bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Pharmacist Intervention in Completing Docetaxel Infusion Within 4 Hours
Authors: Gunasekaran G.H.
Published: September 2018

Background: Docetaxel is a cytotoxic drug that have stability of 4 hours after reconstitution. The infusion must be completed within 4 hour or will result in wastage or patient receiving subtherapeutic effect drug. Aim: This study aims to determine if there is any variable in time taken to complete docetaxel infusion within 4 hour with pharmacist monitoring. Methods: A data collection form was design to record start and end time of reconstitution, preparation collected by ward staff, infusion initiation and completion. This was to identify which process that had been causing a delay in initiating infusion. In preintervention phase (Jan 2015-Jun 2015), the baseline data were traced from pharmacy records and patients chemotherapy administration charts. In postintervention phase (Jul 2015-Dec 2015), the same variables as in preintervention was collected with an additional of pharmacist intervention. Results: Analysis of collected data shows that delay in initiation of infusion is mainly due to delay in collecting reconstituted preparation by ward staff (median 30 min, IQR 13.75-45 min) and delay in initiating infusion to patient after the preparation have been collected (median 77.50 min, IQR 45-150 min). After the implementation of pharmacist intervention, the median time for ward to collect the docetaxel preparation has decreased to 25 min (IQR 20-35 min) and the median time taken from collection to start of infusion have decreased to 55 min (IQR 40-80 min). There were significant relationship in completion of docetaxel infusion within 4 hours of pharmacist intervention, χ2=5.114, P = 0.024. Conclusion: According to this result, pharmacist monitoring can significantly improve completion of docetaxel infusion within 4 hours. This study also shows that there are improvement in collection and initiation of infusion in the ward. Pharmacist infusion checking service could improve better drug utilization in the ward.
Improving the Quality of Outcomes of Complex Cancer Surgery Through National Standards: Lessons From Canada
Authors: Prashad A. , Camuso N. , Argent-Katwala M. , Daly C. , Finley C.
Published: September 2018

Background and context: Evidence shows there is wide variability in cancer care service delivery and patient outcomes. Outcomes of complex surgery can be improved by following standards that outline optimal ways to plan, organize and deliver surgical care. While some cancer surgeries are associated with a high risk of adverse outcomes, they also offer the best option for a cure. To ensure optimal patient outcomes, deliberate approaches are needed to standardize the organization of complex care surgeries. Aim: Leverage the expertise of specialty-based and multidisciplinary communities to develop pan-Canadian standards of practice as a means to elevate the delivery of oncologic surgery in Canada. Strategy/Tactics: A phased, multimodal qualitative and quantitative approach was undertaken to develop evidence-based consensus standards for best practice in complex surgery, through the analysis of administrative data to examine access and outcomes of complex, advanced-care surgery and discussion with public representatives to explore trade-offs for reorganizing cancer surgery. Results informed a literature review to identify best practices in complex surgery. Expert panels were convened with disease specific specialty surgeons to inform the development of evidence-informed consensus standards. Draft standards were finalized after targeted review and validation by a wider community of healthcare professionals. Program/Policy process: The standards were endorsed by national professional organizations. An audit was conducted with all surgical programs in Canada to assess pan-Canadian compliance with the standards. Barriers to compliance were tracked to identify areas where local, regional or national activity could support quality initiatives. Outcomes: National standards were developed and highlighted: surgeon criteria, practice settings, and quality improvement. These comprehensive standards provide actionable recommendations that can be tailored to meet local needs. The standards will help organize care in way that maximizes patient outcomes while maintaining reasonable access to care. This work reflects a Canadian approach to a global problem around appropriate delivery of cancer surgical services and facilitates international conversations to mobilize effective knowledge transfer and best practices. What was learned: • Development of national standards is an iterative process that requires upfront buy-in from surgeons, multidisciplinary communities and national associations. Lessons learned from this initiative can support development of international demonstration projects and can help model a process that others could use. • Mechanisms to enhance knowledge of the optimal organization of complex surgery services requires multifaceted and sustained attention. Thoughtful exploration of how surgical care interfaces with other treatment modalities is paramount to ensure a seamless patient journey.
A Coordinated Approach to Lung Cancer Screening in Canada
Authors: Baines N. , Anderson C. , Tobin P.
Published: September 2018

