bluuebunny/crossref_metadata_2025 huggingface dataset:
The Experience of Living With and Beyond Cancer With Comorbid Illness: A Qualitative Systematic Review
Authors: Cavers D. , Habets L. , Cunningham-Burley S. , Watson E. , Banks E. , Campbell C.
Published: September 2018

Background: There is a need to explore the needs of the growing number of people living with and beyond cancer with additional long term chronic conditions, with implications for cancer survivorship management and support. Aim: This review aims to identify the qualitative evidence on the experience of cancer and comorbid illness from the perspective of patients, carers and health care professionals to identify psycho-social support needs, experience of health care, and to highlight areas where more research is needed. Methods: PRISMA guidance was used to review the evidence. Relevant research databases were searched using an exhaustive list of search terms. Two reviewers independently screened titles and abstracts and discussed variations. Included articles were subject to quality appraisal before data extraction of article characteristics and findings. Thematic synthesis of extracted findings was undertaken following Thomas and Harden's prescribed method. Results: 29 articles were included in the review covering a range of cancer types and comorbid conditions; with varying time since cancer diagnosis and apparent severity of disease for both cancer and other conditions. Studies are set in developed countries and include the views of patients and professionals but not carers. Few studies focused exclusively on the experience of living with comorbid conditions alongside cancer. Key themes identified included: the interaction between cancer and comorbid conditions; the added symptom burden; illness identities and ageing; self-management; prioritizing conditions, and treatment decision-making. Conclusion: In addition to a better understanding of the complex experience of such illness to illuminate developing models of patient-centered care, the review will combine with patient engagement work to inform an interview study with the defined patient group.
Nollywood and Cancer: A Workable Partnership
Authors: Izuegbuna O.
Published: September 2018

Background and context: The Nigerian film industry also known as Nollywood is the biggest in Africa and the second largest in the world in terms of annual production. Nollywood produces hundreds of films every year, most of them low budget straight to DVD tapes. As at 2014 Nollywood had an estimated gross worth of about 5 billion U.S. dollars. It also employs about a million people in the country. Nollywood has since inception been able to blend historical facts with good imagination to create and sustain our society. It has done this across most genres, but a few. Health issues such as cancer is not well represented in Nollywood and about 80,000 Nigerians die of cancer annually. Aim: To encourage cancer themes in Nollywood movies. To help form an alliance between health professionals and Nollywood. Strategy/Tactics: Forming a platform where health professionals and Nollywood practitioners can converge to seek out cancer information for budding stories and get authentic, scientific information concerning cancer and help dispel some local myth on cancer especially in rural Africa. Program/Policy process: A working opportunity whereby more cancer themes can be introduced into Nollywood movies either as a main story, or a secondary one. Outcomes: A work in progress. What was learned: Though Nollywood lags behind in putting health themes in her movies, it is not too late to start off. The journey of a thousand miles starts with a step. Changing people´s perspective can be daunting, but impossible is nothing. Nollywood has to its advantage millions of followers and an established industry. What it requires is a collaboration with health professionals to make movies with cancer themes and highly factual in the science.
Closing the Gap on the Availability of Cancer Staging Information for Healthcare Providers in the Global Cancer Community: Development of a Multilingual Cancer Staging Video Series
Authors: Moraes F.Y. , Giuliani M. , Quartey N.K. , Cardozo J. , Icliates N. , Tittenbrun Z. , Papadakos J. , Brierley J.
Published: September 2018

Background and context: Tumor, Node, Metastases (TNM) classification system provide valuable measures to researchers in facilitating the understanding of disparities in outcomes and allowing for the comparison of these outcomes over time. There is a lack of multimodal formats for disseminating comprehensive information and education about cancer stage to the global cancer community. To address this gap, the Departments of Radiation Oncology and Cancer Education at the Princess Margaret Cancer Centre (PM) (Toronto, Canada) in collaboration with The Union for International Cancer Control (UICC) envisioned the development of a cancer staging video series. Aim: To provide current and accurate information on cancer staging to healthcare professionals and stakeholders for global cancer control. Strategy/Tactics: The Cancer Education program worked with experts in the field of cancer staging to develop 8 videos (average length 4 min) to provide information to the global cancer community about existing information on key issues with cancer staging and how to properly stage patients using the TNM classification. Videos include references to current research and examples of staging across various cancers to illustrate and reinforce the importance of cancer staging. Script development involved defining key messages, refining learning objectives and breaking up information to ensure the content is digestible and easy to understand. Prior to video production, draft scripts were reviewed by international collaborators for completeness of information and accuracy of content. Videos contain appropriate text on screen to reinforce key messages and include a narrated voiceover to orient the learner. To expand the global reach, trained faculties translated the English videos and scripts, into the 5 official United Nations languages: Arabic, Chinese, French, Russian and Spanish. Program/Policy process: Videos in the cancer staging series include: The Importance of Cancer Staging; What is Cancer Stage; General Rules for Cancer Staging; Cancer Staging Examples; Staging Terminology; Importance of a Common Stage Language; Why Stage Language Changes; Essential TNM. Videos will be made available on UICC and PM Web sites (free of charge and globally advertised). Outcomes: The video series will increase education and awareness on the importance of a unified approach to cancer staging among the larger community and have the aim to empower the community on how to access cancer and define prognosis, treatment and or trial eligibility. What was learned: The development and promotion of the cancer staging video series was a meaningful, collaborative and challenging activity. It was learned that educational videos need to be well-designed and simple to provide axiomatic information on cancer stating to the global cancer control community.
Case-Control Study of Diet, Cooking Methods and Colorectal Cancer In Viet Nam
Authors: Tuan N. , Giang L. , Ngoan L.
Published: September 2018

