Health Care and Insurance and Education & Workforce Development and Government

Cancer plan enters action phase: State health initiative unveils multi-pronged strategy to take on deadly disease

January 31, 2005

But Dr. Greg Wilson, the department's commissioner who stepped down Jan. 25 due to the change in administrations, realizes it's going to take more than money to snuff out unhealthful habits, such as smoking.

"Three-hundred-thousand dollars will not cure cancer in Indiana," Wilson said. "We really have to utilize the private sec- tor and we really have to involve all the participants."

Those participants include 110 organizations that make up the Indiana Cancer Consortium, an effort initiated in 2001 to guide cancer control in Indiana. The organizations consist of health care providers, insurance companies, hospitals, advocacy groups and corporations, among others.

Now that the state's Cancer Control Plan has been drafted, the next step is to link the organizations with strategies they hope will make a difference in controlling cancer among Hoosiers.

Judging from a report released Jan. 20 by the Atlanta-based American Cancer Society, the plan couldn't come at a better time. The report said cancer has overtaken heart disease as the nation's top killer of Americans 85 and younger. Death rates for cancer actually have dropped, but death rates for heart disease have dropped more, causing the switch in position.

The goals of the program include reducing risk through lifestyle changes, increasing the percentages of the population who receive cancer screenings, and improving the quality of life for cancer patients, survivors and their families.

"The bottom line is to decrease the mortality [rate] and the number of patients who are diagnosed with cancer," said Dr. Frank Lloyd, co-chairman of the cancer consortium and a faculty member of the Indiana University School of Medicine. "You try to continue to pound on the issue of prevention."

Regarding prevention, for instance, the plan recommends avoiding tobacco products and secondhand smoke, minimizing alcohol intake, following a balanced diet, exercising regularly and protecting against ultraviolet light exposure.

In hopes of reducing the rate of smoking among Hoosiers, participants that offer cessation classes will try to make the classes available to more people. The state's high smoking rate, 27 percent of the adult population, ranks fifth-highest in the nation, according to the ACS, which helped develop Indiana's control plan.

Any reduction in the state's smoking rate, no matter how trivial, would be considered a success, said Vicki Rakowski, ACS executive vice president for medical activities. Based in Michigan as part of the ACS's Great Lakes Division, Rakowski helped craft Indiana's plan, modeled after its northern neighbor's.

"If just 1 percent of the state's smoking population quit, that's a significant number of people," she said. "No one in state government can really reduce the amount of cancer. It's everybody's burden. We all have to come together to fix it."

Overall, cancer is the second-leading cause of adult deaths in Indiana, following heart disease. The state's cancer-incidence rate in 2000 was 3 percent lower than the national rate, but its mortality rate during the same year was 5 percent higher, according to the ACS. A "major" emphasis of the plan is to reduce the number of black men who die from cancer, because their mortality rate is twice as high as that of white males, Wilson said.

Upon the introduction of the control plan in October, the ACS estimated 32,160 new cancer cases would be diagnosed in Indiana in 2004, and 13,250 Hoosiers would die from the disease.

To improve the mortality rate, plan participants want to offer more screenings to detect prevalent types of cancers in the early stages.

For women, the goals of early detection include increasing the percentage of females age 40 and older who receive regular breast cancer screenings.

For men, promoting informed decisionmaking related to prostate cancer screenings is an integral part of the plan. And for all residents, the goals include increasing the percentage of the population age 50 and older who receive colorectal cancer screenings.

"The earlier you can detect a cancer, the lower your mortality rates are," Wilson said. "The number of survivors of cancer is growing."

Indeed, the number of people living with cancer increased from 3 million in 1971 [1.5 percent of the population] to 9.8 million in 2001 [3.5 percent of the population], according to the ACS.

To improve upon available treatments, the plan suggests eliminating barriers to receiving effective follow-ups, and increasing participation in cancer clinical trials and the percentage of patients who receive follow-ups considered acceptable standards of care.

Tisha Reid, director of education for the local Little Red Door Cancer Agency, represents the not-for-profit in its role as a member of the state's cancer consortium. However daunting the mission, she thinks the 110 consortium members can make a difference.

"We have been able to bring organizations together instead of all of us trying to work alone," Reid said. "We are already out in the community, but what else can we do?"

Although Wilson has left his position as state health commissioner, he said he wants to remain involved in the program. The effort is slated to last until 2008, at which time plan leaders will re-evaluate priorities and develop new strategies, if necessary.
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