bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vitro Anti-Cancer Analyses of Selected Apocynaceae Family Species From Sri Lanka
Authors: Kuruppu A.
Published: September 2018

Background: According to the World Health Organization around 65% of the world's population rely on traditional medicines derived from plants for their primary healthcare needs. Plants have been used as medicines for many number of years. Sri Lanka has a rich traditional medicine history of around 3000 years and has an ample amount of plants being a tropical island. Sri Lanka has around 1430 medicinal plant species and number of these species have been used for cancer therapy by traditional medicine practitioners in the country. The cancer incidence in Sri Lanka is rising due to population aging, various life style factors such as westernized diets, smoking and lack of physical activity. Thus preventive measures such as various kinds of anticancer foods should be introduced. Aim: Tabernaemontana divaricata (TD) and Plumeria rubra (PR) which belong to the Apocynaceae family of plants and they are commonly found in Sri Lanka and they were tested to determine their anticancer activity. Methods: Leaves and stems of the plants were collected from Colombo district Sri Lanka. Ethical approval was obtained from the Department of Forest, Sri Lanka. Finely dried leaves and stems were subjected to ethanol extractions. MTT, clonogenic, cell cycle, apoptosis, gamma H2AX, cell migration, reactive oxygen species (ROS), environmental scanning electron microscopy (ESEM) were used to determine anticancer activity. Results: HER2+ SKBR3 cell line showed the best sensitivity to both plants among a panel of breast cancer cell lines. TD-GI50 leaf extract: 6.89 µg/mL ± 1.72; stem extract: 12.49 µg/mL ± 4.04) and PR-GI50 leaf extract 17.45 µg/mL ± 2.05; stem extract was not active. Clonogenic assays showed low colony formation for all active extracts in SKBR3 cells ( P ≤ 0.001). All extracts caused G1 arrests in cell cycle analysis compared with SKBR3 control ( P ≤ 0.0001). Minor amounts of apoptotic populations were observed with extracts compared with SKBR3 control ( P ≤ 0.01). Further, both leaf extracts caused minor amounts of DNA double strand breaks by gamma H2AX analysis in SKBR3 cells ( P ≤ 0.05). All extracts showed low SKBR3 cell migration ( P ≤ 0.0001). Both leaf extract were able to generate high levels of ROS in SKBR3 cells ( P ≤ 0.001). ESEM demonstrated morphologic differences in TD leaf extract treated SKBR3 cells. Conclusion: These results are promising and shows anticancer activity. Chemical compounds are being isolated from these plants. Sri Lanka is yet to develop anticancer drugs from its natural products, and these plants can be a stepping stone in the quest of finding novel therapies for cancer from Sri Lanka. Further, these results can be used to develop cancer preventive food supplements as well since the number of cancer cases are rising in the country.
Barriers for Young Women to Participate in The Danish Cervical Screening Program
Authors: Bigaard J. , Mortensen J.H. , Kvernrød A.-B.
Published: September 2018

Background: In Denmark, the coverage rate for cervical cancer screening is about 75% for women aged 23 to 64 years whereas the participation rate is 65%. The participation rate varies with age, and is between 47%-57% among women in their twenties. In 2005, a qualitative study among women between 23 and 39 years found a range of barriers for nonparticipation. Barriers were lack of knowledge about the aim of cervical screening (i.e., the possibilities for early detection and treatment of cervical dysplasia), lack of knowledge about HPV as a very common virus causing dysplasia and cervical cancer and finding the time to make an appointment with the GP. 10 years later a follow-up study among women aged 30 to 50 years found similar barriers (i.e., lack of knowledge about HPV and cervical screening as a preventative method). Despite the different barriers, most women wanted to take part in screening, but a busy everyday life meant that they forgot about the invitation or they did not book an appointment with their GP. Aim: We investigated barriers for participation in the first generation of HPV-vaccinated women in Denmark aged 23 to 29 years. Methods: Qualitative interviews (focus groups) with women aged 23 to 29 years, who had all received one or more invitations to partake in cervical cancer screening, but who had not participated. Results: A preliminary analysis of the first six focus groups identified a handful of interrelated barriers similar to older women. The most important barrier being insufficient knowledge or lack of knowledge about HPV as the cause of dysplasia/cervical cancer (i.e., the high incidence of HPV-infection in women under the age of 35). Furthermore, few women knew about the screening program being an important supplement to their HPV-vaccine, and therefore did not find the program of relevance to them. Conclusion: Surprisingly, the preliminary results suggest important barriers for participation in cervical screening for women aged 23 to 29 to be insufficient knowledge or lack of knowledge about HPV-infection and the importance of regular smear tests as a supplement to their HPV-vaccine. The women did not perceive the smear test relevant enough to exert action and book an appointment with their GP. Barriers remained similar across age groups within the last 12 years despite health campaigns.
Contribution to the Screening and Early Detection in Breast Cancer
Authors: Rodriguez A.
Published: September 2018

