The Changing Landscape of Cervical Cancer in Africa: Opportunities for Patient, Public, and Professional Education
Assessment of Dental Students' Knowledge and Attitudes About the Epidemiologic and Clinical Characteristics of Oral Cancer: Implications for Other Middle-income Countries
The stage of detection of head and neck cancer and the time between detection and treatment are critical to prognosis. The importance of the dentist in primary diagnosis and treatment planning has been emphasized. The purpose of this study was to evaluate the knowledge of dental students in the prevention and early diagnosis of oral cancer. A descriptive cross-sectional study was conducted on 199 students from different institutions. A self-administered questionnaire with 34 multiple-choice questions on clinical and epidemiologic knowledge and opinions about oral cancer was used. Descriptive analysis to show means and frequencies and the binomial logistic regression test were used to perform the statistical analysis. The confidence level used was 95%. The results showed that all students in the study had heard of the existence of oral cancer, but only 24.6% knew someone with the disease. The majority reported a lack of information in the population about prevention and self-examination, as well as a lack of information campaigns in institutions. Although the majority perform clinical examinations of the oral mucosa (73.4%) and refer patients with suspicious lesions to specialists, there is low confidence in performing biopsies (73.4%) and gaps in training during graduation (84.4%). The majority have never attended continuing education courses on oral cancer but show interest (97.5%). The study identifies deficiencies in the knowledge and practices of dental students and highlights the need for improved teaching and training to promote oral cancer prevention and early detection. Further research in this area and ongoing assessment of students' skills are suggested.
Preparing Medical Students for the Full Cancer Journey: Integrating Survivorship into Oncology Education
Perceived Factors That Enable Resident Entry to the Specialty of Radiation Oncology
The field of radiation oncology (RO) has experienced large fluctuations in the number of applicants to residency programs. It is essential to understand the modifiable factors which influence entry. The objective of this project is to identify factors (i.e., "enablers") that motivate prospective medical students to apply to RO. A survey was developed to characterize RO enablers and barriers as perceived by current RO residents. An existing conceptual framework of why medical students choose primary care was used as the foundation of the survey and was modified for relevance towards RO. The final mixed-methods survey was administered to Canadian RO residents (2015-2019 match years) via Program Directors and the Canadian Association of Radiation Oncologists resident member database. Medical students are most likely to select a career in RO during or after a clerkship experience. Extrinsic factors strongly motivating interest in RO were (% rating as very important or extremely important on a 5-point scale) as follows: positive feedback from radiation oncologists (86%) and RO residents (66%), clinical rotations in RO (84%) and mentorship (77%). Intrinsic factors include perceived fulfillment (95.2%), commitment to patient care (85.3%), and intellectual challenge (67.7%). Qualitative data highlighted the importance of mentorship, the "hand-heart" connection, career variability/flexibility, career satisfaction/lifestyle, and personal connections with cancer/cancer care in motivating students to pursue RO. Increased preclinical exposure such as mentorship may encourage students to seek clerkship opportunities in RO. These findings inform strategies to recruit medical students to a career in RO.
Disparities in Cervical Cancer Knowledge and Trust in Information Sources Among Diverse American Women
Cervical cancer rates have declined due to prevention and screening, but disparities remain. This study examines how trust and preference in information sources affect knowledge and behaviors, alongside demographic differences to identify health disparities. This study used Health Information National Trends Survey data and employed weighted chi-square tests and multivariate logistic regression to analyze associations between knowledge, behaviors, and demographic differences. The results revealed significant disparities in HPV awareness, with lower awareness among Black (OR, 0.521), Hispanic (OR, 0.398), and Asian (OR, 0.138) women compared to Whites. Age and education also played roles, as older and less-educated women were less informed. Trust in doctors was crucial; women with low trust in doctors (aOR, 0.499; 95% CI, 0.252-0.989) had lower odds of having heard of HPV. Preference for written materials as a primary information source (aOR, 0.312; 95% CI, 0.122-0.793) also correlated with lower HPV awareness compared to preferring information from doctors. Furthermore, women with low trust in charity organizations (aOR, 0.647; 95% CI, 0.461-0.909) were less likely to believe HPV causes cervical cancer, while those who preferred the internet as an information source (aOR, 1.544; 95% CI, 1.026-2.324) had higher odds of having heard of HPV compared to those preferring doctors. Minority populations, older women, and those with lower education levels had significantly lower HPV knowledge. These findings highlight the need for tailored communication, community outreach, policy initiatives, culturally sensitive approaches, digital health interventions, and strategies promoting patient-provider trust to address these disparities.
