A study of cancer information for cancer patients on the internet

Background  There have been few studies of the information provided for cancer patients on the internet. Methods  Using the Japanese language, we searched for cancer-related web pages, using the Google search engine, and evaluated the characteristics of the 150 top-ranked search results. We collected information on the operators of the websites, number of links, existence of a search function, and advertisements on the site. According to their contents, the 150 websites were classified into seven categories, of which five (numbers 1, 2, 3, 4, and 6) each accounted for 20% of the websites. The categories were: (1) media-related websites (e.g., newspapers and publishers), and portal sites; (2) patient association websites, patient's diaries, blogs by patients and/or their families (n = 33); (3) websites of medical institutions (e.g., hospitals; n = 27); (4) websites of research institutions (e.g., universities; n = 35); (5) websites of pharmaceutical companies; (6) other websites providing medical information (n = 32); and (7) other websites that did not belong to categories 1–6. Outgoing links were common in websites created by media-related organizations (median, 13) or patients and their families (median, 15), but such links were not common in the other types of websites (median, 0–4). Eight of the 13 cancer based hospitals in Japan, as well as the National Cancer Center were publishing general cancer information on their websites. Of the 13 cancer based hospitals, 12 included a link to the National Cancer Center. The National Cancer Center had the largest amount of information (736 575 words), exceeding the amount provided by the other cancer based hospitals (1 622–155 515 words). Two of the 7 websites of academic associations (included in category 6) had cancer information for patients, but the document sizes were small (3230–44 091 words). Conclusion  The website of the National Cancer Center is the most prominent source of general cancer information for patients, but it still has room for improvement in its usability.     

Coverage of cancer in local television news

Background. The news media provide significant health information to the American public. Although the public turns to and trusts local television news, news about cancer has not been systematically examined. Methods. In this content analysis, we examined 40,112 news stories aired in the 3rd, 25th, 87th, and 150th sized market in the country, all located in the Midwest. Results. In total, 386 stories focused on cancer. News stories about cancer were short and occurred less than once for every 30 minutes of news. The amount of news coverage of specific cancer sites was not consistent with cancer incidence rates. Similarly, the demography of cancer patients featured in the news differed from that in real life. Few stories provided follow-up information. The average story required a 10th-grade education to be understood. Differences across markets were not systematically related to market size. Conclusions. Cancer coverage was scattered and abbreviated. For both cancer practitioners as well as the general public, local television news cannot be counted on as a primary vehicle for cancer information.     

A content analysis of cancer survivorship coverage in a representative sample of US news outlets

Background. Media are popular sources of cancer information, yet little is known about how survivors are depicted. Methods. This study analyzes coverage of cancer survivors in a nationally representative sample of newspapers and television newscasts. Stories were coded for cancer type, gender, age, survivorship length and status, treatment types, and spirituality, among other variables. Results. Media provide limited information about survivors. Also, although breast cancer coverage was close to survivorship rates, nearly every other cancer type was underreported for both incidence and survivorship rates. Conclusions. Inaccurate media coverage may be contributing to public misunderstanding about cancer survivorship.     

Conflict of interest in economic analyses of aromatase inhibitors in breast cancer: a systematic review

To determine whether authors conducting economic analyses of aromatase inhibitors in breast cancer are less likely to reach unfavorable conclusions if the economic study is sponsored by the manufacturer of the drug. Articles reporting the economic analyses of aromatase inhibitors in breast cancer were selected from PubMed in May 2009. Information was collected on the types of analysis, the qualitative conclusion, the quantitative results, and the funding sources. Fisher’s exact test was conducted to compare the frequency of unfavorable conclusions based on study sponsorship. Thirty-two eligible articles were identified. Twenty-six were funded by pharmaceutical companies, and 4 were funded by non-pharmaceutical companies. Two studies did not report a funding source. Twenty-one studies evaluated aromatase inhibitors in the adjuvant setting, while 11 studies examined their use in advanced breast cancer. Twenty-two studies evaluated one type aromatase inhibitor, while 10 compared multiple types of aromatase inhibitors. Only one of the 26 (4%) pharmaceutical company-sponsored studies reported unfavorable cost-effectiveness of an aromatase inhibitor, which was a competitor’s product, whereas two of four (50%) non-pharmaceutical company-sponsored studies concluded aromatase inhibitors are not cost-effective in certain clinical scenarios (P < 0.05). Seven pharmaceutical company-sponsored studies conducted a comparison among several aromatase inhibitors; all 7 studies reported favorable conclusions for the sponsoring company’s products. The majority of economic analyses of aromatase inhibitors in breast cancer are sponsored by pharmaceuticals. Economic evaluations of aromatase inhibitors in breast cancer that are funded by a pharmaceutical company are less likely to reach unfavorable conclusions about the sponsor’s product.     

