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The Essential Role of Public Health in Preventing Disease, Prolonging Life, and Promoting Health of Cancer Survivors

2015; Elsevier BV; Volume: 49; Issue: 6 Linguagem: Inglês

10.1016/j.amepre.2015.08.006

1873-2607

Natasha D. Buchanan, Keisha A. Houston, Lisa C. Richardson,

Cancer survivorship and care

Public health's longstanding mission has been to "prevent disease, prolong life, and promote health" through organized efforts across societies, organizations, communities, and individuals.1Winslow C.E. The untilled fields of public health.Science. 1920; 51: 23-33https://doi.org/10.1126/science.51.1306.23Crossref PubMed Scopus (319) Google Scholar The public health community has worked to achieve this mission of combating both infectious and chronic disease through research and surveillance, public health programs, health communication activities, and policy and system changes. Cancer survivorship serves as an example of the dynamic work of the public health community in addressing this issue. In the U.S., 14.5 million men, women, and children were estimated to be living after a cancer diagnosis (cancer survivors) in 2014.2National Cancer Institute. Estimated number of cancer survivors in the U.S. 2014. cancercontrol.cancer.gov/ocs/statistics/statistics.html. Accessed August 17, 2015.Google Scholar Cancer survivors routinely face physical, psychosocial, neurocognitive, spiritual, and financial challenges. The public health community has an essential role in addressing the needs of survivors and is uniquely positioned to intervene through prevention of recurrences, second cancers, and the side effects or consequences of cancer treatment to improve quality of life for each survivor. CDC is the Federal government's lead public health agency, which for more than a decade has employed an interdisciplinary public health approach to examine and address survivors' needs. CDC and its survivorship workgroup have conducted research, surveillance, and programmatic work aimed at improving the experiences of survivors, their family members, friends, and caregivers across the cancer continuum. In 2004, CDC co-sponsored, with LiveStrong, the development of "A National Action Plan for Cancer Survivorship (NAPCS): Advancing Public Health Strategies."3CDC, Lance Armstrong Foundation. A National Action Plan for Cancer Survivorship: advancing public health strategies. 2004. www.cdc.gov/cancer/survivorship/pdf/plan.pdf. Accessed April 13, 2015.Google Scholar The NAPCS, designed with feedback from nearly 100 experts in cancer survivorship, clearly outlined goals, activities, and priorities for addressing the needs and issues faced by cancer survivors in the U.S. CDC continues to collaborate with national organizations, states, tribes, territories, and Pacific Island jurisdictions to address "priority needs" cited in the NAPCS.4CDC. The National Action Plan for Cancer Survivorship. 2014. www.cdc.gov/cancer/survivorship/what_cdc_is_doing/action_plan.htm. Accessed August 21, 2015.Google Scholar, 5Fairley T.L. Pollack L.A. Moore A.R. Smith J.L. Addressing cancer survivorship through public health: an update from the Centers for Disease Control and Prevention.J Womens Health (Larchmt). 2009; 18: 1525-1531https://doi.org/10.1089/jwh.2009.1666Crossref PubMed Scopus (25) Google Scholar, 6Smith J.L. Pollack L.A. Rodriguez J.L. et al.Assessment of the status of a National Action Plan for Cancer Survivorship in the USA.J Cancer Surviv. 2013; 7: 425-438https://doi.org/10.1007/s11764-013-0276-8Crossref PubMed Scopus (13) Google Scholar CDC has also addressed issues faced by cancer survivors through documentaries, museum exhibits, and national campaigns. The powerful stories of cancer survivors have been shared through the agency's support of the award-winning production, "A Lion in the House,"7A Lion in the House. 2006. lioninthehouse.com/. Accessed August 21, 2015.Google Scholar, 8Abrash B, American University School of Communication School of Social Media. A Lion in the House: a content-centered outreach strategy for public broadcasting. 2006. www.cmsimpact.org/sites/default/files/documents/pages/Lion.pdf. Accessed August 21, 2015.Google Scholar and the acclaimed CDC museum exhibit, "Cancer Survivors in Focus,"9CDC. Cancer survivors in focus. 2013. www.cdc.gov/museum/exhibits/cancer.html. Accessed August 21, 2015.Google Scholar which continues to be shown as a traveling exhibit. Awareness and education campaigns10CDC. Breast cancer in young women. 