Cancer is defined as an amassing and creation of cells (ACS, 2001), and is the result of internal and/or external underlying factors viz. chemicals, radiation, viruses, and health behaviors such as tobacco use.
Among men, the most common cancers are prostate, lung and bronchus, and colon and rectum. For women, breast cancer, followed by lung and bronchus, and colon and rectum are the leading cancer types. African-American males have higher prostate cancer rate and mortality than white men. Of all cancer types for men and women, lung and bronchus cancer are the principal causes of cancer death (Greenlee et al, 2000).
According to the Centers for Disease Control, in 2002, 1,284,900 new cases were expected to be diagnosed, and more than 555,600 people were expected to die from cancer (CDC, 2002; U.S. Cancer Statistics Working Group, 2002). The number of new cases does not include a projected 1.3 million cases of basal and squamous cell carcinoma of the skin (Greenlee et al, 2000).
Cancer mortality overall for all age groups has decreased during the period 1993 to 1999 for men and women, while incidence has stabilized in the period 1995-1999 (Edwards et al, 2002).Coping with Cancer Pain: An Introduction About two thirds of cancer deaths may be avoidable: tobacco usage, diet, exposure to sunlight, ionizing radiation, exogenous hormones and viral and bacterial infections has all been involved in cancer initiation or progression. Useful methods of early detection of cancer through screening and education as a result remain a high research priority. Many cancers are related to lifestyle, and research is also required to spell out the best approach to modifying lifestyle and behavior.This is particularly important for those populations at high risk and those who will have long-term experience, for example adolescents and young adults. Just about half of cancer patients may experience psychological suffering because of their diagnosis and treatment.
The quality of life of cancer patients, their families and carers is thus a priority area. Educational approaches aimed to break down the fear and lack of knowledge surrounding cancer and to develop research-based professional training are also important.Despite the fact that encouraging developments have been taken to stabilize cancer incidence and reduce related mortality (Edwards et al, 2002), it remains second only to heart disease as a principal cause of death in the United States (CDC, 2002). The direct and indirect costs in terms of death, disability, lost years of productivity, and medical expenditures, make cancer a significant public health concern (ACS, 2001) to all population groups regardless of age, gender, race, or geographic region, although some populations are more at risk than others (Miller et al, 1987; Higginbotham et al, 2001).Identifying the breadth and depth of the influence of cancer on the U.
S. population is multi-faceted. It should be observed the United States does not at present have a nationwide cancer registry (Greenlee et al, 2000); nevertheless, cancer data are collected through the National Program of Cancer Registries and the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) registry program (National Program of Cancer Registries, 2002). For the many cancer types, there is disparity in incidence, staging, and mortality among subpopulations by race/ethnicity, age, gender, and geographic region. This inconsistency among subgroups makes drawing a concise picture of the scope of the disease complex.
Data points out that some populations, including the elderly and African Americans, are obviously at increased risk for cancer-related morbidity and mortality. Over one-half of first cancer diagnoses take place among those 65 and older (Ries et al, 2002). Due to population growth and the aging of America, the number of cancer cases is projected to double by the middle of this century (Edwards et al, 2002). There is also significant inconsistency in incidence and mortality rates by gender and race. For total cancers, African-American males have the highest cancer occurrence, followed by white males, white females, and African-American females. Mortality data by race is compatible with incidence data, excluding total cancer mortality, which is higher among African-American females than white women (Greenlee et al, 2000).
There appears to be little difference in the frequency and mortality rates of rural and urban populations, with the exception of cancer staging. There is evidence to suggest rural populations are diagnosed at a more advanced stage of cancer (Higginbotham et al, 2001; Monroe et al, 1992; Liff et al, 1991; Risser, 1996). This finding raises questions regarding availability and utilization of preventive, screening, and diagnostic services in rural areas in addition to the existence of unique social and behavioral barriers.Combating cancer is expressed in the Healthy People 2010 cancer goal to reduce the number of new cancer cases in addition to the illness, disability, and death caused by cancer (U.S.
Department of Health and Human Services, 2000). The objectives addressed are as follows:• Reduce the overall cancer death rate. • Increase the proportion of women who receive a Pap test. • Increase the number of adults who receive colorectal cancer screening.
• Increase the proportion of women aged 40 years and older who received a mammogram within the preceding two years. • Increase the number of states that have statewide population-based cancer registries. • Increase the proportion of cancer survivors who are living five years or longer after diagnosis.Barriers To Cancer Management As with the limited data on individual cancers, there is also limited information on attitudes, social support, and other related behavioral characteristics present within rural populations with respect to cancer. Nevertheless, various uniquely rural attitudes and barriers may impact the stage of diagnosis.
Attitudes such as fatalism (Coronado et al, 2000) fear of the stigma associated with cancer, and denial of presenting symptoms may all be factors to delayed screening and consequently diagnosis (Michielutte et al, 1996).Beyond attitudinal barriers that may impact the stage of diagnosis, a number of other barriers, such as access to services and limited resources, also contribute to all phases of cancer in rural populations. Such factors previously identified are enumerated below:• Poor access to health care services, including specialists (Higginbotham et al, 2001; Monroe et al, 1992; Desch et al, 1992); • Limited geographic access to new, effective therapies and technologies (Higginbotham et al, 2001; Monroe et al, 1992; Desch et al, 1992; Desch et al, 1992); • Sub-optimal care for cancer patients (Desch et al, 1992); • Minimal transportation options for either cancer screening or treatment (Desch et al, 1992; Goodman, 1989); • Low participation in health promotion programs (Higginbotham et al, 2001; Goodman, 1989); • Limited knowledge of cancer, particularly the importance of early detection through regular screening (Michielutte et al, 1996) • Low education levels (Monroe et al, 1992; and • Prohibitive cost of cancer screening and treatment (Casey et al, 2001; Goodman, 1989; Michielutte et al, 1996)Effective Interventions Or Solutions Identified A number of behavioral and social factors have been identified as related to an increased risk of a variety of cancers. Smoking, excessive alcohol use, other modifiable behaviors related with cancer risks, and limited knowledge of cancer and the importance of early detection and regular screening are often addressed through health education efforts to raise understanding and change behavior.
Social factors, such as living in poverty and having limited education, are far more difficult to deal with but often are more important in terms of contributing to the risk of cancer. Factors in both categories are outlined below.
