Transcript Cancer - Native American Cancer Research

Native Cancer 101:
Module 9: Chronic Conditions and
Cancer
Kathleen Ragan, BS, CHES
Linda Burhansstipanov, MSPH, DrPH
(Cherokee Nation of Oklahoma)
Native American Cancer Initiatives, Incorporated
Linda U. Krebs, PhD, RN, AOCN, FAAN, Oncology Consultation,
Education and Advocacy Network (OCEAN)
Kerri Lopez, BS, Tolowa Nation,
Northwest Portland Area Indian Health Board
Paulette Baukol, BS, Mayo Clinic, Rochester, MN
Dana Kontras,RN, Mayo Clinic, Jacksonville, FL
Audience Response
System (the Keypads)
(TP)
Turning Point Keypads
Lanyard
that
goes
around
your
neck
These are
NOT
calculators
and need to
be returned
to the faculty
at the end of
the session
please
Audience Response System (ARS) – keypads
This is how we vote on different items and issues
Although the keypads are “anonymous” (we don’t
know who uses which keypad); but we would like
you to use the same one throughout the workshop
You do not need to “point” the keypad (like a TV
remote control)
You will see a counter on the screen that shows
how many people have “voted” on any item
You press the number on the keypad that best
describes your answer (use “0” for “10” on the
keypad)
Demographic items
(TP, 6)
What is your gender?
1. Male
2. Female
3. Don’t want to answer
About How Old are You?
1.
2.
3.
4.
5.
6.
7.
8.
9.
81 and older
65-80
50-64
41-49
31-40
21-30
13-20
Under 12
Don’t want to answer
0%
1
brthyr5
What is Your Primary Race?
1. American Indian / Alaska Native
(AIAN)
2. Pacific Islander
3. Asian
4. African-American
5. Non-Hispanic white (Caucasian)
6. Other
7. Don’t know / Don’t want to answer
Are you Hispanic, Latino or Chicano?
1.
2.
3.
4.
Yes
No
Don’t Know / Not sure
Don’t want to answer
How Much Schooling have You Completed?
1. Elementary (kindergarten to grade 6 / grade school)
2. 7th , 8th , or 9th grade (middle school)
3. 10, 11, or 12th grade (no degree)
4. High school graduate / GED
5. Technical school /apprentice training
6. Some college (no degree)
7. College AA degree
8. College BA, BS degree
9. Masters’ degree
10. Doctorate or more
Which of the Following Bests Describes You?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Community leader
Community member
Student
Teacher / Faculty
Researcher / Scientists
Healthcare provider (MD, RN, etc.)
Outreach recruiter
Cancer patient, survivor
Other
Don’t know / Don’t want to answer
13
1
Role2
4 Pre-Session
Knowledge Items
Which is an example of an “acute” condition?
1.
2.
3.
4.
5.
Cancer
Arthritis
Trauma (car accident)
Diabetes
Don’t know / Not sure
What is the cause of most (~90%) of all
cancers?
1. Family history
2. Smoking for 5 years
3. Being exposed to
radiation
4. Lifestyle and physical
environment
5. Don’t know / Not sure
If a “breast” cancer cell spreads to the
kidney, what is the new cancer called?
1.
2.
3.
4.
5.
New primary cancer
Recurrent breast cancer
Breast cancer
Kidney cancer
Don’t know / Not sure
Which is NOT part of the “triple triple” threat
of diabetes among American Indians?
1. ~ 3 times the risk of cancer
2. ~ 3 times the risk of heart disease and
stroke
3. ~3 times the risk of kidney failure
4. ~3 times the risk of death
5. Don’t know / Not sure
Cancer 101
Basics and Background
QUESTION: Why do you think we are taking
time to talk specifically about cancer?
Because cancer is now the 2nd leading
cause of death for AIs over 45 years old.
Cancer is continuing to increase with
AIANs even through the disease is
becoming less common among whites.
