World Cancer Day 2016 Key Messages

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WWW.WORLDCANCERDAY.ORGON 4 FEB#WeCanICan#WorldCancerDay

INSPIRE ACTION, TAKE ACTION

WE CAN

The first step in driving progress around cancer is to push for actions that we know will improve survival rates and give cancer patients a better quality of life.

The World Cancer Declaration represents a consensus between public health and cancer experts that sets out 9 targets for an effective response to cancer and other non-communicable diseases (NCDs) – mainly cardiovascular diseases, chronic respiratory diseases and diabetes1. It is a tool that can be used by cancer control organisations, groups of advocates, employers, the media and others to urge governments to implement policies and programmes that the cancer community knows will be successful if they are adequately resourced.

With the inclusion of NCDs in the post-2015 agenda and the world’s governments committed to ‘reduce by one third premature mortality from NCDs through prevention and

treatment, and promote mental health and wellbeing’ as part of the Sustainable Development Goals (SDGs), using the World Cancer Declaration to frame and strengthen advocacy efforts is imperative2. By working together around common targets and each using our spheres of influence, we can unite in driving governments to take decisive action around cancer, commit adequate resources and embed cancer and other NCDs within broader development planning processes.

1. World Cancer Declaration. http://www.uicc.org/world-cancer-declaration

2. Transforming our World: The 2030 agenda for sustainable development. https://sustainabledevelopment.un.org/post2015

INSPIRE ACTION,TAKE ACTION

WE CAN

WE CAN ALL CALL ON GOVERNMENTS TO STEP UP THEIR RESPONSE TO CANCER BY PUSHING FOR ACTIONS THAT WE KNOW WILL REDUCE PREMATURE DEATHS, AND IMPROVE QUALITY OF LIFE AND CANCER SURVIVAL RATES.

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PREVENT CANCER

WE CAN

Changes in the way we live mean that more and more people around the world are exposed to cancer risk factors like smoking, poor diet, and sedentary lifestyles. Educating and informing individuals and communities about the links between lifestyle and cancer risk is the first step in effective cancer prevention.

Smoking is still the biggest cancer risk factor. Tobacco use accounts for five million deaths every year, or 22% of all cancer deaths1,2. Reducing the rates of tobacco use will significantly decrease the global burden of a large number of cancers, including of the lung, oral cavity, larynx, pharynx, oesophagus, pancreas, bladder, kidney, cervix and stomach, and acute myeloid leukaemia. Alcohol use has also been linked to cancers of the mouth, pharynx, larynx, oesophagus, bowel, liver and breast3.

The rising levels of obesity are of concern in many countries around the world. Overweight and obesity are strongly linked with an increased risk of bowel, breast, uterine, ovarian, pancreatic, oesophagus, kidney, and gallbladder cancers later in life4. Yet, about a third of common cancers can be prevented

through a healthy diet, maintaining a healthy weight and being physically active5. Specifically, the World Cancer Research Fund International estimates that for the 13 most common cancers, about 31% of cases in the United States are preventable through a healthy diet, being physically active and maintaining a healthy weight. The estimates for other countries are 32% for the UK, 25% for Brazil and 24% for China6.

1. WHO. (2012). Global Report: Mortality attributable to tobacco 2012. Geneva: World Health Organization.

2. Tobacco Atlas 20153. WHO. (2011). Global status report on alcohol and health.

Geneva: World Health Organization4. World Cancer Research Fund / American Institute for

Cancer Research. Continuous Update Project Report. http://www.dietandcancerreport.org/cup/index.php.

5. World Cancer Research Fund International. Link between lifestyle and cancer risk. http://www.wcrf.org/int/link-between-lifestyle-cancer-risk

6. World Cancer Research Fund International. http://www.wcrf.org/int/cancer-facts-figures/preventability-esti-mates/cancer-preventability-estimates-diet-nutrition and http://www.wcrf.org/int/policy/nourishing-frame-work?utm_source=update&utm_medium=email&utm_campaign=NOURISHINGJuly

PREVENT CANCERWE CAN

EQUIPPING INDIVIDUALS AND COMMUNITIES WITH APPROPRIATE AND ADEQUATE KNOWLEDGE OF THE LINKS BETWEEN LIFESTYLE AND CANCER CAN EMPOWER PEOPLE TO ADOPT HEALTHY CHOICES. INDIVIDUALS AND COMMUNITIES NEED TO BE INFORMED THAT MORE THAN A THIRD OF CANCERS ARE PREVENTABLE THROUGH ADOPTING HEALTHY BEHAVIOURS.

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CHALLENGE PERCEPTIONS

WE CAN

In many cultures and societies today, cancer remains a taboo subject. People living with cancer are often subject to stigma and discrimination that may stop them admitting they have cancer and from seeking care and support. Even within communities where cancer is discussed openly, people affected by cancer can sometimes be discriminated against and feel isolated from friends and peers1.

Specific efforts are required to improve knowledge of cancer, counter misinformation and reduce stigma among all communities2, 3. Supporting awareness campaigns such as World Cancer Day can be a powerful platform to challenge negative beliefs, attitudes and behaviours that perpetuate myths about cancer4. Workplaces, community groups, healthcare providers and schools can all take actions to improve communication about cancer, shifting perceptions and strengthening support for people affected by cancer. In schools, for example, theatre can provide a platform for children, parents, and teachers to work together to improve communication and remove stigma around the disease. Such education programmes have been shown to be successful in supporting the inclusion of children with cancer into everyday life at school5.

