Angela R. Moore

Health status of adolescent and young adult cancer survivors

Adolescents and young adults (AYA) ages 15 to 29 years who are diagnosed with cancer are at risk for long‐term morbidity and mortality associated with treatment of their cancer and the cancer itself. In this article, the authors describe the self‐reported health status of AYA cancer survivors.

Addressing Cancer Survivorship Through Public Health: An Update from the Centers for Disease Control and Prevention

Currently, there are nearly 12 million cancer survivors living in the United States. They face a myriad of personal and health issues related to their cancer treatment. Increased recognition of cancer survivorship as a distinct and important phase that follows the diagnosis and treatment of cancer has contributed to the development of public health-related strategies and plans to address those strategies. CDCs Division of Cancer Prevention and Control (DCPC) uses an interdisciplinary public health approach to address the needs of cancer survivors through applied research, public health surveillance and data collection, education, and health promotion, especially among underserved populations that may be at risk for health disparities. Our surveillance activities contribute to population-based descriptions of the health and treatment experiences of cancer survivors in the United States. These data inform applied research activities as well as provide baseline data on cancer survivors for local comprehensive cancer control programs. The knowledge gained by our research efforts informs the development of interventions, awareness and education campaigns, and other outreach activities targeting cancer survivors and those who care for and support them. Our 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. This article provides an overview of the cancer survivorship activities currently being implemented by DCPC. We highlight several public health surveillance, research, and programmatic outreach and partnership activities currently underway.

Gynecologic Cancer Prevention and Control in the National Comprehensive Cancer Control Program: Progress, Current Activities, and Future Directions

Gynecologic cancer confers a large burden among women in the United States. Several evidence-based interventions are available to reduce the incidence, morbidity, and mortality from these cancers. The National Comprehensive Cancer Control Program (NCCCP) is uniquely positioned to implement these interventions in the US population. This review discusses progress and future directions for the NCCCP in preventing and controlling gynecologic cancer.

Evaluation of a Web-Based Program for African American Young Breast Cancer Survivors.

Introduction: Among women aged <45 years, African Americans have the highest breast cancer incidence rates of any ethnic/racial group and disproportionately higher rates of mortality. Young breast cancer survivors (YBCSs) may require psychosocial and reproductive health support when navigating diagnosis, treatment, and follow-up care. To address these needs, the Young Sisters Initiative: A Guide to a Better You! Program (YSI) was developed, implemented, and evaluated. The purpose of this study was to assess implementation and fidelity; identify barriers and facilitators to implementation; and explore audience access, use, and perceived value of the YSI. Methods: A mixed-method, process evaluation of the YSI using interviews, an online screener, and post-use survey was conducted with data collected and analyzed from February through August 2013. Thematic analysis of qualitative data was conducted without qualitative data analysis software. Survey data were analyzed using PASW Statistics, version 18. Results: YSI core elements were implemented as intended. A total of 1,442 people visited the YSI website; 93% of breast cancer survivors who visited the site (and consented to be in the study) were African American; 75% of post-use survey YBCS respondents were very or somewhat satisfied with the YSI; and 70% of YBCS respondents said the YSI content was somewhat or very useful. Conclusions: Findings suggest the value of using the Internet, including social media, to provide African-American YBCSs who are newly diagnosed, in treatment, and post-treatment with reproductive and psychosocial information and support. Further implementation and evaluation of programs addressing the needs of YBCSs are needed.

Public Health Action Model for Cancer Survivorship

Long-term objectives associated with cancer survivors have been suggested by Healthy People 2020, including increasing the proportion of survivors living beyond 5 years after diagnosis and improving survivors’ mental and physical health-related quality of life. Prior to reaching these objectives, several intermediate steps must be taken to improve the physical, social, emotional, and financial well-being of cancer survivors. Public health has a role in developing strategic, actionable, and measurable approaches to facilitate change at multiple levels to improve the lives of survivors and their families. The social ecological model has been used by the public health community as the foundation of multilevel intervention design and implementation, encouraging researchers and practitioners to explore methods that promote internal and external changes at the individual, interpersonal, organizational, community, and policy levels. The survivorship community, including public health professionals, providers, policymakers, survivors, advocates, and caregivers, must work collaboratively to identify, develop, and implement interventions that benefit cancer survivors. The National Action Plan for Cancer Survivorship highlights public health domains and associated strategies that can be the impetus for collaboration between and among the levels in the social ecological model and are integral to improving survivor outcomes. This paper describes the Public Health Action Model for Cancer Survivorship, an integrative framework that combines the National Action Plan for Cancer Survivorship with the social ecological model to demonstrate how interaction among the various levels may promote better outcomes for survivors.

