bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathways to Diagnosis and Treatment of Patients With Oropharynx, Oral Cavity, and Cutaneous Squamous Cell Carcinoma in New South Wales, Australia
Authors: Venchiarutti R. , Clark J. , Palme C. , Solomon M. , Young J.
Published: September 2018

Background: Early cancer diagnosis is a critical component of comprehensive cancer control, however more than 50% of head and neck cancers (HNCs) are diagnosed at advanced stage. HNC patients from regional/remote areas are less likely to use radiotherapy during treatment and have poorer survival outcomes than metropolitan patients. Aim: The aim of this study was to examine pathways to treatment of patients with HNC in New South Wales (NSW) and associations between duration of components of the pathway with survival. Methods: Patients diagnosed with squamous cell carcinoma (SCC) of the oral cavity, oropharynx, or cutaneous SCC from 1st July 2008 to 30th June 2013 were identified from a prospectively maintained database. Data were extracted and supplemented by a retrospective audit of medical records at Royal Prince Alfred Hospital and specialists' records. Results: Two hundred and fifty eligible patients were identified (78% male) with mean (SD) age at diagnosis 64.5 (13.5) years. At diagnosis, 75%, 24% and 1% lived in metropolitan, regional and remote areas of NSW, respectively. Twelve per cent of patients lived > 100 km from a hospital with a HNC multidisciplinary team (median [IQR] 7.5 km [25.1]). More than two-thirds (69%) of tumors were diagnosed as advanced stage, and mean follow-up time was 3.5 years. We will present additional findings quantifying intervals along the pathway to treatment (from symptom onset, first specialist visit, diagnosis and treatment), and the associations with survival, and compare findings to those from a second regional site on the mid north coast of NSW. Conclusion: An increasing proportion of the NSW population resides outside major cities. This study is the first step in understanding patient and health system factors that facilitate and impede early diagnosis of HNC. Findings from this study may be used to develop interventions aimed at improving early HNC diagnosis.
The Carrot Not The Stick: Creating Incentives for Voluntary Enforcement of Smoke-Free Policies Through Smoke-Free Zone Certification
Authors: Bader R. , Shihab R. , Hawari F.
Published: September 2018

Background and context: Jordan's Public Health Law bans smoking in public places. However, law-enforcement mechanisms are lagging and Jordanians continue to be exposed to second-hand smoke. The Global Tobacco Control Report 2017 rates enforcement at 2/10 dropping even below the previous 3/10 rating of 2015. Aim: Our intervention aims to provide alternative routes for protection from exposure to second-hand smoke. Strategy/Tactics: The intervention builds on results from a 2012 survey which indicated that 85% of the public supports banning smoking in healthcare institutions, schools, and work places. In 2013 King Hussein Cancer Foundation and Center launched the Smoke-free Zone Certificate Program in collaboration with Global Smoke-free Worksite Challenge. The program, currently in its fifth round, recognizes institutions that voluntarily enforce smoke-free environments. Program/Policy process: Interested institutions submit an application requesting certification. Applications go through a screening process to confirm initial alignment with the program criteria. Institutions passing the initial screening are physically inspected for compliance through unannounced spot-check visits. Those passing the inspection receive certification. To qualify, an institution should meet two criteria. The first is enforcing a 100% smoke-free policy within all indoor premises. Designated smoking areas are not allowed. For schools, the criteria require that the smoke-free policy extends to cover both indoor and outdoor premises. The second criterion is that the smoke-free policy should be in effect for a minimum of 9 months on the day of certification. The appeal of the program builds on (1) the institution's belief in the importance of providing a safe and healthy environment, (2) the association of the program with the name of a well-respected national organization, and (3) the media exposure that the certified institutions receive. Active promotion of the program is performed during the application period to recruit additional applicants. Outcomes: Fig. 1 depicts the growth in numbers of applications and of certified organizations. On average 67% of applicants receive certification. Interest varies by category with schools outweighing all other applicants (62%). What was learned: Incentives for voluntary enforcement of smoke-free policies have the potential to support law enforcement. The growing interest and the modifications that institutions undergo to meet the program criteria are a testimony to our success. Several institutions went through three rounds of applications prior to receiving certification, indicating the ability of the program to motivate compliance. There is a need to continue to grow the number of applicants especially in the 'restaurants' and 'healthcare' categories. Sensitization about the benefits of smoke-free environments, technical assistance to interested institutions, and additional media exposure can help.

