bluuebunny/crossref_metadata_2025 huggingface dataset:
Know Your Numbers: A Promising NCD-Prevention Strategy in LMICS
Authors: Muffih T.P. , Sonyuy M. Ferdinant , Boniface T. , Epie N. , Ngong B.
Published: September 2018

Background: Noncommunicable diseases (NCDs) are the leading cause of deaths globally, responsible for 70% of global deaths with two-thirds of these deaths occurring in low- and middle-income countries causing a double burden of disease. The Cameroon Baptist Convention Health Services (CBCHS) has established the first comprehensive NCD Prevention and Control program in Cameroon with a screening component called “Know Your Numbers (KYN)” in response to the growing prevalence of NCDs in the country as noticed in our annual patients’ statistics. KYN is built on the scientific basis that NCDs develop insidiously and progress slowly over time, usually undetected. Aim: To raise awareness on NCDs, screen for risk in 7 health districts and refer for care and treatment. Methods: In partnership with the local government through health districts, we systematically measured blood pressure, blood sugar, body mass index (BMI) and waist circumference measurement as well as assessed the lifestyle risk exposure of all participants, age 18 and above, using a prepared Risk Exposure Assessment Form (REAF) and collected data which were entered into an electronic database by a trained data clerk for analysis using Epi Info v 7.1. Results: Of 10,000 adults who were screened, 20% were hypertensive (BP > 140 systolic or > 90 diastolic), 2% were prediabetic, 31% were overweight (BMI 25-29), and 26% were obese (BMI 30+). Over 98% of all participants had at least one risk factor for NCDs. Conclusion: NCDs pose a major risk to the health of Cameroonians. Risk factors abound and expose the population to high risk of developing these diseases within the next 5-10 years. KYN is a promising strategy to create awareness and link people with obesity for treatment. It may help reduce the prevalence of NCDs and their complications if scaled up.
Impact of Follow-Up Colonoscopy Quality on Canadian Colorectal Cancer Outcomes and Costs
Authors: Fitzgerald N. , Memon S. , Gauvreau C. , Hussain S. , Flanagan W. , Miller A. , Earle C. , Coldman A.
Published: September 2018

Background: Most colorectal cancer (CRC) cases develop from precancerous polyps. Screening using fecal testing for occult blood, with follow-up diagnostic colonoscopy to remove polyps, can prevent invasive cancer from occurring. However, there is variation in the quality of colonoscopy, which may result in nonoptimal health outcomes. Aim: We evaluated the impact of follow-up colonoscopy quality on health outcomes, resource utilization and costs using the OncoSim-CRC microsimulation model (version 2.5). Methods: OncoSim is a microsimulation model led by the Canadian Partnership Against Cancer with model development by Statistics Canada. We compared results of high quality follow-up colonoscopy after positive fecal immunochemical testing (FIT) (colonoscopy sensitivity for cancer detection= 95%; compliance to follow-up colonoscopy = 85%) with that of reduced quality colonoscopy. Variations in colonoscopy performance were simulated through plausible overall effectiveness reduction (ER) and incomplete colonoscopy (IC). Screening system/patient follow-up deficiencies were simulated through poor compliance to diagnostic colonoscopy (PC). Modeling assumptions included: Biennial FIT screening of average-risk people aged 50-74; positive FIT followed by diagnostic colonoscopy; ER = 20% reduction in overall sensitivity; IC = zero sensitivity in proximal colon; PC = compliance reduction by 50%. Overall cost was calculated for 2017-2036 in undiscounted 2016 CAD, and included screening, treatment and end-of-life costs. Results: Compared with high quality colonoscopy follow-up, incomplete colonoscopy with poor compliance over 20 years led to as many as 12% new cases of CRC; 23% more CRC deaths; 89% more interval cancers; and 6% increased costs to the health care system, annually. Conclusion: Reduced colonoscopy quality can lead to considerable declines in the predicted effectiveness of screening and to increased costs to the healthcare system. Efforts to increase and maintain colonoscopy performance is a necessary component of CRC control planning.
Evaluating Clinical and Cost Impacts of Achieving 90% HPV Vaccination Rate Against Cervical Cancer in Canada Using the OncoSim Cancer Simulation Model
Authors: Fitzgerald N. , Hussain S. , Memon S. , Gauvreau C. , Flanagan W. , Nadeau C. , Asakawa K. , Miller A. , Coldman A. , Popadiuk C.
Published: September 2018

