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BACKGROUND: Women diagnosed with breast cancer prior to age 45 years (

Purpose Although there is national recognition for health equity-oriented research, there is limited guidance for researchers to engage partnerships that promote health equity in cancer research. The Cancer Prevention and Control Research Network’s (CPCRN) Health Equity Work Group developed a toolkit to guide researchers in equitable collaborations. Methods The CPCRN’s Health Equity Work Group collectively outlined health and racial equity principles guiding research collaborations with partners that include communities, community-based organizations, implementing partners in the clinical setting including providers and health care organizations, and policy makers. Using a network-wide survey to crowdsource information around ongoing practices, we leveraged and integrated the network’s experience and collaborations. Results Data from the survey formed the preliminary basis for the toolkit, with a focus on sharing fiscal resources with partners, training and capacity building, collaborative decision-making, community-driven research agenda setting, and sustainability. The final toolkit provides reflection considerations for researchers and collated exemplary resources, supported by the contemporary research. Conclusions The toolkit provides a guide to researchers at all experience levels wanting to engage in equitable research collaborations. Future efforts are underway to evaluate whether and how researchers within and outside CPCRN are able to incorporate these principles in research collaborations.

Objective Lung cancer screening (LCS) efficacy is highly dependent on adherence to annual screening, but little is known about real-world adherence determinants. We used insurance claims data to examine associations between LCS annual adherence and demographic, comorbidity, health care usage, and geographic factors. Materials and Methods Insurance claims data for all individuals with an LCS low-dose CT scan were obtained from the Colorado All Payer Claims Dataset. Adherence was defined as a second claim for a screening CT 10 to 18 months after the index claim. Cox proportional hazards regression was used to define the relationship between annual adherence and age, gender, insurance type, residence location, outpatient health care usage, and comorbidity burden. Results After exclusions, the final data set consisted of 9,056 records with 3,072 adherent, 3,570 nonadherent, and 2,414 censored (unclassifiable) individuals. Less adherence was associated with ages 55 to 59 (hazard ratio [HR] = 0.80, 99% confidence interval [CI] = 0.67-0.94), 60 to 64 (HR = 0.83, 99% CI = 0.71-0.97), and 75 to 79 (HR = 0.79, 99% CI = 0.65-0.97); rural residence (HR = 0.56, 99% CI = 0.43-0.73); Medicare fee-for-service (HR = 0.45, 99% CI = 0.39-0.51), and Medicaid (HR = 0.50, 99% CI = 0.40-0.62). A significant interaction between outpatient health care usage and comorbidity was also observed. Increased outpatient usage was associated with increased adherence and was most pronounced for individuals without comorbidities. Conclusions This population-based description of LCS adherence determinants provides insight into populations that might benefit from specific interventions targeted toward improving adherence and maximizing LCS benefit. Quantifying population-based adherence rates and understanding factors associated with annual adherence are critical to improving screening adherence and reducing lung cancer death.

School-based programs are widely implemented to combat childhood obesity, but these programs have mixed results. Dissemination and implementation science approaches to evaluation using qualitative methods can provide more robust details about program functioning that may be able to help explain the variation in the impact of these programs. Fourteen in-depth interviews were conducted with classroom teachers implementing a school-based program, the Integrated Nutrition Education Program (INEP), to explore their experience. Factors related to organization, individual and intervention levels emerged as facilitators and barriers to program implementation. Key factors were school culture at the organization level, individual perception and belief in the intervention at the individual level and program content, perceived complexity and adaptability at the intervention level. Socioeconomic status of the community and family involvement were contextual factors identified across all levels. Findings from this qualitative evaluation can be used for the quality improvement of INEP, but beyond this these can also be informative for other school-based programs to promote adoption, implementation and maintenance.

With the increasing numbers of individuals surviving a diagnosis of cancer, an aging population, and more individuals experiencing multi-morbidity, primary care providers (PCPs) are seeing more patients with a history of cancer. Effective strategies are needed to adequately prepare the primary care workforce for the phase of cancer care now widely recognized as survivorship. A survivorship education program for rural primary care practices was developed using a community engagement process and delivered at the practice level by community health liaisons. A mixed method approach was used to evaluate the program impact which included a questionnaire and interviews. Descriptive analyses and generalized linear regression were used to evaluate quantitative outcomes from the questionnaires. Immersion crystallization was used to define themes from the qualitative components. Thirty-two (32) practices participated, averaging 10.3 team members/practice. The percent of correct responses to the knowledge questionnaire increased significantly, almost doubling between baseline and post-test (25% vs 46%, p .001). Four major themes emerged from the interviews which included positive impact of the training, putting the training into practice, intention to change care delivery, contextual influences in survivorship care. Evidence from the cancer survivorship education program evaluation supports its value to key stakeholders and the potential wider dissemination of the iSurvive Program. These data also suggest the need for additional investigation into other ways beyond education that primary care practices can be supported to ensure the needs of the growing cancer survivor population in the US are met.

Multiple evidence-based approaches (EBAs) exist to improve colorectal cancer screening in health clinics. The success of these approaches is tied to effective implementation. Therefore, the purpose of this study was to assess the implementation of EBAs for colorectal cancer screening and clinic-level correlates of implementation in federally qualified health centers (FQHCs). We conducted descriptive and cross-sectional analyses using data collected from FQHC clinics across seven states ( n = 51). A clinic representative completed electronic surveys about clinic characteristics (e.g., size, patient characteristics, and medical record system characteristics) and the implementation of Community Guide recommended EBAs (e.g., client reminders, small media, and provider assessment and feedback). We used bivariate Spearman correlations to assess clinic-level correlates with implementation outcomes. Most clinics were planning to implement, in the early implementation stages, or inconsistently implementing EBAs. No EBA was fully implemented by more than nine (17.6%) clinics. Clinic size variables were inversely related to implementation levels of one-on-one education; medical record variables were directly related to implementation levels of client and provider reminders as well as provider assessment and feedback; and rapid and timely feedback from clinic leaders was directly associated with implementation levels of four out of six EBAs. Given the varying levels of implementation, clinics need to assess current use of implementation strategies and improve effective program delivery to increase colorectal cancer screening among their patients. In addition, clinics should also consider how their characteristics may support or serve as a barrier to implementation in their respective settings.