Letter to Editor-"Exploring the Correlation Between Health Literacy and Knowledge of Cervical Cancer and Radiotherapy Among Japanese Women: A Web-Based Survey"
Cancer Care Pre-registration Interprofessional Education with Expert Patients: A Qualitative Study
In interprofessional education (IPE) patients with cancer are sometimes recruited to support passive forms of learning but do not seem to have been recruited as expert patients (EPs). The aim of the study was to explore the experiences of patients who acted as EPs in an IPE learning activity in Aotearoa New Zealand. These EPs were completing or had completed receiving radiation therapy as outpatients. Ten EPs were interviewed about their experiences of being interviewed by small interprofessional groups of senior pre-registration students. Four themes were identified: (1) Why EPs decided to take part; (2) EPs' perceptions of the primary purpose of the IPE; (3) EPs' experiences of the interview, and (4) What EPs felt they contributed to student learning or learned about themselves or from students. EPs also made suggestions about how the learning activity could be improved. The study showed EPs felt they had something important to contribute to student learning. They thought the interprofessional nature of the learning activity was uncontentious and took part because they wanted students of all disciplines to learn about what it is like to have cancer and having treatment. The EPs felt the students were well-prepared and professional in their approach. They pointed out the importance of students introducing themselves proficiently and in culturally appropriate ways as this made them relax, open up, and share their experiences and in some cases learn from the students and from themselves. Patients are willing to act as EPs, but selection and approach need careful consideration.
Reducing UVR Exposure in Pregnant Women and Infants: A Pilot Study
Sun protection during pregnancy is critical for both maternal and infant skin cancer prevention, yet gaps remain in addressing this behavior in pre and postnatal settings. This pilot study aimed to evaluate the feasibility and acceptability of a peer-led intervention for expectant mothers' sun protection behaviors for themselves and their newborns and examine the preliminary effects on mothers' skin cancer knowledge, attitudes, and sun protection behaviors for themselves and their infants. Expectant mothers were recruited from medical clinics and community settings and were asked to complete surveys and interviews. The intervention, informed by the Cognitive-Social Health Information Processing model, consisted of two peer coach-led remote sessions. The majority of mothers (81%) attended both intervention sessions and reported increased understanding of (88%) and improved sun protection practices for themselves (79%; such as wearing sunscreen and reapplying sunscreen while outside). Additionally, 89% agreed that SUNRISE content is beneficial for new mothers. Moreover, maternal self-efficacy for implementing sun protection, intention to implement sun-safe behaviors for their infants, and knowledge of infant skin cancer prevention also increased with large effect sizes (d = 0.8-1.3). Mothers reported significantly decreased barriers to sun safety pre- to post-intervention. Feasibility of recruitment and delivery of a peer-led intervention focused on sun safety in women and their infants was high, and the intervention was acceptable to participating women. Mothers improved their sun protection behaviors over time, and implementation of sun protection behaviors for their infants was high. Intervention efficacy with a larger and more diverse sample is warranted, with longer follow-up.
