Healthy People 2020: Cancer

According to the Center for Disease Control and Prevention (CDC), “Healthy People 2020 is the federal government’s prevention agenda for building a healthier nation. The vision of Healthy People 2020 is to have a society in which all people live long, healthy lives.” (​ Centers for Disease Control and Prevention [CDC], 2016). The focus of this paper is the current cancer population; explaining and discussing the targeted goals and objectives regarding cancer patients that were presented in Healthy People 2020. They include current interventions used for treatment, health promotion behaviors, and progress that has been made since 2010 regarding the screening of cancer patients.

“The Cancer objectives for Healthy People 2020 support monitoring trends in cancer incidence, mortality, and survival to better assess the progress made toward decreasing the burden of cancer in the United States” (Office of Disease Prevention and Health Promotion [ODPHP], 2016). Healthy People 2020 has implemented this objective for all types of cancer.

There are multiple types of cancer, which are all equally important and unique in their own way. Each individual type of cancer has various treatment modalities, depending on which area of the patient’s body is affected. Healthy People 2020 has a main focus on the top three types of invasive cancers and how to screen for such diagnoses including: breast cancer, cervical cancer and colorectal cancer.

Whether it is a family member, a friend, or yourself receiving a cancer diagnosis, your life is forever altered. The targeted goal that Healthy People 2020 have created is to “Reduce the​ number of new cancer cases, as well as illness, disability, and death caused by cancer. The objectives reflect the importance of promoting evidence-based screening for cervical, colorectal, and breast cancer by measuring the use of screening tests identified in the


U.S. Preventive


​


e








Services Task Force (USPSTF)







​


recommendations

” (ODPHP, 2016). In order to meet this goal,​  the USPSTF has implemented specific protocols to screen for various types of cancer.

The USPSTF has established that certain invasive cancers are preventable by reducing risk factors in your everyday life such as: avoiding the use of tobacco or any form of smoking inhalation including vaping, reducing the exposure to UV radiation/sunburns and sun exposure, and avoiding obesity and malnutrition by performing daily exercise/healthy eating habits. Healthy People 2020 also informs readers that other cancers can be prevented by getting vaccinated against human papillomavirus (HPV) and hepatitis B virus ​(​ ODPHP, 2016). Through the limiting of these risk factors, families can put healthy practices into place starting in childhood to prevent a future diagnosis of cancer and promote health and wellness for a lifetime.

Healthy People 2020 identifies ways individuals can benefit from annual screenings that identify patients at increased risk for certain cancers. “Screening is effective in identifying some types of cancers in early, often highly treatable stages including; breast cancer (using mammography), cervical cancer (using Pap test alone or combined Pap test and HPV test), colorectal cancer (using stool-based testing, sigmoidoscopy, or colonoscopy). For cancers with evidence-based screening tools, early detection must address the continuum of care from screening to appropriate follow-up of abnormal test results and referral to cancer treatment” (ODPHP, 2016). These screenings are critical in the early detection, diagnosis, and initiation of treatment for patients to achieve the best possible outcome, as early detection indicates early treatment and an early remission process. After all, there is only one shot at this life and we are given one body, and it is our job to keep our body in the best shape possible throughout that lifetime.

Within the last 10 years, unfortunately, the targeted goal Healthy People 2020 had hoped for was not met with the screening of cancers. “Progress toward meeting these objectives is monitored by measuring cancer screening test use against national targets using data from the National Health Interview Survey (NHIS). Analysis of 2015 NHIS data indicated that screening test use remains substantially below HP2020 targets for selected cancer screening tests. Although colorectal cancer screening test use increased from 2000 to 2015, no improvements in test use were observed for breast and cervical cancer screening” (ODPHP, 2016).​ It is an improvement​

that the screening for colorectal cancer was implemented; however, cervical cancer and breast cancer screening rates remained stagnant. The NHIS proceeded to investigate further as to why this is the case.

