The Prostate Cancer
Continuum
 The Changing Face of Disparity:
Taking Health into Our Own Hands
The real voyage of discovery
consists not in seeking new
landscapes but in having new eyes.
- Marcel Proust
Pca is a Global Concern
• Highest incidence of male cancer in
U.S.; 2nd greatest cause of death;
declining overall but increasing in
minority populations(2)
• #1 diagnosed cancer in Europe; deaths
have increased by 16% since 1995(1)
”despite widespread use of PSA
testing...”
• Sources: (1) World Health Organization; (2) American Cancer Society
Why We Must Be Concerned
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1 in every 6 men get Prostate Cancer
1 in every 4 Black men get Prostate Cancer
Latinos have the 3rd highest incidence rate
Blacks and Latinos are diagnosed at advanced disease
stages at a 144% greater rate than whites
 The 5 year survival rate for Blacks and Latinos is
worse than for whites and getting worse
 Black men die at a rate 240% higher than whites
National Healthcare Quality
Report - 2007
• “Preventive healthcare lags significantly
behind other gains in healthcare.”
• Access to care and information varied
widely between racial/ethnic groups and
by socio-economic status
•
Source: www.ahrq.gov
Healthcare Costs represent an
increasing % of GDP
- $650B more for Cancer Treatment
U.S. - World’s Best Medical Care?
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New York Times, 12 August 2007
37th in W.H.O. health system performance (France #1, Italy
#2)
Last in overall quality: lack of coordination of care/access for
preventive and critically ill
Only major industrialized country without universal health
coverage
Life expectancies near the bottom of other industrialized
nations
Worst Infant Mortality stats of any developed nation
• Sources: Commonwealth Fund, Centers for Disease Control, W.H.O.
Exacerbating the Problem
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Increasing employee
cost burden
Regulations on
employers => increasing
costs => decreasing
competitiveness
Insurance compensation
standards
Medicare reimbursement
changes
American Cancer Society
Disparity Study - 2007
• Cancer patients with private insurance are
much more likely to be diagnosed early,
increasing their long-term survival
• Those uninsured patients or those with
Government insurance are more likely to be
diagnosed with advanced stage disease at
first treatment
“Baby Boom” Impact
Estimated Per Capita Health Expenditures
by Age and Sex, 1995
Service Provider Impact
• Continuing nurse
•
•
•
shortage
Resistance to greater
use of nurse
practitioners
Decline in doctors
entering into Primary
Care Medicine
Resistance to
“Convenient Care”
clinics
Population Impacts
 12 million cancer survivors alive in the U.S.
today
 3 out of 4 American families will have a family
member diagnosed with cancer
 25% of American families living with cancer
have children under the age of 18 living at home
 More than 28% of children in America will be
living in poor households
 Sources: American Cancer Society, Institute of Medicine, World
Health Organization, The Policy Press
Treatment Impact
 Skeletal impacts of ADT
 Cardiovascular issues related to hormone therapy
 Conflicting preventive therapeutic recommendations
 SELECT
 Finasteride
 PLCO Study
 Emerging technologies with minimal curative benefit
 Positive benefit of drug therapies
 Targeted disease management
Lifestyle Impact
 Meat becoming more popular in diets globally
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10.4% in the U.S.
25% more in Korea
49.7% in China
>2% in India
 Higher birth weights in emerging countries
 strong cancer association
 Sources: Food & Agriculture Organization of the United
Nations, AICR
Business of Medicine
 The System often has
other issues:
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
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Equipment investment
Revenue production
Pharmaceutical alliances
Pay-for-Performance
 Patients MUST become
their own advocates
Complicating the Issue
 Women vs. Men
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Comparable incidence and mortality
Research funds - 3X for breast cancer
Public health staffing - inconsistent
Government commitment - no agencies
Media focus - inordinately female focus
Men don’t communicate
Why Prostate Cancer Prevention?
 Significant public health risk
 186,000 new cases and 29,000 deaths yearly (2008)
 Risk factors (age, race, genes) are not modifiable
 Benefit of screening on mortality is controversial
 Therapy is associated with morbidity
That Leaves Prevention
Phase III Chemoprevention Trials
RRR = 22.5%
PCPT
RRR = 23.5%
REDUCE
5ARIs for Biochemical Recurrence
Andriole et al, Urology 45:491, 1995
PCPT and REDUCE
What did we learn?
