Empowering Communities Through Cancer Education Programs

Introduction

Reducing the impact of cancer requires proactive engagement in the well-being of individuals before they become patients. Cancer education programs play a vital role in achieving this goal by raising awareness, promoting early detection, and providing access to resources within communities. These programs are particularly crucial for medically underserved populations, where cancer rates and mortality rates are often disproportionately high.

Addressing Cancer Disparities in Medically Underserved Communities

The Office of Community Outreach & Engagement (OCOE) at the UAB O’Neal Comprehensive Cancer Center focuses on improving cancer outcomes among medically underserved populations in Alabama. Alabama’s cancer rates and cancer mortality rates are significantly higher than the national averages, according to 2023 statistics shared by the Alabama Department of Public Health. Breast, colorectal, lung, and prostate cancers account for more than 47% of all new cases in Alabama. As an NCI-designated Comprehensive Cancer Center, the UAB O’Neal Comprehensive Cancer Center focuses on addressing cancer-related health disparities in the region it serves.

OCOE’s work is specific to the needs of its NCI "catchment area" - the region UAB intends to serve through conducting research, community engagement, and community outreach. This area includes the entire state. Service could involve teaching residents to shop for a healthier diet or revisiting the dangers of smoking in new ways. Educational outreach and engagement are especially important for the most common cancers and those with the highest mortality rates in Alabama.

Community Health Advisors: Bridging the Gap

To achieve these ambitious goals, meaningful engagement over time is essential. The OCOE trains liaisons called community health advisors (CHAs) to help provide education and spread awareness about various programs. CHAs are laypeople trained to share information about cancer screenings, early detection, cancer prevention, and research opportunities, serving as an important bridge to care for their neighbors by pointing them toward support services and resources. The OCOE is active through partnerships, programs, and a regularly updated educational curriculum that its CHAs share, providing an up-to-date pathway toward better health choices and access to screenings.

Community Cancer Education Program: A Comprehensive Approach

The Community Cancer Education Program focuses on promoting awareness of cancer prevention, early detection, and resources available within the community at the Community Cancer Center. This program covers a wide range of topics, including:

Cancer & Genetics: Understanding Hereditary Cancer Risk

This presentation helps individuals determine if their family is at risk of having a hereditary cancer syndrome.

Colorectal Cancer: Is It in Your Genes?

This presentation informs individuals about how certain colon cancers may have a genetic link, addressing concerns about colon cancer risk.

Skin Cancer Prevention: Protecting Yourself from the Sun

This presentation educates individuals on how to protect their skin from the sun and dangerous UV rays. Studies show that 1 in 5 people will develop skin cancer in their lifetime, but protection and education can help. The presentation emphasizes that no tan is a safe tan.

Cancer Prevention on Your Plate: The Role of Diet

This presentation explores how dietary choices can affect cancer risk.

Exercise is Your Friend: The Benefits of Physical Activity

This presentation highlights the health benefits of exercise, including the lowered risk of certain kinds of cancer.

Exercise and Your Diet Working Together: A Synergistic Approach

This presentation emphasizes that combining diet and exercise is the best way to reduce cancer risk.

Cancer Screenings: What is Right for Me?

This presentation navigates the various recommendations regarding cancer screening.

How to Support Those Who Support Us: Addressing Caregiver Issues

This presentation addresses the challenges faced by family members and loved ones who take on caregiving roles when someone is diagnosed with cancer, including going to appointments, helping with day-to-day tasks, helping coordinate care/services and providing emotional support. Research shows over 50 percent of caregivers report their health and quality of life is diminished.

Family Support and Quality of Life: Coping with the Emotional Effects of Cancer

This presentation recognizes that a cancer diagnosis affects both patients and their loved ones, causing distress for everyone in the family. It acknowledges that sometimes life-long coping strategies cannot keep up with the emotional effects of cancer, which can include anxiety and/or depression, as well as changes in sleep, appetite, and energy levels.

How to Help Children and Teens When a Family Member Has Cancer

This presentation provides ways to help children and teens deal with the impact cancer is having on their lives and on their entire family.

Advanced Training and Educational Opportunities

Trainee Membership at the Chao Family Comprehensive Cancer Center

The Chao Family Comprehensive Cancer Center offers Trainee Membership to UC Irvine students, postdocs, residents, and fellows in cancer research or oncology training. Eligible applicants must work in a CFCCC member's lab or participate in a CRTEC program. Benefits include event invitations, career development, access to Shared Resources, and travel awards.

