Equitable Cancer Care Research Articles

Women with bladder cancer: an underserved population due to a faulty health care system or in a biological disadvantage?

Abstract
 Although men are four times more frequently diagnosed than women with urothelial bladder cancer, clinical outcomes greatly differ between both genders, as women present a higher lethality rate, as well as a greater loss of life expectancy. At diagnosis, women present more advanced clinical stages, situation which has led to many efforts to elucidate the social determinants of health and the biological factors implied. Women face different challenges associated with a delay in both, diagnosis and treatment, a more limited access to systemic treatment, and lower response rates associated with immunotherapy. Women are underrepresented in the main chemotherapy, immunotherapy, and other systemic treatment trials, as they comprise only 15 to 25% of the overall population, limiting the possibility of drawing any definitive conclusions. Furthermore, through gene expression analysis, women have been linked to a more aggressive biological subtype of bladder cancer (basal), a higher rate of FGFR 1-4 mutated tumors, lower rate of NECTIN-4 expression, and a higher prevalence of germline mutations. Despite the worse prognosis, sex-based recommendations have not been developed. Cancer care teams must not hinder access to treatment options based on sex and should strive for an equitable cancer care.

Abstract PO-041: The impact of COVID-19 on cancer care in the Latinx community in Northern California: A mixed method community-engaged research study

Abstract The COVID-19 pandemic has negatively impacted cancer care including delayed diagnosis, procedures, and patient fears of COVID-19 infection. However, less is known about the impact on specific populations, including Latinx adults, who have been disproportionately affected by COVID-19. Cancer is the leading cause of death among Latinx adults. Alarmingly, they have low participation rates in cancer prevention programs and face multiple barriers in accessing healthcare, even before the pandemic. Rigorous methods and community-engaged approaches are needed to uncover key barriers and facilitators to cancer care across the socio-ecological spectrum and to translate findings into culturally congruent educational strategies and dissemination efforts. The present mixed methods study entails a bi-directional partnership between the Stanford Medicine Office of Community Engagement and Latinas Contra Cancer, a community-based organization increasing equitable cancer care access for Latinxs. This study aims to determine barriers and facilitators of cancer screening, diagnostics, and treatment in the Latinx community as a result of COVID-19 using a community-based survey (n=500) in Northern California. To gain a deeper understanding of the lived experience of Latinxs obtaining cancer-related care during the pandemic, we will conduct focus groups (n=4) with study participants stratified by barriers and facilitators they endorse across the socio-ecological spectrum, as well as by key demographics (e.g., socioeconomic status, nativity, health literacy). Moreover, medical providers and community clinics will be interviewed (n=15) to understand their unique circumstances during this pandemic (e.g., changing healthcare system logistics, telehealth challenges). Data collection is ongoing and expected to be complete by the end of the summer. We will present descriptive data and statistical analysis (e.g., chi-square tests, logistic regressions) exploring associations key sociocultural and demographic participants characteristics and their endorsement of a variety of barriers and facilitators to care. We will also present key themes from the qualitative data to further contextualize survey findings and gain deeper meaning of the complexities of cancer related care during the pandemic. Study findings will allow us to understand the complexity of barriers and facilitators of cancer prevention and care for Latinxs adults, inform the development of health promotion resources, and guide policy and solutions to reduce excess cancer burden for Latinxs communities. Citation Format: Patricia Rodriguez Espinosa, Darcie Green, Yessica Martinez Mulet, Miriam L. Trigo, Natalia M. Zamora Zeledon, Eric Meléndez, Lisa G. Rosas. The impact of COVID-19 on cancer care in the Latinx community in Northern California: A mixed method community-engaged research study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-041.

Sâkipakâwin: Assessing Indigenous Cancer Supports in Saskatchewan Using a Strength-Based Approach.

