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Health Spotlight


Surviving Cancer

elderly couple

Each year, more people diagnosed with cancer are surviving—an estimated 10.5 million Americans are living with a previous diagnosis of cancer.1 A new report from the nation's leading cancer organizations shows that death rates from cancer decreased on average 2.1% per year from 2002-2004, nearly twice the annual decrease of 1.1% from 1993-2002. Moreover, death rates decreased for the majority of the top 15 cancers in men and women. 2

However, cancer is still the second leading cause of death in the United States. Prostate cancer is the most common non-skin cancer in the United States, affecting 1 in 6 men;3 colorectal cancer (CRC) is the second leading cause of cancer-related deaths; and while death rates from breast cancer are declining, in 2007, nearly 180,000 new cases of invasive breast cancer are expected among women.4

Early Detection and Screening

Early detection and screening are crucial to reducing deaths from cancer, thus understanding the risk factors and symptoms for cancer are very important.

Risk Factors

Research shows that certain risk factors increase the chance that a person will develop cancer. The most common risk factors for cancer include:

  • Growing older,
  • Tobacco (smoking)
  • Sunlight (the most common cancer is skin cancer),
  • Family history of cancer,
  • Certain chemicals and other substances,
  • Alcohol use, and
  • Poor diet, lack of physical activity, or being overweight.5

Symptoms

Some of the symptoms caused by cancer may include:

  • Thickening or lump in the breast or other parts of the body,
  • A new mole or change in an existing mole,
  • A sore that doesn't heal,
  • Hoarseness or cough that doesn't go away,
  • Change in bowel or bladder habits,
  • Weight gain or loss for unknown reason, and/or
  • Unusual bleeding or discharge.

Screening

There are several screening tests for different types of cancer. For example, two common screening tests for prostate cancer are the digital rectal examination and the prostate-specific antigen (PSA) blood test that checks the level of PSA in a man's blood stream—a high PSA level may indicate prostate cancer. Current colorectal cancer screening guidelines recommend screening for people aged 50 years or older. Screening can reduce the number of colorectal deaths by up to 60%. Guideline-recommended CRC screening includes: fecal occult blood test (FBOT) series once a year, double-contrast barium enema every 5 years, sigmoidoscopy every 5 years, or colonoscopy every 10 years.6

Screening for cancers that affect women include the mammogram for breast cancer and the Pap test for cervical cancer. In addition, the U.S. Food and Drug Administration approved a human papillomavirus (HPV) vaccine for females ages 9-26 to prevent cervical cancer. The HPV infection is the primary risk factor for cervical cancer. However, the HPV vaccine does not substitute for routine cervical cancer screening (Pap test and pelvic exam).7

HSR&D Research

Following are a few examples of recent and ongoing work by HSR&D investigators in cancer research.

Telehealth Communication Improves Quality of Life for Veterans with Cancer
Uncontrolled symptoms experienced by cancer patients at home during chemotherapy treatment are associated with poor health outcomes, including worse health-related quality of life. Moreover, ineffective communication between patients and their providers impedes treatment of some symptoms and has been associated with poor health-related quality of life. This study was designed to test the feasibility of a Cancer Care Dialogues Model that incorporated daily telehealth interactions (via a home messaging device) between patients at home and their care coordinators, who served as adjuncts to their oncologists. Study results showed that veterans experienced a significant increase in health-related quality of life over the six-month treatment period, and patients who reported reduced nervousness/worry experienced better health-related quality of life .8

Veterans Using Telehealth to Manage Cancer Treatment Symptoms Use Less VA Healthcare Services
Most cancer patients receive chemotherapy treatment in an ambulatory setting, which results in various symptoms including nausea, pain and fatigue. While healthcare providers may view these symptoms as normal, patients might require additional treatment to manage complications. This study analyzed the use of VA healthcare services for veterans with cancer who were enrolled in a Cancer Care Coordination/Home-Telehealth (CCHT) program that managed treatment symptoms remotely via home-telehealth technologies. Veterans participating in the CCHT program were given daily feedback (via telephone) from health care professionals representing a coordinated care team. Investigators compared healthcare services use for these veterans to a control group of veterans with cancer who received standard care. Findings show that as compared to veterans in the control group, veterans in the CCHT program used significantly fewer healthcare services - both inpatient and outpatient. 9

