bluuebunny/crossref_metadata_2025 huggingface dataset:
Contrast Between Incidence of Childhood and Adolescent Cancers: Using a Population Based Cancer Registry, Kyadondo County, Uganda: 2009 to 2014
Authors: Abila D.B.
Published: September 2018

Background: Cancer is relatively rare in childhood compared with later in life. In high-income countries, hematologic malignancies are the most common, then brain tumors and solid tumors. World age-standardized incidence rates in Ireland averaged 142 cases per million children per year, higher than European average and lower than US average. In Africa, distribution of childhood cancers is quite similar, commonest being Kaposi sarcoma (KS), Burkitt's lymphoma, retinoblastoma, leukemia and Hodgkin lymphomas (HL). Among adolescent in Zimbabwe, leukemia has highest incidence rates then osteosarcoma, non-Hodgkin lymphoma (NHL) and KS. Aim: To describe the incidence of cancer among children and adolescents in Kyadondo County, Uganda from 2009 to 2014 which is necessary for planning of cancer control programs. Methods: Descriptive cross-sectional study which involved review of data from Kampala Cancer Registry that gathers information on cancers diagnosed within Kyadondo County (formed by Kampala and Wakiso districts) and analyzed using STATA 13. From 2014 Uganda population census, Kyadondo County had a population of 3,523,910 (32.2% children and 10% adolescents). Study population was children (0-14 years) and adolescents (15-19 years) diagnosed with cancer from January 2009 to December 2014. Results: The spectrum of cancers in adolescents reflects a transition. Carcinomas which are so prevalent in adults occur but at lower frequencies in adolescents. Study results are comparable to others studies indicating that nephroblastoma and retinoblastoma were common among children and not adolescents. Leukaemia and lymphomas cut across both children and adolescents. Conclusion: The spectrum of cancers in adolescents reflects a transition. Carcinomas which are so prevalent in adults occur but at lower frequencies in adolescents. Study results indicate that nephroblastoma and retinoblastoma were common among children and not adolescents. New prospective studies should be done on children and adolescent cancers covering a wide population size. Leukaemia and lymphomas cut across both children and adolescents. National cancer registries should be set up.
Improving Access to Care Through Community Engagement: Zambian Case
Authors: Musonda A.M.
Published: September 2018

Background and context: Zambia has total population of 16,405,229, life expectancy at birth is 53.3% and HIV prevalence rate is 13.3%. Though established in November 1977, the Zambia National Cancer Registry was only enhanced in 2015 leading to the publication of the 2008-2012 report. The overall age-standardized cancer incidence rate for both sexes in 2012 was 136.2 per 100,000 for all cancers, mortality rate was 104.9 per 100,000 71% these being new cancer cases due to patients presenting late with advanced disease. Aim: Increasing awareness and access to cancer care services within the existing health care and community-based systems in addressing the barriers to accessing care. Strategy/Tactics: Designed village-based screening program to provide services to the women in rural and hard to reach areas. Formulate a multisectoral approach engagement of the Ministry of Chiefs and Traditional Affairs (MOCTA) and Ministry of Local Government and Ministry of Education Formulated a VBS national roadmap based on: National Cancer Register Report (2012) and national geographical mapping of breast and cervical cancer clinics. Program/Policy process: Developed and signed a memorandum of understanding with Ministry of Chiefs and Traditional Affairs (MOCTA). Outcomes: Community engagement enabled easy flow of communication to all key stakeholders on the upcoming VBS activities within their area at all levels. Enabled easy acceptance of health education meetings by all key stakeholders to seek leadership buying and support, share VBS objectives and strategic planning of a successful community-based screening program in their area. Community awareness process: training/orientation: community health care workers (CHW) are trained on key messages on breast and cervical cancer and community-based referrals to health centers. Community sensitization: conducted by trained CHW and program staff through: PA announcing, one-to-one and focused group discussions. Developed referral systems: community based: trained community health care workers sensitize clients, clients who accepts to undergo screening are referred to the nearest screening clinic. Clinic based: trained health care workers screen clients those with positive findings are referred. Breast cancer screening: referred to the provincial hospital. Cervical cancer screening: eligible treated. Not eligible referred for further investigation (LEEP/biopsy) to the provincial hospital. What was learned: Engagement of key community stakeholders, multisectoral approach, strategic scale up of breast and cervical cancer services (HR, diagnostic equipment, pathology), standardized referrals systems at all levels (community, district and provincial), strategic continuous health promotion activities and advocacy, implementation of National Cancer Control Strategic Plan, monitoring and evaluation.
Metastatic Breast Care E-Learning Modules
Authors: Amos L. , Ernst K.
Published: September 2018