Given that the health care system for Indigenous people tends to be complex, fragmented, and multi-jurisdictional, their cancer experiences may be especially difficult. This needs assessment study examined system-level barriers and community strengths regarding cancer care experiences of Indigenous people in Saskatchewan. Guided by an advisory committee including Indigenous patient and family partners, we conducted key informant interviews with senior Saskatchewan health care administrators and Indigenous leaders to identify supports and barriers. A sharing circle with patients, survivors, and family members was used to gather cancer journey experiences from Indigenous communities from northern Saskatchewan. Analyses were presented to the committee for recommendations. Key informants identified cancer support barriers including access to care, coordination of care, a lack of culturally relevant health care provision, and education. Sharing circle participants discussed strengths and protective factors such as kinship, connection to culture, and spirituality. Indigenous patient navigation, inter-organization collaboration, and community relationship building were recommended to ameliorate barriers and bolster strengths. Recognizing barriers to access, coordination, culturally relevant health care provision, and education can further champion community strengths and protective factors and frame effective cancer care strategies and equitable cancer care for Indigenous people in Saskatchewan.

Summit Explores Role of Oncology Advanced Practitioners in Equitable Cancer Care Delivery

Summit Explores Role of Oncology Advanced Practitioners in Equitable Cancer Care Delivery

A randomized controlled trial of the effect of a community-based intervention on patient activation, health-related quality of life, and acute care use.

1 Background: Low-income and minority populations have disproportionately less activation in their cancer care, worse health-related quality of life (HrQOL), and greater acute care use than affluent and white populations. Community-based interventions are needed to improve patient experiences and quality of cancer care among these populations. We used community-based participatory methods to refine a previously tested intervention for use in Atlantic City NJ. The intervention, LEAPS, uses community health workers trained to activate patients to discuss advance care planning and their symptom burden with cancer clinicians and to connect patients with culturally-relevant community resources to overcome complications from social determinants of health. We conducted a randomized controlled trial of LEAPS in collaboration with a employer-union health fund. Members of the employer-union health fund with newly diagnosed with hematologic and solid tumor cancers were randomized to the 6-month intervention or to usual care. The objective was to determine if the intervention improved HrQOL at 4 months post-enrollment as compared to baseline more than usual care and secondarily the effect on change in patient activation at 4 months post-enrollment as compared to baseline and acute care use within 12 months post-enrollment. Methods: We conducted patient interviews to assess HrQOL and patient activation and obtained claims data for health care use. We used regression models to evaluate differences in health-related quality of life (validated Functional Assessment of Cancer Therapy-General) scores and patient activation (validated Patient Activation Measure) scores between groups over time and exact poisson regression adjusted for length of follow-up to compare emergency department and hospitalization utilization. Results: A total of 160 patients were consented and randomized into the study (80 intervention; 80 control). There were no differences in demographic or clinical factors across groups. The majority were non-white (74%), female (53%), mean age 57 years. The most common diagnoses were breast (31%) and lung (21%) cancer and the majority were diagnosed with stage 3 or 4 (63%). At 4 months, the intervention group had greater improvements in quality of life as compared to the control group (difference in difference: 9.56 p < 0.001), greater change in patient activation (difference in difference: 12.43 (p < 0.001)), and lower acute care use (hospital visits (1.10 (1.53) +/- 1.83 (1.31), p = 0.02) and emergency department use (1.2 (2.82) versus 3.47 (3.62) p = 0.03). Conclusions: Integration of community-based interventions into cancer care for low-income and minority populations may be a more effective and sustainable way to ensure equitable cancer care. Clinical trial information: NCT03699748.

Cultural Humility: Retraining and Retooling Nurses to Provide Equitable Cancer Care.

Cancer outcome disparities exist among Black, Indigenous, and people of color despite advancements in screening, detection, and treatment. In addition to racial and ethnic diversity, the U.S. population is experiencing shifts in sociodemographics, including a growing aging population, sex and gender identities, spiritual and religious belief systems, and divides between high- and low-income households. This article provides a foundation for cultural humility as a clinical competency in nursing to improve the quality of cancer care. CINAHL®, PubMed®, Google Scholar, and grey literature were searched using keywords, including cultural humility, cultural competence, nursing, nursing pipeline, nursing workforce, and health. Retraining and retooling the nursing workforce promotes multiculturalism in oncology care and increases opportunities to provide more appropriate, patient-centered care to those living with cancer. Increasing the diversity of nursing faculty and staff, enhancing nursing curricula and education, and creating equitable relationships to support patient-centered care are initiatives to ensure high-quality care.

