bluuebunny/crossref_metadata_2025 huggingface dataset:
Working With Organized Groups to Change Cultural Beliefs and Norms Toward Cancer in Uganda
Authors: Agwang A. , Ngonzi H. , Ekudo J.
Published: September 2018

Background and context: Cultural norms, beliefs and practices are great hindrance to efforts toward early detection and treatment of cancer in Uganda as most of the individuals believe its witchcraft, curse or bad luck. Working with organized groups such as churches, cultural associations, women associations, is key in changing such beliefs. HealthAid Uganda (HAU) for the last 3 years has worked in partnership with Watoto Church among other groups to deliver cancer awareness, screening and screening for other health problems in the districts of Mukono, Kampala and Wakiso. Aim: To mobilize organized groups within the community to raise awareness about cancer to correct prevailing myths, misconceptions and negative cultural beliefs, norms and practices. Strategy/Tactics: HAU built a strong partnership with its target groups one of which being Watoto church with whom joint planning activities were carried out. It involved the review of HAU's previous community health outreaches as a source of experience. The review also gave insight into the development of the activity plan; including the services to be rendered, the community leaders to be involved and the day in which the events would be conducted. The event included health talks on HPV, cervical and breast cancer, testimonies by the survivors, practical demonstration for self-breast examination, cervical cancer screening and distribution of cancer education materials. Program/Policy process: Involvement of community groups and champions in changing beliefs toward cancer epidemic is key. Outcomes: There was increased spirit of partnership which attracted various civil society organizations with Watoto church being the key partner. The government health center administration recognized efforts and pledged to offer further support in mobilizing the community. The awareness walk attracted public participation and need for the services. It demonstrated need to further work with organized groups within the community to form cancer task force groups to bring cancer information to every household. The events were covered by media, leading to increased demand for the services provided, with estimated 1500 individuals who received with both awareness, screening and consultative services. What was learned: HAU-Watoto partnership involvement showed that working with organized groups produces better results in cancer control and treatment in Uganda. Indeed changing cultural beliefs, norms and practices toward cancer prevention and control can be a success story if working with organized local groups is taken into consideration as a tool to reaching out to individuals and the approach during this year showed much more results than 2016.
Cervical Cancer in the Commonwealth: Collective Action
Authors: Zubizarreta E. , Lodge M. , Abdel-Wahab M. , Polo A.
Published: September 2018

Background and context: Fifty-three countries are members of the Commonwealth. These countries span Africa, Asia, the Americas, Europe and the Pacific and are diverse - they are among the world's largest, smallest, richest and poorest countries. Thirty-one of these members are classified as small states - countries with a population size of 1.5 million people or less and larger member states that share similar characteristics with them. The Commonwealth Secretariat is planning to tackle the problem of cervical cancer in their low and middle member states (LMIC) through the project “Cervical Cancer in the Commonwealth: Collective Action”. There are 209,100 cervical cancer cases diagnosed per year in the Commonwealth, and in 167,300 cases radiotherapy treatment is indicated. Aim: To analyze the problem of cervical cancer in low and middle-income countries of the Commonwealth and to propose the first step for a collective action. Strategy/Tactics: The treatment of locally advanced cervical cancer includes radiotherapy (teletherapy and brachytherapy) plus concomitant chemotherapy. Cervical cancer has a high rate of curability if brachytherapy is added to teletherapy. We identified radiotherapy departments in Commonwealth LMIC with teletherapy but no brachytherapy and proposed the upgrade of these services to include brachytherapy as a first step. Program/Policy process: The evidence-based treatment of locally advanced cervical cancer is a combination of external beam radiotherapy with chemotherapy and brachytherapy. Brachytherapy has played a major role during many decades in the treatment of gynecologic cancer with good clinical results. EBRT combined with BT leads to superior survival for patients with cervix cancer as compared with EBRT alone, and additionally, MR image-guided BT further improves local control and survival. Countries with no access to BT may only offer palliative treatment to women diagnosed with locally advanced cervical cancer. Any curative attempt for these patients should include brachytherapy. The addition of brachytherapy to external beam radiotherapy in the treatment of cervical cancer is associated with a 12% increase in the 4-y overall survival rates and 13% increase in cause-specify survival. Brachytherapy can save at least 12% more cervical cancer lives than radiotherapy alone. These differences would be much bigger in LMIC because of the limited technology used for external beam radiotherapy. Outcomes: Each high dose rate (HDR) brachytherapy afterloader can treat up to 666 patients per year, of which 466 (70%) could be potentially cured. The capital costs for installing an HDR afterloader is around US$ 1 million, including equipment and building, the annual operating costs are US$ 473,000, and the costs of brachytherapy are US$ 710 per patient. In the lifetime of an HDR afterloader (10 years), 4660 patients could be cured per afterloader installed. What was learned: Brachytherapy saves lives!
Cancer Council New South Wales: Policy and Advocacy Report Community Insights to Inform the Policy Positioning of Tobacco Retailing Reform in NSW, Australia
Authors: Engel A.
Published: September 2018

