bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology and Treatment Outcome of Lymphomas in Children: A Study From a Developing Area in Cameroon
Authors: Ketchen D.
Published: September 2018

Background: Lymphoma makes up about 12% of all childhood malignancies and it is the third most frequent cancer, after leukemia and brain tumors, in developed countries. When treated appropriately, cure rates exceed 90% for Hodgkin lymphoma (HL) and over 80% for non-Hodgkin lymphoma (NHL). However, there is scarcity of data on pediatric lymphomas in Cameroon and several other African countries. Aim: The aim of this study was to describe the epidemiologic pattern and assess the treatment outcome of lymphoma in children at the Mother and Child Centre (MCC), which is the sole pediatric oncologic treatment center in Cameroon. Methods: A retrospective review of medical records from January 2008 to December 2015 was conducted in all cases admitted into the MCC with a diagnosis of lymphoma. Data were analyzed using Epi Info 7 software. Survival analysis was performed using the Kaplan-Meier methods. P value < 0.05 were used to declare statistical association. Results: Of the 1080 files studied, lymphoma was the most common childhood cancer, representing 36% of all (390 of 1080 cases studied). There was a decrease annual incidence of pediatric lymphoma from 2.2 to 1.0 per 1000 children. The age at presentation ranged between 2 and 15 years, with a mean age of 10.7±3.3 years for HL and 8.5±3.4 for NHL. Males were more frequently affected, sex ratio: 1.7:1. Of the 390 cases, 362 (93%) were NHL while 28 (7%) were HL. The most common histopathologic subtype was nodular sclerosis (76%) for HL and Burkitt lymphoma for NHL (72%). The cervico-maxillary region was the most common tumor localization (54%). Nodal involvement (70%) was more predominant than extra nodal (30%). Most patients (79%) presented at advanced stages of the disease (stage III/IV). The treatment protocol used was the GFAOP (Groupe Franco-Africain d'Oncologie Pédiatrique) with median duration of 4 months (range 1-38 months). The five-year overall survival rate for HL was 74% and 51% for NHL. The stage of disease had a significant association with the overall survival ( P = 0.002). Conclusion: This study revealed a decreased annual incidence of pediatric lymphomas in Cameroon over the 8-year study period. Males were more susceptible and most patients present at the advanced stage of the disease. The treatment outcome of Hodgkin lymphoma is better than non-Hodgkin lymphoma, however, remains low when compared with high survival rates in developed countries.
Can Cross-Sector Partnerships Increase Breast Cancer Screening in Hard-to-Reach Migrant Populations?
Authors: Davis M. , Hochberg L. , Zetterberg R. , Pridmore V.
Published: September 2018

Background and context: BreastScreen Victoria (BSV) provides free breast screening to women aged 40+; targeting women aged 50-74. The program reduces breast cancer-related deaths by up to 28%. BSV aims to ensure equitable participation for all women in the target age; however there are large disparities in screening rates for different subpopulations. Emerging migrant women participate in breast screening at lower rates than the general population. These women face complex barriers including cultural factors, low health literacy, and access. BSV identified cross-sector partnerships, with local trusted organizations who engage with emerging migrant women, as an approach to tackle the multidimensional problems in screening inequalities. Aim: Through cross-sector partnerships BSV aims to bring together diverse skills, knowledge and resources for more effective health promotion outcomes, including: 1. Increasing awareness of breast screening in emerging migrant communities, 2. Providing a culturally safe environment for women to access breast screening. Strategy/Tactics: BSV partnered with organizations beyond the traditional health sector. One key partnership is with AMES Australia, who provide settlement services for refugees and migrants. The main approach of this model is two-way capacity building between organizations. BSV built the capacity of AMES to deliver BreastScreen's key messages, and promote screening to eligible women accessing their service. This included training for staff, resource development/sharing, and support. AMES built the capacity of BSV by providing insight into barriers for women they engage, and guidance adapting traditionally clinical environments ensuring cultural safety. To date BSV has undertaken screening initiatives with AMES in 2 Melbourne locations. Outcomes: - Migrant women are introduced to breast screening by a trusted organization - BSV's key messages are delivered in a culturally appropriate manner - Development of sustainable skills, structures and resources in both organizations - Utilization of AMES relationship with their clients to engage women who BSV may not reach -not on the Victorian Electoral Roll - 6 group bookings with specific languages groups - Familiar case worker and in person translator supporting group bookings - Engaging mainly first time screeners who may not have accessed a breast screen - Overcoming cultural, language, and health literacy barriers - Tailored appointments for groups and walk-ins. What was learned: A lack of tailored strategies to engage women in breast screening compounds barriers for migrant women. Cross-sector partnerships increase the efficiency of systems that impact health by making the best use of different but complementary resources. Collaborations, joint resourcing and planned action should be considered ongoing practice, particularly for disengaged populations, to address the many determinants of health that lie outside the reach of the health system.
Systematic Review of Healthcare Economic Evaluation on Malaysia: An Overview on Cancer-Related Economic Studies
Authors: Rahim K.N. Ku Abdul , Farhana K. Hanin
Published: September 2018