Background and context: The McGrath Foundation has created an e-Learning course to upskill breast care nurses in current metastatic breast cancer practice. The e-Learning course has supported better specialist knowledge and helped close the gap in metastatic cancer support services across Australia. Aim: The project aimed to deliver specialist training to breast care nurses on current trends in care and treatment of individuals with metastatic breast cancer, via an e-Learning platform to enable a cost effective delivery across Australia to 119 nurses. Strategy/Tactics: Key learning outcomes were developed to ensure specific information could be delivered via an online platform. Industry experts, clinicians and experienced breast care nurses/nurse practitioners were consulted to develop the content and an outline of what would be delivered. An experienced online content development company was also engaged to ensure that the content would be presented in an engaging way. Program/Policy process: The metastatic e-Learning course was available for McGrath Breast Care Nurses in June 2017 and accredited for professional development hours by the Australian College of Nursing to contribute to registration under the Nursing and Midwifery Board of Australia. Certificates of completion are given to all participants who successfully complete the course once they achieve competency in all areas of assessment. Outcomes: The e-Learning course has had reach across all areas of the country and allowed easy dissemination of information on current trends in metastatic breast cancer to nurses. This is seen to have great reach with almost all McGrath Breast Care Nurses also caring for a proportion of patients with metastatic disease. Additional qualitative and quantitative analysis will be available during the presentation after analysis is completed. What was learned: Some key learnings from this project have been the scalability of e-Learning as a technology enabled professional development solution. The need for good design to enable engagement with content was consistent theme during feedback sessions. As well as using competency based testing to enable participants to gain professional development in a technology enabled platform has reduced nurse down time.
More Robust Monitoring for Continuous Quality Improvement in Screening Programmes
Authors: Nair N. , Sexton K.
Published: September 2018

Background and context: The National Screening Unit in the Ministry of Health is responsible for the safety, effectiveness, and quality of five formal screening programs in New Zealand: breast screening, cervical screening, bowel screening, newborn metabolic screening, and newborn hearing screening. Currently, each screening program has a set of standards against which performance is assessed. Each program is monitored through a range of avenues: formally reported indicators, audits, contract reporting, case reviews, etc. Aim: We aimed to review the existing monitoring across all the screening programs to: (a) Clarify what existing measures served what purpose, and for which audience (b) Review what was being captured through different monitoring avenues, to assess gaps and duplications (c) To better align our monitoring approach across all the screening programs. Strategy/Tactics: For each measure, we used a formal template to justify its existence, covering multiple aspects including rationale, lifespan, dimension of quality, screening pathway step, targets and associated evidence, thresholds for corrective action, and “owner” responsible for triggering quality improvement. We also mapped the screening program standards to various monitoring avenues to assess gaps and duplications. Program/Policy process: This process was timed to coincide with the need for developing monitoring for a new screening program (bowel screening), and revising monitoring for an established screening program undergoing a change (cervical screening switching to HPV testing as a primary screen). Outcomes: *anticipated outcomes in italics, will be completed by time of Congress* This process resulted in an overarching monitoring framework, which functions as a blueprint for screening-program-specific monitoring plans. What was learned: Screening programs have different monitoring requirements depending on what phase they are in (i.e., new versus changing versus established). Having clearly documented rationale ensures that every measure is justified and has an “evidence trail”. Having clearly documented audiences, thresholds and responsibilities for corrective action ensures that monitoring contributes to continuous quality improvement, rather than monitoring for monitoring's sake.
Implementation Learnings From a Cancer-Prevention Multirisk Factor Public Education Campaign
Authors: Dessaix A.
Published: September 2018

Background and context: The Cancer Council New South Wales (CCNSW) is one of Australia's leading cancer charities and is uniquely 95% community funded. Cancer prevention is one of five strategic priority areas for CCNSW. An estimated to 37,000 cancer cases are preventable each year in Australia; 33% of cancers in men and 31% in women. The CCNSW developed and implemented the 1 in 3 Cancers Campaign in 2016, the first Australian multirisk factor cancer prevention campaign. This was also the organization's first experience in implementing a social marketing mass media campaign. Over two years, the campaign's primary objective was to raise awareness that one in three cancers are preventable, to highlight why preventing cancer is important and practical steps for prevention. Aim: To undertake an organizational review of internal learnings from the development, implementation and evaluation of the 1 in 3 Cancers Campaign and make recommendations for future campaign practice. Strategy/Tactics: Cross-organizational perspectives were provided from 20 Cancer Council staff from the areas of cancer prevention, research, fundraising and community engagement through a one-day workshop. Program/Policy process: Workshop participants: 1) reviewed best practice social marketing processes, 2) reviewed published evidence on mass media public education campaigns, 3) against this framework, determined internal organizational learnings from the 1 in 3 Cancers Campaign and made recommendations for future practice. Outcomes: A summary report of key lessons learnt from the implementation of the 1 in 3 Cancers Campaign and recommendations for future practice. What was learned: Areas of strengths were identified including cross-organizational collaboration, the development of an interactive cancer risk quiz, good community awareness of the campaign and key message take out. Areas for improvement included the need for greater resource investment (namely staff capacity, skills and budget), greater lead times for thorough campaign planning and the need to focus on singular behavioral cancer risk factors in communication messaging rather than multiple risk factors. The workshop concluded that well-planned, well-resourced mass media campaigns were an important evidence-based strategy for future cancer prevention practice.
Initial Study of Sexual Function Among Cervical Cancer Survivors in Almaty, Kazakhstan
Authors: Pak R. , Kaidarova D.
Published: September 2018

