Cancer Peak Study

In 2013, the Pan American Health Organization issued a call for improving primary cancer prevention among indigenous populations in the Caribbean. Cervical cancer disproportionately affects women in this region. 36,000 cervical cancer deaths in 2012. 3 times the cervical cancer rate in North America.

The Cancer PEAK Study: A needs assessment of cancer prevention educational needs in a remote Caribbean community Echo L. Warner MPH1,2,3, Zachary Warner MPH4,5, Brandon R. Reid MS4,5, Priscilla Auguste4,5, Danisette Torres4,5, Maria Fam4,5, Ann Gillett-Ellrington MD, PhD, MPH4,5, Matthew Kraybill PhD4,5, Deanna Kepka PhD, MPH1,3 1University of Utah College of Nursing 2Jonas Nurse Scholar Foundation 3Huntsman Cancer Institute 4Salybia Mission Project 5Ross University School of Medicine BACKGROUND RESULTS • In 2013, the Pan American Health Organization issued a call for improving primary cancer prevention among indigenous populations in the Caribbean. • Cervical cancer disproportionately affects women in this region • 36,000 cervical cancer deaths in 2012 • 3 times the cervical cancer rate in North America Table 1. Demographics (N=36) Age 18-39 40-49 ≥50 Gender Female Marital Status Married/Living with partner N(%) 12(33) 8(22) 16(44) 29(80) 20(55) Education* N(%) Primary school 24(67) High school 7(19) Some college /graduate 4(11) Annual Household Income* <$5,000 ECD** 16(44) $5,000-9,999 ECD** 7(19) ≥$10,000 ECD** 8(22) *Missing: Education N=1, Household income N=5 ** $2.67 Eastern Caribbean Dollar=$1.00 United States Dollars • • • • • • Trusted sources of health information Healthcare provider (e.g., nurse, physician) Family member Close friend Preferred format of health education Face to face instruction Radio Television Figure 1: Knowledge of Cervical cancer and Human Papillomavirus SPECIFIC AIMS Heard of cervical cancer Aim 1: Assess knowledge of cancer prevention and cancer screening tests. Aim 2: Identify community strengths, strategies for health education, and future research. Most people get HPV Heard of HPV vaccine HPV causes cervical cancer 0% METHODS Health Belief Model • Incorporates individual perceptions, modifying factors, and likelihood of action to explain barriers to preventive health behaviors. Recruitment & Eligibility • Recruited at the Salybia Mission Project Clinic from September to December 2016 (N=36) KEY FINDINGS Heard of HPV 20% Yes 40% 60% No/Don't Know 80% 100% NA/Missing Figure 2: Likelihood of engaging in cancer prevention behaviors and health education summary, Health Belief Model Community Healthcare System Interpersonal • Eligibility: Ages 18 and older Data Collection • 57-item survey about cancer prevention behaviors, attitudes, and cancer screening tests for cervical, breast, and colorectal cancer. • One-time focus group on: 1) Cancer prevention behaviors, attitudes, and screening 2) Strategies for health education and future research Data Analysis • Descriptive and inferential statistics on survey data • Inductive theme validation of focus group data through discussions among research staff Individual Perceptions High perceived likelihood of being diagnosed with 47.2% any cancer 36.1% colorectal 73.1% cervical* 69.2% breast* • 75% worrisome about getting cancer • 32.3% report fair/poor health status • 30.6% had no primary care provider • 66.7% had not looked for information about cancer *Only asked of women Modifying Factors Knowledge Know these behaviors increase cancer risk 100% smoking 69.4% alcohol 69.4% obesity 0% diet Had Cancer Screening 13.9% colorectal 70.4% breast, self-exam* 66.7% Pap smear* High Perceived threat of cancer Cues to action • Healthcare provider recommendation • Knowing someone who has/had cancer Likelihood of Action • • • • Knowledge Moderate knowledge of cancer prevention behaviors Accessibility No access HPV vaccine Low access and high cost for mammograms and colonoscopies. Very limited access to cancer treatment Likelihood of cancer prevention behaviors Prevention is the key! • While most participants had heard of cervical cancer before, the majority had never heard of HPV or the HPV vaccine. • Only 16.7% knew HPV can cause cervical cancer. • Strategies for future health education include: • Embracing strong community ties • Facilitating culturally tailored messages about cancer prevention and screening • Health education at routine healthcare visits • Targeted materials for low literacy rates • Access to HPV vaccination and fecal immunochemical tests are immediate, costeffective, cancer prevention priorities. Acknowledgements & Funding We are extremely grateful to the community leaders and clinicians who supported this research and the participants who gave their time, energy, and experiences related to cancer. This work was supported by the University of Utah College of Nursing, Huntsman Cancer Institute, the Jonas Nurse Foundation, and the Ross University School of Medicine Research Committee. Contact Information Echo L. Warner, MPH: [e-mail] Zachary Warner, MPH: [e-mail]