2014. www.cdc.gov/cancer/breast/young_women/index.htm. Accessed August 21, 2015.Google Scholar have also shared stories from survivors pertaining to hereditary breast cancer, breast cancer risk, family history of cancer, and breast health to educate future generations of young women at risk for early onset breast cancer. CDC's ongoing surveillance activities continue to contribute to population-based descriptions of the health and treatment experiences of survivors in the U.S. CDC supports state and territorial cancer registries to collect and maintain high quality data through the National Program of Cancer Registries.11CDC. National Program of Cancer Registries. 2015. www.cdc.gov/cancer/npcr/. Accessed August 21, 2015.Google Scholar Along with the National Cancer Institute's Surveillance, Epidemiology, and End Results data, CDC's National Program of Cancer Registries is used to collect Federal government statistics for cancer incidence, along with data on initial treatment. These data provide baseline data on cancer survivors for local comprehensive cancer control programs as well as informing applied research activities. CDC has worked with several governmental partners to create new surveys and add questions to existing surveys to collect information that describes survivors' needs and life experiences including the Behavioral Risk Factor Surveillance System,12CDC. Behavioral Risk Factor Surveillance System. 2015. www.cdc.gov/brfss/. Accessed August 21, 2015.Google Scholar National Health Interview Survey,13CDC. National Health Interview Survey. 2015. www.cdc.gov/nchs/nhis.htm. Accessed August 21, 2015.Google Scholar and the "Experience with Cancer Survivorship Supplement" on the Medical Expenditure Panel Survey.14CDC. Medical Expenditures Panel Survey (MEPS) experiences with cancer survivorship supplement. 2014. www.cdc.gov/cancer/survivorship/what_cdc_is_doing/meps.htm. Accessed August 21, 2015.Google Scholar CDC-led publications (e.g., book chapters, journal supplements, Morbidity and Mortality Weekly Reports) have also brought awareness and action related to topics including, but not limited to the health status, behaviors, and quality of life of cancer survivors; economic burden of survivorship; the uptake and utilization of cancer survivorship care plans; adherence to cancer-specific, long-term follow-up guidelines; health equity; estimating infertility among survivors; genetics; and psychosocial concerns facing survivors.15CDC. Cancer research. 2014. www.cdc.gov/cancer/dcpc/research/index.htm. Accessed August 21, 2015.Google Scholar, 16Underwood J.M. Townsend J.S. Stewart S.L. et al.Surveillance of demographic characteristics and health behaviors among adult cancer survivors—Behavioral Risk Factor Surveillance System, United States, 2009.MMWR Surveill Summ. 2012; 61: 1-23PubMed Google Scholar, 17Pollack L.A. Hawkins N.A. Peaker B. Buchanan N. Risendal B.C. Dissemination and translation: a frontier for cancer survivorship research.Cancer Epidemiol Biomarkers Prev. 2011; 20: 2093-2098https://doi.org/10.1158/1055-9965.EPI-11-0652Crossref PubMed Scopus (17) Google Scholar, 18Buchanan N. Hawkins N.A. Pollack L. Personalized approach to cancer survivorship.in: Lester J. Holmes J. Cancer Rehabilitation and Survivorship: Transdisciplinary Approaches to Personalized Care. Oncology Nursing Society, Philadelphia, PA2011Google Scholar, 19Ekwueme D.U. Yabroff K.R. Guy G.P. et al.Medical costs and productivity losses of cancer survivors—United States, 2008–2011.MMWR Morb Mortal Wkly Rep. 2014; 63: 505-510PubMed Google Scholar, 20Guy G.P. Yabroff K.R. Ekwueme D.U. et al.Estimating the health and economic burden of cancer among those diagnosed as adolescents and young adults.Health Aff (Millwood). 2014; 33: 1024-1031https://doi.org/10.1377/hlthaff.2013.1425Crossref PubMed Scopus (129) Google Scholar, 21Roland K.B. Rodriguez J.L. Patterson J.R. Trivers K.F. A literature review of the social and psychological needs of ovarian cancer survivors.Psychooncology. 2013; 22: 2408-2418https://doi.org/10.1002/pon.3322Crossref PubMed Scopus (93) Google Scholar, 22Buchanan N.D. King J.B. Rodriguez J.L. et al.Changes among U.S. cancer survivors: comparing demographic, diagnostic, and health care findings from the 1992 and 2010 National Health Interview Surveys.ISRN Oncol. 