Patient navigators (PNs) coordinate medical services and connect patients with resources to improve outcomes, satisfaction, and reduce costs. Little national information is available to inform workforce development. We analyzed 819 responses from an online PN survey conducted in 2009-2010. Study variables were mapped to the five Consolidated Framework for Implementation Research (CFIR) constructs to explore program variations by type of PN. Five logistic regression models compared each PN type to all others while adjusting for covariates. Thirty-five percent of respondents were nurse navigators, 28% lay navigators, 20% social work (SW)/counselor navigators, 7% allied health navigators, and 10% were "other" types of PNs. Most were non-Hispanic White (71%), female (94%), and at least college educated (70%). The primary differences were observed among: the core intervention tasks; position structure; work setting; health conditions navigated; navigator race/ethnicity; personal cancer experiences; navigation training; and patient populations served. Lay PNs had fewer odds of identifying as Hispanic, work in rural settings and assist underserved populations compared to others. Nurse navigators showed greater odds of clinical responsibilities, work in hospital or government settings and fewer odds of navigating minority populations compared to others. SW/counselor navigators also had additional duties, provided greater assistance to Medicare patient populations, and less odds of navigating underserved populations than others. In summary, our survey indicates that the type of PN utilized is an indicator of other substantial differences in program implementation. CFIR provides a robust method to compare differences and should incorporate care coordination outcomes in future PN research.

While cities may have compelling agendas for urban health, it is necessary for that vision to be translated into the work of their ministries and local governments. We qualitatively explored how wo...

Colorectal cancer (CRC) is the third most common cancer in the USA. The objective of this study was to compare quality of life (QoL) across long-term colorectal cancer survivors and unaffected matched controls while adjusting for comorbidities. The National Cancer Institute (NCI)-funded Colon Cancer Family Registry (CCFR) was used to randomly select and recruit CRC survivors (≥ 5 years from diagnosis) and matched controls for a cross-sectional survey. Nine geographically diverse sites in the USA from the CCFR participated in the study. Telephone interviews were conducted using computer-assisted methods to assess QoL. A total of 403 cases and 401 controls were included in the final sample. Unadjusted comparison revealed no significant difference between CRC survivors and controls with respect to measures of fatigue, social, emotional, functional, and physical well-being. Multivariate logistic regression revealed that case status had a significant negative influence on colorectal cancer-specific QoL measures. Higher comorbidity indices had a significant negative influence on overall QoL regardless of case status. Quality of life among long-term CRC survivors is similar to control subjects, with the exception of worse CRC-specific QoL measures. Higher comorbidity indices were independently associated with poor QoL for both cases and controls. Survivors and healthcare providers should be aware that long-term QoL is comparable to the general population; however, there is potential that digestive tract-specific issues may persist.

Objective To operationalize constructs from each of the Consolidated Framework for Implementation Research domains and to present psychometric properties within the context of evidence-based approaches for promoting colorectal cancer screening in federally qualified health centers (FQHCs). Methods Data were collected from FQHC clinics across seven states. A web-based Staff Survey and a Clinic Characteristics Survey were completed by staff and leaders (n = 277) from 59 FQHCs. Results Internal reliability of scales was adequate ranging from 0.62 for compatibility to 0.88 for other personal attributes (openness). Intraclass correlations for the scales indicated that 2.4 percent to 20.9 percent of the variance in scale scores occurs within clinics. Discriminant validity was adequate at the clinic level, with all correlations less than 0.75. Convergent validity was more difficult to assess given lack of hypothesized associations between factors expected to predict implementation. Conclusions Our results move the field forward by describing initial psychometric properties of constructs across CFIR domains.

Background The impact of cancer and its treatment on employment and financial burden in adolescents/young adults (AYAs) is not fully known. Methods Eligibility for this cross-sectional study of AYA cancer survivors included the diagnosis of a malignancy between ages 18 and 39 years and survey completion within 1 to 5 years from diagnosis and ≥1 year after therapy completion. Participants were selected randomly from the tumor registries of 7 participating sites and completed an online patient-reported outcomes survey to assess employment and financial concerns. Treatment data were abstracted from medical records. Data were analyzed across diagnoses and by tumor site using logistic regression and Wald-based 95% confidence intervals adjusting for age (categorized), sex, insurance status, education (categorized), and treatment exposures. Results Participants included 872 survivors (breast cancer, n = 241; thyroid cancer, n = 126; leukemia/lymphoma, n = 163; other malignancies, n = 342). Exposure to chemotherapy in breast cancer survivors was associated with an increase in self-reported mental impairment in work tasks (odds ratio [OR], 2.66) and taking unpaid time off (OR, 2.62); survivors of "other" malignancies reported an increase in mental impairment of work tasks (OR, 3.67) and borrowing >$10,000 (OR, 3.43). Radiation exposure was associated with an increase of mental impairment in work tasks (OR, 2.05) in breast cancer survivors, taking extended paid time off work in thyroid cancer survivors (OR, 5.05), and physical impairment in work tasks in survivors of "other" malignancies (OR, 3.11). Finally, in survivors of "other" malignancies, having undergone surgery was associated with an increase in physical (OR, 3.11) and mental impairment (OR, 2.31) of work tasks. Conclusions Cancer treatment has a significant impact on AYA survivors' physical and mental work capacity and time off from work.

Delivery of follow-up care to breast cancer survivors is an important public health issue due to their increasing number and the anticipated shortage of oncology providers. This study evaluated adherence to American Society of Clinical Oncology (ASCO)-recommended surveillance tests in a bi-ethnic cohort of long-term breast cancer survivors. Women (n = 298) in Arizona and Colorado who had previously participated in a population-based study of breast cancer were enrolled into a follow-up survey approximately 6 years post-diagnosis. ASCO-recommended surveillance (mammogram, clinical breast, and physical exam), other non-recommended tests (e.g. tumor markers, imaging scans), and patients’ beliefs were compared by provider type using multivariate logistic regression. No significant differences in patient self-report of physical exam or mammography prevalence by provider type was observed after adjustment for covariates. Receipt of surveillance tests not recommended by ASCO was higher among survivors who saw an oncologist (tumor marker tests: OR = 3.0, 95 % CI 1.5–5.8; and other blood tests: OR = 2.0, 95 % CI 1.1–3.5) as compared to those who routinely see a primary care physician. These observed differences persisted after adjustment for age, stage, lapse in insurance, education, or ethnicity. Although overutilization of non-recommended tests was observed among women who saw an oncologist, the majority of breast cancer survivors received ASCO-recommended surveillance regardless of provider type. Most breast cancer survivors receive recommended surveillance tests, whether their care is managed by a primary care physician or an oncologist, but some women receive unnecessary testing. Women should talk with their providers about tests recommended based on their past breast cancer diagnosis.