Background and context: In the lead-up to the next state election, Cancer Council New South Wales (CCNSW) will run the “Saving Life 2019” advocacy campaign focused on changing NSW Government policy in cancer control. In developing a policy agenda, three priority areas were identified that required further research to better understand public perceptions, inform messaging and engagement strategies. Reform of current tobacco retailing was identified as one of these priorities. Aim: Understand how key audiences view current tobacco retailing laws and widespread tobacco availability in NSW; Find new opportunities to progress our policy objectives by identifying additional key audiences in the general population; Build the evidence base for a salient and convincing messaging guide for the advocacy campaign strategy and CCNSW's broader policy engagement and influencing work. Strategy/Tactics: The campaign will seek to demonstrate community support for reform of current tobacco retailing laws in NSW to the community, the media and political candidates to achieve policy commitments. CCNSW existing campaign strategy includes tactics across grassroots mobilization, targeted political engagement and securing earned media. The development of strategic research to underpin this campaign, including development of an evidence-based communications strategy, was critical in optimizing communications and public engagement. Program/Policy process: CCNSW commissioned an independent external agency to conduct the research. The research used a mixed methodology that included a facilitated online focus group of up to 20 people, followed by polling of the general public. Focus groups were conducted over two days, with participants recruited from a wide geographical spread and constituted a mixture of general population, parents, hospitality workers and small business owners. Outcomes: A research and communications report containing an overview of the research, key findings, as well as communications considerations based on the research was used to inform our overall campaign strategy, including policy messaging and communications planning. What was learned: Findings noted that while cancer of all types is seen as a serious public health issue, cancer specifically resulting from smoking and tobacco use is not top-of-mind. It revealed the link between ease of access to tobacco products and increased usage is clearly understood, and there was support for further restricting where tobacco can be sold. The concept of a “retailer fee” to pay for the cost of antismoking initiatives received limited support, mostly driven by concern for smaller retailers. The most popular arguments were those which reinforced existing community beliefs, rather than challenging them.
Driving Change: Do Nurse-Led Clinics Make a Difference for the Patient?
Authors: Fisher M. , Jorgensen S.
Published: September 2018

Background and context: The number of people living with breast cancer and beyond is increasing. The nurse led clinics prioritise the patient as the center of care, providing the opportunity to address the serious medical, functional and psychosocial consequences of cancer and its treatments. Aim: To evaluate a model of survivorship care from the patient´s perspective. Strategy/Tactics: Eligible patients were identified through the multidisciplinary team breast meeting. Consultation with the breast care nurse at approximately 10 months postdiagnosis. Prior to this appointment, validated screening tools were sent to attendees and completed. Through assessment and discussion, issues were identified and addressed, with onward referral to internal and community based organizations. Resource packs provided together with a care plan. Program/Policy process: Having offered the nurse led clinics for 18 months Western Health conducted a patient satisfaction survey. Data were collected in the form of a questionnaire to ascertain the effect of the clinic in providing optimal and supportive survivorship care. Outcomes: 208 patients seen, 134 were born in a country other than Australia. 208 surveys sent to both English and non-English speaking patients. 91 respondents. 72% made changes to their lifestyles and relationships following the nurse led clinic. 93% of respondents felt they had more time to talk about their concerns and ask questions. 92% felt the BCN provided helpful information about support services and programs that they would otherwise not be aware of. What was learned: Patients may experience significant burden of symptoms following definitive treatment of early breast cancer. The nurse led clinic allows patients space to reflect and explore their disease experience to date, which for many has resulted in positive lifestyle changes.
Makna Mobile Mammography Screening Unit
Authors: Farid F. Mohd
Published: September 2018