Overcoming Barriers to Radiation Oncology Access in Low-Resource Settings in the United States

Providing high-quality radiation therapy in medically underserved, low-resource environments can be challenging in the United States. During the American Society of Radiation Oncology 2020 Annual Meeting, the American Society for Radiation Oncology Committee on Health Equity, Diversity, and Inclusion hosted 4 radiation oncologists from both academic and community practices in an educational session. Speakers discussed creative ways to overcome barriers to equitable cancer care and outcomes for their vulnerable patient populations in both rural and urban settings. Successful tactics have included applying for state-sponsored grants, lobbying hospital leadership for equipment upgrades, implementing quality improvement programs specifically targeting the needs of the patient population, studying novel hypofractionation schedules, monitoring toxicities using wearable devices, and expanding transportation options.

On Becoming an Ally

Earlier this year, I was asked to participate in a meeting titled “Virtual Summit to Define the Role of Oncology Advanced Practitioners in Equitable Cancer Care Delivery: A Closer Look at Care Coordination, Clinical Trials, and Implicit Bias” held by the Association of Community Cancer Centers (ACCC) and Harborside. This conversation brought together a diverse group of participants to discuss the unique difficulties that people of color and underrepresented populations face with a cancer diagnosis and potential pathways for improvement.

Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors.

Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.

Employers: innovators and partners in the delivery of more effective and equitable cancer care.

Employers have the focus, innovative mindset, analytical tools, and drive to partner effectively with innovative cancer care entities to bring better care to their respective members.

Responding to narrowing discrimination protections: Can hospital policies protect transgender and gender diverse patients with cancer?

e14126 Background: The U.S. Department of Health and Human Services recently proposed to eliminate federal protections against discrimination in healthcare on the basis of gender identity. This proposal seeks to alter the Patient Protection and Affordable Care Act Section 1557 Rule, which currently prohibits sex discrimination in any health program receiving federal financial assistance. The provisional change poses imminent threats to transgender and gender diverse (TGD) communities who face discrimination in healthcare, and in cancer care specifically. If current federal protections are eliminated, enacting local non-discrimination policies may safeguard TGD individuals’ rights to access safe equitable cancer care. To determine the need for local policy change, we sought to assess the current protections based on gender identity and expression for patients at National Cancer Institute (NCI)-Designated Cancer Centers. Methods: Publicly available hospital non-discrimination policies and Patients’ Bill of Rights were examined from the main affiliated hospitals of each of the 62 NCI-Designated Cancer Centers, excluding laboratories. The policies were classified as clearly including gender identity and expression or not. McNemar’s Test calculated differences between non-discrimination policies and Patient’ Bill of Rights. Results: Of 62 institutions, 30 (48.4%) clearly included gender identity and expression in their hospital non-discrimination policies, whereas 45 (72.6%) included gender identity and expression in their Patients’ Bill of Rights ( p= 0.014). Thirty-seven (59.7%) institutions included gender identity and expression in only one of the documents (Table). Conclusions: NCI-Designated Cancer Centers do not consistently include gender identity and expression in publicly available non-discrimination documents. The discrepancy between Patients’ Bill of Rights documents and hospital non-discrimination policies suggests a difference between what institutions outwardly convey to patients and what they operationalize in their legal documents. Paired outcomes from 62 independent NCI-Designated Cancer Centers. [Table: see text]

Using implementation science to examine impact of a social responsibility agenda on addressing cancer health disparities in Ceará, Brazil.

e19071 Background: Programs to address disparities in cancer care outcomes in resource-limited settings require attention to social determinants of health (SDoH) to achieve successful clinical care implementation. The Instituto de Câncer do Ceará, the largest cancer center in northeastern Brazil, has implemented a Social Responsibility Agenda (SRA) to guide equitable cancer care delivery. This goal of this study was to develop a framework for an implementation science (IS) study evaluating the longitudinal impact of the SRA on cancer outcomes. Methods: We outlined a mixed-methods and participatory study incorporating a process model, the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework. A list of constructs and links to measurement tools associated with IS models were identified to guide the study phases. Results: We established a logic model to guide in evaluating the health and economic impact of the SRA. We identified >30 constructs and measures across domains of IS models. The table shows a driver diagram to inform the framework. Conclusions: Understanding determinants, key drivers and change concepts are important initial steps in an ongoing evaluation of the impact of evidence based SDoH interventions to address cancer disparities. [Table: see text]

End-of-life palliative care resource utilization in cancer care: A focus on the urban-rural continuum.

