2016-2020 Utah State Cancer Plan

8/20/2019 2016-2020 Utah State Cancer Plan

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Prepared by: Utah Comprehensive Cancer Control Program, Utah Cancer Action Network

2016-2020Utah State

Cancer Plan


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Te members o UCAN created this State Cancer Plan with the shared vision that uture generations will onlyknow cancer as a historical plague. Utah, we dedicate this State Cancer Plan to you with a special dedication toeach and every Utahn who has been touched by this disease.


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January 1, 2016

My Fellow Utahns:

Many o us have been touched by cancer- whether in our own lives or through the lives o someone we know.Cancer has become the second leading cause o death in Utah.

Te fight against cancer is stronger than ever. We fight by supporting early detection. We fight by protecting our-selves and our children rom harmul substances. We fight by supporting medical research and providing state-o-the-art treatment. Last, but certainly not least, we fight by providing cancer survivors and their loved ones withprograms and services that address their physical, mental, and emotional needs, thereby increasing their quality olie.

Te Utah Cancer Action Network (UCAN) joined this fight in 2001. UCAN members offer their time, talents, andother resources to address primary prevention, early detection, and cancer survivorship by ocusing on the high

burden priority areas or the state.

Te 2016 -2020 Utah Comprehensive Cancer Prevention and Control Plan will be used to continue this noblefight. Tis is the ourth comprehensive cancer plan or the State o Utah, and it will guide Utahns as we make apositive impact on the lives o those affected by cancer.

By working together and using this plan, we can increase awareness o how to prevent cancer, detect cancer early,and improve the quality o lie or the courageous cancer survivors in our state. ogether we can help Utahns livehappier, healthier lives.

Sincerely

Gary R. HerbertGovernor


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Table of Contents

Introduction to the Plan.........................................................................................................2 UCAN Priorities.....................................................................................................................................2 Collaboration Priorities.......................................................................................................................2 The Planning Process...........................................................................................................................3

Implementation of the Plan................................................................................................................3

Overview of the Utah Cancer Action Network (UCAN)........................................................4 Overarching Approaches.....................................................................................................................5

How to Use This Plan...............................................................................................................6

Overview of Cancer Burden...................................................................................................8 Utah Demographics.............................................................................................................................8 Incidence and Mortality....................................................................................................................10 Health Disparities and Access to Care..............................................................................................11 Health Insurance and Medicaid Expanision.....................................................................................12

Cancer Screening...................................................................................................................13 Cancer Screening in Utah..................................................................................................................13 Disparities..........................................................................................................................................14 Cancer Screening Goals, Strategies, and Action Steps....................................................................15 Targets for Change.............................................................................................................................18

Physical Activity and Nutrition............................................................................................20 Burden in Utah...................................................................................................................................21 Disparities..........................................................................................................................................21 Physical Activity and Nutrition Goals, Strategies, and Action Steps..............................................23 Targets for Change.............................................................................................................................25

Skin Cancer....................................................................................................................................28 Burden in Utah...................................................................................................................................29 Disparities..........................................................................................................................................29 Skin Cancer Goals, Strategies, and Action Steps.............................................................................30 Targets for Change.............................................................................................................................31

Survivorship and Quality of Life..........................................................................................33 Burden in Utah...................................................................................................................................33 Disparities..........................................................................................................................................34 Cancer Survivorship Care Plan..........................................................................................................35 Survivorship and Quality of LifeGoals, Strategies, and Action Steps............................................36 Targets for Change.............................................................................................................................38

UCAN Collaboration Priorities.............................................................................................40 Human Papillomavirus......................................................................................................................40 Radon..................................................................................................................................................44 Tobacco...............................................................................................................................................47 Genomics............................................................................................................................................50

Glossary.................................................................................................................................54

Acknowledgments................................................................................................................56


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Introduction to the Plan

Te Utah Comprehensive Cancer Control Program (UCCCP), in coordination with the Utah Cancer ActionNetwork (UCAN), developed this five year plan as a guide or all those fighting cancer in Utah. Tis planprovides direction or those involved in the planning, implementation, and evaluation o cancer control efforts.Healthcare providers, community-based organizations, worksites, schools, policy makers, and other Utahns will

find it contains useul inormation on the burden o cancer in Utah and provides evidence-based strategies toreduce cancer risk, find cancers at an early stage, improve treatments, increase the number o people who survivecancer, and improve quality o lie or cancer survivors.Cancer is an evolving problem, and addressing it requires approaches unique to the specific needs o Utahns. oaccomplish this, UCAN chose timely, evidence-based priority areas to address over the next five years. Whilethese priority areas encompass the highest priority areas or the state, they do not necessarily represent all areasbeing addressed by partner organizations. For this reason, the state plan priorities have been divided into twosections: UCAN Priorities and Collaboration Priorities.

UCAN PrioritiesTese priority areas represent the highest burden areas or cancer control in the state, and reflect UCAN’s desire

to achieve meaningul and lasting impact during the next five years.

• Skin Cancer• Physical Activity and Nutrition• Cancer Screening• Survivorship and Quality of Life

Each UCAN Priority includes a set o evidence-based goals, strategies, and action steps. Goals represent thecoalition’s overarching ambitions in that particular area. Strategies describe the chosen method o reaching thegoal. Action steps contain specific efforts or projects that individuals and organizations can do to implementeach strategy. In addition to goals, strategies, and action steps, each priority area includes targets or change.

argets or change represent the long-term outcomes expected upon successul implementation o the goals andstrategies.

Collaboration PrioritiesCollaboration Priorities have been deemed an important area or the coalition to be involved, though thesepriorities will be led by outside organizations which will partner with UCAN to expand reach and improveoutcomes.

• Human papillomavirus (HPV)• Radon

• Tobacco• Genomics

Each Collaboration Priority includes a description o organizations who are involved with the work, a list ostrategies, and how UCAN can collaborate.



Introduction to the Plan

The Planning ProcessTe process o identiying priority areas began early in 2014. UCAN Executive Leadership reviewed previousstate plan priorities, existing data, and available resources to determine which priority areas should be addressed

in the uture. An initial set o priorities was drafed and presented to UCAN leadership or a vote. Tese prioritiewere taken to the larger coalition body and several rounds o discussions and voting occurred beore ourprimary priority areas were identified: skin cancer, physical activity and nutrition, cancer screenings, and cancersurvivorship. eams were established around each o these areas. Tese teams developed goals, strategies, andaction steps to direct coalition efforts.

Implementation of the PlanImplementation o this statewide cancer plan depends on effective evaluation. For this reason, UCAN will trackprogress o targets or change on an annual basis, and produce an annual report. UCAN commits to ongoing,complete evaluation measuring the outcomes and effectiveness o work being done. Te UCCCP evaluation staffwill direct evaluation efforts with aid rom coalition members and subgroups. A separate evaluation plan withall elements o the six steps o the Centers or Disease Control and Prevention (CDC) Framework or ProgramEvaluation will be a critical counterpart this 2016-2020 Utah Cancer Control Plan, and direct its evaluationactivities. Evaluation efforts and progress toward the targets or change will be highlighted on the UCAN website

Framework for Program Evaluation

EngageStakeholders

Describe the

program

Focus theevaluation

designGather

credibleevidence

Justify conclusions

Ensure useand share

lessons learned StandardsUtility

Feasibility Propriety Accuracy

Centers or Disease Control and Prevention. Retrieved rom http://www.cdc.gov/eval/ramework/



Overview of the UCAN

Te Utah Cancer Action Network (UCAN) is Utah’s comprehensive cancer control coalition, comprised o adiverse, proessional group o stakeholders rom across the state. Stakeholders represent a variety o groups andinterest areas, including state and local governments, private and nonprofit organizations, academic institutions,researchers, physicians, cancer survivors, caregivers, patients, and advocates. UCAN is led by an executive

committee that oversees coalition activities and determines coalition priorities.

Te mission of UCAN is to reduce cancer incidence and mortality in Utah.

Since its inception in 2001, UCAN has worked collectively to ensure continued progress with comprehensivecancer issues across Utah. UCAN provides many opportunities or collaboration among coalition partnersthrough activities designed to address the many acets o cancer prevention and control. UCAN links partnersto available resources through regular e-mails and inormation posted on the UCAN website. UCAN memberswork to prevent and control cancer through increasing awareness o cancer issues, connecting eligible patientsto screening services, increasing cancer screening among Utah’s underserved populations, and providingproessional and patient education.

