bluuebunny/crossref_metadata_2025 huggingface dataset:
Adding Triage Ultrasound to a Breast-Cancer Detection Model in Peru
Authors: Bain C. , Scheel J. , Castillo V. , Tsu V.
Published: September 2018

Background: The rising breast-cancer burden in middle-income countries is straining the capacity of health systems to provide early detection and diagnostic services. To bring these services to women in a northern region of Peru, community education and clinical breast exam (CBE) by midwives was introduced as a method for screening asymptomatic women and evaluating women with symptoms; if positive, women were evaluated further by fine needle aspiration (FNA) by a trained physician at a local hospital. Aim: During the pilot phase, this early detection program resulted in increased demand for cytopathology services, invasive procedures for patients, delays in results, and high rates of benign findings. We added basic triage ultrasound (US), performed and interpreted by general physicians at a local hospital, to further evaluate women with a positive CBE and reduce the number of unnecessary FNAs. We aim to evaluate the changes in the FNA rate. Methods: PATH worked with an expert radiologist to develop a breast-US training program that included: teaching physicians to perform and interpret breast US using a triage algorithm based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) and a standardized checklist to document clinical and US findings. The triage algorithm was reviewed and validated by oncologists at Peru's national cancer institute, and later introduced in ten networks in northern Peru. Results: After adding triage ultrasound in 2015, a total of 133 CBE+ women received US at the local hospital; 73 women had a finding on US indicating a need for FNA biopsy, and all received it. Eleven of these women were subsequently diagnosed with breast cancer. Without triage US, all 133 CBE+ women would have received FNA. This represents a 55% decrease (60/133) in FNA biopsies. Conclusion: Triage ultrasound, as part of a resource-adapted model of breast screening, combined with FNA sampling increases the ability of general physicians to manage CBE+ women locally, thereby reducing health system burdens and assuring that patients at highest risk receive timely referrals to a specialized hospital. Triage ultrasound reduces the biopsy rate following a positive CBE. As ultrasound technology becomes more accessible and less expensive, we anticipate there will be an even more significant role for it in early detection models.
Geographic Variation in Colorectal Cancer Incidence and the Disparities in the Prevalence of Modifiable Risk Factors Across Canada
Authors: Tung J. , Politis C. , Chadder J. , Han J. , Niu J. , Fung S. , Rahal R. , Earle C.
Published: September 2018

Background: Colorectal cancer is the third most common cancer worldwide. There is wide geographic variation in incidence with rates varying ten-fold between high- and low-income countries. This heavy burden can be mitigated given previous research has estimated that nearly half of all colorectal cancer cases could have been prevented through healthier diets and physically active lifestyles. In Canada, there is considerable geographic variation in age-adjusted incidence rates for colorectal cancer between jurisdictions, greater than that seen for many other cancers. These wide variations likely reflect differences in the prevalence of risk factors across provinces and territories. Aim: To describe the extent of the variation in colorectal cancer incidence rates across Canada and the disparities in the prevalence of modifiable risk factors across jurisdictions known to contribute to this burden. Methods: Colorectal cancer incident cases were obtained from the Canadian Cancer Registry; 2014 was used for provinces (except Quebec where 2010 was the most recent year available) and years 2012 to 2014 were combined to achieve more stable rates for the territories, which are much smaller in population. Data on four known modifiable risk factors for colorectal cancer (excess weight, physical inactivity, alcohol intake and low fruit and vegetable consumption) were obtained from the 2015-16 combined Canadian Community Health Survey. Results: Findings suggest that there is a north-south and east-west gradient in colorectal cancer modifiable risk factors in Canada. For instance, the percentage of adults with excess body weight ranged from 56.8% in British Columbia (west) to 73.1% in New Brunswick (east) and the percentage of adults not meeting physical activity guidelines ranged from 31.8% in Yukon (north) to 50.3% in New Brunswick (east). Generally, this pattern also reflects colorectal cancer incidence rates. The highest prevalence of modifiable risk factors and rates of colorectal cancer are typically in the northern (territories) and eastern provinces of Canada. Conclusion: The global burden of colorectal cancer is expected to increase by nearly 60% by 2030; therefore, targeted interventions are needed to ensure there is not a widening gap in colorectal cancer burden worldwide. Based on current knowledge, the most effective approaches to reduce the burden of colorectal cancer include: 1) adopting public policies that make healthy choices easier and create healthier environments where people live, work and play, and 2) continuing emphasis on screening and early detection. Strategic approaches to addressing modifiable risk factors, as well as mechanisms for detecting colorectal cancer before it develops, have the potential to translate into positive effects on population health and less people developing and dying from cancer.
Health-Related Quality of Life Changes Among Oral Cancer Patients Treated With Curative Intent: Experience of a Developing Country
Authors: Doss J.G. , Ghani W.M.N. , Razak I.A. , Yang Y.H. , Rogers S.N. , Zain R.B.
Published: September 2018

