The CEO Cancer Gold Standard

The Evidence and the Benefits

Based on Scientific Evidence and Beneficial to Your Organization

The CEO Cancer Gold Standard

The Evidence and the Benefits

The CEO Cancer Gold Standard is a workplace-based initiative developed by the CEO Roundtable on Cancer, a nonprofit organization comprised of chief executives from several corporations, all of whom have a keen interest in fighting cancer because they care about the health of their employees. They created the Gold Standard, a series of requirements that help employers meet three goals, as seen in the Gold Standard seal:

Based on Scientific Evidence

The requirements of the Gold Standard are based on scientific evidence, as outlined in this brochure, Pillar by Pillar. Experts were consulted to help design the program so that more cancers would be prevented and detected early, and employees would be ensured access to the best available treatment. Much of this evidence is not new. For example, it has been known for decades that tobacco causes cancer. As many as 50% to 75% of cancer deaths in the United States are caused by behaviors such as smoking, poor diet, and physical inactivity. But despite the known health risks, individuals are still engaging in these behaviors. By following three positive behaviorsnot using tobacco, eating healthy food, and being physically active, your employees may lower their risk not only for cancer but also for other chronic, serious conditions such as obesity, and diseases such as diabetes, cardiovascular diseases, and respiratory ailments. All of these diseases and conditions are not only very costly, they also may be preventable. The Gold Standard provides a framework to help your employees stay healthy. Your organization is an ideal avenue for helping employees and their families cut their risk of cancer and other preventable diseases because workplace programs are an extremely effective and cost-efficient way to improve employee wellness. Employees are receptive to health-related programs in the workplace, and they as well as your organizationcan benefit from the results.

Risk reduction
Lowering their employees risk of cancer,

Early detection
Helping employees detect cancer early when outcomes are likely to be more favorable, and

Quality care
Ensuring that their employees have access to high-quality cancer treatment, including cancer clinical trials. The Gold Standard has five areas of focus, or Pillars, as outlined fully on page 5. For each Pillar, Gold Standard organizations: provide benefits and programming aimed at preventing cancer, detecting it earlier and offering access to high-quality treatment, including cancer clinical trials, and sustain a culture that values, supports, and promotes a healthy lifestyle and provides the support needed when a diagnosis of cancer becomes a reality. A culture that fosters wellness can serve as a catalyst for employees to actually make use of the benefits and programming. The Gold Standard has been implemented by numerous organizations of varying size, industry, and geographic location. Like the CEOs who created this initiative, the CEOs from every organization that has adopted the Gold Standard care deeply about the health of their employees and have chosen to invest in the health and well-being of their employees. They recognize that healthy employees are essential to the health of their organization.

Adopt the CEO Cancer Gold Standard in your organization.

The CEO Cancer Gold Standard

The CEO Cancer Gold StandardTM At A Glance
Why Participate in the Campaign Against Cancer?
Before you read about the scientific evidence upon which the Gold Standard was created, first lets address why it is so important and beneficial for you to actively work toward reducing the human and dollar costs of cancer. There are three important reasons: The Gold Standard focuses on five critical areas, known as the Five Pillars, which align with the Gold Standards goals and requirements as follows:

Risk Reduction: reducing the risk of cancer by not using tobacco and by maintaining a healthy and active lifestyle
1. Tobacco Use Establish and enforce tobacco-free workplace policies.
Provide coverage for, at either no cost or at a reasonable cost-sharing level, evidence-based tobacco-cessation treatments (counseling and all FDA-approved prescription and nonprescription medications). Provide employer-sponsored tobacco-cessation programming.

The risk is high

The risk of being diagnosed with cancer over the course of ones lifetime is high: In recent years, the overall risk of developing cancer in the course of ones lifetime has been calculated to be approximately 45% for men and 38% for women. It should be noted that doctors often cannot explain why one person develops cancer and another does not. But research shows that certain risk factors increase the chance that a person will develop cancer and some risk factors, such as family history, cannot be avoided. But many of the known risk factors can be avoided. Far too many individuals will receive a cancer diagnosis. According to the National Cancer Institute, in 2010 new cancer cases were estimated to total over 1.5 million in the United States and of those, nearly half a million are expected to die. In the United States, while heart disease remains the leading cause of death, cancer is the second-leading cause.

2. Nutrition Sustain a culture that values, supports, and promotes healthy food choices.
Provide access to healthy weight and/or nutrition programming.

3. Physical Activity Sustain a culture that values, supports, and promotes physical activity.
Provide access to opportunities for physical activity.

Prevention makes a difference

Maintaining a healthy weight, exercising, getting cancer screenings, and not using tobacco products could stop nearly half of all cancer deaths. More than 75% of healthcare costs are due to chronic conditions the most common and costly of all health problemsbut they are also the most preventable. By leading a healthy lifestyle, employees can reduce their risk not only for cancer but also for several conditions such as obesity, and diseases including cardiovascular disease, respiratory ailments, and diabetes.