The primary reason for our continued
increase is due to our daily behaviors
What we eat, drink and smoke
How we get physical activity
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
18
AIAN Patterns of Cancer
Different Types of Cancer by Geographic
Region and Tribal Nation; such as:
Prostate cancer among northern plains
comparable to African Americans and
Whites
More stomach, kidney and gallbladder
among Southwestern tribal nations
More CRC, breast and lung among AK,
northern plains and southern plains
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
19
Examples of Different Patterns of Cancer Sites
and Access
More cancers among AIANs who live in Alaska,
Northern Plains and Southern Plains
BUT, even in Southwest, selected types of cancer
continuing to increase and there are significantly
more AIs living in SW than in other regions of US
Burden of disease is extreme
Average interval from biopsy (diagnosis) to initiation
of cancer care is 6 months for AIAN women and 9
months for AIAN males
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
20
QUESTION: What is cancer?
A group of over 100 diseases in which
abnormal cells
Divide without control
Don’t die when they should (Apoptosis)
Cancer:
Is primarily a disease of older people
Occasionally occurs in young people
(e.g., childhood leukemia, cervical,
testicular)
But, the majority of cancers appear in
people who are older (over 45)
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
21
What is cancer? (continued)
Cancers are identified by the place they
originate within the body. For example:
Breast
Cervix
Colon
Prostate
Pancreas
Stomach
Brain
Bladder
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
22
Normal Cells
Excerpt from the Kansas State University “coloring book”
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
23
Cancer Cells
Excerpt from the Kansas State University “coloring book”
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
24
Cancer (CAN-sir)
Cancer cells have the ability to spread from
one part of the body to another part of the
body
When cancer cells go to another body part,
they can begin to grow without control in the
new location
But a breast cancer cell in the liver is still
“breast cancer” (primary site)
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
25
Metastasis (ma-TAS-sta-sis)
This means that cancer cells have
spread from one body part to another
The cancer cells spread from the
"primary site" to other
organs by traveling
through the blood
vessels or lymph vessels
QUESTION: What is the
lymphatic system?
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
26
Diagnosis (die-egg-NOH-sis)
The process and result of
determining if the symptoms
or evidence of cancer is
really cancer
QUESTION: What type of
information does the provider
need to make a diagnosis?
Ruby Wells
I had a mammogram 6 months prior to finding a lump
and thought I was in the clear. … I give myself a self- Cherokee Nation of OK
Dx. breast 2001
breast exam and I located a knot. I went to the doctor
and they proceeded with tests. …. they thought it was a
cyst, but I still never thought it could be cancer…when
the surgery was over the doctor told me it had grown to
9 cm.
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
27
Diagnosis (die-egg-NOH-sis)
The Provider…
Asks about symptoms
suspicious
Asks about medical
history
Performs a physical exam
Orders tests and imaging
procedures
Performs biopsy--to
determine whether cancer
cells are present
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
28
Biopsy (bye-OP-see)
The physician takes a piece of tissue (a
group of cells) from the growth or cyst
Sometimes these cells are cut, and other
times they are "sucked" out with a needle
(fine needle aspiration)
These cells are examined by a "pathologist”
A biopsy is a sure way to make a diagnosis
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
29
QUESTION: What is a Tumor (TOO-mer)
Normally, cells grow and divide to produce
more cells only when the body needs them
This keeps the body healthy
Sometimes cells keep dividing when new
cells are not needed
Or the cells do not know how to die
(apoptosis)
These extra cells form a mass of tissue,
called a growth or tumor
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
30
Tumor (TOO-mer)
This is a growth or mass formed by excess
cells
A "benign" tumor is not cancer and it does
not “become” cancer. It just stays “benign”
8 out of 10 tumors are not cancer (they are
"benign")
A "malignant" tumor is cancer and can
spread to other parts of the body
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
31
Two types of tumors:
Benign tumors:
not cancer
can often be removed
in most cases do not
come back
do not spread to other
parts of the body
rarely a threat to life
Malignant Tumors
are cancer
cells abnormal
cells divide
without control or
order
enlarge “mass”
metastasize
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
32
Cancer Develops Over Time
It is a result of a complex mix of factors
related to:
Lifestyle (daily behaviors)
Environment
Heredity (~5-10%)
These are called risk factors
See Breast Risk / Health Protection Shield
on NACR web site http://www.NatAmCancer.org
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
33
Examples of “Risk Factors”
Foods and drinks we consume
Tobacco use
Lack of physical activity
Exposure to environmental
contaminants
Spiritual distress
Social distress (dysfunctional
families, neighbors or work
settings)
“Once an Elder asked me
what I smoked. So, I took out
a cigarette. He measured it
and said, ‘It’s such a small
thing that you let control you.’