Background: In Malaysia, the inclusion of health economic evidence in health technology assessment improves the efficiency of the healthcare spending as it is used to promote the use of value for money in policy making. However, despite the potential of its use in ensuring the value of health technologies, its adoption is constrained by several factors. Limited number of researchers to produce economic evaluation, challenges in local data retrieval and lack of awareness and understanding of value-based concept among decision makers are among the most common limiting factors in Malaysia. Aim: To conduct a systematic review of economic evaluation studies in Malaysia and to explore and describe cancer-related economic evaluation studies in Malaysia. Methods: A comprehensive scientific electronic databases was conducted and the last search was done on 20 March 2017. Additional articles were identified from reviewing the references of retrieved articles and personal communication with the local higher institution representatives. Only full text of full and partial economic evaluations conducted in Malaysia were considered to be eligible for the review. Data extraction was performed by first author and verified by second author. Critical Appraisal Skills Program (CASP) checklist and Quality of Health Economic Studies (QHES) instrument was used as the quality appraisal tools in view of variability of the quality of conduct and reporting of economic evaluation. Results: Based on the evidence search, 1014 titles were retrieved from the scientific electronic databases. After articles selection, 39 full text articles were finally selected to be included in this review. Of these, eight studies (20.5%) are cancer-related economic evaluation. Five cost-utility analyses, two cost-effectiveness analyses and one cost-minimization analysis were conducted in Malaysia up to March 20, 2017. The studies are on HPV vaccination in preventing cervical cancer, early screening of cervical cancer, treatment using monoclonal antibody for colorectal cancer, targeted therapy in HER2+ breast cancer and antiemetic in chemotherapy induced nausea and vomiting. Among the interventions that were highly cost effective were screening strategies and HPV vaccination in prevention of cervical cancer as well as additional of granisetron as antiemetic regimens for chemotherapy-induced emesis. Conclusion: This review provides useful information on the overall scenario of economic evaluation in Malaysia, particularly on cancer which incur high financial impact to the healthcare system. Various type of analysis has been conducted in recent years which provide different findings and information such as the incremental value, local costs data, patient preference and economic burden. These information may be adopted by other researchers in conducting future economic evaluation by facilitating and accelerating the process of producing the evaluation.
Improving Nutritional Management of Cancer Patients in Tanzania
Authors: Martin H. , Kimiywe J. , Petrucka P. , Kamanga L.
Published: September 2018

Background: Cancer is one of the leading causes of death worldwide and was reported to cause 8.8 million deaths in 2015. It was long predicted that about 70% of the new cancer cases will be in low-income countries (LIC). In Tanzania, like in many LICs, the need for improved cancer care is critical because cancer rates are rising dramatically. Most cancers are detected late and hence high mortality and poor palliative care for patients. Tanzania lacks trained clinical nutritionists and dieticians to manage different conditions including cancer. Aim: The aim of this project is to build the capacity of nutritionists and other health personnel to provide nutrition care to cancer patients in hospitals. Methods: One nutritionist from Tanzania will be attached to the Kenyatta National Hospital in Kenya for one month to obtain practical experience on the nutritional management of cancer patients. The acquired knowledge will be disseminated among health care professionals in Tanzania, specifically, nutritionist and nurses in selected health care facilities. About six nutrition officers and six nurses who work in Ocean Road Cancer Institute, Bugando Hospital, KCMC hospital and Muhimbili National Hospital will be trained by the incumbent on nutrition care for cancer patients once the fellowship visit has been completed. In addition, a study to identify differences in nutritional care for cancer patients between Tanzania and Kenya will be conducted. Cancer patients visiting hospitals in Tanzania and Kenya will be asked to complete a questionnaire that will assess their nutritional care in detail. Responses from cancer patients from each country will be compared to identify differences. Results: Expected results from this project includes, the transfer of knowledge in nutritional management of cancer patients between Tanzania and Kenya, and the subsequent dissemination of this knowledge to other nutrition specialists based in the home country, Tanzania. Further results will include data obtained from a survey that will be performed on cancer patients from both countries regarding their nutritional care. This study is also expected to open up collaborative research opportunities between the universities and health facilities on best practices for nutrition care and support for cancer patients. Conclusion: This study will not only improve palliative care among cancer patients but will also create more awareness on preventive measures against cancers with emphasis on dietary habits.
Home-Based End-of-Life Care Program for Oncology Patients in Rwanda
Authors: Mukeshimana O. , Uhagaze B. , Ntizimira C.
Published: September 2018

