Cancer Health Research Articles

An evaluation of the accuracy of small-area demographic estimates of population at risk and its effect on prevalence statistics

Demographic estimates of population at risk often underpin epidemiologic research and public health surveillance efforts. In spite of their central importance to epidemiology and public-health practice, little previous attention has been paid to evaluating the magnitude of errors associated with such estimates or the sensitivity of epidemiologic statistics to these effects. In spite of the well-known observation that accuracy in demographic estimates declines as the size of the population to be estimated decreases, demographers continue to face pressure to produce estimates for increasingly fine-grained population characteristics at ever-smaller geographic scales. Unfortunately, little guidance on the magnitude of errors that can be expected in such estimates is currently available in the literature and available for consideration in small-area epidemiology. This paper attempts to fill this current gap by producing a Vintage 2010 set of single-year-of-age estimates for census tracts, then evaluating their accuracy and precision in light of the results of the 2010 Census. These estimates are produced and evaluated for 499 census tracts in New Mexico for single-years of age from 0 to 21 and for each sex individually. The error distributions associated with these estimates are characterized statistically using non-parametric statistics including the median and 2.5th and 97.5th percentiles. The impact of these errors are considered through simulations in which observed and estimated 2010 population counts are used as alternative denominators and simulated event counts are used to compute a realistic range fo prevalence values. The implications of the results of this study for small-area epidemiologic research in cancer and environmental health are considered.

Barriers to Prostate Cancer Prevention and Community Recommended Health Education Strategies in an Urban African American Community in Jackson, Mississippi

This article describes the use of survey research in collaboration with the African American urban community of Georgetown, Jackson, Mississippi to identify and understand prostate cancer knowledge, resource utilization, and health education strategies considered most effective in reaching the community with prostate cancer prevention messages. The study revealed profound needs in disease identification and resources awareness and utilization. Barriers to utilization were identified by participants to include lack of self-efficacy, low self-esteem, lack of trust in the health care system, limited knowledge of prostate pathology, and limited ability to pay. Participants' recommended strategies for reaching the community with prostate cancer education include traditional and nontraditional strategies. The list of recommendations exclude modern-day outlets such as handheld devices, Twitter, Facebook, blogs, wikis, and other Internet-based outlets. The findings provide a road map for program development and an intervention research agenda custom-tailored to the Georgetown community of Jackson, Mississippi.

Survey of Ontario health professionals’ knowledge, attitudes and beliefs of alcohol-related harms: key findings

Introduction: The purpose of this study is to explore the knowledge, attitudes and beliefs among health and health care professionals in Ontario of the risks associated with excessive alcohol use to strengthen attention on alcohol as a key modifiable risk factor for cancer and other health harms.Methods: This study used an online survey to answer the following research questions: (1) What is the level of awareness of excessive alcohol use as a risk factor for injuries, cancer and chronic diseases among health and health care professionals? (2) How do you address alcohol consumption and alcohol-related harm reduction in practice? and (3) What opportunities and barriers exist for health care professionals in addressing alcohol-related harm in practice?Results: Five hundred and eight-one participants responded to the online survey. The majority of respondents were Dietitians, Public Health Nurses, Nurses, Health Promotion Consultants and Health Educators. Results include participant’s attitudes, opinions and knowledge on the identified research questions.Discussion & Conclusion: Results from this survey will be disseminated to promote health and health care professionals awareness surrounding issues of alcohol consumption and alcohol-related harm, with emphasis on physicians and other Allied Health Professionals (including Registered Dietitians and Public Health Nurses). Several knowledge exchange areas are identified.