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From “Being Helped” to “Mutual Help”: Effectiveness Evaluation on Self-Help Group
Authors: Cheng K.Y. , Chen Y. , Chen C.F.
Published: September 2018

Background: In the field of cancer caring, ACS is best known as self-help community among patients. Reach to Recovery, a sharing program between senior breast cancer patients and new comers, for example, helps new patients to understand the treatment process in a relatively more moderate way. Additionally, sense of control and adapted self-image are regained through the sharing between senior and new patients. In 2014, researchers managed to arrange a support group for cancer patients named “Going onto the Next Stop”, a program in which 9 consistent members meet five times as a group for 5 weeks for a total of 16 hours. At the last meting, one member suggested to form an online chatting group named “Forever-Salute”, which means “getting together healthily forever”. With “Forever-Salute”, members hope to create regular meetings as a powerful pivot to each other, thus supporting all members to transform from being helped to mutual help, from receiving help from social workers to helping each other. Aim: To understand the function and meaning to members´ daily lives. Methods: The method for data collecting is focus group. Results: The research shows that empathy between cancer patients can be more easily perceived than that of their family or friends. The program excelled what was initially expected when we see how those patients responded in the group and how they lived out their lives. In the program, talking freely and keeping each other company are important principles. They were also expected to discuss more about how they adapt their lives in the future and topics that might seem as positive. Aside from encouraging passive patients to be more active, they also wish to include more members who are in need. Conclusion: Researchers recommended deeper sharing to be included based on trust among group members, so as to increase mutual merging in the future to obtain more support from each other. In addition, professional intervention is not always necessary to existing self-help communities. It takes one's experience and tactical evaluation to determine when and how much to intervene. When a group transforms from a professional-guided self-help community to an independent one, the transition of the professional leader to simply as a noncancer-participant plays a vital part. During the process the authority is returned and shared between group members, which means making decisions for themselves, deciding how they interact and how they are assigned to certain tasks; and the awareness of sharing leadership in a self-help community is highlighted. Further, professional workers also need to be aware of keeping the group flexible and open, making sure that questions are allowed and power in between members are in a dynamic flow to ensure autonomy and mutual support in a community.
Assessment of Pain in Adult Cancer Survivors in Community Settings
Authors: Lee S.Y. Chiu Katie , Wang C.H. , Su L.Y. , Hsu Y.M.
Published: September 2018

Background: As growing numbers of cancer survivors in Taiwan, the cancer burden shifts from the high mortality rate to the issue of survivorship after cancer and cancer treatment. Pain is one of common issues in cancer survivors. However, there is limited data about pain in cancer survivors especially for those who were not hospitalized or under acute or active treatment. Aim: The purpose of this study is to assess the prevalence of pain in adult cancer survivors who are not hospitalized or those who are under community-care services. Methods: A retrospective telephone survey from a stratified random sample of 337 adult cancer patients that receive services from the Hope Foundation for Cancer Care. The Hope Foundation for Cancer Care is a nongovernmental organization that provides more than 25,000 cancer families across Taiwan. The sample for this study was randomly selected after being stratified by self-reported stages of cancer and residential regions. Those who were diagnosed within a year, not intact to answer the telephone survey by themselves, hospitalized or under intensive cancer treatment were excluded. The patients were recruited and consented via phone after obtaining approval of the IRB. Results: The adult cancer survivors of this study had a mean age of 52.2 and mean surviving year of 3.8. Those who were married, had college degree, had cancer in breast or in early stage were accounted for the most. 44.8% of the sample reported pain. Among them, the pain was scored with a mean intensity of 2.7 and interference of 3.2 on a 0-to-10 scale. Those male survivors without employment diagnosed with oral or head and neck cancer or had recurrent cancer had significantly more likelihood to have pain. Conclusion: This study provides a better understanding of the pain issue among cancer survivors in community setting. Close to half of the adult cancer survivors experience pain that may be related to cancer or its treatment. The pain may be mild but interferes with daily life or work ability. Further supportive care or community services for this high risk group for pain after their cancer treatment are warranted.
Risk for Occurrence of Laryngeal Cancer Among Current Cigarette Smokers
Authors: Pavlovska I. , Taushanova B. , Zafirova B.
Published: September 2018

