Training Experiences of Lay and Professional Patient Navigators for Colorectal Cancer Screening

Patient navigation (PN) is increasingly used in cancer care, but little is known about the identification and training of patient navigators. PN may be implemented by professional health care providers, paraprofessionals, or lay health workers and, therefore, presents an opportunity to compare professional and lay interventionist experiences. The goal of the current report is to compare the training experiences of four professional (Pro) and five lay (LHW) patient navigators enlisted to increase colonoscopy adherence among African American primary care patients. The results of early assessments showed that LHWs’ intervention-related knowledge was significantly lower than that of Pros. However, there were no significant differences in knowledge scores between LHWs and Pros for most subsets of knowledge items in later assessments. Furthermore, there were no significant differences in LHWs’ and Pros’ reported self-efficacy and satisfaction with training. Findings support the use of diverse strategies to train and prepare LHWs as patient navigators.     

Barriers and Challenges of Cancer Patients and Their Experience with Patient Navigators in the Rural US/Mexico Border Region

Patient navigation is a widely used approach to minimize health disparities among socioeconomically marginalized cancer patients. Although patient navigation is widely used, there is a dearth of studies exploring patient experience with navigators among rural cancer patients. This qualitative study explores the challenges and barriers to cancer care faced by cancer patients living in a US/Mexico border region in Southern California. We individually interviewed 22 cancer patients, most of whom were Latino. Data were analyzed using constant comparison with a reiterative analysis method. The main themes relating to barriers to care and experiences with patient navigators include the following: (1) removing financial barriers, (2) coordinating services, and (3) providing therapeutic interventions. The cancer patients highly valued the navigators for their knowledge about community resources, support, and advocacy. This study suggests that it is imperative that navigators know the regional and binational health care utilization issues that impact patients’ access to cancer care.     

Colon Polyp Model Use for Educating About Colorectal Cancer Screening in the Iowa Research Network

Providing a model of a colon segment with an adenomatous polyp and cancer can help to educate patients about the adenoma to carcinoma sequence and how this sequence can be interrupted with appropriate testing. The purpose of this study was to assess the use of a three-dimensional colon model with polyps and cancer provided to family physicians or nurses in some Iowa Research Network family physician offices. Colon models were provided to 117 family medicine healthcare providers interested in colorectal cancer screening. Using a mailed survey and follow-up telephone calls to non-responders, 81 (69 %) questionnaires were returned. Thirty-six (44 %) of the respondents reported they had used the model, 33 (41 %) reported they used the model for a mean 16 % of their patients in a month’s time, 31 (38 %) reported using the model to teach patients about the colon and polyps prior to a colonoscopy. Other model use described by respondents included educating staff to promote patient willingness for colonoscopies, demonstrating the need for colon cancer screening, and teaching patients about annual fecal occult blood tests. Respondents agreed that anatomical models are helpful for patient education, the design of the colon model was good, and that it facilitated demonstration of colon polyps. Possible recommendations for an office-wide adoption of an anatomical model would be an in-service for all employees and a standard location for finding the model.     

The Utility of Urine-Based Sampling for Cervical Cancer Screening in Low-Resource Settings

Background: WHO has recommended Visual Inspection with Acetic acid (VIA) or Human Papillomavirus (HPV)DNA testing if feasible, for cervical cancer screening in low income countries. However, the number of womenundergoing screening is very low as a result of limited information, inadequate infrastructure and invasive nature ofsampling. Methods: A cross sectional study was carried out comparing HPV DNA detection by Polymerase ChainReaction (PCR) in paired cervical and urine samples procured from histologically confirmed cervical cancer cases.Results: Amongst the samples collected from 114 cervical cancer cases, HPV DNA was tested positive in cervicalsamples of 89 (78.1%) and urine samples of 55 (48.2%) patients. The agreement between the two sampling methodswas 66.7% and the kappa value was 0.35 indicating a fair agreement. The sensitivity of HPV detection using urinesamples was 59.6% (95% confidence interval 49.16%-69.15%) and the specificity was 92% (95% confidence interval75.0%-97.8%). Conclusion: Even though not acceptable as an HPV DNA screening tool due to low sensitivity, theurine sampling method is inexpensive and more socially acceptable for large epidemiological surveys in developingcountries to estimate the burden.     

