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National Navigation Roundtable holds its second annual meeting

The National Navigation Roundtable, a nationwide coalition committed to advancing patient navigation, held its second annual meeting November 28 & 29 in Washington, D.C.

The National Navigation Roundtable is a collaboration of more than 50-member organizations, including ACS, representing such diverse sectors as academia, public health, advocacy and survivor groups, professional societies, industry, training, and state and federal agencies. Its mission is to achieve health equity and access to quality care across the cancer continuum through effective patient navigation.  

The first patient navigation program was introduced in the early 90’s by former ACS national president Harold Freeman, MD, as an intervention to address healthcare barriers.  

This year’s theme, “Moving the Dial in Patient Navigation,” showcased accomplishments of the Task Groups, a survivor testimonial, and engaging panel discussions addressing the landscape of patient navigation and payment models to support and sustain the funding of navigation programs.   

Adam Green, a patient from George Washington Cancer Institute, spoke to the core impact of patient navigators when he said, “They make the scariest aspects of cancer much easier to navigate."

ACS Chief Cancer Control Officer Rich Wender, MD, opened the meeting by setting the stage, stating, "It's remarkable that a single type of solution – navigation – has been suggested and proposed to solve such a diverse set of problems - from improving screening rates to completion of diagnostic evaluations to initiation and completion of treatment to improving the quality of end-of-life care.”

"For decades many have worked tirelessly to ensure patient navigation services are offered to our most vulnerable cancer patients across the country, yet many roadblocks remain before that is a reality,” said Tracy Battaglia, MD, chair of the National Navigation Roundtable. “By convening the most influential and experienced leaders from around the country, the NNRT has begun to catalyze the field of navigation to ensure its place in our emerging health care delivery systems. I am excited to share our progress and see what next steps will emerge at our second annual NNRT meeting," she added.

To learn more about the National Navigation Roundtable, visit www.navigationroundtable.org or contact Monica Dean, director of the NNRT, or Katherine Sharpe, MTS, ACS senior vice president of patient & caregiver support.  

Pictured above, left to right, are: Monica Dean, director, National Navigation Roundtable; Andi Dwyer, vice chair, National Navigation Roundtable; Katherine Sharpe, MTS, ACS senior vice president,  Patient & Caregiver Support; and Tracy Battaglia, MD, MPH, chair of the National Navigation Roundtable.

  • ACS: 2018 in Review

    ​We hope you - our volunteers and supporters - will enjoy this year-end video that reviews some, surely not all, highlights (and one lowlight) from 2018.

    The video was created by Ashley Wright, executive producer in our ACS Studios. It has been posted on YouTube for easy access. 

    Please feel free to share it on social media and with fellow volunteers. It's a tribute to you!


  • Declines in smoking prompt health groups to set ambitious new goal

    New target is to reduce smoking among adults with mental illnesses/substance use to 20% by 2022

    A group of two dozen health groups and leaders in behavioral health and tobacco control has set an ambitious new goal to reduce smoking among persons with behavioral health issues, following new data showing the group's previous goal has been reached more rapidly than anticipated.

    In 2016, the National Partnership on Behavioral Health and Tobacco Use, led by the American Cancer Society and the Smoking Cessation Leadership Center at the University of California, San Francisco, set a goal to reduce smoking among adults with mental illnesses and/or substance use disorders from the 34% measured as of 2015 to 30% by the year 2020, thereby preventing an estimated one million deaths. 

    The most recent National Survey on Drug Use and Health (NSDUH) shows that the smoking rate among those populations has now dropped to 30.5%. Upon the new data's release, the Partnership reconvened its 24-member organizations, including leaders from public health agencies, behavioral health provider organizations, federal health agencies, advocacy groups, and health insurance and private corporations and set an ambitious new target to reduce smoking rates to 20% by the year 2022, and set out strategies to achieve that goal. 

    The Partnership's new action plan consists of multiple strategies that fall into six categories: peer education, policy changes, provider education and implementation, systems change, communications, and innovation. Each of the 24 participating organizations pledged to undertake specific actions towards achieving the "20 by 22" target, and multiple collaborative activities were planned. 

