Comprehensive Cancer Control - A National Effort
Comprehensive cancer control is defined by the Centers of Disease Control and Prevention (CDC) as “an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation, and palliation. CDC's National Comprehensive Cancer Control Program (NCCCP) provides funding and technical assistance to states for developing and implementing comprehensive cancer control. This national program is an emerging model that integrates a range of cancer control activities to maximize the use of limited resources to achieve desired cancer prevention and control outcomes. Since 1998, the number of programs participating in CDC's NCCCP has grown from six to 61. With this support, state and tribal health agencies continue to establish broad-based coalitions, assess the burden of cancer, determine priorities for cancer prevention and control, and develop and implement comprehensive cancer control (CCC) plans.
State cancer plans are the stepping stones for advancing state CCC programs. Each state or tribal health agency develops an individual cancer plan to address its unique cancer burden. As states or tribal health agencies implement cancer plans, they integrate expertise and efforts from many disciplines: basic and applied research, evaluation, health education, program development, public policy, surveillance, clinical services, and health communications. More on the National Comprehensive Cancer Control Program can be found in Appendix B.
Development of the Wisconsin Comprehensive Cancer Control Plan
Wisconsin has been actively engaged in cancer control planning and program development over the last 30 years (See Appendix B). In 2002, comprehensive cancer control planning in Wisconsin re-energized with a small group attending the CDC sponsored Leadership Institute and then applying for the CDC planning grant for WI CCC Plan. In September of that year, Wisconsin's Department of Health and Family Services was awarded a comprehensive cancer control planning grant from the Centers for Disease Control and Prevention. In early 2003, The Core Planning Team, with representatives from the Wisconsin Division of Public Health (DPH), Wisconsin Cancer Council, the UW Comprehensive Cancer Center and the American Cancer Society, convened to discuss the initial planning framework. The UW Comprehensive Cancer Center and DPH then hired a CCC program director and began to develop a planning infrastructure.
The WI CCC Plan needed a decision making body with representatives from many cancer control organizations around the state. The Steering Committee came together in November 2003 to provide leadership and support to the plan's development. The Steering Committee approved the overall planning framework. They also developed the mission, vision, goals and cross cutting issues for the WI CCC Plan.
Vision
Healthier people in Wisconsin by reducing the impact of cancer.
Mission
Create a consortium of public and private partners empowered to develop, implement, and promote a statewide coordinated approach to cancer control.
Goals
- Reduce the risk of developing cancer.
- Detect cancer at the earliest stage possible.
- Promote access to quality comprehensive cancer care that meets or exceeds national guidelines and standards.
- Optimize the health-related quality of life along the continuum of care for those affected by cancer and their support networks.
- Improve consistency, coordination, and compliance of cancer data reporting and surveillance.
Cross Cutting Issues
- Disparities
Ensure that priorities and strategies developed in this plan work to eliminate health disparities. These include differences in the incidence, mortality, and related adverse health conditions that exist among specific population groups.
- Public Policy and Advocacy
Ensure that priorities and strategies developed in this plan include population-based and system changes through public policy and advocacy.
- Access to Healthcare
Ensure that priorities and strategies developed in this plan support equal access to services throughout the continuum of cancer for all Wisconsin residents.
- Evaluation
Ensure that priorities and strategies developed in this plan are measurable and can show improvement over time.
In Fall 2003, the Cancer Data Advisory Group (CDAG) came together to look at the data for Wisconsin to identify priorities and inform decision-making. They wrote the Priority Recommendation Report to reflect these emerging priorities and the rationale behind each one. The priorities are data-based and organized to support a continuum of cancer control and cross cutting issues unique to Wisconsin. The Steering Committee then discussed, revised and approved the priorities.
WI CCC Plan Priorities
Prevention
Priority 1:
Decrease tobacco use and exposure to tobacco smoke.
Priority 2: Promote healthy lifestyles through nutrition and physical activity.
Priority 3: Promote and encourage protective behaviors from sun and UV exposure.
Screening and Detection
Priority 1: Increase colorectal screening rates for those 50 years and older, especially in high-risk. populations.
Priority 2: Increase rates of breast cancer screening, especially in high-risk populations.
