Webinar

Exploring New Developments in Cancer: Diagnosis Trends, Outcomes, and Costs


Time & Location

Oct
11

Rates of the most common cancers are increasing, especially among young adults. It is estimated that in 2024, over 2 million Americans will be diagnosed with cancer—a record high. By 2030, it is projected that the cost of cancer, one of the most expensive diseases to treat, will exceed $245 billion. Despite advancements in care, there remain significant variations in screening, diagnosis, and treatment rates by socioeconomic status, age, sex, race, and ethnicity.

Speakers discussed:

  • The latest trends in cancer across the country and drivers of disparities in preventive cancer services and screenings.

  • A health plan’s efforts to improve cancer outcomes and reduce costs through holistic approaches to providing high-quality care and support.

  • The rise in early onset cancer, including efforts to understand what is driving this shift and initiatives to support this younger population.

0:05

Good afternoon.

0:06

I'm Cait Ellis, Vice President and Senior Director of Research Programs at the National Institute for Health Care Management Foundation.

0:12

On behalf of NICM, thank you for joining us today for this important discussion on the latest in cancer care across the United States. The cancer death rate has been steadily declining over the past 30 years.

0:24

Yet the number of new cases is on the rise.

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This year, it was projected that new cancer cases in the United States would surpass 2 million for the first time.

0:32

And the increase in rates especially notable among young adults.

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Cancer continues to be one of the most expensive medical conditions to treat, and its financial impact on the U.S. is steadily increasing.

0:44

Today, we will hear from a prestigious panel of experts to learn more about cancer trends, disparities, and actionable solutions that are being implemented.

0:53

Before we hear from them, I want to thank NIHCM's President and CEO, Avik Roy, and the NIHCM team who helped to convene today's event.

1:00

You can find biographical information for our speakers along with today's agenda and copies of slides on our website.

1:07

We also invite you to join the conversation on Twitter X using the hashtag cancer care.

1:14

I am now pleased to introduce our first speaker Dr. Lorna McNeill.

1:18

Dr.McNeill is a professor and chair in the Department of Health Disparities at the University of Texas MD Anderson Cancer Center.

1:25

Her research focuses on the elimination of cancer related health disparities in minority populations with particular emphasis on understanding the influence of social contextual determinants of cancer in minorities.

1:37

We are so honored that she is with us today to help set the stage for us on the current cancer landscape, including trends in diagnosis and screenings before moving into a conversation about health disparities and cancer outcomes. Dr. McNeill?

1:54

Thank you so much, Cait, for the introduction and thanks for having me be part of today's panel.

2:00

And so, as noted, I'm going to go over a little bit of cancer trends and then focus the remaining of my time on cancer disparities.

2:08

Next slide.

2:12

Next slide.

2:16

So, to set the stage, I just wanted to give a high-level view of, focus on, sorry, the leading sites of new cancer cases and deaths This were estimates for the American Cancer Society for 2024.

2:32

And prostate cancer for men and breast cancer for women are the leading causes of new cases, and followed by lung cancer for both men and women and then colorectal cancer for both men and women.

2:48

In terms of drivers of mortality, you see a similar pattern where lung cancer is a leading cause of mortality for both men and women, followed by breast cancer for men, breast cancer for women.

3:01

And then you'll see the introduction of pancreas cancer as a leading cause of death for both men and women followed closely thereafter.

3:08

Next slide.

3:12

And this slide is talking about survival rates.

3:15

And so the good news for many cancers and several cancers is that if they're caught in more local stages, they are even have a higher survival rate.

3:25

And so we probably already know that that's the case for breast cancer, so the encouragement to get screening and screened early, because you have 99% five-year survival rate, if it's done at a local safe, similar for colorectal cancer, because again, we have screening tools to allow us to detect these cancers early, which we'll also notice, for example, cervical cancer, you know, towards the bottom on the right-hand, also have high five-year survival, one is discovered locally.

3:55

And unfortunately, few cancers, such as pancreas cancer, liver cancer, for example, for all stages, have very poor five-year survival rates.

4:05

Next slide.

4:08

In terms of the drivers of cancer risk factors in terms of cancer incidence and instrumental in cancer mortality, I've outlined some of the leading cancer risk factors, one in particular being age, cancer is particularly a disease of the elderly.

4:27

As you increase in age, your risk for cancer increases.

4:31

But you'll also see that alcohol use is a significant cancer risk factor.

4:35

And these arrows indicate where we are making progress or where we need to have more energy and effort.

4:42

And so alcohol intake is on the rise, significantly contributing to increased cancer risk.

4:50

Processed meat, such as deli meat, as well as charred grilled meat, are also a cancer risk factor.

4:58

And we are making trends in there in that the consumption of these meats are declining over time.

5:04

Also, environmental soldiers, as asbestos is a cancer risk factor.

5:08

Physical inactivity is declining, which is good, and that is a significant risk factor.

5:14

Obesity is increasing.

5:15

Sorry, that bar should be in red, not green.

5:17

obesity is a significant contributor to cancer risk, instrumental in over 13 different cancers.

5:24

That's increasing.

5:25

We've made significant strides in the United States over tobacco use, and that has steadily declined thanks to important legislation that reduces the tobacco age, for example, and other policies around taxation.

5:40

And then we are making strides in increasing HPV screening, for example, infectious cancer – infectious agents also contribute to cancer risk.

5:50

Next slide.

5:54

So now I'm going to briefly talk about a couple of trends in screening in terms of primary prevention of cancer and secondary prevention of cancer.

6:03

Screening is very instrumental as one of our major tools to detect cancer and treat it early.

