Preventive health services and lifestyle practices in cancer survivors: a population health investigation

Introduction  Long term health in cancer survivors require both preventive health services and certain health behavior practices in order to prevent the major chronic diseases that can occur for any adult in the general population. Despite this we currently do not know the pattern of clinical preventive services and health behaviors of cancer survivors in the US population. The present study examines the patterns of preventive health activities in two domains: clinical preventive services and healthy lifestyle practices in a heterogeneous population of cancer survivors. Methods  Longitudinal analyses of Medical Expenditure Panel Survey (MEPS) data, a nationally representative health survey, for the calendar years 2000 through 2004 were conducted. Cancer survivors were defined as individuals diagnosed with cancer in the baseline year and alive in the subsequent year. To address both provider based and behavioral health activities, two categories of care were included: clinical preventive services consisting of influenza immunization, routine physical examination, and a dental check up within the last year using the follow-up year data and healthy lifestyle practices including engaging in moderate/vigorous exercise three times per week, maintaining a body mass index (BMI) within normal range, and not currently smoking. Chi-square tests and Poisson regressions were performed to identify factors that were associated with these preventive health activities. Results  Unadjusted rates of preventive health activities were as follows: 78% had a routine physical check up, 66% visited the dentist at least annually, and 54% received an influenza immunization. Across healthy lifestyle practices, 80% did not smoke, 52% engaged in regular exercise, and 37% maintained their BMI within normal range. Only 31% received all three clinical preventive services and only 16.5% engaged in all three healthy lifestyle practices. Across both domains of preventive health activities, age, marital status, and education were positively associated with the number of services. Presence of diabetes and poorer mental health were associated with greater number of clinical preventive services and lower number of healthy lifestyle practices. Cancer survivors with fair/poor perception of their mental health had lower number of clinical preventive services and those with fair/poor perception of physical health engaged in lower number of healthy lifestyle practices. Demographic and health status factors impacted the two domains differentially. Discussion/Conclusions  The rates and predictors of preventive care varied by type of service/domain suggesting that individualization is needed in creating a comprehensive preventive service and lifestyle activity plan that accounts for the survivor’s specific total care needs, including all comorbidities. However, it was also found that cancer survivors are less likely to engage in all types of preventive activities; a one-size-fit-all approach is not recommended for preventive health education and planning for this population. Implications for cancer survivors  Our study findings suggest the need to address the overall long term healthcare of cancer survivors by prioritizing and developing individualized preventive plans to optimize care that emphasize education, self care perceptions, and incorporate other comorbidities.

Internet health resources and the cancer patient

The last decade has witnessed an explosion of online information regarding cancer and healthcare. Accompanying this has been a large body of research analyzing the quality of this information, how patients perceive these data and how this affects the doctor-patient relationship. This report reviews this literature, summarizing the current state of internet health resources available to the cancer patient and identifying areas for future research. Studies indicate that there are considerable internet resources available to cancer patients and that patients are using these resources as secondary information sources. Specifically, studies indicate that 16-64% of patients are using the internet to obtain health information. For the most part, patients perceive the online information to be reliable but maintain a healthy degree of skepticism. Studies objectively evaluating cancer information on the internet indicate that there is reasonable quality, although the language level of many sites is higher than that of the average American, which may limit the utility of the websites. Finally, while there is widespread internet use by physicians, healthcare providers are skeptical of their patients' ability to use the internet and may even be somewhat threatened by it. In summary, while there is a fairly large literature on internet resources available to the cancer patient, more research is needed. Specifically, it is important to better understand how patients access health information online and their associated preferences so that we can improve cancer patient's access to high quality health information on the internet to facilitate decision-making and health outcomes.     

A review of the relationship between tooth loss,periodontal disease,and cancer

Recent studies have investigated the association between periodontal disease, tooth loss, and several systemic diseases including cancer, cardiovascular disease, and preterm birth. Periodontal disease, a chronic inflammatory condition, is highly prevalent in adult populations around the world, and may be preventable. Estimates of prevalence vary between races and geographic regions, with a marked increase in the occurrence of periodontal disease with advancing age. Worldwide estimates for the prevalence of severe periodontal disease generally range from 10 to 15%. The relationship between oral health and cancer has been examined for a number of specific cancer sites. Several studies have reported associations between periodontal disease or tooth loss and risk of oral, upper gastrointestinal, lung, and pancreatic cancer in different populations. In a number of studies, these associations persisted after adjustment for major risk factors, including cigarette smoking and socioeconomic status. This review provides a summary of these findings, discusses possible biological mechanisms involved, and raises methodological issues related to studying these relationships.     