Getting cancer prevalence right: using state cancer registry data to estimate cancer survivors

Objective  

Cancer incidence and mortality statistics provide limited insight regarding the cancer survivor population and its needs. Cancer prevalence statistics enumerate cancer survivors—those currently living with cancer. Commonly used limited-duration prevalence (LDP) methods yield biased estimates of the number of survivors. National estimates may not allow sufficient granularity to inform local survivorship programs. In this study, complete prevalence (CP) methods are applied to actual North Carolina Central Cancer Registry (NCCCR) data to generate better, more informative prevalence estimates than previous methods.     

Genetic variation in the upstream region of ERG and prostate cancer

Objective  A considerable fraction of prostate cancers harbor a gene fusion between the androgen-regulated TMPRSS2 and ERG, one of the most frequently over-expressed proto-oncogenes in prostate cancer. Here, we investigated if inherited genetic variation upstream of ERG alters prostate cancer risk and survival. Methods  We genotyped 21 haplotype tagging SNPs (htSNPs) covering 123 kb of 5′UTR DNA including exon 3 of ERG in 2,760 incident prostate cancer cases and 1,647 controls from a population-based Swedish case–control study (CAPS). Individual SNPs and haplotypes were tested for association with prostate cancer risk and survival. Results  One haplotype—′CTCGTATG′ located 100 kb upstream of ERG—was associated with lethal prostate cancer (HR, 1.36; 95% CI, 1.2–1.9, p = 0.006). Carriers of the variant ‘T’ allele of rs2836626 were diagnosed with higher TNM-stage (p = 0.009) and had an increased risk of prostate cancer-specific death (HR = 1.3; 95% CI, 1.1–1.7, p = 0.009). However, this association did not remain statistically significant after adjusting for multiple testing. We found overall no association between ERG variation and prostate cancer risk. Conclusions  Genetic variation upstream of ERG may alter prostate cancer stage and ultimately prostate cancer-specific death but it is unlikely that it plays a role in prostate cancer development.     

A retrospective review of the metabolic syndrome in women diagnosed with breast cancer and correlation with estrogen receptor

Women diagnosed with obesity and breast cancer have an increased risk of recurrence and death (Protani et al., Breast Cancer Res Treat 123:627–635, 1). Obesity is associated with the metabolic syndrome—a pathophysiologically distinct inflammatory process comprised of central obesity, insulin resistance, hypertension, and atherogenic dyslipidemia. The relationship of obesity as a risk factor for breast cancer is complex with a protective effect for younger women in contrast to a risk for older women (Kabat et al., Cancer Epidemiol Biomarkers Prev 18:2046–2053, 2; Ursin et al., Epidemiology 6:137–141, 3). The metabolic syndrome has been associated with the risk of cancer, and pro-inflammatory circulating factors may be associated with risk of more aggressive breast cancer (Capasso et al., Cancer Biol Ther 10:1240–1243, 4; Healy et al., Clin Oncol (R Coll Radiol) 22:281–288, 5; Laukkanen et al., Cancer Epidemiol Biomarkers Prev 13:1646–1650, 6). We conducted a retrospective review of 860 breast cancer patients to determine the relationship between estrogen receptor status and the metabolic syndrome. We collected the relevant metabolic diagnoses, medications, physical findings, and laboratory values and adapted the National Cholesterol Education Program criteria to define the metabolic syndrome retrospectively. No relationship was found between estrogen receptor status and the individual components of the metabolic syndrome. Based on findings in the medical records, 15% of the women with breast cancer had the metabolic syndrome, and 26% of the women were considered obese, 16% hyperglycemic, 54% hypertensive, and 30% dyslipidemic. The metabolic syndrome was associated with advanced age and African-American race (P < 0.001). When adjusted for age, race, and stage, the metabolic syndrome was marginally associated with estrogen receptor-positive tumors (P = 0.054). Our findings do not support the concern that the metabolic syndrome may contribute to more biologically aggressive breast cancer.     

