Cancer Control Program Research Articles

Prevalence and genotype distribution of potential high-risk and high-risk human papillomavirus among women attending selected reproductive health clinics in lake victoria basin-kenya: a cross-sectional study

BackgroundPersistent human papillomavirus (HPV) infection is considered the primary etiological factor for invasive cervical cancer. Understanding the epidemiology of circulating potential high-risk (HR) and HR HPV strains is essential in updating epidemiological knowledge and recommendations on genotype-specific vaccination development. This study determined the prevalence and factors associated with Potential HR/HR HPV among women attending selected reproductive health clinics in Lake Victoria Basin.MethodsA cross-sectional facility-based survey made up of 434 women aged 16–68 years was carried out in two selected facilities. Structured questionnaires were administered to collect participant clinical and social characteristics. Cervical specimens were collected and HPV genotyping was carried out using RIATOL HPV genotyping qPCR assay. Descriptive statistics followed by logistic binary regression was done using R version 4.3.2.ResultsThe overall prevalence of potential HR/HR HPV among women attending the selected reproductive health clinics was reported at 36.5% (158/434). Specifically, in the rural setting, Gobei Health Center, the prevalence was 41.4% (41/99) while in the urban setting-JOOTRH, it was 34.6% (117/335). The most prevalent potential HR/HR HPV are 52, 67, 16, 31, 39, 45, and 31 among women. Age was the main factor associated with HPV infection with women between the age of 30–39 having the highest risk (AOR = 0.3, CI:0.2–0.7, p < 0.001).ConclusionIn both rural and urban regions, potential HR/HR HPV infection among women attending reproductive health clinics at the selected facilities remains common. The study identifies the need for effective implementation and clinical follow-up process of cervical cancer control program in the LVB.

Cancer screening uptake by women from India's largest state Uttar Pradesh: district-wise analysis from the fifth round of National Family Health Survey (2019-2021).

The Government of India (GOI) has launched a nationwide cervical, breast and oral cancer prevention and control program. However, the fifth round of the National Family Health Survey (NFHS-5), a nationwide survey conducted by the Ministry of Health and Family Welfare (MoHFW), GOI, has shown concerning results on screening uptake by both men and women across India. This study was conducted to describe the uptake of cancer screening by women residing in Uttar Pradesh (UP), the largest state of India. We analyzed NFHS-5 data available in public domain to determine the number of women (aged 30-49 years) participating in cancer screening across the 71 districts in UP state. We utilized population projections for the year 2021 provided by the population projections for India and states for calculating the number of women. The district-wise estimation was done using a projection of district-level annual population. Although the GOI has made screening available for common cancers, NFHS-5 results indicated that the screening uptake among women aged 30-49 years is a cause for concern. The data revealed less than 1% of women underwent screening, and some of the districts showed no screening uptake. GOI has laid down a framework for cancer screening; however, poor participation among women calls for research to understand the barriers to cancer screening and to develop interventions to address these barriers.

Impact of the COVID-19 pandemic on electronic referrals to rapid access clinics for suspected breast, lung and prostate cancers in Ireland.

The coronavirus disease 2019 (COVID-19) pandemic impacted cancer services worldwide. We examined the effect of the first three pandemic waves on the number of electronic (e)-referrals to rapid access clinics (RACs) for breast, lung and prostate cancer in Ireland. This study used a retrospective, repeated cross-sectional design. The predicted weekly number of e-referrals by suspected cancer types from March 2020 to May 2021 was calculated using the Holt-Winters seasonal smoothing method, based on the observed numbers from a representative pre-pandemic period (01 January 2019 to 01 March 2020) and compared this with the observed number across the first three pandemic waves (02 March 2020 to 09 May 2021). Percentage differences were calculated between observed and predicted numbers of e-referrals for the three RACs and patterns were examined in each wave. Observed e-referrals were lower than predicted for all three RACs in the first wave of the pandemic (15.7% lower for breast, 39.5% lower for lung and 28.1% lower for prostate) with varying levels of recovery in the second and third waves for the three e-referral types. The COVID-19 pandemic impacted patterns of e-referrals to RACs in the first three pandemic waves in Ireland. Early identification of changes in engagement with health services, such as a decrease in primary care presentations with a resultant decrease in e-referrals to RACs can allow for a rapid response from cancer control programmes. Continued surveillance of the impact of service disruption on cancer services allows policy makers and strategic leaders in cancer control programmes to respond rapidly to mitigate the impact on cancer outcomes.

