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Di Sebastiano KM, Murthy G, Campbell KL, Desroches S, Murphy RA. Nutrition and Cancer Prevention: Why is the Evidence Lost in Translation? Adv Nutr 2019; 10:410-418. [PMID: 30915435 PMCID: PMC6520044 DOI: 10.1093/advances/nmy089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/27/2018] [Accepted: 10/08/2018] [Indexed: 01/20/2023] Open
Abstract
With the high burden of cancer worldwide, primary prevention has been identified as a key cancer control strategy to reduce this burden. Diet and nutrition are important modifiable factors that may alter the risk of developing cancer, because several dietary components including alcohol consumption, fruit and vegetable intake, and dietary fiber have been shown to significantly impact cancer risk. Consequently, a number of organizations have developed cancer prevention guidelines that highlight the importance of nutrition (and related factors including body size and physical activity) to reduce the risk of cancer. However, there are barriers to the uptake of these guidelines, particularly with respect to diet and nutrition including awareness, communication, and other factors that influence eating behavior. Improved knowledge translation (KT) of recommendations may help facilitate uptake. The purposes of this narrative review are: 1) to examine issues and challenges related to KT of diet and nutrition evidence in the context of cancer prevention, including public awareness and attitudes towards cancer prevention, engagement in cancer prevention strategies, and effects of KT on diet-cancer preventive behaviors; 2) to discuss examples of effective and ineffective KT of diet and nutrition evidence; and 3) to provide recommendations for improving KT to help move the field of diet, nutrition, and cancer prevention forward. Evidence shows that adherence to nutrition recommendations for cancer prevention significantly reduces the risk of cancer; however, engagement in nutrition-based preventative behaviors is low. Skepticism and confusion around evidence linking diet and nutrition with cancer may arise, in part, through ineffective media KT; the primary source of health information for many people. Simple, tailored, targeted KT communication strategies aimed at increasing the general public's awareness, attitudes, and engagement in cancer preventive behavior should be emphasized to encourage cancer control.
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Affiliation(s)
| | | | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Lawrence LM, Bishop A, Curran J. Integrated Knowledge Translation with Public Health Policy Makers: A Scoping Review. Healthc Policy 2019; 14:55-77. [PMID: 31017866 PMCID: PMC7008688 DOI: 10.12927/hcpol.2019.25792] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Integrated knowledge translation (iKT) refers to the engagement of knowledge users (e.g., policy makers, clinicians, patients) as active participants in the research process. Theoretically, this involvement enhances research relevancy and usefulness, thereby supporting health system change. However, evidence to support best practices for iKT is lacking, particularly in a public health context and with non-clinical decision-makers. The objectives of this research were to report how decision-maker involvement in public health iKT research has been described and operationalized and whether the process was evaluated. We conducted a scoping review of published literature from January 2005 to December 2017 and extracted information related to iKT involvement, barriers and facilitators and outcomes. Studies typically did not distinguish between different kinds of knowledge users, making it impossible to comment specifically on decision-makers' involvement. Authors believed knowledge user involvement was beneficial to the quality and potential impact of research activities, although corroborating evaluation data were unavailable. Broad research-knowledge user partnerships spanning multiple projects, as well as flexible involvement of knowledge users, enhanced engagement and supported the iKT process.
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Affiliation(s)
| | | | - Janet Curran
- Associate Professor, Dalhousie University, Halifax, NS
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Solbak NM, Xu JY, Vena JE, Al Rajabi A, Vaseghi S, Whelan HK, McGregor SE. Patterns and predictors of adherence to colorectal cancer screening recommendations in Alberta's Tomorrow Project participants stratified by risk. BMC Public Health 2018; 18:177. [PMID: 29370789 PMCID: PMC5784699 DOI: 10.1186/s12889-018-5095-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/17/2018] [Indexed: 12/31/2022] Open
Abstract
Background Colorectal cancer (CRC) screening is an important modifiable behaviour for cancer control. Regular screening, following recommendations for the type, timing and frequency based on personal CRC risk, contributes to earlier detection and increases likelihood of successful treatment. Methods To determine adherence to screening recommendations in a large provincial cohort of adults, participants in Alberta’s Tomorrow Project (n = 9641) were stratified based on increasing level of CRC risk: age (Age-only), family history of CRC (FamilyHx), personal history of bowel conditions (PersonalHx), or both (Family/PersonalHx) using self-reported information from questionnaires. Provincial and national guidelines for timing and frequency of screening tests were used to determine if participants were up-to-date based on their CRC risk. Screening status was compared between enrollment (2000–2006) and follow-up (2008) to determine screening pattern over time. Results The majority of participants (77%) fell into the average risk Age-only strata. Only a third of this strata were up-to-date for screening at baseline, but the proportion increased across the higher risk strata, with > 90% of the highest risk Family/PersonalHx strata up-to-date at baseline. There was also a lower proportion (< 25%) of the Age-only group who were regular screeners over time compared to the higher risk strata, though age, higher income and uptake of other screening tests (e.g. mammography) were associated with a greater likelihood of regular screening in multinomial logistic regression. Conclusions The low (< 50%) adherence to regular CRC screening in average and moderate risk strata highlights the need to further explore barriers to uptake of screening across different risk profiles.