6:08

So, breast cancer, for example, we have 20, 30 other people's targets of getting about 81% of women worth to be screened, and you'll see that we're not quite meeting that goal, but about 76% of women have gotten screening in the past two years.

6:26

Screening can be a little tricky because different organizations have different guidelines.

6:31

Some recommend breast cancer screening every year, others every other year.

6:35

Cervical cancer screening, we're making great trends at one point.

6:40

As you can see that we're not quite meeting that target and some indication that cervical cancer screening might be declining.

6:49

Next slide.

6:51

These are also trends, screening trends for prostate, colorectal, and lung cancer.

6:57

I'll start with prostate cancer in the sense that screening on a regular basis, let's say, is declining likely due to the fact that our guidelines for a prostate cancer screening are really shared decision-making between the patient and the physician and the interval in which that occurs is determined by that relationship.

7:21

And so that annual screening of PSA seems to be declining over time.

7:28

Colorectal cancer screening rates are increasing, and that is dramatic.

7:32

And that is, I think, likely due to the expansion of the Affordable Care Act and being able to have these covered services, you can see a dramatic increase in colorectal cancer screening.

7:46

And then for lung cancer screening, one of our most recent diagnostic tools to be able to see and catch cancer at an earlier rate, we've done a lot of work to do in trying increase the number of people who are eligible for lung cancer training to increase.

8:03

Next slide.

8:06

So as noted, we have seen a dramatic, we were seeing a dramatic decline in both new cancer cases as well as death rate is what Kate noted before, but more recent estimates showing that there's been more of an increase now in the rate of cancers, and so this form and are trying to identify what are those causes of that and how we may be able to reverse those trends.

8:33

Next slide.

8:36

So, I'm going to briefly talk about cancer disparities.

8:39

Next slide.

8:42

And so, when we look at diagnosis of cancer, what I did earlier before, looked at by cancers overall, this is looking at new cancer cases that are being diagnosed broken down by race, ethnicity.

8:59

And so what we know and what remains to be true is that black men have the highest incidence of cancer among both any racial, ethnic group and that white women continue to have the highest incidence of cancer that's by race and ethnicity as well.

9:19

What's not featured here is that cancer mortality, though, is highest among black men, but the cancer mortality is high among Black women.

9:29

Next slide.

9:33

So where do we see these disparities and where they are maybe more pronounced?

9:38

And we can see them across all cancer types.

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For example, for breast cancer, we know that African American women are nearly twice as likely to be diagnosed with triple negative breast cancer, which is a more harder to treat form of cancer and less treatment options available.

9:58

Kidney cancer, as well as liver cancer, are higher among American, Indian, Alaska Natives.

10:05

And in particular for liver cancer, we find, for example, the state of Texas, where I am, we leave the nation in cancer, liver cancer incidence and mortality.

10:14

Tri-state cancer is twice as high among Black men.

10:18

Cervical cancer, a very stark disparity for women living in rural areas.

10:23

And then, for example, multiple myeloma is also higher mortality among Blacks.

10:32

Next slide.

10:36

And so when we think about more cancer disparities, we also often think that these things might be occurring because there's so biological differences that are occurring.

10:49

But what we know is that our genetic differences, our makeup, really explain very little of the disparities that we see, when in fact they're often due to non-medical drivers of health, non-genetic differences, and actually more social determinants of health.

11:05

So this is a slide that's commissioned by the Robert Wood Johnson Foundation that is really looking at life expectancy in various areas across the country.

11:15

And this one is particularly looking in the area of New Orleans and Louisiana.

11:21

And what you can see is, and if you live up here, you know, the Navarine Lakewood kind of area, your life expectancy is 80 years.

11:30

If you live here, close to the French Quarter, your life expectancy is 55 years.

11:36

And so this stark difference in terms of number of years, where you have short distances between these areas, you know, these things are not explained by genetic differences that exist in the population.

11:48

They explain by sort of where we invest our resources and where we are, you know, placing access to care so that people are able to live a healthy life.

11:59

So the notion is that these short distances playing very large gaps in health care that are not due to differences that we see biologically.

12:07

Next slide.

12:10

And so the reason why we care that we see these differences basically in this case by and ethnicity is that the face of the United States population is changing dramatically, where minorities and sectors represent 42 to 55 percent of the U.S. population by 2050.

12:29

What this means, though, is the cancers that we're seeing today in terms of the populations that are seeing them, getting them, when we look in the next several years in terms of the changing faces of the population, who gets cancer and who shows up to be treated for cancer, it's also gonna differ.

12:45

So we need to be prepared today for who's going to get cancer over the next 30 years and really address these disparities that we see today.

12:53

Otherwise, it becomes harder for us to reduce and see these declines in infant mortality over time.

13:01

Next slide.

13:04

So to do that then, we need to focus more strongly on other factors that contribute to health disparities, not just focusing on what we see differences by race, ethnicity, for example.

13:17

So as I noted in the earlier slides, we see environmental factors that can help explain these disparities, for example, where people live, work, play, and worship, it varies.

13:29

And the environmental exposures that you have based on where you live, work, play, and worship come to bear.

13:37

I noticed the behavioral factors earlier that are contributing to the overall cancer risk factors.

13:44

But we definitely see differences in behavioral lifestyle factors that contribute to those disparities.

13:51

Social factors, such as education and income, the more money you make, the more higher education, the more likely that you already have lower cancer incidence and lower cancer mortality.

14:04

Clinical factors, such as access to care, is very important, but that does not explain and count for all of the disparities that we see as well.

14:14

Cultural factors and biological factors are also at play.

14:17

And as I noticed, there are some cancers where we see some biological differences and genetic differences, but those aren't the main drivers of the disparities that we see.

14:26

Next slide.

