2018 - 2022 Virginia Cancer Plan:  2020 - 2021 Progress Report


The Cancer Action Coalition of Virginia (CACV) was formed in 1998 as the Cancer Plan Advisory Committee. Under the guidance of the Virginia Department of Health, the first Virginia Cancer Plan (VCP) was developed in 1998 by a team of committed volunteers. Since then, Virginia has developed and updated the cancer plan every five years. Today, CACV serves as an important alliance of organizations and individuals working together to provide statewide guidance, support, leadership, and coordination of cancer prevention and control activities throughout the Commonwealth of Virginia.  

The mission of CACV is to reduce the burden of cancer for all persons living in Virginia utilizing the Virginia Cancer Plan to provide a forum for collaboration, education, and advocacy.

Our key program is to develop the VCP every 5 years which provides a roadmap to addressing the burden of cancer in the Commonwealth. The first plan was developed in 1998. This plan is a framework that presents priority objectives, goals, and strategies to reduce cancer risk, eliminate preventable cancers, and minimize cancer deaths and disabilities.

Cancer is too big a problem to fight alone. CACV fosters relationships between healthcare systems, non-profits, community organizations, and individuals throughout Virginia to implement the goals and objectives of the plan. The CACV members and partners implemented a variety of activities and initiatives in 2020 and 2021 to address the six priorities identified in the VCP. Collaboration between member organizations and partners helped 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, 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. For this report, we combined years 2020-2021 because the pandemic drastically affected cancer control efforts and strategies over these two years.

When Covid-19 began to cause shutdowns nationwide, there was a call to restrict all unnecessary outings and activities. Because of the burden on healthcare providers at the time and the fears of the public, this meant that many cancer screenings and some surgeries were deemed “elective”, and therefore postponed. The American Cancer Society (ACS) called for a pause on cancer screenings to reduce exposure and relieve provider stress, which was unprecedented. Understandably, the pandemic had, and in some ways continues to have, a drastic impact on cancer care and screening, as well as the lives of those living with cancer and their families.

In addition to the changes in clinical care, the pandemic caused our member organizations to adapt outreach and education strategies to a virtual environment. Not only did the pandemic cause messaging challenges, but two of the cancers for which there are screening protocols saw major changes in screening recommendations during 2020-2021 (lung1 and colon2). Despite the challenges, our members worked diligently to keep Virginians informed of the changing cancer landscape.

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 January 2020 through December 2021 to cover progress made throughout the 2020 and 2021 project years. 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 20.7% (25 / 121) of all active CACV members completed the survey.  

Our Priorities

In 2020-2021 CACV members identified the following priorities to address across the state:

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.

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

HPV vaccination is monitored using two different data collections administered by the state and the CDC. The methodology of each survey provides insight into vaccination rates for both younger and older adolescents. The state’s Virginia Student Immunization Survey (SIS) shows in 2020, HPV vaccination for middle school-age children (11-12 years old) as 38.40% of females and 34.02% of males had at least one dose of HPV3. Looking forward, vaccination uptake increases over the life span. According to the CDC’s 2020 National Immunization Survey (NIS) data, 64.8% of females and 48.2% of males aged 13-17 in Virginia have completed the HPV vaccination series3. This was a 30.9% increase for females and a 28.5% increase in males from the 2016 baseline in the Virginia Cancer Plan. Of the 25 members who participated in the 2020-2021 Evaluation Survey, 7 activities focused on achieving this goal. Some of those activities included:

 “Someone You Love: An HPV Epidemic" documentary viewing and Q&A session hosted by the UVA Cancer Center with 403 participants across Virginia. The goal of the event was to help empower health care professionals to be proactive when speaking to their patients and to encourage the HPV vaccine to all who qualify.

“Navigating COVID-19 Communication webinar” that was also hosted by UVA Cancer Center with 85 participants. This activity had a great Q&A section where attendees, which ranged from community members to healthcare practitioners, could ask about the HPV vaccination and bust any myths they've heard or seen on social media platforms.

