HAWAII CANCER PLAN 2004-2009
HAWAII CANCER oped by theHawaii ComprehensiveCancer Control Coalition“Bringing people together tocoordinate cancer prevention,early detection, treatment, support and research efforts toimprove the quality of life forresidents of Hawaii”
Aloha kakou,We are very proud of the accomplishments of the Hawaii Comprehensive CancerControl Coalition in developing the state's first Comprehensive Cancer Control Plan.The plan was created by a group of diverse, focused, and compassionate individualsdedicated to saving lives and improving the quality of life for individuals affected bycancer.Hawaii Comprehensive Cancer Control Plan is intended as a road map for the next fiveyears to achieve reductions in cancer rates and to improve health outcomes and qualityof life for all individuals, families, and communities touched by cancer. We are encouraged by the progress already achieved and mindful that much work needs to be done.The Lehua,is the first blossomto appear ona new lava flow.a symbol of hopeand new lifeThe battle against cancer will require the collective effort, cooperation and collaboration of communities, public and private organizations, and individuals to achieve ourstate vision of “No More Cancer”.I commend the Hawaii Comprehensive Cancer Control Coalition for their excellentwork. Hawaii can significantly change the course of cancer through a coordinatedeffort of organizations working together in a comprehensive, statewide approach tocancer control. There is no doubt that developing and implementing a state cancerplan that addresses the state’s cancer burden requires a new way of thinking and working. Lasting partnerships have been developed and strengthened as a result of thisstrategic plan. We are grateful for those participants and individuals who facilitated theproduction of this blueprint for action and look forward to ongoing collaboration as wemove to implementation of the many objectives of this plan.Chiyome Leinaala Fukino, MDDirectorHawaii State Department of HealthHA W AIICOMPREHENSIVECANCERCONTROL
Chair & Vice Chair MessageDear Residents of HawaiiAlthough cancer death rates are falling in Hawaii, cancer remains the second leadingcause of death in our state, following cardiovascular disease. Effective cancer prevention and control requires an integrated planning process.The Hawaii Comprehensive Cancer Control Coalition is pleased to present you withthe Hawaii Cancer Plan 2004-2009. This plan outlines goals and priorities that willassist Hawaii in making further progress toward reducing the burden of cancer in thepresent and future. The "No More Cancer" Strategic Plan provides the state with a comprehensive, integrated plan of action that highlights strategies targeting cancer education, prevention, screening, early detection, diagnosis and treatment, and quality of lifeconcerns that include pain management, medical costs, and access to supportive care.To produce this Plan, the Hawaii Comprehensive Cancer Control Coalition examinedthe current burden of cancer as well as risk factors that contribute to cancer in Hawaiiand came to a consensus to establish priorities for the next five years.This Plan is merely the beginning. As science and practical experience grow, new challenges, innovative tools, and more effective strategies will emerge based on the changing needs of our state's residents. This Plan is intended to be a living, dynamic roadmap, used by organizations, communities, and individuals to create, implement, and sustain activities to reduce the cancer burden throughout the state. Hawaii’s Cancer Planwill involve many sectors of our society, including community-based organizations,medical insurance companies, social groups, the fields of social work, nursing, medicineand education, local public health agencies and state and local government in additionto many individuals across our unique state.Thank you for using the Hawaii Cancer Plan. The HawaiiComprehensive Cancer Control Coalition invites you to join us in ourongoing efforts to further reduce the impact of cancer in Hawaii.STRATEGVirginia Pressler, M.D.Carolyn Gotay, PhD.HCCCP Coalition ChairpersonHCCCP Coalition Vice ChairpersonICPLANTOADV ANCECANCERCONTROL1
