Dr. Sumedha Penheiter
Appearances
Health Chatter
Minnesota State Cancer Plan
Well, I think from what I understand is that There are some common denominators across the board, but there's also unique factors. Starting with urban, I think I can point out that there's a lot more access in the areas of urban clinics. However, I feel that there's still, depending on what city you live in, transportation can still be a barrier.
Health Chatter
Minnesota State Cancer Plan
And in urban areas, people are working, you know, some cases around the clock. So making time for health appointments and coming in to get their screening done. And a lot of efforts are in clinical trial space to address and understand cancer and provide state-of-the-art therapeutics to make sure that cancers are cured if they are indeed
Health Chatter
Minnesota State Cancer Plan
occurring and there's just that social determinants of health are much more complex in urban areas, although they exist in rural areas as well, but they're different. And so the complexity of the social determinants of health with an additional factors that contribute to risk of cancer, such as environment and pollution, definitely add to that burden.
Health Chatter
Minnesota State Cancer Plan
So I think the strategy has to be different, again, based on the cancer burden, which is different, but also the social determinants of health, which vary between rural and urban areas. And in rural areas, access is a concern. A lot of rural communities have to drive for miles before they can come to a place where they can see a physician or get treatment.
Health Chatter
Minnesota State Cancer Plan
And in that, we've worked hard to establish pilot hubs in the rural areas through the Minnesota Clinical Cancer Trial Network. to have some of these clinical trials available in some of the smaller communities within greater Minnesota. So there's different factors and different social determinants of health, although they exist in both.
Health Chatter
Minnesota State Cancer Plan
They just, the strategy to address them are different based on what they are. There's more food insecurity in urban areas. There's more, you know, inability to walk and get exercise because obesity does help just lead to cancer occurrence.
Health Chatter
Minnesota State Cancer Plan
There's just not as much available even though there is a lot of money in terms of the underserved community being able to access clean trails, to be able to walk to school, to be able to, I mean, just the difficult gap between neighborhoods is immense.
Health Chatter
Minnesota State Cancer Plan
Like I shared, you know, we're kind of using the same playbook with some modifications for the new cancer plan that we're formulating And it was very much based on listening sessions. We call them listening sessions that were at the grassroots level to understand the burden.
Health Chatter
Minnesota State Cancer Plan
But in addition, we fund a lot of grants through the strategy action group is what we call them, where we target any time we have an initiative, we need to make sure that there's community engagement and community involvement. and always, always a community partner as a co-partner if possible. So that's kind of our strategy that we adopt to make sure there's community engagement.
Health Chatter
Minnesota State Cancer Plan
Like I shared, you know, we worked on legislation to get a grant funded for community health workers. We worked with the community health workers organizations in Minnesota very closely to ensure that their work could be covered and paid for. So community is definitely the center of our work.
Health Chatter
Minnesota State Cancer Plan
I think I would like to say that when the cancer plan is formed, there is definitely the burden and the local burden, but also to understand that we rely heavily on our partners. So the feasibility is definitely an aspect of what we end up doing in the sense that we are relying heavily on our extended partners, and somewhat on MDH to help us with the initiatives that we formed.
Health Chatter
Minnesota State Cancer Plan
So a lot of times it seems that whatever the interest of our steering committee members as well as our partners on earth is what we solicit to advance certain initiatives. So I feel that it's very, this is a multifactorial issue when you say prevention it's hard to know what prevention should look like if you don't have data.
Health Chatter
Minnesota State Cancer Plan
And so we have focused highly on getting accurate data, current data, and making sure that a recent win in the legislative efforts was to make sure that the data that Minnesota collects is now linked to other Kansas plans as well as to the CDC. And that was something that we requested through the legislature, and it was a win for us. So, you know, accurate data is one.
Health Chatter
Minnesota State Cancer Plan
And we've funded a lot of grants, strategy action grants around breast, cervical, and colorectal cancer screening. We always have had patient survivors, advocacy groups, and coaches. coalition leaders as part of our members who have gone and brought our message forward, as well as helped bring in the needs of the state and overall the cancer in concern.