Background: Colorectal cancer is one of the most common cancers and the leading cause of death in the world and the third most common cancer in Viet Nam. Aim: To examine the association between diet, cooking methods and the risk of colorectal cancer by a case-control study in the Hanoi city, Viet Nam. Methods: A case-control study was designed. Case was newly incident colorectal cancer (125 cases). Control was hospital-based case without any cancer and matched to case by sex and +/− 5 years old admitted to the same Bach Mai hospital in Hanoi city. Case to control ratio was one. Data collection was performed by face to face interviewed by the trained interviewers in using the validated semiquantitative food frequency and demographic and lifestyle questionnaires. Food frequency intake inquired about a frequent intake per day, per week, per month or per year for 85 items of fruit, vegetables, fishes, meats, salted foods, bean and nuts; lightly browned, medium browned, high browned, well browned, and blackened/charred of cooking meat and fishes. Multivariable adjusted odds ratio and 95% confidence interval (OR, 95% CI) was estimated using STATA 10.0. Results: The significant increased risk of colorectal cancer was observed for a high frequent intake of fried meat (OR=2.63, 95% CI: 1.47-4.66); fried soya cheese (OR=2.00, 95% CI: 1.05-3.80); grilled food (OR=3.18, 95% CI: 1.84-5.48); roasted food (OR=3.56, 95% CI: 2.05-6.20); beef (OR=2.06, 95% CI: 1.17-3.83); eat salty food (OR=1.71, 95% CI: 1.03-2.82); instant noodle (OR=3.08, 95% CI: 1.61-5.91); salted vegetable (OR=1.63, 95% CI: 1.01-2.73); smoking (OR=5.5, 95% CI: 1.90-15.96). In contrast, a significant decreased risk of colorectal cancer was seen for a high frequent intake of soymilk (OR=0.45, 95% CI: 0.24-0.87); sweet leaf (OR=0.28, 95% CI: 0.13-0.60); guava (OR=0.55, 95% CI: 0.32-0.94); orange (OR=0.15, 95% CI: 0.07-0.36). Conclusion: We observed the positive association between cooking methods and the risk of colorectal cancer. Further study of the underlying mechanisms of cooked meat and fish is highly recommended in Viet Nam.
The Impact of Early Dressing Removal on the Tunneled Central Venous Catheters
Authors: Ammar G.
Published: September 2018

Background: There were many studies compared between different types of dressing such as chlorhexidine gluconate gel (CHG), (CHG) disc, gauze dressing and transparent dressing regarding its intact to the skin, infection rate and patients satisfaction. However, there was few studies regarding the impact of removing the dressing on the occurrence of exit site infection of tunneled central venous catheters. Aim: The objective of the current study was to evaluate the impact of early central venous catheter (CVC) dressing removal of the well-healed exit site infections. Methods: It was a quasi-experiment pilot study conducted over 15 months duration in a specialized oncology center. All adult patients who had newly inserted tunneled central venous catheters (CVC) in place were recruited. Patients were distributed to control and experimental group based on first come first served. Patients in the control group (n=8) received the standard protocol of applying (CVC) dressing, while patients in the interventional group (n=8) received the protocol of no dressing. Results: There was no significant difference in the infection rate between the two groups ( P = 1), so that, a total of two cases had developed catheter-related bloodstream infection (CLABSI), one in the control group and the other in the interventional group. Moreover, one patient in the interventional group had developed exit site infection. However, patients with no dressing protocol (interventional group) perceived an improvement in their quality of life and they were satisfied with this protocol. Conclusion: Applying no dressing protocol to a well-healed exit site CVCs showed encouraging results in terms of exit site and bloodstream infections. That is to say; it did not predispose patients to increased risk of infections. Furthermore, patients with no dressing protocol feel more comfortable in their lifestyle.
The Impact of Improved Data Collection at the Ibadan Cancer Registry: Comparison of Two Time Periods (2009-2012 and 2013-2016)
Authors: Ogun G. , Bodunwa O. , Ladipo A. , Fabowale O. , Ogunbiyi O.
Published: September 2018