Breast cancer is a public health issue in Uruguay. The Law 16.097 declared the national interest to fight against cancer and created the Honorary Commission to Fight Against Cancer- CHLCC. One of its tasks is to coordinate and develops programs for prevention and early detection. On 1992, an education campaign about the importance of early detection in breast cancer began. Six years later a program was created for early detection, to increase life expectancy and reduce the mortality. Other actions were done, for example: support National Cancer Register; create a Training Program; collaborate with the Health Ministry in the National Program Cancer to create the National Cancer Guidelines. As a result of these actions, inequalities are drastically reduced because the early detection of the tumor between others reasons; for example universal access to mammography. Mammography equipments were purchased or obtained trough agreements with institutions, so the accessibility to the exams became easily possible. At the same time, a norm was implemented. As a result, women have one free day per year at work to do their exams. All these programs are provided by the CHLCC own fundings, coming from taxation of the state. Twenty years after the beginning of this work, the standardized mortality rate of breast cancer has dropped from 24.8 in 1997 to 19.4 cases per 100,000 inhabitants in 2014, showing a decrease of almost 22% during this period. In the present time, 66% of breast cancers are diagnosed in stages I or II and the survival rate is 86% after 5 years. Between other factors, public global action allows for early diagnosis and improvement of survival rates.
Survival Estimates for Some Types of Cancer in Brazil and Regions Based on the M:I Ratio
Authors: Reis R. , Scaff A.
Published: September 2018

Background: An indirect measure of cancer survival is an application of the mortality and incidence ratio (M:I). In populations with deficits in population survival studies, such as Brazil, using a methodological alternative is a strategy to estimate population survival. Aim: To calculate the cancer survival in Brazilian population using the mortality to incidence ratio. Methods: The complement of the ratio of adjusted incidence rates and cancer mortality rates [1 − (M:I)] was used as an estimate of relative 5-year survival for female breast, lung, prostate, cervix and stomach. As information about the incidence was extracted through 22 PBCR and the mortality information with the atlas of mortality online. Was calculated the medians of the M:I ratios for regions and Brazil, by sex. Results: The median survival estimate for estimated breast cancer was 74%. The southeast region had the highest median (79%) while the north region had the lowest (68%). For lung cancer, the medians were 13% and 16% (male and female, respectively). Prostate cancer has a median survival estimate of 79% and cervical cancer 64%. Stomach cancer also presented the lowest median survival estimates for both sexes. Conclusion: Survival estimates based on M:I ratio could be an alternative in the absence of population survival studies. However, it does not replace the study of survival with active search, it only allows to know the order of magnitude of the survivors in the absence of these studies. This methodology allows to know an estimate of the relative survival in 5 years of cancer since works of population with active search are scarce in Brazil.
Engaging Men in Psychosocial Cancer Support
Authors: Wallace I. , Macgregor C. , Turnbull P. , Allan A. , Howells L. , Anderson A.
Published: September 2018

Background: Despite increasing rates of cancer survivorship, there is still evidence to suggest men are less likely to access information services, health services and cancer screening. Men may be more reticent to express their emotions in relation to health and specifically in relation to cancer; and so it is important to ensure that services offer different routes to inclusion. Maggie´s ( www.maggiescentres.org ) is an innovative, multidisciplinary, health professional led model of holistic supportive cancer care, widely regarded as an exemplar of best practice in cancer rehabilitation and supported self-management. In 2017 Maggie´s received 249,247 visits across their network of twenty-three centres in the UK, Hong Kong and Tokyo. One of the key challenges for Maggie´s and others is to develop sustainable, innovative and equitable approaches to supportive care. Aim: To explore whether male-specific facilitated support groups provide a constructive environment within which men can engage with health professional led holistic cancer services. Methods: Men (n=39) with a range of cancers (including curative and noncurative) from varied socioeconomic backgrounds, attending male-specific facilitated support groups at eight Maggie's Centres in the UK completed questionnaires to give feedback on the social, emotional, practical and informational support the groups aim to provide. A smaller subset of group members (n=12) participated in focus group discussions to capture themes about why men attend the groups. The group facilitators were interviewed to provide observations about the impact of the groups on both the participants and themselves. Results: Men in the facilitated support groups report high levels of satisfaction in relation to practical (94.8%), emotional (95.2%) and social (90.47%) and informational support (92.50%). Thematic analysis of the smaller subset of focus group data suggest reasons why men attend male-specific support groups including “reducing isolation and developing a sense of belonging”, “creating shared experience and understanding”, “safely expressing emotion”, “protecting loved ones from distress” and “use of male specific language and humor”. Conclusion: Globally, the supportive care needs of men affected by cancer are changing but the Maggie´s model of care offers valuable lessons that can be generalized across varied support settings to meet these emerging needs. The current study underlines the importance of engaging and supporting men throughout the cancer experience through the use of professionally facilitated support groups that discuss themes tailored to the challenges the men face and maximize the opportunity for acceptable social support. Further controlled longitudinal research is required to build on these findings.
Ignite Hope (SPARC MBC Challenge Project)
Authors: Alikpala M.J.K.
Published: September 2018