Health Chatter
Minnesota State Cancer Plan
We have also worked with the lung cancer screening task force that was established. And so in addition to screening, you know, the tactical aspect of the technical aspect of screening, There's a lot of information or support that needs to be provided before and after. So we worked in a lot of those support services as well, where we hosted support center events for patients and their families.
Health Chatter
Minnesota State Cancer Plan
And we created these pink shawls for the American Indians, women that were diagnosed with cancer. And so it's very multifactorial and doesn't just target the actual screening part as such.
Health Chatter
Minnesota State Cancer Plan
Well, I think it's interesting. There's a lot of efforts in place to get the screening part done.
Health Chatter
Minnesota State Cancer Plan
And a lot of federally qualified health centers offer screening now. But the thing is, what next if you do end up positive? There has to be this medical neighborhood that exists or the support system that follows through with a patient that doesn't have resources or awareness once they are diagnosed with cancer. And that's where the mortality and morbidity rates become a concern. And so-
Health Chatter
Minnesota State Cancer Plan
we realized that while the medical centers are still on top of screening somewhat because of the HEDIS or their reporting requirements, because that impacts their overall status as health centers, the space that was lacking was really the support. And a lot of people, for instance, in some cultures, in the Indian country, the word cancer is taboo.
Health Chatter
Minnesota State Cancer Plan
And there's so many cultural nuances in the Hispanic community where it's very fatalistic and left to God. And you always discuss things as a family versus alone. So there's a lot of cultural nuances that are not as straightforward as you would think in addressing cancer post-diagnosis. So a navigator is someone who helps this whole
Health Chatter
Minnesota State Cancer Plan
a patient who really may not be part of the mainstream care on a regular basis to then understand what the next steps would be and to make sure that they get the kind of support that they need in terms of childcare if needed or transportation, like again, the social determinants of health, but also a familiar person that they can trust because trust in the medical system is, is low overall.
Health Chatter
Minnesota State Cancer Plan
And with that, this is someone that's familiar, that speaks their language at their level, can spend a lot of time with them. So navigators in that space and community health workers are just instrumental in making sure that this patient doesn't feel lost. There's genetic, there's also always counseling.
Health Chatter
Minnesota State Cancer Plan
I know at the Mayo Clinic, once you're diagnosed with cancer, there's regular counseling for the family to be prepared for what lies ahead. So diagnosis, um, Treatment is one aspect, but the social-emotional aspect of cancer, like you shared, is so shocking.
Health Chatter
Minnesota State Cancer Plan
It can be so overwhelming that we feel that we're letting our cancer patients down if we're not also focusing on the support and the legal aspect of it.
Health Chatter
Minnesota State Cancer Plan
So from what I understand, the challenges has been we've tried to have so many objectives and tactics so that we can indicate the state's interest in this area. And I think a lot of times some agencies and nonprofit agencies or some health agencies can use this plan as a platform for justification for applying for subsequent grants in saying that they align with the state plan.
Health Chatter
Minnesota State Cancer Plan
So we've tried to be very broad and inclusive to allow for those small groups that want to focus on a certain aspect of this plan. The challenge has been, as you said, it's very broad and And again, COVID didn't help. We lost about five years in this mix with COVID where we were really slowed down.
Health Chatter
Minnesota State Cancer Plan
So I think the understanding is that we are going to continue to kind of streamline our efforts based on, as we're developing the plan, reaching out to our partners, ensure that there's commitment at the level that is required to carry out a plan in action. and also resources in place.
Health Chatter
Minnesota State Cancer Plan
So the biggest challenge really has been in that space where we just have not had enough resources in terms of human resources to amplify some of the work. So I think that is really the crux of it is the feasibility of it. But I would say there have been successes as well. We've worked aggressively in like the HPV cancer space and really addressed inequities.
Health Chatter
Minnesota State Cancer Plan
We have a health equity network group, a cancer health equity network group that works very closely with us and has a lot of health equity focused objectives. And so, you know, instead of focusing on one aspect per se, we've really gone through and all, use the inequity as an underlying theme to address a lot of cancers.