Governments can also play a critical role in providing accurate information to communities around effective cancer interventions. For instance, extensive social mobilisation has been identified as critical to the implementation of human papillomavirus (HPV) vaccination programmes in low- and middle- income countries as part of comprehensive cervical cancer prevention strategies. Providing appropriate and adequate information to communities, especially to avoid rumours and myths is a key factor to achieving high vaccine coverage6.

The media also have a particular role to play around public education campaigns by disseminating information and raising population-level awareness of cancer control to change attitudes and dispel common myths.

1. LIVESTRONG. (2011). Cancer Stigma and Silence Around the World: A LIVESTRONG Report . Austin: LIVESTRONG.

2. http://www.livestrong.org/What-We-Do/Our-Actions/Programs-Partnerships/Anti-Stigma-Campaign

3. Cancer Research UK http://scienceblog.cancerresearchuk.org/2014/03/24/dont-believe-the-hype-10-persistent-cancer-myths-debunked/

4. American Cancer Society http://www.cancer.org/aboutus/howwehelpyou/rumors-myths-and-truths

5. dos Santos Gomez LA (2007). Removing the stigma of cancer at school. Lancet Oncol. 8:682-4.

6. Watson-Jones D, Mugo N, Lees S, Mathai M, Vusha S, Ndirangu G, et al. (2015) Access and Attitudes to HPV Vaccination amongst Hard-To-Reach Populations in Kenya. PLoS ONE 10: e0123701. doi:10.1371/journal.pone.0123701

CHALLENGE PERCEPTIONS

WE CAN

GOVERNMENTS, COMMUNITIES, SCHOOLS, EMPLOYERS AND MEDIA CAN CHALLENGE PERCEPTIONS ABOUT CANCER AND DISPEL DAMAGING MYTHS AND MISCONCEPTIONS SO THAT ALL PEOPLE ARE EMPOWERED TO ACCESS ACCURATE CANCER INFORMATION AND QUALITY CANCER PREVENTION AND CARE.

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CREATE HEALTHY ENVIRONMENTS

WE CAN

Schools and workplaces have important roles to play in preventing cancer. Every school can foster a culture of health by providing nutritional meals and time for recreation and sport, and putting practical food and physical education on the school curriculum1,2.

Workplaces of all sizes can put in place policies and programmes that motivate employees to adopt healthier behaviours. Measures such as creating 100% smoke-free workplaces and providing information and access to smoking cessation tools; providing access to healthy food options; promoting active transport to and from work; and increasing movement in the workplace for example, through use of stairs, are all effective ways to support a healthier workforce3-5. Workplace wellness programmes can also promote early detection by using communication channels to communicate about the signs and symptoms of some cancers and where appropriate, encourage and support participation in screening programmes for early diagnosis6.

Workplaces can also put in place policies to prevent occupational exposure to cancer-causing agents, such as asbestos and other workplace carcinogens7.

1. Food Revolution Day. School Resources. http://www.foodrevolutionday.com/schools/#DVCHyR8LzJQL3EIf.97

2. Kitchen Garden Foundation. Teaching Resources. http://www.kitchengardenfoundation.org.au/free-resources/teaching-resources

3. UICC, Bupa. (2014). Cancer – It’s everyone’s business. http://www.iccp-portal.org/cancer-its-everyones-business

4. UICC, Bupa (2014). Less Smoking, Better Business. http://www.iccp-portal.org/less-smoking-better-business

5. Global Smokefree Partnership. Smokefree-in-a-box. www.globalsmokefreepartnership.org

6. UICC, Bupa (2015). Tackling breast cancer in the workplace. http://www.iccp-portal.org/tackling-breast-cancer-workplace

7. International Labour Office. Safety in the Use of Asbestos. http://www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@safework/documents/normativeinstrument/wcms_107843.pdf

CREATE HEALTHY ENVIRONMENTS

WE CAN

SCHOOLS AND WORKPLACES CAN BE ENCOURAGED TO IMPLEMENT MEASURES THAT WILL MOTIVATE AND SUSTAIN HEALTHY HABITS THROUGHOUT A PERSON’S EVERYDAY LIFE.

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IMPROVE ACCESS TO CANCER CARE

WE CAN

Closing the gap in access to affordable, quality cancer care is an imperative for maximising outcomes and quality of life for all people living with cancer, including children and adolescents.

Access to effective, quality cancer care should be embedded within a country’s National Cancer Control Plan (NCCP). NCCPs should cover access to each of the critical components of a multidisciplinary approach encompassing supportive and palliative care, high-quality cancer medicines and effective cancer treatment modalities1,2. This includes radiotherapy, which is recognised as an essential tool in the cure and palliation of cancer and is indicated in more than half of new cancer patients3. Additionally, resource-sensitive clinical guidelines can be used to assist with the planning and delivery of early detection and treatment4,5. Addressing barriers to equitable access to quality cancer services should include the alleviation of cultural and structural issues e.g. transportation, as well as policies and programmes to improve the availability of a skilled cancer workforce.

Of equal importance is to address affordability of care to protect individuals and families from financial hardship as a consequence of out-of-pocket expenses. The provision of universal health coverage (UHC) and other social protection measures can play an important role in closing the unacceptable gaps in access to cancer services that occur in most low-resource settings.

1. International Cancer Control Partnership. Cancer Plans. http://www.iccp-portal.org/cancer-plans

2. Hogerzeil HV, Liberman J, Wirtz VJ, et al. (2013). Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration. Lancet , 381, 680-9.

3. Delaney G, Jacob S, Featherstone C, Barton M. (2005). The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer 104, 1129-37.