Background and context: Almost two-thirds of the 7.6 million deaths every year from cancer worldwide occur in low-income and middle income countries, making cancer a leading cause of mortality in these settings. In Rwanda, we are focused on the development of the tools needed to perform social and health service delivery in addition to policy research in resource-limited settings. There is a real need for qualified staff members who are able to ask appropriate questions, to make relevant hypotheses, develop research protocols, and conduct effective studies to identify innovative approaches in social and health service delivery. Cancer patients undergoing end-of-life care suffer from physical pain, mental illness and psychological trauma. Aim: The aims of this project are to identify cancer patients at end-of-life care at the community level without appropriate support through a mobile clinic, to mobilize existing resources to introduce home based care at the community level with participation of community health workers and to sensitize the population in cancer prevention and supportive care of patient using African socio-cultural perspectives. Strategy/Tactics: This project, the first kind in Rwanda, bring at home the same services cancer patients receive at the hospital level except for access to chemotherapy or radiotherapy. And it's where all those services provided and patients' family are counseled and reduce the burden and challenges they used to have going to hospital. Program/Policy process: During this project patients are visited in their homes and are treated mostly with pain management and their complaints are listened to together with other issues related to cancer, then their families are also approached to clearly explain to them the case of the patient and how to well console him/her and support in their sickness, all these are done periodically with assessment of past visits. Outcomes: Before this project, many people used to die early due to lack of pain management, counseling and follow-up, and also patient families used to abandon them at home or at health facilities. With this current project people have already started to understand that cancer can be treated like other diseases and this awareness helps in the advocacy for pain treatment and availability of pain killers for cancer patients. What was learned: The lessons learned from this project is that home based end of life care for oncology is an important tool to care for oncology patients and to reduce the burdens they have such as pain and depression and also the burdens for their families such as loss of money in the cost of treatment. This program can be expanded to reach as many as possible patients and their families.
Retinoblastoma in Developing Country
Authors: Sthapit P. Rajkarnikar
Published: September 2018

Background: Retinoblastoma is the most common intraocular malignancy of childhood occurring in children below five years of age. Its worldwide incidence is one in 10,000 live births. Mortality rate in developed world is 5%, in developing countries is 50% while it can reach 99% if not treated. The etiology of high mortality in developing world is multifactorial like late presentation due to lack of knowledge or poor health care facility, limited knowledge about the severity of the disease among health care workers, fewer centers for its treatment and lack of modern day treatment facilities in the hospitals. Aim: To describe the profile of retinoblastoma presentation and management in a tertiary care hospital in a developing country. Methods: A retrospective data analysis of all diagnosed retinoblastoma patients who received treatment at a tertiary care hospital since last 12 years. Results: Mortality and morbidity due to retinoblastoma has improved in last 12 years due to earlier presentation when we can still save life as well as globe in many patients. Destructive procedures like exenteration and enucleation can be avoided by going for conservative treatment like chemotherapy if they present early. Conclusion: Early presentation and proper diagnosis of retinoblastoma significantly improves the outcome of its management. Awareness campaigns among parents as well as primary health care personnel is crucial for early detection of disease so that life and globe saving measures can be done to improve mortality and morbidity.
Supportive Care Needs Among Mexican Breast Cancer Patients: From Diagnosis to Post-Treatment Follow-Up Visit
Authors: Perez-Fortis A. , Fleer J. , Schroevers M.J. , López P. Alanís , Sosa J.J. Sánchez , Eulenburg C. , Ranchor A.V.
Published: September 2018

Background: In Latin America, where 7.8% of worldwide new cancer cases occur, the implementation of supportive care services for cancer patients within public hospitals is not common practice and it is often a low priority. Identifying the priority care needs of these cancer patients is relevant to improve care provision, especially in Mexico, where breast cancer is highly prevalent and it is among the three leading causes of death in Mexican women. Objective: To investigate the course and predictors of supportive care needs among Mexican breast cancer patients for different cancer treatment trajectories. Methods: In this observational longitudinal study data from 172 patients were considered. Participants were assessed after diagnosis, neoadjuvant treatment, surgery, adjuvant treatment and the first posttreatment follow-up visit. The Supportive Care Needs Survey (SCNS-SF34) was used to assess psychological, health system and information, physical and daily living, patient care and support, sexual, and additional care needs dimensions. Linear mixed models with maximum-likelihood estimation were computed. Results: The supportive care needs course was similar across the different cancer treatment trajectories. Supportive care needs declined significantly from diagnosis to the first posttreatment follow-up visit. The highest care needs over time were those from the health system and information dimension. Depressive symptoms and time since diagnosis were the most consistent predictors of changes in development of supportive care needs of these patients. Conclusion: Health system and information care needs of Mexican breast cancer patients need to be addressed with priority because these needs are the least met. Furthermore, patients with high depressive symptoms at the start of the disease trajectory have greater needs for supportive care throughout the disease trajectory.
Sentinel and Non-Sentinel Lymph Node Metastasis Prediction and Validation of the MSKCC Nomograms for Indian Breast Cancer Patients
Authors: Choraria A. , Agrawal S. , Arun I. , Chatterjee S. , Ahmed R.
Published: September 2018

