVES AND STRATEGIES

GOAL 6. Objective 6.3: Monitor and coordinate cancer IMPROVE THE COLLABORATION control and quality of life activities in Nevada

AND COORDINATION AMONG GOALS, OBJECTIVES CANCER CONTROL EFFORTS Strategies: Over the years, Nevada continues to increase and  Establish an online information service for cancer AND STRATEGIES enhance the number, quality, and services of cancer- control in Nevada. related programs. This effort has served to increase  Continue to maintain and expand the Nevada community collaborations between the private and Cancer Council. public sector and provide a focus on a common goal for preventing cancer and improving the lives of  Keep apprised of, and disseminate information on cancer patients and their families. Using this plan as a activities or organizations engaged in implementing roadmap, we must move forward with implementing, or supporting cancer control in our state. coordinating, and evaluating our cancer prevention and control work. Objective 6.4: Develop and implement an Objective 6.1: Continue efforts of the Nevada evaluation plan for the Nevada Cancer Council, a public-private Cancer Plan collaboration that focuses on comprehensive cancer prevention Strategies: and control • Recruit and convene a planning and implementation committee experienced and knowledgeable in Baseline: The Nevada Cancer Council has met evaluation techniques. quarterly since 2002 • Assess and evaluate the effi cacy of the Nevada Cancer Plan’s strategies by determining its impact Strategies: on the knowledge and behavior of the citizens  Seek funding sources to support the Nevada Cancer of Nevada. Council and to implement priority strategies of the • Perform an annual evaluation and make available Nevada Cancer Plan. to the community the outcomes through a written  Share programs, resources, and best practices among report and disseminate at an annual Nevada State coalition members. Cancer Conference.  Hold an annual cancer conference to share best • Use the annual evaluation to revise the plan as practices, increase skills, and commence new needed. initiatives where deemed appropriate.

Objective 6.2: Identify and develop an inventory of organizations and programs that engage in or support cancer control and quality of life related activities

Baseline: Five organizations and advocates started the Nevada Cancer Council in 2002

Strategies:  Identify, on an ongoing basis, cancer control and quality of life organizations and activities in Nevada.  Continue to recruit emerging and existing cancer control and quality of life organizations in the Nevada Cancer Council.

33 Page 62 of 88 GLOSSARY

Cancer The umbrella term to describe many different diseases in which cells grow and reproduce out of control

Clinical Trials Research studies of new methods or agents to prevent, detect, or treat a disease,

or to study quality of life issues. Treatment trials with cancer patients usually GLOSSARY involve three phases to compare the current best treatment to a promising new treatment

Digital Rectal Manual examination of the lower rectum Exam (DRE)

Endoscopy Examination of the lining of the gastrointestinal tract using a thin, fl exible, lighted tube; fl exible sigmoidoscopy allows examination of the rectum and lower part of the colon. Colonoscopy allows examination of the rectum and entire colon; polyps can be removed during this procedure

Incidence The number of newly diagnosed cases of a disease occurring in a specifi c population in a given period of time

Mammogram An X-ray of the breast used for the early detection of breast cancer

Melanoma The least common but most life threatening form of skin cancer

Metastasis The spread of cancer cells from the original site to other parts of the body

Morbidity Illness or disability resulting from a disease or its treatment

Mortality In this publication refers to death resulting from cancer

Pap (Papani- A test for cervical cancer that examines cells that are scraped from Nicolaou) Test the cervix; can detect cancer and pre-cancerous conditions

Prevention Primary prevention is preventing or reducing the risks for developing disease. Secondary prevention addresses identifying individuals with a disease, often before they have exhibited symptoms. Tertiary prevention emphasizes delaying advancement of the disease, reducing the risks for complication or recurrence, prolonging life, and promoting quality of life

Prostate-Specific A test to detect levels of a blood protein. Elevated PSA levels may Antigen (PSA) test indicate prostate cancer, prostate infl ammation, or benign prostate conditions

Risk Factor Something that increases a person’s chance of developing a disease, such as age, sex, or tobacco use

Screening Routine tests that are given if an individual is over a certain age, has a family history or other risk factors for any medical conditions. Early detection can mean that a serious health problem or problems may be avoided. Screening includes a range of procedures used by medical professionals to identify individuals with early cancer 34 Page 63 of 88 ACRONYMS 35 88 of 64 Page Complementary Medicine Alternative and a c r o n y mACoS s College American ofACS Surgeons BRFSS Society American Cancer Surveillance System Factor Risk Behavioral CIS CAM Cancer InformationService CCOP Clinical Oncology Community Program CDC DRE Control and Prevention Centers for Disease FOBT Exam Digital Rectal Test Occult Blood Fecal NCC NCDB Cancer Council Nevada National Cancer Data Base NCI NSHD National Cancer Institute State Health Division Nevada NTPC Coalition Prevention Tobacco Nevada NVCI Cancer Institute Nevada PDQ PSA Data Query Physician SPF c Antigen Prostate-Specifi YRBSS Sun Protection Factor Surveillance Risk Behavior System Youth RESOURCES 36 vors vors ed

, and vi , partnerships, , partnerships, rams , training and referrals ement of the quality v vide survivors and their vices .gov .org ers pro viduals and families to become self ritories. It also prepares Cancer Fact It also prepares Cancer Fact ritories. , NV 89104-3013 TE CANCER vention for the impro vention 88 egas of .helpsonv.org .prostatetaskforce.nv ted in 2001 to carry out NCI’s Strategic Plan for for Plan Strategic NCI’s out carry to 2001 in ted l free – 1-866-235-7205 l free – 65 ea r ol

T http://www.livestrong challenges of cancer through education, qualifi loved ones with emotional support, griefloved counseling Carehelps sur SURVIVOR LIVESTRONG HELP assists indi through direct ser cient suffi to support services in the community. CANCER COUNCIL (ICC) INTERCULTURAL http://iccnetwork.org prog The ICC promotes policies, the unequal cancer burden to eliminate and research among racial and ethnic minorities and medically underservedthe United States populations in its associated ter Reducing Cancer Health Disparities. Research will will Research Disparities. Health Cancer and Reducing biological, environmental, cultural, social, investigate care. life end-of- to prevention from continuum behavioral http://crchd.nci.nih.gov ON FORCE TASK GOVERNOR’S PROSTA 702-227-8028 www Cancer on Prostate Force Task The Governor’s early detection promotes education and screening for and inter referrals CancerCare’s and counseling services. oncology social work CENTER TO REDUCE CANCER CENTER TO REDUCE DISPARITIES HEALTH National Cancer Institute C of life of men in Nevada. HELP OF SOUTHERN NEVADA 35B-208 953 E Sahara Ave. Las V 702-369-4357 www Sheets that provide detailed informationSheets that provide on cancer occurrence and risk factors. FOUNDATION LANCE ARMSTRONG CARE SURVIVOR LIVESTRONG face the everyday physical, emotional and practical physical, everyday face the Page anizations, anizations, t group for .