Early Detection: detecting cancer at the earliest possible stage, when treatment has the best chance of improving outcomes, through age- and gender-appropriate screenings
4. Prevention, Screening, and Early Detection
Sustain a culture that values, supports, and promotes the prevention, screening, and early detection of cancer. Ensure that health benefit plans cover, at either no cost or at a reasonable cost-sharing level, screening services for breast, colorectal, and cervical cancer, and all FDA-approved vaccines for the prevention of cancer.

The costs are high

Cancer costs are high on both the individual and national level, and without early detection and quality treatment, the costs can be significantly higher. The cost of cancer in the year 2020 is projected to reach at least $158 billion (in 2010 dollars) and if you assume a 5% annual increase in medical costs in the initial and final phases of care, the projected 2020 costs increase to $207 billion. Costs are likely to increase even more as new, more advanced treatments are adopted as standards of care. These cost figures do not include other types of costs, such as lost productivity, which add to the overall financial burden of cancer. And the personal toll that the disease takes on the individual and his or her family is immeasurable.

Quality Care: ensuring access to the best available cancer treatment including cancer clinical trials
5. Access to Quality Treatment and Clinical Trials
Ensure that health benefit plans provide access to cancer treatment at Commission on Canceraccredited programs and/or National Cancer Institutedesignated cancer centers. Provide education about cancer clinical trials. Ensure that health benefit plans continue to provide coverage for the current standard of care when covered individuals are participating in cancer clinical trials.

Pillar #1: Tobacco Use

The Evidence
Tobacco causes cancer
Smoking causes about 30% of all U.S. deaths from cancer. Smoking is a known cause of multiple cancers, heart disease, stroke, complications of pregnancy, chronic obstructive pulmonary disease (COPD), and many other diseases. There is no safe level of exposure to secondhand smoke. It causes lung cancer in nonsmokers and has also been associated with heart disease in adults and sudden infant death syndrome, ear infections, and asthma attacks in children. Like cigarette smoking, the use of smokeless tobacco, such as chewing tobacco, snuff, or moist snuff, produces addiction to nicotine and has serious health consequences.

Effective tobacco-cessation help is available

Numerous effective medications are available for tobacco dependence. Seven first-line medications approved by the U.S. Food and Drug Administration (FDA) reliably increase long-term smoking abstinence rates. Individual, group, and telephone counseling are effective, and counseling through a quitline is an effective intervention with a broad reach. Counseling and medication are effective when used by themselves, but the combination of counseling and medication is more effective than either alone. Tobacco dependence interventions, if delivered in a timely and effective manner, significantly reduce the smokers risk of suffering from smoking-related disease. It is difficult to identify any other condition that presents such a mix of lethality, prevalence, and neglect, despite effective and readily available interventions. Smokers are significantly more likely to quit successfully if they use an evidence-based counseling or medication treatment than if they try to quit without such aids. Evidence-based treatment can double or triple their odds of success.

It is costly...in loss of life, direct medical costs, and lost productivity

Tobacco use has been cited as the chief avoidable cause of illness and death in our society and accounts for more than 435,000 deaths each year in the United States. Tobacco use exacts a heavy cost to society as well as to individuals. Smoking-attributable healthcare expenditures are estimated at $96 billion per year in direct medical expenses and $97 billion in lost productivity. Tobacco use is a leading cause of lost productivitymore than alcohol abuse or family emergencies.

Programs offered at the workplace are very effective

Policy changes, such as implementing a tobacco-free workplace policy, often lead smokers to seek treatment. Tobacco-cessation treatments are both clinically effective and highly cost-effective relative to interventions for other clinical disorders, so it makes good financial sense for an employer to provide coverage for these treatments. When tobacco-cessation treatment is a covered benefit of insurance plans, it is more likely that a tobacco user will receive treatment and quit successfully. Since individuals spend much of their day at their workplace, employers have a built-in opportunity to encourage tobacco cessation on a sustained basis. Regular offers of support are essential to successfully quitting.

Quitting has immediate health benefits

Quitting dramatically reduces the risk of lung and other cancers, coronary heart disease, stroke, and chronic lung disease.

Many individuals want to quit...but it is very hard

More than 70% of the 45 million smokers in the United States today report that they want to quit, and approximately 44% report that they try to quit each year. Most of these efforts are both unaided and unsuccessful. Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. For most users, tobacco use results in true drug dependence, comparable to the dependence caused by opiates, amphetamines, and cocaine.