2013; (Article ID 238017, 9 pages. http://dx.doi.org/10.1155/2013/238017)PubMed Google Scholar, 23Trivers K.F. Fink A.K. Partridge A.H. et al.Estimates of young breast cancer survivors at risk for infertility in the U.S.Oncologist. 2014; 19: 814-822https://doi.org/10.1634/theoncologist.2014-0016Crossref PubMed Scopus (41) Google Scholar CDC has also leveraged inter- and intra-agency partnerships to create venues for dissemination of information (i.e., co-sponsoring and planning conferences,24CDC. Cancer survivorship research conference. 2014. www.cdc.gov/cancer/survivorship/what_cdc_is_doing/conference.htm. Accessed August 21, 2015.Google Scholar previous supplement issues25Cancer survivorship research: mapping the new challenges. Atlanta Georgia, Supplement to Cancer. Cancer. 2009;115(Suppl 18):i-ii. http://dx.doi.org/10.1002/cncr.24645.Google Scholar). Publication findings have also been used to shape research agendas, provide technical assistance to grantees and their networks, and outline opportunities for innovative approaches26Sisters Network, Inc. Young Sisters Initiative: a guide to a better you! 2012. sniyoungsisters.org/. Accessed August 21, 2015.Google Scholar to addressing the needs of cancer survivors. CDC's partnerships with national organizations, state health agencies, and other key groups are essential in the development, implementation, and promotion of effective cancer control practices related to cancer survivorship. CDC's funded work and collaboration with key partners has led to the development and implementation of comprehensive cancer control plans27CDC. Comprehensive cancer control plans. 2014. www.cdc.gov/cancer/ncccp/ccc_plans.htm. Accessed August 21, 2015.Google Scholar utilized by states, tribes and tribal organizations, territories and Pacific Island jurisdictions, and their partners to identify and act on public health priorities such as cancer survivorship. CDC's support of the National Cancer Survivorship Resource Center28American Cancer Society. National Cancer Survivorship Resource Center. 2015. www.cancer.org/treatment/survivorshipduringandaftertreatment/nationalcancersurvivorshipresourcecenter/index. Accessed August 21, 2015.Google Scholar also led to the development and distribution of a broad range of cancer survivorship informational materials addressing healthy behaviors to reduce late and long-term effects of cancer and its treatment and improve care and screening practices to detect cancer recurrence. The current supplement, "Addressing Cancer Survivorship Through Public Health Research, Surveillance, and Programs" offers a collection of articles highlighting CDC's recent public health–focused research, surveillance, and programmatic work directed at cancer survivors. Articles in this volume represent a collection of work conducted by CDC and its national, state, and local partners and showcase public health approaches to improving service delivery and use of quality clinical services; addressing mental and physical healthcare needs and access to programs and interventions; increasing secondary prevention of behavioral and clinical concerns; evaluating health professional– and survivor-focused educational and resource initiatives; and providing support to those who require additional information and education regarding genetic testing, psychosocial care, and reproductive care. To further illustrate the role of public health in cancer survivorship, Moore and colleagues29Moore A.R. Buchanan N.D. Fairley T.L. Smith J.L. Public health action model for cancer survivorship..Am J Prev Med. 2015; 49: S470-S476Abstract Full Text Full Text PDF Scopus (19) Google Scholar describe how CDC adapted the social ecological model, as a guide for implementing strategies across systematic and societal levels as outlined in the NAPCS.3CDC, Lance Armstrong Foundation. A National Action Plan for Cancer Survivorship: advancing public health strategies. 