Background and context: The Ibadan cancer registry is a population based registry that actively recruits cases of cancer occurring in eleven local government areas in Ibadan and its environs in Southwest, Nigeria. The registry covers a catchment area with a documented population of 2,549,265. Cases are abstracted from the main teaching hospital, designated private hospitals and clinics representing active practices, National Population Commission and private laboratories. We observed a decline in numbers of cases registered compared with what was projected and moved to effect corrections to this decline. In addition to reviewing our usual sources, we enlisted more sources of case recruitment. Aim: This study was done to assess the impact of additional sources of data collection on the number of cases recorded in the registry. Strategy/Tactics: The registry had improved contact with the local Ministry of Health and local governments administration, identified new facilities that treat cancer patients and new histopathologic laboratories that diagnose cancers. Program/Policy process: The registry enlisted cases from thirty (30) sources during 2009-2012 time period. In the 2013-2016 period, the registry improved the data collection sources to sixty (60) due to good advocacy, improved collaborative effort with our partners and very active case finding. Outcomes: A total of 3116 cases were recorded in the registry during the period 2009-2012. This increased to 3744 in the period 2013-2016 giving a 20% increase in the number of abstracted cases in the latter period. The ranking order of cancer in the population we serve changed from breast, cervix and prostate cancers in 2009-2012 to breast, prostate and cervix in the second time period. The ranking order in both genders did not change significantly. What was learned: Changes in health providing facilities affect the recruitment of new cancer cases into the database of cancer registries. Furthermore, cancer registries must always improve the database of sources where cases are recruited, as this is dynamic. Good advocacy, very active case finding and improved relation with the community have increased the number of cases of cancer recorded in our registry.
Site-Specific Lung Cancer to Support National Cancer Control Programs in Indonesia
Authors: Ramadhaniah F. , Suzanna E. , Triana D. , Kadir A. , Widyastoeti T.H. , Sulistyowati L.S. , Rosalina I. , Lubis E.M. , Palupi N. , Hamzah A. , Kartikawati A. , Khairina D. , Agustina J. , Septiawati S. , Rahayu P.S. , Yulianita R.
Published: September 2018

Background: Lung cancer surely increased particularly in developing country that has double burden of disease because of epidemiologic transition effected high incidence in productive age and premature death. Indonesia as a developing country has better life expectancy but there aren't national cancer control yet. National cancer registry as one of pivotal tools in priority setting of national cancer control. Aim: Epidemiology pattern of lung cancer based on National Cancer Registry to determine national cancer control programs. Methods: In 2016 Ministry of Health assigned 14 provinces (26 cities/districts) in Indonesia to enforce population-based cancer registry and Dharmais as a National Cancer Centre. All health facilities sent data to the National Referral Hospitals in each provinces which Canreg5 were used, year 2008-2012. Data from 14 National Referral Hospitals sent to Dharmais NCC for analysis. Results: Lung cancer posed in the first rank for male and the sixth rank for female by comparison 2:1. Peak incidence occurs in age group of 55 years for male meanwhile 50 years for female. However escalation of cases began in age group of 35 years for both sexes. Three provinces which have high incidence for lung cancer were Bali, South Sumatera and DKI Jakarta as capital city of Indonesia. Adenocarcinoma as the most common histology type. Despite most valid percentage and coverage from each province still quite low. Conclusion: Lung cancer become the first priority for cancer control program in male foremost three provinces. This issue highlighted and need further analysis to assess risk factor.
Serum 25(OH) Vitamin D Deficiency and Risk of Breast Cancer in Malaysia: A Case-Control Study
Authors: Jauhari A.H. Asmali , Bhoo-Pathy N. , Islam T. , Jalaludin M.Y. , Moy F.M. , Taib N.A.
Published: September 2018

Background: Despite the emerging literature supporting the beneficial role of sufficient vitamin D level and its association with various cancers, current evidence on the vitamin D and the risk of getting breast cancer is still inconsistent. Furthermore, the study between vitamin D status and breast cancer risk among south east Asian women is limited. Aim: We aimed to investigate the association between vitamin D deficiency and the risk of getting breast cancer among Malaysian women. Methods: We conducted a retrospective nested case control study which consisted of Malaysian Breast Cancer Cohort Study (MyBCC) subjects as the cases and UMMC Mammogram Cohort Study subjects as the hospital control. We also used a secondary data from the Cohort Study on Clustering of Lifestyle Risk Factors and understanding its association with stress on health and well-being among school teachers in Malaysia (CLUSTer), as we only included the data from the schools in Kuala Lumpur as the population control. We measured and compared serum 25-hydroxyvitamin D (25(OH)D) between newly diagnosed breast cancer patients (n= 231), female without cancer who came for mammogram checkup (n= 462) and female teachers without cancer from schools in Kuala Lumpur (n=231). Vitamin D deficiency was defined as serum (25(OH)D) < 50 nmol/L. Results: Median serum (25(OH)D) for cases and controls were 42.43 nmol/L and 44.30 nmol/L, respectively. We examined the association between serum (25(OH)D) and breast cancer risk stratified by age < 50 and ≥ 50 years old. The crude ORs for breast cancer risk in cases and controls did not show statistically significant association with serum (25(OH)D) for both age groups ( P = 0.463 and P = 0.650, respectively). After adjustment for age, ethnicity, education level and BMI the ORs (95% CI) for breast cancer risk among both groups were 1.183 (0.591-2.366) ( P = 0.635) and 1.237 (0.801-1.911) ( P = 0.338) respectively for women with serum (25(OH)D) < 50 nmol/L. Conclusion: Our results suggest that there is lack of association between vitamin D deficiency and the risk of getting breast cancer in Malaysian women.
Establishing Accra Population-Based Cancer Registry
Authors: Opoku P.
Published: September 2018