14:29

One of the ways that we can see this as well, and from a place-based perspective, and where we can understand how policy and investment and resources might come to play, is in this graph right here.

14:43

So this is looking at cancer mortality by race, ethnicity, looking at black men and white, black men, white men, black women, and white women.

14:55

And it's comparing the US race to Texas, which is again where I'm seated for Indiana Cancer Center, Harris County, which is the county in which Houston is located in, and then New York state.

15:12

And what you can see is that if you're a white male or a black woman or a white woman, your cancer death rate is similar from the US average to Texas, Harris County, and the state of New York.

15:24

But if you're a black male, you would much rather live in New York because if you're in New York, your cancer death rate is similar to what you would find for mortality rates for white males.

15:38

And I noted to you before, black men have the highest incidence in mortality rates.

15:42

And so there are policies, procedures, programs that are occurring within the state of New York that have resulted in black men having similar cancer death rates, whereas you can see, for example, in the state of Texas, which did not expand the Affordable Care Act, you may see these higher mortality rates.

16:07

So investment and policies matter as well.

16:12

Next slide.

16:16

So while I'm talking about disparities and showing you these differences, it's all towards having us go towards achieving health equity.

16:26

And achieving health equity, at least in the United States, is this aspirational goal where we're trying to ensure that everyone has the highest level of wealth for all people, where it has a fair and just opportunity to attain their optimal health.

16:40

And that, you've seen this slide many times, to move away from the focus of equality where everybody gets the same resources regardless of needs and abilities, moving to a place where everyone gets exactly what they need to basically to achieve their highest attainment of health.

16:58

Next slide.

17:02

And this health equity is really now an expectation.

17:06

It's definitely an expectation for our government and US entities where to not address health equity and move in that direction of intentionality can be seen as an institutional risk.

17:19

All of these agencies are driving us in that direction.

17:22

The FDA focusing on improving access to clinical trials, the Center for Medicare and Medicaid Services that really want our hospital system to focus on social determinants of health.

17:33

But all of these things you'll see within our Visient Rankings, our Joint Commission, and our U.S.

17:38

News and World Report ranking, as well as in our cancer center specifically, which is where I sit, there is, excuse me, more of an expectation that we document, we ensure that everyone is getting equitable access and having equitable treatment outcomes.

17:56

Next slide.

18:00

And so the solution towards that, which we won't be able to get into today too much, But how do we then move in that direction of health equity?

18:09

And these are just some of the solutions that I want to point out.

18:14

It is in having more focused research on health disparities, full transformational research that is really going to address what are the cancers that we see in the various populations where we see those disparities and to be able to increase the investment in research.

18:32

Having a diverse workforce, right, and all of you that are participating on this webinar who care about this topic, being increasing our capacity and our training and our overall workforce that has expertise in this area, increasing the diversity of our patients and ensuring equity in patient care outcomes, care and outcomes, and I mentioned lots of organizations are really pressing on our healthcare system to ensure that these are equitable outcomes.

18:59

Increasing participation in clinical trials and ensuring equitable enrollment on trials.

19:05

Very few cancer patients participate in trials, but you'll see very disparities there as well.

19:11

Strong focus on community engagement, making investments in communities and evidence-based actions that we know that work.

19:19

This is one of the strongest ways in which we can really seek to reduce cancer disparities promote equity, education and training that were all trained in this particular state.

19:31

And lastly, I'll just note organizational and government investment in resources, really to move towards health equity, it requires an intention.

19:40

It requires a change, systematic change in the way we invest in resources in the United States.

19:46

And that's one of the ways that we will achieve that solution. Thank you so much. And now I'll turn it on to Cait.

19:53

Great. Thank you so much, Dr. McNeill, for sharing those overall trends and walking us through cancer risk factors and drivers of cancer disparities.

20:02

Next, we will hear from Dr. Monica Berner and Kate Duncan from the Health Care Service Corporation.

20:08

As Senior Vice President of Markets and Chief Clinical Officer, Dr. Berner

20:11

is responsible for clinical policy and operations that improve access and support efficient delivery of high-quality affordable medical care.

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Her co-presenter, Kate, serves as the executive director of product strategy and management.

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In this role, Kate focuses on the member and how HCSC can improve outcomes and lower total cost of care.

20:32

We are grateful they are with us today to share more about HCSC's cancer services and support program and their efforts to provide high quality holistic cancer care.

20:41

Dr. Berner and Kate.

20:43

Thank you.

20:45

And are you able to hear me?

20:48

Okay, great.

20:49

Well, good morning, everyone.

20:51

And many thanks to NIHCM for inviting us to present today on what we see as such a critical topic that impacts all of us in the healthcare industry professionally and quite honestly, most of us personally in some capacity or another.

21:07

So what we'd like to do is share with you HCSC's approach to addressing such a complex, costly, heart-wrenching sometimes and increasingly prevalent diagnosis of cancer in our populations.

21:22

And what you'll see is that we've been working to implement a multifaceted approach to support our members over the past several years.

21:30

So when you look at this slide, I think what you, the first thing I want you to acknowledge and that we've internally acknowledged is, you a handful of things.

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And one of those is that, you know, cancer is not a singular entity, nor is there a singular approach to managing it. Every person is different.

21:52

Even chemotherapy, you know, I tend to see patients that think chemotherapy is chemotherapy, everyone has the same, but it clearly is not.

22:02

Secondly, as you just heard, cancer impacts all demographics, certainly some more prevalent than others, whether it's age or race or different risk factors, but we are beginning to see new patterns emerge over the past several years, such as increasing incidence of colon cancer in younger people, which has of course resulted in some recommendations for earlier colonoscopies.

