Welcome To The IPLAN Web-Conference
Welcome to the IPLANWeb-ConferenceLung Cancer:An Overview ofthe Disease and Prevention1Presenters Beth Phelps, Southern Illinois University Cancer Institute Julie Doetsch, Illinois Department of Public Health Lynda Preckwinkle, American Lung Association ofIllinois-Iowa Babs Frederking, Washington County HealthDepartment Angela Tin, American Lung Association of Illinois Barbara Sorgatz, Illinois Department of Human Services2Lung Cancer Beth Phelps RN, MS,APN, ACNPCoordinator ThoracicOncology ProgramSimmonsCooperCancer c.html1
Lung Cancer: Overview “Lung cancer is the leading cause ofcancer death in both men and women,and accounted for approximatelyppy 27%of all cancer deaths in Illinois from1999-2003. Alarmingly, 87% of lungcancer deaths could be prevented byeliminating tobacco abuse.”(American Cancer Society Illinois Cancer Facts & Figures, 2006)Lung Cancer: Incidence New lung cancer diagnosis, Illinois 2006{{ Estimated Deaths from lung cancer, Illinois{{ Male 5,030Female 4,050Male 3,990Female 3,090More deaths from lung cancer than prostate,breast and colorectal cancers combined(American Cancer Society Illinois Cancer Facts & Figures, 2006)Lung Cancer: Women Account for 12% of all new casesMore deaths from lung cancer than breast,ovarian, and uterine cancers combined.Women are more susceptible to tobaccoeffects. 1.5 times more likely to develop lungcancer than men with similar smokingpatterns.Jemal A, Thomas A, Murray T, Thun M. (2002).American Cancer Society Facts & Figures (2004).2
Lung Cancer: What is it? Cell mutation causes uncontrollablegrowth and replicationThese rapidly growing cells begin toinvade adjacent tissuesMicroscopic cells travel through thelymph system to other areas of lungand body. (Metastatic Disease)(Site-Specific Cancer Series: Lung Cancer, 2004)Lymphatic System3
Lung Cancer: Causes Smoking{{{Leading cause oflung cancer87% off llungcancers related tosmokingRisk is related tothe amount ofexposureLung Cancer: Causes Radiation stosRadonPassive SmokeLung Cancer: Symptoms CoughDyspneaHemoptysispyRecurrentinfectionsChest pain4
Lung Cancer: Symptoms Symptoms related to distantmetastases{{ PainOrgan-relatedGeneral Symptoms{{Weight lossFatigueLung Cancer: Screening No proven effective screening tool todateNumerous studies in pprogressgtodetermine most effective screening forlung cancer{{{Chest X-rayCT scanSputum analysisLung Cancer: Diagnosis Chest X-rayBronchoscopyCT ScansNeedle BiopsyPET/CT ScansSurgical Biopsy5
BronchoscopyBronchoscopyBronchoscopy6
PET/CT ScansBiopsyLung Cancer: Metastatic Sites Lymph NodesBrainBonesLiverLung/PleuraAdrenal Gland7
Lung Cancer: MetastasesLung Cancer: TypesNon Small Cell Lung Cancer(NSCLC)Small Cell Lung Cancer(SCLC)8
Non Small Cell Lung Cancer 80% of all lung cancers are NSCLCSurvival is improved when found at anearly stageThree distinct types of NSCLCTreatments are the sameNSCLC: Types AdenocarcinomaSquamous CellCarcinomaLarge CellCarcinomaNSCLC: TNM Staging Stages are 1-4; with 4 being the worstStage is determined by looking at 3separate components{{{T Tumor sizeN Lymph node involvementM Absence or presence of metastases9
NSCLC: TreatmentStageDescriptionTreatment OptionsStage ISingle TumorSurgeryStage IISpread to the lymphnodes of the lungSurgeryStage IIIaSpread to lymph nodesin the tracheal area,chest wall or diaphragmChemotherapy followedby radiation or surgeryStage IIIbSpread to lymph nodesof opposite lung or in theneckCombination ofchemotherapy andradiationStage IVTumor had spreadbeyond the chestChemotherapy and/orpalliative careNSCLC: SurvivalStageIIIIIIaIIIbIV5-year Survival60-80%40-50%25-30%5-10% 1%Surgery10
