Erin Mobley, MPH, a doctoral student in the Department of Health Management and Policy in the UI College of Public Health, has been awarded $5,000 from the Iowa Cancer Consortium to identify and help address gaps in care experienced by adolescent and young adult (AYA) cancer patients in the AYA Program at the University of Iowa Stead Family Children’s Hospital and the Holden Comprehensive Cancer Center at the University of Iowa Hospitals and Clinics. Mobley serves as principal investigator on the project that will use mixed-methods research.
The Iowa Cancer Consortium is a partnership of more than 300 health care providers, public health professionals, caregivers, researchers, cancer survivors, volunteers and other Iowans who work together to reduce the burden of cancer in the state. Through collaboration, the Consortium enhances partners’ abilities to address cancer prevention, early detection, treatment and quality of life in Iowa.
In the AYA Program, patients are between the ages of 13 and 31 and experience unique needs and challenges during their cancer treatment as well as after treatment has been completed. The AYA Program, which was established about a year ago to address those needs, is in the process of gathering information from patients who have been treated at the Stead Family Children’s Hospital and the Holden Comprehensive Cancer Center.
This seven-month project will have the task of analyzing information collected directly from AYA patients to inform program leadership about gaps in current care and ways to help determine subsequent programming and interventions to improve care for AYA patients. The analyses include qualitative data from focus groups and quantitative data from surveys administered to patients. By using a mixed-methods approach to study the needs of this population, the project team hopes to provide significant insight toward understanding what can be done to enhance quality of life for this group of cancer patients locally, as well as AYA patients elsewhere in Iowa and nationally.
University of Iowa researchers have been awarded funding from the Centers for Disease Control and Prevention (CDC) for studies that address oral health and cancer. The first project, led by Susan McKernan, assistant professor of preventive and community dentistry, will explore the integration of oral health and primary care. The second project, led by Richard Hoffman, professor of internal medicine and epidemiology, will examine patients’ decision-making about prostate cancer treatment.
The grants, called Special Interests Projects (SIP), are awarded by the Prevention Research Centers program office at the CDC. The CDC provides SIP funding to its 26 Prevention Research Centers nationwide to design, test, and disseminate effective applied public health prevention research strategies that address major causes of disease and disability.
McKernan’s team will conduct a one-year project to identify best practices for integrating medical and dental care in public health activities and to identify opportunities to include oral health in the ongoing climate of health care reform.
“Oral health is recognized as a critical requirement for overall health, sharing common risk factors with other chronic diseases,” says McKernan. “Dental visits present a valuable opportunity for providing additional health screenings.”
Healthy People 2020, a national health promotion and disease prevention initiative, calls for increasing the proportion of adults who receive chronic disease preventive services in dental settings, including tobacco screenings and cessation counseling, testing and referrals for blood sugar management, screenings for mouth and throat cancer, and dental visits for persons with diabetes.
The researchers will gather information about programs, services, and policies that link oral health and primary care; analyze the collected data to identify programmatic gaps and opportunities; and develop recommendations of best practices to integrate oral health and primary systems of care.
The results will provide policy makers and public health officials with comprehensive information to effectively and efficiently coordinate activities with primary care providers.
Hoffman’s team will conduct a two-year project that examines how men diagnosed with low-risk prostate cancer make decisions about their course of treatment.
The widespread availability of prostate-specific antigen (PSA) testing has dramatically increased the diagnosis of prostate cancers in the United States. Many PSA-detected cancers are slow growing, but men with these low-risk cancers usually opt for active treatments even though evidence suggests that these treatments offer no survival benefit and often adversely affect quality of life. As a result, guidelines recommend offering these men active surveillance, a strategy of closely monitoring cancers with biopsies and PSA tests and offering active treatment only with clinical evidence of the cancer’s progression.
“Patients’ decisions about treating prostate cancer often are not well informed, made with undue haste, and can be inconsistent with personal values,” Hoffman says. “Men face particularly difficult decisions in selecting active surveillance because they must weigh the anxiety of living with an untreated cancer and the complication risks of repeat biopsies against avoiding harm from potentially unnecessary treatment.”
Many patients continue to have anxiety even after choosing active surveillance; about 20 percent of the men who switch to active treatment do so in the absence of any clinical trigger. Understanding the decision factors influencing adherence to active surveillance is crucial for developing interventions to reduce unnecessary treatments.
The researchers will conduct formative research to identify patient, provider, and decisional factors associated with adhering to active surveillance. They will then develop an instrument to predict adherence to active surveillance among men with low-risk prostate cancers in the absence of disease progression.
Findings from this research could be used to develop active surveillance decision-support tools and strategies that could ultimately lead to reducing the burden of prostate cancer treatment in men with low-risk prostate cancer.