2012 President's Plenary International Psycho‐Oncology Society: future directions in psycho‐oncology

AbstractThe inaugural President's Plenary was held at the 2012 International Psycho‐oncology Society's World Congress in Brisbane to provide a platform for dissemination of important initiatives and achievements of interest to cancer professionals globally. The vision of the International Psycho‐oncology Society – clarified and defined in 2004 – is that all cancer patients and their families throughout the world should receive optimal psychosocial care at all stages of disease and survivorship. Recent initiatives have been driven by the need to see psychosocial care available as a seamless part of holistic multidisciplinary quality cancer care and life‐extending lifestyle changes promoted and supported through the expertise of behavioural and social scientists. In keeping with World Health Organization targets that there is ‘no health without mental health’, cancer health must include mental health. This is in line with the patients' declaration to ‘See us – not our disease’. The aim is to ensure that within the next decade, psychosocial care is acknowledged as a vital part of the patient journey and accepted globally as good practice within cancer care. The President's Plenary session covered the need for the following:Behavioural and social scientists to be integral to the planned lifestyle changes that the United Nations agreed, at a high‐level meeting in 2011, to reduce world cancer incidence and morbidity over the next decade;An internationally agreed standard of quality cancer care that includes psychosocial care for patients and their families and carers;An endorsement to assess distress as the 6th vital sign;A declaration that mental health within cancer health is a human right;Psycho‐oncology professionals to integrate into a federation promoting better national and international outcomes; strength in numbers speaking with a unified voice.The aim is to encourage dialogue between all cancer professionals and patient representatives to progress these targets; everyone has a voice. Copyright © 2013 John Wiley & Sons, Ltd.

Attitude Towards Personal Protective Equipment in the French Nuclear Fuel Industry

This descriptive cross-sectional study examines the compliance of workers from the European Gaseous Diffusion Uranium Enrichment Consortium (EURODIF) with personal protection equipment (PPE) in view of the various hazards in the nuclear fuel industry. The PPE inventory was drawn up by an industrial hygienist in charge of the PPE at EURODIF. Two hundred and twenty seven (10%) randomly selected, active and retired, EURODIF workers filled in a questionnaire on their attitudes towards PPE. Exposure data from the EURODIF job exposure matrix were used to examine whether PPE usage varies according to exposure level. The study suggests a PPE usage profile that varies depending on the hazards present and PPE available. Anti-uranium PPE and gloves were among the best rated, while anti-spray goggles were the least used. We found that, for most hazards known to cause cancer or irreversible health damage, PPE usage varied according to exposure (homogeneity test, p<0.05; trend test, p<0.05). The continuous use of PPE among workers should be encouraged through improvements to the PPE management system. A precise model of individual exposure can only be designed if the use and efficiency of PPE are taken into consideration.

Cancer risks, beliefs, and health care access among the underprivileged.

6563 Background: One goal of the current French National Cancer Plan is to reduce health inequities in cancer control. In the present work, an underprivileged population was explored to analyze exposure to cancer risk factors and cancer screening attendance in order to highlight ways to improve cancer control. Methods: Within the nationwide observational study EDIFICE 3, conducted by phone interviews among a representative sample of 1603 subjects aged between 40 and 75 years old, we used the “EPICES” validated questionnaire to examine the association of underserved status with cancer risk factors, beliefs, and health care access. Results: Based on EPICES score, underserved subjects represent 33% of the sample. These subjects subjectively perceive a higher risk of cancer compared to non-underserved subjects (21% vs 14% respectively, p&lt;0.01). They more often consider that the cancer always has an external cause (18% vs 12%, p&lt;0.01), rely less on information from the general practitioner (48% vs 56%, p&lt;0.01) and lay press (28% vs 37%, p&lt;0.05). They trust the national health system less (average score from 1 to 10; 6.0 vs 6.3, p &lt;0.05). They also have more cancer risk factors: BMI (26.0 vs 24.8, p&lt;0.01), active smoking (38% vs 23%, p&lt;0.01) and less practicing sport (42% vs 77%, p&lt;0.01). They have more comorbidities: average (2.2 vs 1.8, p&lt;0.01), at least one (76% vs 65%, p&lt;0.01), anxiety (27% vs 12%, p&lt;0.01), hypertension (24% vs 19%, p&lt;0.05) and cardiovascular disease (13% vs 9%, p&lt;0.05). Among persons with a cancer, underserved subjects have a higher rate of lung cancer (10% of cancers vs 1%, p&lt;0.05). However, no difference in cancer screening attendance was observed between underserved and non-underserved subjects: colorectal cancer (60% vs 60%); breast cancer (94% vs 97%) and prostate cancer (46% vs 52%). Access to healthcare is not an issue (consultations with a general practitioner more frequent for underserved group: 5.4 vs 3.7 per year, p&lt;0.01). Conclusions: To reduce inequities in cancer control, as screening attendance is not discriminating, the effort for upstream interventions should be focused on prevention. Cancer risk factors such as smoking, overweight and a sedentary life style are appropriate targets for communication campaigns.

Long-term symptom burden and orodental health of oropharyngeal cancer (OPC) survivors following treatment with chemoradiotherapy (CRT) or sequential therapy (ST).