ov/cancer , NV 89109 .g

, NV 89509 775-329-0609 .candlelighters.org

eno R CANDLELIGHTERS FOR CHILDHOOD CANCER Suite 600 Maryland Pkwy, 3201 S. Las Vegas 702-737-1919 www The American Cancer Society is a volunteer based The American Cancer Society is a volunteer health service organization dedicated to eliminating Support servicescancer. include: Cancer Information loan closet; gift closet; support Line (800) ACS-2345; to Better” program, Road “Look Good Feel groups, to Recovery. and Reach Recovery Candlelighters is a parent-run suppor CENTERS FOR DISEASE CONTROL AND PREVENTION and Control ProgramCancer Prevention free - 1-888-842-6355 Toll www.cdc families of Help is available with cancer. children parent-to-parent through bi-monthly newsletters, for siblings workshops referrals same diagnosis, for the of teen groups and/ for patients with cancer, the child togethers, get holidays and summer siblings, teen their or advocates parent December, in services memorial annual diagnosis child’s the upon bag” care “parent new a and child. and parent the for books includes that 1325 E. Harmon Ave AMERICAN CANCER SOCIETY (ACS) Southern Nevada The of list following organizations agencies and a resource for locating cancer is intended to be services This listing does throughout the state. control org not include all cancer an endorsement ofnor does it constitute these organizations or their programs the Nevada by State Health Division. LOCATING CANCER SERVICES IN NEVADA RESOURCES Las Vegas, NV 89119 Las Vegas, Northern 702-798-6877 Nevada 6490 S McCarran #40 Blvd. 37 RESOURCES concerns. All services are provided free of charg areprovided freeof concerns. Allservices access tocare, employ S Foundation’s areavailable casemanagers tohelpwith E and professionaladvice, while Patient Advocate NEVADA C IN R SERVICES U CANCER LOCATING O S E R national clinical trials. resources, tolocal and nationalassistance, and referrals helps individuals withinsurancequestions, community inthecommunity and serves staff patient services adiagnosis.residents bettermanage dedicated The tohelpour the state, services andpatientnavigation availablecancer research, clinicaltrialsnotcurrently in Nevada breaking CancerInstituteisdeveloping ground T www 702-821-0000 Las V 10000 W. CharlestonBlvd., Suite140 NEVADA CANCER INSTITUTE(NVCI) cancer patients. cancerpatientsandthefamiliesof continuing careof cancer, rehabilitationfromcancer, andthe treatment of with respecttothecause, diagnosis, prevention, and dissemination,andotherprograms health information research,which training, conductsandsupports Institute coordinatestheNationalCancerProgram, andagencies. NationalCancer organizations The and healthinitiativesprogramming forcommunity thatoffershelpwithlocal a Partnership Program system(1-800-4-CANCER)and toll-free telephone which includesa Service, the CancerInformation forcancerresearchagency andtraining. Itoperates 1937andistheFederal Government’sAct of principal NCI was establishedundertheNationalCancer The Las V 10000 W. CharlestonBlvd., Suite140 (localrepresentative) Services Cancer Information NATIONAL CANCER INSTITUTE(NCI) patientsandtheirfamilies. lifeof quality of Hodgkin’s diseaseandmyeloma, andtoimprove the T www 702-436-4220 Las V 6280 S. Valley ViewBlvd. Suite342 LEUKEMIA LYMPHOMA SOCIETY www.cancer.go 702-821-0003 he offi cial cancer institute of the state of Nevada,he offi the thestateof cial cancerinstituteof he Society’s missionistocureleukemia, lymphoma, .nevadacancerinstitute.org .lls.org/sn egas eg egas as, NV89135 , NV89135 , NV89118 v v ment questionsandfi Page nancial 66 e . of 88 T 702-384-0013 Las V 601 S. Rancho Dr., C-26 NEVADA CANCERRESEARCH FOUNDATION Las V 2827 UticaCircle OF NEV OVARIAN CANCERALLIANCE people moving towards atobacco-freelifestyle. tosupport needs, andeducationinformation and individualized treatment planstomeetindividual’s intensive treatment;confiinclude longterm, dential dependence, bothsmoked andsmokeless. Services tobacco of thattreatsallforms treatment program Helpline isastatewidenicotinedependence The www.li T 702-877-0684 Nev theUniversity of A division of NEVADA TOBACCO USERS’HELPLINE Drive andPalomino Lane. University MedicalCenteronSouthRancho of north a non-profi centrallylocatedjust t research organization [email protected] Las Vegas, NV89103 4850 W. Flamingo, Suite27 Nev Southern CANCER FOUND SUSAN G. KOMEN BREAST cancerscreenings.include breastandcervical sixpriorityareas, which disparities inoneormoreof develop andimplementactivities toreducethelevel of REACH fundscomm The program http://www COMMUNITY HEALTH (REACH) RACIAL ANDETHNICAPPROACHES TO (directly orindirectly)ovarian cancer. and a Provides support www 702-796-0430 oll Free –888-866-6642 he Southern Nevadahe Southern CancerR ada School of .ocan.org egas eg vingtobaccofree.com as, NV89146 ADA (OCAN) , NV89106 .cdc ada .gov/reach2010 Medicine ATION wareness forthoseaffectedwith 702-822-2324 esearch Foundation is unity coalitionsto RESOURCES LOCATING CANCER SERVICES IN NEVADA

Northern Nevada WOMEN’S HEALTH CONNECTION P.O. Box 19538 Breast and Cervical Cancer Early Detection Program RESOURCES Reno, NV 89511 775-355-7311 Nevada State Health Division [email protected] 505 East King Street, Room 103 Carson City, NV 89701 The Susan G. Komen Breast Cancer Foundation was founded in 1982 on a promise made between two 775-684-5900 sisters – Susan Komen and Nancy Goodman Brinker. The Women’s Health Connection is a breast and cervical More that 20 years later, the Komen Foundation is a cancer early detection program available to eligible Nevada global leader in the fi ght against breast cancer through women at no cost. This program is made possible its support of innovative research and community- by funding from the Centers for Disease Control and based outreach programs. Working through a network Prevention. Women age 40 and above are eligible for of U.S. and international affi liates and events like the annual pelvic exams and pap smears, clinical breast exams, Komen Race for the Cure©, the Komen Foundation is and some diagnostic services. Women age 50 and above fi ghting to eradicate breast cancer as a life-threatening are also eligible for an annual screening mammogram. disease by funding research grants and supporting Women age 40 and above who do not have Medicaid education, screening and treatment projects in or Medicare Part B, are not a member of an HMO, or communities around the world. are underinsured or uninsured, and meet the income guidelines are eligible. UsTOO 5003 Fairview Avenue Downers Grove, IL 60515 Toll Free – 800-808-7866 www.ustoo.org or http://www.ustoo.com Northern Nevada P.O. Box 19538 Reno, NV 89511 775-355-7311 UsTOO is a grass roots organization started in 1990 by prostate cancer survivors to serve prostate cancer survivors, their spouses/partners and families. They are a 501(c)(3) not-for-profi t charitable organization dedicated to communicating timely and reliable information enabling informed choices regarding detection and treatment of prostate cancer. Ultimately, UsTOO strives to enhance the quality of life for all those affected by prostate cancer.