Background: Cervical cancer can be largely prevented through vaccination against the human papillomavirus (HPV). In Canada, HPV vaccination of school-aged girls started in 2008 and has reached an average rate of 67% across the country. However, this rate is below a current national target of 90%. Aim: We project the difference in lifetime clinical outcomes and health system costs of achieving a 90% HPV vaccination rate versus a 67% rate for girls vaccinated in 2015 using the OncoSim-Cervical model. Methods: The OncoSim-Cervical model (version 2.5) is a microsimulation model led by the Canadian Partnership Against Cancer, with model development by Statistics Canada, to evaluate the impacts of cervical cancer interventions in Canada. It has two parts, the first, the HPV Microsimulation Model, simulates the transmission of HPV between males and females including possible modulation by vaccination and herd immunity, and provides projections of HPV infection and prevalence for input to the cervical cancer natural history component in the second part. We simulated two cohorts of 5-10 year old girls in 2015; one receiving HPV vaccination at the rate of 67% and another at 90%. Their relative lifetime cervical cancer outcomes and costs were compared. Assumptions included: 100% efficacy of the HPV vaccine; triennial cytology screening between ages 21 and 65; 90% screening recruitment of age-eligible women with 80% rescreening; and a $500 cost for a 3-dose quadrivalent HPV vaccine regimen. Projected costs were undiscounted and are in 2016 CAD. Results: Compared with the 67%-vaccinated cohort, in the 90%-vaccinated cohort there was a lifetime reduction of 23% in cervical cancer incident cases and 21% in cervical cancer deaths. Lifetime cancer treatment costs decreased by $26 million (23%), and wart treatment costs and precervical cancer costs decreased by $3.2 million (15%) and $45 million (16%) respectively. Lifetime screening costs decreased by $47 million (2%). Conclusion: Achieving a nationally-set target of 90% HPV vaccination in Canadian girls would not only save more lives but would free up funds that could be redirected to other health system needs. Planners could aim for relatively high nation-wide rates of HPV vaccination coverage to enhance their cervical cancer control strategy.
Evaluating the Synergistic Effects of Carica papaya Linn, Vernonia amygdalina Delile, Artemisinin and Iodine As Potential Agents in the Management of Breast Cancer
Authors: Nowak J.
Published: September 2018

Background: The rise in breast cancer prevalence rate across the globe and in Africa is a public health issue. Accessibility to the effective and affordable therapeutic options for the management of breast cancer in sub-Saharan Africa is challenging due to high costs, questionable effectiveness and toxicity of treatments available. Studies have documented the use of complimentary and alternative medicine in contemporary cancer treatment in form of standardized phytomedicines. However, the scientific evidence on their efficacies, synergy, safety and adequacy is still lacking. Vernonia amygdalina Delile (leaf extract). Furthermore, Carica papaya Linn (leaf extract), artemisinin and molecular iodine have been previously reported to have activity against breast cancer but their synergistic effect has not been validated. Aim: This study seeks to evaluate synergistic effects of Carica papaya Linn (leaf extract), Vernonia amygdalina Delile (leaf extract), artemisinin and molecular iodine against breast cancer cell lines in vitro and safety profile in selected animal models in vivo. Four specific objectives where stated: (i) to determine inhibitory concentration (IC50) of the plant and compound combinations in vitro against breast cancer cell lines; (ii) to determine effective dose (ED50) of most effective combination(s) against cancer cell lines using animal models (in vivo); (iii) to assess the acute, subacute, chronic toxicity profile of most efficacious combination against breast cancer cell lines; (iv) to identify and characterize bioactive compounds in the combination that shows the highest activity against breast cancer cell lines. Methods: Breast cancer cell lines: MCF 7, MDA-MB-231 will be used to determine IC50 of combinations in vitro. MTT assay will be applied for quantification of viable cells in culture. Both positive and negative controls will be adopted in the study. Mice and rats animal models will be used for toxicity study and determination of ED50 of most active combinations. Bioactive compounds in combination(s) will be identified using chromatographic and spectroscopic methods. Standard procedures according to WHO. Graph Prism computer software will be used to obtain LD50. The results will be statistically analyzed using Student t-test and one-way analysis of variance (ANOVA) using SPSS 16 (Statistical Package for Social Sciences) software. Results: Study in progress. Conclusion: This study will provide a significant contribution into aspects of herbal medicine in breast cancer research, as there is limited research and development efforts in respect to new products to treat breast cancer in the African context. The development of natural, efficacious, cost effective, safer, easier accessible breast cancer management alternative is anticipated as a result of the study. Some of the compounds found in the chosen plants may be used as templates for development of new anticancer product.
Improving Population-Wide Collection of Stage at Diagnosis for Childhood Cancer: International Collaboration and Progress
Authors: Aitken J.F. , Youlden D.R. , O'Neill L.J. , Ballantine K.R. , Cross S. , Nam D. , Thursfield V.J. , Baade P.D. , Moore A.S. , Valery P.C. , Green A.C. , Gupta S. , Frazier A.L.
Published: September 2018