Surgery Surgery is done if there is anincreased life expectancy after thepprocedureSurgery is not for metastatic lungcancerThe earlier a cancer is caught themore likely that surgery will be curativeAdvances in Surgery More procedures done usingminimally invasive techniquesClinical trials are looking at diagnosticprotocolsSurgeons are looking at newtechniques to decrease localrecurrence rateshttp://www.cancer.gov/nlst11
Small Cell Lung Cancer (SCLC) Most aggressive type of lung cancerResponds to chemotherapy andradiationRecurrence rates are highSCLC: TypesOat CellIntermediateCombinedSCLC: Staging Limited{ Tumor is in one lung, the mediastinum,and lymphy p nodes that can be radiatedusing a single radiation port.Extensive{Tumor has spread beyond one lung, themediastinum and local lymph nodes.12
SCLC: Treatment Limited Disease{{{ ChemotherapyConcomitant RadiationProphylactic Cranial RadiationExtensive Disease{{ChemotherapyPalliative RadiationSCLC: ChemotherapySCLC: Chemotherapy A combination of chemotherapeuticagents is usedGoal: improvepdisease-free intervaland length of survivalResearch is ongoing{{{New agentsVaccinesRadiation protocols13
SCLC: Survival Limited Disease:{{ Median survival 18-20 months5-year5year survival 10%Extensive Disease:{{Median survival 10-12 months5-year survival 1-2%RadiationRadiation: Intensity-Modulated “Intensity-modulated radiation therapy(IMRT) is an advanced mode of highprecision radiotherapyppy that utilizescomputer-controlled x-ray acceleratorsto deliver precise radiation doses to amalignant tumor or specific areaswithin the pg imrt14
Lung Cancer: The FutureAdvances Public awareness of the link betweensmoking and lung cancer hasincreasedTherapy has moved away from onesize fits allPeople with lung cancer are livinglongerThe End15
References Alam, N., Shepherd, D. G., Mackay, J. A., Wvans, W. K., & Members of the Lung CancerDisease Site Group. (2006). Postoperative adjuvant chemotherapy, with or withoutradiotherapy, in completely resected non-small cell lung cancer: A clinical practiceguideline. The Annals of Thoracic Surgery., may 1, 2006; 81(5): 1926 - 1936., 81(5),1926. Retrieved from SumSearch database.American Cancer Society Illinois Cancer Facts & Figures 2006, United States, 2006.American Cancer Society Facts & Figures 2004, Atlanta, Ga., 2004.Birdas TBirdas,T., KoehlerKoehler, RR. MM., ColoniasColonias, AA., TrombettaTrombetta, MM., MaleyMaley, JJ.,RichardH.,RichardH LandreneauLandreneau,R., et al. (2006). Sublobar resection with brachytherapy versus lobectomy for stage ibnonsmall cell lung cancer. The Annals of Thoracic Surgery, 81(2), 434-439.Chapple, A., Ziebland, S., & McPherson, A. (2004). Stigma, shame, and blameexperienced by patients with lung cancer: Qualitative study. Online First BMJ, , October20, 2007. doi:10.1136/bmj.38111.639734.7CFeld R, Ginsberg RJ, Payne DG, Shepherd FA. Lung. In: Abeloff MD, Armitage JO,Lichter AS, Niederhuber JE, eds. Clinical Oncology. 2nd ed. New York, NY: ChurchillLivingstone; 2000:1398-1477.Ginsberg RJ, Vokes EE, Rosenzweig K. Non-small cell lung cancer. In: DeVita VT Jr ,Hellman S, Rosenberg SA, eds. Cancer Principles and Practice of Oncology. 6th ed.Philadelphia, Pa: Lippincott-Raven; 2001:925-981.References Houlihan, N. G. (Ed.). (2004). Site-specific cancer series: Lung cancer. Pittsburgh,Pennsylvania: Leonard Mafrica, MBA, CAE.Jemal A, Thomas A, Murray T, Thun M. Cancer statistics, 2002. CA Cancer J Clin.2002;52:23-47.Lally, B. E., Zelterman, D., Colasanto, J. M., Haffty, B. G., Detterbeck, F. C., & Wilson, L.D. (2006). Postoperative radiotherapy for stage II or III non-small-cell lung cancer usingthe surveillance, epidemiology, and end results database. Journal Clinical Oncology, 