bluuebunny/crossref_metadata_2025 huggingface dataset:
A Unique Approach Toward Cancer and Tobacco Control Using Philately As Innovative Tool
Authors: Sanyal U.
Published: September 2018

Background and context: Presently estimated annual cancer cases in India are ∼1 million new incidences and 0.6 million deaths leading to a serious problem. Tobacco habit is very common in India with estimated 330 million tobacco users and is attributed to ∼45% of all cancers. Presently each year ∼0.9 million Indians die due to tobacco related diseases including cancer. Aim: Thus combined awareness programs on cancer and tobacco are essential to educate people for avoiding risks of cancer and other diseases. Strategy/Tactics: In our unique approach, we have included in the PowerPoint & other presentations anticancer and antitobacco philatelic items along with up-to-date data, pictures etc. Cancer awareness presentation is divided in 28 sections covering cause, treatment, detection etc. emphasizing prevention in respect of dietary and lifestyle habits. In our pioneer paper, we have demonstrated that anticancer and other stamps can be used to describe different aspects of cancer covering 12 sections. Further based on universally accepted “caution” describing seven danger signals of cancer, we have created equivalent words in two Indian languages namely Bengali and Hindi spoken by ∼215 and ∼490 million people worldwide. These are included in our presentations to aware people about its symptoms. Our philatelic display on tobacco is divided in 19 sections including tobacco associated diseases, tobacco and women and children, quitting tips etc. Outcomes: Since 2002, we have conducted ∼230 awareness programs in various organizations in urban and rural areas in individual capacity and as Principal Investigator, Tobacco Cessation Centre, Kolkata, during 2005-09. It is found that irrespective of age and educational status, everybody understands the message conveyed through this visual display. A section of people has quitted the tobacco habit while another section could reduce tobacco consumption significantly. Further we have published 70 and 40 write-ups on cancer and tobacco respectively in several widely circulated Indian newspapers, magazines etc. that have reached the community. We have also delivered radio and TV talks. All these efforts have helped, to some extent, to control cancer and tobacco in India. Based on this work I have received prestigious 'I'm like me' award in the preventive healthcare category of the most circulated Bengali newspaper group in West Bengal. This large collection of stamps on cancer has been recognized as the world Record and published in Limca Book of Records 2018 page 30. What was learned: It is learnt that along with other methods this philatelic approach may be adopted for getting excellent results.
Cervical Cancer Screening Financing in Indonesia
Authors: Wahidin M.
Published: September 2018

Background: Indonesia has been developing social health insurance as attempt of universal health coverage with target of 100% population by 2019. The coverage was for all diseases from primary care until secondary care. Cervical cancer screening was among these which were covered by the insurance. In line with national program of cervical cancer screening, the insurance will strengthen the development of the program. As a new concept of financing - started in 2014- it need to know many circumstances of cervical cancer screening financing in Indonesia. Aim: The study was aimed to know overview of cervical cancer screening financing in Indonesia. Methods: Design of the study was descriptive study through literature review from related sources. Secondary data were collected from Directorate of Noncommunicable Disease Control and Center of Health Financing, Ministry of Health, and National Health Insurance Body (BPJS). The study was conducted in January- February 2018. Results: Cancer was ranked number 3 of highest claim for national health insurance with total IDR 1.54 trillion in 2014, became IDR 2.3 trillion in 2015. Number of cases of cancer, as claimed in hospitals, was also increasing from 702,207 cases in 2014 became 1,325,776 cases in 2015. Cervical cancer was among the highest claim. Based on Minister of Health Decree No. 52/2016 about tariff of healthcare in social health insurance, cervical cancer screening was covered by the insurance. Tariff of visual inspection with acetic acid (VIA) was maximum IDR 25,000 (USD 2), tariff of Papanicolaou test was maximum IDR 125,000 (USD 10), and tariff of cryotherapy of positive VIA was IDR 150,000 (USD 11.5). These tariffs can be claimed by providers of cervical screening in primary care facilities to BPJS through noncapitation scheme. This scheme was number of claim financing by BPJS to primary health centers according to type and number of health services. Mechanism of claiming was conducted by screening providers to financing officers in primary health centers using specific form to be sent to BPJS. Then, BPJS will process payment for accepted claim. Number of population became of BPJS in 2017 was 187.9 million out of 257 million target (73%). Meanwhile number of primary care facilities collaborated with BPJS was 20,708 (including 9813 primary health centers) out of 24,336 primary care facilities (84%). It means the financing of cervical screening could be used as optimal as possible to achieve national target of screening which was 37.4 million women aged 30-50 years. Conclusion: Cervical cancer screening financing was covered by national health insurance in Indonesia. Majority of primary care facility collaborated with BPJS which become strengthening factor to enhance achievement of national target of cervical screening.
Clinicopathological Characteristics and Outcomes of the Ongoing “Joven & Fuerte” Cohort of Young Women With Breast Cancer in Mexico
Authors: Villarreal-Garza C. , Platas A. , Miaja M. , Castro-Sanchez A. , Fonseca A. , Lopez-Martinez E.A. , Muñoz-Lozano J.F. , Chapman J.-A. , Goss P. , Bargallo-Rocha J.E. , Mohar A.
Published: September 2018