Amount allocated in 2017 for this initiative RM 754,892.00 (US$ 195,353 or CHF 187,509.16) Background and context: Urbanization and its discontent have seen more urban poor in need of immediate medical intervention. Only a small percentage of women ever performed mammogram due to medical screening cost and poor knowledge pertaining to mammography screening for breast cancer. A massive health education campaign through multiple methods and agencies is necessary to upend this deep-seated perception. Aim: MAKNA's mobile mammography screening unit aims to improve lifesaving chances of people afflicted by cancer through early detection of presymptomatic cancer, using approved and fully equipped vehicle with the latest technology available. Focusing in early detection Garnering resources inter alia to help the financially-challenged cancer patients Many cases that come to MAKNA come in the late stages where help of a cure is usually less than 30% Enhancing knowledge and awareness among general public Economic-wise: cheaper to screen for diseases compared with treating patient Reducing death rate from breast cancer by conduct and deliver nationwide campaign all over Malaysia from districts to cities, rural to urban dwellings Strategy: Equipment overall specs Breast screenings with mammography using full fledge digital unit (GE SENOGRAPHE 2000D) Primary objectives: To conduct mammograms and clinical breast examinations (CBE) to public. To conduct general screening to public. Secondary objectives: To conduct cancer awareness and screening program to public. To educate staffs on early detection of cancer. To raise fund for financially challenged cancer patients via MAKNA various fundraising projects Key messages: Early detection saves lives - know the early warning signs and get screened. Care for yourself and others -help us to help the financially challenged cancer patient. (Cancer treatment is very expensive.) Get involved! -Participate in our activities Further targeted communities: Rural interior villages across Malaysia Costs and returns: A. Total 2007-2017: Total costs: RM 5,787,634 (US$ 1,497,398 or CHF 1,437,713) (RM 2,499,500 for fixed assets + RM 3,288,134 for services) Total ROI: Total screenings: 204 locations Results (by case): Normal: 20,027 Benign: 2434 Abnormal/referred: 383 Cancer diagnoses: 23 B. Year of 2017´s impacts: Costs: RM 753,109 (US$ 194,878 or CHF 187,083) ROI: 6378 screenings: 47 locations Result (by case) Normal: 5329 Benign: 956 Abnormal/referred: 93 Cancer diagnoses: 7 What was learned: Majority of cancers are the result of unhealthy lifestyle rather than inherited genetic faults. Breast cancer rate by ethnic: highest in Chinese > Malay > Indian > others. Early stage of breast cancer most detected. Patient navigation program to improve follow-up with positive cases. Overall, this is a scalable solution. Specifically in good prospect to operate in Borneo, East Malaysia with 2 more units.
Policy Report: Introducing an Effective National Cancer Control Plan in the Maldives
Authors: Saeed J.
Published: September 2018

Background and context: There is no National Cancer Control Plan (NCCP) in the Maldives. The Health Plan has identified cancer as an area with a need for development of separate policy, strategy paper while it is also reflected in the Multi-Stakeholder Action Plan for NCDs. Aim: The main aim of the project is to produce a policy report to guide the development of an effective National Cancer Control Plan (NCCP) in the Maldives. The objectives are to estimate the total period prevalence of cancer in the Maldives (2013-2014); to understand the views of key stakeholders; and synthesize this to develop a policy report and applying the “Cancer Control, Knowledge into Action: WHO Guide for Effective Programmes - in Low and Middle Income Countries”, to the Maldives context to identify priority components in light of the prevalence estimates and views of the key stakeholders. Strategy/Tactics: The policy report will bring together the findings from secondary analysis of quantitative data, analysis of key informant in-depth interviews from stakeholders, using the framework analysis method for qualitative data analysis and applying the “WHO Guide for Effective Programmes - in Low and Middle Income Countries”, to the Maldives context and identify priority components in light of the prevalence estimates and views of the key stakeholders. Outcomes: Among a population of 344,023 people, the estimated total period prevalence for all cancers in the period of 2013-2014 in Maldives is 0.92% (920 cases per 100,000 population). The estimated prevalence is 0.84% for males and 1.01% for females. Oral cancers (including lip, tongue, gum, mouth, and palate) is the most common cancer, followed by eye, breast (with carcinoma in situ), sinuses, skin (melanoma and skin cancers and carcinoma in situ). How common eye cancers and sinus cancers could be reflected as an anomaly in the data as these are uncommon when regional prevalences are compared or is an area where further research is warranted. Thyroid, prostate, lymphomas, leukemias and lung cancers are among the top 10 cancers. The key informant interviews, revealed that there are very limited services available for cancer prevention, diagnosis, treatment and care. What was learned: It is evident that there is a substantial amount of work to be done with regard to cancer control in the Maldives. The high prevalence of cancer and the views of the respondents from the study emphasizes the need for developing a National Cancer Control Plan (NCCP) as an initial step toward comprehensive cancer control efforts in the Maldives. A comprehensive cancer prevention strategy with early detection-early diagnosis and screening should be a priority component for the NCCP, with improvement of diagnosis and treatment services and establishment of a comprehensive palliative and psychosocial care program across the cancer care continuum. This policy report will provide guidance to development of an NCCP with priorities identified.
Participation in Improving Clinical Outcomes of Cancer Patients by Nongovernmental Organisations in Low- and Middle-Income Countries: A Case for Zambia
Authors: Soko U. , Lombe D.
Published: September 2018