38 Page 67 of 88 united in the fight against cancer

Published by the Nevada State Health Division, 2005.

To request a copy of the Nevada Cancer Plan or the American Cancer Society’s Nevada Facts and Figures 2005, Comprehensive Cancer Control Program Nevada State Health Division

505 E. King Street, Room 103 Carson City, NV 89701-4774 Phone: 775-684-5900 Fax: 775-684-5998

To download a copy of the Nevada Cancer Plan www.health2k.state.nv.us/cccp

Page 68 of 88

One hope. One promise

Department of Health Point of Contact: Name: Chris Wood, Manager, Chronic and Communicable Disease Programs, Bureau of Child, Family and Community Health, Nevada State Department of Health Phone: (775) 684-5953 Email: [email protected]

Nevada Cancer Council Steering Committee Chair: Name: Sheila Baez, RN, MN, AOCNS Address: 4375 Mountaingate Dr., Reno, NV 89519 Phone: (775) 787-2218 Email: [email protected]

Web Site: www.nevadacancercouncil.org

1. Why is Comprehensive Cancer Control needed?

In 2005, Nevada ranked 20th in the nation for overall cancer mortality rates. Source: US Mortality Public Use Data Tapes, 1969-2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. ©2006, American Cancer Society, Inc., Surveillance Research

In 2005, Nevada experienced 4,238 cancer deaths. Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2005 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2009. Available at: www.cdc.gov/uscs.

Cancer is the second leading cause of death in the United States, accounting for almost one in every four deaths. 22% of all deaths in Nevada in 2005 were due to cancer. The American Cancer Society estimates that 11,030 new cases of cancer were diagnosed in Nevada in 2007, including 1,120 new cases of colorectal cancer and 1,180 new cases of breast cancer in women. Source: National Centers for Disease Control and Prevention-State Profiles.

Nevada challenges include: • Limited infrastructure • Limited resources for cancer control • Limited data use for decision making

Page 69 of 88 • Lack of coordination among cancer control providers • Heavy & unequal cancer burden in the state of Nevada • Insufficient information about effective programs and services

2. What is the purpose of the Nevada Cancer Council (NVCC)?

The NVCC is dedicated to bringing together and coordinating cancer prevention, early detection, treatment, support, and research efforts to improve the quality of life for everyone in Nevada. Its aim is to increase coordination among programs, to reduce duplication, and to increase opportunities for cancer prevention and control.

The NVCC, with input from diverse community groups, has set six broad goals: • Reduce the risk of developing cancer • Increase early detection and appropriate screening for cancer • Increase access to appropriate and effective cancer treatment and care • Increase access to clinical trial initiatives • Address quality of life issues for health care consumers affected by cancer • Improve the coordination and collaboration among cancer control efforts

What NVCC brings to Nevada: • Focus on infrastructure development and enhancement • Improved utilization of existing resources • Decision making based on sound evidence • Active and broad involvement by stakeholders • Reduced morbidity and mortality from cancer and reduced disparities in cancer burden • Systematic strategies for assessing process and outcomes in Nevada Cancer Plan implementation

3. List of NVCC activities to date

December 2005: Publication of the Nevada Comprehensive Cancer Plan January 2006: Plan Implementation and Operational Subcommittees established September 2007: Bylaws approved January 2008: Election of Steering Committee Chair and Vice-Chair June 2008: Membership Application Packet available August 2008: Colon Cancer Task Force established October 2008: First NVCC Newsletter published November 2008: Website established @ www.nevadacancercouncil.org. December 2008: First Annual Cancer Control Summit January 2009: Membership Satisfaction Survey March 2008: Colon Cancer Screening Campaign in Northern Nevada

Page 70 of 88 4. Describe the efforts of Plan Implementation Committees to date

Prevention Committee GOAL 1: Reduce the Risks for Developing Cancer. A proactive approach to keeping the population healthy, involving continuous efforts for community development and mobilization, public policy, public health initiatives, and informed personal choices. • Tobacco Use – Support the Nevada Clean Air Act • Sun Exposure – Advocate for controls on minor exposure to tanning booths • Nutrition and Diet • Physical Activity

Screening and Early Detection Committee GOAL 2: Increase Early Detection and Appropriated Screening for Cancer Regular population-based screening or high risk targeted screening and early detection provides a good approach to cure or control of cancer. • Breast Cancer – Support the Women’s Health Connection Breast and Cervical Cancer Early Detection Program by improving public awareness and clinical follow-up of Medicaid recipients. • Cervical Cancer – Improve public awareness of SB-409, signed into law in 2007, that provides insurance coverage for prostate cancer screenings and for the cervical cancer vaccine. • Colorectal Cancer – Support activities of the Colon Cancer Task Force. The 4P3: • Any Colon Cancer Screening program needs to first address the 4 key areas that will become its foundation. These 4 critical areas, the 4 Ps, include the Provider, the Patient, the Procedure and the Payor. • Additionally, there are 3 critical supporting Ps that need to be addressed to implement the program. These, represented by the superscript P3, are Payment (funding), a Public Relations Campaign, and Political Action. The Colon Cancer Task Force is for a CDC grant, “Integrating Colorectal Cancer Screening within Chronic Disease Programs-Comprehensive Colorectal Cancer Screening Program.”

Treatment / Access to Care Committee GOAL 3: Increase Access to Appropriate and Effective Cancer Treatment and Care Provide traditional and newer approaches to cancer treatment to all Nevadans • Develop and maintain a Nevada Community Cancer Resource Guide and distribute throughout the state • Support provision of cancer treatments to Nevada’s Medicaid recipients

Page 71 of 88

Clinical Trials/ Research Committee GOAL 4: Increase the Number and Diversity of Clinical Trial Participants in Nevada. Clinical trials improve scientific knowledge and offer cutting edge therapies. • Increase clinical trial accrual within the state by 5% every year. • Increase awareness of clinical trials. • Survey institutions as to their clinical trial availability

Survivorship/Palliative Care Committee GOAL 5: Address Quality of Life Issues for Health Care Consumers Affected by Cancer The exceptional diversity of Nevada’s population presents both a challenge and an asset to offering services to address the needs of people dealing with cancer in their lives. • Increased membership needed to address quality of life issues • Education focus

5. Highlight additional resources that will support the implementation process.

Effective implementation of the diverse strategies in the Plan will require ongoing, coordinated, and collaborative effort by the Council. Coordinating existing resources and generating new resources to implement strategies will be a key Council function. Because capacity for implementation is determined by the size and strength of the Council, recruitment of new partners is an important and ongoing activity.