Background: Despite high rates of breast cancer (BC) in young women from low and middle income countries, their needs and concerns are not systematically studied or addressed. Understanding the characteristics of young women with BC in limited-resource settings and the issues they face is of great relevance to the medical community, to tailor clinical interventions and supportive care for this unique and understudied patient population. The Mexican cohort Joven & Fuerte has the goal of comprehensively characterizing and assessing the needs of YWBC in Mexico using patient- and physician-based surveys. Aim: The Mexican cohort Joven & Fuerte has the goal of comprehensively characterizing and assessing the needs of YWBC in Mexico using patient- and physician-based surveys. Methods: A prospective cohort of newly diagnosed YWBC was established at the three Joven & Fuerte sites. Eligible women answer electronic surveys on relevant topics, such as sociodemographic characteristics, fertility, genetics, and psychosocial needs, among others, while clinicians complete prespecified surveys registering clinicopathologic features and outcomes. Patients are evaluated at diagnosis, after 6 months, and annually for 5 years. Substudies assessing changes in cognition, sexual function and satisfaction, quality of life, and depression/anxiety are being carried out, and biologic samples are obtained and stored frozen for future research. Here, we report the baseline clinicopathological characteristics of patients included up to March 2018, as well as data on recurrence and mortality. Results: To date, 276 young women with BC with median age at diagnosis of 36 years (2140 y) have been accrued. 22% were single and 23%, childless. 42% had higher education and 31% were used. 80% presented with a self-detected mass. Clinical stage at diagnosis was distributed as follows: stage 0: 3%, I: 11%, IIA: 26%, IIB: 18%, III: 36%, and stage IV: 8%. The most frequent subtype was hormone-receptor (HR) pos/HER2 neg (52%), followed by triple neg (23%), HER2 pos/HR pos (17%) and HER2 pos/HR neg (8%). Histologic grade distribution among the patients was as follows: low grade (16%), intermediate grade (18%), and high grade (66%). Up to June 2017, 15 patients out of 120 (12.5%) have developed distant recurrences, and 12 patients (10%) have died as a consequence of breast cancer. With a median follow-up of 19 months, breast cancer free survival and overall survival was 87.7% and 89.9%, respectively. Conclusion: To our knowledge, this represents the first prospective cohort of young women with BC in Latin America. We are expanding this project to other centers in the region. Our findings will help develop culturally tailored interventions aimed at improving the medical and psychosocial outcomes of this vulnerable patient population.
Improving Information and Support for Metastatic Breast Cancer in Nigeria
Authors: Asuzu C. , Akin-Odanye E. , Ntekim A. , Ogundiran A. , Asuzu M. , Henry M. , Watson M. , Adedokun A.
Published: September 2018

Background: Breast cancer is a global health problem of the 21th century. In developing countries, it is the third most common cause of death after infectious, parasitic, and cardiovascular diseases. Experience of late stage cancer carries a high emotional burden, due to poor outcomes and lack of comprehensive care. Currently in Nigeria, most cancer patients are looked after almost solely by their primary clinical oncologists, with minimal psychological and social care. There is a great need to broaden the care to include the psychosocial component now, considered a priority in clinical practice guidelines worldwide. Aim: To assess distress levels and improve quality of life of metastatic breast cancer patients through a continued support group system and psychotherapy. Produce field-tested audio-visual community education, psychosocial support and advocacy materials aimed at improving early diagnosis and reducing breast cancer death. Methods: This is a mixed-methods design study including a prepost design and qualitative focus group discussions. The study will enroll all consecutive patients in advanced stages 3 and 4 of their illness who consent to be included in the study until the estimated sample size of about 100 for the given period of the study is attained. The knowledge and attitude questionnaires, quality of life instruments as well as the distress thermometer will be administered to the patients to ascertain both their levels at baseline presentation as well as identify those who may benefit from psychotherapy. The eligible (stage 3 and 4) patients will be exposed to group psychosocial supportive interventions for three months before reassessment of the baseline parameters to ascertain the value of these interventions for the patients. Breast cancer education tools will be developed during the group interactions and construct validated with nonbreast cancer patients in the community. Results from focus group discussions will be used to triangulate the findings from the other aspects of the study. Data will be analyzed both descriptively and inferentially. Results: Progress to date includes obtaining ethical committee approval for the study protocol with the registration number NHREC/05/01/2008a from the UI/UCH Joint Research Ethics Committee. The research nurses have been trained in distress assessment. Their sociodemographic characteristics, knowledge and attitudes in regard of cancer, distress states, effects of the various psychological and social interventions on the patients and advocacy tools from the group therapy will be the products of this research. Conclusion: The results of this work will be used to advance cancer care and promote advocacy in the UCH and other similar cancer care settings in Nigeria and other developing countries.
Quality of Life of Egyptian Cancer Patients in Relation With the Types and Quality of Information Given
Authors: Elkateb N. , Monir W. , Abdelhady M.
Published: September 2018

