Think About the Link®: A case study of a U.S.-based
campaign tackling public awareness of
virally-induced cancers
0
Prevent Cancer Foundation Union for International Cancer Control
2016 World Cancer Congress November 1, 13:10 – 14:10 p.m.
About Public Awareness Campaigns
Viruses and Cancer Campaign Need and Strategic Approach
Campaign Components and Results
Lessons Learned and Next Steps
Questions and Answers
AGENDA
2
What are
public awareness campaigns?
About Public Awareness Campaigns
3
How do successful awareness campaigns work?
About Public Awareness Campaigns
4
What can awareness
campaigns do? What can’t they do?
About Public Awareness Campaigns
6
Viruses and Cancer Campaign: Need and Strategic Approach
5
Estimated 79 million Americans currently infected
with human papillomavirus (HPV)
14 million new infections/year in the US
Almost everyone will be infected with at least one
type HPV at some point
Most will never know they’ve been infected
6 out of 10 girls (63%) and 5 out of 10 boys (50%)
in the U.S. have started the HPV vaccine series
HPV Infection
10
Need for Viruses and Cancer Campaign: HPV
HPV–Associated Cancers United States: Scope of
Problem From 2008 to 2012, HPV-associated cancers climbed
to nearly 39,000
11,700 cases of cervical cancer in women
12,600 oropharyngeal cancers in men
5,000 anal cancers
30,700 (79%) can be attributed to HPV
28,500 (73%) of these are attributable to HPV types
preventable with the 9-valent HPV vaccine
11
Need for Viruses and Cancer Campaign: Hep B
248 million have chronic hepatitis B (hep B) virus infection worldwide
1 in 3 people infected Each year, 1 million die of chronic hep B;
more than half due to liver cancer About 2 million Americans have chronic
hep B 1 in 20 Americans has been infected; 50% of Asian descent
World’s leading cause of liver cancer
Hepatitis B Infection
7
Hepatitis C Infection
170 million people have chronic hepatitis C
(hep C) virus infection worldwide
About 5 million Americans have chronic hep C
Baby boomers are 5x as likely to have hep C
than other adults
Leading cause of liver cancer in the U.S.
8
Need for Viruses and Cancer Campaign: Hep C
Liver Cancer: Scope of the Problem
World’s 6th most common cancer 2nd leading cause of cancer-related deaths
Fastest-growing cause of cancer deaths for Americans ages 65 and younger
3rd leading cause of cancer deaths in the U.S. by 2030 2015: 36,000 new cases and 25,000 deaths Asian-Americans have highest incidence of
liver cancer Hispanics have 2x higher incidence rate than
non-Hispanic whites
9
12
Think About the Link® Objectives
HPV, hep B, hep C Goals include raising awareness:
Of the link between these viruses and specific types of cancer
That certain cancers are preventable in many cases through
vaccination and/or treatment
Of the effectiveness of HPV and hep B vaccines
Of the availability of hep B and hep C treatments
13
Key Messages
There is a link between certain viruses and cancer.
Vaccination and/or treatment can prevent cancer.
Make an appointment now to talk to your – or your child’s – physician.
14
Strategic Approach
Leverage results of original research among physicians and
consumers regarding awareness of viruses and cancer.
Engage national physician spokesperson and local experts to
educate at-risk consumers.
Empower health care professionals and educate/screen at-risk
consumers through grassroots education events in 6 to 10 target
states.
Secure campaign visibility through proactive and ongoing media
outreach.
