Gastrointestinal Cancer Prevention Policies: A Qualitative Systematic Review and Meta-Synthesis

Neda Kabiri, Rahim Khodayari-zarnaq, Manouchehr Khoshbaten, Ali Janati


This qualitative systematic review was conducted to summarize the policies for prevention of common gastrointestinal cancers worldwide. This study was conducted using PubMed, Web of Science, SCOPUS, and ProQuest databases. Two independent reviewers assessed included studies for methodological quality and extracted data by using standardized tools from Joanna Briggs Institute (JBI). Primary study findings were read and reread to identify the strategies or policies used in the studies for prevention of gastrointestinal cancers. The extracted findings were categorized on the basis of their similarity in meaning. These categories were then subjected to a meta‑synthesis. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis. From the nine included studies in this review, 39 findings were extracted and based on their relevance in meaning were aggregated into 12 categories. Four synthesized findings were developed from these categories. We used World Health Organization report on 2000 for synthesizing the findings. The four synthesized findings were “service provision”, “resource generation”, “financing”, and “stewardship”. In order to reach a comprehensive evidence informed policy package for the prevention of gastrointestinal cancers, there should be a great communication among the interventions conducted directly on patients, health system infrastructures, and resources.


Gastrointestinal cancer; policy; primary prevention; secondary prevention; strategy

Full Text:



WHO. Time to deliver: Report of the WHO Independent

high‑level commission on noncommunicable diseases. 2018.

Fidler MM, Gupta S, Soerjomataram I, Ferlay J,

Steliarova‑Foucher E, Bray F. Cancer incidence and mortality

among young adults aged 20–39 years worldwide in 2012:

A population‑based study. Lancet Oncol 2017;18:1579‑89.

Murray CJL, Lopez AD. Alternative projections of mortality and

disability by cause 1990–2020: Global Burden of Disease Study.

Lancet 1997;349:1498‑504.

Pourhoseingholi MA, Vahedi M, Baghestani AR. Burden of

gastrointestinal cancer in Asia; an overview. Gastroenterol

Hepatol Bed Bench 2015;8:19‑27.

Darabi M, Lari MA, Motevalian SA, Motlagh A, Arsang‑Jang S,

Jaberi MK. Trends in gastrointestinal cancer incidence in

Iran, 2001‑2010: A joinpoint analysis. Epidemiol Health


Henderson TO, Oeffinger KC. Reducing the global cancer burden

among young adults. Lancet Oncol 2017;18:1554‑5.

Global Burden of Disease Cancer C. Global, regional, and

national cancer incidence, mortality, years of life lost, years

lived with disability, and disability‑adjusted life‑years for 32

cancer groups, 1990 to 2015: A systematic analysis for the global

burden of disease study. JAMA Oncol 2017;3:524‑48.

Daar AS, Singer PA, Persad DL, Pramming SK, Matthews DR,

Beaglehole R, et al. Grand challenges in chronic

non‑communicable diseases. Nature 2007;450:494‑6.

Bennett JE, Stevens GA, Mathers CD, Bonita R, Rehm J,

Kruk ME, et al. NCD Countdown 2030: Worldwide trends

in non‑communicable disease mortality and progress

towards Sustainable Development Goal target 3.4. Lancet


Assembly U. Political declaration of the high‑level meeting

of the general assembly on the prevention and control of

non‑communicable diseases. 2011.

WHO. Global action plan for the prevention and control

of noncommunicable diseases 2013‑20202013. Report No.:

Peykari N, Hashemi H, Dinarvand R, Haji‑Aghajani M,

Malekzadeh R, Sadrolsadat A, et al. National action plan for

non‑communicable diseases prevention and control in Iran;

A response to emerging epidemic. J Diabetes Metab Disord


Zargaraan A, Dinarvand R, Hosseini H. Nutritional traffic

light labeling and taxation on unhealthy food products in Iran:

Health policies to prevent non‑communicable diseases. Iran Red

Crescent Med J 2017;19:18.

Juma PA, Wisdom J. Introduction: Non‑communicable disease

prevention policies in six African countries. BMC Public Health

;18(Suppl 1):955.

Mukanu MM, Zulu JM, Mweemba C, Mutale W. Responding to

non‑communicable diseases in Zambia: A policy analysis. Health

Res Policy Syst 2017;15:34.

Mendis S. The policy agenda for prevention and control of

non‑communicable diseases. Br Med Bull 2010;96:23‑43.