Amount raised: $8000 Background and context: The Zambian Cancer Society (ZCS) is a nongovernmental organization dedicated to fighting cancer along the continuum of care. Until recently, ZCS had provided nonclinical social support to patients by donating food, toiletries, clothing and transport money. The Society also runs a patient navigation desk at the national Cancer Diseases Hospital, which provides information to patients, cancer survivors and their care givers. In 2017, ZCS in collaboration with Oncocurae Consultancy decided to participate in clinical outcomes by fundraising for service delivery costs. Aim: To improve clinical outcomes of cancer patients by filling in the financial gap in cancer care in Zambia. Strategy/Tactics: The Zambian Cancer Society engaged with technocrats in the field of oncology to understand the barriers to quality care and good outcomes for cancer patients treated at the national Cancer Diseases Hospital. Solutions within realistic budget lines were then proposed. Partners such as the Rotaract Club of Lusaka, Zambia Active Ambassadors, Zambians living in the UK and many more were sensitized to these needs for fundraising. Program process: Three main areas were identified: Knowledge gap in implementation of more conformal radiotherapy techniques. Pathology costs inhibitive for patients (especially pediatric oncology and breast cancer). Lack of organized preventative, screening and surveillance services at the cancer center. Costs and returns: Activity 1: Sponsorship for radiotherapist to attend the European Society of Medical Oncologists (ESMO) Africa Summit, in Cape Town. Cost: $1000 Return: Achieved networking and mentorship relationships with view to enhance skills and training opportunities. Activity 2: Provision of funds to allow for timely diagnosis of disease to enable treatment. Cost: ongoing Return: Immunohistochemistry is an important aspect to enable oncologists to make good treatment decisions but often too costly. Activity 3: Equipment for preventative, screening and surveillance clinic bought. Cost: $2700 Return: Launch of preventative, screening and surveillance clinic at Cancer Diseases Hospital. What was learned: Social support is very important for patients but lack of clinical support can turn a potentially curable disease into an incurable one in the LMICs. Leveraging of relationships between NGOs and goodwill sponsors can bridge financial gaps in poorly funded health care systems.
A Brazilian Health Tech Start-Up Which Aim Is to Prevent Cancer Mortality and Reduce Treatment Costs With Early Detection and Primary Prevention
Authors: Filho H.R. de Oliveira , Pechibilski S. Marcos , Camargo R.A. Alves
Published: September 2018

Background and context: Brazil is a huge and developing country that has an universal public system of health. This system takes care of approximately 75% of our population (150 millions). Cancer is a major problem in Brazil and have high mortality rates mainly because of late diagnosis and lack of information. Besides the mortality impact, it brings high costs to the health system (public and private) and have poor survival rates and lost of productive work people. Aim: To assess an technology system able the identify high risk patients, patients that have normal risk but have they screening exams delayed and propose an individual strategy to reduce the risk an give important information about primary and secondary prevention for the 5 principal solid tumors: breast cancer, prostate cancer, lung cancer, cervical cancer and colon cancer. Strategy/Tactics: We developed a Web based platform that can estimate the risk of developing cancer in general population based on questions and risk factor established by medical societies and science and stratifies into 3 groups: high risk (lifetime risk greater then 20%) moderated risk (normal risk but delayed screening exams) and normal risk. Based on the risk or delayed exams, the system generates a personalized strategy to reduce the risk or to ensure the necessary exams are completed. Besides this we give general information about the importance of prevention and habits that can reduce the risk of cancer. Program/Policy process: The system is based on the Web site http://www.previneo.com.br and was initially made available to all population. As the access rate got too high we had to restrict the access. Since then it has been provided as a service to interested companies to give Previneo the necessary financial sustainability. We have a giant acceptance by big corporations which are concerned in controlling the risk of their employees, saving lives and reducing the cost of the health insurance. Outcomes: We have found that approximately 40% of the population that need to do screening exams (by age and gender) do not make. Besides this we found 5%-12% of population in high risk of developing one or more of the solid tumors we assess (in concordance with international literature). All participants have approved the system and were empowered with important information about their health and certainly will have a better take care of their own life. What was learned: We have learned that with a Web based technology system we can achieve a big part of our population and provide quality information and effectively reduce the mortality and cost of a disease that will be the global leader of mortality in our world.
Advocacy for Early Detection and Treatment of Cervix and Breast Cancer
Authors: Shukla P. , Tripathi N. , Gupta P.
Published: September 2018

Background and context: According to ICO Information Centre on HPV and Cancer (HPV Information Centre) 2014 in females with 23.8% breast cancer is highest and at 20.2% cervix cancer comes at number 2 in India. India has a population of 432.20 million women aged 15 years and older who are at risk for developing cervical cancer. Current estimates indicate that every year 122,844 women are diagnosed with cervical cancer and 67,477 die of the disease. Cervical cancer in India ranks as the 2nd most frequent cancer among women between 15 and 44 years of age. Aim: Accessibility for the early detection of cervix and breast cancer for the females in Uttar Pradesh. Strategy/Tactics: Lucknow is the capital city of Uttar Pradesh the most populous State of India having 1/6 of population and equivalent burden of cervical cancer. Any action aimed at an effect in Lucknow shall further have impact in the entire state. Advocacy training was organized at Lucknow on the occasion of “World Cancer Day” (4th February) with material for capacity building of organizations working on cervical cancer and female health. We were able to mobilize 10 different organizations working for cervical cancer and female health issue. Presence of Hon'ble Governor and Principal Health Secretary enabled us in making a dent on the issue from the very beginning. His Excellency the Governor of Uttar Pradesh being a cancer survivor was the best advocate, stressing during the lecture on the need to address the issue. Principal Health Secretary, the ultimate deciding authority for developing the policies assured for full cooperation and early action. Program/Policy process: Principal Health Secretary of Government of Uttar Pradesh announced to establish the screening clinics forscreening of cervical cancer in 23 districts of Uttar Pradesh. Treatment facilities would be provided in all the government medical colleges of Uttar Pradesh. The clinic set up shall be monitored by National Health Mission Unit of Uttar Pradesh. Outcomes: Currently Sampoorna clinics are established in 28 districts of Uttar Pradesh which is for females of age group 15 to 60 years for all kind of screening, advice and treatment. What was learned: For advocacy we need ground work to be done before meeting to any policy maker to influence the policy. Different organization working on the same or related issues has to bring together to strengthen the impact.
Profile of Colorectal Cancer in 14 Provinces in Indonesia
Authors: Khairina D. , Suzanna E. , Triana D. , Kadir A. , Widyastuti T.H. , Sulistyowati L.S. , Rosalina I. , Palupi N. , Lubis E.M. , Hamzah A. , Kartikawati A. , Ramadhaniah F. , Agustina J. , Rahayu P.S. , Septiawati S. , Yulianita R.
Published: September 2018

