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How We Dealt with Catchment Area in our Site Visit
Ted Yank, MHA, Associate Director for Administration
CCAF Meeting March 2015
The General Plan
• Made Sure CEO made comment about who we
served in opening remarks.
• Reviewed Catchment Area Analysis in Directors
Overview before Six Essential Elements
• Emphasized Heavily in CPPS Presentation
• Showed Examples in programs
• Reemphasized and Closed strong in the Women,
Children and Minorities section of CPDM
Presentations.
Welcome and Brief Overview of BCM
and Institutional Commitment
Paul Klotman M.D.
President and CEO
Baylor College of Medicine
Catchment Area
Harris County Demographics
White
Hisp/Latino
Black
Asian/Other
5
8%
Population in Millions
4
7%
4
18%
3
4%
2%
3
1
1
19%
20%
2
2
18%
<1%
20%
1%
20%
16%
23%
33%
41%
10%
6%
74%
69%
63%
54%
42%
33%
1960
1970
1980
1990
2000
2010
-
Source: US Census Bureau
Ethnic Distributions of Cancer Patients
at BCM Hospitals
White
6%
11%
Hisp/Latino
5%
Black
Other
6%
9%
10%
30%
20%
30%
15%
44%
45%
66%
55%
37%
19%
Texas Ca Pts
VA
Source: U.S. Census Bureau 2010 Decennial Census, SF1
Ben Taub
Texas Children's
DLDCC Accrual
Interventional Studies 2010-2014
48.9% of subjects are female
Accrual by Race
Accrual by Ethnicity
Unk/Unrep
4.5%
Unk/Unrep
10.1%
Amer Ind
4.3%
Asian
4.6%
White
66.3%
Hispanic
35.8%
Not Hispanic
59.7%
Black
14.2%
N = 1,792
Cancers Important in our
Catchment Area
1. Obesity-related cancers
- HCC in Hispanics and Blacks
- Esophageal cancer in White males
- Pancreas cancer in Blacks
- Prostate cancer in Blacks
- Advanced stage TN breast cancer in young
Hispanic and Black women
2. Tobacco-related cancers
3. Advanced cervical cancer
Catchment Area Cancers con’t
4. Colorectal cancer in young Hispanics
5. HIV-related cancers
- HIV clinics in Harris County
- Center for AIDs Research
- AIDS Malignancy Consortium
- AIDS Biospecimen Resource
6. Pediatric cancers
- ALL in Hispanics (ARID5B)
- Osteosarcoma, retinoblastoma, germ cell
tumors
HCC Accomplishments
Programs: CE, CB, NR, CPPS, PCP,
CCGT
Prevention and Screening
Screening Reduces Mortality.
Hepatology 2010
Hep C Genotype 3 has 80% higher
risk of HCC. Hepatology 2014
Tenofovir reduces HCC incidence.
Hepatology 2014
Video games increase intake of
fruits and vegetables and increase
exercise.
Games Health J 2013
Genomics and Biology
HBX decreased β interferon,
promotes viral replication and HCC.
J Virol 2011
WES of 503 HCC provided the
mutational landscape, new targets.
Nature Genetics 2014
New Treatment Targets
Alterations in HIPPO signaling lead
to bile acid accumulation and HCC.
New targets SHP/FXR. Cell
Reports 2013
CAR receptor promotes HCC.
Inhibited by clotrimazole and
meclizine. Nature Commun 2015
Planned HCC Trials
1. Meclizine in newly diagnosed HCC. Sada (Liver
Working Group), Moore (NR).
2. CAR T cell therapy specific for glypican 3. Heczey
(K12 Trainee) and Gottshalk (CCGT).
Impact
Potential to reduce incidence and
mortality of HCC in Catchment Area and
Globally.
Cancer Prevention and Population
Sciences (CPPS) Program
Leader: Hashem B. El-Serag, MD, MPH
Co-Leader: Melissa Bondy, PhD
Catchment Area Research
Problem
Related Research Examples
Tobacco Use
Examples to follow
Obesity
Diet assessment and biobehavioral research in
pediatric populations, Barrett’s and esophageal ca
Infectious Agents
HPV related malignancies; AIDS Malignancy
Consortium, Microbiome
Environmental Exposures
NIEHS Environmental Center with Texas A&M
Breast Cancer
Molecular predictors of recurrence
Cervical Cancer
Cervical Cancer P01, novel screening technology
Pediatric Cancers
Cancer survivorship, genetic and environmental
studies in rhabdomyosarcoma, ALL
Hepatocellular Carcinoma
Examples to follow
Disparities
Examples to follow
Catchment Area Research
Tobacco Control Across the Life Span
In-Utero/
Infancy
Childhood/
Adolescence
In utero exposure to polyaromatic hydrocarbons in
pregnant smokers (Suter)
Smoking susceptibility in Mexican American
adolescents (psychosocial and genetic) (Spitz, Bondy)
Genetics of impaired functional connectivity in brains of
tobacco smokers (Salas, De la Garza, Kosten)
Early Adulthood/
Middle
Adulthood
Perception of e-cigarettes and traditional cigarettes
(structural and functional brain imaging) Supplement to
P30 (De La Garza, Salas)
Genetic susceptibility (exome sequencing) for lung cancer
and COPD in former and current smokers (Spitz, Liu)
Late Adulthood
Genetics of resistance to lung cancer in old smokers (Spitz,Liu)
Vaccine development for any age (Kosten)
•A 35% decrease in the proportion of early-stage cancers diagnosed was observed.