    The planned collaborative efforts designed by the partner organizations range from trainings, public communications and program implementations, to policy statements and educational offerings.

    Members of the Partnership include:

    • American Academy of Family Physicians (AAFP)
    • American Cancer Society (ACS)
    • American Cancer Society Cancer Action Network (ACS CAN)
    • American Cancer Society National Lung Cancer Roundtable (NLCRT)*
    • American Lung Association (ALA)
    • American Psychiatric Association (APA)
    • American Psychiatric Nurses Association (APNA)
    • American Psychological Association
    • Centers for Disease Control and Prevention (CDC)
    • National Alliance on Mental Illness (NAMI)
    • National Association of Social Workers (NASW)
    • National Association of State Mental Health Program Directors (NASMHPD)
    • National Council for Behavioral Health
    • North American Quitline Consortium (NAQC)
    • Optum
    • Pfizer
    • Robert Wood Johnson Foundation (RWJF)
    • Smoking Cessation Leadership Center (SCLC)
    • Substance Abuse and Mental Health Services Administration (SAMHSA)
    • Tobacco Control Legal Consortium (TCLC)
    • Truth Initiative
    • UnitedHealth Group
    • University of Wisconsin—Center for Tobacco Research and Intervention
    • Veterans Administration 

    Examples of the many strategic actions undertaken by members during the past two years include:

    • The National Association of State Mental Health Program Directors (NASMHPD) adopted a groundbreaking national policy statement strongly recommending that all behavioral health settings be tobacco-free and offer smoking cessation services. The policy affects applies to all state mental health programs and facilities in the United States.
    • The U.S. Department of Housing and Urban Development (HUD) implemented a historic rule in July 2018 creating a sweeping smoke-free policy for all public health authority (PHA) locations, eliminating the use of all combustible (burned) tobacco products in all public housing living units, indoor common areas in public housing, and in PHA administrative office buildings. Multiple national partners – including the American Cancer Society, the Smoking Cessation Leadership Center, the American Lung Association and the North American Quitline Consortium, among others – are now working to support the rule and PHA residents across the nation by collaborating with community health centers, promoting the use of toll-free quitlines and employing other resources to aid residents in quitting. They are also helping to guide and support PHAs and their residents in reinforcing effective community adherence to the new smoke-free standard.
    • Optum developed and implemented the Tobacco Cessation Behavioral Health Program, which utilized a new helpline to support thousands of smokers with reported behavioral health conditions in their quest to become tobacco-free. The program is now being offered in 4 states (FL, MN, OK, SC) and continues to grow.
    • The National Partnership on Behavioral Health and Tobacco Use submitted a joint public comment to the Centers for Medicare and Medicaid Services (CMS), urging the agency to retain two important tobacco measures as quality indicators (TOB-1 and TOB-3). Due to the public comment response, CMS retained the tobacco measure regarding tobacco use at discharge (TOB-3), allowing health professionals to be reimbursed for providing this service – a critical component of ensuring more robust delivery of tobacco treatment services.
    • The Smoking Cessation Leadership Center, in partnership with the National Council for Behavioral Health, and the Substance Abuse and Mental Health Services Administration, held Leadership Academy State Strategy Sessions in New Jersey, Pennsylvania, South Carolina, Kansas, and North Carolina, convening state health leaders to strengthen strategies to reduce smoking prevalence among the behavioral health population in their respective states. In September 2018, SCLC was named the National Center of Excellence for Tobacco-Free Recovery by SAMHSA in order to continue these and similar efforts.

    "The new data on smoking in the behavioral health population are very encouraging," said Cliff Douglas, JD, the American Cancer Society's vice president for tobacco control. "But smoking rates remain more than twice as high for patients with a behavioral health condition compared to the general population, so while we can take a moment to celebrate, we must accelerate our efforts to reduce smoking among those most at risk, who are frequently marginalized from society." 