15
Campaign Advisory Council
Stanley Block, MD Institution of Kentucky Pediatric and Adolescent Research Elmer E. Huerta, MD, MPH Washington Cancer Institute MedStar Washington Hospital Center
Larry Maxwell, MD, FACOG Inova Fairfax Hospital Lopa Mishra, MD George Washington University
Lewis Roberts, MB ChB, PhD Mayo Clinic Kathleen Schmeler, MD UT MD Anderson Cancer Center Erich M. Sturgis, MD, MPH UT MD Anderson Cancer Center (campaign spokesperson)
Gyongyi Szabo, MD University of Massachusetts Medical School
Survey Highlights:
Health Care Professionals
15
National Health Care Provider and Consumer Surveys
Research objectives:
Measure virus and vaccine familiarity Evaluate vaccination recommendations, strategies for compliance, education
methods and compliance barriers Measure awareness of HPV, hep B and hep C facts Evaluate perceptions of vaccinations in general
Study Population 657 health care professionals 1,026 general population adults The general population sample was augmented in order to have readable segments: African-Americans, Asians and Hispanics
18
Not All Patients Receiving HPV Recommendation
Not all patients who meet the CDC guidance criteria receive recommendation for HPV vaccination.
Sixty-three percent of general practitioners don’t recommend to all patients.
Fifty-seven percent of nurse practitioners/physician assistants don’t recommend to all patients.
19
Primary Barriers to HPV Vaccine
Recommendation Health care professionals who don’t always recommend the HPV vaccine most often cite:
Parents being uncomfortable (43%)
Patients being too young (40%)
20
43
40
24
19
17
14
10
7
4
2
5
3
- 10 20 30 40 50 60 70 80
Parents are uncomfortable
They are too young
I know they will not be able to …
They are not high-risk
They are not sexually active
I'm concerned about side effects
I am not comfortable making the …
The vaccination is not needed by …
I don't know what the …
Too old/my patients are older/elderly
Some other reason
No answer
Total
Health care professionals who don’t always recommend the hep B vaccine most often cite:
Adult patients not being high-risk (41%)
Parents being uncomfortable (39%)
21
41
39
20
17
10
9
7
2
8
5
- 10 20 30 40 50 60 70 80
They are not high-risk
Parents are uncomfortable
They are too young
I'm concerned about side effects
They are not sexually active
I am not comfortable making the recommendation
I don't know what the recommendations are
Patient refusal
Some other reason
No answer
Total
Primary Barriers to Hep B Vaccine Recommendation
Hep B Vaccine and Link to Cancer Prevention
Seven in 10 health care professionals indicate cancer prevention works very or somewhat well for hep B vaccination compliance.
However, only 27% of health care professionals use cancer prevention as a compliance strategy.
22
27 33
28
16
0
10
20
30
40
50
60
70
80
90
100
Total (n=657)
Pedia- trician
(n=253) [P]
GP (n=252)
[G]
NP/PA (n=152)
[N]
16 19 18 7
54 49 56
59
25 24 23
28
5 8 3 7
0
10
20
30
40
50
60
70
80
90
100
Total (n=657)
Pedia- trician
(n=253) [P]
GP (n=252)
[G]
NP/PA (n=152)
[N]
Not at all well
Not very well
Somewhat well
Very well
Patients Receiving Hep C Treatment
Only three in five patients (59%) diagnosed with hep C ultimately receive treatment.
23
Under 50 29%
50 to 69 21%
[CATEGORY NAME]
[PERCENTAGE]
Primary Barriers to Hep C Treatment
Cost and lack of insurance are the primary barriers of hep C treatment.
24
44
26
13
13
2
[VALUE]
[VALUE]
25
25
8
74
60
38
37
10
- 10 20 30 40 50 60 70 80
The cost of treatment
Lack of insurance coverage
Denial of insurance coverage
Adverse effects
Physician reimbursement procedures
Primary Additional Total
Survey Highlights: General Population
23
Lack of General Knowledge
Less than one-half of adults are very or somewhat familiar with hepatitis C (49%), HPV (45%) and hep B (44%).
Only one in five adults (20%) is very or somewhat concerned with being at increased risk for HPV (22% of females).
Less than one in six adults is very or somewhat concerned about hep C (16%) and hep B (16%).
26
Need for Increased Cancer Prevention Message
Adults report cancer prevention is a rarely-used strategy for vaccine compliance.
7% of adults indicate a physician has recommended one or more vaccinations to them specifically to reduce the risk of cancer.