Background: The African Cancer Organization (ACO) seeks to establish Accra Population-Based Cancer Registry (ACR). The whole idea is to collect, store and analyze data on persons with cancer to provide complete, accurate and timely cancer report for interventional programs. Such information would guide us to monitor patient care, prioritize and allocate resources effectively, give understanding of the things we do not yet know, and also act as a driver for policy development for the urgent need of comprehensive cancer control in Ghana. Countries require cancer surveillance programs to collect and analyze data on the scale of the cancer burden in each country. These are urgently needed in Africa as cancer data sources are scarce. Data can help to evaluate the impact of prevention, early detection/screening, treatment and palliative care programs. The proposed population-based cancer registry will help to act as a driver for policy development and program evaluation as recommended by the WHO. ACR intends to capture cancer cases diagnosed and/or treated within the Greater Accra region of Ghana and then further extend to cover the Central, Eastern, Western and the Volta regions of Ghana later. Aim: The goal of ACR to collect, store and analyze data on persons with cancer to generate incidence, prevalence, trends, mortality, and survival rates which is required to help develop a realistic and sustainable cancer control plan for Ghana. Methods: Cancer registry staff will be trained to abstract cancer cases diagnosed and/or treated within the southern regional geography of Ghana using a customized cancer notification form designed to capture detailed information on cancer patient demographics, tumor details, treatment, reporting sources and follow-up information based on both analytic and nonanalytic active case-finding reportability methods. These cases will then be classified and coded using the ICD-O-3, FIGO and/or SEER Summary Staging 2000 Manual. The data will be stored in customized cancer registry software which will be configured with various address codes from the registry geography. The cancer registry software checks for duplicate cases, data edits and consolidation. The software tracks down duplicate records and multiple primaries using a probability matching and consistency checking for impossible or rare cases. Conclusion: Establishing a cancer registry in Africa is challenging but very possible. Conflicts of interests are common norms among new cancer registries. With a good budget and working plan backed by few sincere and dedicated staff, it will be very possible to sustain the registry to capture all cancer cases within the catchment area, to take advantage of available modern technology to produce timely results. ACO is by this seeking for partnership to raise the needed support to embark on this national cancer registry campaign in the region.
Relaxation and Exercise in Lymphoma Survivors (REIL Study): A Randomised Clinical Trial Protocol
Authors: Hathiramani S. , Pettengell R. , Moir H. , Younis A.
Published: September 2018

Background: Cancer survivors commonly report ongoing physical and psychological needs and adverse effects due to disease and treatment exposures including fatigue, pain, depression and decreased quality of life (QoL). Both relaxation and exercise interventions have demonstrated a positive effect on these symptoms. However these benefits have been relative to a control group, and there has been a call for further intervention studies in survivors to move beyond wait-list control groups and to compare with active control or other empirically supported interventions, such as comparison of relaxation to exercise intervention, to determine which is more beneficial. Aim: This paper presents the REIL (Relaxation and Exercise In Lymphoma) study protocol using recommended SPIRIT 2013 guidelines. The primary aim of the REIL Study is to compare the effect of two interventions - exercise and relaxation on QoL in a sample of lymphoma patients in remission postchemotherapy. Secondary aims are to investigate the effects of the two interventions on body composition, cardiovascular status, pulmonary function, muscle strength, functional exercise capacity, well-being and psychological status; and explore perceptions about participation in the posttreatment intervention program. Methods: Eligible participants (n=36) will be randomized to an exercise or relaxation home-based program to perform at least three times per week. The primary outcome measure is QoL, assessed by the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30). Secondary outcome measures include body composition, cardiovascular status, pulmonary function, strength, functional exercise capacity, well-being and psychological status. Total duration of the study will be 12 weeks and outcome measures will be assessed at baseline, 6 weeks and at the end of the study. Results: Results from this study will inform development of effective care pathways for the increasing population of cancer survivors in general, and lymphoma in particular. It is anticipated that preliminary results from this study will be available by October 2018. Conclusion: Although it is well documented that cancer survivors commonly suffer from consequences of treatment which have a negative impact on their QoL, there are currently no recommended care pathways following completion of primary medical treatment. Evidence suggests that both relaxation and exercise can significantly improve ongoing symptoms in cancer survivors, but there is no consensus on which intervention is more effective. Results from the REIL study will aid in the development of evidence-based survivorship care pathways for cancer and lymphoma survivors, potentially prevent long-term complications, and help in a smooth transition from being a cancer patient to a fully-functioning member of society. This may lead to reduced use of healthcare resources by this population.
Screening for Cervical Cancer in Kazakhstan
Authors: Kaidarova D. , Zhylkaidarova A. , Dushimova Z. , Bolatbekova R.
Published: September 2018