Table of ContentsDirector’s MessageInside CoverChair & Vice Chair Message1Acknowledgements3Comprehensive Cancer Control Strategies For HawaiiExecutive Summary8Overview11The Face of Cancer in Hawaii12How Cancer Affects the Citizens of Hawaii13Comprehensive Cancer Control Approach to Hawaii’sCancer Problem15The Process Used to Develop this Section of this Document 16NO MORE CANCERThe Cancer Vision Statement for the State of Hawaii17Goals18Guiding Principles19Crosscutting Issues and Strategies20Priority Issues and Recommendations For Each Goal Area20TAKE ACTION!To Advance Cancer Control 2004-200935The Evolution of Hawaii Comprehensive Cancer Control368 Take Action Strategies 2004-200551Conclusion53References54Coalition Participant Interest Form55COVER PHOTO: RON DAHLQUIST, COURTESY OF HAWAII VISITORS BUREAU2HA W AIICOMPREHENSIVECANCERCONTROL
Members:Lehua Abrigo, Papa Ola Lokahi, Inc.Alice Adee, MD, Hospice of Hilo-HawaiiMark Ah Sing, Tripler Army Medical CenterEllen Akaka, MD, Ke Ola O HawaiiCheryl Albright, PhD,Cancer Research Center of HawaiiUniversity of HawaiiGary Allen, Hawaii Business Health CouncilNoa Emmett Aluli, MD,Molokai Family Health CenterRep. Dennis A. Arakaki,Hawaii State House of RepresentativesLloyd Y. Asato, Office of Rural HealthHawaii State Department of HealthAmy Asselbaye, Office of Congressman NeilAbercrombie, U.S. House of RepresentativesSylvia Au, MS, CGC, Genetics ProgramHawaii State Department of HealthRep. Emily Auwae,Hawaii State House of RepresentativesLulu Bagnol, MPH, CHES, Breast andCervical Cancer Control ProgramHawaii State Department of HealthSen. Rosalyn H. Baker, Hawaii State SenateSheila Beckham,Waianae Coast ComprehensiveHealth CenterJeffrey Berenberg, MD,John A. Burns School of MedicineUniversity of HawaiiKim Kuulei Birnie, Papa Ola Lokahi, Inc.Charlene Blair,Hawaii Primary Care AssociationR. Kekuni Blaisdell, MD,John A. Burns School of MedicineUniversity of HawaiiCarol Boback, Office of Sen. SuzanneChun Oakland, Hawaii State SenateJohn D. Boyer, MD. Queen’s Medical CenterKathryn Braun, DrPH, Papa Ola Lokahi, Inc.Jonathan Brookfield,Stacy Brookfield Cancer FoundationLee Ellen Buenconsejo-Lum, MD,Pacific Association for Clinical TrainingJohn A. Burns School of MedicineUniveristy of HawaiiSen. Jan Yagi Buen, Hawaii State SenatePolly Busby, Maui District Health OfficeHawaii State Department of HealthSTRATEGICPLANBeth Freitas, RN, MSN, OCN,Queen’s Medical CenterChiyome Leinaala Fukino, MD,Director’s OfficeHawaii State Department of HealthSen. Carol Fukunaga, Hawaii State SenateOlga Geling, PhD, Department of PublicHealth Sciences and EpidemiologyJohn A. Burns School of MedicineUniversity of HawaiiRebecca Gladu, MD, Family PracticeResidency Program John A. Burns Schoolof Medicine University of HawaiiMarc T. Goodman, PhD, Hawaii TumorRegistry, Cancer Research Center of HawaiiUniversity of HawaiiCarolyn Gotay, PhD, (Vice Chairperson)Cancer Research Center of HawaiiUniversity of HawaiiJoshua Green, MD, Kau HospitalMichael Green, CTR,Cancer Research Center of HawaiiUniversity of HawaiiEuwilde Greenleaf,Personal Parenting Assessment ServicesSister Francine Gries,St. Francis Healthcare SystemJames L. Grobe, Jr., MD,Queen’s Medical CenterScott Y. Grosskreutz, MD, Hawaii