Checkpoint Cancer Patient Information Sheet - PDF

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					                       Section II : Guidelines for Prevention, Diagnosis and Management

                       J. Oral Health
                               Included as Attachment 14 is the Executive Summary from a report recently issued by the New
                       York State Department of Health, Oral Health Care During Pregnancy and Early Childhood: Practice
                       Guidelines. The full report may be accessed at:

                       K. Chronic Disease

                       Cancer Prevention and Control
                       Breast Cancer

                       Breast cancer kills about 1,200 in New York City every year and still 25% of women 40 and older have
                       not had a recent mammogram.
                       The NYC Department of Health and Mental Hygiene recommends that women ages 40 and older get a
                       mammogram every 1-2 years. Women under age 40 with a strong family history of breast cancer should
                       consult with a breast specialist about screening options. The number of women receiving mammograms
                       has dropped in New York City recently. Included in Attachment 15 is a NYC ‘Vital Sign’ bulletin that
                       includes information on women who are being screened at lower rates. The following sites offer
                       mammograms at little or no cost.

                                 BRONX                        BROOKLYN                     MANHATTAN                     QUEENS
                                                                                                 Bellevue                  Elmhurst
                        Segundo Ruiz Belvis Diagnostic          Coney Island
                                                                                             Hospital Center            Hospital Center
                            and Treatment Center                  Hospital
                                                                                             462 First Avenue           79-01 Broadway
                            545 East 142nd Street            2601 Ocean Parkway
                                                                                              (212) 562-4384            (718) 334-1900
                               (718) 579-4010                  (718) 616-4432

                           Jacobi Medical Center          Cumberland Diagnostic and             Gouverneur
                                                                                                                        Hospital Center
                         1400 Pelham Parkway South            Treatment Center             sHealth Care Services
                                                                                                                       82-68 164th Street
                               (718) 918-4734             100 North Portland Avenue         227 Madison Street
                                                               (718) 260-7855            (212) 238-7897/7797/7510
                                                                                                                        (718) 883-4509

                         Lincoln Medical and Mental      East New York Diagnostic and
                                                                                          Harlem Hospital Center
                                Health Center                  Treatment Center
                                                                                            506 Lenox Avenue
                            234 East 149th Street             2094 Pitkin Avenue
                                                                                              (212) 939-8060
                               (718) 579-5550                   (718) 240-0531

                          Morrisania Diagnostic and
                               Treatment Center          Kings County Hospital Center   Metropolitan Hospital Center
                             1225 Gerard Avenue              451 Clarkson Avenue             1901 First Avenue
                                (718) 960-2710               (718) 245-3267/3268              (212) 423-7993
                          After 4PM: (718) 960-2814

                                                                                          Renaissance Health Care
                                                         Woodhull Medical and Mental
                         North Central Bronx Hospital                                     Network Diagnostic and
                                                               Health Center
                            3424 Kossuth Avenue                                              Treatment Center
                                                               760 Broadway
                               (718) 519-3969                                              215 West 125th Street
                                                              (718) 388-5889
                                                                                              (212) 939-8060

                 Section II : Guidelines for Prevention, Diagnosis and Management

                 Cervical Cancer
                 The primary known cause of cervical cancer is the human papilloma virus (HPV). Included in
                 Attachment 5 (Section 2) is information about Gardasil®, a vaccine licensed to prevent infection
                 with several HPV types, including two that cause cervical cancer.
                 Regular pap tests can prevent cervical cancer by detecting abnormalities before they become cancer-
                 ous. Despite this, 20% of New York City women do not have regular pap tests. Included in
                 Attachment 15 is a NYC Vital Signs bulletin on cervical cancer screening in New York City that
                 explores why these women are not being screened. The DOHMH recommends pap tests at least
                 every 3 years for women 21– 65.