Background: Sentinel lymph node (SLN) biopsy accurately stages the axilla, but is time consuming and resource intensive. Nomograms and scoring systems have been developed, based on clinical and pathologic data available before surgery, to attempt to predict the likelihood of lymph node metastasis before surgery. As the management of the axilla in patients with low nodal burden changes, it is also important to predict whether there will be further axillary disease in patients with a positive SLN. Aim: To explore the risk factors for SLN and non-SLN metastasis in Indian women with breast cancer, by analysis of clinical and pathologic data. To assess the validity and clinical utility of two MSKCC nomograms that predicts axillary lymph node status for Western patients. Methods: Clinical data, and pathologic data available from core biopsy, for a consecutive series of women having SLNB was analyzed, and was plotted on two MSKCC nomograms. Univariate analysis was done by χ2 and Fischer exact tests and multivariate analysis was done by logistic regression method. A receiver-operating characteristic (ROC) curve was drawn and predictive accuracy was assessed by calculating the area under the ROC curve (AUC). Results: 34% (89 out of 256) of our patients had SLN positivity. When correlated with SLN metastasis by univariate analysis, LVI (χ2 = 80, P ≤ 0.001), PNI (χ2 = 13.36, P ≤ 0.001), ER+ (χ2 = 6.85, P = 0.009), PR+ (χ2 = 7.1, P = 0.008) and age ( P = 0.03) were significant. However, multivariate analysis showed that age (OR=1.04, P = 0.007) and LVI (OR=0.07, P ≤ 0.001) were identified as independent predictors for SLN metastasis. The area under the ROC curve was 0.772 and it fairly correlated with MSKCC nomogram. Patients with MSKCC scores lower than 38% had a frequency of SLN metastasis of 7.7% (5/65) and this cut-off could be used as a guide for not doing frozen section analysis in this subgroup. Further axillary dissection showed 41% (38 out of 92) had non-sentinel nodes positive. When correlated with non-SLN metastasis by univariate analysis, LVI (χ2 = 8.8, P = 0.003), PNI (χ2 = 6.85, P = 0.009), and extracapsular extension (χ2 = 4.18, P = 0.04) were significant. Number of SLN negative ( P = 0.01), SLN ratio (number of SLN positive/total number of SLN removed) ( P = 0.01) and size of SLN metastasis ( P = 0.002) were significant. However, multivariate analysis showed that only size of SLN metastasis (OR=0.845, P = 0.02) was identified as independent predictor for non-SLN metastasis. The area under the ROC curve was 0.66 and it poorly correlated with MSKCC nomogram. Conclusion: The MSKCC nomogram can provide a fairly accurate prediction of the probability of SLN metastasis, but is not for non-SLN metastasis. An institutional nomogram for non-SLN metastasis, including additional factors such as size of SLN metastasis, may improve prediction.
A Pan-Canadian Framework for Cancer Survivorship Research
Authors: Urquhart R. , Kontak J. , Rothfus M. , Collier G. , Green E. , Osinchuk M. , Badovinac K. , Urowitz S.
Published: September 2018

Background and context: Across all cancer types, two-thirds of Canadians diagnosed with cancer today will survive long-term, reflecting great progress in cancer detection and treatment. Many survivors, however, will experience substantial and long-term impacts of their diagnosis and treatment. Within this context, the Canadian Cancer Research Alliance (CCRA) sought to inform the cancer research funding community on how, and what kinds of research are needed, to enable research that will make a difference to patients as they move from treatment to the posttreatment phase. Aim: To develop and implement a national framework and recommendations to enable coordinated and strategic action among cancer research funders that advances cancer survivorship research in Canada in ways that improve survivors' care and experiences. Strategy/Tactics: Multiple approaches were used to inform framework development: a strategic literature review; an analysis of cancer survivorship research funding from 2005-13; and an online survey and key informant interviews from the broader stakeholder community. An Expert Panel and Patient Advisory Committee were also engaged to provide guidance and feedback. Program/Policy process: Over the course of one year, the project team and a working group of CCRA members met regularly to steer framework development. This involved activities such as developing data collection approaches and tools, reviewing data and emerging findings, and translating findings into priority areas and recommendations. In total, > 200 Canadian and international stakeholders provided input through the survey and interviews. Outcomes: Released March 2017, the Pan-Canadian Framework for Cancer Survivorship Research provides four recommendations for cancer research funders: 1) ensure ongoing and meaningful involvement of cancer survivors; 2) align funding calls with existing needs and potential for impact; 3) create opportunities for the translation of research into practice and policy; and 4) build and maintain infrastructure and expertise to advance research. Specific research priorities were emphasized across three research domains: survivors' experiences and outcomes; late and long-term effects; and models of care. The priorities ranged from investigating the mechanisms of late/long-term effects to conducting intervention research to improve psychosocial outcomes, prevent and ameliorate late effects, and improve integration of follow-up care. What was learned: A broad range of stakeholders came together to develop a national framework to maximize the impact of shared targeted research investment in cancer survivorship research. Survivors' voices were key to agreeing on definitional issues of survivorship, identifying priority research areas, and ultimately lending credibility to the resulting framework. Implementation of the framework is the next step of work for CCRA members. Planning has commenced on identifying an initial priority for joint action.
Lessons Learned From Canada in Working Together to Support Indigenous Health and Wellness
Authors: Politis C. , Keen D.
Published: September 2018