Background and context: Lung cancer screening with low-dose computed tomography is recommended by the Canadian Task Force on Preventive Health Care for individuals at high risk. While no organized lung cancer screening programs currently exist, several Canadian jurisdictions have begun to plan for program implementation with pilot programs, studies, or business cases. Aim: The Canadian Partnership Against Cancer (the Partnership) has supported lung cancer screening activities by initiating a series of projects to promote lung health in Canada. Strategy/Tactics: The Partnership responded to emerging evidence on lung cancer screening with the establishment of the Pan-Canadian Lung Cancer Screening Network (PLCSN) in 2012. The PLCSN brings together key stakeholders from across Canada to promote pan-Canadian collaboration and serves as a national platform for knowledge exchange. Program/Policy process: One of the first priorities of the PLCSN was the development of a consensus statement-based Lung Cancer Screening Framework for Canada in 2014. The Framework outlines key considerations for lung cancer screening programs, including screening eligibility, radiologic testing, pathology quality and reporting, diagnostic treatment and follow-up, and the inclusion of smoking cessation interventions. As the development of the Framework drew to completion, the second priority of the PLCSN was the development of national quality indicators for lung cancer screening. An initial set of ten national-level lung cancer screening quality indicators was developed for national reporting. Most recently, the PLCSN developed a list of five quality-related lung cancer screening questions that should be explored in advance of the widespread implementation of lung cancer screening programs. These considerations included eligibility, enrollment, smoking cessation, nodule management and the effect of lung cancer screening programs on projected lung cancer mortality. Other Partnership initiatives to promote lung health include health economic modeling for lung cancer screening and collecting data on evidence-based smoking cessation programs. Outcomes: These initiatives have aligned pan-Canadian lung cancer screening efforts to facilitate knowledge sharing and resource efficiency, standardization of data collection and reporting, and acceleration of lung cancer screening in Canada. As of January 2018, four provinces have completed business cases, one province has implemented a pilot study, and three trials are ongoing across the country. Partnership initiatives and resources were used by several jurisdictions to inform the development of lung health activities. What was learned: By initiating these activities in advance of organized lung cancer screening programs, the Partnership has contributed to the evidence base on best practices in lung cancer screening that will be necessary for successful program implementation.
Acute-Care Hospital Use Patterns Near End-of-Life for Cancer Patients Who Die in Hospital in Canada
Authors: Tung J. , Decaria K. , Dudgeon D. , Green E. , Moxam R. Shaw , Niu J. , Rahal R.
Published: September 2018

Background: Acute-care hospitals have a role in managing the needs of people with cancer when they are at the end-of-life; however, overutilization of hospital care at the end-of-life results in poorer quality of life and can worsen the patient's experience. Early integration of comprehensive palliative care can greatly reduce unplanned visits to the emergency department, reduce avoidable admissions to hospital, shorten hospital stays, and increase the number of home deaths as well as improve the quality of life of patients with advanced cancer. Aim: To describe the current landscape of acute-care hospital utilization near the end-of-life across Canada and indirectly examine access to palliative care in cancer patients who die in hospital. Methods: Data were obtained from the Canadian Institute for Health Information. The analysis was restricted to adults aged 18+ who died in an acute care hospital in 2014/15 and 2015/16 for nine provinces and three territories. The Discharge Abstract Database was used to extract acute-care cancer death abstracts. Data on intensive care unit (ICU) admissions includes only facilities that report ICU data. Results: Acute care utilization at end-of-life remains commonplace. In Canada (excluding Québec), 43% (48,987) of deaths from cancer occurred in acute-care hospitals, with 70% admitted through the emergency department (ED). In the last six months of life, cancer patients dying in hospital had a median cumulative length of stay ranging from 17 to 25 days, depending on the province. Between 18.1% and 32.8% of patients experienced two or more admissions to the hospital in the last month of life. The proportion of cancer patients admitted to the ICU in the last 14 days of life ranged from 6.4% to 15.1%. Patient demographics (age, sex, place of residence) and clinical factors (cancer type) were often predictors of hospital utilization at end-of-life and likely point to inequities in access to palliative and end-of-life care. Conclusion: Despite previous patient surveys indicating that patients would prefer to receive care and spend their finals days at home or in a hospice, there appears to be overuse of and overreliance on acute care hospital services near the end-of-life in Canada. The high rates of hospital deaths and admissions through the ED at the end-of-life for cancer patients may signal a lack of planning for impeding death and inadequate availability of or access to community- and home-based palliative and end-of-life care services. Acute care hospitals may have a role in managing the health care needs of people affected by cancer; however, end-of-life care should be an option in other settings that align with patient preferences. Standards or practice guidelines to identify, assess and refer patients to palliative care services earlier in their cancer journey should be developed and implemented to ensure optimal quality of life.
Awareness of Undergraduate Dental and Medical Students Toward Oral Cancer
Authors: Shrestha A.
Published: September 2018