Background: Cervical cancer is the second most common cancer in women worldwide, where the majority of registered patients are in developing countries. Screening programs in developed countries have reduced morbidity and mortality from cervical cancer by more than 2 times. Cervical cancer (CC) is the most common gynecologic cancer in Kazakhstan. In 2016, the standardized incidence rate of CC was 19.1 per 100,000, while the mortality rate was 7.1 per 100,000. The National Cervical Screening program in Kazakhstan has been using cytology (The Papanicolaou test) since 2008, free for women aged 30 to 60 years and performed at 5-year intervals. Despite the introduction of cytologic screening, the mortality rate remains high. Aim: The purpose of this study is to analyze the effectiveness of cytologic screening in Kazakhstan. Methods: Coverage analysis, the number of screened women, the level of precancer detection and cervical cancer during screening have been obtained from specific reports (form no. 025, no. 08) for 2008-2016. Results: The number of screened women totaled at 4,460,320. There has been a decrease of 32% in the number of screened women within the nine-year period. Furthermore, the coverage rate has decreased within the said period by 27%, from 72.9% in 2008% to 45.9% in 2016, with the highest coverage in 2012. According to the results of the screening, 1576 cases of CC were registered. The analysis of the screening results showed a marked increase in the detection of CC with an increase of 37%. At the same time, the percentage of detection of the initial stage during screening remains insufficient and for 2016 was 50.8%. The percentage of registered cases of ASH+HSIL increased from 0.136% to 0.673%. Conclusion: An analysis of the cytologic screening for 2008-2016 showed a high incidence of CC. Despite sufficient coverage and relative success in detecting the initial stages of CC, the mortality rate remains high. Thus, it is necessary to improve the effectiveness of CC screening in Kazakhstan through the introduction of HPV-screening.
Cervical Cancer Screening of Commercial Sex Workers in NW and SW Regions of Cameroon
Authors: Muffih T.P. , Manjuha F. , Fai M. , Babey M. , Nulah K. , Welty T. , Welty E.
Published: September 2018

Background: In 2008, the Cameroon Baptist Convention Health Services (CBCHS) organized New Life Clubs (NLC) for commercial sex workers to provide: 1) medical information and free HIV testing and male and female condoms to reduce transmission of HIV and other reproductive tract infections (RTIs); 2) psychosocial and spiritual support, and; 3) training on safer sex and more sustainable income-generating opportunities. Since about one third of the 600 NLC members are HIV-positive, they are high risk for cervical cancer. Methods: In 2017 CBCHS educated NLC members in Mutengene, Bamenda and Banso about cervical cancer, obtained informed consent to screen them visually after application of acetic acid and Lugol's iodine enhanced by digital cervicography, examined those who consented for free, treated women with precancers, provided condoms at no cost to reduce transmission of HIV and prevent unintended pregnancies, and evaluated the program impact. Results: Of the 103 NLC members screened, 101 records were analyzed; 40 were HIV-positive (39.6%) and 33 of those (82.5%) were on treatment. Six were diagnosed with cervical precancer (5.9%). Three were treated (50%); two with thermal coagulation and one with LEEP. Three were treated for RTIs and two for genital warts. Conclusion: Cervical cancer screening and treatment of precancers of commercial sex workers is feasible, if the costs are subsidized. The WHP will expand screening and train NLC coordinators to be cervical cancer educators and to assess unmet family planning needs. Treatment of HIV-positive sex workers is a priority because treatment is prevention.
An Ecological Study on the Risk of Gastric Cancer With Helicobacter Pylori Prevalence and Other Potential Cofactors in Korea
Authors: Park J. , Park E. , Lim S. , Lim M.K.
Published: September 2018