Background: Cancer is a leading cause of death worldwide. It is on the second place as a death cause in developed countries and among the three leading death causes in adults in developing countries. Every year, worldwide, approximately 10 million persons have been diagnosed with malignant tumors (in every locations), and more than 6 million of these people die. According to many studies, several risk factors are brought in connection with laryngeal cancer (LarC). The most significant and generally accepted is alcohol consumption and the habit of cigarette smoking. Cigarette smoking habit caused about 30% of all cancers, due to which it represents the most significant risk factor for occurrence of these disorders in humans. Aim: Aim of the study was to determine the existence of the eventual causal associations among the cigarette smoking and development and distribution of the laryngeal cancer. Methods: This study is an analytical type of case-control study. It elaborated 185 patients, suffering from laryngeal cancer and the same number of persons without malignant disease (control group-CG). Risk analyses were done using unconditional logistic regression, which provides results in the form of adjusted odds ratio. The odds ratios and their 95% confidence intervals (CI) were computed. Results: Among patients were 79% of current smokers (CS), 18.3% of former smokers (FS) and only 2.7% of never smokers (NS), compared with 40.5% of CS, 28.7% of FS and 30.8% of NS among controls. More than a half of the CS has been smoking 21-40 cigarettes per day (c/day) (54.8%), while in CG members this percent was 29.3%. Group of so called “heavy” smokers (> 40c/day), includes 13.7% of patients, and only 4% from CG. Majority of CS with LarC had smoking length, ranging from 31-45 years (56.2%). CS had 16.03 (95% CI, 6.25-41.12), times significantly higher risk to become ill from LarC, compared with NS. CS who were smoking < 20 c/day had 10.49 (95% CI, 3.87-28.45), while those who were smoking > 20 c/day, had 45.6 (95% CI, 16.55-125.67), times significantly higher risk to become ill, compared with NS. Univariate analysis in CS showed significantly higher risk for the persons to become ill, who were smoking > 40 years, compared with those who were smoking < 40 years (OR=3.73; 95% CI 2.03-6.84). The risk of occurring LarC has been four times (95% CI, 2.35-7.88), significantly higher in the CS who are smoking > 20 years, > 20 c/day, compared with those, who in the same time period, smoke < 20 c/day. Conclusion: Cigarette smoking is by far the most important risk factor for laryngeal cancer. Concerted control of smoking appears to be an urgent priority in LarC prevention, including efforts to prevent adolescents from starting to smoke.
Early Clinical Outcome of the First Lung SBRT Program in Jordan: Importance of International Collaboration
Authors: Khader J. , Ramahi S. Wadi , Abu Hijleh F. , Ghatasheh H.
Published: September 2018

Background: The stereotactic radiotherapy (SBRT) program was established at King Hussein Cancer Center (KHCC) in Jordan through cooperation with an internationally renowned institution MD Anderson Cancer Center (MDACC) in USA, and it went clinical in 2012. Until the present day, it stands as the only SBRT program in the entire country with patient population that has increased in the past few years due influx of refugees from regional conflicts. In this presentation, we will present the clinical outcome of our SBRT program. Methods: 17 patients treated to date in the SBRT service. All patients underwent 10-phase 4DCT and PET-CT scans. The internal target volume (ITV) was constructed from the minimum intensity projection (MIP) dataset and expanded, if needed, following PET findings. 5 mm margin added to create the PTV. A dose scheme of 48 Gy in 4 fractions or 50 Gy/4 fractions were used for all patients except for two patients who received 60 Gy in 8 fractions due to toxicity concerns. Lung heterogeneity correction was used during planning and treatment delivery was done on Elekta Precise Linear Accelerator and using CBCT imaging for positioning for every fraction. Follow- up done by performing CT chest 3 months after completion of SBRT, and CT/PET every 6 months in the two years, CT chest every 4-6 months thereafter, and keeping CT/PET whenever indicated. Results: All patients treated were males except one, with age ranging from 50-84 years old (mode of 79). All patients were unfit for surgery except for one who refused surgery. All patients except one are alive with only one patient recurred locally. One patient died not due to cancer. Conclusion: The newly established SBRT clinical service in our country, serves as the only such treatment of a population of 9.5 million including 2.5 million refugees. We have started recruiting inoperable lung patients to the service at a slow pace to gain more confidence and experience before admitting larger number of patients. Clinical results are encouraging with most showing tumor regression/complete response as of last follow-up. This model of collaboration between KHCC and MDACC represents a successful scientific collaboration between cancer centers in developed and developing countries that lead to effective and safe implementation of new techniques and procedures.
Vaccinate Your Baby and Do Not Smoke: Integrated Approach of Lung Health for Premature Babies
Authors: Turcanu O. , Guzun M.
Published: September 2018

