The Cancer Moonshot and the key role of behavioral and social sciences

The Cancer Moonshot and the key role of behavioral and social sciences

By William Elwood, Ph.D.

Prevention, screening, detection, collaboration, information sharing, patient-physician communication, and barrier breaking all seem to be crucial for landing in the new moon of a world with a cure for cancer. A moonshot indeed.

What else all of those have in common? They all involve individual and collective behaviors.

Last May, JAMA Oncology published a Harvard analysis of 135,910 participants in publicly available datasets and found that habits and practices accounted for 25% of carcinoma occurrence in women, and 33% among men. These lifestyle behaviors accounted for 48% of carcinoma deaths in women and 44% in men. Unsurprisingly, they concluded, “A substantial cancer burden may be prevented through lifestyle modification. Primary prevention should remain a priority for cancer control.”

Lifestyle behaviors accounted for 48 percent of carcinoma deaths in women and 44 percent in men

In January 2016, President Barack Obama rallied, “America [to be] the country that cures cancer once and for all.” Vice President Joe Biden elaborated, “We’re talking about prevention and early detection” plus “game-changing treatments” for “people who need them.”

NIH Director Dr. Francis Collins and Acting National Cancer Institute (NCI) Director Douglas R. Lowy wrote,

Much of this success [reducing cancer deaths by 23% over the last 25 years] has been fueled by strong, sustained federal investments in basic, epidemiologic, and clinical research and resulting advances in prevention, screening, diagnosis, and therapy.

Still, prevention isn’t a panacea. That’s why health-literacy researchers merge myriad social-behavioral and medical disciplines to ensure “the success of each interaction between health care professionals and patients—every prescription, every treatment, and every recovery.” NIH’s web-based resources provide patients with information and communication skills to help them understand diagnoses and treatments, and facilitate recovery.

Lifestyle change could prevent big cancer burden so primary prevention should remain priority 4 cancer control

During a June 29 Cancer Moonshot meeting, Vice President Biden chided researchers for their recalcitrance to share data collected through federally-funded research projects, although a 2008 federal law requires these researchers to provide such datasets to clinicaltrials.gov within a year of a research grant’s completion. Collins said NIH soon will implement rules with “teeth.”

NIH’s Human Genome, Cancer Genome Atlas, and immunological research projects have enhanced diagnoses and treatments—and facilitated much to reduce cancer deaths by almost one-quarter over the last quarter century. Drs. Lowy and Collins continue to lead in this regard and expect,

  • “To overcome barriers that often prevent collaboration and information sharing among the various groups working to defeat cancer and that limit access to state-of-the-art research.”
  • To retrieve “input from the patient community and [to] ensure that patients and their families are treated as partners, with access to their own health information and opportunities to contribute to research.”

Data sharing issue will be solved by forthcoming rules with teeth #cancermoonshot

No patients, especially cancer patients, exist in a vacuum. In addition to healthcare providers, patients have friends, families, neighbors, colleagues. We know that people with cancer who count on the (in-person and mobile phone) support of others often do better in treatment than patients living in isolation. Lack of social support can lead some people to abandon cancer treatment, while biobehavioral research finds that mindful exercise helps cancer survivors’ behavioral, psychological, and neurohormonal well-being.

Greg Simon, Cancer Moonshot Executive Director, said the project gives us “a chance to change the culture of science.” Culture change requires collective attitude and behavior change, among everyday people, medical practitioners, research funders, and health researchers. NIH may issue a regulation with “teeth” so investigators will share data; organizational and industrial psychologists (among other experts) have the expertise to influence others to create a collaborative scientific culture.

White House Cancer Moonshot mtg VP Biden called on researchers to share data collected from federally-funded research

Regarding culture change, NIH/OBSSR funded an 18-month project with 30 researchers trained in anthropology, medicine, nursing, psychology, psychiatry, public health, and sociology, who recommended that health researchers recognize that each research participant exists “within a multi-level, multi-dimensional, biopsychosocial, ecological framework” and that those levels and dimensions reflect personal “geographic, historical, social, and political” experiences.

Researchers equally exist in multi-dimensional cultural frameworks. Curing cancer requires these many dimensions to overlap with one another. How? Researchers and participants, regardless of academic discipline, must communicate ideas and results with one another using terms everyone understands.

Culture change requires collective attitude and behavior change #cancermoonshot

The public conversations on the Cancer Moonshot implicitly reference social and behavioral sciences. For example, the City of Miami Beach created a partnership with a local cancer center and suntan lotion manufacturer to provide at least 50 free SPF30 sunscreen dispensers available in the city’s parks and beaches through 2021. Skin cancer is the most commonly diagnosed cancer in the U.S.; yet news reports on this project state this five-year project celebrates the city’s centennial, its local hospital, and the local suntan-lotion manufacturers. There is no news on whether and how this partnership will evaluate the preventive- and cost-effectiveness of this intervention. Social and behavioral scientists naturally ask and answer such questions—and to recommend whether and how other communities might benefit by implementing it.

According to the Vice President, everyone’s aboard the Cancer Moonshot. If almost 50% of cancer deaths are related to habits and behaviors, it seems appropriate that a similar percentage of scientific disciplines should be on board to prevent them.

REFERENCES

De Jongh, T., Gurol-Urganci, I., Vodopivek-Jamsek, V., Car, J., & Atun, R. (2012). Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database of Systematic Reviews, 12, CD007459. DOI: 10.1002/14651858.CD007459.pub2.

Gurol-Urganci, I., de Jongh, T., Vodopivek-Jamsek, V., Atun, R., & Car, J (2013). Mobile phone messaging for attendance at health care appointments. Cochrane Database of Systematic Reviews, 13, CD007458. doi: 10.1002/14651858.CD007458.pub3.

Harris, G. (2016, March 18). Biden names leader for ‘Moonshot’ cancer campaign. The New York Times. Accessed at, http://www.nytimes.com/2016/03/18/us/politics/biden-names-leader-for-moonshot-cancer-campaign.html?_r=0, 30 June 2016.

Kagawa-Singer, M., Dressler, W.W., George, S.M., & Elwood, W.N. (2015). The cultural framework for health: An integrative approach for research and program design and evaluation. Bethesda, MD: NIH Office of Behavioral and Social Sciences Research.

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Lowy, D.R. & Collins, F.S. (2016). Aiming high: Changing the trajectory for cancer. New England Journal of Medicine, 374, 1901-1904. DOI: 10.1056/NEJMp1600894

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Song, M & Giovannucci, E. (2016, May 19). Preventable incidence and mortality of carcinoma associated with lifestyle factors among white adults in the United States. JAMA Oncology, DOI:10.1001/jamaoncol.2016.0843

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Author.

Vodopivek-Jamsek, V., de Jongh, T., Gurol-Urganci, I., Atun, R., & Car, J (2012). Mobile phone messaging for preventive health care. Cochrane Database of Systematic Reviews, 12, CD007457. doi: 10.1002/14651858.CD007457.pub2.

Williams, J. (2016, June 29). White House announces next steps on cancer moonshot. CQ Rollcall.

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