1206 Correspondence | JNCI Vol. 102, Issue 15 | August 4, 2010
Low Awareness of and
Referral to National Cancer
There are currently more than 11 million
cancer survivors in the United States ( 1 ).
With improvements in cancer screening
technology and treatment, this number is
likely to increase. The information needs
of cancer patients and survivors could strain
an already burdened health-care system,
underscoring the need for reliable cancer
information from credible sources ( 2 – 4 ).
Although many quality cancer informa-
tion resources are available, recent data ( 5 )
indicate that health-care professionals are the
most trusted source for health information,
followed by US government health agencies
that produce and scientifi cally vet materials
for patients and health-care professionals,
such as the National Institutes of Health
(NIH) and the Centers for Disease Control
and Prevention (CDC). The National Cancer
Institute’s Web site ( www . cancer . gov ) and
the Cancer Information Service (1-800-4-
CANCER) serve as NIH’s primary cancer
information resources. The CDC Web site
( www . cdc . gov ) also serves as a cancer infor-
To assess the awareness of and referral
to national cancer information resources
among primary care physicians, we ana-
lyzed data from the National Survey of
Primary Care Physicians ’ Recommendations
and Practice for Breast, Cervical, Colorectal,
and Lung Cancer Screening. The survey
was fi elded in 2006 and 2007 as a mailed
questionnaire. The sample was drawn from
the American Medical Association Physician
Masterfi le by using a systematic sample
design that was stratifi ed by medical spe-
cialty type. Eligible respondents were non-
federal offi ce-based family physicians,
general practitioners, general internists,
and obstetricians and gynecologists aged
75 years or younger. A total of 1212 physi-
cians completed the survey for a 73.4%
cooperation rate and a 67.5% response rate.
Details about sampling and survey method-
ology are published elsewhere ( 6 ).
Respondents were asked “Are you aware
of, and have you ever referred a patient to,
any of the following services for cancer in-
formation: 1-800-4-CANCER; www . cancer
. gov ; and www.cdc.gov?” Response options
were “aware and referred,” “aware of it,
never referred,” and “not aware of it.”
Awareness and referral were assessed by phy-
sician and practice characteristics.
(Research Triangle Institute, Research
Triangle Park, NC), was used to calculate
weighted percentages and 95% confi dence
intervals (CIs). Cross tabulations with
two-sided ? 2 and t tests and a multinomial
regression analysis were conducted to dis-
cern physician and practice characteristics
associated with awareness and referral.
Awareness and referral to national in-
formation resources was low: 6.2% of phy-
sicians reported awareness and referral to
1-800-4CANCER, 14.0% reported aware-
ness and referral to www . cancer . gov , and
23.1% reported awareness and referral to
www . cdc . gov ( Table 1 ). Greater awareness
of and referral to at least one of these re-
sources was associated with more time
spent teaching ( P = .046 [ t test]) and con-
ducting administrative duties ( P = .046
[ t test]). Lower awareness and referral was
observed among physicians who were in
private practice ( P = .001 [ ? 2 test]), had
larger patient loads ( P = .015 [ ? 2 test]), or
had a higher percentage of uninsured
patients ( P = .015 [ ? 2 test]). A multinomial
logistic regression analysis revealed that
compared with physicians in university
Table 1 . Physician awareness of and referral to national cancer information resources
Resource Sample size
Aware and did
not referNot aware
www . cancer . gov
www . cdc . gov
At least one resource
settings, those in private practice were less
likely to be aware of and refer to national
cancer information resources (odds ratio =
0.50, 95% CI = 0.34 to 0.74) and less likely
to report awareness and no referral (odds
ratio = 0.49, 95% CI = 0.32 to 0.74).
Low levels of awareness of and referral to
national cancer information resources were
observed across physician and practice char-
acteristics. Efforts to raise awareness and use
of these resources could improve informa-
tional support to health-care providers, can-
cer patients, and survivors.
LILA FINNEY RUTTEN
KELLY D. BLAKE
1. Horner MJ , Ries LAG , Krapcho M , et al ., eds.
SEER Cancer Statistics Review, 1975 – 2006 .
Bethesda, MD : National Cancer Institute ;
2009 . Based on November 2008 SEER data
submission, posted to the SEER Web site. http
:// seer . cancer . gov / csr / 1975_2006 / . Accessed
May 21, 2010 .
2. Arora NK . Interacting with cancer patients:
the signifi cance of physicians ’ communication
behavior . Soc Sci Med . 2003 ; 57 ( 5 ): 791 – 806 .
3. Hesse BW , Arora NK , Burke Beckjord E ,
Finney Rutten LJ . Information support for
cancer survivors . Cancer . 2008 ; 112 ( 11 suppl ):
2529 – 2540 .
4. Finney Rutten LJ , Arora NK . Provider-patient
communication across the cancer care con-
tinuum . In: O’Hair HD , Kreps GL , Sparks L ,
eds. Communication and Cancer Care . Cresskill,
NJ : Hampton Press ; 2007 : 13 – 36 .
5. Hesse BW , Moser RP , Rutten LJ . Surveys of
physicians and electronic health information .
N Engl J Med . 2010 ; 362 ( 9 ): 859 – 860 .
6. Yabroff KR , Saraiya M , Meissner HI , et al .
Specialty differences in primary care physician
reports of papanicolaou test screening prac-
tices: a national survey, 2006 to 2007 . Ann
Intern Med . 2009 ; 151 ( 9 ): 602 – 611 .
This project was funded in part with fed-
eral funds from the National Cancer Institute,
National Institutes of Health, under contract
The content of this publication does not neces-
sarily reflect the views or policies of the
Department of Health and Human Services, nor
does mention of trade names, commercial prod-
ucts, or organizations imply endorsement by the
by guest on April 13, 2012
JNCI | Correspondence 1207
Affiliations of authors: Clinical Monitoring
Research Program, SAIC-Frederick, Inc, National
Cancer Institute-Frederick, Frederick, MD (LFR,
KD); Health Communication and Marketing,
Research Triangle Institute, Research Triangle
Park, NC (LS); Health Communication and
Informatics Research Branch, Behavioral Research
Program, Division of Cancer Control and
Population Sciences, National Cancer Institute,
Bethesda, MD (KDB) .
Correspondence to: Lila Finney Rutten, PhD,
MPH, Clinical Monitoring Research Program,
SAIC-Frederick, Inc, National Cancer Institute-
Frederick, Frederick, MD 21704 (e-mail: finneyl
@mail.nih.gov ) .
Published by Oxford University Press 2010.
Advance Access publication on June 25, 2010.
by guest on April 13, 2012