Background and context: Since 2008 Republic of Moldova registers and provides medical care to newborns from 500 g and 22 weeks of gestation. Thus, challenges related to lung health (respiratory distress in neonatal period, respiratory infections in childhood) are faced while taking care of premature babies. More 400 of them (from 2000 preterms in the country) are born in our institution. While in neonatal period we succeed to save them, the quality of their life depends on further protection from risk factors, as infections, environment polluants and second hand smoke. Aim: To rise awareness among parents about evidence based approaches for protecting a premature baby from infection (one of that being the immunization) and from second hand smoke harm (through smoking cessation among parents, but also among other family members). Strategy/Tactics: Early neonatal period is a very sensitive, but also a precious opportunity to speak with parents about risk factors for a healthy childhood. Smoking being one of factors for premature birth, but also for lung diseases in childhood, our neonatal team included “smoking” issue while speaking with parents about the severity of baby´s condition in neonatal intensive care unit. The discussion target the risk factors for respiratory diseases. This year we changed the approach - we include in the same discussion not only smoking issue, but also immunization, to see if it´s more effective than to aware about smoking only. Program/Policy process: When combining two topics (immunization and no-smoking) parents are less reticent to discussion, thus measured by: •How often they recall discussion, or come back with other questions. •Their reaction (body language, duration of discussion) to physicians´ explanation. Outcomes: 1. Targeting both topics help a smoking parent “not to fill so guilty”, “obtaining other leverages to ensure good quality of life for the baby”. Comparing to the period when we were targeted only smoking issue, parents (especially fathers) were more likely to recall discussion (72%, compared with 41% in the previous stage) and they were more willing/open for communication (77%, compared with 48%). 2. This strategy it´s an opportunity to catch parents´ attention for important things. Usually, when they come in neonatal intensive care unit to see their baby, they expect to be told only about the treatment the baby receives in the unit, and not about smoking (“this is not a drug?”) or vaccination (“something that they see long further”). What was learned: A holistic preventive approach for healthy lifestyle (vaccination + not to expose to tobacco smoke) as measures for premature baby respiratory health, seems to be better accepted by smoking parents, that related on smoking only.
The Integration of Palliative Care in DR Congo “A Model Of Sustainability”: A Field Study
Authors: Kananga A. Mubeneshayi
Published: September 2018

Background and context: In DR Congo, many cancer patients in the terminal phase of their condition have minimal access to palliative care. There is a combined effect of poverty, the deterioration of the health system and the absence of a well-defined national policy on palliative care. Patients are for the most part abandoned to the care of inexperienced family members. Driven by the fact that the number of palliative patients has been increasing steadily over the past five years, the Palliafamilli association and its partners have taken leadership in the fight for palliative care. The major issue that blocks palliative care in RD Congo is the lack of knowledge about palliative care both in the population and even in health professionals. Most patients are treated at home with strong family involvement in many aspects of care. Aim: To promote good health practices at the community level and equip them with the knowledge and means to prevent their health problems, with a focus on palliative care and to contribute to the implementation of the Strategy for Strengthening the Health System of DR Congo by facilitating a program of access to palliative care for the entire Congolese population. Strategy/Tactics: During the last 7 years, we have organized conferences, congresses, various training sessions on pain management, sensitization activities, capacity building courses and advocacy activities within the Ministry of Health for national palliative care guidelines. Program/Policy process: - The organization of two International Congress of Palliative Care in Kinshasa in April 2013 (550 participants) and September 2015 (700 participants) - Training of 3 health professionals on the palliative approach in Uganda (2013) - Participation at the Second Francophone Palliative Care Congress in Montreal 2013 - A palliative care training course at the University of Kinshasa in 2015 (115 participants) - The organization of the International Colloquium of Pediatric Palliative Care in Kinshasa in 2015 - Participation in the 4th International Francophone Congress of Palliative Care in Geneva (2017) - Participating in the drafting of national guidelines for palliative care within the Ministry of Health (2017) - Capacity building for two members of PalliaFamilli thanks to the scholarship offered by the UICC. What was learned: In DR Congo, palliative care and pain relief require a cross-cutting approach, as resources are limited, many people are in need of care, and there are few nurses and doctors empowered to provide care. An effective approach is to involve community or volunteer caregivers supervised by health professionals, and Palliafamilli is successful due in its multidisciplinary and multisectoral approach, with adaptation to cultural, social and economic specificities and its integration with existing health systems, focusing on primary health care and community and home care.
Assessment of Oral Lesions and Its Association With Smoking Habits in Paniya Tribes of India
Authors: Palliyal S.
Published: September 2018

Background: The tribal populations throughout India have remained socially and culturally alienated from mainstream Indian society until developmental and conservation activities in tribal areas forced interactions between them. Oral health remains far neglected especially among the underprivileged tribal populations in India. Oral leukoplakia and oral submucous fibrosis are the most common oral mucosal diseases that have a very high malignant transformation rate. Aim: The aim of this study was to assess the oral lesions among smoking habits in Paniya tribes of Wayanad, India. Methods: A cross-sectional survey was done among 170 nonsmoking and 145 smoking Paniya tribal populations of Wayanad district from January 2016 after approval from the institutional ethical committee. A pretested structured questionnaire was used to collect data regarding study variables. Results: In this study oral lesions was found to be far more prevalent among smoking Paniya tribes than among the non smoking ( P < 0.0001). The prevalence of oral lesions was found to be 48% among smokers. This was much higher than the 7% found among the nonsmokers. Among smokers gingivitis (82%) and periodontitis (68%) is the common lesions followed by oral pigmentation (33%), angular cheilitis (16%), oral submucous fibrosis (12%), leukoplakia (8%) and oral candidiasis (4%). Among the smokers a statistically significant relationship was observed between oral lesions and poor access to oral health care ( P < 0.001). Conclusion: The current study demonstrates gross disparities in oral lesions among smoking and nonsmoking Paniya tribes. Oral health problems due to tobacco use are highly prevalent in the tribal community of Wayanad. Hence attention should be focused on improving the oral health status of this unprivileged group.
Difficulties to Provide Palliative Care in West Bengal, India
Authors: Manna A.
Published: September 2018