4. WHO. (2013). WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Geneva: World Health Organization.

5. Yip CH, Smith RA, Anderson BO, et al. (2008). Guideline Implementation for Breast Healthcare in Low- and Middle-Income Countries Early Detection Resource Allocation. Cancer 113, 2244-56

IMPROVE ACCESS TO CANCER CARE

WE CAN

WE CAN ADVOCATE FOR IMPROVED ACCESS TO CANCER TREATMENT AND SERVICES ACROSS THE CARE CONTINUUM. ALL PEOPLE HAVE THE RIGHT TO BENEFIT FROM THESE INTERVENTIONS ON EQUAL TERMS, REGARDLESS OF GEOGRAPHY AND WITHOUT SUFFERING ECONOMIC HARDSHIP AS A CONSEQUENCE.

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BUILD A QUALITY CANCER WORKFORCE

WE CAN

Inadequate education of healthcare providers is one of the most pervasive and urgent obstacles to address in delivering quality cancer care1.

Investment in continuing professional development (CPD) to equip healthcare workers with the appropriate tools and knowledge to deliver best practice services across the cancer care continuum is vital. This includes building expertise and capacity amongst health professionals to recognise the early signs and symptoms of some cancers, as well as appropriate early detection measures; ensuring the safe and proper administration of chemotherapy and other cancer treatment modalities including radiotherapy and surgery; and delivering palliative care and pain and distress management.

Whilst education can include both conventional teaching methods as well as e-learning platforms and multimedia tools, where possible it should also build on existing materials, training networks and infrastructure2-4.

1. Global Health Workforce Alliance. (2013). A universal truth: no health without a workforce. Geneva: World Health Organization.

2. C-Change. (2012). A National Strategy to Strengthen the Cancer Workforce: Position Statement and Call to Action. http://c-changetogether.org/Websites/cchange/images/Workforce/WORKFORKCE_POSITION_STATEMENT-_with_endorsements-_February_28_2013.pdf

3. iheed Institute. (2012). Preparing the next generation of community health workers: The power of technology for training. iheed Institute, the Barr Foundation, the mHealth Alliance, and the MDG Health Alliance. Cork, Ireland: Dalberg Global Development Advisors.

4. The Recife Political Declaration on Human Resources for Health (HRH). http://www.who.int/workforcealliance/forum/2013/recife_declaration_13nov.pdf

BUILD A QUALITYCANCER WORKFORCE

WE CAN

THE CANCER WORKFORCE CAN BE EQUIPPED WITH THE SKILLS, KNOWLEDGE AND COMPETENCIES REQUIRED TO MEET THE NEEDS OF INDIVIDUALS AND COMMUNITIES ACROSS THE CANCER CONTINUUM.

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MOBILISE OUR NETWORKS TO DRIVE PROGRESS

WE CAN

Identifying and mobilising networks to support efforts to reduce the global cancer burden goals are critical to strengthen advocacy efforts and build capacity through education and training1.

For example, UICC as a founding member of the NCD Alliance recognises the power of working together as a network united in the goal of creating sustained global action on non-communicable diseases (NCDs). Through the NCD Alliance, local, national and regional networks of cancer experts and advocates have come together to drive remarkable progress in elevating cancer and other NCDs on the global health and development agenda.

Other key global cancer networks, such as the global coalition Cervical Cancer Action, aim to maximise the impact of those working to stop cervical cancer. Through political mobilisation, the coalition is increasing outreach activities to expand global support to end cervical cancer, engaging champions from diverse constituencies—youth, cancer,

women’s issues, HIV/AIDS, sexual and reproductive health and health policy—to support a comprehensive approach to cervical cancer prevention.

Building networks of experts can also provide a platform for knowledge exchange. For example, the McCabe Centre for Law and Cancer builds capacity in the use of law to prevent and control cancer and other NCDs particularly in the context of developing coherence between health, trade and investment laws, policies and sectors.

1. UICC Advocacy Toolkit 2014. http://www.uicc.org/advocacy/advocacy-resources

2. NCD Alliance. http://www.ncdalliance.org/

3. Cervical Cancer Action. http://www.cervicalcanceraction.org/home/home.php

4. McCabe Centre for Law and Cancer. Intensive legal training program. http://www.mccabecentre.org/events/intensivelegaltrainingprogram

MOBILISE OUR NETWORKS TO DRIVE PROGRESS

WE CAN

THE GLOBAL CANCER COMMUNITY CAN MOBILISE THEIR NETWORKS TO REDUCE THE GLOBAL CANCER BURDEN, TO PROMOTE GREATER EQUITY, AND TO INTEGRATE CANCER CONTROL INTO THE WORLD HEALTH AND DEVELOPMENT AGENDA.

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SHAPE POLICYCHANGE

WE CAN

The law and regulatory measures can be used effectively to reduce exposure to cancer risks including to tobacco, alcohol and unhealthy foods, as well as environmental exposures.

Tobacco taxation has been identified as the single most important policy intervention that governments can take to reduce major risk factors for NCDs1. It costs little to implement and increases government revenues. The World Health Organization (WHO) calculates that if all countries increased taxes on cigarette packs by 50%, there would be 49 million fewer smokers (38 million fewer adult smokers and 11 million fewer young future smokers) and this would avert 11 million deaths from smoking2. Additionally, policy interventions around product labelling, procurement and regulation of advertising, promotion and sponsorship can reduce exposure to unhealthy foods and drinks3,4.

Effective policy at the national level can also improve access to essential cancer medicines including pain relief medicines, and deliver quality cancer care. Following a targeted advocacy campaign, in 2014 at the World Health Assembly, governments adopted a resolution which provided clear recommendations to improve access to palliative care5. These include ensuring palliative care is embedded in all national

health policies and budgets, and in the curricula for health professionals. Vitally, it also highlights the need for countries to ensure that there is an adequate supply of all essential palliative care medicines for adults and children.

