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In order to celebrate the accomplishments of the Centers for Disease Control and Prevention’s (CDC) National Comprehensive Cancer Control Program (NCCCP), the Comprehensive Cancer Control National Partners (CCCNP) developed this Special Issue on Cancer Causes and Control. This, the third Special Issue on Comprehensive Cancer Control (CCC), is a ref...
Citations
... Funded coalitions are encouraged to address health equity through developing a culturally competent workforce, promoting equitable access to cancer screening, treatment, and care, and improving the measurement and use of data to guide their cancer prevention and control plans. Best practices for plan development and modification include engagement with key stakeholders affected by disparities in the state, jurisdiction, or tribe [2,3]. ...
... NCCCP comprehensive cancer control (CCC) plans provide decision makers in U.S. states, jurisdictions, tribes, and tribal organizations with crucial cancer information, priorities, and goals to reduce the burden of cancer. Within the context of increasing evidence of cancer-related LGBTQ+ inequities, the inclusion of LGBTQ+ populations in CCC plans is of upmost importance as we work towards eliminating existing LGBTQ+ inequities and sustaining future LGBTQ+ health equity [2]. Four overarching recommendations have been identified from the findings of this study including using existing plans with robust LGBTQ+ content as a roadmap, collecting SOGI data, disentangling sex and gender, and increasing community engagement. ...
The National Comprehensive Cancer Control Program, a Centers for Disease Control and Prevention funded program, supports cancer coalitions across the United States (US) in efforts to prevent and control cancer including development of comprehensive cancer control (CCC) plans. CCC plans often focus health equity within their priorities, but it is unclear to what extent lesbian, gay, bisexual, transgender, queer/questioning, plus (LGBTQ+) populations are considered in CCC plans. We qualitatively examined to what extent LGBTQ+ populations were referenced in 64 U.S. state, jurisdiction, tribes, and tribal organization CCC plans. A total of 55% of CCC plans mentioned LGBTQ+ populations, however, only one in three CCC plans mentioned any kind of LGBTQ+ inequity or LGBTQ+ specific recommendations. Even fewer plans included mention of LGBTQ+ specific resources, organizations, or citations. At the same time almost three fourths of plans conflated sex and gender throughout their CCC plans. The findings of this study highlight the lack of prioritization of LGBTQ+ populations in CCC plans broadly while highlighting exemplar plans that can serve as a roadmap to more inclusive future CCC plans. Comprehensive cancer control plans can serve as a key policy and advocacy structure to promote a focus on LGBTQ+ cancer prevention and control.
... For a number of years, the Centers for Disease Control and Prevention (CDC)'s National Comprehensive Cancer Control Program (NCCCP) has worked with national partners and funded jurisdictional cancer control programs to form partnerships, develop cancer control plans, prioritize survivorship as a program priority, and implement interventions. 44 This work may be most salient in geographic areas where there are a greater number of people who are medically underserved. In these areas, PCPs may often be the main point of contact for survivors, rather than an oncologist. ...
Background:
National organizations have issued comprehensive cancer survivorship care guidelines to improve care of cancer survivors, many of whom receive care from primary care providers (PCPs).
Methods:
We analyzed Porter Novelli's 2019 fall DocStyles survey to assess use of cancer survivorship care guidelines, receipt of survivorship training, types of survivorship services provided, and confidence providing care among PCPs in the United States. We grouped PCPs by use of any guideline ("users") versus no guideline use ("nonusers"). We calculated descriptive statistics and conducted multivariable logistic regression analyses to examine guideline use, having received training on providing survivorship care services, and confidence in providing care. Within the panel, sampling quotas were set so that 1000 primary care physicians, 250 OB/GYNs, 250 pediatricians, and 250 nurse practitioners/physician assistants were recruited.