Background: Korea has a high incidence of gastric cancer and a high prevalence of Helicobacter pylori infection. Observation of prevalence trends and determination of risk factors for gastric cancer are important to establish health policies to prevent and reduce the burden of disease. Currently, there is no evidence of complete correlation between prevalence of H. pylori infection and the occurrence of gastric cancer. Several explanations have been proposed for the paradox of high prevalence of infection and low gastric cancer incidence in certain places, including diet and salt consumption, genetic susceptibility, other infections, aflatoxin-contaminated food, and the interaction of all these factors, but none of them has been clearly established. Aim: To explore the potential effects of prevalence of H. pylori infection and other risk factors on gastric cancer incidence in Korea. Methods: Information on gastric cancer incidence, prevalence of H. pylori infection, and the risk factors for gastric cancer were evaluated from nationally representative data - the Korean National Cancer Registry, nationwide routine health check-up surveillance system, and National Health and Nutrition Survey, respectively. Secular trends of H. pylori infection prevalence and age-standardized incidence rates for gastric cancer by region were examined. Furthermore, trends of income level, education level, marital status, number of family members, smoking status, drinking status, obesity, diabetes, hypertension, dyslipidemia, and age-standardized incidence rates for gastric cancer by region were examined. Results: Gastric cancer incidence showed a decreasing trend from 2011 to 2015; 50.6%–44.4% for men and 22.1%–17.0% for women. The prevalence of H. pylori infection also showed a decreasing trend; from 66.9% in 1998%–54.4% in 2011. In Korea, areas with high prevalence of H. pylori infection also showed high gastric cancer incidence. However, the Chungcheong area showed relatively low prevalence of H. pylori infection, but had the highest gastric cancer incidence in Korea. Other factors which showed similar effects on gastric cancer incidence, like H. pylori infection were large family size (4 or more family members), low income, low education, and obesity. The effect of introduction of 'National Cancer Screening Program' will be evaluated in the final outcome. Conclusion: The results of this study indicated that significant regional differences exist between trends in H. pylori infection prevalence and gastric cancer incidence in Korea. Also, the possibility of lack of association between H. pylori prevalence and the incidence of gastric cancer are suggested. Overall, this study suggests the need for further research to explore potential factors accounting for regional differences in gastric cancer incidence in Korea.
Intrafraction Verification Using ExacTrac 6D Imaging for Frameless Cranial Radiosurgery
Authors: Sharma S.
Published: September 2018

Background: Radiosurgery has been an integral component in the management of intracranial tumors. It involves the administration of a high dose to the tumor. An essential aspect of this kind of treatment delivery is accurate localization of the tumor target that is precisely reproducible during treatment. To achieve this, the methods of positioning and immobilization of the patient play a critical role. Conventionally, the patient has been immobilized with invasive head frame and the location of internal anatomy deduced by external coordinates. This method has some drawbacks. - It works on the assumption that the external coordinates represent the isocentre location correctly. - It depends on the spatial relationships between the frame and the skull. Slippage and deformity of the frame, although rare, can cause an error in positioning. - From the patient's perspective, the placement of the frame is a source of discomfort. It also puts them at risk for bleeding and infection. Frameless SRS has come into use in recent times. This is a noninvasive method. However, giving up the use of an invasive head frame leads to increased intrafraction motion. To overcome this, we require constant verification of the patient's positioning at every step of the treatment. Aim: The objective of this study is to compare the precision and accuracy between Brainlab ExacTrac imaging and CBCT and evaluate the intrafraction motion of patient undergoing intracranial SRT. Methods: For this study we included 10 patients with intracranial tumors who are eligible to undergo SRS. A frameless stereotactic head frame mask was prepared to immobilize the head during SRS. During treatment the patients were immobilized with the same frame and the 6D positional accuracy was checked for every single field before the treatment execution by taking verification image using 6D ExacTrac and Onboard Imagers. The 6D ExacTrac tolerance were set to rotation < 1.00 and translational shift < 0.7 mm. We make sure of intrafarction movement by taking frequent ExacTrac images during the treatment of every 30 s. After the treatment the registration between the planning CT image and CBCT image taken before treatment were cross verified 6 dimensionally using offline review. The difference in shift between ExacTrac and CBCT are evaluated by means of RMS. Results: The RMS of the difference in the translational dimensions between the ExacTrac System and CBCT was < 1.0 for online matching and < 1.10 for offline matching. Furthermore, the RMS of the difference in the rotational dimensions between the ExacTrac System and CBCT were < 0.81 for online matching and < 0.96 for offline matching. Conclusion: It is concluded that the discrepancies in residual set-up error between the ExacTrac 6D x-ray and the CBCT were minor. ExacTrac 6D imaging provides additional advantage of patient intrafraction movement control by means of imaging during treatment.
Bridging Barriers, Building Partners: Success of a Multistakeholder Collaborative Effort in Building and Implementing a Free Mammography Programme for Underprivileged Malaysian Women
Authors: Nair V. , Nazri D. , Hashim R. , Lau A. , Muniasamy M.
Published: September 2018