An Update on Tobacco Control Initiatives in Comprehensive Cancer Control Plans

Introduction Comprehensive cancer control (CCC) coalitions address tobacco use, the leading cause of preventable death in the United States, through formal plans to guide tobacco control activities and other cancer prevention strategies. Best Practices for Comprehensive Tobacco Control Programs (Best Practices) and The Guide to Community Preventive Services (The Community Guide) are used to assist with this effort. We examined CCC plans to determine the extent to which they followed the Centers for Disease Control and Prevention’s (CDC’s) tobacco control and funding recommendations. Methods We obtained 69 CCC plans, current as of August 1, 2011, to determine which CDC recommendations from Best Practices and The Community Guide were incorporated. Data were abstracted through a content review and key word search and then summarized across the plans with dichotomous indicators. Additionally, we analyzed plans for inclusion of tobacco control funding goals and strategies. Results CCC plans incorporated a mean 4.5 (standard deviation [SD], 2.1) of 5 recommendations from Best Practices and 5.2 (SD, 0.9) of 10 recommendations from The Community Guide. Two-thirds of plans (66.7%) addressed funding for tobacco control as a strategy or action item; 47.8% of those plans (31.9% of total) defined a specific, measurable funding goal. Conclusion Although most CCC plans follow CDC-recommended tobacco control recommendations and funding levels, not all recommendations are addressed by every plan and certain recommendations are addressed in varying numbers of plans. Clearer prioritization of tobacco control recommendations by CDC may improve the extent to which they are followed and therefore maximize their public health benefit.

Capacity Building for and Implementation of Policy, Systems, and Environmental Change: Results from a Survey of the National Comprehensive Cancer Control Program

Policy, systems, and environmental (PSE) approaches are commonly used to improve population health. Cancer-related examples include providing data and education to stakeholders about policies that support healthy living, or health systems changes such as universal reminders about recommended cancer screening. The National Comprehensive Cancer Control Program (NCCCP) funds health departments to form cancer coalitions that develop and implement cancer plans. NCCCP initiated a demonstration program in 13 of 65 funded grantees to determine whether skilled, dedicated staffing and using a strategic process to examine data, form a workgroup, and develop an agenda would enhance their capacity to implement PSE approaches, recruit new partners, and provide data and education to stakeholders. The objective of this study was to compare demonstration program grantees to other NCCCP grantees on their ability to develop and implement PSE strategies, and the short-term results that were achieved. Program directors (PDs) from each NCCCP-funded jurisdiction completed web surveys at 2 time points during implementation to assess changes in their capacity for PSE approaches, identify implementation activities, and document short-term outcomes. Responses from demonstration program PDs and other PDs at both time points were compared in a descriptive analysis. Demonstration program grantees experienced greater increases in skills and capacity to address PSE approaches, engaged in necessary implementation activities more often, and achieved greater improvements in stakeholder and decision maker awareness and support for PSE strategies, compared to nonparticipating NCCCP grantees. These findings support continued implementation of PSE approaches for sustainable cancer prevention and control.

Abstract PR10: Factors associated with decreased survival in epithelial ovarian cancer patients from the southern United States