The National Health Interview Survey (NHIS), CDC/NCHS reviews the use of cancer screenings being utilized in the United States. The NHIS focuses on why there may be disparities​ between the screenings of colorectal cancer versus various other types of cancer screenings. “Disparities exist in screening test use by race/ethnicity, socioeconomic status, and health care​               access indicators. Increased measures to implement evidence-based interventions and conduct targeted outreach are needed if the HP2020 targets for cancer screening are to be achieved and the disparities in screening test use are to be reduced” (White, et al., 2017). Coverage with health insurance and ‘paying out of pocket’ for certain screenings are a significant encumbrance as to why some are unable to complete the Healthy People 2020 targeted goal. Colonoscopies are one of the major ways health care providers screen for colorectal cancer, most insurance companies will cover colonoscopies if you are above the age of 50 due to the high rates of colorectal cancer. If the individual has health insurance coverage that does not cover certain screenings that the patient wishes to undergo, including mammograms and pap smears, the patient now has to pay out of pocket for the test. These tests can cost hundreds to thousands of dollars each, something that is simply not feasible for most working-class Americans to be able to afford. If the patient does not have a family medical history of such cancers and are wishing to screen for cancer due to pain/discomfort in the certain region of the body, they may opt out of the testing due to financial reasons. If they opt out of the screening, they are putting themselves at risk physically but if they perform the tests, they are putting themselves at risk financially. Patients are put in an impossible decision to decide being able to keep their home and feed their families, or early detection of a potentially fatal diagnosis.

With the new data about the decrease in cancer screenings, The Affordable Care Act (ACA) has provided hope towards progress in achieving the Healthy People 2020 objectives. The ACA is providing cancer screening to all individuals, regardless of your health insurance coverage. “The Affordable Care Act has helped to reduce such barriers by expanding insurance coverage and eliminating cost sharing, in most insurance plans, for preventive services such as breast, cervical, and colorectal cancer screening rated A and B by the USPSTF” (White, et al., 2017). This provides Americans with access to health care they can afford, which means that people will be able to participate in recommended annual screenings without being buried by medical debt. Some cancer screenings are advised when you reach a  certain age in life and are recommended every so often, like the colonoscopy screening upon your 50​th​ birthday, or an annual mammogram beginning at age 45. **Maybe use a source for these facts?**​

“The progress in increasing use of colorectal cancer screening is promising, but more needs to be done if the HP2020 target is to be achieved. The lack of progress for breast and cervical cancer screening use highlights the need for more initiatives to reach persons facing barriers to screening. Persons without a usual source of health care and the uninsured had the lowest test use, with the overwhelming majority of the uninsured not up to date with breast and colorectal cancer screening” (Bentio, et al., 2017). There are multiple ways the health care provider can use patient education regarding the importance of cancer screening. If the individual does not have a primary care provider due to financial disturbances, they will not receive the same patient education and reminders.

The

Community Preventive Services Task Force (CPSTF


)



​

recommend

​

s

the use of​ client reminders to increase colorectal cancer screening with fecal occult blood testing based on strong evidence of effectiveness. “Client reminders are written (letter, postcard, email) or​ telephone messages (including automated messages) advising people that they are due for screening. Client reminders may be enhanced by one or more of the following: Follow-up printed or telephone reminders, additional text or discussion with information about the indications for, benefits of, and ways to overcome barriers to screening, assistance in scheduling appointments” (ODPHP, 2016).

If the patient has a primary care provider they see on a regular basis, they will continuously hear the need and importance for these screenings each time they visit the office. In most offices, there are visual boards and posters inside the waiting room as well as individual treatment rooms identifying the importance of health promotion including cancer screening. Often times there are also pamphlets, magazines and TV channels that are directed towards these topics. The patients who do not have a primary care provider will not hear the suggestions for the recommended screening, they will not have access to assistance with scheduling appointments and they will not see the health care promotions in office. Lack of a reliable primary care provider puts patients at a huge disadvantage when it comes to preventive care and screenings. “The objectives for Healthy People 2020 assess whether people understand​ and remember the information they receive about cancer screening. Research shows patients cite a recommendation from a health care provider as the most important reason for having cancer screening tests​

”

​(ODPHP, 2016).

In order to achieve their goal of the increased cancer screening throughout the United States, there needs to be some changes with the health care coverage and financial portion of the process. “Progress toward achieving the HP2020 targets will require implementation of evidence-based interventions to increase cancer screening. Such interventions can be both provider- and patient-oriented. Screening among some racial and ethnic minorities and medically underserved populations is suboptimal and innovative approaches to eliminate these disparities might be needed” (Slyne, et al., 2017). Along with the screening, patient education and nursing interventions at bedside remain critical components of community health care promotion.