Background: Standard outcome disease parameters like tumor control, overall survival and complications are now complemented with health-related quality of life (HRQoL) data as an important source of information concerning the impacts of disease and treatment outcomes for head and neck cancer patients. Aim: This study aims to assess changes in oral cancer patients' HRQoL and the impact of disease stage on HRQoL scores from the point of diagnosis (pretreatment) through the one, three and six month follow-ups. Differences in characteristics between patients presenting early and late were also explored. Methods: HRQoL data were collected from seven hospital-based centers using the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) V4.0. A total of 300 patients were recruited. Independent sample t-test, χ2 and paired sample t-test were used to analyze data. The Statistical Package for Social Sciences (SPSS) version 12.0 was used, whereby P < 0.05 was considered to be statistically significant. Results: Mean age was 61.0 ± 13.7 years old with most of them being females (60.7%) and of Indian ethnicity (35.0%). Betel quid chewing was the most common risk habit practiced (48.2%). The most common subsite was tongue and floor of mouth (42.6%). Surgical intervention (41.1%) was the most common treatment. Significant differences in ethnicity and treatment modality were observed between early and late stage patients. Among late stage patients, attrition rate increased significantly with increasing age, with higher proportions of attrition at later follow-ups. At pretreatment, HRQoL scores were significantly lower for late than early stage patients. At one month posttreatment, GF, H&N domains and FACT-H&N (TOI) summary scores showed significant deterioration among both early and late stage patients. In contrast, emotional domain showed significant improvement for early and late stage patients at 1, 3 and six month posttreatment. Although HRQoL deterioration was still observed among early and late stage patients at six months posttreatment, it did not achieve statistical significance. Conclusion: Advanced disease is associated with poorer HRQoL. Domains most commonly affected were the functional, physical and head and neck concerns. Although ethnic differences were observed across different disease stages, its influence on patients' HRQoL was not evident in this study.
From “Running for Hope” to “5 Tips to Stay Away From Cancer”
Authors: Su L.Y. , Wu C.Y. , Wang C.L.
Published: September 2018

Background and context: In 2012, Hope Foundation for Cancer Care initiated “Running for Hope” project (road running around Taiwan) to raise awareness of Pap test and female cancers, during which lack of awareness about cancer prevention among general public was observed. To further educate the awareness, HOPE foundation launched campaigns in campus to aim at younger generations. According to both World Cancer Research Fund (WCRF) and Union for International Cancer Control (UICC), by adopting healthier style of life, which includes staying away from cancer-causing factors, healthy diet, regular exercise, weight management and effective cancer screening, millions cancers on a global scale can actually be prevented. Aim: To implement campaigns about healthy life styles which include staying away from cancer-causing factors, healthy diet, regular exercise, weight management and effective cancer screening. Strategy/Tactics: To implement “5 Tips to Stay Away From Cancer” campaign. The five tips are: proper diet, regular exercise, saying no to cigarettes, alcohol and beetle nuts, weight management and regular screening. Program/Policy process: In 2013 and 2014, cancer prevention short films were played in campuses. In 2015, taken inspiration from Running for HOPE project in 2012, a campaign for raising awareness for female cancer was initiated by using new social media and smart phones with the display of “HOPE” logo on screens. In 2016, renowned cross-disciplinary artist Mr. Eyeball was invited to create the mascot Bao-Di, launching the new cancer-prevention slogan “Cancer prevention—five tips to keep you safe—proper diet, regular exercise, saying no to cigarettes, alcohol and beetle nuts, weight management and regular screening”. The mascot Bao-Di took on the role of educating the public about how to prevent cancer. In 2017, more social media strategies were applied, including the Bao-Di journal, celebrity-featured short-films, Line stickers and taxi advertisements. Outcomes: 1. 7 screenings of short films with 1843 views in campus (2013), 9 screenings of documentary in local communities with 545 views (2014). 2. 505 people joined Running for Hope project in photo-taking with the “HOPE” logo during 6 weeks of campaign (2015), 1028 people participated “Hope You are Here” campaign. 3. 24,290 people were reached through Bao-Di Journal project with its friendly campaign “Cancer prevention–five tips to keep you safe”. 4. 121,335 people total viewed the two celebrity-featured short films on YouTube. 5. 365 download of Line stickers. What was learned: 1. Lack of awareness about cancer-prevention through direct contact with general public during the road running project was observed. Therefore, more effort in education is foreseen. 2. Development of localized risk-reducing signs and mascots taken inspiration from campaigns of international cancer-prevention organizations. 3. Application of new social media to raise cancer-prevention awareness.
Knowledge and Screening Practices of Breast and Cervical Cancer in Rural and Urban South Africa
Authors: LaVigne A. , Grover S. , Rayne S.
Published: September 2018

