Minnesota State Cancer Plan

Stanton Shanedling: Hello, everybody welcome to health chatter. And today's show is on the state of Minnesota Cancer plan. But I'm only guessing that all the different objectives that we're gonna be talking about for this particular State plan is appropriate for many of the other States in the country as well. We'll also link some of our discussion with healthy people 2030 to see how we connect with the plans and objectives for the nation as a whole. So stay tuned. In 1 s. We'll introduce our illustrious guests. We got a great crew that really does super duper work in the background for us. We have our researchers that include Manny, Levine, Wolf, Erin, Collins, Deandra Howard, and shared and Die guide, shared. It also does some marketing work for us and then our math our production person is Matthew Campbell, who gets our shows out almost on a weekly basis now. So it's been great. This is our. I believe it's close to our seventieth show. So it's been a good run. Clarence Jones is my co-host with me on this show, and it's been a wonderful venture. He provides some incredible insights from a community perspective, and greatly, greatly appreciates it. So Clarence, thanks for being with us, and then also human partnership is our sponsor for these. These great shows, a community health organization that's involved in a lot of different issues around health for all of us, for all of us, you could check them out at human partnership.org. So thanks to everybody. So today, like I said, we're gonna be talking about a cancer plan, the 2025 cancer plan, 2025, cancer plan and Today we have Doctor Sumeda Penhider from the mail clinic with us, and she's got an illustrious background here. She's done her postdoctoral work at Mayo Clinic, and has her doctoral degree in biochemistry and genetics. She currently works as a manager and consultant with the Mayo clinic in their strategy department, where she advises on strategies for systems and procedures for clinical practice optimization and enhancement. It's interesting. My daughter in Boston works in that area, at the in, in, in cancer. Actually, also, she's involved a lot with health equity, which also overlaps with a lot of the different objectives in the state plan. So thank you. Thank you so much for being with us. By the way, she also serves as the vice chair of the Minnesota Cancer Alliance, which frankly was involved in developing this. This plan that we're going to be talking about today. So thank you very, very much. So let's get this show going here. Let's talk about the answer in general. You know, from your perspective, the summed  answer, obviously, is one of the major chronic diseases that we're facing in the country. ironically, in, in, maybe sadly, in the State of Minnesota. Cancer is the number one cause of death. Okay, in Minnesota. not in most other states in the country. It's second behind cardiovascular disease, heart disease and strokes. So you wanna comment on that a little bit?

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Sumedha G. Penheiter Ph.D.: I think that the reason being is that we have great health inequities in our state, 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 and therefore I think cancer is the number one cause of death in the United. 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. 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 cancer being the number one cause in in Minnesota versus the rest of the State.

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Stanton Shanedling: So let so let me ask you, as a follow up to that is that, do you think that's unique for Minnesota? Or do you think that that the similar problems. as far as cancer reporting exist in in other States as well.

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Sumedha G. Penheiter Ph.D.: Well, I think I think that there's great inequities in cancer, incidence and mortality inequities, and they are around race ethnicity and other underserved populations, and along ability, disability?I think it's a 2 edged sword. I think Minnesota has is a is a very health, conscious state. 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 it's it's that we're doing really well in that space, or we continue to do well in the space of cardiac health. So we are ahead of other States. But then we don't. We don't have that level of matching efforts yet, or even understanding, because cap cancer is a very complex disease, and it stands all the way from etiology to prevention, detection, treatment. So I think one is this just not enough understanding 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 and and your Bmi, and also making sure that exercise is part of your early

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Sumedha G. Penheiter Ph.D.: early lifestyle, the the same level of awareness and intention is not there in the cancer space to the same degree? Yeah. Yeah. And then a quick one. And then, Clarence, you can chime in here.

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Stanton Shanedling: Do we link our efforts that you know of? You know that even our statewide efforts that we'll get into in a in a second here with other. with other groups around the country, like like, for instance, I mentioned, like my daughter, she works at Dana Fiber Cancer Institute in in Boston. So do we? Do we cross over with any of their initiatives at all, or or look at data together? Or is it really more state by state, from what you can, what you know.

