University of Iowa researchers have been awarded funding from the Centers for Disease Control and Prevention (CDC) for studies that address oral health and cancer. The first project, led by Dr. Susan McKernan, assistant professor of preventive and community dentistry, will explore the integration of oral health and primary care. The second project, led by Dr. Richard Hoffman, professor of internal medicine and epidemiology, will examine patients’ decision-making about prostate cancer treatment.
[Photo: Dr. Susan McKernan (left and Dr. Richard Hoffman)
The grants, called Special Interests Projects (SIP), are awarded by the Prevention Research Centers program office at the CDC. The CDC provides SIP funding to its 26 Prevention Research Centers nationwide to design, test, and disseminate effective applied public health prevention research strategies that address major causes of disease and disability.
The University of Iowa Prevention Research Center based in the College of Public Health will distribute the grants to the UI investigators for the research projects that begin Sept. 30, 2016.
Dr. McKernan’s team will conduct a one-year project to identify best practices for integrating medical and dental care in public health activities and to identify opportunities to include oral health in the ongoing climate of health care reform.
“Oral health is recognized as a critical requirement for overall health, sharing common risk factors with other chronic diseases,” says McKernan. “Dental visits present a valuable opportunity for providing additional health screenings.”
Healthy People 2020, a national health promotion and disease prevention initiative, calls for increasing the proportion of adults who receive chronic disease preventive services in dental settings, including tobacco screenings and cessation counseling, testing and referrals for blood sugar management, screenings for mouth and throat cancer, and dental visits for persons with diabetes.
The researchers will gather information about programs, services, and policies that link oral health and primary care; analyze the collected data to identify programmatic gaps and opportunities; and develop recommendations of best practices to integrate oral health and primary systems of care.
The results will provide policy makers and public health officials with comprehensive information to effectively and efficiently coordinate activities with primary care providers.
Dr. Hoffman’s team will conduct a two-year project that examines how men diagnosed with low-risk prostate cancer make decisions about their course of treatment.
The widespread availability of prostate-specific antigen (PSA) testing has dramatically increased the diagnosis of prostate cancers in the United States. Many PSA-detected cancers are slow growing, but men with these low-risk cancers usually opt for active treatments even though evidence suggests that these treatments offer no survival benefit and often adversely affect quality of life. As a result, guidelines recommend offering these men active surveillance, a strategy of closely monitoring cancers with biopsies and PSA tests and offering active treatment only with clinical evidence of the cancer’s progression.
“Patients’ decisions about treating prostate cancer often are not well informed, made with undue haste, and can be inconsistent with personal values,” Dr. Hoffman says. “Men face particularly difficult decisions in selecting active surveillance because they must weigh the anxiety of living with an untreated cancer and the complication risks of repeat biopsies against avoiding harm from potentially unnecessary treatment.”
Many patients continue to have anxiety even after choosing active surveillance; about 20 percent of the men who switch to active treatment do so in the absence of any clinical trigger. Understanding the decision factors influencing adherence to active surveillance is crucial for developing interventions to reduce unnecessary treatments.
The researchers will conduct formative research to identify patient, provider, and decisional factors associated with adhering to active surveillance. They will then develop an instrument to predict adherence to active surveillance among men with low-risk prostate cancers in the absence of disease progression.
Findings from this research could be used to develop active surveillance decision-support tools and strategies that could ultimately lead to reducing the burden of prostate cancer treatment in men with low-risk prostate cancer.