Background: The South African government has recently released cancer policies for breast and cervical cancer—the most common types and causes of cancer-related death in South African women. Increased mortality rates and advanced disease at presentation in comparison with developed countries suggests a need for greater awareness of risk factors, screening and preventative methods individualized for the population at risk. Aim: To characterize and compare the knowledge base and perceptions of women in urban and rural settings, we assessed these factors in two different cohorts in South Africa. Methods: A cross-sectional sample was taken in South Africa of women invited to participate in a survey regarding breast and cervical cancer knowledge, and awareness of risk factors, prevention and screening. Participants were approached in shopping malls and health facilities in urban Johannesburg in 2015 (“urban”) and semirural Bushbuckridge, 450 km northeast of Johannesburg (“rural”) in 2016. Results: 600 total women were surveyed, with 300 from each cohort. 83% of the urban cohort completed matriculation or higher, versus 60% of rural participants for whom high school was their highest level of education. Both groups demonstrated comparable levels of cancer awareness, and > 70% felt that cervical cancer is preventable. While the urban cohort was more knowledgeable about Pap smears (76% vs. 66%, P = 0.004), > 75% of both cohorts were willing to get one. Although both groups were largely unfamiliar with the role of HPV in cervical cancer, rural women were more aware of HIV (38% vs. 59%, P < 0.0001), smoking (43% vs. 62%, P < 0.0001) and parity (39% vs. 54%, P = 0.00019) as risk factors. Nevertheless, urban participants were more knowledgeable about breast self exams (71% vs. 59%, P = 0.001) and mammograms (62% vs. 42%, P < 0.0001), and more likely to undergo one (79% vs. 66%, P = 0.0002). Both groups identified family history and genetics as risk factors, but rural women appeared more aware of the roles of diet (30.67% vs. 39.93%, P = .011), oral contraceptives (17.33% vs. 34.77%, P < .0001), alcohol (26.67% vs. 52.15%, P < .0001) and lack of exercise (8.67% vs. 55.12%, P < .0001). Conclusion: Overall knowledge of breast and cervical cancer did not differ between both groups, despite varying levels of education and geographic setting. Women in the rural cohort demonstrated more awareness of several oncologic risk factors. Yet, the greater familiarity with and uptake of screening methods, especially for breast cancer, among women in the urban cohort may point to the benefits of proximity to health care infrastructure, such as tertiary care centers. This data supports a need for further implementation and distribution of cancer care services within cancer policies, to capitalize on increasingly sufficient levels of awareness among South African women.
Strengthening Screening and Detection Services for Breast Cancer in Vietnam
Authors: Jenkins C. , Ngan T.T. , Ngoc N.B. , Phuong T.B. , Lohfeld L. , Donnelly M. , Minh H.V. , Murray L.
Published: September 2018

Background: The incidence of breast cancer has increased consistently in Vietnam over the past two decades. Data from 2012 indicates an increase from an age-standardized rate of 16.2 per 100,000 in 2002, to 23.0 per 100,000 in 2012. Despite this, and consistent studies indicating late diagnosis, there has been a lack of empirical studies on what breast cancer services exist and how they function across different levels of the Vietnamese health system. Aim: Our project sought to examine the accessibility, affordability, and appropriateness of breast cancer services in Vietnam with the objective of making recommendations to strengthen service delivery. Methods: The project used a mixed-methods approach, collecting data through self-administered questionnaires (n=69) and in-depth interviews (n=23) with health professionals working at facilities across all four levels of the Vietnamese health system (national, provincial, district, & commune). We completed in-depth interviews with women (n=12) diagnosed with breast cancer, focusing on their experiences of accessing and using services. Our study was located across three provinces, representing the northern, central, and southern regions of the country. Results: Our results show that screening activities for breast cancer in the community are not systematically organized or provided. There are no stand-alone screening campaigns for breast cancer and facility-based opportunistic screening is limited. There is scope for strengthening the primary and secondary levels of the Vietnamese health system to detect, diagnose and treat breast cancer. Increased autonomy and support for commune-level health stations to conduct screening activities, the systematic incorporation of opportunistic screening, and the extension of breast cancer-specific training for commune and district level health care staff are potential areas for strengthening. Conclusion: Our study suggests that there should be concerted efforts to implement the Ministry of Health's strategic objectives to decentralise and strengthen commune and district levels of the health system in relation to detection, diagnosis and treatment of breast cancer. No studies have been conducted that pilot interventions to provide systematic and comprehensive breast cancer services at the lower levels of the health system. Specific attention should be given to increasing autonomy and support for commune level health stations to conduct screening activities; for the systematic incorporation of opportunistic screening; and the extension of breast cancer-specific training for commune and district level health care staff.
The Implementation of ISO 9001:2015 to Improve the Supportive Care Services for the Cancer Survivors
Authors: Lai J. Tsai , Yu Z.
Published: September 2018