Health Chatter
Minnesota State Cancer Plan
And so I think that the challenge has been, you know, going from just individual organ focused, really understanding a common health equity theme, which we have overcome successfully now, but it was difficult during the times of COVID. So just, you know, and also the support from, Agencies and lobbying agencies, our policy network has done a lot of work to lobby for some of those things.
Health Chatter
Minnesota State Cancer Plan
So once they are in policy, it's been a lot easier. So without policy work, some things have not advanced as much as you would think. So those are the general challenges that I can, did I address your question correctly?
Health Chatter
Minnesota State Cancer Plan
I think we looked at a variety of resources. And although I was not in the leadership team at the time, I am
Health Chatter
Minnesota State Cancer Plan
almost certain that we did you know we we did follow a lot of guidelines and healthy people 2020 must have been one of them as well yeah i can imagine that i can't imagine that not being a resource that we so we we solicit help from a lot of resources and information and then ultimately we you know vetted with the communities and those that are going to actually do the work
Health Chatter
Minnesota State Cancer Plan
to see what's most feasible and what speaks to them. Because if it is not addressing the local burden and if it has not got the engagement of our partners, it's not going to go anywhere. So long story, you know, the crux of it is yes, I'm sure we looked at healthy people. We've looked at many other parameters. There's the Minnesota Community Measurement Resource.
Health Chatter
Minnesota State Cancer Plan
There's a variety of resources that establish many things around cancer burden cure treatment, availability, access, community resources. it's a, it's a composite picture. I know mine doesn't seem straightforward, but what I'm saying is it probably was one of the reasons.
Health Chatter
Minnesota State Cancer Plan
So the Minnesota Cancer Alliance is actually an organization that's formed in partnership with the Minnesota Department of Health. And it's a result of the new CDC requirement that all states receiving cancer funding must have a state plan and should be done independent of the guidance of MDA, direct guidance, and really be an outcome of public awareness, public concerns, and public needs.
Health Chatter
Minnesota State Cancer Plan
The main purpose of the Minnesota Cancer Alliance is really to form this cancer plan independently in collaboration with the community and focus on the spectrum from etiology to detection to cure and then palliative care or survivorship. So I feel the Alliance is an organic evolution
Health Chatter
Minnesota State Cancer Plan
It was initiated around the cancer plan, but it is a lot of advocates as well as institutions, health institutions, advocacy institutions, all gathered together to help reduce the burden of cancer across the state of Minnesota.
Health Chatter
Minnesota State Cancer Plan
Definitely. I think you spoke very elegantly. It is the framework that is written and documented and a guideline that helps us go back and see where our efforts are productive, where they need more energy, and also...
Health Chatter
Minnesota State Cancer Plan
For us to point out what the burdens are and bring it to the attention of the general public as well as state level, there can be a lot of individual efforts that are not concerted and then although they are very valuable, sometimes collective efforts lead to collective actions which are more impactful. So this helps identify
Health Chatter
Minnesota State Cancer Plan
what the framework is, but then also for individuals, like I shared, you know, they're able to use these as guidelines in their own community partnerships, action groups to further their work and reduce the burden of cancer. So it's a nice guideline, as I would say, for people to go to. So I agree. I think the framework is very necessary.
Health Chatter
Minnesota State Cancer Plan
And it also helps, you know, everybody's so focused in their specific space. Clinicians are very focused on diagnosis and treatment. And then there's this financial legal companies that are focused very much on the financial legal part of it. Insurance clinical trials group focuses very much on making sure that, you know, state-of-the-art clinical therapeutics are available to the patients.
Health Chatter
Minnesota State Cancer Plan
So everybody can end up being kind of in their own very focused, silo is not the right word, but field. And I think this plan then kind of also connects the dots between all aspects of cancer from, you know, prevention, detection to all the way to survivorship. And it's a composite picture so that not just one aspect of the disease gets more of the attention or effort.
