Native Cancer 101: Module 9: Chronic Conditions and Cancer Kathleen Ragan, BS, CHES Linda...
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Transcript of Native Cancer 101: Module 9: Chronic Conditions and Cancer Kathleen Ragan, BS, CHES Linda...
Native Cancer 101: Module 9: Chronic Conditions and
CancerKathleen 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 2 3
38%
0%
63%1. Male
2. Female
3. Don’t want to answer
brthyr5
About How Old are You?
1 2 3 4 5 6 7 8 9
0%
38% 38%
13%
0%0%0%
13%
0%
1. 81 and older
2. 65-80
3. 50-64
4. 41-49
5. 31-40
6. 21-30
7. 13-20
8. Under 12
9. Don’t want to answer
What is Your Primary Race?
1 2 3 4 5 6 7
75%
0% 0% 0%
13%13%
0%
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
0% 0%0%
100%1. Yes
2. No
3. Don’t Know / Not sure
4. Don’t want to answer
How Much Schooling have You Completed?
1 2 3 4 5 6 7 8 9 10
0% 0%
13%
25%
13%
0%
25%
0%
13%13%
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
Role2
Which of the Following Bests Describes You?
1. Community leader
2. Community member
3. Student
4. Teacher / Faculty
5. Researcher / Scientists
6. Healthcare provider (MD, RN, etc.)
7. Outreach recruiter
8. Cancer patient, survivor
9. Other
10. Don’t know / Don’t want to answer
1 2 3 4 5 6 7 8 9 10
13%
38% 38%
0% 0%
13%
0%0%0%0%
4 Pre-Session Knowledge Items
Which is an example of an “acute” condition?
1 2 3 4 5
13%
25%
13%
25%25%
1. Cancer
2. Arthritis
3. Trauma (car accident)
4. Diabetes
5. Don’t know / Not sure
What is the cause of most (~90%) of all cancers?
1 2 3 4 5
38%
13%
0%
50%
0%
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
14% 14%
0%
71%
0%
1. New primary cancer
2. Recurrent breast cancer
3. Breast cancer
4. Kidney cancer
5. Don’t know / Not sure
Which is NOT part of the “triple triple” threat of diabetes among American Indians?
1 2 3 4 5
38%
0%
38%
25%
0%
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 101Basics and Background
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
18
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 smokeHow we get physical activity
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
19
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 nationsMore 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]
20
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]
21
QUESTION: What is cancer?
A group of over 100 diseases in which abnormal cells
Divide without controlDon’t die when they should (Apoptosis)
Cancer: Is primarily a disease of older peopleOccasionally 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]
22
What is cancer? (continued)
Cancers are identified by the place they originate within the body. For example:
BreastCervixColonProstatePancreasStomachBrainBladder
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
23
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]
24Excerpt from the Kansas State University “coloring book”
Cancer Cells
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
25
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]
26
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 thelymphatic system?
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
27
Diagnosis (die-egg-NOH-sis)The process and result of determining if the symptoms or evidence of cancer is really cancerQUESTION: What type of information does the provider need to make a diagnosis?
I had a mammogram 6 months prior to finding a lump and thought I was in the clear. … I give myself a self-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.
Ruby WellsCherokee Nation of OK
Dx. breast 2001
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
28
Diagnosis (die-egg-NOH-sis)The Provider…
Asks about symptoms
Asks about medical history
Performs a physical exam
Orders tests and imaging procedures
Performs biopsy--to determine whether cancer cells are present
suspicious
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
29
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]
30
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]
31
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]
32
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
Two types of tumors:
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
33
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
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
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
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
Behaviors that help “protect” the shield of health against cancer include:
Native American Cancer Research 303-838-9359 Fact vs. Fallacy36
“Cancer 101”
Bear (True) vs. Coyote Trickster (False)
5 items
Native American Cancer Research 303-838-9359 Fact vs. Fallacy37
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
Ceremonial tobacco use is just as dangerous as habitual cigarette smoking.
Coyote / False
Native American Cancer Research 303-838-9359 Fact vs. Fallacy38
Cigarette smoking is the single most preventable cause of cancer in the US.