Levels of acute health service use among cancer survivors in the United Kingdom

Background

In the United Kingdom, there are approximately two million cancer survivors (3.2% of the entire population), composed of groups of people in different phases of survivorship and with different health service needs. The aim of this study was to quantify the level of acute health service utilisation by cancer survivors in the UK, according to tumour type, age, sex, time since diagnosis, and time until death.

Methods

Linked national cancer registry and hospital activity data were analysed. The data covered all cancer-related admissions to public hospitals operated by the National Health Service in England occurring in 2006 among people diagnosed with cancer in the period 1990-2006. The intensity of cancer-related health service utilisation was categorised as ‘none’, ‘low’ (up to 10% of an individual’s time), or ‘high’ (>10% of an individual’s time), among groups defined by time since diagnosis and time until death. Results were extrapolated from the population of England in 2006 (51 million) to that of the UK in 2008 (61 million).

Findings

Sixty one thousand of the two million cancer survivors (3%) were in the ‘high’ utilisation category; 240,000 (12%) were in the ‘low’ category; 1.70 million (85%) had no cancer-related hospital admissions. 147,000 cancer survivors (7%) were in the last year of their life, and it was this group that had the highest levels of hospital utilisation. 1.57 million cancer survivors (78%) were more than 1 year from both diagnosis and death, and had no cancer related hospital admissions.

Interpretation

A considerable proportion of cancer survivors in the UK have a high level of hospital utilisation soon after diagnosis or before death, but the large majority of them are neither recently diagnosed nor near the end of their life, and do not utilise acute health services for cancer-related care.     

Long term care planning for cancer survivors: a health services research agenda

Introduction The recent Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition recommended that ‘survivorship care plans’ be created for patients as they complete primary therapy for cancer in order to ensure clarity for all involved about patients’ diagnoses, treatment received, and plan for surveillance. It should explicitly identify the providers responsible for each aspect of ongoing care, and provide information on resources available for psychosocial and other practical issues that may arise as a result of the prior cancer diagnosis. The IOM stated that survivorship care plans ‘have strong face validity and can reasonably be assumed to improve care unless and until evidence accumulates to the contrary.’ Materials and methods As an example of how to approach evaluation of a new health care delivery service, this article reviews the health services research agenda that will have to be carried out in order to refine and determine the clinical utility of survivorship care planning. Results For any change in medical practice such as this to really occur, not only is advocacy needed from a number of different stakeholders, but there must also be convincing, scientifically sound evidence that the change is cost effective, improves outcomes of interest, and is feasible. Conclusion It is incumbent on the research community to rigorously evaluate each element of survivorship care plans in order to justify their widespread adoption. Similar approaches can be taken to evaluate other health care delivery questions. An earlier form of this article served as a background paper for the ‘Implementing Survivorship Care Planning’ Workshop, an Institute of Medicine National Cancer Policy Forum in collaboration with the National Coalition for Cancer Survivorship, Lance Armstrong Foundation, and National Cancer Institute, May 15 and 16, 2006, The National Academies Keck Center, 500 Fifth Street, NW, Washington DC     

Lesbians and cancer: an overlooked health disparity

Objective  To evaluate the breast, cervical, ovarian, lung, and colorectal cancer literatures using a novel application of the cancer disparities grid to identify disparities along domains of the cancer continuum focusing on lesbians as a minority population. Methods  Computerized databases were searched for articles published from 1981 to present. Cumulative search results identified 51 articles related to lesbians and disparities, which were classified by domain. Results  The majority of articles identified were related to breast and cervical cancer screening. Barriers to adequate screening for both cancers include personal factors, poor patient-provider communication, and health care system factors. Tailored risk counseling has been successful in increasing lesbian’s mammography and Pap screening. Ovarian, lung, and colorectal cancer have been virtually unexplored in this population. An “Adjustment to Illness/Quality of Life” domain was added to capture literature on psychosocial aspects of cancer. Conclusions  This review revealed a lack of research for specific cancers and for specific aspects of the cancer continuum. The limited number of studies identified focused on issues related to screening/prevention in cervical and breast cancers, with almost no attention to incidence, etiology, diagnosis, treatment, survival, morbidity, or mortality. We present implications for social and public health policy, research, and prevention.     