Background: There are huge international disparities in childhood cancer survival. The International Agency for Research on Cancer's Global Initiative for Cancer Registry Development has improved cancer registry coverage of the world's population, particularly in low- and middle-income countries (LMICs). However, for virtually all registries around the world, the challenge remains of collecting comparable and population-wide information on stage at diagnosis. This information is essential to understand and address disparities in outcomes. In response to this, a UICC-endorsed set of consensus guidelines for assigning stage for 16 of the most common types of childhood cancer was recently developed (the Toronto Guidelines), for use by population registries in both high and LMICs. Aim: To trial the Toronto Guidelines on a population-basis, and develop a structured protocol, suitable for global implementation, for collecting the required data elements and assigning cancer stage at diagnosis for childhood cancer. Methods: Using an innovative approach, data items as defined in the Toronto Guidelines were gathered from the medical record and entered electronically. Stage at diagnosis was assigned automatically using computer algorithms, thus reducing errors and maximizing consistency. Data collection and assignment of stage were incorporated into an online platform that was then trialed in the national childhood cancer registries of Australia and New Zealand for cases diagnosed between 2006 and 2014. Results: Stage at diagnosis was successfully assigned for 94% of all eligible patients (n=1662) across both countries. In contrast, stage as recorded by the treating clinician was located in the medical record for only 39% of cases in Australia. Conclusion: Practical implementation of the Toronto Guidelines has been highly successful to date and further testing is planned in LMICs. This approach has the potential to improve global epidemiologic monitoring of childhood cancer and lead to better understanding of the reasons underlying disparities in outcome.
Would You Like A Free Mammogram? Effectiveness of Utilizing WhatsApp As a Social Marketing Tool in Improving Uptake for a Free Mammography Service in Kuala Lumpur Malaysia
Authors: Muniasamy M. , Hashim H.S. Mohd , Lim C. , Junazli N.I. Binti , Choo S.L. , Low K.Y.
Published: September 2018

Background: Social media and messaging services are increasingly targeted by health providers as an avenue to spread health messages, increase awareness and also for social marketing. WhatsApp is a social media application which has wide penetration in Malaysia, with more than half the population relying on WhatsApp for news. Aim: This study aimed to determine the effectiveness of WhatsApp as a social marketing tool to increase uptake for a free mammography service for underprivileged women. Methods: This was a randomized clinical trial conducted in Kuala Lumpur, Malaysia. Individuals from the National Cancer Society of Malaysia database were randomized into 1 of 3 arms receiving a WhatsApp message; i) a poster of a free mammography service for underprivileged women; ii) a poster of the free mammography service for underprivileged women with a personal message from the Director of the National Cancer Society of Malaysia; and iii) the poster, personal message from the director and a specific Saturday screening date with the exhortation that there were only 40 places available for that date on a first-come first-serve basis. The outcomes of the trial were i) number of women who returned a call or WhatsApp message to the designated numbers; ii) number of women who booked an appointment for the mammography service; and iii) numbers of women who attended the appointment. Results: The number of calls and inquiries to designated numbers increased by more than 200% as a result of the WhatsApp messages. There were statistically significant differences between the three delivery arms; with the highest percentages of women booking and attending their mammography appointments coming from the arm which had a designated screening date with limited availability. Conclusion: WhatsApp was highly effective at increasing community penetration and marketing a free mammography service for underprivileged women in Kuala Lumpur. Messages with an appeal from a personage and with a specific date of “expiry” were more effective at getting the targeted group to avail themselves of the service.
To Gastric Cancer Patients, Diet Calls - On Living Demands by Gastric Cancer Patients
Authors: Cheng K.
Published: September 2018

Background: My father died with gastric cancer about a decade ago. I missed him a lot in my daily life. It seems like a surprising opportunity for me to join the research on postcancer living for gastric cancer patients, through which I could share what I experienced as a caregiver to my father and delve more into issues pertaining to the details of the disease to make it more understandable and to make more demands satisfied. Gastric cancer ranked 7th (1.74%) among individual cases in HOPE Foundation for Cancer Care last year. Not as common as breast, colorectal or lung cancers, gastric cancer triggers more apparent side effects from surgeries, radiation treatment, and chemotherapy, which exhaust less stamina and compromise less life quality. And the condition is even worse when there is frugal number of resources in medical units and community health care systems. Thus the importance of demands for stomach cancer patients is critical. Aim: This research depicts the dietary influences and changes in regard to gastric cancer and treatment. Methods: By means of observing focus groups by 26 gastric cancer patients attending three times respectively. Results: These 26 gastric cancer patients experience extreme sensations such as “every gram counts” or “reaching to the tipping point of either too full or not enough “. The patients shared some precious novel dietary ideas like chopping or mashing, stewed rice, fluid-and-non-fluid separation for better digestion, or finding suitable dietary preferences through trial-error strategies and so on, most of which can not be derived merely by pure theoretical research rather than personal sharing and interactions with detailed “bloody cruel” living experiences. The information is right to the bulls-eye, comprehensible and advisable for coming dietary strategies. Conclusion: There´s only one word to describe the living conditions of a gastric cancer patient: diet. When the access and awareness to dietary information for gastric cancer patients are very limited, the aim for field practice lies in knowing how to have those patients to eat, and eat richly, and happily. Firstly, we can provide patients with places for group talking, in which they design creative and tailor-made cuisine for their own by trial-errors. Secondly, to those who suffer gastric cancer, it is fairly inconvenient to eat out, finding nowhere to get the right food for their specific dietary needs. Therefore, a “community gourmet spots”, a gathered sharing for food information, is suggested among patients to offer more choices to each other and to make healthier dieting environments. Lastly, more dietary consulting stations ought to be set in hospitals and community service centers for gastric cancer patients to acquire the right food information lest the disease adaptation inclines due to malnutrition.
Patient-Reported Outcomes of Colorectal Cancer Patients in University Malaya Medical Centre
Authors: Magaji B.A. , Moy F.M. , Law C.W. , Roslani A.C.
Published: September 2018