Background: The concept of quality of life (QOL) refers to the ability to enjoy normal life activities; it is a complex combination of satisfactory functioning in essential four core domains — physical, psychological/emotional, social and quality of life is an important aspect of care in the clinical setting; nurses can improve patients´ quality of life by ensuring they are competent in daily practice, and by giving patients a high quality holistic care based on safe, effective intervention and providing required information. Aim: To evaluate the quality of life of cancer patients in relation to different treatment modalities and evaluate the impact of the information given on the quality of life. Methods: A convenient sample of adult cancer patients recruited from a university hospital, Cairo, Egypt. Data were collected through self-administered questionnaire or patient structured interview. Tools used: EORTC QLQ-C30 (Version 3) and QLQ-INFO25. Data analysis includes descriptive statistics and exploration of relationships between key variables; physical, emotional, social well-being, type of treatment, information given and quality of life. Results: Preliminary results revealed significant correlation between fatigue, emotional disturbance and quality of life. Lack of information is also correlated with low quality of life. Patients expressed their needs for more clarification about treatment, coping with disease and future consideration. Conclusion: Quality of life should be assessed frequently by nurses throughout treatment phases to identify patients at risk. Nurses also should emphasize on proper patients teaching and counseling to promote physical psychosocial balance and improve quality of life.
Case Discussion As a Strategic Planning Tool: Exploring Medical Tourism at Hospital Infantil Telethon De Oncología
Authors: Popatia S. , Wachter K. , Vega-Vega L. , Albanti I.
Published: September 2018

Background: As medical tourism rises globally, healthcare leaders are required to make strategic decisions about accepting international patients, as a means to diversify income, increase access to cancer care, and optimize patient experience. Hospital Infantil Teletón de Oncología (HITO), a free-standing pediatric oncology hospital in Mexico, currently has no international patients. Aim: We posed a hypothetical case to a group of HITO's senior leaders to understand the strategic priorities, examine the decision-making process around allocating beds for self-paying patients, and explore how changes in hospital governance influence the healthcare system. Methods: A literature review and prediscussion interviews were conducted, and IRB exemption was obtained. Two facilitators led the discussion using a structured case guide. Participants (N=13) were randomly assigned to teams supporting or opposing the decision to accept international patients. Thirty minutes were allocated for team discussion, thirty minutes for team presentation and group discussion. Session was recorded and transcribed. Results: Four themes emerged around ethics and equity, finance, operations, and community. Ethical considerations included concerns that this possibility disrupted HITO's mission to serve the Mexican population. Financial considerations focused on the creation of a new billing system and cost-efficiency questions. Operational issues included new processes and systems in care delivery to accommodate international patients such as transfer of records and hiring of translators. Community topics covered HITO's reputation and the impact on local economy. Conclusion: Our study revealed the importance of a multidisciplinary approach to complex decision-making and the need for systematic strategic planning that lead to system strengthening and improvement of childhood cancer outcomes. The use of a hypothetical case as a learning and consensus-building tool in exploring team dynamics and mapping strategies was also highlighted. With medical tourism as a potentially realistic scenario, healthcare leaders must be prepared to evaluate its impact on their organization, healthcare system, and society.
Lung Cancer–Related Clinical and Economic Impacts of Achieving a 5% Smoking Prevalence Rate by 2035 in Canada
Authors: Gauvreau C. , Fitzgerald N. , Hussain S. , Memon S. , Flanagan W. , Miller A. , Goffin J. , Evans W.
Published: September 2018