越秀区居民接受防癌知识教育4年效果的评价

目的：探讨社区开展防癌知识宣传教育的有效方式,提高居民对癌症预防知识的知晓率。方法：分别于１９９６年和２０００年在广州市越秀区调查４９５名和１１７０名居民对肿瘤的认识和知识来源,并进行了前后对比统计学分析。结果：居民对各种癌症病因认识的平均得分由１０．４９分提高到３８．８０分,提高了２８．３１分;对癌症早期症状的平均得分８．９１分提高到３５．１３分,提高了２６．２２分;居民对癌症知晓率从７．９％提     

The impact of disease progression on perceived health status and quality of life of long-term cancer survivors

Introduction  The number of cancer survivors experiencing disease progression (DP) is increasing with the number of cancer survivors. However, little is known whether DP affects health-related quality of life (HRQL) of long-term cancer survivors. We aimed therefore to compare the health status (HS) and HRQL of DP and disease-free (DF) survivors up to 15 years after initial diagnosis. Methods  232 cancer survivors with DP identified through the Eindhoven Cancer Registry were matched with 232 DF survivors of similar demographic and clinical characteristics. Patients completed generic HS (SF-36) and cancer-specific HRQL (QOL-CS) questionnaires 5–15 years after diagnosis. Results  Compared with DF survivors, DP survivors exhibited significantly lower scores on all SF-36 and QOL-CS (except spiritual well-being) dimensions. DF survivors had better scores than the normative population on all SF-36 dimensions. Among survivors with DP, those with short survival (<5 years) had significantly poorer HS scores on all dimensions except bodily pain compared with the normative population. Comparatively, the long survival (≥5 years) DP group had better HRQL than the short DP group but poorer HRQL than the normative population. In multivariate analyses, DP and DF survival time were independently associated with aspects of HS and HRQL in cancer survivors. Discussions/Conclusions  DP cancer survivors have poorer long-term HS and HRQL compared with DF survivors. However, there is suggestion that HS and HRQL does improve over time following DP. Implication for Cancer Survivors  Although DP survivors report poorer long-term HRQL compared with DF cancer survivors, results suggest that time can attenuate the distress of DP on HRQL. Psycho-educational programs could help to increase patients’ sense of empowerment and personal control should DP occur.     

Making progress against cancer in Europe in 2008

Europe is facing a cancer epidemic, with rapidly increasing incidence rates. Population growth and ageing will further increase the annual number of new patients with cancer. Cancer is a huge and growing contributor to the burden of disease and premature death within the European Union (EU). One in four of all deaths in the EU is attributable to cancer, and in the age range 45–64 years, the figure is almost one in two deaths. The 27 EU Member States differ greatly in cancer incidence, mortality and survival. Yet at least one-third of the cancer burden is preventable and a further third can be detected early and treated effectively, even on the basis of existing knowledge. “Cancer”, however, comprises an extremely complex group of diseases and achieving the full potential for prevention and treatment poses very significant challenges. Success in cancer control will depend on a co-ordinated approach that involves every aspect of policy and service delivery.The objective of this paper is to outline the basic requirements of an integrated strategy for cancer control, emphasising the co-ordination of the key elements of primary prevention, secondary prevention (screening), integrated care and advances in research, all at national and EU level. It is based on a detailed review of the status of cancer control in the EU today and summarises the policy recommendations arising from this review, undertaken under the auspices of the Slovenian Presidency of the European Union in 2008.     

结直肠癌快速康复外科的发展与问题

自2001年快速康复概念提出以来,其在结直肠癌患者手术治疗过程中便有了极为深入的应用。研究表明,接受快速康复的患者获得了早期恢复、缩短了住院时间,同时降低了住院的费用。根据英国NICE指南推荐,快速康复是值得在结直肠癌外科治疗中推荐使用的。从结直肠癌快速康复外科的理念与发展、优势、对老年患者康复的作用及经济效益4个方面来探讨快速康复在结直肠癌领域近10年来的发展与问题。     

Mind the gap: An analysis of foregone health gains from unfunded cancer medicines in New Zealand

