2018 - 2022 Virginia State Cancer Plan:
2019 Progress Report

The Cancer Action Coalition of Virginia began as the Cancer Plan Advisory Committee in 1998, when the Virginia Department of Health (VDH) convened a small group to begin writing a statewide cancer plan. In 2003, the Cancer Plan Advisory Committee became the Cancer Plan Action Coalition (CPAC) of Virginia and a transitional executive board was formed to oversee development of by-laws and ensure implementation of the cancer plan. CPAC continued to grow and in 2005 the first elected executive committee took office. In 2012, the organization became a 501c3 and changed its name to the Cancer Action Coalition of Virginia (CACV). The purpose of CACV is to facilitate statewide collaborations of organizations and individuals to focus on activities related to objectives contained in the state plan, which is updated every five years. Membership in the volunteer coalition includes representatives of both National Cancer Institute-designated Clinical Cancer Centers in Virginia, the American Cancer Society, VDH, foundations, community groups, medical associations, national cancer coalitions, the General Assembly, hospitals, cancer survivors, universities, health insurance companies and community medically-related groups.  

Cancer Action Coalition of Virginia (CACV) membership used multiple activities in 2019 to address the six priorities identified in the Virginia State Cancer Plan. Collaborations between membership organizations as well as new affiliates to CACV helped to support and foster increased cancer prevention, screening, and control efforts throughout the commonwealth. 

Introduction

The 2018-2022 Virginia Cancer Plan is a five year guide to address the burden of cancer in Virginia. Each year, the Cancer Action Coalition of Virginia (CACV) selects specific priorities from the Virginia Cancer Plan to focus on for the upcoming year. This report aims to highlight the efforts of CACV members and partner organizations to address these selected priorities. It also highlights cancer control efforts that align with the other priorities in the state cancer plan.

Due to the timing of collection and reporting of surveillance data, this progress report does not include data from the Behavioral Risk Factor Surveillance System (BRFSS) or the Virginia Cancer Registry (VCR). BRFSS is a system of telephone surveys that collects health-related data on the residents in the state. The surveys inquire about chronic health conditions, use of preventative services, and health-related risk behaviors. The Virginia Cancer Registry houses data pertaining to cancer incidence and mortality of Virginia residents. It aims to present the burden of cancer in Virginia. Information from these sources will be included in the final report in 2023, as well as annual progress reports where relevant. 

Methodology

To gather information on the efforts made by CACV members to address the burden of cancer in Virginia, surveys were distributed to all CACV members. These surveys inquired if efforts were made to address the specific priorities from the state cancer plan. The surveys were designed to include specific activities implemented to address the priorities, a measure of success for each activity and what lessons were learned from the activities.

Surveys were distributed through the CACV newsletter to all members beginning in late summer 2019 through February 2020 to cover progress made throughout the 2019 project year. Having the survey available for a longer amount of time allowed for activities to be entered as they were completed. This report is a snapshot of the activities of the CACV membership as 42% (26 / 62) of all active CACV members completed the survey.  

Priorities Identified to Address Across Virginia

Objective 3.1: Increase the percentage of Virginians under 18 years of age completing the HPV vaccine series.

Objective 6.1: Increase the percentage of Virginians aged 40-74 who received a mammogram in the past two years.

Objective 6.3: Increase the percentage of adults aged 50-75 who received recommended colorectal cancer screening.

Objective 7.2: By 2022, reduce socioeconomic, structural, and cultural barriers to obtaining quality diagnosis and effective treatment.

Objective 8.1: By 2022, increase awareness among the public, policymakers, survivors, healthcare providers, and others about survivorship issues, palliative care and end of life care.

Goal 10: Improve long-term follow-up care for childhood cancer survivors.

CACV Members Activities to Address Priorities

Objective 3.1: Increase the percentage of Virginians under 18 years of age completing the HPV vaccine series


According to 2018 data, 59.1% of females and 50.8% of males aged 13-17 in Virginia have completed the HPV vaccination series. Of our 18 survey respondents, 8 (44%) conducted activities related to increasing the percentage of HPV vaccinations in Virginians under 18.