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Sumedha G. Penheiter Ph.D.: 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. 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 tri tribal land versus  urban communities versus rural communities and understanding that the cancer burden is different. So although we definitely get implementation and design ideas from other states. Cdc does a really good job of center for the 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. There are meetings that Mdh. Attends with other State cancer plan committees

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Stanton Shanedling: the goal is really to get ideas from them. But to focus on the local burden. Yeah, Gotcha.

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clarence jones: you spoke in your previous conversation a lot of times about the lack of awareness and among groups of people. Could you talk about this plan, and how does it it it plan to to address that?  I mean, P. Are people not aware, or is there a strategy for that, or communicating more effectively with people to make them more aware of the the risk of cancer. 

Sumedha G. Penheiter Ph.D.:this plan is 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. So the way this is done is trying to reach communities at the grass root levels to the most extend 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. 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 areHa! I 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 again going to grassroot level, looking at burdens and then forming our strategy. So it's never in isolation or vacuum. It's always done in concert with the community members and the members that are part of the alliance. 

Stanton Shanedling:  So you know, a few shows back. We had  Matt Florrie on the show, and he was talking about cancer screening. And I and I noticed, as I reviewed, reviewed the plan. Some of the objectives really focus in on on screening, whether it be for breast cervical, colorectal cancer, lung cancer, screening, etc. So talk to me about screening from an from objective standpoint, and then perhaps, we can apply this to many of the objectives here. You're you're 8 years into this plan already. Okay, so how are we doing? So let's talk about screening. First of all, go ahead.

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Sumedha G. Penheiter Ph.D.: So, as you mentioned, we are focused on. 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. And so to that. But 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, you know, long term sustainable and come to fruition. So we have done significant work in that space, for instance. we have made sure that the cost for sharing for best the cost sharing part of us, you know, 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.  We have made sure that those are covered by state regulated insurers. So we have made some efforts in that space through policy. In addition, we have also gone up through things like mobile mammography units and a lot of awareness in that space into rural areas. We actually use funding mechanisms through the Alliance where we fund our partners and community members to amplify the work around these objectives. So we have done significant amounts in each base 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 And you know, while I do talk about detection, early detection, I want to say that we follow the whole spectrum from detection. But then, you know, a lot of people are in the treatment phase. and the survivorship phase. We also support them in that space. But early detection there. 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. But then there's a lot that do not have a familiar history and yet would develop some of these cancers. So the idea is to do early screening based on a variety of techniques, one of which is genetic testing or genetic screening, and and several others like diagnostics like breast exams, and just going into communities and removing the hesitation and cultural nuances that are round testing and and and encouraging them to take care of their help.

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clarence jones: Okay. yeah. So that's just me you talk a little bit about about about challenges. There's always the rule versus Urban strategy. Cause you talk a little bit more about that, because were the were the challenges the same? Or did was was there special strategy? They had to be developed for each for each group? You probably rural versus urban.

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Sumedha G. Penheiter Ph.D.: 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. there's still, you know, depending on what city you live in. Transportation can still be a barrier and in urban areas people are working. You know, some cases round the clock. So, making time for help appointments and coming in to get their screening done, and a lot of efforts are in clinical trials, space to address and understand cancer and provide state of the art therapy therapeutics to make sure that answers are cured if they are indeed occurring. And there's just that social determinants of how 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 additional factors that contribute to risk of cancer, such as environment and pollution definitely add to that burden. So I think the strategy has to be different again, based on the campus 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.you know, treatment. and in that we've worked hard to establish pilot hubs in the in the rural areas to the Minnesota Clinical Cancer Trial Network.

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clarence jones: To have some of these clinical trial 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. It just strategy to address them are different, based on what they are. There's more food security in urban areas. There's more you know, inability to walk and get exercise, because obesity does help just lead to cancer occurrence.this is 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, it's just that that difficult gap with the neighborhoods is immense.

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Stanton Shanedling: so let me let me let me connect a little bit here. So we just got done couple of weeks ago doing a a similar show in the cardiovascular arena, and they just finished the development of their new plan 2023 to 20 or 2035, I think. Okay. So this particular plan was developed in 2015 and I, I'm just curious with the cardiovascular side of the equation. Th, this, their plan really focuses on community engagement. Okay, so was that part of the that perhaps you could recall was that part of the Psyche putting together the the plan for cancer, or has community engagement as far as the objectives for this plan become more of a thing that's happening today than it did back in 2015. Do you recall at all?