Results:
To reach selected quotas, 2696 health professionals were initially contacted to participate, resulting in a response rate of 64.9%. Sixty-two percent of PCPs reported using guidelines and 17% reported receiving survivorship care training. Use of any guidelines or receiving training was associated with reporting providing a range of survivorship services and confidence in providing care. After adjusting for demographic characteristics, guideline users were more likely than nonusers to report assessing genetic cancer risk (OR = 2.65 95% confidence interval (CI) (1.68, 4.17)), screening for cancer recurrence (OR = 2.32 95% CI (1.70, 3.18)) or a new cancer (OR = 1.63, 95% CI (1.20, 2.22)), and treating depression (OR = 1.64, 95% CI (1.20, 2.25)). Receipt of training was also positively associated with providing genetic risk assessment, surveillance for recurrence, as well as assessing late/long-term effects, and treating pain, fatigue, and sexual side effects.
Conclusion:
Survivorship care guidelines and training support PCPs in providing a range of survivorship care services.
... The Centers for Disease Control and Prevention's (CDC's) National Comprehensive Cancer Control Program, established in 1998, supports CCC development and provides funding, guidance, and technical assistance to US territories and freely associated states, the District of Columbia, and tribes and tribal organizations, to design and implement plans (4). Plans guide cancer prevention and control activities with the goal of reducing cancer incidence and death rates by addressing all parts of the cancer continuum (1)(2)(3)5). Although including goals, objectives, and strategies is standard across plans, each plan is unique to its region, and content varies in scope, priorities, and length. ...
... Statewide coalitions are responsible for creating CCC plans, and these plans generally span a 5-year period (3). When working on the development of CCC plans, coalitions are encouraged to engage people with diverse perspectives, such as community members, advocacy groups, people representing multiple sectors, and working partners (1,2,(5)(6)(7). Meaningful community engagement can advance cancer health equity by informing practice, research, and policy with input from people who are typically marginalized and by identifying community-aligned solutions (8). ...
Introduction:
Comprehensive cancer control (CCC) plans are state-level blueprints that identify regional cancer priorities and health equity strategies. Coalitions are encouraged to engage with community members, advocacy groups, people representing multiple sectors, and working partners throughout the development process. We describe the community and legislative engagement strategy developed and implemented during 2020-2022 for the 2022-2027 Illinois CCC plan.
Methods:
The engagement strategies were grounded in theory and evidence-based tools and resources. It was developed and implemented by coalition members representing the state health department and an academic partner, with feedback from the larger coalition. The strategy included a statewide town hall, 8 focus groups, and raising awareness of the plan among state policy makers.
Results:
A total of 112 people participated in the town hall and focus groups, including 40 (36%) cancer survivors, 31 (28%) cancer caregivers, and 18 (16%) Latino and 26 (23%) African American residents. Fourteen of 53 (26%) focus group participants identified as rural. Participants identified drivers of cancer disparities (eg, lack of a comprehensive health insurance system, discrimination, transportation access) and funding and policy priorities. Illinois House Resolution 0675, the Illinois Cancer Control Plan, was passed in March 2022.
Conclusion:
The expertise and voices of community members affected by cancer can be documented and reflected in CCC plans. CCC plans can be brought to the attention of policy makers. Other coalitions working on state plans may consider replicating our strategy. Ultimately, CCC plans should reflect health equity principles and prioritize eliminating cancer disparities.
... 1,2 Compared to conventional hernia repair, oncologic AWR patients possess numerous comorbidities, including prior radiotherapy, immunosuppression from chemotherapy, malnutrition and dehydration attendant to cancer diagnoses, among others. 1,3,4 The abdominal wall of oncologic patients is predisposed to fibrosis due to aberrant collagen deposition, widespread microvascular damage and chronic activation of proinflammatory factors. 5 This results in altered pliability of normal soft tissue, obliteration of surgical planes and impaired wound healing processes. ...
