Oncology and Public Health
summary
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, Introduction in Oncology and Public Health 3
Introduction in Public Health 4
Introduction in Oncology 7
Tumor Diagnosis and Treatment 10
Targeted Therapy and Immunotherapy 13
Oncogenesis 15
Psycho-oncology 18
Cancer Epidemiology 23
Pain Management in Oncology 29
Prevention and Screening 33
End-of-life and Palliative Care 37
E-health in Oncology 40
Cognitive Function 43
Adolescents and Young Adults (AYAs) with Cancer 46
Netherlands Cancer Registry 47
Late E ects After Treatment for Hodgkin Lymphoma 50
Nutrition 52
Emotions in Cancer Patients 56
Cancer and Work 57
Rare Cancer 61
Shared Decision Making (SDM) 63
Risk Communication and Population Cancer Screening Decisions 67
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, Introduction in Oncology and Public Health
ONCOLOGY
- Europe 2020:
- Incidence: >4 million cases
- Mortality: 1.9 million
- The Netherlands:
- Incidence 2019: 118,492
- Expected incidence 2032: 156,541
- Covid-19 and cancer: ~8000 new cases per month in 2020 (compared to 2011-2019), but drop
around spring
- Reasons:
- Population-based screening stopped in spring 2020
- Patients hesitant to go to GP or hospital
- Most common cancers:
- Males: prostate, skin, lung, colon, lymph node and leukemia, bladder and urinary tract,
esophagus, head-neck, kidney, pancreas
- Females: breast, skin, lung, colon, lymph node and leukemia, uterus, ovary, pancreas,
head-neck, kidney
- In the Netherlands, mortality due to cancer was 45,840 in 2020
- 5-years survival:
- 1990-1994: women 56%, men 42%
- 2015-2019: women 70%, men 66%
- In the Netherlands, 20-year prevalence of cancer is 830,413
- Total number of persons living with/after cancer in the Netherlands in 2032 is 1,400,000
(=1/13); impact on healthcare
ONCOLOGY AND PUBLIC HEALTH
- In the Netherlands: cancer is the leading cause of death
- ~1/3 of deaths from cancer are due to 5 leading behavioral and dietary risks:
- High body mass index
- Low fruit and vegetable intake
- Lack of physical activity
- Tobacco use
- Alcohol use
PUBLIC HEALTH
- Public health: the science and art of preventing disease, prolonging life, and promoting health
through the organized e orts of society
- Health: a state of complete physical, mental and social wellbeing, and not merely the
absence of disease or in rmity
- Goals of public health:
- Focus on prevention: limit risk factors for cancer (obesity, smoking, alcohol use, UV
radiation)
- Increase healthcare capacity: working in healthcare should be made more attractive
- E cient organization of healthcare: use of technology, the right care at the right location
- Digitalization: connecting data
- Support the needs of patients and survivors
- Increase quality of life and quality of end-of-life
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, Introduction in Public Health
DEFINITION AND APPLICATION OF PUBLIC HEALTH
- De nition of public health:
- 1988: public health is the science and art of preventing disease, prolonging life, and
promoting health through the organized e orts of society
- WHO 1948: health is a state of complete physical, mental and social well-being, and not
merely the absence of disease or in rmity
- New addition to de nition: public health is the science and art of preventing disease,
prolonging life, and promoting health through the organized e orts and informed choices
of society, organizations, public and private, communities and individuals
- It refers to collective actions to improve population health
- WHO: all organized measures (whether public or private) to prevent disease, promote
health, and prolong life among the population as a whole
- Application of public health:
- 3 elds of public health research:
- Epidemiology and community diagnosis
- Collective prevention and health promotion
- Healthcare organization and performance
- Public health vs. medical science:
- Public health involves: population, disease prevention, health promotion, interventions
(environment, human behavior)
- Populations: from local areas to the world population
- Causes of disease (“causes of causes”): from behaviors to broader environments
- Prevention of disease: from individual patients to national policies
- General health outcomes: from quality of life to healthy life expectancy
- Medical science involves: individual, diagnosis, treatment, intervention (medical care)
- Main public health functions (WHO):
- Assessment and monitoring of the health of communities and populations at risk to
identify health problems and priorities
- The formulation of public policies designed to solve identi ed local and national health
problems and priorities
- Assure that all populations have access to appropriate and cost-e ective care, incl. health
promotion and diseases prevention services
- Major public health achievements:
- Since 1900: vaccination, safer workplaces, control of infectious diseases
- Latency period: when exposed to asbestos, there is a long onset (tens of years) for
mesothelioma to develop
- Since 1920: safer and healthier foods, healthier mothers and babies, family planning
- Infant mortality dropped since 1920
- Since 1965: uoridation of drinking water, motor vehicle safety, recognition of tobacco use
as a health hazard, decline in deaths from coronary heart disease and stroke
- Biggest success in public health: improved sewage disposal and clean water supply
systems (since 1840)
- Current/future public health challenges:
- Examples: infectious diseases (ebola, Covid-19), chronic diseases, overweight and obesity,
mental health, environmental quality and planetary health, social issues (e.g. violence, drug
abuse, teenage pregnancy)
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