Te coalition meets once per quarter to report on events and activities and to provide updates on current cancerissues and sponsorship opportunities. UCAN activities are unded by the UCCCP through a ederal grant romthe Centers or Disease Control and Prevention (CDC).



Overview of the UCAN

Policy, System and Environment Change

Te environments in which people live, work,learn, and play have an impact on their health,including cancer prevention. Policies, systems, andenvironmental (PSE) changes have the ability tomake long-term, sustainable improvements to the

health by addressing the root causes o poor health.PSE changes are included in the strategies andaction steps throughout the plan.

Statewide cancer prevention and control effortsrequire strong collaborations between communityorganizations, healthcare organizations, state andlocal health departments, policy makers, schools,and businesses. Tis plan will serve as a roadmap

or cancer-related collaboration efforts in the stateo Utah or the next five years.

Collaboration

Quality Improvement

Measuring quality and improving perormancein health care systems is important or patients to

receive quality cancer screening, treatment, andquality-o-lie services. Quality improvement willlead to better patient outcomes and decreased costs.

Strong Healthcare Workforce

Te quality and quantity o the healthcareworkorce or cancer prevention, screening,treatment and quality-o-lie services is importantor Utahns. Health workers must be adequately andappropriately trained to ensure that Utahns receive

access to the quality services and care they need.

Disparities

Te 2016-2020 Utah State Cancer Plan addressescancer-related health disparities and promoteshealth equity by improving access to quality andaffordable health services or all Utahns regardlesso geography, age, socioeconomic status, race,ethnicity, and culture.

Overarching ApproachesTe Utah State Cancer Plan addresses five overarchingapproaches to cancer prevention and control. In order

to meet the goals o this plan, these approaches havebeen incorporated into the strategies and action stepslisted in the plan.



How to Use This Plan

Te 2016-2020 Utah State Cancer Plan represents the largest ormal effort to address the burden o cancer in thestate o Utah. Tis plan identifies timely and significant priority goal areas or the state. Success in addressingthese areas is dependent on a diverse set o individuals and organizations working collaboratively, sharingresources, and utilizing unique skills. Below are examples o how different groups and individuals can help

achieve the goals o the plan.

Healthcare ProvidersHealth proessionals provide individuals and communities with the support necessary to prevent diseaseand promote health. Healthcare providers can work with patients to prevent and control cancer by routinelyasking about healthy liestyles actors including tobacco use, physical activity, diet, and in-home radon testing,recommending appropriate cancer prevention vaccines and screening tests, implementing office-basedreminders that identiy patients due or cancer prevention and screening services, learning about clinical cancerresearch studies available to patients, and providing cancer patients with a written summary o their care plan.

Local Health Departments

Local health departments are uniquely positioned to understand the needs o local communities and providequality services to those they serve. Local health departments can address the burden o cancer in a variety oways including providing cancer awareness education to Utahns; supporting community wellness campaigns;promoting prevention o chronic disease through healthy liestyle behaviors; and providing access to low-costcancer screenings, radon tests, and other health services.

Community-Based OrganizationsMany Utah communities ace significant challenges that affect the health and well-being o Utahns. Poorindividual and community health is ofen associated with other problems including poverty, educationalopportunities, crime, access to quality services, and an unhealthy environment. Community-based organizationsplay a key role in addressing these challenges, though many organizations can promote health as part o the work

they do. Community-based organizations can collaborate to provide community disease prevention programs;create a local action plan to reduce barriers to cancer screenings; provide cancer awareness inormation toUtahns; and provide community-based educational orums to address the specific and unique needs o cancersurvivors including physical, psychological, financial, social, and spiritual needs.

WorksitesMany Utahns spend a large proportion o their time at work. Worksites can impact the health o individualemployees, but also play a larger role in ensuring all Utahns are healthy and ree o disease. Employers andworksites can do this through encouraging employees to increase physical activity at home and during thework day; encouraging workplace participation in wellness programs; providing ull financial coverage orrecommended cancer screenings including time off or employees to get screened; providing healthy oodsand beverages in vending machines and caeterias; and providing protective clothing to employees applying

ertilizers, pesticides, and insecticides as well as sun-protective gear to employees working outside.

SchoolsSchools are important to the education o our students, but the school setting is also important to ensuring a



How to Use This Plan

healthy uture or our children. Healthy students are more involved in the classroom, exhibit ewerdisciplinary problems, and are better able to learn. School organizations should utilize this plan asan opportunity to promote health as an important aspect o school activity. Schools can prioritizehealth in the classroom by including chronic disease prevention messages in health classes, increase

physical education opportunities, make school campuses tobacco-ree, open acilities to the communityduring off hours to encourage community health, ensure ample shade is available or playgrounds andoutdoor acilities, provide only healthy oods and beverages on campus and in caeterias, and provideinormation to students and aculty about issues aced as cancer survivors return to school.

Policy MakersPublic policy plays a critical role in determining the prevalence o chronic diseases, including cancer.In Utah, access to necessary cancer services is not distributed equally across the state. Barriers toquality treatment include lack o access due to location, insurance status, culture, language, and lack oawareness. As a policy maker, there are important ways to address these issues. Using the inormation inthis plan, a policy maker could influence cancer prevention and control by ensuring that all Utahns have

access to affordable, high quality health care, raising awareness o cancer as an important health issue,and strengthening and establishing programs supporting cancer control.

UtahnsWhile many Utahns pride themselves on their healthy liestyles, there are still many things that canbe done to decrease the burden o cancer in our state. Utahns can choose to improve their own healthand reduce their risk o cancer through quitting smoking or never starting to smoke, eating a primarilyplant-based diet, increasing daily physical activity, maintaining a healthy weight, and protectingthemselves rom exposure to UV light. We can create a healthier environment or our amilies bytesting and remediating our homes or radon, limiting our use o pesticides and ertilizers, ensuringour children receive appropriate cancer prevention vaccines, and support community efforts to develop

and improve public spaces or physical activities. Even with these changes, it is important that Utahnsdiscuss cancer screenings with health care providers and receive necessary screenings, support cancercontrol policies, consider enrolling in clinical trials i diagnosed, and show support and provide care orthose living with cancer in their lives.



Overview of Cancer Burden

Utah DemographicsIn 2014, it was estimated that the population in Utah was 2,942,902. Utah’s population continues to grow rapidlyeach year. Te growth rate in Utah is almost double o the national growth rate.1 Utah is the “youngest” state in

the nation with the lowest median age o any state at 30.5, compared to the national median age o 37.7.2

Utah is the 13th largest state in geography. Much o the state is considered rural or rontier with very lowpopulation density. Approximately 80% o the state population lives along the Wasatch Front within the greaterurban centers o Salt Lake City, Ogden, and Provo.




Utah has limited racial and ethnic diversity with non-Hispanic Whites comprising nearly 80% o the population.Utah has a significant reugee population with over 45,000 reugees being resettled in Utah since 1988.3 Approximately 8.2% o Utahns are oreign born.1

Summary of Utah Race/Ethnicity Demographics 2014

Race/Ethnicity Number in thePopulation

Percent ofPopulation

N o n - H i s p a n i c

White 2,335,011 79.3%

Black or Arican American 31,051 1.1%

American Indian or AlaskanNative

28,583 1.0%

Asian 66,837 2.3%

Native Hawaiian or Other Pacific

Islander

26,769 0.9%

wo or more races 55,891 1.9%

Hispanic/Latino o Any Race 398,760 13.5%

Total: 2,942,902Source: Population Estimates by Age, Sex, Race, and Hispanic Origin or Countiesin Utah, U.S. Bureau o the Census, IBIS Version 2014

_________________________________________________________________________

1 U.S. Census Bureau. Utah QuickFacts. http://quickacts.census.gov/qd/states/49000.html Updated October 14, 2015. Accessed November 23, 20152 U.S. Census Bureau. U.S. QuickFacts. http://quickacts.census.gov/qd/states/00000.html Updated September 30, 2015. Accessed November 23, 2015.3 Utah Reugee Center. FAQ - About Reugees. http://utahreugee.org/aqs.html. Updated November 17, 2015. Accessed November 23, 2015.




Incidence and MortalityIn 2014, 3,033 Utahns died rom cancer. Cancer isthe second leading cause o death in both Utah and

the United States, exceeded only by heart disease.

Utah’s cancer incidence rate is approximately 10%lower than the national rate, and the mortality rate is26% lower.