Background: In Malaysia, colorectal cancer is ranked the second most frequent cancer among men and women. Despite that, research on patient-reported outcomes in colorectal cancer is scarce. Aim: This study aimed to determine the pattern and factors affecting health-related quality of life (HRQOL) among colorectal cancer patients treated at the University Malaya Medical Centre (UMMC), Malaysia. Methods: This study is a cross sectional assessment of health-related quality of life of colorectal cancer patients attending UMMC using locally validated Bahasa Malaysia (BM) and Malaysian Chinese versions of the EORTC QLQ-C30 core and colorectal cancer specific EORTC-QLQ-CR29 tools. Data were drawn from patients' records, national registration department and interviews (physical and telephone). Statistical analyses included descriptive, psychometric evaluations and stepwise multiple linear regression models. Results: The reliability and validity of the BM and Malaysian Chinese tools were examined among 189 patients. The questionnaires were acceptable to the patients, with adequate Cronbach's alpha in all but the cognitive function scale, test-retest coefficient were adequate, and all items fulfilled the criteria for convergent and discriminant validity except question number 5 in QLQ-C30 in both the tools. Three hundred and twenty patients not involved in the validation study were surveyed and these patients rated their global health status/quality of life (GHS/QOL) and functional well-being higher than the EORTC reference values and reported fewer symptoms. Ethnicity was associated with the GHS/QOL at univariate level only. Role, social/family functioning scales were the two independent predictors of GHS/QOL and both are modifiable. Conclusion: Proactive engagement of patients to share their experiences with colorectal cancer and its treatment is recommended. Emphasis should be role, social and family functions, which were found to be proxies for the overall GHS/QOL.
How the UK´s Macmillan's “World's Biggest Coffee Morning” Has Raised £200 Million (US $282 Million) Since 1990
Authors: Gandara M.
Published: September 2018

Amount raised: The World's Biggest Coffee Morning (WBCM) is Macmillan's flagship fundraising event raising £200 (US $282) million since its inception in the United Kingdom in 1990. Aim: Behind the success of WBCM, one of the UK's biggest fundraising events, lies a simple ask: get together with friends, colleagues and neighbors for a coffee morning and raise money for Macmillan Cancer Support. Strategy/Tactics: Our strategy focuses on marketing, both to existing and new hosts, and the development of a fully integrated, multichannel campaign. A collaborative approach is required to achieve growth across all areas of the organization, with celebrity endorsement, PR, and activity with corporate partners such as MandS helping to further drive awareness and income. Program process: Supporters register to receive their free Coffee Morning Kit and host a Coffee Morning at their chosen venue. While there are several weird and wonderful twists on the event, most hosts choose to serve coffee, cake and other treats in return for donations to Macmillan. Coffee Morning takes place on the last Friday in September each year (although supporters can host on any day that suits them) with the majority holding their event on this day. Costs and returns: The expenditure as a proportion of the amount we raise is roughly 30 p in the £1, the return on investment is £3.39 raised for every £1 invested. What was learned: Our experience shows that our key drivers to success are: Using research and insight to drive strategy: In 2011, we undertook a large research piece to understand who the audience were, their motivations for taking part and this was used to (a) develop a relevant proposition which met supporters' needs and (b) identify the key target market. Measurable, direct response activity across channels: using the right channels to reach the target market (e.g., direct mail to our existing hosts and an ATL campaign), including TV, to reach new hosts. Recognizing importance of retention and supporter experience: delivering a relevant, tailored experience to supporters that adds value. Ease of participation: no training over heavy commitment is needed - it can be as simple as buying a few cakes for neighbors to huge community events open to the public.
Tackling Late-Stage Diagnosis of Breast Cancer Patients in Sub-Saharan Africa: A Case Study From Mali
Authors: Frie K. Grosse , Kamaté B. , Traoré C.B. , Ly M. , Kantelhardt E.J.
Published: September 2018