52 Background: Despite the advances in end-of-life cancer care, disparities exist in the availability, accessibility and use of palliative care services across the urban-rural continuum. This review explores this disparity by synthesising retrospective quantitative studies on palliative care patterns of resource use for adults during end-of-life cancer care. Methods: Five databases were searched and data analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria involved; a) original research; b) quantitative studies; c) English-language; d) study assessed palliative care related service use in adult (18yrs+) cancer patients with any malignancy excluding non-melanoma skin cancer; e) exclusive end of life focus and f) urban-rural focus. Narrative reviews and discussions were excluded. Results: After reviewing all titles and abstracts ( N= 816) and full text review ( N= 163) 44 studies met the inclusion criteria and were included in the analysis. End-of-life palliative care access and utilisation patterns varied across the geographical urban-rural continuum. Geographical region of residence had the strongest association with multiple ED visits and hospitalizations in rural or remote areas. Most common palliative care services used within the last 30 days of death were ED visits and hospital admissions. Two studies assessed palliative radiotherapy and one study assessed palliative care pharmacotherapy. The odds of palliative service use were lowest for males and individuals with a survival diagnosis (0-3months). The largest inequities were explained by individual level factors including gender as assessed in ( N= 44 studies), socioeconomic status ( N= 15), proximity to service ( N= 10) and survival time from cancer diagnosis ( N= 9). Conclusions: Rurality was an important predictor for poorer outcomes in the quality of end-of-life cancer care. Findings suggest that addressing the urban-rural continuum is critical for equitable, timely and efficient palliative cancer care. Further research is required to understand barriers to service usage to achieve optimal palliative care.

Coverage of cancer services in Australia and providers\u2019 views on service gaps: findings from a national cross-sectional survey

BackgroundIn response to the increasing cancer prevalence and the evolving health service landscape across the public and private health sectors in Australia, this study aimed to map cancer services and identify factors associated with service provision and important service gaps.MethodsA prospective, cross-sectional survey was conducted throughout 2016. Extensive search strategies identified Government or privately-owned, hospital or community-based healthcare organisations with dedicated cancer services. One nominated staff member from each organisation answered a purpose specific online/paper questionnaire. Descriptive statistics, standardised rates, and single level and multilevel multinomial logistic regression were used to analyse the data. Analysis was augmented with a qualitative descriptive analysis of open-ended questions.ResultsFrom the 295 eligible organisations with a cancer service in Australia, 93.2% participated in the survey. After adjusting for remoteness, for-profit companies were significantly more likely than Government operated services to provide only one or two types of cancer services (e.g. radiotherapy) in a limited range of settings (e.g. day hospital with no in-patient or home care) (p < 0.001) and less likely to provide comprehensive cancer services (p < 0.001). After adjusting for ownership and the respondent’s role in the organisation, respondents located in remote regions of Australia were more likely to identify cancer services that are dependent upon specialist medical practitioners as the most important service gaps in their region (p = 0.003). Despite 76.0% of organisations across Australia offering some type of supportive care or survivorship services, providers identified this group of services as the most pressing service gaps in major cities, rural and remote regions alike (standardised rate: 47.9% (95%CI: 43.6–57.4%); p < .000). This included the need for improved integration, outreach and affordability.ConclusionsThe broad range of cancer services, settings and ownership identified by this survey highlights the complexity of the Australian healthcare system that cancer survivors must navigate and the challenges of providing comprehensive cancer care particularly in rural and remote regions. Whilst the significant role of supportive care and survivorship services are increasingly being recognised, the findings from this survey support calls for innovative service models and funding mechanisms that expand the focus from preventing and treating cancer to supporting cancer survivors throughout the cancer continuum and promoting the delivery of integrated and equitable cancer care across the public and private sectors.

