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April 22, 2010 Volume VI, No. 47

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to the American Cancer Society, about 77 percent of all cancers are diagnosed in persons 55 years and older. Unfortunately, this age group is less likely to be screened for skin cancer, according to this week's prevention tip, which describes how this can jump-start prevention efforts. This issue also highlights the risk of lung cancer in African American patients and colorectal cancer in patients who take statins.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Lung Cancer in African Americans
  2. Do Statins Protect Against Colorectal Cancer?
  3. A Coordinated Discharge Approach Reduces Readmissions
  4. Aligning DM Concepts with the Medical Home
  5. Tools That Measure Medication Adherence
  6. Benchmarks in Patient Education
  7. Skin Cancer Screenings
  8. Obesity and Weight Management 2010

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African Americans More Likely to Develop, Die of Lung Cancer

Despite lower smoking rates, African Americans are more likely to develop and die of lung cancer than whites, according to an American Lung Association report. The report is a compilation of research examining lung cancer among African Americans and the need to eliminate this and other health disparities. The report also provides important information on the possible biological, environmental, political and cultural factors that make African Americans more likely to get lung cancer and more likely to die from it. Lung cancer is the number one cancer killer in the nation. It has been the leading cause of cancer death among men since the early 1950s, and in 1987 it surpassed breast cancer as the leading cause of cancer deaths among women. African Americans, however, suffer from lung cancer more than any other population group in the United States. Key facts regarding this disparity include:

  • African American men are 37 percent more likely to develop lung cancer than white men, even though their overall exposure to cigarette smoke — the primary risk factor for lung cancer — is lower.
  • African Americans are more likely to be diagnosed later, when cancer is more advanced.
  • African Americans are more likely to wait longer after diagnosis to receive treatment, to refuse treatment and to die in the hospital after surgery.
While the reasons for this unequal burden are not entirely clear, the Lung Association’s report presents a compilation of research that examines smoking behavior, workplace exposures, genetics, access to healthcare, discrimination and social stress, as well as other possible contributors as to why African Americans are disproportionally affected by lung cancer.

According to Charles D. Connor, American Lung Association president and CEO, “While some progress has been made, especially in reducing smoking rates and exposure to secondhand smoke, much remains to be done. Reducing lung cancer needs a focused effort. The Lung Association stands ready to work with the healthcare industry as well as governments, community leaders and individuals, to eliminate the disparity of lung cancer in African Americans.”

To learn more about this research, please visit:

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Statins Do Not Protect Patients Against Colorectal Adenoma Risk

Statins did not protect patients against colorectal adenomas, which are benign precursors of colorectal cancer, according to results of a secondary analysis of the Adenoma Prevention with Celecoxib (APC) trial. In a population at high risk for developing these lesions, results of this analysis suggested statin use may increase the risk of developing benign colorectal tumors. Statins are commonly used to prevent cardiovascular disease by lowering cholesterol levels. Previous studies have indicated that statins may also play a role in the prevention of colorectal cancer among patients who are at high risk for this cancer. The goal of this study was to determine whether statin use was associated with the development of recurrent colorectal adenomas after removal by colonoscopy.

The overall APC trial was a randomized trial of 2,035 adenoma patients; 679 received placebo, 685 received 200 mg of celecoxib, a non-steroidal anti-inflammatory drug that is commonly used for patients with arthritis, twice a day and 671 received 400 mg of celecoxib twice a day. In the placebo group, patients who used statins at any time had no benefit in tumor growth over a five-year period compared with those patients who never used statins. Statins were used by 36 percent of the participants. Risk of developing recurrent benign colorectal adenomas increased with time in patients who were using statins. As expected, based on their need for a statin, patients who were taking a statin experienced more serious cardiovascular side effects such as heart attack and stroke, according to the researchers.

“In this analysis, statins did not prevent the development of non-malignant colorectal tumors or colorectal adenomas,” said lead researcher Monica Bertagnolli, M.D., chief of the Division of Surgical Oncology at Brigham and Women’s Hospital and professor of surgery at Harvard Medical School, Boston, Mass. “Given our results, we do not think that it is reasonable to further study statins for chemoprevention of colorectal cancer, as the chance that they have this activity is very small.”

To learn more about this research, please visit:

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A Coordinated Discharge Planning Approach to Reduce Avoidable Hospital Readmissions

Sharing the latest literature on the causes and prevention of hospital readmissions is Susan Shepard, the director of patient safety education for The Doctors Management Company. Ms. Shepard describes the type of patient most at risk for readmission, some of the risks inherent in transitioning patients from one care site to another, and the contribution of the patient's primary physician to a successful discharge.

To listen to this complimentary HIN podcast, please visit:

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Aligning DM Concepts with the Patient-Centered Medical Home

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Ariel Linden, Dr.P.H., M.S., president of Linden Consulting Group, and Dexter Shurney, M.D., M.B.A., M.P.H., medical director of Employee Health and Care Plan at Vanderbilt University and Medical Center.

