Cancer Prevention Interventions Research Articles

Childhood sun safety at different ages: relations between parental sun protection behavior towards their child and children\u2019s own sun protection behavior

BackgroundSunburns during childhood are strongly associated with development of melanoma in later life. While parents play an important role in children’s sun protection, insight in possible shifts in behavioral responsibility from parents towards their children and the possible effect of children’s sex is important for targeting sun safety interventions throughout childhood and adolescence.MethodsThis cross-sectional survey study was conducted among a representative sample of Dutch parents (N = 1053) of children aged between 4 and 13 years old. Questionnaires measured both parental and children’s own sun safety behavior during planned (e.g. going to the beach) and incidental (e.g. bycicling) sun exposure situations. Analyses of variance were used to test for age group differences and linear regression models were computed to detect behavioral shifts in executive behavior.ResultsParents applied all sun safety behaviors (i.e. sunscreen use, wearing UV-protective clothing and seeking shade) more often on younger children, except for supportive behavior (facilitating children’s own sun safety behavior), which remained relatively stable over the years. Older children and girls were more likely to execute sun safety behaviors themselves. A behavioral shift was found in wearing UV-protective clothing during planned situations among 11 year old children. For other behaviors, shifts were predicted after the age of 13.ConclusionsOlder children execute sun safety behaviors more often than younger children, although they still largely depend on their parents’ protection. Specific attention for boys in the primary school years, and for both boys and girls in the years adjacent to adolescence is warranted in skin cancer prevention interventions.

Dietary Intake of Fatty Acids, Total Cholesterol, and Stomach Cancer in a Chinese Population.

To investigate the associations between dietary fatty acids and cholesterol consumption and stomach cancer (SC), we analyzed data from a population-based case-control study with a total of 1900 SC cases and 6532 controls. Dietary data and other risk or protective factors were collected by face-to-face interviews in Jiangsu Province, China, from 2003 to 2010. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multiple unconditional logistic regression models and an energy-adjusted method. The joint associations between dietary factors and known risk factors on SC were examined. We observed positive associations between dietary saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), and total cholesterol and the development of SC, comparing the highest versus lowest quarters. Increased intakes of dietary SFAs (p-trend = 0.005; aOR, 1.11; 95% CI, 1.01–1.22 with a 7 g/day increase as a continuous variable) and total cholesterol (p-trend < 0.001; aOR, 1.13; 95% CI, 1.06–1.22 with a 250 mg/day increase as a continuous variable) were monotonically associated with elevated odds of developing SC. Our results indicate that dietary SFAs, MUFAs, and total cholesterol are associated with stomach cancer, which might provide a potential dietary intervention for stomach cancer prevention.

Perceptions of politicization and HPV vaccine policy support

BackgroundSince its FDA approval in 2006, the Human papillomavirus (HPV) vaccine has been politically-charged, given its association with sexual health among young women and its history of controversial, and largely unsuccessful, legislative mandates. The extent to which perceived politicization is related to public support for the vaccine’s use, however, is not clear. We sought to examine the relationship between public perceptions of politicization of the HPV vaccine and public support for HPV vaccine policies. MethodsWe fielded a survey from May-June 2016 using a nationally representative sample of U.S. adults (18–59 years). Among respondents aware of the HPV vaccine (n = 290), we predict support for HPV vaccine policies based on respondents’ perceptions of three characteristics of the vaccine’s portrayal in public discourse: degree of controversy, certainty of the scientific evidence supporting the vaccine’s use, and frequency with which the vaccine appears in political discussion. ResultsRespondents who perceived greater certainty about the scientific evidence for the HPV vaccine were more supportive of HPV vaccine policies (p < 0.0001) than respondents who perceived the scientific evidence to be uncertain, after adjusting for respondents’ characteristics, including demographics and partisanship. ConclusionsPublic perceptions of the HPV vaccine’s politicization, particularly the portrayal of scientific evidence, are associated with receptivity to legislative mandates. Policy implicationsHow the certainty of a body of evidence gets communicated to the public may influence the policy process for a critical cancer prevention intervention.