Health Chatter
Minnesota State Cancer Plan
No, like I said, a lot of it is the success. We gauge our success as reality. enforcing or emboldening something to policy. I think the biggest successes from what I see based on the evaluation database is we have really addressed the HPV vaccination issue. The Minnesota Commission on Cancer has presented to a lot of medical professionals on increasing HPV vaccinations.
Health Chatter
Minnesota State Cancer Plan
We've funded some stakeholder advisory groups and trained young leaders on the information of HPV and really tried to bring awareness of this very preventable cancer to a lot of areas. And I think we've seen a lot of effort and success database in adoption of the vaccine. in young preteen adolescents, despite of a lot of hesitation in both males and females.
Health Chatter
Minnesota State Cancer Plan
So I think HPV cancer vaccination and awareness of the HPV cancers has been a very successful aspect of it. I also think tobacco use in general, we've presented several times and advocated for statewide legislation for raising the age of tobacco to 21. And that was passed into a law in 2020. We also advocated for 2019 legislative session to ban e-cigarette use indoors.
Health Chatter
Minnesota State Cancer Plan
And so I think tobacco has always been kind of like a favorite spot of the policy committee and also ours in general. But like I would say, the success has been weaving in health inequities as a premise in every single objective. We have come away from not only focusing on the greatest, but for the greatest number of all, but also for those that are not in the greatest number.
Health Chatter
Minnesota State Cancer Plan
And I think that just the understanding of health inequities and the availability of clinical care, as well as survivorship, and how differently it impacts some community versus the other and making sure that that's kept in mind. I think that's been the biggest success. It's just increasing awareness and focus on health inequities in addition to overall cancer care.
Health Chatter
Minnesota State Cancer Plan
I think when it comes down to it, it's the Minnesota Department of Health that is the center point of receiving funding and reallocating funding for the work we do is the one that sends these reports. But we definitely have input on that and we definitely review that. And we have an evaluation committee within our alliance as well where we have evaluation scientists that
Health Chatter
Minnesota State Cancer Plan
I think that The reason being is that we have great health inequities in our states. And a lot of those numbers are skewed a little primarily because we have high rates of incidents and mortality, not in total number, but rates in tribal areas. And we also have a lot of underserved populations that are so disproportionately impacted by this that the numbers overall are skewed.
Health Chatter
Minnesota State Cancer Plan
continuously review and evaluate on how we're doing in terms of, you know, indicators, the success, the effort put in, and the barriers addressed. And so the answer is it's MDH, Minnesota Department of Health, that sends the progress reports on a regular basis. But definitely it's not something that we do just for reporting purposes.
Health Chatter
Minnesota State Cancer Plan
We constantly review our strategies and tactics and the efforts that have gone in and how much we've done.
Health Chatter
Minnesota State Cancer Plan
So the plan, the leadership team for the plan is already in place and they've done a lot of great work already. Heather Keene is leading the actual plan team, formed an advisory team. And what we have done is we've really used, we've gone within our alliance and used the equity portion to inform us on the cancer health, through the Cancer Health Equity Network, which is again, one of the
Health Chatter
Minnesota State Cancer Plan
within the alliance that focuses on health equity. We have brought the policy committee in, the evaluation committee in, and then we have the community listening sessions that we have started with our partners. We had a summit not too long ago where we did some listening sessions to understand the burden. We are looking at the Minnesota cancer reporting systems to see what our current burden is.
Health Chatter
Minnesota State Cancer Plan
And then also the commission on cancer network for the practice aspect of it. So we are looking at the playbook from other cancer plans that we feel have similar burdens and dynamics as the state of Minnesota. We are looking at the last plan as really some of the things that were very successful in establishing that plan, the lessons from that playbook.
Health Chatter
Minnesota State Cancer Plan
But like I said, we are using a multi-pronged approach with equity policy evaluation community data and practice to make sure that we form this plan. So although it will be a similar framework, I think it will be very current and informed based on the recent concerns and burdens of cancer and making sure that every objective has health equity embedded, like I said, to eliminate health equity.
Health Chatter
Minnesota State Cancer Plan
And the main goals will be still around etiology, prevention, detection, treatment, survivorship. That's the general spectrum that we followed over the years.
