Translating Research into Practice: Integrating Science with Service through

Comprehensive Cancer Control

Jon F. Kerner, Ph.D.Deputy Director, Division of Cancer Control

& Population SciencesIndiana Cancer Consortium Fall Meeting

October 18, 2006

The Central Goals of Healthy People 2010*

Increase quality and years of healthy life

Eliminate health disparities

* USDHHS Healthy People 2010. Washington D.C. January 2000. Volume #1: page 2

Carcinogenesis as a Multi-Stage Process*

Normal Cell

Initiated Cell

Preneoplastic Lesion

MalignantTumor

ClinicalCancer

Metast.Disease

Initiation Promotion Conversion Progression

Support& Follow-up

Cancer Control as a Multi-Stage Process

Health Risk FactorBehaviors

Surveillance Follow-up Support

Prevention Early Detection Diagnosis & Treatment

TerminalCare

*Adapted from Shields PG, Harris CG. Principles of Carcinogenesis: Chemical. In: Devita VT, Hellman S, Rosenberg SA. Cancer Principles & Practice of Oncology. J.B. Lippencott Co. Philadelphia :1993.

NCI’s Challenge: Close the Gap Between Discovery and Delivery

There is a critical disconnect between research discovery and program delivery and this disconnect is, in and of itself, a key determinant of the unequal burden of cancer in our society.

Barriers that prevent the benefits of research from reaching all populations, particularly those who bear the greatest disease burden, must be identified and removed.

THE CANCER CONTROL CONTINUUM

Cancer Control Continuum

Prevention

Focus

• Tobacco Control• Diet• Physical Activity• Sun Exposure• Virus Exposure• Alcohol Use• Chemoprevention

Detection• Pap Test• Mammography• FOBT• Endoscopy• PSA Informed

Decision Making

Treatment• Health Services

and Outcomes Research

• Clinical Trials

Survivorship• Palliation• Coping• Health Promotion

Diagnosis• Informed

Decision Making

• Clinical Follow-up

• Imaging

Cross Cutting Issues

• Communications• Surveillance• Social Determinants and Health Disparities• Genetic Testing• Decision-Making• Evidence-Based Health Care• Quality of Cancer Care• Epidemiology

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

NCI Grants Awarded to the Institutions in the State of Indiana In (FY 05)

(n= 65, Total Dollars= $21 million)

DCCPS7 Grants (11%)

$1 million

DCB19 Grants (29%)

$5 million

DCP9 Grants (14%)

$4 million

DCTD21 Grants (32%)

$8 million

OD9 Grants (14%)

$3 million

Cancer Centers by State (P30 Core Grants) Year 2005 All Types - All States

100.0%$21,004,10265Total

19.8%$4,162,42412Total for Other Nine Institutions

80.2%$16,841,67853Total for Two NCI-designated Cancer Centers

%Total Dollars

Total NCI Dollars

No. of Grants

Summary Distribution for NCI Grants for state of Indiana

THE DISCOVERY-DELIVERY CONTINUUM

DiscoveryDiscovery DevelopmentDevelopment DeliveryDelivery

Public Public Health Health

PracticePractice

Primary Primary Care Care

PracticePractice

Disease Disease Specialty Specialty PracticePractice

Reducing the cancer burden

Fundamental Research

Surveillance Research

Intervention Research

KnowledgeSynthesis

Application and Program Delivery

Dynamic Model of Cancer Research & Diffusion and Dissemination

Adapted from the Advisory Committee on Cancer Control, National Cancer Institute of Canada, 1994.