Background: There were not any evaluation of sexual dysfunction of cervix cancer patients in Almaty, Kazakhstan, to date. The study of 58 CC patients is an attempt to start filling this gap and to develop recommendations for the treatment of this kind of patients. Aim: The objective of this study was to examine sexual function of cervical cancer (CC) survivors receded different treatment approaches. Methods: 58 women subjected to CC treatment of at least 1 year in the past were examined at the initial stage of the research. The examined women were split into 5 groups by treatment methods: conization of cervix, hysterectomy with removal of ovaries, hysterectomy without removal of (one or both) ovaries, chemotherapy with radiotherapy, and those passed exclusively radiotherapy. The sexual function of the examined women was evaluated through Female Sexual Function Index (FSFI) instrument consisted of 19 questions. The questions were mainly related to the main aspects like desire, arousal, lubrication, orgasm, satisfaction and pain. The data were collected by online and face-to-face interviews. Results: The median age of the 58 interviewed women was 44.5 years. 49 of the interviewees reported that they experienced desire. 79% of the interviewed women had sexual activity, among which 74% answers pointed out high lubrication condition above 2 within 0-5 possible range, 66% indicated high score of excitation, while 72% replied positively on orgasm section of the questionnaire. The highest portion of sexual active women experienced satisfaction (76%) although 33 of the interviewees felt the pain during coitus. The total FSFI score varied between 3.9 and 32.4 in the group of women who reported their sexual activity. Conclusion: This study demonstrates that lower total score of sexual function index is found in the patients passed chemotherapy with radiotherapy, or those cured exclusively with radiotherapy. In parallel, the highest score is traced in the women treated surgically. Therefore, it proves that surgery is more preferable treatment to keep higher level of sexual function in patients with cervix cancer. For the purpose of higher accuracy at the next stages of the research the inclusion of control group of women without history of cancer and with similar social, economic and demographic characteristics is needed.
Cancer Council NSW - Policy and Advocacy: “I Care For Palliative Care” Campaign to Increase Government Investment in Specialist Palliative Care Services
Authors: Engel A.
Published: September 2018

Background and context: I Care for Palliative Care Campaign was developed and delivered by the Cancer Council NSW between November 2015 and July 2017. This advocacy campaign was developed in recognition of the fact that the state had fewer palliative physicians and palliative care nurses than were needed to meet the palliative care demands of the NSW community. This meant that some people with life-limiting cancer were being denied quality of life and were unable to die in the place of their choosing. Moreover, Aboriginal people remained disadvantaged by limited access to specialist palliative care that fits with their community values, beliefs, rituals, heritage and place. Aim: The primary aim of the campaign was to secure additional funding from the NSW Government for an additional 10 FTE palliative physician positions; an extra 129 FTE palliative care nurse positions; and provision of culturally-appropriate specialist palliative care services to Aboriginal people. Strategy/Tactics: Various tactics were used, including collection and sharing of engaging community stories via media and online channels, mobilizing community support via training and events, and targeted engagement of key decision-makers and members of parliament (MPs), which took into consideration marginal electorates, personal experiences with cancer, and geography, noting the issue disproportionally impacts regional and rural communities. An online and offline “pledge” activity was also used, providing both the public and MPs with an opportunity to support the campaign. Program/Policy process: Meetings, the pledge activity, collection and presentation of stories and community-events were all incorporated into a program of activities over the campaign period to engage decision-makers and ultimately influence the policy-making process. Outcomes: An independent qualitative evaluation confirmed that the campaign was undoubtedly a success. It noted that the campaign created an environment in which the NSW government made a historic decision to provide an additional $100 million in funding for palliative care services over four years. Without the campaign, palliative care could well have lost out to other healthcare and government spending priorities. What was learned: The campaign confirmed the power of personal stories as an effective campaign tactic to influence decision-makers. Empowering volunteers to generate local media coverage also resulted in significantly greater coverage for the campaign. The “pledge” activity for MPs was also an effective tactic that brought together the issue, the politician and our brand. Aspects to be improved include simplifying our policy ask, evaluating the resources we invest in key decision makers versus less influential MPs, and assessing how we better integrate political context and political experts into our campaign planning and governance.
National Planning and Policy Improvement for ABC Patients in Kyrgyzstan
Authors: Sabyrbekova T.
Published: September 2018

