1. Native Cancer 101: Module 9: Chronic Conditions and Cancer Kathleen Ragan, BS, CHES Linda Burhansstipanov, MSPH, DrPH (Cherokee Nation of Oklahoma) Native American Cancer Initiatives, Incorporated Linda U. Krebs, PhD, RN, AOCN, FAAN, Oncology Consultation, Education and Advocacy Network (OCEAN) Kerri Lopez, BS, Tolowa Nation, Northwest Portland Area Indian Health Board Paulette Baukol, BS, Mayo Clinic, Rochester, MN Dana Kontras,RN, Mayo Clinic, Jacksonville, FL

2. Audience Response System (the Keypads) (TP)

3. Turning Point Keypads Lanyard that goes around your neck These are NOT calculators and need to be returned to the faculty at the end of the session please

4. Audience Response System (ARS) – keypads This is how we vote on different items and issues Although the keypads are “anonymous” (we don’t know who uses which keypad); but we would like you to use the same one throughout the workshop You do not need to “point” the keypad (like a TV remote control) You will see a counter on the screen that shows how many people have “voted” on any item You press the number on the keypad that best describes your answer (use “0” for “10” on the keypad)

5. Demographic items (TP, 6)

6. What is your gender? 1.Male 2.Female 3.Don’t want to answer

7. brthyr5 About How Old are You? 1.81 and older 2.65-80 3.50-64 4.41-49 5.31-40 6.21-30 7.13-20 8.Under 12 9.Don’t want to answer

8. What is Your Primary Race? 1.American Indian / Alaska Native (AIAN) 2.Pacific Islander 3.Asian 4.African-American 5.Non-Hispanic white (Caucasian) 6.Other 7.Don’t know / Don’t want to answer

9. Are you Hispanic, Latino or Chicano? 1.Yes 2.No 3.Don’t Know / Not sure 4.Don’t want to answer

10. How Much Schooling have You Completed? 1.Elementary (kindergarten to grade 6 / grade school) 2.7 th, 8 th, or 9 th grade (middle school) 3.10, 11, or 12 th grade (no degree) 4.High school graduate / GED 5.Technical school /apprentice training 6.Some college (no degree) 7.College AA degree 8.College BA, BS degree 9.Masters’ degree 10.Doctorate or more

11. Role2 Which of the Following Bests Describes You? 1.Community leader 2.Community member 3.Student 4.Teacher / Faculty 5.Researcher / Scientists 6.Healthcare provider (MD, RN, etc.) 7.Outreach recruiter 8.Cancer patient, survivor 9.Other 10.Don’t know / Don’t want to answer

12. 4 Pre-Session Knowledge Items

13. Which is an example of an “acute” condition? 1.Cancer 2.Arthritis 3.Trauma (car accident) 4.Diabetes 5.Don’t know / Not sure

14. What is the cause of most (~90%) of all cancers? 1.Family history 2.Smoking for 5 years 3.Being exposed to radiation 4.Lifestyle and physical environment 5.Don’t know / Not sure

15. If a “breast” cancer cell spreads to the kidney, what is the new cancer called? 1.New primary cancer 2.Recurrent breast cancer 3.Breast cancer 4.Kidney cancer 5.Don’t know / Not sure

16. Which is NOT part of the “triple triple” threat of diabetes among American Indians? 1.~ 3 times the risk of cancer 2.~ 3 times the risk of heart disease and stroke 3.~3 times the risk of kidney failure 4.~3 times the risk of death 5.Don’t know / Not sure

17. Cancer 101 Basics and Background

18. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 18 QUESTION: Why do you think we are taking time to talk specifically about cancer? Because cancer is now the 2 nd leading cause of death for AIs over 45 years old. Cancer is continuing to increase with AIANs even through the disease is becoming less common among whites. The primary reason for our continued increase is due to our daily behaviors What we eat, drink and smoke How we get physical activity

19. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 19 AIAN Patterns of Cancer Different Types of Cancer by Geographic Region and Tribal Nation; such as: Prostate cancer among northern plains comparable to African Americans and Whites More stomach, kidney and gallbladder among Southwestern tribal nations More CRC, breast and lung among AK, northern plains and southern plains

20. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 20 Examples of Different Patterns of Cancer Sites and Access More cancers among AIANs who live in Alaska, Northern Plains and Southern Plains BUT, even in Southwest, selected types of cancer continuing to increase and there are significantly more AIs living in SW than in other regions of US Burden of disease is extreme Average interval from biopsy (diagnosis) to initiation of cancer care is 6 months for AIAN women and 9 months for AIAN males

21. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 21 QUESTION: What is cancer? A group of over 100 diseases in which abnormal cells Divide without control Don’t die when they should (Apoptosis) Cancer: Is primarily a disease of older people Occasionally occurs in young people (e.g., childhood leukemia, cervical, testicular) But, the majority of cancers appear in people who are older (over 45)

22. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 22 What is cancer? (continued) Cancers are identified by the place they originate within the body. For example: Breast Cervix Colon Prostate Pancreas Stomach Brain Bladder

23. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 23 Normal Cells Excerpt from the Kansas State University “coloring book”

24. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 24 Excerpt from the Kansas State University “coloring book” Cancer Cells

25. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 25 Cancer (CAN-sir) Cancer cells have the ability to spread from one part of the body to another part of the body When cancer cells go to another body part, they can begin to grow without control in the new location But a breast cancer cell in the liver is still “breast cancer” (primary site)

26. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 26 Metastasis ( ma-TAS-sta-sis) This means that cancer cells have spread from one body part to another The cancer cells spread from the "primary site" to other organs by traveling through the blood vessels or lymph vessels QUESTION: What is the lymphatic system?

27. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 27 Diagnosis (die-egg-NOH-sis) The process and result of determining if the symptoms or evidence of cancer is really cancer QUESTION: What type of information does the provider need to make a diagnosis? I had a mammogram 6 months prior to finding a lump and thought I was in the clear. … I give myself a self- breast exam and I located a knot. I went to the doctor and they proceeded with tests. …. they thought it was a cyst, but I still never thought it could be cancer…when the surgery was over the doctor told me it had grown to 9 cm. Ruby Wells Cherokee Nation of OK Dx. breast 2001

28. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 28 Diagnosis (die-egg-NOH-sis) The Provider… Asks about symptoms Asks about medical history Performs a physical exam Orders tests and imaging procedures Performs biopsy--to determine whether cancer cells are present suspicious

29. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 29 Biopsy (bye-OP-see) The physician takes a piece of tissue (a group of cells) from the growth or cyst Sometimes these cells are cut, and other times they are "sucked" out with a needle (fine needle aspiration) These cells are examined by a "pathologist” A biopsy is a sure way to make a diagnosis

30. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 30 QUESTION : What is a Tumor (TOO-mer) Normally, cells grow and divide to produce more cells only when the body needs them This keeps the body healthy Sometimes cells keep dividing when new cells are not needed Or the cells do not know how to die (apoptosis) These extra cells form a mass of tissue, called a growth or tumor

31. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 31 Tumor (TOO-mer) This is a growth or mass formed by excess cells A "benign" tumor is not cancer and it does not “become” cancer. It just stays “benign” 8 out of 10 tumors are not cancer (they are "benign") A "malignant" tumor is cancer and can spread to other parts of the body

32. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 32 Benign tumors: not cancer can often be removed in most cases do not come back do not spread to other parts of the body rarely a threat to life Malignant Tumors are cancer cells abnormal cells divide without control or order enlarge “mass” metastasize Two types of tumors:

33. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 33 Cancer Develops Over Time It is a result of a complex mix of factors related to: Lifestyle (daily behaviors) Environment Heredity (~5-10%) These are called risk factors See Breast Risk / Health Protection Shield on NACR web site http://www.NatAmCancer.org

34. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 34 Examples of “Risk Factors” Foods and drinks we consume Tobacco use Lack of physical activity Exposure to environmental contaminants Spiritual distress Social distress (dysfunctional families, neighbors or work settings) “Once an Elder asked me what I smoked. So, I took out a cigarette. He measured it and said, ‘It’s such a small thing that you let control you.’ I quit smoking that day.” - Edward McCarty, Cherokee

35. Daily physical activity Healthy, low fat diet high fruits and vegetables Maintain recommended body weight Limited to no alcohol No store-bought tobacco use limit tobacco to ceremonial use only Follow cancer screening guidelines Knowing your personal risk factors ex. history of polyps, exposure to cigarette smoke, or your family’s history Behaviors that help “protect” the shield of health against cancer include:

36. Native American Cancer Research 303-838-9359 Fact vs. Fallacy 36 “Cancer 101” Bear (True) vs. Coyote Trickster (False) 5 items

37. Native American Cancer Research 303-838-9359 Fact vs. Fallacy 37 The lifestyle our ancestors lived put them more at risk for getting cancer. Coyote / False If a “breast” cancer cell spreads to the kidney, the new cancer is still referred to as “breast cancer” Bear of Truth Ceremonial tobacco use is just as dangerous as habitual cigarette smoking. Coyote / False

38. Native American Cancer Research 303-838-9359 Fact vs. Fallacy 38 Cigarette smoking is the single most preventable cause of cancer in the US. About 30% of all cancer deaths are directly related to habitual smoking. Bear / True Coyote / False – Answer: 5-10% About 25% (1/4) of all cancers are inherited from your parents.