Background: In Indonesia, the incidence of colorectal cancer was separated in colon and rectum cancer. The incidence of rectum cancer ranked number five in male and number eight in female. The incidence of colon cancer ranked number seven in male and number nine in female. Aim: The aim of this study is to know the profile of colorectal cancer in Indonesia. Methods: Using data collected from population based cancer registry in 14 provinces (26 cities/districts) in Indonesia which was developed into a site specific cancer registry. All of the data diagnosed from 2008-2012. The classification of cases is used WHO criteria, ICD-O-3 (C18-C20). There were 3453 patients included in this study. CanReg5 was used as the software for entry and analyze the data. All primary health care and hospitals sent the data to the 14 National Referral Hospitals which located in each provinces. Finally, the 14 National Referral Hospitals sent the data to Dharmais National Cancer Center. Results: Incidence of colorectal cancer was higher in male (54%) than female (46%). Peak cancer cases occurred in the age of 50-54 years. DKI Jakarta, Central Java, DIY Yogyakarta as the three provinces which have highest incidence for colorectal cancer. The highest microscopic verification was in Papua, Central Java, and South Sulawesi. The highest percentage location was in the colon. The type of morphology was adenocarcinoma. Conclusion: The incidence of colon cancer entered in the top ten most common cancers in Indonesia. The quality of data still needed to be improved.
Implementation and Incidence Data of Cancer Registries Network in Algeria
Authors: Cherif M. Hamdi
Published: September 2018

Background and context: Cancer is becoming a true health public problem in Algeria in the last years. The National Cancer Plan (2015-2019), has given a priority to cancer registration, and the Ministry of Health proceeded to the institutionalization of cancer registries. Aim: The objective is to implement a cancer registries network covering a large population, and provide cancer incidence data for Algeria. Strategy/Tactics: Regional organization of the cancer registries network. Training of coordinators of cancer registries on cancer registration tools. The new cases recorded were from 18 registers covering a population of 20,224,844, from a general population of 38,700,000 inhabitants for the year 2014. The data are entered and analyzed by the CanReg software 5, provided by IARC. Program/Policy process: The cancer registries network covers is becoming an important tool for the cancer control in Algeria. It provides data public health and cancer research. Outcomes: The coverage of national registration rate is 82% with 52% of cancer registries were validated. The number of new cases during the year 2014 is 41,870 cases (16,748 men and 25,122 women). The overall crude rate is 106/100,000 (h), the standardized rate is 114.5/100,000. Crude and standardized rates in men are respectively 100.2 and 109.2/100,000. In women are respectively 111.8 and 119.8/100,000. In men, frequent cancers are lung, colon-rectum, bladder, prostate, stomach, pharynx naso, NHL, larynx and leukemia cancers. In women, breast cancers followed by colorectal, cervical, thyroid, NHL, stomach, biliary and leukemia cancers.
Women's Knowledge, Attitudes and Practices (KAP) Relating to Breast and Cervical Cancers in Rural Zimbabwe: A Cross Sectional Study in Mudzi District, Mashonaland East Province
Authors: Makurirofa L. , Mavu J. , Mangwiro P. , Nyamuranga M.
Published: September 2018