Cancer trends and disparities in India: data needs for providing equitable cancer care.

Cancer trends and disparities in India: data needs for providing equitable cancer care.

Survivorship Care, the Poor Cousin of Australian Cancer Services: Findings From a National Cross-Sectional Survey

Background: The significant role of survivorship care in improving the outcomes and experiences of cancer survivors is increasingly being recognised. In response to the changing health service landscape in Australia, this study aimed to map cancer services and identify important service gaps and factors associated with service provision. Methods: A mixed-method, prospective, cross-sectional survey was conducted throughout 2016. Government or privately-owned, hospital or community-based healthcare organisations with dedicated cancer services were identified. Each organisation was invited to nominate a staff member to answer a purpose specific online/paper questionnaire. Included was an open-ended question that asked about the most important unmet service needs and gaps in their region. Descriptive statistics, standardised rates, and single level and multilevel multinomial logistic regression were used to analyse the data that was augmented with a qualitative descriptive analysis. Findings: Of the 295 eligible organisations that were identified, 93·2% responded. After adjusting for remoteness, compared to government operated services, for-profit companies were significantly more likely to provide only one or two types of cancer services (e.g. radiotherapy) in a limited range of settings (e.g. day hospital with no in-patient or home care) (p<0·001) and less likely to provide comprehensive survivorship services (p<0·001). Survivorship services, either during or after treatment (e.g. allied health, psychosocial support) were most commonly identified by providers as the most pressing service gaps in major cities, rural and remote regions alike. This included the need for improved integration, outreach and affordability of these services. After adjusting for ownership and the respondent's role in the organisation, compared to major cities, remote regions of Australia were more likely to have service gaps that are dependent upon specialist oncology services (p=0.003). Interpretation: The findings from this survey provide intelligence for health service planning and policy in Australia along with insights for other countries with mixed public-private healthcare. Despite being a high-income country with well-established prevention, primary and secondary care, the challenge of providing equitable care across the continuum of cancer care persists. The low rate of service survivorship services in the for-profit sector suggests that current policies are failing to incentivise their provision. The results support calls for innovative service models and funding mechanisms that shift the focus from cancer to the survivor and deliver integrated and equitable cancer care across both the public and private health sectors. Funding: Western Sydney University in partnership with South West Sydney Local Health District and Oncology Massage Ltd. Declaration of Interests: Authors CS, JH, KT and SG are academic researchers at NICM Health Research Institute. The institute receives research grants and donations from foundations, universities, government agencies, individuals and industry. Sponsors and donors provide untied funding for work to advance the vision and mission of the institute. The project that is the subject of this article was not undertaken as part of a contractual relationship with any donor or sponsor. Author GD is Director of Cancer Services for the South Western Sydney Local Health District and Director of Liverpool Cancer Centre in Australia. Author JH is a general practitioner with a clinical interest in evidence-based integrative medicine. Author SG works as an acupuncturist at the Chris O’Brien Lifehouse cancer treatment center in Camperdown, Australia. Author JU is an academic researcher at the Translational Research Institute that receives research grants from foundations, universities, government agencies, and industry. The institute and JU have no competing interests to declare. Ethics: Approval was obtained from Western Sydney University Human Research Ethic Committee (HREC) (H11389) and the Joint University of Wollongong and Illawarra Shoalhaven Local Health District Health and Medical HREC (HREC/16/WGONG/178).

Mobilising Expertise and Resources to Close the Radiotherapy Gap in Cancer Care

Closing the gap in cancer care within low- and middle-income countries and in indigenous and geographically isolated populations in high-income countries requires investment and innovation. This is particularly true for radiotherapy, for which the global disparity is one of the largest in healthcare today. New models and paradigms and non-traditional collaborations have been proposed to improve global equity in cancer control. We describe recent initiatives from within the radiation oncology community to increase access to treatment, build the low- and middle-income countries' radiation oncology workforce, mobilise more professionals from within high-income countries and raise awareness of the global need for equitable cancer care.

Health information seeking preferences of Mexican cancer survivors: Creating an evidence base for the design of high-quality communication programs.

