Horizons Community Solutions

In early-stage oncology clinical trials, the use of endpoints beyond overall survival (OS), including recurrence-free survival (RFS) or event-free survival (EFS), is becoming more common. To understand whether these outcomes are important to patients, this study explored the perceived value of non-OS endpoints among Canadians treated for early-stage cancer or with curative intent. Canadians treated for early-stage breast, lung, or gastrointestinal cancer participated in semi-structured interviews. Participants provided perspectives on OS, RFS, disease-free survival (DFS), EFS, and pathological complete response (pCR) endpoints. Reflexive thematic analysis was used to explore patterns in responses and alignment of trial endpoints with patient treatment goals, priorities and preferences. The mean age of the 33 participants was 54.8 years, and 21 were female; 28 reported prior surgery, and 21 were also treated with chemotherapy (11 specified as neo-adjuvant; 9 specified adjuvant). All participants valued OS, and most viewed non-OS endpoints as reflective of their treatment priorities, including maintaining health-related quality of life and getting back to 'normal'. They also valued timely and equitable treatment access and equated having access to new treatments with better options. While participants considered efficacy data from clinical trials provided by non-OS endpoints sufficient to want access to new treatments, the relative importance of being disease- or recurrence-free versus maximizing length of life differed according to recurrence status, prognosis, cancer type and life stage. These findings support the relevance and importance of non-OS endpoints to Canadians with early-stage cancer and highlight participants' desire for rapid approval of treatments with demonstrated improvements in non-OS endpoints.

We assessed the effectiveness of an intervention targeting home food and activity environments to reduce energy intake and increase physical activity among overweight and obese patients from 3 community health centers in rural Georgia. We conducted a randomized controlled trial (n = 349) from 2011 to 2013, with follow-up at 6 and 12 months. Health coaches delivered the 16-week intervention by using tailored home environment profiles showing areas in need of improvement and positive aspects of the home environment, behavioral contracts for healthy actions, and mailed support materials. Participants were mostly African American women (84.8%), with a mean age of 50.2 years and a mean body mass index (weight in kilograms divided by the square of height in meters) of 38.3. Daily energy intake decreased more for the intervention than control group at 6 (-274 vs -69 kcal) and 12 months (-195 vs -76 kcal). We observed no change for either objective or self-reported physical activity. At 12 months, 82.6% of intervention participants had not gained weight compared with 71.4% of control participants. The intervention was effective in changing home environments and reducing energy intake.

Community health centers are uniquely positioned to address disparities in colorectal cancer (CRC) screening as they have addressed other disparities. In 2012, the federal Health Resources and Services Administration, which is the funding agency for the health center program, added a requirement that health centers report CRC screening rates as a standard performance measure. These annually reported, publically available data are a major strategic opportunity to improve screening rates for CRC. The Patient Protection and Affordable Care Act enacted provisions to expand the capacity of the federal health center program. The recent report of the Institute of Medicine on integrating public health and primary care included an entire section devoted to CRC screening as a target for joint work. These developments make this the ideal time to integrate lifesaving CRC screening into the preventive care already offered by health centers. This article offers 5 strategies that address the challenges health centers face in increasing CRC screening rates. The first 2 strategies focus on improving the processes of primary care. The third emphasizes working productively with other medical providers and institutions. The fourth strategy is about aligning leadership. The final strategy is focused on using tools that have been derived from models that work.

Background-Ecological models of healthy eating and physical activity emphasize the influence of behavioral settings such as homes and worksites in shaping behavior.Research on home environments suggests that both social and physical aspects of the home may impact physical activity and healthy eating.Objective-Using a community-based participatory research (CBPR) approach, the Emory Prevention Research Center (EPRC), Cancer Coalition of South Georgia, and the EPRC's Community Advisory Board (CAB) designed and tested a coach-based intervention to make the home environment more supportive of healthy eating and physical activity for rural adults.Methods-The 6-week intervention consisted of a tailored home environment profile, goalsetting, and behavioral contracting delivered through two home visits and two telephone calls.The study used a quasi-experimental design with data collected via telephone interviews at baseline, 2 and 4 months post-baseline.Ninety households (n = 90) completed all three telephone interviews.Results-Multilevel models indicated that intervention households reported significant improvements in household food inventories, purchasing of fruit and vegetables, healthier meal preparation, meals with the TV off, and family support for healthy eating, relative to comparison households.Intervention households also reported increased exercise equipment and family support for physical activity relative to comparison households.Percent of fat intake decreased significantly, but no changes were observed for fruit and vegetable intake, physical activity, or weight among intervention relative to comparison households, although trends were generally in a positive direction. Conclusion-Coaching combined with a focus on the home environment may be a promising strategy for weight gain prevention in adults.