Feasibility of Computed Tomography Colonography as a Diagnostic Procedure in Colon Cancer Screening in India

Computed Tomography Colonography (CTC) is a medical imaging technology used in identifying polyps and colon cancer masses in the large intestine. The technique has evolved a great deal since its invention and has become a routine diagnostic procedure in Western countries due to its non invasiveness and ease of use. The objective of our study was to explore the possibility of CTC application in Indian hospitals. This paper gives an overview of the procedure and its commercial viability. The explanation begins with the domain aspects from gastroenterologist perspective, the new way of thinking in polyp classification, the technical components of CTC procedure, and how engineering solutions have helped clinicians in solving the complexities involved in colon diagnosis. The colon cancer statistics in India and the results of single institution study we carried out with retrospective data is explained. By considering the increasing number of patients developing colon malignancies, the practicality of CTC in Indian hospitals is discussed. This paper does not reveal any technical aspects (algorithms) of engineering solutions implemented in CTC.     

Acupuncture as an Evidence-Based Option for Symptom Control in Cancer Patients

OPINION STATEMENT: Current technology suggests that acupuncture modulates neurological processes within the central nervous system, especially the spinal cord gating mechanisms, cerebral subcortical nuclei, and the hypothalamic-endocrine axis. Many single arm clinical studies report the effectiveness of acupuncture for controlling symptoms in cancer patients. However, the challenge has been to separate the nonspecific effects of the practitioner, as well as regression to the mean, from the neurophysiological effects of needle penetration. Recently, randomized controlled trials have attempted to answer this question, with mixed results. For example, needle penetration (or equivalent stimulation) is effective for nausea and vomiting, whereas it does not appear to be a major factor in reducing hot flashes. Safety and quality are priorities, so regulation of the practice of acupuncture is important, as well as excellent communication between practitioners. In addition, continuing research is mandatory, using validated methodology and reporting principles as outlined in the CONSORT and STRICTA recommendations.     

Intramedullary Spinal Cord Metastasis in a Patient with Colon Cancer: A Case Report

Introduction  

Intramedullary spinal cord metastasis (ISCM) is both a rare and devastating event, since it is clinically evident in 0.1–0.9% of cancer patients and the mortality rate at 3–4 months is 80%.     

Challenges in knowledge translation: the early years of Cancer Care Ontario's Program in Evidence-Based Care

Background

Cancer Care Ontario’s Program in Evidence-Based Care (pebc) was formalized in 1997 to produce clinical practice guidelines for cancer management for the Province of Ontario. At the time, the gap between guideline development and implementation was beginning to be acknowledged. The Program implemented strategies to promote use of guidelines.

Methods

The program had to overcome numerous social challenges to survive.

• Prospective strategies useful to practitioners—including participation, transparent communication, a methodological vision, and methodology skills development offerings—were used to create a culture of research-informed oncology practice within a broad community of practitioners.
• Reactive strategies ensured the survival of the program in the early years, when some within the influential academic community and among decision-makers were skeptical about the feasibility of a rigorous methodologic approach meeting the fast turnaround times necessary for policy.

Results

The paper details the pebc strategies within the context of what was known about knowledge translation (kt) at the time, and it tries to identify key success factors.

Conclusions

Many of the barriers faced in the implementation of kt—and the strategies for overcoming them—are unavailable in the public domain because the relevant reporting does not fit the traditional paradigm for publication. Telling the “stories behind the story” should be encouraged to enhance the practice of kt beyond the science.     

Research Training of Students in Minority and International Settings: Lessons Learned from Cancer Epidemiology Education in Special Populations

This article describes the development and evaluation of an NCI-sponsored short-term summer cancer research education program. The study questions examined: the feasibility of conducting a cancer education program in special populations at multiple US and international field sites for masters students; the merit and worth that students and faculty attribute to the program; and students' scholarly and cancer-related career outcomes. Developing a new curriculum, increasing the pool of mentors, utilizing and increasing the number of field sites, and program dissemination were also evaluated. Evidence of the program's success included students' completion of field experiences at multiple sites and their subsequent 70% project-related publication rate, with 79% of trainees reporting themselves as likely to pursue future cancer-related careers. Evaluation-guided future plans for the program include implementing faculty development to further enhance the program outcomes.     