Background Scientists and practitioners alike need reliable, valid measures of contextual factors that influence implementation. Yet, few existing measures demonstrate reliability or validity. To meet this need, we developed and assessed the psychometric properties of measures of several constructs within the Inner Setting domain of the Consolidated Framework for Implementation Research (CFIR). Methods We searched the literature for existing measures for the 7 Inner Setting domain constructs (Culture Overall, Culture Stress, Culture Effort, Implementation Climate, Learning Climate, Leadership Engagement, and Available Resources). We adapted items for the healthcare context, pilot-tested the adapted measures in 4 Federally Qualified Health Centers (FQHCs), and implemented the revised measures in 78 FQHCs in the 7 states (N = 327 respondents) with a focus on colorectal cancer (CRC) screening practices. To psychometrically assess our measures, we conducted confirmatory factor analysis models (CFA; structural validity), assessed inter-item consistency (reliability), computed scale correlations (discriminant validity), and calculated inter-rater reliability and agreement (organization-level construct reliability and validity). Results CFAs for most constructs exhibited good model fit (CFI > 0.90, TLI > 0.90, SRMR

A nationwide cross-sectional study was conducted to assess patient navigator, patient population, and work setting characteristics associated with performance of various patient navigation (PN) tasks.Using respondent-driven sampling, 819 navigators completed a survey assessing frequency of providing 83 PN services, along with information about themselves, populations they serve, and setting in which they worked. Analyses of variance and Pearson correlations were conducted to determine differences and associations in frequency of PN services provided by various patient, navigator, and work setting characteristics.Nurse navigators and navigators with lower education provide basic navigation; social workers typically made arrangements and referrals; and individuals with higher education, social workers, and nurses provide treatment support and clinical trials/peer support. Treatment support and clinical trials/peer support are provided to individuals with private insurance. Basic navigation, arrangements and referrals, and care coordination are provided to individuals with Medicaid or no insurance.Providing basic navigation is a core competency for patient navigators. There may be two different specialties of PN, one which seeks to reduce health disparities and a second which focuses on treatment and emotional support.The selection and training of patient navigators should reflect the specialization required for a position.

While PN initially began in the cancer arena, the concept has spread to numerous chronic conditions such as HIV/AIDS, diabetes, cardiovascular disease, asthma/COPD, and mental health [1, 2, 3, 4]. Patient navigation is also used in primary care to improve access and care coordination in patient-centered medical homes [5], and The Affordable Care Act calls for PN in the future reformed healthcare system [6].

Translating evidence-based exercise interventions into practice is important for expanding the capacity to support cancer survivors. Using the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework and scoping study methodology, we addressed the research question, "What is known about the maintenance of exercise interventions for cancer survivors that would inform translation from research to practice and community settings?" Maintenance was investigated at the individual and setting level.Literature searches were performed in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Sport Discus databases for articles published from January 2009 to June 2012. Abstracts were judged using a priori criteria for the survivor population, exercise intervention, and maintenance on the individual or setting level. We included completed and planned randomized controlled trials (RCTs) and other study designs. Publications meeting the criteria were reviewed and coded.Of the 211 abstracts meeting patient and exercise criteria, 24 (19 RCTs) met the maintenance criteria. Nine of the 12 completed RCTs demonstrated maintenance of intervention outcomes after 3 to 14 months of follow-up. The planned RCTs described interventions lasting 2 to 4.5 months and maintenance intervals lasting 3 to 12 months following the active intervention. Maintenance at the setting level was reported in one publication.On the individual level, intervention outcomes were maintained in most studies, in a variety of settings and survivor subpopulations. Maintenance on the setting level was scarcely addressed. This scoping study suggests several strategies that could be taken by agencies, clinicians, and researchers to develop more effective and sustainable exercise programs for cancer survivors.Many benefits of exercise training are maintained for months after cancer survivors complete controlled research studies but relatively little is known about how to translate research to sustainable community-based exercise programs. A better understanding of how programs can be sustained in practice beyond short-term research or grant funding is needed to support a growing number of survivors.

Self-management in chronic disease has been shown to improve patient-reported and health care-related outcomes. However, relatively little information about its utility in cancer survivorship is known. We evaluated the feasibility and acceptability of the delivery of an adaptation of the evidence-based Chronic Disease Self-management Program (Stanford) called Cancer Thriving and Surviving (CTS). Triangulated mixed methods were used to capture baseline characteristics and post-program experiences using a combination of closed- and open-ended survey items; emergent coding and simple descriptive statistics were used to summarize the data. Twenty-seven workshops were delivered by 22 CTS leaders to 244 participants between August 2011 and January 2013 in a variety of settings (48 % community, 30 % health care, 22 % regional/community cancer center). Representing a variety of cancer types, about half the participants were 1-3 years post-diagnosis and 45 % were 4 or more years from diagnosis. Program attendance was high with 84 % of participants attending four or more of the six sessions in the workshop. Overall, 95 % of the participants were satisfied with the program content and leaders, and would recommend the program to friends and family. These results confirm the feasibility and acceptability of delivery of a high-fidelity, peer-led model for self-management support for cancer survivors. Expansion of the CTS represents a powerful tool toward improving health-related outcomes in this at-risk population.