Background and context: Breast cancer is the number one cancer in the Philippines. It has 20,267 new cases a year representing nearly 20% of all new cancer cases. The few government medical access programs for the poor cater to patients with early stage breast cancer. Yet there is no access to free breast cancer screening. There has been a bias against women with advance and metastatic breast cancer (mbc) in terms of medical access programs and support services. Most assume that the needs of breast cancer patients with late stage cancer are the same as those with early stage. The ICANSERVE Foundation would like to identify the needs of patients with advance and mbc and know the resources available to them. Only one city in the country has community-based patient navigators. Their orientation has been geared toward the newly diagnosed with early stage breast cancer. The project will involve retraining of these navigators to include the unique needs of patients with advance and mbc. A new batch of navigators will be trained from other cities. ICANSERVE will try to convince these partner cities to institutionalize patient navigation through local legislation. Aim: To identify the needs of women with late stage breast cancer and mbc; to make a listing of available resources to them; for patient navigators to encourage women who are in remission to go for regular check-ups to monitor the possibility of a recurrence; to institutionalize a patient navigation program for breast cancer patients through legislation Strategy/Tactics: The patient navigation training and retraining will be conducted with existing partners of ICANSERVE so the buy in is faster. ICANSERVE will ask the help of its other partner, the influential Metro Manila Mayors' Spouses Foundation, to convince its member cities to institutionalize the navigation program. Program/Policy process: A research agency will conduct interviews with 12 women with late stage or mbc to know their needs. Research will be done to study the available resources for them. Brochures and media releases will be produced listing these resources. A patient navigation training course shall be conducted for 10 navigators representing 4 cities. Discussions will be made with city officials to convince them to institutionalize the patient navigation program. Outcomes: Anticipated outcomes: A study on the needs of women with advanced and mbc, a first for the country, can be a basis for government to provide programs responsive to these patients. The study can make patient navigators more attuned to their needs. Navigators can lead the way in showing these patients must not be discriminated. They can still be productive members of society. Knowing where help is available, navigators can offer clearer patient pathways. Hopefully the patient navigation program can be institutionalized through a local law.
Mapping Stakeholders to Enhance Coordination of Cancer Prevention and Control: The Kenyan Experience
Authors: Karagu A. , Cira M. , Akhavan M. , Duncan K.
Published: September 2018

Background: Coordination of stakeholders in cancer prevention and control ensures prudent use of available resources toward a common goal while limiting overlaps and redundancies. The National Cancer Institute of Kenya (NCI-K) is a statutory body with an overall mandate to coordinate and centralize all activities related to cancer prevention and control in Kenya. To identify baseline status of cancer control stakeholder activity to guide implementation of the National Cancer Control Strategy, NCI-K collaborated with US National Cancer Institute (NCI-US) to map stakeholders involved in cancer control in Kenya. Aim: The survey set out to determine the geographical distribution, scope of cancer prevention and control activities, and sources of financing for identified stakeholders involved in cancer prevention and control in Kenya. Methods: Between October 2017 and March 2018, we conducted an online survey among stakeholders involved in cancer prevention, research and control in Kenya adapted from similar stakeholder mapping activities coordinated by NCI-US in other settings. Using attendance lists to past multisectoral forums organized by NCI-K, Kenyan Ministry of Health, and NCI-US, a Google link to a standard pretested questionnaire was circulated. Descriptive analysis was conducted using Microsoft Excel. Results: A total of 52 responses were received with 38 respondents reporting Kenya as their institution country. Twenty (38%) had ongoing activities in all the counties in Kenya. Nairobi County had the highest reported number of active institutions (19) followed by Kisumu (16) and Uasin Gishu (10). The three program focus areas most reported were training 28 (54%), clinic-based screening 27 (52%) and advocacy/information and educational 26 (50%), while the least reported was financing 12 (23%). For organizations involved in cancer screening, 22 (81%) focused on breast cancer while 18 (67%) prioritized cervical cancer. Among the programs that identified cancer prevention as one of their focus areas, a large majority (91%) were involved in health education, while only 1 organization focused on environmental control activities. The most reported source of funding for the cancer programs was grant funding 17 (33%). Conclusion: This stakeholder mapping activity has identified a strong stakeholder presence in most parts of the country while also highlighting gaps in the focus of cancer prevention and control programs. This baseline information on stakeholder activity will help shape future collaborations in cancer prevention and control and will guide NCI-K in developing appropriate policies and ensuring effective coordination.
The Relationship Between Psychological Flexibility, Value-Based Living and Emotional Well-Being in People Affected by Cancer
Authors: Smith E. , Gow A. , Forsyth L. , Bryne B. , Howells L. , Anderson A. ,   Maggie's Centres
Published: September 2018