Background and context: Cancer has been the leading cause of death in Taiwan since 1982. According the most updated cancer registry published by the Ministry of Health and Welfare, a total of 105,156 new cases (302/100,000 population) were diagnosed and 46,829 people (128/100,000 population) died of cancer which accounted for 28.6% of all deaths. Currently, around 500,000 people live with cancers in Taiwan. The Formosa Cancer Foundation (FCF) operates two Cancer Survivor Supportive Care Centers in Taipei and Kaohsiung cities which provide comprehensive, professional services to cancer survivors and their families. These centers regularly offer free medical, nutritional and psychological counseling, nutrition and transportation subsidies for low-income survivor households, critical emergency relief as well as hold a regular courses of body and mind rehabilitation to help cancer survivors successfully navigate their road to optimal recovery. As the number of cancer survivors needed supportive care services are rapidly increasing, the resources allocated for the services is not proportionately increased. Therefore, how to improve both the quantity and quality for the survivors' supportive care services becomes an essential issue. Aim: To ensure service standardization as well as to improve the quantity and quality of the supportive care services for the cancer survivors. Strategy/Tactics: FCF began the process necessary to certify its Survivor Supportive Care Service Quality Management System under ISO 9001 since 2015. Program/Policy process: To certify the FCF Survivor Supportive Care Service Quality Management System under ISO 9001:2015 by (1) Clearly defining the assessment and service goals (2) Systemized management and control of service delivery procedures (3) Regular collection and utilization of client-satisfaction data and comments (4) Systemized tracking and management of documents (5) Standard method for records storage and maintenance (6) Standardized procedures for managing and maintaining service facilities; and (7) Standardized procedures for evaluating and training staff. Outcomes: After implementation of the ISO 9001:2015 quality management system, FCF's overall service capacity has increased by 18-20%. Each service now covered by a standardized procedure, high levels of service quality and teamwork have been well maintained even under reduced staffing conditions. Survivors’ satisfaction with FCF services has risen significantly from an average of 4.0 prior to implementation of the quality management system to 4.7 afterward (full score: 5). The survivor´s family members also indicate strong satisfaction with FCF services. What was learned: Implementing the ISO 9001:2015 quality management system in the cancer survivor supportive care service has assisted FCF not only to increase the quality and quantity of its service deliveries but also to enhance the effectiveness of its professional team.
Loss to Follow-Up in a Cervical Cancer Screening and Treatment Program in Western Kenya
Authors: Kiptoo S. , Otieno G. , Tonui P. , Mwangi A. , Orango O. , Itsura P. , Muthoka K. , Oguda J. , Rosen B. , Loehrer P. , Cu-Uvin S.
Published: September 2018

Background: Increasingly, evidence is emerging from developing countries like Kenya on the burden of loss to follow-up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the western region of Kenya. This study is designed to determine the proportion of and predictors and reasons for defaulting from follow-up care after positive cervical cancer screen. Aim: To determine the rates and factors associated with loss to follow-up in a multivisit cervical cancer screening and treatment program in western Kenya. Methods: We conducted a prospective study of women, who presented for cervical cancer screening at Chulaimbo and Webuye subcounty hospitals, and screened positive by VIA. A 2-3 weeks appointment was then set for review by a gynae-oncologist. A total of 100 women, scheduled for review, were recruited in the study and followed between August 2016 and May 2017. LTFU was defined as failure to keep a second rescheduled appointment or being unreachable for 3 consecutive months and failure to confirm that a woman sought for care in another health facility. Descriptive statistics was used for summary and the Cox regression model was used to estimate the risk of LTFU for different covariates. Results: The age range was 21-77 years, with a mean of 44.45 years. 39% of the women defaulted from scheduled follow-up appointment of which 25 (64%) were LTFU. Univariate Cox regression was conducted for HIV cases (HR=2.7, P value=0.021), clinic revisits (HR=2.6, P value=0.026), married (HR=0.63, P value=0.237) and previously screened women (HR=1.67, P value=0.198). Increased risk of LTFU was observed for HIV cases (HR=2.4, P value=0.04) and revisits (HR=7.5, P value=0.014) in an adjusted model. Conclusion: LTFU affects cervical cancer management due to several factors some of which are beyond the control of the women. We recommend a larger study be replicated for ease of generalizability of results; awareness and strategies are required to retain them to obey the treatment appointment since they are the highly vulnerable.
Losing Themselves From Following Up: Barriers to Accessing Further Clinical Investigations for Women With Abnormal Clinical Breast Examination (CBE) Findings in Klang Valley, Malaysia
Authors: Choo S.L. , Kamaruddin D. , Sabu S.S. , Lim C. , b. N.I. , Low K.Y. , Hashim H.S. Mohd , Munisamy M.
Published: September 2018