DisseminationDissemination

Diffusion

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

Publication

Bibliographic databases

Submission

Reviews, guidelines, textbook

Negative results

variable

0.3 year

6. 0 - 13.0 years50%

46%

18%

35%

0.6 year

0.5 year

9.3 years

Dickersin, 1987

Koren, 1989

Balas, 1995

Poynard, 1985

Kumar, 1992

Kumar, 1992

Poyer, 1982

Antman, 1992

Negative results

Lack of numbers

Expertopinion

Inconsistentindexing

It takes 17 years to turn 14 per cent of original researchIt takes 17 years to turn 14 per cent of original research to the benefit of patient careto the benefit of patient care

17:14

Original research

Acceptance

Implementation

E.A. Balas, 2000

Dissemination

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

Translational Research vs. Research Translation

"Cutting-Edge" "State-Of-The-Art" "Resource-Limited"

Academic Cancer& Medical Centers

CCOPs & ACoSApproved CancerPrograms

Municipal & RuralHospitals & Clinics

TRANSLATION

Evidence-basedKnowledge

“The transfer of evidenced-basedknowledge into routine

or representative practice”

ClinicalPractice

Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22:Disseminating Behavioral Medicine Research: Making the Translational Leap.

What is Evidence…..?Surveillance DataSystematic Reviews of Multiple

Intervention Research StudiesAn Intervention Research StudyProgram EvaluationWord of Mouth/MarketingPersonal Experience

OBJECTIVE

SUBJECTIVE

INTEGRATION

Explicit Evidence-Based Knowledge

InformedApplication

Tacit Clinicaland

Contextual Knowledge

“The informed combination of evidence-basedknowledge and local contextual knowledge

into community applications.”

Adapted from Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22:Disseminating Behavioral Medicine Research: Making the Translational Leap.

TTranslating RResearch into IImproved OOutcomes (TRIOTRIO)

Use and communicate cancer and behavioral surveillance data to identify needs, track progress and motivate action.

Collaboratively develop tools for accessing, and promoting adoption of, evidence-based cancer control interventions.

Support regional and local partnerships to develop models for identifying infrastructure barriers, expanding capacity and integrating science into comprehensive cancer control planning and implementation.

A Modest Proposal – More Focused Accrual & Reimbursement by Government?

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

What % of Diagnosed IN Patients on Protocol?

Protocols within 100 miles for 46260

Protocols within 100 miles for 46260

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

"Not everything that can be counted counts, and not everything that counts can be counted."

- Albert Einstein (1879-1955)

Source: Harvard Report on Cancer Prevention, Cancer Causes and Control, November/December, 1996

What else do we need to know to motivate action?

“Cancer statistics are people with the tears wiped away.”

Why did Joanne die?

Models for Systems Change

Circles of Influence/Circles of Impact

Source: M Peck ScD, UNMC

“Joanne”

Joanne’s Family

Joanne’s Health Care Providers

Joanne’s Workplace

Transportation

Community Programs

ACS

Health Department

Local Officials & Policy Makers

State & National Policy Makers

Media

So Many Forces Influence Her Life …and Death

Source: M Peck ScD, UNMC

“Joanne”

Joanne’s Family

Joanne’s Health Care Providers

Joanne’s Workplace

Transportation

Community Programs

ACS

Health Department

Local Officials & Policy Makers

State & National Policy Makers

Media

Circles of Influence

Source: M Peck ScD, UNMC

Insert circles of influence slides here …n=6

“Joanne”

Joanne’s Family

Joanne’s Health Care Providers

Joanne’s Workplace

Transportation

Community Programs

ACS

Health Department

Local Officials & Policy Makers

State & National Policy Makers

Circles of Impact

Source: M Peck ScD, UNMC

When “Joanne” dies…Circles of Influence, Circles of Impact

Source: M Peck ScD, UNMC

Source: M Peck ScD, UNMC, adapted from J Richmond

Tacit & ContextualKnowledge

From Experience

ExplicitExplicitKnowledgeKnowledge from from

Research EvidenceResearch Evidence

Integrating Science with Service: Do We Have the Right Stuff?

“To him who devotes his life to science, nothing can give

more happiness than increasing the

number of discoveries, but his cup of joy is full when the results of his studies

immediately find practical applications.”

~Louis Pasteur

Our goal is to turn knowledge into applications that benefit people.