Study design and setting

This was a cross-sectional survey conducted between 2021 and 2023 at UCI. Founded in 1965, UCI was ranked among the United States’ top 10 public universities by U.S. News & World Report [19]. With close to 30,000 undergraduates enrolled, UCI was designated as an Asian American and Native American Pacific Islander-serving institution. This study was exempted by UCI Investigational Review Board, and a waiver of informed consent to participate was obtained for this study.

Inclusion/exclusion criteria

Undergraduate students enrolled in the Life After Cancer Freshmen Seminar course (Uni Stu 3) at UCI between 2021 and 2023 were invited to participate in this study.

Teaching pedagogy behind the freshmen seminars series and Life After Cancer

At UCI, the Freshman Seminar Series is designed to bring a high-impact learning experience to undergraduate students in their first year of study. In a small class environment, students can explore and learn about a special theme or topic by engaging with their peers and the faculty instructor. These seminars are typically scheduled for 1 h a week per quarter, with stimulating discussions and critical thinking being the primary goals. Most seminars are open to all interested students, with no pre-requisites and with enrollment preference given to freshmen. Each seminar course is designed as a one-unit small group seminar enrolling 15 students. Students normally took this course for a letter grade, though students may elect the pass/not pass option.

Designed as one of Freshmen Seminar Series by the principal investigator of this study, Life After Cancer was a 1-unit weekly seminar series designed to introduce concepts of cancer survivorship to undergraduate students. Through a total of 11 weeks of seminars, discussions, and group presentations, students learned how cancer has become a chronic condition in many survivors, especially among those who are cured. Students learned about the long-term complications of cancer treatments, as well as the cutting-edge research that is currently undertaking around the globe to mitigate these complications. The specific learning objectives of the seminar course were to:

1.

Understand the definition and issues surrounding cancer survivorship.

2.

Identify common toxicities and complications that are affecting various groups of cancer survivors.

3.

Appreciate the disease trajectory of common cancers, from diagnosis to survivorship.

4.

Discuss management strategies that are commonly employed to manage complications of cancer during survivorship.

5.

Discuss the impact of cancer survivorship on the health care system.

6.

Discuss the research directions that are taken to address the concerns related to cancer survivorship.

In this course, a number of topics were taught including the following: (1) an orientation of cancer management and cancer survivorship; (2) trajectory of cancer treatment from diagnosis to cancer survivorship; (3) survivorship in the elderly; (4) survivorship in pediatric, adolescent, and young adults; (5) survivorship in stem cell transplant patients; (6) model of survivorship care and rehabilitation technology.

When the course was offered in 2021, there  were two assignments for this course, which included a group presentation and a term paper. However, the assignment was reduced to the group presentation only in 2022 and 2023.

For the group presentation, students were assigned in groups to present a 15-min PowerPoint presentation with 10 min Q&A on the management of a toxicity that is commonly faced by cancer survivors. Two students were randomly paired to present on one of the following issues: cardiotoxicity, cognitive impairment, fatigue, financial toxicity, infertility, pain, and peripheral neuropathy. Students were required to use evidence-based information to introduce the management strategies.

For the term paper, each student was assigned to write a 1500-word research paper on an assigned survivorship-related topic.

The seminar course was offered and taught for three consecutive years between 2021 and 2023. When the course first launched in January 2021, the course was taught virtually in view of the COVID-19 pandemic. The course was then subsequently taught fully in person in April 2022 and April 2023.

Data collection

During the first 2 weeks of the course, a pre-implementation survey was administered to the students. The survey was administered electronically using Qualtrics® in 2021 as the course was taught virtually, while the survey was administered on paper in 2022 and 2023. At the end of the course, the same survey was administered to the students before the end of the course.

Survey instrument

In view of the lack of a validated tool available for this study, a survey instrument was designed by the principal investigator (A.C.) of the study after conducting an extensive literature search on the impact of medical education on undergraduate students [3, 4, 7,8,9,10,11,12,13, 15]. As part of the survey development process, a panel of experts in cancer survivorship (R.C., Y.K., C.J.T., Y.L.T., D.Q.N.) reviewed the survey and provided feedback on the user-friendliness and appropriateness of the questions to the principal investigator. The survey instrument consisted of 4 main sections: (1) demographics, (2) knowledge of cancer survivorship, (3) attitude towards cancer survivorship, and (4) perception and awareness of cancer survivorship.

Knowledge items

Respondents were asked to determine whether each of the 10 items was true or false. Three items were related to general understanding of cancer survivorship, five items focused on outcomes/toxicities issues among cancer survivors, and two items focused on lifestyle issues in cancer survivorship. These knowledge items were derived from learning objectives of each weekly seminar.

Attitude items

Respondents were asked to rate each statement using a 4-level Likert scale (strongly disagree, disagree, agree, and strongly agree). Three items focused on respondents’ comfort level in listening and responding to concerns of a cancer survivor, as well as looking after own family member who is a cancer survivor. Three items focused on respondents’ attitude on education, whether it was appropriate to offer the course to college freshmen, respondents’ understanding of cancer as a chronic disease, and respondents’ interest in pursuing a healthcare profession (general vs cancer specialist).

Perception items

Respondents were asked to rate each statement using a 4-level Likert scale (strongly disagree, disagree, agree, and strongly agree). Six items focused on their awareness of current resources, mental health complications, benefits, research, personalization of cancer survivorship, and conceptualizing cancer as a chronic disease.

Statistical analysis

Descriptive statistics were used to summarize responses to each item. The chi-square test or Student’s t-test was conducted for cross-sectional analyses to determine whether demographics were different before and after course implementation, with a two-sided p value < 0.05 considered statistically significant. Paired analysis was not conducted in view a few respondents dropped out during the course. All statistical analyses were conducted using SPSS version 28.