24,2998.Montazeri, A., Milroy, R., Hole, D., McEwen, J., & Gillis, C. (2001). Quality of life in lungcancer patients: As an important prognostic factor. Lung Cancer, 31(2-3), 233-24Pettiford, B., Schuchert, M., Santos, R., & Landreneau, R. (2007). Role of sublobarresection (segmentectomy and wedge resection) in the surgical management of Non–Small cell lung cancer. Thoracic Surgery Clinics, 17(2), 175-190.Schild, S. E., Bonner, J. A., Shanahan, T. G., Brooks, B. J., Marks, R. S., Geyer, S. M., etal. (2004). Long-term results of a phase III trial comparing once-daily radiotherapy withtwice-daily radiotherapy in limited-stage small-cell lung cancer. International Journal ofRadiation Oncology*Biology*Physics, 59(4), 943-951.Sirzen, F., Kjellen, E., Sorenson, S., & Cavallin-Stahl, E. (2003). A systematic overview ofradiation therapy effects in non-small cell lung cancer. Acta Oncologica, 42(5/6), 493.Targeting Interventions toPopulations withTobacco-useTobaccouse DisparitiesJulie B. Doetsch, M.A.Tobacco Program ManagerIllinois Department of Public Health(217) 785-1054Julie.Doetsch@illinois.gov16
Why? Smoking and lung cancer Definition of populations with tobacco-related disparities: “Differences in patterns, prevention, and treatment oftobacco use; differences in the risk, incidence, morbidity, mortality,and burden of tobacco-related illness that exist amongspecific population groupsgroups ;; and related differences in capacity and infrastructure,access to resources, and environmental tobaccosmoke exposure.”(Source: CDC. Best Practices for Comprehensive Tobacco Control Programs – 2007. Atlanta: U.S. Department of Health and HumanServices, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office onSmoking and Health; October 2007.)Where are populations with tobacco usedisparities? Everywhere!17
Who? Populations with tobacco usedisparities in Illinois MalesAge: 18 to 24 year olds 25 to 34 year olds 35 to 44 year oldsLower educational attainment: Some high school no degree GEDLower incomeHomosexuals and bisexualsPregnant women with no or late access to prenatal careMiddle East immigrantsNative Hawaiian/Pacific IslandersPeople residing in rural areasData available to identify populations withtobacco use disparities County Behavioral Risk Factor System Adult Tobacco Survey http://app.idph.state.il.us/brfss/Smoking rates by demographic /ILATS2007.pdfIPLAN Data Systemhttp://app.idph.state.il.us/Income, educational attainment,rurality, Medicaid U.S. Census www.census.govLocal data sourcesRecommendations CDC Best Practices recommendsthat a comprehensive tobaccocontrol program includeidentifying and eliminatingtobacco-related disparitiesamong populationl ti groups by:b Preventing smoking initiationReducing exposure to secondhandsmokeAssisting smokers to quit smokingAvailable at: www.cdc.gov/tobacco/tobacco control programs/stateandcommunity/best practices/18
Approaches: Reducing exposure tosecondhand smoke Smoke-free Illinois Act [PA 95-0017] Information available at: www.smoke-free.illinois.govApproaches: Cessation Local cessation programsIllinois Tobacco Quitline:Lynda Preckwinkle, BA, RRTDirector, ALA Helpline and Tobacco QuitlineAmerican Lung Association of Illinois-Iowalynda@lunghelpline.org217-787-5864 x 26119
PLAN TO QUIT QUIT TO WIN!!!PurposeThe Illinois Tobacco Quitline is herefor one reason . . .to help people quit tobacco.Why Should Tobacco Dependencebe Treated? Tobacco causes premature death ofalmost half a million Americans eachyear1/3 off all tobacco users in this countrywill die prematurely from tobaccodependence losing an average of 14years70% of smokers see a physician eachyear70% of smokers want to quit20