In another concerted advocacy effort, UICC led a close collaboration with WHO and a dedicated task team to ensure the best representation of cancer drugs in the WHO Model List of Essential Medicines (EML). As a result of these efforts, in May 2015, the latest edition of the WHO EML was published and includes 16 new cancer treatments - a milestone in patients’ access to cancer medicines6,7.

Patients, families, healthcare providers and civil society now need to continue to advocate to governments for the implementation of policies and programmes at the national level that translate these commitments into action for patients and their families.

1. Jamison DT, Summers LH, Alleyne G, et al. (2013). Global health 2035: a world converging within a generation. Lancet, Published Online December 3, 2013 http://dx.doi.org/10.1016/.

2. WHO (2014). Raising tax on tobacco: What you need to know. Geneva: World Health Organization.

3. WHO. (2010). Set of recommendations on the marketing of foods and non-alcoholic beverages to children. Geneva: World Health Organization.

4. WCRF International. (2014). WCRF International Food Policy Framework for Healthy Diets: NOURISHING. http://www.wcrf.org/policy_public_affairs/nourishing_framework/index.php.

5. WHO (2014). Strengthening of palliative care as a component of integrated treatment throughout the life course. A67/31 4 April 2014.

6. 19th WHO Model List of Essential Medicines (April 2015). www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-15.pdf

7. 20th WHO Expert Committee report on the Selection and Use of Essential Medicines (2015) www.who.int/medicines/publications/essentialmedicines/Executive-Summary_EML-2015_7-May-15.pdf

SHAPE POLICY CHANGEWE CAN

EFFECTIVE ADVOCACY FOR POLICY CHANGE AT ALL LEVELS - LOCAL, NATIONAL, AND GLOBAL - CAN REDUCE EXPOSURE TO CANCER RISK FACTORS AND IMPROVE ACCESS AND AVAILABILITY OF ESSENTIAL CANCER MEDICINES AND QUALITY CANCER CARE.

MAKE THE CASE FOR INVESTING IN CANCER CONTROL

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The economic case for investment is becoming a vital piece of the jigsaw to change mind-sets around the value of investing in cancer prevention and control1.

There is already a compelling argument for investing in prevention of cancer rather than dealing with the consequences. A case in point is tobacco control. While the annual economic costs of tobacco-attributable cancers exceed USD 200 billion, for the average low- and middle- income country (LMIC), the amount necessary to deliver the four “best buy” tobacco control measures is approximately USD 0.11 per capita2,3. The four measures include: tobacco tax increases, smoke-free policies, package warnings, and advertising bans.

Of these four measures, increasing excise taxes on tobacco products is widely accepted as one of the most effective and affordable tobacco control intervention4. The World Health Organization (WHO) estimates that raising tobacco taxes costs as little as USD 0.005 per person per year and can save millions of lives4. Additionally, it has been shown that raising tobacco taxes does not lead to a fall in government revenues – evidence suggests that if countries increased tobacco tax by 50% per pack, governments around the world would earn an extra USD 101 billion in revenue5.

The cancer community is now drawing on its networks of experts to build the global evidence base on the economic costs and the return on investment (ROI) in taking on other proven strategies for cancer prevention, early detection and health systems strengthening. This includes the case for investment in radiotherapy, an essential tool in the cure and palliation of cancer that is indicated in more than half of new cancer patients6. The Global Task Force on Radiotherapy for Cancer Control (GTFRCC) has convened radiotherapy professionals, industry partners, cancer leaders, global health experts, economists, and enablers of healthcare change, to quantify the investment needed to provide equitable access to radiation therapy worldwide7.

1. UICC. The Economics of cancer prevention & control: Data digest (2014). http://www.iccp-portal.org/economics-cancer-prevention-control-data-digest

2. World Health Organization. Scaling up action against noncommunicable diseases: how much will it cost? Geneva : WHO Press; 2011

3. Tobacco Atlas. Investing in tobacco control. http://www.tobaccoatlas.org/topic/investing-in-tobacco-control/

4. Chaloupka F, Yurekli A, Fong G. Tobacco Taxes as a Tobacco Control Strategy. Tobacco Control. 2013.

5. World Health Organization. (2014). Raising tax on tobacco - What you need to know, Geneva: WHO Press.

6. Delaney G, Jacob S, Featherstone C, Barton M. (2005). The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer 104, 1129-37.

7. Global Task Force on Radiotherapy for Cancer Control (2014). http://gtfrcc.org/

MAKE THE CASE FOR INVESTING IN CANCER CONTROL

WE CAN

BUILDING THE ECONOMIC CASE FOR INVESTMENT IN CANCER CAN CHANGE MIND-SETS AND ALLOW GOVERNMENTS TO JUSTIFY PLACING CANCER CONTROL AT THE HEART OF THEIR NATIONAL HEALTH PLANS.

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WORK TOGETHER FOR INCREASED IMPACT

WE CAN

The global cancer burden can be reduced through synergistic partnerships between governments, civil society and the private sector, that leverage complementary skills, competencies and spheres of influence to accelerate progress on shared goals and aspirations.

By joining forces, civil society organisations, cancer patient advocacy groups and other stakeholders can bolster their advocacy efforts around common issues by creating a united voice for positive change. Collaborating actively with partners in advocacy can also significantly reduce duplication of efforts and ensure the best use of scarce resources, as well as increasing access to policy and political decision-makers.