Since the publication of the Plan, the Council has succeeded in generating support, funding and resources for implementing Plan priorities. Generally, the partnership has secured on-going in-kind resources and staffing that ultimately contributes to its success. In-kind resources have included use of partner: • meeting rooms and facilities • light refreshments and lunches to compliment meetings • The hours of leadership activities from the chairs of the Operational and Plan Implementation Committees, the Steering Committee, and Task Forces. • Partner member hours to contribute to drafting articles for our newsletter Funding support for implementing Plan priorities have included: • The First Annual Cancer Control Summit had a $38,500 budget, covered in part by Council organizational members, including Renown Institute for Cancer, Carson-Tahoe Cancer Center, Gastro-Intestinal Consultants, and interested pharmaceutical companies. This event secured additional resources and support to further the implementation of one of our plan goals to improve the quality of cancer care in Nevada. • Development and maintenance of the NVCC website was sponsored by Renown Institute for Cancer

Page 72 of 88 6. Describe Plan evaluation process to ensure program outcomes are measured.

The Plan defines “effectiveness” as appropriately implemented strategies, achieved objectives, and reached goals. Where possible, measurable objectives (i.e., quantifiable) have been developed. For quantifiable objectives, baseline data will be used to measure progress and determine the effectiveness of plan strategies. To assess performance on process-oriented objectives, activities that lead toward the objectives will be monitored and documented. The overall Plan evaluation framework lays out the approach for evaluating the Department of Health Comprehensive Cancer Control Program and the Council. Evaluation of the Plan includes both the evaluation of process and outcomes of interventions. In addition, annual Council membership satisfaction surveys will be designed to measure the functioning of the Council itself.

Page 73 of 88 NEVADA CANCER COUNCIL

Membership Organizations American Cancer Society American Heart & Stroke Association American Lung Association of Reno Cancer & Chronic Illness Center Foundation Candlelighters Childhood Cancer Foundation of Nevada Carson Tahoe Cancer Center Chamber of Commerce, Laughlin, Nevada Colon Cancer Task Force Community Partnership of Northern Nevada Cancer Institute Comprehensive Cancer Center of Nevada Gastroentestional Consultants, Inc. Inter‐Tribal Council of Nevada Leukemia and Lymphoma Society National Cancer Institute’s Cancer Information Services Nevada Cancer Institute Nevada Cancer Research Foundation Nevada HealthLinks Nevada State Health Division ‐ Immunization Nevada State Health Division ‐ Oral Health Nevada State Health Division ‐ Women's Health Connection Nevada State Health Division – Tobacco Education and Control Program Prostate Cancer Task Force Quest Diagnostics Renown Regional Medical Center, Institute for Cancer Southern Nevada Health District St. Mary's Hospital St. Rose Dominican Hospital State of Nevada Health Officer Sunrise Hospital and Medical Center Surgeons Chartered Susan G Komen for the Cure, Northern Nevada Affiliate Susan G Komen for the Cure, Southern Nevada Affiliate University of Nevada, Las Vegas University of Nevada, Reno Us TOO Washoe County District Health Department

Page 74 of 88 THE STAKEHOLDER FEBRUARY 2009

THE STAKEHOLDER

A MESSAGE FROM THE STEERING C O M M I T T E E FIRST ANNUAL NEVADA SHEILA BAEZ, RN, MN, AOCNS, CHAIR, NEVADA CANCER COUNCIL CANCER CONTROL SUMMIT INSIDE THIS I S S U E : On December 6, the NVCC spon- proximately 129 persons at- sored a highly successful meeting, tended the all day event. Institu- the First Annual Nevada Cancer tional, corporate and pharma- MEMBERSHIP 2 COMMITTEE Control Summit at the Peppermill ceutical sponsors, as well as Resort Casino in Reno. The Summit registration fees funded this first SCREENING AND 2 Planning Committee, pursuing Can- class meeting. EARLY DETECTION cer Control Plan Goal #6, to COMMITTEE ‘Improve the collaboration and coor- The faculty consisted of na- dination among cancer control ef- tional cancer non-profit leaders First Annual Nevada Cancer forts in the state’ realized the need as well as public health and Control Summit, Dec. 2008 ACCESS TO CARE 3 state government representa- COMMITTEE to: tives who provided a broad spec- Members of the Planning Com- -Increase awareness of national trum of perspectives and ap- mittee (left to right) Christine Belle, Sheila Baez and CCCP WELCOMES 3 cancer control efforts; proaches. ADMIN. ASSISTANT Susan Robinson -Mobilize Nevada stakeholders to Hala Moddelmog, MA, Presi- better coordinate efforts aimed at dent and CEO, Susan G. Komen COLON CANCER 3 reducing new cancer cases and for the Cure Foundation, over- TASK FORCE cancer related deaths; and viewed the history and fund- raising goals of the organization, -Improve quality of life for those as well as emphasized their CCCP REPORT 4 affected by cancer. access to care priority. Hala CCCP WELCOMES 4 The Summit targeted all members voiced concern for the plight of EVALUATION SPEC. of the health care community, in- the uninsured in Southern Ne- cluding providers, payors, govern- vada in light of recent Medicaid POLICY AND 5 cuts. (Cont. on Pg. 5) Cancer Control Summit LEGISLATIVE mental policy makers, public health COMMITTEE officials, and academicians. Ap- Mr. Bill Welch, President/CEO, Nevada Hospital Association NVCC MEETING CAL- 5

ENDAR CDC SITE VISIT 6 BECOME MORE INVOLVED IN THE NVCC

ENCOURAGE YOUR PEERS TO ACCEPT NOMINATIONS SPECIAL FEATURES IN Nominations accepted through February 20, 2009 THIS ISSUE: CALL FOR NOMINA- TIONS CALL FOR NOMINATIONS ANGELA BERG, COMMITTEE CHAIR FIRST ANNUAL NEVADA CANCER CONTROL Call for Nominations to the 9—20, 2009. 2009, 1:30 PM. SUMMIT NVCC Steering Committee The NVCC Steering Commit- coming via email on February NVCC POLICY tee meets one hour each 9, 2009. STATEMENT month via teleconference. The Nominations will be ac- first Steering Committee meet- NVCC MEETING cepted until February 20, ing, with the newly elected offi- CALENDAR 2009. Voting will occur March cials, is scheduled for April 2,

