Cancer Information Service Research Articles

Increasing the Effectiveness of Tobacco Quitlines

Increasing the Effectiveness of Tobacco Quitlines

The relation between the cancer screening rate and the cancer mortality rate in Japan

The aim of this research was to clarify the relation between the screening rates for five cancers (lung cancer, stomach cancer, colorectal cancer, uterus cancer, and breast cancer) and their mortality rate by using publicly accessible databases. The used information materials were those prepared by the Ministry of Health, Labour and Welfare, the Center for Cancer Control and Information Services, and the National Cancer Center. Our results were as follows: 1) regarding stomach and colorectal cancers, a positive correlation was found between the screening rate and the mortality rate (p<0.001); 2) in the relation between the screening rate and the mortality rate according to administrative divisions, the mortality rate decreased significantly when the lung cancer screening rate improved (p<0.005); 3) the mortality rate for breast cancer increased in those aged 50 or over; 4) the mortality rate for uterus cancer had been slightly increasing since 1990; and 5) regarding the screening rate, a positive correlation was found between breast cancer and uterus cancer (p<0.001). In future, improvement in lifestyle and in the knowledge of cancer should be promoted to enhance the screening rates.

ACCISS study rationale and design: activating collaborative cancer information service support for cervical cancer screening.

BackgroundHigh-quality cancer information resources are available but underutilized by the public. Despite greater awareness of the National Cancer Institute's Cancer Information Service among low-income African Americans and Hispanics compared with Caucasians, actual Cancer Information Service usage is lower than expected, paralleling excess cancer-related morbidity and mortality for these subgroups. The proposed research examines how to connect the Cancer Information Service to low-income African-American and Hispanic women and their health care providers. The study will examine whether targeted physician mailing to women scheduled for colposcopy to follow up an abnormal Pap test can increase calls to the Cancer Information Service, enhance appropriate medical follow-up, and improve satisfaction with provider-patient communication.Methods/DesignThe study will be conducted in two clinics in ethnically diverse low-income communities in Chicago. During the formative phase, patients and providers will provide input regarding materials planned for use in the experimental phase of the study. The experimental phase will use a two-group prospective randomized controlled trial design. African American and Hispanic women with an abnormal Pap test will be randomized to Usual Care (routine colposcopy reminder letter) or Intervention (reminder plus provider recommendation to call the Cancer Information Service and sample questions to ask). Primary outcomes will be: 1) calls to the Cancer Information Service; 2) timely medical follow-up, operationalized by whether the patient keeps her colposcopy appointment within six months of the abnormal Pap; and 3) patient satisfaction with provider-patient communication at follow-up.DiscussionThe study examines the effectiveness of a feasible, sustainable, and culturally sensitive strategy to increase awareness and use of the Cancer Information Service among an underserved population. The goal of linking a public service (the Cancer Information Service) with real-life settings of practice (the clinics), and considering input from patients, providers, and Cancer Information Service staff, is to ensure that the intervention, if proven effective, can be incorporated into existing care systems and sustained. The approach to study design and planning is aimed at bridging the gap between research and practice/service.Trial RegistrationNCT00873288

Cancer Prevention Information Seeking: A Signal Detection Analysis of Data From the Cancer Information Service

Communication and health information seeking play a significant role in the promotion of cancer prevention behaviors, including screening. Data from a sample of information seekers who contacted the National Cancer Institute's (NCI's) Cancer Information Service (CIS; N = 20,412) were split randomly into an exploratory and validation sample to conduct signal detection analysis predicting cancer prevention information seeking. Important predictors of seeking prevention information in the exploratory sample were type of information seeker, communication channel, age, and gender; these findings generally were confirmed in the validation sample. Our findings also reveal important information about the demographic characteristics and communication channel preferences of cancer prevention information seekers.

Cancer - we're here to listen

The National Cancer Forum (2006) recommended that high-quality efficient information resources should be made available to the public. In order to address the needs of the public, the Irish Cancer Society provide a national Cancer Information Service (CIS) incorporating a Prostate Cancer Information Service (PCIS). This audit was designed to explore the information and support needs of those who contacted the Irish Cancer Society's information services during 2007.