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Affiliation(s)
- Nathan M Solbak
- Cancer Measurement, Outcomes, Research and Evaluation, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada. .,Alberta's Tomorrow Project, CancerControl Alberta, Alberta Health Services, 1820 Richmond Road SW, Calgary, AB, T2T 5C7, Canada.
| | - Jian-Yi Xu
- Cancer Measurement, Outcomes, Research and Evaluation, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Jennifer E Vena
- Cancer Measurement, Outcomes, Research and Evaluation, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Ala Al Rajabi
- Cancer Measurement, Outcomes, Research and Evaluation, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Sanaz Vaseghi
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Heather K Whelan
- Department of Health and Physical Education, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada
| | - S Elizabeth McGregor
- Population, Public and Indigenous Health, Alberta Health Services, Calgary, AB, Canada
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Graham C, Orr C, Bricks CS, Hopman WM, Hammad N, Ramjeesingh R. A retrospective analysis of the role of proton pump inhibitors in colorectal cancer disease survival. ACTA ACUST UNITED AC 2016; 23:e583-e588. [PMID: 28050148 DOI: 10.3747/co.23.3204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Proton pump inhibitors (ppis) are a commonly used medication. A limited number of studies have identified a weak-to-moderate association between ppi use and colorectal cancer (crc) risk, but none to date have identified an effect of ppi use on crc survival. We therefore postulated that an association between ppi use and crc survival might potentially exist. METHODS We performed a retrospective chart review of 1304 crc patients diagnosed from January 2005 to December 2011 and treated at the Cancer Centre of Southeastern Ontario. Kaplan-Meier analysis and Cox proportional hazards regression models were used to evaluate overall survival (os). RESULTS We identified 117 patients (9.0%) who were taking ppis at the time of oncology consult. Those taking a ppi were also more often taking asa or statins (or both) and had a statistically significantly increased rate of cardiac disease. No identifiable difference in tumour characteristics was evident in the two groups, including tumour location, differentiation, lymph node status, and stage. Univariate analysis identified a statistically nonsignificant difference in survival, with those taking a ppi experiencing lesser 1-year (82.1% vs. 86.7%, p = 0.161), 2-year (70.1% vs. 76.8%, p = 0.111), and 5-year os (55.2% vs. 62.9%, p = 0.165). When controlling for patient demographics and tumour characteristics, multivariate Cox regression analysis identified a statistically significant effect of ppi in our patient population (hazard ratio: 1.343; 95% confidence interval: 1.011 to 1.785; p = 0.042). CONCLUSIONS Our results suggest a potential adverse effect of ppi use on os in crc patients. These results need further evaluation in prospective analyses.
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Affiliation(s)
- C Graham
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - C Orr
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - C S Bricks
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - W M Hopman
- Clinical Research Centre, Kingston General Hospital, and Department of Public Health Sciences, Queen's University, Kingston, ON
| | - N Hammad
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON
| | - R Ramjeesingh
- Department of Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS
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Campbell LA, Blake JT, Kephart G, Grunfeld E, MacIntosh D. Understanding the Effects of Competition for Constrained Colonoscopy Services with the Introduction of Population-level Colorectal Cancer Screening. Med Decis Making 2016; 37:253-263. [PMID: 27681989 DOI: 10.1177/0272989x16670638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Median wait times for gastroenterology services in Canada exceed consensus-recommended targets and have worsened substantially over the past decade. Meanwhile, efforts to control colorectal cancer have shifted their focus to screening asymptomatic, average-risk individuals. Along with increasing prevalence of colorectal cancer due to an aging population, screening programs are expected to add substantially to the existing burden on colonoscopy services, and create competition for limited services among individuals of varying risk. Failure to understand the effects of operational programmatic screening decisions may cause unintended harm to both screening participants and higher-risk patients, make inefficient use of limited health care resources, and ultimately hinder a program's success. METHODS We present a new simulation model (Simulation of Cancer Outcomes for Planning Exercises, or SCOPE) for colorectal cancer screening which, unlike many other colorectal cancer screening models, reflects the effects of competition for limited colonoscopy services between patient groups and can be used to guide planning to ensure adequate resource allocation. We include verification and validation results for the SCOPE model. RESULTS A discrete event simulation model was developed based on an epidemiological representation of colorectal cancer in a sample population. Colonoscopy service and screening modules were added to allow observation of screening scenarios and resource considerations. The model reproduces population-based data on prevalence of colorectal cancer by stage, and mortality by cause of death, age, and sex, and attendant demand and wait times for colonoscopy services. CONCLUSIONS The study model differs from existing screening models in that it explicitly considers the colonoscopy resource implications of screening activities and the impact of constrained resources on screening effectiveness.
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Affiliation(s)
- Leslie Anne Campbell
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS (LAC)
| | - John T Blake
- Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS (JTB)
| | - George Kephart
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS (GK)
| | - Eva Grunfeld
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON (EG)
| | - Donald MacIntosh
- Division of Digestive Care & Endoscopy, Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS (DM)
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