    "There are about 65 million adults in the U.S. with one or more behavioral health conditions," said Steven Schroeder, MD., the director of the Smoking Cessation Leadership Center at the University of California, San Francisco. "Based on the current estimate of a 30.5% smoking rate, that translates to about 19 million adult smokers with a behavioral health condition, or 56 percent of the approximately 34 million adult smokers in the U.S. Reducing smoking among persons with behavioral health conditions to the 20% target would mean 6 million fewer smokers. And since half of smokers die from a tobacco-related condition, would mean potentially 3 million premature smoking-related deaths averted. Accomplishing such a goal would be a momentous public health achievement."

  • Dr. Wender promotes Cancer Screen Week on The View - watch!

    Rich Wender, MD, our chief cancer control officer, did a great job Tuesday on the Emmy-award winning TV show The View. Watch the interview here and feel free to share it with family, friends, and volunteers.

    He informed viewers that lung cancer kills more women than breast cancer does, and that 30,000 Americans who never smoked will die of lung cancer this year. As many as 20% of people who die from lung cancer in the U.S. every year have never smoked or used any other form of tobacco. In fact, if lung cancer in non-smokers had its own separate category, it would rank among the top 10 fatal cancers in the U.S.

    He also noted that 20% of lung cancer deaths could be avoided in people at high risk - both current and x-smokers - got screened. The American Cancer Society recommends annual lung cancer screening with a low-dose CT scan (LDCT) for certain people at higher risk for lung cancer who meet certain criteria.

    Dr. Wender also encouraged viewers to know their family health history, and he put in a plug for annual mammography starting at age 45, or at 40 for those who choose to start earlier.

    When asked about cervical cancer screening, Dr. Wender announced that with HPV vaccinations and regular screening "we can, and I believe we will, make cervical cancer the first cancer eliminated in the United States."

    To learn more and to take your pledge to get screened, visit cancerscreenweek.org.




  • Dr. Wender to appear on The View!

    Tune in Tuesday, Dec. 4, 11 a.m. ET, 10 a.m. CT and PT 

    Monday, Dec. 3, marks the start of Cancer Screen Week, an important public health initiative to increase awareness of the lifesaving benefits of early cancer detection through recommended screenings.  

    The initiative was started last year as a collective effort by ACS, Stand Up To Cancer, Rally Health, and Genentech. In its first year, thousands of consumers took an online pledge to get screened.

    This year’s plans include an interview with Chief Cancer Control Officer Rich Wender, MD, on ABC’s The View. Rich will be discussing cancer screening with the show’s celebrity hosts - Whoopi Goldberg, Sunny Hostin, Joy Behar, Sara Haines, Paula Faris, and Meghan McCain. Tune in to watch on Tuesday, Dec. 4!  The talk show airs at 11 a.m. ET, 10 a.m. CT and PT.

    The core partners will provide social media amplification and earned media outreach to support the campaign. This year there will be a greater emphasis on reaching diverse communities, with materials and media interviews being conducted in Spanish and English.  As part of that effort, ACS Board Member Carmen Guerra, MD, will be interviewed by Healthline.com, among others.

    With the help of ACS CAN, elected officials will do their part to show the importance of cancer screening, too. On Monday there will be a national proclamation highlighting Cancer Screen Week by the National Lieutenant Governors’ Association, and Illinois state representative Marcus Evans will issue a Cancer Screen Week state proclamation, along with similar announcements in Oregon, Colorado, California, Connecticut, Hawaii, New York, and Rhode Island.

    Cancer Screen Week is an ideal opportunity for everyone to think about their personal risks and to talk with their doctors about screening options.  

    Please share the news about Cancer Screen Week on your social channels using #CancerScreenWeek. The url to share is: https://www.cancerscreenweek.org/


  • Life expectancy declines again as drug and suicide deaths escalate

    Deaths from cancer continued their long, steady, downward trend.

    The Centers for Disease Control and Prevention's annual mortality report released today shows that life expectancy in the U.S. declined again in 2017.

    Overall, Americans could expect to live 78.6 years at birth in 2017, down a tenth of a year from the 2016 estimate, according to the CDC's National Center for Health Statistics. Men could anticipate a life span of 76.1 years, down a tenth of a year from 2016. Life expectancy for women in 2017 was 81.1 years, unchanged from the previous year.

    These annual statistics are considered a reliable barometer of a society's health. In most developed nations, life expectancy has marched steadily upward for decades.