Correction: Evaluation of a pilot cancer patient navigation program in the limited-resource setting of Trinidad and Tobago
Gender Differences in Self-Advocacy Among Cancer Survivors: How Women and Men Vary in How They Learn to Engage in Decision-Making and Social Support
Understanding gender variations in self-advocacy can help oncology clinicians support the educational needs of cancer survivors. This study aims to examine the role of gender along with additional other sociodemographic variables in how cancer survivors self-advocate including their engagement in decision-making, communication with healthcare providers, and use of social support. Data from two cross-sectional descriptive studies were combined for analyses. Each study used convenience sampling methods to recruit adults (≥ 18 years old) with a history of invasive cancer who had English literacy from cancer clinics and community advocacy groups. The first study recruited women (n = 317), and the second study recruited men (n = 179). In both studies, participants completed two assessments of self-advocacy: Self-Advocacy in Cancer Survivorship (SACS) Scale and the Patient Self-Advocacy Scale. We built a linear regression model to test the association between gender and self-advocacy total and subscale scores controlling for covariates. N = 496 participants completed study procedures between 2014 and 2022. On both self-advocacy scales, women reported higher self-advocacy scores compared to men, with women's higher scores on the SACS subscales of connected strength and informed decision-making driving the gender difference in cancer-specific self-advocacy. Self-advocacy behaviors are associated with gender, most notably by way of individuals' ability to derive strength through social connection. Women tend to have greater engagement in care with larger and more meaningful social networks, while men report less engagement. Educational materials for cancer survivors should leverage gender-associated self-advocacy skills and bolster skills that require support.
Self-Assessment of Psychosocial Care Proficiency among Nurses and Oncologists at the Mohammed VI University Hospital Center (Morocco)
In Morocco, cancer is a disease with a concerning incidence to the point that patients are diagnosed at advanced stages. As a result, patient care requires a holistic approach, integrating medical treatment and appropriate psychosocial support to improve their well-being. This study aimed to evaluate the psychosocial care competencies of oncology healthcare professionals at the Mohammed VI University Hospital Center (CHU) in Marrakech. This was a cross-sectional descriptive study of doctors and nurses in the oncology department of the Mohammed VI University Hospital Center, Marrakech. A questionnaire containing sociodemographic variables was drawn up, together with the Psychosocial Care Competency Self-Assessment Scale (PCCSAS), which measures psychosocial care competencies. A descriptive and analytical analysis was performed via SPSS software (V.26). The overall PCCSAS score was moderate (54.99 ± 13.96), with similar scores for the subscales of symptom diagnosis, intervention, information use and psychosocial care assessment. Professionals working in day hospitals scored significantly higher than those in inpatient settings did (p < 0.05), although the differences between nurses and oncologists were not statistically significant. Seniority showed no significant association with the PCCSAS score, although professionals with 15 or more years of experience obtained the highest scores (61.71 ± 11.22). A significant correlation was observed between the PCCSAS scale and its subscales (p < 0.005). This study revealed a moderate level of psychosocial care skills among healthcare professionals in oncology, compounded by a lack of specialized training. In the Moroccan context, developing a profile of nurses specializing in psychosocial care, introducing continuing education programs adapted to the specific needs of different departments, and promoting experience sharing between professionals to strengthen practical skills and improve the quality of patient care are recommended.
A Survey on Knowledge and Attitudes Towards Vaccination Against Herpes Zoster Virus Among Medical Oncologists for Patients with Solid Tumors
Herpes zoster (HZ) virus reactivation is a significant medical problem among immunocompromised patients, especially considering its potential complications. Although the recombinant HZ vaccine has demonstrated > 90% efficacy against HZ in adults, its use is not as frequent as needed in daily oncology practice due to several barriers, including oncologists' knowledge, patients' willingness, and organizational issues. A web-based survey was sent to 139 oncologists treating solid tumors concerning their knowledge and attitudes toward the adjuvanted gE-based recombinant HZ vaccination. The survey included questions regarding the characteristics of medical oncologists participating, such as the type of hospital, main field of expertise, percent of work with patients, awareness of the HZ risk in cancer patients, knowledge of scientific data and scientific societies guidelines on HZ vaccination, familiarity with vaccinations, frequency of HZ detection in clinical practice, barriers, and challenges toward vaccine administration. Fifty-four physicians (46%; 95% CI 0.2918 to 0.5069) responded to all the questions. The main reason for non-response was the lack of time due to the overwhelming burden of assistance. When the survey was launched, 31 participants reported good knowledge of scientific and clinical data of HZ vaccines, 10% none, and 36 were aware of guidelines. Reported barriers included knowledge of the problem, patients' willingness, and organizational issues. Surveying medical oncologists on the adjuvanted gE-based recombinant HZ vaccination provides essential insights into their knowledge, attitudes, and practices regarding vaccination for cancer patients. These data suggest that continuing medical education is necessary to implement HZ vaccination prescription among oncologists.
