February 4th, 2020 is the midpoint of the Union for International Cancer Control’s (UICC) three-year call-to-action of ‘I Am and I Will’. The theme of World Cancer Day 2020 asks for personal, collective and government pledges to raise awareness, reduce deaths, and improve quality of life for those affected by a cancer diagnosis. The impact of cancer beyond physical health and equity in access to care are key issues named by the UICC, and the focus of many clinical trials registered in the ISRCTN registry.

Beyond the physical impact

A cancer diagnosis has an effect beyond physical health for both patients and their caregivers. The effect on mental and emotional wellbeing may have an impact on recovery, as well as on quality of life. Studies registered in ISRCTN are tackling this key target by investigating how to best support patients to manage the emotional impact of their diagnosis, from screening tests through to survivorship.

The effect on mental and emotional wellbeing may have an impact on recovery, as well as on quality of life.

Beyond physical health at diagnosis

The ongoing ProCeSS study is investigating the impact of waiting times for a diagnosis on multiple parameters of distress in men with suspected prostate cancer. The aim is to determine the impact of uncertainty around waiting times between initial consultation, diagnosis, and treatment by comparing stress in men undergoing standard care versus a fast-track set schedule.

Distress around screening is not always solely due to the possibility of a cancer diagnosis. One in four eligible patients in the UK do not attend their cervical smears – a screening test where a small sample of cells is taken from the cervix and assessed for changes associated with cervical cancer. Patients from a variety of demographics failing to attend the national cervical screening program, such as older women and black women living in London, cited embarrassment, fear of the procedure, and previous negative experiences as reasons for avoiding appointments. 

An NIHR-funded study, currently recruiting, is aiming to gain an understanding of the anxiety around cervical screening and use this to boost attendance and develop the text of clinic letters to best explain results and reassure patients.

Beyond physical health in treatment

Chemotherapy is known to cause fatigue. Identifying patients who might suffer from higher levels of fatigue would allow healthcare workers to provide additional support for patients and manage their expectations.

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The TR-FATIGUE study aims to identify the effect of anxiety, depression, and social support on fatigue in colorectal cancer patients receiving chemotherapy in France. 

Beyond physical health in survivorship

Some ISRCTN-registered trials are investigating how quality of life can be improved in the later stages of a patient’s journey with a cancer diagnosis and what interventions are beneficial to survivors.

A Hong Kong-based trial aiming to improve the quality of life of gynecological cancer survivors found that intimacy and sexuality were key issues for this population. The currently recruiting project involves a nurse-led intervention to improve intimate partner relationships, sexual functioning, and psychological adaptation following illness.

Breast cancer diagnosis rates are increasing in women under 55 and, due to improvements in treatments, long-term survival rates are also increasing. Therefore, there is an increase in survivors in the workforce. The BRiC@Work study plans to investigate if neurocognitive training has a positive impact on memory, attention, and emotional wellbeing in this population.

Beyond physical health for caregivers

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A cancer diagnosis causes a psychological challenge for both a patient and their caregivers. The German INPART study plans to investigate the impact of a blood cancer diagnosis on patients and their partners and whether group psychotherapy sessions could lead to a reduction in depression and anxiety symptoms for both the patient and their partner.

Equity in access to cancer services

The UICC advocates that life-saving cancer diagnosis, treatment, and care should be accessible for everyone. Many 

ISRCTN-registered trials are specifically focusing on early detection and investigating how screening services and education on diagnoses can be made more accessible.

Cervical cancer is one of the most preventable cancers with vaccination against HPV (a common virus that can lead to cell changes in your cervix and cancer) and effective screening, yet there is still a disease burden globally. 

The cervical cancer screening method used in the NHS screening program is not accessible globally. Visual inspection by health workers is the current WHO-recommended approach for screening in low-resource settings as it requires less infrastructure and staff training. The feasibility of implementing a cervical cancer early detection service in routine primary health care services is being assessed by the CARE4Afrique study in Benin, Chad, Cote d’Ivoire, and Senegal.

Health education interventions improved knowledge and confidence in women with regards to cervical cancer and screening.

The IHEICCSWG trial investigated community health education on cervical cancer and screening for Ghanaian women and the impact it had on knowledge and perception of susceptibility and barriers and benefits to screening. The results in BMC Public Health found that health education interventions improved knowledge and confidence in women about cervical cancer and screening.

Personal responsibility 

The World Cancer Day 2020 theme ‘I Am and I Will’ encourages individual action against cancer. Through education, individuals are empowered to take personal responsibility and increase the adoption of prevention behaviors and the use of early detection services.

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A feasibility study asking “Do you know your skin?” assessed a school-based intervention to increase adolescent sunscreen use and identification of skin changes. The results in BMC Public Health show the intervention had a positive impact on adolescent intention to use sunscreen.

Colorectal cancer screening is recommended for over 50-year-olds in Spain but uptake is low, so a trial investigated using an online decision aid to empower participants to make informed decisions about undergoing screening. 

The results of this study suggested that knowledge levels and confidence in decision making were both increased by using the decision aid, but that knowledge about the diagnostic tests was sufficiently high in the control group. However, the control group reported feeling uninformed, despite their adequate understanding. 

Education about cancer diagnoses and services not only gives patients an increased understanding of their diagnosis and healthcare options but also empowers them to make confident, informed decisions.

Conclusion

With increases in cancer diagnoses, there is a growing need for research to ensure the best outcomes for patients beyond their physical health. As individuals, we can enact change by supporting cancer charities, getting involved in research, petitioning for government action, and raising awareness. On World Cancer Day 2020, what can and will you do to reduce the impact of cancer?