    Robert Redfield, MD, CDC director, called the trend tragic and troubling. "Life expectancy gives us a snapshot of the Nation's overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable," he wrote in a statement.

    The 10 leading causes of death in 2017 remained the same as in 2016, but only deaths from cancer declined

    There is good news involving cancer. Of the 10 leading causes of death in the U.S., only cancer declined. In 2017, the 10 leading causes of death were: heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer disease, diabetes, influenza and pneumonia, kidney disease, and suicide - the same as in 2016 – and accounted for 74.0% of all deaths in the United States in 2017. From 2016 to 2017, age-adjusted death rates increased for 7 of 10 leading causes of death and decreased for just one, cancer.

    The rate increased 4.2% for unintentional injuries, 0.7% for chronic lower respiratory diseases, 0.8% for stroke, 2.3% for Alzheimer disease, 2.4% for diabetes, 5.9% for influenza and pneumonia, and 3.7% for suicide. The rate decreased 2.1% for cancer. Rates for heart disease and kidney disease did not change significantly.

    "This continues a trend that began in the early 1990s," said Rebecca Siegel, MPH, scientific director, Surveillance Research. "Cancer was the only of the 10 leading causes of death for which there was a statistically significant decline in 2017 (2.1%). The continued decline in cancer mortality is driven by the drop in smoking, as well as improvements in treatment and early detection for some cancers," she explained.

    Drug overdoses set another annual record in 2017, cresting at 70,237 — up from 63,632 the year before, the government said in a companion report. The opioid epidemic continued to take a relentless toll, with 47,600 deaths in 2017 from drugs sold on the street such as fentanyl and heroin, as well as prescription narcotics. That was also a record number, driven largely by an increase in fentanyl deaths.

    Here are findings documented in the overdose report:

    • The age-adjusted rate of drug overdose deaths in 2017 (21.7 per 100,000) was 9.6% higher than the rate in 2016 (19.8). This percent increase was lower than that seen between 2015 and 2016 when the rate increased by 21% (from 16.3 to 19.8).
    • Adults aged 25-34, 35-44, and 45–54 had the highest rates of drug overdose deaths in 2017.
    • The age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) increased by 45% between 2016 and 2017, from 6.2 to 9.0 deaths per 100,000. This percent increase was lower than that seen between 2015 and 2016 when the rate doubled in a single year (from 3.1 to 6.2).
    • The age-adjusted death rate from heroin overdose did not change between 2016 and 2017 – 4.9 deaths per 100,000. But the 2017 rate was seven times higher than the rate in 1999.
    • West Virginia (57.8 per 100,000), Ohio (46.3), Pennsylvania (44.3), and the District of Columbia (44.0) had the highest observed age-adjusted drug overdose death rates in 2017.

    A third report reveals that the suicide rate in the U.S. has increased from 10.4 suicides per 100,000 in 1999 to 14.0 in 2017. Suicide rates have increased since 1999 for both males and females ages 10-74. Rates in the most rural U.S. counties are nearly two times higher than rates in the most urban counties.

    The three reports are available on the NCHS web site at www.cdc.gov/nchs

    TOP PHOTO: This illustrates age-adjusted drug overdose death rates by state for 2017.


  • Buffalo, NY, clinic achieves 75% colorectal cancer screening

    Erie County Medical Center (ECMC) in Buffalo is making good on its 80% by 2018 pledge. The results of a campaign to introduce FIT testing into their safety net system were recently published in the British Medical Journal.

    ECMC partnered with the American Cancer Society to introduce FIT to increase colorectal cancer screening in primary care. Jason Coleman, senior manager, Primary Care Systems, is the ACS staff partner for the project that helps provide critically important colon cancer community education and screenings to the underserved populations in the Buffalo area.

    FIT tests were offered annually, and a patient navigator worked directly with patients, following up and navigating them through the screening process. The patient navigator performed an essential role, following up by phone to increase the return of tests, and navigating the patient through the screening process to ensure treatment for any positive results.