Improving Patient Understanding and Outcomes in Lung Cancer Using an Animated Patient's Guide with Visual Formats of Learning
Lung cancer patient education resources that address barriers to health literacy, improve understanding, and demonstrate improved patient outcomes are limited. Our study aim was to evaluate and report on learner knowledge improvement and intent to implement behavior change, and validate the benefits of the You and Lung Cancer website and YouTube resources. Our study occurred from November 2017 to December 2023. We evaluated audience reach (visit sessions, unique visitors, country origins, page views) and calculated top views by media type (animations, expert videos, patient videos). We assessed the impact and commitment to change through learner surveys (areas of interest, intention to modify behaviors, and intention to discuss disease management with providers) and tested the knowledge of learners pre- and post-reviewing of website content. Our program reached 794,203 views globally; 467,546 were unique visitors; and 243,124 (51%) were unique visitors from the USA. Of US visitors, 46% identified as lung cancer patients. These were patients in treatment (38%), survivors (8%), family members or caregivers (21%), and healthcare providers (14%) with other audiences unspecified (19%). Three areas of highest learner importance were the animations "Understanding Non-Small Cell Lung Cancer" (180,591), "Staging of Lung Cancer" (144,238), and "Treatment and Management of Small Cell Lung Cancer" (49,244). Our study confirmed areas of importance to lung cancer patients and suggests that visual formats of learning, such as animations, can mitigate health literacy barriers and help improve patient understanding and outcomes. Exporting this format of learning to other cancers has the potential to benefit patients and improve health outcomes.
Manual Hair Removal for Intraoral Flaps: a Simple Practice for Professional Education and Patient Cancer Care
After resection of malignant tumors of the head and neck, reconstructions are commonly performed using surgical free flaps. In non-irradiated patients, hair may continue to grow at the reconstruction site after surgery, causing undesirable effects such as difficult to maintain oral hygiene, food and saliva accumulation, halitosis, dysphagia, moral distress, and impact on intimacy and sexuality. Until a standardized laser therapy protocol is available, manual depilation is an option that should not be underestimated to improve the patient's quality of life and available to every oral healthcare team. This case illustrates a simple practice that contributes to improving patients' quality of life and oral health in an interprofessional way.
Competency of Family Medicine Residents in Performing Skin Cancer Examination
Early recognition of skin cancer reduces associated morbidity and improves survival. Most patients with suspicious skin lesions present to family medicine physicians. We aimed to evaluate the self-reported competency of family medicine residents in performing skin cancer examination (SCE) and assess the impact of different factors on their competency. All family medicine residents completed a previously validated questionnaire aimed at evaluating their skin cancer examination competency in this cross-sectional study. In total, 250 residents participated in this study. More than half of the residents never had a rotation in dermatology or received training under the supervision of a dermatologist. Approximately 70%, 72%, and 77% of residents had not observed SCE, received SCE training, and performed SCE, respectively. Although most residents were aware of the risk factors for skin cancer and the ABCD acronym for melanoma, only one out of ten residents screened their patients for these factors, enquired about changes in skin lesions, and personally practiced SCE. Only 16% of family medicine residents consider themselves competent in performing SCE. Training under the guidance of a dermatologist, SCE training, evaluating patients for cancer risk factors and any changes in moles, and SCE practice on personal level were associated with SCE competency. Multivariate analysis showed a significant association between the frequency of observing SCE and competency in performing SCE. Only 16% of family medicine residents considered themselves competent in performing SCE. The frequency of observation of SCE during residency was a significant predictor of self-reported competency in performing SCE.