Background: Receiving a cancer diagnosis can have detrimental effects on an individual's psychological flexibility (ability to adapt constructively to reality), emotional well-being and ability to live aligned with personal values, for example, in relationships and work. Higher levels of psychological flexibility and emotional well-being are associated with better quality of life and lower psychological cancer-related distress. In turn, value-based living is positively associated with psychological flexibility and emotional well-being. There is, however, limited research specifically exploring the relationship between value-based living and emotional well-being within individuals affected by cancer. Maggie's Centres ( www.maggiescentres.org ) offer an innovative, multidisciplinary model of holistic supportive cancer care, widely regarded as an exemplar of best practice in cancer rehabilitation and supported self-management. In 2017 Maggie's received 249,247 visits across the network of Centres in the UK, Hong Kong and Tokyo. Principles of ACT (acceptance and commitment therapy) are incorporated within the program of individual support, psychoeducational courses and groups to help people maximize their quality of life. Aim: To explore the associations between psychological flexibility, value-based living and emotional well-being in individuals affected by cancer. Methods: Sixty-five people, affected by a cancer diagnosis personally or in a family member, were recruited from four UK Maggie's Centres. Participants completed standardized questionnaires measuring psychological flexibility, valued-based living and emotional well-being. Results: Moderate positive associations were found between emotional well-being and psychological flexibility (r=.4750), as well as emotional well-being and valued-living (r=.37983). Psychological flexibility was also positively associated with valued living (r=.443474). Multiple regression analysis revealed a significant model (F(5,54)=9.35, P < .001), accounting for 41.4% of the variance in emotional well-being (adjusted R2 = .414). Both psychological flexibility (b=.357, P = .002) and valued-living (b=.337, P = .004) were predictors of emotional well-being across all ages, gender and time since diagnosis. Conclusion: The study provides support for the positive associations between psychological flexibility, valued-living and emotional well-being and indicates that psychological flexibility and valued-living may be predictors of emotional well-being. This was a small observational study, so conclusions about causation or change over time cannot be made. Longitudinal intervention studies need to explore the potential impact valued-living and psychological flexibility may have on emotional well-being in those affected by cancer, and so contribute to understanding the potential importance of encouraging valued-living as a therapeutic tool within cancer care.
Promoting Early Diagnosis of Breast Cancer in Nigeria Using Materials Designed to Cross Communication Barriers of Fear, Taboo and Literacy Between Health Care Teams and the Community at Risk From Breast Cancer
Authors: Beaumont C. Ellsworth , Nwankwo E.
Published: September 2018

Background: Nigeria, annually, has the highest numbers of death from breast cancer (BC) in Africa, estimated at 10,000. While BC incidence is declining in many parts of the world, it is increasing in Nigeria. Delay in BC diagnosis in Nigeria is due to: i) health care professionals (HCPs) and patients having poor knowledge of BC causation and symptoms; ii) incorrect diagnosis of symptoms; iii) delay in treatment seeking; iv) use of ineffective/harmful treatment methods.1 Low literacy rates, fear of cancer and the cultural taboos associated with BC create communication hurdles difficult to overcome.2 Aim: Increased HCP and patient of knowledge of BC causes, symptoms and detection, and improved communication between HCP and patients, resulting in increased and improved diagnostic protocol adherence, more patients self-reporting symptoms, and ultimately down-staging of patients. Methods: i) Aggregation of historical data of participating clinics of patients BC stage at diagnosis; ii) survey of HCP knowledge of BC symptoms and diagnostic protocols before and after seeing Worldwide Breast Cancer´s (WBC) Know Your Lemons (KYL) education materials; iii) frequency of display of KYL posters in clinics; iv) HCP survey of frequency of BC health discussions during a clinic visit; v) pre- and postsurvey of patient knowledge, interest and willingness to report symptoms at community education sessions, vi) count of number of patients reporting symptoms while making/attending clinic appointments. Results: Increase in HCP knowledge of symptoms and diagnostic protocols before and after seeing the KYL education materials; more visible use of patient friendly BC education materials displayed in the clinic; increase in frequency of breast health discussions initiated by HCPs with their patients; improved patient interest and knowledge of symptoms and diagnostic protocols; increase in patient confidence in being able to recognize a BC symptom; increase in patients making clinic appointments and self-referring symptoms to HCPs. Conclusion: As proven in other parts of the world with the KYL education materials, the researchers aim to prove, in undertaking this study in Lagos, Nigeria, that training HCPs (e.g., patient navigators, community workers, primary care physicians, mammography technicians) and patients in the signs/symptoms and risk factors for breast cancer using WBC´s bright, appealing and eye catching KYL materials can improve how HCPs and patients communicate about BC symptoms and detection option, which leads to earlier stage of diagnosis. 1. Agba et al, 2012; American Cancer Society, 2011; Cancer Today, 2012; Ogundipe, 2011; Osain, 2011; Prevalence of Breast Cancer, 2015. 2. Okpara and Kabongo, 2011; Total Facts Nigeria, 2017; World Atlas, 2017.
BWS Experience in Integrating Cancer Care
Authors: Iloanusi N. , Nnamani A. , Okoye I. , Lasebikan A. , Okwuosa C. , Ezeilo L. , Mba I.
Published: September 2018