Background: Breast and cervical cancer constitute the most common cancers among women in sub-Saharan Africa. In Zimbabwe, cervical cancer accounts for more than a third of all cancers among women of African descent. Cancer knowledge levels, attitudes and practices of people in different sections of society, especially in remote and disadvantaged peripheral areas, should be assessed to guide current cancer interventions. Aim: This study aimed to assess breast and cervical cancer knowledge, attitudes and practices of women of reproductive age, in Mudzi District, Republic of Zimbabwe. The study forms the baseline for cancer intervention in this remote, rural district. Methods: This cross-sectional, community-based survey was conducted by triangulation of both quantitative and qualitative research methods. A total of 409 survey household questionnaires were administered to women of reproductive age (15-49 years) in 2014. Key informant interviews and focus group discussions were conducted to provide context for the survey responses. Results: The response rate was 100%. Nearly 85% of respondents had heard of cancer. About 34.2% did not know of any cervical cancer risk factors, while 51% were not familiar with the signs and symptoms of cervical cancer. About 55% had not discussed cancer issues with partners in the past 12 months, and only 27.4% had discussed cancer issues with partners at all. Most of the respondents (96.2%) had never undergone cervical cancer screening. The majority of the respondents (70.8%) had never discussed breast cancer issues with community members. About 70% had never discussed cervical cancer issues with community members. Conclusion: This study revealed a lack of awareness and comprehensive knowledge about breast and cervical cancer. It also revealed low self-risk perception, low uptake of cancer early detection services and low capacity of local health institution in offering cancer services. It is recommended that the scaling-up of cancer information dissemination and early detection services must be prioritized, including training of local health institutions.
Clinicopathologic Profiles of Malignant Verrucopapillary Lesions of the Oral Cavity
Authors: Hassan S. , Kadir K. , Mannil T.A. , George K. Thomas , Zain R.B.
Published: September 2018

Background: Morphologically, oral SCC (OSCC) may present with verrucopapillary (VP) features. Those with VP features may have a different histologic presentation and different growth pattern. Histologically, papillary SCC, verrucous carcinoma and conventional OSCC (CSCC) with VP features are designated as the verrucopapillary (VP) variants. Aim: The objective of this study was to determine the clinicopathologic profiles of OSCC with VP features and to compare it with OSCC with non-VP features. Methods: A retrospective search of the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS) at Oral Cancer Research & Coordinating Center (OCRCC), Faculty of Dentistry, University of Malaya on verrucopapillary OSCC (VP) and nonverrucopapillary OSCC (non-VP) cases diagnosed from 2004 to 2016 was conducted to identify suitable cases for this study. 23 cases of VP and 29 cases of non-VP were studied based on the inclusion criteria. Formalin-fixed paraffin embedded (FFPE) samples from surgical specimens of VP and non-VP were retrieved. All cases were initially reviewed by two oral pathologists and consensus achieved to subdivide into VP and non-VP group. Clinicopathologic parameters were analyzed using frequency and % (for categorical variables). The χ2 test was used for appropriate P values. Results: The age group of VP patients ranged from 38 to 79 years old (mean age, 64.3 ± 11.23 years) while the non-VP group ranged from 20 to 81 years old (mean age, 54.1 ± 12.3 years). Both groups had a female predilection with a male to female ratio of 1:3.8 and 1:1.4 for VP and non-VP patients, respectively. Indians predominated in both the groups and the results were found to be statistically significant ( P < 0.05). Most cases of VP were located on the buccal mucosa (45.8%) while most of non-VPL cases were located on the tongue and floor of the mouth (75.9%). Most of non-VP (85.7%) cases presented with significant lymph node involvement when compared with the VP group (36%), ( P < 0.05). In the VP group, 29.2% were treated by surgical excision alone while 70.8% were treated with a combination of surgical excision with neck dissection. Conclusion: This study showed that patients with OSCC exhibiting VP features were significantly older (> 60 years old). The OSCC with non-VP features behaved more aggressively than the OSCC with the VP features necessitating surgical excision in combination with neck dissection as the preferred treatment modality.
Advanced NSCLC: Treatment From 261 Cases of Lung Adenocarcinoma in a Brazilian Public Health Service
Authors: Lenz G. , Stefani S.D. , Cacilhas P. , Paludo L. , Gonçalves V.K. , Lorandi V. , Tsukazan M.T. , Lago L.S.
Published: September 2018