JBI. Joanna Briggs Institute Reviewers’ Manual: 2014 edition.

Australia: The Joanna Briggs Institute, The University of

Adelaide; 2014.

Munn Z, Porritt K, Lockwood C, Aromataris E, Pearson A.

Establishing confidence in the output of qualitative research

synthesis: The ConQual approach. BMC medical research

methodology 2014 Sep 20;14:108.

Buchman S, Rozmovits L, Glazier RH. Equity and practice

issues in colorectal cancer screening: Mixed-methods study.

Canadian Family Physician 2016;62:e186-93.

Dawson G, Crane M, Lyons C, Burnham A, Bowman T, Perez D,

et al. General practitioners’ perceptions of population based

bowel screening and their influence on practice: A qualitative

study. BMC Fam Pract 2017;18:36.

Bridges JF, Gallego G, Blauvelt BM. Controlling liver cancer

internationally: A qualitative study of clinicians’ perceptions of

current public policy needs. Health Res Policy Syst 2011;9:32.

Clavarino AM, Janda M, Hughes KL, Del Mar C, Tong S,

Stanton WR, et al. The view from two sides: A qualitative

study of community and medical perspectives on screening for

colorectal cancer using FOBT. Prev Med 2004;39:482‑90.

Dowswell G, Ryan A, Taylor A, Daley A, Freemantle N,

Brookes M, et al. Designing an intervention to help people with

colorectal adenomas reduce their intake of red and processed

meat and increase their levels of physical activity: A qualitative

study. BMC Cancer 2012;12:255.

Goel V, Gray R, Chart P, Fitch M, Saibil F, Zdanowicz Y.

Perspectives on colorectal cancer screening: A focus group study.

Health Expect 2004;7:51‑60.

Jilcott Pitts SB, Lea CS, May CL, Stowe C, Hamill DJ,

Walker KT, et al. “Fault‑line of an earthquake”: A qualitative

examination of barriers and facilitators to colorectal cancer

screening in rural, Eastern North Carolina. J Rural Health


Liles EG, Schneider JL, Feldstein AC, Mosen DM, Perrin N,

Rosales AG, et al. Implementation challenges and successes

of a population‑based colorectal cancer screening program:

A qualitative study of stakeholder perspectives. Implement Sci


Sarfaty M, Stello B, Johnson M, Sifri R, Borsky A, Myers RM.

Colorectal cancer screening in the framework of the medical

home model: Findings from focus groups and interviews. Am J

Med Qual 2013;28:422‑8.

WHO. Report 2000 health systems: Improving performance.

DeTroye A, Christner M, Eganhouse D, Manning B, Sunkin E,

Gregory T. The effects of physical activity on survival in patients

with colorectal cancer. JAAPA 2018;31:21‑5.

Anderson AS, Craigie AM, Caswell S, Treweek S, Stead M,

Macleod M, et al. The impact of a bodyweight and physical

activity intervention (BeWEL) initiated through a national

colorectal cancer screening programme: Randomised controlled

trial. BMJ 2014;348:g1823.

Pimpin L, Cortez‑Pinto H, Negro F, Corbould E, Lazarus JV,

Webber L, et al. Burden of liver disease in Europe: Epidemiology

and analysis of risk factors to identify prevention policies J Hepatol 2018;69:718‑35.

Wang Z, Huang S, Zhao Y, Zhao W, Liang X. [Role of

vaccination in chronic disease prevention and control]. Zhonghua

Yu Fang Yi Xue Za Zhi 2015;49:757‑60.

Chang MH. Cancer prevention by vaccination against hepatitis

B. Recent Results Cancer Res 2009;181:85‑94.

Meireles LC, Marinho RT, Van Damme P. Three decades

of hepatitis B control with vaccination. World J Hepatol


Chang MH, You SL, Chen CJ, Liu CJ, Lee CM, Lin SM, et al.

Decreased incidence of hepatocellular carcinoma in hepatitis

B vaccinees: A 20‑year follow‑up study. J Natl Cancer Inst


Mhaidat NM, Al‑Husein BA, Alzoubi KH, Hatamleh DI,

Khader Y, Matalqah S, et al. Knowledge and awareness of

colorectal cancer early warning signs and risk factors among

university students in Jordan. J Cancer Educ 2018;33:448‑56.

Al‑Sharif MN, Fayi KA, Alobaidi AA, Alshamrani BA.