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Sumedha G. Penheiter Ph.D.: Like I shared? You know, we're kind of using the same playbook with some modifications for the new cancel plan that we're formulating.

And it was very much based on listing sessions. We call them listing sessions that were at the grassroots level to understand the burden. 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, 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 if possible. So that's kind of our strategy that we adopt to make sure this community engagement. Like, I said. You know, we worked on legislation with a grant funded for community health workers. We worked with the community health workers organizations in Minnesota very closely to ensure that their work would be covered and paid for. So community is definitely the the center of our work.

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clarence jones: I wanted to say I can vouch for that. I was involved with the the Alliance. And there was a a definitely a community engagement aspect of it. So it was. yeah, which is, which is, you know why, we're glad that Dr. Sama is here to talk about that. Yeah, great. So you know a lot. There's like

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Stanton Shanedling: 19 objectives in in the plan that I that I see and a bunch of em focus on prevention such. And you know, maybe we can kind of encapsulate them all because I'm sure they all have some kind of a risk factor aspect to it. But you know, like tobacco. Obesity, vaccinations, radon sunburn and inboard, tanning salons, etc., so can you kind of encapsulate? I guess the best is the best way of saying this. The Prevention oriented objectives, and how it is that the plan hopes to engage the public more in prevention.

Sumedha G. Penheiter Ph.D.: I think I would like to say that when the cancel plan is formed up, 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 form. 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 to advance certain initiatives. So I feel that it's very. This is this is a multifactorial issue in. When you say, prevention. It's hard to know what prevention should look like if you don't have data. And so we have focus highly on on getting accurate data current data and making sure that the recent win in the legislative efforts was to make sure that the data that Minnesota collects is now linked to other cancers plans as well as to the Cdc And that was something that we requested through the Legislature, and it wasn't a win for us. So you know, accurate data is one. and we funded a lot of grants. Strategy action grants around breast cervical and colorectal cancer screening have always had patient survivors advocacy groups and  coalition leaders as part of our members who have gone and brought our message forward as well as opt bring in the needs of the state and overall the cancer and concern. We have also worked with a lung cancer screening task force that was established. Is so in addition to screening, you know the tactical aspect of the the technical aspect of screening, there's a lot of information that 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 centered events for patients and their families and we created these pink shawls for the American Indians, women that were diagnosed with cancer and and so it's it's it's very multi factorial and doesn't just target the actual screening part as such.

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Stanton Shanedling: you know. I you know it's interesting. I can't help but think that  for most people.  it's a major shock when you are diagnosed with cancer.: I mean, it's just like, you know all. If all of a sudden, somebody you know, the healthcare Provider says, unfortunately, of cancer, whatever cancer it may be. and I was struck by the objectives that they're focused on help or assistance, like support services or patient navigation, or financial and legal burdens, those those those types of things. So Ca, can you touch on that a little bit to to help people who are all of a sudden they're recently diagnosed with it, or they're in the midst of it.I'm impressed frankly by the by, the objectives that focus on assistance.

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Sumedha G. Penheiter Ph.D.: Well, II think it's interesting. There's there's a lot, you know. There's a lot of efforts in place to get the screening part done and a lot of federally qualified health centres offer a screening now.  But the thing is what next? If you do end up positive. There. 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 you know the mortality and morbidity rates become a concern. And so we realize that while the medical centers are still on top of screening somewhat because of the heaters or their reporting requirements. Does that impacts their overall status as help centers? the space that was lacking was really the support. And in a lot of people, for instance, in some cultures in the Indian country the word cancer is taboo and there's so many cultural nuances in the Hispanic community where it's basic idealistic and left to God. And and you always discuss things as a family versus a loan. So there's a lot of cultural nuances  that are not as straightforward as you would think in in addressing cancer. Post diagnosis. So a navigator is someone who helps this 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 child care 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, 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 pounds paying for it. I know what the Mayo clinic is. Once you're diagnosed with cancer, there's that counselling for the family to be prepared for what lies ahead. So diagnosis, is, and treatment is one aspect that the social, emotional aspect of cancer like you said, it's so shocking and then can be so overwhelming  that we feel that we are not. We're letting our cancer patients down if we're not

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clarence jones: also focusing on the support and the legal aspect of things. Yeah, yeah, clearance. Yes. So, Dr. Samuel. So you know, this is help chat. If someone asked you a very, very chattery chatter chat question, what's been the biggest challenge with this plan? I mean, you've been, I mean, you've got some you got. You've got all these. You got 90 strategies. A lot of focus is what's been the biggest challenge with this plan.