Background: Oral cancer is a common malignancy in Nepal and many other southeast Asian countries, which is predisposed by a variety of potentially malignant oral diseases. Considering the importance of knowledge of health professionals and their role in early diagnosis and reduction of cancer statistics. Aim: This study aims to evaluate the awareness of undergraduate dental and medical students toward oral cancer. Methods: The study involved undergraduate dental and medical students of BP Koirala Institute of Health Sciences, Dharan, Nepal. A self-administered questionnaire adapted from Carter and Ogden was distributed among undergraduate medical and dental students. Results: 143 dental and 311 medical students responded to the questionnaire. Significantly more dental (80.4%) than medical students (36.0%) were found to routinely examine the oral mucosa. Tobacco smoking and chewing were the most commonly recognized risk factors by both medical and dental students. Most of the students found ulcer as the most common change associated with oral cancer. Only 30 out of the total students felt very well informed about oral cancer. Conclusion: This study has demonstrated a lack of awareness in some aspects of oral cancer among medical and dental students which highlights the need to frame new teaching methodologies. Similar studies from other health institutions would provide an insight regarding the same and could be a base for formulating a uniform curriculum in the implementation of knowledge regarding oral cancer.
A Study to Assess the Quality of Life of Postoperative Patients With Oral Cancer in B.R.A I.R.C.H., AIIMS, New Delhi
Authors: Paulose N. , Sinha A. , Deo S.V.S.
Published: September 2018

Introduction: Cancer is a leading cause of death in both developed and underdeveloped countries in the world. The Indian subcontinent accounts for one-third of the world burden of head and neck cancer. Surgery is the standard treatment of choice for head and neck cancers. It is imperative to give supportive care to improve the quality of life. Aim: To assess the quality of life of postoperative patients with oral cancer in B.R.A I.R.C.H, AIIMS, New Delhi. Methodology: The study was conducted at B.R.A.I.R.C.H, AIIMS, New Delhi. The data were collected by convenience sampling from 50 adults who underwent surgery for oral during June 2017 to December 2017. Standardized self-structured EORTC QOL(H&N) was used to assess the perceived level of the quality of life of postoperative patients with oral cancer during hospital stay and at one month follow-up. Ethical clearance was obtained from institutional ethics committee. Results: 80% patients were male. Majority of the patients underwent mandibulectomy (66%) modified neck dissection (60%) and regional flap reconstruction (56%). The major symptoms perceived during hospital stay were pain (98%), speech problem (84%), problem in opening mouth (82%), felt ill (80%), weight loss (74%), etc. and at one month follow-up were problem in opening mouth (90.6%), pain (90.5%), speech problem (83.6%), weight loss (82%), among many others. There was a significant decrease in the perceived pain (11.2 ± 2.99) at one month follow-up (9.12 ± 3.42). Conclusion: Most of the patients experience pain, problem in opening mouth, sticky saliva, speech problem, trouble in social contact, weight loss, etc.
Strategies Are Required for Strengthening Integration of Cancer Control Program in Ethiopia Primary Health Care System
Authors: Abate Z.M.
Published: September 2018

Background: Cancer is one of the leading causes of morbidity and mortality worldwide. The number of new cases is expected to rise by about 70% over the next 2 decades. Approximately 70% of deaths from cancer occur in low- and middle-income countries. This growing cancer burden requires innovative approaches to place cancer control and care within existing health systems, while resources should be amalgamated to optimize cost-effective use. Neglect of cancer prevention and care leads to unnecessary death, suffering, and unaffordable treatment. Thus, extension of cancer prevention, diagnosis, and treatment to millions of people with or at risk for cancer is an urgent priority. Integrating cancer prevention and management into primary health care system will tackle cancer-specific priorities while addressing the gaps within the health system, optimizing the use of resources, ensures access to the community and improving coverage. According to World Health Organization regardless of resource level, all countries can implement basic components of cancer control. In the light of the rapidly increasing global cancer burden, it is becoming essential to use the limited resources available in the most effective way. In resource-constrained countries like Ethiopia without specialized services, experience has shown that much can be done to prevent and treat cancer. A strategy to integrated approach thus addresses health problems by providing services in a comprehensive manner. Aim: The purpose of this study is to make a document analysis to assess the requirement of developing strategies for strengthening integration of cancer control program in primary health care system (PHCS). Methods: Document analysis. Results: The Ethiopian National Cancer Control Program unlike most low resource countries planned with necessary implementation cost. The cancer control plan despite its presence usually lack integration in existing health system. There is a variation and significant gaps in the current state of comprehensive cancer control. Conclusion: The country requires strategies to ensure that this plan translated into fully operational interventions. Country specific approaches of integration are required. Integrated framework for cancer prevention is critical to make the most efficient use of its meager resources. This study recommends Ethiopia to develop tailored strategies to strengthen integrated and people-centered cancer control program in its primary health care system.
New Approaches to Skin Cancer Prevention: Can Encouraging Skin Checking Increase Engagement in Sun Protection Behaviours?
Authors: Jongenelis M. , Strickland M. , Minto C. , Slevin T. , Pettigrew S.
Published: September 2018