27
7
5
9
17
7
1 0
7 7
11 11
-
2
4
6
8
10
12
14
16
18
Total (n=1026)
Male (n=508)
Female (n=518)
Age 18-34
(n=311)
Age 35-49
(n=253)
Age 50-64
(n=259)
Age 65+
(n=203)
Cauc- asian
(n=794)
African- Am.
(n=211)
Hisp- anic
(n=207)
Asian Am.
(n=207)
Physician recommended vaccination to reduce cancer risk
Need for Increased Physician
Communication More than nine in ten adults (92%) believe more education is needed
about the dangers of HPV.
Nearly four in five adults (78%) would be more likely to get vaccinations if their physicians provided more detailed information.
28
49 33 36
43
44 42
6 16 14
2 6 8
- 10 20 30 40 50 60 70 80 90
100
I believe more education is needed about the dangers of the HPV virus
I would be more likely to get vaccinations if my physician provided
more detailed information
I don't believe I'm fully aware of all the facts about the risks of HPV
Agree completely Agree somewhat Disagree somewhat Disagree completely
92 78 78
Need for Increased Screenings
Many American adults in at-risk populations have never been screened.
Three in ten Asians (30%) reported having been screened for hep B.
One-quarter of Hispanic adults (24%) reported having been screened for hep C and only 21% reported having been screened for HPV.
29
45
11
14
19
21
21
23
- 10 20 30 40 50
None of the above
Meningococcal (meningitis)
Tetanus (lockjaw)
Human Papillomavirus (HPV)
Hepatitis B
Hepatitis C
Cancer
Base: Total Respondents (n=1026)
Need for Increased Education
Large percentages of at-risk populations do not know they’re at risk.
One in eight Hispanic adults (12%) were previously aware Hispanic adults have higher rates of hep C-associated liver cancer.
One in nine baby boomers (11%) were previously aware baby boomers have higher rates of hep C.
Nearly three in ten Asian adults (29%) were previously aware Asian adults have higher rates of hep B.
30
Campaign Components and Results
29
32
Campaign Components
Educating Lawmakers: Congressional Briefings
Informing Press and Generating Buzz: National, Local and Social Media
Outreach
Engaging the Community: Elevating the Dialogue in Priority Local Markets
Provider and Patient Engagement: Advertisements and Direct Mail
Provider and Patient Education: Webinars
Consumer Engagement: ThinkAboutTheLink.org, Educational Materials
Campaign Components: Congressional Briefing
80+ attendees representing 18 members of Congress, as well as medical institutions, patient advocates, health care providers, nonprofit associations, media and the general public
33
Introduced campaign to members of Congress/Hill staffers and educated key stakeholders about the link between HPV, hep B, hep C and cancer.
34
Campaign Components: Community Outreach
Day 1: Viruses and Cancer Summit
Six local partners hosted summit for 100+ physicians, nurse practitioners, patients and advocates about HPV, hep B and hep C
Attendees solved real-life case studies to foster greater collaboration Enduring materials
Print directory of attendees (Houston Health Department) Summit white paper
Day 2: Screenings (75+ screenings) Low-cost pap smear at HOPE Clinic targeting Asians and Hispanics Third ward hep B and hep C screenings targeting African-Americans Faith-based health fair offering hep B and hep C screenings and hep B vaccines
35
Community Outreach: Houston, TX
Think About the Link® between Viruses and Cancer Summit and Screenings
Community Outreach: Palos Park, IL
Typical Response: “I don’t fit the bill. I’m just picking up a friend.”