Assessment of YouTube Videos Related to Radioactive Iodine Therapy for Thyroid Cancer for Patient Education
Thyroid cancer is the most common cancer diagnosis among those aged 15-29, with a noticeable increase in cases over the last decade. YouTube, one of the most frequented websites on the internet, serves as a common platform to obtain health information. This study uses a systematic approach to characterize YouTube videos related to radioactive iodine (RAI) therapy for thyroid cancer. The first 50 videos across four distinct YouTube search terms related to RAI therapy for thyroid cancer were identified after applying exclusion criteria. A previously validated video assessment tool was utilized to evaluate the videos. Two independent reviewers assessed a random sample of 10 videos, while the remaining 40 videos were evaluated by one reviewer as there were minimal discrepancies in coding. Among the identified videos, 26 videos were published within the past 3 years, with a median video length of 4 min and 53s. The three most common publishers' affiliations were non-profits (15 videos), personal accounts (12 videos), and health care facilities/organizations (11 videos). Most of the videos originated in the United States, used an interview format, featured physician presenters, and were directed towards patients. Highly covered topics included "side effects and risks" and "RAI therapy overview". The findings underscore the significant role YouTube plays in aiding patient comprehension of RAI therapy for thyroid cancer based on video parameters and content. These results can inform physicians' discussions with patients regarding YouTube and contribute to the development of new, high-quality YouTube videos to support thyroid cancer education.
An Opportunity for Developing Cancer Prevention Leadership in Mexico
Cancer in Mexico is a major public burden for which rates are expected to increase over time. In settings like Mexico, much potential for reduction through cancer prevention efforts remains unrealized, due in part, to a lack of formal cancer prevention and control training and career opportunities. We trained a cadre of instructors to deliver a pilot cancer prevention education program for oncology professionals and leaders. Instructors were oriented to the curriculum and its purpose, given instruction in interactive adult learning techniques using video conferencing tools, and supported by small-group and one-on-one meetings. Throughout this initiative, we learned the importance of mentoring of young professionals interested in cancer prevention and in having careers in the field. Instructors reported highly favorable ratings for participating in training and having high expectations of being recognized as instructors, highlighting the importance of this approach. Strengthening cancer prevention in Mexico rests on the sustainability of cancer prevention professional education programs and their disseminating impact through support of trained instructors to deliver cancer prevention curricula in the future.
Unveiling Cervical Cancer Inequities Among Georgia Immigrant Latinas: A Robust Qualitative Examination of the Facilitators and Barriers to Prevention, with Emphasis on the Impact of Community-Based Organizations
This qualitative study delves into the facilitators and barriers surrounding cervical cancer prevention among Latina women in Georgia, with a specific focus on the impact of community-based organizations (CBOs). Employing semi-structured interviews with healthcare providers and representatives from CBOs, faith-based organizations, and other key stakeholders, the study uncovers key themes and subthemes shaping cervical cancer disparities. Themes such as challenges in cross-cultural healthcare access, difficulties due to lack of US citizenship, and limited mobility emerge as significant barriers, while community and family support stand out as crucial facilitators to cancer prevention. Additionally, the study examines community intervention methods from CBOs to target cervical cancer disparity, highlighting the importance of public awareness campaigns, building trust within the Latina community, and providing medical support tailored to immigrant populations. Through this comprehensive examination, the study not only offers invaluable insights into the intricate web of issues surrounding cervical cancer prevention but also endeavors to serve as a catalyst for targeted interventions and evidence-based policies aimed at ameliorating cervical cancer disparities among immigrant Latinas in Georgia and beyond.