Background and context: Nigeria, being the most populous African country has the highest cancer burden. Fragmentation of healthcare services leads to late presentation, inappropriate navigation, delay in diagnosis, intervention and an increased loss to follow-up. Aim: To have a harmonized and fast-tracked cancer diagnosis and management via providing an integrated cancer care and effective navigation to tertiary hospitals, when required. Strategy/Tactics: We set up a center to screen, diagnose and treat cancers in partnership with collaborators, at low cost to patients. Program/Policy process: The BWS (Breast Without Spot) Screening and Wellness Centre was set up in 2016 to offer cancer/NCD education, screening services for cancers and other noncommunicable diseases. A multidisciplinary volunteer team takes care of diagnostic ultrasound, ultrasound-guided biopsies, cryotherapy of premalignant cervical lesions, histopathology and chemotherapy. Where radiotherapy and surgery are indicated, patients are navigated appropriately to our collaborators in tertiary hospitals. Outcomes: 721 persons were seen. 112 men and 609 women, 14 men had PSA/DRE and 411 women had VIA and CBE. 58 women had sonomammography while 9 with suspicious masses had ultrasound-guided biopsies followed by histologic diagnosis and IHC for proven malignancy. In the women with proven breast cancer, 7 underwent chemotherapy while 8 were navigated to radiation therapy and surgery. What was learned: There is improved patient experience and compliance when there is an accessible “one stop” facility for their care. Early detection, prompt diagnosis and facilitated treatment improves prognosis. With prompt access to care, patients feel supported and eager to go through the entire cancer care process.
Cancer Council New South Wales Policy and Advocacy Report: Community Insights to Inform the Policy Positioning of Smoke-Free Legislation Reform in NSW, Australia
Authors: Engel A.
Published: September 2018

Background and context: In the lead-up to the next state election, Cancer Council New South Wales (CCNSW) will run the “Saving Life 2019” advocacy campaign focused on changing NSW Government policy in cancer control. In developing a policy agenda, three priority areas were identified that required further research to better understand public perceptions, inform messaging and engagement strategies. Reform of current smoke-free laws was identified as one of these priorities. Aim: Understand how key audiences view current smoke-free laws and issues of exposure to second-hand smoke in NSW licensed venues; Find new opportunities to progress policy objectives by identifying additional key audiences in the general population; Build the evidence base for a salient and convincing messaging guide for the advocacy campaign strategy and our broader policy engagement and influencing work. Strategy/Tactics: The campaign will seek to demonstrate community support for the reform of current smoke-free laws in NSW to the community, the media and political candidates to achieve policy commitments. CCNSW existing campaign strategy includes tactics across grassroots mobilization, targeted political engagement and securing earned media. The development of strategic research to underpin this campaign, including development of an evidence-based communications strategy, was critical in optimizing our communications and public engagement. Program/Policy process: Cancer Council NSW worked with an external agency to conduct the research. The research used a mixed methodology that included a facilitated online focus group of up to 20 people, followed by polling of the general public. Focus groups were conducted over two days, with participants recruited from a wide geographical spread. Targeted sampling to ensure participants visit a pub or club at least once per fortnight was also incorporated. Outcomes: A research and communications report containing an overview of the research, key findings, as well as communications considerations based on the research was used to inform our overall campaign strategy, including policy messaging and communications planning. What was learned: Preliminary findings noted that while smoking and related health issues is a key concern for participants, it is of greatest concern among those who are smokers, have previously smoked, or are close to someone who does. They revealed a high level of awareness of the meaning.
The Feasibility and Performance of the Patient Navigation Programme in Improving Breast Cancer Care in Malaysia
Authors: Jaganathan M. , Zainal N.H. , Rajaram N. , Hwang T. Soo , Wahab M.Y. Abdul
Published: September 2018