Diagnostic and therapeutic delays among a multiethnic sample of breast and cervical cancer survivors

BACKGROUND:

Several publications reporting on health disparities document that ethnic minorities disproportionately experience delays in healthcare access, delivery, and treatment. However, few studies examine factors underlying access and receipt of healthcare among cancer survivors from the patient perspective. This study explores diagnostic and therapeutic care delays among a multiethnic sample of breast and cervical cancer survivors and examines contextual factors influencing diagnostic and therapeutic care delays.

METHODS:

Population‐based sampling and a cross‐sectional design were used to recruit 1377 survivors (breast cancer, n = 698; cervical cancer, n = 679). This multiethnic sample included 449 European American, 185 African American, 468 Latina American, and 275 Asian American survivors.

RESULTS:

Latina Americans were more likely to report diagnostic delays (P = .003), whereas African Americans were more likely to report therapeutic delays (P = .007). In terms of cancer type, cervical cancer survivors were more likely to report diagnostic (P = .004) and therapeutic delays (P = .000) compared with breast cancer survivors. “Fear of finding cancer” was the most frequently cited reason for diagnostic delays, and “medical reasons” were most frequently cited for therapeutic delays.

CONCLUSIONS:

Due in part to a higher proportion of diagnostic and therapeutic delays, ethnic minorities endure greater cancer burden, including poorer survival and survivorship outcomes. The medical community must recognize the impact of existing psychological and cultural dimensions on diagnostic care, as well as the personal and healthcare system level barriers that contribute to therapeutic delays. Cancer 2010. © 2010 American Cancer Society.     

From planning to implementation to outcomes: comprehensive cancer control implementation building blocks

Since 2002, the US Centers for Disease Control and Prevention’s Guidance for Comprehensive Cancer Control Planning has been an important driver of success in the development of comprehensive cancer control (CCC) plans among states, tribes, tribal organizations, territories and Pacific Island Jurisdictions. CDC’s Guidance for Comprehensive Cancer Control Planning laid out a number of key action steps, or planning building blocks, that are essential to successful cancer plan development. Now, all 50 states and many tribes, tribal organizations, territories and Pacific Island Jurisdictions are actively implementing their comprehensive cancer control plans. This article describes a new set of key actions aimed at assisting CCC coalitions with systematic implementation of their cancer plan priorities—implementation building blocks for comprehensive cancer control.     

Barriers to seeking cancer information among Spanish-speaking cancer survivors

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

Patterns of relapse in breast cancer: changes over time

Adjuvant systemic treatment for breast cancer has evolved resulting in improved outcomes. A relevant question is whether these advances have changed the pattern of distant relapse. Women diagnosed with stage I–III breast cancer were divided into three time cohorts according to changes in adjuvant therapy; A: 1989–1991—CMF chemotherapy in premenopausal and tamoxifen for postmenopausal women; B: 1992–1997—anthracycline chemotherapy and tamoxifen for pre/postmenopausal women; C: 1998–2001—broader use of anthracyclines. The primary endpoint was 5-year cumulative incidence of bone metastasis (BM) as first site of metastasis (FSOM) versus non-bone metastasis (NBM). The ratios NBM/BM in each period were calculated. The eligibility criteria were met by 21,415 cases; Cohorts A: 1989–1991 (n = 3,915), B: 1992–1997 (n = 9,229) and C: 1998–2001 (n = 8,271). Between 1989 and 2001, the percentage of patients receiving adjuvant chemotherapy increased from 23.1 to 34.4%. A decline in cumulative 5-year incidence rates for BM and NBM as FSOM was seen comparing cohort A to C, P < 0.0001. The ratio NBM/BM was significantly increased from 1.53 in the early cohort to 2.00 in the later one, P = 0.0083. The most prominent increase (84%) was in the ER-negative group, chemotherapy treated, P = 0.0272. A significant decline in 5-year cumulative incidence of metastases and an increase in the proportion of NBM as first site of metastasis were observed between earlier and later cohorts. This may reflect the need for more successful adjuvant treatment options for aggressive breast cancer subtypes which are more likely to present with early spread to visceral organs. Understanding patterns of relapse may help design new adjuvant strategies.     

