Purpose: Primary liver cancer is the fifth most common cancer globally, yet few countries have comprehensive liver cancer control strategies. Liver cancer control is hindered by a complex etiology, poor prognosis (often due to late diagnosis) and a lack of advocacy and public awareness. As part of a broader study on national needs and priorities for liver cancer control, we examined the impact that a national competence for liver cancer advocacy and public awareness had on that country’s priorities for liver cancer control. We hypothesize that a greater capacity for advocacy and public awareness will be positively correlated the value that advocacy and public awareness will have in a national comprehensive liver cancer control program.
Methods: Data were derived from a comparative study of stakeholder perceptions of needs and priorities for liver cancer control in 12 countries. Competence for liver cancer advocacy and public awareness was estimated as part of a subjective needs assessment using a self-explicated method. Priorities were assessed using conjoint analysis that examined preference for 11 possible liver cancer control strategies previously identified. Estimates for needs and priorities were normalized to a 100 point scale and the relationship between needs and priorities were estimated using ordinary least squares.
Results: 579 potential respondents were identified and 240 respondents from Australia, China, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, Thailand, Turkey, and USA completed the survey (completion rate: 42%). Competence for liver advocacy and public awareness was low in all countries (p<0.001), but it was consider a valuable strategies for inclusion in a national liver cancer plan (p<0.001). When country level variation was examined, a positive relationship between national competence for liver cancer advocacy and public awareness and that country’s priority for advocacy and awareness as part of a comprehensive liver cancer control plan (p=0.05).
Conclusions: Despite the overall low capacity for liver cancer advocacy and public awareness identified in all countries, we confirm our hypothesis that greater capacity for liver cancer advocacy is positively correlated with value that that country places on advocacy and public awareness. This catch-22 situation – where liver cancer advocacy may only become a priority once it is established – implies a role for international collaboration to promote advocacy and public awareness for this burdensome disease.
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