Background: Breast cancer is the most common cancer in Malaysia and it is anticipated that incidence will increase by 49% from 2012 to 2025. Unfortunately, survival remains poor because of late presentation and poor adherence to evidence-based medicine. Barriers to early presentation include inadequate knowledge about the disease, financial issues, negative influence of relatives and perceived poor quality of care and services in state-run hospitals. Poor adherence to treatment is also a common struggle, and is further exacerbated by the use of traditional, alternative healing methods. While patient navigation (PN) programs have been shown to improve breast cancer outcomes in the US, its implementation and performance in low and middle income countries is not well studied. Aim: We sought to determine the impact of a PN program in reducing treatment delays and improving adherence to treatment and patient satisfaction, as well as to evaluate the barriers faced by women seeking breast cancer care in Malaysia. Methods: We established a nurse-led patient navigation center at a secondary government hospital in Klang. This clinical team involved the surgery, pathology, radiology and nursing departments and provided patient-centered care, including patient tracking and call reminder systems, family counseling, health education and decision aids. The community team involved a Patient Navigator Program Coordinator and a Community Navigator. We compared treatment delays and adherence to treatment between navigated patients and patients registered in the year prior to the PN program. We used Student t-tests and Pearson χ2 or Fisher's Exact tests to compare timeliness between navigated patients and patients registered in the year prior. Results: Of the 136 Malaysian women enrolled in the PNP in 2015, 48.9% were diagnosed with advanced disease (stage 3 or 4). Women with advance disease had a lower median monthly household income compared with women with early disease (USD $350 vs $540, P = 0.023). Women with advance disease were also less likely to have personal transportation to the hospital (36.4% vs 56.5%, P = 0.048). Compared with the year before PN, more navigated patients underwent mammography within 7 days of their first visit (96.4% vs 74.4%, P < 0.001) and received their diagnosis within 14 days of their first visit (80.0% vs 58.5%, P < 0.001). The proportion of women who met timeliness to treatment initiation was similar for navigated patients and patients in the year prior. The proportion of defaulters were marginally lesser among navigated patients compared with the year prior (4.4% vs 11.5%, P = 0.048). Conclusion: We found that integrating PN within a breast clinic of a middle income country is feasible, and in the long run, could improve outcomes for breast cancer patients. Long-term follow-up is needed to assess the impact of the PN program on improving treatment completion and survival.
Delays on Breast Cancer Treatment in Brazil: Implications on Survival
Authors: Silva I.F.d. , Monteiro S.D.O. , Koifman R.J.
Published: September 2018

Background: Breast cancer survival may vary among regions in Brazil, being lower in northern and northeastern than in southern and southeastern regions. Earlier studies in developed countries have suggested that increased time intervals of care are associated with poorer chances for survival. There is a lack of studies on developing countries about the effect of time interval on survival. Aim: To estimate the effect of treatment delay on 3- and 5-years survival among women diagnosed with breast cancer treated on the National Cancer Institute in Rio de Janeiro, Brazil. Methods: A retrospective study on a cohort of 3220 women newly diagnosed with breast cancer between 2011 and 2013 was accomplished. Follow-up time was 60 months for women diagnosed in 2011-2012 (n=836), and 36 months for the whole cohort. Times from diagnose to treatment initiation were analyzed according to the Brazilian law for cancer patient treatment (< 60 > days). All data were obtained from hospital-based cancer registry and medical reports. Estimates of 3- and 5-survival were proceeded by Kaplan-Meier method. Survival curves differences were evaluated by 95% log-rank test. Crude and adjusted hazard ratios between delay on treatment initiation, age, education, stage and 1st treatment and death risk were estimated by proportional Cox regression with respective 95% confidential interval. Results: Mean time follow-up in the 2011-2012 cohort was 55.3 (± 12.7) months with median time of 60 months; while in the whole cohort mean follow-up time was 34.1 (± 6.1) months with 36 months of median time. Concerning the treatment delay, 3-years survival rates were 88.7% among women with ≤ 60 days for treatment initiation and 88% among women with delay on treatment (log-rank: 0.786); while 5-years survival rates were 85.2% among women with ≤ 60 days to treatment and 82.5% for women with delays on treatment (log-rank: 0.373). Delay on treatment (OR=0.77; 95 CI: 0.61-0.97), age ≥ 70 years old (OR=2.03; 95% CI: 1.46-2.82), late stage at diagnosis (OR=7.48; 95% CI: 2.27-24.61), and 1st treatment (ORCHEMO=2.66; 95% CI: 1.82-3.90; ORRADIATION/HORMONE=2.53; 95% CI: 1.58-4.06) were independently associated with death risk in 3 years. Death risk in 5 years is independently associated to age ≥ 70 years (OR=3.37; 95% CI: 1.89-6.00), chemotherapy as 1st treatment (OR=2.05; 95% CI: 1.04-4.03), and late stage (OR=11.14; 95% CI: 1.41-88.06). Conclusion: Delay on treatment initiation seems not influence 3- and 5-years survival rates in the studied population. However, after adjusted by age, stage, and treatment, delays on treatment initiation affected negatively the death risk in 3 years. On the other hand, 5-years death risk was independently associated with age ≥ 70 years, chemotherapy as 1st treatment, and late stage.
Learning Experience Contribution to Effective Cancer Education?
Authors: Muhamad M. , Maskor N.A. , Ismail A.
Published: September 2018