Objective: In a southern district of West Bengal, India almost 75% of cancer patient die a sad death of neglect due to lack of awareness about palliative care and low economic level. To identify and try to solve to the extent possible the main difficulties in giving palliative care to the terminal cancer patients of the area. Method: Home visit by volunteers and enumeration of the problems as discussed by the patient and their families. Result: Analysis the following data and identify these main problems. Patient problems: Pain, vomiting, respiratory distress, fatigue, etc. Our volunteers visited terminal cancer patients and their families in our areas. Family problems: Inability to match work life with the care of the patients. Adverse attitude of neighbors and local peoples. Social problems: Lack of awareness of the neighbor of local people about cancer and palliative care resulting in isolation of the family. Projected Intervention: Trying to relieve the patient's problems through home based medications and intervention by volunteers and family members. Reorientating the attitude of family members through discussions and other methods of communication (i.e., get-together of cancer survivors). Social effort to raise the awareness of neighbors and local people through discussion and other audio visual method (i.e., poster, leaflet, slide presentation, etc.). Conclusion: We believe that if we are able to continue our program for a long enough period the suffering of the terminal cancer patient and their families might be resolved to a large extent over time.
Survival Childhood Cancer in a Paediatric Ward
Authors: Bouzbid S. , Boutabia A.-W. , Bouchair N.
Published: September 2018

Background: In the world the overall ASR childhood cancer was 141 per million at age 0-14 years. In Algeria the ASR is 96.3 per million [IICC-3] and the rate of paediatric neoplasm among overall cancers was approximately 3%. There is a lack of data on survival childhood cancer. Aim: Describe the survival of 0-14 years old children diagnosed with a cancer in the pediatric ward of University Hospital (UHA). Methods: All cancer cases admitted in pediatric ward of University Hospital of Annaba, in the period between 2014 and 2017 were included. The tumors were classified according to the third edition of the International Classification of Childhood Cancer (ICCC-3). Survival overall and specific rates (according cancer group and age groups) were calculated using Kaplan-Meier method. Results: Among 272 cancer cases included, 56% were boys and 44% were girls. The main cancer groups were: leukemia (36.8%), lymphoma (14.7%), central nervous system tumors (13.6%), nephroblastoma (11.8%), bone tumors (5.9%), sympathetic nervous system tumors (5.1%), soft-tissue sarcomas (5.1%) and others 6.0%. The median survival of overall cancers was 2.7 ± 0.5 years. According the sex, it was 2.7 ± 0.5 years for girls and 2.3 ± 0.6 years for boys ( P > 0.05). According age groups: the median survival was better for children aging more 2 years old (3.0 ± 0.5 years) compared with children less than 2 years old (1.4 ± 0.6 years) and P < 0.05. The median survival of leukemia was 3.0 ± 0.6 years, of lymphoma was 5.9 ± 0.00 years and 1.8 ± 0.0 years for central nervous system tumors. For nephroblastoma 56.7% of cases were in live until 2 years. Conclusion: More efforts must be made to improve medical care and survival childhood cancer.
Ireland Takes Action on Alcohol and Cancer
Authors: Lyng A. , McCarthy T. , Glynn R. , Costello S. , Harte A. , Bonas F. , Laffoy M.
Published: September 2018