36
Community Outreach: Philadelphia, PA
National Hepatitis Testing Day 50+ attendees at press briefing at City Hall to urge Philadelphia City Council and
city-managed health centers to test high-risk patients for hep B and hep C
38
Community Outreach: San Francisco, CA
60+ attendees at press briefing on the steps of City Hall to call attention to hep B and hep C and the needs of patients and at-risk populations
Speakers included Dr. Tung Nguyen, Chair of the President’s Advisory Commission on Asian-Americans and Pacific-Islanders
City Hall illuminated in the colors of hep B and hep C in recognition of World Hepatitis Testing Day
37
Think About the Link® City Hall Illumination: Shining A Light on the Link Between Viral Hepatitis and
Liver Cancer (World Hepatitis Testing Day)
Community Outreach: Harlem, New York
Hep C Academy Nearly 80 patients and at-risk individuals
learned about hep C, liver cancer and latest in treatment options and advocacy efforts in NYC
Free outdoor community health fair 70 hep C screenings
1 individual tested positive for hep C 5 hep B screenings, 57 blood pressure,
cholesterol and glucose tests
39
Day of Action: Think About the Link® – Understanding the Link Between Hep C
and Liver Cancer
Community Outreach: Queens, New York
More than 350+ Asian attendees Attended by local politicians who
promoted cancer prevention Featured local medical experts Free hep B, hep C, blood pressure
screenings, annual physicals and more
40
Viruses and Cancer Community Health Fair: HPV, hep B, hep C
Community Outreach: Queens, New York Significant increase of the % of people who obtained
the knowledge of viruses and cancer
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Hep-B vaccine can prevent liver
cancer
Most common HepB transmission
for Asians is mother-to-child
Hep-C is treatable The most common sexually
transmitted virus is HPV
Most effective way to prevent cervical cancer is vaccine
The most common transmission of HPV is sexual
conduct
All teenagers need to get HPV vaccine
Before
After
41
Campaign Components: Advertisements
Regional Digital Advertisements New York, Philadelphia, Houston, San
Francisco, Palos Park 2.5 million people reached combined
Times Square Digital Advertisement (September – November 30, 2016) 10-second slot running 10 – 12x per
day 300,000+ daily visitors 115,000 drivers
Los Angeles Billboard Advertisements (November 2016 – January 2017) 10 billboard ads noting the link between HPV,
hep B, and hep C and cancer
42
Campaign Components: Media Outreach
Reached nearly 192 million Americans through media hits in national, local, special interest, health and cancer trade publications 100% inclusion of campaign messaging
Social Media Activity
85+ Facebook campaign posts, 56K impressions and 980+ new “likes”
180+ campaign tweets, 112K impressions and 950+ new followers
43
Campaign Components: Webinars
Viral Hepatitis and Liver Cancer (December 2015) Hosted in partnership with Hepatitis B Foundation 70+ attendees, including representation from Africa
HPV and Cancer: Opportunities to Increase
Vaccine Compliance in the U.S. (August 2016) 105+ attendees across the U.S. Featured Dr. Stanley Block (private practice pediatrician),
Anna C. Dragsbaek (The Immunization Partnership) and Dr. Lois Ramondetta (MD Anderson Cancer Institute)
Over 95% satisfaction from attendees
45
Campaign Components: Change.org Petition
Nearly 5000 new advocates signed petition to enforce CMS’ recommendation that state Medicaid agencies provide hepatitis C medication for anyone with chronic hepatitis C infection, with no barriers to access
Petition received almost all of these signatures in 12-hour period
Letter to be delivered to Sylvia Burwell, Director of HHS and Andy Slavitt, Director of CMS
46
“Tell Medicaid to Cover Lifesaving Hepatitis C Medication”
47
About the Results
What does it all mean?
48
What Works
Simple messaging for the general public
Engaging lawmakers and other stakeholders on Capitol Hill
Multiple spokespeople, including patients and advocates
Engagement of multiple decision makers in target cities
Local hospitals, health centers, health departments
Targeting specific populations and tailoring events
Conducting screenings through trusted sources
49
Looking Ahead: 2017 Campaign Efforts
Public Service Announcement Raising awareness of the link between HPV, hep B, hep C and cancer To be distributed to television and radio stations across the U.S.
Satellite Media Tour
Promote link between viruses and cancer, PSA and campaign messaging
Targeted media outreach, community events, webinars and culturally-sensitive advertising to reach African-American, Asian and Hispanic consumers Build relationships with pharmacy, nursing and primary care organizations to foster enhanced doctor/patient communication around viruses and cancer Advocates: Build advocacy database in key target states
Questions and Answers
47
