Comprehensive cancer control is a rapidly changing field. One of the developments driving this change is the trend toward personalized cancer care based on the use of the genetic profile of a tumor to make improvements in diagnosis and allow for targeted therapies. Traditional classification of cancer cases has been based on the tissue of origin of the cancer. Increasingly, cancers are being classified and subclassified by their molecular characteristics. On a limited scale, the molecular characteristics are becoming part of information gathered by state cancer registries. For example, registration of breast cancers now includes their estrogen and progesterone receptor status and HER2/neu status.
GENETIC RISK ASSESSMENT
Genetic risk assessment has only recently been seen as a routine part of cancer control. Information is being distributed to clinicians, patients and the public in many formats. The National Cancer Institute (NCI) has developed information for hereditary cancer syndromes. The Connecticut DPH Genomics Office has also developed guidelines entitledCancer Genomics Best Practices for Connecticut Healthcare Providers – Hereditary Breast and Ovarian Cancer Syndrome and Lynch Syndrome.
As many as ten percent of pancreatic cancers may also be due to abnormal genes, for which tests are available. (34a) Pancreatic cancer, a disease with low incidence but high mortality, causes more deaths in Connecticut than breast or prostate cancer. Since there are no proven evidence-based early detection tests and a disparity exists (blacks experience greater incidence and mortality rates), monitoring the potential for the use of genetic testing for these inherited genetic mutations may be a useful approach to the control of this especially difficult type of cancer.
CANCER RESEARCH AND CLINICAL TRIALS
The landscape of clinical trials is also evolving. While trials continue to be the definitive method for defining best practices, the approach to their organization is undergoing changes. The emergence of targeted therapies based on molecular sub-classifications of cancer requires further specialization in cancer research. This is leading to new challenges in clinical trial accruals, because patients will be required to have a particular molecular lesion to qualify.
According to the National Cancer Institute website, “For over 50 years, NCI has supported a standing infrastructure — the NCI Clinical Trials Cooperative Group Program — to conduct large scale cancer clinical trials across the nation, with successful completion of many important trials that have led to new treatments for cancer patients. Over time, however, oncology has evolved into a more molecularly-based discipline including genetic sub-classification of tumors and individualized treatments. It is truly an exciting time in oncology research and we are presented with immense scientific opportunities to be systematically explored. NCI must ensure that the Cooperative Groups are optimally situated and well-prepared to design, enroll and complete state-of-the-art trials for cancer patients.”
The Partnership will continue to monitor this issue and, as appropriate, educate the cancer control community on new developments.
ELECTRONIC HEALTH RECORDS
The emergence of the electronic health record (EHR, the more comprehensive version of the electronic medical record), health information exchanges and patient portals will provide important opportunities for cancer control. The adoption of EHR will be helpful in the promotion and documentation of screening tests and survivorship care plan development.
“This collaborative relationship has allowed for the first “official” Patient Navigator curriculum to be developed and implemented in our state. Many conversations regarding the role of community healthcare workers and patient navigators have occurred over the last two years, all of which have been very useful.”
Workforce Development and
Continuing Education Gateway
Two-year Partnership member
“The Connecticut Cancer Partnership has provided me with key resources with respect to patient education, available trials and the latest technologies.”
Nancy Teixeira, MSN, RN
Two-year Partnership member