Lung cancer is the leading cancer cause o death orUtah men. Breast cancer is the leading cancer cause

o death or Utah women.

Prostate cancer is the most commonly diagnosedcancer in Utah men. Breast cancer is the most

commonly diagnosed cancer in Utah women. Utah has the highest rate o melanoma in the US,and has a much higher rate o thyroid and prostatecancers.

Utah has the lowest rate o lung cancer in the US, aswell as the lowest smoking rates.

65%

34%

19%

-8%

-18%

-19%

-22%

-36%

-55%

-10%

-100% -50% 0% 50% 100%

Melanoma

Thyroid

Prostate

Breast

Urinary Bladder

Kidney and Renal Pelvis

Colorectal

Stomach

Lung

Overall

Comparison of Utah and U.S. Incidence for Select Cancer Site, 2008-2012

Source:

SEER

176.32 173.39 171.76 168.71 166.4

124.8 124.2 131.9 125.2 127.6

0

50

100

150

200

250

2008 2009 2010 2011 2012

U.S.

Utah

Utah and U.S. Cancer Mortality by year, Age-

adjusted Rate, Deaths Per 100,000 Population,

2008-201

Data Sources:

U.S. Data: United States Cancer Mortality Statistics: 1999-2012, CDC WONDER Database.

Utah Data: Utah Death Certificate Database, Office of Vital Records and Statistics, Utah Department of Health.

1,916

2,123

2,393

4,122

4,770

0 1,000 2,000 3,000 4,000 5,000

Lung and Bronchus

Colon and Rectum

Melanomas of the

Skin

Breast

Prostate

Number of New Cases

Top 5 leading Cancers by New Cases, Utah 2010-2012

Source:

619

638

737

757

1,352

0 200 400 600 800 1000 1200 1400

Prostate

Pancreas

Colon and

Rectum

Breast

Lung and

Bronchus

Number of Deaths

Top 5 leading Cancers by Number of Deaths, Utah 2010-2012

Source:

SEER*Stat Database: Mortality - All COD, National Cancer Institute


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Health Disparities and Access to CareHealth DisparitiesHealth disparities are differences in the incidence, prevalence, mortality, burden o disease, and other adverse

health conditions or outcomes that exist among specific population groups in the United States. Healthdisparities can affect population groups based on gender, age, ethnicity, socioeconomic status, geography,sexual orientation or gender identity, disability, or special health care needs. Disparities also affect groups thathave persistently experienced historical trauma, social disadvantage or discrimination, and who systematicallyexperience worse health or greater health risks than more advantaged social groups (National Association oChronic Disease Directors). Socioeconomic status (SES), poverty, and poor access to health care have a largeimpact on health outcomes. Tese actors play an important role in the prevalence o behavioral risk actors orcancer, such as tobacco use, poor nutrition, and physical inactivity. Individuals with low SES are also less likely toreceive recommended cancer screenings. Because o the significant and overarching role health disparities playin cancer control in Utah, a determination was made to integrate this issue into the priority areas o the 2016-2020 Plan.

Access to CareAccess to health services encompasses our components: coverage, services, timeliness, and workorce. Te ourcomponents are defined below.

Coverage: Health insurance assists patients in accessing the health care system. Lack o adequateinsurance makes it difficult or people to get the health care they need, and when they do get care,burdens them with large medical bills. Uninsured individuals are less likely to receive medical care,more likely to have poor health status, and more likely to die prematurely.

Services: Many patients, even those with health insurance, may orgo recommended or essentialhealth services. While many actors influence this problem, ensuring that people have a primary

care provider is a vital part o receiving appropriate services. People with a usual source o care havebetter health outcomes and ewer disparities and costs associated with their care.

Timeliness: imeliness is the health care system’s ability to provide health care quickly afer aneed is recognized as measured by the time spent between diagnosis and receipt o care and timespent waiting to receive care. Poor timeliness is associated with clinically significant delays in care,including increasing the number o patients not receiving services.

Workforce: Health specialists and primary care providers play an important role in promoting andensuring the health o the communities they serve. Tis is especially true in cancer prevention andcontrol where demand or oncologists is expected to exceed supply by as much as 30% by 2020. In

order to ensure an adequate health care system, it is important to track and increase the number ohealth care providers available to patients.

_________________________________________________________________________4 National Cancer Institute. Health Disparities Defined. Rockville, MD: U.S. Department o Health and Human Services, National Institutes o Health,

National Cancer Institute.5 C-Change. Sustaining a Strong National Cancer Workorce. 2012. C-Change Web site. http://c-changetogether.org/workorce.




Healthcare coverage rates have risen annually in thelast five years. In 2014, 86.6% o Utahns indicatedthat they had health care coverage (includinghealth insurance, prepaid plans such as HMOs, orgovernment plans such as Medicare).7

Health Insurance and Medicaid ExpansionHealth insurance plays a critical role in both health disparities and access to health care. Access to affordablehealth care helps all people stay healthy, avoid or delay the onset o disease, keep diseases they already have rom

becoming worse or debilitating, lead productive lives, and reduce costs. Despite the benefits o preventive healthservices, too many Utahns go without needed medical and preventive care, ofen because o financial barriers.Te Affordable Care Act (ACA) makes health care more affordable and accessible in generally two ways: first byrequiring private health plans to cover certain recommended preventive services without charging a deductible,copayment, coinsurance, or other cost sharing; and second by expanding access to Medicaid or low incomeindividuals. As a result o the ACA, Utah’s uninsured rate dropped 15% between 2013 and 2014. 6 Currently,Utah has not yet chosen to expand Medicaid resulting in more than 53,000 Utahns who are currently unable toaccess affordable health coverage o any kind. Medicaid expansion is critical to ensuring all Utahns have access toaffordable health care.

Healthcare coverage rates have risen annually in the last five years. In 2014, 86.6% o Utahns indicated that theyhad health care coverage (including health insurance, prepaid plans such as HMOs, or government plans such asMedicare).

81.6% 82.2% 83.1% 84.2%

86.6%

75%

80%

85%

90%

95%

100%

2010 2011 2012 2013 2014

P e r c e n t I n s u r e d

Utahns with Health Care Coverage,

Age-adjusted, 2010-2014

DataSource:

_________________________________________________________________________6 Gallup. Arkansas, Kentucky See Most Improvement in Uninsured Rates. 2014. Gallup Web site. http://www.gallup.com/poll/181664/arkansaskentucky-

improvement-uninsured-rates.aspx7 2014 Survey Results, Utah Behavioral Risk Factor Surveillance System, Office o Public Health Assessment, Utah Department o Health



UCAN PrioritieCancer Screeing

Finding cancer early is one o the most important ways to increase a person’s chance o survival. Tere is strongevidence that screening or breast, cervical, colorectal, and lung cancers is effective and can detect cancer atan early stage. Routine cancer screenings are the best way to identiy and detect cancers early. In addition todetecting cancer early, screening or colorectal and cervical cancers can prevent these cancers by identiying

precancerous lesions that can be removed.8

According to the American Cancer Society, early detection o cancer through screening has been determined toreduce mortality rom breast, cervical, colorectal, and lung cancers.9

Tree key priorities have been selected to aid in finding cancer in its earliest stages:1. Educate and encourage the public to ollow screening recommendations.2. Increase access to quality recommended cancer screenings.3. Implement healthcare systems-based strategies to increase cancer screening rates.

Cancer Screening in UtahTe rates o mammography and Pap tests historicallyand currently are lower in Utah compared nationalrates.Additionally, over the past 15 years bothmammography and Pap tests in Utah have beendecreasing.

For the last decade or more, colon cancer screeningrates in Utah have closely mirrored national screeningrates.