About 30% of all cancer deaths are directly related to habitual smoking. Bear / True
Coyote / False – Answer: 5-10%
About 25% (1/4) of all cancers are inherited from your parents.
Introduction to Chronic Conditions
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
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
Objective 1: Distinguish between a health condition that is acute versus
one that is chronic.
41Mayo 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)
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
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?
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
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
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?
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
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
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)
Objective 2 Identify at least 3 common chronic conditions in AIAN
communities.
47
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
Common Chronic Conditions
The most common, costly, and preventable chronic conditions in the U.S. are:
Heart diseaseCancerDiabetesArthritisObesity
This is true for AIANs too
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]; Northwest Portland Area Indian Health
Board50Indian Health Service, Regional Differences in Indian Health, 2002-2003. Data from 1999-2001
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
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) 52
Cancer
Now considered a chronic disease
Most common types among AIANs are:
Lymphoma
Lung & Bronchus
Colon & Rectum
Corpus & Uterus
Kidney & Renal
Breast
Ovarian
Pancreas
Cervix
Thyroid
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
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) 54
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) 55
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) 56
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: 1679-87Larsson SC et al JNCI 2005;97:22: 1679-87
Objective 4: Describe how
co-morbidities impact cancer and
quality of life.
57Mayo 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)
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
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) 59
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) 60
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) 61
Concerns for people with chronic conditions AND cancer
Lack of information
Potential impact on:
Quality of life
Ability for self-care
Cancer treatment decisions
Cancer treatment outcomes
AIAN Cancer Survivors, Denver, CO 2009
How Can I Get Cancer Screenings?
Excerpt from Get on the Path for Breast Health Native American Cancer Research 1-800-537-8295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2 [NCI1U54CA153605]
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.
Medicare
Excerpt from Get on the Path for Breast Health Native American Cancer Research 1-800-537-8295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2 [NCI1U54CA153605]
Medicare can pay for people 65 years of age and older: Mammogram once a year Pap Test once a yearCRC 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)
Native American Cancer Research 303-838-9359 Fact vs. Fallacy64
“Chronic Conditions and Cancer”
Bear (True) vs. Coyote Trickster (False)
5 items
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
65
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]
66
“Chronic” conditions mean they last at least 5 years
Coyote / False – Answer ~1 year +
The most common chronic conditions experienced by AIANs are cancer, diabetes and HIV infection
AIANs have nearly 2½ times deaths from cardiovascular disease (CVD) than whites.
Coyote / False
Bear of Truth
67
Post Session Knowledge Items (TP)
4 items
Which is an example of an “acute” condition?
1 2 3 4 5
0% 0% 0%0%
100%
1. Cancer
2. Arthritis
3. Trauma (car accident)
4. Diabetes
5. Don’t know / Not sure
What is the cause of most (~90%) of all cancers?
1 2 3 4 5
0%
14%
0%
86%
0%
1. Family history
2. Smoking for 5 years
3. Being exposed to radiation
4. Lifestyle and physical environment
5. Don’t know / Not sure
Which is NOT part of the “triple triple” threat of diabetes among American Indians?
1 2 3 4 5
57%
14%
0%
14%14%
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
If a “breast” cancer cell spreads to the kidney, what is the new cancer called?
1 2 3 4 5
13%
38%
0%
25%25%
1. New primary cancer
2. Recurrent breast cancer
3. Breast cancer
4. Kidney cancer
5. Don’t know / Not sure
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 72
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]
73E_undrst
Overall, how understandable was the presentation?
1 2 3
100%
0%0%
1. Very understandable
2. Fairly understandable
3. Not understandable
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
74E-useful
Overall this session provided useful information to me.
1 2 3 4
75%
0%0%
25%
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]
75E_quality
Overall, what was the quality of the information content of the presentation?
1 2 3
100%
0%0%
1. High
2. Average
3. Low
Cancer 100 “Overview of Cancer” (Burhansstipanov)Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]
76E_rec
Would you recommend this workshop to your friends or colleagues?
1 2 3 4
100%
0%0%0%
1. Yes
2. Maybe
3. No
4. Not Sure
E_rec
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
Thank you for allowing me to
share this workshop
information with you