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Sumedha G. Penheiter Ph.D.: So from what I understand, the challenges has been, we try 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 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 plans. 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 and and again Covid didn't help. You know we we lost about 5 years in this mix with Covid where we were really slow down. So II think 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 we that is required to to carry out a plan in action and also resources in place, so that the biggest challenge really has been in that space. Where we 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 what the H can be cancerous space and really addressed inequities. We have a health Equity Network Group, a cancel 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. I think that the challenge has been. you know, going from just individual organ focused, really understanding a common health equity thing which we have overcome successfully now. But it was difficult during the time 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. So it, you know, once 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. So those are the general challenges that I can today. Address your question correctly.

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Stanton Shanedling: You know 1 one thing that I've I've I know, cause I've been involved in in in creating plans. You know, these big, all-encompassing plans. you don't want to forget something. That's one thing you know, no matter how complicated the in this case, the chronic disease might be. You don't want to forget some aspect of it. And so you're always assessing and reassessing in the development of the plan. One thing that that we we had Dr. Nico prank from from health partners on who was the the Co. Chair in the development of the healthy people? 2030 objectives for the nation that were developed basically in in 2020. Okay? And so this, this particular plan, this state plan in cancer was already 5 years into it, even though there was kind of a shall we say a holding pattern? And on many of the the objectives given Covid in what Covid did for a lot of the public health oriented things. So let me ask you, when when you developed the the 2015 plan, was there a connection made with healthy people. 2020 to see if there was overlap between the objectives that you're developing and the objectives for the nation. So there's some sinking going on.

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Sumedha G. Penheiter Ph.D.: I think we looked at a variety of resources. Although I was not in the leadership team at the time, II am almost certain that we did. You know we we did follow a lot of guidelines and healthy people. 2020 must been one of them as well: I can imagine that I can't imagine that, not being there. 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 to see what's most feasible and and what speaks to them? Because if it is not addressing the local burden, and if it is not got the engagement of our partners, it's not going to go anyway. So long story, you know the the prox of it is. Yes, I'm sure we looked at healthy people. We've looked at many other parameters. That's the Minnesota community measurement resource. There's a variety of resources that establish many things around cancer burden cure treatment, availability access. You know, community resources. So it's a, it's a composite picture. I know my answer doesn't seem straightforward. But what I'm saying is probably was one of the reasons. Yeah. Yeah. And I'm sure it will be going going forward in the, in, the, in the development of of a new plan. So talk to us a little bit about the the Minnesota Cancer Alliance overall, you know who who are, who's part of that what's their their particular goal, etc., as it relates to the plan itself. 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 and should be done independent  of the with the guide independence of the guidance of Mba. Direct guidance, and really be

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Sumedha G. Penheiter Ph.D.: an outcome of public awareness, public concerns and and public needs and so the main purpose of the Minnesota Cancer Alliance is really to form this cancer plan independently in collaboration with the community and and focus on the spectrum from etiology to detection  to cure. And and then then, you know, palliative care or survivorship.So I feel the alliance is, is, is an organic evolution. 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.

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Stanton Shanedling: So it, you know it's it's interesting that you you say how Cdc requires it, as far as as as a grant to develop, to have first of all have an alliance, and then, second of all, to develop a plan. It's interesting in the cardiovascular meana. They did that. They required that as well for years, and then most recently, they did not require it, but it was interesting because we had a cardiovascular alliance. And we asked the very question, well, should we continue doing a plan making a a plan? And the answer from the partners was absolutely yes, and I'm sure it's the same thing is to in the cancer arena as well because they felt that a plan provides a framework.It it helps us frame what we want to do. And we're all talking, you know, within that frame, going forward as opposed to all over the place. Do you think that there's that same sense in the in the cancer arena as well?

