Peer Reviewed: Profiles of 800,000 Users of the National Cancer Institute’s Cancer Information Service Since the Debut of Online Assistance, 2003-2008

Introduction

In 2002, the Cancer Information Service (CIS) of the National Cancer Institute added to its toll-free telephone number 2 choices of media for access to cancer information specialists: e-mail and a proprietary online instant messaging service called LiveHelp. We sought to determine how new media users differ from telephone callers and the US population in general.

Methods

During the 6 years since the new media were added, we collected data from more than 800,000 people who contacted CIS.

Results

Telephone calls to CIS declined while the number of LiveHelp and e-mail inquiries steadily increased. People who contacted CIS by telephone and LiveHelp were predominantly white and female and, compared with the general population, were relatively well educated. LiveHelp users were significantly younger, more educated, and more affluent than telephone callers. CIS clients asked most frequently for general cancer site information, information about treatment and side effects management, screening programs, and economic assistance. Telephone callers most often asked about breast cancer.

Conclusion

The Internet has introduced new sources of health information and possibly a new type of health information seeker. With LiveHelp and e-mail, CIS is poised to meet the needs of the digital health consumer and also the traditional telephone caller.     

Cancer incidence in Ireland—the possible role of diet,nutrition and lifestyle

Aim

This observational ecological study aims to compare Ireland’s age-specific cancer incidence rates (ASRs) with equivalent European and global data and to highlight possible dietary, nutritional and lifestyle contributors to cancer in Ireland.

Subjects and methods

Using the International Agency for Research on Cancer’s (IARC) GLOBOCAN database, Irish ASRs for all-site cancer and for “lifestyle-related” cancers such as those of the colo-rectum, oesophagus, breast, lung and prostate were compared with European and global incidence data. Irish dietary and nutrient intake data were reviewed and evaluated in the context of these cancer incidence data and in relation to the established dietary, nutritional, lifestyle and anthropometric predictors of increased cancer risk previously articulated in the literature.

Results

Incidence rates of colorectal, oesophageal, breast, lung, prostate and all-site cancer are higher in Ireland than in most other countries. National nutrition surveys in Ireland indicate that dietary, nutritional, lifestyle and anthropometric risk factors for cancer occur with high frequency in the Irish population. For example, low fruit and vegetable consumption, high red and processed meat intake, low fish intake, low dairy consumption, high saturated fat intake, low folate and vitamin D intakes, and excessive alcohol consumption are all common amongst Irish adults.

Conclusions

Our data suggest that unfavourable diet and nutrient intakes prevail in Ireland and that these may contribute to Ireland’s excess cancer burden. These risk factors should be targeted by interventions seeking to sustainably redress Ireland’s high cancer incidence. Such initiatives may provide a template for intervention in other high-risk countries.

     

The use of the Epidemiology Cancer registry Baden-Württemberg in the follow-up of the EPIC cohort

The European Prospective Investigation into Cancer and Nutrition (EPIC) is a prospective multicentre study that has been implemented to further the understanding of the association between diet and chronic diseases with emphasis on cancer. In Heidelberg from June 1994 until October 1998 about 25,500 subjects aged 35 to 65 years in women and 40 to 65 years in men were recruited. Apart from extensive questions about food intake, the participants were also asked to provide detailed information about their smoking habits, physical activity, subjective well-being, medical history and use of medications. As well as completing the questionnaire and a personal interview, the participants also gave blood samples and anthropometiric measures and the blood pressure were taken in standardized manner. The analyses of the EPIC study will depend on achieving a comprehensive record of all new cancer cases, and all deaths, together with the corresponding cause of death, within the study population. To date all self-reported incident cancer cases are verified by comparing them with pathology reports and hospital records. They are then coded according to the coding list for the International Classification of Diseases (ICD-O2) issued by the World Health Organisation (WHO). Since at begin of the investigation in the study region no cancer registration existed, the participants are followed -up by interval questioning ('active follow-up'). In order to integrate increasingly the data of the Cancer registry Baden-Württemberg (EKR-BW) attempts were made to explore record linkage systems. For this purpose, in the years 2000, 2002, 2003 record linkages between EPIC-Heidelberg and EKR-BW were performed. Procedures were evaluated for performing an anonymous linkage of the EPIC data with the data of the EKR-BW. After a pilot project on the feasibility of the linkage the program was evaluated on the EPIC data, record linkages are performed regularly. Different coding systems were applied. Simultaneously, the EPIC data about on cancer cases among the Heidelberg study participants are passed on to the Cancer Registry, thus contributing to improve completeness of the registry. So far the active follow-up can not be replaced by passive follow-up through record linkage with the cancer registry, but in the long-term it may be possible. Since the technical requirements are complied with, attempts should be made to improve the completeness of the epidemiological cancer registry Baden- Württemberg.     