2020-2021 Evaluation Survey, CACV. 02/2022

Virginia HPV Immunization Taskforce (VHIT)

The Virginia HPV Immunization Taskforce (VHIT) is a CACV taskforce comprised of medical providers, school employees, and members of health care systems and non-profit organizations that is focused on increasing HPV vaccination rates in Virginia. Moving into 2022, our goal is to continue to unite providers and communities together to combat HPV-related cancers and infections. We are excited to continue working with our partners to reach our goals. Our priorities for 2022 include:

Increase taskforce membership by 10% by January 2023

Expand VHIT reach by increasing presence on social media platforms

Create cross-partnership with other state coalitions

Identify funding for sustaining and growing VHIT outreach

Foster opportunities to educate providers and community members 

Objective 6.1: Increase the percentage of Virginians 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. This remained consistent from the 2019 survey results and shows a continuous focus on this objective.

The pandemic caused distinct disruptions in mammography in different ways at different times. At the beginning of the pandemic in 2020, many health care services deemed non-essential were put on pause to preserve personal protective equipment (PPE) and other resources for healthcare providers, and screening mammograms were one of those services. Once the initial PPE emergency had passed and mammogram services resumed, mammography rates did not and have not yet returned to pre-pandemic levels.6 A possible explanation early in the pandemic is people were reluctant to go back to the doctor due to Covid-19 safety concerns. Another aspect that has complicated mammography during the pandemic is a side effect of the Covid-19 vaccines. Some people who receive a Covid-19 vaccine have experienced lymph node swelling under the arm where they received their vaccine, and this swelling can also be a sign of breast cancer independent of Covid-19 vaccination. 

 Because of this confounding symptom, people who are scheduling a mammogram have to ensure that their appointment is more than six weeks after any Covid-19 vaccination so that any residual swelling can go down. This side effect may mistakenly connect receiving a Covid vaccine with a risk of breast cancer, and this confusion could cause further delay. To add to the confusion, there is now a question on whether the delay is necessary.7

There are other societal impacts on people that are likely causing screening delays across multiple cancer types. Parents have increased child care responsibilities with school and daycare closures or quarantine requirements. 


If workers have access to paid sick time they are likely using it for these caregiving responsibilities in addition to actual illness, especially during the Omicron wave when federal sick time policies had expired. If someone does have support and paid sick time to make appointments, the current stressful environment does not lend itself to people adding more responsibilities and obligations to their plate, even if it would be beneficial to their health in the long term.

Despite the challenges caused by the pandemic, providers continued to serve those due for cancer screening. Every Woman’s Life is a Virginia program that improves access to breast and cervical cancer screening for low-income, uninsured women. Cervical cancer screening recommendations for women aged 30 - 65 include HPV testing alone or in combination with cervical cytology every five years. Every Woman's Life provided 1,125 HPV tests from January 2020 through December 2021. In addition, Every Woman's Life provided 6,337 mammograms to low-income, uninsured women from January 2020 through December 2021.

Objective 6.3: Increase the percentage of adults aged 50-75 who received 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 (ACS) and remains the second leading cause of cancer-related death in Virginia (CDC). 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.

According to the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of adults aged 50-75 who receive recommended colorectal cancer screening has increased by 10.2%, from 70.3% (2016) to 75.7% (2020).

Of those who completed the 2021 evaluation survey, 8 organizations made efforts towards increasing this metric. Those activities included:

Bon Secours raised all of the screening scores over the past 4.5 years by implementing and empowering Cancer Nurse Navigators to reach out daily to their patients with follow-up and education. Due in part to the increase in Cancer Nurse Navigators across 21 primary care practices in the Bon Secours Medical Group over a 5 year period, CRC screening has seen the highest increase in patient participation from a baseline of 42% (2015) of patients screened to 65% (2020) of patients screened at the end of the program.

The UVA Cancer Center participated in a small media campaign that reached 6 healthcare facilities and clinics and encouraged community champions via radio broadcast to seek screening opportunities.