Publicly funded cancer medicines listed on the New Zealand Pharmaceutical Schedule were compared with those listed on the Australian Pharmaceutical Benefits Scheme. To quantify the health gains offered by the cancer medicines funded in Australia but not in New Zealand, clinical trial data reporting median progression-free survival (PFS) and overall survival (OS) were sought. The differences in the median PFS and OS for the unfunded medicines, relative to the comparator medicine funded in NZ, were then assessed against the American Society of Clinical Oncology Cancer Research Committee (ASCO-CRC) recommended targets for clinically meaningful health gains. Our analysis confirms that, whilst New Zealand funds fewer cancer medicines than Australia, most of the additional medicines funded in Australia do not deliver clinically meaningful health gains as defined by the ASCO-CRC guidance. This suggests that New Zealand is not missing substantive opportunities for improvements to New Zealand’s cancer survival rates through additional medicines funding. A policy of funding more new cancer medicines in order to achieve numerical parity with Australia or other countries would not result in substantive health improvement and would cost significantly more, and investing the millions of dollars needed to achieve funding parity with other countries would not represent good value for money in terms of delivering the best health outcomes for all New Zealanders, rather selective funding of new medicines that demonstrate clear clinical benefit and that are cost-effective and affordable is the sensible approach.     

Mental health service utilization among long-term cancer survivors

Background Although generally well-adjusted, a subset of cancer survivors have been observed to experience ongoing psychological distress. There has been little study of mental health care utilization among cancer survivors, however. Materials and methods We identified a cohort of cancer survivors continuously enrolled in a managed care organization who were alive at least 5 years after a diagnosis of cancer and without evidence of recurrence. We matched them each to four controls without a history of cancer based on age, sex, and clinic location. We then obtained their health care claims and evaluated their health care utilization along with explanatory variables such as cancer type, non-cancer comorbid conditions, and types of health care providers seen. Results One thousand one hundred eleven survivors were matched to 4,444 controls. Cancer survivors were more likely than controls to have a mental health diagnosis (33.5 vs. 30.3%, p < 0.05), accounted for mostly by anxiety and sleep disorders. Other predictors of receiving any mental health diagnosis on multivariable analysis were age: Odds Ratio (OR) 0.99 (95% Confidence Interval (CI) 0.99–0.99) for each year; male sex: OR 0.87 (95% CI 0.77–0.99), and comorbidity: OR 0.56 (95% CI 0.49–0.64) for each point on the Charlson scale. The largest subgroup was breast cancer survivors, who were more likely to have a diagnosis of major affective disorder than were female survivors of other cancers. Survivors had more outpatient medical visits in general (mean 27.4 versus 21.9, p < 0.001) and specifically more mental health visits (2.5 versus 1.7 on average, p < 0.001) than did controls. Conclusion Long-term cancer survivors have increased rates of mental health care utilization. Given the size and growth of the survivor population, this represents a significant amount of ongoing distress with important health resource allocation implications for policy makers.     

The public health informatics infrastructure: anticipating its role in cancer

Cancer information and surveillance, historically conducted with manual data collection and submission, are viewed increasingly as inherently dependent on the effective application of information science. One challenge is to use information technology (IT) in a manner that improves cancer-related decision-making and ultimately the quality of care that is offered to patients with cancer. In this article we begin by envisioning a future view of IT-supported surveillance and care that can be made available for application in cancer and its management. We then ask what barriers need to be overcome and what forces are at work that may help us in our efforts to effect the necessary changes. Our future vision for surveillance and information, although appealing and widely shared, requires major cultural change, financial investment, and logistical planning. Competition in the medical marketplace, coupled with fiscal pressures affecting providers and health systems, suggests that leadership for regional and national coordination will need to come from elsewhere-and likely from governments.     

Breast cancer in Mexico: a growing challenge to health and the health system

Breast cancer is a major public health issue in low-income and middle-income countries. In Mexico, incidence and mortality of breast cancer have risen in the past few decades. Changes in health-care policies in Mexico have incorporated programmes for access to early diagnosis and treatment of this disease. This Review outlines the status of breast cancer in Mexico, regarding demographics, access to care, and strategies to improve clinical outcomes. We identify factors that contribute to the existing disease burden, such as low mammography coverage, poor quality control, limited access to diagnosis and treatment, and insufficient physical and human resources for clinical care.     