Introduction: Breast cancer is the most frequent cancer among women in sub-Saharan Africa with high mortality rates. As 60%–100% of the patients are diagnosed at late stages, downstaging strategies have been the focus of international discussions to improve survival. The aim of this study was to analyze the entire breast cancer patient´s pathway from first symptom recognition to begin of treatment and survival in Mali to advice on such strategies. Methods: The model of pathways to treatment was used as a framework to assess important time intervals during the patient´s pathway and to match results of the mixed-methods approach. For the quantitative part, N=64 breast cancer patients were interviewed, with a structured questionnaire at the only pathology department in Mali, about breast symptom recognition and first health care visit. Information on begin of treatment and survival were collected at 18-months follow up. Simple Cox regression analyses were performed. To discover additional barriers, three focus group discussions in the communities in Bamako were conducted (2). Results: Median time to first health care visit was 4.8 months, from first health care visit to diagnosis 0.9 months, and for the patients who started treatment (N=46) time from diagnosis to treatment was 1.3 months. Knowledge of breast-self-examination, and correct symptom interpretation increased the chance to visit health care earlier. Shorter duration to first health care visit, working women compared with housewives, and living within Bamako prolonged time to diagnosis. Living outside Bamako, and smaller tumor size (T1/T2) prolonged time to treatment. Visit of a traditional healer, and larger tumor size (T3/T4) shortened survival time, while time to first health visit, and subsequent time to diagnosis had no influence on survival. In the focus groups, low level of breast cancer knowledge, mistrust in the community health care centers, and economic hardship were reported as additional barriers to first health care visit. Low quality of health care services, and lack of social support were reported as barriers to diagnosis and high costs, and lack of specialized services for treatment begin. Discussion: Patients are diagnosed with late stage diseases, due to low knowledge of breast cancer. A weak health care system and out of pocket expenses discourage patients to seek health care, to have diagnostic services, and to start treatment. Conclusion: The continuum of care has to be warranted for the majority of patients to benefit from down-staging strategies.
EUROPA DONNA´s First MBC Advocacy Training Course
Authors: Knox S.
Published: September 2018

Background and context: Breast cancer is the most common type of cancer in European women and has the highest mortality of any cancer. Although women with metastatic breast cancer (MBC) are living longer today, in many European countries all their needs and rights to high quality care are not being met. In European countries, MBC services run the gamut from some of the best in the world to services so minimal and basic that most women who present with breast cancer already have MBC. Aim: To impart MBC advocates with the tools and knowledge to initiate and carry out best practice MBC advocacy programmes in their own countries and at the European level. Strategy/Tactics: 1) Provide simple, clear and scientifically sound information to MBC advocates and that ED National Fora can use effectively in their advocacy efforts; 2) Provide a forum in which members from a broad spectrum of European countries learn from one another through the exchange of ideas, experiences and best practices; 3) Provide expert presentations on important MBC topics with the ultimate aim of bringing every country to the level of MBC service described in the EU Guidelines, enhancing the public's knowledge of MBC and therefore reducing stigma surrounding the disease. Programme/Policy process: ED will invite MBC advocates from each of our 47 member countries to attend our 1st MBC Advocacy Training Course and all their expenses will be paid. The 2 1/2 day course will involve: Introductions of ED and participants. Scientific Lectures/Advocacy Skills: Experts will cover such topics as treatment of MBC and the European Commission Initiative on Breast Cancer. Professionals will discuss issues including breast cancer registries and insurance in Europe. ED trainers will share the latest developments from ABC4, the ABC Global Alliance and successful MBC advocacy strategies. A showcase will include MBC related videos and publications. Communication Skills Training Workshops: Three experienced trainers will conduct intensive workshops teaching practical presentation skills and assertiveness techniques. Trainees will be coached individually on handling various situations relevant to MBC advocacy. Participants will role-play to practice these skills. Course materials: A detailed course manual will be developed, distributed and discussed. Follow-up reports will be expected of course attendees to encourage the development of strong and sustainable MBC advocacy programmes. Outcomes: We expect to arm MBC advocates and, through them, ED Fora, with accurate, up-to-date information and proven strategies to lead their countries in advocating for improved MBC services and educating people about MBC. This will lead to improvements in MBC services and public health knowledge, reduce inequalities in MBC services and information provision among European countries, and reduce stigma of the disease at the country- and European-level. What was learned: The course will be held in September 2018.
Cancer Awareness Among Community Pharmacists: A Systematic Review
Authors: Mensah K.B.
Published: September 2018

Background: The WHO recognizes that community pharmacists are the most accessible healthcare professionals to the general public. Most patients regularly visit community pharmacies for health information and also seek advice from pharmacists with respect to signs and symptoms of cancer. As readily accessible health care professionals, community pharmacists are also in the best position to include cancer-screening initiatives into their practice. Pharmacists are therefore in a good position to raise awareness when they counsel people who buy over-the-counter medication for the control of possible cancer-related symptoms. Aim: The aim of this review was to critically appraise evidence gathered from studies that; (1) explore or assess knowledge of community pharmacist on signs and symptoms of cancer, (2) explore or assess knowledge of community pharmacist on cancer screening. Methods: Embase (Ovid), CINAHL (EBSCOhost) and MEDLINE (EBSCOhost) were systematically searched for studies conducted between 2005 to July 2017. Studies that focused on knowledge of community pharmacist in cancer screening, signs and symptoms were included. Results: A total of 1538 articles were identified from the search, of which 4 out of the 28 potentially relevant abstracts were included in the review. Findings of the selected studies revealed lack of sufficient knowledge on breast cancer screening, signs and symptoms. Both studies attributed knowledge limitation as the cause of reason for the key findings of their studies. Conclusion: The selected studies focused largely on breast cancer, which hinder the generalizability and transferability of the findings. Hence there is a need for more studies to be conducted in this area to draw a better conclusion.
An Organized Approach to Multi-Organ Screening in Rural Honduras
Authors: Kennedy L. , Bejarano S. , Larochelle E.P. , Tsongalis G.J.
Published: September 2018