Background: Cancer patient needs information to make informed decision. A registered cancer society in Malaysia, KanWork supports those affected by cancer by providing such information through regular structured education program. The programs were designed based on the learners needs addressing issues related to medical, clinical, psychological, spiritual, motivational, and healthy lifestyle. The programs were carried out in collaboration with cancer hospitals at their venues. Each program lasted 3 hours. The program was guided by adult learning principles. For accountability and further improvement, there is a need to evaluate the effectiveness of the program. This paper reports the programs and their effectiveness from the participants' perspective. Aim: To determine the relationship between program management (learning experience provided to participants, and facilities), and the cancer education program effectiveness. To determine predictors that contribute toward the program effectiveness. Methods: A customized instrument to measure the education program effectiveness related constructs was developed guided by literature. The questionnaire was administered to 868 participants of 8 cancer education programs carried out between 2015 and 2017. 481 (55%) returned the questionnaire. Descriptive statistics, Pearson product-moment correlations and multiple linear regression were used to analyze the data. Results: Majority (91%) who attended the education program were women and cancer patient/survivor (50%). There is positive relationship between learning experience (r=0.895, P = 0.00), program facilities (r=0.435, P = 0.00), and program effectiveness. Learning experience (β = .916; P < .000) showed a predictor and major contribution to cancer education program effectiveness. An appropriate learning experience to learner is critical to ensure the education program effectiveness. Adult learners joined the program to solve their problematic situation in their cancer journey. An appropriate learning experience is one that contributes to meeting their needs, they can follow (e.g., conducted in local language) (Bahasa Malaysia) and terms they can comprehend, and with two way communication channel that gives them chance to be engaged. The experienced facilitators, expert in their respective fields were able to provide meaningful learning experience to participants. Conclusion: Appropriate learning experiences and program facilities contributes toward effective cancer education program in a Malaysian context. The findings strengthen adult learning constructs that guide such program. Further research will give insight to education program in different contexts.
Prevalence and Spectrum of Breast Cancer Inherited Mutations in Uganda and Cameroon Women
Authors: Adedokun B. , Zheng Y. , Ndom P. , Gakwaya A. , Makumbi T. , Sallam A. , Olopade O. , Huo D.
Published: September 2018

Background: Breast cancer among indigenous Africans is characterized by higher prevalence of triple-negative disease and poor prognosis. A previous study in Nigeria reported a strikingly high prevalence of deleterious germline mutations in BRCA1 and BRCA2 among Nigerian women with breast cancer. It is unknown if this is true in other sub-Saharan African countries. Aim: The objective of this study is to determine the frequency of germline mutations among an unselected sample of women in Africa. Methods: We conducted a case-control study of breast cancer in Uganda and Cameroon to investigate genetic and nongenetic risk factors for breast cancer. Breast cancer cases were enrolled in two tertiary hospitals in the two countries, unselected for age at diagnosis and family history. Controls who were free of breast cancer were enrolled in the same hospitals and matched to cases on age. A 24-gene sequencing panel was used to test germline mutations in cases and controls. Results: There were 176 cases and 177 controls with a mean age at diagnosis of 46.2 years for cases and mean age at interview of 46.7 years for controls. Among cases, 18.2% carried a pathogenic mutation in a breast cancer gene: 6.3% in BRCA1, 6.3% in BRCA2, 1.7% in ATM, 1.1% in PALB2, 0.6% in BARD1, 0.6% in CDH1, 0.6% in TP53, and 1.2% in any of 17 other genes. Among controls, 2.3% carried a pathogenic mutation in one of the 24 susceptibility genes. Cases were 9.6-fold more likely to carry a mutation compared with controls (odds ratio=9.61, 95% confidence interval: 3.28-38.1; P < 0.001). The mean age of breast cancer cases with pathogenic BRCA1 mutations was 38.3 years compared with 46.7 years among other cases without such mutations ( P = 0.03). There was a trend that cases with a positive family history had higher chance of carrying a mutation (33.3%) than cases without (17.1%), but few cases reported a positive family history. Conclusion: Our findings confirm the earlier report of a high proportion of deleterious mutations in BRCA1 and BRCA2 among breast cancer patients in sub-Saharan Africa. As most of these women present with advanced breast cancer, there is an urgent need to improve access to genomic testing and life saving cancer medicines including chemotherapy and clinical trials of novel agents like PARP inhibitors. Given the high burden of inherited breast cancer, genetic risk assessment should be integrated into cancer control plans in sub-Saharan Africa.
Effect of Nurse Navigation Program on Colorectal Cancer Screening Behaviour of the Individuals Aged 50-70
Authors: Temucin E. , Nahcivan N.O.
Published: September 2018