Background:
Outcomes studies for abdominal wall reconstruction (AWR) in the setting of previous oncologic extirpation are lacking. We sought to evaluate long-term outcomes of AWR using acellular dermal matrix (ADM) after extirpative resection, compare them to primary herniorrhaphy, and report the rates and predictors of postoperative complications.
Methods:
We conducted a retrospective cohort study of patients who underwent AWR after oncologic resection from March 2005 to June 2019 at a tertiary cancer center. The primary outcome was hernia recurrence (HR). Secondary outcomes included surgical site occurrences (SSOs), surgical site infection (SSIs), length of hospital stay (LOS), reoperation, and 30-day readmission.
Results:
Of 720 consecutive patients who underwent AWR during the study period, 194 (26.9%) underwent AWR following resection of abdominal wall tumors. In adjusted analyses, patients who had AWR after extirpative resection were more likely to have longer LOS (β, 2.57; 95%CI, 1.27 to 3.86, p < 0.001) than those with primary herniorrhaphy, but the risk of HR, SSO, SSI, 30-day readmission, and reoperation did not differ significantly. In the extirpative cohort, obesity (Hazard ratio, 6.48; p = 0.003), and bridged repair (Hazard ratio, 3.50; p = 0.004) were predictors of HR. Radiotherapy (OR, 2.23; p = 0.017) and diabetes mellites (OR, 3.70; p = 0.005) were predictors of SSOs. Defect width (OR, 2.30; p < 0.001) and mesh length (OR, 3.32; p = 0.046) were predictors of SSIs. Concomitant intra-abdominal surgery for active disease was not associated with worse outcomes.
Conclusions:
AWR with ADM following extirpative resection demonstrated outcomes comparable with primary herniorrhaphy. Preoperative risk assessment and optimization are imperative for improving outcomes.
... Considering the aging population, greater cancer risk with age, and improving cancer survival rate, the global incidence of cancer is expected to rise from ~ 9 million in 2017 to ~ 26 million by 2030 (Welzel and Tanner 2018;Eurostat 2019;Radkte 2022). Approximately 50% of cancer patients receive definitive or adjuvant radiotherapy (Verellen et al. 2007;Carlotto et al. 2013;Hayes et al. 2018;Delaney et al. 2005). Thus, given that foreign patients living in Germany are equally affected by this development, their use on radiotherapy as a component of their cancer treatment regimen is expected to increase in the future. ...
Background
Major demographical changes in Germany commenced in the 1960s. Ongoing humanitarian crises in the Ukraine with subsequent immigration will have also long-range effects on national provision of cancer treatment. Ensuring the best possible outcomes for each cancer patient undergoing radiotherapy requires the prediction and prevention of unfavorable side effects. Given that recent research has primarily focused on clinical outcome indicators solely, less is known regarding sociodemographic predictors of therapeutic outcomes, such as patient nationality. Here, we investigated whether the severity of early side effects after radiotherapy are associated with patient nationality and other sociodemographic and clinical characteristics.
Methods
Out of 9187 patients treated at a German university medical center between 2017 and 2021, 178 German and 178 non-German patients were selected for matched-pair analysis based on diagnostic and demographic criteria. For all 356 patients, data on side effects from follow-up care after radiotherapy were collected.
Results
Non-German patients were more likely to have severe side effects than German patients. Side effect severity was also associated with tumor entity, concomitant therapy, body mass index, and age.
Conclusion
Foreign cancer patients are at higher risk of experiencing severe side effects of radiotherapy, suggesting a need to develop and implement targeted preventive measures for these patients. Further research investigating factors predicting the occurrence of radiotherapy side effects, including other sociodemographic characteristics, is needed to better personalize therapy regimens for cancer.
... Adult professionals have reported learning practice skills on the job or through self-study, while learning research skills in their formal education [1]. The literature shows that leaders of cancer control coalitions [2], navigators [3], and leaders of health departments [4] could benefit from more extensive knowledge about the science of implementation. Some scholars claim that all people who have a hand in implementation should be trained [5]. ...