Biomarkers in Lung Cancer Screening: Achievements,Promises, and Challenges

The present review is an update of the research and development efforts regarding the use of molecular biomarkers in the lung cancer screening setting. The two main unmet clinical needs, namely, the refinement of risk to improve the selection of individuals undergoing screening and the characterization of undetermined nodules found during the computed tomography–based screening process are the object of the biomarkers described in the present review. We first propose some principles to optimize lung cancer biomarker discovery projects. Then, we summarize the discovery and developmental status of currently promising molecular candidates, such as autoantibodies, complement fragments, microRNAs, circulating tumor DNA, DNA methylation, blood protein profiling, or RNA airway or nasal signatures. We also mention other emerging biomarkers or new technologies to follow, such as exhaled breath biomarkers, metabolomics, sputum cell imaging, genetic predisposition studies, and the integration of next-generation sequencing into study of circulating DNA. We also underline the importance of integrating different molecular technologies together with imaging, radiomics, and artificial intelligence. We list a number of completed, ongoing, or planned trials to show the clinical utility of molecular biomarkers. Finally, we comment on future research challenges in the field of biomarkers in the context of lung cancer screening and propose a design of a trial to test the clinical utility of one or several candidate biomarkers.     

Addressing Racial Disparity in Colorectal Cancer Screening With CT Colonography: Experience in an African-American Cohort

Background

Incidence and mortality from colorectal cancer (CRC) are higher among African Americans where CRC screening rates lag behind non-Hispanic whites. The purpose of this investigation was to evaluate CT colonography (CTC) performance and outcome measures in an African-American cohort.

Community-based Mobile Cervical Cancer Screening Program in Rural India: Successes and Challenges for Implementation

Background: The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical cancer-screening program in rural India. Methods: Communities were mobilized through extensive peer education and by screening in existing community spaces using a mobile clinic model. An initial “screen and treat” protocol was transitioned to “screen, test, and treat” using Pap smears for confirmatory testing, and cryotherapy or Loop Electrosurgical Excision Procedure (LEEP) for treatment. We trained 50 Peer Educators and conducted 190 screening camps in 58 locations. Results: Of 3,821 registered women, 3,544 (92.8%) accepted screening. Overall, 440/3544 (12.4%, 95% CI 11.3-13.5%) women had VIA-positive lesions. Under “screen and treat”, 56/156 (35.9%) women accepted same-day treatment. Under “screen, test, and treat”, 555/762 (72.8%) women received a Pap smear. Overall, 83 women underwent cryotherapy (n=56) and LEEP (n=27). Of those, 49 (59.0%) participants were followed up, with normal VIA results up to two years after treatment. In summary, the peer educators promoted awareness of cervical cancer and helped in gaining buy-in from communities. Acceptance of same-day treatment was low and accompanied by loss to follow-up, limiting the utility of VIA in these studies. Conclusions: Mobile infrastructure utilized in community spaces brought screening directly to rural women. Culturally appropriate methods to increase linkage to treatment and additional screening options such as HPV DNA testing should be explored.     

Testis Cancer Care in North Carolina: Implications for Real-World Evidence and Cancer Surveillance