Differences Between Older and Younger Cancer Survivors in Seeking Cancer Information and Using Complementary/Alternative Medicine

The purpose of this study was to describe the differences between younger and older cancer survivors in seeking cancer information, using complementary and alternative medical (CAM) services, and using conventional support services. Participants were 836 survivors of adult cancers (6 months-43 years since completion of primary cancer treatment) in New Zealand who answered a mailed questionnaire between April 2007 and January 2008. Younger survivors (aged <60 years at diagnosis) were more likely to seek information from sources beyond their physicians and used different sources for that information, compared to older survivors. Older and younger survivors used similar conventional support services, but different CAM services. In logistic regression analyses, information-seekers were 5.9 times more likely to use CAM than those who did not seek cancer information (p = 0.02), but the association between information-seeking and CAM use depended on age (p = 0.02). Older cancer survivors who did not seek information from sources beyond that provided by physicians were less likely to use CAM. Physicians should consider talking to older cancer survivors about their use of information sources or CAM therapies. A conversation between physician and patient may uncover inaccurate information or CAM use that has potential for adverse effects, while allowing the physician to encourage CAM that is potentially useful. Even a brief conversation may be sufficient to encourage older cancer survivors to take action themselves to find services that support their recovery from cancer and cancer treatment.

Cancer Prevention Information-Seeking Among Hispanic and Non-Hispanic Users of the National Cancer Institute's Cancer Information Service: Trends in Telephone and LiveHelp Use

Evidence-based strategies to enable, encourage, and support cancer prevention information seeking among Hispanic populations are needed. We examined cancer prevention information requests to the Cancer Information Service (CIS) via telephone (1-800-4-CANCER toll-free telephone information service) and LiveHelp (an instant messaging service provided in English only) from 2003 to 2006. We summarized differences in the communication channel utilized by ethnicity (Hispanic vs. non-Hispanic) and, among Hispanic information seekers, the language used during the contact (English vs. Spanish). Utilization of LiveHelp was higher among non-Hispanic than Hispanic seekers of cancer prevention information. LiveHelp use for seeking cancer prevention information increased between 2003 and 2006 for both groups, but the increase was greater among non-Hispanics than Hispanics. Nearly half of Hispanics who sought cancer prevention information did so in Spanish. Because LiveHelp is not available in Spanish, the number of Spanish-only speakers who preferred to contact CIS via LiveHelp instead of telephone is unknown. When communicating cancer prevention information via multiple channels, it is important to consider differences in access to communication technologies and preferred communication channels among ethnic minority groups.

Barriers to Seeking Cancer Information Among Spanish-Speaking Cancer Survivors

Hispanics face barriers in seeking cancer information from sources such as the National Cancer Institute's Cancer Information Service. Their cancer screening rates are lower than those for whites. Three focus groups were conducted with 40 Spanish-speaking cancer survivors. Few patients had used a toll-free telephone number to get cancer information. Only five had used the Internet. Fear of feeling worse was a common concern in seeking cancer information, as was trying to discuss their cancer in English. Spanish language media promotions were recommended. Beliefs and attitudes about cancer must be taken into account when developing culturally competent education programs for Spanish speakers.

Who visits mobile UK services providing cancer information and support in the community?

People can access a variety of sources of information and support when they have questions about cancer according to their needs. There are various sources of information and support for cancer beyond the health-care setting. In this study, we set out to assess reasons for visiting two mobile cancer information and support services in the UK during 2006. Data were collected about each visitor by staff on the mobile services. The two mobiles travelled to 109 UK locations over a 7-month period. Fifty-nine per cent of visitors were women. Thirty-one per cent of visitors had (had) cancer; very few were still undergoing treatment. For 95% of visitors the visit had been spontaneous rather than pre-planned, and 89% of visits lasted <15 min. Most visitors required information or support for themselves, but a third requested information for someone else. A quarter of enquiries were about cancer prevention and early detection (e.g. screening, genetic testing, lifestyle). The mobiles appear to serve an important function in providing information and support in the community where visitors can drop in for an informal conversation with trained members of staff to ask questions and receive support in relation to cancer.