9530 Background: OPC treatment is associated with significant long-term toxicity. Very little is known about the long-term symptom burden and orodental health in OPC survivors &gt;2 yrs from treatment. Methods: Survivors treated for OPC with CRT/ST (involving definitive RT) at Dana Farber Cancer Institute between 2002-2011 and &gt;2 yrs from treatment completion, were identified by chart review and asked to complete the Vanderbilt Head and Neck Symptom Survey version 2 (VHNSS v2), National Health And Nutrition Examination Survey for Oral Health Questionnaire, health care availability survey. Results: 200 survivors were contacted, 127 responded (RR: 64%). Median age at diagnosis was 54 yrs; 85% males; 85% stage IVA/B, 13% stage III; 56% CRT, 43% ST. HPV status: 47% (+), 10% (-), 43% unknown. Median time from treatment completion: 50 mths (24-135 mths). Residual moderate to severe toxicities reported in VHNSS v2: 71% dry mouth; 59% difficulty chewing/swallowing food; 53% feeling of food becoming stuck in the throat; 53% prolonged time to eat; 31% thick mucus, 6% had difficulty sleeping secondary to this; 16% trouble speaking, 27% trouble hearing;30% limitation of neck/shoulder movement; altered taste/smell - 45%/23%; sensitivity to spicy food and dryness-57%/62%; 30% decreased desire to eat, 11% had moderate weight loss. Orodental health assessment: 13% thermal sensitivity, 21% teeth cracking and chipping, 20% loose teeth, 33% had treatment for gum disease, 42% had lost bone around teeth. 98% survivors had health insurance; only 66% had dental insurance. No statistically significant difference was noted with respect to symptoms between CRT or ST. ST did not affect long-term toxicity compared to CRT alone. Conclusions: OPC is known to correlate with HPV positivity, early age at diagnosis and high rates of long-term survival after appropriate therapy. Our study documents that the OPC survivors have substantial residual long-term head and neck and orodental symptoms directly related to the treatment that significantly impacts their quality of life. A substantial number of patients lack dental health coverage, which likely further impacts symptom burden and QOL.

The role of families in decisions about cancer treatments.

6528 Background: Shared decision-making is an important component of patient-centered care and is associated with improved health outcomes. Little is known about patients’ involvement of family members in decisions about cancer treatments or whether family involvement varies by patient demographic or clinical characteristics. Methods: Data for this study were collected as part of the Cancer Care Outcomes Research and Surveillance (CanCORS) study, a large multi-regional prospective cohort study of cancer care and outcomes of lung and colorectal cancer patients. Patients were surveyed about the roles of their families in decisions about surgery, radiation, and/or chemotherapy. We used multinomial logistic regression to identify patient factors independently associated with family roles in decisions. Results: Among 5284 patients, 28.5% reported little or no family input in decisions, 22.1% reported making decisions after considering the family’s opinion, 47.9% reported the patient and family made decisions together, and 1.5% reported the family made decisions. In adjusted analyses, married, female, older, and insured patients were more likely to report making decisions with their family (all P&lt;.001). Family involvement varied substantially by race/ethnicity and language, with Chinese-speaking Asian (63.5%) and Spanish-speaking Hispanic (56.8%) patients reporting making decisions with their family more often than English-speaking Hispanic patients (48.5%) and whites (48.3%). Patients from Veterans Affairs hospitals were least likely to report making decisions together with family (P&lt;.001). Family involvement varied statistically by cancer type, stage, comorbidity, health status, and depression, but differences were minimal. Conclusions: Most patients with a new diagnosis of lung or colorectal cancer involve family members in treatment decisions. Certain groups, such as non-English speaking Hispanics and Asians rely significantly on family; for these groups, it is important that physicians inquire about patients’ preferences for family involvement and work to integrate family members in decisions accordingly. Further studies are needed to determine the impact of family involvement in treatment decisions on oncology outcomes.

Cherry: mobile application for children with cancer.

The Cherry project seeks to address the information needs of young cancer patients, their parents, and health care providers. It aims at helping the patients to understand various aspects of their disease and treatment, and allow them to assess and record their disease related quality of life. It uses elements of social media to offer a meeting point with the physician and peers. Information is presented in a way that is both understandable and appealing to young children in school age and adolescents. Preschool children will be studied as a separate user group to address their needs and possibilities to meet them. The Cherry system wants to utilize Internet and mobile technologies to benefit patient outcome.