    Four hundred and seven patients visiting the Internal Medicine Clinic were offered FIT, and 252 (62%) completed the test. Twenty-two patients (8.7%) were FIT positive, 14 of those (63.6%) underwent a subsequent diagnostic colonoscopy. ECMC achieved a 75% screening rate in age appropriate patients - exceeding its 18-month project goal.

    Successful strategies included engaging the leadership, the front-line staff, and a highly effective multidisciplinary team. For average-risk patients, FIT was the preferred method of screening.

    For further detail on ECMC's project to increase colorectal cancer screening, read the article about it in the Oct. 25, 2018, edition of the BMJ.

    You may recall in 2016, Buffalo was among the first communities to declare support across all health systems and the local government at an 80% by 2018 press event attended by Rich Wender, our chief cancer control officer.




  • Fourth article in our Blueprint for Cancer Control in the 21st Century outlines cancer screening’s future potential

    Cancer screening has contributed substantially to reduced incidence, morbidity, and mortality, but issues like access and quality care have kept screening from fulfilling its full potential, according to the latest chapter in the Society's Blueprint for Cancer Control in the 21st Century. The report, published Nov. 19 in CA: A Cancer Journal for Clinicians, summarizes the status of cancer screening and proposes key areas where attention is needed to further advance screening's contribution to cancer control.

    Since the mid-20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The authors of the new report, led by Robert A. Smith, PhD., vice president of screening for the American Cancer Society, say even as new discoveries could improve outcomes, there has been a failure to fulfill the potential of existing technology due to lack of access among the target population and the delivery of state-of-the art care at each crucial step in cancer care. The report adds there is insufficient commitment to invest in the development of new technologies, incentivize the development of new ideas, and rapidly evaluate promising new technology.

    The report outlines five key focus areas to help cancer screening realize its full potential:

    • Research to improve the implementation of existing screening modalities: Research should be directed at facilitating the uptake of organized screening, including for populations that are less likely to undergo screening. Elements of this research should include the study of reminder systems, population management, public messaging, team-based care, and navigation. On a broader scale, studies of different approaches to organizing and paying for health care are needed.
    • Research to improve the quality and performance of currently available screening tests: Increased financial commitment is needed to evaluate the performance of current screening technology in the community, to support research and development to improve and evolve existing technology, and to develop new technology. No less important are strong quality assurance programs to ensure that performance is monitored and that steps are taken when performance falls below acceptable standards.
    • Research to develop entirely new screening strategies to screen for cancers currently amendable to screening: New directions in breast cancer screening that are functional versus anatomic, including contrast-enhanced MRI and molecular breast imaging, are being tested, with promising results in overcoming the limits of 2D and 3D mammography in women with significant mammographic breast density. Blood tests that detect circulating DNA and potentially can detect many types of asymptomatic cancers are in development. Developing new higher performing, more affordable, and/or more culturally acceptable screening tests warrants a substantial research investment.
    • Research to develop increasingly refined, risk-based screening strategies: All approaches to screening incorporate assessments of risk. Organizations have issued guidelines to screen individuals who are at higher than average risk for some cancers, but the depth of data supporting these recommendations is highly variable. It may someday be possible to identify individuals who are well below average risk and might choose to forgo screening or to be screened differently. However, to date, reducing the intensity of screening to levels below those currently recommended for average-risk individuals has led to a loss of screening effectiveness overall in exchange for reducing the number of adults who undergo screening and reducing the overall rate of harms.
    • Research to develop effective ways to screen for cancers for which screening tests do not currently exist: At this time, no screening strategy has been developed and tested for pancreatic cancer, which by 2030 is likely to become the second leading cause of cancer-related death in the United States among men and women are combined. Liver cancer and bladder cancer are other diseases for which reliable and practical risk-based screening tests are needed. Screening for less common causes of cancer-related death may be possible but would demand highly accurate screening tests and well-defined and acceptable diagnostic and treatment approaches, to favorably tip the risk/benefit ratio.

    "The capacity to screen for asymptomatic cancer and cancer precursors defines one of the great successes in the history of cancer control, but the full potential of cancer screening is not being achieved," said Dr. Smith. "Millions of individuals who should be screened are not being screened, and millions who are being screened are not receiving the highest quality testing available."