Abstract LB-200: A cGMP-grade chimeric papillomavirus candidate vaccine (HPV16 RG1-VLP) confers long term cross-protection compared to a nonavalent hpv vaccine in a pre-clinical papillomavirus animal model

Abstract Background: The National Cancer Institute (NCI) PREVENT Cancer Program (PREVENT) is a peer-reviewed R&amp;D pipeline with the core emphasis on preclinical development and clinical translation of novel cancer preventive interventions. One of the latest PREVENT-supported projects include cGMP production and IND enabling studies of a broad spectrum experimental human papillomavirus (HPV) vaccine- HPV16 RG1-VLP. This monovalent chimeric virus-like particle (VLP) displays 360 copies of the highly conserved epitope RG1 (aa 17-36 of minor capsid protein HPV16 L2) in the DE loop of HPV16L1 VLP backbone, and is capable of eliciting broadly neutralizing antibodies that target several clinically relevant HPV genotypes. RG-1 induced cross-neutralizing titers are typically lower than anti-L1 antibodies generated by currently licensed HPV vaccines. Hence, durability of protection has been cited as a cause of concern. Here, using engineering-run cGMP grade HPV16-RG1VLPs formulated with alhdyrogel®, the durability of protection 6 month post-vaccination of HPV16 RG1-VLPs against Gardasil-9®, a licensed HPV vaccine was evaluated using an established papillomavirus disease model. Methods: New Zealand white rabbits (n=15 per treatment group) were administered three intra-muscular vaccinations of HPV16-RG1 (80 µg), human doses of Gardasil-9®, or no vaccine (adjuvant only). Following vaccination, in vivo protection was assessed against 8 high-risk oncogenic HPVs utilizing methods from an established cottontail rabbit papillomavirus (CRPV) disease model. Within each treatment group, 5 rabbits were challenged two weeks post-final vaccination (at peak serum ELISA titer), while another 5 were challenged six months post-final vaccination to assess durability of protection. The remainder 5 rabbits will be challenged one year post final vaccination. Results: During the peak-titer period, rabbits vaccinated with monovalent HPV16-RG1VLP were protected from disease development, which was comparable to the protection afforded by Gardasil-9®. Six months after final vaccination, despite lower serum titers, HPV16-RG1VLP immunized rabbits were still protected from disease development with vaccine efficacy comparable to that of Gardasil-9®. And, in some instances, HPV16-RG1VLP vaccine demonstrated a superior cross-protection. Conclusions: Even as a monovalent formulation, HPV16 RG1 VLP vaccination was able to provide comparable protection against a number of high-risk oncogenic HPV types, including types not covered by Gardasil-9®, even after six months post-vaccination. As a monovalent VLP, HPV16 RG1 VLP holds promise as a broad-spectrum preventative vaccine candidate that could potentially provide broader protection at lower production costs. Studies evaluating protection one-year-post vaccination is currently in progress. Citation Format: Jiafen Hu, Karla Balogh, Ken Matsui, Huimin Tan, Pola Olczak, George Buchman, Brian Howard, Jonathan White, Michelle Kennedy, Shizuko Sei, Elizabeth Glaze, Sarah Brendle, Christina Schellenbacher, Reinhard Kirnbauer, Richard Roden, Robert Shoemaker, Neil Christensen, Joshua Weiyuan Wang. A cGMP-grade chimeric papillomavirus candidate vaccine (HPV16 RG1-VLP) confers long term cross-protection compared to a nonavalent hpv vaccine in a pre-clinical papillomavirus animal model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-200.

Associations between linguistic acculturation and skin cancer knowledge and beliefs among U.S. Hispanic adults.

The incidence of melanoma among U.S. Hispanics is rising and Hispanics have poorer melanoma survival compared to non-Hispanic whites. Acculturation has been linked with skin cancer-related behaviors among Hispanic individuals, such that Hispanic individuals who are more acculturated to U.S. norms and attitudes have been found to use sunscreen more frequently, to seek shade and use sun protective clothing less often, to sunbathe and indoor tan more frequently, and to have more sunburns than less acculturated individuals. However, little is known about factors that may account for the effect of acculturation on such behaviors and outcomes. The goal of this study was to examine the association between linguistic acculturation and skin cancer-related knowledge and beliefs among Hispanic adults. 788 Hispanic adults completed an online survey measuring linguistic acculturation, sun protection knowledge, perceived skin cancer risk, perceived severity, perceived worry, skin color preference, perceived suntan benefits, photo-aging concerns, sun protection norms, tanning norms and skin cancer fatalism. Compared with Spanish-acculturated Hispanics, English-acculturated Hispanics had greater knowledge, lower levels of perceived risk of skin cancer, lower perceived severity of skin cancer, less worry about skin cancer, greater perceived suntan benefits, and lower photo-aging concerns. This study highlights the importance of considering an individual's level of acculturation when designing skin cancer prevention interventions. Additional research is warranted to develop and test culturally relevant, tailored interventions to reduce the risks of skin cancer among U.S. Hispanics.