I quit smoking that day.”
- Edward McCarty, Cherokee
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
34
Behaviors that help “protect” the shield of health
against cancer include:
Daily physical activity
Healthy, low fat diet
high fruits and vegetables
Maintain recommended body weight
Limited to no alcohol
No store-bought tobacco use
limit tobacco to ceremonial use only
Follow cancer screening guidelines
Knowing your personal risk factors
ex. history of polyps, exposure to
cigarette smoke, or your family’s history
“Cancer 101”
Bear (True) vs. Coyote Trickster (False)
5 items
Native American Cancer Research 303-838-9359
Fact vs. Fallacy
36
Ceremonial tobacco use is just as dangerous
as habitual cigarette smoking.
Coyote / False
The lifestyle our ancestors lived put them more
at risk for getting cancer. Coyote / False
If a “breast” cancer cell spreads to the kidney,
the new cancer is still referred to as “breast
cancer”
Bear of Truth
Native American Cancer Research 303-838-9359 Fact vs. Fallacy
37
About 30% of all cancer deaths are directly
related to habitual smoking. Bear / True
Cigarette smoking is the single most
preventable cause of cancer in the US.
About 25% (1/4) of all cancers are
inherited from your parents.
Coyote / False – Answer: 5-10%
Native American Cancer Research 303-838-9359
Fact vs. Fallacy
38
Introduction to
Chronic Conditions
QUESTION: Why is Understanding Chronic
Conditions Important to AIANs?
Leading causes of death among adult
AIANs
Leading causes of conditions that interfere
with our daily quality of life
I want my grandchildren to live long, healthy lives like
our ancestors. Today we forget how to act in ways
that honor those who came before us. Our ancestors
didn’t have these diseases.
Anonymous AI, 2011
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
40
Objective 1:
Distinguish between a health
condition that is acute versus
one that is chronic.
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
41
Definitions
Acute (uh-KYOOT) condition:
A condition or disease that begins and
worsens quickly.
Usually lasts less than a year.
If managed well will resolve (or improve
and become chronic).
What would be an example of an
acute illness?
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
42
Examples of Common Acute
Conditions
Cold or flu
Infection
Trauma (car accident, broken leg)
Allergic reactions
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
43
Definitions
Chronic (KRAH-nik) condition:
A condition or disease that persists or
progresses over a long period of time.
May have previously been acute
Can be managed, but usually does not
go away completely
What would be an example of a
chronic condition?
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
44
Examples of Common Chronic
Conditions
Heart Disease
Cancer
Diabetes
High blood pressure (hypertension)
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
45
Characteristics of Chronic
Conditions
Lasts 1 year or longer
Requires ongoing
medical care
Limits daily activities
Often interferes with
one’s quality of life
“We tell each other what our
blood sugar readings are.
And, we remind each other to
take our medicine.”
– Gwen Barnett
Muscogee (Creek)
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
46
Objective 2
Identify at least 3 common
chronic conditions in AIAN
communities.
47
Common Chronic Conditions
The most common, costly, and
preventable chronic conditions in the
U.S. are:
Heart disease
Cancer
Diabetes
Arthritis
Obesity
This is true for AIANs too
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
48
Examples of Other Chronic
Conditions
Stroke
Substance abuse and addiction disorders
Mental illness
Dementia
Cognitive impairment disorders
Developmental disabilities
NOTE: Heart disease, cancer and stroke
account for ½ of all deaths each year.