Background: Smoking is responsible for nearly 85% of lung cancer cases and 30% of all cancer-related deaths. Canada has set an ambitious target to reduce tobacco use to 5% by 2035 in alignment with a world-wide tobacco endgame initiative. Aim: We project the impact of achieving a national 5% smoking prevalence rate by 2035 on population-level lung cancer outcomes and costs. Methods: OncoSim-Lung (version 2.5), led by the Canadian Partnership Against Cancer with model development by Statistics Canada, is a microsimulation model that incorporates Canadian demographics, risk factors, registry data, resource utilization and other data to project clinical and economic impacts of cancer control measures. Smoking cessation parameters were modified to reduce the current average national smoking prevalence rate of 18% over time to 5% in 2035. Impacts were compared with those in a reference scenario, which maintained the current prevalence rate. Outputs of interest included lung cancer incidence, mortality, treatment costs, and quality-adjusted life-years (QALYs). Costs and QALYs are undiscounted and reported in 2016 CAD. Results: Achieving a 5% smoking rate by 2035 would result in a 2017-2035 cumulative total of 31,000 fewer lung cancer cases, 21,000 fewer lung cancer-related deaths, and 457,000 additional QALYs compared with projections based on a constant smoking prevalence rate of ∼20%. When stratified by sex, there would be 15,600 and 15,700 fewer lung cancer diagnoses and 11,000 and 10,000 fewer lung cancer-related deaths for males and females respectively. Furthermore, treatment-related costs would be reduced by $680 million dollars. On average there would be 4,500 fewer lung cancer cases, 3,500 fewer deaths, and $35 million in cost savings annually. If a 5% smoking rate is sustained until 2050, then there would be a 15% reduction in lung cancer cases and a 13% reduction in deaths from 2017-2050. Conclusion: Reducing Canada's smoking prevalence to 5% by 2035 could result in a significant reduction in lung cancer cases, deaths and treatment costs. Like Canada, other countries with relatively high smoking prevalence could use averted treatment costs to offset costs of aggressive smoking prevention and cessation programs or redirect them to other healthcare services.
Study on Treatment Expenditures of Urban Cancer Patients: An Evidence-Based Study From Jinan, China
Authors: Sun X. , Xu F. , Yao N.
Published: September 2018

Background: Cancer has become the leading cause of death in China. A recent systematic review showed that the data about economic burden of cancer in China were still very limited. Aim: This study aims to use the linked registry-claims data to analyze treatment expenditures among the patients diagnosed with lung, female breast, colorectal, and stomach cancer between 2011 and 2014 in Jinan of Shandong Province. Methods: A total of 410 urban patients were identified and selected in a tertiary hospital in Jinan of Shandong Province. We have linked the cancer registry data with health insurance claims and hospital discharge data. We were able to create the linked data of a total of 349 patients (85.1%). Inpatient, outpatient, and total treatment expenditure were computed. We also estimated the one-, two-, and three-year healthcare costs after cancer diagnosis. The local consumer price index (CPI) was used to adjust for inflation in medical expenses during the study period, and we calculated our estimates in terms of 2016 Chinese yuan (CNY). We generalized linear models to examine the factors that were associated with treatment expenditure. Results: The average total treatment expenditures of lung, female breast, colorectal, and stomach cancer were respectively 114,965, 115,344, 92,905, and 105,571 CNY. The one-, two-, and three-year total treatment expenditures of all four cancers were 78,801, 101,370, and 113,024 CNY respectively. For patients enrolled in Urban Employee Basic Insurance, 68.1%, of total expenditures were paid by the insurance. In contrast, Urban Resident Basic Insurance and New Rural Cooperative Medical Scheme only paid 46.7% and 39.1% of total expenditures of their beneficiaries. After adjusting for other control variables, health insurance type, receipt of surgery, and length of hospital stay were statistically significant associated with healthcare expenditures in male patients. For female patients, clinical stage, number of hospitalizations, and length of stay were statistically significant factors. Conclusion: The average total treatment expenditures of urban cancer patients were over two times of local disposable income per capita of urban residents in 2016. So, it makes economic sense to invest in cancer prevention and control in China, and the reimbursement gaps between different social insurance plans should be narrowed.
Delving KS-01 as a Novel Therapeutic Strategy in Treating Breast Cancer
Authors: Saha S.T. , Kaur M.
Published: September 2018

Background: Cancer cells have an increased need for cholesterol, which is required for cell membrane integrity. Cholesterol accumulation has been described in various malignancies including breast cancer. Cholesterol has also been known to be the precursor of estrogen and vitamin D, both of which play a key role in the histology of breast cancer. Thus, depleting the cholesterol levels in cancer cells is a proposed innovative strategy to treat cancer. Therefore, novel cholesterol-depleting compounds are currently being investigated. KS-01 is a cyclic amylose oligomer composed of glucose units. It solubilizes the cholesterol and is proven to be toxicologically benign in humans. Aim: To deplete cholesterol from cancer cells and investigating KS-01 to be a clinically useful compound. Our work provides preliminary experimental evidences to support this hypothesis. Methods: MTT assay (growth inhibition) APO percentage assay (apoptosis) Western blotting (protein expression) MOMP assay (mitochondrial membrane potential for apoptosis) Caspase 3,7 assay (caspase 3,7 activity for apoptosis) Cholesterol assay (to check cholesterol levels) RT-PCR (gene expression). Results: We identified the potency of KS-01 in vitro against two breast cancer cell lines: MCF-7 (estrogen positive, ER+), MDA-MB-231 (estrogen negative, ER-) and compared the results against two normal cell lines: MRC-5 (normal human lung fibroblasts) and HEK-293 (normal human embryonic kidney cells) using cytotoxic, apoptosis, protein expression and cholesterol based assays. KS-01 treatment reduced intracellular cholesterol resulting in significant breast cancer cell growth inhibition through apoptosis. The results hold true for both ER+ and ER-. Conclusion: The data obtained from our experiments suggest that KS-01 can prevent cholesterol accumulation in breast cancer cells and is a promising new anticancer agent. We are currently testing our hypothesis in vivo to validate the in vitro results. N.B: We have submitted the preliminary data to WITS ENTERPRISE (university's internal patenting agency). Once we get our in vivo data, the compound would be patented for its mechanism of action in breast cancer.
Establishing a Childhood Cancer Survivorship Program in Rwanda
Authors: Rubagumya F. , Greenberg L. , Manirakiza A. , Kanyamuhunga A. , Manirakiza A. , Shyirambere C. , Chinyundo K. , Slone J.
Published: September 2018