Background and context: Breast cancer takes the first place among the cancer diseases in the Kyrgyz Republic. Almost 40% of breast cancer cases are detected in the advanced III and IV stages. Specialized oncology services for cancer patients are available in two oncology centers in the Kyrgyz Republic. One is in Bishkek (capital of the country), and another is in Osh (the second large city). However, medical services provided by the government are limited to the surgery, particularly, with mastectomy. Radiotherapy is not available because of deterioration and breakdown of equipment. Mandatory Health Insurance Fund does not cover chemotherapy cost for cancer patients, and patients pay out of pocket. Kyrgyz National Essential Drug List does not include many vital antineoplastic agents recommended by WHO. The absence of essential antineoplastic agents in National Essential Drug List negatively affects medicine registration and procurement, makes them unavailable, inaccessible and unaffordable in Kyrgyzstan. Advanced breast cancer patients cannot plan their upcoming expenses. Many patients can´t finish the full course of treatment. Ergene is the only organization in Kyrgyzstan that advocates and provides technical assistance to the Oncology Institute and the Ministry of Health to improve access to oncological drugs for the treatment of breast cancer. Aim: Improve access to oncology medicines and treatment of patients with advanced breast cancer. Strategy/Tactics: Ergene team accessed National Essential Drug List (EDL) and selected available oncology drugs. Then the experts compared available oncological drugs from the National EDL and oncology drugs from the WHO list. Together with oncologists, experts analyzed the availability of essential drugs for advanced breast cancer and identified missing drugs to be included in National EDL. These drugs are trastuzumab, anastrozole, paclitaxel, and gemcitabine. Program/Policy process: The team of experts calculated the cost of treatment of breast cancer regimens including therapy with trastuzumab and started negotiations with Mandatory Health Insurance Fund (MHIF) for chemotherapy treatment coverage. The policy makers agreed that the cost of basic chemotherapy regimens is affordable for insurance coverage (adriamycin cyclophosphamide-245 USD, cyclophosphamide methotrexate fluorouracil - 390USD, fluorouracil adriamycin cyclophosphamide -426 USD). However, the cost of monotherapy regimen is more expensive (capecitabine, docetaxel -2400 dollars) and requires additional financial resources. Outcomes: MHIF will include coverage of essential AC, FAC, and CMF regimens for women with breast cancer and will consider partial coverage of trastuzumab and several monotherapy regimens. What was learned: Chemotherapy regimens cost calculation is an integral part of advocacy and policy work. It helped to negotiate chemotherapy treatment insurance coverage for women with breast cancer.
Role of Colposcopy in Detection of Dysplastic Cervical Lesion as a Screening Tool
Authors: Gyawali P. , KC S.R. , Ghimire S.
Published: September 2018

Background: Age standardized cervical cancer incidence rate in Nepal is 19.2/100,000 woman, compared with 14.0 worldwide. Similarly, mortality rate is 12.0 women which is significant in comparison with 6.8 worldwide. Cervical intraepithelial neoplasm is a precursor lesion, having high transformation rate into the cervical carcinoma. Data clearly indicates that CIN 2 and 3 has more progression into cervical carcinoma. Despite the fact that Papanicolaou test has remained an important tool in the screening for cervical cancer and has contributed in significant decrease in cervical cancer, sensitivity and specificity of conventional Papanicolaou test is quite low. Colposcopy is visual inspection of cervix under magnification. Study revealed that the positive predictive rate of the colposcopic impression is better as the cervical lesion is more severe. Aim: To find out the significance of colposcopy in the detection of dysplastic cervical lesions and possible use of this method as a screening tool. Methods: This is an observational study done at Cancer Care Foundation, Nepal done from a period of January 2015 to February 2018. Permission was obtained from ethical committee and written consent was obtained from the patients. All the patients suspected having dysplastic or invasive lesions or in whom colposcopy-guided biopsy was performed; were included in the study. Relevant data were collected which included age, colposcopic diagnosis, histopathological diagnosis. Data were entered into Microsoft Excel and statistical analysis was done from statistical package SPSS 21. Results: 6109 females were screened through colposcopy. Out of these 900 patients underwent colposcopy-guided biopsy for being suspected of dysplastic lesions or inflammatory lesions. Mean age of females was 40.65 years. With colposcopy, 407 (45.2%) were suspected to have low grade lesion, followed by 401 (44.6%) high grade lesion and 15 (1.7%) carcinoma. Nonneoplastic lesions were suspected in 77 (8.6%) females. In the histopathological examination low grade dysplasia was observed in 403 (44.8%) followed by 250 (27.8%) high grade dysplasia and 8 (0.9%) carcinoma in-situ or invasive carcinoma. Similarly, 239 (26.6%) patients had nonneoplastic lesions. In colposcopy, high grade lesions were suspected more frequently in females of 41-50 years age group than in 31-40 years age group ( P < 0.01). Correlation between increasing age and dysplastic lesions were also observed ( P < 0.05). There was significant correlation between colposcopic diagnosis and histopathological diagnosis with a P value < 0.01. The sensitivity of colposcopy to diagnose dysplastic lesions were high 96.44% with positive predictive value of 62.65%. The specificity of colposcopy to diagnose various grades of dysplastic lesions is 34.98%. Conclusion: Colposcopy is highly sensitive method of screening dysplastic cervical lesions and should be used more frequently as a screening purpose.
The ECF Marie Curie Campaign: Promoting Radiotherapy to Capture Value
Authors: Gasparotto C. , Leci A. , Verfaillie C. , Cortese A.
Published: September 2018