Background and context: First Nations, Inuit and Métis bear a disproportionate burden of cancer in Canada. In the spirit of truth and reconciliation, and to have the greatest impact, it is important for nonindigenous and indigenous partners to work together, and reflect on lessons learned in collaborating, to support First Nations, Inuit and Métis health and wellness. Aim: In response to the national Truth and Reconciliation Commission Calls to Action, the Canadian Partnership Against Cancer committed to understanding how collaborative projects funded through the Coalitions Linking Action and Science for Prevention (CLASP) initiative were successful in bringing together diverse groups - both indigenous and nonindigenous - to create and apply culturally-relevant cancer prevention approaches. Strategy/Tactics: Seven projects funded through the CLASP initiative, from 2009 to 2016, brought together over 275 First Nations, Inuit, or Métis communities, schools, and organizations with government, nongovernment, and academic partners in collaborative coalitions. The projects addressed cancer prevention issues prioritized by First Nations, Inuit, and Métis (e.g., unhealthy eating and physical inactivity) through approaches that were holistic and culturally-relevant, such as utilizing intergenerational knowledge sharing, incorporating mental wellness, and supporting existing capacity within communities. Program/Policy process: Over 30 knowledge products developed by the projects were reviewed to identify preliminary lessons learned about partner collaboration. Preliminary lessons learned were verified and expanded upon through nine key informant interviews with CLASP partners. Key informant interviews were informed by four advisors representing indigenous and nonindigenous leaders and partners. The refined set of lessons learned were finalized through qualitative analysis and validated through a conference session and one-day workshop with CLASP partners and First Nations, Inuit, and Métis community leaders. Outcomes: Twenty-seven lessons learned that describe how nonindigenous and First Nations, Inuit and Métis CLASP partners worked together to develop and put into practice culturally-appropriate cancer prevention approaches were identified. The lessons learned were grouped into six themes: 1. respectful relationships; 2. engagement with indigenous communities; 3. addressing accountability requirements, decision-making, and governance; 4. community direction; 5. supports and resources; 6. communication and knowledge exchange. What was learned: The actionable lessons learned are intended to guide future relationship building and engagement between nonindigenous partners and First Nations, Inuit and Métis partners. It is intended that these lessons will be beneficial to collaborative cancer prevention efforts around the world and inform broader system change leading to a reduction in indigenous cancer burden disparities.
Pan-Canadian Framework for Palliative and End-of-Life Care Research
Authors: Bray J. , Robbins S. , Dudgeon D. , Badovinac K. , Urquhart R. , Urowitz S.
Published: September 2018

Background and context: Ongoing advances have been made in the conceptualization and operationalization of palliative and end-of-life care (PEOLC) (e.g., palliative approaches to care, early identification of people who would benefit from palliative care). In addition, Canada has been a leader in PEOLC research and continues to have an internationally recognized research community. However, many Canadians continue to experience unnecessary pain and suffering at the end of life and receive care inconsistent with their goals and preferences. Within this context, the Canadian Cancer Research Alliance (CCRA) sought to develop a national research framework to guide Canada's cancer research funders in response to their strategic priority to improve the patient experience and quality of life for all cancer patients. Aim: To develop and implement a national framework and recommendations to enable funders to capitalize on existing research strengths and build capacity to address unmet needs to advance the field and broaden the scope, beyond its historical affiliation with advanced cancer, to include PEOLC for all those living and dying with life-limiting conditions. Strategy/Tactics: The framework's development was informed by multiple approaches, including: a strategic literature review; an analysis of PEOLC research funding in Canada from 2005-13; and an online survey and key informant interviews from the broader stakeholder community. Program/Policy process: A working group of CCRA member representatives and palliative care experts met regularly to provide guidance and feedback to a consultant who synthesized the data and formulated recommendations. In total, > 200 stakeholders (e.g., patients, caregivers, researchers, volunteers, practitioners, decision-makers, and policy-makers) provided input through the survey and interviews. Outcomes: The Pan-Canadian Framework for Palliative and End-of-Life Research was released March 2017. It emphasizes priorities for research funding across three broad themes: 1) Transforming models of care; 2) Patient and family centredness; and 3) Ensuring equity. The identified research priorities are underpinned by four building blocks: capacity building; knowledge, synthesis, exchange, and implementation; data access and standardization; and research network development. What was learned: Successful implementation of the framework's recommendations requires strong leadership from champions within the community. The formation of the Pan-Canadian Palliative Care Research Collaborative led by palliative care clinician-researchers, in response to the identified need for a research network, is an example of an early success resulting from release of the framework. Continued efforts are needed to ensure ongoing uptake of the framework's recommendations. CCRA members have commenced planning to identify next steps for joint action.
Communication Issues and Challenges of Information Sharing, Care Plans and Treatment Modalities for Cancer Patients and Families Accessing Hospice and Palliative Care Services in Nigeria and South Africa
Authors: Oyebola F.O.
Published: September 2018