11517 Background: Young Adult (YA) survivors face challenges unique from those survivors of childhood cancer or of middle and older age adults. The potential impact of cancer, its treatment or the lasting effects on daily mental and physical tasks are not fully understood. Methods: Eligibility included diagnosis of malignancy between ages 18-39, 1-5 years from diagnosis and ≥1 year from therapy completion. Participants were randomly selected from tumor registries of 7 academic institutions. Enrolled participants were asked to complete an online patient reported outcomes (PRO) survey related to the effects of cancer and its treatment on daily functionality, finances, and cancer-related distress. All enrolled subjects had diagnostic and treatment information abstracted by a standardized protocol and entered into a database. Results: Enrollment and the online PRO survey was completed by 872 survivors (43.5% of eligible survivors). Survivors were 72.3% female, 90% non-Hispanic or Latino and the most common cancer for males and females were testicular and breast cancer respectively. Cancer, its treatment or the lasting effects limited the kind or amount of instrumental activities of daily living (IADLs) in 649 (76.3%) of survivors. Exposure to chemotherapy was associated with a 3.2-fold increased odds of interference with IADLs (CI 2.08-4.83, p < 0.01) after controlling for diagnosis, age, gender, radiation and surgery exposure. This impairment lasted longer than 1 year in 268 (41.3%) of survivors. Cancer, its treatment or the lasting effects interfered with their ability to perform any mental tasks as part of their IADLs in 454 (53.3%) of survivors. Exposure to chemotherapy was associated with a 2.8-fold increased odds of interference with mental impairment of IADLs (CI 1.94-3.96, p < 0.01) after controlling for diagnosis, age, gender, radiation and surgery exposure. Exposure to radiation was also associated with an increased odds of interference with mental impairment of daily activities (CI 1.05-1.91, p < 0.01) after controlling for diagnosis, age, gender, chemotherapy and surgery exposure. Conclusions: In YA cancer survivors, cancer, its treatment or the lasting effects of treatment commonly impact the daily physical and mental IADLs and many survivors report ongoing limitations > 1 year from therapy completion.

SUMMARY There are more than 2 million breast cancer survivors in the USA. Approximately 5–10% of survivors will develop a second, metachronous breast cancer within 10 years’ time; a risk two- to six-times higher than that in the general population. Women who develop metachronous cancer are more likely to die from the disease compared with women with unilateral cancer. Risk factors for metachronous cancer include BRCA mutation status, young age, family history and tumor phenotype, while adjuvant chemotherapy and endocrine therapy may attenuate the risk. Surveillance guidelines recommend annual mammography, but MRI is not currently indicated for most women. An increasing number of women are choosing prophylactic contralateral mastectomy, although it is not likely to be beneficial for most women. Improved strategies are needed for identifying survivors at an increased risk in order to help guide clinical decisions regarding follow-up care. This review presents an overview of the burden and risk factors for metachronous breast cancer and discusses challenges and opportunities for a population approach to mitigating risk and adverse outcomes from these cancers.

Introduction to the 3rd Biennial Conference of the Society for Implementation Research Collaboration: advancing efficient methodologies through team science and community partnerships

The Cancer Prevention and Control Research Network (CPCRN) is a thematic network dedicated to accelerating the adoption of evidence-based cancer prevention and control practices in communities by advancing dissemination and implementation science. Funded by the Centers for Disease Control and Prevention and National Cancer Institute, CPCRN has operated at two levels: Each participating network center conducts research projects with primarily local partners as well as multicenter collaborative research projects with state and national partners. Through multicenter collaboration, thematic networks leverage the expertise, resources, and partnerships of participating centers to conduct research projects collectively that might not be feasible individually. Although multicenter collaboration is often advocated, it is challenging to promote and assess. Using bibliometric network analysis and other graphical methods, this paper describes CPCRN's multicenter publication progression from 2004 to 2014. Searching PubMed, Scopus, and Web of Science in 2014 identified 249 peer-reviewed CPCRN publications involving two or more centers out of 6,534 total. The research and public health impact of these multicenter collaborative projects initiated by CPCRN during that 10-year period were then examined. CPCRN established numerous workgroups around topics such as: 2-1-1, training and technical assistance, colorectal cancer control, federally qualified health centers, cancer survivorship, and human papillomavirus. This paper discusses the challenges that arise in promoting multicenter collaboration and the strategies that CPCRN uses to address those challenges. The lessons learned should broadly interest those seeking to promote multisite collaboration to address public health problems, such as cancer prevention and control.

Hispanics are more likely to be diagnosed with breast cancer at a younger age, with more advanced stage at diagnosis, hormone receptor-negative tumors, and worse prognosis than non-Hispanic whites (NHW). Little is known regarding the association between behavioral risk factors and breast tumor characteristics and whether these associations vary by race/ethnicity. We evaluated the association between several behavioral risk factors and tumor phenotype in a population-based study of Hispanics and NHWs. Participants are cases (846 Hispanic and 1,625 NHW women) diagnosed with breast cancer between 1999 and 2004 in Arizona, Colorado, New Mexico, or Utah. The association between breast cancer characteristics and obesity, physical activity, smoking, alcohol intake, and reproductive factors was examined. Logistic regression was used to compute the ethnic-specific odds ratios for the association between these risk factors and estrogen receptor (ER) status, tumor size, and histologic grade. Hispanics had more ER-negative tumors (28 vs. 20%), tumors >2 cm (39 vs. 27%), and poorly differentiated tumors (84 vs. 77%) than NHW. Among premenopausal women, obesity was associated with more ER-negative cancers among NHW [OR = 2.47 (95% CI: 1.08, 5.67)] but less ER-negative cancers among Hispanics [OR = 0.29 (0.13, 0.66)]. Obesity was associated with larger tumors among NHW [OR = 1.58 (1.09, 2.29)], but not among Hispanics. Never using mammography was associated with larger tumors in both ethnic groups. Moderate alcohol drinking and moderate and vigorous physical activity were weakly associated with smaller tumors in both ethnic groups. Our findings suggest that the association of obesity and other behavioral risk factors with breast cancer characteristics differ by ethnicity. We observed a divergent pattern between Hispanic and NHW cases in the association between obesity and ER status and tumor size. These observations suggest that a complex set of metabolic and hormonal factors related to estrogen and insulin pathways influence tumor characteristics.