There is a gap between the optimal and the current utilization of radiotherapy in Europe: the ESTRO Cancer Foundation (ECF) was set-up to support ESTRO in tackling the barriers preventing patients to receive the treatment they need. The ECF aims at creating value for multiple stakeholders - patients, healthcare professionals and national societies, decision makers. The value creation will be captured in a virtuous circle: the ECF builds up on the ESTRO knowledge base and activities, while ESTRO research outcomes will be better accessible to external publics. The key success factors of the ECF are the engagement of the corporate partners and the synergies with the ESTRO activities: both are instrumental for the sustainability of the ECF. The Marie Curie Legacy campaign is the first project of the ECF. Leveraging on the 150th anniversary of Marie Curie's birth, it raises awareness on radiotherapy, and is based on the ESTRO toolkit for radiotherapy advocacy. The 7th November marked the launch of the campaign at European level, with an animation commemorating the legacy Marie Curie left to radiotherapy. The campaign was then led in a few European countries: in Belgium and Poland national key opinion leaders, selected in agreement with national RT societies, voiced the benefits of RT through interviews in traditional media. More countries will be targeted in 2018. With a 6 weeks campaign using social media the video was viewed by 250,000 viewers in YouTube only, and in full length by more than 60,000 viewers. In Belgium, the media campaign run for 2 days, obtaining 25 clippings, with headlines on traditional media and primetime on TV channels. In Poland, the campaign and video were launched in occasion of the World Cancer Day. The social media push of the video with subtitles ensured 125,000 views. The traditional media campaign, in one week, obtained 155 online and printed articles. The campaign, combining an European approach and national deployments, is an instrument for the European society to empower the national societies in the positioning of RT in their countries. The animation video proved to be an excellent hook to attract attention, while the engagement of national key opinion leaders is necessary for the overall success of the campaign, health remaining a national matter. Targeting the content is essential: radiotherapy is impersonated by Marie Curie in the animation, while in the national campaigns where the messages are also directed to decision makers, radiotherapy is impersonated by national experts. Overall, the process of raising awareness initiated by the ECF requires strong synergies with ESTRO activities, to ensure a two ways street: the ECF projects ensure that the benefits of radiotherapy treatment are better known, and ESTRO activities can capture the value created, by fostering radiotherapy: securing investments in radiotherapy resources, providing education, creating a more favorable policy environment, advancing research.
A Pink Wave for Breast Cancer Awareness and Prevention
Authors: Fonseca C.
Published: September 2018

Background and context: Integrated in the Pink October Movement, we decided since 2014 to challenge people and institutions to use the color pink as a way to raise awareness concerning breast cancer prevention. Aim: Raise awareness and reinforce the idea that breast cancer prevention is possible, namely with screening. Strategy/Tactics: We present a list of possibilities to be done individually or in community, indoor or outdoor, in one day or several, with family, friends and colleagues or with the anonymous community. Program/Policy process: We disseminate this idea to all our partners: schools, municipalities, enterprises and, of course, mass media. Between the 15th and 31st October hundreds of institutions join us in this Pink Wave. Outcomes: Each year we raise the number of partners which develop creative and dynamic activities, engaging themselves a high number of participants. Information sessions, awareness workshops, gymnastics challenges, arts and crafts initiatives, call for partnerships throughout the rest of the year and fundraising. All of this empowers community and turns out to be totally impossible to run away from this wave and consequently from the theme of breast cancer prevention. What was learned: First, we learnt that sometimes less is more. We started to do a list of activities and we didn´t offered anything more. And the truth is people didn´t need it because the list was the trigger for their creativity and originality. Secondly, the spiral movement is reinforcement and each year we add new activities that were done successfully in the past by partners. This way people believe is possible and try it also. Finally, it´s very important to listen to the community: which kind of activities they enjoy the most and how can we help them... and of course to share with the community the good results, disseminating the best practices on social and mass media, stressing the idea that without them nothing (or nearly nothing) could be done!
Developing Surgical Oncology Services in Resource Constrained Settings: Results of a Systematic and Motivated Approach
Authors: Mohan R. , Jaiswal P.
Published: September 2018