IntroductionContemporary testis cancer management requires fastidious adherence to clinical guidelines and care principles, especially for those pursuing active surveillance (AS). However, real-world testis cancer care remains largely undescribed. Accordingly, we sought to assess the rigor of evaluation and monitoring among men with testis cancer.Patients and MethodsUsing North Carolina Central Cancer Registry data linked to insurance claims, we selected adult males diagnosed with primary testis cancer from 2003 to 2013. After identifying demographics, care setting, histology, stage, and index management, we evaluated the receipt of tumor markers, imaging, and clinic visits during initial evaluation and subsequent monitoring with respect to contemporaneous clinical guidelines. Care patterns were compared using chi-squared testing and multivariable logistic regression.ResultsOf 2526 men with primary testis cancer, we assembled a cohort of 487 with seminoma (59.3%) or nonseminoma (40.7%), losing most to a lack of insurance or continuous coverage. The cohort was predominantly white (92.4%) and had stage I disease (87.9%). Overall, 18.9% had complete tumor markers, staging imaging, and visits with 2 relevant specialists as recommended during their initial evaluation. For subsequent monitoring, 17.5% of patients with seminoma on active surveillance met minimal thresholds for recommended testing and follow-up during the first year vs. 21.9% and 34.9% of patients with seminoma treated with adjuvant radiation and chemotherapy, respectively. For nonseminoma, 10.1% of men on active surveillance met the minimal thresholds for recommended monitoring compared with 60.4% and 62.0% of those treated with surgery and chemotherapy, respectively. Recommended monitoring also differed by academic vs. community setting and receipt of recommended evaluation (P < .05).ConclusionsFrom real-world data, the evaluation and monitoring of patients with testis cancer appears substandard. Ongoing data and quality gaps highlight potential challenges with generating real-world evidence and ensuring adequate surveillance in this population.     

Bringing the Real World to Psychometric Evaluation of Cervical Cancer Literacy Assessments with Black, Latina, and Arab Women in Real-World Settings

This research describes the development and evaluation of a new scale for assessing functional cervical cancer health literacy, the Cervical Cancer Literacy Assessment Tool (C-CLAT). In phase 1, 35 items in English, Spanish, and Arabic for C-CLAT were generated, taking into account three content domains—Awareness, Knowledge, and Prevention/Control. After content validation, 24 items were retained for psychometric evaluation. In phase 2, the 24-item C-CLAT was evaluated in three racial/ethnic populations of urban women (N?=?543). Psychometric methods included item analysis, multifactor item response theory modeling, and concurrent correlations. The final C-CLAT consisted of 16 items, with an internal consistency reliability of 0.72. C-CLAT reliabilities in Black, Latina, and Arab women were 0.73, 0.76, and 0.60, respectively. The rank order correlations of item difficulties across racial/ethnic groups was high (r's?=?0.97 to 0.98). The C-CLAT was positively related to educational level, and Arab women scored significantly higher than the Black and Latina participants. This study presents a psychometrically sound instrument that measures health literacy related to cervical cancer. The C-CLAT is a tool that can be orally administered by a lay person and used in a community-based health promotion intervention.     

Ramucirumab as Second-Line Therapy in Metastatic Gastric Cancer: Real-World Data from the RAMoss Study

Background

Ramucirumab—alone or combined with paclitaxel—represents one of the main options for patients failing first-line treatment for advanced gastric cancer.

Objective

The RAMoss study aimed to evaluate the safety and efficacy profile of ramucirumab in the “real-life setting”.

Patients and Methods

Patients from 25 Italian hospitals started therapy consisting of ramucirumab 8 mg/kg i.v. d1,15q28 with or without paclitaxel 80 mg/m² i.v. d1,8,15q28. The primary endpoint was safety, and secondary endpoints were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS).

Results

One hundred sixty-seven patients with disease progression on first-line therapy received ramucirumab as monotherapy (10%) or combined with paclitaxel (90%). Median treatment duration was 4 months (1–17 months). Global incidence of grade (G) 3–4 toxicity was 9.6%, and for neutropenia 5.4%; treatment was discontinued due to toxicity in 3% of patients. The most frequent adverse events (AE) were G1–2 fatigue (27.5%), G1–2 neuropathy (26.3%), and G1–2 neutropenia (14.9%). ORR was 20.2%. Stable disease was observed in 39.2% of patients, with a disease control rate of 59.4%. With a median follow-up of 11 months, median PFS was 4.3 months (95% confidence interval [CI] 4.1–4.7), whereas median OS was 8.0 months (95% CI: 7.09–8.9). In a multivariate analysis, ECOG performance status <1 or ≥1 (HR 1.13, 95% CI 1.0–1.27, p?=?0.04) and the presence versus absence of peritoneal metastases (HR 1.57, 95% CI 1.63–2.39, p?=?0.03) were independent poor prognostic factors.

Conclusions

These “real-life” efficacy data on ramucirumab treatment are in line with previous randomized trials. Ramucirumab is well tolerated in daily clinical practice.