Accuracy Analysis of Topographical and Morphological Code in the RSUP Dr. Sardjito Cancer Registry, Indonesia

In cancer cases, a cancer registry functions as a national cancer control program to analyze cancer severity and risk factors in specific areas, aiming to reduce morbidity and mortality. Accurate coding is essential for producing a high-quality cancer database. This study aims to analyze the accuracy of the cancer registry at RSUP Dr. Sardjito in assigning topography and morphology codes. A mixed-methods approach was employed to evaluate code accuracy and identify factors influencing accuracy and inaccuracy based on the 5M framework. Data were sourced from the Hospital-Based Cancer Registry at RSUP Dr. Sardjito, with a total population of 4500 patients in 2021. A sample of 1000 cancer patients was selected using a simple random sampling technique. Each sample was analyzed as true or false based on verifier notes, revealing that 904 topography codes were accurate (90.40%) and 96 were inaccurate (9.60%). For morphology codes, 913 were accurate (91.30%) and 87 were inaccurate (8.70%). Researchers conducted in-depth interviews with registrars and verifier doctors and observed all cancer registry activities, focusing on topography and morphology codification. Observations and interviews indicated no obstacles in codification activities, but inaccuracies occurred, possibly due to case complexity. In conclusion, the study demonstrates high accuracy in the coding of cancer cases at RSUP Dr. Sardjito. The complexity of cases may contribute to inaccuracies. The study suggests continuous evaluation to enhance coding accuracy, which is crucial for effective cancer control programs.

National age-specific mortality trends for cervical and breast cancers in urban–rural areas of China from 2009 to 2021: a population-based analysis

BackgroundCervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women. This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.MethodsAge-specific mortality data for cervical and breast cancers among Chinese women aged 20–84 years were obtained from China’s National Disease Surveillance Points system spanning the years 2009 to 2021. Negative binomial regression models were utilized to assess urban–rural differences in mortality rate ratios, while Joinpoint models with estimated average annual percent changes (AAPC) and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.ResultsFrom 2009 to 2021, there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas. A rising trend in the screening age of 35–64 [AAPC: 4.0%, 95% confidence interval (CI) 0.5–7.6%, P = 0.026] for cervical cancer was noted in rural areas, while a stable trend (AAPC: − 0.7%, 95% CI − 5.8 to 4.6%, P = 0.78) was observed in urban areas. As for breast cancer, a stable trend (AAPC: 0.3%, 95% CI − 0.3 to 0.9%, P = 0.28) was observed in rural areas compared to a decreasing trend (AAPC: − 2.7%, 95% CI − 4.6 to − 0.7%, P = 0.007) in urban areas. Urban–rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer. Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments, with the most significant surge in mortality observed among the 35–54 age group across urban and rural areas, periods, and regions in China.ConclusionsSpecial attention should be given to women aged 35–54 years due to mortality trends and rural–urban disparities. Focusing on vulnerable age groups and addressing rural–urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.

Optimizing tracking and completion of follow-up colonoscopy after abnormal stool tests at health systems participating in the Centers for Disease Control and Prevention's Colorectal Cancer Control Program.

We present findings from an assessment of award recipients' partners from the Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP). We describe partners' processes of identifying and tracking patients undergoing stool-based screening. We analyzed data from eight CRCCP award recipients purposively sampled and their partner health systems from 2019 to 2023. The data included number of stool-based tests distributed and returned; abnormal findings; referrals and completion of follow-up colonoscopies; and colonoscopy findings. We also report on strategies to improve tracking of stool-based tests and facilitation of follow-up colonoscopies. Five of eight CRCCP award recipients reported that all or some partner health systems were able to report stool test return rates. Six had health systems that were able to report abnormal stool test findings. Two reported that health systems could track time to follow-up colonoscopy completion from date of referral, while four could report colonoscopy completion but not the timeframe. Follow-up colonoscopy completion varied substantially from 24.2 to 75.5% (average of 47.9%). Strategies to improve identifying and tracking screening focused mainly on the use of electronic medical records; strategies to facilitate follow-up colonoscopy were multi-level. Health systems vary in their ability to track steps in the stool-based screening process and few health systems can track time to completion of follow-up colonoscopy. Longer time intervals can result in more advanced disease. CRCCP-associated health systems participating in this study could support the implementation of multicomponent strategies at the individual, provider, and health system levels to improve tracking and completion of follow-up colonoscopy.

Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries.

The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.