Nurses play a huge role in the promotion of health care and guiding our patients towards the goals outlined in Healthy People 2020.  Ever present at the bedside, nurses are their patients’ trusted navigator through the scary and unknown; guiding them not only physically, but emotionally and spiritually towards health and recovery.  Through our patient education teachings, we can help steer our patients towards a great understanding and sense of control when it comes to making positive decisions regarding their health.  We can translate foreign medical terms into concepts that the patient can truly understand and provide the support that is needed to face scary realities and make tough choices following a cancer diagnosis.

The cancer diagnosis is only the first step, what follows that diagnosis is what brings on stress, emotions, and financial burdens that will change the life of the patient and their family. With chemotherapy and radiation comes hair loss, weight loss, constant hospital admissions, and general fatigue. Surgery means a change in physical appearance and pain which will alter their self-esteem, body image, and often leads to depression. It can be completely traumatizing losing a portion of your body that had to be cut out and removed due to the diagnosis of cancer. Nursing education and spiritual healing are so important at that moment, and it is the nurse’s duty to ensure that a holistic approach is taken with the patient, not only focusing on the medicine, but the soul of the person they’re treating.

Jan Preston wrote a fantastic article that marks the importance of the nurse’s role in prevention of cancer. In her article she explains how nurses need to lay a groundwork of education with their patients, referring to how one needs to walk before they can run. “Because cancer is not a single disease and each cancer experience is individual, outcomes can be hard to predict, and fear of the unknown during that journey and beyond can be overwhelming. The need to change the environment to ensure the healthy choice is the easiest choice is missing. It mentions healthy weight, healthy eating, physical activity and fewer people smoking. Increased cessation advice is to be given in hospitals and primary health-care settings” (Pearson, 2015).

With the little progress the 2010-2020 goals, some major aspects need to change in order for the CDC and Healthy People to meet any goal they attempt to implement. Nursing care can assist in this cause by using a holistic model approach during nursing education. This can include helping patients find an AA meeting, making a weight loss goal that is within limits, creating a food diary to track intake/output and searching for apps to assist with weight loss goals and at home exercises.

The goals for Healthy People 2020 are designed to decrease the number of diagnosed cancer patients and mortalities. In order to meet this goal many things need to change, including: patient education, insurance coverage and health care promotion. The aspect of nursing that correlates with this goal is to understand the impact of the cancer diagnosis and how to care for someone who has a recent cancer diagnosis or currently undergoing treatment. It also touches upon how nurses can use patient education to ensure patients will want to take care of themselves and make positive healthy choices in their everyday lives. Every cancer treatment plan individualized for that specific patient, it is imperative that nurses ensure they utilize the evidence-based practice of the holistic model of care. It takes a special person to become a nurse, but an extra special nurse to specialize in oncology.

References

• Benito, L., Lluch, M. T., Falcó, A. M., García, M., & Puig, M. (2017). Identifying nursing interventions in a cancer screening program using nursing interventions classification taxonomy.
  
  International Journal of Nursing Knowledge
  
  ​              ​,
  
  28
  
  ​ ​(2), 70–75. https://doi.org/10.1111/2047-3095.12115
• Mahon, S. M. (2018). Cancer Prevention and Detection: Application across the cancer trajectory.
  
  Clinical Journal of Oncology Nursing
  
  ​​,
  
  22
  
  ​ ​(1), 108–112. https://doi.org/10.1188/18.CJON.108-112
• Healthy People 2020|About DHDSP|DHDSP|CDC. (2014, March 13). Retrieved November 17, 2019, from https://www.cdc.gov/dhdsp/hp2020.htm​
• White, A., Thompson, T. D., White, M. C., Sabatino, S. A., de Moor, J., Doria-Rose, P. V., … Richardson, L. C. (2017, March 3). Cancer screening test use – United States, 2015. Retrieved November 17, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657895/.
• Slyne, T. C., Gautam, R., & King, V. (2017). Colorectal Cancer Screening: An educational intervention for nurse practitioners to increase screening awareness and participation. ​
  
  Clinical Journal of Oncology Nursing
  
  ​, ​
  
  21
  
  ​(5), 543–546. https://doi.org/10.1188/17.CJON.543-546
• Pearson, J. (2015). Nurses’ role in preventing cancer. ​
  
  Kai Tiaki Nursing New Zealand
  
  ​, ​
  
  21
  
  ​(4), 2. Retrieved from http://search.ebscohost.com.proxy.baystate.edu/login.aspx?direct=true&db=rzh&AN=10 3802802&site=ehost-live&scope=site