Page 75 of 88 THE STAKEHOLDER Page 2

MEMBERSHIP COMMITTEE LAUREN SLOVIC, CHAIR

Lauren Slovic, Ms. Slovic will work If you have sugges- MSW, the National throughout the state to tions regarding or- Cancer Institute, Can- expand and increase ganizations or per- cer Information Ser- the diversity of the cur- sons not currently at vice's and the Compre- rent Council member- the table, please let hensive Cancer Con- ship to include repre- Ms. Slovic know. trol Program (CCCP) sentation from varied Cancer Control Summit Partnership Program professions, commu- If you would like to First Lady Dawn Gibbons at Coordinator for the Ne- nity and civic groups, assist Ms. Slovic in VIP Reception vada Cancer Council faith-based groups, these efforts, forward has agreed to act as rural/frontier communi- and email directly to Chair for the Council’s ties, as well as survi- her: Membership Commit- vors. tee. [email protected]. Dr. Gray , Chair, SCREENING AND EARLY DETECTION COMMITTEE Colon Cancer Task SUSAN ROBINSON, CHAIR Force, presented to Cervical Cancer Task that fear and limited pro- Physician’s annual meet- Force: viders in the Las Vegas ing at Lake Tahoe on the Nevada Academy Branda Kent, Laz area may require a spe- January 25. Paz, Pat Elzy and Susan cial approach to increase Dr. Gray requested of Family Physician’s Robinson ordered cervi- screenings in their area. that the Nevada Cancer annual meeting on cal cancer materials. Jim Bauserman of Council arrange to have A press release was The Bauserman Group a booth at the Nevada Sunday, January 25 distributed in early Janu- provided the executive Academy of Family Phy- ary and media interviews committee with ideas for sician’s meeting, stating, at Harrah’s in scheduled to encourage a media campaign to ―The meeting will be at- women to get Pap tests. increase screenings. tended by a large num- Lake Tahoe Members of the group The sample creative ber of Nevada Family will be doing community boards were great, and Practitioners and I be- presentations about cer- he has been asked to put lieve a booth would in- vical cancer as opportu- costs together for the crease the Colon Cancer nities afford themselves. media and public rela- Screening marketing po- Colon Cancer Task tions campaign. The tential in our region and Force: goal is to have media the state.‖ Dr. John Gray, the going out in March – co- Ike Cress has agreed chair of the task force, lon cancer awareness to staff the booth, utiliz- met with providers in Las month. ing the same materials Vegas to get their feed- Dr. Gray presented at that were used at the back and support for in- the Nevada Cancer Con- summit. It was sug- creasing colon cancer trol Summit on Decem- gested that the "Cover screenings. He believes ber 5, 2008 and will also Your Butt" brochures be Cancer Control Summit that while they are sup- be speaking at the Ne- available at the booth as Susan G. Komen for the Cure portive of the task force, vada Academy of Family well. Foundation Group attendees

Page 76 of 88 THE STAKEHOLDER Page 3

ACCESS TO CARE COMPREHENSIVE CANCER CONTROL PROGRAM WELCOMES NEW C O M M I T T E E ADMINISTRATIVE ASSISTANT ANGELA BERG, CHAIR IKE CRESS, PROGRAM COORDINATOR The Access to Care WELCOME SUSAN! During the Nevada Committee held a telecon- Susan Buehrle has State Health Division’s ference in January with very joined the Comprehen- reorganization, BFHS low attendance. Ms. Berg sive Cancer Control was incorporated in the reported the excitement of Program as the new Bureau of Child, Family Cancer Control Summit the committee due to sev- Administrative Assis- and Community Well- Keynote Address eral new members. tant. ness. Hala Moddelmog, President/ Prior to her move to Susan’s contact infor- CEO, Susan G. Komen for the The Access to Care Cure Foundation Committee is in need of a Comprehensive Can- mation follows: co-chair. Please consider if cer, she was employed you would be interested in by the Nevada State Phone: 775.684.4239 being a team member to Health Division, Bu- Fax: 775.684.5998 move this committee for- reau of Family Health Email: ward. Services (BFHS). [email protected]

COLON CANCER TASK FORCE

DR. JOHN GRAY, CHAIR Cancer Control Summit Nevada’s Comprehensive cational outreach to primary cians and payors that have Dr. Dileep Bal presenting “In Cancer Control Program and care providers. The result information about colorectal Your Face ”Tobacco Control” the Nevada Cancer Council of this vision and mission will cancer and where to call for (NVCC) has been steadily be the reduced physical, screening. The task force is working on implementation of emotional and economic also working to educate provid- its cancer plan. One of the burden of colorectal cancer ers about options when Council’s priority areas is in the state of Nevada. colonoscopy is not an available early detection. The Early to a patient such as the use of Detection Committee and The task force has 4 key a FIT test, which is a much committees is prevention and areas of focus that are re- more accurate test for Fecal early detection, under which is ferred to as the ―4 P’s, which Occult Blood then the tradi- the colorectal task force. The include the provider, the pa- tional guiac-based stool task force is chaired by Dr. tient, the procedure and the hemoccult. Education about John Gray of GI Consultants payor (insurance compa- the newer bowel preparations nies). Additionally, there are in Reno, Nevada. that make the procedure more Cancer Control Summit 3 critical supporting P’s that tolerable for patients is also The vision of the task force need to be addressed. important. Tom Kean, MPH, Executive is a healthier Nevada where These are; payment Director, C Change colon cancer is prevented (funding), a public relations Education for the general through universal screening, campaign and political ac- public about improved bowel Panel Discussion: “Cancer where positive test follow-up tion. preparation, the safety of Control: The National Agenda” care is timely and appropriate, colonoscopy and the life sav- and where the number of The task force will be ing benefits of the procedure is avoidable colon cancer deaths working with Primary Care also a key goal of the task is decreased. Physicians to increase the force and a media campaign number of patients referred will be rolled out during Colo- The mission of the task for colonoscopy, as well as rectal Cancer Awareness force is to dramatically im- to educate patients that they Month in March, 2009. prove access of all Nevadans may also self refer. Payors to appropriate colorectal can- will be encouraged to send If you are interested in get- cer screening by increasing notices to their members ting involved in these efforts, public awareness about colo- ages 50+ to remind them of please contact Ike Cress, rectal cancer, by influencing the need to have a colono- Comprehensive Cancer Con- Cancer Control Summit legislation that supports scopy. The task force will be trol Program Coordinator at Networking Luncheon screening, and through edu- providing brochures to Physi- [email protected]