Background: Poverty, poor healthcare infrastructure and geographic location contribute to a total lack of cancer screening for most residents of rural Honduras. Three projects built upon each other to develop, with local leaders, multiorgan screening events that mitigated barriers to screening-based early detection of cancers. Targeted barriers included transportation, cost, community perception and convenience. Aim: To test a novel system of multiorgan screening for feasibility, acceptability and effectiveness. Methods: Leveraging well-known brigade-style medical outreach methods, two large-scale weekend programs for women and one for men over four years in the same rural location screened women for cancers of the cervix, breast, oral cavity, thyroid; and men for cancers of the testes, oral cavity, skin, prostate and colon; and connected participants with follow-up care at a Honduran cancer center. Screening methods ranged from simple throat palpation for thyroid lesions to molecular screening for high risk HPV. Generally, screening began with low-tech methods onsite to triage the participants and identify those at high-risk for cancer who should have more technical follow-up at an equipped clinic. Well-trained Honduran medical students provided screening capacity and community leaders were solely responsible for promoting the screening opportunities. Masking was not possible onsite, but data analysis in the U.S. was anonymized. Results: Participants were accrued to each program's capacity (n=400) in 2013 and 2016 and near capacity in 2017 with high levels of participants completing the screening programs, community engagement with the process, and compliance with referrals for clinical follow-up at a collaborating cancer center located three hours away. Participants identified at the screenings for clinical follow-up included for women: breast 2.7% (2013) and 4.2% (2016), thyroid 1.7% (2016), cervix/positive for high risk HPV 8.2% (2013) and 11.8% (2016); and for men all in 2017: skin 0%, testes 7%, colorectal 1%, oropharynx 1 participant, and prostate 6.7%. The dominant local narrative predicted men would not participate in screening, yet 326 participated and of that group, 239 self-identified as having possible colorectal symptoms based on seeing an advertising flyer with questions about symptoms of constipation, bloody stools, or unintended weight loss. That self-identified subset took the initiative to see the local nurse in advance, obtain a colorectal sample kit, collect three days of stool samples, and bring them to the screening event. Conclusion: With community engagement and attention to planning for organized and rapid throughput, large-scale multiorgan cancer screening may be feasible in low-income rural communities. Funding: The Jornada studies were funded by Norris Cotton Cancer Center at Dartmouth's Geisel School of Medicine and a special grant from Geisel's Munck-Pfefferkorn Fund.
Factors Causing Delays and Barriers to Early Diagnosis and Treatment Among Women With Breast Cancer in Shwe Yaung Hnin Si Cancer Foundation Charity Clinic, Yangon
Authors: Shwe S. , Htoon P. Thet , Win T. , Sin M.P. , Zan E. , Htun Y.Y.
Published: September 2018

Background: Breast cancer is the most common cancer among females in Myanmar but patients often receive treatment rather late. Delays in seeking treatment of breast cancer for a period longer than 3 months, is associated with lower survival. Hence it is important to find out the causes of the delays so that necessary measures may be implemented with a view to improving treatment outcome. Aim: To explore the delays and barriers to early diagnosis and treatment among the breast cancer patients in Yangon. Methods: A mixed method design. All breast cancer patients (total 104) participated in the structured interview and (16) in the Focus Group Discussion (FGD) sessions. Site at Shwe Yaung Hnin Si Cancer Foundation's Charity clinic from September 2017 to February 2018. Results: Some 32.4% had (patient delay - consulted a medical personnel more than 3 months after noticing signs and symptoms), 19.4% had (general practitioner (GP) delay- to refer to cancer specialist) and 44.4% had (hospital or system delay –i.e., treatment delay after first consultation with specialists). Reasons for patient delay were not knowing that painless small breast lump could be serious (37.5%), socioeconomic constraints (18.8%), too busy working (9.4%) too scared (7.8%) and too shy (4.7%). People living in Yangon had 3.8 times less delay than those living outside (OR 3.8, χ2 = 7.4, P < 0.004); those unemployed were 2.4 times less delay than used (OR 2.4, χ2 = 3.77, P < 0.02); negative attitude toward breast lump and being worried had 8 times less chance of patient delay (OR= 8, χ2=19.9, P ≤ 0.0001). Those who perceived that a painless breast lump was serious are 8.8 times less likely to have patient delay (OR 8.8, χ2 = 3.08, P < 0.001). The odds of having GP delay are 3.2 times higher among those having patient delay (OR=3.2, χ2=5.6, P < 0.02). By FGD most of the survivors revealed reasons for delay which were limited information, economic, use of traditional medicine and sociocultural issues. Conclusion: Lack of knowledge was the highest cause of the patient delay, followed by perception, socioeconomic factors and accessibility to health care and so these need to be overcome. The GP delay and system delay need to be further explored to ascertain the exact causes.
Raising Patient Voices in Tajikistan
Authors: Abdullaeva F.
Published: September 2018