Background: Skin cancer is one of the most common types of cancer in the world and incidence rates are increasing globally. Efforts to encourage individuals to engage in sun protection behaviors that minimize their risk of skin cancer are therefore urgently needed. In Australia, the context of the current study, UV radiation levels are particularly intense and public health campaigns have been successful in encouraging behaviors such as using sunscreen and wearing a hat. However, recent years have seen a plateau in engagement in such behaviors and new approaches are required to facilitate further gains. Encouraging people to check their skin for signs of skin cancer may be one such approach as it has the potential to increase the salience of skin cancer and the need to protect oneself from UV radiation. Aim: To assess the relationship between skin checking and sun protection behaviors to inform skin cancer prevention campaigns. Methods: Computer-assisted telephone interviewing was used to survey nearly 700 adults. Frequency of engagement in various sun protection behaviors (wearing a hat, wearing protective clothing, using sunscreen) was assessed. Respondents were also asked whether they had checked their skin for skin cancer and how confident they were in their ability to spot the signs of skin cancer. Results: Path analysis revealed greater confidence in one's ability to detect the signs of skin cancer to be associated with skin checking. In turn, skin checking was found to be associated with more frequent engagement in all of the assessed sun protection behaviors. Conclusions: Public health campaigns that increase people's confidence in their ability to detect the signs of skin cancer have the potential to encourage skin cancer reduction behaviors in the form of both skin checking and sun protection and perhaps shift the plateau in engagement of sun protection behaviors observed in recent years.
Reaching Out to Public Libraries to Help Reduce Cancer Information Disparity
Authors: Yamaki C. , Takayama T. , Itoh Y. , Nakatani Y. , Wakao F.
Published: September 2018

In light of growing interest in people taking more proactive roles in managing the course of long term illnesses, ensuring ready access to cancer information supporting programs has become one of the paramount mandates, for many national cancer control programs. In Japan, the Center for Cancer Control and Information Services, a division of the National Cancer Center Japan (NCC-CIS), is tasked with dissemination of reliable and comprehensive cancer information for all citizens including patients and their families. NCC-CIS compiled cancer information has long been delivered via both dedicated portal “Ganjoho (Cancer Information) Service” ( https://ganjoho.jp ) as well as brochures. As majority of cancer patients and their carers tend to be seniors who are not net-savvy, the portal has its limitations as dissemination channel. A more personalized support is provided by a nationwide network of Cancer Information and Support Centers (CISCs), collocated within 434 state-designated cancer hospitals. CISCs offer both information and counseling support to anyone who has cancer related issues, even if they have never been treated at the given facility. While CISC is a public service, subsidized with national and prefectural funding, many of those in need, remain unaware of the CISCs - at least in part, due to its very location, within a hectic acute care settings. To reach a wider audience, NCC-CIS and CISCs have started to collaborate with public libraries which have traditionally been a neighborhood source of reference information for both the young and old, and clearly more approachable than medical professionals in large hospitals. We have begun by disseminating a “starter-kit” of NCC-CIS publications to public libraries that have signed up with “Cancer Information Gift” project, a donor funded effort launched last summer. To date, almost 60 libraries have taken up this opportunity to either launch a new “Cancer Information Corner”. We have also brought the participating libraries and local CISCs together in regional workshops settings, to explore ways to mutually complement the information services offered by both parties. Collaborative initiatives that have come out of such explorations include “Book Talk on Disease in Library”, an interactive session in relaxed settings, where participants can feel more at ease, raising a wide range of personal concerns, around an issue highlighted in a given book, with both librarians and cancer counselors mediating the discussion. Referrals to CISCs from libraries are also beginning though in low volumes. While the “Cancer Information Gift” project, and its related initiatives are still very much at a nascent stage, we believe this collaboration could potentially go a lot further, to make reliable cancer information (and CISCs) more accessible to a wider segment of those in need, and in the process, help reduce the cancer disparity across the nation.
Media Arrows Striking the Cancer Scourge
Authors: Awebwa A. Linda
Published: September 2018

