National Cancer Institute Health Disparity And Cancer Survivorship: Exploration of Uncharted Research Diana D. Jeffery, Ph.D., Program Director Office of Cancer Survivorship Division of Cancer Control & Population Sciences presented to Center for Health/HIV Intervention and Prevention University of Connecticut June 11, 2006 U.S. DEPARTMENT Storrs, Connecticut OF HEALTH AND HUMAN SERVICES National Institutes of Health
National Cancer Institute Outline • Definition of cancer survivorship • Prevalence of cancer survivors • Scope of cancer survivorship research • Cancer survivorship research focused on health disparities – Select findings of OCS grants • Learning from cancer screening research: barriers to care and surveillance • Uncharted research U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
National Cancer Institute Definition of Cancer Survivor Definition of Cancer Survivor � Anyone diagnosed with cancer, from the time of diagnosis to the end of life (National Coalition of Cancer Survivors) � Caregivers and family members U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
The Dream of Yesterday The Dream of Yesterday National Cancer Act of 1971 President Richard Nixon signs National Cancer Act on December 23, 1971 “Make the Conquest of Cancer a National Crusade”
National Cancer Institute Estimated Number of Cancer Survivors in 1996 • There are 8.4 million cancer survivors in 11 the United States. Data Sources: Connecticut 1994 prevalence estimates applied to1996 population estimates from the US Census Bureau U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
Estimated Number Cancer Survivors in the United States from 1971 to 2003 12,000,000 10,000,000 8,000,000 Number 6,000,000 4,000,000 2,000,000 0 1 3 5 7 9 1 3 5 7 9 1 3 5 7 9 1 3 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9 0 0 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 Year Data source: 2004 Submission. U.S. Estimated Prevalence counts were estimated by applying U.S. populations to SEER 9 and historical Connecticut Limited Duration Prevalence proportions and adjusted to represent complete prevalence. Populations from January 2002 were based on the average of the July 2001 and July 2002 population estimates from the U.S. Bureau of Census.
Estimated Number of Persons Alive in the U.S. Diagnosed With Cancer by Site (N = 10.5 M): 2005 23% 17% Female Breast Prostate 3% Colorectal Gynecologic 6% Other GU (Bladder & Testis) Hematologic (HD, NHL, Leukemia) 7% Melanoma 19% Lung 6% Other 9% 10% Data sources: U.S. Estimated Prevalence counts were estimated by applying U.S. populations to SEER 9 and historical Connecticut Limited Duration Prevalence proportions and adjusted to represent complete prevalence. Populations from January 2003 were based on the average of the July 2002 and July 2003 population estimates from the U.S. Bureau of Census.
IOM Reports National Cancer Institute From Cancer Patient to Unequal Treatment: Confronting Cancer Survivor: Lost in Racial and Ethnic Disparities in Transition, 2005 Healthcare, 2003 • No health disparities in Cancer Survivor report • No survivorship in Unequal Treatment report U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
U.S. Census 2004 Estimated National Cancer Institute Population by Race/Ethnicity N = 293,655,404 120,000,000 100,000,000 80,000,000 60,000,000 40,000,000 20,000,000 0 Males Females U.S. DEPARTMENT OF HEALTH AND White Black AIAN Asian NHPI Hispanic HUMAN SERVICES National Institutes of Health
National Cancer Institute 2003 Estimated U. S. Cancer Prevalence of Male Cancer Survivors by Race/Ethnicity and Years Since Diagnosis 2000000 Estimates are incomplete , based on SEER 1800000 White and Black: 9 SEER areas Asian/PI: 11 SEER areas and Rural Georgia 1600000 Hispanic: NHIA for 11 SEER areas and rural 1400000 Georgia excluding Hawaii and Seattle. 1200000 1000000 800000 600000 400000 200000 U.S. DEPARTME 0 NT OF HEALTH 0 to <5 5 to <10 10 to <15 15 to <20 20 to < 25 AND HUMAN White Black Asian/PI Hispanic/Latino SERVICES National Institutes of Health Source: SEER Cancer Statistics Review 1975-2003, Table II – 16, All Sites (Invasive)