Purpose
Cancer control interventions are difficult to implement with fidelity, while tailoring to fit contexts. Engaged approaches are suggested to advance equity. On-the-ground practitioners are needed to serve as collaborators in the implementation process with research teams, but few trainings are designed with them in mind.
Methods
The Cancer Control Implementation Science Base Camp (CCISBC) was created to improve capacity among cancer control practitioners when implementing evidence-based cancer screening programs in specific contexts. Development of the curriculum included the following: (1) performing a literature review assessing extant curricula, (2) comparing competencies of these curricula, (3) user-centered design, (4) producing learning materials, (5) recruiting two teams to test a pilot, (6) running the pilot, and (7) evaluating results.
Results
Nine competencies overlapped between four of the curricula scanned in this study, all of which served as the basis for learning objectives. Principles that emerged from design sessions included staying clear about terminology, supporting the brokerage of knowledge, reframing theories, models, and frameworks as tools, and including equity in everything. Pilot testing showed that the average learner increased 74.5% in knowledge and 75% in confidence regarding implementing evidence-based cancer screening. Evidence suggests that the training increased the skill of implementing evidence-based interventions (EBIs) with a health equity lens.
Conclusion
In order to scale practice-based evidence, practitioners will need to be engaged. This engagement is optimized when practitioners are trained to collaborate on implementation research. The CCISBC is a feasible program to develop capacity among practitioners in comprehensive cancer control in order to optimize EBIs tailored to context.
... With more than 20 years' history of building successful partnerships to address cancer control and improve cancer survivors' quality of life, the NCCCP currently supports Comprehensive Cancer Control (CCC) planning, implementation, and evaluation in all 50 states, the District of Columbia, eight tribes or tribal organizations, and seven Pacific Island Jurisdictions and US territories. Cancer control plans are guided by six NCCCP priorities: primary prevention, early detection and treatment, supporting survivors and caregivers, and the cross-cutting areas of policy, systems and environmental change approaches, health equity, and evaluation [5].CDC provides CCC programs with funding, guidance, and technical assistance and training (TAT) to develop cancer control plans and also supports affiliated cancer coalitions to further build CCC capacity [6]. TAT, as shown in Table 1, is offered in multiple forms, including online trainings, webinars, toolkits, workshops, tip sheets, and other products. ...
The National Comprehensive Cancer Control Program (NCCCP) was established in 1998 by the Centers for Disease Control and Prevention (CDC) to advance national cancer control implementation across US states and affiliated tribes and territories. To build capacity of NCCCP recipients, technical assistance and training (TAT) is offered in the form of online trainings, webinars, toolkits, workshops, tip sheets, and other products. To determine TAT needs of NCCCP recipients, the George Washington University (GW) Cancer Center conducted a qualitative evaluation to inform TAT planning and implementation. Data on the utilization, applicability, impact, and dissemination of TAT received were collected from comprehensive cancer control practitioners through semi-structured interviews. Detailed memos of interviewee responses were documented and deductively coded based on three themes: promotion of TAT, use of existing TAT, and recommendations for future TAT. Interviewees reported a need for diverse topics, modalities, and TAT reminders. The most widely used TAT resources were social media toolkits, webinars, newsletters, patient navigation resources, and online trainings. Recommendations for future TAT included a focus on coalition support, adaptation and evaluation of evidence-based cancer control strategies, and health equity. Offering a blend of TAT, including educational webinars and trainings, was preferred by CCC professionals and could increase use. Future TAT will provide new opportunities for coalition capacity building, adaptation of evidence-based strategies for cancer control, and center health equity.
... 1 Most plans include an overview of state cancer rates; cover relevant topics such as prevention, screening, treatment, and survivorship; and include goals that are measured by objectives. There are currently 66 coalitions with a cancer control plan, which includes all fifty US states, the District of Columbia, eight tribal organizations, and seven US territories/jurisdictions. 2 As of June 2021, most US states have created at least two versions of a cancer control plan, with plans typically spanning 5 years. ...
