CPRIT Funds Research, Prevention

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Public Health Feature – December 2012

Tex Med. 2012;108(12):47-50.

By Crystal Conde 
Associate Editor

Connecting residents in medically underserved Texas communities with lifesaving cancer screenings is not easy. It requires tremendous local resources and working together.

Keith Argenbright, MD, medical director of Moncrief Cancer Institute in Fort Worth, knows this all too well. From 2010 to September of this year, he headed the Breast Screening and Patient Navigation (BSPAN) project, a breast cancer screening program that received a $999,960 two-year grant from the Cancer Prevention and Research Institute of Texas (CPRIT). It provided more than 3,000 women in five counties with mammograms, resulting in 99 breast cancer diagnoses.

Moncrief is an affiliate of The University of Texas Southwestern Harold C. Simmons Comprehensive Cancer Center in Dallas.

The project works with community leaders and health care professionals to increase access to breast cancer screening, mammograms, and biopsies. Dr. Argenbright says BSPAN raised public awareness of breast cancer screening and resources available to women who would not be able to afford mammograms and diagnostic services.

"We've been able to take that awareness and use it to build functional partnerships among Moncrief, local hospitals and physicians, and community leaders. BSPAN has provided an opportunity to educate local physicians about best practices in breast cancer screening and diagnostics," he said.

CPRIT funds allowed BSPAN to serve women in Denton, Wise, Parker, Johnson, and Hood counties, which make up a region that has a slightly elevated incidence rate of invasive breast cancer. The average incidence rate for the five counties in 2009 was 120 cases per 100,000 compared with the state rate of 118 per 100,000, according to the Texas Cancer Registry. Dr. Argenbright hopes researchers can analyze the information collected through the program to determine why the incidence rate is higher in the area.

Dr. Argenbright testified before the Senate Finance Committee in early 2011 that BSPAN saves $2.70 in state health care costs for every $1 spent on breast cancer prevention. BSPAN reached more than 287,000 people through advertisements, public service announcements, events, and other outreach efforts, he says.

BSPAN was so successful at providing comprehensive mammography and appropriate follow-up services in the five-county region the program is entering phase two and expanding into 12 surrounding counties. CPRIT awarded UT Southwestern $2.8 million this year to fund BSPAN2.

Moncrief is one of many institutions to benefit from CPRIT grant funding totaling more than $760 million for research, commercialization, and prevention projects since the 2007 Texas Legislature approved $3 billion in bonds to create the organization. With additional funds from grant recipients, the institute has invested more than $902 million in Texas' quest to prevent and cure cancer.

CPRIT Chief Prevention Officer Becky Garcia, PhD, says more than 200,000 Texans received a CPRIT-funded clinical service such as vaccinations, tobacco cessation counseling, genetic testing and counseling services, survivor care, or screenings and diagnoses for breast, cervical, and colorectal cancers. In addition, CPRIT grants enabled 38,021 Texans to be screened for cancer for the first time. Screenings provided by CPRIT detected 534 cancers.

She adds CPRIT prevention funds benefit Texas physicians and their patients by educating Texans about early detection of cancer and healthier lifestyles, providing access to cancer screenings, detecting cancers, and reaching populations at highest risk and most in need.

"As of August, CPRIT's education and training programs have reached 621,020 Texans. This includes direct public education and training of health professionals to promote positive health behavior change among the public." 

CPRIT Makes a Difference

Cancer is the leading cause of death among Texans younger than 85, according to the Texas Department of State Health Services. The Texas Cancer Registry predicts the disease will take a devastating toll on the state's population this year alone, with 110,000 estimated cancer diagnoses and 39,000 projected deaths.

In the 2011 update of its assessment of the economic impact of cancer and CPRIT, the Perryman Group estimates Texas' annual direct medical costs and morbidity and mortality losses associated with cancer totaled approximately $28.1 billion in 2011, up from $25.3 billion in 2010.

Costs have increased 28.6 percent since 2007. 

The report found CPRIT-funded programs in cancer research and prevention have had a total economic impact of $1.1 billion in output (real gross product) and 14,212 jobs. It also says CPRIT generated about $291.6 million in annual state revenue, along with $183 million in annual revenue to various local governments.

CPRIT awards grants for cancer-related research and for cancer prevention programs and services by public and private Texas entities. For every research award, CPRIT requires recipients to dedicate their own funds to the cancer research project. Recipients' matching funds must equal at least one-half of the institute's grant award and be spent on the same area of cancer research.

The legislature charged CPRIT to focus on these goals: 

  • Create and expedite innovation in cancer research, thereby enhancing the potential for a medical or scientific breakthrough in preventing cancer and finding cures.
  • Attract, create, or expand research capabilities of public or private universities and other public or private entities that will promote a substantial increase in cancer research and in the creation of high-quality new jobs in this state.
  • Continue to develop and implement the Texas Cancer Plan, a statewide guide for cancer prevention and control. The plan, updated this year from the 2005 version, helps physicians access current best practices in risk reduction and early detection. 

Lewis Foxhall, MD, chair of the Texas Medical Association's Physician Oncology Education Program (POEP) Steering Committee and a member of the TMA Board of Trustees, says CPRIT's focus dovetails nicely with the work of POEP, which receives funding from the institute. POEP uses those funds to advance prevention efforts in a physician's practice. (See "POEP Receives CPRIT Funds.")

Dr. Foxhall says the cancer prevention funding from CPRIT is a great resource for the state. He says all physicians, not just researchers, benefit from the institute's grant awards.