Background and context: Traditional and new media are powerful platforms for shaping public agendas and promoting stakeholder action. The main stream media is a key mode of sharing information that directly reaches different stakeholders in the country. Media needs to be kept abreast of the developments especially in relation to the cancer world. Regular interface between media practitioners, cancer control advocates and champions facilitates building of synergies and momentum to push for the implementation. Additionally journalists need skills and information tools reinforcement particularly in the area of cancer control which is a relatively new subject in the development discourse. Aim: Equip journalists from the national as well as regional media houses with information on the provisions of cancer control and the rationale behind the provisions. Strategy/Tactics: Cancer control: building alliances and networks in the media for cancer support and control, through activities such as monthly media dialogues and engagement. Program/Policy process: There was a survey done at the start of the project. It enabled us understand the level of knowledge that the media had on the issue of cancer and cancer control. It also helped us know how far the media could reach in lines of cancer control. These enabled us know what is needed for us to fully use the media in this cancer fight. Outcomes: We reached more than 1000 journalists from over 100 media houses spread across the country. And through these media houses we have reached over 2,500,000 people who are part of the audience of the media houses. We have more than 30 in-depth stories in the broadcast and print media. We have offered fellowships to more than 15 journalists, held one-on-one meetings with more than 30 producers, editors and other managers. We have conducted more than 50 media dialogues and generated a database of over 1000 individuals in our tobacco control outreach efforts. What was learned: There is more need for media engagement and education. Media is one of the outlets where cancer information can be shared and you are sure that even the people at the grassroot are able to get the information.
Canada's Progress to Make Smoking Cessation a First-Line Cancer Treatment
Authors: Halligan M. , Keen D.
Published: September 2018

Background: Evidence indicates that smoking cessation improves the effectiveness of treatment and likelihood of survival among all cancer patients, not just those with tobacco-related disease, yet smoking is rarely addressed in oncology practice. Prior to 2016, only 3 provinces in Canada (out of a total of 10 provinces and three territories) reported implementation of smoking cessation for ambulatory cancer patients. Aim: Based on this evidence, the Canadian Partnership Against Cancer (CPAC) implemented a systems change initiative to promote adoption of evidence-based smoking cessation within provincial and territorial cancer systems across Canada. Methods: In 2016, CPAC funded seven provinces and two territories over a 15-month period to plan, implement or evaluate integration of evidence-based smoking cessation for ambulatory cancer patients within cancer systems. Funds were used to plan (2 provinces and 2 territories), implement (3 provinces) or evaluate (2 provinces) systematic, evidence-based approaches to smoking cessation within ambulatory cancer care settings (e.g., establishing routine systems for identification of smoking cancer patients and system to support patients to quit). Funds could not be used for direct service delivery (e.g., cessation counseling). Results: After 15-months of funding from CPAC, 6 provinces reported implementation of smoking cessation for ambulatory cancer patients. The remaining province and 2 territories funded by CPAC reported development of plans for adoption of smoking cessation for cancer patients in the future. Within provinces reporting implementation of smoking cessation for cancer patients, between 65%-97% of ambulatory cancer patients were screened for smoking status; 22%-80% of these patients were offered a referral to cessation services, and 21%-45% of cancer patients accepted a referral. Conclusion: Despite provincial and territorial variations in readiness to uptake evidence-based smoking cessation for cancer patients, CPAC's approach has led to substantial progress in adoption of this approach across Canada. While progress has been made, adoption of smoking cessation and relapse prevention by cancer systems is not yet widespread in Canada. Scale-up to remaining provinces and territory, and spread within existing provinces and territories is required to reach all cancer patients and families who require support to quit smoking. Framing smoking cessation as a therapeutic intervention, not prevention, and a routine part of cancer treatment will be critical for sustainability of this work.
Edutainment As a Means of Cancer Awareness Creation
Authors: Mujulizi J. , Nambasa J.
Published: September 2018

Background: The burden of cancer globally is on the increase and late stage diagnosis is a major challenge in many developing countries, which is partly due to lack of awareness among the population. Research and studies on cancer have been made over generations. The challenge however is the mode of dissemination as the majority of the population, more so the uneducated have a poor reading culture coupled with negative mind set about the facts on cancer thus making traditional cancer awareness medium limited in nature. Aim: It was under such understanding that a group of artist established Friends Crew Africa (FCA) to empower communities through raising awareness and advocacy using creative arts through edutainment to increase on cancer awareness to contribute toward the reduction of the burden of cancer in Uganda. Strategies: FCA adopts and uses multimedia information, education and communication (IEC) interventions including developing music, films, drama and live performances during events, community dialogues, the print and electronic media to carry out comprehensive cancer awareness programs for different target groups. Outcome: FCA has successful disseminated the developed/adapted IEC cancer awareness materials/content like music, films, drama, cancer magazine and brochures on local and international platform like World Cancer Day and community outreaches creating chances for the communities to be informed about cancer and interact with cancer service providers. Conclusion: Basing on the fact that entertainment attracts the attention of the majority; cancer awareness strategy that embeds edutainment stands higher chances of being adapted thus contributing to the reduction of cancer burden. FCA appeals to all organizations and the government to consider investing into edutainment as a means to increase on cancer awareness.
Empowering Cancer Survivors to Become Mentors, and Leaders Through Various Workshops and Programs
Authors: Mohamed A.
Published: September 2018