Background: The recent upsurge in the prevalence of cancer cases in Nigeria and other African countries is fast becoming a great challenge for the clinicians and urgently required holistic interventions. Most patients (60%–70%) usually present at an advanced incurable stage. Communication issues such as breaking bad news, discussions around treatment options, prognosis and advance care plans are often neglected. Cancer diagnosis is often synonymous to a death sentence and inadequate knowledge about disease trajectories and information sharing with patients and their families is often responsible for patients' frustration. A supportive palliative oncology teams play a critical role in facilitating and communicating between clinicians, patients and their families to bridge the gap and ensure effective therapeutic communication. Aim: In preparation for the forthcoming UICC African Cancer fellowship visit to the Life Abundant Palliative Care, Victoria Hospital in Wynberg, South Africa, a preliminary study will be made to identify relevant challenging issues and data among cancer patients at the Federal Medical Center Abeokuta Nigeria. Methods: A retrospective and prospective study will be performed of diagnosed cancer patients referred to the Pain and Palliative Medicine Department of the Federal Medical Centre Abeokuta, Nigeria between 2016 and 2017. Their diagnosis, treatment options, treatment compliance and defaults, offer of advance care plans, extent of interdisciplinary team and family involvement will be evaluated using the patients' case-notes. For surviving patients attending the pain and supportive palliative oncology clinic, their knowledge of the disease, treatment challenges, prognostication and family support will be identified and documented. Results: The observational gaps in the retrieved information and data about the treatment outcomes and interdisciplinary team support and challenges will form the basis or rather the prestudy platform for the planned fellowship visit on to the Life Abundant Palliative Care, Victoria Hospital in Wynberg, South Africa. The identified knowledge and skills gap would be used to design the final study in South Africa in August 2018. Conclusion: It is expected that the two studies will reflect communication issues and the approach to cancer patients' management in two different African clinical settings. The acquired lessons or experience during the second phase studies in the South Africa clinical setting would be translated to Nigeria practice and also shared at the 2018 UICC World Congress.
Association Between Living in Urban Areas and Obesity in Haitian Breast Cancer Patients
Authors: Fadelu T. , Damuse R. , Pecan L. , Greenberg L. , Danjoue S. , Lormil J. , Rebbeck T. , Shulman L.
Published: September 2018

Background: Obesity and metabolic syndrome (MS) have been linked to increased risk of breast cancer recurrence and mortality in prospective cohorts. These studies have mostly occurred in high-income countries. Little is known about rates of obesity and what factors predict obesity in breast cancer patients from low- and low-middle income countries (LMIC). However, there are increasing rates of obesity in the general population of LMICs. Hôpital Universitaire de Mirebalais (HUM) in Haiti established the main public comprehensive cancer center in the country in 2013. The facility serves patients from all around the country. Aim: To establish the prevalence of obesity in a retrospective cohort of breast cancer patients at HUM, and evaluate the association between living in urban areas and obesity in this population. Methods: We evaluated 1035 women who had their first visit between July 1, 2013 and December 31, 2016, with a coded diagnosis of breast cancer, and who had been followed in the HUM program for ≥ 90 days. We abstracted their first recorded height, weight and blood pressure (BP). We identified individuals who met criteria for obesity (body mass index [BMI] ≥ 30 kg/m2), systolic hypertension (systolic BP [SBP] ≥ 135 mmHg), and diastolic hypertension (diastolic BP [DBP] ≥ 90 mmHg). After exclusion of missing data in the variables of interest, the final analysis cohort was 678. We classified home commune location as rural or urban based on World Bank and UN standards. We used logistic regression analysis to determine the odds of being obese for individuals living in urban areas compared with rural dwellers. Results: 179 breast cancer patients (26.4%) had BMI ≥ 30, of which 58 (8.5%) were morbidly obese (BMI ≥ 35). 309 (45.6%) patients had systolic hypertension (HTN) and 180 (26.6%) had diastolic HTN. 417 (61.5%) lived in urban areas; 125 (30%) of urban dwellers were obese while only 20.7% of rural dwellers were obese. The crude OR for obesity in urban versus rural areas was 1.64 (95% CI: 1.16-2.36). Using logistic regression analysis and controlling for age the OR for obesity in urban areas was 1.67 (95% CI: 1.15-2.40), P = 0.0162. We did a similar analysis for morbid obesity, while controlling for age, the OR in urban compared with rural patients was 2.16 (95% CI: 1.15-4.03), P = 0.0162. There were no statistically significant differences in SBP and DBP comparing rural and urban patients. Conclusion: HUM breast cancer patients from urban areas were more likely to be obese than rural dwellers. Urban patients were twice as likely to be morbidly obese. There were no differences in HTN between the groups. Higher rates of obesity in the HUM breast cancer population is partly driven by the higher proportion of urban patients. Further studies need to be done to evaluate the causes and mediators of obesity as well as its effect on patient cancer outcome in Haiti.
Relay for Life UAE: A 24-Hour Community Gathering for the First Time in the Mena Region and North Africa
Authors: Al-Jaaidi B.
Published: September 2018