Survivorship navigation is a relatively new concept in the field of patient navigation but an important one. This article highlights the essential functions of the survivorship navigator and defines core outcomes and measures for navigation in the survivorship period. Barriers to access to care experienced by patients during active cancer treatment can continue into the post-treatment period, affecting quality follow-up care for survivors. These barriers to care can be particularly acute for non-English speakers, immigrants, the uninsured, the underinsured, and other vulnerable populations. The survivorship navigator can help reduce barriers and facilitate access to survivorship care and services through communication and information exchange for patients. Survivorship navigation may improve appropriate health care utilization through education and care coordination, potentially improving health outcomes and quality of life of survivors while reducing cost to the health care system. Survivorship navigators can also educate survivors on how to improve their overall wellness, thereby directly impacting the health of a growing population of cancer survivors.

10013Background: YA survivors face challenges unique from those survivors of childhood cancer or older adults. The potential impact of cancer or its treatment upon employment and financial burden i...

115 Background: Fertility is a critical survivorship issue for young adults (YA) with cancer. Data regarding use of fertility preservation (FP) and fertility outcomes in this population are limited. Methods: In 2013-2014, 868 patients, aged 18-39, 1-5 years post diagnosis (dx) of an invasive cancer completed a survey about the impacts of cancer and treatment including fertility. Descriptive statistics were used to characterize FP options pursued, reasons for not undergoing FP, and pregnancy outcomes. Logistic regression was used to identify factors associated with pre- treatment FP. Results: Median age at dx was 32. Most respondents were female (73%), married (61%), with a college degree (71%). Breast (28%), thyroid (15%), and lymphoma (13%) were the most common dx. 13% (77/614) of women and 36% (82/231) of men reported FP attempts prior to treatment, including 57% of testicular, 39% of lymphoma, 27% of leukemia, and 18% of breast cancer survivors. In men, sperm banking (96%) was the most common approach; in women, embryo (47%) and oocyte (23%) cryopreservation. Of those who did not pursue FP (N=686), 19% reported lack of information on risks/options as the reason. In multivariable analyses, FP was associated (p

This study explores whether certain population characteristics are associated with adherence to mammography screening guidelines among Hispanic and non-Hispanic white (NHW) women living in the southwestern United States.Participants in a population-based study (4-Corners' Breast Cancer Study) included in this analysis were 790 Hispanic women and 1,441 NHW women. Multivariate logistic regression was used to compute the ethnic-specific adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association of the outcome variable (adherent vs. nonadherent) and its correlates. Women were adherent if they had obtained their first mammogram between 41 and 50 years of age and had received at least one mammogram per 2 years or less.Ethnic-specific associations were observed with certain population characteristics and mammography adherence. Specifically, characteristics that were significantly associated with adherence among Hispanic women were younger age (50-59 years), having a family history of breast cancer, nulliparity, hormone replacement therapy (HRT) use, nonsteroidal anti-inflammatory drug (NSAID) use, and performing regular breast self-examinations (BSE). Among NHW women, younger age (50-59 years), family history of breast cancer, obesity, consuming moderate amounts of alcohol, and taking HRT were associated with mammography adherence. When adjusting for the evaluated population characteristics, the relationship between ethnicity and mammography adherence was no longer apparent.Ethnic-specific characteristics appear to explain differences in mammography adherence among Hispanic and NHW women. Disparities in screening rates, late-stage disease and breast cancer mortality that impact Hispanic women could potentially be addressed more effectively by interventions that specifically target the unique characteristics of the Hispanic population.

Hispanic women are at lower risk for incident breast cancer, but the reasons for this lower risk are unknown. Among postmenopausal women, breast cancer risk is inversely associated with circulating levels of 2-hydroxyestrone but directly associated with levels of 16alpha-hydroxyestrone, according to most studies. Likewise, according to most research, the ratio of 2-hydroxyestrone/16alpha-hydroxyestrone is, therefore, inversely associated with breast cancer risk.We measured levels of these two circulating estrones as well as estradiol in 40 Hispanic women and 40 non-Hispanic white women who were all postmenopausal and not taking hormones.Compared with non-Hispanic white women, Hispanic women had 69% higher circulating levels of 2-hydroxyestrone (p = 0.04), and 10% lower levels of 16alpha-hydroxyestrone (p = 0.09). Consequentially, Hispanic women had more favorable estrogen profiles than non-Hispanic white women, with an 89% higher 2:16 ratio (p = 0.01). This finding was not substantially affected by adjustment for other breast cancer risk factors, including matching on body mass index (BMI).This ethnic difference in estrogen profile requires further research to establish whether there is a causal relationship to breast cancer risk that may, at least partially, explain why postmenopausal Hispanic women have a lower incidence of breast cancer.

To evaluate the association between family history of breast cancer and breast cancer risk among Hispanic and non-Hispanic white (NHW) women.Logistic regression models were used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using data collected from the 4-Corners Breast Cancer Study, a population-based case-control study of breast cancer conducted in the Southwest United States (3,074 NHW and 1,647 Hispanic women).The association between family history of breast cancer and early-onset breast cancer risk differs among NHW and Hispanic women. Among women50 years old, having a family history of breast cancer was associated with a greater increase in risk among NHWs, with an OR of 2.34 (95% CI: 1.64-3.35) when compared to an OR of 1.32 (95% CI: 0.82-2.19) for Hispanics. This difference in risk was not observed among women 50 years and older, with an OR of 1.69 (95% CI: 1.34-2.13) for NHW and 1.47 (95% CI: 1.03-2.10) for Hispanics.Family history of breast cancer poses a greater risk for early-onset breast cancers among NHW when compared to Hispanic women and may reflect ethnic differences in certain predisposing genetic factors that promote breast cancer development.

OBJECTIVE To compare the prevalence of urinary incontinence (UI) between Hispanic and non-Hispanic White women in a population-based study. SUBJECTS AND METHODS The prevalence of moderate to severe UI, defined as Sandvik severity score of ≥3, was assessed in relation to ethnicity by stratification, age adjustment and logistic regression models among 250 Hispanic and 491 non-Hispanic White women in Colorado, USA, who were participants in a breast cancer case-control study. RESULTS Hispanic women reported more stress UI (odds ratio 1.7, P = 0.005) and mixed UI (odds ratio 1.8, P = 0.005) than did non-Hispanic White women. These higher prevalences were largely associated with ethnic differences in parity, body mass index, diabetes, hysterectomy and bilateral oopherectomy. CONCLUSIONS The prevalence of moderate to severe UI in Colorado is higher among Hispanic women than among non-Hispanic white women. This difference is largely compatible with differences in reproductive history, adiposity and diabetes.