Nueva Vida, Inc. held an Increase Colorectal Cancer Screening Webinar with 65 live participants that focused on provider outreach and best practices on addressing health disparities, CRC screening during Covid, and screening in high-risk populations.

The VCU Massey Cancer Center launched Project COALESCE, Communities Tackling Racial Disparities, Systemic in (Colon and Cervical) Cancer Screening, in January 2021.

2020-2021 Evaluation Survey, CACV. 02/2022

Virginia Colorectal Cancer Roundtable (VCCRT)

CACV became a member of the National Colorectal Cancer Roundtable (NCCRT) in 2017 making it one of approximately 100 organizations across the nation committed to taking action in screening, prevention, and early detection of colorectal cancer. One of CACV’s key priority taskforces is the Virginia Colorectal Cancer Roundtable (VCCRT). The goals of VCCRT are to develop a robust colorectal cancer roundtable to facilitate partnerships across Virginia to reduce the burden of colorectal cancer. Currently, there are 49 members representing 24 organizations including our two NCI centers, Commission on Cancer accredited hospitals, Federally Qualified Health Centers, health plans, industry leaders, and non-profits all focused on the colorectal cancer continuum. VCCRT also aims to increase colorectal cancer screening rates in Virginia while focusing on the colorectal cancer mortality hotspot in Central and Eastern Virginia. Additionally, VCCRT advocates for increased access to colorectal screening for all Virginians.

VCCRT activities in 2021 included:

1. Establishment of three active subcommittees: Education, Clinical Practices and Advocacy which meet regularly to work on VCCRT short and long-term goals.

2. Hosted an educational program “Increasing Colorectal Cancer Screening”. This webinar informed healthcare providers (MD, RN, PA, NP, and navigators) on the decline in screening during the pandemic and the increased need from the change in screening age, as well as appropriate screening options that include home-based tests for colorectal cancer screening. Sixty-five (65) people attended the webinar.

3. Hosted quarterly meetings in March, June, September, and December on a variety of topics related to CRC prevention, diagnosis, treatment, and survivorship.

4. Colorectal Cancer Awareness Month (March): Developed and promoted the Colorectal Cancer Action Guide which provides simple and effective ways for healthcare providers and the community to get involved in colorectal cancer awareness.

5. New Screening Guidelines Toolkit: In May of 2021, the United States Preventive Services Task Force (USPSTF) released new screening recommendations for colorectal cancer. The primary change was that average-risk adults are now recommended to start screening at age 45 instead of 50. This is also in alignment with the American Cancer Society guideline (2018). In response, the Virginia Colorectal Cancer Roundtable (VCCRT) has developed both patient and provider messaging to raise awareness of the new recommendations. The toolkit can be used by organizations looking to increase awareness of the new screening age.

6. VCCRT will support a catalyst award given to the American Cancer Society Cancer Action Network in late 2021 from Fight Colorectal Cancer to increase awareness at the state legislature on the colorectal cancer burden in Virginia.

7. VCCRT serves on the Southeastern Colorectal Cancer Consortium and moved Virginia forward as a host site for their 2023 annual meeting.

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

The Covid-19 pandemic took the barriers and inequities that have long existed in our healthcare system and highlighted them for the general public, and the Covid-19 inequities that have emerged mirror those in cancer. There is an increased Covid-19 disease burden as well as a financial burden on Black and Hispanic Americans, which we have known to exist in the cancer space for decades. The obstacles that the vaccine rollout faced when reaching under-resourced communities are the same obstacles that populations face when trying to access cancer screenings and other healthcare information. Lack of reliable transportation, unavailable evening/weekend hours, and lack of culturally competent or native language information affected the uptake of the vaccine similar to in other areas of our healthcare system every day.

One access issue that has received attention because of the pandemic is the lack of high-speed internet access across the country. In Virginia, currently 91% of households have access to high-speed internet, but the percentage drops dramatically in some rural counties, as low as 23%.8 Beyond telehealth, internet access has benefits for cancer patients as it is a way to access information about their disease as well as virtual support groups which can be invaluable for rare cancers or people who live in rural areas.