Pillar #2: Nutrition & Pillar #3: Physical Activity

Pillar #4: Prevention, Screening, & Early Detection

The Evidence
Obesity is associated with increased risk of several cancers as well as other major diseases. Both healthy nutrition and physical activity can lower those risks.
Compelling evidence exists that prevention of obesity reduces the risk for several types of cancer, such as colon, postmenopausal breast, uterine, esophageal, and renal cell cancers. Excess weight can stimulate cancer growth and it is estimated that 20% to 30% of the most common cancers in the United States may be related to being overweight and/or lack of physical activity. Healthy diets rich in fruits and vegetables may reduce the risk of cancer and other chronic diseases. Regular physical activity affects body weight and systems in multiple ways, and has been shown to reduce the incidence (morbidity) of and deaths (mortality) from diseases such as several cancers, cardiovascular diseases, respiratory diseases, stroke, and diabetes.

The Evidence
Screening for three cancers makes sense
Screening tests for three cancers: breast, cervical, and colorectal, can prevent or detect at least half of all new cancer cases. Patients whose cancers are found early and treated in a timely manner are more likely to survive these cancers than are those whose cancers are not found until symptoms appear. The use of screening tests to detect certain cancers early allows your employees to obtain more effective treatment with fewer side effects and better outcomes. Specifically: Breast cancer: Screening mammography in women aged 40 to 70 years decreases breast cancer mortality. Screening by clinical breast examination reduces breast cancer mortality. Cervical cancer: Most cervical pre-cancers develop slowly, so nearly all cases of cervical cancer can be prevented if a woman is screened regularly with a Pap test. In addition, the FDA has approved vaccines that are highly effective in preventing infection with certain types of human papillomaviruses (HPVs), which are a group of viruses, certain types of which can cause cancer. HPV vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds. Colorectal cancer: Regular screenings can reduce the number of people who develop colorectal cancer by 20%.

Pillar #5: Access to Quality Treatment & Clinical Trials

The Evidence
Clinical trials: a path to improved current and future treatments
Only a very small percentage of adult cancer patients participate in clinical trialsbut participation in clinical trials is essential in order to give current cancer patients more treatment options, find increasingly effective treatment methods with fewer side effects, and advance cancer research progress overall.

The Benefits to Your Organization

By leading a healthy lifestyle, employees can reduce their risk not only of cancer but of several conditions such as obesity, and diseases, including cardiovascular diseases, respiratory ailments, and diabetes. Your organization can decrease its direct medical costs, including those related to treating medical conditions that are preventable, while increasing productivity, enjoying greater ease of attracting new talent, and improving staff retention, worker satisfaction, and morale.

Clinical trials awareness and understanding needs to come before a cancer diagnosis, not after
Virtually every employee has known a family member, colleague, neighbor, or friend who was diagnosed with canceror they have been diagnosed themselves. Enabling employees to learn the facts, debunk the myths, and understand both the process and purpose of clinical trialsall before they need itcan help save their own life, the life of someone they care about, and lives in the future. Offering clinical trials participation to a just-diagnosed individual can add to a sense of stress and confusion if that person has either no knowledge or misinformation about clinical trials, and this affects their ability to make a decision about participation.

Here are just a few of the benefits to your organization for each Pillar of the Gold Standard:
Helping employees quit tobacco use, and incorporating healthy nutrition and physical activity into your companys culture can lead to increased productivity, lower healthcare costs, and better overall health. When employees are offered health benefits that include coverage for prevention and early detection, your direct and indirect costs of cancer can be reduced. Ensuring that your employees have access to quality care and expanded cancer treatment options such as cancer clinical trials means that employees may have a better treatment outcome and have the ability to return to work. Clinical trial participants are involved in the development of new drugs that may someday help everyoneincluding your organizations future employees.

Quality treatment makes a difference

Treatment for cancer varies widely across the country and even within communities. Although significant progress is taking place, moving research advances into medical practice continues to be challenging. In order for your employees and their dependents to have up-to-date options for treating cancer, access to accredited and recognized facilities is important. Cancer centers that meet these Gold Standard guidelines have the ability to collaborate with local practitioners where it is most geographically feasible, including a patients participation in some clinical trials.

In addition, there are other benefits:

Gold Standard recognition increases an organizations standing as an industry and community leader, and for healthcare organizations, commitment to the Gold Standard provides both internal and external integrity, with regard to practicing and upholding major health recommendations for ones own employees. Your organization joins the Gold Standard Community, symbolized by the addition of your logo and name on our accredited employers list, and actualized by access to post-accreditation information, materials, and shared experiences of successes and lessons learned. There is no membership cost or fees associated with becoming a CEO Cancer Gold Standard employer.