Genetic test results can substantially impact the care of cancer survivors even long after their initial oncologic treatments, and can also lead to testing and initiation of clinical care for their relatives. There are two scenarios in which it is particularly important to assess genetic risk and consider genetic testing during survivorship: (1) in cancer survivors whomeet criteria for genetic testing but have not yet had this performed, and (2) in cancer survivors who had genetic counseling and testing previously yet should now consider additional testing because of a newcancer diagnosis (personal or family) or updated testing options (e.g., availability of expanded molecular analyses). To illustrate the importance of addressing genetic risk in survivors, consider the following patient case. J.S. is a 53-year-old woman who had tested negative for BRCA1/2mutations in the late 1990s after having been diagnosed with breast cancer at age 29. Last year, her nieces inquired about her testing history and results because they were concerned about their own risks. When J.S. learned that more extensive testing had become available (including testing for BRCA1/2 gene rearrangements), she opted for additional testing and was found to carry a deleterious BRCA1 mutation. Based on this new information, she underwent bilateral salpingo-oophorectomy, at which time she was diagnosed with stage 2 ovarian cancer. In addition to facilitating J.S.’s care, the knowledge of her BRCA1mutation allowed her family members to make informed decisions about their own testing and treatment. Thus, genetic testing can play a critical role in optimizing a patient’s survivorship care and in mitigating future risks for her and her family. The evolution of testing, as illustrated in this case, is one of several reasons we discuss for revisiting genetics in the care of cancer survivors. In this article, we describe barriers to genetic testing, which must be considered to address the needs of cancer survivors who meet testing criteria but have not yet been evaluated. Testing for pathogenic mutations in susceptibility genes known to be associated with familial cancer syndromes has been recommended for many cancer patients and their family members for two decades, but not everyone who receives this recommendation is tested. Genetic testing may be appropriate for some people based on concerning family histories or their own characteristics (e.g., young age at diagnosis with cancer, Ashkenazi Jewish heritage, personal diagnosis with a particular cancer site or histology, or a syndromic presentation). However, many individuals who meet criteria for BRCA testing, Lynch syndrome testing, and/or testing for mutations in other cancer-predisposing genes have not been tested for various reasons, including insurability concerns (which are now less relevant thanks to the 2009 Genetic Information Nondiscrimination Act, or GINA, which protects against genetic discrimination in insurance or employment), costs, inadequate access to subsequent care, and emotional distress. Jagsi et al recently found among survivors of early-stage breast cancer that racial/ethnic minorities were less likely to have discussed genetic testing with a health professional even when they had a strong desire for testing, and that those who had received genetic testing were younger, less likely to be black, and more likely to have a family cancer history. Similarly, Levy et al reported that young survivors of early-stage breast cancer (diagnosed at age 40 years or younger) were less likely to have had genetic testing if they were black or Latina rather than white (even when Jewish women were excluded). Those enrolled in a health maintenance organization were also less likely to have been tested than those with point-ofservice insurance plans. Some patients may be too sick or distressed by their cancer and/or cancer treatment to pursue testing. Emotional barriers to genetic testing exist even in healthy populations. For example, in 2002, 76 black women at high risk for breast cancer were found to be less likely to agree to genetic testing if they were anticipating negative emotional responses to testing and were more concerned about result-based stigmatization. A decade later, a qualitative interview study of 120 Latina women at risk for BRCA mutations found that logistic concerns (e.g., health insurance coverage), emotional concerns (e.g., distress), and competing life concerns (e.g., caregiving responsibilities for children or other family members) were the biggest barriers to genetic testing. Historically, fear of loss of health insurance has been one of the greatest barriers to genetic testing. In fact, in a survey in 2000, a majority of 163 genetic counselors reported that they themselves would not have chosen to bill insurance for any genetic testing they might have needed, because of concern about potential discrimination based on the results. GINA was passed by Congress in 2008 to protect individuals from discrimination based on testing results. An interview study of 25 clinicians, 20 insurance executives, and six patient advocates identified poor coordination of tests relative to treatment decisions and reimbursement-related disincentives as the major barriers to BRCA testing. Five of the six

Background The Consolidated Framework for Implementation Research (CFIR) is a comprehensive meta-framework widely applied to implementation related studies. Yet, few have used validated measures to operationalize constructs in CFIR in real-life settings. In this study, we operationalized selected CFIR constructs in an assessment to identify factors influencing implementation of evidence-based practices for increasing colorectal cancer screening in Community Health Centers (CHC).

Purpose Describe the development and evolution of a primary-care-based, multidisciplinary clinic to support the ongoing care of adult survivors of childhood cancer. Methods A consultative clinic for adult survivors of childhood cancer has been developed that is located in an adult, academic internal medicine setting and is based on a long-term follow-up clinic model available at Children's Hospital Colorado. Results The clinic opened in July 2008. One hundred thirty-five patients have been seen as of April 2014. Referrals and clinic capacity have gradually increased over time, and a template has been developed in the electronic medical record to help facilitate completion of individualized care plan letters. Conclusions A primary care-based, multidisciplinary consultative clinic for adults with a history of childhood cancer survivor is feasible and actively engages adult primary care resources to provide risk-based care for long-term pediatric cancer survivors. This model of care planning can help support adult survivors of pediatric cancer and their primary care providers in non-academic, community settings as well.

