Fulfilling the Potential of Cancer Prevention and Early Detection (2003) / Chapter Skim
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10. Research Trends and Opportunities
10. Research Trends and Opportunities
Pages 365-399
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From page 365... ...
In this chapter the National Cancer Policy Board describes the range of research activities in the field of cancer prevention and early detection, with a focus on translational research the research needed to move the fruits of research into provider and community practice. The chapter also presents estimates of the level of cancer prevention and early detection research through an analysis of publication trends in cancer prevention and control and a description of the current research portfolios of selected federal and private research sponsors.
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From page 366... ...
. Both cancer control and health services research can be defined broadly to include behavioral and psychological research, evaluations of programs that may fall outside the purview of the traditional health care systems (e.g., school-based health programs)
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and the Advisory Committee on Cancer Control, National Cancer Institute of Canada (1994)
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Department of Veterans Affairs Privately Sponsored Research · American Cancer Society · Foundations (e.g., Robert Wood Johnson Foundation and the Legacy Foundation) Although these organizations are not the only sponsors of research on cancer prevention and early detection, they represent the major funding sources for such research.
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5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 4.4% 4.4% 3.9% 3.3% 2.4% 1 .9% 1985 1988 1991 1994 1997 2000 Year FIGURE 10.2 PubMed citations for cancer-related prevention and control research as a percentage of all cancer-related citations, 1985-2000. reflect changes in the ways in which MESH headings were applied to index the literature rather than real increases in cancer-related research.
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(Grantmakers in Health, 2000~; and · announcements of research support in prevention-related newsletters and listservs (e.g., Health Behavior Information Transfer and the Susan G Komen Breast Cancer Foundation's Newsletter)
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Behavioral research grants and contracts on obesity and physical activity totaled over $25 million and there were 37 grants totaling $15 million in the Behavioral Research Applied Cancer Screening grants portfolio. Listed below are selected NCIsupported grants that represent applied or translational research active in 1999 according to the RADIUS database.]
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S creeping women · Increasing use of mammography among older, minority, and rural Increasing use of screening mammography through urban churches Breast cancer screening in a biracial rural population Reducing barriers to the use of breast cancer screening Screening of older minority women
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. rings e-v~s~t cervical cancer prevention program Intergroup cancer prevention research units: screening of first-degree relatives for colorectal cancer · Informed decision making in prostate cancer screening (test methods of unbiased patient education)
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. · Reducing cancer risk in migrant Hispanic adolescents · Community-based randomized trial of cancer prevention in the Hispanlc pope .atlon · Community-based outreach for high-risk Mexican-American women (focus on cervical cancer screening, safe sex practices, and smoking)
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· Cervical cancer control in a Cambodian population (focus on cervical cancer screening) · Cancer control needs among Native American Samoans · Health promotion for women at risk for breast cancer.
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.2 In the area of control of tobacco use, a budget increase of $67 million was requested for 2003, with $24 million to be used to develop, test, and disseminate more effective interventions to prevent and treat tobacco use and tobacco-related cancers. Collaborative and interdisciplinary research in this area is being fostered by the Transdisciplinary Tobacco Use Research Centers, launched in 1999 under the joint sponsorship of NCI, the National Institute on Drug Abuse, and the Robert Wood Johnson Foundation (http://www.partnerstturc.com)
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, . information; · research projects to test strategies to increase access to and use of online and other interactive cancer communications by underserved populations; Basic biobehaviorai 5% Applied cancer screening 13% Health communication and informatics 16% Health promotion 19% Tobacco control 47% FIGURE 10.4 Distribution of research dollars (not the number of grants)
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Reducing Health Disparities. NCI established the Center to Reduce Cancer Health Disparities in December 2000 to direct the implementation of NCI's Strategic Plan to Reduce Health Disparities (Box 10.2)
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Projects under way include analyses of the effectiveness of systemwide smoking cessation policies and services, analyses of barriers to cancer screening, and studies of the efficacy of preventive strategies such as mammography and prophylactic mastectomy (http://healthservices.cancer.gov/ hmo.htmI)
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. National Institute of Nursing Research · Perceived risk of inherited susceptibility to cancer · Factors associated with colorectal cancer screening (examination of the relationship of selected predisposing, reinforcing, and enabling factors on stages of adoption of screening)
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Activities related to cancer (e.g., tobacco use, nutrition, physical activity and obesity, health promotion, youth media campaign, and prevention centers) made up a large share of the chronic disease prevention and health promotion budget (Table 10.3~.
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· Cancer screening. Approximately $2.9 million was made available in FY 2001 to support research on interventions to improve rates of screening for breast and cervical cancer, colorectal cancer, and prostate cancer.
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carriers, and with an equal number of preferred provider organizations. As part of the Partnering with Employers for Prevention initiative, health claims have been linked to personnel data to identify potential barriers to cancer screening tests.