 Consistency of effect
 Similar magnitude of risk reduction across all
risk groups
 No longer any grade issues
 Conclusion
 Use of 5-alpha reductase inhibitors is an effective
primary prevention strategy
Healthcare Disparity
• Disaffected classes
• racial/ethnic minorities
• high risk populations
• Socio-economic impact
• lack of/limited insurance
• breaking the “social contract”
• Equal Access:
• education
• preventive mechanisms
• care
Moving the Bar Forward:
Success Stories and Templates for
Change
Technology for Change
 71% of the people in North America are online
 113 million Americans seek health information
online
 Almost half of adult users and 84% of teens will
be on social sites
 40% of self-classified “non-users” became direct
or indirect users after a cancer diagnosis
 Sources: Internet World Stats, Pew Internet & American
Life Project
Social Network Integration
 Credible peer-to-peer communications
Quic kT ime™ and a
dec ompress or
are needed to s ee this pi cture.
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“New” Prostate Cancer Infolink
“Pints for Prostate”
Prostate Cancer Internet Alliance
FaceBook
Quic kTime™ and a
TIFF ( LZW) dec ompres s or
are needed to s ee this pic tur e.
Opciones de Tratamiento
Investigación Traslacional
Toma de Decisión Informada
Hormonas
Gleason 7: ¿Una Nueva Categoría de
Riesgo?
Diagnósticos
Terapia Citotóxica
¿Está considerando un Ensayo Clínico?
Quimioterapia
Medicina Alternativa / Complementaria
Espera Alerta
Terapias de Ataque
Soluciones Quirúrgicas
Manejo de Efectos Colaterales
Soluciones Oncológicas de la Radiación
Cuidado Paliativo
Manejo del Dolor
Fuentes de Información
Servicios de asistencia pacientes
Este sitio se ha producido con la ayuda de la familia de
Roberto "Tito" Warat y una concesión educativa de la
oncología de Sanofi-Aventis
Reinforcing the Message
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“In The Know” newsletter
Hard Copy - 29M circulation
Online supplement - > 100M
Broad spectrum content
Audience diversification
 consumers/patients
 advocates
 professionals
 researchers
 international
Media Syndication
 Mass impressions
 Minimal cost
 Increase reach
PodCasting for Health
•Reinforce the print message
•Portability for consumers
•Viability for diverse
situations:
•personal
•public health
•clinical
•research
Cell Casting for Health
•Enhanced consumer
interactivity
•Opt-in network
1.877.2CHECKNOW
•Customized content
•Applications for:
clinicians
researchers
public health
Going to the Barbershop:
Empowering Communities Through Risk
Communication
Barbershop based Health
Awareness Initiative
 Project BHAI (Brother):
 48 shops in Jharkhand and Orissa Provinces - India
 cancer prevention and tobacco control
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enhance knowledge
enhance healthy behavior
create a sustainable environment
build on existing networks and partnerships
expand to co-morbid disease
Research Partnerships
Creating a New Network
The Prostate Net
Sponsors
Participating
Medical/Research
Centers
> 300
Core Distribution:
80,000+ Website visits/month
1,200 Patient Support Group Leaders
1,000+ Public Health Workers
~ 6,000 Medical Oncologists
> 4,000 Urological Specialists
> 2,000 Cancer Researchers
American/National
Medical
Ass’ns.
> 5,000 Doctors
National Ass’n.
of Barber Boards
of America
Community
~ 200,000 Barbers
Create Heroes
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•Warren brought his son to a Pca
screening
•To educate him about being
responsible for his health
Meet James
He came to a Health Fair
On HIS BIRTHDAY!!
To give himself The Gift
of Life!!
Why is all this needed?!
To Eliminate the Suffering and Death from
Cancer
“If You’re Not the Lead
Dog, the View Never
Changes”
- Mike Ditka
Thank You!
WWW.THEPROSTATENET.ORG
1.888.477.6763