National Cancer Institute 2003 Estimated U. S. Cancer Prevalence of Female Cancer Survivors by Race/Ethnicity and Years Since Diagnosis 1800000 Estimates are incomplete , based on SEER 1600000 White and Black: 9 SEER areas Asian/PI: 11 SEER areas and Rural Georgia 1400000 Hispanic: NHIA for 11 SEER areas and rural Georgia excluding Hawaii and Seattle. 1200000 1000000 800000 600000 400000 200000 U.S. DEPARTME 0 NT OF HEALTH <5 5 to <10 10 to <15 15 to <20 20 to < 25 AND HUMAN SERVICES White Black Asian/PI Hispanic/Latino National Institutes of Health Source: SEER Cancer Statistics Review 1975-2003, Table II – 16, All Sites (Invasive)
National Cancer Institute 2003 Estimated U. S. Cancer Prevalence of Male Cancer Survivors by Race/Ethnicity and Years Since Diagnosis N = 4.7 million 4500000 4000000 3500000 Estimates are complete , based on SEER 3000000 White and Black: 9 SEER areas 2500000 Asian/PI: 11 SEER areas and Rural Georgia Hispanic: NHIA for 11 SEER areas and rural 2000000 Georgia excluding Hawaii and Seattle. 1500000 1000000 500000 U.S. DEPARTME 0 NT OF HEALTH Total 0 to <13 0 to <28 >=28 AND HUMAN SERVICES White Black Asian/PI Hispanic/Latino National Institutes Source: SEER Cancer Statistics Review 1975-2003, Table II – 16, All Sites (Invasive) of Health NHIA - NAACCR Hispanic Identification Algorithm
National Cancer Institute 2003 Estimated U. S. Cancer Prevalence of Female Cancer Survivors by Race/Ethnicity and Years Since Diagnosis N = 5.8 million 6000000 5000000 4000000 Estimates are complete , based on SEER 3000000 White and Black: 9 SEER areas Asian/PI: 11 SEER areas and Rural Georgia Hispanic: NHIA for 11 SEER areas and rural 2000000 Georgia excluding Hawaii and Seattle. 1000000 U.S. DEPARTME 0 NT OF HEALTH Total 0 to <13 0 to <28 >=28 AND HUMAN SERVICES White Black Asian/PI Hispanic/Latino National Institutes Source: SEER Cancer Statistics Review 1975-2003, Table II – 16, All Sites (Invasive) of Health NHIA - NAACCR Hispanic Identification Algorithm
2003 Estimated U. S. Cancer National Cancer Institute Prevalence of Cancer Survivors by Race/Ethnicity < 25 years • 9.3 million non-Hispanic whites • 816,249 Blacks < 10 years • 138,541 Asians/Pacific Islanders • 308,536 Hispanics/Latinos U.S. DEPARTME NT OF HEALTH AND HUMAN SERVICES National Institutes Source: SEER Cancer Statistics Review 1975-2003, Table II – 16, All Sites (Invasive) of Health
National Cancer Institute U. S. Map of SEER Areas, 2005 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
National Cancer Institute Geographic Distribution of Hispanics/Latinos, 2002 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
Age Distribution by Sex and Hispanic Age Distribution by Sex and Hispanic Origin: 2002 Origin: 2002 Non-Hispanic Hispanic White 85+ 75-79 Male Female Male Female 65-69 55-59 45-49 35-39 25-29 15-19 5-9 6 4 2 0 2 4 6 6 4 2 0 2 4 6 Each bar represents the percent of the Hispanic (or non-Hispanic White) population who were within the specified age group and of the specified sex. Source: Current Population Survey, March 2002, PGP-5
Twelve Year Prevalence Counts of Cancer Survivors on 1/1/2002 Among Hispanics N=349,805 oral digestive colon & rectum respiratory 3% 2% 5% bones & joints 12% 1% skin, basal & squamous Urinary 5% melanoma Digestive breast L 1% y m female gyn p h 8% o l a 5% prostate m t c a e U r r male genital system i o n a l o r y C 2% urinary system 3% brain & other nervous system 0% lymphoma e t a 2% t s o Hodgkin lymphoma r Breast P l 2% Leukemia o c Pediatric < age 20 e 18% n y G 19% 10% Statistics provided by Statistical Research and Applications Branch, NCI, Data Source, November 2004 Submission. Populations from January 2002 were based on average of July 2001 & July 2002 population estimates from US Bureau of Census. US Estimated Prevalence Counts were estimated by applying US populations to SEER Limited Duration Prevalence proportions.
National Cancer Institute Office of Cancer Survivorship: Scope of Cancer Survivorship Research � Identify, examine, prevent, and control adverse cancer- and treatment-related outcomes � Physical symptoms, late-effects � Psychological sequelae � Social and economic problems � Provide a knowledge base regarding optimal follow-up care and surveillance of cancer survivors, and � Optimize health after cancer treatment. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
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