BreastSociety, HRA Women’s Imaging CentersJana Hall, PhD, MBA, Hawaii Pacific HealthRonald Halpern,Compassion in Dying of HawaiiPatricia Hamamoto,Hawaii State Department of EducationKathleen Hanai-Lee, MSW, LSW,Hawaii Children’s Cancer Foundation /Tripler Army Medical CenterJean Hankin, DrPH,Cancer Research Center of HawaiiUniversity of HawaiiBrenda Hernandez, PhD, MPH,Cancer Research Center of HawaiiUniversity of HawaiiPaula Higuchi BANational Cancer Institute’sCancer Information ServicesGuy K. Hirayama, Maui Medical Group, Inc.Robert Hirokawa, MPH,Hawaii State Asthma Control ProgramHawaii State Diabetes Preventionand Control ProgramHawaii State Department of HealthCynthia Cabot, MPA,Healthy Hawaii InitiativeHawaii State Department of HealthVictoria Calvin, Hospice of KonaKevin Cassel, BA, National CancerInstitute’s Cancer Information ServicesDarlena Chadwick, RN, MSN,Hawaii Pacific HealthMichael Chaffin, MD,Kaiser Permanente Medical CenterSusan Chandler, PhD, Director’s OfficeHawaii State Departmentof Human ServicesClifford Chang, MPH, CHES,Hawaii Community FoundationSandra Chang, RN, BSNChronic Diseases SectionHawaii State Department of HealthClayton Chong, MD,St. Francis Medical CenterRev. Frank Chong, MSW, MDiv,Individual ParticipantSen. Suzanne Chun Oakland,Hawaii State SenateTina Clothier,American Cancer SocietyHawaii Pacific, Inc.Dorothy Coleman, RN, MS,Cancer Research Center of HawaiiUniversity of HawaiiJay Conley, Hospice HawaiiCharlene Cuaresma, MPH, National CancerInstitute’s Cancer Information ServicesKristine Wallerius Cuthrell, MPH, RD,Cancer Research Center of HawaiiUniversity of HawaiiChris Dein-Gaughen,Hawaii Tobacco-Free Partnership,West HawaiiPaul DeMare, MD,Pacific Radiation OncologyQueen’s Medical CenterRoger Drue, Board of DirectorsKapiolani Medical CenterTravis Fernandez, StudentEd Fess, MD, ConsultantInes Finin, APRN-CNS,Kapiolani Medical Centerfor Women and ChildrenJoan Foley, BSN,Spark Matsunaga Veterans ClinicSusan Forbes,Hawaii Health Information CorporationTOADV ANCECANCERCONTROLAcknowledgementsHAWAII COMPREHENSIVECANCER CONTROL COALITION3
Acknowledgements4Benda Ho, RN, MS, Hospice of HiloReginald Ho, MD,Straub Clinic and HospitalKarin Hohman,Strategic Health Concepts, Inc.Laura Hoque, MD,Kapiolani Women’s CenterTerri Imada, APRN, ANP-C,St. Francis Medical CenterLola Irvin, MEd,Tobacco Settlement Fund ManagementHawaii State Department of HealthMae Isonaga, RD, MPH, American CancerSociety Hawaii Pacific, Inc.Brian Issell, MD,Cancer Research Center of HawaiiUniversity of HawaiiSusan Jackson, PhD,Hawaii State Department of HealthStephen P. Jiang, MSW, ACSW,American Cancer SocietyHawaii Pacific, Inc.Lila Johnson, RN, MPH, CHES,Tobacco Preventionand Education ProgramHawaii State Department of HealthJudy Jonas, PhD, RD,American Cancer Society, Texas DivisionAnn Jones, American CancerSociety, Hawaii Pacific, Inc.John T. Kaizuka,Hawaii District Health OfficeHawaii State Department of HealthGary K. Kajiwara, Kuakini Medical CenterPat Kalua, RN, BSN, MAOM,St. Francis Medical CenterMomi Kamau, RN, MPHMaternal and Child Health BranchHawaii State Department of HealthLana Kaopua, PhDCancer Research Center of HawaiiUniversity of HawaiiRep. Bertha C. Kawakami,Hawaii State House of RepresentativesTom Kean, Strategic Health Concepts, Inc.Mark Kimbrell, MD, Hospice HawaiiGregg Kishaba,Hawaii State Asthma Control ProgramHawaii State Department of HealthKent Kitagawa, MPH,Breast and Cervical CancerControl ProgramHawaii State Department of HealthAnn H. Kobayashi, Honolulu City CouncilHA W AIICOMJeannette Koijane, MPH, ConsultantLillian B. Koller,Hawaii State Departmentof Human ServicesCarol Kostubo, RN, MS, MPH,Kapiolani Medical Centerfor Women and ChildrenDaryl