Background: Clinical breast examination (CBE) is one of the most accessible screening methods for breast cancer and widely used in the Malaysian public health system due to the wide availability of trained healthcare personnel and low costs; especially in government hospitals. However, discovery of an abnormal finding from the CBE does not necessarily translate into action for further clinical investigations. An understanding of the patients' motivations in decision making, which causes them to ignore the need for further clinical investigations despite abnormal findings in CBEs may be an important element to improve holistic cancer prevention efforts; of which early detection is a key strategy. Aim: The aim of this study was to investigate the barriers for women to receive follow-up care upon obtaining abnormal results for CBE. Methods: The National Cancer Society of Malaysia has an active ongoing public outreach program in which trained healthcare personnel conduct CBEs at various screening campaigns throughout the Klang Valley with a total of 1017 women screened in 2017. Women who were screened and found to have an abnormal finding from the CBE were referred for further investigations at a center of their choice. Women found to have an abnormal CBE finding were reached via a phone call to determine whether they had proceeded to i) get an appointment for further clinical examination; or ii) had already undergone a further clinical examination. Those who had done neither were interviewed via phone to determine their reasons for not proceeding with further clinical investigations despite an abnormal CBE finding. Results: Out of the 1017 women screened, 38 were found to have an abnormal CBE finding. Of them, 16 women had not sought further investigations. Qualitative interviews revealed that there strong issues that posed barriers to these women pursuing further investigations. These barriers included a lack of knowledge and understanding about breast cancer or rationale of undergoing a CBE; a lack of urgency pertaining to CBE results and feeling of embarrassment engaging with family members on facilitating attendance to the investigation. Conclusion: Significant barriers remain which deter women who have abnormal CBE findings from pursuing further clinical investigations which ultimately reduces the effectiveness of current breast cancer screening strategies. These findings may prove to be important for designing effective methods to encourage confirmatory clinical examination among those already found to have abnormal findings from tests such as the CBE.
Comparing and Contrasting Patient and Health Care Professional Views on Spiritual Care: Implications for Practice
Authors: Fitch M.
Published: September 2018

Background: Providing spiritual care has been identified as important in cancer care, especially for those individuals who are living with advanced disease. However, the busy nature of the current health care environment has created challenges for health care practitioners to identify spiritual distress and engage in appropriate interventions. Aim: This project was undertaken to deepen our understanding of spiritual care and the realities of identifying spiritual distress in a busy clinical environment. We sought to identify if there was a simple question that would be useful in screening for spiritual distress when used by the frontline provider. Methods: Patients with advanced disease (N=16) and health care practitioners (N=21) who care for them were interviewed in depth using an open-ended approach. Verbatim transcripts were analyzed separately for each group and themes identified. Subsequently, the perspectives from each group were compared, and common as well as discordance perspectives were identified. Results: Common views included spirituality as unique to the individual; spiritual distress as isolation, loneliness, and a sense of disconnection; spiritual care as listening, being with, and engendering a sense of connectedness; and identifying spiritual distress as needing a conversation rather than a single question. Contrasting views were seen in the difficulty health care practitioners had in describing spirituality, giving examples of spiritual distress and spiritual care from their own practices, and seeing a role for themselves in providing spiritual care. Patients, on the other hand, easily described these concepts and offered eloquent examples of their experiences related to spirituality and receiving spiritual care. Conclusion: Health care practitioners in this study struggled in describing spirituality and identifying roles for themselves in providing spiritual care. Patients considered spiritual care as important to their experience of living with advanced disease and expected it would be provided by their practitioners. The variation in perspectives could contribute to “missed opportunities” to support individuals and provide meaningful spiritual care.
Familial Risks Between Urolithiasis and Cancer
Authors: Li X.
Published: September 2018