Background and context: Friends of Cancer Patients UAE conducts various moral support programs for cancer patients, one of which is the “Color My World” program, which focuses on provide moral support to predominantly men and women, who have undergone, or are currently undergoing treatment of cancer. Aim: The aim is to empower cancer survivors to become leaders and mentors to other ladies/men currently undergoing treatment, and to establish a survivor led support program, as a result of these various programs and workshops. Strategy/Tactics: We believe that to for such a program to be a success, you need to understand your target group, their interests, as well as their backgrounds. A needs assessment needs to be conducted prior to the selection of workshops, whether through direct interviews with the patients, or internally by examining the different support programs available in the country, and what is available/not available. Program/Policy process: There are numerous workshops that take place throughout the year, and they are divided as follows: - There are workshops that focus on healthy living, and the importance of a healthy diet, which involves numerous cooking workshops, and educational sessions. - There are workshops that focus on skin care and make-up, where the ladies are taught how to take care of themselves by certified stylists and makeup artists. - Those who are interested in crochet and handicrafts, have the chance to take part in group workshops, or in focused 1 to 1 sessions. Outcomes: There are a number of positive outcomes that came about from our attempts to empower cancer survivors, the ones we believe are worth of being highlighted are: - A group of survivors are now leading, and running a cancer support program, that visits hospitals within the UAE, to visit those currently undergoing treatment, to provide support, and assist those still undergoing treatment in any way possible. - Many of the ladies, who attended previous workshops, will now start to lead similar workshops during hospital visits to children and women with cancer. What was learned: Cancer survivors must be the driving force in providing support to other cancer patients, and the existing model of the support groups can be linked with the educational workshops, to not only provide moral support, but also social support to the cancer patient.
Effects of Concurrent Expression of Myc and Bcl-2 on the Treatment and Prognosis in Extranodal Diffuse Large B Cell Lymphoma
Authors: Sonmez M. , Konca C.
Published: September 2018

Aim: We aimed to investigate the effects of immunohistochemical and molecular presence of double-hit lymphomas (DHL) (combined expression of myc and bcl-2) on overall and progression-free survival rates of patients with extranodal diffuse large B-cell lymphoma (DLBCL). Methods: A total of 31 patients (17 female, 14 male; mean age 57 years) with diagnosis of extranodal DLBCL were included into the study. Patients transforming from low grade B cell lymphoma, and patients with HIV positivity were not included. In a retrospective manner, patient characteristics were noted (age at diagnosis, sex, sites of extranodal involvement, stage, high-risk group, histopathological diagnosis, IPI score, LDH level at diagnosis, bone marrow involvement, and treatment modalities). Histopathological specimens underwent immunohistochemical (bcl-6, bcl-2, myc, CD10, Mum-1) and molecular (bcl-2 and myc, by means of PCR) analysis. All patients was treatment with R-CHOP protocol. Results: DHL was observed immunohistochemically in only one patient, while molecular studies found 6 cases. Three-month overall survival rates were 50% and 88% in DHL positive and negative groups, respectively. Six-month overall survival rates were 16% and 76% in DHL positive and negative groups, respectively. Progression-free 3-month survival rates were 51% and 88% in DHL positive and negative groups, respectively. Progression-free 6-month survival rates were 33% and 76% in DHL positive and negative groups, respectively. No relation with histopathological type of the disease was noted. Conclusion: We conclude that DHL presence in patients with extranodal DLBCL was an independent factor leading to shortened overall or progression-free survival.
Application of a Cancer Hotspot Panel to Guide Lung Cancer Therapy: Asian Experience
Authors: Nairismägi M.-L. , Tung K.-C. , Yang Y.-T. , Lu Y.-J. , Jhou R.-S. , Yu P.-N. , Liu Y.-T. , Hsieh Y.-L. , Poon S.L. , Chen S.-J. , Tan K.T.
Published: September 2018