Demographic, health and socioeconomic characteristics related to lung cancer diagnosis: a population analysis in New South Wales, Australia

BackgroundLung cancer is a major cause of health loss internationally, and in Australia. Most of that loss is inequitably concentrated among vulnerable or disadvantaged people and amenable to prevention and earlier detection. In response, best practice lung cancer care considers peoples’ background, circumstances and care needs. Comprehensive, person level descriptions of demographic, health and discrete socio-economic disadvantage related factors are therefore required to inform best practice. We examine population wide correlations of demographic, health and socioeconomic characteristics with lung cancer diagnosis for use in cancer control programs, including screening.MethodsA study of 5,504,777 (89.9%) adults living in New South Wales and participating in Australia’s Census in August 2016 with subsequent follow-up to the end of 2018. The Australian Bureau of Statistics’ (ABS) person-level integrated data asset linked census records with the NSW population cancer registry which includes primary site. Our study compared census participants who did not experience cancer in the follow-up period with those diagnosed with lung cancer, (n = 6160 and ICD10 C33-34). Outcomes are expressed as the adjusted relative odds (aOR) of incident lung cancer among adults in the community and measured using multi-variable logistic regression models. Validated ABS methods informed categorisation of social and economic variables.ResultsMultivariable comparison of those with lung cancer and those without a first cancer diagnosis (3276 lung cancers among 2,484,145 males; 2884 lung cancers among 2,944,148 females) showed associations with increasing age, varying ancestry, living alone (aOR = 1.30 95% CI 1.19–1.42 males; 1.24 95% CI 1.14–1.35 females), number of health conditions medicated, less than Year 12 education (aOR = 1.40 95% CI 1.30–1.51 males; 1.37 95% CI 1.27–1.48 females) and housing authority rental (aOR = 1.69 95% CI 1.48–1.94 males; 1.85 95% CI 1.63–2.11 females). Additional associations occurred among males with low income, disabilities before age 70, those unemployed and labouring occupations. As numbers of characteristics increased, so did the likelihood of lung cancer.ConclusionWe provided a population wide description of characteristics relevant to lung cancer diagnosis. Deeper knowledge of these characteristics inform continuing development of lung cancer programs in prevention (e.g. tobacco control) and detection (e.g. lung cancer screening), then help prioritise targeted delivery of those programs.

Successful Establishment of a National Cancer Control Program (NCCP) and Cancer Registry in Eswatini: Lessons to Inform NCCPs in Low- and Mid-Income Countries

Successful Establishment of a National Cancer Control Program (NCCP) and Cancer Registry in Eswatini: Lessons to Inform NCCPs in Low- and Mid-Income Countries

Prostate cancer: A review paper of the evidence in relation to prostate cancer screening in the Irish Defence Forces

The lack of national guidelines for prostate cancer (PCa) screening in Ireland has historically led to ad-hoc screening practices among healthcare providers. This review focuses on evidence for and against prostate cancer screening among military personnel in Ireland, set against the backdrop of evolving guidelines and practices both in Ireland and internationally. A review of published literature was conducted, incorporating data from various studies and guidelines relevant to prostate cancer screening. To assess the risk specific to the Defence Forces Ireland, both civilian and military sources were cited. This included national surveys, landmark trials, and guidelines from the Irish College of General Practitioners (ICGP), the National Cancer Control Programme (NCCP), and international bodies like the UK National Screening Committee (NSC) and the American Urological Association (AUA). Synthesising these numerous, high quality, resources, led to a conclusion that the evidence does not support prostate cancer screening in the Irish military as there is no reduction in overall mortality from this process.

The Structure and Function of Oral Cancer Control in Kerala, India: A Narrative Review of Cancer Control Policy Documents from 1988 to 2020

The government of Kerala was the first state in India to come out with a comprehensive plan for cancer control based on National Cancer Control Program. The purpose of this review was to identify the structure and function of cancer control in Kerala, India with specific reference to oral cancer. A systematic search was done in PubMed using the keywords “Health Policy”, “Cancer”, “Oral cancer”, “Guiding document” and “Kerala”. All government of Kerala health-related websites were searched electronically for cancer-related policy documents. The medical library catalogs of the two government Comprehensive Cancer Care Centres in the state were searched. All available Government documents, institutional documents, other online resources related to cancer prevention were collected. A checklist was prepared to review the documents. Out of 18 documents identified, two cancer-specific policy documents and two health policy documents were included in the review.The cancer control strategies outlined in the reviewed documents presented a pragmatic vision for cancer control in low-resource settings. The concept called the ‘Kerala Cancer Care Grid’ outlined in one of the documents is a novel strategy to address the geographical inequality in access to cancer care. It recognized interdepartmental coordination and partnership with private sector institutions and community organizations as crucial for achieving comprehensive cancer control. In the reviewed documents, oral cancer was discussed mainly in the context of early detection, health education, and capacity building at the primary care level.