Kurozawa, MD,Kona Community HospitalCarrie Kuwada, Hawaii District Health OfficeHawaii State Department of HealthGregory LaGoy, MD,Hospice MauiMorris K. Lai, PhD,Curriculum Researchand Development GroupUniversity of HawaiiDew-Anne Langcaon, CPA, MACC,Hawaii Pacific HealthLissa Lang, RN, BSN, OCN, American CancerSociety Hawaii Pacific, Inc., Kauai UnitJohn Lederer, MD,Pacific Radiation OncologyQueen’s Medical CenterFlorence Lee, American Cancer SocietyHawaii Pacific, Inc.Jodi Leslie, MPH, RD,Nutrition and Physical Activity SectionHawaii State Department of HealthJulian Lipsher, MPH, CHES,Tobacco Preventionand Education ProgramHawaii State Department of HealthClifton Liu, PharmD,St. Francis Medical Center-WestTonya Lowery-St. John, MPHTobacco Preventionand Education ProgramHawaii State Department of HealthJay Maddock, PhD,Department of Public Health SciencesJohn A. Burns School of MedicineUniversity of HawaiiJohn McComas, MPH, AlohaCareRep. Bob McDermott,Hawaii State House of RepresentativesJohn McDonnell, MD,Hawaii Medical AssociationSandra McGuinness,Maui Tobacco-Free PartnershipGeorge McPheeters, MD,Straub Clinic and HospitalMichelle Meredith, Kapiolani Breast CenterKapiolani Medical Centerfor Women and ChildrenRonald L. Metler, MD,Kauai District Health OfficeHawaii State Department of HealthJudy Mikami, RN, MPH,Na Puuwai Native Hawaiian HealthCharles Miller, MD,Kaiser Permanente Medical CenterCatherine Morris, Esq, JD, CPC,Hawaii Society of Clinical OncologyPaul Morris, MD,Hawaii Society of Clinical OncologySuzanne Murphy, PhD, RD,Cancer Research Center of HawaiiUniversity of HawaiiAnalika Nahulu, Office of Hawaiian AffairsJo-Anna Nakata, Individual ParticipantJuanita Namahoe, Na Puuwai, MolokaiGretchen Neal, MPH, American CancerSociety Hawaii Pacific, Inc.Mea Neal,Leukemia and Lymphoma SocietyClaudio R. Nigg, PhD,Department of Public Health SciencesJohn A. Burns School of MedicineUniversity of HawaiiWendy K. Nihoa, BSW, MAOM,Hawaii ComprehensiveCancer Control ProgramHawaii State Department of HealthPatricia Nishimoto, BSN, MPH, SN,Tripler Army Medical CenterRep. Scott Y. Nishimoto,Hawaii State House of RepresentativesMarina Nogues, MS,Hawaii State Diabetes Preventionand Control ProgramHawaii State Department of HealthAbraham Nomura, MD, DrPH,Cancer Research Center of HawaiiUniversity of HawaiiSusan Oliver, RN, Hospice of KonaAlvin T. Onaka, PhD,Office of Health Status MonitoringHawaii State Department of HealthDavid O’Riordan, PhD,Cancer Research Center of HawaiiUniversity of HawaiiRep. Marcus R. Oshiro,Hawaii State House of RepresentativesChris Pablo, Esq,Kaiser Permanente Medical CenterNeal Palafox, MD, Department of FamilyPractice and Community HealthJohn A. Burns School of MedicineUniversity of HawaiiPCREHENSIVECANERCONTROL
STRATEGICPLANSharon Shigemasa, RN, MS,Cancer Research Center of HawaiiUniversity of HawaiiSharon Sirling, BSN, RN,Maternal and Child Health BranchHawaii State Department of HealthHardy Spoehr, Papa Ola Lokahi, Inc.Merle Sprague, MD, Radiation OncologyTripler Army Medical CenterValerie Starkey, RN, Na Puuwai, MolokaiNancy Strach, LSW,Oncology, St. Francis Health ServicesKen Sumida, MD, St. Francis Medical CenterNeal Sutherland, MD, Kauai HospiceMary Jo Sweeney,Kauai Rural Health AssociationElizabeth Tam, MD, Department of MedicineJohn A. Burns School of MedicineUniversity of HawaiiTina Tamai, JD, MPH Tobacco Preventionand Education ProgramHawaii State Department of HealthAllison Taylor, MS, Genetics ProgramHawaii State Department of HealthSister Beatrice Tom,St. Francis Medical CenterCaryn Tottori,Office of Health Status MonitoringHawaii State Department of HealthLeo L. Trinidad, MD,United Filipino Council of HawaiiJo Ann Tsark MPH, Papa Ola Lokahi /‘Imi HaleArthur Ushijima, Office of the PresidentQueen’s Medical CenterRay Vara, Straub Clinic and HospitalRobert Walker, Office of the PresidentCastle Medical CenterRoger D. Watanabe,Department of Parks and RecreationCity and County of HonoluluJonathan Weisul, MD,St. Francis Medical CenterMisae Wela, RN, MS, Hospice of Hilo-HawaiiCarl Wilhelm-Vogel, MD, PhD,Cancer Research Center of HawaiiUniversity of HawaiiLynne Wilkens, DrPH,Cancer Research Center of HawaiiUniversity of HawaiiRobert Wilkinson, MD,Kapiolani Medical Centerfor Women and ChildrenTOADV ANCECAMyra Williams, MPH, Care ManagementHawaii Medical Service AssociationSuasin Winlove, MD,St. Francis Medical CenterVanessa S. Wong,Department of Family Practice andCommunity HealthJohn A. Burns School of MedicineUniversity of HawaiiDanette Wong Tomiyasu, MBA,Chronic Disease Managementand Control BranchHawaii State Department of HealthBetty Wood, PhD,Public Health Block Grants ManagementHawaii State Department of HealthBarbara Yamashita, MSW,Community Health DivisionHawaii State Department of HealthTracie Yoshimoto,Hawaii Tobacco Control CoalitionHawaii State Department of HealthKarleen Yoshioka,Hawaii District Health OfficeHawaii State Department of HealthJackie Young, PhD, American CancerSociety Hawaii Pacific, Inc.Ken Zeri, RN, MS, CRNH, Hospice HawaiiDeborah Zysman, MPH,Coalition for a Tobacco-Free HawaiiNCERCONTROLAcknowledgementsLaeton Pang, MD, MPH,Pacific Radiation OncologySt. Francis Medical CenterLorrin Pang, MD, MPH,Maui District Health OfficeHawaii State Department of HealthAnn Pobutsky, PhD,Community Health DivisionHawaii State Department of HealthParan Pordell, MPH, CHES,Hawaii ComprehensiveCancer Control ProgramHawaii State Department of HealthRose Ann Poyzer, Home Care HospiceHealthcare Association of HawaiiVirginia Pressler, MD, MBA, FACS,(Chairperson)Hawaii Pacific HealthFlory Quarto, RN, MPHPublic Health Nursing BranchHawaii State Department of HealthSusan Redpath, Hawaii Affiliateof the Susan G. KomanBreast Cancer FoundationKen Robbins, MD,Straub Clinic and HospitalHali Robinett, MPH,National Cancer Institute’sCancer Information ServicesCharles Roessler, MA, Tobacco-Free KauaiLinda M. Rosen, MD, MPHHawaii State Department of HealthPaul Ross, APRN, ANPCS, MA,Oncology ServicesSt. Francis Medical CenterSusan Saka, MEd,Curriculum Researchand Development GroupUniversity of HawaiiDavid Sakamoto, MD,State Health Planningand Development AgencyFlorentina Salvail, MS,Behavioral Risk Factor Surveillance SystemHawaii State Department of HealthLisa Sanchez-Johnsen, PhD,University of HawaiiAdeline Sasaki, Kauai District Health OfficeHawaii State Department of HealthJane Sharkey, RN, Hospice Hawaii, OahuSangita Sharma, PhD, RPHNutr,Cancer Research Center of HawaiiUniversity of HawaiiLeimomi Shearer, Hui Malama Ola NoOiwi, Hawaii Island5
Acknowledgements2001 GOVERNOR’S BLUE RIBBON PANELJonathan BrookfieldRev. Frank Chong, MSW, MDivPaul DeMare, MDReginald Ho, MDBrian Issell, MDPat Kalua, RN, MAOMCarol Kotsubo, RN, MS, MPHChris Pablo, EsqVirginia Pressler, MD, MBA, FACSSharon Shigemasa, RN, MSCarl Wilhelm-Vogel, MD, PhDRobert Wilkinson, MDJackie Young, PhD2003-2005 STEERING COMMITTEEHCCCP Coalition Chair:Virginia Pressler, MD, MBA, FACSHCCCP Coalition Vice Chair:Carolyn Gotay, PhDCommittee Members:Stephen P. Jiang, MSW, ACSWRep. Scott Y. NishimotoAnn JonesChris Pablo, EsqJay Maddock, PhDJo Ann Tsark, MPHSen. Rosalyn H. BakerTravis FernandezMyra Williams, MPHBarbara Yamashita, MSW2003 WORK GROUPSCOST/INSURANCELeader: Myra Williams, MPHMembers:Jo-Anna NakataMarina Nogues, MSGary AllenPolly BusbyLorrin Pang, MD, MPHDATA/SURVEILLANCELeader: Ann Pobutsky, PhDMembers:Robert Hirokawa, MPHAlvin T. Onaka, PhDTonya Lowery-St. JohnParan