Disconnect Between Attitudes and Behaviors on Cancer Prevention and Other Findings From 2019 ASCO National Cancer Opinion Survey

Disconnect Between Attitudes and Behaviors on Cancer Prevention and Other Findings From 2019 ASCO National Cancer Opinion Survey

Clifford A. Hudis, MD, FASCO, FACP

Jan 16, 2020

Editor’s note: Dr. Hudis hosts the ASCO in Action Podcast, which focuses on policy and practice issues affecting providers and patients. An excerpt of a recent episode is shared below; it has been edited for length and clarity. Listen to the full podcast online or through iTunes or Google Play.

I want to share some very interesting findings from ASCO’s 2019 National Cancer Opinion Survey. ASCO started doing this annual survey 3 years ago in collaboration with the Harris Poll so we could track the public’s views on cancer research and care. The poll (supported by the Mission Endowment of Conquer Cancer, the ASCO Foundation) is conducted annually to measure shifts in the public’s perceptions of a range of cancer-related issues over time. The findings come from a large, nationally representative sample of U.S. adults ages 18 and older that included individuals with cancer.

As the world’s leading organization of oncology professionals who care for people with cancer, ASCO believes it is critical to understand what the public, including patients, think of, expect, and need from the nation’s cancer care system.

So, what did this year’s survey tell us? Well, this year’s findings raise serious concerns about an area of cancer care that should be uppermost in all our minds: cancer prevention in America. I’ll get into the details in just a moment, but the results tell us that much more education on cancer prevention is needed, beginning at a young age—when it can have the greatest impact.

This year’s survey also tells us that far too many young people regularly use e-cigarettes and believe they are harmless and not addictive. A third area the National Cancer Opinion Survey examined is end-of-life care, and here we found gaps in awareness about the importance of patients discussing end-of-life wishes with their doctors and family members.

Turning to the area of cancer prevention, the ASCO survey found that only one in four Americans incorporate cancer prevention into their daily lives. When you think about it, this low rate is remarkable since research shows that as many as half of all cancer cases are preventable. Interestingly, our survey also reported six in 10 adults (57%) are concerned about getting cancer. You might think more than 25% of us would care deeply about cancer prevention and take risk reduction steps every day. So, we’re seeing a disconnect between attitudes and behaviors on this point.

We also found low levels of public awareness of known cancer risk factors such as alcohol and obesity, and misconceptions that artificial sweeteners and cell phones cause cancer in humans. Clearly, this is a larger public health issue and more work needs to be done. For starters, we urge every American to have regular conversations with their physician about reducing their risk of cancer and other chronic diseases.

As I’m sure most of you know, stories about the use of e-cigarettes—or vaping—have been in the headlines with reported deaths from severe respiratory illness with e-cigarette use. As an organization of oncology professionals, we’re very concerned about the potential for e-cigarettes to become a gateway for youth to use cancer-causing tobacco products and the serious side effects that are beginning to emerge. We wanted to examine this issue more deeply in this year’s National Cancer Opinion Survey and what we found is troubling: Roughly one in five young adults uses e-cigarettes daily or recreationally, and nearly one in four believes the products are harmless and not addictive. These findings reflect survey responses from Generation Z respondents (ages 18 to 22) and Millennials (ages 23 to 38).

I also want to note that there is also evidence that e-cigarette use among pre-teens and teens is on the rise. Make no mistake, this is very worrisome news. The U.S. Surgeon General has warned that e-cigarettes contain addictive and harmful or potentially harmful ingredients, including nicotine; lead and other heavy metals; and flavorants such as diacetyl, a chemical linked to serious lung disease.

For ASCO’s part, we issued a policy statement with the American Association for Cancer Research which called for putting safety labels with a warning about nicotine addiction on all e-cigarette packaging; prohibiting youth-oriented advertising; and banning the sale of e-cigarettes containing candy or youth-oriented flavors unless there is evidence demonstrating these products do not encourage use of e-cigarettes by youth. We will continue to monitor this issue closely and keep ASCO members informed of developments.

Finally, I want to touch on a notable survey finding related to end-of-life care. Our survey found that most people affected by cancer aren’t discussing end-of-life care with their doctors, even though they believe it’s important. We, as oncology professionals, understand that it’s critical to plan ahead for end-of-life care in the advanced stages of cancer or any disease. Physicians and patients should discuss all available care options and develop a plan that reflects patients’ wishes and goals. This can ease the emotional and may even reduce the financial burden for patients and their loved ones.

I want everyone to know that resources for planning for end-of-life care, including a patient booklet, are available at Cancer.Net. I encourage you to take advantage of this free resource.

Learn more about the ASCO National Cancer Opinion Survey.


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