190 Background: In order to improve the quality of the communication between the healthcare system and cancer survivors, it is fundamental to understand their preferred sources of health information. In low and middle-income countries (LMICs), little is known regarding which sources are used and trusted the most. This information is crucial to develop effective communication aimed at achieving high-quality equitable cancer care. Our objective was to explore the preferred sources of health information in Mexico, and to understand which factors influence these choices. Methods: We examined sources of health information among cancer survivors in Mexico City using questions from the Spanish Version of the Health Information National Trends Survey (HINTS). The characteristics of survivors who preferred the internet were compared with those who preferred other sources (doctors, printed materials, family members, organizations) using Fisher’s exact test. Logistic regression was used to assess the effects of patient characteristics on health information-seeking. Results: Of 148 participants, 82 (56%) had internet access. Of the 88 patients who had sought health information, 61 (69%) listed the internet as their preferred source. Those 65 and older were less likely to seek health information, regardless of the source (OR 0.17, p &lt; 0.0001). Survivors who preferred the internet were more likely to be younger (p = 0.001), male (p = 0.003) and to have a higher educational level (p = 0.009). Comorbidities, stage, cancer type, and time from diagnosis had no effect on patient preferences. Doctors were the most trusted source of information (85%), followed by the internet (28%) and government agencies (23%). Conclusions: Mexican patients who seek health information online are more likely to be young educated males. Doctors represent the most trusted source of information, particularly for patients from vulnerable populations (such as older women with low educational levels). High-quality healthcare information programs in LMICs should be designed taking these behaviors into account, and patients should continue to receive health information via their most trusted sources.

A snapshot of cancer in Chile: analytical frameworks for developing a cancer policy.

IntroductionThe South American country Chile now boasts a life expectancy of over 80 years. As a consequence, Chile now faces the increasing social and economic burden of cancer and must implement political policy to deliver equitable cancer care. Hindering the development of a national cancer policy is the lack of comprehensive analysis of cancer infrastructure and economic impact.ObjectivesEvaluate existing cancer policy, the extent of national investigation and the socio-economic impact of cancer to deliver guidelines for the framing of an equitable national cancer policy.MethodsBurden, research and care-policy systems were assessed by triangulating objective system metrics – epidemiological, economic, etc. – with political and policy analysis. Analysis of the literature and governmental databases was performed. The oncology community was interviewed and surveyed.ResultsChile utilizes 1% of its gross domestic product on cancer care and treatment. We estimate that the economic impact as measured in Disability Adjusted Life Years to be US$ 3.5 billion. Persistent inequalities still occur in cancer distribution and treatment. A high quality cancer research community is expanding, however, insufficient funding is directed towards disproportionally prevalent stomach, lung and gallbladder cancers.ConclusionsChile has a rapidly ageing population wherein 40% smoke, 67% are overweight and 18% abuse alcohol, and thus the corresponding burden of cancer will have a negative impact on an affordable health care system. We conclude that the Chilean government must develop a national cancer strategy, which the authors outline herein and believe is essential to permit equitable cancer care for the country.

Objective Need for Cancer Prevention in the Czech Republic and Europe, and the State Thereof

There is no doubt today of the need for cancer prevention. The growing incidence of cancer itself provides a sufficient justification for prevention programmes. A review of literature presented in this paper also documents the strong background of evidence-based cancer prevention programmes. The article also provides a critical analysis of the current status of primary cancer prevention and cancer screening in the Czech Republic in contrast with available international comparisons. Relevant international data have been obtained from the regularly repeated "Health at a Glance" studies (published by the OECD). Although the Czech Republic is one of the countries with the highest cancer burden in Europe, it has failed to develop and support a cancer prevention policy on a central level, and this also applies to smoking prevention. The Czech population needs an effective national strategy for the support of cancer prevention, as well as a strategy which would ensure equitable cancer care in terms of both quality and correct indication; a strategy which would be sustainable for at least 10 to 15 years to come.Key words: oncology - screening - risk factor - prevention - population burden This study was supported by the project 36/14//NAP "Development and implementation of methodology for the evaluation of effectiveness of personalised invitations of citizens to cancer screening programmes" as part of the pro-gram-me of the Czech Ministry of Health "National action plans and conceptions". The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE "uniform requirements" for biomedical papers.