Background: Over 80% of children diagnosed with cancer survive in high-income countries (HICs). While the survival rate remains poor in low- and middle-income countries (LMICs) such as Rwanda, a growing number of children with cancer are surviving to adulthood. These children and young adults will face an increased risk of secondary cancers and late complications from their curative treatment. Cancer centers in HICs have established Long Term Survivorship (LTS) programs to cater for childhood cancer survivors and to capture these complications and/or recurrences at an early stage. They also address the more complex psychological and social aspects of surviving cancer in childhood. Aims: To develop an LTS program in Rwanda, initial training will take place in Botswana where a pediatric hematology-oncology (PHO) program was established at the national referral hospital, Princess Marina Hospital (PMH), in 2007. This training program will allow successful methods and lessons learned from the development of an LTS program in Botswana to establish a similar program in Rwanda with ongoing bidirectional collaboration. Methods: The Texas Children's Cancer and Hematology Centers (TXCH) Global Hematology-Oncology Pediatric Excellence (HOPE) program in Botswana is the only provider of PHO care in the country, provided at PMH, through a partnership with the Botswana government. The program has over 130 childhood cancer survivors in active follow-up. A one-month bench-marking visit will be conducted. During this period, Dr. Rubagumya will spend time with the medical director of the program learning how the LTS program was established and current operations. He will spend time with clinicians during consultations to understand the scope of tests requested, frequently asked questions across all parties: clinicians, survivors and/or caretakers and use of technology to aid in the management of LTS patients. Focused interviews of clinicians, patients, caregiver and administration will be conducted to further understand the challenges of the pediatric cancer survivors and the development of an LTS program in an LMIC face. Results: After this month visit, critical areas of knowledge transfer will include: how to set up a childhood cancer survivorship programs; methods for sustainable operation of a childhood cancer LTS program, and how to help childhood cancer survivors navigate health care systems. A similar model will be established in Rwanda. Long-term mentorship with Botswana colleagues will help to build Rwanda's first LTS. Conclusion: Survivors involved in dedicated LTS follow-up care have better health outcomes. This indicates the need for life long survivorship care. There is a dearth of data on how to establish and operate a childhood cancer LTS program in LMIC settings. Lessons learned through this program will guide us on how to set up such program in Rwanda.
Impact of Chemotherapy Stock-Out on Standard Therapy Delivery Among Cancer Patients in Botswana
Authors: Martei Y. , Grover S. , Bilker W. , Setlhako D. , Ralefala T. , Manshimba P. , Gross R. , Shulman L. , DeMichele A.
Published: September 2018

Background: Cancer drug shortages represent a complex global issue with potentially adverse survival outcomes. Up to 98% of oncologists and pharmacists surveyed in North America reported at least 1 drug shortage in the prior year and 66% reported at least one patient who had clinical care impacted by the shortage. In low- and middle-income countries (LMICs), these shortages are even more frequent. No studies to our knowledge have evaluated the impact of chemotherapy stock-out on receipt of standard cancer therapy in LMICs. Aim: Quantify the association between the duration of chemotherapy stock-out and the risk of having a suboptimal therapy delivery event, compared with standard delivery of therapy among cancer patients in Botswana. Methods: Prevalent cohort study of patients with cervical, breast, prostate, esophagus, Kaposi sarcoma, head and neck cancers, lung, uterine, ovarian and colorectal cancers who received any systemic therapy between 01/01/16-12/31/16 at Princess Marina Hospital, Botswana. Primary exposure was stock-out duration per cycle interval calculated by generating a code for the six different patterns for chemotherapy stock-out, using stock data at the Central Medical Stores. Primary outcome was suboptimal therapy delivery defined as a dose reduction, dose delay or switch in intended therapy. We measured statistical associations using two sample t-test and mixed effects univariate and multivariate logistic regression models. Results: 378 patients were identified who met diagnostic criteria and received systemic chemotherapy in 2016. Of these, 293 received commonly prescribed standard regimens who contributed 1452 cycle intervals and were included in our analysis. Majority of the patients (48%) had breast cancer. The mean duration of stock-out for receipt of standard therapy without events was 3.2 days (95% CI: 2.8-3.7) compared with 7.8 days for patients who had a suboptimal therapy delivery event (95% CI: 6.6-9) ( P < 0.0001). Male sex, age < 65 and HIV-positive status were also significantly associated with an increased risk of experiencing dose reduction, change in therapy or switch in therapy. Adjusting for these factors in a mixed effects logistic regression, each week of stock-out was independently associated with an 80% increased risk of having a suboptimal therapy delivery event (OR=1.8 (95% CI: 1.6-2.0, P < 0.0001)). Conclusion: Chemotherapy stock-out is independently associated with an 80% increased risk of a patient experiencing dose reduction, change in therapy or delay in therapy. The risk increases with longer duration of stock out. Given prior data showing that these events lead to worse survival outcomes, our further analysis is focusing on quantifying risk of stock-out on survival outcomes in this population. to determine whether interventions promoting standard therapy delivery are warranted to optimize survival outcomes.
Prevalence of Gul Use, Its Predictors and Association With Oral Potentially Malignant Disorders and Oral Cancer Development in the Users of Noida, India: A Cross-Sectional Study
Authors: Nethan S.T. , Kumar V. , Sharma S. , Hariprasad R. , Mehrotra R.
Published: September 2018