Background: General surgeons trained in surgical oncology and working in a general service hospital can offer and provide a wide variety of oncological services although significant limitations exist compared with a true tertiary cancer care center in developed high income countries. Providing optimal and standard of care surgical oncology services is truly demanding and limitations in ancillary and support services can potentially limit the quality of care provided in resource constrained settings like ours. Aim: The aim of this study was to analyze the patterns of care, surgical outcomes in terms of morbidity and mortality, quality of resection in terms of margins and nodal yield over a period of 08 weeks in a general service hospital with resource constrained setting and with two trained and motivated surgical oncologists. Methods: Data of 22 patients with solid organ cancers who underwent major operative treatment both curative and palliative under the surgical oncology services were analyzed retrospectively. All patients were evaluated clinically, imaging as required and pathologic tissue diagnosis of cancer obtained as was possible and after adequate preoperative preparation were operated upon. Results: Four patients of carcinoma rectum underwent low anterior resection with diverting ileostomy, one patient with rectal cancer had APR with permanent end colostomy, two patients underwent total thyroidectomy for papillary thyroid cancer, eight patients underwent modified radical mastectomy for carcinoma breast, two patients had optimal cytoreductive surgery for carcinoma ovary -one patient upfront and another as interval cytoreduction, two cases of soft tissue tumor underwent limb salvage surgery, one case of carcinoma stomach underwent subtotal gastrectomy, one case of carcinoma cecum underwent classic right radical hemicolectomy. Two patients underwent emergency exploration for acute abdomen who were otherwise metastatic for palliation. All but one case received neoadjuvant therapy prior to surgery in carcinoma rectum, one case of carcinoma ovary and carcinoma breast were operated after neoadjuvant chemotherapy. Overall there was only one margin positive resection after low anterior resection who was operated upfront due to impending obstruction. The average nodal yield in all cases of colorectal carcinomas and breast cancer cases were as per current NCCN standards. Morbidities included seroma collection in 3 patients, minor surgical site infection in 2 patients, peristomal allergy in two patients, there were no deaths in elective cases. Conclusion: Providing quality surgical oncology services in a resource constrained general service hospital is challenging. Through an aggressive, well planned and motivated approach with a good surgical oncology training background and with available resources it is possible to achieve a varied spectrum, quality care and an improved and sustainable healthcare oncology systems for better outcomes even in these settings.
E-cigarettes: Do They Have Any Role in Tobacco Control?
Authors: Acharya D.K.
Published: September 2018

Introduction: and objective: E-cigarettes -an entity, unheard of until a few years ago, has taken up the market in a big way. They are being aggressively marketed all over the world, are being increasingly used by smokers as well as new vapers because of its easy availability and no regulation on its sale or use. These gadgets come in nearly 250 varieties and are being frequently upgraded. Methods: The promoters of e-cigs claim that it exposes the user and persons around them to much lesser degrees of nicotine and other chemicals, which is definitely far less toxic then the cigarette smoke. It is less likely to cause the health hazards-mainly cardiovascular, cancer and lung diseases as compared with cigarettes. However, no detail study has been done to clearly show the amount of nicotine absorbed and the health hazards of these noncombustibles, toxic substances have been found to be present in e-cig vapors, but again the level is very low. Results: People are worried, that this may become a starting point, the gateway of smoking for the young generation. The youngsters are easily attracted to newer, cool things and with no regulation on its advertisements, the use among youth is definitely going up. Down the line these people just remain e-cig user or easily switch to smoking cigarettes, only the time will tell. But the likelihood of this is very high. Many are using cigarettes and e-cigarettes in tandem. Conclusions: Unlicensed, unregulated e-cigarettes fail to meet standards of safety, quality and efficacy and therefore health professionals in India, as of now, do not recommend e-cigs for quitting.
Breast Cancer Reduction Initiatives in Rwanda
Authors: Nimbabazi O.
Published: September 2018

Background and context: Breast cancer is a leading cause of cancer-related death for women. In Africa women are diagnosed much younger, with a substantial number of cases affecting women under the age of 20. In Rwanda, breast cancer patients constitute 15.8% of overall cancer patients and new cases increase as people start being aware and go screening, however breast cancer with early detection can be well treated to live longer and palliative care can be given. It's with that reason in Rwanda different initiatives have put in place to reduce the breast cancer. Aim: The aim of these initiatives is to raise awareness of breast cancer to the population and promoting early detection as breast cancer is treatable when it's diagnosed at early stage. Also these initiatives gives information about risk factors and how changing lifestyle with early detection can help on reducing new cases. Strategy/Tactics: These initiatives are done through public health campaigns, gatherings and walks throughout the country educating breast cancer risk factors, prevention and importance of early diagnosis. The programs reached young ladies to start prevention early by making outreaches at school and youth centers. And all the initiatives are accessible by every citizen as they are all free. Program/Policy process: In promotion of early diagnosis many nurses for health center have been trained how to diagnose breast cancer and how to educate patients that attend those health facilities, then for awareness public health campaigns are done and also with different media are used like talk shows and informative posters are in different public places like hospitals. Outcomes: With the past 2 years of mass campaigns, walks and outreaches, there have been improvement in understanding of population about breast cancer, and both men and women are interested to be educated more with that the number of people going for diagnosis have been increased and participation in outreaches is high. What was learned: The population is always eager to be educated about cancer and how they can prevent it and with these initiatives have been proved by numbers that attend campaigns and it's important to take initiative to reduce its incidence by making the community aware of it and take early preventive measures. And this to be more successful there should be public and private partnership to put effort and reach a large population for breast cancer can be diagnosed treated at early stage hence reduction its prevalence.
The Need for Culturally Congruent Psychosocial Care for Muslims With Advanced Cancer in Non-Muslim Majority Settings
Authors: Lazenby M. , Alward Z. , Gatarny R. , Ayash C. , Gany F.
Published: September 2018