Stage at diagnosis and survival among adult patients with cancer in Rwanda: A population-based study.

There are marked disparities in cancer survival in low-income countries compared to high-income countries, yet population-based data in the first is largely lacking. In this study, data from the national cancer registry of Rwanda were examined for 542 patients diagnosed with eight of the most common cancers of adults stomach (C16), colorectum (C18-20), liver (C22), breast (female) (C50), cervix (C53), ovary (C56), prostate (C61), and non-Hodgkin lymphomas (C82-85) between 2014 and 2017. Subjects were randomly selected for active followed-up to calculate 1-, 3-, and 5-year observed and relative survival (RS) by cancer type and stage. Overall, 53.7% of cases had died within 5 years of diagnosis. Five-year RS varied by malignancy and ranged from 17.6% (95% confidence interval [CI]: 6.7%-32.6%) for liver cancer to 68% (CI: 51.6%-79.8%) for cancers of the prostate. Stage was assigned for 71.6% of patients (n = 388 of 542), with over half (58%) having advanced stage (III/IV) at diagnosis. For all except liver and ovary, stage was a strong predictor of survival; for example, three-year observed survival was 90.9% and 44.8% (p-value: .002) for early and advanced breast cancer, respectively. This study demonstrates that stage specific survival can be obtained from population based cancer registries in sub Saharan Africa, data that are invaluable for international benchmarking, and for local planning and evaluation of cancer control programs.

An analytical framework for breast cancer public policies in Sub-Saharan Africa: results from a comprehensive literature review and an adapted policy Delphi

BackgroundBreast cancer is the leading cause of death from cancer in women and is a major public health problem worldwide. Despite the lower incidence rates of breast cancer in resource-limited settings, especially sub-Saharan Africa, there is a higher mortality rate compared to high-resource countries where the disease has a higher incidence. This makes breast cancer the second deadliest cancer in African women. These poor results reflect the weakness in public health policies. The aim of this paper is to contribute to the effective control of breast cancer by designing a framework for a comprehensive and systemic analysis of these policies in Sub-Saharan Africa.MethodsThis research is based on a literature review that adopted a systematic approach followed by a modified policy Delphi involving breast cancer experts in Sub-Saharan Africa. We included narrative reviews and systematic reviews/meta-analyses published between 2015 and 2022 as well as official documents in the analysis. We integrated the World Health Organization’s health system building blocks with Walt and Gilson’s policy analysis triangle to analyse the information collected and develop our analytical framework.ResultsA total of 22 reviews and documents were included in the study. Sixteen breast cancer experts from Sub-Saharan Africa participated in the first Delphi round, and nine participated in the second round. The different components identified for a comprehensive and systemic analysis of effective breast cancer policies can be classified into policy content divided according to the health system building blocks and related policy processes; individual, organized national and international policy stakeholders; and policy contexts.ConclusionThis study enabled the design of a framework suitable for the comprehensive and systemic analysis of breast cancer control policies in Sub-Saharan Africa. This framework can be used as a checklist for stakeholders to guide the planning, implementation and evaluation of policies and specific breast cancer control programmes at the national and facility levels.

Cancer stigma: the need for policy and programmatic action.

Cancer is a stigmatized disease in many countries that impacts the quality of life and mental health of people affected by cancer. This commentary examines some dimensions of cancer stigma and has been developed based on insights from participants in a Union for International Cancer Control program dedicated to cancer patient organizations in low- and middle-income countries. Aimed at program managers and policy makers, this commentary highlights the importance of developing strategies to reduce cancer stigma in cancer control programs in different contexts, working closely with community-based civil society organizations and those with lived experience of cancer to understand, evaluate, and take action regarding the impact of cancer stigma on health-seeking behavior and patients' quality of life.

Temporal trends of cancer incidence rates for the most frequent cancer sites in Cyprus (2004-2017).