Awareness of colorectal cancer among public in Asir region.

J Family Med Prim Care 2018;7:87‑92.

Zafer E, Tanriotakulu P, Atakul T, Omurlu IK, Yuksel H. Status

and awareness of cervical, breast, and colon cancer screening in

a Turkish city. Eur J Gynaecol Oncol 2017;38:391‑7.

Shah SC, Nunez H, Chiu S, Hazan A, Chen S, Wang S, et al.

Low baseline awareness of gastric cancer risk factors amongst

at‑risk multiracial/ethnic populations in New York City: Results

of a targeted, culturally sensitive pilot gastric cancer community

outreach program. Ethn Health 2020;25:189‑205.

Majidi A, Majidi S, Salimzadeh S, Khazaee‑Pool M, Sadjadi A,

Salimzadeh H, et al. Cancer screening awareness and practice in

a middle income country; A systematic review from Iran. Asian

Pac J Cancer Prev 2017;18:3187‑94.

Galal YS, Amin TT, Alarfaj AK, Almulhim AA,

Aljughaiman AA, Almulla AK, et al. Colon cancer among older

saudis: Awareness of risk factors and early signs, and perceived

barriers to screening. Asian Pac J Cancer Prev 2016;17:1837‑46.

Benito L, García M, Binefa G, Mila N, Vidal C, Lluch MT, et al.

Cross‑sectional survey on awareness of colorectal cancer and a

screening programme for primary health care professionals in

Catalonia, Spain. Eur J Cancer Care (Engl) 2016;25:992‑1004.

Yoon JY, Cha JM, Jeen YT. Quality is the key for emerging

issues of population‑based colonoscopy screening. Intest Res


Signorelli IV, Gonçalves PL, Gonçalves LL, Emery Ferreira LS,

Parpaiola Mendonça AT, Franklin GL, et al. Socioeconomic

disparities in access to a hepatocellular carcinoma screening

program in Brazil. Clinics (Sao Paulo) 2016;71:361‑4.

Hamashima C. Cancer screening guidelines and policy making:

years of experience in cancer screening guideline development

in Japan. Jpn J Clin Oncol 2018;48:278‑86.

Federici A, Giorgi Rossi P, Bartolozzi F, Farchi S, Borgia P,

Guasticchi G. Survey on colorectal cancer screening knowledge,

attitudes, and practices of general practice physicians in Lazio,

Italy. Prev Med 2005;41:30‑5.

Benito L, Farre A, Binefa G, Vidal C, Cardona A, Pla M, et al.

Factors related to longitudinal adherence in colorectal cancer

screening: Qualitative research findings. Cancer Causes Control


Koo JH, You MY, Liu K, Athureliya MD, Tang CW,

Redmond DM, et al. Colorectal cancer screening practise is

influenced by ethnicity of medical practitioner and patient.

J Gastroenterol Hepatol 2012;27:390‑6.

Triantafillidis JK, Vagianos C, Gikas A, Korontzi M, Papalois A.

Screening for colorectal cancer: The role of the primary care

physician. Eur J Gastroenterol Hepatol 2017;29:e1‑7.

Dietrich AJ, Tobin JN, Robinson CM, Cassells A, Greene MA,

Dunn VH, et al. Telephone outreach to increase colon cancer

screening in medicaid managed care organizations: A randomized

controlled trial. Ann Fam Med 2013;11:335‑43.

Kempe KL, Shetterly SM, France EK, Levin TR. Automated

phone and mail population outreach to promote colorectal cancer

screening. Am J Manag Care 2012;18:370‑8.

Posadzki P, Mastellos N, Ryan R, Gunn LH, Felix LM,

Pappas Y, et al. Automated telephone communication systems for

preventive healthcare and management of long‑term conditions.

Cochrane Database Syst Rev 2016;12:CD009921.

Viola LA, Cassella F, Wonaga A, Arnao Dellamea G, Di Paola L,

Ubeira Salim R, et al. Implementation of a program to improve

the quality of colonoscopy increases the neoplasia detection rate:

A prospective study. Endosc Int Open 2016;4:E68‑72.

Green BB, Fuller S, Anderson ML, Mahoney C, Mendy P,

Powell SL. A quality improvement initiative to increase

colorectal cancer (CRC) screening: Collaboration between a

primary care clinic and research team. J Fam Med 2017;4:1115.