22:28

Third is, and this is super important, third and fourth are important.

22:33

Cancer is not necessarily a death sentence, although I think people often feel that way when they receive the diagnosis.

22:41

And last but not least, cancer not only impacts the person who receives the diagnosis, but their family, their friends, their co-workers, everyone, you know, that surrounds them.

22:53

So for this reason, for all of these reasons, our organization has chosen to approach the management of members with malignancy in a holistic manner, both across the chronological continuum from pre-diagnosis to kind of post-cure, if you will.

23:11

And you'll see that infused in the concepts on this slide where we look at preventive care, behavioral health, pharmacy, medical and surgical support, partnerships with providers, and community initiatives.

23:24

So we really are looking not only across the continuum of diagnosis, but across the continuum of where we can reach in and support our members.

23:33

Next slide, please.

23:34

So we'll start by talking a little bit about preventive care advocacy.

23:39

And as a family physician, you can imagine that this particular component of our program is very near and dear to my heart.

23:47

Plus, who doesn't want to either prevent cancer or catch it at its very earliest appearance to improve the outcomes and avoid treatments like radiation, surgery, or chemotherapy, all of which bring their own set of risks and side effects.

24:05

So for those cancers that have recommended screenings like colonoscopies, mammography, pap smear, chest CTs, and high-risk populations, we typically leverage our wellness and condition management programs to send targeted reminders to our members, as well as reminders to their providers that are engaged in our value-based care arrangements.

24:28

And we always consider our PCPs to be the first line of defense in cancer detection and prevention.

24:35

As a wrap-around, we engage our local communities. You can see a few examples on this slide.

24:42

Mobile mammography units, state-specific cancer summits, and partnering with local American Cancer Society's programs such as transportation and lodging assistance.

24:54

And then, you know, last but not least, we also, over the past several years, have sent out over 334 home colon cancer screening kits to members who have not met screening criteria by claim, so they are at risk and they should be getting the So you can imagine all of that going through our U.S.

25:16

postal system, but we've had incredible uptake.

25:20

People, you know, especially you can imagine during COVID, people don't want to go in, don't want to go to colonoscopy.

25:26

This is an easy way for them to do a recommended colon cancer screening on an annual basis.

25:32

Next slide, please.

25:35

So now I want to dive a little bit deeper into how we engage and support our network of clinicians in the screening, diagnosis, and management of cancer.

25:45

Currently, you can see on the left side of the slide, we have three different oncology programs across our geographies.

25:54

And they're distinctly different.

25:57

In Illinois, we have an intensive medical home that incents providers on a per member per month basis for quality performance around advanced care planning, site of service, hospice, really kind of again not necessarily looking at what are the clinical outcomes but what can we do to support the members and the families that have received this diagnosis.

26:21

In New Mexico we have a pay for performance program which incents our oncologists to include psychosocial and tobacco screenings in their visits, perform medication reconciliation, manage ER and inpatient stays.

26:35

So again, you know, very, very different.

26:38

I mean, we're really looking at how can we meet the needs of our local populations and engage our local oncologists.

26:45

So we develop these measures and these programs collaboratively.

26:49

And in Oklahoma, we have an episode of care model that looks at total cost of care and shared savings specific to a handful of cancers.

26:58

In the next year, 2025, we will be rolling out what you see on the right side of the slide.

27:05

So this will be across all of our current HCSC geographies.

27:10

And it is a program that includes multiple cancer types, we'll be measuring multiple utilization metrics, and in particular, I'm fond of the quality measures, which are again intended to improve not only clinical outcomes, but quality of life for those members with the diagnosis.

27:30

And we've got providers of all different sizes.

27:34

Some are very small groups, some are very large integrated groups.

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Some of them year over year have performed fabulously, others not so much, and we continue to work and share our data with them because regardless of where we start out, we know by sharing data and collaborating, we will improve outcomes for those patients in those programs.

27:55

So next slide, please.

27:59

So we're gonna transition here.

28:01

You know, you've heard me talk a little bit about how we work with our providers, how we work with our communities, but I'm going to hand off to Kate in just a minute here who will share details around our cancer service and support suite of products and programs that are offered to our employer groups and other members.

28:20

And you'll see, again, as I mentioned, that not only did we take a holistic approach around the continuum of services, but also around how those members are supported.

28:29

And, you know, while I describe providers, direct member communications and community support, Kate's going to do a deeper dive on the components of this product, including the care management, co-management, working with pharmacy, discharge planning, getting second opinions to ensure that members receive the right diagnosis and have comfort that receiving also the best and most up-to-date treatment for their diagnosis.

29:00

So Kate, I'm going to hand it off to you. Great. Thanks, Dr. Berner. And I wanted to echo her sentiments.

29:08

Cancer is personal. I think we all can think of a example.

29:12

I myself lost my mom at the young age of six to breast cancer.

29:17

So I personally kind of understand this and it helps drive myself and our team to really continue to understand what we can do for the member and their family's lives.

29:27

So as Dr. Berner

29:28

said, she started us off, I'll kind of continue talking through our components of our program.

29:34

So this is a key area, our cancer services and support program.

29:38

You'll see that we have a variety of different areas here in this.

29:42

It spans really, this is when the member has unfortunately been diagnosed and we need to best manage their care.

29:49

And so you see we do this in a variety of different ways.

29:53

This is really holding the hand of those members through this journey, whether it's really helping them understand their diagnosis, managing that diagnosis through whether it's co-management of behavioral health services, social determinants of health programs.

30:13

I'll hit on both BH and pharmacy in a minute.

30:16

Also ensuring that that member understands that diagnosis and is comfortable with the

treatment care.