Cancer is one of the leading causes of morbidity and mortality, worldwide. Little information is available for the temporal trends of cancer in the Mediterranean region, including Cyprus. We aimed to analyze cancer incidence trends overall and by sex for the period 2004-2017 regarding the five most common cancer sites for the population of Cyprus. Data were obtained from the nationwide cancer registry dataset that included 27 017 total cancer cases in Cyprus (2004-2017). We estimated the crude, sex-, and age-specific, as well as age-standardized (ASR) cancer incidence rates and we analyzed the time trends of ASR using the joinpoint regression program. For the general population (0-85+ years of age), the most common cancer sites in descending order, were breast, prostate, lung, colorectal, and thyroid cancer. During the study period, breast and thyroid cancer ASR presented a significant (p < .05) increasing temporal trend. Lung cancer ASRs seemed to stabilize (no increase or decrease) during the more recent years (2009 onwards) for both sexes; a similar pattern was observed for colorectal cancer in males. The ASRs of prostate cancer in men were in steady decline from 2012 onwards and the same was observed for the female ASRs of colorectal cancer from 2007 onwards. The colorectal cancer ASR temporal patterns overall, during the whole study period appeared unchanged. This temporal analysis would feed into cancer surveillance and control programs that focus on prevention, early detection, and treatment, particularly for cancer sites of higher mortality rates or those with temporally increasing trends.

Association between patient tumour characteristics and five-year survival in Nigerian patients with breast cancer.

e13504 Background: Breast cancer is a heterogeneous disease. The sociodemographic features and biological profile of breast cancer differ globally, especially in women of African descent. In Nigeria, limited studies explore the impact of these breast cancer-related factors on survival. This study evaluated the association between patients' tumour characteristics and survival in breast cancer patients in three regional tertiary cancer treatment centres across Nigeria. Methods: Data were extracted from patients' case files with a histopathologic diagnosis of breast cancer from January 1, 2005 - January 1, 2019. Patients' sociodemographic and clinical features were presented, and survival probabilities were reported; the Log-rank test was used to determine the association between time to death and categorical variables. Results: The study included 1020 patients across the three centres. Five-year survival probability was 0.65; 95% C.I: 0.60- 0.69. Most patients were between ages 30 and 49, and 49% presented with left-sided breast cancer. Patients aged&gt;70 had significantly better survival. Only 40% had Immunohistochemistry (IHC) done, out of which HR+ breast cancer accounted for 43% while triple-negative breast cancer was 30%. Patients who received Herceptin and had molecular subtyping (immunohistochemistry) done had a higher survival probability. Conclusions: Most breast cancer patients in Nigeria present at earlier ages with advanced disease. Regardless of patient tumour characteristics, 5-year survival rates are lower than global rates. Only a few patients have access to optimal breast cancer management, molecular subtyping and targeted treatment inclusive. There is an urgent need to fund the National Cancer Control program to aid in implementing its strategic framework for breast cancer screening and management to improve access to cancer care in Nigeria.

Navigating disparities: Insights from a colorectal cancer screening program in federally qualified community healthcare centers.

1537 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in Georgia. Despite evidence for the effectiveness of CRC screening, disparities in access are prevalent in underserved populations. Georgia’s Federally Qualified Health Centers (FQHCs) struggle with low screening rates (42.8%), partly due to Georgia’s lack of Medicaid expansion, poor access to health services in rural areas, and deficiencies in coordinated strategies. The Georgia Colorectal Cancer Control Program (GCRCCP) was funded by the Centers for Disease Control and Prevention to implement evidence-based interventions (EBIs) in qualifying FQHCs across South Georgia. Here, we assess the program's impact on clinic-level screening rates (SR). Methods: Fourteen clinics with 12,159 CRC-eligible patients (ages 50-75) were enrolled from East Georgia Healthcare Center (EGHC) and Albany Area Primary Health Center (AAPHC). FQHC clinics had to have a SR below 60% to participate in the program. In addition to the EBIs (provider assessment and feedback, provider reminders, patient reminders, reducing structural barriers), the GCRCCP integrated provider education using the ECHO Model and navigation through a nationally recognized, evidence-based patient navigation program. We compared baseline (2020 and 2021) and follow-up data (2022) to determine the average change in SR over time, overall, and by demographic sub-groups. Results: The overall change in SR for the 14 clinics was +6.7%, from a baseline average of 45.3% to 52% in 2022. The average change in SR for EGHC clinics (n=9) was +11.5% (from 32.2 to 43.7%). Women had a higher SR (44.9%) than men (41.8%), but both realized an increase in SR, +10.5% and +9.1%. Non-Hispanic Black Americans (NHBA) experienced a higher increase in SR, +13.7% (from 37.2 to 50.9%) than their Non-Hispanic White (NHW) counterparts (+7.5% (from 29.8 to 37.3%)). The uninsured vs. insured followed a similar pattern (+15.3% (from 17.8 to 33.1%)) vs. +2.1 (from 45.9 to 48%). The average change in SR for AAPHC clinics (n=5) was +1.8% (from 58.4 to 60.2%). There was a decline in SR for men, -8.6% (from 64 to 55.4%), and an increase for women, +3.8% (from 58.2 to 62%). NHBA had a decrease in SR, -0.8% (from 61.2 to 61%), while NHW Americans had an increase in SR, +0.2% (from 53.8 to 54.2%). The uninsured and insured groups realized minimal increases of +0.6% (from 46 to 46.6%) and +0.8% (from 62 to 62.8%), respectively. Conclusions: The implementation of EBIs and patient navigation show varied potential to reduce disparities in accessing CRC screening in underserved populations. FQHC clinics that sustain implementation activities and workflow processes can benefit communities long-term and improve health equity.

