Provide Cancer Screening Services Research Articles

The differential needs and expectations from general practitioners in oncology between high-income countries and low- and-middle-income countries: results from a survey of Canadian and Nepali oncologists.

To address the shortage of oncologists in the wake of the rapidly increasing global cancer burden, general practitioners of oncology (GPOs) have been added to cancer care teams worldwide. GPOs are family physicians with additional training in oncology and their roles differ by both country and region. In this study, we aimed to learn about the roles and expectations of GPOs from the perspective of oncologists in Canada and Nepal. A survey was designed and administered to Canadian and Nepali Oncologists between February and November 2022 using Research Electronic Data Capture, a secure web-based software platform hosted at Queen's University in Kingston, Ontario, Canada. Participants were recruited through personal networks/social media in Nepal and the survey was distributed through an email list provided by the Canadian Association of Medical Oncologists. The survey received 48 responses from Canadian and 7 responses from Nepali oncologists. Canadian respondents indicated that in terms of educational content delivery, clinics with oncologists followed by didactic lectures by oncologists were thought to be the most effective, followed by a small group learning and online education. Nepali oncologists also indicated didactic lectures by oncologists and small group learning would be the most effective teaching techniques, followed by online education and clinics with oncologists. Critical knowledge domains and skills most relevant for GPO training identified by Canadian respondents were managing pain and other common symptoms of cancers, as well as treatment of common side effects, followed by goals of care discussion, post-treatment surveillance for recurrence, and the management of long-term complications from treatment. Respondents from Nepal, however, suggested an approach to diagnosis to patient with increased risk of cancer, and cancer staging were the most critical knowledge domains and skills. The majority of oncologists in both countries thought a training program of 6-12 months was optimal. We found many similarities in oncologist's opinions of GPOs between the two countries, however, there were also some notable differences such as the need to provide cancer screening services in Nepal. This highlights the need to tailor GPO training programs based on local context.

Improving colorectal, oral, breast, and cervical cancer screening rates using an inreach approach

The Taiwanese national cancer screening program was established in 1985 by providing Pap smear tests for women. At the same time, trial-based screening for colorectal, oral, and breast cancer screening was initiated. In 1999, outreach services for cancer screening were started and gradually scaled up to the national level. Our hospital is located in Hsinchu, Taiwan. Like many hospitals in Taiwan, we provide cancer screening services to the community. Our baseline screening rate was 96.6% in 2016. Aiming to increase the overall cancer (including colorectal, oral, breast, and cervical cancer) screening rates, we implemented two strategies. First, we modified the cancer screening workflow so that patients could receive screening counseling before the scheduled appointment. Second, we redesigned the clinic waiting room layout by moving check-in and cancer screening counters next to each other. By the end of 2017, the overall cancer screening rate increased from 96.6% to 105.4%. Our future efforts will be focused on collecting patient feedback, increasing coverage of hard-to-reach populations, and understanding barriers to cancer screening for specific groups of patients.

Willingness of potential service suppliers to provide cancer screening in urban China

Objective: Based on the investment for potential suppliers of cancer screening services, we assessed the reasons that affecting their participation motivation related to the long-term sustainability of cancer screening in China. Methods: Hospitals that had never been involved in any national level cancer screening project were selected by using the convenient sampling method within the 16 project cities of Cancer Screening Program in Urban China (CanSPUC) with 1 or 2 hospitals for each city. All the managers from the institutional/department level and professional staff working and providing screening services in these hospitals, were interviewed by paper-based questionnaire. SAS 9.4 was used for logical verification and data analysis. Results: A total of 31 hospitals (18 hospitals at the third level and, 13 hospitals at the second level) and 2 201 staff (508 hospital and clinic unit managers, 1 693 professional staff) completed the interview. All the hospitals guaranteed their potential capacity in service providing. 92.5% hospital managers showed strong willingness in providing cancer screening services, while 68.3% of them declared that the project fund-raising function was the responsibility of the government. For professional staff, their prospect gains from providing screening service would include development on professional skills (72.4%) and material rewards (46.8%). Their main worries would include extra work for CanSPUC might interfere their routine work (42.1%) plus inadequate compensation (41.8%). Medians of the prospect compensation for extra work ran between 20 to 90 Chinese Yuan per screening item respectively. For all the screening items, workers from the third-level hospitals expected their compensation to be twice as much of those working at the second level hospitals. Conclusion: Professional capacity building and feasible material incentive seemed to be the two key factors that influenced the sustainability and development of the programs.

Mobile Screening Units for the Early Detection of Cancer: A Systematic Review.

Mobile screening units (MSUs) provide cancer screening services outside of fixed clinical sites, thereby increasing access to early detection services. We conducted a systematic review of the performance of MSUs for the early detection of cancer. Databases (MEDLINE, EMBASE, Cochrane Library, WHO Global Health Library, Web of Science, PsycINFO) were searched up to July 2015. Studies describing screening for breast, cervical, and colon cancer using MSUs were included. Data were collected for operational aspects including the performance of exams, screening tests used, and outcomes of case detection. Of 268 identified studies, 78 were included. Studies investigated screening for cancers including breast (n = 55), cervical (n = 12), colon (n = 1), and multiphasic screening for multiple cancers (n = 10). The median number of screening exams performed per intervention was 1,767 (interquartile range 5,656-38,233). Programs operated in 20 countries, mostly in North America (36%) and Europe (36%); 52% served mixed rural/urban regions, while 35% and 13% served rural or urban regions, respectfully. We conclude that MSUs have served to expand access to screening in diverse contexts. However, further research on the implementation of MSUs in low-resource settings and health economic research on cost-effectiveness of MSUs compared with fixed clinics to inform policymakers is needed. Cancer Epidemiol Biomarkers Prev; 26(12); 1679-94. ©2017 AACR.