The Cost of TobaccoDependence in Illinois Nearly 17,000 deaths each year areattributable to tobacco use 6.7 billion in added health carecosts/year and lost productivityAddictions Stopping smoking is difficult because,in order to quit, a person needs to:– OvercomeOaddictionddi ti tot nicotinei ti Physical Addiction– Change the habits of lighting up andinhaling smoke Psychological AddictionMany Methods of Quitting “Cold Turkey” “Cutting Back”HypnosisLaser Therapy/Auricular TherapyAcupunctureNicotine Replacement Prescription Medications 21
Behavioral Modifications22
Effective UIT--YESResources Cessation Guide and Information mailed Cessation Program is tailored to the callers needs One--onOneon--one counseling in Spanish Interpretation services for more than 150 languages Telecommunication Line for the Deaf Line capacity to handle hundreds of calls per day1-800800-501501--106823
Qualified, Experienced Staff Registered Nurses Registered Respiratory Therapists Certified Tobacco Cessation Counselors Medical Advisory BoardHours of OperationOpen Extended Business Hours7 a.m. to 9 p.m. Monday through FridayCalls received outsideof these times aretaken by voice mail –responded to the nextworking dayServices Dual Function– Stand Alone Counseling Cessation Program one--ononeon-one over the phone– Alongside or in Follow Up to other cessation efforts Reactive Services: Client phonesÆphonesÆ Counselor weeklyProactive Services: Counselor phonesÆphonesÆ Client, atscheduled intervalsUnlimited Services24
How does it work? Clients are educated inthe newest techniquesIndividualized quitting plans are developed and may include:– Behavioral Modification Techniques– Nicotine Replacement Products– Medication TherapyAll the tools are there PacketsTobacco Cessation Information Packetis provided: nicotine replacementprescription medicationbehavior modificationthe recovery processwithdrawal symptomstips for cravings, coping, stress management25
BenefitsQuitline staff offerencouragement andsupport throughout thequitting processQuitlines canincrease successby up to 56%!5 Steps to Helping People Quit– The 5 A’sASK about tobacco use.ADVISE to quit. ASSESS willingnessillitot makek a quititattempt. ASSIST in quit attempt. ARRANGE for followfollow-up Free Promotional Tools promote through company intranet, use print materialsin break rooms, offer enrollment forms through companynurse or during routine health screenings Coasters Tear Off Style PadsBrochures (English & Spanish)Window ClingsPostersMagnetsEnrollment FormsPower Point PresentationPrint Ads26
The Illinois Tobacco QuitlineTelecommunication Line for the Deaf: 1-800-501-1068The Quitline’s knowledgeable staffis waiting to serve youBreak the HabitBabs Frederking, RNHealth Educator/Tobacco CoordinatorWashington County Health Dept.618-327-3644wchd191@yahoo.comBreak the Habit WHAT IS BREAK THE HABIT? In the beginning there was IDPH Officeof Health Promotion Division of ChronicDisease Prevention & Control – whew! Then there was Tobacco SettlementFunds Then there was Illinois Tobacco FreeCommunities Grants And then there was Break the Habit!27
Break the Habit Washington County Health Departmentwas the first to pilot the Break the HabitProgram in 2001-2002.gyyear 2 other counties The followingjumped on board Break the Habit offered state wide for FY2006 ITFC grantees. Counties that now offer break the habithave grown tremendously!Break the Habit HOW THE PROGRAM WORKS Individuals are referred Individuals are then screened forfunding If approvedfunding.approved, agreement issigned Now it’s on to the ITQ – Illinois TobaccoQuitline ITQ makes contact with healthdepartment via e-mailBreak the Habit HD makes contact with participant forfurther instructions HD notifies pharmacy of new participant EducationalEdil materiali l iis givenitoparticipant Participants are followed up at 3, 6, & 12months. In a nutshell28