Every Woman’s Life” is a Virginia program that improves access to breast and cervical cancer screening for low income, uninsured women. Every Woman's Life provided 741 HPV tests during 2019. Cervical cancer screening recommendations for women aged 30 - 65 includes HPV testing alone or in combination with cervical cytology every five years.


In 2019 the Virginia HPV Immunization Taskforce (VHIT), a CACV taskforce, focused on increasing system collaborations, enhancing focus and education for males, school based and parent focused HPV educational campaigns, and implementing new data collection opportunities. This taskforce is continuing its work in 2020 by continuing with strategic outreach to providers, hospitals, Federally Qualified Health Centers, Health Plans and other health care entities. Through this partnership the taskforce will provide quality improvement strategies to systems, opportunities to partner with stakeholders, and school based initiatives. The taskforce will ensure effective communication and education about work to enhance HPV Vaccination in Virginia for boys & girls ages 11– 13.

VHIT hosted their second HPV educational summit for medical and dental providers in September 2019. The summit, which was held in Roanoke and Richmond through the use of conferencing technology, was once again a resounding success. According to pre and post test data, the attendees went from 16% “being very confident” in their confidence level of being able to discuss the HPV vaccine as cancer prevention to 67% being “very confident and positive.” In addition, 75% of the participants reported that they “strongly agreed that the content and learning materials addressed a need or gap in knowledge or skills to increase HPV vaccinations among my patients.” 

Objective 6.1: Increase the percentage of women aged 40 - 74 who received a mammogram in the past two years.


Increasing the mammography rate remains a priority for CACV members with 50% of respondents for Goal 6 providing information on activities targeting the percentage of women, aged 40-74, who have received a mammogram in the past two years. 

In Petersburg, Southside Regional Medical Center threw “Pink Parties” to encourage women to get a mammogram. Out of 73 "Pink Parties" participants, 22 received their first mammogram. VCU Massey Cancer Center collaborated with Virginia Breast Cancer Foundation in educating Brunswick County Department of Social Services employees on breast health and mammography as a part of a grant they received to teach clients about preventive health as well as the other services they provide. Every Woman's Life provided 3,741 mammograms to low income, uninsured women throughout the state of Virginia during 2019.


Objective 6.3: Increase the percentage of adults aged 50 -75 who receive recommended colorectal cancer screening. 


Colorectal Cancer (CRC) is the second most common cause of malignancy-related death in men and women in the United States (American Cancer Society) and remains the second leading cause of cancer-related death in Virginia (CDC). In order to reach the shared goal of 80% screened for colorectal cancer across the state of Virginia, CACV continues to prioritize addressing the burden of colorectal cancer in the Commonwealth.

Of those who completed the 2019 evaluation survey, 9 organizations made efforts towards increasing the percentage of adults aged 50-75 who receive recommended colorectal cancer screening.

CACV members were able to reach thousands of Virginians through the distribution of colorectal cancer educational materials and resources. The VCU Massey Cancer Center Cancer Research and Resource Center was able to distribute over 1000 relevant materials including those pertaining to colorectal cancer to their patients.

CACV partner organizations, The American Cancer Society, Hitting Cancer Below the Belt, and Remote Area Medical (RAM), worked to organize colorectal cancer screenings to eligible Virginians across the state. Through their combined efforts, more than 500 people were able to receive preventative colorectal cancer screenings.