Background: Little is known about the psychosocial care experience of Muslims who are in treatment of advanced cancer in non-Muslim majority settings. Aim: To describe the experience of Muslims who are in treatment of advanced cancer in a non-Muslim majority setting and to identify beliefs and practices for culturally congruent psychosocial care. Methods: This cross-sectional study, which is in progress, uses a semistructured interview guide and self-report questionnaires with Muslim patients ≥ 21 years who are in treatment of stage III or IV cancer at an academic cancer center in the northeast of the United States. Analysis of interviews is by grounded theory and of questionnaires by frequencies, percentages, and measures of central tendency and dispersion for quality of life: Functional Assessment of Cancer Therapy-General (FACT-G; range 0-108) with subscales: Physical Well-Being (PWB [range 0-28]), Social Well-Being (SWB [range 0-28]), Emotional Well-Being (EWB [range 0-24]), and Functional Well-Being (FWB [range 0-28]; higher scores reflect better quality of life Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp [range 0-48]), with subscales: peace (range 0-16), meaning (range 0-16), and faith (range 0-16); higher scores reflect better spiritual well-being. Distress Thermometer (DT; 0 = no distress, 10 = worst distress). Hospital Anxiety and Depression Scale (HADS), with subscale: anxiety (0-21) and depression (0-21); higher scores reflect worse condition. Results: Eleven (female, n=5 [45.5%]) Muslim patients from 10 countries of origin with a mean age of 55.2 (±10.9) years who were in treatment of breast, colorectal, gastric, lung, ovarian, prostate, melanoma and lymphoma cancers (Stage 4, n=8 [72.7%]) have been interviewed to date. Mean scores were: FACT-G 85.6 (±17.9) (PWB 22.3 [±5.1], SWB 23.8 [±3.8], EWB 18.6 [±4.5], FWB 20.7 [±6.7]; FACIT-Sp 123.8 (±24.6) (peace 11.6 [±4.5], meaning 13.7 [±3.1], faith 12.9 [±3.8]), DT 2.13 (SD 2.58); HADS anxiety 3.9 (±3.2) and depression 3.8 (±3.7). Four universal themes emerged: (1) Faithful Muslims must seek and submit to treatment. (2) Spiritual practices (prayer and other traditional healing practices) are sources of meaning. (3) Psychosocial care in a non-Muslim majority setting is often presented in ways incongruent with Muslims' beliefs and practices. (4) Psychosocial care would be acceptable if congruent with Muslims' beliefs and practices. Conclusion: Presenting psychosocial care as part of routine cancer treatment and, in non-Muslim majority settings, delivering psychosocial care that is culturally congruent with Islamic beliefs and practices, may increase the acceptability of psychosocial care among Muslims who are in treatment of advanced cancer.
The Impacts of Nutrition Education Programs on Cancer Survivors' Nutritional Status
Authors: Chang Y.-F. , Yu Y.-C. , Lai J. Tsai
Published: September 2018

Background and context: Since 1982, cancer has been the leading cause of death in Taiwan, claiming more than 40,000 lives each year. This not only caused huge medical expenses, but also affected the quality of life of patients and their families. However, many cancer survivors and their caregivers do not fully understand lifestyle advice, including nutrition and dietary behaviors, to lower the progression of the disease. Due to cancer and painstaking treatment, cancer patients often suffer from inadequate calories intake and serious body weight (BW) loss, which is highly related to malnutrition or cancer cachexia. After they leave the hospital, they still need nutritional guidance; therefore, the importance of providing nutrition services in the community should be emphasized. Aim: To help cancer survivors achieve better nutritional status by teaching them how to have adequate calories intakes and maintain BW that they're supposed to have better quality of life. Strategy/Tactics: (1) Cancer survivors with nutritional needs were referred from 66 cooperative cancer resources centers of hospitals nationwide. (2) Dietitians assess their nutritional conditions and provide nutritional guidance. (3) Deliver free nutritional supplements to the cancer survivors who are financially disadvantaged or have dysphagia problems. Program/Policy process: The registered dietitians conducted nutritional education through nutrition counseling and guidance. For those who are financially disadvantaged or have dysphagia problems, the 24-hour dietary recall and PG-SGA scale were used to assess the survivors' nutritional status, including BW and calories intake, then free nutritional supplements according to their needs and a regular follow-up to collect their BW and nutritional information changes after our interventions were done. Outcomes: From 2016 to 2017, a total of 434 of cancer survivors who have financial difficulties or dysphagia problems accepted the free nutritional supplements and nutritional guidance services. 178 survivors completed follow-up and collected nutritional information. 40.4% of them are head and neck cancers, 38.2% are digestive system-related cancers that were in poor eating conditions. After our interventions, 70.2% of these survivors can maintain or increase their BW with average BW 57.9 ± 12.8 kg; and 77.0% can maintain or increase the calories intake, which average increased from 1798 ± 252.5 kcal/day to 1541.6 ± 347.9 kcal/day. What was learned: We can effectively help cancer survivors achieve adequate calories intakes and maintain BW to prevent the occurrence of malnutrition by providing the services of nutritional supplements and nutritional guidance.
Tobacco Cessation Programme for Cab Drivers in Mumbai, India and Assessment of Impact of Smoke Free Cabs on Cab Drivers and Commuters
Authors: Mishra G.A. , Pimple S. , Kulkarni V. , Gupta S. , Majmudar P.
Published: September 2018