_________________________________________________________________________8 Smith RA, Manassaram-Baptiste D, Brooks D, et al. Cancer screening in the United States, 2015: a review o current American Cancer Society guidelines and

current issues in cancer screening. CA Cancer J Clin. 2015 Jan;65(1):30-54.9 Cancer Prevention and Early Detection Facts and Figures 2015-2016 American Cancer Society http://www.cancer.org/acs/groups/content/@research/

documents/webcontent/acspc-045101.pd

76.6% 76.0% 74.2% 76.1% 76.2% 74.9% 73.1% 72.3%

72.6%68.8% 66.4% 67.8% 67.2% 66.4% 67.8% 64.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2000 2002 2004 2006 2008 2010 2012 2014

U.S. Utah

Mammography in the Past Two Years Among Women 40+,

Utah and U.S. 2000-2014

DataSource : BRFSS

54.1%

57.0% 60.8% 64.1%

66.5% 65.5%

48.2%

57.7% 61.5%

66.8% 68.8% 68.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2002 2004 2006 2008 2010 2012

U.S. Utah

Recommended Colon Cancer Screening Among Adults 50+,

Utah and USA, 2002-2012

Source: BRFSS



UCAN Priorities-Cancer Screening

DisparitiesUtah women with lower income, lower education, andliving in rontier communities have significantly

lower rates o breast cancer screening. Te only racial/ethnic group o woman to have significantly lowerrates o breast cancer screening are American Indians.From 2010 to 2014, an estimated 54.4% o UtahnAmerican Indian/Alaskan native woman 50-74 years oage had received a mammogram in the past 2 years. 10

Colorectal Cancer Screening rates are significantlylower with more income and education levels.

Pacific islanders, Hispanics, Asians, American Indian/

Alaskan Natives in Utah have lower rates o coloncancer screening compared to the Utah state rate.

Utahns living in rontier setting have lower rates o

colorectal cancer screening. Tere is no differencebetween colorectal cancer screening rates among menand women.

74.3% 73.8%

63.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Urban Rural Frontier

Percent of Women Ages 50-74 Who Have Completed Recommended

Breast Cancer Screening,

by Population Density, 2010-2014

Source: Utah BRFSS

70.8%68.8%

60.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Urban Rural Frontier

Percentage of Women ages 50-74 Having a Mammogram in thePast 2 Years, by Population Density, Utah, 2010-2014

Source: Utah BRFSS

46.4%52.6% 53.6% 55.1%

69.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pacific

Islander

Hispanic Asian American

Indian/Native

Alaskan

State (All

Race/Eth.)

Percent of Utahns Ages 50-74 Who Have Completed Recommended Colon

Cancer Screening, by Race/Ethnicity (disparate groups only), 2010-2014

Source: Utah BRFSS

___________________________________10 Utah Behavioral Risk Factor Surveillance System, Office o Public Health

Assessment, Utah Department o Health

53.3%

67.5%73.9%

78.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

B el ow H ig h Sc ho ol H ig h Sc ho ol o r GE D S om e Po st H ig h Sc ho ol C ol le ge G ra du at e

Percent of Utahns Ages 50-74 Completing Recommended Colon Cancer

Screening, by Education, 2013-2014

Source:UtahBRFSS




Cancer ScreeningGoals, Strategies, and Action Steps

Goal: Increase the number of Utahns who receive recommended cancer screenings

Strategy A: Encourage the public to receive recommended cancer screenings by providing educationusing evidence-based communication methods.

What will success look like? Te public will have received education that positively influences their decision toreceive recommended cancer screenings.

Action Steps• Increase public knowledge about cancer screening acts and guidelines through multiple avenues,

including small media and provider recommendation.

• Provide culturally competent and cancer-specific educational materials, including small media, inmultiple languages to targeted communities.• Coordinate with state and local health partners to promote cancer screening opportunities throughout

the state.• Advocate or a statewide accreditation or community health workers.

National Strategy Alignment: Centers for Disease Control and Prevention. (2014). Increasing Population-basedBreast and Cervical Cancer Screenings: An Action Guide to Facilitate Evidence-based Strategies. Atlanta, GA.Centers for Disease Control and Prevention. (2013). Increasing Colorectal Cancer Screening: An Action Guide forWorking with Health Systems. Atlanta, GA.




_________________________________________________________________________11 Te Guide to Community Preventive Services: Te Community Guide. 2015. Increasing Cancer Screening: Reducing Structural Barriers or Clients.

Community Preventive Services ask Force Web site. http://www.thecommunityguide.org/cancer/screening/client-oriented/ReducingStructuralBarriers.html.

Strategy B: Decrease barriers to cancer screenings.

What will success look like? All Utahns will have access to affordable cancer screenings.

Action Steps• Increase awareness related to health care reorm and subsequent changes in coverage or recommended

cancer screenings.• Educate underinsured and uninsured Utahns about available programs offering cancer screenings that

are provided at little or no cost.• Advocate or programs that provide cancer screening at little or no cost.• Increase awareness o ree or low-cost cancer screening programs.

• Increase access to mobile screening acilities in rural areas.• Encourage the use o in home testing options, such as ecal occult blood test (FOB) or ecal

immunochemical tests (FI).

• Support partnerships with organizations that provide patient navigation, case management, andcommunity health worker services.

• Support initiatives to identiy unrecognized barriers to screening, including barriers that affect disparatepopulations.

National Strategy Alignment: Centers for Disease Control and Prevention. (2014). Increasing Population-basedBreast and Cervical Cancer Screenings: An Action Guide to Facilitate Evidence-based Strategies. Atlanta, GA;Centers for Disease Control and Prevention. (2013). Increasing Colorectal Cancer Screening: An Action Guide forWorking with Health Systems. Atlanta, GA.

Structural barriers are non-economic burdens or obstacles that make it difficult or people to access cancer

screening. Te action steps address access issues to cancer screening including offering mobile mammographyunits in rural settings, ree or low cost screening services, patient navigators, and community health workers. 11




Strategy C: Increase uptake of recommended cancer screenings in health care settings throughevidence-based strategies and policy change.

What will success look like? Health care providers will adopt policy changes that aim to increase the uptake orecommended cancer screenings.

Action Steps• Offer education to providers on strategies to educate patients about recommended screenings and their value.

• Encourage clinics to adopt a policy to discuss risk actors that affect routine screening recommendations(e.g. amily history and genetics) with patients.

• Encourage clinics to adopt a policy to assess cancer screening during a patient’s periodic healthexamination.

• Encourage clinics to adopt a policy to assess clinic workflow and implement a reminder system oridentified patients requiring cancer screenings.

National Strategy Alignment: Centers for Disease Control and Prevention. (2014). Increasing Population-basedBreast and Cervical Cancer Screenings: An Action Guide to Facilitate Evidence-based Strategies. Atlanta, GA;Centers for Disease Control and Prevention. (2013). Increasing Colorectal Cancer Screening: An Action Guide for

Working with Health Systems. Atlanta, GA.

Strategy D: Encourage employers to implement policies that increase recommended cancerscreenings among employees.

What will success look like? Employers will have implemented policy changes to encourage and acilitateemployees receiving recommended cancer screenings.

Action Steps• Encourage employers to implement policies that allow employees to receive recommended cancer

screenings during work time including the use o a mobile screening van or paid time off.

• Encourage employers to provide education about recommended cancer screenings, including insurancecoverage, to employees• Encourage employers to incorporate cancer screenings into worksite wellness programs.

National Strategy Alignment: Centers for Disease Control and Prevention. (2014). Increasing Population-basedBreast and Cervical Cancer Screenings: An Action Guide to Facilitate Evidence-based Strategies. Atlanta, GA;Centers for Disease Control and Prevention. (2013). Increasing Colorectal Cancer Screening and PromotingScreening Quality: An Action Guide for Engaging Employers and Professional Medical Organizations. Atlanta, GA.

UCAN has taken the 80% by 2018 pledge to increase colorectal cancer screening rates to 80% by theyear 2018. Te 80% by 2018 is a national initiative that was launched by the National Colorectal CancerRoundtable (NCCR). Te first step in reaching this goal is to create a Colorectal Cancer Roundtable that

will be a subgroup o UCAN. Te subgroup will ocus on implementing the strategies developed by theNCCR and their partners including education, decreasing barriers to screening, and promoting policy andsystems changes.