    The report concludes that "the barriers that are impeding improvements in screening rates need to be systematically identified and rectified with no less than a mission-oriented commitment. Research dedicated to improving existing screening strategies and finding new ones is necessary, and the current level of investment in this type of research is insufficient."

    For more information about this chapter and our Blueprint for Cancer Control in the 21st Century, please see the resource list below. Subsequent Blueprint chapters will focus on treatment and research and will be released in the coming months.

    Blueprint Resources:

  • New HHS physical activity guidelines include Americans as young as age 3

    Some physical activity is better than none, and even small increases lead to additional health benefits.

    ​For the first time, the U.S. Department of Health and Human Services (HHS) is recommending that children as young as age 3 be physically active every day. 

    The second edition of the Physical Activity Guidelines for Americans emphasizes the health benefits of physical activity for Americans of all ages. Also new in the second edition: any amount of activity for adults, even if it’s less than 10 minutes, counts toward the weekly goal of 150 to 300 minutes. The guidelines were published November 12, 2018, in the Journal of the American Medical Association.

    Getting physical activity is one of the most effective things people can do to improve their health and reduce risk for many chronic diseases and conditions, including cancer. However, 80% of adults and adolescents in the U.S. aren’t active enough, which can have negative effects on health. For the overall U.S. population, an estimated $117 billion in annual health care costs and about 10% of premature deaths are associated with inadequate physical activity.

    Benefits of physical activity

    The HHS Physical Activity Guidelines Advisory Committee reviewed the current science on physical activity and health. Evidence shows physical activity fosters normal growth and development including bone health, weight control, and heart, respiratory, and muscle fitness. Regular physical activity helps people sleep and think better. It also reduces the risk of anxiety and depression, high blood pressure, dementia, and several types of cancer.

    Previously, HHS guidelines only counted periods of activity lasting 10 minutes or more as enough to meet daily or weekly goals. Based on current evidence, the new guidelines say that moderate-to-vigorous activity of any amount, even less than 10 minutes, is related to health benefits. (Moderate activity is equivalent in effort to brisk walking, and vigorous activity is equivalent in effort to running or jogging.) This finding is consistent with tips for more routine daily physical activity, such as parking farther away from a destination and walking or taking the stairs rather than the elevator.

    Recommendations by age

    The guidelines emphasize that moving more and sitting less will benefit nearly everyone. Some physical activity is better than none, and even small increases lead to additional health benefits. The HHS says doctors should help their patients develop a physical activity plan that works best.  For optimal health benefits, the guidelines recommend:

    • Children ages 3 to 5 should be physically active throughout every day for healthy growth and development.
    • Children and adolescents ages 6 to 17 should get at least 60 minutes of moderate-to-vigorous physical activity every day.
    • Adults of all ages should get at least 150 -300 minutes of moderate-intensity activity or 75-150 minutes of vigorous-intensity activity each week, or a combination, preferably spread throughout the week. Adults should also do muscle-strengthening activities (such as resistance training or weight lifting) 2 or more days a week.
    • Older adults should do a variety of activities that include balance training (such as lunges or walking backward) along with the recommended adult aerobic exercise (such as brisk walking, running, or bicycling), and muscle-strengthening activities.
    • Pregnant women should do at least 150 minutes of moderate-intensity aerobic activity a week.
    • Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities.

    Physical Activity for Preschool-aged Children

    For the first time, HHS guidelines address the physical activity needs of children younger than age 6. At ages 3 to 5, children are undergoing periods of rapid growth and need physical activity throughout the day to develop properly and learn important movement skills. Adult caregivers of preschool-aged children should encourage active play that includes a variety of activity types.

    The guidelines do not specify how much physical activity is required for this age group, but the authors write that a reasonable target may be 3 hours per day of activity of all intensities: light, moderate, or vigorous. This is the average amount of activity observed among children of this age.

    A coordinated effort

    The authors conclude that an increase in physical activity among Americans will benefit the entire U.S. population and will require the cooperation of many sectors of society including health care professionals, health care organizations, and the government.

    This article by Stacy Simon first appeared on cancer.org.



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