Travel Awards for Trainee Members

The Chao Family Comprehensive Cancer Center offers Travel Awards to Trainee Members for conference travel and presentation funding. These awards support students, postdocs, residents, and fellows presenting cancer-related research at conferences. Applicants must be accepted to present, have a letter of support from a CFCCC member, and apply within specified deadlines.

High School Programs

These programs, California State Summer School for Mathematics and Science, Youth Science Fellowship Program, and our Summer Surgical Program, provide high school students with exposure to the field of cancer research and cancer clinical care.

Undergraduate Programs

The Chao Family Comprehensive Cancer Center offers undergraduate students the chance to engage in cancer research and treatment through programs such as CURE-Cancer, CHERP, and UROP. These initiatives provide research opportunities, mentorship, and professional development in various cancer research disciplines, including basic, clinical, and population sciences.

Graduate and Postdoctoral Programs

Throughout the UCI campus there are programs to support graduate students, postdoctoral and clinical fellows in their cancer career journey. These programs provide education, mentorship and training to support the next generation of cancer researchers.

The Allen and Lee-Hwa Chao Lectureship in Cancer Research

The Allen and Lee-Hwa Chao Lectureship in Cancer Research was established in 1999 with a gift from Allen Chao and his wife Lee-Hwa Chao. The Chao family has been generous contributors to UC Irvine and the Cancer Center over the years, with three generations of Chaos giving nearly $30 million to the campus. The lecture series provides a forum to share and discuss topics related to cancer research, prevention and treatment. Each year the lectureship hosts an internationally renowned leader in cancer research, who delivers a technical colloquium in addition to a public lecture.

CancerCare Connect® Education Workshops

CancerCare offers free CancerCare Connect® Education Workshops on cancer-related topics. Pre-registration is required.

Participation Details

Participation is free, and no phone charges apply. To register, view the calendar of upcoming workshops and register online or call 800‑813‑HOPE (4673). After registering, participants receive additional information about the workshop.

Interactive Question-and-Answer Sessions

Each live, hour-long Connect Education Workshop program includes a question-and-answer session where listeners can submit their own questions to a panel of experts.

Accessing Past Workshops

Connect Education Workshops are available for replay online or by telephone. To listen online, view the past workshop directory by clicking the "Listen to Podcasts" tab. To listen by telephone, hear a directory of featured programs available by phone, 24 hours a day, seven days a week, by calling 888-337-7533 or 800‑813‑HOPE (4673).

Systematic Review of PCP Cancer Survivorship Programs

A systematic review was conducted to identify and evaluate existing PCP cancer survivorship programs in published literature. The review addressed the following questions: (1) What are the behavioral/learning theories, pedagogy, and/or frameworks used in PCP survivorship education programs?

Methodology

The systematic review was prepared and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered with PROSPERO. The Quality of Cancer Survivorship Care Framework was used to define survivorship care and guide article inclusion.

Education programs were considered “survivorship care programs” if they described or contained at least one of the following core domains: (1) cancer and cancer treatment (prevention and surveillance for recurrences and new cancers; surveillance and management of physical effects; surveillance and management of psychosocial effects); (2) general health care (surveillance and management of chronic medical conditions; health promotion and disease prevention); and (3) contextual domains (clinical structure; communication and decision-making; care coordination; patient/caregiver experience).

An educational program was defined using the United Nations Educational, Scientific and Cultural Organization’s (UNESCO) International Standard of Classification of Education as a coherent set or sequence of educational activities designed and organized to achieve pre-determined learning objectives or accomplish a specific set of educational tasks over a sustained period.

Study titles were considered eligible for inclusion if the study or program evaluated met the following criteria: (1) describe a “survivorship care program” as per the above definition, (2) describe and evaluate an education program, (3) report outcomes of the evaluation, (4) explicitly specify PCPs as the intended participants of the program or include PCPs as a learner type, and (5) be written in English. Only studies published after 2005 were included. Further, only articles or abstracts with published evaluated outcomes were eligible for inclusion.

Three databases (PubMed, Embase, and CINAHL) were searched between January 2005 and September 2020 using the search strategy listed in Supplementary File 3. Reference lists of all full text articles were checked for potentially relevant programs and studies. Google Scholar was also searched for additional studies.

Titles and abstracts of articles retrieved from the search strategy were independently screened by two authors. The same two authors then assessed the eligibility of relevant full-text articles for inclusion in the review. Data extraction was conducted by one author and checked for accuracy by a second author. Key information extracted included author, publication year, study type, research methods, program/resource objectives, curriculum content, pedagogy, learning theories used, course participants, and survivorship components.

