RH: There has been a push over the last three years, led to a large extent by the Centers for Disease Control but also by then-Governor Ridge, for every state to have a comprehensive cancer control plan. The prior plan was a Department of Health plan that was developed in the early 1980s and, in order to make a new plan that would be truly comprehensive and involve all the stakeholders – not just the state government – there was a decision made jointly by the Pa. Department of Health and the Pa. division of the American Cancer Society to bring together stakeholders who have interest and expertise relating to cancer and begin developing a plan. This occurred about two and a half years ago.

RH: It’s a very wide array of individuals and organizations which is growing steadily. Currently, there are over 300 individual members of the PAC3 who represent more than a 100 different organizations, including both the academic cancer centers and community cancer centers, other hospitals and health care providers, cancer researchers, health insurers, the Oncology Nurses Association, the Pennsylvania Cancer Alliance – which is a group that was formed about four years ago to try to push more for allocation of the tobacco settlement money to go toward cancer-related issues, cancer survivors and advocates, foundations, the pharmaceutical and bio-tech industry in the state, social work, public health officials at the city and county level, the American Cancer Society and the Pa. Department of Health. It’s an especially broad consortium.

RH: It was initially a relatively small group of people convened by the Department of Health back around three years ago, including cancers centers, hospitals, cancer survivors and several other constituencies, who began to strategize about who else should be brought to the table. A list was constructed of about 60 or 70 people who were invited to come to a conference to develop a broad outline of priority areas. That provided a foundation to invite people to serve on an executive team, which among other things helped develop larger lists of people and stakeholders that ought to be brought in. The initial focus was to decide on the goals and priorities across the entire cancer continuum, which quickly evolved into eight working groups, each being charged with developing priority goals and objectives and recommending action strategies. The eight areas are screening and diagnostic follow-up, quality of life, tobacco prevention and cessation, research, treatment and care delivery, access to services, healthy lifestyles, and information management and dissemination. Last summer we had a series of six video teleconferences where we opened up the opportunity for anyone who wanted to join in the process in which members of PAC3 listened to the draft recommendations from each of the work groups and have input into the final design of the plan, which was released at the end of this January.

RH: The transcending mission is to substantially reduce the burden of cancer for the entire population of Pennsylvania. The priority goals and recommendations include becoming more effective in preventing cancer, with a major emphasis on preventing people –especially youths – from beginning to smoke, or helping people who are smoking to stop smoking, and also recommending other lifestyle-type issues like exercise and nutrition. Another major component is implementing effective and statewide screening programs for early detection of cancer, particularly with proven screening modalities like mammography, pap tests and colorectal cancer screening. There are also recommendations about making Pennsylvania number one in cancer research. Currently, Pa. is the third most successful recipient of cancer research grant funding nationally and the feeling strongly expressed in the plan is that, by changing the paradigm from individual research institutions working on their own to get grant funding, to banding together and cooperating in meaningful ways on common problems, that we will be substantially more effective and competitive in terms of bringing in research funding and can become the best cancer research-funded state in the country.

There’s a total of about 50 goals or so that are summarized in the executive summary, under each goal there are several objectives, and under each objective there are several recommended strategies. This isn’t just a one-time effort to get the best collective wisdom into a report and end at that point, but rather to have the implementation go forward as an ongoing active process where there will be working committees that will re-evaluate the priority goals and objectives – which are the ones that are most susceptible to being implemented within the next year or two, and which are longer-term goals. The idea is that this should be a living plan that would constantly evolve as there is increased perception about what the needs and opportunities are to impact on cancer.

The initial plan was to come up with priority goals, objectives and recommended actions in a five-year time span. Now that we’re in the implementation phase, the thinking is to single out some things that are relatively easy to accomplish during the first year and the next year after that, but also keep an eye on long term goals and objectives that will be more difficult to accomplish that might require a substantial garnering of new resources.

RH: It requires a lot of input from as many different constituencies and disciplines as possible. For the implementation phase we’ve developed a new board of directors, which has 15 members on it, to weigh the recommendations and priorities and then to decide on what the action plan will be. I was put on the board to represent the comprehensive cancer centers from the state, and other board seats include representation from community-based cancer centers, the foundation community, the pharmaceutical industry, cancer survivors and advocacy groups, public health organizations in the state, and the business community.