Effects of a cancer prevention education program on elementary school students' knowledge, attitude, self-efficacy, and intentions in South Korea.

OBJECTIVESMost children and adolescents have low levels of cancer knowledge and awareness, and infrequently engage in preventive behaviors. This study examined the effects of a short classroom-based intervention for cancer prevention on knowledge, attitude toward cancer preventability, self-efficacy, and behavioral intentions of fifth-grade elementary school students.METHODSThe study was based on a pre-post-follow-up, 2-group, quasi-experimental design. Participants in the intervention group attended two 40-minute sessions on cancer prevention education and watched a music video about cancer prevention, while participants in the control group were only exposed to the music video. Self-reported knowledge, attitude toward cancer preventability, self-efficacy, and behavioral intentions were assessed 1 week pre-intervention and post-intervention, as well as 3 months post-intervention.RESULTSThe 3-month post-intervention results revealed partial effects, indicating that the education intervention improved knowledge and attitudes toward cancer preventability; however, no effects were observed on self-efficacy and behavioral intentions 3 months after the intervention.CONCLUSIONSLong-term regular booster sessions are required to improve not only social-cognitive factors, but also behavioral intentions, which could result in behavior changes promoting cancer prevention.

Lifestyle interventions for cancer prevention in primary care: Differences between family physicians and nursing professionals.

Prevention offers the most cost-effective long-term strategy for cancer control. The objective of this study was to ascertain opinions, attitudes, and professional practices towards cancer prevention among primary care professionals and to assess differences between family physicians (FP) and nursing professionals (NP). A cross-sectional study was performed in 2012 in the Community of Madrid. A random sample of 3586 professionals received an online questionnaire about opinions/attitudes, training, and interventions in cancer prevention. The chi-square test was used to analyse the association of the profession with all the variables. Factors associated with the usual practice of individual, group, and community interventions were analysed using multivariate logistic regression, with separate models for FP and NP. The response rate was 39.4% (N=1413). Approximately 90% of the participants attributed "sufficient/high" utility to individualized counselling. NP attributed higher utility to group and community interventions than FP (70.1% vs 60.1% and 64.9% vs 57.7%, respectively, P-value<0.01). The usual practice of group and community interventions was more frequent among NP. The practice of group and community interventions was associated with knowledge of resources for prevention, specific training in group interventions, and the utility attributed to these methods. Among FP, the ability to dispense effective health advice and the utility attributed to this advice were associated with the usual practice of the three interventions. Group and community interventions are rarely practised, especially among FP. Actions targeting improved ability and knowledge could lead to higher involvement in the promotion of health. It would also be necessary to intervene in the examination of the utility of such interventions.

A four-group experiment to improve Western high school students' sun protection behaviors.

Multicomponent skin cancer preventive interventions for adolescents that aim to decrease ultraviolet radiation (UVR) exposure and sunburns are particularly needed given their intentional tanning and infrequent use of sun protection. The purpose of this study was to conduct an early-phase study within the Multiphase Optimization Strategy framework that experimentally tested four unique intervention components targeting high school students' skin cancer prevention behaviors. Schools (11 total, N = 1,573 students) were assigned to receive one of four interventions: skin cancer education (control), education plus a sunscreen activity (to illustrate sunscreen's UVR-blocking properties), or behavior change worksheet (sun protection goal setting and planning) or receipt of a personalized UV damage photograph (photograph of facial damage). Sun protection, sunburn, and tanning outcomes were assessed before intervention and at 1-month follow-up. Within- and between-intervention changes in outcomes were examined using generalized estimating equation modeling. All interventions were associated with significant improvements in sun protection. The photograph was superior in controlling intentional tanning and sunburn when compared to the behavior change worksheet (ps < .05). In contrast, the worksheet was associated with greater increases in sun protection use when compared with the photograph (ps < .05). In this experiment testing four skin cancer preventive intervention components that varied in approach, content, and interactivity, the behavior change worksheet was superior in improving sun protection use whereas the UV photograph was superior in controlling intentional tanning and sunburn. Future randomized trials to test combinations of these intervention components are needed, and could identify mechanisms underlying improved effects and demographic or behavioral moderators of intervention effects.