Catchment Area Research
Community Network for Cancer Prevention
Patient Education & Counseling, 2014, Jibaja-Weiss (CPPS)
Patient
Navigation
Patient Education at Point-of-Care
Screening
Eligibility
(EMR)
Educational
Video
Viewing
PatientPhysician
Conversation
Test
Performed
or Ordered
 Dedicated colorectal
and cervical cancer
navigators
 Follow-up of screenpositives
• 130% and 250% increase in cervical and colorectal cancer screening
• Loss-to-F/U reduced from >40% to <1%
IMPACT: Multi-tiered systems design strategy
increases cervical and colorectal cancer
screening and follow-up in a public hospital
system
Collaborations:
Harris Health
System , MDACC,
UTHSC-Houston,
other community
partners
Catchment Area Research
Liver Cancer
Incidence Rates for Liver & Bile Duct, 2007-2011
Hispanic (Male all races and ages)
Risk Factors
 Genetic epidemiology of HCVrelated HCC (VA Merit El-Serag)
 Constitutive Androstane
Receptors (CAR) in HCC (Moore
(NR), El-Serag, White
Outcomes
 Effectiveness of HCC surveillance
(El-Serag)
 Effectiveness of Tenofovir in
reducing HCC in patients with
HBV (Kanwal)
 Guideline-based treatment of HCC
(R01 NCI, Davila)
Collaborations
 Texas Hepatocellular Carcinoma
Consortium (THCCC)
 First Annual HCC Symposium
Nuclear Receptor Program
Leader: Orla Conneely, PhD
Co-Leader: Suzanne Fuqua, PhD
Co-Leader: Nicholas Mitsiades, MD PhD
Theme 1:
Targeting FXR for Liver Cancer Prevention
in High Risk Patients with Cholestasis
Cell Reports 2013, Anakk (NR) Finegold (PC) El-Serag (CPPS)
Bile Acids
FXR/SHP
Translation
Bile Acid
Synthesis
Cholestasis Patients
FXR/SHP KO
Hippo Pathway
Bile Acids
FXR agonist: Obeticholic Acid
BA Resin: Cholestyramine
Cholestasis
Liver Cancer
Hippo Pathway
Clinical trials being developed
Impact: Novel therapies targeting disease
of high incidence in catchment area
SRs: Mouse Models
Genomic Profiling
Breast Cancer Program
Leader: Jeff Rosen, PhD
Co-Leader: Mo Rimawi, MD
Clinical Trials Activity
Interventional Studies
 24 open studies
– 10 investigator initiated studies (8 are a direct
translation of research findings)
 75 patients accrued in
last 12 months
70% minorities, 45% Hispanic
Pediatric Cancer Program
Leader: David Poplack, MD
Co-Leader: Sharon Plon, MD, PhD
Catchment Area
• Treat >90% of childhood cancer in Harris County
(45% Hispanic)
– Enrollment in our clinical trials reflects this distribution
• Our Research targets cancers more frequent in the
Hispanic population in our catchment area:
– Retinoblastoma - Developed Retinoblastoma Center of
Houston (MDACC & TMH)
– Osteosarcoma
– Acute Lymphocytic Leukemia
– Germ Cell tumors
Statewide Projects with Under- represented
Patients
• Leveraging statewide birth defects and
cancer registries to identify novel cancer
susceptibility syndromes
Lupo(CPPS)/Plon(PC)
• Outreach Clinic in Rio Grande Valley
serves an underserved Hispanic
population
– Obtained COG membership to enable this
patient population to participate in clinical
trials
– Increase Hispanic representation in COG
trials
Global Health Initiatives
Uganda
Angola
Botswana
Malawi
Inclusion of Women Children and Minorities
Martha Mims, MD, PhD
Catchment Area
Area:
1,703.8 sq miles
Population Estimate 2013:
4,336,853
Gender: Almost 50:50 split
Race
Amer Ind /Alaskan
Asian
Hawaiian/Pacific Islander
Black
White
(31.2% Non-Hispanic
whites=Anglo)
More than One
Origin
Hispanic or Latino
1.1%
6.8%
0.1%
19.5%
70.7%
1.7%
41.6%
Catchment Area
Population changes in
Harris County in the last
25 years
Asians/Others
Latinos
Blacks
Anglos
Among Hispanics
75% Mexican in origin
>1/3 report Spanish as the
language spoken at home
Catchment Area
A “young” county
68% of the population
< than 45 years old
Younger population
more diverse
Non-Hispanic Whites
tend to be older
DLDCC Accrual
Interventional Studies 2010-2014
48.9% of subjects are female
Accrual by Race
Accrual by Ethnicity
Unk/Unrep
4.5%
Unk/Unrep
10.1%
Amer Ind
4.3%
Asian
4.6%
White
66.3%
Hispanic
35.8%
Not Hispanic
59.7%
Black
14.2%
N = 1,792
DLDCC Accrual
Noninterventional Studies 2010-2014
46.4% of subjects are female
Accrual by Race
Accrual by Ethnicity
Unk/Unrep
8.4%
Unk/Unrep
11.7%
Amer Ind
3.1%
Asian
3.3%
White
64.9%
Not Hispanic
60.5%
Black
16.0%
N=17,054
Hispanic
31.1%
How We Do It
• Research Coordinators/Nurses diverse ethnically
– 10 speak Spanish – many physicians also fluent
– 2 speak Mandarin
– ~20% are African American
• Ongoing efforts of the Office of Outreach and Health
Disparities
– Community Needs Survey
– Education
– Theater Outreach Program
• Translators readily available on site and by phone
• Consent forms in many languages
Inclusion of Children
• Pediatric Cancer Program at Texas
Children’s Hospital
• In 2014 Pediatric Program accrued
– 116 patients to interventional studies
– 959 patients to non-interventional studies
• Highest accrual nationally to COG
studies
• COG-U01 Phase I and PBTC consortia
site
• Pediatric program investigators have
multiple leadership roles in COG, PBTC
and other consortia sites