Background: Oral cancer is the third most common cancer in India which is attributed to the high tobacco burden especially due to a myriad of smokeless tobacco (SLT) products available in the market. Gul/Gul manjan is a commercially-produced, tobacco-based dentifrice, indigenous to rural India and Bangladesh, and mainly used by women. It is both highly addictive and carcinogenic; yet its prevalence, reasons for use and association with oral potentially malignant disorders (OPMDs) and oral cancer are scarcely documented in literature, making this study the first of its kind. Aim: To determine the prevalence of Gul use, its predictors and resultant OPMDs and oral cancer in such consumers. Methods: A cross-sectional study was performed among 3452 individuals visiting the Institute's Oral Health Promotion Clinic between December 2016-March 2018. Their basic demographic details, tobacco use history and abnormalities found on oral examination, were documented in the clinical record form. Data pertaining to Gul users was subjected to further statistical analysis. Results: Of the total individuals screened, 2.9% (n=101, P < 0.001) consumed Gul (89.1% current and 10.9% former users), with majority female consumers (86.1%) from peri-urban Noida. It was used (up to 5 times daily) mainly to alleviate dental pain due to caries/endodontic lesions, which were present in 35.6% users ( P = 0.004). A statistically significant positive association was seen between Gul use and development of OPMDs ( P < 0.001) and oral cancer ( P = 0.001), with 7.9% (n=10; 70% Gul alone users) of the overall leukoplakias/preleukoplakias (n=127), and 7.1% (n=1, Gul alone user) of all the oral cancer cases (n=14), found in Gul users. The duration of Gul use ranged up to 25 years, indicating its high dependency. Conclusion: Gul use is relatively uncommon than other SLT products in India, even among males (the major group of tobacco consumers). Apart from teeth cleaning, Gul is a cheap, easily accessible antidote for acute dental pain relief (owing to nicotine-induced analgesia) among rural women who apply it multiple times daily onto the affected teeth and adjacent gum/mucosa, often leading to its dependency. Courtesy its significant carcinogenic potential which has been clearly reported here (OPMDs and oral cancer development among users), combating/preventing its production, easy availability (in spite of the complete ban on tobacco use in dentifrices) and consumption, is essential. Therefore, the public health challenge of prevention of the use of this form of SLT ie tobacco-based dentifrices, warrants greater interest and action than that has been received thus far, which in turn would contribute to the overall mission of oral cancer prevention.
“Colorectal Cancer Survivors” Program in Istanbul, Turkey and Its Impact on Cancer Awareness
Authors: Aykan F. , Asoğlu O. , Kizir A. , Oral E.
Published: September 2018

Background: Colorectal cancer (CRC) is fourth most frequent cancer in men and third most common cancer in women in Turkey according to GLOBOCAN 2012 data. Its age-standardized incidence is 16.6 per 100,000 population in both sexes. CRC screening is globally accepted program and was shown that reduces CRC mortality. Aim: Public awareness is highly important to increase screening rate and to decrease mortality from CRC. Methods: We initiated a social program for patients with CRC, which is called “Colorectal Cancer Survivors”. Program contained interactive talks with patients and their relatives during cocktail and lunch in selected five stars hotels. We performed this activity in 2011 and 2012 in Istanbul. We invited patients with CRC who already diagnosed and successfully treated in Istanbul University Institute of Oncology. They were all 5 years or more survivors after surgery alone for stage I and II disease or last chemotherapy cycle for stage III or some stage IV cases. During meetings, surgeons, medical and radiation oncologists shared latest information about the risk factors, prevention and treatment modalities with participants. Media health correspondents were also participated to these activities. We monitored and compared screening rate before and after 2011. As a source, we used the nation-based data of cancer screening of Ministry of Health. Results: In April 30th, 2011, and in March 29th, 2012, 34 survivors joined to this program. We offered “Certificate of 5-Year Survivor” and “Blue Bead” to all patients. Blue Bead is a kind of symbol of hope in Turkey. In 2014, we observed significant increase in CRC screening compared with 2011 in Istanbul and all over the country. Conclusion: Since 2011 until present, there is a significant increase in CRC screening in Turkey. Among many positive factors, some social programs using media such as our “CRC Survivors” program that gives the message that CRC is a treatable and also curable in early stages, may stimulate screening.
Prevención 365 (Prevention 365)
Authors: Saavedra D. Milla
Published: September 2018