Break the Habit SUCCESS RATES This will be brief!! From FY 04 to date, 20 – 25% of ourparticipantsi iwere tobaccobfreefat theh 1year follow up contact. ITQ calls for Washington County FY 04Break the Habit WRAP IT UP! Flexible program What helps make the program work Thank you so much for your time. Pleasefeel free to contact me.HAVE A WONDERFUL DAY!!!Improving Life, One Breath at a TimeMISSION: A WORLD FREE OF LUNG DISEASE29
RADON: ARE YOU AT RISK?Angela Tin, M.S.Director of Environmental ProgramsAmerican Lung Association of Illinois(217) 787787-58645864atin@lungil.orgRADON: ARE YOU AT RISK? Where do we spend most of our time?What is radon?How do we measure exposure?What is the level of concern?How and why does it come into my home?How does radon affect the lungs?How and where can I sample for radon?What if there is radon in my home?What can local health departments do?National Human Activity Pattern Survey:Time Spent IndoorsNATION: PERCENTAGE TIME SPENTTotal n 9,196 Total Time Spent Indoors (86.9%)8%6%11%In a ResidenceOutdoors2%In a Vehicle5%Other Indoor LocationBar-RestaurantOffice Factory68%Source: Ott, Klepeis, and Switzer, Journal of the Air& Waste Management Association, 200330
What is Radon?99999Radon3.8 daysRadiumNaturally occurringTastelessOdorlessColorlessRadioactive decay ofuranium in rock soiland water1,600 yearsUranium4.5 billion yearsU.S. Radon PotentialRadon Facts All homes have somelevels of radon High levels in everycounty / every state Influenced by natureoutside the home Controlled by manonce inside the home Primary exposurethrough inhalation Secondary exposurethrough water supply31
How Do We Measure Exposure? Radioactive alpha radiation on lung tissueClass A human carcinogenGreatest source of radiation to publicHistorical miner studiesMore likely to die from radon - accidents,accidents drowningdrowning, orfires2500021000# of deaths per year20000150008000100003900500028005000RadonFalls in the HomeDrow ningsHome FiresCarbon MonoxidePoisoningWhat is the Level of Concern? EPA estimates 21,000 (or 12%) lung cancerdeaths per year attributable to radon Average indoor radon concentration 1.3 piC/L EPA action level is 4.0 piC/L USEPA estimatesti t thatth t ¼ off allll radond relatedl t dlung cancers can be averted by lowering radonlevels below the 4.0 piC/L More than 40,000 homes in Illinois have beentested in the last two years Over 40% of homes above EPA action levelHow is Radon Influencedby Cigarette Smoke? Radon binds - dustparticles or cigarettesmoke Indoor smoke increasesthe amount of dust in aroom as much as 600times Health effects - multipliedwith cigarette smoke Leading cause of cancerin non-smokers32
How Does Radon Enter the Home? Natural source– Soil and rock– Ground water supply ManM maded– Utilities and plumbing– Foundation cracks– Building materialHow Does Radon Affect the Lungs? Radon decays intoradioactive particlesknown as radon decayproducts.poduc s These particles areeasily inhaled anddeposited in the lungswhere they can damagesensitive lung tissue.Radon Decay ProductsRadonRadonHow is Radon Distributed? Radon enters frombeneath foundation andtravels upward.– Diluted with outdoorair infiltratingg buildingg If radon is less than 4pCi/L in lower level,upper floors are probablyless than 4 pCi/L. 55-61033