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ;
Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated
(NACI)
49
Burhansstipanov, Native American Cancer Initiatives, Inc. (NACI) subcontract to Mayo
Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605];
50
Indian Health Service, Regional
Differences
in Indian
Health,
2002-2003. Data from 1999-2001
Northwest
Portland Area
Indian Health
Board
Heart (Cardiovascular) Disease (CVD)
AIANs have the highest percentage (36%) of
deaths from premature heart disease.
This is nearly 2½ times that of whites.
AIANs have more risk factors for CVD than
do Non-Hispanic Whites
Obese
High blood pressure (21% to 41% AIs)
Commercial tobacco use (15 to 70% AIs)
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
51
Cancer
Now considered a chronic disease
Most common types among AIANs are:
Breast
Lymphoma
Ovarian
Lung & Bronchus
Pancreas
Colon & Rectum
Cervix
Corpus & Uterus
Thyroid
Kidney & Renal
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
52
Diabetes
Type 2 diabetes – caused by body’s
resistance to the action of insulin and by
impaired insulin secretion.
Most AIANs with diabetes have type 2
usually develops in adults but within AIAN
communities it is no longer uncommon for
diabetes to develop in children and
adolescents.
A small number (2-4%) have type 1 diabetes.
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
53
Diabetes (cont)
The “TRIPLE TRIPLE” of diabetes in
Native America
~3x risk of heart disease and stroke
3.5x risk of kidney failure
3x rate of death
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
54
Diabetes (cont)
Diabetes can be PREVENTED
Disease and early death is not inevitable.
It is never too late to change and improve
health.
Family & community efforts are the key
7% weight loss from 150 min of activity per
week and healthy meals can reduce the risk of
diabetes by > 50%
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
55
QUESTION: What is the relationship between
Diabetes and Cancer among AIANs?
30+% of AI/AN over age 55 have
diabetes
38% of AIANs (n-822) in “Native
American Cancer Education for
Survivors” survivorship program
have both diabetes and cancer
Diabetes is associated with a 30%
increased risk of colon cancer
Larsson SC et al JNCI 2005;97:22: 1679-87
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
56
Objective 4:
Describe how
co-morbidities
impact cancer and
quality of life.
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
57
Co-Morbidities AND Cancer
Many older adults with cancer often have
one or more other chronic conditions, such
as:
Diabetes, heart disease, depression,
arthritis, obesity, menopausal symptoms
All contribute to quality of life (ability of the
individual to do everything they want to do
body, mind, emotions and spirits)
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
58
Co-Morbidities AND Cancer
Diabetes and cancer have similar risk
factors (unhealthy diet, lack of physical
activity, obesity)
Organs / systems damaged by diabetes
include eyes / vision, nerves (peripheral),
kidneys, immune system
Organs / systems damaged by cancer /
cancer treatment include nerves
(peripheral), liver, immune system
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
59
Co-Morbidities AND Cancer
Survivors who have both diabetes and
cancer have significantly more problems
that can affect quality of life
Chemo medications may interfere with
insulin management
Insulin management may interfere with
absorption of chemo medications
Resulting in increased problems / side
effects of both diseases
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
60
Concerns for people with chronic
conditions AND cancer
AIAN Cancer Survivors, Denver, CO 2009
Lack of information
Potential impact on:
Quality of life
Ability for self-care
Cancer treatment
decisions
Cancer treatment
outcomes
Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest
Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)
61
How Can I Get Cancer Screenings?
Doctor recommendation or referral.
You can also ask your doctor to send you for a screening if you
have symptoms (ex. breast lump).
Veterans Administration (VA) hospitals and clinics (for vets only).
Private insurance or Medicare can pay.
Check with local health department or clinics.
State, community programs may also pay for specific tests.
Contact local Community Health Educator/Worker.