Health Chatter
Minnesota State Cancer Plan
And that's what most cancer plans as well as the National Cancer Institute follows to make sure that, you know, one of the, you know, it's very, sometimes celebrities bring a lot of attention to one aspect of prevention and detection and they become the, the highlight of the whole work, um, but we want to make sure that all the entire spectrum is addressed.
Health Chatter
Minnesota State Cancer Plan
So, so yes, using the playbook from the last cancer plan, but then also using current data burden and input from the communities to understand what we should do next.
Health Chatter
Minnesota State Cancer Plan
I think, again, you know, I would hate to say that prevalence is so dependent on health disparities.
Health Chatter
Minnesota State Cancer Plan
I would alienate some if I said that, for instance, gallbladder cancer is a real concern in Native communities, but doesn't even come in the top five overall in the numbers. But I would say the... The most preventable and the most addressed are colorectal cancer, the breast cancer, the prostate. Those are the ones. Then there's also pancreatic cancer that has very high mortality rates. Correct.
Health Chatter
Minnesota State Cancer Plan
And therefore I think cancer is the number one cause of death in Minnesota. However, I also think that our state has spent a lot of energy and time in controlling cardiovascular diseases and also investing in efforts to prevent cardiovascular diseases. bringing awareness to those.
Health Chatter
Minnesota State Cancer Plan
There's the incidence rate, the mortality rate. There's a whole balance of that. Really, it's through the lens that you're looking at. I don't want to pick or bring attention to a favorite cancer, but in general, I would say that there's the incidences and then there's the treatments and then there's the mortality. And the most commonly discussed ones are colorectal, breast, front stage.
Health Chatter
Minnesota State Cancer Plan
And some of these are early detection, have early detection. And the earlier you're diagnosed, the better the prognosis is. Yeah, yeah.
Health Chatter
Minnesota State Cancer Plan
Sure, we have the plan listed on our website. I can share that. And we are also now constantly updating how our new plan is evolving on our main page. So minnesotacancerline.org. I'm happy to send the website to you. I also want to say I'm really honored and thankful to be part of this discussion. The Alliance means a lot to me. I've been part of the Alliance for over a decade.
Health Chatter
Minnesota State Cancer Plan
And the fact that we were able to bring some attention to it this morning means a lot to me.
Health Chatter
Minnesota State Cancer Plan
But that level of engagement is still lacking in the cancer space, especially in the preventive and early detection areas. A lot of work is done post-diagnosis in treatment and then survivorship. And sometimes that is too late. And so I think those are a couple of factors that I can think of right away that are contributing to
Health Chatter
Minnesota State Cancer Plan
cancer being the number one cause in Minnesota versus the rest of the state.
Health Chatter
Minnesota State Cancer Plan
Well, I think that there's great inequities in cancer incidence and mortality rates. inequities, and they are around race, ethnicity, and other underserved populations and along ability, disability. I think it's a two-edged sword. I think Minnesota is a very health-conscious state.
Health Chatter
Minnesota State Cancer Plan
So I think compared to other states, we have a lot of efforts on health fitness in general, which has lowered our cardiac death rates compared to other states. So it's that we're doing really well in that space or we continue to do well in the space of cardiac health.
Health Chatter
Minnesota State Cancer Plan
So we are ahead of other states, but then we don't have that level of matching efforts yet, or even understanding because cancer is a very complex disease and it spans all the way from etiology to prevention, detection, treatment. So I think one is there's just not enough understanding
Health Chatter
Minnesota State Cancer Plan
of the disease amongst common people and to the methods that are in place vigorously for cardiac disease, you know, such as getting your parameters checked cholesterol and your BMI, and also making sure that exercise is part of your early lifestyle. The same level of awareness and intention is not there in the cancer space to the same degree.
Health Chatter
Minnesota State Cancer Plan
Well, we definitely get ideas on how to design and implement the cancer plan. across, based on other states. However, the emphasis here is to really focus on local Minnesota problems because of the fact that there is quite a bit of differences between states in terms of local burden.