Timeliness of Breast Cancer Diagnosis and Initiation of Treatment in the National Breast and Cervical Cancer Early Detection Program, 1996�C2005

Objectives. To determine the effects of program policy changes, we examined service delivery benchmarks for breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).Methods. We analyzed NBCCEDP data for women with abnormal mammogram or clinical breast examination (n = 382 416) from which 23 701 cancers were diagnosed. We examined time to diagnosis and treatment for 2 time periods: 1996 to 2000 and 2001 to 2005. We compared median time for diagnostic, treatment initiation, and total intervals with the Kruskal–Wallis test. We calculated adjusted proportions (predicted marginals) with logistic regression to examine diagnosis and treatment within program benchmarks (≤ 60 days) and time from screening to treatment (≤ 120 days).Results. Median diagnostic intervals decreased by 2 days (25 vs 23; P < .001). Median treatment initiation intervals increased by 2 days (12 vs 14; P < .001). Total intervals decreased by 3 days (43 vs 40; P < .001). Women meeting the 60-day benchmark for diagnosis improved the most for women with normal mammograms and abnormal clinical breast examinations from 77% to 82%.Conclusions. Women screened by the NBCCEDP received diagnostic follow-up and initiated treatment within preestablished program guidelines.Screening for breast cancer reduces morbidity and mortality from breast cancer when women receive timely follow-up and appropriate treatment.¹ There are few data to indicate what the optimal diagnostic and treatment intervals are that might ensure the best chances of survival from breast cancer detected by screening with mammography.^2,3 Recent information from organized screening programs in Canada and the United Kingdom showed that women who waited longer than 6 to 12 months for diagnostic workup were more likely to have larger cancers and more positive lymph nodes, which might lead to poorer survival.^2,3 In the case of symptomatic women, delays greater than 3 to 6 months to start therapy are associated with poorer survival.⁴Recent modeling studies have shown that the declines in mortality are attributable to both early detection and subsequent treatment.¹ Minority women, uninsured women, and women from lower socioeconomic backgrounds often do not have access to early detection.^5–7 These women are less likely to participate in mammography screening,⁸ less likely to have timely and complete follow-up after an abnormal screening test result,^9,10 more likely to be diagnosed with late-stage breast cancer,^6,7,11 more likely to die from breast cancer once diagnosed,^6,7 and might be more likely to receive suboptimal treatment.^12–15The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was authorized by Congress in 1990 to reach underserved women.¹⁶ Since the inception of the program, the NBCCEDP has established service delivery benchmarks to ensure timely and complete diagnostic follow-up and treatment initiation for underserved women screened through the program.¹⁷ Previous analysis of program benchmarks demonstrated that the national program was meeting its predefined quality standards of having a diagnosis within 60 days of an abnormal screening test result and initiation of treatment within 60 days of diagnosis.¹⁸ Legislation for program enhancements that added case management services, which was fully implemented in 2000, and a Medicaid waiver authorized by Congress in 2000 and fully implemented in 2003, should have improved the program''s ability to meet these standards.^19–22Accordingly, we hypothesized that NBCCEDP service delivery benchmarks would improve over time with shortening of time intervals after an abnormal mammogram or clinical breast examination (CBE) finding to final diagnosis, as well as the interval to treatment initiation after diagnosis, and the interval to treatment initiation after abnormal screening test result. We investigated this by using 2 time periods, 1996 to 2000 and 2001 to 2005,²⁰ to examine the effects of program policy changes on intervals in the 2001–2005 period.^20–22     