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A Case Study: Johnson & Johnson A Case Study: Johnson & Johnson

The adoption of comprehensive worksite wellness programs can benefit employees and can generate substantial positive financial returns.
Johnson & Johnson (J&J) was among the first organizations to adopt the CEO Cancer Gold Standard, and has been accredited since January 2006. As part of J&Js commitment to excellence in employee health, wellness and performance, in 2011 Thomson Reuters was commissioned to conduct an evaluation of the J&J health and wellness programs and services (from 2004 to 2010) with two goals in mind: Measure the impact of adopting the Gold Standard on the health and health behaviors of the J&J population. Develop a dashboard for J&J to utilize in conversations with other companies considering adoption of the Gold Standard, positioning J&J current year results as a benchmark or goal for other companies to achieve. What follows are the studys high-level J&J-specific findings and key messages for each of the Five Pillars:

2. Nutrition:
About one-fourth of the J&J employees who reported not following a healthy diet (defined as consuming fewer than five servings per day of fruits and vegetables) changed their lifestyle, subsequently reporting that they had improved their nutrition by consuming five or more servings per day. Over one-third of J&J employees who reported not following a healthy diet (defined as consuming three or more servings of fatty food per week) changed their lifestyle, subsequently reporting that they had improved their nutrition by consuming less than three servings per week. Obesity prevalence increased from 17% in 2004 to 21% in 2010, and is an area J&J is working to improve. The Gold Standard can serve as a framework to help employers lower obesity rates in their population by offering and promoting nutrition, weight control, and fitness programs. As seen in the J& experience, this is a challenging area, and will require ongoing efforts to change employees behavior. Encouraging healthy eating habits and lowering obesity rates will ultimately result in long-term healthcare cost savings.

1. Tobacco use:
At J&J, smoking prevalence in 2010 was 30% lower than it was in 2004. The tobacco-cessation success rate at J&J is high, ranging from 18% and 46% depending on the year. Employers who adopt the Gold Standard and successfully reduce tobacco-use rates may experience fewer absences, higher productivity, lower long-term healthcare costs, and healthier employees.

J&J recognizes that improving the health of their employees requires a long-term, sustained investment which will benefit the health of the organization as well as their most valuable asset, their employees and their families.

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A Case Study: Johnson & Johnson A Case Study: Johnson & Johnson

3. Physical activity:
The percentage of J&J employees with a sedentary lifestyle declined two percentage points between 2008 and 2010 (from 16.6% to 14.5%). Between 2006 and 2010, fewer individuals reported engaging in optimal levels of moderate physical activity, suggesting further outreach is necessary to encourage employees to have a higher level of physical activity. In a Gold Standard organization, employees are encouraged to increase their level of physical activity, and employers are likely to experience fewer absences, enhanced at-work productivity, and potentially lower healthcare costs. Again, it requires a long-term investment in the health of your employees.

5. Quality care:
Though still low, clinical trial participation rates increases steadily from 2006 through 2010. The percentage of cervical and colon cancer patients utilizing Commission on Canceraccredited facilities or NCI-designated cancer centers was higher in 2010 than in 2008. Encouraging clinical trial participation may contribute to discovering new, more effective treatments and higher quality of care. Promoting the use of high-quality cancer centers that have greater surgeon and hospital volumes could lead to better surgery outcomes. As noted above, the fact that J&J employee health programs showed favorable trends in key outcome metrics between 2004 and 2010 suggest that adopting programs aligned with the Gold Standard have had a favorable impact on the health of the Johnson & Johnson population. However, the study also identified that the opportunity for improvement remains in many areas, and J&J is committed to enhancing their culture of health. By implementing the CEO Cancer Gold Standard within the context of a broader health promotion initiative, J&J has helped their employees improve their health, engagement and performance while reducing their overall healthcare costs. J&J recognizes that improving the health of their employees requires a long-term, sustained investment which will benefit the health of the organization as well as their most valuable asset, their employees and their families.

4. Screening & early detection:

Screening rates have increased each year from 2008 to 2010 for breast, cervical, and colorectal cancers. Early detection rates for those same three cancers were high. Encouraging appropriate cancer screenings can lead to early cancer detection and improved outcomes for individuals. Employers may expect lower healthcare costs as well as favorable absence and productivity experience.

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Resources
Information in this brochure was primarily gathered from information published by the United States Department of Health and Human Services (HHS), specifically:

Fiore MC, Jaen 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 http://www.ahrq.gov/path/tobacco.htm

And from the websites of HHS and three of its Operating Divisions: The U.S. Department of Health and Human Services (HHS) www.hhs.gov The National Cancer Institute (NCI), National Institutes of Health (NIH) www.cancer.gov Centers for Disease Control and Prevention (CDC) www.cdc.gov Agency for Healthcare Research and Quality (AHRQ) http://ahrq.hhs.gov/

For More Information www.CancerGoldStandard.org an initiative of the CEO Roundtable on Cancer www.CEORoundtableOnCancer.org