In Peru every year there are 1200 new cases of skin cancer, of which 80% is caused by overexposure to unprotected ultraviolet rays. In Peru, there was no culture of ultraviolet prevention. The population believed that they should only be protected from solar radiation in the summer season. Therefore, in 2017 the League Against Cancer - Peru, two major objectives were set: breaking the paradigm about protection only in summer and/or in aggressive solar exposure, and generate annual preventive check-ups. To achieve this, we created “Prevention 365”, a campaign designed to sensitize the population about the importance of protecting from the ultraviolet rays 365 days a year and not only in summer (Fig 1). Aim: Promote a change in the culture of skin cancer prevention in Peru, breaking the paradigm that you only have to protect yourself from ultraviolet rays in summer, and generate annual preventive check-ups. Strategy/Tactics: We identified the regions with the highest index of ultraviolet radiation at national level and the group of people who work under solar radiation who are more vulnerable for developing the disease, such as policemen, serene, cleaning staff, workers, journalists, taxi drivers, fishermen, among others, to carry out awareness actions. To achieve a greater impact, we convinced various characters from theater, television and sports to become spokespersons and image of the campaign, and to influence Peruvians to prevent skin cancer. We implemented a powerful digital plan that included communication on various platforms - our own and those of third parties. In this way we are able to exponentially expand the scope of our message. The mobile unit of the institution - outpatient clinic - visited municipalities, buildings, police stations, among others, where they conducted screening, educational talks and delivery of information material. Outcomes: More than 900 publications in media, which obtained 389,425,940 views and an advertising investment savings of more than US $5,660,452.00 dollars. More than 200 celebrities who shared each of our messages. More than 10 thousand people who were sensitized through outdoor advertising and media. More than 100 thousand Peruvians from areas more exposed to ultraviolet rays sensitized by materials and informative talks. More than 2 million people who received our message through our official fan page. Thanks to the campaign “Prevention 365” more than 130 thousand people made for the first time a preventive skin check. That is, more than 300% of what was projected. We have understood that a well-structured communication campaign can achieve great results. Thanks to this, the League Against Cancer has helped to reduce the incidence of skin cancer thanks to the fact that more than 130,000 Peruvians were screened for skin cancer for the first time. [Figure: see text]
Juntos Si Liga (We Get It Together)
Authors: Saavedra D. Milla
Published: September 2018

Amount collected: The campaign achieved that more than 10,000 young people joined “Juntos Sí Liga”, generating that the collection of cans in the street increased by 40% (from S/1.4 million to S/2.0 million soles). Background and context: The League Against Cancer - Peru plans and executes annually its “Public Collection”, which allows to obtain funds to fulfill its mission to educate and prevent cancer in the most vulnerable areas of the country. To collect these funds, it has different collection channels, which the one that generates the highest revenue is the street CANS: statistically one can in the street can collect 3 times more than a piggy bank at a fixed point. Until 2017 , The League Against Cancer - Peru, only had a limited group of volunteers who went out on the days of collection (80% adults and 20% young), and who collaborated sporadically. Thus, to achieve greater collection, it was necessary to increase the number of street volunteers. This way, “Juntos Sí Liga” was created, with the aim of encouraging young people to decide to become volunteers to prevent cancer in the country. Aim: Increase the number of young volunteers during the days of the public collection. Strategy/Tactics: We identified the influencers of the social networks with greater connections to the young people so that they influence their followers to register as volunteers. We also created an advertising spot to call even more participation. Considering that the whole approach would be digital, we relied on 2 registration platform www.proa.pe and www.meunoperu.com . We invited the main universities and higher education centers to be part of the campaign. The social networks of the League Against Cancer served to inform in real time of the activities that were held for the community. Costs and returns: More than 50 influencers and more than 100 celebrities were part of the campaign. More than 2000 publications in the social networks of the influencers, which generated an advertising investment savings of more than US $500,360.60. More than 200 publications in media with a saving of advertising investment of more than US $532,323.30. More than 1.5 million young people reached through the official Web site. More than 100,000 views of the advertising spot. More than 50 study centers joined the fight against cancer. The campaign achieved that more than 10,000 young people joined “Juntos Sí Liga”, generating that the collection of cans in the street increased by 40% (from S/1.4 million to S/2.0 million soles). What was learned: The influencers were powerful allies for the success of the campaign. Thanks to them, the number of young volunteers of the institution represented 80% of the total participants in the days of collection (before they were 20%). In addition, we invited them to understand about the disease and to realize that they can be a key piece in the change of cancer in Peru.