Background: Ovarian cancer is the fifth leading cause of cancer death among women. While there are no effective prevention methods available for ovarian cancer, adherence to standard treatment guidelines, which have been in place for almost two decades, has been shown to increase survival. However, 5-year ovarian cancer survival remains lower than for many other cancers including breast, uterine, cervical, colorectal, and prostate cancers. The objective of this study was to determine factors associated with lower survival in patients with epithelial ovarian cancer. Methods: Medical records from ovarian cancer patients in Georgia (GA) and South Carolina (SC) were examined and demographic, tumor, treatment, and vital status information was abstracted. These states were chosen in part for their racially diverse ovarian cancer patient population. The study sample was limited to malignant epithelial ovarian cancer cases. The vast majority of women in the sample were diagnosed between 2009 and 2012, to allow for the availability of more complete and accurate treatment and vital status information at the time of analysis. A Cox proportional hazards model was used to determine factors significantly associated with epithelial ovarian cancer survival at 3 years in this patient sample. Results are presented as hazard ratios (HR) and 95% confidence intervals (CI). Results: A total of 1,457 women were included in the analysis; 48% were from GA and 52% were from SC. A total of 68% of women in our sample had Type II epithelial ovarian cancer (high-grade serous adenocarcinoma [aca]), and 32% had Type I epithelial ovarian cancer (low-grade serous aca, endometrioid aca, clear cell aca, mucinous aca, or low-grade aca, not otherwise specified [nos]). After adjusting for demographic, tumor, and treatment factors, we found a significant association with race in that black women were more likely to die from epithelial ovarian cancer than white women (HR=1.25, 95% CI 1.04-1.51). The presence of comorbidities was also associated with decreased survival (HR=1.28, 95% CI 1.03-1.60 for 1 condition and HR=1.86, 95% CI 1.50-2.31 for 2+ conditions compared to no comorbidity). Additionally, women diagnosed with advanced-stage disease (FIGO stages II,III or IV) had worse survival. Tumor histology also had an effect on survival, but the effect differed within the standard Type I and Type II epithelial groups. Some Type I tumors, specifically clear cell aca, mucinous aca, and low-grade aca, nos were significantly associated with decreased survival compared to Type II tumors (HR=1.93, 95% CI, 1.38-2.71); however, low-grade serous aca and endometrioid aca Type I tumors had better survival than type II tumors (HR=0.68, 95% CI 0.48-0. 96). Other factors associated with increased survival included being treated at an NCI-designated cancer center (HR=0.63, 95% CI 0.50-0.80), receiving ovarian cancer-specific cytoreductive/debulking surgery (HR=0.53, 95% CI 0.43-0.66), and chemotherapy (HR=0.55, 95% CI 0.44-0.70). Discussion: Our data show that the standard epithelial Type I and Type II histologic characterization masks key differences in survival within these categories. Our findings suggest it may be more appropriate to further divide the Type I category in studies related to epithelial ovarian cancer survival, and that using a Type I subcategorization may result in improved study design and more accurate survival estimates. Our findings also reveal a significant racial disparity in epithelial ovarian cancer survival. The increased mortality among black women with ovarian cancer may be related to lack of access to quality care or other socioeconomic factors. Future studies exploring these factors would help determine the underlying reasons for lower survival. Programmatic efforts that ensure receipt of standard treatment may help increase survival among black women. Citation Format: Sherri L. Stewart, Trevor D. Thompson, Angela R. Moore, Sun Hee Rim, Jennifer M. Wike. Factors associated with decreased survival in epithelial ovarian cancer patients from the southern United States [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr PR10.

Adult leukemia survival trends in the United States by subtype: A population-based registry study of 370,994 patients diagnosed during 1995-2009.

The lifetime risk of developing leukemia in the United States is 1.5%. There are challenges in the estimation of population‐based survival using registry data because treatments and prognosis vary greatly by subtype. The objective of the current study was to determine leukemia survival estimates in the United States from 1995 to 2009 according to subtype, sex, geographical area, and race.

Abstract C32: Developing culturally appropriate interventions providing psychosocial and reproductive health support to young breast cancer survivors: Evaluation findings

Introduction/Objectives: Research demonstrates that after a breast cancer diagnosis, young women, especially those of racial and ethnic groups, may experience a more negative impact on their quality of life, emotional functioning, and reproductive health than older women. For women under the age of 45, African American women have the highest breast cancer incidence of any racial/ethnic group, and there is an increased risk of hereditary breast cancer among Jews who carry BRCA mutations. In conjunction with Sisters Network Inc. and Sharsheret, The Centers for Disease Control and Prevention launched a formative evaluation to understand African American and Jewish young breast cancer survivors9 (YBCS) psychosocial and reproductive health needs and preferred communication channels to obtain needed health information. Methods: Sisters Network Inc. conducted four focus groups with African American YBCS. Sharsheret conducted four groups with Jewish YBCS. Thematic analysis identified major themes/patterns within and across the focus groups. Results: Fertility and sexual health were major YBCS concerns. Participants reported barriers to obtaining psychosocial and reproductive health information, including sexual taboos and lack of provider sensitivity to address these needs. Participants said that breast cancer resources are not tailored to YBCS. Participants preferred to receive breast cancer information via multiple channels, including written materials, the Internet, telephone and smartphone applications. Discussion/Implications: African American and Jewish women encounter similar barriers to obtaining psychosocial and reproductive health information. Both groups report difficulty in obtaining relevant health information and advice from their medical providers. Study findings may be used for developing of culturally-appropriate communication and interventions for YBCS that would help eliminate breast cancer health disparities in YBCS. Citation Format: Temeika L. Fairley, Natasha Buchanan, Ashani Johnson-Turbes, Leslie R. Schover, Angela R. Moore, Brandie Yancy, Dara Schleuter, Mary-Ann K. Hall, Kelly P. Hodges, Rochelle Shoretz. Developing culturally appropriate interventions providing psychosocial and reproductive health support to young breast cancer survivors: Evaluation findings. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C32. doi:10.1158/1538-7755.DISP13-C32