Since 2015, the Virginia Colorectal Cancer Screening Program at VDH has worked with nine health system partners, including eight Federally Qualified Health Centers and one hospital based health system, to implement four evidence based interventions aimed at increasing colorectal cancer screening. Partner health systems increased utilization of their electronic health record systems to notify providers when patients were due for screening. Additionally, each health system implemented reminders to patients informing them they were due for screening. Although implemented slightly differently in each, health systems used either patient portals, phone, email, text, postcard, letters or a combination of different types of reminders. Health information technology was employed to produce monthly screening rate reports shared with each clinic and provider to inform providers about their effectiveness in recommending and providing appropriate screening to eligible patients. Lastly, clinics took steps to reduce structural barriers that were making it difficult for patients to receive recommended screenings. These measures included flexible clinic hours such as evening or Saturday hours, transportation assistance, and the use of patient navigators in five health systems. The navigator’s role was to provide education, conduct a barrier assessment and develop a care plan to assist patients in completing screening or any recommended follow up diagnostic procedures until a final diagnosis is achieved. The program achieved an average increase of 21.9 percentage points in screening rates from baseline through the end of 2019, including an average increase of 3.2 percentage points from 2018 to 2019. The program concludes in June 2020. The colorectal program collaborated with VDH’s Comprehensive Cancer Control Program to implement the four evidence based interventions across breast and cervical cancer screening as well.

In 2019, the American Cancer Society partnered with the Virginia Community Healthcare Association to facilitate and implement the VA Colorectal Cancer Screening QI Learning Collaborative. During this yearlong learning collaborative eleven of Virginia’s FQHCs from across the commonwealth increase colorectal cancer screening rates through peer-to-peer learning and teaching, application of quality improvement techniques, process and policy changes and implementation of evidence-based interventions. Together these eleven FQHCs, with 48 participating clinics, saw a 7.2 percentage point increase. In comparison, the Virginia state UDS rate only increased by 3.9 percentage points and the National UDS rate only increased by 1.5 percentage points during 2019.

Objective 7.2: By 2022, reduce socioeconomic, structural, and cultural barriers to obtaining quality diagnosis and effective treatment. 

RAM Partnership

VCU Massey Cancer Center partnered with Remote Area Medical (RAM), a major non-profit that provides free mobile health clinics, at a summer event in Emporia, Virginia. During this event, staff worked with a VCU Family Medicine physician volunteer to provide FIT kits to eligible RAM patients. Of the 823 RAM Emporia patients, 47 met the screening criteria or were interested in learning more about colorectal cancer screening. These individuals were then pre-screened to determine eligibility to receive FIT tests. Thirty six FIT kits were provided to eligible patients and two participants were referred for additional screening options. In 2020, VCU Massey Cancer Center will continue to receive the completed test results.

At the Wise County clinic, Virginia Breast Cancer Foundation and UVA Cancer Center worked together with other CACV partners to provide cancer focused health information to patients using the clinic.

LGBT Conference

Multiple CACV partners and outside organizations came together to host a summit for providers focused on education around patients who identify as LGBTQ+. We do not have numbers on how many LGBTQ+ patients are affected by cancer in the United States, let alone Virginia, because that information is not collected. According to the National LGBT Cancer Network there are approximately 1 million LGBT cancer survivors in the country. However, we do know that LGBTQ+ patients can have a greater exposure to cancer risk factors (tobacco, alcohol use, obesity, issues receiving preventive care) and often have less frequent access to regular medical care due to lack of health insurance and previously experienced healthcare discrimination. Because of these factors, it is imperative to educate providers on how to improve their interactions with LGBTQ+ patients so that they are more likely to seek available medical care. This summit was hosted in Richmond and had 56 attendees. Attendees left satisfied with the information provided and eager to learn more and receive more guidance on how to implement changes within their own practice or organization. 


Objective 8.1: By 2022, increase awareness among the public, policymakers, survivors, healthcare providers, and others about survivorship issues, palliative care and end of life care.


Life changes the moment a person is diagnosed with cancer; in that moment they become a cancer survivor. Cancer survivorship focuses on living with, through or after cancer.

It is important for CACV members to initiate programs to address gaps in care for survivors and to work towards addressing them. In 2019, UVA Cancer Center presented its Understanding Cancer program to 390 people through 21 workshops. This program provides attendees with a very basic and general understanding of cancer that they can then build upon as they move through their cancer journey.

Goal 10: Improve long-term follow-up care for childhood cancer survivors.