"CPRIT prevention funds can help physicians address risk factors such as tobacco use or manage obesity and its health complications in patients, for example. The funds also can be used for public or professional education. The grant application process is open to all physicians and physician groups in Texas."

The Texas Constitution authorizes CPRIT to issue up to 10 percent of funding, or $30 million, annually to pay for cancer prevention and control programs. The remaining 90 percent funds research and commercialization projects.

When determining which cancer prevention programs to fund, Dr. Garcia says CPRIT is looking for projects that:  

  • Focus on underserved populations,
  • Involve evidence-based prevention,
  • Show potential to make an immediate public health impact, and
  • Cover primary, secondary, and tertiary cancer prevention. 

Recently, though, the organization was criticized over allegations that politics played a role in some of its grant decisions. The controversy led to the resignation of its chief scientific officer and numerous reviewers of grant applications. CPRIT officials denied the charges.

CPRIT is asking the 2013 Texas Legislature for $600 million in general obligation bond proceeds for 2014-15, or $300 million per year, as authorized in the Texas Constitution. 

Heidi McConnell, chief operating officer of CPRIT, says the request reflects the same amount of funding appropriated to CPRIT for 2012-13 and includes no additional budget or exceptional item requests. The estimated cost of the debt service is $63.5 million for anticipated bond issuances. 

CPRIT also awards grants for commercialization. CPRIT gives priority to proposals that expedite innovation and commercialization, attract private sector entities that drive job creation, and enhance higher education, applied science, or technological research capabilities in the state.

 Joseph Bailes, MD, an Austin oncologist and vice chair of the CPRIT Oversight Committee, says to date, CPRIT has awarded $95,892,727 for commercialization in Texas.

"The authors of the legislation that created CPRIT understood that commercialization addresses the need to move groundbreaking science from the laboratory to the patients. Incidentally, it is also the quickest and most effective way to make a difference over the course of CPRIT's 10-year life span," Dr. Bailes said.

For a list of all funded projects, visit the CPRIT website

Funds Benefit Physicians, Patients

Principal investigator and medical anthropologist Simon Craddock Lee, PhD, assistant professor of clinical sciences at The University of Texas Southwestern Medical Center, leads BSPAN2. The second stage of the breast screening program focuses on increasing screening and timely referral to breast cancer treatment services, while creating a program model that serves residents in more than 14,000 square miles in 17 underserved counties.

"We're going to be serving an area roughly the size of Maryland with some counties that have more veterinary facilities than health clinics," Dr. Lee said.

With the latest CPRIT-funded project, UT Southwestern will collaborate with North Texas civic groups, physicians, community hospitals, and churches. UT Southwestern, a Texas Breast and Cervical Cancer Services (BCCS) contractor, will use state and federal funds to provide regional services. BCCS offers clinical breast examinations, mammograms, pelvic examinations, and Pap tests throughout Texas at no or low cost to eligible women. To qualify for the program, women must be at or below 200 percent of the federal poverty level, uninsured or underinsured, and meet certain age requirements.

According to UT Southwestern, mammography rates in the 17 rural and underserved counties served by BSPAN2 are poor. More than 74,000 women haven't had a mammogram within the past two years. Dr. Lee says the collaborative, regional approach in BSPAN2 will allow UT Southwestern to provide more than 6,700 screening mammograms, 6,100 diagnostic mammograms, and 2,300 biopsies.

"CPRIT has made it possible for us to bring quality care to these underserved counties. We're able to find cancer faster and earlier," Dr. Lee said.

Eighty percent of the cancers detected through BSPAN – both in symptomatic and asymptomatic women – have been diagnosed at early stages, Dr. Lee says.

"I'm hopeful the BSPAN project can serve as a model that can be replicated in other parts of the state and nation," he said.

The University of Texas M.D. Anderson Cancer Center received several CPRIT grants. A 2010 prevention grant of $298,531 funds an education program on breast, colon, and prostate cancer survivors for primary care physicians and providers. Dr. Foxhall, vice president of health policy at M.D. Anderson, is the principal investigator on the project, which includes lectures on breast, colon, and prostate cancers.

"The project is intended to provide some background information for primary care clinicians and other health professionals about managing the health issues of cancer survivors. We think it will be increasingly important for physicians to be comfortable managing these patients," Dr. Foxhall said.

He explains the lectures inform physicians about routine surveillance and preventive measures, lifestyle modifications, screening for second cancers, management of long-term health problems associated with treatment, and dealing with psychosocial issues in survivors of breast, colon, and prostate cancers.

To view an introductory video and enroll in the M.D. Anderson cancer survivorship series, visit http://bit.ly/ds2y6Q.

 Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email.


POEP Receives CPRIT Funds  

In September, the Cancer Prevention and Research Institute of Texas (CPRIT) contracted with the TMA Physician Oncology Education Program (POEP) and provided $347,699 for its prevention initiatives through August 2013.

Proposed POEP core projects for fiscal year 2013 include:  

  • Live educational activities that provide statewide clinical symposia in cancer prevention, early detection, screening, and control, in collaboration with relevant organizations;
  • Speakers' Bureau lectures that feature volunteer experts who address physicians and other health care professionals on cancer prevention, screening, early detection, and control;
  • A TMA Medical Student Section cancer education activity that consists of one-hour lectures on the revised Texas Cancer Plan and cancer screening at four Texas medical schools; and
  • Electronic materials such as podcasts and online modules, iPhone and iPad applications for skin and childhood cancers based on the current POEP pocket guides, and updates to existing applications CanSearch, CanQuit, and HPVSearch. 

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