Measuring the impact of cancer: a comparison of non-Hodgkin lymphoma and breast cancer survivors

Introduction  

Self-report instruments such as the Impact of Cancer (IOC) are designed to measure quality of life (QOL) impacts that cancer survivors attribute to their cancer experience. Generalizability of QOL findings across distinct diagnostic categories of survivors is untested. We compare measurement of the impact of cancer using the IOC instrument in breast cancer (BC) survivors (n = 1,188) and non-Hodgkin lymphoma (NHL) survivors (n = 652).     

Screening practices in cancer survivors

Introduction  Ten percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Little is known, however, about survivors’ screening practices for other cancers. The purpose of this study was to examine the impact of a cancer diagnosis on survivors’ screening beliefs and practices compared to those without a cancer history. Materials and methods  This study examined cancer survivors’ (n = 619) screening beliefs and practices compared to those without cancer (n = 2,141) using the National Cancer Institute’s 2003 Health Information National Trends Survey (HINTS). Results  The typical participant was Caucasian, employed, married, and female with at least a high school education, having a regular health care provider and health insurance. Being a cancer survivor was significantly associated with screening for colorectal cancer but not for breast or prostate cancer screening. Screening adherence exceeded American Cancer Society recommendations, national prevalence data, and Healthy People 2010 goals for individual tests for both groups. Physician recommendations were associated with a higher level of screening but recommendations varied (highest for breast cancer and lowest for colorectal cancer screening). Conclusions  Cancer survivors had different health beliefs and risk perceptions for screening compared to the NoCancer group. While there were no differences between survivors’ screening for breast and prostate cancer, survivors were more likely to screen for colorectal cancer than the comparison group. Screening adherence met or exceeded recommendations for individual tests for both cancer survivors and the comparison group. Implications for cancer survivors  Cancer survivors should continue to work with their health care providers to receive age and gender appropriate screening for many types of cancers. Screening for other cancers should also be included in cancer survivorship care plans.

Postoperative adjuvant chemotherapy of gastric cancer: scrutiny into the clinical evidence based on quality assessment of medical literature of randomized controlled trials

The aim of this study was to scrutinize the evidence of adjuvant chemotherapy of gastric cancer by assessing the quality of the medical literature of randomized controlled trials (RCTs). A quality assessment (QA) scoring system was devised with the three parameters—control of bias, quality of report, and quality of design—which consisted 19 items. We searched for all the publications of the RCTs, from 1969 to 2007, with surgery-only arm, and their associated meta-analyses to score. Among the 26 RCTs, quality of three articles were graded as (2+), 10 articles as (1+), and 13 articles as (−). Recently published studies had overall better quality of report, but not necessarily better quality of design. Three studies demonstrating a positive survival benefit of adjuvant chemotherapy had a grade (1+). Hierarchical clustering revealed that the 26 articles were grouped into three major branches associated with study quality and a multi-institutional setting. We also obtained a statistically significant set of ten items (P < 0.001) that could differentiate articles of good (1–2+) and low quality (−) through supervised two-way hierarchical clustering. Finally, the level of recommendation for adjuvant chemotherapy in gastric cancer was to be a “B” according to the Scottish Intercollegiate Guidelines Network (SIGN) System. QA of medical literature should be an essential consideration for medical-related decision-making and the formation of evidence-based guidelines. Multidisciplinary discussion to develop and refine trial design is important for procuring better quality of RCTs of adjuvant chemotherapy of gastric cancer.     

