Effects of web-based intervention on risk reduction behaviors in melanoma survivors.

PURPOSE: Melanoma is the most severe form of skin cancer, and survivors of melanoma carry increased risk of additional melanoma diagnosis. Multiple methods exist for primary and secondary prevention of melanoma in survivors. This study tested a web-based family communication intervention to improve these preventive behaviors in melanoma families. METHODS: Families (a survivor, at least one first-degree relative and a parent) were randomized either to receive the intervention package or to serve as comparison families. We assessed melanoma prevention behaviors in each cohort member before and after the intervention. The intervention was a web-based multicomponent intervention focused on increasing family communication and exchange of risk information. RESULTS: Results indicated that, compared to comparison survivors, intervention survivors improved their skin self-examination and their sun protection behaviors significantly from before to after intervention. CONCLUSION: These data support the use of web-based interventions for behavioral changes in survivors and allow for consideration of dissemination of this successful intervention. These data have implications for interventions that can help cancer families deal with issues of risk and illness. IMPLICATIONS FOR CANCER SURVIVORS: These data indicate that survivors can benefit from exposure to a website that helps direct their future health behaviors.

Oncologists' attitudes toward KRAS testing: a multisite study.

Recent discoveries promise increasingly to help oncologists individually tailor anticancer therapy to their patients' molecular tumor characteristics. One such promising molecular diagnostic is Kirsten ras (KRAS) tumor mutation testing for metastatic colorectal cancer (mCRC) patients. In the current study, we examined how and why physicians adopt KRAS testing and how they subsequently utilize the information when discussing treatment strategies with patients. We conducted 34 semi-structured in-person or telephone interviews with oncologists from seven different health plans. Each interview was audiotaped, transcribed, and coded using qualitative research methods. Information and salient themes relating to the research questions were summarized for each interview. All of the oncologists in this study reported using the KRAS test at the time of the interview. Most appeared to have adopted the test rapidly, within 6 months of the publication of National Clinical Guidelines. Oncologists chose to administer the test at various time points, although the majority ordered the test at the time their patient was diagnosed with mCRC. While oncologists expressed a range of opinions about the KRAS test, there was a general consensus that the test was useful and provided benefits to mCRC patients. The rapid adoption and enthusiasm for KRAS suggests that these types of tests may be filling an important informational need for oncologists when making treatment decisions. Future research should focus on the informational needs of patients around this test and whether patients feel informed or confident with their physicians' use of these tests to determine treatment access.

Using a family systems approach to investigate cancer risk communication within melanoma families.

OBJECTIVE: The family provides an important communication nexus for information and support exchange about family cancer history, and adoption of family-wide cancer risk reduction strategies. The goals of this study were to (1) use the family systems theory to identify characteristics of this sample of families at increased risk of developing melanoma and (2) to relate familial characteristics to the frequency and style of familial risk communication. METHODS: Participants were first-degree relatives (n=313) of melanoma patients, recruited into a family web-based intervention study. We used multivariable logistic regression models to analyze the association between family functioning and family communication. RESULTS: Most participants were female (60%), with an average age of 51 years. Fifty percent of participants reported that they spoke to their relatives about melanoma risk and people were more likely to speak to their female family members. Familial adaptation, cohesion, coping, and health beliefs were strongly associated with an open style of risk communication within families. None were associated with a blocked style of risk communication. Only cohesion and adaptation were associated with the amount of risk communication that occurred within families. CONCLUSIONS: Overall, individuals who came from families that were more highly cohesive, adaptable, and shared strong beliefs about melanoma risk were more likely to communicate openly about melanoma. The fact that this association was not consistent across blocked communication and communication frequency highlights the multifaceted nature of this process. Future research should focus on the interplay between different facets of communication.

Personal communication in primary and secondary cancer prevention: evolving discussions, emerging challenges.

Over the past several years, the science of cancer communication has been recognized as integral to the dissemination of cancer prevention and control strategies in both the general population as well as higher-risk groups. In this article we draw upon current literature and small group discussion in the 2008 Society for Behavioral Medicine Cancer Special Interest Group Pre-Conference Workshop on Cancer Communication to identify current findings, critical challenges, and future opportunities regarding personal communication of primary and secondary prevention of cancer. We organize our article with six critical questions: (1) What are the most important directions of research in this area? (2) Does personal cancer communication work through rational processes, or are affective and nonrational processes also involved? (3) Are our efforts adequate to reach underserved populations? (4) Are naturalistic communicative contexts given adequate consideration? (5) Has the field been adequately informed by social psychological and communication theories? (6) What are the best outcomes to document communication effectiveness? Our goals are to initiate thought and collaborative efforts among communication, public health, and behavioral science experts, as well as to establish research priorities at the interface of communication and cancer prevention and control sciences.

Interest in genetic testing among affected men from hereditary prostate cancer families and their unaffected male relatives.

PURPOSE: The objective of this study was to evaluate potential sociodemographic, medical, psychosocial, and behavioral correlates of interest in genetic testing in men from hereditary prostate cancer families. METHODS: Family members affected with prostate cancer (n = 559) and their unaffected male relatives (n = 370) completed a mailed survey. Multivariable logistic regression models were used to examine the association between potential correlates and interest in genetic testing for prostate cancer. RESULTS: Forty-five percent of affected and 56% of unaffected men reported that they definitely would take a genetic test for prostate cancer. More affected men reported high levels of familiarity with genetic testing than unaffected men (46 vs. 25%). There were several variables that were significantly correlated with interest in either affected or unaffected men, but only age and familiarity with genetics were significant in both groups. After controlling for confounding variables, only familiarity remained a significant correlate in both groups. CONCLUSIONS: The contrast between low levels of familiarity with genetics and high test interest among unaffected men highlights the need for increased educational efforts targeting hereditary prostate cancer families. Overall, results illuminated several novel characteristics of men from hereditary prostate cancer families that should be considered when developing future informed consent procedures or educational materials for prostate cancer genetic testing.

Predictors of self-referral into a cancer genetics registry.

UNLABELLED: Recruitment is a challenging part of developing and maintaining any population-based disease registry and different methods are used to increase enrollment. However, recruitment methods may attract different subgroups of individuals, so examining characteristics of samples recruited using different methods can help detect threats to the external validity of research results. OBJECTIVES: There were two main objectives of this study: to examine differences between participants who were self-referred and those who were recruited into a cancer genetics registry and to identify predictors of self-referral status. METHODS: A cross-sectional survey was done with two groups of cancer genetics registry members (n = 268): (a) members recruited through self-referral and (b) members recruited through population-based sampling. RESULTS: There were no significant differences in demographic variables between the two samples except for education (higher in the self-referral group; P < 0.01). The self-referral group showed significantly higher levels of anxiety, depression, and cancer history and was more likely to report the strongest response to statements about cancer risk, screening intentions, and views on genetic testing. Logistic regression modeling indicated these predictors of self-referral status: previous cancer diagnosis, viewing self as a candidate for genetic testing, education higher than high school, and wanting assistance with personal future risk (R2 = 0.41). CONCLUSIONS: Our results suggest that whereas groups recruited via different strategies may seem to be the same based on demographic variables, underlying psychosocial variables differ between those self-referring and those recruited via population-based screening. To accurately estimate the generalizability of population-based studies or studies conducted using a cancer genetics registry, method of recruitment should be examined when interpreting and analyzing results.