There already has been a major commitment from the state through the tobacco settlement for providing rather generous funding to individual institutions to help support cancer research. There are currently various resources in the state for individual institutions. If we can first get an effective inventory of what resources already are coming in to different institutions, we could come up with some joint strategies to redeploy some of the resources in cooperative and more effective ways than the individual institutions have been able to do on their own. We’re early in the process, but we’re hoping to get a number of the stakeholders to agree to redeploy some of the resources that they’re already spending in the state under the auspices of the joint programs of PAC3. Another way is to be very vigilant to look at funding opportunities from the federal and state government, and from private sources. Since there are different pots of money that are largely restricted for one type of thing as opposed to another, say, just for cancer treatment or screening or palliative care, this would be a way to move forward on several fronts in parallel without having to make the harder choices of which one is more important than early detection or prevention or treatment.

RH: There’s no way to eliminate competition, but rather to try to convince people to see advantages for the cause that we’re all engaged in – to relieve the burden of cancer – but also in a pragmatic way to begin to understand and embrace the notion that one could help their own organization by working together for garnering resources, rather than competing with each other for limited resources. As an example, the Pennsylvania Cancer Alliance involves eight different cancer centers around the state which traditionally compete very strongly with each other for federal grants or other resources from industry. We came together realizing that there would be a significant portion of tobacco settlement money allocated for cancer if we could talk to the state administration and the legislature with one voice rather than with eight different voices. It was repeatedly told to us in Harrisburg that it was most impressive and virtually unprecedented to have so many different organizations being on the same page rather than giving different, and self-serving messages.

Once the tobacco settlement was in place, the members of the Cancer Alliance got together very soon after the release of a request for proposals to deal with cancer-related informatics and, in one meeting, we agreed rather than individual centers putting in their own competitive application that we would all go together on a common application for a statewide infrastructure that would be common across the different centers for collecting cancer-related information, especially related to bio-markers for cancer tissues. It ended up with $5.5 million in funding coming to the Cancer Alliance Bioinformatics Consortium, which actually provided a foundation for an initiative last year from the National Cancer Institute to create a nationwide grid for cancer informatics. Because of the precedent and actual track record of doing this so well in Pennsylvania, essentially all of the participants in the state consortium were quite successful in getting National Cancer Institute funding for this. I’m quite certain that we wouldn’t have had that high level of success if we hadn’t had the precedent of working together on the statewide level.

RH: Probably the central practical challenge is the availability of resources. The board of directors needs to grapple with how to move forward several things in parallel and accomplish at least a reasonable set of goals the next year and the next year after that. It’s too early to give a more specific answer than that because the first meeting of the board, which was held in June, was an organizational meeting. In the upcoming meeting this Fall, both the board and the overall PAC3 membership will for the first time since the plan was released get down to the specifics of how we’re going to pick and choose and get some high priority things accomplished quickly.

RH: I think overall the state is very well-resourced. We have five NCI-designated cancer centers in the state. We have a lot of high quality cancer programs across the state. The headquarters for the Oncology Nursing Society, and for a couple of the National Cancer Institute-supported clinical trials and cooperative groups are headquartered in Pennsylvania. We have a strong pharmaceutical and biotech industry in the state. So, we are building on a stronger foundation than a number of other states. How do we compare in terms of the cancer plan? We’re behind probably about eight or ten of the states that had their plans finalized and have gone into implementation a year or more ago. But as best as I can tell, we’re catching up very quickly. A consultant that we had in developing our plan was also a consultant for the majority of the states for their plans, and he thinks that Pennsylvania is now one of the lead states in terms of its plan across the country.

RH: This is really a key point: not only maintaining the interest and enthusiasm of the members of the consortium, but actually enlisting more members and have this be a continually growing and evolving group to wrestle with the tough problems of dealing with cancer more effectively than we do today. In order to achieve that, one of the things that’s going on right now is to have a number of regional conferences in each corner of the state to bring in people from that particular region to hear presentations about the plan, how they should and could get involved, and to assess their capabilities to get behind some of the priority goals and objectives and become members of the consortium. We’ve had the first of those regional meetings in Erie, which was extremely successful – there were about 100 people there and a large portion of them who had previously not been engaged were volunteering to become involved. Over the next three months or so there’s going to be four more such regional conferences in various parts of the state.