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The Impact of Varying Number of OSEM Iterations on Standardized Uptake Value and Image Quality of Discovery STE PET/CT Scanner
Authors: Ali B. , Afshan A. , Kakakhel M.B.
Published: September 2018

Background: In PET imaging both quantitative and qualitative interpretations are used. Qualitative and quantitative interpretations depend upon PET/CT image quality that along with many biologic factors strongly depends upon image reconstruction parameters. Aim: The objective of this experimental work was to study the impact of one of the key reconstruction parameter, i.e., number of reconstruction iteration, on standardized uptake value and image quality of PET/CT scan. Methods: Images of NEMA IEC Image Quality Phantom were acquired in list mode for 10 mins on Discovery STE PET/CT scanner, using tumor to background ratio of 4:1 and 18F-FDG as radiotracer. List mode data were further transformed into data sets of varying acquisition time (0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0 mins) per bed position. Transformed data set of 5.0 mins were used to study the impact of varying number of iterations (2, 3, 4, 5, 7, 10, 15, 20) using OSEM approach of iterative reconstruction. Standardized uptake value (SUV) and underestimation in SUV were calculated as quantitative measures, while hot lesion contrast, cold lesion contrast and background variability were calculated as qualitative measures. Results: Standardized uptake value, hot and cold lesion contrast, image spatial resolution and background variability showed increasing trend with increase in reconstruction iterations. Maximum increase of 20.25%, 16.33%, 9.79% and 6.88% was observed in SUV for 10 mm, 13 mm, 17 mm and 22 mm lesions as number of iteration change from 2 to 3. Smallest and the largest diameter lesions showed maximum underestimations of 54.67% and 8.20% at 2 iterations respectively. Percentage hot lesion contrast showed rapid increase as the number of iteration change from 2 to 7 and increased slowly afterward. Background variability range from 4.4% to 6.4%, 4.1%–5.7%, 3.6%–4.6%, 3%–3.8%, 2.7%–3.2%, 2.4%–2.7% for 10.0 mm, 13.0 mm, 17.0 mm, 22.0 mm, 28.0 mm and 37.0 mm sphere respectively. Conclusion: Optimized reconstruction parameters for routine clinical studies 3 iterations with image matrix size of 128 × 128 with filters FWHM of 6 mm and for high resolution studies 3 iterations image matrix size of 256×256 with filters FWHM of 6 mm.
Integrating Palliative Care in Cancer Care in Kenya
Authors: Ali Z.
Published: September 2018

Background and context: Most Africa countries now recognize the pain and suffering of many patients and families who have no access to cure (where cure is possible), cannot afford treatment of cancer or other progressive chronic illnesses, are stigmatized or discriminated against because of their illness among many other dehumanizing issues. This project aims to ensure that all those in need of palliative care and pain relief have access close to their homes. Aim: This project aims to ensure that all those in need of palliative care and pain relief have access close to their homes. Strategy/Tactics: In the recent past Kenya Hospices and Palliative Care Association has extensively advocated for the integration of palliative care into the Kenya health services; thus, resulting in many health care professionals being trained in palliative care; integration of palliative care in public, private and mission health institutions and integration of palliative care in undergraduate medical and nursing curricula, as well as policy documents. Program/Policy process: The process of integrating palliative care in public hospitals involved advocacy at the national level as well as at the institutional level, training of health care professionals and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Outcomes: Palliative care units have been set up in over 25 government hospitals across the country. National Palliative Care Guidelines have been developed. A Diploma in Palliative Care for nurses has been initiated at the Kenya Medical Training College since 2012. Palliative care has been included in all the relevant health policies/strategies. Kenya Essential Medicines List includes Opioids. The Ministry of Health is supplying morphine powder for the country. More patients are now able to access quality palliative care. What was learned: National associations are challenged by an enormous need for services, education and training of health care professionals as well as educating the public and policy makers. The government has no budget for palliative care and most of the work is donor funded. Cultural beliefs are a big barrier to accessing PC. Only a small fraction of patients in need of opioids for pain medication are receiving opioids due to lack of awareness; reluctance of HPCs to prescribe. For many years PC in Kenya has been provided by a few hospices, thus making access very limited to many who are in need. Regional and national associations in Africa should work together with African Ministries of Health and other relevant stakeholders to ensure that there is greater access to palliative care for cancer patients. This encompasses addressing issues of accessibility, affordability, quality palliative care (PC) and a human's right approach to PC.