Targets for Change

Increase the proportion of adults who

receive a colorectal cancer screeningbased on the most recent USPSTFguidelines.Baseline: 71.0% (adults ages 50-75, 2014 BRFSS)Utah 2020 arget: 80%Data Source: BRFSSAligns with: Healthy People 2020, C-16;Comprehensive Cancer Control National Priorities,National Colorectal Cancer Roundtable

Reduce the rate of colorectal cancerdiagnosed at an advanced (regional ordistant) stage among adults ages 50 to 74.2014 Baseline: 36.08 per 100,000 population (2012 SEER)Utah 2020 arget: 32 per 100,000 populationData Source: Utah Cancer Registry/SEER Aligns with: Healthy People 2020, C-16;Comprehensive Cancer Control National Priorities

Increase the proportion of women whoreceive a breast cancer screening based onthe most recent USPSTF guidelines

Baseline: 73.3% of women ages 50-74 hadmammography in the past 2 years (2014 BRFSS)Utah 2020 arget: 76%Data Source: BRFSSAligns with: Healthy People 2020, C-17

Reduce the rate of breast cancerdiagnosed at an advanced (regional ordistant) stage among women ages 40 to74.Baseline: 86.45 per 100,000 Women (2012 SEER)

Utah 2020 arget: 80 per 100,000 womanData Source: Utah Cancer Registry/SEER Aligns with: Healthy People 2020, C-11

Increase the proportion of women whoreceive a cervical cancer screening basedon the most recent USPSTF guidelines.Baseline: 77.6% of women ages 21-65 had a pap

test in the past 3 years (2014 BRFSS)Utah 2020 arget: 83%Data Source: BRFSSAligns with: Healthy People 2020, C-15

Reduce the rate of cervical cancerdiagnosed at an advanced (regional ordistant) stage among women ages 20 to64.Baseline: 2.88 per 100,000 woman (2012 SEER)Utah 2020 arget: 2.5 per 100,000 woman

Data Source: Utah Cancer Registry/SEER Aligns with: Healthy People 2020, C-15

Increase the proportion of men ages40 and above who have discussed theprostate-specific antigen (PSA) test toscreen for prostate cancer with theirhealth care provider.Baseline: 54.7% (2012-2014 BRFSS)Utah 2020 arget: 57.5%Data Source: BRFSS

Aligns with: Healthy People 2020, C-19

Reduce the rate of lung cancer diagnosedat an advanced (regional or distant) stageamong adults ages 55 to 74.2014 Baseline: 69.16 per 100,000 population (2011-2012 SEER)2020 Goal: 62 per 100,000 populationData Source: Utah Cancer Registry/SEER Aligns with: Healthy People 2020, C-2





Policy, Systems, and Environmental (PSE) versus Individual Behavior Approach forCancer Screening

Setting Individual Behavior Approach PSE ApproachHealthcare Organizations ell a patient he or she is due or a

cancer screening test.Establish an electronic and paper remindersystem to notiy providers to recommendscreenings, and to patients to get screenings.Establish clinical staff roles or ollowing upon screening reerrals and appointments.

Workplace Provide inormation to employeesabout recommended ages orcancer screenings.

Provide incentives or employees to getcancer screenings, including paid timeoff, monetary incentives, or incentives orworkplace wellness programs.

Cancer Screening Efforts• A subgroup o UCAN, Utah Mammography Action Coalition (UMAC), is currently working withworksites to receive the CEO Cancer Gold StandardM Accreditation. Te accreditation provides aramework or employers to have a healthier workplace by ocusing on cancer risk reduction, earlydetection, access to clinical trials, and high-quality care. http://www.cancergoldstandard.org/

• Jakob Jensen, a Proessor at the University o Utah, is partnering with the Utah Department o Health,University o Utah, and Huntsman Cancer Institute screening acilities in a “real-time” evaluation studythat will provide precise longitudinal data concerning the quantity, characteristics, and motivations opatients or getting a mammogram or colonoscopy. Te study will also evaluate the impact o ongoingscreening interventions. A survey will be administered to patients during registration and data will besent in real-time through a secure server.

• Te Utah Breast and Cervical Early Detection Program provides ree and low cost breast and cervicalcancer screenings to Utah’s low-income population.



UCAN PrioritiesPhysical Activity and NutritionDiet, physical activity, and weight play an important role in determining an individual’s cancer risk. Maintainingrecommended levels o physical activity and eating a diet filled with a variety o plant oods such as vegetables,ruits, whole grains and beans helps lower the risk or many cancers. Weight management is also important.More than two-thirds o American adults are overweight or obese.12 Being overweight or obese is a risk actor or

several types o cancer, including breast, colorectal, kidney, and esophageal.

It is estimated that one third o all cancers, or 345,000 cases in the US, are preventable through improved diet,physical activity, and weight management.13 o reduce risk o chronic disease and promote overall health,including reducing the risk o cancer, it is important to eat a nutritious diet and be physically active. Tisincludes:14

• Be as lean as possible without becoming underweight• Be physically active or at least 30 minutes every day • Avoid sugary drinks and limit consumption o energy-dense oods• Eat more o a variety o vegetables, ruits, whole grains and legumes such as beans• Limit consumption o red meats (such as bee, pork and lamb) and avoid processed meats

• I consumed at all, limit alcoholic drinks to 2 or men and 1 or women a day • Limit consumption o salty oods and oods processed with salt (sodium)• Don’t use supplements to protect against cancer• It is best or mothers to breasteed exclusively or up to 6 months• Afer treatment, cancer survivors should ollow the recommendations or cancer prevention

“Obesity is on its way to replacingtobacco as the number onepreventable cause o cancer. We

need to conront this growingproblem and develop all thenecessary tools to limit its impact.”

- Clifford Hudis, MD, 2013-2014

American Society o Clinical Oncology

(ASCO) President

_________________________________________________________________________12 http://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/obesity-and-cancer13 http://www.aicr.org/research/research_science_policy_report.html14 Food, Nutrition, Physical Activity, and Cancer Prevention: A Global Perspective, AICR and World Cancer Research Fund, November 2007. http://www.aicr.

org/reduce-your-cancer-risk/recommendations-or-cancer-prevention/



UCAN Priorities-Physical Activity and Nutrition

Burden in Utah

Compared nationally in 2014, Utah ranks 45th lowest

in adult (18+) sel-reported obesity rates with 25.7%o Utahns reporting obese (BMI 30+) compared to thenational rate o 29.5%. In 2008, Utah obesity-relatedadult health care expenditures were estimated at $485million.

Historically Utah has higher ruit consumption andslightly higher vegetable consumption compared innational rates. Nutrition data in Utah shows littleincrease or decrease over time. Fruit and vegetableconsumption generally are lower among those withlower education and income.

DisparitiesAccess to healthy oods and physical activityopportunities and resources can be a barrier to eating abalanced diet and being active; thereore the strategiesand action steps in this plan ocus on increasing access,especially in rural and underserved areas.

Tere is little measurable difference nutritional dataamong race and ethnic groups. American Indiansin Utah have significantly lower ruit consumption

but not significantly lower vegetable consumptioncompared to the state rate. Compared to the state rate,ruit consumption is lower in the rural and rontierpopulations and vegetable consumption is only loweramong the Utah rontier populations.16

Pacific Islanders, Blacks, American Indians, andHispanics all have significantly higher obesity oroverweight rates than the state rate.

_________________________________________________________________________15 http://health.utah.gov/opha/publications/hsu/1205_EIObesity.pd 16 2011-2013 Survey Results, Utah Behavioral Risk Factor Surveillance System, Office o Public Health Assessment, Utah Department o Health

79.1%

70.9%68.3% 68.2%

60.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pacific

Islander

Black American

Indian/Native

Alaskan

H is pa nic Al l Ut ahns

Age-adjusted Percentage of Adults Overweight & Obese (BMI 25+)

by Race/ Ethnicity, Utah, 2012-2014 (disparate groups only)

Source: Utah BRFSS

32.8%

40.9%

26.3%

46.8%

27.0% 26.2%

0%

10%

20%

30%

40%

50%

60%

Ideal Overweight obese

Male Female

Weight Status Among Adult 18+,

Age-Adjusted by Sex, Utah 2014

Source: 2014 Utah BRFSS



Utah males tend to have more weight problemsthan emales. Adolescent obesity among Utah HighSchoolers was reported as twice as high among Males(10.2%) compared to Females at (4.6%).17 Among

Utah adults Women have reported significantly higherrates o having a healthy weight, while men showhigher rates o being overweight, however there isno statistical difference o obesity rates among Utahadults.18

Compared to heterosexual women, women who

identiy as homosexual, bisexual, or other sexualorientation have significantly higher rates o obesity.Tere is no such significant difference among maleobesity rates by sexual orientation.