What makes cancer survivor stories work? An empirical study among African American women

Introduction Cancer survivors play a vital role in cancer control as messengers of hope and information, and advocates for prevention and screening. Understanding what makes survivor stories effective can enhance survivor-delivered programs and interventions. Methods By random assignment and using a cross-classified design, 200 African American women viewed videotaped stories (n = 300) from 36 African American breast cancer survivors. Analyses examined effects of story attributes (narrative quality, health message strength), participant characteristics (ways of knowing, experience with breast cancer) and identification with the survivor on women’s: (1) level of engagement in the story; (2) positive thoughts about the story; and, (3) remembering key messages about breast cancer and mammography in the story. Results Participant characteristics were significant predictors of all three study outcomes, accounting for 27.8, 2.6 and 22.2% of their total variance, respectively. In comparison, the variability in these outcomes that could be attributed to differences in the stories was small (0.6, 1.1 and 2%, respectively). The effects of participant characteristics on level of engagement and positive thoughts were mediated by identification with the survivor. Conclusions The best predictor of a woman becoming engaged in a breast cancer survivor’s story and having positive thoughts about the story was whether she liked the survivor and viewed her as similar to herself (i.e., identification). Implications for cancer survivors Survivor stories may be most effective when audience members identify with the survivor. Finding key characteristics that can reliably match the two will advance cancer communication science and practice.     

Abstracting height and weight from medical records, and breast cancer pathologic factors

Cancer registries routinely collect data on clinicopathologic factors, but rarely abstract anthropometric variables. We conducted a chart review study, examining the feasibility of abstracting weight, height, alcohol use, and smoking from medical records in women (n = 1,974) diagnosed with invasive breast cancer, and investigated the association between the abstracted variables with clinicopathologic features. Qualitative data were reviewed and categorized. Frequencies of the abstracted data, and demographic and clinicopathologic variables were calculated. Logistic regression models measured the relationship between the outcome variables, tumor size, stage of disease, and estrogen/progesterone (ER/PR) status with the abstracted variables. Data on current alcohol-use/no-use, current-smoker/non-smoker, and height/weight data were obtained on 96%, 97%, and 88–89% of the participants, respectively. The multivariate analysis showed that overweight (≥25 kg/m²) women had significantly larger (≥2 cm) tumor size compared with normal weight for both women <50 years (OR = 1.79; 95% CI = 1.14–2.81; p ≤ 0.05) and for women ≥50 years at diagnosis (OR = 1.58; 95% CI = 1.19–2.09; p ≤ 0.05). These results suggest that abstracting current height and weight via medical records is feasible, and at minimum, current alcohol use and smoking status can be ascertained. In addition, being overweight was significantly associated with cancer clinicopathologic/prognostic factors, which has implications for monitoring etiologic factors that could be associated with cancer trends, incidence, and survival. Therefore routine collection of height and weight via cancer registries should be explored further.     

Complication rates among cancer patients with peripherally inserted central catheters.

PURPOSE: Peripherally inserted central catheters (PICCs) are frequently used to deliver outpatient courses of intravenous therapy. However, the rates and risks of complication for this device have not been well-studied. Our objective was to determine the incidence and risk factors of PICC-related complications with a 1-year prospective observational study. PATIENTS AND METHODS: All PICCs inserted in adult and pediatric patients at Memorial Sloan-Kettering Cancer Center (MSKCC) were followed prospectively. The device insertion team, inpatient nurses, and various home-care companies and outside institutions collected longitudinal data. RESULTS: Three hundred fifty-one PICCs were inserted during the study period and followed for a total of 10,562 catheter-days (median placement, 15 days; range, 1 to 487 days). Two hundred five PICCs (58%) were managed by home-care companies and outside institutions, and 146 PICCs (42%) were managed exclusively at MSKCC. For these 205 PICCs, 131 nurses from 74 home-care companies and institutions were contacted for follow-up clinical information. In all, 115 (32.8%) of 351 PICCs were removed as a result of a complication, for a rate of 10.9 per 1,000 catheter-days. Patients with hematologic malignancy or bone marrow transplant were more likely to develop a complication, whereas those with metastatic disease were less likely. CONCLUSION: Complications occur frequently among cancer patients with PICCs, and long-term follow-up is onerous. Despite a high complication rate, the ease of insertion and removal argues for continued PICC use in the cancer population.     