Page 77 of 88 THE STAKEHOLDER Page 4

THE COMPREHENSIVE CANCER CONTROL PROGRAM (CCCP) 2009 NVCC CALENDAR IKE CRESS, COORDINAT OR 2/5 12:00 Survivorship

The continuation grant Improve coordination Increase early de- 3/19 1:30 Summit Planning for the Nevada Compre- and collaboration among tection and appropriate hensive Cancer Control cancer control efforts. screening for cancer. 4/1 1:00 Access to Care (CCC) Program was sub- Increase the number Ongoing CCCP ac- 4/2 12:00 Survivorship mitted to CDC on January and diversity of clinical tivities will include: 30, 2009. trial participations in Ne- Conduct evaluation 4/2 1:30 Steering Comm. In accordance with the vada. of the CCC Program, 4/16 1:30 Summit Planning Nevada Cancer Plan, Ne- Increase access to as well as the Cancer vada’s Cancer Council appropriate and effective Plan. 4/21 1:30 Clinical Trials priorities for this grant cancer treatment and Effect policy 4/30 1:30 Summit Planning funding period (June 30, care. change. 2009—June 29, 2010) Reduce the risks for Monitor changes in 5/7 12:00 Survivorship are: developing cancer. population-based 5/7 1:30 Steering Comm. measures. 5/6 1:00 Access to Care

CCCP ALSO WELCOMES NEW EVALUATION 5/14 1:30 NVCC Gen Mtg. CONSULTANT/MANAGEMENT ANALYST II 5/28 1:30 Summit Planning IKE CRESS, PROGRAM COORDINATOR 6/4 1:30 Steering Comm. Deborah Aquino, nator (Ike Cress) with cesses, identify priority Evaluation Consultant tracking the program’s areas for improvement 6/10 1:00 Access to Care and Management Ana- expenditures and will and provide input into 6/11 1:30 Summit Planning lyst II, with the Nevada offer input into the iden- what works well and State Health Division’s tification and implemen- where improvement or Thank-you to our Summit Chronic and Communi- tation of evaluation re-assessment of ob- sponsors who made the cable Disease section components for CCCP jects may be necessary. symposium possible has agreed to provide activities. She will as- The evaluation plan -Renown Institute for Cancer support to the Compre- sist in the creation of a -CDC Comprehensive Cancer will also include how the hensive Cancer Control comprehensive evalua- Control Program Grant to the goals/objectives link to Program (CCCP). tion plan that will map a Nevada State Health Division outcomes and plans for -sanofi-aventis U.S. Inc. systematic process to Ms. Aquino will as- communication and utili- -Gastroenterology Consult- track the Program and ants, LTD. sist the CCCP Coordi- zation of findings. Cancer Plan suc- -Carson Tahoe Regional Healthcare -Genentech -Candlelighters Childhood EXTRA MILE AWARDS (EMAs) PRESENTED AT THE SUMMIT Cancer Foundation of Nevada JENNIFER STOLL-HADAYIA, COMMUNICATIONS CHAIR December 8th gone the "extra mile" in donated their creative marked the 2-year an- terms of protecting their brainchild (the EMAs) to niversary of the Nevada employees and customers the NVCC to be awarded Clean Indoor Air from the dangers of sec- each year at Annual Act. To commemorate ondhand smoke (i.e., ban- Cancer Control Summit that event, Washoe ning smoking on outdoor to commemorate agen- County District Health patios, stand-alone bars cies, programs, cam- Department (WCDHD) that have banned smoking, paigns, individuals, etc. Cancer Control Summit created the EMAs smoke-free casino gaming going the extra mile for EMA Award Winner: (a.k.a., the Extra Mile areas, etc.). all areas of cancer pre- Lake Tahoe’s first and only Awards) to honor local vention. 100% smoke-free casino WCDHD has graciously businesses that had Bill’s Casino Lake Tahoe

Page 78 of 88 THE STAKEHOLDER Page 5

POLICY AND LEGISLATIVE COMMITTEE Nevada Cancer TOM MCCOY AND JENNIFER STOLL-HADAYIA Council priorities What are Nevada Cancer and lung disease. Also, status of access to cancer Council’s priorities for this support legislation to in- prevention, screening, and set for Legislative Session? crease the tobacco tax and treatment in Nevada. This dedicate some of the addi- will generate practical solu- As difficult funding deci- tional revenue to cancer tions from subject matter FY2009—2010 sions are made this Legisla- control programs, including experts to ensure that all tive Session, the Nevada tobacco prevention. Nevadans have access to Cancer Council urges your life-saving services, regard- consideration for the follow- •Pass the cancer drug less of ability to pay. ing policy positions: donation program bill with WORLD CANCER DAY hospital-based pharmacies Who can provide expertise on All are cost-neutral identified as the drug re- cancer issues? February 4, 2009 was •Preserve funding already positories. This program •Sheila Baez, RN, MN, World Cancer Day. The allocated to tobacco pre- allows cancer patients to AOCNS, Chair, NVCC following websites offer info receive life-saving medica- 775.982.4019 vention and control pro- on this health observance. grams. These programs tions at no cost to the state. or prevent tobacco use, which •Tom McCoy, Director of •As a component of the * World Health Organiza- contributes to all types of Government Relations, next interim health commit- tion (WHO) website - http:// cancers and other chronic American Cancer Society tee, conduct a study of the diseases, including heart 775.232.0194 www.who.int/mediacentre/ events/annual/ world_cancer_day/en/ CONT. FROM PAGE 1 — A MESSAGE FROM THE index.html STEERING COMMITTEE * International Union Dileep Bal, MD, District recommendations for colon the delivery of pediatric can- Against Cancer (UICC) Health Officer, Kauai and cancer screening and pro- cer services in the state. w e b s i t e - h t t p : / / former President of the posed steps to counteract www.uicc.org/index.php? American Cancer Society, the colonoscopy crisis in the Kathryn Dawson, MSN, NP- C, discussed hospice and tion=com_content&task=vie gave ‘In Your Face’ recom- state. w&id=67&Itemid=312 mendations to improve to- palliative care issues and Charlene Howard, MHA, stressed the need for end-of- bacco cessation efforts in For additional infor- Nevada. Dr. Bal motivated Manager, Nevada State To- life services. bacco Prevention and Educa- mation, The World Cancer the attendees through laugh- Bill Welch, President/CEO, ter to be the agents of tion Program, gave an infor- Campaign website can be mative update on current Nevada Hospital Association, change in our state. accessed from the second state efforts to reduce to- painted a sobering picture of Tom Kean, MPH, Executive bacco consumption, and reimbursement realities cur- website above. Director of C-Change ex- Jennifer Stoll-Hadayia, rently being faced by hospi- plained the goals and pur- Washoe County District tals in the state. His presen- posed of his organization, Health Department, summa- tation could not have been and outlined national policy rized upcoming legislative timelier, considering Ne- vada’s upcoming Legislative change initiatives. bills that impact cancer con- session and the proposed trol. Tim Byers, MD, Deputy health care cuts. Director of Colorado Compre- Charlene Herst, Health hensive explained how Colo- Program Manager II, Service The final panel addressed rado funds free colonoscopy Assurance & Systems Devel- both the burden of cancer screening and treatment opment Group, gave a history control in Nevada, given the programs for the uninsured of the Cancer Control Plan current budget shortfalls and through an increase in the and described the early days access to care realities, and the need now, more than tobacco tax. of the Council. Cancer Control Summit ever, for all stakeholders to John Gray, MD, Chair of the Angela Berg, RN, BSN, join the Council, to promote Employees attending on behalf of Nevada Colon Cancer Task Candlelighters Childhood change and to impact cancer Renown Institute for Cancer Force, overviewed current Cancer Foundation, assessed control in Nevada. Platinum Sponsor