Greening Ireland’s oncology practice: Reducing climate toxicity and improving sustainability in a national chemotherapy formulary.

e13557 Background: Climate change has been acknowledged by the World Health Organisation (WHO) as a “fundamental threat” to healthcare delivery. However, healthcare now accounts for more than 5% of global emissions. Over 25% of the oncology services contribution to this relates to the development, transport and administration of systemic anticancer therapies (SACT), and represents a modifiable factor. In Ireland, the National Cancer Control Programme (NCCP) determines the standard of care systemic anticancer therapy (SACT) protocols. This study proposes to review existing protocols and assess for and highlight nationally implementable climate toxicity mitigation strategies. Methods: NCCP SACT protocols (available at https://www.hse.ie/eng/services/list/5/cancer/profinfo/chemoprotocols/) were reviewed for impact reduction potential under the following headings: 1) Baseline and regular tests and investigations; 2) Pre-medications; 3) De-escalation, and 4) ESMO Magnitude of Clinical Benefit. Results: A total of N = 333 protocols were reviewed. N = 32 protocols had multiple indications across more than one tumour stream. Overall, N = 702 opportunities were identified where the protocol impact could be reduced, either by consolidation of pre-medication and pre-hydration to oral administration, regimen or investigation de-escalation, dose banding, switching non-oral to equivalent oral SACT alternative or re-considering regimen use where clinical benefit is measured as non-substantial. In addition, there were a further N = 507 opportunities identified where baseline and regular investigations required by the protocol could be incorporated into routine visits, minimising hospital travel and time toxicity to patients. Conclusions: This study considered just one aspect of oncology care in Ireland, the delivery of SACT, and identified over 1200 opportunities across standardised national protocols where associated climate toxicity could be reduced without compromising standard of care. A sustainability matrix to promote identified action points is proposed for inclusion within all protocols and could be used in other jurisdictions. Further work to consider impact reduction opportunities in other areas of cancer care, including radiology and diagnostics should be considered.

A framework and process for community-engaged, mixed-methods cancer needs assessments

PurposeCommunity health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky.MethodsWe convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities.ResultsThe resulting CNA has helped guide strategic planning and priorities for Kentucky’s Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations.ConclusionThis framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.

LGBTQ+ cancer: priority or lip service? A qualitative content analysis of LGBTQ+ considerations in U.S. state, jurisdiction, and tribal comprehensive cancer control plans.

The National Comprehensive Cancer Control Program, a Centers for Disease Control and Prevention funded program, supports cancer coalitions across the United States (US) in efforts to prevent and control cancer including development of comprehensive cancer control (CCC) plans. CCC plans often focus health equity within their priorities, but it is unclear to what extent lesbian, gay, bisexual, transgender, queer/questioning, plus (LGBTQ+) populations are considered in CCC plans. We qualitatively examined to what extent LGBTQ+ populations were referenced in 64 U.S. state, jurisdiction, tribes, and tribal organization CCC plans. A total of 55% of CCC plans mentioned LGBTQ+ populations, however, only one in three CCC plans mentioned any kind of LGBTQ+ inequity or LGBTQ+ specific recommendations. Even fewer plans included mention of LGBTQ+ specific resources, organizations, or citations. At the same time almost three fourths of plans conflated sex and gender throughout their CCC plans. The findings of this study highlight the lack of prioritization of LGBTQ+ populations in CCC plans broadly while highlighting exemplar plans that can serve as a roadmap to more inclusive future CCC plans. Comprehensive cancer control plans can serve as a key policy and advocacy structure to promote a focus on LGBTQ+ cancer prevention and control.