30:24

We have and just rolled out recently a new second opinion program that offers members the ability to receive kind of an expert medical review, understand what clinical trials are available to them.

30:39

And in cases where members may not even want a proactive second opinion, we're already looking at any rare and complex cancers so that we have a peer-to-peer review with that oncology, treating oncology, so that we're really ensuring that member is getting the right plan of care moving forward.

30:59

And then you'll see we support and navigate that member through, what are their benefits, what resources are available to them, and how can we best handhold them through this whole process.

31:10

We can go to the next slide, And I'll talk a little bit about pharmacy.

31:15

So as Dr. Berner mentioned, right?

31:19

Chemopharmaceuticals are a unfortunate but necessary component of our cancer treatment.

31:24

So we have a pharmacy care management program.

31:27

And this program is a medication therapy management program.

31:31

It provides clinical intervention and outreach that leverages pharmacy and medical claims data, which includes mental health and their medications within their BH diagnosis to identify potential adverse drug reactions.

31:48

The intent is to identify quickly and intervene quickly if there is some sort of drug to drug interaction.

31:55

And then we actually outreach to the treating physician for optimal dosing regimen.

32:01

They also are looking to support members in medication adherence, support site of care redirection to really ensure that we're optimizing the best possible medication therapy for our members in the most advantageous cost.

32:16

Next slide.

32:18

Given the cost and complexity of cancer treatment, we know that medical necessity review is critical to ensuring members are receiving the appropriate care that is also evidence-based in the right setting.

32:33

So reviews that we have here are listed.

32:35

It includes a variety of different areas including advanced imaging.

32:41

So we were mentioned earlier, you know, CT scans, MRIs, PET scans. We also look at specialty drugs, as I just mentioned.

32:49

We're looking at genetic testing, radiation therapy, as well as site of care redirection.

32:55

So is that source of treatment the right place for you to get it or are there potentially lower cost options for members and they're out of pocket.

33:05

Next slide.

33:09

Unfortunately, right, as we mentioned, we all know someone who has been diagnosed with cancer.

33:14

So we know firsthand the mental toll that that devastating news can have on an individual and their loved ones.

33:21

In fact, according to the World Mental Health Survey, one in three cancer patients has a mental health condition.

33:29

And with rates of major depressive disorder being three times higher than the general population.

33:37

So it's critically important that we have a appropriate and comprehensive behavioral health program to meet all of our members, but especially members who are going through our cancer journey.

33:49

So you'll see here a number of components that make up our behavioral health program.

33:54

The first, of course, goes without saying, is that we have an extensive network of our behavioral health physicians.

34:00

We continue to keep our foot on the gas here, lots of momentum in 2025 to really be able to address various niche needs of BH.

34:11

So this is a key one for us.

34:13

But our BH programs go beyond just our network.

34:16

We have a comprehensive set of behavioral health resources.

34:20

And this can span what that member needs in their journey.

34:24

This can be whether members are simply exploring some troubled feelings for the first time using the free self-guided digital mental health resource that we have available to them, or perhaps they're grappling with the reality of the life threat altering diagnosis and need to speak with someone.

34:43

Or perhaps, unfortunately, they're at a point where they need some end of life legacy planning and they can speak with someone through our EAP program.

34:52

Through all of their journey, we have a solution within our BH program to meet their needs.

34:58

Next slide. So we've talked about a lot of things, right?

35:04

I wanted to take a moment to really kind of bring this all together and say, what does this all mean, right?

35:09

Like, okay, you've got a lot of cool things in your toolbox, but at the end of the day, what does this really mean for a member?

35:16

And so I wanted to take a moment to really kind of walk you through a journey of a member. And so we can look at Sarah here. Sarah is a 45-year-old female.

35:26

She's a working mother of two. And as Dr. Berner mentioned, right, because we're always looking at various information, we see her age, her gender, her past claim history, and we identified her as someone that needs a routine mammogram. So we sent her a targeted screening reminder.

35:45

She received that communication and she called her doctor and she got her mammogram scheduled.

35:51

Unfortunately, after the screening, she was diagnosed with stage one breast cancer.

35:55

The new cancer diagnosis triggered our case management outreach and an HCSC nurse outreach to Sarah to complete an assessment, which included a mental health screening, as well as identifying any social determinants of health needs that we can address, as were mentioned on the first topic.

36:15

The nurse also helped confirm that Sarah's providers were in fact in network, which is always I know a big question and something we want to make sure that she has peace of mind on.

36:24

Given she's a mom of two little ones, Sarah was grappling with this news.

36:28

And so our case manager helped Sarah find an in-network behavioral health therapist for her and her children, while an HCSE social worker assisted with her EEP and medical leave needs.

36:42

A few weeks later, Sarah had some questions around the proposed course of treatment.

36:47

She spoke with her case manager about it, where her nurse informed her that she has access to an expert advisory review.

36:53

And so she was warm transferred to that second opinion partner.

36:57

A peer review was occurred through the two oncologists and they determined that, you know, this was the best course of treatment for Sarah and her family, which gave her peace of mind.

37:08

Weeks later, following Sarah's chemo infusion, she was experiencing some nausea.

37:13

Her HCSC nurse worked with the pharmacist to get Sarah an anti-emetic prescription filled, as well as her treating oncologist who suggested IV hydration after treatments to avoid any unnecessary side effects and potential ER visits.

37:29

After Sarah's treatment was complete, the HDSC team connected her with her plan or long-term plan. She has a support group and encouraged active engagement with her therapist.

37:41

She is now a cancer survivor and an advocate for others.

37:45

So not all of our, you know, journeys always end up so happy like this, but hopefully this gives you an idea of how at every step of the way we strive to be there and hold members like Sarah's hands throughout this journey.