PurposeSurvivorship care plans (SCPs) have been suggested to reduce fragmentation of care experienced by cancer survivors. Acceptance of SCPs is high, but trials in the United States are few. This pilot study used a quasiexperimental design to examine the outcomes achieved by breast cancer survivors receiving a standardized SCP visit at one of seven comprehensive cancer centers.Materials and methodsOutcomes were assessed before and again 3 months after delivery of an SCP and included survivors' use of and satisfaction with SCPs, perceived knowledge about survivorship, and assessment of the quality and coordination of survivorship care.ResultsOne hundred thirty-nine survivors of breast cancer completed baseline and follow-up measures and received a standardized SCP visit. Participants most commonly used SCP materials to make decisions about exercise (64%), which tests to receive and when (62%), and dietary changes (62%). Only 21% shared the SCP with their primary care provider during that time. Satisfaction with the SCP was high, with 90% of participants reporting being at least satisfied with the SCP. Perceived knowledge about survivorship improved after SCP delivery, as did perceived care coordination and the provider's knowledge of the effects of cancer on survivors (all P < .001). Individuals closer to the time of diagnosis reported greater satisfaction with and use of SCPs.ConclusionThis study demonstrates improvements in perceived knowledge and quality of survivorship care after receipt of a comprehensive SCP. Survivors were satisfied with their SCP, and those closer to diagnosis reported greater satisfaction with and use of the materials.

Background Enhancing the capability of community health centers to implement best practices may mitigate health disparities. We investigated the association of Practice Adaptive Reserve (PAR) to implementation of Patient Centered Medical Home (PCMH) colorectal cancer (CRC) screening best practices (BPs) at community health center clinics in seven states.

Background: Although cancer research has advanced at a rapid pace, a gap remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within health care systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with more than 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions. Methods: The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model. Results: We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice. Conclusions: The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control. Impact: Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them. Cancer Epidemiol Biomarkers Prev; 23(11); 2512–21. ©2014 AACR.

Background: Special events are common community-based strategies for health promotion. This paper presents findings from a systematic literature review on the impact of special events to promote breast, cervical or colorectal cancer education and screening. Methods. Articles in English that focused on special events involving breast, cervical, and/or colorectal cancer conducted in the U.S. and published between January 1990 and December 2011 were identified from seven databases: Ovid, Web of Science, CINAHL, PsycINFO, Sociological Abstract, Cochrane Libraries, and EconLit. Study inclusion and data extraction were independently validated by two researchers. Results: Of the 20 articles selected for screening out of 1,409, ten articles on special events reported outcome data. Five types of special events were found: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. Reach ranged from 50-1732 participants. All special events used at least one evidence-based strategy suggested by the Community Guide to Preventive Services, such as small media, one-on-one education, and reducing structural barriers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening. Conclusions: Special events found in the review varied and used evidence-based strategies. Screening data suggest that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening. The heterogeneity of populations served, event activities, outcome variables assessed, and the reliance on self-report to measure screening limit conclusions. This study highlights the need for further research to determine the effectiveness of special events to increase cancer screening. © 2014 Escoffery et al.; licensee BioMed Central Ltd.

Overall, participation rates in cancer clinical trials are very low, ranging from 3 to 20% of eligible participants. However, participation rates are especially low among the socially disadvantaged and racial/ethnic minority groups that have been historically underrepresented in clinical research. Structural factors such as study duration, treatment or intervention schedule, cost, time, followup visits, and side effects represent more of a barrier to participation among these groups compared with white, non-Hispanics. Attitudes, beliefs, perceptions, and knowledge regarding clinical research, and cultural characteristics of underrepresented minorities pose additional barriers to participation. This article focuses on the structural, cultural, and linguistic factors that affect participation in clinical cancer research for each major U.S. racial/ethnic group. Low socioeconomic status, speaking a primary language other than English, differences in communication styles, mistrust of research and the medical system, fear, embarrassment, and lack of knowledge about the origin of cancer appear to have a negative impact on clinical cancer research participation rates. Much of the information about these factors comes from studies of cancer screening because little data is available on the factors that prevent and facilitate participation of minorities in clinical cancer trials specifically. Such research is needed, and, given the heterogeneity within and between minority populations, should occur in several different geographic settings and with as many different minority subpopulations as possible.

PURPOSE: The health issues which have historically faced American Indians are related to infectious disease, but today many chronic diseases play a large role in the health status of this special population. For example, existing data indicate that American Indians have the poorest cancer survival of any group in the U.S. (34% vs. 50% for U.S. Whites). Regular participation in cancer screening and lifestyle factors such as smoking, diet, and alcohol have been found to significantly contribute to cancer risk. However, available information about these behaviors is sparse and suffers from limitations. The purpose of this study was to assess the prevalence of cancer risk behaviors and provider recommendation for cancer screening among urban American Indian women. METHODS: A random household cross-sectional survey was administered to 519 adult American Indian women in Phoenix, Arizona. Smoking and weight status, alcohol consumption, physical activity, and provider referral were assessed by self-report. RESULTS: The results indicate that weight (69.6% were overweight) and excessive alcohol consumption (12.1% reported chronic drinking) were significant health issues in this population. The prevalence of provider referral for smoking cessation (14.9% among ever smokers) and breast as well as cervical cancer screening (30.1% and 55.5%, respectively) were below the 75% level set forth in the Year 2000 Goals. CONCLUSIONS: The results of this study suggest that increased cancer prevention and control efforts are needed in this special population to address the link between diet, weight, and long-term disease prevention.

The Institute of Medicine (IOM) and Commission on Cancer have called for provision of treatment summaries (TSs) and survivorship care plans (SCPs) at the end of primary cancer therapy and endorsed guidelines for content. Institutions are providing TS/SCPs but with little guidance concerning concordance with IOM recommended content. This manuscript presents a recently developed tool to allow rating of breast cancer-specific TS/SCPs as a model for assessing concordance with IOM recommendations and facilitating research and clinical fidelity.An interdisciplinary team developed items mapped to the IOM recommendations for TS/SCP content as well as scoring rules. Dual raters used this tool to independently assess 65 completed TS/SCPs from 13 different cancer treatment facilities affiliated with the LIVESTRONG Survivorship Centers of Excellence to assess reliability.The final set of measures contained 92 items covering TSs and SCPs. The TS scale consisted of 13 informational domains across 60 items, while the SCP scale had 10 domains across 32 items. Inter-rater reliability within TSs indicated substantial agreement (M kappa = 0.76, CI = 0.73-0.79), and interclass correlation (ICC) was high (ICC = 0.85, CI = 0.76-0.91). For the SCP scale, inter-rater reliability was also substantial (M kappa = 0.66, CI = 0.62-0.70), as was interclass correlation (ICC = 0.75, CI = 0.62-0.84).Concordance with IOM recommendations for TS/SCP information can be reliably assessed using this instrument, which should facilitate implementation efforts, allow comparison of different TS/SCPs, and facilitate research into the utility of TS/SCPs including which elements are essential.