M1291 Familial Pancreatic Cancer: BRCA2, CDKN2A and CDk 4 Gene Alterations and Screening of Relatives

pancreatitis, CCP), those without calcification but marked ductal changes according to Cambridge criteria (non-calcified chronic pancreatitis, NCCP), and those with mild ductal change on MRCP or mild parenchymal changes on endoscopic ultrasound (early stage chronic pancreatitis, ECP). Patients were considered lost to follow up when they failed to attend our hospital for more than one year. Standardized incidence ratio (SIR) was estimated as the ratio of the observed number of cases of pancreatic cancer in the cohort to the expected number of cases according to the age stratified and sex specific data provided by Center for Cancer Control and Information Services, National Cancer Center, Japan. The study was approved by the institutional review boards of our hospital. Results: Two hundred twenty patients (169 with CCP, 51 with NCCP, and 21 with ECP) were enrolled. The median follow-up in each group was 3.2, 3.1, and 1.2 years, respectively. Pancreatic cancer developed in 6 patients from CCP group alone, none in NCCP or ECP group. The expected number of cases was 0.20, yielding an SIR of 29.8 (CI 6.0-53.7) in CCP. The cumulative incidence of pancreatic cancer in CCP at 5 and 10 years were 6.8% and 10.3%, respectively. All of the cancer developed in the pancreas where the calcifications were observed. Although the cancer was diagnosed during regular follow-up in 3 cases, only one of them was surgically resected. Conclusion: Calcification in the pancreas is the risk factor of cancer incidence in chronic pancreatitis.

A randomized trial of a tailored barriers intervention for Cancer Information Service (CIS) callers in pain

Cancer pain management can be improved by overcoming patients’ attitudinal barriers to reporting pain and using analgesics. A simple cost-effective barriers intervention designed to reach a large number of persons with cancer has not yet been tested. Such an intervention should be tested against barriers’ assessment-alone, as well as no-treatment control. The purpose of this study was to test the efficacy and the cost effectiveness of a tailored barriers intervention (TBI), an educational intervention tailored to participants’ attitudinal barriers toward reporting pain and using analgesics. This was a randomized three-group (TBI, assessment-alone, or control) trial with measures at baseline and 28days later conducted at the NorthCentral and Heartland offices of the Cancer Information Service (CIS), an NCI program that provides information to persons seeking answers to cancer-related questions. Participants (1256 adult CIS callers diagnosed with cancer with moderate to severe pain in the past week) joined the study and were randomized. Of these participants, 970 (77.23%) provided follow-up data. The TBI consisted of educational messages tailored to each participant’s attitudinal barriers, delivered orally over the telephone, followed by a printed mailed copy. The outcome measures were attitudinal barriers to pain management, as well as pain outcomes (duration, severity, and interference with life activities). At follow-up the TBI group had significantly lower attitudinal barriers scores compared to assessment-alone and control, but the groups did not differ on the pain outcome variables. TBI and assessment-alone had similar cost effectiveness. The TBI needs to be strengthened to achieve reductions in pain severity.

Complementary therapies for cancer patients: assessing information use and needs

Many cancer patients seek complementary therapies (CTs) for cancer management; however, relatively little is known about patients' CT information seeking behaviour. Therefore, we assessed: 1) cancer patients' use of the types and sources of CT information; 2) their information preferences; and 3) their understanding of the phrase "scientific evidence or proof that a therapy works." We collected data from 404 patients attending the Tom Baker Cancer Centre (TBCC) in Calgary and 303 patients calling the Cancer Information Service (CIS) helpline. In most cases, patients wanted information on the safety of CTs, how CTs work and their potential side effects. Physicians and conventional cancer centres were the most desired sources of CT information, but relatively few patients obtained information via these sources. Although patients were aware of the meaning of scientific evidence, they often used information based on non-scientific evidence, such as patient testimonials. The creation of a supportive care environment in conventional cancer treatment centres, by providing CT information, may help address cancer patients' concerns and alleviate some of the stress that may have been caused by the cancer diagnosis.