Pordell, MPH, CHESSusan Saka, MEdMichael Green, CTRBrenda Hernandez, PhD, MPHLisa Sanchez-Johnsen, PhDCaryn TottoriDIAGNOSIS/TREATMENTCo-Leaders: Kent Kitagawa, MPH Sharon Shigemasa, RN, MSMembers:John D. Boyer, MDDarlena Chadwick, RN, MSNKevin Cassel, BAInes Finin, APRN-CNSMark Ah SingGretchen Neal, MPHEARLY DETECTIONCo-Leaders: Terri Imada, APRN, ANP-C Flory Quarto, RNMembers:James L. Grobe, Jr., MDPaul Morris, MDLissa Lang, RN, BSN, OCNVirginia Pressler, MD, MBA, FACSSharon Sirling, BSN, RNSylvia Au, MS, CGCCharlene Cuaresma, MPHLeo L. Trinidad, MDJonathan Weisul, MDPREVENTIONLeader: Claudio R. Nigg, PhDMembers:Stephen P. Jiang, MSW, ACSWCarrie S. KuwadaLila Johnson, RN, MPH, CHESJodi Leslie, MPH, RDGregg KishabaJulian Lipsher, MPH, CHESJoan Foley, BSNJean Hankin, DrPHLola Irvin, MEd6HA W AIICOMPREHENSIVECANCEJay Maddock, PhDCharles Roessler, MARoger D. WatanabeRCONTROL
Amy AsselbayeRev. Frank Chong, MSW, MDivNeal Palafox, MDPaul Ross, APRN, ANPCS, MARESEARCHCo-Leaders: David O’Riordan, PhD Hali Robinett, MPHMembers:Jean Hankin, DrPHPaul Ross, APRN, ANPCS, MAParan Pordell, MPH, CHESFlorentina Salvail, MSKristine Wallerius Cuthrell, MPH, RDCarolyn Gotay, PhDSangita Sharma, PhD, RPHNutrJo Ann Tsark, MPHUNIFORM ACCESSCo-Leaders: Lloyd Y. Asato Analika NahuluMembers:Judy Mikami, RN, MPHDanette Wong Tomiyasu, MBAAdeline SasakiBarbara Yamashita, MSWSen. Rosalyn H. BakerJackie Young, PhD2004 ACTION TEAMSCOST/INSURANCECo-Leaders: Darlena Chadwick, RN, MSN Scott Y. Grosskreutz, MDMembers:Ed Fess, MDStephen P. Jiang, MSW, ACSWOlga Geling, PhDKent Kitagawa, MPHRev. Frank Chong, MSW, MDivMichelle MeredithDATA/SURVEILLANCELeader: Ann Pobutsky, PhDMembers:Brenda Hernandez, PhD, MPHParan Pordell, MPH, CHESRobert Hirokawa, MPHSusan Saka, MEdAlvin T. Onaka, PhDDavid Sakamoto, MDOlga Geling, PhDMichael Green, CTRFlorentina Salvail, MSCaryn TottoriEARLY DETECTIONLeader: Myra Williams, MPHMembers:Charlene Cuaresma, MPHStephen P. Jiang, MSW, ACSWJames L. Grobe, Jr., MDKent Kitagawa, MPHTerri Imada, APRN, ANP-CCarrie KuwadaJohn D. Boyer, MDLee Ellen Buenconsejo-Lum, MDAcknowledgementsQUALITY OF LIFELeader: Jeannette Koijane, MPHMembers:Jay ConleyRebecca Gladu, MDTravis FernandezCarol Kostubo, RN, MS, MPHJuanita NamahoeVirginia Pressler, MD, MBA, FACSPREVENTIONLeader: Claudio R. Nigg, PhDMembers:Carrie KuwadaSandy McGuinnessJodi Leslie, MPH, RDMarina Nogues, MSJulian Lipsher, MPH, CHESLorrin Pang, MD, MPHLola Irvin, MEdStephen P. Jiang, MSW, ACSWGregg KishabaSTRATEGICPLANTOADV ANCECANCTina TamaiDeborah Zysman, MPHERCONTROL7
Executive SummaryComprehensive Cancer ControlStrategies For HawaiiExecutive SummaryCancer is the second leading cause of death in our nation, causing 25% of all deaths eachyear (ACS, 2004). Last year, more than 5,000 Hawaii residents were told they have cancer(Hawaii Cancer Facts & Figures 2003-2004). In over a six-year period in Hawaii (19952000), close to 10,400 of our neighbors lost their lives to this disease. Cancer continuesto take a terrible toll on the state, year after year; however, advances in research havebrought us to the point where cancer is no longer the automatic death sentence it oncewas. Today there are over 10 million cancer survivors, not just the individual diagnosedwith cancer, but their family, friends, and caregivers (2002). Scientific evidence suggeststhat it may be possible to reduce cancer deaths by up to one-third by preventing tobaccouse, improving nutrition and maintaining a body weight within the recommended range(Hawaii Cancer Facts & Figures 2003-2004). Due to advances in scientific research andclinical practices as well as increased patient access toclinical trials, the number of residents surviving cancerand defeating it continues