38:00

So if you flip to the next slide, we'll talk a little bit about, you know, what was the outcome?

38:04

What did we see from this?

38:07

You know, given kind of the comprehensive nature of our oncology resources, Sarah and her family benefited from the support throughout her end-to-end journey.

38:16

It began, as Dr. Berner mentioned, with preventive care reminders, which helped detect the cancer in treatment early, which really helped ensure a successful recovery.

38:27

And the holistic approach we took with her health management enabled a broader care delivery and deeper trust in relationships between her and her case manager, as well as through her oncologists and therapists.

38:40

And finally, having resources available to help her understand her care plan, make sure that was the right care plan for her.

38:47

It really helped empower her to focus on her health journey and improve her quality of life. So if we flip to the next slide, you know, that is just one example.

38:58

We wanted to zoom out and now say, what have we learned about our program so far?

39:03

Because we're constantly learning, right?

39:05

We're evolving, we're learning, we're trying to continue to learn and grow.

39:09

And so everything hopefully you have heard today has really hinged on focusing on those goals on the left, right?

39:15

It's all about, and these are things that we literally think every single day here at HCSC, but how do we best improve the members' experience, improve their health outcomes, improve their network access, and ultimately drive down the cost of care?

39:30

And so you'll see on the right some of the actual outcomes that we have of this program.

39:36

And so we know that we are in fact making an impact in our communities, which is really great.

39:42

We see that of our cancer care management program, we're engaging 52% of the members that we're identifying.

39:49

And of those, a good number of them are benefiting from the resources and connections that we're giving them.

39:55

So 34% were referred to a social worker for any of their SDOH needs, 25% of them were referred to a behavioral health resource.

40:05

Dr. Berner mentioned the effort that we've been doing to, while we always want them to get into the doctor, sometimes they can't, right? Rural communities, inability to leave the room, the home.

40:16

So within the 334,000 colorectal screening kits we've sent out, we're seeing a 5% of those returned kits have a positive test result.

40:26

That means that we are in fact catching care earlier to individuals that may not have ever gone and gotten it caught at all.

40:35

And then finally, as we look at our expert Medical Review Program that I mentioned just recently got launched.

40:42

Still fairly new, right?

40:43

It just got launched this year, so we're still assessing it, but we do see very strong historical results with our partner.

40:50

And the goal is really that we're seeing that members are, their knowledge is growing in terms of cancer, they're making more informed decisions, and overall it's improving the quality of life for our members.

41:04

So we can flip to the final slide.

41:06

What I wanted to really land on was that hopefully you've taken some bits and pieces away from what we've been able to accomplish at HCSE so far, but we are not done, right?

41:19

We are certainly proud of what we've accomplished so far, but we are continuously evaluating and innovating to be able to provide the most optimal support to our members, as well as meeting or exceeding what the market is demanding of us.

41:34

And so in addition to all the items that you've heard about today, we are actively working on a couple things in the pipeline.

41:40

So you'll see in 2025, we have some enhancements that are rolling out, including a new cancer care hub.

41:48

The intent here is that we make those resources that we just talked about much easier to find and navigate for our members, because sometimes it is very difficult to find and not knowing where to go. We want to make that easy for members right then and there.

42:01

We're also working on how we can best improve the support we provide to members who need palliative care.

42:08

And while a little bit further out, we're also looking at how we can best support and advocate a strong survivorship community, make our short-term and long-term disability products more integrated within this cancer experience, as well as exploring the advances of genetic testing and precision medicine in this space moving forward.

42:27

So lots more to come.

42:30

We are so humbled to be here.

42:32

We're excited to partner on this and very much appreciate the opportunity to be here.

42:38

So I will pass it back to Kate.

42:42

Great, thank you so much, Dr.Berner and Kate for sharing HCSC's holistic approach to cancer care.

42:48

The programs you're implementing now, the outcomes you are seeing, and really the vision for the coming years.

42:54

Next, we will hear from

42:56

Dr. Veda Giri, a medical oncologist and division chief of clinical cancer genetics for Yale Cancer Center and Smillow Cancer Hospital, an assistant director of clinical cancer genetics for Yale Cancer Center. She's also the director of early onset cancer program.

43:12

We are grateful to have her with us today to share more about our understanding of early onset cancers. Dr. Giri? Hello.

43:20

I hope everyone can hear me okay. It's a real pleasure to be here. Thank you so much for inviting me to come talk about the Early Onset Cancer Program.

43:30

Next slide, please.

43:36

Great.

43:37

So this is a new program that has been launched by Yale Cancer Center and Smillow Cancer Hospital, co-led by myself and co-director, Dr. Nancy Borstelman.

43:49

I have a background in medical oncology and focus in clinical cancer genetics from a clinical and research standpoint.

43:58

and along the way really had developed this really deep interest in early-onset cancers.

44:06

And so I was really delighted to co-lead this new program for early-onset cancers with Dr. Nancy Borstelman.

44:13

Dr.Borstelman is Chief of Family Behavioral Health Services in the Yale Child Study Center, has long-standing expertise in social work, Leading the social work program for over 20 years at Dana Farber and then coming to Yale to about two years ago Two and a half years ago and is now co-leading the early onset cancer program with myself as well Next slide, please.

44:45

So I'm going to cover just sort of brief in general for the sake of time Some these four aspects in terms of the recognition of the early onset cancer burden the rise in early onset cancers that has been noted, addressing the needs of family, friends, patients, caregivers, giving a little bit of an overview of the Yale Early Onset Cancer Program.

45:09

And then what can we do now, which are often questions that we receive from patients and from providers and caregivers as well.

45:17

Next slide, please.