Spatial variation in prostate cancer survival in the Northern and Yorkshire region of England using Bayesian relative survival smoothing

Primary Care Trust (PCT) estimates of survival lack robustness as there are small numbers of deaths per year in each area, even when incidence is high. We assess PCT-level spatial variation in prostate cancer survival using Bayesian spatial models of excess mortality. We extracted data on men diagnosed with prostate cancer between 1990 and 1999 from the Northern and Yorkshire Cancer Registry and Information Service database. Models were adjusted for age at diagnosis, period of diagnosis and deprivation. All covariates had a significant association with excess mortality; men from more deprived areas, older age at diagnosis and diagnosed in 1990–1994 had higher excess mortality. The unadjusted relative excess risks (RER) of death by PCT ranged from 0.75 to 1.66. After adjustment, areas of high and low excess mortality were smoothed towards the mean, and the RERs ranged from 0.74 to 1.49. Using Bayesian smoothing techniques to model cancer survival by geographic area offers many advantages over traditional methods; estimates in areas with small populations or low incidence rates are stabilised and shrunk towards local and global risk estimates improving reliability and precision, complex models are easily handled and adjustment for covariates can be made.

Promoting participation in physical activity using framed messages: An application of prospect theory

Messages designed to motivate participation in physical activity usually emphasize the benefits of physical activity (gain-framed) as well as the costs of inactivity (loss-framed). The framing implications of prospect theory suggest that the effectiveness of these messages could be enhanced by providing gain-framed information only. We compared the effectiveness of gain-, loss-, and mixed-framed messages for promoting moderate to vigorous physical activity. Randomized trial. Sedentary, healthy callers to the US National Cancer Institute's Cancer Information Service (N=322) received gain-, loss-, or mixed-framed messages on three occasions (baseline, Week 1, and Week 5). Social cognitive variables and self-reported physical activity were assessed at baseline, Week 2, and Week 9. Separate regression analyses were conducted to examine message effects at each assessment point. At Week 2, gain- and mixed-framed messages resulted in stronger intentions and greater self-efficacy than loss-framed messages. At Week 9, gain-framed messages resulted in greater physical activity participation than loss- or mixed-framed messages. Social cognitive variables at Week 2 did not mediate the Week 9 framing effects on physical activity participation. Using gain-framed messages exclusively may be a means of increasing the efficacy of physical activity materials.

Cancer information seeking among African Americans

Relatively little is known about the factors that impact African Americans' health information seeking, a behavior relevant to cancer disparity. In this article, we examine African American cancer information seeking using data from Cancer Information Service (CIS) call data (N = 32,834 African American callers). Compared to members of other racial groups, fewer African American callers sought information on prevention and psychosocial support. African American calls were likely to result in information on medical referrals and support services. Increased knowledge of CIS resources relevant to treatment and support may increase African American use of CIS.

Information support for cancer survivors

Survivors' information-seeking behavior has traditionally been documented through analysis of inquiries to hotlines and cancer information services. Data from these self-selected inquiries tend to be restricted to a time around diagnosis, and to those populations possessing the wherewithal and motivation to seek information actively. The current study used data from a general population survey to assess 1) the prevalence of information-seeking behavior among survivors in the general population, 2) characteristics of seekers versus nonseekers, 3) ratings of information-seeking experience, and 4) actual versus preferred sources of information. Data were analyzed from the 2005 administration of the Health Information National Trends Survey (HINTS). HINTS is a cross-sectional, random digit dial telephone survey, weighted to provide estimates for the general population. Nearly half of all Americans (48.7%) indicated that they have looked for cancer information from 1 source or another. Percentages were highest for those who have been touched by cancer (63.1% of cancer survivors and 54.6% of those with family histories) and lowest for those with no cancer history (27.6% of those with no history). Quality concerns topped the list of information-seeking experiences for those recalling the last time they looked. Patterns of information-seeking revealed a discrepancy between preferred and actual source when tracked over years since diagnosis. Information-seeking is prevalent among cancer survivors and does not diminish over time. Prescriptions are given for reengineering the information environment to improve long-term outcomes for survivors.