Elevated Platelet Count Appears to Be Causally Associated with Increased Risk of Lung Cancer: A Mendelian Randomization Analysis.

Platelets are a critical element in coagulation and inflammation, and activated platelets are linked to cancer risk through diverse mechanisms. However, a causal relationship between platelets and risk of lung cancer remains unclear. We performed single and combined multiple instrumental variable Mendelian randomization analysis by an inverse-weighted method, in addition to a series of sensitivity analyses. Summary data for associations between SNPs and platelet count are from a recent publication that included 48,666 Caucasian Europeans, and the International Lung Cancer Consortium and Transdisciplinary Research in Cancer of the Lung data consisting of 29,266 cases and 56,450 controls to analyze associations between candidate SNPs and lung cancer risk. Multiple instrumental variable analysis incorporating six SNPs showed a 62% increased risk of overall non-small cell lung cancer [NSCLC; OR, 1.62; 95% confidence interval (CI), 1.15-2.27; P = 0.005] and a 200% increased risk for small-cell lung cancer (OR, 3.00; 95% CI, 1.27-7.06; P = 0.01). Results showed only a trending association with NSCLC histologic subtypes, which may be due to insufficient sample size and/or weak effect size. A series of sensitivity analysis retained these findings. Our findings suggest a causal relationship between elevated platelet count and increased risk of lung cancer and provide evidence of possible antiplatelet interventions for lung cancer prevention. These findings provide a better understanding of lung cancer etiology and potential evidence for antiplatelet interventions for lung cancer prevention.

Testing Scalable, IVR-supported Cancer Prevention Interventions in the Rural Alabama Black Belt

Testing Scalable, IVR-supported Cancer Prevention Interventions in the Rural Alabama Black Belt

Somatic genome alterations in relation to age in lung adenocarcinoma.

Lung adenocarcinoma (LUAD) is the most common cause of global cancer-related mortality and the major risk factor is smoking consumption. By analyzing 486 LUAD samples from The Cancer Genome Atlas, we detected a higher mutational burden among younger patients in the global cohort as well as in the TP53-mutated subcohort. The interaction effect of patient age and TP53 mutations significantly affected the mutational rate of younger TP53-mutated patients. Furthermore, we detected a significant enrichment of the smoking-related signature SI4 (SI4) among younger TP53-mutated patients, meanwhile the age-related Signature 1 (SI1) significantly increased in proportion to patient age. Although present and past smoking is reported in the TP53 wild-type patients, we observed a lower average number of somatic mutations, with no correlation with patient age. Overall, TP53 mutations were significantly higher in younger patients and mainly characterized by SI4 and Signature 24 (SI24). Therefore, TP53 seemed to acquire a particular sensitivity to smoking related C>A mutations in younger patients. We hypothesize that TP53 mutations at a younger age might be a crucial factor enhancing the sensitivity to smoking-related mutations leading to a burst of somatic alterations. The mutational profile of cancer cell might reflect the mutational processes operative in aging in a given tissue. Therefore, TP53-mutated and TP53 wild-type patient groups might represent phenotypes which endure aging-related mutational processes with different strength. Our study provides indications of age-dependent differences in mutational backgrounds that might be relevant for cancer prevention and age-adjusted treatment approaches.

Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review.

BackgroundThe use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited.ObjectiveThe main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care.MethodsA systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions’ features, outcome measures, and results.ResultsWe identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors.ConclusionsOur results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations.

Layers of information: interacting constraints on breast cancer risk-management by high-risk African American women

ABSTRACT Objectives: To understand how various decision-making dynamics interact to shape the risk-management choices of African American women at high-risk of breast cancer, and to explore whether African American and White women have differential access to the information and interactions that promote proactive, confident risk-management behavior. Design: This paper draws on 50 original in-depth, semi-structured interviews with African American and White women at elevated risk of breast cancer. We used inductive grounded-theory methodology to explore the processes by which women make risk-management decisions and to compare those processes between racial groups. Moving backward from women’s decisions about whether or not to engage in specific risk-management behaviors, we explored the patterns that underlie behavioral decisions. Results: We find that decisions to engage in risk-management behavior rest on three accumulated layers of information. The layer most proximal to making risk-management decisions involves specific information about risk-management options; the middle layer involves general information about managing breast cancer risk; and the foundational layer involves personal perceptions of breast cancer risk and prevention. African American and White women experience distinct dynamics at each of these levels, and these differences may help explain racial differences in risk-management behavior. Compared to their White counterparts, African American women faced additional burdens at every step along the risk-management journey. Conclusion: These findings suggest that information gathering is more complex than has previously been addressed, that information access and provider access are closely related, and that African American women may be systematically disadvantaged with respect to information-generating experiences. Preventing cancer morbidity and mortality requires that all high-risk women have access to the layers of information necessary to engage in cancer screenings and preventive interventions. These results exemplify the ways that structural, social, and interpersonal inequalities combine to influence risk-management choices.