In many ways, West Liberty is a typical small Iowa town. The main street of this east-central Iowa community boasts a movie theater, hair salons, several restaurants, and other small businesses. What sets the town of 3,700 residents apart are its demographics—West Liberty is the first Iowa town to have a majority Latino population.
West Liberty is just one reflection of Iowa’s increasing diversity. From 2000 to 2014, the state’s Latino population grew 110 percent and now makes up 5.6 percent of Iowa’s total population.
The town’s diversity often attracts groups wanting to offer health care or other social services. However, says Jason Daniel-Ulloa, clinical assistant professor with the Department of Community and Behavioral Health, successful programs depend on trust that’s built with the community over time.
“You have to be present,” says Daniel-Ulloa. “You can’t roll in from out oftown, put up a couple of fliers, and have people to show up to your meeting.”
Concern about Cancer
In 2012, a team of College of Public Health investigators, including Daniel-Ulloa, began studying cancer issues and priorities in the state’s Latino population with funding from the Iowa Cancer Consortium. Cancer is the leading cause of death among Latinos, according to the American Cancer Society.
The researchers narrowed their focus to West Liberty, where they partnered with residents on community-based participatory research in cancer prevention. St. Joseph’s church, the local Catholic parish, has been an important partner in facilitating the effort.
“The church is a gathering place for the Latino community,” says Rev. Greg Steckel, pastor at St. Joseph, who helped identify a group of six church members to take part in a Photovoice project.
The participants took photos of what they perceived to be barriers to cancer prevention, then held group discussions. To disseminate the results of the project back to the community, a bilingual forum was held in in 2014, drawing about 50 residents. The forum revealed a community concern about cervical cancer, which had caused several residents’ recent deaths.
“The Photovoice project demonstrated that people get enough information about cancer to be afraid of it, but don’t really know what to do about it,” says Daniel-Ulloa.
Based on that feedback, the team developed a human papillomavirus (HPV) education intervention. HPV is the most common sexually transmitted infection in the United States and can cause cervical and other cancers. The HPV vaccine, given in a series of three doses over six months, protects against HPV-related cancers. The CDC recommends vaccination for all boys and girls ages 11 or 12, as well as catch-up vaccines for males through age 21 and for females through age 26 if they didn’t get vaccinated as adolescents. (See a related story about an HPV vaccine study on page 21.)
The intervention included the video Tamale Lesson, which uses storytelling to educate viewers about cervical cancer prevention and screening. Group discussions helped define what people did and didn’t know about cancer, HPV, and the vaccine.
“What was a revelation to me is that there’s a stigma attached to cancer in the Latino community that is culturally sensitive,” notes Steckel. “Cancer has a sense of guilt attached to it—that you must have done something to get this. That gray area is true for everyone, but it’s accentuated in the Latino community.”
A Sustainable Solution
The research team is now working to provide free HPV vaccinations to West Liberty residents. The effort is part of a pilot study intervention funded by the Cancer Prevention and Control Research Network and administered through the UI Prevention Research Center.
Another partner in the effort is the University of Iowa Mobile Clinic, a student-run organization that provides free basic health services to underserved populations. The clinic visits West Liberty every month.
The goal is to make the intervention sustainable by training a community health worker within the church who can conduct information sessions about HPV vaccination and direct people to resources.
“We’re trying to get people to get the first shot in the Mobile Clinic, then refer them to a nearby pharmacy or someplace they can get in and out with little paperwork and wait time,” explains Daniel-Ulloa. “The biggest barrier for the community is time. When you’re working hourly and the clinic closes before you get off work, it costs you money [to take time off].”
The researchers will track how many people receive the vaccine as a result of the intervention.
Building Trust, Embracing Ambiguity
As Daniel-Ulloa noted earlier, gaining a community’s trust doesn’t happen overnight.
“You have to take the time to get to know people and build relationships,” says Steckel, who has lived in West Liberty for more than three years and has worked with Daniel-Ulloa for much of that time. “You can’t come in and say you have all the answers. If you try to dominate the situation, you’ll run into resistance.”
“We found people who the community trusts,” Daniel-Ulloa says of the process. “We sat down with them and asked, What do you want us to do? And then you do it. You make an impact by creating relationships, being present in the community, and caring.”
Once relationships are established, cultural differences can still present some unexpected challenges. Meetings, for instance, may veer wildly from an outside organizer’s agenda.
“Latin America is built on a communal experience,” explains Daniel-Ulloa. “That’s why you talk for 45 minutes before you get down to business.”