Factors influencing long-term follow-up clinic attendance among survivors of childhood cancer

Introduction  Attendance at long-term follow-up clinic is necessary for survivors of childhood cancer to facilitate education about cancer-related health risks, early detection of treatment-related morbidity, and implementation of health-promoting interventions. Despite the need for continued care, barriers to clinic attendance exist. The purpose of this prospective study was to identify the demographic, medical, and logistic factors impacting clinic attendance and long-term follow-up care among survivors of childhood cancer. Methods  Adherence to clinic attendance was monitored among 941 long-term childhood cancer survivors scheduled for evaluation. Patients were classified as “attenders” or “non-attenders” based on the outcome of their first scheduled clinic appointment over a one year period. Social work staff contacted non-attenders by telephone to determine reasons for missed appointments. Results  Nearly 15% of survivors were classified as non-attenders. Univariate findings revealed that older age, lower SES, being non-white, less medically insured, traveling by car, living shorter distance from clinic, having a scheduled social work consultation, and entering or exiting survivorship clinic were associated with clinic non-attendance (all p values < 0.05). The final multivariate model indicated that non-whites (OR = 1.88, 95% CI = 1.19–2.97), patients without insurance (OR = 2.36, 95% CI = 1.98–3.79), those traveling by car (OR = 12.74, 95% CI = 3.97–40.86), and those who have not experienced secondary cancer events (OR = 1.76, 95% CI = 0.94–3.28) were more likely to be non-attenders. Work or school conflicts were the primary reasons cited for missed appointments. Discussion/conclusions  Despite mechanisms designed to reduce financial burdens associated with attending survivorship clinic at our institution, demographic, medical, and logistic barriers exist which impact participation in long-term follow-up. Implications for cancer survivors and providers  These results highlight the importance of developing tailored outreach strategies for survivors of childhood cancer at-risk for clinic non-attendance, particularly among underserved populations.     

Enhancing physical well-being and overall quality of life among underserved Latina-American cervical cancer survivors: feasibility study

Introduction  Evidence for the effectiveness of behavioral interventions are lacking for cervical cancer survivors (CCS). Disparities in survivorship outcomes exist for CCS, especially Latina-Americans. This study assessed the feasibility of implementing a culturally sensitive intervention delivered in a telephonic format. Methods  A convenience sample of 23 Latina-Americans diagnosed with stages 1–3 invasive cervical cancer who were 1–3 years post diagnosis and disease free participated. A random assignment, pre- and post-test design was used with 15 intervention and 8 control participants. Intervention group participants completed 6 sessions that included problem-focused, telephone counseling. The areas covered included family and partner concerns and communication; relaxation and stress management; psychological, medical and treatment concerns; and self-nurturing activities. Outcomes were measured by the FACT-G QOL scale. Results  Increases in physical well-being and overall QOL were observed for the intervention group only (p < 0.05). The intervention group showed a non significant trend towards improvements in family/social, emotional and functional well-being from pre- to post-test. Discussion  Results demonstrate the feasibility of implementing a culturally responsive, telephonic behavioral intervention. The intervention was associated with an improvement in physical and overall quality of life. A randomized controlled trial with a long term follow-up is warranted. Implications for Cancer Survivors  An ethnically sensitive, behaviorally based telephone counseling approach with Latina Americans cervical cancer survivors can achieve short term improvements in physical well-being and overall QOL. Funding sources: Research supported by a grant from the California Cancer Research Program (#2110008).