Patterns and trends of HPV-related cancers other than cervix in South Africa from 1994–2013

BackgroundHPV infection causes several cancers which include cervical, vaginal, vulval, penile and oropharyngeal cancer (OPC). Understanding the burden of HPV-related cancers is important for guiding cancer prevention and treatment interventions. MethodsTo inform policy, we analysed trends of age-standardised incidence (ASIR) and mortality (ASMR) rates for HPV-related head and neck (HNC) and anogenital cancers (AGC) in South Africa between 1994 and 2013. ResultsA total of 1 028 330 incident cancers and 617 044 cancer-related deaths were reported during the study period. The overall ASIR (-5.5%) and ASMR (-2.2%) for HNC declined, in part related to the anti-smoking legislation. In contrast, incidence (2.9%) and mortality (0.8%) rates for AGC increased with the rising HIV prevalence. ASIR for oral cavity cancer (OCC: -6.3%) and laryngeal cancer (LC: -11.3%) declined, including mortality associated with these cancers (OCC:-1.9%, and LC:-2.6%). However, oropharyngeal cancer showed a slower rate of decline in ASIR (-4.4%) and ASMR did not change. Compared to women, ASIR and ASMR for HNC were 3-fold higher among men. ASIR for both anal (7.5%) and vulval cancer (16.1%) increased. Median age at diagnosis of vulval cancer declined by 18 years (p-value = 0.01). Mortality rates for anal (3.9%) and vulval (2.6%) cancer increased. ASIR (-3.2%) and ASMR (-2.0%) for penile cancer declined. Rates for vaginal cancer did not change. ConclusionsAnal and vulval cancers have increased over the reporting period. There is need to continuously monitor trends of these cancers. Implementation of HPV vaccination could significantly reduce the burden of HPV-related cancers.

Evaluating centralized technical assistance as an implementation strategy to improve cancer prevention and control.

In 2015-2016, the Comprehensive Cancer Control National Partnership provided technical assistance workshops to support 22 cancer coalitions in increasing human papillomavirus (HPV) vaccination uptake and increasing colorectal cancer (CRC) screening in their local communities. As national efforts continue to invest in providing technical assistance, there is a current gap in understanding its use as a strategy to accelerate implementation of evidence-based interventions (EBIs) for cancer prevention. The objective of this study was to evaluate the impact of technical assistance on the participants' knowledge, attitudes, and skills for implementing EBIs in their local context and enhancing state team collaboration. Data were collected August-November 2017 using web-based questionnaires from 44 HPV workshop participants and 66 CRC workshop participants. Both HPV vaccination and CRC screening workshop participants reported changes in knowledge, attitudes, and skills related to implementing EBIs in their local state context. Several participants reported increased abilities in communicating and coordinating with partners in their states and utilizing additional implementation strategies to increase HPV vaccination uptake and CRC screening rates. Findings from this study suggest that providing technical assistance to members of comprehensive cancer control coalitions is useful in promoting collaborations and building capacity for implementing EBIs for cancer prevention and control.

Evidence of promoting prevention and the early detection of breast cancer among women, a hospital-based education and screening interventions in low- and middle-income countries: a systematic review protocol