Current activities and future directions of the cancer registration system in Japan

Cancer surveillance is essential for implementing evidence-based cancer control programs, and cancer registries provide core information for cancer surveillance. In 2006, the Cancer Control Act was approved in Japan and it is clear that the national government will take the initiative in promoting cancer control programs, including cancer registries. There are three types of cancer registries: population-based, hospital-based, and site-specific cancer registries. Although each has its own aim and function, the population-based cancer registry is the only one that can provide cancer incidence data. Currently, 35 of the 47 prefectures in Japan, and one city (Hiroshima) have population-based cancer registries; however, there are two major issues with these registries, i.e., standardization of procedures and completeness of incidence data. In order to improve the level of standardization, the Japan Cancer Surveillance Research Group has developed a standard registry system in which standardized procedures are implemented; this system is currently being disseminated into several registries. To improve completeness of incidence data, it is planned, first, to establish hospital-based cancer registries at designated cancer-care hospitals (a newly developed hospital network to provide standardized high-quality cancer care). This strategy will be effective in rural areas, where most cancer patients are covered by designated cancer-care hospitals, but in urban areas additional action will be needed. In 2006, the Center for Cancer Control and Information Services (CIS) was launched at the National Cancer Center. It is expected that the CIS will play a central role in improving the quality of the cancer surveillance system in Japan.

The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire’s breast cancer patients

BackgroundThe 1995 Calman-Hine plan outlined radical reform of the UK’s cancer services with the aim of improving outcomes and reducing inequalities in National Health Service cancer care. Its main recommendation was to concentrate care into the hands of site-specialist multidisciplinary teams. This study aimed to determine whether these teams improved processes and outcomes of care for breast cancer patients. Patients and methodsAll patients diagnosed and treated with breast cancer in the Yorkshire region of the UK from 1995 to 2000 were identified within the Northern and Yorkshire Cancer Registry and Information Service database. Changes in the use of breast-conserving surgery, adjuvant radiotherapy following breast-conserving surgery and 5-year survival were assessed among these patients in relation to their managing breast cancer team’s degree of adherence to the manual of cancer service standards (which outlines the specification of the ‘ideal’ breast cancer team) and the extent of site specialisation of each team’s surgeons. ResultsVariation was observed in the extent to which the breast cancer teams in Yorkshire had conformed to the Calman-Hine recommendations. Increases in adherence to the recommendations in the manual of cancer service standards were associated with a reduction in the use of breast-conserving surgery [odds ratio (OR) = 0.83, 95% confidence interval (CI) = 0.70–0.98, P<0.01]. Increases in both surgical specialisation (OR = 1.23, 95% CI = 1.00–1.55, P = 0.06) and adherence to the manual of cancer service standards (OR = 1.22, 95% CI = 0.97–1.52, P = 0.05) were associated with the increased use of radiotherapy following breast-conserving surgery. There was a trend towards improved 5-year survival (hazard ratio = 0.93, 95% CI = 0.86–1.01, P = 0.10) in relation to increasing surgical site specialisation. All these effects were present after adjustment for the casemix factors of age, stage of disease, socio-economic background and year of diagnosis. ConclusionsThe extent of implementation of the Calman-Hine report has been variable and, on the basis of limited clinical and organisational information available, its recommendations appear to be associated with improvements in processes and outcomes of care for breast cancer patients.

The NCI's Cancer Information Service's Research Continuum Framework: integrating research into cancer education practice (1999-2004).

Between 1999 and 2004, the National Cancer Institute's (NCI) Cancer Information Service's (CIS) Research Initiative supported over 50 research projects representing a broad range of activities from research capacity building, development, implementation to diffusion and dissemination. These research activities are represented in the CIS Research Continuum Framework which the authors describe through a number of short case studies. Based on the experiences and successes of the CIS, other professionals working in the cancer field might consider establishing collaborative relationships across the research continuum and participating in research that has relevancy to advances in cancer education.

8141 POSTER Integrating diversity into a nurse led cancer information service

8141 POSTER Integrating diversity into a nurse led cancer information service