Background: Colorectal cancer (CRC) is the third leading cause of cancer mortality in the world. In Turkey, it is the third most commonly diagnosed cancer and fourth leading cause of cancer death. Cancer screening activities are mostly initiated and implemented at primary health care services. Despite it is known that benefits of screening in reducing CRC incidence and mortality rates CRC screening rates are significantly lower among men and women in Turkey. However there are several interventions have been proposed to identify and remove barriers for increasing CRCS in the literature, navigation programs, also known as individualized counseling, have begun to used as a promising method recently. Aim: The aim of this study is to evaluate effects of Nurse Navigation Program that is administered to individuals aged 50-70 on their screening behavior concerning colorectal cancer (fecal occult blood test and colonoscopy) and their beliefs about this process. Methods: The study was designed experimental pretest-posttest control group design. In the study it is used random assignment to intervention and control groups, with blocking stratified. The participants of the study were 110 individuals aged between 50 and 70 registered to a family health center in İstanbul. The 'Nurse Navigation Program' was administered to the participants. The data were collected through the use of the following three tools: the Demographical Information Form, The Harvard Colorectal Cancer Risk Assessment Tool, Instruments to Measure Colorectal Cancer Screening Benefits and Barriers. The data obtained were analyzed by the descriptive and significance analyses. Results: Following the Nurse Navigation Program the experimental groups FOBT (82% and 84%) and colonoscopy completion rate (15% and 22%) were significantly higher in the control group at 3 and 6 months follow-up. Following the program when compared with the control group it is found that the mean score of the barriers perception of the experimental group was significantly lower and the mean score of the benefits perception of the experimental group was significantly higher. Conclusion: The results show that the Nurse Navigation Program had significant effects on the CRC screening behavior and health-related beliefs concerning the CRC screening. It can be suggested that the Nurse Navigation Program can be further tested on different groups to observe its effects.
Collection and Reporting of System-Wide Cancer Treatment Activity Data As Part of the Stage, Treatment and Recurrence (STaR) Project
Authors: Long R. , Luzuriaga J. , Biondi C. , Woods A. , Jackson P. , Anderiesz C. , Giles C. , Zorbas H.
Published: September 2018

Background: The need for high quality, comprehensive national data on the treatments applied to cancers is widely recognized within the Australian cancer control community. The analysis and reporting of cancer treatment data will greatly enhance our ability to better understand cancer care activity and outcomes - and in particular the treatments being applied across population groups. Aim: To collect and report national data on cancer treatments, as part of Cancer Australia's Stage, Treatment and Recurrence (STaR) project. The linking of this data with national data on stage at diagnosis, survival and recurrence, will help inform policy and practice and ultimately improve cancer outcomes. Methods: Cancer Australia developed a dataset of selected surgical procedures for the treatment of the top five incidence cancers (prostate, breast, colorectal, lung, and melanoma). A dataset of key selected radiotherapy, and systemic therapies for the treatment of all cancer types was also developed.

Data for reporting system-wide treatment activity were extracted from existing national health administrative datasets, including: the Pharmaceutical Benefits Scheme (PBS), the Medicare Benefits Schedule (MBS) and the National Hospital Morbidity Database (NHMD). The scope of the analysis was selected surgical procedures, radiotherapy procedures, or pharmaceutical agents administered with the general intent to change the outcome of the cancer and/or provide symptom relief/ palliative care. Results: The data reported provide a high-level national system-wide overview of cancer treatments applied, including: • More than 1 million radiotherapy services were provided for all cancers combined in Australia (as indicated by MBS reimbursement claims data) for the years 2013 to 2015 inclusive; • The number of people receiving systemic anticancer therapies in Australia for all cancers combined (as indicated by PBS reimbursement claims data) increased from 198,756 in 2012 to 247,939 in 2016; and • The number of hospital separations recorded in the NHMD (i.e., episodes of admitted patient care) for patients with a principal diagnosis of cancer undergoing surgery for the treatment of the top five high incidence cancers in Australia increased from 53,516 in 2010 to 57,651 in 2015. Conclusion: National cancer treatment data were successfully collected and reported. Australia is one of very few countries in the world to collect and report national system-wide treatment data with a specific focus on cancer. These data will be linked to cancer incidence, stage at diagnosis, survival and recurrence data to help inform for population-level reporting of cancer outcomes.
Understanding Cancer Survivors' Employment Experiences When Returning to Work After Primary Treatment: A Longitudinal Qualitative Study
Authors: Urquhart R. , Drake E.K.
Published: September 2018

Background: Worldwide, the number of people surviving cancer long-term is growing. This is due to an increase in incidence rates, coupled with earlier detection and improved treatments. Among the difficulties many cancer survivors face are the unique challenges associated with reintegrating back into the work environment after an absence for primary treatment. Aim: To explore cancer survivors' perspectives on and experiences with employment during their return to work (RTW) following primary cancer treatment. Methods: Guided by an interpretive phenomenological approach, this prospective qualitative longitudinal study used in-depth telephone interviews (three interviews/survivor) to develop a rich understanding of how 13 cancer survivors experienced the RTW process. Interviews occurred following primary treatment, and 3 and 9 months later. Data were analyzed using a thematic analysis approach. Results: Preliminary findings indicate that (1) survivors feel they lack information on the RTW process, including logistical information from insurance companies, applicable government agencies (e.g., disability benefits), and employers. Survivors reported that (2) support from colleagues dwindles throughout their cancer treatment and RTW process and (3) pressure to return to work adds to the physiologic and psychosocial side effects they are left to manage during the survivorship period. Finally, survivors felt that having (4) an experienced person to navigate the process with them would be beneficial to easing what they experienced as a difficult transition. Conclusion: Preliminary results suggest survivors have unmet informational and navigational needs around the RTW process after primary cancer treatment. Improved psychosocial support that includes and extends beyond the initial RTW period could help survivors more successfully reintegrate into the work environment.