                 Additional Resource:
                 CDC Advisory Committee on Immunization Practices (ACIP) provisional recommendations:

                 Colon Cancer
                 Colon cancer can be prevented and cured if found early. The best way to test for – and prevent –
                 colon cancer is colonoscopy.
                 The DOHMH recommends colonoscopy every ten years for average-risk men and women 50 years
                 and older, with annual high sensitivity FOBT for people unwilling or unable to undergo
                 colonoscopy. People with a family history of colon cancer should begin colonoscopy screening at
                 age 40. Included in Attachment 15 is a City Health Information bulletin that provides New York
                 City-specific guidelines for colorectal cancer screening and answers frequently asked questions
                 about screening and prevention. Also included are several tools that can be used in clinical settings:
                 I       Chart stickers: Is Colon Cancer Screening Needed? These can be used in the medical record
                         as prompts for screening. The office receptionist, medical assistant or nurse can place a
                         sticker at the top of the visit notes.
                         Note: stickers have been formatted for printing on 5160 Avery labels.
                 I       Direct Referral for Colonoscopy Procedure: Patients meeting the criteria on this single-sheet
                         assessment will not need a preliminary evaluation by a gastroenterologist saving them an
                         additional doctor visit.
                 I       Birthday cards: These can be sent to patients who have recently had their fiftieth birthday
                         to remind them to make an appointment for a colonoscopy.

                 Low cost cancer screening
                 The New York State Department of Health Cancer Services Program operates sites in New York City
                 that offer free screening for breast, cervical and colon cancer to qualified uninsured persons. In this
                 program, FOBT (Fecal Occult Blood Test) is the colorectal cancer screening test offered unless there
                 are medical indications that would suggest a colonoscopy. When calling, please identify any need for
                 handicapped accessible accommodations, such as an adjustable exam table. (The entire list of sites
                 for New York State is located at this website:

                       Section II : Guidelines for Prevention, Diagnosis and Management

                                                      Low Cost Cancer Screening
                       Bronx County Cancer Services                       Manhattan County Cancer Services
                       Breast, Cervical and Colorectal Cancer Screening   Breast, Cervical and Colorectal Cancer Screening
                       Cancer Services Network, Inc (Bronx) –             The Trustees of Columbia University in the City
                       Bronx Cancer Services Program Partnership          of New York – Columbia University Cancer
                       2330 Eastchester Road, 3rd Floor                   Screening Partnership
                       Bronx, NY 10469                                    1130 St. Nicholas Avenue
                       Phone: (718) 547-5064 ext. 214                     New York, NY 10032
                       Fax: (718) 547-5947                                Phone: (212) 851-4516
                                                                          Fax: (212) 851-4530
                       New York City Health and Hospital Corporation
                       (Lincoln Medical and Mental Health Center) –       Cancer Services Network, Inc. (Manhattan) –
                       South Bronx Healthy Living Partnership             Cancer Services Program of Manhattan
                       234 E. 149th Street, Room 1B1                      132 West 32nd Street, 2nd Floor
                       Bronx, NY 10451                                    New York, NY 10011
                       Phone: (718) 579-5134                              Phone: (212) 237-3910
                       Fax: (718) 579-4744                                Fax: (212) 237-3855

                       Mobile Mammography
                       St. Barnabas Hospital                              Queens County Cancer Services
                       Case Manager
                                                                          Breast, Cervical and Colorectal Cancer Screening
                       4422 Third Avenue
                       Bronx, NY 10457                                    Cancer Services Network, Inc. (Western
                       Phone: (718) 960-9131                              Queens) – Queens Healthy Living Partnership
                       Fax: (718) 960-3612                                American Cancer Society
                                                                          97-77 Queens Blvd, Suite 1110
                                                                          Rego Park, NY 11374
                       Brooklyn (Kings) County Cancer Services            Phone: (718) 263-2225 ext. 5540
                                                                          Fax: (718) 261-0758
                       Breast, Cervical and Colorectal Cancer Screening
                       Cancer Services Network, Inc (Kings) –             Mobile Mammography
                       Brooklyn Healthy Living Partnership                Queens Cancer Center of the Queens Health
                       American Cancer Society
                                                                          79-01 Broadway
                       17 Eastern Parkway, 5th Floor
                                                                          Elmhurst, NY 11373
                       Brooklyn, NY 11238
                                                                          Phone: (718) 334-1235
                       Phone: (718) 622-2492 ext. 5133
                                                                          Fax: (718) 334-1220
                       Fax: (718) 789-1746
                                                                          Fax: (718) 883-6295
                       Mobile Mammography                                 Queens Cancer Center of the Queens Health
                       St. Vincent Catholic Medical Centers               Network
                       152-11 89th Avenue                                 82-68 164th Street, Room A531
                       Jamaica, NY 11432                                  Jamaica, NY 11432
                       Phone: (718) 558-2054                              Phone: (718) 883-4031
                       Fax: (718) 558-2022                                Fax: (718) 334-1220
                                                                          Fax: (718) 883-6295