Cancer mortality and oil production in the Amazon Region of Ecuador, 1990–2005

Objectives  To compare cancer mortality rates in Amazon cantons (counties) with and without long-term oil exploration and extraction activities. Methods  Mortality (1990 through 2005) and population census (1990 and 2001) data for cantons in the provinces of the northern Amazon Region (Napo, Orellana, Sucumbios, and Pastaza), as well as the province with the capital city of Quito (Pichincha province) were obtained from the National Statistical Office of Ecuador, Instituto Nacional del Estadistica y Censos (INEC). Age- and sex-adjusted mortality rate ratios (RR) and 95% confidence intervals (CI) were estimated to evaluate total and cause-specific mortality in the study regions. Results  Among Amazon cantons with long-term oil extraction, activities there was no evidence of increased rates of death from all causes (RR = 0.98; 95% CI = 0.95–1.01) or from overall cancer (RR = 0.82; 95% CI = 0.73–0.92), and relative risk estimates were also lower for most individual site-specific cancer deaths. Mortality rates in the Amazon provinces overall were significantly lower than those observed in Pichincha for all causes (RR = 0.82; 95% CI = 0.81–0.83), overall cancer (RR = 0.46; 95% CI = 0.43–0.49), and for all site-specific cancers. Conclusions  In regions with incomplete cancer registration, mortality data are one of the few sources of information for epidemiologic assessments. However, epidemiologic assessments in this region of Ecuador are limited by underreporting, exposure and disease misclassification, and study design limitations. Recognizing these limitations, our analyses of national mortality data of the Amazon Region in Ecuador does not provide evidence for an excess cancer risk in regions of the Amazon with long-term oil production. These findings were not consistent or supportive of earlier studies in this region that suggested increased cancer risks.     

Unraveling the Determinants of Cancer Patients’ Intention to Express Concerns

Little is known about the behavioral determinants that underlie cancer patients’ intention to express concerns during a consultation. This information can be relevant to developing effective interventions for cancer patients. In this study, the integrative model of behavioral prediction (IMBP) is used as a framework to unravel the determinants of patients’ intention to express concerns. The objectives of this study are to examine which of the IMBP determinants (attitude, perceived social norm, and/or self-efficacy) are significantly related to intention and what content of these determinants can be targeted to effect a change in patients’ intention. An online survey based on the IMBP determinants was distributed. A total of 236 cancer patients and cancer survivors participated. The results of the survey showed that patients’ attitudes and perceived social norm were the most important determinants of their intention to express concerns. The largest change in patients’ intention might be achieved by targeting the affective attitude, referring to the extent to which patients believe that expressing concerns is (un)pleasant, and the social norm, referring to the extent to which patients feel (un)supported by significant others in expressing concerns.     

The Experience of Living With Metastatic Breast Cancer—A Review of the Literature

Women's experiences with metastatic breast cancer have received little research attention. We reviewed published articles (1984–2013) reporting research examining women's experiences of metastatic breast cancer (n = 33). Findings from quantitative studies were categorized into three broad areas: adverse consequences, satisfaction with health care providers, and strategies for living. Themes identified from qualitative findings include living as a social outsider; importance of hope; health and quality of life; positive experiences; experiences at end of life; and strategies for living. More research is needed to explore experiences of subgroups to appropriately respond to women's diverse care needs.     

Korean version of the Caregiver Quality of Life Index – Cancer (CQOLC-K)

Objective: The aim of this study was to develop and evaluate the internal consistency and construct validity of a Korean version of the Caregiver Quality of Life Index – Cancer (CQOLC-K). Methods: The CQOLC-K was administered to 270 caregivers, along with the Medical Outcomes Study Short Form-36 (SF-36) and the Beck Depression Inventory (BDI). Results: Internal consistency of the CQOLC-K (0.90) and all inter-scale correlations were significant in the expected direction (p < 0.001). Convergent validity was supported with moderate to strong correlations between the CQOLC-K and the mental component scores of the SF-36 (r = 0.39–0.58), and between the CQOLC-K and the two BDI scores (r = 0.50 and 0.60). Divergent validity was supported by weaker or negligible correlations between the CQOLC-K and the physical component scores of the SF-36 (r = 0.16–0.30). Contrasting groups validity showed that the CQOLC-K was able to distinguish clearly between patients differing in treatment history (p < 0.005), performance status (p < 0.005), care area (p < 0.005), and length of time after diagnosis (p < 0.005). Conclusion: These findings support the internal consistency reliability and construct validity of the Korean version of the CQOLC-K. The instrument can be used to measure quality of life in caregivers of cancer patients in clinical and epidemiological research.     