Study Identifies Primary Care Practice Characteristics Associated with Optimal Colorectal Cancer Screening
Despite the availability of effective screening tests, colorectal cancer (CRC) accounts for 10% of all cancer deaths. In 2000, the average screening rate was 47% among Americans enrolled in commercial health plans and 50% among Medicare beneficiaries. The VA increased CRC screening rates to 68% through several methods, including a focus on primary care screening efforts. This study explored VA primary care practice-level characteristics, as well as patient characteristics associated with CRC screening. Overall, VA facilities in this study (n=155) achieved a 62.2% CRC screening rate. Veterans who received their care at primary care practices with higher levels of autonomy and greater clinical support resources were more likely to receive CRC screening. Patient characteristics predictive of CRC screening included older age, higher income, having health insurance, and higher primary care visit rates.10

Editorial Discusses New Guidelines for Breast Cancer Screening
In April 2007, the American College of Physicians issued new guidelines on screening mammography for women aged 40-49. Rather than advocating universal screening, the new guidelines recommend that women make an informed decision after learning about the benefits and harms of mammography. The last time this type of guideline was issued (in 1997, by the NIH), it caused an intense response from the press, the public, and government, which led to the National Cancer Institute recommending universal screening for women in their 40s. In contrast, there has been little reaction to the new guidelines. The reason for this may be that both the public and healthcare professionals increasingly accept that breast cancer screening has both benefits and harms. The main benefit of screening is to avoid death from breast cancer. In the U.S., for every 1000 women screened over the next ten years, less than one life will be "saved" for younger women and about three lives will be saved for older women (50 years and older). The harm of mammography may include false positives that can cause short-term anxiety and, sometimes, unnecessary biopsies. In this editorial, the authors advocate the new guideline as an improvement because it integrates informed decision-making into policy recommendations. Therefore, clinicians need to help women understand what is likely to happen if they do - or do not undergo breast cancer screening.11

References

  1. Cancer Prevention and Control. Centers for Disease Control and Prevention.
  2. Annual Report to the Nation Finds Cancer Death Rate Decline Doubling: Progress in Cancer Treatment Varies by Disease. National Institutes of Health.
  3. FAQs about Prostate Cancer. Prostate Cancer Foundation.
  4. American Cancer Society Report Finds Breast Cancer Death Rate Continues to Drop. American Cancer Society.
  5. What You Need to Know about Cancer: Risk Factors. National Cancer Institute.
  6. Screening Guidelines. Centers for Disease Control and Prevention.
  7. The Pap Test: Questions and Answers. National Cancer Institute Fact Sheet.
  8. Chumbler N, Mkanta W, Richardson L, et al. Remote patient-provider communication and quality of life: Empirical test of a dialogic model of cancer care. Journal of Telemedicine and Telecare January 2007;13(1):20-25.
  9. Chumbler N, Kobb R, Harris L, et al. Health care utilization among veterans undergoing chemotherapy: The impact of a Cancer Care Coordination/Home Telehealth Program. Journal of Ambulatory Care Management October 2007;30(4):308-317.
  10. Yano E, Soban L, Parkerton P, and Etzioni D. Primary care practice organization influences colorectal cancer screening performance. Health Services Research June 2007;42(3 Pt 1):1130-49.
  11. Schwartz L and Woloshin S. Participation in Mammography Screening: Women should be Encouraged to Decide what is Right for Them, Rather than Being Told what To Do. Editorial. British Medical Journal 335(7623):731-732.
  12. Welch H, Fisher E, Gottlieb D, and Barry M. Detection of Prostate Cancer via Biopsy in the Medicare-SEER Population During the PSA Era. Journal of the National Cancer Institute September 2007;99:1-6.