Both higher education and higher income areassociated with higher activity levels among Utahadults

32.8%

40.9%

26.3%

46.8%

27.0% 26.2%

0%

10%

20%

30%

40%

50%

60%

Ideal Overweight obese

Male Female

Weight Status Among Adult 18+,

Age-Adjusted by Sex, Utah 2014

Source: 2014 Utah BRFSS


_________________________________________________________________________17 2014 Survey Results, Utah Youth Risk Behavior Surveillance System, Utah State Office o Education18 2014 Survey Results, Utah Behavioral Risk Factor Surveillance System, Office o Public Health Assessment, Utah Department o Health

24.4%

31.1%

0%5%

10%15%20%25%30%35%40%45%50%

Heter osex ual Homosex ual/Bisexual/Other

Percent Obesity (30+ BMI) Among Females, by Sexual

Orientation,Age-Adjusted, Utah 2011-2014

Source:

Utah BRFSS

47.5%52.8% 54.6%

64.6%

0%

10%

20%

30%

40%

50%

60%

70%

0-$24,999 $25,000-$49,999 $50,000-$74,999 $75,000+

Percentage of Adults (age-ajdusted)

Who Meet Aerobic Activity Recommendations

by income, Utah, 2013

Source: Utah BRFSS




Physical Activity and NutritionGoals, Strategies, and Action Steps

Goal 1: Increase the number of Utahns who meet current Dietary Guidelines19

Strategy A: Increase the access to healthy foods in schools, worksites, and communities throughpolicy, systems, and environmental changes.

What will success look like? Schools, worksites, and communities throughout the state will have access to healthyood options.

Action Steps• Advocate or increased access to armer’s markets and community gardens or underserved populations.• Develop interventions to increase access to healthy oods in areas with little or no access.

• Partner with worksites to implement healthy ood policies that increase access to ruit and vegetables oremployees.• Increase access to culturally appropriate oods.• Encourage the use o space or community gardens and armer’s markets in underserved areas.• Partner with community supported agriculture (CSA) programs to increase access to locally grown oods.

National Strategy Alignment: Centers for Disease Control and Prevention. (2014). Healthier Food Retail: An ActionGuide for Public Health Practitioners. Atlanta, GA; Centers for Disease Control and Prevention. (2011). Strategies toPrevent Obesity and Other Chronic Disease: Te CDC Guide to Strategies to Increase the Consumption of Fruits andVegetables. Atlanta, GA.

_________________________________________________________________________19 http://health.gov/dietaryguidelines/



Goal 2: Increase the amount of Utahns who meet current Physical Activity Guidelines20

Strategy A: Increase physical activity in schools, worksites, and communities through policy, systems,and environmental change.

What will success look like? Opportunities and resources or physical activity will exist in Utah communities.

Action Steps• Advocate or more parks and open spaces in underserved communities.• Promote and support state and local policies that create environments conducive to regular physical activity.• Work with communities to develop active transportation plans and policies to encourage physical activity.• Assist underserved communities to implement policies that encourage the development and utilization ophysical activity resources including affordable recreation acilities, green spaces, and parks.• Promote programs, such as the Sae Routes to School Program, that make it sae or students to walk to androm school.

• Collaborate with worksites and schools to implement policies that increase opportunities or employees andstudents to be physically active.• Work with underserved communities to increase social support interventions in community settings.

National Strategy Alignment: U.S. Department of Health and Human Services. (2015). Step It Up! Te SurgeonGeneral’s Call to Action to Promote Walking and Walkable Communities. Washington, D.C.; U.S. Departmentof Health and Human Services. 2008. Physical Activity Guidelines for Americans. Washington, D.C; CommunityPreventative Services ask Force. (2014). Behavioral and Social Approaches to Increase Physical Activity: SocialSupport Interventions in Community Settings

Research has shown associations between physical activity and maintaining a normal weight lowers the risk

o breast cancer. Physical activity has also shown to be linked with lower risk o recurrence o cancer andhigher quality o lie ollowing treatment.21

_________________________________________________________________________20 http://health.gov/paguidelines/21 Department o Health and Human Services. Physical Activity - Te Missing Link in Cancer Care. Retrieved rom http://odphp.tumblr.com/

post/131766503025/physical-activity-the-missing-link-in-cancer




Targets for Change

Reduce the proportion of adolescents in

grades 9 through 12 who are consideredobese (at or above the 95th percentile forbody mass index, by age and sex).Healthy People 2020Baseline: 7.5% (2011 & 2013 YRBS)Utah 2020 Target: 5.5%Data Source: YRBSAligns with: Healthy People 2020, NWS-10

Reduce the proportion of adults who areobese (defined as a BMI of 30 or more).Baseline: 26.3% (2014 BRFSS age-adjusted)Utah 2020 Target: 24.5%Data Source: BRFSSAligns with: Healthy People 2020, NWS-9

Increase the proportion of adults who areat a healthy weight (defined as a BMI lessthan 25).Baseline: 39.5% (2014 BRFSS age-adjusted)Utah 2020 Target: 41.5%Data Source: BRFSSAligns with: Healthy People 2020, NWS-8

Increase the consumption of fruits to two or moreservings per day.Baseline: 34.2% adults (2013 BRFSS age-adjusted),34.3% adolescents (2013 YRBS)Utah 2020 Target: 36% (adults and adolescents)Data Source: BRFSS, YRBSAligns with: Healthy People 2020, NWS-14; NationalPrevention Strategy

Increase the consumption of vegetables tothree or more servings per day.Baseline: 17.5% adults (2013 BRFSS age-adjusted),14.2% adolescents (2013 YRBS)Utah 2020 Target: 18.4% adults, 15% adolescentsData Source: BRFSS, YRBSAligns with: Healthy People 2020, NWS-15.1; NationalPrevention Strategy

Increase the proportion of adolescents ingrades 9 through 12 who are physicallyactive for 60+ minutes daily.Baseline: 48.7% (2013 YRBS)Utah 2020 Target: 51.1%Data Source: YRBS

Aligns with: Healthy People 2020, PA-3.1; NationalPrevention Strategy

Increase the proportion of adults whoare physically active as defined as “150+min/week of at least moderate intensity,or 75+ min/week of vigorous intensity,or an equivalent combination of aerobicphysical activity.”Baseline: 58.5% (2011- 2013 BRFSS)Utah 2020 Target: 62%

Data Source: BRFSSAligns with: Healthy People 2020, PA-2.4; NationalPrevention Strategy





Policy, Systems, and Environmental (PSE) versus Individual Behavior Approach forPhysical Activity

Setting Individual Behavior Approach PSE ApproachSchool each the benefits o physical

activity in a health course.Develop a walking school bus program that makes iteasy or students to walk and exercise beore and aferschool.

Workplace Host a one-time “get fit” challengeor employees.

Develop an incentive program that encourages walkingand exercising during the workday.22

Community Promote recreation center acilitiesand community classes or physicalactivity.

Advocate or local government to develop open spacesinto public parks and recreation areas that allow orincreased physical activity.

Physical Activity Efforts

• Utah Department o Health’s Comprehensive Cancer Control Program is in partnership with theHealthy Living through Environment, Policy, and Improved Clinical Care (EPICC) program and theUtah Department o ransportation (UDO) or bike-pedestrian master planning processes to integratephysical activity into local community planning efforts in five rural areas in Utah. Tis project expandsupon the previous year o unding three municipal active transportation efforts, which was highlysuccessul.

• Te National ongan American Society (NS) is currently working on increasing community-widephysical activity in two cities in Salt Lake County that have a large Pacific Islander population. Joint-Use-Agreements (JUA) will be used to increase ree, sae, and available acilities that will be open to the publicor physical activity.

• he Utah Department o Health WISEWOMAN Program provides eligible Utah women with the

knowledge, skills, and opportunities to improve their diet, physical activity, and other lie habits toprevent, delay, or control cardiovascular disease (CVD) and other chronic diseases.

_________________________________________________________________________22 U.S. Department o Health and Human Services. 2015. Step It Up! Te Surgeon General’s Call to Action to Promote Walking and Walkable Communities.

U.S. Surgeon General Web site. http://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/.




Policy, Systems, and Environmental (PSE) versus Individual Behavior Approach forNutrition

Setting Individual Behavior Approach PSE ApproachSchool Discuss the importance o healthy

eating with students during theschool day.

Develop a walking school bus program that makes iteasy or students to walk and exercise beore and aferschool.

Workplace Challenge employees to bringhealthy lunches to work.

Dedicate workplace land or use as an employee garden,incentivize employees to tend the garden, and utilize theresulting produce in the onsite caeteria.

Community Promote a local armer’s marketthrough flyers, signs, email, andnewsletters.

Facilitate arm-to-plate agreements between local oodproducers and community organizations includingschools and hospitals.

