A Comprehensive Approach to Cancer Prevention and Control:
A Vision for the Future

Infrastructure to Support Programs

• Program Management and Administration
  
  
• Comprehensive Cancer Control Plans
  
  
• Surveillance and Evaluation
  
  
• Partnerships
  
  
• Communications

Program Management and Administration
Building infrastructure is a critical activity in any comprehensive approach to cancer prevention and control. Such infrastructure, including staff, funding, and in-kind support from partners, must be adequate to support the implementation of program activities.

To build an effective infrastructure for a comprehensive cancer prevention and control program, the coordinating agency should provide at least a full-time coordinator and preferably several dedicated staff positions. Because of the importance of cancer data for identifying problems, evaluating programs, and making decisions, the core planning team for any comprehensive cancer control program should include cancer registry personnel as well as people with expertise in evaluation and epidemiology both from within and outside the health department.

Back to Top

Comprehensive Cancer Control Plans
Essential Elements for Developing/Expanding Comprehensive Cancer Control Programs (http://www.cdc.gov/cancer/ncccp/cccpdf/elements.pdf) uses case studies to illustrate barriers to fully implementing comprehensive approaches and provide examples of successful comprehensive programs. CDC’s Guidance for Cancer Control Planning (www.cdc.gov/cancer/ncccp/index.htm) also suggests specific activities (called building blocks for comprehensive cancer control planning) to help public health agencies and their partners develop a comprehensive cancer control plan and establish a comprehensive cancer control program. These building blocks are presented graphically in Figure 1. Estimates of the time needed to complete the activities suggested in the building block model range up to 2 years.

Figure 1. Building Block of Comprehensive Cancer Control Planning

View enlarged version View text version

A comprehensive cancer control plan that is thorough, integrated, and realistic will provide participating organizations with a detailed outline of what each is doing and allow for better coordination of activities. Comprehensive cancer control plans should

• Include a population-based assessment of the cancer burden in the jurisdiction.

• Include short-term and long-term goals, measurable objectives, proposed strategies for reducing the cancer burden, and a plan for evaluating the effectiveness of proposed interventions.

• Be created with diverse partners, inside and outside the health department, who are committed to achieving the goals and objectives of the plan.

• Address cancer-related issues across a continuum of care, including those associated with primary prevention, early detection, treatment, rehabilitation, pain relief, and survivorship.

Back to Top

Surveillance and Evaluation

Using Data and Research
The commitment of participants in comprehensive cancer control planning will be substantially influenced by the quality of the data on which the planning is based.

To evaluate their effectiveness, comprehensive cancer control programs need an established mechanism with which to identify and track cancer case data, including the extent of disease, the kinds of treatment patients receive, and patient outcomes (death or survival). Such mechanisms also allow them to monitor overall changes in disease and risk-factor rates as well as changes within specified geographic areas and populations.

Sources of data on cancer-related deaths, cancer incidence, and cancer screening include vital records; cancer registries; the Behavioral Risk Factor Surveillance System (BRFSS, www.cdc.gov/brfss); state cancer registries supported by CDC’s National Program of Cancer Registries (NPCR, http://www.cdc.gov/cancer/npcr); cancer registries participating in NCI’s Surveillance, Epidemiology, and End Results (SEER) program (www.seer.cancer.gov); and United States Cancer Statistics: 1999 Incidence (www.cdc.gov/cancer/npcr), a joint publication of CDC and NCI in collaboration with the North American Association of Central Cancer Registries, which contains the first set of official cancer incidence statistics from states that meet high-quality data standards, as well as statistics on more than 1 million invasive cancer cases diagnosed during 1999 in residents of 37 states, 6 metropolitan areas, and the District of Columbia—geographic areas in which approximately 78% of the U.S. population resides. Another data source is the National Breast and Cervical Cancer Early Detection Program (www.cdc.gov/cancer/nbccedp/index.htm), which maintains program records incorporating a set of standardized data elements, called minimum data elements; these records provide consistent and complete service and outcome information on women screened by the program. Cancer control programs should also incorporate data collection activities into their own plans.

Conducting Evaluations
Stakeholders should be involved in the entire evaluation process, including describing program processes and defining program activities and expected results. By collaborating to define specific activities and the results they should achieve, partners will have a common basis for understanding evaluation plans, activities, and results.

Evaluations should include both quantitative and qualitative measures and should address short-term, intermediate, and long-term outcomes. The planning group should build evaluation processes into the program itself rather than consider evaluation activities as separate from program activities and should identify resources necessary for evaluation early in the planning process. Some agencies have in-house evaluation staff, while others obtain help from partners or through contracts with local colleges or universities. The Community Toolbox (ctb.lsi.ukans.edu) is another resource that can help agencies monitor their comprehensive cancer prevention and control activities.