Abstract C07: Transitions to Medicare for Cancer Care Services: A Study of Safety Net Clinics in Georgia

Abstract Background: Advanced age and low socioeconomic status are major risk factors for cancer among women in the United States. Beginning at age 50, the probability of developing invasive cancer increases for women for almost every major type of cancer, including breast, colon, lung, and uterine cancer. Furthermore, uninsured patients and those from many ethnic minority groups are substantially more likely to be diagnosed with cancer at a later stage. Safety net health care providers offer primary care as well as cancer screening services for medically underserved patients. Publicly funded programs, such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), offer breast and cervical cancer screening services in many of these safety net settings. Little is known, however, about whether and to what extent safety net providers prepare older women for transitions to cancer care once they become eligible for Medicare and age out of publicly funded cancer screening programs like the NBCCEDP. To better inform future research, policy, and intervention programs designed to promote a coordinated transition to cancer screening and treatment among older women using safety net services, this study explored safety net provider practices about transitions to cancer care in Georgia. Study Purpose: The purpose of this study was to: 1) assess the extent to which safety net clinics in Georgia provide cancer screening services to medically underserved women ages 50 and older; and (2) explore safety net provider policies and practices for assisting older women to transition to Medicare for their cancer care services. Methods: This study applied an explanatory sequential mixed methods design. The quantitative phase included an online-survey with safety net providers who offer breast and cervical cancer screening services to older, uninsured and medically vulnerable women in Georgia. The survey addressed clinic and client characteristics, provision of cancer care services, health education and patient navigation services, and policies and practices specific to care transitions. In-depth interviews with a purposive sample of participating providers were conducted as the following explanatory qualitative phase to explore the survey results in greater detail. Results and Implications: Quantitative survey results from 193 safety net clinic providers in Georgia indicate about 20% of their clientele are uninsured women ages 50-64. A large majority of clinics offer breast and cervical cancer screening services (95%), as well as referrals for diagnostic follow-up (80%) and referrals for cancer treatment via the Georgia Women's Health Medicaid Program (82%). Most safety net clinics (57%) do not provide cancer screening services to women older than age 65 and do not have a formal policy in place to help these older women transition to Medicare for their cancer care (51%). However, about one-third of safety net clinics offer some information or informal counseling to older women about how to enroll in Medicare and find a Medicare-participating provider. Qualitative findings suggest that providers support the development of a care coordination model, such as patient navigation, to assist older women in their transition from safety net clinics to private, Medicare providers for cancer care services. Enhanced provider education and training regarding Medicare benefits and policies was also recommended. Considered together, these strategies offer an opportunity to enhance safety net provision of cancer screening services for older women and to create new models of transition cancer care for the medically underserved in Georgia Citation Format: Sarah Blake, Jonathan Hawley, Susanne Erni, Arpita Mehrotra. Transitions to Medicare for Cancer Care Services: A Study of Safety Net Clinics in Georgia. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C07.

Methodology of revision of Korean national cancer screening guideline

The National Cancer Screening Program (NCSP) was established to provide cancer screening services for low-income Medicaid recipients in 1999. Since then, the NCSP has expanded its target population to include National Health Insurance beneficiaries. Currently, the program targets the five most common types of cancer in Korea: stomach, liver, colorectal, breast, and cervical cancer. The National Cancer Center has been involved in developing and revising the practice guidelines for the NCSP in collaboration with the Ministry of Health and Welfare and related academic societies. The main methodological principles of development were determined as follows: an evidence-based approach to the development of recommendations on cancer screening was used, that the recommendation could be drawn by an adaptation process if evidence-based current reliable clinical practice guidelines were available, and that the level of evidence was assessed by methodologies. The process of recommendation development was divided into planning, development, and finalization steps. Planning tasks consisted of selection of clinical practice guideline topics, organization of a clinical practice guideline development group, reviewing the existing clinical practice guidelines, establishment of development plans, and definition of key questions. Development tasks consisted of steps including searching the literature evidence base, assessment of the quality of evidence, integration of evidence, and formulation of recommendations and deciding on the recommendation grade. The finalization tasks included external review, up-dating of the plan, and publication of the clinical practice guidelines.

Strengthening breast and cervical cancer control through partnerships: American Indian and Alaska Native Women and the National Breast and Cervical Cancer Early Detection Program

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has played a critical role in providing cancer screening services to American Indian and Alaska Native (AI/ANs) women and strengthening tribal screening capacity. Since 1991, the NBCCEDP has funded states, tribal nations, and tribal organizations to develop and implement organized screening programs. The ultimate goal is to deliver breast and cervical cancer screening to women who do not have health insurance and cannot afford to pay for these services. The delivery of clinical services is supported through complementary program efforts such as professional development, public education and outreach, and patient navigation. This article seeks to describe the growth of NBCCEDP's tribal commitment and the unique history and aspects of serving the AI/AN population. The article describes: 1) how this program has demonstrated success in improving screening of AI/AN women; 2) innovative partnerships with the Indian Health Service, state programs, and other organizations that have improved tribal public health infrastructure; and 3) the evolution of Centers for Disease Control and Prevention work with tribal communities.