Background and context: The incidence of breast cancer in Tajikistan is 5.5 new cases per 100,000 (statistics, Tajikistan, 2016). Stigma and discrimination among patients with breasts cancer is one of the main cause of low attendance rate of patients of hospitals for investigation and treatment. Aim: Is to empower Tajik women living with advanced breast cancer to lead productive lives with a high quality and improve communication of patients with advanced breast cancer at all levels; republican, regional level and community levels. Strategy/Tactics: Improve communication of patients with advanced breast cancer (at all levels of health care systems) to address breast cancer patients' needs. Women's voices raised at the republican level and directions to Ministry of Health to improve services with metastatic breast cancer. Women's voices raised at the regional level. Women's voices raised at the community level. NGO Avesto will assist patients to improve communication in their 16 communities. On the patient group level NGO Avesto will hold patient's forums and organize discussions to decrease stigma, increase awareness on treatment, adherence to treatment and rehabilitation activities. 700 people- patients, family and community members will receive information about treatment, rehabilitation, available social services and will be connected by social network. Patients will get assistance through hotline, Web site information. Program/Policy process: Working plan have been developed. We have used interviews with key respondents: Ministry of Health and Social protection, patients, oncology department and key staff members of specialized institutions. A baseline survey has been commissioned and an end of program evaluation is planned. Outcomes: NGO Avesto has organized patients groups in Tajikistan whose voice have been heard at Parliament, Ministry of Health of Social protection. There was a meetings and round tables discussions organized jointly with Parliament; Ministry of Finances have agreed to allocate an additional resources and budget for the purchase of the medicines. There was a formation of first patient group's Web site, Facebook, hotline. Hotline staff members receive 120 calls from women on a daily basis. There was (6) six awareness campaigns (300 women attended). What was learned: Political commitment is very important in advocacy activities. Involvement of key members of Parliament was a key factor for a success of program. Patient's involvement and participation at the meetings, higher level round table discussions, organized at the ministries have influenced on policy changes and increasing the financial support to oncology departments and specialized oncology health institutions in Tajikistan. Creation of patients and survival support groups, their Web site, Facebook page, hotline have increased the awareness of patients on necessity to continue and complete treatment.
Trastuzumab as An Adjuvant Therapy for Early Breast Cancer
Authors: Lee S.W. , Kamaruzaman H.F. , Sabirin J.
Published: September 2018

Background: In Malaysia, breast cancer is the most common cancer in females and also the first most common cancer among population regardless of gender. Trastuzumab is used for the treatment of early-stage breast cancer that is HER2 positive. Although this treatment has been routinely used, there are still controversial on the duration of the addition of trastuzumab to the chemotherapy regimen. Aim: To assess the safety and effectiveness of trastuzumab as an adjuvant in early breast cancer patients through a systematic review. Methods: Electronic databases were searched through the Ovid interface. The titles and abstracts were screened against the inclusion and exclusion criteria and then evaluated the selected full-text articles. Results: There was high level of evidence to suggest that the risk of congestive heart failure (CHF) was significantly higher in patients treated with trastuzumab compared with nontrastuzumab control group (RR 5.11; 90% CI: 3.00-8.72, P < 0.00001) in one Cochrane review, (RR 3.19; 95% CI: 2.03-5.02, P < 0.00001) in one systematic review and meta-analysis. Evidence also suggested that the risk was significantly higher with longer duration of treatment (> 6 months) RR 5.39; 90% CI: 3.56-8.17, P < 0.00001. The overall survival (OS) significantly favored trastuzumab-containing regimen over nontrastuzumab control group, (HR 0.66; 95% CI: 0.55-0.77, P < 0.00001). In terms of duration, subgroup analysis reported that the overall survival (OS) significantly favored trastuzumab-containing regimen over nontrastuzumab control group trials where trastuzumab was given longer (> 6 months), HR 0.67; 95% CI: 0.57-0.80, P < 0.00001. In the trials that gave trastuzumab and chemotherapy concurrently, HR significantly favored trastuzumab-containing regimens (HR 0.64; 95% CI: 0.57-0.80, P < 0.00001). The evidence from Cochrane systematic review suggests that disease-free survival (DFS) favored trastuzumab-containing regimen over the nontrastuzumab control group (HR 0.60; 95% CI: 0.50-0.71, P < 0.00001). In terms of duration of treatment, there was no significant difference in DFS when trastuzumab was used for less than six months or more than six months. The DFS significantly favored trastuzumab-containing regimen over nontrastuzumab control group when used either concurrently or sequentially. Limited evidence to suggest that two years duration of adjuvant trastuzumab was not more effective that one year of treatment. However, six months treatment with trastuzumab failed to show that it was noninferior to twelve months of trastuzumab. There was limited retrievable evidence to suggest that there is no significant difference in OS and DFS between the twelve months regimen and 9-week regimen for trastuzumab. Conclusion: Despite the higher rates of cardiac events, twelve months of adjuvant trastuzumab was suggested as the standard of care. However, other issues including cost and cost-effectiveness should be considered.
The Dietary Behaviours of Cancer Caregivers: Preliminary Findings on How Becoming a Cancer Caregiver Might Influence Food Choices and Dietary Behaviours in the Carer Compared With Pre-Caring
Authors: Warren R. , Lambert S. , Razee H.
Published: September 2018