to grow in our state.Hawaii can significantly change the course of cancerthrough a coordinated effort of organizations workingtogether in a comprehensive, statewide approach tocancer control. Developing and implementing a statecancer plan that comprehensively addresses a state’scancer burden requires a new way of thinking. No single organization has the capacity to address all ofHawaii’s cancer control needs. Therefore, during themonths of October 2002 – January 2003, approximately75 key leaders from cancer, health care, and communityorganizations throughout the state came together for aseries of four meetings sponsored jointly by the American Cancer Society, The CancerResearch Center of Hawaii, and the Hawaii State Department of Health. The overall purpose of the four meetings was to develop a strategic plan that included a common comprehensive cancer control vision for the state of Hawaii and to identify correspondinggoals, challenges, and strategies. Framed by guiding principles and overarching crosscutting strategies that include health parity and cultural competancy as well as coordinationand collaboration, this plan reflects the diversity of the participants and the diversity ofour island state. The following eight goals were determined to be the top priorities thatwill advance cancer control in Hawaii. These goals are:Goal 1: Prevention - Prevent cancer from occurring, especially through education andbehavior change strategies.Goal 2: Early Detection - Detect cancer at its earliest stages and assure coordinationwith cancer management services.Goal 3: Diagnosis/Treatment - When cancer is detected, manage cancer with themost current and effective treatments available.Goal 4: Quality of Life - Assist cancer patients and their loved ones in achieving thehighest quality of life available to them.8HA W AIICOMPREHENSIVECANCERCONTROL
Executive SummaryGoal 5: Research - Promote research to advance the capabilities in Hawaii for prevention, early detection, treatment, and quality of life.Goal 6: Data/Surveillance - Improve and maintain a high quality surveillance systemon all aspects of cancer to ensure informed decision-making.Goal 7: Uniform Access - Achieve uniform access to cancer services on each islandand within each population group.Goal 8: Cost/Insurance - Address cost and payment coverage issues for cancer-relatedservices. Subsequently, 99 strategies were identified to address the eight goalareas and became the cornerstone for the statewide cancer planing during thesecond year.In year two, the Coalition prioritized the 99 strategies of the strategic plan to create the"Take Action!" section of the cancer plan. This section includes 22 of the strategies foraddressing cancer priorities in Hawaii over the next 5 years.Eight of the 22 strategies have been selected for implementation throughout 2004 2005. Combined, the “No More Cancer” Strategic Plan and the “Take Action!” sectionsmake up the Hawaii Cancer Plan in its entirety. The eight strategies consist of:8 Take Action Strategies, 2004 - 2005Prevention Goal: Prevent Cancer from occurring, especially through education and behavior change strategies.1. Establish mandatory physical education policies in all schools in Hawaii.2.Adopt, adapt, and implement proven behavior change interventions targetingincreased consumption of fruits and vegetables.3. Engage in efforts to create norms that positively support smoke-free behavior.4. Implement "Healthy Foods" policies in schools.Early Detection Goal: Detect cancer at its earliest stages and assure coordination with cancer management services.5. Conduct patient and public education about the importance of cancerscreening with the emphasis that screening saves lives.6. Develop and