Technical Assistance and Training Needs of Comprehensive Cancer Control Programs: a Qualitative Analysis.

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.

Alcohol Use During Chemotherapy: A Pilot Study.

INTRODUCTION: Alcohol use increases the risk for some cancers and can cause complications during treatment. The prevalence of alcohol use during chemotherapy has not been well documented in current literature. This pilot study aimed to examine self-reported alcohol use during chemotherapy among cancer survivors as a basis for future research and interventions. METHODS: We surveyed Wisconsin cancer survivors (N=69) who participated in the ongoing population-based research study, Survey of the Health of Wisconsin (SHOW), on alcohol use during chemotherapy. RESULTS: Of the cancer survivors who reported receiving chemotherapy, 30.4% (N=21) reported consuming alcohol while receiving chemotherapy, and 38.1% (N=8) of those who drank reported complications. Alcohol use during chemotherapy was higher among older adults (age 65+, rate ratio [RR], 1.9; 95% CI, 0.7-4.9), men (RR, 2.7; 95% CI, 1.3-5.4), former and current smokers (former: RR, 1.6; 95% CI, 0.7-3.8, current: RR, 2.5; 95% CI, 1.1-5.8), and those with non-alcohol-related cancers (RR, 2.0; 95% CI, 0.9-4.2.). CONCLUSION: Alcohol use during chemotherapy is common and may increase the risk of complications. More research is needed to better understand this problem and to design effective interventions.

Building implementation science capacity among practitioners of cancer control: development of a pilot training curriculum.

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.

Results of the George Washington University cancer center's comprehensive cancer control cancer communication mentorship program and implications for future practice.

PURPOSE: The Comprehensive Cancer Control Cancer Communication Mentorship Program ("Mentorship Program") was created by the George Washington University Cancer Center (GWCC) to provide technical assistance (TA) in implementing evidence-based cancer screening communication interventions and support networking for comprehensive cancer control (CCC) professionals. The Mentorship Program matched entry-to mid-level CCC professionals with health communication and/or CCC experts and offered monthly web-based discussions with academic researchers and practitioners who shared their knowledge and provided applied learning opportunities throughout mentees' project planning, implementation and evaluation. The program objective was for mentees to improve health communication skills and apply evidence-based knowledge to reduce the burden of cancer. METHODS: A mixed methods evaluation was conducted, including a qualitative description of each project and its outcomes as well as quantitative measures of satisfaction with the program and self-rated changes in competence. RESULTS: Mentees represented the following locations: New Jersey, Arkansas, Michigan, West Virginia, and Republic of Palau. Project topics ranged from increasing Human papillomavirus (HPV) vaccinations to increasing screening uptake for colorectal cancer, lung cancer, cervical cancer, and breast cancer. Evaluation results from pre- and post-program communication competency self-assessments and mid- and post-program surveys revealed that the Mentorship Program advanced personal and professional goals and improved public health communication skills. CONCLUSION: The Mentorship Program achieved its objectives for peer networking and offering expert TA in cancer prevention and control communication, offering a promising model for others involved in supporting implementation of evidence in practice.

The current status of survivorship care provision at the state level: a Wisconsin-based assessment.

PURPOSE: As the number of cancer survivors grows, the responsibility for addressing their unique physical and emotional needs also increases. Survivorship care services vary by geography, health system, and insurance coverage. We aimed to understand the state of survivorship care services in Wisconsin's cancer facilities. METHODS: The selection of cancer treatment facilities sought to provide a geographically representative sample. An adapted Patient-Centered Survivorship Care Index was comprised of questions regarding different aspects of survivorship practices. Areas of interest included disciplines incorporated, services provided, standards of care, and discussion of late-term effects, among others. RESULTS: Out of 90 sites invited, 40 responded (44.4%). Oncologists, physician assistants, and nurse practitioners were the most common follow-up care disciplines. Risk reduction services, dietary services, access to physical activity, and behavioral health specialist referral were described as standards of care in less than half of sites. All sites reported working with community partners, 92.5% of which worked with YMCA-related programs. Discussion of long-term effects was a standard of care for all sites. Effects such as emotional distress and health practice changes were frequently discussed with almost all patients, while sexual functioning and fertility were not. CONCLUSIONS: Services and specialties related to behavioral health, fertility/sexual health, and rehabilitation and physical activity varied between sites. Such services may be offered less often due to variable insurance coverage. IMPLICATIONS FOR CANCER SURVIVORS: Policy solutions should be explored to increase insurance coverage and provision rates of necessary survivorship services to keep up with the projected increase in demand. Given imperfect and evolving measurement tools to assess needs for cancer survivorship care services, cancer survivors should feel empowered to voice when they have unmet needs and request referrals.

Current Trends in HPV Vaccine Uptake: Wisconsin and United States, 2016-2019.