Page 79 of 88 Visit our webpage:

nevadacancercouncil.org

Nevada State Health Division Bureau of Child, Family and Community Wellness 4150 Technology Way, #101 Carson City, NV 89706

Contacts: Ike Cress at 775.684.5983 [email protected] Susan Buehrle at 775.684.4239 [email protected]

NVCC STEERING COMMITTEE NOMINATIONS ACCEPTED UNTIL FEBRUARY 20 (SEE PAGE 1) CDC Comprehensive Cancer Control Program Site Visit

Susan White, Comprehensive Cancer Control Branch , Division of Cancer Prevention and Control, National Centers for Disease Control and Health Promotion (CDC)

CDC submitted the fol- an important member of ments, of Cancer Informa- address problem that lowing key overall recom- the Cancer Council part- tion Service (CIS) staff in may occur when CIS mendations to the Compre- nership. grant years 01 and 02. As funding is discontinued. hensive Cancer Control •Suggest to the Council in YR 01, update manage- •Consider whether it Program subsequent to the that they do a periodic ment and communication might be appropriate for site visit conducted De- satisfaction survey to bet- plan for CIS position. the Cancer Council to cember 3—8, 2008: ter understand member- •Continue to work with have a membership sub- •Reconfigure steering ship challenges. CDC as an evaluation committee. committee to guide the •Redefine the role of plan for Nevada is devel- •Consider how the Nevada Cancer Council to the CCC Program Coordi- oped. Nevada Chronic Disease include Health Division nator, in relation to the •Work to ensure that Action Alliance can coor- management (e.g. Chronic council. CCC work plan for YR 03 dinate with the Nevada Disease Manager or Bu- •Ensure, through CDC includes measureable, Cancer Council. reau Chief) and CCC Pro- funding, high-functioning SMART objectives. •Consider, if funds gram Coordinator. administrative support (to •Use implementation are available, offering •Clarify role of State arrange travel, take min- guide to track and inform mini-grants to the Ne- Health Division in relation utes, arrange meetings, Council about progress vada Cancer Council in to the Cancer Council; etc.) for the Program Co- towards meeting cancer Action Teams, in order to that is that the council is ordinator. plan goals and objectives. develop projects to ad- not an Advisory body to the •CDC needs documen- • Work with the Ne- dress priorities in the State Health Division, but tation in file of specific vada Cancer Council Nevada Cancer Plan. the State Health Division is activities, and accomplish- Steering Committee to

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AMERICAN CANCER SOCIETY Nevada

Offices in Las Vegas and Reno Resource Centers in Many Nevada Hospitals

The American Cancer Society (“ACS”) is the nationwide, community based, voluntary health organization dedicated to eliminating Cancer as a major health problem by Preventing Cancer, Saving Lives, and Diminishing suffering from Cancer, through Research, Education, Advocacy, and Service.

For a complete view of all of the ACS programs nationwide and in Nevada, go to www.cancer.org

Research: While most of ACS research is done at national centers, an ACS grant is funding research on Brain Tumors at the Nevada Cancer Institute in Las Vegas. The purpose of ACS research is to determine the causes of Cancer and to support efforts to prevent and cure the disease.

Education: Offering programs to educate the public about Cancer risks, Early Detection methods, and prevention.

Advocacy: Working in concert with ACS Research, Education, and Service, initiates and supports legislative efforts at the national, state, and local levels to strengthen laws, regulations, and programs related to Cancer. In Nevada, advocacy is carried out by the American Cancer Society Cancer Action Network (“ACS CAN”). Its staff in Reno and Las Vegas are supported by several thousands volunteers throughout the state who serve in a grassroots capacity to support Cancer’s issues in Carson City, Washington, and in communities across the state. ACS CAN is the non-profit, non-partisan advocacy affiliate of the American Cancer Society. It supports evidence-based policy and legislative solutions designed to eliminate Cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make Cancer a top national priority. ACS CAN, through those several thousand volunteers in Nevada, gives ordinary people extraordinary power to fight Cancer with the training tools they need to make their voices heard. For more on ACS CAN visit its website www.acscan.org

Page 81 of 88 ACS Nevada

Service: Offering one on one and group support and service programs to lessen the impact of diagnosis, treatment, and recovery.

Through its Quality of Life and Patient Navigator staffs in Reno and Las Vegas, ACS provides activities that directly help to diminish suffering as well as the emotional uncertainties associated with the diagnosis, treatment, and recovery from Cancer. Navigating through all the unknown steps and emotional benchmarks is extremely helpful to the recently diagnosed Cancer patient.

Look Good Feel Better events involve Cancer patients and volunteer cosmetologists from the local community who demonstrate and apply makeup for each of the attending Cancer patients who are given makeup kits to use at home.

Reach to Recovery is a service activity wherein recently diagnosed, about to go through surgery and treatment, or those in recovery from Breast Cancer are joined with a volunteer who is a Breast Cancer survivor. The special relationship created by the program helps the Cancer victim in so many practical and emotional ways. The program has been underway for over 35 years. Road to Recovery provides transportation for Cancer patients, who often can not drive or may not have their own transportation, to get to treatment

ACS Resource Centers offer materials to help the patient and family members understand particular forms of Cancer, their treatments, and recovery. Prostheses and accessories are available for anyone who needs them. A selection of wigs is available for use by those Nevada ladies who have experienced the hair-losing experience of Chemotherapy.

The key to the efforts of the American Cancer Society in Nevada are the thousands of volunteers who share their time, their compassion, and their financial support to make a difference in every region of our state.

Relay for Life

Perhaps the most visible aspect of ACS is the Relay for Life events held every year throughout Nevada. From April through August, nearly every weekend in Nevada, a Relay for Life is taking place. Numerous Relays take place in the Las Vegas and Reno areas. There are also Relays in Elko, Ely, Winnemucca, Incline Village, South Lake Tahoe, Carson City, Douglas County, Fallon, Fernley, Lovelock, and Pahrump. Each of this community planned and executed events serves to represent the Hope that those lost to Cancer in Nevada will never be ACS Nevada

Page 82 of 88 ACS Nevada

forgotten, that those who have Cancer will be supported, and that one day Cancer will be eliminated.