Virginia is one of only three states that includes pediatric cancer in their state cancer plans, and the inclusion of this often disregarded patient population has encouraged major activity amongst pediatric cancer advocates in Virginia. In 2019, the Virginia Childhood Cancer Workgroup was successful in increasing participation of the Inova Schar Cancer Institute so they now have all five of Virginia’s pediatric cancer treatment centers participating in their monthly communications. The workgroup also surveyed all nonprofits in Virginia that serve children with cancer about their interest in specific psychosocial topics. This information will be used to design a pediatric track at CACV’s 2021 state cancer conference.

In addition, the workgroup hosted a well-received advocacy day at the State Capitol in early 2019 that focused on building support for the establishment of a pediatric cancer fund in Virginia. In June 2019, the Virginia Childhood Cancer Workgroup wrote a white paper on the need for dedicated resources for children with cancer in Virginia. This white paper served as the basis for continued conversations between workgroup members and the state legislators throughout the rest of 2019.

Joining Together for Other Activities

Goal 6: Increase high-quality cancer screening and early detection rates for Virginians 


 We Rock Cancer,” a new CACV member organization, that promotes prevention and early detection of skin cancer through partnership with artists to host musical events, provided free skin cancer screenings at their inaugural fundraising event in the fall of 2019. They partnered with board-certified dermatologists from Braun Dermatology who detected findings on 70% of the 52 individuals who elected to be screened. Two of these were presumptive diagnoses of basal cell carcinoma. In addition they referred 20% of the screened individuals for follow-up treatment and / or biopsy.

The UVA Cancer Center hosted its annual free community skin cancer screening in partnership with UVA Dermatology and the American Academy of Dermatology SPOT Me program in May 2019. As a result of this screening, 358 patients were screened, 96 patients were referred for follow up with 2 presumptive diagnosis of melanoma.

CACV Member Organizations Represented

American Cancer Society

American Cancer Society Cancer Action Network

American College of Radiation

ASK Childhood Cancer Foundation

Barksdale Cancer Foundation

Bon Secours

Bon Secours Hampton Roads

Bon Secours Richmond Health System

Breast Cancer Move Foundation

Bristol Myers Squibb

Cancer Dancer

Central Virginia Community College

Community Care Network of Virginia

Crater Health District

Fight Colorectal Cancer

Halifax County Cancer Association

Hampton University

Hampton University Proton Beam Therapy Institute

Hampton University School of Nursing

Kyowa Kirin-Oncology

Merck

Merck Vaccines

Mountain Empire Older Citizens, Inc.

National Cancer Institute

New Horizons Healthcare

Novartis

Nueva Vida, Inc.

Onco Inc.

Patient Advocate Foundation

Pfizer

Pfizer Oncology

Sentara

Sentara Martha Jefferson Hospital

Sentara Obici Hospital

Southern Gastroenterology Associates, P.C.

Southside Regional Medical Center

Southwest Virginia Community Health Centers, Inc.

Sovah Health Danville

Sovah Cancer Center

Strategic Health Concepts


Susan G. Komen Blue Ridge Affiliate

Patient Advocate Foundation

Pfizer

Pfizer Oncology

Sentara

Sentara Martha Jefferson Hospital

Sentara Obici Hospital

Southern Gastroenterology Associates, P.C.

Southside Regional Medical Center

Southwest Virginia Community Health Centers, Inc

Sovah Health Danville

Sovah Cancer Center

Strategic Health Concepts

Susan G. Komen Blue Ridge Affiliate

Tobacco Free Alliance of Virginia

University of Virginia

University of Virginia Cancer Center

University of Virginia Medical Center




Virginia Community Healthcare Association

Valley Health--Winchester Medical Center

Valley Health System

Virginia Association for Hospices and Palliative Care

Virginia Breast Cancer Foundation

Virginia Cancer Patient Navigator Network

Virginia Commonwealth University

VCU Health

VCU Massey Cancer Center

VCU Massey Cancer Center | Cancer Research and Resource Centers

Virginia Department of Health

VDH--Hampton Health District

VDH--Mount Rogers Health District

VDH--Virginia Cancer Registry

Virginia Tech

We Rock Cancer

Women’s Health Virginia