Steckel echoes that events flow at their own pace, which runs counter to the time-conscious Anglo culture. “Leadership is also very fluid,” adds Steckel, who is Anglo. “You can easily be offended and offensive. I’ve learned to be aware of my own prejudices. I have different expectations, but I have to embrace the ambiguity.”
“You can’t plan everything,” Daniel- Ulloa agrees. “You can try, but you have to understand that it will disintegrate. And that’s difficult for providers. We train providers to be very uncomfortable with ambiguity.
“And that is the opposite of what you need to work in the community,” Daniel-Ulloa continues. “It’s more than being okay with ambiguity, you have to like it. Because it’s exciting. You have to be ready to change the course of the program.
“Set your eyes on the big goal you’re trying to get to,” Daniel-Ulloa advises, “and be creative about how you know that you’re getting there.”
This story originally appeared in the Spring 2016 issue of InSight
The latest annual report on cancer in Iowa estimates 16,600 new cancers will be diagnosed among Iowa residents in 2016. In addition, an estimated 6,400 Iowans will die from cancer, according to the “Cancer in Iowa: 2016” report released March 30 by the State Health Registry of Iowa, based in the University of Iowa College of Public Health.
“Lung cancer continues to be the most common cause of cancer death for both males and females,” says Mary Charlton, Ph.D., assistant professor of epidemiology at the UI College of Public Health. “It will be responsible for one out of every four cancer deaths in Iowa.”
According to Charlton, breast cancer will remain the most common type of cancer diagnosed among females, while prostate cancer remains the most common type among males. However, prostate cancer rates have been declining, likely due to recommendations against prostate specific antigen (PSA) screening by the U.S. Preventive Services Task Force.
The report, based on data from the Iowa Cancer Registry and the Iowa Department of Public Health, is available online in the “publications” section on the registry’s website, or by calling the registry at 319-335-8609. The report includes county-by-county statistics, summaries of new research projects, and a section focused on cancer among adolescents and young adults.
Cancer is the leading cause of disease-related death in the adolescent and young adult (AYA) population in the U.S. (defined as people between ages 15 and 39). Only accidents, suicide, and homicide claim more lives than cancer in this age group. (Read the full Iowa Now story)
The College of Public Health will be participating in the American Cancer Society’s Relay for Life on Friday, April 1, from 6 p.m. to midnight. We would love to have representation from all of our departments on our team! All students, faculty, staff, friends, and family of the College of Public Health are welcome to join our team. Just visit our team page to sign up.
Relay for Life at the University of Iowa is held in the Field House, where we will walk around the track while fundraising and advocating for the American Cancer Society.
If you cannot attend, but would like to support our team, you are welcome to make a donation. There is no minimum fundraising requirement, however we have set a team goal of raising $500.
If you have any questions, please reach out to Erin Mobley in HMP.
A research study highlighting the powerful potential of human papillomavirus (HPV) vaccines drew upon the work of the Iowa Cancer Registry and is being celebrated as one of 2015’s major achievements in clinical cancer research by the American Society of Clinical Oncology.
The research study, co-authored by University of Iowa Professor of Epidemiology Charles Lynch and published in the Journal of the National Cancer Institute, found that widespread HPV vaccination with Gardasil or Cervarix could prevent as many as 25,000 HPV-related cancers per year in the United States alone. These include the majority of invasive cervical, anal, oropharyngeal, and vaginal cancers, as well as some other genital cancers. The Gardasil 9 vaccine could prevent an additional 4,000 cancer cases per year, according to the research.
The study, utilizing the Iowa Cancer Registry’s Residual Tissue Repository and other U.S. registries, was recently selected by the American Society of Clinical Oncology for inclusion in Clinical Cancer Advances 2016, the society’s annual review of progress against cancer and emerging trends in the field. The full report is available on the ASCO website and also is published online in the Journal of Clinical Oncology at http://www.jco.org.
The American Cancer Society Cancer Action Network (ACS CAN) invites everyone to take part in two upcoming advocacy events:
2016 Advocacy Webinar: Making YOUR Voice Heard in the Fight Against Cancer
Wednesday, January 13
Noon to 1:00 p.m.
ACS CAN is the nation’s leading voice advocating for public policies that are helping to defeat cancer. As the advocacy affiliate of the American Cancer Society, ACS CAN works to encourage elected officials to make cancer a top state and national priority. This webinar will:
Discuss what ACS CAN is and does
Walk you through how ACS CAN priorities are developed
Update you on ACS CAN legislative priorities
Give you ideas on how to get involved and make YOUR voice heard
Register at https://www.surveymonkey.com/r/IAAdvocacy
For more information contact Danielle Oswald-Thole, Iowa ACS CAN Grassroots Manager, at Danielle.email@example.com or 563-580-9340