Oleuropein,a Secoiridoid Derived from Olive Tree,Inhibits the Proliferation of Human Colorectal Cancer Cell Through Downregulation of HIF-1α

Oleuropein (OL) is the most prominent phenolic compound in the fruit of olive tree. Although OL has shown powerful anticancer activity the underlying action mechanism remains largely unknown. The present study evaluated the effects of OL on hydroxityrosol (HT)-29 human colon adenocarcinoma cells in comparison to hydroxytyrosol, its hydrolysis product, and to elucidate the underlying anticancer molecular mechanisms involved. Cell proliferation was determined using SRB assay. Cell cycle and apoptosis were assessed by flow cytometry and changes in MAPK cascade protein expression, HIF-1α, p53, PPARγ, and NFKβ signaling pathways by Western blot. Although OL showed less potency than HT, in terms of cell growth inhibition, induced significant changes in cell cycle analysis and caused a significant increase in the apoptotic population. Both compounds produced a remarkable decrease in HIF-1α protein and an upregulation of p53 protein expression. However, no significant changes in IkB-α and MAPK cascade protein expressions were observed. HT produced a significant upregulation in peroxisome proliferator-activated receptor gamma (PPARγ) expression whereas OL failed. PPARγ upregulation may be one of the principal mechanisms of the tumor shrinkage by HT. Our novel findings demonstrate that OL limits the growth and induces apoptosis in HT-29 cells via p53 pathway activation adapting the HIF-1α response to hypoxia.     

Dietary Cadmium Exposure and Risk of Breast,Endometrial, and Ovarian Cancer in the Women’s Health Initiative

Background: In vitro and animal data suggest that cadmium, a heavy metal that contaminates some foods and tobacco plants, is an estrogenic endocrine disruptor. Elevated estrogen exposure is associated with breast, endometrial, and ovarian cancer risk.Objectives: We examined the association between dietary cadmium intake and risk of these cancers in the large, well-characterized Women’s Health Initiative (WHI).Methods: A total of 155,069 postmenopausal women, 50–79 years of age, who were enrolled in the WHI clinical trials or observational study, participated in this study. We estimated dietary cadmium consumption by combining baseline food frequency questionnaire responses with U.S. Food and Drug Administration data on food cadmium content. Participants reported incident invasive breast, endometrial, or ovarian cancer, and WHI centrally adjudicated all cases through August 2009. We applied Cox regression to estimate adjusted hazard ratios (HRs) and 95% CIs for each cancer, comparing quintiles of energy-adjusted dietary cadmium intake.Results: Over an average of 10.5 years, 6,658 invasive breast cancers, 1,198 endometrial cancers, and 735 ovarian cancers were reported. We observed no statistically significant associations between dietary cadmium and risk of any of these cancers after adjustment for potential confounders including total dietary energy intake. Results did not differ in any subgroup of women examined.Conclusions: We found little evidence that dietary cadmium is a risk factor for breast, endometrial, or ovarian cancers in postmenopausal women. Misclassification in dietary cadmium assessment may have attenuated observed associations.Citation: Adams SV, Quraishi SM, Shafer MM, Passarelli MN, Freney EP, Chlebowski RT, Luo J, Meliker JR, Mu L, Neuhouser ML, Newcomb PA. 2014. Dietary cadmium exposure and risk of breast, endometrial, and ovarian cancer in the Women’s Health Initiative. Environ Health Perspect 122:594–600; http://dx.doi.org/10.1289/ehp.1307054     

Measurement invariance of the Functional Assessment of Cancer Therapy—Colorectal quality-of-life instrument among modes of administration

Objectives

To test for the measurement invariance of the Functional Assessment of Cancer Therapy—Colorectal (FACT-C) in patients with colorectal neoplasms between two modes of administration (self- and interviewer administrations). It is important to establish the measurement invariance of the FACT-C across different modes of administration to ascertain whether it is valid to pool FACT-C data collected by different modes or to assess each group separately.

Methods

A cross-sectional sample of 391 Chinese patients with colorectal neoplasms was recruited from specialist outpatient clinics between September 2009 and July 2010. Confirmatory factor analysis (CFA) was used to test the original five-factor model of the FACT-C on data collected by self- and interviewer administrations in single-group analysis. Multiple-group CFA was then used to compare the factor structure between the two modes of administration using chi-square tests and other goodness-of-fit statistics.

Results

The hypothesized five-factor model of FACT-C demonstrated good fit in each group. Configural invariance and metric invariance were fully supported in multiple-group CFA. Some item intercepts and their corresponding error variances were not identical between administration groups, suggesting evidence of partial strict factorial invariance.

Conclusions

Our results confirmed that the five-factor structure of FACT-C was invariant in Chinese patients using both self- and interviewer administrations. It is appropriate to pool or compare data in the emotional well-being and colorectal cancer subscale scores collected by both administrations. Measurement invariance in three items, one from each of the other subscales, may be contaminated by response bias between modes of administration.     

