Office of Cancer Control and Prevention

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Task Force Background

Making Way for Comprehensive Cancer Control in New Jersey

Anastasia Roussos
Lisa E. Paddock, MPH

Compared to the U.S., New Jersey's cancer mortality rates are slightly higher in the categories of 'whites' and 'all races', according to 2001 State Health Profiles from the Centers for Disease Control and Prevention (CDC). Cancer remains the second leading cause of death in New Jersey and the nation. The American Cancer Society (ACS) estimates that New Jersey will have 41,200 new cancer cases for all sites combined and a total of 18,000 cancer deaths in the year 2001. The New Jersey State Cancer Registry's (NJSCR) Cancer Incidence in New Jersey 1995-1999, showed that a total of 42, 476 cases of invasive cancer were reported in 1999. During the period of 1995-1999, a total of 214,971 cases of invasive cancer were diagnosed among New Jersey citizens, 51% among males and 49% among females.3 Between the years of 1995-1999, the overall cancer incidence rate increased through 1997 for white males and has continuously declined for black males. Preliminary 1999 data show an incidence rate of 488.2/100,000 for white males compared to 547.6/100,000 in black men for all cancer sites combined. The overall cancer incidence rate for females increased between the years 1995-1999. Preliminary data for 1999 show that white females had a higher incidence in all cancer sites combined (380.1/100,000) than black females (328.7/100,000), indicating racial and ethnic disparities in cancer incidence in NJ.3

The statistics on cancer have captured the attention of New Jersey citizens, legislators, health care professionals and other stakeholders in cancer control. Former Governor Christine Todd Whitman issued New Jersey Executive Order 114, on May 9, 2000, which created of the "Task Force on Cancer Prevention, Early Detection and Treatment in New Jersey " ("Task Force"). In conjunction, the Office of Cancer Control and Prevention (OCCP) was formed as a program in the New Jersey Department of Health (NJDOH).

Public health efforts to establish a comprehensive cancer control plan for New Jersey are long standing. Since the 1970's, cancer control stakeholders have made contributions in establishing cancer awareness programs directed towards various NJ populations including a coalition to fight tobacco, the Advisory Committee on Smoking or Health, and screening programs. In 1991, a group designated as the State Cancer Plan Task Force (SCPTF), was formed to develop goals and objectives for a cancer control plan. A version of this plan appeared as a chapter in the NJ State Health Plan, which was completed in 1992. Priorities were identified to reduce cancer mortality in NJ by addressing surveillance, prevention/detection, diagnosis and t treatment, continuum of care, research and finance.

In July of 2000, a Leadership Roundtable was held in NJ to enhance the understanding of cancer professionals statewide concerning comprehensive cancer control. The University of Medicine and Dentistry of New Jersey - School of Public Health (UMDNJ-SPH), NJDOH, and the New Jersey Commission on Cancer Research, assembled a group of key organizations to gain support from leaders and foster outreach to NJ citizens to prepare for the formation of the Task Force.

The Task Force is comprised of sixteen Governor-appointed, public members, representing cancer survivors, The Breast Cancer Resource Center of the YWCA, Bristol-Myers Squibb, the New Jersey Hospital Association, the Cancer Institute of NJ, The University of Medicine and Dentistry of NJ - School of Public Health, Rutgers University, Health Research and Educational Trust of NJ, health care providers, Hunterdon Hospice, NJ Osteopathic Association, NJ Dental Association, National Black Leadership Initiative on Cancer (NBLIC), American Cancer Society, and Robert Wood Johnson Hospital. The Task Force has called upon NJDOH to provide resources from Cancer Epidemiology Services, OCCP, Center for Health Statistics, Office of Local Health, Prevention and Tobacco Control Services, and the Division of Family Health Services.

The Task Force will address the impact of cancer on NJ citizens by formulating a comprehensive cancer control plan for NJ. More specifically, the Task Force is charged to evaluate current trends in cancer incidence, morbidity, mortality, screening, diagnosis, behaviors that increase the risk of cancer, and historic, current and emerging cancer control strategies. Additionally, the Task Force must establish goals to reduce cancer incidence and mortality rates. An integrated set of priority strategies will also be delineated to achieve these cancer reduction goals. Finally, the Task Force will articulate the respective roles and responsibilities for the State and each of its partners for implementation of the comprehensive cancer control plan.