Background: Lung cancer is a worldwide health problem. Brazil is no different with over 31,000 new cases estimated in 2018 nationwide. Unfortunately the majority of cases are diagnosed in advanced stage. Molecular testing for driver alterations, such as EGFR and ALK are mandatory as they are both prognostic and predictive biomarkers to recommend target therapy for metastatic disease. Many guidelines advocate to use a tyrosine kinase inhibitors (TKI) as first line therapy on advanced NSCLC (nonsmall cell lung cancer) based on increased PFS data compared with chemotherapy. In Brazil, molecular testing and target therapy for EGFR and ALK are not widely available in public health system. Aim: We aimed to evaluate the prevalence of patients with advanced NSCLC tested for EGFR and/or ALK that who received target therapy in a public health hospital in southern Brazil. Methods: All patients with NSCLC adenocarcinoma stage IIIB-IV from January 2013 through March 2018 were included. Medical records were reviewed to evaluate for molecular testing and target treatment. Results: We found a total of 261 patients diagnosed with NSCLC (adenocarcinoma). Out of these, 102 patients were staged IIIB/IV or with relapsed disease. In 49/102 (48.4%) cases some molecular testing was performed; EGFR 36 (35.3%), mutEGFR: 9/36 (25%), unknown (UK): 8/36 (22.2%); ALK: 19 (18.6%), without transloc. (w-o): 6/19 (31.6%); wtransloc: 1/19 (5.3%); UK 3/19 (15.8%). Out of 102 patients, only nine (8.8%) were included in a clinical trial; 6/102 (5.9%) received a TKI outside of a clinical trial setting. Only 2/6 received TKI as first line treatment whether the remaining 4/6 received a TKI on second line or beyond. Conclusion: Only half of the patients with advanced NSCLC were tested for either EGFR or ALK. Of these patients, 25% tested positive for a mutation in EGFR and 5.3% were found to have an ALK-rearrangement. Only 6 received TKI. Both molecular testing and target therapy are restricted by the public healthcare system. We depend on clinical trials or the pharmaceutical industry support, in many cases, to test for and identify such patients with target therapies. Treatment of lung cancer in Brazil contradicts a number of guidelines, expert's recommendations and best clinical practice. Unfortunately, legal measures are expensive and deleterious to national financial sustainability, but in many cases represent the only form to guarantee access to a TKI treatment. We found many systematic problems (loss of some patient's data) as a result from cross-sectional study. This may contribute to small number of patients. However the challenge to offer better treatment of lung cancer patients in Brazil was not affected.
Making a Difference in ABC Patients´ Quality of Life: Uganda´s Case
Authors: Walusimbi J. Nabitwere
Published: September 2018

Background: According to UWOCASO's research “Assessment of clinical and psychological needs of metastatic breast cancer patients, challenges and gaps in meeting their needs in Uganda” metastatic breast cancer (MBC) is not well understood, patients often feel isolated, invisible and stigmatized, have limited access to targeted treatment, specialized and comprehensive supportive services. Provision of information for available services and options for their care including open communication with health care providers, access to psychosocial services, pain control, financial support and cost of the treatment were important needs during the study. Patients end into depression, drop out of care thus compromising their quality of life. This project was designed as an intervention to address the unmet needs and barriers that limit access to supportive services. Aim: To improve access to supportive services for ABC patients and their families in Kampala and Wakiso districts. Methods: Fifteen (15) patients with advanced and metastatic breast cancer who were not respondents for the SAPRC research were recruited from the patients who sought psychosocial support from UWOCASO for a systematic follow-up. Using a bio-psycho-social (BPS) tool baseline data were collected to assess their psychosocial situation before our intervention and after 12 months. Baseline data were compared with the outcome. Results: At seven months more than 70% of patients had restored hope, pain kept under control, resumed treatment, reunited with families and some received in-kind and financial support. 30% of the patients passed on with no pain and legally supported. 2 patients were enrolled into a compassionate program for a targeted therapy. Conclusion: Patients living with advanced breast cancer have various needs that can only be met by a well-coordinated team of experts. UWOCASO's patient navigation program is important to bridge the gap between experts and improve access to supportive services.
Evaluation of a Telephone Navigation Program to Increase Cancer Control Behaviors
Authors: Fernandez M.E. , Savas L.S. , Baumler E.R. , Atkinson J.S. , McGauhey K.G. , Vernon S.W.
Published: September 2018

Background: Health behaviors such as cancer screening and HPV vaccination can reduce colorectal, breast, and cervical cancer incidence and mortality yet they are underutilized, particularly among low income and minority populations. Interventions targeting medically underserved individuals are needed to increase use of cancer control and prevention services to eliminate inequities in cancer-related morbidity and mortality. The University of Texas School of Public Health (UTHealth) and the 2-1-1 Texas telephone Helpline partnered to develop, implement and evaluate a telephone-based cancer prevention program to reach large numbers of underserved Texans. The 2-1-1 U.S. designated Helpline connects low-income and underserved callers with health and social services. In 2017, the 2-1-1 Texas/United Way Helpline answered over 1,056,000 calls. The goal of the intervention, which used telephone navigation, was to screen, educate, motivate and link 2-1-1 Texas callers to local cancer control and prevention services Aim: The study aim was to evaluate the effectiveness of the intervention. Methods: We used a randomized comparison group design to evaluate the effectiveness of the 2-1-1 -delivered Cancer Control Navigation (CCN) intervention on increasing use of cancer control services among 2-1-1 callers. We assessed the impact of the program on increasing mammography, Pap test, colorectal cancer screening, HPV vaccination, and smoking cessation among a sample of 2-1-1 callers. Trained 2-1-1 information specialists invited callers to complete a risk assessment after receiving usual 2-1-1 service (addressing the need that they called about). They then offered eligible callers referrals and invited them to participate in the program. Consented participants were randomized to either the CCN condition or referral only condition. We conducted follow-up at three and six months to assess whether participants obtained any of the needed cancer control services. Results: When considering any needed cancer control outcome, CCN significantly increased completion of the cancer control behavior by 18% ( P < .05). CNN also increased Pap test completion by 33% ( P < .05). For other behaviors, while not statistically significant, results indicated that CNN increased colorectal cancer screening by 43%, mammography by 18%, and HPV vaccination of daughters by 29%. Conclusion: Outcome evaluation results demonstrate effectiveness of the 2-1-1 CCN program in increasing cancer control behaviors among callers. This study also demonstrates the feasibility of reaching minority, low income and underserved individuals through 2-1-1 to connect them to cancer control services. This 2-1-1-delivered program has great potential to connect large numbers of medically underserved individuals to cancer prevention services, decrease the burden of cancer and reduce inequities.
Activities of the International Atomic Energy Agency in the Field of Cervical Cancer
Authors: Paez D. , Zubizarreta E. , Abdel-Wahab M. , Polo A.
Published: September 2018