Nutrition Success Stories• Salt Lake County has accomplished great strides in urthering arm to school programs not only within

Salt Lake County, but around the state as a whole. Salt Lake County began their project by compilingthe first list o all the local growers, armers, and producers in the state which previously did not exist inUtah. Salt Lake County then began to offer arm field days to low income elementary schools to educatekids, teachers, and administrators about how local ood can be incorporated into school curriculum.Afer creating contacts with both local armers and school nutrition administrators, staff, and schoolprincipals, Salt Lake County set up met and greet sessions between the two groups that culminated inhosting the first arm-to-school conerence in Utah being cosponsored by the State Office o Educationand the Department o Agriculture. Te conerence was very successul resulting in partnerships betweenmultiple growers and school districts around the Salt Lake metropolitan area. Salt Lake County also

developed resources or both schools and armers to use to develop working and lasting relationships aswell a complete toolkit any school can use to procure more resh local ood. Te arm-to-school programwas so successul and grew so ast, that the State Office o Education has taken over management o theprogram to encourage schools around the state to buy local as ofen as possible.

• Te International Rescue Committee (IRC) opened the Sunnyvale Farmer’s Market in June 2015. Temarket operated or 18 weeks in Valley Center Park, located in the panhandle o Millcreek, in what theUSDA designates as Salt Lake County’s largest ood desert. By offering a “match” program or customersusing the Supplemental Nutrition Incentive Program (SNAP), the SFM was able to double, up to $10,resh ruit and vegetable purchases. Afer establishing itsel as a source or local, nutritious ood, the SFMdrew in more than 100 people each week and became a source o economic generation or armers andprepared ood vendors throughout the Salt Lake Valley.



UCAN PrioritiesSkin Cancerkin cancer is the most commonly diagnosed cancer in the United States, and most cases are preventable.Melanoma is the most serious o three types o skin cancer (basal cell carcinoma, squamous cell carcinoma, andmelanoma). It is estimated that 90 percent o non-melanoma skin cancers and 65 percent o melanoma skincancers are associated with exposure to ultraviolet (UV) radiation rom the sun. Te risk or melanoma is greatly

increased by tanning, both outside UV exposure and by using indoor sunlamps and tanning booths.

Geography plays a role in determining melanoma risk. Individuals who live in areas with a high elevation,warmer climate, and where sunlight can be reflected by sand, water, snow, and ice experience higher rates omelanoma. Utah is the third highest state in elevation with an average elevation o 6,100 eet and the occurrenceo snow and ice in the winter months. Outdoor recreation is popular in Utah, urther exposing residents to UVradiation.

Te risk o skin cancer can be decreased through exercising proper sun saety measures including wearingprotective clothing (e.g. long-sleeved shirts and long pants that utilize tightly woven abric); hats and sunglasses;using sunscreen with an SPF o 15 or higher; seeking shade under an umbrella, tree, or shelter when possible;

avoiding be outdoors during peak sunlight hours (9:00 am to 3:00 pm); and avoiding indoor tanning andsunbathing.23

_________________________________________________________________________23 Guide to Community Preventive Services. Preventing skin cancer: education and policy approaches. www.thecommunityguide.org/cancer/skin/education-

policy/index.html. Last updated: 05/22/2014.



UCAN Priorities-Skin Cancer

Burden in UtahUtah’s melanoma cancer incidence is higher than thenational rate and continues to be on an upward trend.

In 2012, the age-adjusted melanoma incidence ratein Utah was 34.6 per 100,000 compared to 19.9 per100,000 nationally. Te mortality rate o melanomain Utah is also much higher than the national rate.In 2012, the age-adjusted melanoma mortality ratein Utah was 3.7 per 100,000 and 2.7 per 100,000nationally.

DisparitiesTe risk o melanoma increases with age and affectsmen more than women. Utah males are significantlymore likely than Utah emales to be diagnosed withmelanoma o the skin among those 45-64 years o age(58.3 per 100,000 males vs. 41.9 per 100,000 emales)and among those 65 years o age and over (194.7 per100,000 males vs. 63.5 per 100,000 emales).

Te risk is also much higher or non-Hispanic whitesthan or any other racial group, especially those withred or blond hair, blue or green eyes, or air skinthat reckles or burns easily. Utah’s population o

non-Hispanic whites comprises nearly 80% o thepopulation.

Utah emales 18 to 34 years o age are significantlymore likely to practice one or more sun saetymeasures compared to males o a similar age (63.2percent compared with 48.9 percent). However,emales are more likely to report using an indoortanning device compared to males (9.5 percentcompared to 4.0 percent in the last 12 months). Tissame pattern is seen in adolescents (grades 9-12) who

reported using an indoor tanning device with 6.1percent o adolescent males reporting using an indoortanning device compared to 12.8 percent o adolescentemales.

99.6

48.6

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Male Female

R a t e

p e r 1 0 0 , 0 0 0

Source:

Utah Cancer Registry, Population estimates provided by the National Center for Health Statistics

(NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2014.

Utah Incidence of Melanoma Skin Cancer Among Adults 45+,

Rate per 100,000, by Sex; 2008-2012

30.330.7

33.7 34.2 34.6

19.7 20.1 19.7 20.1 19.9

0

5

10

15

20

25

30

35

40

2008 2009 2010 2011 2012

Utah U.S.

Incidence of Melanoma Skin Cancer, Utah and U.S.

Rate per 100,000 Age Ajdusted 2008-2012

DataSource: United States Cancer Statistics: 1999 -2012 Incidence, WONDER Online Database. United States Department of Health and Human

Services, Centers for Disease Control and Prevention and National Cancer Institute; 2015.




Skin CancerGoals, Strategies, and Action Steps

Goal: Prevent skin cancer

Strategy A: Increase awareness through education on skin cancer prevalence and prevention.

What will success look like? Schools, worksites, policy makers, and the general public will be aware o skincancer prevalence in Utah and ways they can prevent it.

Action Steps• Develop strategies or increasing awareness o skin cancer prevention or use in a school-based setting.• Increase skin cancer prevention education in worksites and public entities.• Provide education on skin cancer prevention and prevalence to policy makers.

• Identiy and educate populations at high risk or skin cancer.• Create and market an educational campaign in conjunction with National Skin Cancer Prevention andDetection Month in order to increase Utahns’ awareness o skin cancer prevention and prevalence.

National Strategy Alignment: U.S. Department of Health and Human Services. (2014). Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, DC; Community Preventative Services ask Force. (2012). CommunityBased Skin Cancer Prevention that Works.

Strategy B: Promote policy, system and environmental changes to decrease the risk for skin cancer.

What will success look like? Schools, worksites, and public entities will implement policy, systems, andenvironmental changes that will decrease the risk o skin cancer.

Action Steps• Advocate or increased availability o shade in schools, worksites, and public places through natural and builtstructures.• Advocate or policy changes in worksites that increase sun protective measures, such as shade and sunscreen,or outdoor employees.• Advocate or policy efforts and interventions addressing tanning behavior.• Monitor the population’s engagement in skin cancer preventive behaviors or use in the development oevidence-based interventions.• Advance statewide policy efforts that increase the legal age o tanning to 18.

National Strategy Alignment: U.S. Department of Health and Human Services. (2014). Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, DC; Community Preventative Services ask Force. (2012). CommunityBased Skin Cancer Prevention that Works.




Targets for Change

Reduce Melanoma Cancer Deaths.

Baseline: 3.42 deaths per 100,000 persons (age-adjusted 2013-2014)Utah 2020 Target: 2.8 deaths per 100,000 persons(age-adjusted)Data Source: Utah Death Certificate Database, Officeo Vital Records and StatisticsAligns with: Healthy People 2020, C-8

Reduce the percentage of adults whoreport sunburn in the last twelve months.Baseline: TBD in 2016 BRFSSUtah 2020 Target: 5% improvement

Data Source: BRFSSAligns with: Healthy People 2020, C-20.2

Reduce the proportion of adolescents ingrades 9 through 12 who report sunburn. Baseline: TBD in 2015 YRBSUtah 2020 Target: 5 percent improvementData Source: YRBSAligns with: Healthy People 2020, C-20.1

Reduce the proportion of adolescents in

grades 9 through 12 who report usingartificial sources of ultraviolet light fortanning.Baseline: 9.5% (2013 YRBS)Utah 2020 Target: 7%Data Source: YRBSAligns with: Healthy People 2020, C-20.3

Reduce the proportion of adultswho report using artificial sources ofultraviolet light for tanning.