As referenced in the mammography section, there was also a national conversation during the pandemic around the importance of paid sick time in preserving public health and an emergency provision for an increased sick time from the federal government.9 This conversation is easily applicable to other areas of public health, outside of a pandemic. 

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; at that moment, they become a cancer survivor. Cancer survivorship focuses on living with, through, or after cancer. Family members, friends, and caregivers also are survivors.

Palliative care is a systematic application of methods that assist people in daily life, including employment, and in managing practical, legal, and financial needs. The survivorship and palliative goals create means and opportunities to enhance survivors’ quality of life.

CACV survey respondents engaged 16% of their efforts in activities focused towards optimizing the quality of life for patients and caregivers across the cancer continuum. Those activities include:

VCU Massey Cancer Center held an educational event on palliative care for healthcare providers in the Danville & Martinsville areas. Over 75 individuals participated in the event.

Nueva Vida, Inc. offers monthly support groups to cancer survivors. In 2021, over 80 people participated in their groups.

CACV and our member organizations became social media partners for the National LGBT Cancer Center’s OUT Cancer Survey of LGBTQ+ cancer survivors. Data on LGBTQ+ cancer survivors and patients are essentially nonexistent. CACV and member organizations helped promote this survey to collect this vital information. The results of the survey were published in November 2021 and CACV promoted the results to members and the greater community.

UVA Cancer Center provides a program designed to educate providers on the state of survivorship care and provide follow-up care for cancer survivors dealing with physical and psychological challenges.

The Virginia Department of Health deployed the Cancer Survivorship modules of the Behavioral Risk Factor Surveillance Survey in 2020. The modules will be included in 2022 and in even years going forward. 

2020-2021 Evaluation Survey, CACV. 02/2022

CACV member organizations provided education on survivorship issues to healthcare professionals, patients, and caregivers. These events included:

· Virginia Breast Cancer Foundation: Cancer & Careers

· VCU Massey Cancer Center: Financial Toxicity & Cancer Survivorship

· VCU Massey Cancer Center: Cancer Survivorship Series

· UVA & American Cancer Society: Cancer Survivorship Forum

With continued gaps in care for survivors, CACV members and partners continue to work towards addressing these gaps.  

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

Virginia is one of only three states that include 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 2020, ASK participated in an advocacy day in which 44 passionate advocates from around the state came to Richmond and were able to reach out to 140 legislators about childhood cancer and the need for dedicated resources. Right now our state budget includes $20 million for cancer and none of it is designated for children. Due in part to ASK and its partners, two budget amendments are currently under consideration.

Working in partnership with the Virginia Department of Health and the Children's Hospital of Richmond at VCU, ASK held an educator conference in Virginia Beach on February 7, 2020. It was attended by 24 school personnel. Later that month, another educator conference was held in Fairfax on February 28th and was attended by 74 school personnel. ASK educator conferences are aimed at providing teachers and other school personnel with information on childhood cancer and how to support patients, survivors and their siblings in the classroom.

CACV in partnership with ASK Childhood Cancer Foundation and other partner organizations held the state’s annual Childhood Cancer Awareness Day at the Virginia General Assembly. The event was held virtually in January 2021 with 88 advocates participating.

In partnership with the Virginia Department of Health, ASK Childhood Cancer Foundation hosted a FREE virtual conference to help teachers, school nurses and administrators learn about childhood cancer, common late effects, and how to support patients, survivors, and siblings in the classroom.

The 2021 Virginia Cancer Conference provided two sessions on pediatric cancer. These sessions included an overview of children and cancer and the psycho-social needs of pediatric patients and families. 

Joining Together for Other Activities:
CACV Member Success Stories

Virginia Cancer Conference

The Virginia Cancer Conference is a biennial event hosted by the CACV. The purpose of the Virginia Cancer Conference is to provide education and training to key stakeholders in the Virginia cancer community. The conference is attended by physicians, nurses, clinical social workers, patient navigators, health educators, survivors, caregivers, advocates, and community members.