Promoting active participation in partnerships can also assist with building capacity through the exchange of knowledge and skills. For example, the International Cancer Control Partnership (ICCP) launched its web-based portal on cancer control planning and capacity-building in 2013 (www.iccp-portal.org). The ICCP Portal supports sharing of best practice resources relevant to the development, implementation and evaluation of national cancer control plans via a unique online platform. All in the convenience of one place, the portal provides a comprehensive and reliable source of materials for policymakers and cancer planners - the key audience for making sustainable change at a national level.

WORK TOGETHER FOR INCREASED IMPACT

WE CAN

WORKING IN PARTNERSHIP AROUND PROVEN SOLUTIONS FOR CANCER CAN ACHIEVE GLOBAL IMPACT BY STRENGTHENING ADVOCACY AND BUILDING CAPACITY AROUND COMMON GOALS.

MAKE HEALTHY LIFESTYLE CHOICES

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Everyone can take steps to reduce their risk of cancer by choosing healthy options including quitting smoking, keeping physically active and choosing healthy food and drinks.

Tobacco use is the single largest preventable cause of cancer globally. Quitting smoking will have a major positive impact on an individual’s health and that of their families and friends. The good news is that quitting at any age is beneficial, increasing life expectancy and improving quality of life1.

Individuals can also reduce their risk of many common cancers by maintaining a healthy weight, and making physical activity part of their everyday lives2, 3. Being overweight or obese increases the risk of ten cancers - bowel, breast, uterine, ovarian, pancreatic, oesophagus, kidney, liver, advanced prostate and gallbladder cancers4, 5. Alcohol is also strongly linked with an increased risk

of several cancers. Reducing alcohol consumption decreases the risk of cancers of the mouth, pharynx, larynx, oesophagus, bowel, liver and breast6. Overall, more than a third of common cancers could be prevented by a healthy diet, being physically active and maintaining a healthy body weight.

Reducing exposure to ultraviolet (UV) radiation from the sun and other sources, such as solariums, is also important to reduce the risk of many skin cancers7.

1. Jha P, Peto R. (2014). Global Effects of Smoking, of Quitting, and of Taxing Tobacco. N Engl J Med. 370:60-8.

2. World Cancer Research Fund International. Our cancer prevention recommendations. http://www.wcrf.org/int/research-we-fund/our-cancer-prevention-recommendations

3. World Cancer Research Fund International. Link between lifestyle and cancer risk. http://www.wcrf.org/int/link-between-lifestyle-cancer-risk

4. World Cancer Research Fund International/American Institute for Cancer Research. Continuous Update Project. http://www.wcrf.org/int/cancer-facts-figures/link-between-lifestyle-cancer-risk/cancers-linked-greater-body-fatness

5. World Cancer Research Fund International/American Institute for Cancer Research. Continuous Update Project Reports. http://www.wcrf.org/int/research-we-fund/continuous-update-project-findings-reports

6. WHO. (2011). Global status report on alcohol and health. Geneva: World Health Organization.

7. SunSmart. UV and sun protection. http://www.sunsmart.com.au/uv-sun-protection

MAKE HEALTHY LIFESTYLE CHOICES

I CAN

EVERYONE CAN MAKE HEALTHY LIFESTYLE CHOICES TO REDUCE THEIR RISK OF CANCER.

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UNDERSTAND THAT EARLY DETECTION SAVES LIVES

I CAN

Diagnosing cancer isn’t always easy – not all cancers show early signs and symptoms and other warning signs appear quite late when the cancer is advanced.

However, for a number of cancers, increasing awareness of signs and symptoms and the importance of timely treatment has been shown to improve survival from cancer. This is because finding cancer early almost always makes it easier to treat or even cure. In fact, recent figures from the United Kingdom for example, have found that for eight common cancers - bladder, bowel, breast, cervical, womb, malignant melanoma, ovarian and testicular cancers - survival is three times higher when cancer is diagnosed early1.

Health professionals play a critical role in early diagnosis. Being equipped with the knowledge and skills to recognise the early warning signs of some cancers, knowing when symptoms need to be investigated and referring patients promptly for tests, can contribute to increasing the proportion of cancers that are found early. For instance, clinical breast examination (CBE) can be performed by trained healthcare workers in low resource settings and has the potential to detect cancers earlier, particularly in areas where the majority of breast cancers are diagnosed at an advanced stage 2,3. For childhood cancers, healthcare workers can

be educated to recognise the warning signs and symptoms of paediatric cancer in order to reduce the likelihood of misdiagnosis and ensure prompt referral to specialist medical care at an early stage of the disease4.

Individuals can also be encouraged to know what’s normal for their body and to recognise any unusual or persistent changes5. For example, a person can become familiar with the look of their skin so they can be aware of any changes that might suggest a skin cancer, such as recognising a spot that is growing and changing in shape or size6.

For some cancers, there is robust evidence to support cancer screening. For example, visual screening for oral cancer is effective in reducing deaths from this type of cancer in users of tobacco and/or alcohol in countries with high incidence, most notably in South Asia 7,8.

1. Cancer Research UK. Survival three times higher when cancer is diagnosed early: po.st/PilTnn

2. El Saghir NS, Adebamowo CA, Anderson BO, et al. (2011). Breast cancer management in low-resource countries: consensus statement from the Breast Health Global Initiative. The Breast 20, S3-S11.

3. Knowledge summaries of comprehensive breast cancer control. http://www.iccp-portal.org/knowledge-summaries-comprehensive-breast-cancer-control

4. Workman GM, Ribeiro RC, Rai SN, et al. (2007). Pediatric cancer knowledge: assessment of knowledge of warning signs and symptoms for pediatric cancer among Brazilian community health workers. J Cancer Educ 22, 181-5.