45:23

So in general, when we're talking about early onset cancers, the definition here for the sake of our discussion and thinking about this more broadly, is an individual who was diagnosed with a cancer between the ages of, from 18 to 49.

45:40

So basically under the age of 50 for adults.

45:44

And what's been noted is that over the last many years, there's been noted to be an increase in early onset cancers, which actually spans across the cancer spectrum.

45:54

And this has really come more to light in the last couple of years in terms of public awareness from some new data about the rise in early-onset cancers.

46:04

This includes across the spectrum from breast cancer, colorectal cancer, pancreatic cancer, ovarian and prostate cancers, skin cancer, thyroid cancer, hematologic malignancies.

46:16

And what's of concern is that these individuals can have worse outcomes, and the outcomes can be defined in different ways, whether it's cancer-related outcomes for some of these individuals who are diagnosed with a younger cancer diagnosis.

46:32

Outcomes related to impact on fertility, fertility preservation, pregnancy potential, and then also secondary health outcomes such as cardiovascular diseases, secondary cancer risks.

46:45

So really thinking about this broadly when we are looking at worse outcomes. Next slide, please.

46:59

So this is one of the studies that was published in 2020-2023 that really launched a lot of public conversation about the rise in early onset cancers.

47:12

This was a study that looked at data from 17 NCIC registries comparing the incidence of early onset cancers from 2019 compared to 2010.

47:26

And what was noted was that overall in individuals diagnosed younger than age 50, that there was an overall increase in early-onsite cancers of 0.7%.

47:36

But really, what was noted was the dramatic increase in those individuals between the ages of 30 to 39 and diagnosed between the ages of 20 to 29, as can be seen.

47:46

The cancers that are kind of the top ranking in terms of these increase in incidence for early-onsite cancers are colorectal cancer, breast cancer, and sort of endocrine-related cancers.

48:00

But what we notice, next slide please, is that actually this increase in cancer incidence is actually noted across the board for multiple cancer types, from, as I mentioned, thyroid cancer to pancreatic cancer to prostate cancer and the hematologic malignancies.

48:19

So it's really as important to think about when we develop a program to think about this across the cancer spectrum and really thinking about across populations as well.

48:29

Next slide please.

48:35

This is another paper that was very intriguing looking at the cancer incidents in successive generations and what we can see here is that really this is kind of a busy slide but to kind of summarize it what they did was looked at generations looking at gen x versus baby boomers versus the silent generation kind of going back and thinking about do we see a difference in these incidents of cancers?

49:02

And which specific cancers are we seeing a change in by successive generations?

49:06

And what we see here kind of in the bottom right of the slide is that, you know, looking at say gen X versus baby boomers, that we do see an increase in incidence for those cancers where they're showing up on the right side of that vertical bar.

49:23

And some cancers have decreased in successive generations but others have continued to rise.

49:29

And again, these primarily like sort of the top ranking ones are colorectal cancer, breast cancer, but a host of other cancers as seen there.

49:37

And so we see this for males and females, and disparities are therefore incredibly critically important to address as we think about making a difference here. Next slide, please.

49:52

Now, we often get questions about why this is happening.

49:55

And that really is an area of active research thinking about why are these Cancers increasing across generations?

50:04

Why are we seeing earlier onset cancers on the rise?

50:08

Is it inherent factors?

50:10

Is it environmental factors?

50:11

Is it dietary factors?

50:13

Is it a combination of factors?

50:14

It's probably a multifactorial set of reasons for why this is going on.

50:21

And also is a very active area of research.

50:25

And so while the research has been going on, our program has taken the approach of what really can we do now and what needs to be addressed.

50:33

The challenges for patients with early onset cancers are multiple, and these can be categorized as clinical and research challenges and complexities, impact on quality of life, impact on responsibilities that these individuals have, and access to care.

50:51

So from the clinical and research complexities, as I mentioned, in terms of they can potentially experience worse clinical outcomes, there are gaps in research that needs to be addressed in terms of why this is happening and how to enhance the patient experience.

51:05

Additional modalities that are brought into the care of these patients like genetic testing, which can just be a lot to think about when a person is diagnosed with cancer, thinking about multiple approaches to the treatment of their cancer, and then now bringing in additional factors such as genetic testing and approaches to fertility preservation and things like that.

51:27

Quality of life is certainly impacted for these individuals, coping with the cancer, impact on mental health, social isolation that can be experienced from their peers and friends and networks going through this at a younger age, impact on fertility and sexual health, body image and physical challenges as well.

51:47

And then these are individuals who are very busy in their lives and have many, many responsibilities typically.

51:53

So, there can be a strain on their employment and engagement with their jobs and their careers with the cancer diagnosis and dealing with the cancer, you know, trajectory.

52:04

Oftentimes these are parents and, you know, these individuals have childcare responsibilities or they're taking care of aging parents and have caregiver responsibilities.

52:13

So, you know, thinking about how they're going to balance everything really becomes a strain on how they can engage with their care.

52:19

And then access to care becomes critical.

52:23

So financial stress that can come out of, you know, cancer treatments and impact on their own finances.

52:30

And, you know, when we think about things such as disparities or under-resourced populations, transportation to appointments, how are they gonna, who will take care of the kids while they're at the appointments?

52:43

You know, a lot of these things come to mind which can really impact the engagement in cancer care.

52:48

Next slide, please.

52:54

Terrific.

52:54

And then you can advance actually to the next slide as well while I talk about this, which is that while we know we need to address patients in terms of all of these challenges, we must address what is also happening to caregivers, friends, and family members who are also impacted by a loved one diagnosed with an early onset cancer.

53:15

So many of these challenges that are being faced impact the caregivers as well.