Background and context: Research has revealed two large problems in the Malaysian breast cancer control context. First, a large disparity existed in diagnostic stages of Malaysian patients during first presentation; with a large percentage of patients presenting in Stage 3 or 4. Second, patients presenting in later stages of disease were revealed to be of lower socioeconomic backgrounds. Shortcomings are thus thought to exist in the capability of women from lower socioeconomic groups to access breast cancer screening. To address these gaps, the National Cancer Society of Malaysia conceptualized and put together a multistakeholder collaborative project. Aim: The aim of this project was to build, finance and implement a free mammography program for underprivileged Malaysian women. Strategy/Tactics: To ensure geographic equity in provision of this program, 14 individual private hospitals in 10 different states in peninsular Malaysia were negotiated with and agreed to provide the mammogram at highly competitive prices. To address transport and other costs which may have acted as a barrier for patients to attend their screening, transportation costs for groups going for their screening was also subsidized. Additional stakeholders' engaged were nongovernmental organizations (NGOs) especially those working with the economically underprivileged such as religious and other community NGOs. They were roped in as partners to spread the message, identify eligible participants and schedule visits. Some NGOs carried this out as part of their own outreach activities; reserving specific days at the screening centers for themselves. Program/Policy process: The program consisted of a free mammogram provided to Malaysian women above 40 years of age who were determined to be underprivileged; defined for this program as those having a monthly household income below the poverty line (RM5000). If the mammogram was found to be suspicious, a confirmatory breast ultrasound was also performed sans payment. Once conceptualized, the program was successfully pitched by NCSM to ETIQA Insurance, a large Malaysian insurer, who agreed to fund this project as part of their sustainable corporate social responsibility (CSR) initiative. In total, the program funded mammograms for 5000 women over a period of 1 year from July 2017 to July 2018. NCSM advertised the program through various channels; including traditional media, social media, and at various outreach programs and events. Outcomes/What was learned: The program has run for 8 months and has already screened 3550 women nationwide. The multistakeholder collaborative effort has been highly successful at creating awareness on breast cancer screening and providing accurate breast cancer screening for a large number of underprivileged women, some for the first time in their lives.
Comparison Between Drug Costs for the Systemic Treatment of Metastatic Lung Cancer, Overall Survival Gain and Economic Growth in Brazil
Authors: Vinicius G. , Stefani S. , Lorandi V. , Rafaela P. , Souza M. , Leonardo P.
Published: September 2018

Background: Systemic treatment of patients with metastatic lung cancer is considered a major advancement in the field of oncology. Although undeniable progress has been made in the treatment of such patients, affordability of the more recently implemented treatments, for people in the less developed parts of the world has been questioned. Aim: To expose the disparity between cancer drugs costs, survival gain and economic growth in a developing country (Brazil), using first line therapy to metastatic lung cancer (nonsquamous only without driver mutations) as an example. Methods: First we analyzed the costs of all included first-line systemic therapy regimens from NCCN guidelines for metastatic lung cancer (nonsquamous and no driver mutation identified) over the last two decades, dividing the therapy in five broad categories, each one corresponding to a “generation” of treatment. The following regimens were considered: single-agent chemotherapy (cisplatin), first-generation platinum doublet (cisplatin/carboplatin + etoposide), second-generation platinum doublet (cisplatin/carboplatin + vinorelbine/gemcitabine/docetaxel/paclitaxel), third-generation platinum doublet (cisplatin/carboplatin + pemetrexed) and immunotherapy (pembrolizumab). After that, we identified in the pivotal studies, how much median overall survival cumulative gain was obtained in each generation of treatment in comparison with the last one. Then we compiled the data and compared, in graphics, with economic metrics observed for Brazil during the same period, such as nominal gross domestic product (GDP) growth, GDP per capita and inflation. Results: It was observed that the current choice of first line therapy for metastatic nonsquamous lung cancer, without driver mutation: cisplatin + pemetrexed or immunotherapy (for patients with high PD-L1 expression), now costs more than 130 to 200 times the price of single-agent cisplatin. Median overall survival has been increased from 4-6 months to around 10-12 months (all patients considered) or 30 months (for patients with high PD-L1 expression), with small incremental gains for each generation of treatment. In comparison, Brazilian GDP had an increase of 85% during the same time span, while GDP per capita increased 45%. Conclusion: The exponential rising in the price of the drugs surpassed much of the economic growth of Brazil in the last two decades. Although the observed median overall survival has been steadily increasing during the same time span, reaching now an impressive mark of 30.2 months (for patients with a high level of PD-L1 expression), it is not in the same pace as the cost of the drugs. This provides major questions about affordability and access to such treatments, especially in developing countries with larger populations, even if their economy is rapidly growing.
Self-Reported of Awareness, Trial and Current Use of Electronic Cigarettes (ECS) Among of Adult Smokers in Malaysia
Authors: Ruzlin A.N. Mat , Omar M. , Yong H.-H. , Tangiisuran B. , Rani N.A. Abdul , Samin A.S. Mohd , Quah A.C. , Baharom N. , Driezen P.
Published: September 2018