Background: Tobacco epidemic is one of the biggest public health threats, killing nearly seven million people annually. With implementation of smoke free public places legislation, cabs in India are smoke free. However, large majority of the cab drivers are addicted to tobacco. Aim: The aims of the study were to measure cab driver's knowledge, about tobacco, understand pattern of tobacco usage, provide assistance in quitting tobacco, perform oral cancer screening, measure effectiveness of smoking ban in cabs and understand perceptions of cab drivers and commuters to ban. Methods: 400 cab drivers in Mumbai were enrolled after obtaining informed consent. Personal interviews were conducted to understand their knowledge, attitudes and practices regarding tobacco use, smoke free cab policies and their experiences and opinion regarding ban on smoking in cabs. They were offered health education, oral cancer screening and tobacco cessation assistance at regular intervals over a year. Results: 64% cab drivers used tobacco, mainly in smokeless forms (80%). 94% intended to quit, 64% had made previous quit attempts and 70% expressed need of assistance for quitting tobacco. 62% had displayed a No Smoking sign in their cab and 75% expressed full compliance by passengers to the ban. 112 cab drivers had oral precancerous lesions and one cab driver was diagnosed with invasive oral carcinoma. 49% cab drivers quit tobacco and 46% reduced their tobacco consumption by the end of ten months. Conclusion: Smoke free cab policy has increased awareness and reduced passive smoking and this may encourage tobacco users to quit the habit. However, many cab drivers are themselves addicted to tobacco and need professional assistance for quitting. Hence, tobacco cessation - assisting the current users to quit tobacco needs to go hand in hand with smoke free policies. Smoke free cab policies have received enormous support from the cab drivers in Mumbai. There was encouraging compliance to smoke free policies from the commuters. Tobacco quit rate of 49% was achieved by the end of the program.
Strengthening Cervical Cancer Screening Program in Low Resource–Setting Communities: IPPF Success in Employing the Single-Visit Approach
Authors: Carl-Spencer R.
Published: September 2018

Background and context: Cervical cancer is the 2nd most common cancer among women (WHO, 2012). It is estimated that 260,000 women die every year (WHO, 2014). Cervical cancer is preventable and can be treated if detected early, yet, it remains one of the leading causes of cancer-related deaths in the world. Nearly, 90% deaths occur in developing countries (WHO, 2014), and majority of women who suffer cervical cancer in sub-Saharan Africa seek care when the disease has advanced and is beyond the capacity of surgery or other treatment modalities. It is against this background that IPPF Member Associations in Kenya, Nigeria, Tanzania and Uganda, with other reproductive health network implemented the Cervical Cancer Screening and Preventive Therapy (CCS&PT) initiative. In the first 2 years, most women needing cryotherapy were lost to treatment due to referrals made. Aim: The initiative was to institutionalize and scale up the services, using visual inspection with acetic acid (VIA) & cryotherapy, through existing reproductive health networks to reach more people especially, the marginalized and vulnerable people. Strategy/Tactics: Main intervention used was the single visit approach facilitated by • Equipping all sites with cryo-machines to enable cryotherapy services • Providing portable cylinders (5-10 kg) to ensure adherence to SVA during outreaches. • Capacity building of service providers in cryotherapy and continuous supportive supervision • Quality counseling prior to the VIA to ensure clients understood the importance of immediate treatment • Well planned logistics during outreaches to ensure a wider coverage and cryotherapy treatment. • Training of community health workers and mobilizers to ensure right information dissemination. • Use of media and collaboration with political and religious leaders helped local partners to raise awareness of cervical cancer. Program/Policy process: Used SVA at all screening sites to address the loss of clients needing cryotherapy and avert the progress to cancer disease stage. Outcomes: The game changer was the implementation of the single visit approach. Results recorded were; year 3- (59%), year 4- (94%), year 5- (92%) and year 6- (97%). What was learned: It is imperative to implement SVA with high degree of planning, organizing and coordination from the beginning of a project • Ensure resources and capacities to implement VIA and cryotherapy are in place by conducting a facility assessment • Ensure continuous training and mentorship to enhance providers competences. • Portable gas cylinders are very essential and convenient to ensure adherence to the practice of SVA. Conclusion: The single visit approach used strengthened the cervical cancer screening program, made treatment more accessible to a wider number of marginalized women. Thousands (514,681) were screened and 14,083 treated to avert progress to cancer stage in future, and this contributed to reduce cervical cancer related morbidity and mortality.