The Task Force adopted the CDC's operational definition of comprehensive cancer control, as an "integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention, early detection, treatment, rehabilitation and palliation". The Task Force designated eight Workgroups to undertake specific areas for the NJ comprehensive cancer control plan. The first seven Workgroups focus on specific cancer sites, including breast, cervical, prostate, lung, melanoma, colorectal, and oral / pharyngeal cancers. The eighth Workgroup addresses overarching issues, dealing specifically with topics in advocacy, palliation, resources and access, childhood cancer, and nutrition and physical activity. The Workgroups are comprised of decision-makers for industries, academicians, researchers, organization leaders, community health groups, public health representatives and cancer survivors -- all of whom are stakeholders in cancer control. Each workgroup is chaired by a member of the Task Force, facilitated by a member of the OCCP, and provided with background information by an epidemiologist. Issues in cancer research, surveillance, education, outreach, screening and treatment are reviewed by each Workgroup.

The OCCP is dedicated to coordinating cancer control efforts in NJ. The OCCP is participating in the national efforts of the CDC to establish state-based comprehensive cancer control plans. By reviewing the work done by other states and working directly with individuals from the CDC's National Comprehensive Cancer Control Initiative, the OCCP can support the Task Force in forming and implementing the action plan for the NJ comprehensive cancer control plan. After the plan is submitted to the Governor in July 2002, the OCCP will begin evaluating the effectiveness of the implementation strategies in order to continually improve comprehensive cancer control in NJ.

The Task Force is utilizing a framework for developing a comprehensive cancer control and prevention plan constructed by the CDC. The comprehensive cancer control framework is a "harmonized model" consisting of four essential phases, which flow in a cycle allowing planners to continually revisit the efforts invested in cancer issues.4 Phase I pertains to setting optimal objectives by having stakeholders examine data such as cancer burden, risk factor prevalence, existing facilities, programs and services in NJ. Phase II incorporates the collection and development of specific state data and the review of scientific literature. Stakeholders then provide possible strategies to attain the objectives established in Phase I. Phase III is capacity driven and involves the planning of feasible strategies, reviewing existing partner programs and defining roles and networking approaches. Phase IV involves implementation of the recommended strategies to attain the goals established during Phase I. Evaluations of specific interventions, program activities, infrastructure improvements and data developments are conducted continuously by the OCCP to assure improvements occur during subsequent planning cycles.

Currently the Task Force Workgroups are completing Phase III of the harmonized model by setting realistic priorities, reviewing existing partners and programs, and identifying funding and additional resources. Each month the Workgroups convene and utilize tools created by other states to aid in the development of the comprehensive cancer control plan.

To date, many Workgroups have identified goals such as increased early detection through improved screening efforts, and increased public awareness and education, especially in high-risk populations. The involvement of community-based organizations, hospitals/clinics and schools are possible resources for outreach into the diverse communities that exist in NJ.

Once the goals, objectives and strategies of each Workgroup are presented to the Task Force, those that are specific, measurable, attainable, realistic and time-phased will be retained to create a first draft of the NJ comprehensive cancer control plan.

Expert reviewers external to the Task Force and Workgroups have been identified and asked to provide insight. Upon revision, the final document will be presented to the Governor in July of 2002. In the future, as the plan is approved and with the direction of the OCCP, implementation and evaluation will be started to improve cancer control in NJ while setting standards for the rest of the nation.

References

Centers for Disease Control and Prevention. New Jersey 2001 State Health Profile. Atlanta, GA: US Department of Health and Human Services, CDC, 2000.

American Cancer Society. Cancer Facts and Figures 2001. Atlanta, GA: American Cancer Society, Inc., 2001.

New Jersey Department of Health, Cancer Epidemiology Services, New Jersey State Cancer Registry. Cancer Incidence in New Jersey 1995-1999. Trenton, NJ: NJDOH, September 2001.

Abed J, Reilley B, Butler MO, Kean T, Wong F, Hohman K. Developing a Framework for Comprehensive Cancer Prevention and Control in the United States: An Initiative of the Centers for Disease Control and Prevention. J Public Health Management Practice, 2000, 6(2), 67-78.