BackgroundGiven the increasing burden of breast cancer in the low- and middle-income countries, cost-effective approaches are needed to improve the early detection of breast cancer in these continents. Global policies and guidelines are now placing much emphasis on promoting early detection of breast cancer through integrated education and screening interventions. The proposed systematic review aims to map evidence on hospital-based breast cancer education, breast self-examination, and clinical breast examination services for women in low- and middle-income countries.Methods/designWe will conduct a systematic review of peer-reviewed studies on hospital-based breast cancer prevention intervention (breast cancer education, breast self-examination, and clinical breast examination) for women in low- and middle-income countries. An electronic search will be conducted in the following electronic databases CINAHL Plus with full text (EBSCOhost), MEDLINE with full-text (EBSCOhost) PsychINFO (EBSCOhost), and PubMed. Articles will also be searched through the “Cited by” search and citations included in the reference list of included articles. A two-stage mapping approach will be conducted. The first stage will involve screening studies through assessing their titles. Also, we will screen abstracts of identified studies descriptively and by focus and methods as dictated by the inclusion and exclusion criteria. The second stage will include extraction of data from eligible studies. A parallel screening and data extraction will be conducted by two reviewers. The quality of included studies will be assessed using the mixed methods appraisal tool (MMAT). A narrative account of the data extracted from the included studies will be analyzed using the thematic analysis.DiscussionWe hope to find relevant studies reporting evidence on promoting prevention and the early detection of breast cancer among women in a hospital-based education and screening interventions in low- and middle-income countries. The evidence obtained from the included studies when summarized will help guide future research. The study results will be disseminated electronically and in print. Also, it will be presented at conferences related to breast cancer.Systematic review registrationThe protocol has been registered with PROSPERO, with registration number CRD42017077818.

Interventions Using Social Media for Cancer Prevention and Management: A Systematic Review.

Regarding cancer awareness, social media effectively promotes health and supports self-management. Given the diverse study designs, methodologies, and approaches of social media interventions in oncology, it is difficult to determine the effects of social media on cancer prevention and management. We aim to systematically review intervention studies using social media for cancer care. A systematic search, using 7 electronic databases (PubMed, Web of Science, CINAHL, Cochrane Library, Scopus, EMBASE, and PsycINFO), was conducted to identify surveys and interventions using contemporary social media tools with a focus on cancer. Of the 18 selected studies, 7 were randomized controlled trials. Most studies were conducted for all types of cancer, and some were conducted for breast cancer in the United States, with mostly white female participants. Facebook was the most frequently used platform. Most studies targeted healthy participants providing cancer prevention education. With social media platforms as part of a larger intervention, or the main component of interventions, interventions were overall feasible and showed a significant improvement in cancer prevention and management. Social media tools have the potential to be effective in delivering interventions for cancer prevention and management. However, there was a dearth of studies with rigorous study methodologies to test social media effects on various cancer-related clinical outcomes. Social media use in cancer care will facilitate improved communication and support among patients, caregivers, and clinicians and, ultimately, improved patient care. Clinicians need to carefully harness social media to enhance patient care and clinical outcomes.

Cost-effective interventions for breast cancer, cervical cancer, and colorectal cancer: new results from WHO-CHOICE

BackgroundFollowing the adoption of the Global Action Plan for the Prevention and Control of NCDs 2013–2020, an update to the Appendix 3 of the action plan was requested by Member States in 2016, endorsed by the Seventieth World Health Assembly in May 2017 and provides a list of recommended NCD interventions. The main contribution of this paper is to present results of analyses identifying how decision makers can achieve maximum health gain using the cancer interventions listed in the Appendix 3. We also present methods used to calculate new WHO-CHOICE cost-effectiveness results for breast cancer, cervical cancer, and colorectal cancer in Southeast Asia and eastern sub-Saharan Africa.MethodsWe used “Generalized Cost-Effectiveness Analysis” for our analysis which uses a hypothetical null reference case, where the impacts of all current interventions are removed, in order to identify the optimal package of interventions. All health system costs, regardless of payer, were included. Health outcomes are reported as the gain in healthy life years due to a specific intervention scenario and were estimated using a deterministic state-transition cohort simulation (Markov model).ResultsVaccination against human papillomavirus (two doses) for 9–13-year-old girls (in eastern sub-Saharan Africa) and HPV vaccination combined with prevention of cervical cancer by screening of women aged 30–49 years through visual inspection with acetic acid linked with timely treatment of pre-cancerous lesions (in Southeast Asia) were found to be the most cost effective interventions. For breast cancer, in both regions the treatment of breast cancer, stages I and II, with surgery ± systemic therapy, at 95% coverage, was found to be the most cost-effective intervention. For colorectal cancer, treatment of colorectal cancer, stages I and II, with surgery ± chemotherapy and radiotherapy, at 95% coverage, was found to be the most cost-effective intervention.ConclusionThe results demonstrate that cancer prevention and control interventions are cost-effective and can be implemented through a step-wise approach to achieve maximum health benefits. As the global community moves toward universal health coverage, this analysis can support decision makers in identifying a core package of cancer services, ensuring treatment and palliative care for all.