Study outcomes were categorized and synthesized using Barr’s adaptation (the addition of two sub-domains) of Kirkpatrick’s 4-level model of evaluation. This model specifies four levels of training evaluation: reaction, views on learning experience; learning, the modification of learner attitudes and acquisition of knowledge and skills; behavior change, the transfer of learning to the workplace; and results, changes in organizational practice or benefits to patients.

Survivorship program content was independently categorized by two authors using the Quality of Cancer Survivorship Care Framework, with inclusion of special populations considerations (e.g., adolescents and young adults, geriatric populations). Quality assessment of pre-test, post-test studies was undertaken using the NIH “quality assessment tool for before-after (pre-post) studies with no control group”. Post-test only studies were also appraised using this tool, with items pertaining to pre-test, post-test differences recorded as “not applicable.” Mixed-methods studies were appraised using the mixed-methods appraisal tool.

Results

Database searches resulted in 2555 potentially eligible records. Of these, 24 articles (seven abstracts and 17 full text studies) representing 21 studies and evaluating 21 unique survivorship education programs met the inclusion criteria and were included in the review. All 21 studies utilized single-group designs with no comparators. Thirteen studies used a pre-test, post-test design. Five studies used a post-test only design, two studies used a mixed-methods approach, and one study had an unspecified methodology. Of the 21 survivorship education programs evaluated within these studies, 15 were developed in the USA, three were developed in Australia, one in Germany, and two in Canada.

All studies were susceptible to bias due to the lack of comparison groups. The quality of most pre-test, post-test and post-test studies was rated poor, with one rating fair. Across all studies, outcome measures generally consisted of non-validated self-response measures, increasing risk of self-rater bias. Intended cancer survivorship content differed across education programs and included clinician education targeted towards the management of fear of cancer recurrence; utilization of survivorship care plans (SCPs); management of sexual complications in female cancer survivors; survivorship management specifically for Hodgkin’s lymphoma, breast cancer and prostate cancer survivors, and cervical, breast, and colon cancer survivors; childhood cancer survivors; survivors undergoing immunotherapy; and “general cancer survivorship” across all populations.

A range of sources and guidelines were used to inform survivorship education curricula and content. Eight of 21 programs specified the utilization of at least one specific recognized guideline or framework to inform survivorship program content or curricula. These guidelines/frameworks included the Children’s Oncology Group Long-Term Follow-up Guidelines; the Quality of Life Model for Cancer Survivors; the American Cancer Society Clinical Care Guidelines; the American Society of Clinical Oncology (ASCO) Breast Cancer Survivorship Care Guidelines and ASCO Treatment Summary Survivorship Care Plan; the Institute of Medicine (IOM) survivorship recommendations; and the 5A’s communication framework.

Schools vs. Cancer Program

The American Cancer Society Schools vs. Cancer program brings education and community service to an elementary & middle school classroom in a fun and exciting way that also allows students to help save lives from cancer. Through Schools vs. Cancer program, students will learn about cancer, steps they can take to reduce their risk of developing the disease, and tips to stay healthy.

Huntsman Cancer Institute Trainee Membership

The Dr. Huntsman Cancer Institute is dedicated to training the next generation of cancer researchers. All students, postdocs, medical fellows, and residents mentored by a cancer center member are encouraged to apply for trainee membership. This membership is intended to give official status in the Huntsman Cancer Institute community and includes funding and leadership opportunities.

Cancer Health Awareness through screening and Education (CHANGE) Initiative

The Cancer Health Awareness through screening and Education (CHANGE) initiative was designed to improve cancer care and reduce racial disparities and inequities in a sustainable and collaborative community‐based manner by: (1) increasing evidence‐based cancer awareness though health literacy and education, with an emphasis on prevention of modifiable risk factors, screening, and early detection; and (2) providing access and navigation to high‐quality cancer screening and early detection services.

Program Structure

Residents of five communities participated. At each site, four education sessions were provided by trained facilitators on cancer risk factors and etiology, racial disparities, eligibility for cancer screening, and participation in clinical trials. Participants were eligible for breast (n = 12), prostate (n = 15), and colorectal screening (n = 25) based on American Cancer Society guidelines, and 22 for tobacco cessation; 21 participants accepted navigation assistance for these services.