Excerpt from Get on the Path for Breast Health Native American Cancer Research 1-800537-8295; http://www.NatAmCancer.org; sponsored by
Mayo Clinic’s Spirit of Eagles Communities Network Program 2 [NCI1U54CA153605]
Medicare
Medicare can pay for people 65 years of age and older:
Mammogram once a year
Pap Test once a year
CRC screening for people who do not have symptoms, are “at
average risk” (compared to “high risk”), and are 50 and older*
FOBT once a year
Sigmoidoscopy once every 4 years
Colonoscopy every 2 years for “high risk” people
PSA blood test
Lung screening (pays for diagnostic tests if you have symptoms)
Excerpt from Get on the Path for Breast Health Native American Cancer Research 1-800537-8295; http://www.NatAmCancer.org; sponsored by
Mayo Clinic’s Spirit of Eagles Communities Network Program 2 [NCI1U54CA153605]
“Chronic Conditions and
Cancer”
Bear (True) vs. Coyote Trickster (False)
5 items
Native American Cancer Research 303-838-9359
Fact vs. Fallacy
64
About 15% of AIANs have diabetes.
Coyote / False – Answer: ~30%
The “triple triple” threat for diabetes among
AIANs is >3 times the risk of heart disease
and stroke, kidney failure and death.
,
Bear of Truth
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
65
The most common chronic conditions
experienced by AIANs are cancer, diabetes
and HIV infection
Coyote / False
AIANs have nearly 2½ times deaths from
cardiovascular disease (CVD) than whites.
Bear of Truth
“Chronic” conditions mean they last at
least 5 years
Coyote / False – Answer ~1 year +
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
66
Post Session
Knowledge Items (TP)
4 items
67
Which is an example of an “acute” condition?
100%
1.
2.
3.
4.
5.
Cancer
Arthritis
Trauma (car accident)
Diabetes
Don’t know / Not sure
0%
1
0%
2
0%
3
4
0%
5
What is the cause of most (~90%) of all
cancers?
1. Family history
2. Smoking for 5 years
3. Being exposed to
radiation
4. Lifestyle and physical
environment
5. Don’t know / Not sure
86%
14%
0%
1
0%
2
3
0%
4
5
Which is NOT part of the “triple triple” threat
of diabetes among American Indians?
57%
1. ~ 3 times the risk of cancer
2. ~ 3 times the risk of heart disease and
stroke
3. ~3 times the risk of kidney failure
4. ~3 times the risk of death
14% 14%
14%
5. Don’t know / Not sure
0%
1
2
3
4
5
If a “breast” cancer cell spreads to the
kidney, what is the new cancer called?
1.
2.
3.
4.
5.
New primary cancer
Recurrent breast cancer
Breast cancer
Kidney cancer
Don’t know / Not sure 13%
38%
25%
25%
0%
1
2
3
4
5
Workshop
Evaluation (TP)
5 items
(you won’t see the answers)
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
72
Overall, how understandable was the presentation?
1. Very understandable
2. Fairly understandable
3. Not understandable
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
73
E_undrst
Overall this session provided useful
information to me.
1. I strongly agree
2. I agree
3. I don’t agree
4. I strongly disagree
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
E-useful74
Overall, what was the quality of the
information content of the presentation?
1. High
2. Average
3. Low
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
75
E_quality
Would you recommend this workshop to your
friends or colleagues?
1. Yes
2. Maybe
3. No
4. Not Sure
Cancer 100 “Overview of Cancer” (Burhansstipanov)
Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
E_rec76
Would you be interested in attending
another workshop?
1. Yes, on Breast Cancer
2. Yes, on Cervix Cancer
3. Yes, on Colon Cancer
4. Yes, on Lung Cancer
5. Yes, on Prostate Cancer
6. Yes, on a combination of cancers
7. Yes, on Genetics and Cancer
8. Yes, on Biospecimens and Biobanking
9. No
10.Not Sure/Don’t want to answer
E_rec
Thank you for
allowing me to
share this
workshop
information
with you