13A. Integrative Cancer Care: The Life over Cancer Model

Focus Areas: Integrative Algorithms of CareIntegrative cancer treatment fully blends conventional cancer treatment with integrative therapies such as diet, supplements, exercise and biobehavioral approaches. The Life Over Cancer model comprises three spheres of intervention: improving lifestyle, improving biochemical environment (terrain), and improving tolerance of conventional treatment. These levels are applied within the context of a life-affirming approach to cancer patients and treatment. Clinical staff involved include MDs, psychosocial, physical therapy, and dietetic professionals, all located in a single private clinic, the Block Center for Integrative Cancer Treatment.This session will describe the rationale and operation of the clinical model. An outpatient chemotherapy unit is incorporated in the clinic. Chronomodulated chemotherapy is used for selected chemotherapy drugs. Physical care includes massage, exercise and other therapies as directed by the center's physical therapy staff. Notably, cancer patients who are physically active have lower mortality and recurrence risks. Behavioral approaches are being shown increasingly to affect physiological parameters and expression of genes potentially related to cancer. Thus, biobehavioral approaches such as relaxed abdominal breathing and comfort space imagery are taught to patients by a staff including a clinical psychologist and other practitioners. Nutrition is also emerging as a relevant area of intervention in cancer, with recent guidelines from the American Cancer Society. A team of registered dietitians counsels patients individually and conducts cooking classes. Finally, the Life Over Cancer model includes analysis of multiple biological parameters relevant to cancer and general health, with standard laboratory tests. Inflammation, glycemic variables, immune functioning and other variables are regularly monitored. Dietary changes and where necessary supplements are suggested when laboratory results are abnormal. Interaction of supplements with cancer treatment drugs is monitored. The session will highlight the roles played by both conventional and integrative therapies in the treatment of cancer patients.

A Multisource Approach to Improving Epidemiologic Estimates: Application to Global B-Cell Malignancies

The compilation of comprehensive, worldwide epidemiologic data can inform hypotheses on cancer etiology and guide future drug development. These statistics are reported by a multitude of sources using varying methods; thus, compiling a complete database of these statistics is a challenge. To this end, this paper examined the usefulness of a novel, multisource approach—extracting data from the peer-reviewed literature, online reports, and query systems from cancer registries and health agencies and directly contacting cancer registry personnel—for building a comprehensive, multinational epidemiologic cancer database. The major B-cell malignancies were chosen as the cancer subtype to test this approach largely because their epidemiology has not been well characterized in the peer-reviewed literature. We found that a multisource approach yields a more comprehensive epidemiologic database than what would have been possible with the use of literature searches alone. In addition, our paper revealed that cancer registries vary considerably in their methodology, comprehensiveness, and ability to gather information on specific B-cell malignancy subtypes. Collectively, this paper demonstrates the feasibility and value of a multisource approach to gathering epidemiologic data.

Health risk assessment of occupational exposure to hazardous volatile organic compounds in swine gestation, farrowing and nursery barns

Livestock producers are exposed to a high number of airborne pollutants during their daily duties of cleaning, feeding and maintenance activities. Hazardous air pollutants (HAPs) are a major group of pollutants that may cause cancer or other serious health effects including neurological, respiratory, reproductive and developmental disorders. In this study, health risks of occupational exposure to eight hazardous VOCs (phenol, p-cresol, o/m-cresol, benzene, toluene, ethylbenzene, o-xylene, and m/pxylene) that are most likely to be emitted from swine buildings were assessed using Monte Carlo simulation. The purpose of the study was to calculate emission rates and to quantify cancer and hazard risks of the target VOCs. Cancer and hazard risks were calculated for workers A, B, and C, who spent six hours in the gestation, farrowing and nursery barns, respectively, and one hour in the office space every day. Concentrations of the target VOCs did not exceed their recommended exposure limits (RELs). But, concentrations of p-cresol and benzene exceeded their preliminary remediation goals (PRGs). The highest emission rates in mg s(-1) were measured from the gestation rooms while the highest emission rates in mg per s per head were measured from the farrowing rooms. Cancer risks of ethylbenzene, benzene and p-cresol were higher than EPA's benchmark of one per million. Hazard risks of benzene, toluene, p-cresol, and o/m-cresol were higher than the maximum acceptable risk threshold (10(-4)). Worker B (farrowing) had the highest cumulative cancer (16.6 in one million) and hazard (11 342 in one million) risks. It was followed by workers A (gestation) and C (nursery). Sensitivity analysis showed that inhalation unit risk (IUR) had the highest impact on cancer risk assessment while recommended exposure limit (REL) had the highest impact on hazard risk assessment.

