Periodic Reporting for period 1 - PIECES (TOWARDS LARGE-SCALE ADAPTION AND TAILORED IMPLEMENTATION OF EVIDENCE-BASED PRIMARY CANCER PREVENTION PROGRAMMES IN EUROPE AND BEYOND)
Reporting period: 2023-06-01 to 2024-11-30
Cancer is a major global health burden, with rising incidence. However, prevention is possible and effective for many cancer types and known risk factors. Primary cancer prevention (PCP) focuses on reducing exposure to these risks, as outlined in the European Code Against Cancer. Key factors include smoking, second-hand smoke, poor diet, obesity, physical inactivity, alcohol abuse, sun exposure, workplace carcinogens, and infections like HBV and HPV. An estimated 30% to 45% of cancers could be prevented through healthier lifestyles, reducing risks for multiple cancer types. The International Agency for Research on Cancer (IARC) confirms the preventive impact of smoking cessation, weight control, sun protection, exercise, and reduced alcohol consumption.
Despite strong evidence supporting prevention programmes, their effectiveness is hindered by socioeconomic inequalities, poor integration into routine practice, and barriers to behavioral change. Implementation challenges stem from ineffective processes, lack of planning, and failure to adapt programmes to local settings. Consequently, evidence-based programmes (EBPs) that succeed in controlled trials often fail in real-world applications, leading to persistent health disparities and inefficient use of resources.
Implementation science, the study of methods to integrate research into practice, provides insights into overcoming these barriers. It identifies key factors influencing successful PCP implementation, such as individual reluctance, organizational gaps, and political inertia. Common obstacles include healthcare providers' doubts about intervention effectiveness, patients' low motivation, lack of institutional resources, and policymakers' reluctance to invest in long-term gains beyond election cycles.
PCP strategies are fragmented across Europe, leading to disparities. Solutions to enhance implementation remain scarce and poorly contextualized. Policymakers, health stakeholders, and clinicians need effective implementation strategies to address barriers and improve outcomes. Given the high prevalence of modifiable risk factors and the rising cancer burden, implementation science is essential for public health.
Tailored implementation, a key concept in this field, customizes strategies to local settings by engaging stakeholders, identifying barriers, adapting interventions, and evaluating outcomes. This approach acknowledges that a one-size-fits-all solution is ineffective and emphasizes the need for context-specific strategies. Though still evolving, tailored implementation has shown promise in improving programme outcomes.
In summary, the growing cancer burden underscores the urgency of addressing modifiable risk factors. While EBPs are effective in controlled settings, real-world implementation faces challenges. Decision-makers need structured methods to adapt and implement prevention programmes effectively.
The PIECES project (Agreement 101104390) aims to enhance the implementation of EBPs for PCP by addressing a range of risk factors and behavior change mechanisms to reduce cancer incidence in the EU and beyond. The project focuses on smoking, alcohol consumption, physical inactivity, HPV infection, sun exposure, and diet. Rather than testing effectiveness, PIECES emphasizes implementation processes and outcomes.
Specifically, PIECES will develop, test, and disseminate a systematic framework for selecting, adapting, and implementing PCP programmes at individual, organizational, and policy levels. It will provide an integrated toolkit to guide structured identification, tailoring, and application of EBPs, ensuring interventions are customized to local barriers and implementation contexts.
Despite strong evidence supporting prevention programmes, their effectiveness is hindered by socioeconomic inequalities, poor integration into routine practice, and barriers to behavioral change. Implementation challenges stem from ineffective processes, lack of planning, and failure to adapt programmes to local settings. Consequently, evidence-based programmes (EBPs) that succeed in controlled trials often fail in real-world applications, leading to persistent health disparities and inefficient use of resources.
Implementation science, the study of methods to integrate research into practice, provides insights into overcoming these barriers. It identifies key factors influencing successful PCP implementation, such as individual reluctance, organizational gaps, and political inertia. Common obstacles include healthcare providers' doubts about intervention effectiveness, patients' low motivation, lack of institutional resources, and policymakers' reluctance to invest in long-term gains beyond election cycles.
PCP strategies are fragmented across Europe, leading to disparities. Solutions to enhance implementation remain scarce and poorly contextualized. Policymakers, health stakeholders, and clinicians need effective implementation strategies to address barriers and improve outcomes. Given the high prevalence of modifiable risk factors and the rising cancer burden, implementation science is essential for public health.
Tailored implementation, a key concept in this field, customizes strategies to local settings by engaging stakeholders, identifying barriers, adapting interventions, and evaluating outcomes. This approach acknowledges that a one-size-fits-all solution is ineffective and emphasizes the need for context-specific strategies. Though still evolving, tailored implementation has shown promise in improving programme outcomes.
In summary, the growing cancer burden underscores the urgency of addressing modifiable risk factors. While EBPs are effective in controlled settings, real-world implementation faces challenges. Decision-makers need structured methods to adapt and implement prevention programmes effectively.
The PIECES project (Agreement 101104390) aims to enhance the implementation of EBPs for PCP by addressing a range of risk factors and behavior change mechanisms to reduce cancer incidence in the EU and beyond. The project focuses on smoking, alcohol consumption, physical inactivity, HPV infection, sun exposure, and diet. Rather than testing effectiveness, PIECES emphasizes implementation processes and outcomes.
Specifically, PIECES will develop, test, and disseminate a systematic framework for selecting, adapting, and implementing PCP programmes at individual, organizational, and policy levels. It will provide an integrated toolkit to guide structured identification, tailoring, and application of EBPs, ensuring interventions are customized to local barriers and implementation contexts.
Initial activities and objectives accomplished in the PIECES project are related with the development of the integrated implementation toolkit for PCP programmes. Since the beginning of the project, the consortium worked mainly on the development of a repository of evidence-based interventions for PCP programmes as well as the creation, set up, and translation into 8 languages of the Implementation toolkit (PCP-IT), which is now ready to be tested by implementation sites. Steps have also been made towards the Evaluation and Dissemination phases of the project, with the finalization of the study design and protocol for the PCP-IT evaluation and the mapping of stakeholders.
The main result of the PIECES project is the creation and production of the PCP-IT and its embedded PIECES Repository of Evidence-based Primary Cancer Prevention Programmes. The PCP-IT has been recently launched so its impact is still yet to be explored. On the Scientific domain, the PCP-IT is expected to contribute to the development and consolidation of implementation science in cancer prevention and become a tool that might be further applied in other clinical situations. On the economic side, PIECES efforts are expected to improve implementation efficiency of primary prevention of cancer programmes; this will be object of study in WP4, through assessment of feasibility, acceptability, sustainability, uptake, and cost-effectiveness of interventions. Finally, from a societal standpoint, a valuable and growing body of knowledge will be built on the adequacy of different interventions, activities, and preventive strategies to improve success of cancer prevention, and policy proposals will be issued based on the gained experience. The project is expected to reduce not only cancer-related morbidity and mortality, but also inequities in public health.