Impact of a National Virtual Oncology Course on Medical Student Competency and Interest in Oncology
Globally, surveys have identified that medical learners of all levels perceive their oncology instruction to be inadequate. To address these gaps, we systematically developed and implemented the Oncology National Course for Advocacy, Research, and Education (ONCARE), a novel, nationally organized virtual course available to all Canadian medical students and evaluated its impact on oncology competency and interest. ONCARE was designed utilizing Kern's Six-Step Model for Curriculum Development. Components of ONCARE included lectures, career panels, and a mentorship program. Pre-course and post-course survey responses were collected to determine course impact on oncology knowledge and interest. Between October 2023 and March 2024, ONCARE enrolled 235 students representing 14 Canadian medical schools. One hundred forty (60%) students enrolled reported having only 0 to 10 h of formal oncology instruction. Baseline interest in a career in oncology was high (mean Likert score 3.9/5) and remained unchanged following course completion. ONCARE increased both self-perceived knowledge in clinical oncology (mean Likert score 3.9/5 vs 2.9/5, p < 0.001) and confidence in oncology communication skills (mean Likert score 3.6/5 vs 3.1/5, p < 0.001). Ninety-seven percent of students were satisfied with the course (mean Likert score 4.6/5). The implementation of ONCARE as a proof-of-concept initiative builds upon previous educational interventions in oncology and highlights important principles for the development of related initiatives. Future work will target greater interdisciplinary and multinational collaboration as well as long-term follow-up of the ONCARE cohort.
The Impact of Standardized Training Resident on Pain Management in Patients with Advanced Lung Cancer
This study aimed to investigate the effects of Standardized Training Resident on pharmacological interventions for pain management in patients with advanced lung cancer. A total of 84 patients with advanced lung cancer and associated pain were enrolled in the study from December 2019 to August 2023 and were divided into two groups based on their attending physician: a group managed by physician-ST Training Physicians (joint group) (n = 42) and physician-only group (usual group) (n = 42). The Brief Pain Inventory (BPI), oral morphine equivalent, and length of hospital stay. Furthermore, the Pain Management Index (PMI) was calculated. Health-related quality of life (HRQoL) was assessed at the 4-week follow-up using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). At week 4, compared to the usual group, the four BPI pain intensity categories were significantly lower in the joint group [worst pain: 4 (3-5) vs 8 (7-9); least pain: 1 (0-2) vs 3 (1-4); average pain: 2 (1-2) vs 5 (4-6); pain right now: 1.2 (0.7-1.9) vs 4 (3-5)] (all P > 0.05). The hospital stay duration was significantly reduced; for the seven pain interference categories, there were no significant improvements in the joint group. Significantly more patients achieved adequate pain control in the joint group than the usual group (p = .002). A reduction in OMEDD scores was observed for both cohorts, and the joint group's reduction was statistically more significant (p = 0.016). There were no significant differences in HRQoL between the two groups. Standardized Training for Radiation Oncology Physicians may lead to improved pharmacological interventions and enhanced pain relief. Recognizing the importance of these trainees in the healthcare team is crucial for achieving optimal pain management outcomes.
Evaluation of Knowledge, Attitudes, and Practices towards Colorectal Cancer in a Community in Mexico City: A Cross-Sectional Study Based on Surveys
Colorectal cancer (CRC) is one of the most common and deadly neoplasms worldwide, with a growing burden in low- and middle-income countries, such as Mexico. This study seeks to evaluate the knowledge, attitudes, and practices related to CRC in a community in Mexico City. A cross-sectional survey was conducted between March and April 2023 among adults aged 45 to 74 residing in six neighborhoods of the Tlalpan borough in Mexico City. The questionnaire included sections on sociodemographic characteristics, medical family history, lifestyle habits, knowledge about CRC, attitudes towards prevention, and willingness to undergo screening. Data were analyzed using logistic regression models to identify factors associated with greater knowledge, attitudes, and practices. A total of 349 people were surveyed. A total of 35.2% reported knowing what CRC is, with greater knowledge of CRC being associated with higher education levels and having a family history of cancer. A total of 23.8% showed positive attitudes towards CRC screening, influenced by having a tertiary level of education. A total of 80.8% of participants expressed willingness to undergo CRC screening if offered, with lower intention observed among men. Levels of knowledge about CRC within the studied community are low, especially among those with lower education levels and without a family history of cancer. Intervention strategies should improve CRC education and foster positive attitudes towards early detection, particularly in high-risk groups.