Priority 3: Increase rates of cervical cancer screening, especially in high-risk populations.
Priority 4: Increase prostate cancer screening rates for men 50 years and older, especially in high-risk populations.
Treatment
Priority 1: Increase access to cancer treatment by reducing economic, geographic, cultural, and systems barriers.
Priority 2: Encourage adherence by physicians to cancer treatment guidelines.
Priority 3: Increase awareness of and participation in cancer clinical trials.
Quality of Life
Priority 1: Increase reimbursement for services related to quality of life at time of diagnosis and throughout the cancer continuum.
Priority 2: Provide education that will enhance the understanding of the importance of quality of life in the treatment continuum.
Priority 3: Assemble data on quality of life to establish best practices in measuring optimal treatment outcomes.
Palliative Care / End of Life Issues
Priority 1: Increase access to palliative care.
Priority 2: Provide education that will enhance the understanding of palliative care in the treatment continuum.
Priority 3: Identify best practices for delivering palliative care.
Data Collection and Reporting
Priority 1: Promote the collection and use of information to increase professional and public understanding and education about cancer and its impact on Wisconsin residents.
Priority 2: Increase timeliness of reporting cancer cases to Wisconsin Cancer Reporting System.
Priority 3: Improve the quality and completeness of treatment data.
Priority 4: Improve racial and ethnic cancer data collection.
On March 18, 2004, approximately 200 participants from healthcare, public health agencies, community based organizations, businesses, universities and other organizations came together at the WI CCC Kick Off Summit as a statewide coalition to begin working on Wisconsin's plan for comprehensive cancer control. Workgroups were formed around the areas of prevention, screening and detection, treatment, quality of life, palliative care, and data collection and reporting. These workgroups developed strategies and action plans to address the priorities of the Wisconsin Comprehensive Cancer Control Plan.
Each of the workgroups had participants with knowledge and experience in the specific areas of comprehensive cancer control. The workgroup members recommended appropriate strategies by looking at:
- what has worked well in the past both in Wisconsin and in other states,
- what new strategies should be considered,
- what is the action plan for implementing the strategies, and
- what are the key indicators of success.
The products of each workgroup's efforts are the strategies with action plans recommended implementation steps for each. These tables contain the steps that need to be implemented to reach the WI CCC Plan goals. Since the scope of the plan is broad and resources are limited, it will be necessary to set priorities among plan priorities, strategies and action plans.
Implementation of the Wisconsin Comprehensive Cancer Control Plan
Strategies and action plans will be prioritized for implementation from the plan by the Steering Committee through a systematic process using specific, measurable criteria (e.g., the magnitude of the burden, the strength of evidence suggesting an effective solution exists, the likelihood that interventions will lead to significant improvements, the presence of major gaps in current efforts, and the existence of disparate burden). The resulting priorities will set the direction for the initial implementation efforts of the statewide coalition.
In April 2005, the statewide coalition that came together to kick off the planning process in March 2004 will once again convene in a daylong "Transition to Implementation" Summit. From this summit, action plans for the next five years of who will be doing what activities from the WI Cancer Plan will be identified. These action plans will be posted on the WI CCC Plan web site. They will also be the foundation for evaluating the implementation of the WI Cancer Plan.
To assure the continued implementation of this plan, we must maintain our current coalition of public and private partners empowered to develop, implement, and promote the WI CCC Plan. With this group, successful implementation will include:
- Sustaining and growing the current coalition to include key decision-makers in cancer prevention and control.
- Assuring leadership and accountability with implementation of the plan.
- Promoting the WI CCC Plan with key decision-makers and healthcare consumers in Wisconsin.
- Obtaining additional funding for comprehensive cancer control efforts in Wisconsin.
- Continually evaluating our implementation progress and adjusting our action plans as needed.
Evaluation of the Wisconsin Comprehensive Cancer Control Plan
The purpose of developing and implementing the WI CCC Plan is ultimately to reduce cancer incidence, morbidity, and mortality and to improve the quality of life for those affected by the disease. The plan and its implementation must be evaluated to ensure that:
- Strategies are being appropriately implemented.
- Priorities are being addressed.
- 2010 targets for change are being achieved.