Background and context: The 2006 EU strategy to reduce alcohol-related harm focuses on protecting young people and children; preventing alcohol-related harm in adults; raising awareness of the impact of harmful alcohol consumption. Ireland is the first EU country to develop alcohol legislation with a focus on cancer control. The Irish Public Health Alcohol Bill (PHAB) aims to reduce alcohol harm. Each year in Ireland > 900 new cancer cases are attributed to alcohol. < 20% of people are aware of the link between alcohol and breast cancer. It was timely the theme for 2017 European Awareness Week on Alcohol Related Harm (20-24th Nov) was “Alcohol and Cancer”. Aim: Capitalising on the theme, Ireland's National Cancer Control Program partnered with the Health Service Alcohol Program for “Action on Alcohol” a national public campaign to - raise awareness of the link between alcohol and cancer - call the public to action, to assess alcohol intake using the drinks calculator on askaboutalcohol.ie - enhance support for the PHAB Strategy/Tactics: Overarching message: “Drinking alcohol increases your risk of developing cancer. Drink less to reduce the risk”. Each day a target audience and message was identified: Monday: Women – 1 in 8 breast cancers are caused by alcohol Tuesday: Youth – drinking less in your teens and 20s can reduce your risk of developing cancer in later life Wednesday: Men – drinking less cancer reduce your risk of developing mouth, head and neck cancer. Thursday: LGBT – drinking less can reduce your risk of developing 7 types of cancer Program/Policy process: Statutory bodies, NGOs and charities were briefed and supplied with partner packs containing key messages, social assets, supporting research and planned campaign activity: - Press release to local and national media and health service staff - Local radio interviews with spokespeople (cancer expert and target audience expert) - National radio advertisement highlighted link between alcohol and breast cancer - Articles in print and online media - Social media campaign. Outcomes: - askaboutalcohol.ie received 35,855 page views (highest in 2 week period) 1,157 direct Web site visits, 427 completed drinks calculator (previous fortnight 409 visits, 58 completed drinks calculator) - > 25k people read “6 alcohol-related health risks everyone in their 20s should know about”, 38% completed drinks calculator - 9 Facebook posts had 109,852 views - National TV program invited spokesperson for interview - National and local newspapers coverage. In the period after campaign the PHAB passed through the next stage of legislation process with an amendment nominated by senators to add cancer warning labels to alcohol products.What was learned: - Clear division of target audiences and themes provided varied content with a consistent message - Partner pack empowered partners to deliver messages - Allow time for structured collaboration and communication with partners in advance.
Online Health Promotion to Reduce Cancer Risk: Lessons From Learning With Alaska’s Tribal Primary Care Providers
Authors: Cueva K. , Cueva M. , Revels L. , Hensel M. , Dignan M.
Published: September 2018

Background: Alaska's tribal primary care providers in rural Alaska - community health aides and practitioners (CHA/Ps) - requested online education about cancer for themselves and their communities. Aim: A research team at the Alaska Native Tribal Health Consortium engaged in community-based participatory action research to develop culturally respectful online cancer education to support CHA/Ps to increase their knowledge, reduce their own cancer risk, and share cancer information. Methods: This project created ten online learning modules, a semester-long online course that combined the modules with synchronous conversations, and a supplemental webinar series. All modules were community-based and collaboratively developed with input from a community advisory group of CHA/Ps, content experts, and interested partners. Learners completed an evaluation survey at the end of each module and webinar. Course participants completed a precourse assessment, and evaluations at the end of each module, at the end of the course, two-months postcourse, and six-months postcourse. Results: While evaluation is ongoing, as of March 2018, 194 unique individuals, including 27 course participants, had completed 1,288 module evaluation surveys. Learners reported an increase in cancer knowledge, and intentions to reduce their personal cancer risk and share cancer information as a result of the online learning. On 98% of completed surveys, learners shared that they planned to change their interactions with patients as a result of the learning, including talking more about cancer screening, cutting down/quitting tobacco, being more physically active, and eating healthy. A total of 88% of unique learners planned to reduce their personal cancer risk as a result of the learning, including by quitting tobacco, having recommended cancer screenings, exercising, and eating healthier. Comparison of pre and postcourse survey responses showed CHA/Ps’ had changed to eat more fruits and vegetables and exercise more, as well as felt more knowledgeable about cancer, and more comfortable both with finding medically-accurate cancer information online and talking to their patients, families, and communities about cancer. Conclusion: This culturally respectful education strategy may be adaptable to other populations to support primary care providers and their communities to reduce cancer risk. This intervention may be of particular interest to health care providers, public health professionals, and those interested in health systems in rural and remote regions and in areas with limited medical infrastructure.
Introducing Patient Navigation to Trinidad and Tobago As a Method to Improve Public Cancer Care Delivery
Authors: Badal K. , John M.
Published: September 2018