Baseline: 6.7% (2011- 2012 BRFSS age-adjusted, usewithin the last 12 months)Utah 2020 Target: 5%Data Source: BRFSSAligns with: Healthy People 2020, C-20.4




Policy, Systems, and Environmental (PSE) versus Traditional Approach

Setting Individual Behavior Approach PSE Approach

School each students the importance o

wearing sunscreen.

Incorporate sun protection as part o school policies,

planning and development o school acilities.Workplace Encourage employees to avoid

prolonged UV exposure.Develop an incentive program that encourages walkingand exercising during the workday.

Community Organize races or walks to raiseawareness o skin cancer.

Incorporate shade planning in land use development,support organizational policies that discourage indoortanning by adolescents and young adults, or advocateor additional policy restrictions.

Skin Cancer Prevention Efforts• UCAN has and continues to advocate or stricter teen tanning laws in Utah. In 2012, Utah Senate Bill 41

was passed requiring parental consent each time a minor visits an indoor tanning salon unless they have

a doctor’s note. In 2014, a study was conducted by Te Utah Department o Health revealing that teentanning rates decreased ollowing the implementation o the tanning restriction.25

• UCAN partners are concerned with children who are at a higher risk or melanoma due to amily historyor genetics. Current efforts include the development o educational materials and research to determinewhat prevents high risk amilies who have children rom engaging in preventive behaviors, such assunscreen use. Some o the collaborators include dermatologists, genetic counselors, behavioral scientistsrisk communication specialists, and science writer and graphic artists rom the Genetic Science LearningCenter at the University o Utah.

_________________________________________________________________________24 U.S. Department o Health and Human Services. 2014. Surgeon General’s Call to Action to Prevent Skin Cancer. U.S. Surgeon General Web site. http://www.

surgeongeneral.gov/library/calls/prevent-skin-cancer/.25 Rebecca G. Simmons, Kristi Smith, Meghan Balough, Michael Friedrichs. Journal o Skin Cancer. Decrease in Sel-Reported anning Frequency among

Utah eens ollowing the Passage o Utah Senate Bill 41: An Analysis o the Effects o Youth-Access Restriction Laws on anning Behaviors. Volume 2014(2014), Article ID 839601, 6 pages. August 20, 2014.



UCAN PrioritiesSurvivorship and Quality of Life

Te American Cancer Society reports that there are currently more than 14 million cancer survivors living in theUnited States. By 2024, this number is expected to grow to almost 19 million. It is estimated that 81,260 cancersurvivors reside within the state o Utah. As screenings become more efficient and treatments become moreeffective, it is expected that more people will enter remission or their cancer or live longer with their diagnosis.

Cancer survivorship begins at diagnosis and extends through the rest o the patient’s lie. Cancer survivorshipcan also include caregivers and support systems around the individual diagnosed. Cancer survivors includethose who are undergoing treatments, have completed treatments, and those who are receiving palliative orhospice care temporarily or or the remainder o their lives.Cancer survivors ace difficult realities as they cope with short- and long-term symptoms o the diseaseincluding the side effects o treatment.

Cancer can be a stigmatizing disease. Social, economic, physical, and emotional barriers exist or cancersurvivors. Physical effects include peripheral neuropathy, pain, atigue, memory and concentration loss, ertilityissues, or body disfigurement. Many cancer survivors ace difficulties achieving and maintaining employment,

paying or medical bills, and accessing healthcare services and support. Cancer may also devastate amilyrelationships which may result in despair, hopelessness, and isolation.

Burden in UtahMany institutions and community groups offer excellent support programs and ofen find challenges in makingthese programs accessible to cancer survivors, in and out o treatment, and their loved ones. Ofen, cliniciansand patients are not aware o these programs or that the need even exists. Tere seems to be a need within thestate o Utah to determine what the needs are o cancer survivors, what resources exist, and how to best connectthose affected by cancer to the programs and services that can meet those needs.

As much o the attention on cancer remains on prevention and early detection, the burden that cancer places

on the quality o lie issues or survivors and their caregivers is ofen overlooked. It is recommended that ormalneeds and resource assessments be conducted to improve the quality o lie o cancer patients and their lovedones through access to services and the adoption o healthy behaviors. In addition, by improving access toquality treatment, appropriate supportive care, and ollow-up, the burden o cancer on patients and their lovedones may become reduced throughout cancer survivorship.



DisparitiesWithin Utah, rural cancer survivors ace geographicbarriers preventing access to medical services and

routine healthcare. Researchers at Huntsman CancerInstitute and Primary Children’s Hospital identifiedthat rural caregivers o children with cancer are morelikely to miss work, quit or change jobs, relocateresidences, and had a greater financial burden. Techildren themselves missed more school and weremore likely to repeat a grade i they lived more than anhour away rom their treatment center.

Cancer Survivors in Utah ace lower health outcomesand quality o lie compared to the general population.Cancer survivors are nearly twice as likely to besmokers compared to the rest o the population andnearly twice as likely to report their activities beinglimited because o physical, mental, or emotionalproblems.

UCAN Priorities-Survivorship and Quality of Life

39.1

19.3

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Diagnosed with cancer No cancer

Age-adjusted Percentage, Activities Limited Due to Physical,

Mental, or Emotional Problems , Utah 2010-2014

Source: Utah BRFSS

18.9

10.1

0%

5%

10%

15%

20%

25%

Diagnosed with cancer No cancer

Percent of Current Cigarette Smoking, by Cancer

Diagnosis, Utah, 2010-2014

Source: Utah BRFSS

“For the 1 million LGBcancer survivors in the countrytoday, the impact o the diseaseand treatment on quality o lieis significantly different romtheir heterosexual counterpartsin the areas o sexuality, social

relationships, and dealingswith the medical community”.



UCAN Priorities-Survivorship and Quality of Life

Cancer Survivorship Care Plan

Te transition rom cancer treatment to primary care can be a conusing and difficult process. Many cancer

survivors complete treatment without a clear understanding o how to manage ongoing symptoms and ail toreceive proper ollow up care moving orward. Survivorship care plans can help bridge this process by providingan individualized post-treatment plan or the survivor, their oncology team, and their primary care providers.

A survivorship care plan generally offers inormation about the original diagnosis, the treatment that wasgiven, inormation about the treatment team, a summary o possible ongoing health symptoms and concerns,instructions or ollow-up tests, a psycho-social assessment, and lists o inormation and resources available.

Research is being conducted within the state o Utah and nationwide to learn more about survivorship careplans, barriers to their use, and ways to make them more useul or the survivor and medical teams goingorward.

_________________________________________________________________________26 Fang Fang Zhang MD, PhD, Shanshan Liu MS, MPH, Esther M. John PhD, Aviva Must PhD, Wendy Demark-Wahneried PhD, RD. Diet quality o cancer

survivors and noncancer individuals: Results rom a national survey. Cancer. 2015. Volume 121, Issue 23, pages 4212–4221. http://onlinelibrary.wiley.com/doi/10.1002/cncr.29488/abstract. Published October 13, 2015.

A current study has shown that many US cancer survivors are eating less healthy diets than the generalpopulation, consuming too many energy dense oods and not eating the recommended amount o vegetablesand whole grains. Cancer survivors also showed low dietary intakes o vitamin D, vitamin E, potassium, andcalcium. Te findings o the study revealed a need or dietary interventions in this vulnerable population. 26



Survivorship and Quality of LifeGoals, Strategies, and Action Steps

Goal: Ensure that the needs of cancer survivors and their caregivers are metthroughout the continuum of care.

Strategy A: Identify the needs of cancer survivors and their caregivers.

What will success look like? Utah cancer survivors and caregiver needs will be known and understood.

Action Steps:• Conduct a comprehensive needs assessment to determine the unique needs o cancer survivors and their

caregivers in Utah.• Conduct a comprehensive review o survivorship programs nationwide to determine best practices or

developing survivorship programs in Utah.• Create and adopt methods or programs or connecting cancer survivors and caregivers to resourcestailored to their needs, including health disparities.

• Administer the BRFSS Cancer Survivorship Module every two years to identiy survivor and caregiverneeds.

Strategy B: Improve quality of life among cancer survivors and their caregivers.What will success look like? Utah

2016-2020 Utah State Cancer Plan

Documents

Transcript of 2016-2020 Utah State Cancer Plan