Amount raised: 793,309.28 USD (2,913,900 AED). Background and context: Relay For Life began in the USA in May 1985 when colorectal surgeon, Dr. Gordy Klatt, wanted to raise awareness around cancer and boost his local cancer charity income. Since then, Relay For Life has become the largest fundraising event for cancer in the world. Friends of Cancer Patients launched the region´s first ever Relay For Life in Sharjah, United Arab Emirates with participation of more than 2500 people. Aim: Relay For Life UAE aims to raise awareness around cancer and spread the importance of leading a healthy life style, raise funds to support the FOCP patients mission against cancer, empower the cancer patients and create a community to support them and their families. Strategy/Tactics: Relay is a team fundraising event where members take turns walking around a track for 24 hours. Each team is asked to have a member on the track at all times to signify that cancer never sleeps. Taking place for the first time in UAE, Relay for Life gives everyone a chance to celebrate cancer survivors and carers; remember loved ones lost to cancer; and fight back by raising awareness and funds to support the work of Friends of Cancer Patients. FOCP has organized number of roadshows to explain to the different communities the concept of Relay for Life and how to be part of it. We reached to schools, universities, public events and parks, private and government organization. We offered a customized package for corporates to encourage their employees to participate as volunteers or as relayers. Furthermore, special packages for families were made to make it easy for them to join, while schools and universities student had a free entry. Program process: Press conference, to announce the date and venue of the event and explain to the media what is Relay For Life. Roadshow, to explain to the public what is Relay for Life and drive registration and donations. Opening ceremony. Survivors lap. Celebrate cancer survivors. Remember loved ones lost to cancer. Fight back by raising awareness and donations. Sponsored WiFi offered to all participants. Teams and families participating have the chance to fundraise during the event by selling items or offering services for a donation. Security all over the venue for 24 hours. ATM machine on site. Sponsored water for all participants. Food providers onsite for 24 hours. What was learned: 24 hours Relay for Life UAE has given the community a chance to create a strong community feeling with the cancer patients and their families. The most important lesson learnt was that people with no affiliation with cancer have seen the cancer survivors and how to be strong and never give up.
Evaluation of the Global Pattern of Cancer Survival and the Correlation With Healthcare Expenditures
Authors: Choi H. , Lam K.-O. , Pang H. , Tsang S. , Ngan R. , Lee A.W.M.
Published: September 2018

Background: Cancer is a global health burden; the outcome varies widely across all countries. Sharing of experience in setting health policy (including health expenditure) is important. However, there is yet no comprehensive comparison of cancer outcome across all countries. Furthermore, comparison of cost-effectiveness of different systems is especially complex because the incidence of different cancers varies across countries, and their chances of curability differ substantially. Aim: We aims to provide the comparisons using available data and to stimulate global attention to the association of economic parameters with different outcomes. Methods: Cancer statistics from all 184 countries and 27 major cancers listed in GLOBOCAN 2012 were analyzed. The overall outcome of cancer patients was estimated by taking the complement of age-standardized mortality/incidence ratio [1 − (ASM/ASI)] as the proxy relative survival (RS). Taking into account the variation of country-specific cancer pattern, the proxy cancer site-standardized RS (SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. The overall economic parameters of different countries listed by the World Bank were correlated with the corresponding proxy SS-RS. Results: The unadjusted proxy RS among the 184 countries ranged from 0.111 to 0.702 (median = 0.386), the corresponding proxy SS-RS ranged from 0.124 to 0.622 (median = 0.359). The median total health expenditure per capita (HE) increased from US$37 for countries with proxy SS-RS < 0.2, to $4255 for countries with proxy SS-RS ≥ 0.5. Results from logarithmic regression model showed exponential increase in total HE for better outcome. The expenditure varied widely among different strata, but the widest difference was observed among countries with SS-RS ≥ 0.5 (with total HE ranging from US$962 to $9361). Conclusion: Similar to age-standardization, estimation of outcome with adjustment for variation in pattern of cancer incidence is suggested for comparison among different countries, especially for studies related to assessment of health systems. Cancer outcome correlated significantly with economic parameters; the amount of HE escalated exponentially and varied widely among countries with high SS-RS ≥ 0.5. Sharing of experience among different countries will be valuable for developing the most cost-effective health system.
Factors Affecting Diagnostic Timeliness and Safety in Symptomatic Patients Subsequently Diagnosed With Bladder and Kidney Cancer: A Systematic Review
Authors: Zhou Y. , van Melle M. , Lyratzopoulos G. , Walter F.
Published: September 2018