Background: Comprehensive genomic profiling (CGP) has transformed personalized medicine but is still not affordable to all patients, especially in developing countries. The price of CGP differs based on panel size. Aim: The aim of this study was to explore the benefits between a cancer hotspot panel and CGP in Asian lung cancer patients. Methods: One hundred sixty-two formalin-fixed, paraffin-embedded (FFPE) lung cancer clinical samples were subjected to next-generation sequencing using the Ion Torrent Proton System. Sixty-six cases were profiled using a 35-gene cancer hotspot panel and 96 with pathway-based CGP (400+ genes) for base substitutions (single nucleotide variants and small indels) and copy number variants (CNV). Results: In total, actionable variants were discovered in 86.4% (57/66) cases using the cancer hotspot panel, with 57.9% (33/57) derived from base substitutions, 10.5% (6/57) from CNVs and 31.6% (18/57) from both alterations. Contrarily, CGP identified actionability in 97.9% (94/96) patients, 17.0% (16/94) of which were from base substitutions, 22.3% (21/94) from CNVs and 60.6% (57/94) from both. EGFR mutations were identified in comparable frequency with both panels, with almost half (48.8%; 79/162) of all samples harboring activating mutations in the tyrosine kinase (TK) domain. Identification of EGFR TK inhibitor (TKI) resistance mechanisms, including EGFR mutations (T790M and C797S), EGFR amplification, abnormal downstream EGFR signaling ( KRAS, BRAF and PIK3CA mutations, PTEN loss) and activation of the bypass pathways ( MET amplification, HER2 mutation and amplification), was equivalent with both panels. Additional targetable genetic alterations were detected in 70.0% (21/30) and 83.3% (39/47) of EGFR-wild type patients using the cancer hotspot assay and CGP, respectively. Conclusion: In most Asian lung cancer patients, a cancer hotspot panel is sufficient to discover targetable genetic alterations and TKI resistance mechanisms.
Clinical Targeted Next-Generation Sequencing to Identify Potentially Actionable Alterations in the Majority of Asian Cancer Patients
Authors: Poon S.L. , Lu Y.-J. , Jhou R.-S. , Yang Y.-T. , Yu P.-N. , Liu Y.-T. , Hsieh Y.-L. , Nairismägi M.-L. , Chen S.-J. , Tan K.T.
Published: September 2018

Background: Clinically innovative genomic diagnostics may expedite the selection of effective targeted therapies if the patient can be stratified correctly based on their unique cancer driven events/pathways during tumorigenesis. Aim: Here, we performed a pan-cancer analysis on the clinical utility of a targeted gene panel, ACTOnco+, in characterizing the prevalence of actionable mutations. Methods: A total of 229 formalin-fixed, paraffin-embedded (FFPE) tissues from 40 tumor types were subjected to next-generation sequencing (NGS) using the Ion Torrent Proton System. All coding exons in 440 cancer-related genes were assessed at average depth of > 800X. Therapeutic implications were based on information obtained from base substitutions, indels, and copy number alterations (CNAs). Results: 58.5% (n=134) patients harbored at least one actionable mutation while CNAs, including homozygous and heterozygous deletions, were detected in 83.9% (n=191) of patients. Across all tumor types, the most frequently altered pathway that can confer either sensitivity or resistance to targeted therapies was PI3K/AKT/mTOR signaling, contributed by PIK3CA and AKT1 activating mutations as well as NF1, NF2, PTEN, TSC1, STK11 and TSC2 inactivating mutations or deletions. In parallel, dysregulation of cell cycle was mostly owing to CCND1, CDK4 and CDK6 amplification and/or loss of CDKN2A. Notably, on top of BRCA1/ 2 mutations, deletion of BRCAness-related genes ( MRE11, RAD50, PALB2, FANCD2, ATM, ATR, CHEK1 and CHEK2) that may result in homologous recombination deficiency (HRD) was observed in 71.4% breast, 70.6% ovarian, 61.0% lung, 58.3% pancreatic, and 52.2% colorectal cancers. Other targetable alterations on receptor tyrosine kinase (RTK), angiogenic and hedgehog signaling pathways were also observed. Conclusion: A comprehensive pathway-based genomic profiling characterized significant actionable alterations across different solid tumors that may play a role in tissue-agnostic tailored treatment.
Engaging Health Ministers to Integrate Palliative Care Into National Health Systems in Africa
Authors: Luyirika E. , Kiyange F.
Published: September 2018

Background and context: The African Palliative Care Association (APCA) is a pan-African entity aiming to strengthen health systems in Africa by integrating palliative care for life threatening illnesses. Africa has 54 states and 1.2 billion people with high burdens of cancer, HIV and other infectious and NDCs for which palliative care is needed. Most of them lack national palliative care policies, palliative care delivery system, access to controlled medicines and radiotherapy for treatment or palliation of cancer. Aim: The aim was for APCA to gather ministers of health from Africa to be informed about palliative care and have them support the setting up of sustainable palliative care models in their countries. Strategy/Tactics: The strategies involved contacting individual ministers by country and specifically sharing with them the evidence in terms of palliative care need, making them aware of national, regional and international frameworks that commit them to support palliative care integration into health systems, improving access to controlled medicines, radiotherapy and other palliative care interventions. These frameworks include their own national laws and policies, the 2012 African Common Position on access to controlled substances for pain control, the WHA resolutions related to palliative care and cancer and the international frameworks calling for balancing control and access to controlled medicines for medical and scientific use. APCA working with host ministers of health at the international triennial palliative care conference, organizes a preconference African ministers of health session on palliative care. Program/Policy process: The process involves engaging APCA partners to fund the ministers´ palliative care session. APCA then works with the minister of the host country to invite African ministers to a one-day session where selected ministers share their best practices and challenges. International agencies such as WHO, IAEA, INCB and UICC have a chance to update the ministers too. The host country provides security and protocol requirements while APCA and partners work on the technical input into the day´s program and the preparation of the declaration which is passed at the end of the session. Outcomes: Two ministers of health sessions on palliative care have been held. The first was cohosted with the Minister of Health of South Africa in 2013, attracted 92 delegates from 23 countries. It resulted into the Johannesburg Declaration with ministers committed to supporting palliative care and working together on a consensus before the 2014 WHA Palliative Care Resolution. The 2016 meeting was held in Kampala attracted 163 delegates from 48 countries who signed on the Kampala Declaration committing to implementing the WHA PC Resolution and availing essential technologies. What was learned: Ministers in Africa are open to engaging with civil society to improve the health system and access to cancer and palliative care.
Adoption of Patient-Centered Tools by Cancer Care Teams: A Closer Look at Survivorship Care Plans and Patient Decision Aids
Authors: Glenn A. , Urquhart R.
Published: September 2018