The Pink Ribbon Survivors Network: An Internet resource for breast cancer survivorship education for patients and the health care providers that care for them.

329 Background: The authors identified a need to provide three online tools for the benefit of breast cancer survivors and health care providers: 1) An online collection of relevant publications from all cancer specialties regarding breast cancer survivorship housed in one virtual library. 2) An online collection of guidelines and relevant publications as a resource for primary care providers to access clinical information on medical care and psychosocial issues regarding breast cancer survivorship. 3) An online collection of resources, organizations, and supportive programs and selected readings for breast cancer survivors. These readings would be organized in a "Curriculum for Recovery" Library. We were motivated by the belief that, "all breast cancer survivors are underserved, if their healthcare providers are undereducated." Methods: Using the Joomla software system, a free, online website has been developed. This site houses the three virtual libraries, on separate landing pages, described above. Additional resources for breast cancer survivors are also housed on the website. Results: The Pink Ribbon Survivors Network now provides a resource of over 500 separate listings designed to educate and support breast cancer survivors, and health care professionals. The online professional libraries were created from abstracts available from medical journals and similar mainstream oncology publications. The libraries are continuously updated with new publications. These collective libraries will serve as unique breast cancer survivorship tools for women and their health care providers, for new publications, and for resources. Conclusions: This abstract establishes that a system using internet technology can provide virtual resources for breast cancer survivors, cancer specialists, and primary health care providers. This is now a functional online system for the 2.5 million breast cancer survivors and nearly 500,000 health care providers involved in the care of these survivors. The organization’s website is www.PinkRibbonSurvivorsNetwork.org.

Abstract A09: Adherence to the WCRF/AICR recommendations for cancer prevention is associated with all-cause and cancer mortality among elderly female cancer survivors

Abstract Background: Lifestyle recommendations to decrease risk of primary cancer such as eating a healthy diet, maintaining ideal body weight and staying physically active may also decrease risk of subsequent cancers and other chronic disease. The 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) body weight, physical activity and dietary guidelines encourage cancer survivors to follow its cancer prevention recommendations. However, the quantity and quality of research available to support evidence-based recommendations specific to cancer survivors are deemed to be insufficient. Methods: A total of 2,080 participants in the Iowa Women's Health Study who had a confirmed cancer diagnosis between 1986 and 2002 and completed the follow-up questionnaire in 2004 were included in analysis. Dietary intake, body weight, and physical activity level, as well as other demographic and lifestyle factors were collected in the 2004 survey. An adherence score to the 2007 WCRF/AICR recommendations (range: 0–8) was calculated assigning one point each of eight recommendations. Vital status and cause of deaths were collected through annual linkage with the State of Health Registry of Iowa and the National Death Index. Multivariate hazard ratios (HR) and 95% confidence intervals (CI) of cancer, cardiovascular disease (CVD), and all-cause mortality were computed for quartiles of adherence scores by Cox regression proportional hazard regression models. Mortality was also compared by body weight, physical activity, or dietary recommendation adherence scores. Results: From 2004 through 2009, 495 deaths were identified, including 197 due to cancer and 153 due to CVD. All-cause mortality was lower for women with the highest (6-8) versus lowest (0-4) adherence scores (HR=0.63, 95%CI=0.47-0.85) after adjusting for age, number of comorbid conditions, perceived general health, current smoking, type and stage of cancer, type of cancer treatment, current cancer treatment and subsequent cancer diagnosis. When stratifying by time since diagnosis or cancer type, this inverse association was confined to women who survived 5-10 y, survivors of breast cancer, and survivors in the “other cancers” category (cancers other than breast, colorectal and endometrial cancers). Similarly, cancer mortality was lower among women with the highest versus lowest adherence scores (HR=0.55, 95%CI=0.34-0.90), but only among survivors in the “other cancers” category. CVD mortality was not different by adherence scores. Meeting the physical activity recommendation was associated with lower risk of death from any cause (ptrend&amp;lt;0.0001), CVD (ptrend=0.045) and cancer (ptrend=0.01) after adjusting for dietary and body weight recommendation adherence scores and other covariates. Meeting the dietary recommendations was not associated with mortality after adjusting for physical activity recommendation adherence scores. Conclusions: Adherence to lifestyle recommendations to prevent primary cancers may improve all-cause and cancer mortality among elderly female cancer survivors. Being physically active appears to have a strong and independent association with lower mortality among elderly cancer survivors. Citation Format: Maki Inoue-Choi, DeAnn Lazovich, Kim Robien. Adherence to the WCRF/AICR recommendations for cancer prevention is associated with all-cause and cancer mortality among elderly female cancer survivors. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A09.