Comprehensive cancer control programs should monitor the cancer-related indicators defined in Indicators for Chronic Disease Surveillance: Consensus of CSTE, ASTCDPD, and CDC, which is available at www.cste.org. These indicators provide a common set of measures for chronic disease surveillance that program planners can use to establish priorities and implement surveillance activities consistent with those in other jurisdictions.

Contained in this consensus document are surveillance indicators specific to cancer. These indicators include the incidence and rate of death attributable to the following types of cancer: lung, colon/rectum, female breast, prostate, cervix, bladder (in situ included), melanoma, and oral cavity/pharynx, as well as overall rates for all types combined. The document also includes indicators related to screening for colorectal, cervical, and female breast cancers. These indicators closely mirror several of the Healthy People 2010 objectives.

Evaluation questions should be designed to identify those issues most pertinent to stakeholders. Care should be taken to select questions that can be readily answered with available evaluation resources. Examples of evaluation questions that can be asked at different stages in an evaluation process are shown in Table 2.

Back to Top

Partnerships
To create a fully comprehensive approach to cancer prevention and control, organizations must work synergistically with others involved with similar activities. Collaboration is key to a comprehensive effort.

In most of the examples presented in this section, health department staff serve as core members of comprehensive cancer control programs; however, the staffing pattern can vary, as can the “lead” responsibility for the program. Participating organizations can work semi-independently to implement plan activities as long as they keep the planning group (and thus other participating organizations) informed of what they are doing.

Table 2. Sample Evaluation Questions for Comprehensive Cancer Control

Early in the planning process, agencies should identify and solicit the help of partners able to support their efforts. Possible partners include

• Representatives of organizations likely to implement plan strategies.

• Legislators who can provide political and legislative support.

• Representatives of priority populations who can suggest health-promoting strategies and interventions appropriate for those populations.

• Representatives of organizations that may be able to fund activities or that will be doing similar activities under other sponsorship.
  

To reach specific priority populations, cancer control programs should also seek community partners who can help them create culturally sensitive messages and programs.

As comprehensive cancer control projects move from the planning stage to the implementation stage, what might have begun as a loose network of organizations and individuals should be forged into a fully functioning collaborative capable of significant advocacy, coordination, and action. To ensure the continued involvement of committed partners, project leaders should work to identify and recruit new partners, involve partners in decision-making processes and planning activities, and regularly assess the satisfaction and commitment of partners.

Samples of state-developed tools, including a planning meeting invitation letter and registration form, a partner interest survey and commitment form, a partner questionnaire, and a proposed process for creating a comprehensive cancer control plan can be found in Guidance for Comprehensive Cancer Control Planning (www.cdc.gov/cancer/ncccp/index.htm).

Back to Top

Communications
A solid health communications strategy is essential to successful interventions. For comprehensive cancer control, this strategy should entail an integrated and coordinated approach to educating the public, government leaders, health care providers, and others about cancer and its risk factors and how best to prevent, detect, and treat the disease. Health communications strategies should be coordinated as much as possible with other program initiatives such as improving health care service delivery and creating supportive public policies.

Because everyone is at risk for cancer, cancer messages are needed for all population groups. However, each message should be tailored for a specific, targeted audience (e.g., people with a certain form of cancer, members of a specific racial or ethnic group, members of professional and health organizations). Messages should be accurate, use consistent terminology, and describe what people can do to help reduce their risk for cancer, detect it in its early stages, and obtain appropriate treatment if cancer is diagnosed.

Health communications activities should be part of a larger plan to address factors affecting behavior (e.g., social norms, governmental policies). In developing their communication plan, states should

• Identify and define the health problem they want to address.

• Incorporate an evaluation component into the communications plan.

• Be culturally sensitive in developing strategies and messages, conducting research, and implementing and evaluating communications efforts.

• Ensure that the targeted audience receives a single, simple, specific, and consistent message.

• Conduct qualitative and quantitative audience research to help understand how the audience perceives concepts and to determine their willingness and ability to do what is being asked. In addition to conducting formative research and pretesting concepts and messages, health communicators should monitor the effectiveness of the communications campaign itself.

• Examine the wide range of actual and perceived barriers to and incentives for healthy (and unhealthy) behaviors and address them. Social marketing provides a useful framework for thinking about how to make behavior change easier.

• Devise health communications messages capable of competing effectively against possibly conflicting “unhealthy” messages that people may receive from other sources, including advertisers, the music and entertainment industry, and family and friends.

Back to Top