Background: Moving interventions (i.e., new knowledge, tools, and technologies) into clinical practice are often lengthy and challenging processes, even when they are strongly supported by research evidence. Conversely, organizations and providers sometimes adopt interventions in the absence of strong research evidence. Understanding decision-making around the adoption of new interventions is paramount to developing more effective strategies to facilitate the use of evidence-based interventions in practice. Aim: To illuminate the decision-making processes involved in the adoption of patient-centered interventions by cancer care teams, including how research evidence is considered, and identify additional factors influencing these decisions. We focused on two interventions (survivorship care plans [SCPs] and patient decision aids [PtDAs]) due to their differing levels of research evidence and real-world adoption: SCPs = low evidence; high adoption; PtDAs = high evidence; low adoption. Methods: Guided by the principles of grounded theory, we conducted semistructured interviews with clinicians, managers, and administrators of cancer care programs across Canada (n=21). Data were collected and analyzed concurrently, using a constant comparative approach. Data collection ended upon reaching theoretical saturation. Results: Participants emphasized that high-quality research evidence is often unnecessary when making adoption decisions around interventions that are intuitively “good ideas.” Six key factors contributed to adoption/nonadoption decisions around SCPs and PtDAs: 1) alignment (or misalignment) of research evidence with clinical experiences, patient experiences/preferences, and local data; 2) perceived benefit to clinicians themselves; 3) endorsement by respected organizations; 4) existence of local champions; 5) ability to adapt the intervention to local contexts; and 6) ability to routinize the intervention across a large patient population. Conclusion: Many factors influence decisions to adopt patient-centered interventions, including clinicians' experiences and perceived benefits, the existence of organizational and extraorganizational advocates, and ease/reach of implementation.
Hard-Core Smoking Among Daily Smokers in Male and Female Adults in 27 Countries: A Secondary Data Analysis of Global Adult Tobacco Surveys (2008-2014)
Authors: Sreeramareddy C.T. , Hon J. , Abdulla A.M. , Harper S.
Published: September 2018

Background: Hard-core smokers (HCS) who do not want to quit make it more difficult for tobacco control efforts to further reduce smoking prevalence. Information about burden of hard-core smokers helps plan cessation services. Aim: Estimate sex-specific, country-wise proportion of HCS among the current daily smokers, and the population prevalence of HCS and estimated total number of hard-core smokers in 27 GATS countries. Methods: We used the Global Adult Tobacco Survey (GATS) data to estimate the prevalence of HCS (i.e., daily smokers who smoke within 30 minutes after waking up, smoke ≥ 10 cigarettes per day, not made any quit attempts during previous 12 months or have no intention to quit at all or quit during coming 12 months). For each GATS country, we estimated sex-wise, weighted and age-adjusted prevalence of daily smoking and HCS. Results: Overall weighted population prevalence (%) of HCS was highest in Greece (21.0), followed by Russia (13), Poland (9.4), Romania (9.0), and Ukraine (8.9) and lowest in Nigeria (0.4%). Estimated number of HCS (in millions) was highest in China (35.8) followed by India (28.2), Russia (18.5), Indonesia (16.1) and lowest in Panama (0.03). The proportion (%) of daily smokers classified as HCS was highest in Greece (56.2%) followed by Russia (42.2%), Ukraine (37.2) and Poland (36.2) and lowest in Mexico (8.29). Overall, proportion of HCS was higher among males in all countries. However, in Greece, Russia, Romania, Ukraine and Poland, both population prevalence of HCS among women and proportion of HCS among daily smoking women was higher than in other countries. Conclusion: At the country-level, a higher daily smoking rates also suggest a higher proportion of HCS. Countries with greater burden of HCS pose greater challenges in tobacco control efforts specifically toward tobacco cessation interventions. Interventions to reduce tobacco use and smoking-related mortality may need to be altered in populations with high proportions of HCS.