Non-cancer adverse health conditions and perceived health and function among cancer survivors participating in a community-based cohort study in Washington County, Maryland

Introduction This study was conducted in an ongoing community-based cohort study to examine the prevalence of non-cancer adverse health conditions among cancer survivors and the association of these conditions with self-rated health and functional status. Methods Data were analyzed from CLUE II, a community-based cohort study in Washington County, Maryland that began in 1989. Cross-sectional comparisons were made between 1,261 cancer survivors and 1,261 age- and gender-matched individuals without a history of cancer. Information on non-cancer adverse health conditions, self-rated health, and activities of daily living was based on self-report. Results Compared to individuals without a history of cancer, cancer survivors were significantly more likely to report a diagnosis of cardiovascular disease (33.8% versus 29.8%; p = 0.009) and endocrine disease (other than diabetes) (17.0% versus 14.3%; p = 0.02). Further, cancer survivors reporting two or more non-cancer adverse health conditions had a greater likelihood of reporting fair or poor self-rated health (odds ratio (OR) 4.11; 95% confidence interval (95% CI) 3.06, 5.54), and difficulty with at least one activity of daily living (OR 6.03; 95% CI 4.01, 9.05) compared to cancer survivors who did not report other adverse health conditions. Discussions/Conclusions Findings from this cross-sectional data analysis indicate that cancer survivors are at increased risk for non-cancer adverse health conditions, which are associated with poorer self-rated health, more interference with normal activities, and functional limitations. Implications for Cancer Survivors Increased attention must be given to the preventive care and treatment of non-cancer adverse health conditions among cancer survivors to decrease non-cancer morbidity and mortality and to maintain and improve quality of life.     

Health Council of the Netherlands and evaluation of the fifth generation, 5G,for wireless communication and cancer risks

Currently the fifth generation, 5G, for wireless communication is about to be rolled out worldwide. Many persons are concerned about potential health risks from radiofrequency radiation. In September 2017, a letter was sent to the European Union asking for a moratorium on the deployment until scientific evaluation has been made on potential health risks (http://www.5Gappeal.eu). This appeal has had little success. The Health Council of the Netherlands released on September 2, 2020 their evaluation on 5G and health. It was largely based on a World Health Organization draft and report by the Swedish Radiation Safety Authority, both criticized for not being impartial. The guidelines by the International Commission on Non-Ionizing Radiation Protection were recommended to be used, although they have been considered to be insufficient to protect against health hazards (http://www.emfscientist.org). The Health Council Committee recommended not to use the 26 GHz frequency band until health risks have been studied. For lower frequencies, the International Commission on Non-Ionizing Radiation Protection guidelines were recommended. The conclusion that there is no reason to stop the use of lower frequencies for 5G is not justified by current evidence on cancer risks as commented in this article. A moratorium is urgently needed on the implementation of 5G for wireless communication.     

Use of mobile phones and cancer risk

Mobile phones work by transmitting and receiving radio frequency microwave radiation. The radio frequency (RF) emitted by mobile phones is stronger than FM radio signal which are known to cause cancer. Though research and evidence available on the risk of cancer by mobile phones does not provide a clear and direct support that mobile phones cause cancers. Evidence does not also support an association between exposure to radio frequency and microwave radiation from mobile phones and direct effects on health. It is however clear that lack of available evidence of cancer as regards the use of mobile phone should not be interpreted as proof of absence of cancer risk, so that excessive use of mobile phones should be taken very seriously and with caution to prevent cancer.     

Implementation of a comprehensive cancer plan. A health planning experience

Here we describe the working method used to implement an Integrated Cancer Health Plan in Andalusia (Spain) and to set out some of the lines of work for improving quality of care and health network planning. Four main initial considerations were made: (1) work must be centred on patients and respect for their autonomy; (2) cancer requires action at every healthcare level; (3) integration of expert professionals is to be encouraged; and (4) relevant information and data should be systematically used for planning. Two operative approaches were also established: structured participation and evidence-based healthcare. This methodology was used in various planning programmes, largely in relation to healthcare resources. In this article, as examples, we describe the development of two types of programmes: one for radiotherapy equipment and another for the management of lymphoedema in breast cancer patients. Analysis of results obtained against cancer is always controversial. It is necessary to review the healthcare structure used in terms of effectiveness and excellence. Comprehensive or integrated health plans are a useful model for a wide-ranging and multi-level approach to cancer. The structured and real participation of experts and an evidence- based healthcare strategy proved very useful in this public health planning experience.