Background: Urolithiasis (UL, urinary tract stone disease) has been reported to increase subsequent cancers in the urinary tract. Recently, we showed data that surveillance bias may be an important confounder in the reported associations. Aim: In the present approach we want to address the question of possible cancer risk posed by UL mechanistically. Both UL and cancer have strong genetic components and we hypothesize that familial association between UL and cancer may be plausible. We thus assess familial risks between UL and cancer, hoping to find an explanation why UL may pose a risk of cancer. Methods: UL patients were identified from hospital inpatient and outpatient records and they were organized in families based on the multigeneration register into which also national cancer data were linked. Standardized incidence ratios were calculated for cancer in the offspring generation when parents were diagnosed with UL, and conversely for UL when parents were diagnosed with cancer. Results: Familial risks between UL and cancer were generally small and inconsistent providing no convincing support of genetic sharing between UL and cancer. However, bladder UL was associated weakly with prostate cancer, and ureter and bladder UL were associated with salivary gland cancer. The current study did not provide data in support of UL leading to systemic cancers. Nor did we find any strong support for the induction of local tumors in the urinary tract; however, as the cause for local tumors may be chronic mechanical wear and inflammation, a family study may not find such a link. Conclusion: We found support for a weak familial association of bladder UL and prostate cancer but could not distinguish between genetic or familial prostate hyperplasia mechanisms. Unexpected findings showed associations of ureter and bladder UL with salivary gland cancers. The likely initial link was familial predisposition to both salivary gland and urinary tract stones but the necessary final link between salivary gland stones and salivary gland cancer needs yet to be demonstrated.
Drug Utilization and Cost Analysis Review of Anticancer Drugs Used in a Tertiary Care Teaching Hospital in South India
Authors: Babasahib S.K. , Maria S. , Rawther S. Chillakunnel Hussain
Published: September 2018

Background: Cancer is ranked high among noncommunicable diseases and millions of people in India receive treatment of cancer every year. Aim: The current study aims to evaluate the trends and pattern of prescribing of anticancer drugs. The objectives of the study were to assess the rational use of anticancer drugs, to identify various types of cancer and to analyze the cost distribution of anticancer drugs. Methods: An observational, prospective study was conducted in 200 prescriptions in oncology department. Data were collected from case reports, prescriptions and medication charts in specially designed forms. Results: Out of 200 patients enrolled, majority were female (59.5%) and in the age group of 40-60 years (52%). Gastrointestinal tract cancers (25%) were most commonly observed, followed by breast cancer (18.5%) and genitourinary cancers (16.5%). Cisplatin (35%) was the most commonly prescribed anticancer drug, followed by paclitaxel (18.5%), carboplatin (14%), 5-fluorouracil (12.5%) and oxaliplatin (7.5%). Ranitidine, dexamethasone and ondansetron were used as palliative therapy either to prevent or manage the adverse reactions of the anticancer drugs. Trastuzumab contribute to the major cost (Rs. 450,000) in the drug therapy. The average cost of drug per prescription was Rs. 11,135. The overall prescribing indicators, point that the average number of total drugs, anticancer drugs and antibiotics were 12.22, 1.73 and 0.43 respectively. Conclusion: The usage of drugs was found to be rational and about 99.38% of the drugs used were from the hospital formulary. The prescribing habits are appropriate and are in accordance with WHO guidelines. The current study may support best prescribing practices to promote cost effective treatment and better health care delivery.
Evaluation of Invitation Strategies for Community-Based Papanicolaou Test Screening: A Randomized Controlled Trial
Authors: Chiu S.Y.-H. , Song W.-T. , Yeh J.-Y. , Yeh Y.-P.
Published: September 2018

Background: In Taiwan, Papanicolaou test for cervical cancer screening has been implemented since 1995, previous study has shown that Papanicolaou test can substantially decrease the cervical cancer incidence and mortality rates. However, the regulated triennial participate rate, a policy key performance index, has never reached 70%, indicates the methods of inviting people to attend the Papanicolaou test still have room to improve. Aim: Our study aim was to evaluate the effectiveness of different invitation strategies stratified by frequency of clinic visiting per year using randomized controlled trial approach. Methods: The health bureau and local hospital collaborative program was initiated in Changhua County, the middle county in Taiwan. We enrolled the eligible women aged 30 or more who never attend to undergo cervical cancer screening in recent three years to initiate a randomized control trial based on different times of clinic visiting per year. Based on clinic visiting records in recent year as hospital loyalty, participants are classified into three levels, including no clinic visiting history, 1-3 times, and 4 times or more of clinic visiting in 2005, and then randomly allocated into no-intervention, postcard invitation, telephone call reminding only, and telephone call with reservation appointment. The study outcome was measured by whether the participant completes the Papanicolaou test within four months after the invitation was launched. We conducted univariate and multivariable Poisson regression models to evaluate the effectiveness in different strategies compared with no-invitation group, also used Cox proportional hazards regression taking hesitating period for participating the Papanicolaou test into account. Results: Using the intention-to-treat analysis, among those who without clinic visiting, compared with control group (no intervention), the result shows no significant benefit of postcard reminding. After adjustment for other potential factors, the results show the strategies of invitation were postcard (adj. RR=1.40, 95% CI: 1.22-1.61), telephone call reminding only (adj. RR=1.79, 95% CI: 1.52-2.10), and telephone call with scheduling appointment (adj. RR=1.90, 95% CI: 1.62-2.23). Regarding the different frequency of clinic visiting, compared with subjects without clinic visiting, those who were higher clinical visiting are tend to being attendee of screening and telephone call with scheduling appointment is higher effectiveness, respectively. Conclusion: Telephone-call reminding only and telephone-call with scheduling appointment significantly increased Papanicolaou test participation rates in those who were low and high loyalty patients as well.
SPARC 2017 MBC Challenge: Validation of CALM Therapy Model in MBC Patients in Portugal: An Intervention to Address Patients' Psychosocial Needs
Authors: Travado L. , Gil A. , Rodin G.
Published: September 2018