The OncoSim Cancer Simulation Platform: A Tool to Project the Population Effects of Cancer Control Interventions in Canada

Background: Cancer control interventions exert their effects over multiple decades. To evaluate diverse and competing opportunities to reduce future cancer burden it is desirable to understand long-term effects prior to any new program implementation or significant change. Internationally, modeling is becoming an accepted source of planning information for decision-makers. Aim: We will describe the construction and use of the OncoSim microsimulation model, which was developed to evaluate cancer control strategies in Canada. Methods: OncoSim is a suite of models (cancers of the lung, colorectum, cervix and breast, plus a composite 32-cancer model) used to address key policy questions and support decision-making. It is led by the Canadian Partnership Against Cancer with model development by Statistics Canada. OncoSim incorporates risk factors, cancer natural history, screening, treatment, survival and end-of-life care. Wherever possible it is informed by Canadian data sources. Models are calibrated to reproduce a range of cancer-specific statistics, e.g., current and historical Canadian cancer-specific incidence and mortality, smoking patterns, and results of screening. The site-specific models have undergone further validation by replicating reported short-term effects of cancer prevention and screening interventions. Users may customize interventions through modifying input parameters. Outputs include incidence, mortality, costs, cost-effectiveness, and resource utilization. Users from the public sector have access at no cost to OncoSim and receive extensive support from a multidisciplinary technical team. The model is continually updated to incorporate emerging knowledge. Results: OncoSim has been used to support cancer control decision-making at the national and provincial/territorial levels. Applications include: national guidelines recommendations for colorectal and lung cancer screening; comparison of cytology vs. HPV based cervical cancer screening; and integration of smoking cessation into low-dose CT lung cancer screening. Conclusion: Validated simulation models such as OncoSim can be a versatile and efficient tool for cancer control planners to evaluate and prioritize cancer control strategies.

Culture, Communication, and Cancer Risk Behaviors Among Pacific Islanders in Hawaii

Background: A priority of the National Cancer Institute (NCI) is to acquire, aggregate and integrate cancer control data that facilitates collaborations to address health disparities and communication inequalities. To better communicate cancer research to the public, the NCI developed the Health Information National Trends Survey (HINTS). However, as with most national health surveillance systems, HINTS nationally obtained data are not sufficient to address the behaviors of unique demographic and geographic subpopulations. US Pacific Islanders are one of the fastest growing population groups in the US, and cancer is the leading cause of death in this group. Limited knowledge about the cancer communication practices and risk behaviors of US Pacific Islanders drive the poor implementation of effective cancer prevention interventions. Aim: This study aims to document the prevalence and differences in the cancer relevant knowledge, attitudes, and information seeking practices of Pacific Islander populations residing in Hawaii. Specifically, we aim to expand HINTS assessment to native Hawaiians and recent migrant Marshallese and Chuukese populations in Hawaii. Methods: We conducted surveys with 352 native Hawaiians, 282 Chuukese, and 129 Marshallese residing in HI. We used Respondent Driven Sampling method (RDS) to recruit these geographically diffuse populations in HI. The survey included questions about basic knowledge, attitude and behavior about various cancers, detailed communication behaviors about health information, and cultural beliefs and practices. Results: Data show there are clear differences among the three ethnic groups across a variety of cancer-related attitudes, knowledge, behaviors and risk factors. For example, a larger proportion of Chuukese have BMIs that can be described as obese or morbidly obese compared with native Hawaiians. On the other hand, native Hawaiians are significantly more likely to smoke than Marshallese and Chuukese. These groups also differ significantly regarding the level of acculturation, religiosity, fatalism about cancer, and trust in medical professionals. Regarding communication, cell phone use was common with 75% of native Hawaiians, 80% of Marshallese and 88% of Chuukese having cell phones. This use of cellphone technology was in stark contrast to Internet use with only 45% of native Hawaiians, 49% of Marshallese and 27% of Chuukese reporting access to the Web. Conclusion: There is a need for cancer prevention programs for Pacific Islanders in Hawaii. An effective health program has to address their unique cultural beliefs and practices, and fit their unique communication ecology. This study provides new knowledge concerning the use of nonprobability based study sampling methods, and the role of culture in cancer-related communications in influencing cancer risk behaviors that may be generalizable to the growing number of migrant Pacific Islander populations living in the US.