What is Relay? It is ACS’ signature event. It offers everyone in one of the communities listed above and in the over 4,000 relays that will be held each year around the country to participate in the Fight Against Cancer! Teams of people camp out at a local high school stadium or community park and take turns walking or running around a track or path. Each team is asked to have a representative on the track at all times during the event which are always overnight events – sometimes for as long as 24 hours. Teams of people from all walks of life have fun while raising much needed funds to fight Cancer and raise awareness of Cancer prevention and treatment issues in Nevada or wherever the event takes place. In any given year, nearly 4 million people participate in Relay. There is no other non-profit, health related, event of its magnitude.

It is a celebration of those in the community who have battled Cancer. The strength of the Survivors inspires others to continue to fight. It is a remembrance of loved ones who lost their lives to Cancer.

It is a way of Fighting Back as the volunteers who have been touched by Cancer walk to demonstrate their resolve to end this disease which in the year 2010 it will have the dishonor of being the #1 health related cause of death.

Making Strides Against Breast Cancer

Each October, thousands of Las Vegas area residents come together early on a Saturday morning and walk to raise money and awareness specifically to Breast Cancer in Nevada.

Cancer Answers are always available 24/7 by just dialing 1-800-ACS-2345 Trained specialists can answer questions, provide sources of information and guide callers to local resources. Information is always available to anyone about anything Cancer and the American Cancer Society by dialing 1-800-ACS-2345.

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Without A Cure Because every woman is at risk for breast cancer – a disease that strikes at random and for which the causes and cures are still unknown – we know that every moment matters: • Without a cure, 1 in 8 women in the U.S. will continue to be diagnosed with breast cancer – a devastating disease with physical, emotional, psychological and financial pain that can last a lifetime. • Without a cure, an estimated 5 million Americans will be diagnosed with breast cancer – and more than 1 million could die – over the next 25 years. • Without a cure, an estimated 32 million women around the world will be diagnosed with breast cancer - and 12 million could die – over the next 25 years.

Breast Cancer In Our Community • An estimated 1270 women in the state of Nevada will be diagnosed with breast cancer this year, and 340 women may die from the disease. • Approximately 1 out of every 5 women in the state of Nevada are lacking health insurance, causing them to delay essential health screenings.

Our Victories Susan G. Komen for the Cure has played a critical role in every major advance in the fight against breast cancer over the past 25 years – transforming how the world talks about and treats this disease and helping to turn millions of breast cancer patients into breast cancer survivors. Among the victories since we started: • More early detection – nearly 75 percent of women over 40 years old now receive regular mammograms, the single most effective tool for detecting breast cancer early. • More hope – the five year survival rate for breast cancer, when caught early before it spreads beyond the breast, is now 98 percent (compared to 74 percent in 1982). • More research – the federal government now devotes more than $900 million each year to breast cancer research, treatment and prevention. • More survivors – America’s 2.4 million breast cancers survivors, now the largest group of cancer survivors in the U.S., are a living testament to the power of society and science to save lives.

How Funds are Spent • 75% of the net funds raised by the Komen Southern Nevada Affiliate remain in Southern Nevada. The Komen Southern Nevada Affiliate awards grants to community organizations to provide breast cancer screening education, treatment and support services for the uninsured and underserved. The 2009 grant cycle has awarded $800,000 in local community grants. • 25% of net funds raised by the Affiliate are allocated to research grants through Komen Headquarters. From the discovery of the key genes linked to breast cancer to the development of revolutionary treatments and therapies, Susan G. Komen for the Cure has supported virtually every major advance in breast cancer research over the past 25 years, with research investments to date of more than $300 million.

Page 84 of 88 Fact Sheet | March 2009 Susan G. Komen for the Cure in Nevada

KKomenomen NNevadaevada AAffiliatesffiliates

X The Komen Northern Nevada Affiliate services the Pershing, Washoe, Storey, Churchill, Carson City, Douglas and Lyon Counties in Nevada, and the El Dorado, Nevada and Placer Counties in California. Komen Northern Nevada Race for the Cure: October 4, 2009 University of Nevada, Reno Phone: 775-355-7311 Website: www.komennorthnv.org

X The Komen Southern Nevada Affiliate services Clark, Nye, Lincoln, and Esmeralda Counties. Komen Southern Nevada Race for the Cure: May 2, 2009 The Fremont Street Experience, Las Vegas Phone: 702-822-2324 Website: www.komensouthernnevada.org X Collectively, the Komen Nevada Affiliates have invested millions in local programs that provide education, early detection, and treatment of breast cancer.

BBreastreast CCancerancer iinn NNevadaevada • Did You Know? In Nevada, an estimated 1,270 new cases of invasive breast cancer were diagnosed among women in 2008, and 340 women died of the disease.

• Did You Know? Except for skin cancers, breast cancer is the most frequently diagnosed cancer among women, and is second only to lung cancer in cancer deaths among women.

• Did You Know? An estimated 182,460 new cases of invasive breast cancer are expected to occur among women in the United States during 2008; an estimated 40,480 women and 450 men will die from breast cancer this year.

FFulfillingulfilling OOurur PPromiseromise • Last year, Komen awarded $100 million in research grants nationwide and invested $160 million in local communities to provide underserved populations with access to breast cancer education, screening and treatment.

901 E Street N.W., Suite 400 Washington D.C. 20004 1-877 GO KOMEN | www.KomenAdvocacy.org

Page 85 of 88 GOVERNOR’S PROSTATE CANCER TASK FORCE

Prostate Cancer is not a matter of IF but a matter of WHEN!

1. Dr. William Catalona from Northwestern University recently stated:

“Prostate cancer is an insidious disease that arises silently, passes through a curable phase silently, and becomes incurable silently. If you wait for symptoms to signal its presence, it is too late to cure it.”

2. Start by getting a prostate-specific antigen (PSA) test to determine a baseline PSA starting at age 40, or at age 35 if you are at high risk of prostate cancer (i.e., those who are African-American, have bloodline relatives who had Prostate Cancer or have an indeterminate family history).

3. Keep a record; schedule your exam on an annual calendar basis such as Father’s Day, your birthday, or perhaps every September (Prostate Awareness Month).

4. An increase in the PSA is more important than the number itself and should be discussed with your physician.

5. I stated at the outset that it isn’t a matter of “IF”, but a matter of “WHEN”. If you do the things I just mentioned, you are taking control of the WHEN because Early Detection Saves Lives!!

Respectfully submitted,

Lewis Musgrove Chairman Governor’s Prostate Cancer Task Force

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