BACKGROUND: Human papillomavirus (HPV) is a recognized cause of cancer in both males and females. HPV vaccination prevents development of HPV-associated diseases. METHODS: Wisconsin HPV vaccination rates (2016-2019) were obtained from the Wisconsin Immunization Registry. Data was stratified by age, sex, Medicaid status, race/ethnicity, and ZIP code. Wisconsin vaccination rates were compared with national trends using data from the 2016, 2018, and 2019 National Immunization Survey-Teen. RESULTS: Wisconsin HPV vaccination rates remain consistently below national averages. HPV vaccination rates are improving-especially among males; however, vaccine coverage at the recommended age of 11-12 remains low. Rates of vaccine uptake differ by race/ethnicity, rurality/urbanicity, and Medicaid status. CONCLUSION: Further initiatives are needed to increase awareness and acceptance of HPV vaccination for cancer prevention throughout Wisconsin.

Variation in Breast Cancer Screening Recommendations by Primary Care Providers Surveyed in Wisconsin.

BACKGROUND: Cancer screening is chiefly performed by primary care providers (PCPs) who rely on organizational screening guidelines. These guidelines provide evidence-based recommendations; however, they are often without unanimity leading to divergent screening recommendations. OBJECTIVE: Due to the high incidence of breast cancer, the availability of screening methods, and the presence of multiple incongruent guideline recommendations, we sought to understand breast cancer screening practices in Wisconsin to identify patterns that would allow us to improve evidence-based screening adherence. METHODS: A 46-question survey on breast cancer screening beliefs and practices for average-risk women was sent to healthcare providers in Wisconsin in 2018, who provided cancer screening services to women. Providers included physicians, nurse practitioners (NPs), physician assistants (PAs), and midwives. RESULTS: A total of 295 people responded to the survey, for a response rate of 28.6%. Most respondents were physicians (64.1%), followed by NPs (25.7%), PAs (5.3%), and midwives (1.5%). Of physicians, most practiced family medicine (65.3%), followed by internal medicine (25.3%) and gynecology (9.4%). The United States Preventive Services Task Force (USPSTF) was reported as being "very influential" for 60.5% of providers, followed by the American Cancer Society at 46.8%. For patients 40-49 years old, 75.6% of providers performed clinical breast exams and 58.5% recommended self-breast exams; these numbers increased for women 50+ years old to 78.7% and 61.2%, respectively. Mammography was more likely to be recommended annually for women aged 40-49 rather than biennially by non-physician clinicians compared to physicians (p < .001). CONCLUSIONS: PCPs in Wisconsin continue to overestimate the efficacy of clinical and self-breast exams as well as overuse these in clinical practice. Providers find multiple screening guidelines influential but favor the USPSTF; however, these guidelines are frequently not being followed. Further research needs to be done to investigate the lack of national guideline adherence by providers to improve compliance with evidence-based screening recommendations.

The Nine Habits of successful comprehensive cancer control coalitions.

The nine habits of successful comprehensive cancer control coalitions (Nine Habits) is a guide that outlines the key elements of successful comprehensive cancer control (CCC) coalitions. The guide was developed under the auspices of the Comprehensive Cancer Control National Partnership (CCCNP) and is based on evaluation including a literature review, qualitative and quantitative data collection from high-performing comprehensive cancer control coalitions. Comprehensive cancer control coalitions are made up of key stakeholders who come together to create a shared vision and shared plans to fight cancer, improve health outcomes, and reduce the burden from cancer. The CCCNP produced this guide to help coalitions maintain the health of their coalition efforts by providing tools to examine the key elements of successful coalitions, including leadership, membership, organizational structure, shared resources, and efforts in planning and communications. This paper provides information on how the guide was used by two states to rebuild their coalition and ultimately improve their efforts in improving health outcomes and reducing cancer burden. Lastly, the paper outlines future efforts to continue to support CCC coalitions in their work.

Application of a gender-based approach to conducting a community health assessment for rural women in Southern Illinois.

Rural populations in the United States experience unique challenges in health and health care. The health of rural women, in particular, is influenced by their knowledge, work and family commitments, as well as environmental barriers in their communities. In rural southern Illinois, the seven southernmost counties form a region that experiences high rates of cancer and other chronic diseases. To identify, understand, and prioritize the health needs of women living in these seven counties, a comprehensive gender-based community health assessment was conducted with the goal of developing a plan to improve women's health in the region. A gender-analysis framework was adapted, and key stakeholder interviews and focus groups with community women were conducted and analyzed to identify factors affecting ill health. The gender-based analysis revealed that women play a critical role in the health of their families and their communities, and these roles can influence their personal health. The gender-based analysis also identified several gender-specific barriers and facilitators that affect women's health and their ability to engage in healthy behaviors. These results have important implications for the development of programs and policies to improve health among rural women.