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Childhood Cancers Addressed

Preventing Tennesseans from getting cancer and helping ensure better treatment for those who do is the purpose of the Tennessee Comprehensive Cancer Control Coalition (TC4), which last November unveiled its Tennessee Cancer Control Plan covering 2009 to 2012. The state's first plan, published in 2005, covered three years.

More than a decade ago, the federal government mandated that every state develop a plan, but no grant money came Tennessee's way until 2003. That's when the coalition, a collaborative group of organizations and citizens, kicked cancer awareness into high gear. TC4 Co-Chair Debbie Wujcik, RN, PhD, director of clinical trials at Meharry Medical Center, acknowledged that Tennessee lagged behind back then when it came to data collection for the Tennessee Cancer Registry. "It didn't meet credentialing standards, so our data wasn't included in the national report," she said. That's changed now, and the state's registry enjoys "gold status" with the North American Association of Central Cancer Registries. "By organizing ourselves and really advocating with the legislature and working with the state Department of Health," she said, "we not only increased the number of staff (working with the registry), but we worked with hospitals and pathology labs across the state to ensure that the data about cancer diagnoses were being submitted."

Data in the new plan is much improved. "We not only have statewide data, but we have data that's broken down by county. That allows us to really understand where the biggest problems are and how to prioritize our efforts and resources to address particular cancers that may be higher in one part of the state than others. The problems in West Tennessee are not the same issues as in East Tennessee," Wujcik said. "However, by having a comprehensive, coordinated state cancer plan, we can maximize our resources and really address the problems head on."

And Tennessee does have problems. For the years 2000 to 2004 combined, the state's overall cancer mortality rate was 208.7 per 100,000 population, which was higher than the national mortality rate of 185.7. The leading cancers causing death in Tennessee were lung and bronchus, colorectal, breast and prostate. One-in-three cancer deaths were due to lung and bronchus, and 87 percent of those deaths were attributed to smoking. There is more bad news: Cancer mortality is 10 to 25 percent higher in overweight people and 50 to 100 percent higher in obese people, and the number of Tennesseans who are overweight has been increasing steadily over the last two decades.

The new plan delineates specific goals for the continuum of cancer care, including primary prevention, early detection, treatment and care, survivorship and palliative care. The issues of cancer disparities, health literacy, surveillance, and lifestyle and environment that were identified in the 2005-2008 plan remain in the 2009-2012 plan. New to the plan are goals regarding clinical trials and advocacy. There are specific strategies to address tobacco-related cancers, women's cancers, colorectal cancer, prostate cancer, skin cancer and melanoma, and childhood cancers. In fact, the Tennessee plan is making headlines in cancer circles because of its childhood cancers chapter.

TC4 Vice-Chair Rob Clark, director of public policy and government relations for St. Jude Children's Research Hospital in Memphis, credited St. Jude's chief medical officer, Joe Mirro, MD, for helping ensure the plan's childhood cancers focus. Mirro chaired the coalition's Childhood Cancers Workgroup.

"Because of his early involvement in the development of the plan, he wanted to make sure that our state plan had an emphasis on childhood cancers. Even though the incidents of childhood cancer are small, childhood cancers are still the No. 1 killer by disease of children in the state," Clark said. "I think the takeaway is that the state plan recognizes that children are different than adults in terms of how someone gets cancer, how it's treated and the late effects on survivors of cancer. Fortunately, as we and others in the childhood oncology business have made progress in cures and treatments, it's no longer a death sentence. So we have many, many survivors of childhood cancer who live to be adults, and they have unique health issues at times because of the natural progression of the disease and how it's treated."

Clark said Tennessee's new plan will see success "because we have some measurable goals that we have outlined, not just for childhood cancer, but for all of the other issues that we address."

While dollars are limited at both the state and federal level, Wujcik said TC4's top resources are the seven employees and more than 400 volunteers focused on education. "Although we're very interested in persons getting the best state-of-the-art treatment for cancer, the bigger battle is to get people to change behaviors to reduce their risks and prevent cancer," she said.

Tags:

Debbie Wujcik, Joe Mirro, Rob Clark, Tennessee Cancer Registry, Tennessee Comprehensive Cancer Control Coalition

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