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Sumedha G. Penheiter Ph.D.: Definitely? I think you spoke very elegantly. It is the framework that is written and documented, and and a guideline that helps us go back and see where our efforts projective, where they, where they need more energy, and and and also 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 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 and their work and reduce the burden of cancer. So it's a it's a nice: a guideline, as I would say, to go to. So I agree, yeah, I think the framework is very necessary.

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Sumedha G. Penheiter Ph.D.: So and it also helps. You know, everybody's so focused in their specific space. Clinicians are very focused on diagnosis and treatment.

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Sumedha G. Penheiter Ph.D.: And then, there's there's this financial legal companies that are focused very much on the financial legal part of it. Insurance clinical Ta Trials group focus is very much on making sure that you know state of the art. Clinical therapeutics are available, so everybody can end up being kind of in their own very focus silos, 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. Rather.

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clarence jones: Yes, Dr. Samuel. Once again, I know I asked you about the biggest challenges. Now, I'm gonna ask you and this plan, and I know it doesn't end up 2025. But what is some of your some of your greatest successes. What do you? What do? What really stands out for you as a success with this plan?

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Sumedha G. Penheiter Ph.D.: No, like, I said, a lot of it is the success we gauge our success as as enforcing when building something through policy. I think the biggest successes from what I see based on evaluation of database is, we have really address. The Hpp vaccination issue. The Minnesota Commission on Cancer has presented to a lot of medical professionals on increasing Hpv vaccinations. We've funded some stakeholder, you know, specific advisory groups  and trained young leaders on the information of HB. And really tried to bring awareness of this very preventable cancer to a lot of areas. And I think we've a lot of effort and success database in in a adoption of the vaccine in young you know. Pre teen a adolescence despite a whole lot of hesitation in males and female. So I think, Hpv. Cancer screen. A vaccination and awareness of the Hpv. Cancer has been a very successful aspect of it. I also think tobacco you know, tobacco use in general. We've presented several times, and advocated for State by legislation for raising the age of 5 or 2 21, and that was passed into a law in 2020.

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Sumedha G. Penheiter Ph.D.: We also advocated for the 2019 legislative session to ban e-cigarette use indoors. 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 that, not only focusing on the greatest, but for the greatest number of all, but also for those that are not in the greatest number. and I think that just the understanding of your health and equities, and and and that's, you know, availability of clinical care as well as survivorship.: And how differently it impacts some communities versus the other, and making sure that that's kept in mind. I think that's been the biggest success is just increasing awareness and focus on health inequities in addition to overall cancer care.

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Stanton Shanedling: Let me let me let me ask you, is there an entity that's responsible for reporting out how things are going with the plan? Or was it just kind of a a total partnership type of thing you know, like, there's some some plans where the Department of Health, for instance, is responsible for getting the measurement. Where are we with our screening levels? Or where are we with our, you know, policy, development, or whatever. And then, consequently, then reporting out, is there is like the Cancer Alliance responsible for that, or is it like a shared ownership on everything?

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Sumedha G. Penheiter Ph.D.: I think when it comes down to it, it's the Minister of Department of Health. That was, you know, is is the center point of receiving, funding, and reallocating. Funding for the work we do and is, is the is the one that sends these reports. But we definitely have input on that. And we definitely review that. And we have a very, we have an Evaluation Committee within our alliance as well. Where we have evaluation scientists that continuously review and evaluate on how we're doing in terms of, you know, indicators. Success, the effort put in and the barriers addressed. And so your the answer is, it's Mdh. That's the Department of Health that send progress reports on a regular but definitely, it's not something that we do just reporting purposes. We constantly review our strategies and tactics and and and the efforts that have gone in how much we've done.

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Stanton Shanedling: Yeah. So you know, going forward. Okay, cause you are, you are going forward in the development of a plan. These plans take a while to to develop for sure. if you're seated at the table for the development of the the next plan and you were, you're you were kinda heading up the initiative Where would you start? Okay, would you start on the existing plan that we have and where we've been or, you know, clean this late, and let's get a new plan going with some different exciting things in it. Tell me. maybe, where your head is at with regards to that, and then maybe your assessment on where the Minnesota Cancer Alliance is on the development of a new plan.