Background: Cancer is often called a “we-disease” as the effects of the diagnosis can go beyond the patient to others, including the caregiver. In Australia, it is estimated that approximately 138,000 new cancer diagnoses will be made in 2018, with the 5 year survival rate currently at 68%. This has shifted the way that cancer care is delivered, with many patients now being cared for at home by a loved one. As a result, cancer caregivers report higher levels of fatigue, stress, mood disturbances and mental illness (depression and anxiety), insomnia and digestive complaints than noncaring counterparts. While it is known that these characteristics can influence diet, very little has been published with relation to cancer caregivers as a stand-alone population. Aim: To explore how being a cancer caregiver might influence dietary behaviors, food choices and eating patterns in the caregiver to see if these have changed/not changed from precaring. Methods: Participants were recruited from a number of avenues, including not-for-profit cancer support services and support groups. Our study is a descriptive qualitative study where participants complete an online questionnaire to determine their Burden of Care score (through Given and Given's Caregiver Reaction Assessment) and current dietary patterns and behaviors. Some of these participants were further interviewed using a semistructured interview to explore their role as a carer, dietary patterns and food choices and this interview data were thematically analyzed. Results: Preliminary results (as part of an ongoing study) from six completed semistructured interviews with cancer caregivers from New South Wales, Australia suggests that the food intake and dietary behaviors of cancer caregivers were influenced by five main aspects: food access and availability, caregiver health, food preferences, the impact of cancer or the patient and caregivers needing more support. This study is ongoing, with an additional 6-8 interviews proposed (or until data saturation is achieved). In the case of some caregivers their dietary behaviors and food choices improved when they became a caregiver (e.g., eating more fruit and vegetables, reducing sugar consumption and an increase in their perception of the importance of healthy eating). Others reported a decline (e.g., increased “grazing” on “junk food”, losing motivation for healthy eating and preparing healthy food and skipping meals). Conclusion: This preliminary data clearly suggests that dietary behaviors and food choices of cancer caregivers do change from precaring. There is however, still a gap in our understanding as to why some carers report improvements and others report a decline. This is an ongoing area of research and is an important aspect of public health given the role cancer caregivers play in Australia.
Impact of High Cost Anticancer Drugs´ Indications Throughout Time in Noncurative Advanced (Stage IV) Cancer Patients With Solid Tumors
Authors: Lacava J. , Geist V. , Ortiz D.
Published: September 2018

Background: Most high cost anticancer drugs (HCAD) are indicated in noncurative advanced (stage IV) cancer patients (NCP) for palliative reasons with variable impacts on quality of life and survival. HCAD challenge health care systems because of their high prices specially in nonhigh income countries. Aim: To evaluate the proportional impact (HDCA indications/overall survival) in NCP throughout years. To analyze causes of HDCA discontinuation. To calculate time elapsed from end of HCDA treatment to end of life (ETEL index). Methods: We reviewed charts of 268 NCP treated in a Patagonian cancer institution between 2009 to 2017 with an HCDA (either alone or in combinations) according to standard of care. Mean age was 58 y (26-84), sex (m/f) 126/142, primary tumor: GI 106 (40%), GU 27 (10%), GYN 20 (7%), BR 58 (22%), LG 43 (16%), others 14 (5%). 29 different HCAD were indicated in 402 treatments (small targets therapies 35%, Moabs 60%, others 5%): 1st line 268 (100%), 2nd line 89 (33%), 3rd line 34 (13%), thereafter 11 (4%). Results: Median OS for the entire population was 26 m (1-120), while it was: GI 20 m, GU 28 m, GYN 27 m, BR 47 m, LG 18 m, Others 21 m. Proportion of OS with HCAD indications: 50% (1-100) in the whole population, while it was: GI 49% (25-100), GU 62% (5-100), GYN 39% (6-93), BR 50% (3-100), LU 45% (6-93), others 61% (25-100). HDAC indications increased over time: 26% (2009-11), 33% (2012-14), 40% (2015-17), with a more than 2% of new NCP increment per year. Additionally proportion (HCAD/OS) was: 43% (2009-11), 47% (2012-14), 52% (2015-17). Median time of HCAD according to line of therapy was: 1st line 6 m, 2nd line 4 m, 3rd line 6 m, 4th+ lines 4.5 m. Causes of discontinuation of HCAD were: disease progression in 87% of cases and 13% for toxicity/others. Median ETEL index (days) was 80 d (1-340). Conclusion: 1) HCAD are indicated during a significant proportion of life (50%) in stage IV NCP with many solid tumors. 2) Its use is increasing over years with a rate of 2% of NCP per year and for more proportion of time. 3) A great number of HCAD treatments are discontinued due to failure reasons, while it is expected more than 10% of adverse events causes. 4) ETEL index is proposed as a measurement indicator of GCP. 5) Impact of HCAD treatments is a major issue in health care policies.