Background: Psychological distress is common in patients with metastatic cancer and the progression of disease brings multiple predictable challenges. However, there are very few cost-effective evidence-based interventions that address these specific needs of this population. CALM (Managing Cancer and Living Meaningfully) is a brief intervention model recently developed in Canada for this purpose. CALM includes 3-6 individual sessions, each approximately 45 minutes in length, delivered over 3 months, that cover 4 critical domains for this population: 1) symptom management and communication with health care providers; 2) changes in self and relations with close others; 3) spiritual well-being, or sense of meaning and purpose; 4) preparing for the future, sustaining hope and facing mortality. CALM has been successfully tested in Canada and other countries, showing significant reductions in depressive symptoms and death anxiety in therapy participants and a significant improvement in spiritual well-being over time. In Portugal there are no available short cost-effective psychotherapeutic interventions to address psychosocial needs of advanced cancer patients. Aims: (i) Translate and adapt the original CALM therapy manual for Portuguese patients with metastatic breast cancer (MBC) for its application and dissemination in Portugal and in other Portuguese speaking countries; (ii) Test the feasibility of the CALM therapy intervention in Portuguese patients with MBC; (iii) Test the effectiveness of CALM in reducing depression and other psychological distress in this population; (iv) Increase the availability of psychosocial resources to address the specific psychosocial needs of MBC patients and to reduce the current gap of psychosocial care for this population in Portugal and Portuguese speaking countries. Methods: Conduct a Phase II single-arm, intervention-only study, with assessments at baseline, 3 months and 6 months; Site Champalimaud Clinical Centre, Lisbon, PT; Primary outcome: depressive symptoms assessed by PHQ-9; Secondary outcome measures include: FACIT-Sp, measure of spiritual well-being in palliative care; Death and Dying Distress Scale (DADDS); Experiences in Close Relationships Inventory (ECR-M16); and the Clinical Evaluation Questionnaire (CEQ). We will also collect additional information including demographics and relevant medical data. We plan to recruit 35 patients over an 18-month period at the Breast Unit. Eligible participants will receive the CALM individual semistructured psychotherapy. The Canadian CALM team is closely monitoring and supporting the study. Results: In progress.
Quality of Death of Patients With Advanced Cancers in India
Authors: Revathy S. , Surendran V. , Prasanth G. , Kalpana B.
Published: September 2018

Background: Death with dignity is a basic right of all patients with advanced cancer, whereas in India, the healthcare providers have not closely examined whether the end-of-life care promotes the quality of death. The quality of death analysis can give us an insight on the impact of the disease and palliative treatment on end-of-life care. Aim: This study aims to explore the quality of death of patients with advanced cancers. Methods: A mixed method study where the caregivers (n=108) of advanced cancer patients, who expired either during hospitalization or at home, were chosen through purposive sampling and interviewed to assess the quality of death, using validated caregiver ratings of patients' physical and mental distress on a scale of 0-10, along with an open ended question. The data thus obtained was analyzed using descriptive statistics, t-test and χ2 test. The transcripts and scores were analyzed through thematic analysis and descriptive statistics respectively. Results: The mean quality of life during the final week of the patients who had expired is 4.17 (SD=2.44), while the psychological and physical health are 5.27 (SD= 2.49) and 3.75 (SD= 2.30), respectively. Almost 60% of the patients were reported to have average to good quality of life during their final week, whereas 73.1% and 52.7% of the patients had average to good psychological and physical health respectively. The physical health was found to be significantly higher among men ( P = 0.000) and among those who were aware of their prognosis ( P = 0.000). Also, patients who had expired at the hospital were found to have significantly better physical health during their end-of-life, than those who had expired at home ( P = 0.006 ), whereas, the psychological health and overall quality of life of the patients did not differ significantly between the place of death. The most commonly reported reason by the caregivers for the patients' distress was physical suffering. Pain, lack of appetite, difficulty in breathing and compromised mobility, irrespective of the site, was reported by 41.6%, 38.8%, 25.9% and 27.7% respectively. Majority of the patients (65.7%) were not aware of their prognosis, thus leading to psychological distress pertaining to anticipation about survival and worsening of physical symptoms. Despite the high distress, 60% reportedly had moderate to high quality of life in their last week of life. The thematic analysis of the transcripts resulted in seven subthemes, which were categorized under four major themes namely 'bodily discomfort', 'psychological experiences' with the subthemes moral emotions and emotional disturbances, 'awareness of prognosis' with the subthemes aware, unaware and conjecture and 'carers coping' with the subthemes perceived strain and contentment. Conclusion: Although the quality of life of patients under end of life care was perceived to be good, they suffered physically and psychologically, as reported by the caregivers.
Exploring the Post-Treatment Experiences of Childhood Cancer Survivors
Authors: Fernandez A.S.
Published: September 2018