Background and context: Despite significant public health care investment, Trinidad and Tobago (T&T) has poor cancer patient outcomes. For example, T&T has one of the highest breast cancer (BC) mortality rates in the Caribbean and the highest BC mortality/incidence ratio in the Americas. The BC 5-year survival rate for the period 1995-2007 was approximately 20%-30%, compared with 80% for the US. Many factors contribute to this disparity including healthcare administration challenges such as unavailability of drugs, long delays in securing appointments, loss of paper records and loss to follow-up. The introduction of a tailored patient navigation model is intended to address these challenges. Aim: To pilot the first, comprehensive public cancer patient navigation program with a focus on advanced breast cancer (ABC) patients in the Caribbean. Strategy/Tactics: Following ethical approval, focus groups will be held with hospital staff and the Ministry of Health to ascertain the most pressing patient needs and develop a clinical pathway that includes the navigator. Another focus group will be held with patients to determine needs. One full-time oncology nurse navigator will be assigned to an oncology unit where a physician and nurse liaison will be identified to provide support and supervision. A job description, scope of work, code of ethics, clinical pathway, consent forms, an oncology navigation software and instructions for use will be provided to the navigator. After patient consent, the navigator will provide tailored navigation services based on the predetermined scope of work. Services may include education, referrals to support groups and cancer treatment options, ensuring follow-up is complete, booking appointments and tracking all medical records electronically. The navigator will meet with the project coordinator biweekly to address challenges. The Patient Satisfaction with Cancer Care (PSCC) and the Patient Satisfaction with Navigator (PSN-1) questionnaires will also be administered as part of the process of validating of these metrics for this setting. Program/Policy process: Advocacy and support through personalized case management for cancer patients. Outcomes: We aim to enroll > 100 ABC patients. The following will be reported: (i) Number of ABC patients navigated; (ii) Average number of navigation appointments per patient and average time per appointment; (iii) Results of patient needs assessments; (iv) Validated PSCC and PSN-1 questionnaires; (v) Description of the clinical epidemiology of the cohort; (vi) Description of navigation role and code of ethics; (vii) Protocols for software use; (viii) Recommendations for implementation of a local training program; (ix) Evaluation of time to diagnostic resolution, time to treatment and follow-up care with comparisons to nonnavigated patients where possible.
Building Community-Based Awareness and Navigating Breast Cancer and Palliative Care Programme in Kumasi, Ghana
Authors: Asoogo C. , Aitpilla F. , Hoyte-Williams F.M. , Awittor F. , Awuah B. , Akpaloo J. , Morhe E. , Dassah E.
Published: September 2018

Introduction: Breast cancer is the leading cancer in Ghana and most patients report with advanced disease. Patients face many challenges in trying to access health care and support; these are particularly relevant in the case of metastatic diseases. A structured program would provide a means of rapid referral for definitive diagnosis, treatment and palliative care, where necessary. Aim: To establish community-based structured patient network, navigation and breast health awareness programs that will reduce delays in accessing care, improve the quality of end-of-life care among patients with metastatic breast cancer. Strategy: We established a community-based patient network program comprising 15 community-based patient navigators in the Kumasi metropolis and a social media networking and navigation platform made up of a team of experts and community navigators, breast cancer survivors and patients with advanced breast cancer to share experiences and express/address concerns. We assessed the breast cancer database of Komfo Anokye Teaching Hospital to establish the number, location and density of patients. Community navigator's established direct in-person contacts with the patients to offer support explain and enroll them into the social media network and navigation platform. The project team carried out various awareness campaigns including talks to organized groups, house-to-house and media campaigns. Program/Policy process: We engaged with the Ghana Health Service, local government authorities as well as traditional and community leadership in the design and implementation of the program, to encourage community ownership from the onset. These key stakeholders were also pivotal in organizing durbars, talks to organized groups and community meetings to reach out to the people. Recruitment of volunteers within the communities will ensure that patient navigation has the best chance to continue within these communities beyond the grant period. The project coordinator and her team were available for consultation and also paid periodic visits to the communities. Outcomes: A structured program to enhance referral and access to care; a community-based patient navigation system to recruit and provide support to patients with advanced breast cancer; a social media platform to provide guide and immediate support to patients with metastatic breast cancer; and improved awareness of breast cancer and its prevention in the communities. Conclusions: The program improved the health care system in the communities and also expands outreach to persons living with metastatic breast cancer to provide support and improve treatment outcomes and quality of life. It also encourages patients to visit hospitals for treatment through ease of access to medical care and informed treatment choices and palliative care.
Experiences of Patients Diagnosed and Living With Metastatic Breast Cancer in Kumasi, Ghana: A Lesion to Learn From Low-Middle Income Country
Authors: Asoogo C. , Hoyte-Williams M. , Dwobeng B. , Sam D. , Amankwa-Frimpong E.
Published: September 2018

Background: Breast cancer is a leading cause of death among women in Ghana. About 50% of cases seen at the oncology directorate are breast cancer-related, and 85% of these cases present in advanced stage with very poor prognosis and high mortality. Objectives: To explore and describe the experiences of patients diagnosed and living with metastatic breast cancer. Methods: A cross sectional descriptive study design was used to involved breast cancer patients at Komfo Anokye Teaching Hospital who comes from various social and ethnic groups as well as geographically distinct areas from the vast territory of the Ashanti region and the Northern part of Ghana. Convenient sampling was used to select 120 participants for the study using semistructured questionnaire. Data of their social and demographic background and experiences living with metastatic breast cancer were obtained after seeking informed consent. Results: The study revealed that 12% of participants diagnosed and living with metastatic breast cancer experience loneliness and devastated, 22% experience fear and anxiety, while 35% experience stigma from both family and the society. Moreover, feeling of anger and hopelessness also account for 15%, 11% experience financial changes, while 5% of participants experience both physical and emotional pain with their diagnosis and treatment. Recommendations were made for policy makers, health care professionals, and other researchers. These include the need for intensified metastatic breast cancer awareness campaigns, educating health care providers on the need for professional counseling on metastatic breast cancer and the need to organized support groups, so that patients could contact each other. Emphasis should be placed on training of nurses to deal with issues relating to metastatic breast cancer. Conclusion: Generally, fear and anxiety, stigma, feeling of loneliness, devastated, anger and hopelessness, emotional and physical pain and financial changes are the variables that explain the experiences of women diagnosed and living with metastatic breast cancer. Some support groups has shown an improvement, therefore efforts to raise public awareness of metastatic breast cancer should be continued. The current study became imperative to fill this identified gap and improve health interventions and health outcomes for metastatic breast cancer patients in future.
Agreement Against Cancer: A Citizen Proposal to Fight Cancer and Influence in Public Policies
Authors: Rivadeneira W. Merino
Published: September 2018