Cancer on the Island of Réunion: results of a survey preliminary to the creation of a tumor registry

Before the organization of a cancer registration in "l'Ile de la Réunion" a retrospective survey about cases notified by public and private physicians was setted in 1981. 1128 cases were notified and 618 were new cases. The estimation of the total incidence of cancer is 1.2 cases by 1000 inhabitants in "l'Ile de la Réunion".     

Cohort profile and representativeness of participants in the Diet,Cancer and Health—Next Generations cohort study

European Journal of Epidemiology - The Diet, Cancer and Health—Next Generations (DCH-NG) study is a large population-based cohort study that was established as a resource for...     

The knowledge of the population of Viçosa, MG, about the ways of AIDS transmission

AIDS is a major public health problem reaching all social strata. Knowing about the ways of transmission is a way of preventing the disease. For evaluating the level of knowledge of the population of the city of Vi?osa about AIDS transmission, a questionnaire about the ways of transmission of the disease based on studies made in Europe was applied to 376 individuals. The questionnaire consisted of eleven multiple-choice questions about the ways of AIDS transmission, sex, age and educational level of the interviewees. The results showed that the ways of transmission emphasized in health campaigns are well assimilated, while the questions about everyday situations that offer no risk received a high number of incorrect answers. The differences were not significant when data were stratified by sex. The same data stratified by age or educational level showed significant differences for some questions; people aged over 55 and with a lower educational level had a significantly higher number of incorrect answers. It can be concluded that the population of Vi?osa knows the main ways of AIDS transmission, but a part of the population does not know that some everyday situations do not pose risk of transmission. These data can be useful for the preparation of elucidative campaigns for reducing prejudice.     

Evaluation of the Sources of Contamination in the Suburban Area of Koropi–Markopoulo, Athens, Greece

Heavy metal concentrations were monitored in agricultural soils and irrigation groundwaters of Koropi–Markopoulo area, a representative agricultural suburb in Athens, Greece, aiming at the identification of the sources of contaminants. Multivariate analyses of geochemical data demonstrated that agricultural practices and industrial activities considerably affected the quality of both environmental compartments. The levels of Ni, Cr, Co, Mn and Fe in agricultural soils were associated with geological parent materials whereas Pb, Zn and Cu mainly originated from anthropic activities. Referring to groundwaters, individual major anions and cations (K⁺, Na⁺, Ca²⁺, Mg²⁺, NO₃ ^?, SO₄ ^2?, Cl^?) were influenced by various natural and anthropogenic factors whereas Ni, Cr, Cu and Zn were controlled by industrial and agronomic activities. The identification of the sources of contaminants in soil and groundwater environments is a valuable basis for encouraging mitigation strategies preventing further quality degradation.     

The Economic Potential of Smoking Cessation Interventions at the Point of Diagnosis of Non–Small Cell Lung Cancer

ObjectivesStopping smoking has proven benefits in nearly all illnesses but the impact and health economic benefits of stopping smoking after a diagnosis of lung cancer are less well defined. We assessed the cost-effectiveness of smoking cessation (SC) services for patients with newly diagnosed lung cancer against current usual care, where patients are unlikely to receive SC service referral.MethodsA health economic model was constructed in Excel. The modelled population comprised of patients with a new diagnosis of non–small cell lung cancer (NSCLC). Data from the LungCast data set (Clinical Trials Identifier NCT01192256) were used to estimate model inputs. A structured search of published literature identified inputs not represented in LungCast, including healthcare resource use and costs. Costs were estimated from a 2020/2021 UK National Health Service and Personal Social Services perspective. The model estimated the incremental quality-adjusted life-year (QALY) gained in patients with newly diagnosed NSCLC receiving targeted SC intervention than those receiving no intervention. Extensive one-way sensitivity analyses explored input and data set uncertainty.ResultsIn the 5-year base case, the model estimated an incremental cost of £14 904 per QALY gained through SC intervention. Sensitivity analysis estimated an outcome range of between £9935 and £32 246 per QALY gained. The model was most sensitive to the estimates of relative quit rates and expected healthcare resource use.ConclusionThis exploratory analysis indicates that SC intervention for smokers with patients with newly diagnosed NSCLC should be a cost-effective use of UK National Health Service resources. Additional research with focused costing is needed to confirm this positioning.