39. Introduction to Chronic Conditions

40. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 40 QUESTION: Why is Understanding Chronic Conditions Important to AIANs? Leading causes of death among adult AIANs Leading causes of conditions that interfere with our daily quality of life I want my grandchildren to live long, healthy lives like our ancestors. Today we forget how to act in ways that honor those who came before us. Our ancestors didn’t have these diseases. Anonymous AI, 2011

41. Objective 1: Distinguish between a health condition that is acute versus one that is chronic. 41 Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

42. 42 Definitions Acute (uh-KYOOT) condition: A condition or disease that begins and worsens quickly. Usually lasts less than a year. If managed well will resolve (or improve and become chronic). What would be an example of an acute illness?

43. Examples of Common Acute Conditions Cold or flu Infection Trauma (car accident, broken leg) Allergic reactions Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 43

44. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 44 Definitions Chronic (KRAH-nik) condition: A condition or disease that persists or progresses over a long period of time. May have previously been acute Can be managed, but usually does not go away completely What would be an example of a chronic condition?

45. Examples of Common Chronic Conditions Heart Disease Cancer Diabetes High blood pressure (hypertension) Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 45

46. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 46 Characteristics of Chronic Conditions Lasts 1 year or longer Requires ongoing medical care Limits daily activities Often interferes with one’s quality of life “We tell each other what our blood sugar readings are. And, we remind each other to take our medicine.” – Gwen Barnett Muscogee (Creek)

47. Objective 2 Identify at least 3 common chronic conditions in AIAN communities. 47

48. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 48 Common Chronic Conditions The most common, costly, and preventable chronic conditions in the U.S. are: Heart disease Cancer Diabetes Arthritis Obesity This is true for AIANs too

49. Examples of Other Chronic Conditions Stroke Substance abuse and addiction disorders Mental illness Dementia Cognitive impairment disorders Developmental disabilities NOTE: Heart disease, cancer and stroke account for ½ of all deaths each year. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 49

50. Burhansstipanov, Native American Cancer Initiatives, Inc. (NACI) subcontract to Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605]; Northwest Portland Area Indian Health Board 50 Indian Health Service, Regional Differences in Indian Health, 2002-2003. Data from 1999-2001

51. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 51 Heart (Cardiovascular) Disease (CVD) AIANs have the highest percentage (36%) of deaths from premature heart disease. This is nearly 2½ times that of whites. AIANs have more risk factors for CVD than do Non-Hispanic Whites Obese High blood pressure (21% to 41% AIs) Commercial tobacco use (15 to 70% AIs)

52. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 52 Cancer Now considered a chronic disease Most common types among AIANs are: Lymphoma Lung & Bronchus Colon & Rectum Corpus & Uterus Kidney & Renal Breast Ovarian Pancreas Cervix Thyroid

53. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 53 Diabetes Type 2 diabetes – caused by body’s resistance to the action of insulin and by impaired insulin secretion. Most AIANs with diabetes have type 2 usually develops in adults but within AIAN communities it is no longer uncommon for diabetes to develop in children and adolescents. A small number (2-4%) have type 1 diabetes.

54. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 54 Diabetes (cont) The “TRIPLE TRIPLE” of diabetes in Native America ~3x risk of heart disease and stroke 3.5x risk of kidney failure 3x rate of death

55. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 55 Diabetes (cont) Diabetes can be PREVENTED Disease and early death is not inevitable. It is never too late to change and improve health. Family & community efforts are the key 7% weight loss from 150 min of activity per week and healthy meals can reduce the risk of diabetes by > 50%

56. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 56 QUESTION: What is the relationship between Diabetes and Cancer among AIANs? 30+% of AI/AN over age 55 have diabetes 38% of AIANs (n-822) in “Native American Cancer Education for Survivors” survivorship program have both diabetes and cancer Diabetes is associated with a 30% increased risk of colon cancer Larsson SC et al JNCI 2005;97:22: 1679-87

57. Objective 4: Describe how co-morbidities impact cancer and quality of life. 57 Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

58. 58 Co-Morbidities AND Cancer Many older adults with cancer often have one or more other chronic conditions, such as: Diabetes, heart disease, depression, arthritis, obesity, menopausal symptoms All contribute to quality of life (ability of the individual to do everything they want to do body, mind, emotions and spirits)

59. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 59 Co-Morbidities AND Cancer Diabetes and cancer have similar risk factors (unhealthy diet, lack of physical activity, obesity) Organs / systems damaged by diabetes include eyes / vision, nerves (peripheral), kidneys, immune system Organs / systems damaged by cancer / cancer treatment include nerves (peripheral), liver, immune system

60. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 60 Co-Morbidities AND Cancer Survivors who have both diabetes and cancer have significantly more problems that can affect quality of life Chemo medications may interfere with insulin management Insulin management may interfere with absorption of chemo medications Resulting in increased problems / side effects of both diseases

61. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI) 61 Concerns for people with chronic conditions AND cancer Lack of information Potential impact on: Quality of life Ability for self-care Cancer treatment decisions Cancer treatment outcomes AIAN Cancer Survivors, Denver, CO 2009

62. How Can I Get Cancer Screenings? Excerpt from Get on the Path for Breast Health Native American Cancer Research 1-800- 537-8295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2 [NCI1U54CA153605] Doctor recommendation or referral. You can also ask your doctor to send you for a screening if you have symptoms (ex. breast lump). Veterans Administration (VA) hospitals and clinics (for vets only). Private insurance or Medicare can pay. Check with local health department or clinics. State, community programs may also pay for specific tests. Contact local Community Health Educator/Worker.

63. Medicare Excerpt from Get on the Path for Breast Health Native American Cancer Research 1-800- 537-8295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2 [NCI1U54CA153605] Medicare can pay for people 65 years of age and older: Mammogram once a year Pap Test once a year CRC screening for people who do not have symptoms, are “at average risk” (compared to “high risk”), and are 50 and older* FOBT once a year Sigmoidoscopy once every 4 years Colonoscopy every 2 years for “high risk” people PSA blood test Lung screening (pays for diagnostic tests if you have symptoms)

64. Native American Cancer Research 303-838-9359 Fact vs. Fallacy 64 “Chronic Conditions and Cancer” Bear (True) vs. Coyote Trickster (False) 5 items

65. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 65 About 15% of AIANs have diabetes. Coyote / False – Answer: ~30% The “triple triple” threat for diabetes among AIANs is >3 times the risk of heart disease and stroke, kidney failure and death., Bear of Truth

66. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 66 “Chronic” conditions mean they last at least 5 years Coyote / False – Answer ~1 year + The most common chronic conditions experienced by AIANs are cancer, diabetes and HIV infection AIANs have nearly 2½ times deaths from cardiovascular disease (CVD) than whites. Coyote / False Bear of Truth

67. 67 Post Session Knowledge Items (TP) 4 items

68. Which is an example of an “acute” condition? 1.Cancer 2.Arthritis 3.Trauma (car accident) 4.Diabetes 5.Don’t know / Not sure

69. What is the cause of most (~90%) of all cancers? 1.Family history 2.Smoking for 5 years 3.Being exposed to radiation 4.Lifestyle and physical environment 5.Don’t know / Not sure

70. Which is NOT part of the “triple triple” threat of diabetes among American Indians? 1.~ 3 times the risk of cancer 2.~ 3 times the risk of heart disease and stroke 3.~3 times the risk of kidney failure 4.~3 times the risk of death 5.Don’t know / Not sure

71. If a “breast” cancer cell spreads to the kidney, what is the new cancer called? 1.New primary cancer 2.Recurrent breast cancer 3.Breast cancer 4.Kidney cancer 5.Don’t know / Not sure

72. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 72 Workshop Evaluation (TP) 5 items (you won’t see the answers)

73. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 73 E_undrst Overall, how understandable was the presentation? 1.Very understandable 2.Fairly understandable 3.Not understandable

74. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 74 E-useful Overall this session provided useful information to me. 1.I strongly agree 2.I agree 3.I don’t agree 4.I strongly disagree

75. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 75 E_quality Overall, what was the quality of the information content of the presentation? 1.High 2.Average 3.Low

76. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811] 76 E_rec Would you recommend this workshop to your friends or colleagues? 1.Yes 2.Maybe 3.No 4.Not Sure

77. E_rec Would you be interested in attending another workshop? 1.Yes, on Breast Cancer 2.Yes, on Cervix Cancer 3.Yes, on Colon Cancer 4.Yes, on Lung Cancer 5.Yes, on Prostate Cancer 6.Yes, on a combination of cancers 7.Yes, on Genetics and Cancer 8.Yes, on Biospecimens and Biobanking 9.No 10.Not Sure/Don’t want to answer

78. Thank you for allowing me to share this workshop information with you