Background: One of the great successes in medicine is the treatment of childhood cancer. Due to the overall increase in the survival rate of individuals with cancer, the disease is now considered a chronic condition (Meeske, Patel, Palmer, Nelson, & Parow, 2007) rather than a terminal illness, drawing tremendous amount of attention toward examining the subjective well-being among cancer patients and survivors. In the Philippines, there is a growing number of childhood cancer survivors, however, they face posttreatment challenges that are given less attention in research in the country. Aim: The study sought to understand the experiences of Filipino childhood cancer survivors, focusing on the challenges, triumphs, and experiences related to postcancer treatment. An awareness and a better understanding of these will likely help psychosocial oncology professionals improve survivors´ level of functioning and quality of life in the posttreatment period. Methods: Using a qualitative design, six focus group discussions were conducted with 21 survivors of childhood cancer. Two of the FGDs were with survivors ages 13-18 years old and four FGDs were with 19-25 years old. The discussions were recorded and then transcribed for data storage, management, and analysis. Results: The results consisted of information grouped into two broad categories as positive and negative experiences. Survivors of childhood cancer reported positive experiences during the post-treatment period. They experienced improvement in their physical condition (healthy lifestyle, better health), in psychosocial wellness (gratefulness, determination), and in sustained religious engagement (prayerfulness, involvement in religious activities). On the other hand, the survivors also reported negative posttreatment experiences. Their negative experiences were thematically clustered according to the broad areas of cognitive (inefficient memory retrieval), physical (limitations on physical activities, pain, body issues), and socio-emotional (worry about cancer in the family, fear of relapse, fear of rejection, irritability) aspects. Conclusion: The experiences of the survivors in the posttreatment have both positive and negative dimensions. However, the reported negative experiences seem to weigh heavily on the survivors, with numerous cognitive, physical and socio-emotional concerns. There is an increasing urgency to understand the posttreatment psychological needs of the growing population of childhood cancer survivors, and develop follow-up psychosocial interventions for them. These psychosocial interventions can equip survivors with strategies to effectively manage and overcome their chronic worries, instill confidence and a sense of security and be able to plan for their future more positively.
Perceived Risk, Anxiety and Alexithymia in Sisters of Breast Cancer Patients Veena Shukla Mishra and Dhananjaya Saranath
Authors: Mishra V.S.
Published: September 2018

Background: Breast cancer is the most common cancer in Indian women with an annual incidence of 144,937 cases and mortality of 70,218. The perception of cancer risk has consistently been mentioned as major factor influencing the women, who are at increased risk of inherited breast and ovarian cancer. The overestimation of cancer risk has been associated with many negative outcomes like anxiety and distress for one's self and family. Study suggests that women those who have higher perceived breast cancer risk experience greater worry and disengage coping. Aim: The purpose of the study was to examine the perception of risk of breast cancer in sisters of newly diagnosed breast cancer patients and further examine the association with anxiety and alexithymia, as compared with healthy controls without a family history of breast cancer. Methods: The participants were requested to complete questionnaires including demographic and risk perception of breast cancer. The association of risk perception was evaluated by using the State Trait Anxiety Inventory Scale and Toronto Alexithymia Scale in sisters of breast cancer patients and healthy controls. Results: Sisters of 111 breast cancer patients and 123 healthy controls completed the questionnaire. Sisters with high perceived risk showed high scores on anxiety and alexithymia scale as compared with healthy control. Regression analysis showed significant association between perceived risk and anxiety (t=2.023, P < .05) and alexithymia factor difficulty in identifying feelings and total alexithymia score (t=6.787, P < .000 and 3.726, P < .000). Conclusion: Sisters of breast cancer patients showed significantly higher perceived risk, anxiety and alexithymia than their healthy counterparts. The sister's perception of breast cancer risk influences the anxiety and emotional experience. Our data emphasizes that medical professional should discuss risk appraisals to anxiety and emotional concerns in both breast cancer patients and their sisters to help them in coping with breast cancer and concerns in the family.