**8. Acknowledgement**

C-Change would like to acknowledge John Simmons, Program Coordinator for SPIPA and Jennifer Olson, MPH, MA, Epidemiologist, SPIPA CCC Project, for their leadership and technical guidance on SPIPA's competency grant project; C-Change's Pain & Palliative Care Competency Advisory Committee for their leadership and expertise; and Purdue Pharma L.P. for their generous funding. For a full report from all of the competency projects see www.cancercorecompetency.org.

**About C-Change:** The vision/mission of C-Change is to eliminate cancer as a major public health problem at the earliest possible time by leveraging the expertise and resources of its members. C-Change is a 501(c)3 organization comprised of leaders from public, private, and not-for-profit organizations. The organization convenes multi-sector leaders in the cancer community to address issues that we cannot affect alone. For more information about C-Change visit www.c-changetogether.org.

#### **9. References**

424 Cancer Prevention – From Mechanisms to Translational Benefits

(Betancourt 2010; Lie, Lee-Rey et al. 2011) Ineffective curricula, as measured by positive changes in health outcome, thus far appear to be common to both health literacy and cultural competence training. Despite academic "longing", there has not been evidence based tools that can guide health care workers to influence health behavior in a manner that improves outcomes. The literature is rife with "assessments", but outcome thus far belies

Nevertheless, some ongoing efforts are encouraging. Lichtveld and colleagues are planning to build a curriculum based on healthcare provider competencies. The 'competencies' will provide the metrics to measure the didactic effectiveness of the curriculum. A second order of assessment will determine linkage between health outcomes and provider/learner achievement. Price-Haywood proposes a physician practice guide and didactic curriculum built on self-expressed needs and expectations of the target population obtained through analysis of information obtained from focus

What is most encouraging is the movement from assessment to plans for action and measurement of health outcomes. (Chun 2010; Echeverri, Brookover et al. 2010; Kamaka 2010; Wilkerson, Fung et al. 2010; Crenshaw, Shewchuk et al. 2011) These evolving tools will enrich the health care provider and enhance the relationship between diverse patients and the health care system. The next five years should be exciting as these tools, guides, and curricula emerge. Today, however, health care providers remain confronted by their ineffectiveness in normalizing the disparate outcomes and their impotence in fostering better health behaviors among their patients. What can the 2012 graduate from medical school, dental school, nursing school, pharmacy school and school of public health do to optimize communication and shared decision making? (Kumagai and Lypson 2009) As we enter the era of "team care" the challenge intensifies because responsibility may become diffuse. The team leader should be the primary care giver with the appropriate knowledge base. The team leader should assess and define the patient's knowledge base and then – and only then – involve the appropriate team members to work with the patient. The team leader should begin by asking the patient to ask any questions and to speak his understanding of his condition and the advice he has received. Often, the patient is or should be accompanied by family or friends who will play an important role in the shared decision making. These principles are fundamental to all courses teaching history, physical examination, and medical decision making. Our professional schools should reinforce the fundamental didactics while preparing for the enhancements which will come from ongoing research into more effective, more focused communication and more elegant science that

C-Change would like to acknowledge John Simmons, Program Coordinator for SPIPA and Jennifer Olson, MPH, MA, Epidemiologist, SPIPA CCC Project, for their leadership and technical guidance on SPIPA's competency grant project; C-Change's Pain & Palliative Care Competency Advisory Committee for their leadership and expertise; and Purdue Pharma L.P. for their generous funding. For a full report from all of the competency projects see

will combine to contribute to the elimination of outcome disparity.

success.

groups of various health literacy.

**8. Acknowledgement** 

www.cancercorecompetency.org.


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**17** 

*USA* 

**The Changing Landscape of Prostate Cancer** 

Current controversy exists regarding the role of chemopreventative agents for prostate cancer. However, prostate cancer's role in our society remains prevalent. Prostate cancer continues to be the leading cause of newly diagnosed male cancers in the United States. In 2011, the American Cancer Society estimated 241,740 new cases and 28,170 deaths from prostate cancer.1 Only lung cancer has more male cancer deaths. Current treatment strategies such as surgery, radiation, chemotherapy and hormone therapies have been successful in decreasing prostate cancer related morbidity and mortality. However, the physician's armamentarium is focused on treating existing prostate cancer and not preventing it. Despite the prolongation of life for patients with prostate cancer, each therapy

Due to improved early detection, prostate cancer is now often identified at an earlier stage and grade. Newly diagnosed tumors are often organ confined and slow growing. However, once a patient's PSA laboratory value is abnormal, he will most likely receive a prostate biopsy for diagnosis. Given the fact that less than 10% of Americans select active surveillance, screening starts a snowball effect that usually "buys" a treatment. It is well known that treatment including radical prostatectomy or radiation has been shown to overtreat prostate cancer in as many as 30-50% of patients.2 Morbidity, including incontinence and impotence can significantly affect a patient's quality of life. In addition, the knowledge of prostate cancer may cause emotional, financial and physical harm.3,4 Given that the US male population faces a 16.7% lifetime risk of prostate cancer, prostate cancer is

Cancer chemoprevention focuses on the use of natural or synthetic agents to suppress, delay, or prevent the development of tumors. Natural substances have long been utilized with varying results for prostate cancer prevention. More recently in the 2000s, 5-alpha reductase inhibitors (5-ARI) have also been used. These substances have focused on both primary prevention and secondary prevention. Primary prevention focuses on deferring or preventing the presence of cancer prior to cancer formation. Secondary prevention focuses on preventing premalignant lesions from progressing to cancer. For prostate cancer, secondary prevention focuses on preventing the progression of high grade prostate

**1. Introduction** 

carries a side effect profile.

an ideal candidate for prevention strategies.

epithelial neoplasia (HGPIN).

**Chemoprevention: Current Strategies** 

**and Future Directions** 

Jason M. Phillips and E. David Crawford *University of Colorado Division of Urology* 