Health Chatter
Minnesota State Cancer Plan
And even within the state of Minnesota, we're trying to be very mindful of identifying regional burdens of cancer, for instance, like I said, on tribal land versus urban communities versus rural communities and understanding that the cancer burden is different.
Health Chatter
Minnesota State Cancer Plan
So although we definitely get implementation and design ideas from other states, CDC does a really good job of, Center for Disease Control does a really good job of making sure that there's data available openly for all of us to examine what the cancer burdens are per state. And we are aware of that. So we do contact other states for tactics.
Health Chatter
Minnesota State Cancer Plan
There are meetings that MDH attends with other state cancer plan committees. The goal is really to get ideas from them, but to focus on the local burden.
Health Chatter
Minnesota State Cancer Plan
So, This plan is actually, the genesis of this plan is a lot of listening sessions, data review of cancer burden, and then concerns of the community. And Minnesota Cancer Alliance has a very robust partnership of members across the state that act as amplifiers of our information as well as information in and information out.
Health Chatter
Minnesota State Cancer Plan
So the way this is done is trying to reach communities at the grassroots levels to the most extent possible and ensuring that not only are we looking at the data, but looking at logistics and practical tactics that either prevent early detection and screening or eventual cure and the process of cure. So we even help with legal insurance
Health Chatter
Minnesota State Cancer Plan
we help with legal tactics with making sure that some of the screens as well as treatments are covered by insurance and are legislatively impacting the insurance companies so that they're enforced almost to cover some of the costs occurring with diagnostics as well as treatment. So I think the way that we are addressing this is
Health Chatter
Minnesota State Cancer Plan
Again, going to grassroots level, looking at burdens, and then forming our strategies. So it's never an isolation or vacuum. It's always done in concert with the community members and the members that are part of the alliance.
Health Chatter
Minnesota State Cancer Plan
So as you mentioned, we do focus on breast, cervical, and colorectal cancer screening. I want to point out that things that are in the objectives can only go so far unless they are adopted into policy. They really don't continue long-term and they are not sustainable.
Health Chatter
Minnesota State Cancer Plan
And so to that, well, we have a very robust policy committee within the Alliance that has gone and lobbied at the state level with the senators and tried to tie almost every initiative with a policy so that it can actually be long-term sustainable and come to fruition. So we have done significant work in that space.
Health Chatter
Minnesota State Cancer Plan
For instance, we have made sure that the cost sharing part of insurance, that insurance charges for breast cancer diagnostic testing is removed. We have also recently worked hard to have biomarker testing, which would be biomarkers that could lead to understanding of early cancer. that is not symptomatic yet or very early symptoms.
Health Chatter
Minnesota State Cancer Plan
We have made sure that those are covered by state regulated insurers. So we have done some efforts in that space through policy. In addition, we have also gone through things like mobile mammography units and a lot of awareness in that space into rural areas
Health Chatter
Minnesota State Cancer Plan
We actually use funding mechanisms through the Alliance where we fund our partners and community members to amplify the work around these objectives.
Health Chatter
Minnesota State Cancer Plan
So we have done significant amounts in each space in terms of we've created a community health worker program where we talk about insurance, again, covering community health worker charges so that they can be navigators within the system to talk about screening and detection and awareness at an early stage with the communities. So it's a multi-pronged approach.
Health Chatter
Minnesota State Cancer Plan
And while I do talk about early detection, I want to say that we follow the whole spectrum from detection, but then a lot of people are in the treatment phase and the survivorship phase. So we also support them in that space. But early detection, this is an ever-evolving, innovative space. You have people that can be family or genetically predisposed to cancer that are human for early screening.
Health Chatter
Minnesota State Cancer Plan
But then there's a lot that do not have familial history and yet could develop some of these cancers. Yeah.
Health Chatter
Minnesota State Cancer Plan
The idea is to do early screening based on a variety of techniques, one of which is genetic testing or genetic screening and several others like diagnostics, like breast exams, and just going into communities and removing the hesitation and cultural nuances that are around testing and encouraging them to take care of their health.