53:20

So, comprehensive programs need to think about addressing this for patients and for caregivers or friends.

53:26

And then incredibly important, as I mentioned, disparities, because any of these challenges really exponentially rise when we're thinking about the impact of underserved, under-resourced, underrepresented populations.

53:40

Next slide, please.

53:50

So, in our state here in Connecticut, we have a real opportunity at Yale to make an impact for our state regarding early onset cancers.

54:02

And this is because really Yale Smillow touches the cancer care of about 50% of the Connecticut population, if not more.

54:09

And so in looking at the data, we see a substantial burden of early onset cancers that about 10 to 15% of cancer cases are early onset cases.

54:21

And annually that accounts to about over 3000, perhaps even close to 4 ,000 new diagnoses of early onset cancers on a yearly basis.

54:32

And that doesn't even account for the many thousands of individuals who are living with a cancer or are survivors of cancer who were diagnosed at a younger age and may still have a lot of challenges that they're facing after their cancer treatments are completed.

54:47

So Yale and Smillow have 16 care centers actually expanding across the state of Connecticut and into Rhode Island.

54:53

And therefore, again, we have a real potential to make a statewide impact and really think of disparities.

55:00

Connecticut actually has some very profound disparities when it comes to education, income, you know, engagement in care.

55:08

And so, again, really thinking of paradigms that make a difference here.

55:12

Next slide, please.

55:18

So, in general, our Early Onset Cancer Program, the mission is to reduce the burden of early cancer for patients and families, driven by innovation, equity, and support.

55:27

There are four pillars of our program.

55:30

A clinical pillar, which is to help develop novel clinical paradigms.

55:33

The research pillar, which is to lead groundbreaking research and collaborative research to uncover the causes, advance treatment, and support patients.

55:42

Strong emphasis on psychosocial needs that need to be addressed for patients and families.

55:47

And then a community engagement arm, which is to help create community-based collaborative initiatives for individuals, healthcare providers, advocacy organizations about early onset cancers, to raise awareness and to help spearhead ways to help these individuals and families engage in care.

56:03

Again, with addressing disparities throughout all of this.

56:06

Next slide, please.

56:15

This is certainly a team effort here at Yale.

56:17

We have a large steering committee that includes experts that span across the cancer spectrum in terms of their clinical expertise and their academic expertise and contributions to the field.

56:30

We also have a growing patient engagement in our steering committee.

56:36

And also we know that we need to engage diverse populations as well.

56:39

So really helping to think about that, to make sure that we're having all of the perspectives as we're developing our strategic plans for how this program should roll out.

56:50

Next slide, please.

56:56

We have launched a new website, so I will point you here with the shortened website link and the QR code.

57:05

And this is really helpful at this point in time to help us kind of spread the word out there about early-onset cancers.

57:13

The website highlights our programs for like the four arms that I mentioned, gives some summary cancer statistics, and then also in terms of thinking of you know presentations that we're doing and you know informational needs that we can put out. Next slide please.

57:33

So what can we do now? I'll kind of go through this pretty quickly. Next slide please.

57:45

And you can go forward. Next slide please.

57:46

In terms of addressing the psychosocial needs of patients and families, one of the studies that we have going on is called the PROSPER study which is looking at addressing the social needs of individuals who are Black, Hispanic, Latinae, and developing an e-navigation tool that includes their perspectives from focus groups and interviews for developing this e-navigation tool for the informational needs of patients, which we will then pilot.

58:15

We've also launched early onset support groups.

58:18

I just held a fertility preservation symposium this morning before this presentation and really launching our patient navigation and Next slide, please.

58:32

And then just what you can do now or what can be, you know, spread out there in terms of public awareness, a couple of things is, in terms of how do individuals know to screen younger for cancers, one of the best ways to think about that is knowing family history, so which can guide cancer screening recommendations, sometimes younger ages to begin screening.

58:51

It can help inform genetic testing, which also can inform, you know, cancer risk estimation and starting screening at younger ages.

58:59

And so individuals should really bring that family history information to their doctors. Consider genetic testing if appropriate.

59:06

And in the meantime, really maintain a healthy lifestyle, physical activity, diet.

59:10

American Cancer Society has a really great website for thinking about diet and physical activity for cancer risk reduction.

59:17

And then just really making sure that individuals have regular visits to their doctors.

59:22

Young people, it's a harder thing to go to the doctor, but you know, go to the doctor, get the vaccines and bring any symptoms to doctors, to the healthcare team so that it can be addressed and really taken care of. Next slide please.

59:40

So I just wanted to give a brief overview of our early onset cancer program and put this in the context of this really critical field and so I really again appreciate your time for inviting me to come and speak today. Thank you.

59:59

Thank you Dr. Giri for walking us through all of that information about early onset cancer.

1:00:06

We are at the hour and so unfortunately it looks like we are not going to have time for additional questions.

1:00:14

I would like to thank our excellent panel of speakers for sharing their thoughtful and valuable perspectives with us today and thank you to our audience for joining us for this discussion.

1:00:22

Your feedback is incredibly important so please take a moment to complete the brief survey that will open on your screen after the event and please check out the other resources available on our website, including a recent webinar on cancer, or sorry, a recent newsletter on cancer care.

1:00:37

A recording of today's event will be shared along with other related materials in the coming weeks.

1:00:42

Thank you so much for joining us today and thank you again to our wonderful group of panelists.


Lorna H. McNeill, PhD, MPH

University of Texas MD Anderson Cancer Center

Monica Berner, MD

Health Care Service Corporation

Kate Duncan, MBA

Health Care Service Corporation

Veda Giri, MD

Yale School of Medicine


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