conduct health care provider trainings on screening guidelinesand the need to talk with patients about the guidelines.Data/Surveillance Goal: Improve and maintain a high quality surveillance system on all aspects of cancer to assure informed decision-making.7. Develop a process to share and disseminate information regarding uses of thehealth data.To assess the cancer problem in Hawaii, our state needs to beginwith the best available data.Five major sources of data are:Death certificates;Hospital dischargesummaries;Hospital and physicianoffice pathology reports;Hawaii Tumor Registry(SEER) data;Behavioral Risk FactorSuveillance System (BRFSS) PHOTO BY: SRI MAIAVA, COURTESY OF HAWAII VISITORS BUREAUSTRATEGICPLANTOADV ANCECANCERCONTROL9
Cost/Insurance Goal: Address cost and payment coverage issues for cancerrelated services.8. Fund a study that is specific to Hawaii to answer the following questions:What is the average cost of providers to deliver treatment? (chemotherapy,radiation, doctors, hospital stay, etc.).What do health plans reimburse for and how does it differ by health careplan?What is/is not covered by insurance plans?What is the cost of non-reimbursable services such as seeing social workers,obtaining psychological services, or participating in patient navigation programs, etc.?What are the differences between hospital based service reimbursement andmedical office service reimbursement–and why?What are the differences between reimbursement and the actual cost ofservices?What is the funding pool? And how should it be prioritized?What is the list of all the services that comprise cancer diagnosis andtreatment?What funding is available for the uninsured and underinsured? Is part of thecost transferred to the insured?What barriers limit access to care due to insurance coverage limitations?Are there other medical economic models?Identify where money can come from to fund prevention and education.(Recommendation 8.2b)Determine the most efficient allocation of resources, e.g., funding the‘front-end’ – by spending the same overall amount of money, but putting themoney into prevention instead. (Recommendation 8.3a) Early Hawaiiansused the wood tocarve sacred templeartifacts. This Plan is only the beginning. As science and practical experience grow, new challenges, new tools and new strategies will emerge. The intent of this plan is to provide aroadmap for organizations, communities, and individuals to create, implement, and sustain activities to reduce the cancer burden throughout Hawaii. To track progress of theplan,Action Teams will provide regular status updates and the cancer plan will be revisited and updated as state priorities change. Hawaii’s Cancer Plan will involve many sectors of our society including community-based organizations, medical insurance companies, social groups, and the fields of social work, nursing, medicine, nutrition, and education, local public health agencies and state and local government in addition to manyindividuals across our unique state.The Coalition envisions a Hawaii with "No More Cancer" and this plan is the first steptoward that vision!10HA W AIICOMPREHENSIVECANCERCONTROL
OverviewOverviewThe Hawaii Comprehensive Cancer Control Coalition is a consortium of organizationsand individuals with interests in the prevention and control of cancer in Hawaii. TheCoalition’s membership is more than 100 individuals strong, representing over 75 agencies, stakeholders, and programs from around the state.The first four meetings of the Hawaii Comprehensive Cancer Control Coalition in 2003resulted in the creation of the 2003 Hawaii Comprehensive Cancer Control StrategicPlan. The strategic plan outline
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