How Can I Sample For Radon? Most homes/apts should be testedAt least once every two yearsFoundation footprintIllinois – free residential test kitsClosed house conditionsSeasonal effectsShort term - activated charcoalLong term - more sensitiveWater sampling (well)What if Radon Is Abovethe EPA Action Levels? Licensing - Illinois Emergency Management AgencyLicensed measurement professionalLicensed mitigation professionalMitigation standards and requirementsEquipment /installation costs 1000 - 1500On-going operating cost of fanSide benefit of moisture and odor removalWhat is Radon Mitigation?Sub slab (sub(sub--membrane) depressurization is a means of removingradon beneath the foundation and venting the gas away from thebuilding. One or more suction pipes are placed through the groundor soil and a fan is attached to facilitate the ventilation process.34
New Homes BuiltWith Radon Control SystemsRadon Resistant New Construction This involves techniques that reduceradon entry as well as make radonremoval easier and less costly.These methods vary with differentq,foundations and site requirements,but basic elements are:A. Gas Permeable LayerB. Plastic SheetingC. Sealing and CaulkingD. Vent PipeE. Junction BoxLegislation, Rules, and Regulations Radon Industry LicensingAct (420 ILCS 44) Radon Awareness Act((420 ILCS 46)) ((1/1/08))– Residential testingdisclosure¾ Proposed RadonResistant NewConstructionRequirementsWhat can Local Health Departments Do InTheir Communities to Impact Radon? Raise awareness regarding health effectsProvide education - additive effects of tobaccoInclude radon as an element of tobacco programsSeveral LHD’s are currently providing test-kitsthrough grant from Illinois EMA Participate in radon forums – expanding toawareness of medical community35
Radon Websites and Resources Mike Murphy - USEPAwww.epa.gov/radon Pat Daniels – Il Emergency Management Agencywww.radon.illinois.govg ALA online requests for test kitswww.lung.il.org/environment/radon.cfm May 9, 2009 Medical Forum in Schaumburg, ILBarbara Sorgatz, B.S.Lung Cancer Survivorringer234@sbcglobal.netRadon Induced Lung CancerSurvivor DiagnosisTreatmentPrognosisLife Afterwards36
Lynda Preckwinkle, BA, RRTDirector, ALA Helpline and Tobacco QuitlineAmerican Lung Association of Illinois-Iowalynda@lunghelpline.org217-787-5864 x 261Resourceswww.lungil.org/tobacco/clinics.cfm - Cessation clinics in Illinoiswww.quityes.org Illinois Tobacco Quitline Websitewww.lungusa.org American Lung Association Websitegg Lungg Cancer Alliancewww.lungcanceralliance.orgwww.cancer.org American Cancer Societywww.cancer.gov National Cancer Institutewww.thewellnesscommunity.org The Wellness Communitywww.pprx.org Partnership for Prescription Assistancewww.chestnet.org American College of Chest PhysiciansAdditional resources and the links above are all posted on theIPHI website at www.iphionline.org.Feedback Thank you for participating! Your feedback is VERY important. Pleasecomplete the online evaluation survey:http://www.surveymonkey.com/s.aspx?sm TWNrE 2bSAthC4XFCObOUjzw 3d 3drE 2bSAthC4XFCObOUjzw 3d 3d If you registered for a group, please ask them tocomplete the evaluation also. We will use this information to plan futuresessions and continually improve.11137
Question and Answer Session Please join us now for a LIVE Q & ASession with the presenters:– Dial 1(877) 411-9748– Enter the access code: 3467868#– Mute your phone (*6 to mute or un-mute). If you have a question that is notaddressed on the conference call, pleaseemail the question to Laurie Call atLLC1185@msn.com.38
Lung Cancer: Overview "Lung cancer is the leading cause of cancer death in both men and women, and accounted for apppp yroximately 27% of all cancer deaths in Illinois from 1999-2003. Alarmingly, 87% of lung cancer deaths could be prevented by eliminating tobacco abuse." (American Cancer Society Illinois Cancer Facts & Figures, 2006)
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. 3 Crawford M., Marsh D. The driving force : food in human evolution and the future.