Key Findings

CHANGE participants demonstrated improved health knowledge and intentions to improve their modifiable health behaviors. Participants reported being motivated and confident in seeking preventive care and satisfaction with community engagement efforts. Replication of this project in similar communities may improve knowledge and health equity among underserved populations.

Intervention Components

The CHANGE intervention was composed of four education sessions completed in a group setting and facilitated by trained research staff. One session was presented weekly for four weeks. Each session lasted approximately 90 minutes. Facilitator and participant manuals were reviewed by the CAB and content experts; and were written at an 8th grade literacy level.

Session Topics

Session 1: Fight for Your Life, What is Cancer? The CHANGE program was introduced, and information shared about what cancer is, common causes, incidence and prevalence was defined, and relevant local and state numbers were presented, risk factors for cancer, and their individual cancer risk were also presented and discussed. The American Cancer Society screening recommendations for various cancers, including the benefits of genetic testing was also presented. Tobacco cessation resources were shared, and current smokers were also navigated to Georgia Cancer Center's evidence‐based cessation services.
Session 2: Prostate Cancer, Breast Cancer, and Colorectal Cancer. Participants learned about prostate, breast, and colorectal cancer, the benefits of early detection, signs and symptoms, and treatment options. Participants also learned about specific cancer incidence, prevalence, and disparities.
Session 3: Obesity and Overweight as Risk Factors for Cancer. Obesity and overweight as risk factors for cancers and risk reducing behaviors for participants and their families were also discussed.
Session 4: Cancer Myths & Cancer Care Connections. Participants learned common myths about cancer. Supportive community resources for cancer patients and their families were presented. All participants received a printed copy of the CHANGE resource guide for this module. The concept of navigation was introduced. Progress in cancer treatment with an emphasis on minority participation in clinical trials was also highlighted. This session ended with an interactive game that summarized key points of all sessions. Participants developed a personal action plan related to risk reduction and screening.

Screening and Referral

As part of the first session, participants completed a guided family health history to assess familial risk of cancer and completed simple screening questions to evaluate eligibility for prostate, breast, and CRC screenings. Eligible participants were offered referrals to screening by project staff. Family history indicative of other cancers resulted in personalized recommendations. High risk participants were contacted by study staff, and referral options discussed and offered.

Tobacco Cessation

Participants self‐identified current smoking and/or other tobacco use. Current tobacco users were encouraged to quit. Those who agreed were referred to the GCC tobacco cessation services, a no cost evidenced‐based tobacco treatment program that includes four sessions (once a week) of counseling services and pharmacotherapy for 6 to 12 weeks depending on the level of nicotine addiction.

Follow-up

Three months after the intervention, individuals flagged for cancer screening were contacted to determine if they had either obtained appropriate screening or discussed the screening with their healthcare provider. If a participant indicated a desire for cancer screenings but lacked the resources to pay for it, additional contact was facilitated with the with the GCC patient navigators to identify local resources to assist them, including the GCC and the Georgia Department of Public Health.

Data Collection and Analysis

At baseline and post‐intervention, participant data was collected at each respective site. This included sociodemographic data and relevant health information such as cancer history and cancer risk factors including history of tobacco use, as well as information about cancer screening history. All participants had their height, weight, waist and hip circumference measured at baseline and post‐intervention by trained staff.

The statistical analysis focused on evaluating the pre and post‐intervention changes in participant knowledge and behaviors related to cancer prevention, risk factors, and screenings. Paired T‐tests, Chi‐Square, and ANOVA tests were used.

Participant Demographics

Ninety participants completed informed consent and baseline measures. A majority of the participants were African/Back American (88%). Almost 80% of participants were overweight or obese, and 24% reported tobacco use. At baseline, 58% of participants reported ever having a previous colon cancer screening, 77% of women had had at least one mammogram, and only 27% of males reported ever having a PSA screening.

Screening Uptake

After completing cancer screening eligibility questionnaires during the program sessions, 46 participants were identified as eligible for a breast, prostate, or colorectal cancer screening, genetic cancer risk due to family history, or for tobacco cessation. Of these, 21 participants chose to have a referral made on their behalf to their primary care physician or the Georgia Cancer Center.

Knowledge Improvement

One third of participants demonstrated improved knowledge of breast cancer risk and screening information, although this was not significant; men showed greater improvement in knowledge than women. Twenty‐two percent of female respondents felt that getting a mammogram would be easier for them after participation. Overall, knowledge about prostate cancer risk factors and screening types also improved, but not significantly; there was no difference between men and women.

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