Abstract ED01-02: Methodologic considerations for large-scale prevention trials: Lessons from the Women's Health Initiative

Abstract The Women's Health Initiative was one of the premiere primary prevention trials of its era. The core component was a partial factorial randomize trial designed to test three chronic disease prevention hypotheses in over 68,000 postmenopausal women: hormone therapy (HT) for the prevention of coronary heart disease; a low fat diet for the prevention of breast cancer and colorectal cancer, and calcium/vitamin D supplements for hip fracture risk reduction. This large diverse program provides useful lessons for many of the issues that arise in the design, implementation, analysis and interpretation of large-scale public health trials. The greatest public health impact of WHI has come from the two HT trials. The estrogen plus progestin trial in women with an intact uterus was stopped early, in 2002, based on an increased risk in breast cancer and overall health risks exceeding benefits. In 2004, the estrogen alone trial in women with prior hysterectomy, was stopped for an increased risk in stroke. These results were immediately translated into a public health message that had a rapid impact on HT use, followed shortly by a reduction in national breast cancer incidence rates. The HT trial results were considered highly controversial, however, because of their failure to show benefit for coronary heart disease, a hypothesis supported by numerous observational studies, animal studies, and randomized trials with intermediate outcomes. These contradictory findings fueled a persistent debate about the interpretation and integrity of the trial. Many of the purported flaws in the trial were easily refuted, owing to the strength of the trial's design, implementation and analyses. The design required excellent power for conservative projections of intervention effects. Key implementation factors included multicenter recruitment directly from the general population of postmenopausal women using broadly inclusive eligibility criteria, well-established, commonly used interventions, double-blinded trial conduct, ongoing support for adherence to interventions, broad-spectrum but prioritized outcomes ascertainment processes, standard of care safety monitoring including requirements for regular mammography, and a written trial monitoring plan to address the multiple testing for the numerous trial outcomes and interim analyses. To address these discrepancies between observational and randomized trial data directly, joint analyses of the WHI Observational Study (OS) and the HT trials were conducted. While the usual analysis of HT effects in the OS led to inferences similar to the preceding observational studies, analyses that carefully controlled for multiple confounders and took into account time from initiation of therapy and for breast cancer, time between menopause and first use of HT, yielded good alignment between the WHI HT trial and observational studies. These analyses yielded opposite trends with time for CHD and breast cancer, that is early initiators tended to have lower CHD risk but greater breast cancer risk than later initiators, providing some support for the so-called “timing hypothesis” yet confirming the limited utility of these agents for chronic disease prevention. Citation Format: Garnet L. Anderson. Methodologic considerations for large-scale prevention trials: Lessons from the Women's Health Initiative. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr ED01-02.

Using Hierarchical Multivariate Analysis to Examine Interactions Between Alternative Appraisals of Cancer and Virtual Health Support Among Middle-Aged and Older Internet Users

The advent of online communication is transforming how older adults find social support with a community of peers who cope with similar health issues. This article explores whether participation in virtual health support groups demonstrates a significant interaction with users’ appraisal of their illness experience and predicts self-reappraisal among adults 50 years of age and older ( N = 157). Hierarchical multiple regressions demonstrate the significance of the combined effect of virtual health support and its interaction with illness appraisal measures to predict the outcome variable of self-reappraisal. The results indicate that even though appraisal of cancer as a traumatic experience reduces positive self-reappraisal, those who appraised their illness to have been a traumatic experience perceived virtual support to be more influential on their sense of positive change after cancer. In contrast, perceived benefit of virtual support on positive self-appraisal is reduced if illness is appraised as an opportunity for personal growth.