Weight gain following breast cancer diagnosis is common, but limited data exists on whether this gain is in excess of that gained during normal aging. This study investigated weight patterns among women with and without breast cancer to determine the effects of the breast cancer experience on weight change. Using the SHINE 4-Corners Breast Cancer Study, 305 women with breast cancer and 345 women without were followed prospectively. Weight change of ≥5% was defined as the difference between the self-reported weight measurements obtained at breast cancer diagnosis (or referent date for women without breast cancer) and about 6 yr later. Multiple logistic regression analyses were used. Within this cohort, 60% of women were overweight or obese and 37% of women gained weight. No significant greater weight gain was observed between women with vs. without breast cancer [adjusted odds ratio (ORadj) = 1.15, 95% CI 0.79-1.68] or between Hispanic vs. non-Hispanic White women (ORadj = 1.09, 95% CI 0.72-1.66) after adjustment. Weight gain was associated with being younger and having a lower body mass index. Among breast cancer survivors, cancer treatment factors were not associated with weight gain. These results suggest that weight management approaches are needed, especially those targeted to at-risk populations such as breast cancer survivors.

Body size and ethnicity may influence breast cancer tumor characteristics at diagnosis. We compared Hispanic and non-Hispanic white (NHW) cases for stage of disease, estrogen receptor (ER) status, tumor size, and lymph node status, and the associations of these with body size in the 4-Corners Breast Cancer Study.One thousand five hundred twenty-seven NHW and 798 Hispanic primary incident breast cancer cases diagnosed between October 1999 and May 2004 were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multiple logistic regression.Hispanic women were more likely to have larger (1 cm) ER- tumors and more than four positive lymph nodes (P.003). Lymph node status was not associated with body size. However, among NHW women, obesity (body mass index30) and increased waist circumference (38.5 inches) were significantly positively associated with ER- tumor status (OR, 1.87; 95% CI, 1.24-2.81 and OR, 2.59; 95% CI, 1.58-4.22, respectively). In contrast, among Hispanic women, obesity and waist circumference had inverse associations with ER- tumor status (OR, 0.49; 95% CI, 0.29-0.84 and OR, 0.56; 95% CI, 0.30-1.05, respectively).Hispanic ethnicity may modify the association of body size and composition with ER- breast cancer. This finding could have relevance to clinical treatment and prognosis.

Polymorphisms in the beta-2-adrenergic receptor (ADRB2) gene have been studied in relation to risk of type 2 diabetes and obesity, risk factors that have received increased attention in relation to breast cancer. We evaluated the hypothesis that ADRB2 variants (rs1042713, rs1042714) are associated with breast cancer risk in non-Hispanic white (NHW) and Hispanic (H) women using data from a population-based case-control study conducted in the southwestern United States.Data on lifestyle and medical history, and blood samples, were collected during in-person interviews for incident primary breast cancer cases (1,244 NHW, 606 H) and controls (1,330 NHW, 728 H). ADRB2 genotypes for rs1042713(G/A) and rs1042714(G/C) were determined using TaqMan assays. The associations of each variant and corresponding haplotypes with breast cancer were estimated using multivariable logistic regression.Two copies compared to one or zero copies of the ADRB2 G-G haplotype were associated with increased breast cancer risk for NHW women [odds ratio (OR), 1.95; 95 % confidence interval (95 % CI), 1.26-3.01], but with reduced risk for H women [OR, 0.74; 95 % CI, 0.50-1.09]. Effect estimates were strengthened for women with a body mass index (BMI) ≥25 kg/m(2) [H: OR, 0.50; 95 % CI, 0.31-0.82; NHW: OR, 3.85; 95 % CI, 1.88-7.88] and for H women with a history of diabetes [H: OR, 0.32; 95 % CI, 0.12-0.89].These data suggest that ethnicity modifies the association between the ADRB2 G-G haplotype and breast cancer risk, and being overweight or obese enhances the divergence of risk between H and NHW women.

This study evaluates the concordance of treatment summaries (TSs) and survivorship care plans (SCPs) delivered to breast cancer survivors within the LIVESTRONG™ Network of Survivorship Centers of Excellence with Institute of Medicine (IOM) recommendations and describes additional structure/process variables.Seven NCI-designated comprehensive cancer centers and six community-based centers participated. TS/SCPs for 65 patients were rated against IOM recommendations using a study-derived checklist, and surveys were administered to better understand the structure and process of delivering TSs/SCPs.On average, fewer than half of IOM content recommendations were met for TSs (M = 46%) and less than two thirds for SCPs (M = 59%). No sites achieved ≥75% overall concordance with IOM recommendations for TSs and only two of 13 met this criterion for SCPs. Content domain scores across sites varied widely, as did the number of sites addressing domain content with ≥75% concordance. Nonetheless, resources required for document preparation and delivery were substantial.Gaps in concordance with IOM recommendations exist even in dedicated survivorship centers. A substantial time burden was also noted. Further research is needed to determine which informational elements are essential, to develop and test strategies for improving efficiency and reach, and to determine if outcomes of survivorship care planning warrant the resources required in their preparation and delivery. IMPLICATIONS FOR SURVIVORS: TSs and SCPs have been recommended for all cancer survivors. Essential elements must be determined, approaches made more efficient, outcome improvements demonstrated, and cost-benefit analyses determined before survivors should expect widespread implementation of this recommendation for survivorship care.

As the field of survivorship research grows, the need for translation is imperative to expand new knowledge into arenas that directly impact survivors. This commentary seeks to encourage research focused on dissemination and translation of survivorship interventions and programs, including practice-based research. We overview diffusion, dissemination and translation in the context of cancer survivorship and present the RE-AIM and Knowledge to Action frameworks as approaches that can be used to expand research into communities. Many academic, governmental, and community-based organizations focus on cancer survivor. Future survivorship research should contribute to harmonizing these assets to identify effective interventions, maximize their reach and adoption, and integrate promising practices into routine care. Cancer Epidemiol Biomarkers Prev; 20(10); 2093–8. ©2011 AACR.