Background: Timely diagnosis of cancer is important for good clinical outcomes and patient experience. Bladder and kidney cancer, being two relatively common cancers, can pose diagnostic challenges. Symptoms such as hematuria and urinary tract infections in some patients have a higher than 3% positive predictive value for cancer, a threshold above which English GPs are advised to consider the referral of patients for, under the 2015 NICE guidelines. However, the majority of patients with these symptoms will end up not having cancer. Therefore, the decision to perform further investigations or refer patients with these common urinary symptoms may differ despite the existence of guidelines. Studying in whom, and why, some patients may experience a longer than average time to diagnosis is important to understanding how avoidable diagnostic delay can be reduced, so that targeted interventions to improve early diagnosis can be developed to improve, ultimately, the outcome of these cancers. Aim: A systematic review was therefore performed to identify the factors that affect the diagnostic timeliness and safety of patients with urological symptoms that may be suggestive of kidney and bladder cancer. Methods: We searched Embase and Medline (Ovid) between 2000 and January 2018, for publications on symptoms/conditions including hematuria and urinary tract infection (UTI). We focused on clinical features that are listed in the English 2015 NICE guidelines for suspected cancer to examine the population that are most likely to have cancer, and in whom a timely diagnosis is the most crucial for outcomes. We also included symptoms that might be suggestive of a UTI (including dysuria, urinary frequency, urgency, incontinence and nocturia) to be overinclusive in our search. Results: Our initial search identified 7787 articles. Following title and abstract screening, 37 full texts were assessed for eligibility. A final 23 relevant studies were included. Our preliminary findings include evidence on patient, clinician and system factors contributing to diagnostic timeliness and safety issues (such as completeness of evaluation/investigations and referrals) in patients with possible urological cancer. These include patient sociodemographic factors (age, gender, ethnicity), clinician type (generalist, urologist vs gynecologist) and experience, and system factors such as delay in specialist appointment scheduling and patient no-shows. Conclusion: Our findings will provide a granular understanding of the factors contributing to avoidable diagnostic delay of patients with possible urological cancers globally. This is particularly important so that targeted interventions can be developed to help clinicians and health systems to better identify and manage at-risk patients with symptoms, so as to improve early diagnosis and outcomes of urological cancers.
Developing a National Cancer Control Plan Through Effective Partnerships: A Case of Kenya National Cancer Control Strategy 2017-2022
Authors: Karagu A. , Ng'ang'a A. , Kibachio J. , Gichangi P.
Published: September 2018

Background and context: A National Cancer Control Strategy (NCCS) provides a strategic framework that guides the systematic approach toward cancer prevention and control based on the existing cancer burden, risk factor prevalence and available resources. Though Kenya developed her first Kenya National Cancer Control Strategy in 2011, its implementation was characterized with various shortcomings. Aim: The Kenyan Ministry of Health set out to develop the second edition of the National Cancer Control Strategy with a focus on greater partnerships, evidence-based interventions and shared accountability of roles informed by lessons learnt from the NCCS 2011-2016. Strategy/Tactics: The Head of the National Cancer Control Program at the Ministry of Health was identified as the National Coordinator to lead the process and keep each stakeholder on track. A clear road map for developing the strategic plan was drawn with specific timelines. The process was further aligned to the Ministry of Health performance contracting system, a mechanism under the Government's public sector reforms aimed at improving performance. Program/Policy process: The Ministry hosted an integrated mission of Program for Action on Cancer Therapy (imPACT) coordinated by the International Atomic Energy Agency in August 2016 that reviewed the implementation of the NCCS 2011-2016. Following submission of the final imPACT report to the Ministry in November 2016, a steering committee led by the National Coordinator was established in December 2016. An initial one-day stakeholder meeting held in January 2017 developed consensus on the general outline of the document. Two multistakeholder retreats were held between March and April to develop the content for the strategy with an intervening review meeting to further refine the draft which was submitted to a set of 3 external reviewers. A final stakeholder validation meeting was held in May 2017 followed by proofreading and printing of the document. The process culminated with a national launch of the second National Cancer Control Strategy held in July 2017. Outcomes: A National Cancer Control Plan covering the entire continuum of care with interventions around 5 key pillars: prevention, screening and early detection; diagnosis and registration; treatment, palliative care and survivorship; coordination, partnerships and financing; monitoring, evaluation and research. The document was developed and launched in a record 6 months and contains an elaborate implementation matrix with clear indicators. What was learned: It is important to identify a focal person to steer the NCCS development process guided by a clear road map with specific timelines. A well-coordinated multisectoral partnership is crucial to developing such a comprehensive document.