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Support for intramural and extramural cancer-related health services research grants active since FY 1999 totals $5.2 million, roughly $1.7 million per year. An additional $650,000 was awarded to support the update of the smoking cessation guideline (FYs 1998 to 2001)
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. stats perceptions, organlzatlona support, coverage, and factors associated with success 84,526 Rural emergency department Randomized controlled trial of an 340,069 as access point for teen intervention to help a low-income teen smoking intervention population quit smoking Smoking control in maternal Randomized study to test effectiveness of a 637,805 and child health clinics: centralized counseling service and academic dissemination strategies detailing Practice profiling to increase Randomized controlled trial of effectiveness 351,932 rates of tobacco use cessation of personalized data feedback on physician performance A trial of two decision aids for colon cancer screening Randomized controlled trial pilot study to 52,409 compare decision-making aids on the process and outcome of decision making
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in a low-income population Cancer patients' attitudes Assessment of positive and negative 32,296 toward cancer trials attitudes toward cancer trials with a focus on prevention trials Health communication over Development of an electronic Web-based 100,858 the Internet intervention to improve informed decision making for colorectal cancer screening SOURCE: Wendy Perry, AHCPR, personal communication to Maria Hewitt, Institute of Medicine, August 3, 2001. issued a technical review of colorectal cancer screening in 1998 (www.
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. CONQUEST includes measures related to the management of several cancers (i.e., colorectal, lung, prostate, and breast cancer)
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The following are some active CMS-supported research and demonstration projects related to cancer prevention and early detection (Health Care Financing Administration, 2001~: · Study on expansion or modification of preventive benefits provided to Medicare beneficiaries (included skin cancer screening) ($1,333,656, September 1998-February 2000)
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· Cervical and breast cancer screening for post-reproductive-age Hispanic women residing near the U.S.-Mexico border ($263,281, September 2000-September 2001) · A systematic approach to improving Pap smear screening rates among Hispanic and Latino women in managed Medicaid systems ($124,450, September 2000-September 2001 ~ As part of CMS's Healthy Aging Initiative, a literature review has been completed of the evidence of the effectiveness of prevention services (e.g., screening and smoking cessation programs)
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In FYs 1999 and 2000, 5 of 584 research awards were for breast cancer-related health services research (http://cdmrp.army. mill: , ..
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pharmacists as health educators and risk communicators in the prevention of prostate cancer. Smoking cessation is 1 of 18 prioritized areas of the DoD Peer-Reviewed Medical Research Program, but only one award for smoking cessation research has been made since the program's inception in 1999.
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From page 392... ...
Houston Center for Quality of Care and Utilization Studies · Cost utility analysis of alternative strategies for screening for colorectal cancer · Identification of factors prognostic of late-stage disease, particularly those that are modifiable · Barriers and facilitators for colorectal cancer screening in VA and non-VA settings · Smoking cessation, prevention in the elderly, exercise · Barriers to colorectal screening · Hepatitis C screening and surveillance patterns recent CSP trial demonstrated that colonoscopy may be the best method of screening for colon cancer for asymptomatic individuals. Privately Sponsored Research American Cancer Society The American Cancer Society (ACS)
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RWTF makes available grants for studies that evaluate the effectiveness of replicable organizational strategies that lead health care providers, practices, and plans to adopt and adhere to the recommendations of the AHCPR Smoking Cessation Clinical Practice Guideline. Projects funded under this initiative examine the impacts of organizational strategies (including clinical, financial, and administrative practices)
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1 1 1 . · Smoke-Free Families: Innovations to Stop Smoking During and Beyond Pregnancy uses a multicomponent strategy to improve current clinical practice and advance the smoking and tobacco use cessation field into the next generation of smoking cessation techniques for childbearing women.
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Type of Support American Institute for Cancer Research Federated Department Stores Foundation 11,513,341 General Mills 15,009,937 Foundation Susan G Komen Breast 23,497,426 Cancer Foundation Metropolitan Life 13,186,931 Foundation Robertson Foundation 5,410,959 $4,924,212 Diet, nutrition, and cancer Breast cancer Health and .
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. Translational Research Models A hallmark of translational cancer prevention and control research is its interdisciplinary nature and potential for broad application to the practices of individuals, clinicians, educators, social service providers, and community-based programs.
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RESEARCH TRENDS AND OPPORTUNITIES 397 Other interesting models for the conduct of translational research can be found in the areas of diabetes and mental health. Translational research for the prevention and control of diabetes is being supported through a public-private collaboration of the National Institute of Diabetes and Digestive and Kidney Diseases, the National Eye Institute, the National Institute of Nursing Research, and the American Diabetes Association (http:// grants.nih.gov/grants/guide/pa-files/PA-01-069.htm)
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Private sponsors making significant contributions to research include the ACS and, for smoking-related research, the Robert Wood Johnson Foundation and the American Legacy Foundation. When it could be ascertained, the share of total research spending devoted to cancer prevention and early detection is relatively low: 12 percent at the National Cancer Institute (this estimate includes the entire spectrum of cancer prevention and control)
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Specific recommendations for research are outlined in Chapter 11. 4This estimate includes the following chronic disease prevention and health promotion areas cancer prevention and control; tobacco; nutrition, physical activity, and obesity; health promotion; and the youth media campaign (see Table 10.3)
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