5. Cancer Research UK. Key signs and symptoms of cancer. http://www.cancerresearchuk.org/about-cancer/cancer-symptoms#accordion_symptoms13

6. Cancer Council Australia. Skin Cancer Identification poster. http://www.cancer.org.au/content/pdf/Factsheets/MS%20214%20CCA%20MELANOMA%20POSTER%20V4%20.pdf#_ga=1.144286962.678793188.1438205862

7. Rajaraman P, Anderson BO, Basu P, et al. (2015). Recommendations for screening and early detection of common cancers in India. Lancet Oncol 16:e352-61.

8. Sankaranarayanan R, Ramadas K, Thara S et al. (2013). Long term effect of visual screening on oral cancer incidence and mortality in a randomized trial in Kerala, India. Oral Oncol 49:314-21.

UNDERSTAND THAT EARLY DETECTION SAVES LIVES

I CAN

HEALTHCARE PROFESSIONALS AND INDIVIDUALS CAN BE INFORMED OF THE VALUE OF EARLY DETECTION AND THE IMPORTANCE OF SEEKING CARE TO IMPROVE CANCER SURVIVAL.

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ASK FOR SUPPORT

I CAN

Maintaining social support networks and talking about cancer can be important strategies for coping with the social and emotional impact of cancer, both in the short and long term.

This is true for both the person living with cancer and their carer(s). Support can come from many sources – partners, friends, family, colleagues, healthcare professionals and counsellors – with some people choosing to join self-help or support groups. Support groups can provide a caring and supportive environment for people living with cancer to express their feelings and reduce anxiety and fear1.

Sometimes the people at work make up another vital network of support. Talking about cancer with colleagues as well as keeping in touch with them during work absences can have a positive impact on recovery2.

Cancer caregiving can also have an enormous influence on both physical and mental health. Carers – most commonly partners, family members or friends - receive little preparation, information or support to carry out their vital role3. Many carers put their own needs and feelings aside to focus on the person with cancer, and as a consequence may experience emotional distress and social isolation4. Recognising the challenges of looking after someone with cancer and seeking support can have wide-ranging benefits for coping and quality of life5.

1. Ussher J, Butow P, Wain G. et al. (2005). Research into the Relationship Between Type of Organisation and Effectiveness of Support Groups for People with Cancer and their Carers. http://staging.cancercouncil.com.au/wp-content/uploads/2011/02/Executive-Summary-for-CSG-research-2005.pdf.

2. Macmillan Cancer Support. Work and Cancer. http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Workandcancer/Workandcancer.aspx

3. Northouse LL, Katapodi M, Song L, et al. (2010). Interventions with family caregivers of cancer patients: meta-analysis of randomized trials. CA Cancer J Clin, 60, 317-339.

4. NBCF. (2013). So I Bit down on the Leather: Ending the Silence. Sydney: National Breast Cancer Foundation

5. Looking after someone with cancer. http://be.macmillan.org.uk/be/s-330-information-for-carers.aspx

ASK FOR SUPPORTI CAN

PEOPLE LIVING WITH CANCER AND THEIR CAREGIVERS CAN ASK FOR SUPPORT TO HELP THEM COPE WITH CANCER.

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SUPPORT OTHERS

I CAN

Support from friends, families, employers and colleagues can help a person living with cancer better adjust to the changes cancer brings to their lives and improve their quality of life.

For some people, support may be needed over many years after the initial diagnosis as they continue to live with the physical and emotional impacts of cancer even when treatment is finished.

Family members, especially partners can be a critical source of support for a person living with cancer. Often, family members take on the role of carer and sometimes adjusting to this change in roles can place strain on relationships1. Keeping the lines of communication open and talking about feelings can be important ways to help couples cope with changing relationships and other physical and emotional challenges of cancer.

Friends can play a major role in providing emotional, social and practical support. Spending time with a person, being willing to talk about their experiences and providing assistance with errands or tasks can all be enormously helpful2.

At work, a supportive approach from employers and colleagues can reduce anxiety and provide the skills and confidence to return to work successfully. For employers, making adjustments such as changes in tasks, hours, or function and maintaining open communication can be important factors in getting people back to work successfully. For colleagues, being sensitive to the needs and feelings of the person affected by cancer at work and keeping in touch during time away from the workplace can be very helpful. Some workplaces have an employee assistance programme or other type of support network to help employees affected by cancer or other illnesses3, 4.

1. Girgis A, Lambert S, Johnson C, et al. (2013). Physical, Psychosocial, Relationship, and Economic Burden of Caring for People With Cancer: A Review. J Oncol Practice, 9, 197-202

2. American Cancer Society. Be a friend to someone with cancer. http://www.cancer.org/treatment/understandingyourdiagnosis/talkingaboutcancer/how-to-be-a-friend-to-someone-with-cancer

3. Macmillan Cancer Support. Work and Cancer. http://www.macmillan.org.uk/information-and-support/organising/work-and-cancer/if-youre-an-employer

4. American Cancer Society. When someone you know has cancer. http://www.cancer.org/treatment/understandingyourdiagnosis/talkingaboutcancer/whensomeoneyouknowhascancer/when-someone-you-know-has-cancer-toc

SUPPORT OTHERSI CAN

GIVING HOPE AND SUPPORT TO SOMEONE LIVING WITH CANCER CAN MAKE A BIG DIFFERENCE IN THEIR LIFE.

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TAKE CONTROL OF MY CANCER JOURNEY

I CAN

Cancer patients and families should be empowered to have a greater degree of control over the choices that influence their health and wellbeing and preserve their dignity at all stages throughout the cancer journey.