Background: In many parts of the world, E-cigarette (EC) devices are becoming popular and an increasing trend in its usage especially among young people and adult smokers. Aim: To examine the self-reported awareness, trial and current use of ECs among current smokers and to determine the predictors associated with the outcomes. Methods: A total of 40,000 current smokers aged 18 years and above were recruited through intercept face-to-face interview in wave 1 (May-September 2016), wave 2 (December 2016-April 2017) and wave 3 (May-August 2017). The samples were drawn from 5 streets randomly (two in hotspot and three in nonhotspot) within stratified urban and rural areas in 14 states of Malaysia. Respondents were recruited using systematic sampling. Every fifth person passing an interview station in each street was approached. Descriptive analysis and multivariate logistic regression were applied by using PASW 18. Results: Overall, 93% were aware of ECs, 19.9% were ECs trials and 14.6% were current users. Multivariate logistic regression shows that those states with no ban of ECs sales were more likely and significantly associated with these outcomes compared with those in states that this device has already been banned. Those who believe that ECs are “less harmful” (AOR=6.28; 95% CI=5.79-6.81, P < 0.001; AOR=4.84; 95% CI=4.12-5.69, P < 0.001) and “equally harmful” (AOR=2.06; 95% CI=1.91-2.22, P < 0.001; AOR=2.25; 95% CI=1.93-2.62, P < 0.001) were significantly associated with EC trials and current use of ECs respectively. In addition, intention to quit smoking (AOR=2.91; 95% CI=2.72-3.13) was also directly associated with EC trials. Conclusion: Awareness, trials and current use of ECs are likely due to the banning regulation implemented in specific states and strong belief that ECs is less harmful to health. Hence, this should be considered in the formulation of ECs policy in Malaysia.
“Joven y Fuerte Metastásico”: Integrative Oncology Intervention for Metastatic Breast Cancer Patients
Authors: Platas de la Mora A. , Hernández C.L. Gálvez , Platas de la Mora A.L. , Perezamador A. Fonseca , Menéndez-Aponte R. , Rocha E. Bargalló , Betancourt A. Mohar , Garza C. Villarreal
Published: September 2018

Background and context: Breast cancer (BC) patients in Mexico are frequently diagnosed at advanced stages, with stages III or IV comprising up to 60%. Advanced BC (ABC) patients face distinct practical and emotional challenges and are recognized to be vulnerable to additional emotional distress and psychosocial issues, thus needing special supportive interventions. Equally significant are the consequences of the illness for their partners, children, parents and peers. However, in Mexico, a middle-income country with significant socioeconomic limitations, cancer control efforts have been predominantly directed to enhance medical care, while psychological and supportive interventions have not been a priority, especially among the ABC patients. Aim: To promote the empowerment of ABC patients, their children, spouses and caregivers by developing a supportive care model to help them cope better throughout the complex process of ABC. This proposed support intervention is an innovative approach for psychosocial support in a variety of modalities adapted for ABC patients' needs. This project is being supported by the SPARC Metastatic Breast Cancer Challenge. Strategy: Our target population includes patients with ABC followed at the National Cancer Institute in Mexico City. A supportive care model will be developed based on two main interventions: Support groups: Comprises a support group exclusively designed for women with ABC. Also, a toll-free telephone support session will be provided for patients with transportation restrictions to share their concerns. Integrative oncology techniques: This approach involves the implementation of four integrative oncology techniques, which include: occupational therapy, expressive creative techniques, mind–body interventions, and acupuncture. Policy process: The implementation of this adaptive model will allow us to understand the repercussions of the proposed strategy, to prioritize specific techniques in subsequent interventions. This novel support intervention will provide ABC patients, their caregivers, and children, with techniques to better cope through the disease process. We intent to further increase this model to reach patients of other medical institutions. Outcomes: At least 80 patients and their caregivers will participate in the proposed intervention. The results of this project will give us grounds to establish a replicable scheme, ensuring that ABC patients' needs will be addressed in an integral approach. This intervention aims to improve the quality of life of patients and their families. What was learned: At the end of this project a proven supportive care model will be defined and shared with other oncological clinical care centers and NGOs. Ultimately, we aim to contribute to the established guidelines in Mexico for ABC patients.
Financial Resources Digital Navigation Tool for Metastatic Breast Cancer Patients
Authors: Ammendolea C. , Gordon J. , Hall W. , Armstrong R. , Chari N. ,   Canadian Breast Cancer Network
Published: September 2018

Background and context: Although Canadians enjoy a universal health care system, there continues to be costs to patients that are not covered by the system. The economic impact of breast cancer is huge and, in many cases, devastating for patients and their families. As a result there is a need for educational and navigational resources that assist patients with the financial burden of facing a metastatic breast cancer diagnosis. Aim: The aim of this project is to develop an online navigation tool that will assist Canadians living with metastatic breast cancer source financial supports and resources to help lessen the financial impact of their diagnosis. Strategy/Tactics: An advisory board of people living with metastatic breast cancer was convened to help guide this project and provide input on the lived experience and financially challenges of Canadians living with this stage of the disease. The input from the advisory board along with the responses from a survey of over 150 Canadian metastatic breast cancer patients informed the type of information that should be included in the resource. Through an environmental scan and research of various financial supports, a comprehensive list of financial resources available locally, regionally and nationally was compiled. This data were integrated into a database that will be accessed through an intuitive online interface that will be integrated with CBCN´s Web site. The advisory board reviewed the draft content and framework to ensure that identified needs and priorities have been addressed. All content was translated into French as this tool will be offered in both French and English. The anticipated launch of this resource is November 2018. Outcomes: CBCN anticipates that over 1200 people living with metastatic breast cancer will access this resource in the first year and that over 50 institutions will be informed that this tool is available for their patients. Given that this will be a unique resource, CBCN expects that patients, health care professionals and support workers will access this resource to better support people living with metastatic breast cancer. What was learned: This resource has not launched, but based on CBCN´s research and the feedback of the patient advisory board, it is understood that there is a great need for this financial resources navigation tool.