Sumedha G. Penheiter Ph.D.: So the the plan is the leadership team, for the plan is already in place, and they've done a lot of great work already. Heather King is leading the actual plan. Team formed an advisory team and what we have done is really used. We've gone within our alliance and used equity portion to inform us on the cancel help through the cancel help equity network, which is again one of the networks within the alliance that focuses on health equity. We have brought a policy committee in the Evaluation Committee in. And then we have the community listing sessions that we've started with our partners. We had a summit on not long ago where we did some listing sessions to understand the burden. We are looking at the Minnesota Cancer reporting systems to see what our current burden is and then also the Commission on Cancer network to for the practice aspect of it. So we are looking at the playbook from other accounts, plans that we feel have similar burdens and dynamics as the State of Minnesota. We are looking at the last plan as as really some of the things that were very successful in establishing that plan the lessons from that playbook But, like, I said, we are using a multi-pound approach with equity policy, evaluation, community data and practice  to make sure that we form this plan. So, although it'll be a similar framework, I think it'll be very current and informed, based on the recent concerns and burdens of cancer, and making sure that every objective has help, equity embedded like, I said, to eliminate health equity and the main goals will be still around each technology prevention, detection treatment. So I wish that's the general spectrum that we followed over the years. And that's what most cancer plans as well as the National Cancer Institute follows to make sure that you know one of the one of the, you know, it's very sometimes celebrities bring a lot of attention to one aspect of prevention and detection, and they they become the highlight of the whole work but we wanna make sure that all the entire spectrum is addressed. so yes, using the playbook from the last answer plan. But then also using current data burden and and input from the communities to understand what we should do next. Yeah, yeah. So let's go full circle here. We started out by saying that cancer is the leading cause of of death. And Minnesota and every year close to 30,000 Minnesotans are diagnosed with cancer. Okay. just for our listening audience. in Minnesota. Do you have a handle on? What's the most prevalent cancer that that we're dealing with?

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Sumedha G. Penheiter Ph.D.: I think again, you know, I would hate to say that prevalence is so dependent on how disparities you know. What might III would alienate some if I said that versus all that or cancer is is a real concern, and native communities, but doesn't even come in the top 5 overall in the numbers. But I would say the most preventable and the most you know, the most addressed are cancer. The breast cancer, the prostate, you know. Those are the ones then there's also pancreatic cancer that has very high mortality rate. So there's the incidence rate, the mortality rate. So there's a whole balance of that. And and really it's through the lens that you're looking at. So I don't wanna pick or bring attention to a favorite cancer. But I would say that there's incidences. And then there's the treatments, and then there's the mortality, and the most commonly this best ones are color, actual brass from state, and and some of these are early detection. How many detectives and and the earlier you're diagnosed, the the more the better the

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Stanton Shanedling: final comments. Clarence.

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clarence jones: Well, I just want to say that's Samir. I thank you for for the conversation. I mean, there's so much that there's so much that we need to learn more about, I mean. And and I think that one of the important things for us is having people like you who can come on and to help us understand more clearly and also for us to better understand the communities impact, but also to talk about also how the community can be more engaged. So we need to to make sure that the community is engaged in this conversation as well. And so I just wanted to thank you once again. And I'll turn it back to you, Stan.

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Stanton Shanedling: and and I thank you as well for for your leadership on, on, on this. I think it's important for the community to know that we have good, trusted professional leaders that are trying to really, really make a difference in in this arena. So many thanks to you and your and your insights into the this plan and the future plan for our listening audience. We will have a lot of information available on our website. And you know, Dr. Sumeda, if there's other information that you want to share with regards

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Sumedha G. Penheiter Ph.D.: sure? We have the plan listed on our website. I can share that. And we are also not constantly updating how our new plan is evolving main page. So Minnesota cancel line.org. I'm happy to set. Send the website to you. I also wanna 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 and

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Stanton Shanedling: The fact that we were able to bring some attention to it this morning means a lot to me. Yeah. Well, thank you. You're great. You're a great spokesman for it. So thank you. Thank you. So, going forward our next show for health chatter, we are going to be addressing the issue of grief. So Clarence and I are going to look at that topic. : And there's a lot of things that we're grieving about individually as a nation and as a world that certainly affects our health. So with that everybody keep health chatting away.