Many patients value having a voice in their care, so it is important for cancer specialists to agree on a treatment plan that respects their expertise as well as the patients’ individual needs and preferences1. Providing clear explanations of the available options, including the risks, benefits, and uncertainty associated with the options are all important to help patients play an active role in decisions about their care across the entire cancer journey2,3.

Cancer patients receiving palliative or supportive care may have particular needs to get relief from symptoms, pain, and distress4. Having access to person-centred, dignity-conserving care

where patients take part in decisions, and all their care needs are addressed – their physical, emotional, spiritual, and social needs – is essential to delivering effective palliative or supportive care5,6.

1. Kehl KL, Landrum MB, Arora NK, et al. Association of actual and preferred decision roles with patient-reported quality of care: shared decision making in cancer care [published online February 12, 2015]. JAMA Oncol. doi:10.1001/jamaoncol.2014.112.

2. Politi MC, Studts JL, Hayslip JW. (2012). Shared Decision Making in Oncology Practice: What Do Oncologists Need to Know? Oncologist. 17:91-100

3. MacMillan Cancer Support. Making treatment decisions. http://www.macmillan.org.uk/information-and-support/treating/treatment-decisions

4. American Cancer Society. A Guide to Palliative or Supportive Care. What is palliative care? http://www.cancer.org/treatment/treatmentsandsideeffects/palliativecare/supportive-care

5. Pringle J, Johnston B, Buchanan D. (2015). Dignity and patient-centred care for people with palliative care needs in the acute hospital setting: A systematic review. Palliat Med. Mar 23. pii: 0269216315575681

6. WHO (2014). Strengthening of palliative care as a component of integrated treatment throughout the life course. A67/31 4 April 2014.

TAKE CONTROL OF MY CANCER JOURNEY

I CAN

PEOPLE LIVING WITH CANCER CAN TAKE CONTROL OF THEIR CANCER JOURNEY BY BEING EMPOWERED TO BE ACTIVE PARTICIPANTS IN DECISIONS ABOUT THEIR CARE, HAVING THEIR CHOICES RESPECTED AND THEIR NEEDS MET.

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LOVE, AND BE LOVED

I CAN

Cancer and its treatment can place strain on relationships, with both the person living with cancer and their partner facing challenges around communication, intimacy and sexual wellbeing.

Cancer touches everyone in a patient’s life in a different way. Partners may be especially affected and experience feelings of anger, frustration and anxiety1-3. They may also be adjusting to changes in their role and responsibilities as the primary caregiver, all of which can lead to strain on a relationship. While there is no ‘right way’ for a cancer patient and their partner to cope with cancer, there are things that couples can do to support each other through this challenging time1. For example, keeping the lines of communication open and taking time to talk about feelings and difficult topics such as a fear of recurrence or financial concerns can be helpful in dealing with the emotional impacts4. Some couples may also benefit from talking with a counsellor or others who have been through their own cancer journey.

For many, one of the longest lasting, and most devastating consequences of a cancer diagnosis is the impact on sexual health and wellbeing5. Both men and women can experience changes to sexual function and sexuality after cancer treatment6. For example,

men may experience physical changes to their sexuality arising from nerve damage as a result of some surgery or radiotherapy for prostate cancer. Changes may be also be associated with side effects of treatment such as fatigue, pain and weight gain, which can contribute to distress and negative emotional responses and lead to feelings of sexual unattractiveness. Seeking information and assistance from health professionals and cancer support services can help cancer patients to adjust to changes in sexual function and help couples to renegotiate sex and intimacy.

1. Macmillan Cancer Support. Relationships – You and your Partner. http://www.macmillan.org.uk/information-and-support/coping/relationships/you-and-your-partner

2. Girgis A, Lambert S, Johnson C, et al. (2013). Physical, Psychosocial, Relationship, and Economic Burden of Caring for People With Cancer: A Review. J Oncol Practice, 9, 197-202

3. NBCF. Ending the silence for men whose partners have breast cancer. http://www.nbcf.org.au/Research/Research-Achievements/Partners-and-Breast-Cancer-Report.aspx

4. Livestrong. Communicating with your partner. http://www.livestrong.org/we-can-help/preparing-yourself/communicating-with-your-partner/

5. Ussher JM, Perz J & Gilbert, E. (2012). Changes to sexual well-being and intimacy after breast cancer. Cancer nursing, 35, 456-65

6. Perz J, Ussher JM, Gilbert et al (2014). Feeling well and talking about sex. BMC Cancer 14:228.

LOVE, AND BE LOVEDI CAN

WORKING TOGETHER THROUGH THE CHALLENGES OF CANCER AND ITS TREATMENT CAN HELP PEOPLE LIVING WITH CANCER AND THEIR PARTNERS CONTINUE A CLOSE AND LOVING RELATIONSHIP.

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BE MYSELF

I CAN

Cancer and its treatment can change how people living with cancer feel about themselves and the way they look.

These feelings may come from the physical changes that can occur during and after treatment. Changes may be short-term such as hair loss from chemotherapy, or long-term changes such as impairment to speech or loss of a limb from surgery for some cancers, all of which can diminish a person’s quality of life and result in stigma and discrimination1-3. Even if others can’t see these changes, for example urinary incontinence sometimes arising from prostate cancer treatment, they can have an enormous impact on body image, contributing to anxiety and depression.

For many cancer patients, addressing issues of body image is an important way of regaining control and preserving a degree of normality. Accessing dedicated support services to manage their physical appearance such as

wearing a wig or prosthesis, can improve self-esteem and quality of life4,5. Seeking counselling from a health professional and keeping active with regular exercise are other ways for cancer patients to build confidence in the way they look and feel about themselves6.