Question: Do you see the concepts of DM coming together with the concept of the medical home? If so, how and when?

Response: (Dr. Dexter Shurney) I certainly do think they come together. When we bring the two together, it’s much more powerful than either one of them by themselves. When you have the luxury of that medical home and the DM program, there’s a lot more you can do to exchange information. There’s also much more that you can do to motivate individuals because you have that synergy where these two parties are working together.

(Dr. Ariel Linden) Having the patient’s PCP as a centerpiece — the quarterback — is essential not only in getting patients to have a focal point, but also ensuring that all other pieces of the care team and the needs of the patient are met. Our fragmented system ensures that a patient is going to fall between the cracks. Therefore, a provider-centered model makes perfect sense.

For more information on DM and health improvement, please visit:

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ReadmissionsRx delivers strategies to reduce hospital readmissions that encompass care plan development, case management, care transitions, pre- and post discharge planning, medication reconciliation and much more — with a special focus on reducing rehospitalizations among the Medicare population.

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Tools That Measure Medication Adherence

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Benchmarks in Patient Education — Prevention, Self-Care Top Lessons

How prevalent are patient and member education programs, and which health areas are addressed by these efforts? How are healthcare organizations delivering health education, and who is the primary health educator? What is the chief impact of patient education programs, and how do organizations measure ROI from patient education efforts? This executive summary of responses from 134 healthcare organizations to HIN's Patient Education and Outreach Benchmarks e-survey offers lessons in the value of educating patients and members about DM and self-care.

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Few Men and Women Over 50 Receive Skin Cancer Screenings

Among people over 50, those who did not finish high school or have not recently had common cancer screenings such as a mammogram, prostate-specific antigen (PSA) test or colorectal cancer screening, are also less likely to be screened for skin cancer. This finding appears in a new study by an investigator at The Cancer Institute of New Jersey (CINJ) and colleagues, which shows screening rates for skin cancer are low among middle-aged and older Caucasian adults and that physicians may want to further emphasize skin examinations for this population, especially for men and those with less education.

According to the American Cancer Society, skin cancer is the most common of all cancers. Melanoma represents about 5 percent of all skin cancer cases, but accounts for most skin cancer deaths. In contrast to many other types of cancer, the mortality rate for melanoma has been steadily rising over the past 35 years. The current study focused on skin cancer screening among middle-aged and older Caucasian adults, as the mortality rate for melanoma has been increasing most notably among these individuals.

The study examined 10,486 Caucasian men and women aged 50 and older drawn from a random sample of 31,428 adults aged 18 and older who took part in the 2005 National Health Interview Survey. Participants indicated whether they had undergone a skin examination by a dermatologist or other doctor in the past year, and also completed questions about their demographic characteristics, health and healthcare access, history of skin cancer and other cancer screenings received, such as a mammogram, PSA test and colorectal cancer screening. Somewhat more than half of the participants (54 percent) were female, and nearly all participants (91 percent) said they had been to a physician at least once in the past year. Of those interviewed, relatively few noted that they had a personal or family history of skin cancer.

The study found that 16 percent of men and 13 percent of women reported having a skin examination in the past year. Factors associated with the lowest rates of having a skin examination in the past year included being aged 50 to 64 years (12 percent skin examination rate among men and women), having a lower education level (some high school education or less: 9 percent skin examination rate among men and 8 percent among women), lacking screening for breast (7 percent skin examination rate among women), prostate (8 percent skin examination rate among men) and colorectal cancers (7 percent skin examination rate among men and 9 percent among women), and not having a personal history of skin cancer (13 percent skin examination rate among men and 12 percent among women).

One study author, Alan C. Geller, MPH, RN, Division of Public Health Practice at Harvard School of Public Health, notes that the correlation between lack of skin cancer screening and other cancer screenings could speak to a larger issue. "These results should indicate to physicians that a more proactive approach is needed in order to assess whether patients have received screening for multiple types of cancer. Physicians can screen their patients for skin cancer as part of a cancer-related checkup during a general health examination," Geller noted. "Free skin cancer screenings are also available as part of a nationwide program provided by the American Academy of Dermatology in partnership with local dermatologists."

To learn more about this research, please visit:

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Obesity and Weight Management 2010

Despite early indicators of success on the management front, obesity is still tied to an estimated $117 billion in healthcare costs. New healthcare reform will reward prevention-related initiatives, and first lady Michelle Obama's Let's Move campaign hopes to solve the childhood obesity epidemic within a generation. Describe how your organization is working to prevent and reduce obesity and related conditions and costs in your population by taking the Obesity and Weight Management survey by April 30, and receive a free e-summary of the results. More than 80 organizations have responded so far; your responses will be kept confidential.

To participate in this survey and receive its results, please visit:

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