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Aligning Public Perception With Clinical Realities

Kagan, Sarah H. PhD, RN

doi: 10.1097/NCC.0000000000000437

Author Affiliation: School of Nursing, University of Pennsylvania, Philadelphia.

The author has no funding or conflicts of interest to disclose.

Correspondence: Sarah H. Kagan, PhD, RN, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia PA 19104 (

Accepted for publication July 28, 2016.

The nature of cancer, both because of changing lifestyles and as result of advances in translational science and improvements in clinical care, is radically different from a few decades ago. For those with access to adequate prevention and detection and to current standard of care, most diagnoses of cancer result in controllable and even curable disease.1,2 Active prevention of certain malignancies—as with colonoscopy for premalignant colon polyps or sun protection for those spending time outdoors—is now within reach. The days of poorly understood risk and universally life-limiting prognosis are rapidly fading.

In the public view, cancer continues to be broadly feared as an almost certain death sentence despite evident clinical realities.3,4 Fear dominates most social reactions to cancer. More critically, resulting anxiety often guides decisions about when and how to seek healthcare.3 Much public knowledge of cancer lacks understanding of personal risk, actual behavioral control, and relevant disparities. As a result, individuals are likely to misperceive their own health risks, missing opportunities to act in ways that reduce risk and the fear underlying those behaviors.

Most societies around the world are aging, with greatest demographic changes anticipated in low- and middle-income nations. With shifting age demographics, increases in cancer and other chronic noncommunicable diseases are expected. Increasing incidence and prevalence of age-associated diseases like cancer expands needs to promote health through risk reduction and early detection. As they age, individuals need to understand conditions for which they are at risk, plausible control over such risk, and appropriate screening measures.

Nursing prioritizes values of health promotion and education. Promoting health by educating the public about cancer risks, risk reduction, and treatment outcomes is clearly in line with these values. Yet, our research addressing public perception of cancer and intervention to improve lay knowledge is more limited than our disciplinary values imply. Much research in lay perception of cancer is guided by public health, and often by medicine in particular, while lacking a clearly appreciable nursing perspective. Rather, nurses typically explore either specific behavior change to reduce cancer risk or investigate cancer fear and stigma among those already carrying a diagnosis of cancer. This science is worthy and influential. However, the scope and import of our science must expand to meet the needs of aging populations around the world.

As cancer nurse researchers, we are distinctively well positioned to define and redress the gap in accurate public knowledge of cancer. In addition to values of health promotion and education, our skills in studying disparate cancer care offer a strong foundation for public knowledge, perception, and behavior. Our challenge then is to leverage our scientific strengths in cancer disparities and survivorship to enlarging needs for knowledge in aging populations, the role of ageism in disparate care, and improved public knowledge of cancer risk and prevention. Redefining the beneficiary of our research and resultant care from patient and survivor to lay public is central to meeting this challenge.

Claiming the general public as our clients or patients offers vast potential for cancer nursing research to more directly influence public health in aging societies. In doing so, we bring to bear our vantage point on behavior, emotion, and decisions along with a notable credibility in understanding the realities of cancer. Documenting gaps in public awareness of changes in cancer outcomes and in knowledge of cancer risk and prevention alone are inadequate in improving public health. Overcoming lags in knowledge along with misperception requires active intervention. Here, our reflections on cancer outcomes—combined with skills in psychosocial and emotional support—lend themselves to novel public education programs, behavioral interventions, and development of nurse-led cancer risk services.

The evolving character of cancer seen around the world calls for advancing cancer nursing science. As researchers, as mechanisms of prevention and risk become ever better understood, we possess essential perspective and necessary skills well placed in improving public health. We can respond to the imperative of cancer in an aging world with our active engagement in public education to improve cancer knowledge, prevention, screening, and detection.

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1. Colditz GA, Sutcliffe S. The preventability of cancer: Stacking the deck. JAMA Oncol. 2016.
2. Song M, Giovannucci E. Preventable incidence and mortality of carcinoma associated with lifestyle factors among white adults in the United States [published online ahead of print May 19, 2016]. JAMA Oncol.
3. Vrinten C, van Jaarsveld CHM, Waller J, von Wagner C, Wardle J. The structure and demographic correlates of cancer fear. BMC Cancer. 2014;14(1):1–9.
4. Moser RP, Arndt J, Han PK, Waters EA, Amsellem M, Hesse BW. Perceptions of cancer as a death sentence: prevalence and consequences. J Health Psychol. 2014;19(12):1518–1524.
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