The status of oral health in oral cancer

The status of oral health in oral cancer

How do health professionals learn their communication skills? Lessons for SBI implementation

Although the vital components of effective screening and brief intervention (SBI) are unknown, many studies have defined SBI as including various elements of effective communication. If SBI is to become part of routine practice, it is likely that practitioners will need to be comfortable with a high level of communication and a less authoritarian style. This study explored how staff across the National Health Service learn and develop patient communication skills, attitudes, and behaviors. Fifty-two semi-structured, in-depth, qualitative telephone interviews were carried out to saturation point. Participants included junior and senior doctors, nurses and allied health professionals in cancer, heart disease, respiratory, palliative and mental health care. Interviews were recorded, transcribed in full, and analyzed thematically. Development of communication skills mainly relied on individual practitioners reflecting on their own practice. Few external processes or triggers to encourage or support this among staff were reported. Much emphasis was placed by interviewees on learning by observing and modeling others. Again, this was generally informal and not actively supported or developed. Overall, managers or supervisors reported addressing communication skills with staff only if there was a patient complaint or obvious problem. There were few mechanisms for continuous improvement of skills. Formal appraisals of experienced staff tended to focus on inter-professional versus patient communication. In frontline health care, there is little overt emphasis on developing how well practitioners communicate with patients, especially as practitioners become more senior. Aligning SBI initiatives with initiatives to develop generic communication abilities may have mutual benefits, although there are challenges to overcome.

Evolution of Cancer Control P.L.A.N.E.T.: moving research into practice

Evidence-based interventions (EBIs) are not broadly implemented, despite widespread availability of programs, policies, and guidelines. Systematic processes for integrating EBIs with community preference remain challenging for cancer control and prevention, as well as other areas. The Cancer Control P.L.A.N.E.T. (P.L.A.N.E.T) Web portal provides a platform to access data, EBIs, and resources to foster local partnerships and assist public health researchers and practitioners design, implement, and evaluate evidence-based cancer control programs. This article summarizes the evolution of P.L.A.N.E.T. and describes effective and innovative Web 2.0 strategies to increase Web visits, create more interactive platforms for researchers and practitioners to integrate evidence-based resources, community preferences, and the complex context in which programs and policies are implemented. Lessons learned could benefit public health settings and reach low-income, high-risk communities. Researchers, community practitioners, and government partnerships should continue to develop and test innovative ways to address pressing issues in cancer control, health disparities, and health delivery.

Changes in glucose, insulin, and insulin resistance from presurgery to post adjuvant treatment for breast cancer.

1511 Background: Elevated fasting insulin levels at breast cancer diagnosis are associated with increased risk of recurrence and reduced survival. (Goodwin PJ, et al. JCO. 2012;30:164-171) Weight gain related to adjuvant treatment coupled with sedentary activity habits may further alter insulin-related measures for breast cancer survivors. We present results from a prospective longitudinal study examining changes in insulin-related markers from pre breast cancer surgery to post adjuvant treatment. Methods: Subjects were recruited from St. James’s hospital, Dublin, Ireland at the time of breast cancer diagnosis (stage I-III). Fasting pre-surgery blood samples were drawn to measure insulin, glucose and glycosylated haemoglobin A1c (HBA1C). Insulin resistance was calculated using the homeostatic model assessment (HOMA). Subjects with no evidence of active cancer completed the same measurements 2-5 years later. Paired sample t-tests were used to measure changes from pre-surgery to post-adjuvant treatment. Statistical significance was set at P = .05. Results: Forty-four subjects (n = 22 postmenopausal) completed both measurements (mean ± SD age 54.1±8.6 years). Mean time since diagnosis to follow-up measures was 3.4±0.8 years. Adjuvant therapy included chemotherapy (n=37), radiotherapy (n=36), biological therapy (n=8) and concurrent hormonal therapy (n=37). There was a statistically significant increase in insulin (mean ± SD change 2.8±4.1mU/L, P=.000), insulin resistance (0.54±1.0, P=.001) and HBA1C (0.1±0.2 %, P= .003). Fasting glucose levels did not change (P = .06). Conclusions: Results indicate that patients with breast cancer experience significant increases in insulin, insulin resistance and HBA1C from pre-surgery to post adjuvant treatment. Elevated post-treatment insulin levels may further contribute to risk of breast cancer recurrence and mortality, while also predisposing to the development of cardiovascular disease and type 2 diabetes mellitus. Exercise and diet interventions are warranted in this population to improve markers of insulin resistance as a surrogate for improving breast cancer and overall health outcomes.