2004. www.cdc.gov/cancer/survivorship/pdf/plan.pdf. Accessed April 13, 2015.Google Scholar Smith et al.30Smith J.L. Hall I.J. Advancing health equity in cancer survivorship: opportunities for public health.Am J Prev Med. 2015; 49: S477-S482Google Scholar then take a closer look at approaches to addressing health disparities and the needs of underserved and under-resourced cancer survivors. In this supplement, other authors explore the use of quality clinical services and healthcare expenses for cancer survivors. Hall and Smith31Hall I.J. Smith J.L. Evolution of a CDC public health research agenda for low risk prostate cancer.Am J Prev Med. 2015; 49: S483-S488Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar examine decision making for prostate cancer treatment and promotion of active surveillance as a treatment option. Guy and colleagues32Guy G.P. Yabroff K.B. Ekwueme D.U. et al.Healthcare expenditure burden among nonelderly cancer survivors, 2008-2012.Am J Prev Med. 2015; 49: S489-S497Abstract Full Text Full Text PDF Scopus (72) Google Scholar examine the burden of out-of-pocket healthcare expenses for cancer survivors and Underwood et al.33Underwood J.M. Lakhani N. Finifrock D. et al.Evidence-based cancer survivorship activities for comprehensive cancer control..Am J Prev Med. 2015; 49: S536-S542Abstract Full Text Full Text PDF Scopus (10) Google Scholar examine the impact of activities implemented by five CDC-supported national comprehensive cancer control grantees. Two other manuscripts examine the mental and physical healthcare needs of young breast cancer survivors. Buchanan and colleagues34Buchanan N.D. Dasari S. Rodriguez J.L. et al.Post-treatment neurocognition and psychosocial care among breast cancer survivors.Am J Prev Med. 2015; 49: S498-S508Abstract Full Text Full Text PDF Scopus (42) Google Scholar explore neurocognitive impairment after receiving chemotherapy and adjuvant treatment, while also examining factors associated with provider discussion and receipt of treatment for neurocognitive concerns. Johnson-Turbes et al.35Johnson-Turbes A. Schlueter D. Moore A.R. Buchanan N.D. Fairley TL. Evaluation of a web-based program for African American young breast cancer survivors.Am J Prev Med. 2015; 49: S543-S549Abstract Full Text Full Text PDF Scopus (15) Google Scholar present findings from an evaluation of two national organization's efforts to provide psychosocial and reproductive health support to young African American breast cancer survivors. This supplement also contains three articles focused on increasing health behaviors that will lower the risk of new and secondary cancers among colorectal cancer survivors. Hawkins and colleagues36Hawkins N.A. Berkowitz Z. Rodriguez J.L. Awareness of dietary and alcohol guidelines among colorectal cancer survivors..Am J Prev Med. 2015; 49: S509-S517Abstract Full Text Full Text PDF Scopus (15) Google Scholar describes colorectal cancer survivors' awareness of U.S. Department of Agriculture dietary recommendations, current eating habits, and barriers to following recommended dietary patterns. Rodriguez and colleagues37Rodriguez J.L. Hawkins N.A. Berkowitz Z. Li C. Factors associated with health-related quality of life among colorectal cancer survivors.Am J Prev Med. 2015; 49: S518-S527Abstract Full Text Full Text PDF Scopus (38) Google Scholar also report on the impact of being physically active on health-related quality of life among long-term colorectal cancer survivors. An article by Ryerson et al.38Ryerson A.B. Eheman C. Styles T. Rycroft R. Snyder C. Connecting the dots: linking the National Program of Cancer Registries and the needs of survivors and clinicians.Am J Prev Med. 2015; 49: S528-S535Abstract Full Text Full Text PDF Scopus (10) Google Scholar describes innovative uses of the National Program of Cancer Registries infrastructure and data for comparative effectiveness and patient-centered outcomes research as a recruitment source for survivorship research studies and behavioral interventions, as well as for the collection, consolidation, and dissemination of treatment summaries for cancer survivors and their providers. Finally, the supplement concludes with a paper by White and colleagues39White M.C. Hayes N.S. Richardson L.C. Public health's future role in cancer survivorship.Am J Prev Med. 2015; 49: S550-S553Scopus (9) Google Scholar highlighting findings from all articles included in this supplement from the perspective of future needs and opportunities for public health work in cancer survivorship. This collection of articles provides an overview of CDC's recent research, surveillance, and programmatic activities over the past decade to identify and address the needs of cancer survivors in the context of public health. As the nation's lead prevention agency, CDC will continue to work with a variety of partners to improve the lives of cancer survivors and their families. Publication of this article was supported by the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of CDC. No financial disclosures were reported by the authors of this paper.