Background and context: The Constitution of Ecuador provides the right to free and specialized attention. The state has fallen short due various reasons: limited political support, weak infrastructure and limited resources, inadequate cancer information system, lack of integration and coordination of efforts to control the disease, scarce research, lack of monitoring and evaluation of interventions and social inequity. Agreement Against Cancer was born aiming to improve disease control and priority attention with a comprehensive approach: health promotion and prevention, early detection, adequate treatment, rehabilitation and palliative care: it adheres 18 organizations who have worked in the promotion and defense of the rights of cancer patients. Aim: Raise the national debate around cancer and influence in public policies to combat this catastrophic disease. Strategy/Tactics: 1) Social mobilization to awaken interest in the disease: 2) Proposal of a bill to fight cancer and include the issue in the public agenda Program/Policy process: Acc decided to act on 3 axis: Social: strategy to fight cancer was established: 1. Creation of National Cancer Control Council 2. Investigation 3. Prevention 4. Integral attention: timely diagnosis, treatment and rehabilitation, palliative care, access to blood products, emotional health 5. Education 6. Labor security 7. Mobility: transparent, prehospital care, hostels and home 8. Family surroundings 9. Infrastructure 10. Economic fund Communication: This proposal was taken to the 8 presidential candidates in 2017. Emphasis was placed on digital communication. A public relations campaign mobilized the media, stakeholders and opinion makers. The problem was risen at a national level and citizens demanded a response from the authorities, private company and other actors in society. However, this social demand needed a channel to introduce it to the government´s agenda. Political: it was decided the construction of a bill, that required the submission of citizen signatures to reach the National Assembly. A campaign was launched to collect a minimum of 35,000. Outcomes: • Approximately 150,000 citizens signed; more than 5000 volunteers mobilized. • Concert for Life, participation of more than 10,000 people. • Support of 8 presidential candidates. • Bill proposed to the National Assembly. Validation of 111,157 signatures. The bill meets all the requirements necessary by the law and is awaiting its analysis. What was learned: 1. Cancer management from the legal, political and social point of view. 2. Reality of cancer patients. 3. Collaborative network. 4. Public–private articulation to promote citizen initiatives. 5. Social mobilization supported by new technologies. 6. Use of volunteers and training. 7. Citizen participation mechanisms and their empowerment. 8. Structuring process of a bill.
Prostate Cancer in Morocco: The Epidemiological Evidence
Authors: Haimer A. , Habib F. , Soulaymani A. , Mokhtari A. , Hami H.
Published: September 2018

Background: Prostate cancer is one of the most common types of cancer in men. It is the fourth most common cancer and the fourth leading cause of cancer death among men after liver, lung and bladder cancer in northern Africa, with an estimated 7548 new cancer cases and 5000 deaths from cancer in 2012, the most recent year for which international estimates are available ( GLOBOCAN 2012 ). Aim: The aim of this study is to determine the prevalence and the epidemiologic characteristics of prostate cancer in Morocco. Methods: This is a descriptive retrospective analysis of prostate cancer cases, diagnosed and treated at Al Azhar Oncology Center in Rabat between 2005 and 2015. Results: During the period of study, there were 644 new cases diagnosed with prostate cancer at Al Azhar Oncology Center, accounting for 20% of all new cases of cancer in men reported during this period. The average age of the patients at diagnosis was 68.1 ± 9.6 years (range 8-97 years). The risk of developing prostate cancer is associated with advancing age, 97.7% of cases were diagnosed in men aged 50 years and older, with 85.1% of new cancer cases occurring among those aged 55-79 years. Among all detected cases, 6.5% were diagnosed with metastatic disease and 4.8% died during the study period. Conclusion: Prostate cancer is the second leading cause of death from cancer in elderly men. Early detection to improve prostate cancer outcome and survival remains the cornerstone of prostate cancer control.