1. Fingaret MC, Teo I, Epner DE. (2014). Managing body image difficulties of adult cancer patients: Lessons from available research. Cancer. 120:633–41.

2. Rosenberg SM, Tamimi RM, Gelber S et al. (2013). Body image in recently diagnosed young women with early breast cancer Psycho-Oncology. 22:1849-55.

3. Taylor-Ford M, Meyerowitz BE, D’Orazio, LM, et al. (2013). Body image predicts quality of life in men with prostate cancer. Psycho-Oncology 22, 756–761

4. National Cancer Institute. Self Image and Sexuality. http://www.cancer.gov/about-cancer/coping/self-image

5. American Cancer Society. Prostheses. http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/dealingwithsymptomsathome/caring-for-the-patient-with-cancer-at-home-prostheses

6. Macmillan Cancer Support. Changes to appearance and body image. http://www.macmillan.org.uk/information-and-support/coping/changes-to-appearance-and-body-image/body-image-after-treatment

BE MYSELFI CAN

WITH THE RIGHT SUPPORT, PEOPLE LIVING WITH CANCER CAN FEEL LIKE THEMSELVES AGAIN.

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RETURN TO WORK

I CAN

Although returning to work after cancer treatment can be challenging for many people, managing a smooth transition back into the workplace can be a significant factor both from a personal and a practical standpoint. A job can restore normality, routine, stability, social contact and income1.

Most often, people living with cancer need their employers to make some allowances to support them to get back to work successfully. Talking about cancer to their employers can help them to make adjustments such as changes in tasks or function, or supporting a phased-return to work. People affected by cancer can be encouraged to know that when they return to work they are likely to find a workplace environment that is willing to help them adapt to the challenges they face from their illness.

It is also important for people with cancer who want to return to work to understand their rights. In many countries, employers have a legal obligation to make reasonable adjustments at work for people living with cancer and to ensure they are not at a disadvantage to other employees2.

1. Macmillan Cancer Support. Work and Cancer. http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Workandcancer/Workandcancer.aspx

2. McCabe Centre for Law & Cancer, Cancer Council Victoria. (2013). Making the law work better for people affected by cancer. Melbourne: McCabe Centre for Law & Cancer.

RETURN TO WORKI CAN

WITH THE RIGHT SUPPORT, PEOPLE LIVING WITH CANCER CAN RETURN TO WORK SUCCESSFULLY.

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SHARE MY STORY

I CAN

Cancer survivors can give hope to those newly diagnosed with cancer.

By sharing their experiences, people living with cancer can play an important role in increasing knowledge about cancer prevention and the importance of early detection. Importantly, they can also reduce fear around the challenges of returning to everyday life after cancer.

Sharing stories through the media, community networks and support groups can raise awareness of the full impact of cancer on both emotional and physical wellbeing and be a powerful part of advocacy efforts by showing policy makers the heart and soul of an issue.

By telling their own stories, cancer survivors can also help others by breaking the silence around cancer and reducing the fear and stigma that often deter others from seeking care

and support1. For example, the impact assessment of an anti-stigma campaign in Mexico that centred on giving cancer survivors a platform to tell their own stories, showed that 76% of people exposed to the campaign learned something new about cancer and 70% said they now talk more openly about cancer. Participants also commented that they were more supportive of a person with cancer because of what they learned2. We kindly encourage you to share your story and experience with us at worldcancerday.org/share-your-story

1. LIVESTRONG. (2011). Cancer Stigma and Silence Around the World: A LIVESTRONG Report. Austin: LIVESTRONG. http://www.livestrong.org/What-We-Do/Our-Actions/Programs-Partnerships/Anti-Stigma-Campaign

2. Results from LIVESTRONG Mexico anti-cancer stigma campaign. http://blog.livestrong.org/2012/08/27/results-from-livestrong-mexico-anti-cancer-stigma-campaign/

SHARE MY STORYI CAN

BY SHARING STORIES, CANCER SURVIVORS CAN GIVE HOPE AND SUPPORT TO OTHERS AFFECTED BY THE DISEASE.

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SPEAK OUT

I CAN

The participation of cancer patients and their families in decision-making around cancer policies and programmes can foster a holistic approach to cancer care.

Individuals can be part of the conversation through engaging in public campaigns, communicating with decision-makers, and joining with consumer support groups to ensure the patient perspective is heard. In this way, cancer patients and their families can inspire change by helping to define the issues that matter to them and advocate for measures to address these1-3.

Young people, for example, have a particular role to play in shaping the national and global response to cancer. Through meaningful participation in policy making processes as well as grassroots advocacy, young people can be advocates for cancer in their communities, spreading knowledge and shaping attitudes.

1. Cancer Voices Australia. http://www.cancervoicesaustralia.org/

2. International Society of Paediatric Oncology. Childhood Cancer Advocacy. http://siop-online.org/node/25

3. LIVESTRONG. (2011). Cancer Stigma and Silence Around the World: A LIVESTRONG Report . Austin: LIVESTRONG. http://www.livestrong.org/What-We-Do/Our-Actions/Programs-Partnerships/Anti-Stigma-Campaign and http://media.marketwire.com/attachments/201208/50210_SOW_MEXICO_ENGLISH_FINAL.pdf

SPEAK OUT I CAN

BY BEING PART OF THE CONVERSATION ABOUT CANCER, INDIVIDUALS CAN BE POWERFUL AGENTS OF INFLUENCE AND CHANGE FOR ALL PEOPLE AFFECTED BY CANCER.

Health & Medicine

World Cancer Day 2016 Key Messages