Background
A well-designed cancer control plan is an important tool for a nation, state, or community to address the burden of cancer. Furthermore, it provides the opportunity to devise and implement measurable objectives. However, there has been little to no assessment of the success rates of such objectives.
Methods
I compared the success rate of objectives between US states’ current plan and most recent past plan to determine the proportion of success in the United States overall. I also tested possible reasons for low success rates.
Results
The mean success rate was 20% for stringent successes (only exact matches between plans) and 28% for loose successes (exact and similar matches between plans). The magnitude of change in percentage between the baseline and target for loose objectives significantly predicted success (P = .0347). Higher change resulted in lower success. However, neither the number of objectives nor the level of overlap significantly predicted success rate. Nor was population size, region, or rural–urban status significantly related to success rate. The most successful states had high proportions of objectives that were measurable and a high number of overlapping objectives.
Conclusion
I found that objective success rates were low for cancer control plans. To improve success rates, I suggest that future cancer control plans ensure each objective has a measurable baseline and realistically attainable target.
... While there has been notable CCC progress among state and local cancer coalitions [18][19][20][21][22], cancer remains a leading cause of death in rural populations, and ruralurban disparities persist [17,23,24]. Compared to other US counties, rural Appalachian counties have poorer cancer-related health outcomes across the cancer care continuum and suffer from persistent disparities [25][26][27][28][29][30][31]. ...
... Rather, it takes concerted efforts and thoughtful, purposeful partnership building approaches [13]. Despite steady US progress pertaining to CCC efforts over the past two decades [18,19], evidence suggests that rural communities are lagging behind [15][16][17]. Thus, there is a clear need to link cancer control outreach and engagement efforts with research efforts. ...
Plain English summary There has been notable progress among state and local cancer coalitions in developing and implementing comprehesive cancer control plans. Yet, gaps exist in rural communities and cancer remains a leading cause of death in rural populations. This paper reports on how the involvement of a Community-Academic Advisory Board (CAB) helped to prioritize cancer control and research needs in the medically-underserved, rural Appalachian region. CAB members were asked to participate in meetings and to share their experiences through surveys and interviews. Through this three-year process, four cancer control needs were prioritized: human papillomavirus vaccination, tobacco control, colorectal cancer screening, and lung cancer screening. Also, over the course of the project, CAB members’ experiences improved, including: communication, priority work plans, roles/accountability, shared decision making, value-added collaboration, empowered leadership, diversified funding, trust, satisfaction. During the interviews, CAB members identified specific challenges, strengths, and recommendations. The opportunities and barriers at building and sustaining capacity as well as advancing a community-driven research agenda to address cancer disparities in rural Appalachia is discussed.
... A crucial component of comprehensive cancer control (CCC) is a plan developed collaboratively by multiple and diverse stakeholders with aspirational goals, evidencebased strategies, and measurable objectives [1][2][3]. Historically, each state prioritizes their goals, strategies, and objectives based on several factors including specific cancer burdens affecting their communities, stakeholder capacity, feasibility, and political will [4]. A typical cancer plan can contain twelve to sixty objectives, but usually encompasses the continuum of cancer from prevention to early detection to treatment to survivorship. ...
State cancer plans facilitate prioritization and stakeholder engagement in preventing and controlling cancer. Implementation plans further help stakeholders prioritize efforts, reduce redundancy, and find opportunities for work synergies. A review of cancer plan implementations plans was performed in the development of an implementation plan for the Florida Cancer Plan. This review sought to identify, characterize, and summarize the use of implementation plans that support comprehensive cancer control activities. Although 100% of states and territories published a cancer plan and 78% of states provided funding for implementing their state cancer plans, only 32% published an implementation plan. Commonalities and unique features of state cancer plan implementations are presented and discussed. An example implementation plan is provided for states without a plan to model.