                 Section II : Guidelines for Prevention, Diagnosis and Management

                 St. Vincent Catholic Medical Centers
                 152-11 89th Avenue
                 Jamaica, NY 11432
                 Phone: (718) 558-2054
                 Fax: (718) 558-2022

                 Richmond (Staten Island) County
                 Cancer Services
                 Breast, Cervical and Colorectal Cancer Screening
                 Cancer Services Network, Inc. (Richmond) –
                 Staten Island Health Living Partnership
                 256 Mason Avenue
                 Building B, 2nd Floor
                 Staten Island, NY 10305
                 Phone: (718) 226-6447
                 Fax: (718) 226-6142

                       Cardiovascular Disease Prevention and Control
                       Included in Attachment 16 are two City Health Information bulletins: “Lipid Control: Preventing
                       Cardiovascular Disease Events in Patients with Atherosclerotic Disease or Diabetes” (July/August
                       2006) and “Management of Hypertension in Adults” (October 2005).

                       Additional resources include

                       Primary Prevention
                       1) Diet and Lifestyle Recommendations, Revision 2006: A Scientific Statement from the American
                       Heart Association Nutrition Committee, Circulation, 2006;114:82-96
                       * See also resources listed under disease conditions Diabetes, Obesity, Smoking

                       1) Berger DK, Silver L, Bassett MT. Lipid Control: Preventing Cardiovascular Events in Patients
                       With Atherosclerotic Disease or Diabetes. City Health Information. 2006;25(5):33-40.
                       2) New York City Department of Health and Mental Hygiene. Public Health Detailing Program.
                       Cholesterol Action Kit.
                       3) U.S. Preventive Services Task Force. Screening for Lipid Disorders in Adults: U.S. Preventive
                       Services Task Force Recommendation Statement. AHRQ Publication No. 08-05114-EF-2, June 2008
                       Agency for Healthcare Research and Quality, Rockville, MD.

                       1) Angell SY, Silver L, Bassett MT. Management of Hypertension in Adults. City Health
                       Information. 2005;24(7):39-50.
                       2) New York City Department of Health and Mental Hygiene. Public Health Detailing Program.
                       Hypertension Action Kit.
                       3) Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee
                       on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), Hypertension,
                       4) Recommendations for Blood Pressure Measurement in Humans: A Statement from the
                       Subcommittee of Professional and Public Education of the American Heart Association Council on
                       High Blood Pressure Research, Hypertension, 2005 Jan;45(1):142-61.

                       Self Blood Pressure Monitoring in Patients with Poorly Controlled Hypertension

                       1) Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: A Joint
                 Scientific Statement from the American Heart Association, American Society Of Hypertension, and
                 Preventive Cardiovascular Nurses Association, Hypertension, 2008 Jul;52(1):1-9.

                 1) Primary prevention of ischemic stroke: a guideline from the American heart
                 Association/American Stroke Association Council on Stroke, Stroke, 2006;37:1583-1633.
                 2) Guidelines for Prevention of Stroke in Patients with Ischemic Stroke or Transient Ischemic
                 Attack: A Statement from the American Heart Association/American Stroke Association Council on
                 Stroke, Stroke, 2006;37:577-617.

                 Medication Adherence
                 1) Osterberg L and Blaschke T. Adherence to Medication. N Engl J Med. 2005 Aug 4;353(5):487-97.

                 Diabetes Prevention and Control
                 Diabetes is epidemic throughout the United States. Approximately 1 in 5 New Yorkers 65 years of
                 age and older has diabetes. Included in Attachment 17 is the City Health Information on Diabetes
                 Prevention and Management as a resource on screening and diagnosis, and recommendations for
                 provider practices and interventions.
                 In response to the city’s diabetes epidemic, the NYC DOHMH is offering an innovative new training
                 program: The Medication Adherence Project (MAP) - Tools for Improving Self-Management.
                 Tailored to the needs of small group and solo practice physicians, MAP provides practical tools and
                 techniques to improve medication adherence among patients with diabetes, placing the medication
                 adherence challenge within the broad spectrum of self-management strategies for all chronic disease