The 2021 conference theme was “Joining Together for a Virginia Without Cancer” and was held as a virtual event on September 15, 22, and 29, 2021. The conference offered 9 hours of presentations over three (3) days providing 15 presentations. The conference was attended by 113 individuals representing all regions of Virginia.

Ninety-one percent (91%) of conference attendees agree or strongly agree that the content provided in the presentations applied to their daily work. Conference attendees shared the following regarding conference participation.

Greatest Takeaways from the Conference:

· Health disparities continue in the realm of cancer care.

· Everyone seems to be in a creative thinking space and eager to work together to tackle challenges.

· Better understanding of challenges for Virginians to receive the same level of care.

· Limited support for children.

· Need more training in supporting/caring for the LGBTQ community.

· The compounding effects of a pandemic and healthcare disparities on outcomes.

· The effect of the pandemic on the cancer continuum is going to be extensive.

Overall, I was impressed with the virtual format – one of the better organized virtual meetings I have attended the past two years.”

“The conference was very informative. I really enjoyed looking at health disparities related to cancer. There is so much information that I have to move forward in my current position with improving outcomes.


The next Virginia Cancer Conference is scheduled for early 2023 with the launch of the new 5-year Virginia Cancer Plan (2023-2027).

Ways to Get Involved

We cannot do this alone. Become a member.

The Cancer Action Coalition of Virginia (CACV) is a community of individuals and organizations working together to reduce the burden of cancer in Virginia. Membership in CACV is open to anyone interested in cancer control in the Commonwealth of Virginia.

By joining CACV, you become part of a group of dedicated individuals and organizations that are committed to fostering communication, collaboration, and community awareness to meet the multi-faceted needs of persons living with cancer.

We cannot do this alone. Together our impact to improve the health and well-being of all Virginians is greater. These are a few ways you can get involved:

To learn more about CACV, visit our website at cancercoalitionofvirginia.org

CACV Member Organizations Represented

American College of Obstetrics & Gynecology

Alliance Group

American Cancer Society

American Cancer Society Cancer Action Network

American Childhood Cancer Organization

American College of Radiology

American Lung Association

ASK Childhood Cancer Foundation

B2L Consulting

Barksdale Cancer Foundation

Birth Sisters of Charlottesville

Bon Secours

Breast Cancer Move Foundation

Briston Myers Squibb

CancerDancer

Central Virginia Community College

CMG

Colon Cancer Alliance

Crater Health District

Danville Community College

Exact Sciences

Genentech

Geographic Health Equity Alliance/CADCA

George Washington University Cancer Center

GRAIL

Grassroots Health Advisors


Halifax County Cancer Association

Hampton University

Hampton University Proton Therapy Institute

HCA-Sarah Cannon Cancer Institute

Healthy Living and Learning Center

Hitting Cancer Below the Belt

Illumina

Incyte

Inova Schar Cancer Institute

Johnson Health Center

Kyowa Kirin

Life in Fitness – LIFT

Low Ultraviolet (L.U.V.)

Mary Washington Healthcare

Merck

Mountain Empire Community College

Mountain Empire Older Citizens, Inc.

National Cancer Institute

New Horizons Healthcare

Norfolk State University

Novartis

Nueva Vida, Inc.

Onco, Inc.

Our Amazing Fighter

Patient Advocate Foundation

Pfizer

Riverside Health System


Sentara Healthcare

Sisters Network

Southeastern Virginia Health Systems

Southern Gastroenterology Associates

Southside Regional Medical Center

Southwest Virginia Community Health Systems

SOVAH Health Danville

Strategic Health Concepts

Susan G. Komen Blue Ridge Affiliate

Tobacco Free Alliance Virginia

Triage Cancer

UVA Cancer Center

Valley Health

VCU Massey Cancer Center

VCU School of Pharmacy

Virginia Association for Hospices & Palliative Care

Virginia Breast Cancer Foundation

Virginia Cancer Patient Navigator Network

Virginia Cancer Registry

Virginia Community Healthcare Association

Virginia Department of Health

Virginia Health Catalyst

Virginia Tech

Virginia Cooperative Extension

We Rock Cancer