Background and context: In 2012, 560,000 women were diagnosed with cervical cancer (CXCA) worldwide and 266,000 women died of the disease: 86% of cases and 88% of deaths occurred in low- and middle-income countries (LMICs), and two thirds of the cases are locally advanced. For locally advanced CXCA the evidence-based treatment is a combination of external beam radiotherapy with chemotherapy and brachytherapy. Five-year overall survival for all stages combined ranges between 60%-69%, depending on the case-mix and the treatment modalities used. Countries with no access to radiotherapy may only offer palliative treatment to women diagnosed with locally advanced cervical cancer. Any curative attempt for these patients should include the two components of radiotherapy: concomitant radio-chemotherapy and brachytherapy. Radiotherapy is also a cost-effective treatment modality. Aim: To show the contribution and impact of the International Atomic Energy Agency (IAEA) to the improvement of results of CXCA in LMICs. Strategy/Tactics: Through its various programs, such as the Technical Cooperation programs, the Human Health program and the Program of Action for Cancer Therapy, the IAEA is committed to address these disproportionate geographic incidence and mortality rates introducing, expanding and improving radiotherapy services, working with partners such as WHO to improve cancer diagnosis, treatment, care, and control through collective action in these countries. Program/Policy process: During the last six decades, the IAEA has helped in addressing the growing cancer burden, delivering cancer-related assistance to LMICs, with financial and in-kind support from member states, donors and partners. The IAEA assistance has been primarily facilitated through the deployment of robust radiotherapy and nuclear medicine programs, coordinated research activities, documentation system and quality assurance program. This has enabled many member states to establish safe and effective diagnostic imaging and radiation therapy capacity to provide treatment and higher quality care to many of their cancer patients. The Program of Action for Cancer Therapy (PACT) is the IAEA's umbrella program for combating cancer and builds upon the above experience in radiation medicine expertise and technology. The WHO-IAEA Joint Program enable LMI member states to introduce, expand and improve their cancer treatment capacities and therapeutic effectiveness by integrating radiotherapy into a comprehensive national cancer control program. Outcomes: The IAEA provides tools for improving the practice of radiation medicine around the world. A fully implemented department (megavoltage and afterloading units, trained staff and quality assurance procedures in place) can treat up to 666 new CXCA cases per year, of which around 70% (466) can be cured. What was learned: Investing in radiotherapy can save lives!
Impact of Support Group Intervention on Quality of Life of Patients With Advanced Breast Cancer
Authors: Okwor V. , Nwankwo K. , Obidiebube P. , Lasebikan N. , Okwor C. , Okoye I. , Nwogu C. , Chiwendu B. , Nwabufo C. , Nwankwo K.C.
Published: September 2018

Background: Health-related quality of life is an important end point in breast cancer care. Assessing quality of life in breast cancer patients could contribute to improved treatment outcome and could even serve as monitor along with medical parameters. The need for psychosocial support is well established among breast cancer patients with levels of psychological distress and depression, particularly after diagnosis and treatment. Cancer support helps patients to cope with cancer by adjusting their attitudes, knowledge, and expectation about the disease. Aim: To determine the impact of support group intervention on quality of life of patients with advanced breast cancer To create awareness, educate, counsel and support as well as to mediate in the weaknesses of the medical care system in dealing with breast cancer patients. Methods: A prospective cohort study involving breast cancer patients using a system of breast cancer support group that organizes a two month period meeting for all breast patients in University of Nigeria Teaching Hospital Enugu. Educational information on breast cancer, nutritional needs, exercise and the need for regular follow-up in breast cancer care were given to them as well as the means of overcoming the psychosocial burden in cancer. QOL assessment evaluating the four domains (physical, social, psychological and environmental) on selected patients with advanced breast cancer using WHO BREF was administered. Results: A total of 113 breast cancer patients were involved in this study. At the end of the intervention, 14 women (12.4%) were censored due to death, while postassessment was carried out for only 99 women. Postintervention analysis showed that there was a significant positive correlation between availability of social support to respondents (FS score) and the four quality of life domains ( P < 0.05). Further analysis also showed that respondents' quality of life significantly increased across all domains at postintervention ( P < 0.05). Conclusion: Patients receiving support group intervention all had improved quality of life.