                       Section II : Guidelines for Prevention, Diagnosis and Management

                       The MAP is designed as a peer learning program. As such, we are currently recruiting physicians
                       interested in becoming Trainers and Trainees for early 2008. Trainers will be responsible for training
                       five of their peers via workshops and one-on-one in-office sessions. Participants will be compensat-
                       ed with a stipend, CMEs, and other incentives. For more information contact Bronwyn Starr,
                       Program Manager:
                       Additional resources include:
                               •       Standards of Medical Care in Diabetes – 2007. American Diabetes Association,
                                       Diabetes Care 2007; 30(Suppl 1):S4-41.
                               •       Diagnosis and Classification of Diabetes Mellitus. American Diabetes Association,
                                       Diabetes Care 2007; 30(Suppl 1):S42-47.
                               •       Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the
                                       Initiation and Adjustment of Therapy. Nathan et al, Diabetes Care 2006; 29(8):1963-
                               •       Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or
                                       Meformin Diabetes Prevention Program Research Group. New England Journal of
                                       Medicine 2002; 346(6):393-403.

                       The New York City A1C Registry
                                A health code amendment that took effect on January 15, 2006 requires that most laborato-
                       ries report the results of a blood test called A1C to the Department of Health and Mental Hygiene.
                       A1C is a blood test that measures average blood sugar level in the blood over 3 months for people
                       with diabetes. A1C levels are used by providers and patients to monitor and change treatment plans
                       for individuals with diabetes, the goal for most people being an A1C less than 7.0% (average blood
                       sugar of 170 mg/dL). Good control of A1C can help prevent complications such as heart, eye,
                       kidney, and nerve disease.
                       These test results are entered in the Registry which the Department uses to:
                               •       Support providers and their patients in improving diabetes care
                               •       Monitor blood sugar control in New York City over time
                       Quarterly reports with patients listed by A1C level are distributed to providers. These reports can
                       help you identify individuals who may benefit from additional support, such as intensification of
                       therapy, or a referral to a physical activity program or self-management program. See sample report
                       included in Attachment 17; the report is also posted at
                       Free Patient Letter Service with recent A1C test results, information and a reminder to return to
                       care will be sent to patients with high A1C levels under your letterhead if your practice requests this
                       service. See sample letter included in Attachment 17; the letter is also posted at
                       Resources such as free recreation center memberships, diabetes supplies for those who are
                       uninsured, and blood pressure cuffs for patients to use at home are also made available to providers
                       to distribute to their patients, subject to funding availability.
                       This program is being implemented first in high need areas and will be expanded over time. As part

                       of the implementation, the Department conducts outreach visits to introduce the A1C Registry and
                 Section II : Guidelines for Prevention, Diagnosis and Management

                 the support tools for providers. In the summer of 2007, outreach to South Bronx-serving providers
                 was initiated.
                 If we have not yet made it to your practice and you would like to receive information and updates
                 about the A1C Registry, please call 212.788.4125.

                 Overweight and Obesity
                 Overweight and obesity are epidemic in New York City and across the country. About two thirds of
                 the US population are overweight or obese, including more than half (approximately 3 million) of
                 the adults in New York City. Included in Attachment 17 is the City Health Information Preventing
                 and Managing Overweight and Obesity in Adults. This is an excellent resource for how to assess
                 weight status in adults, develop realistic weight loss plans for patients, and promote healthy lifestyle
                 choices for life-long weight management.

                 Asthma Control
                 To assist health care providers with the diagnosis, management and evaluation of children and adults
                 with asthma, we have included as Attachment 18 the recommendations of the National Heart, Lung
                 and Blood Institute’s Expert Panel Report 3: Guidelines for the Diagnosis and Management of
                 Asthma. The full report can be found at
                 Another useful resource for providers to complete routinely to encourage patient self-management is
                 the Ashtma Action Plan, included in Attachment 18 in English, Spanish & Chinese and found at
        NYC providers can also call 311 to
                 order blank copies.

                 Tobacco Control
                 Included in Attachment 19 is the newly updated Guide to Smoking Cessation Counseling Programs
                 in New York City (Oct. 2008), produced by the New York City Department of Health and Mental
                 Hygiene’s Bureau of Tobacco Control, and City Health Information, Treating Tobacco Addiction
                 which was updated in Dec. 2007/Jan. 2008. For additional information, please refer to the following
                 Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical
                 Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health
                 Service. May 2008.
                 The 2008 guidelines may be reviewed online at:
                 For providers, included here is a list of on-line CME courses to enhance clinical skills for treating
                 tobacco addiction:
                 by Michael Fiore MD, MPH – University of Wisconsin Center for Tobacco Research and Intervention


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