bluuebunny/crossref_metadata_2025 huggingface dataset:
Protein Classification of Diffuse-Type Gastric Cancer Using Formalin-Fixed Paraffin-Embedded Samples
Authors: Huang W. , Xia X. , Gao J. , Li Z. , Ge S. , Qin J. , Shen L.
Published: September 2018

Background: Gastric cancer (GC) is the third leading cause of cancer deaths in the world. It is highly heterogeneous. Many molecular therapies for GC have entered clinical trials but, apart from trastuzumab, apatinib and ramucirumab, all have failed. One important reason is that insufficient attention is paid to the underlying subtypes and characteristics of GC, especially the diffuse-type gastric cancer (DGC) according to the Lauren classification with worst clinical outcomes. Aim: Here we firstly investigated formalin-fixed paraffin-embedded (FFPE) samples of DGC to establish clinically relevant molecular classification based on proteomics analysis. Also, we tried to generate a suitable classifier of DGC that can guide patient therapy. Methods: We screened a total of 2548 cases retrospectively, who underwent GC resection at Beijing Cancer Hospital from October 2006 to December 2011. We used a fast mass spectrometry workflow for proteome profiling. Finally we carried out proteome profiling of 99 DGC paired tumor-nearby tissues from FFPE sections. Median overall survival of the whole population was 55.0 months. Proteome profiling data from these samples were used to develop a subtype prediction model. We used consensus clustering to identify molecular subtypes based on differentially expressed proteins. The pathway enrichment was performed by GSEA, and the prediction classifier was generated by elastic-net machine learning. Kaplan-Meier survival analysis and Cox regression multivariate analysis were used. Results: A total of 8201 gene products were identified in this study, and 1249 differential expressed proteins between tumor and nearby-normal tissue was detected (FDR q-value < 0.01 by SAM). Tumor upregulated proteins mostly enriched into pathways including RNA processing, epithelial-mesenchymal transition (EMT), immune response and inflammation related pathways. Tumor downregulated proteins mostly enriched into metabolic pathways such as oxidative phosphorylation pathway. Based on proteome profiling alone, DGC can be subtyped into 3 major classes (PX1-3) that exhibit distinct proteome features and correlate with distinct clinical outcomes. PX1 (31 patients) exhibits RNA processing proteins and associates with the best prognosis; PX2 (26 patients) exhibits highly expressed cell cycle features, and the patients have poorer prognosis than those with cluster1 but better prognosis than those with cluster3; PX3 (42 patients) features EMT and the worst prognosis. We built a classifier of 12 marker proteins that can stratify DGC patients into these 3 subtypes, opening a door for protein classification in clinical application and intervention. Conclusion: Our study demonstrated that proteome profiling alone from FFPE samples was able to subtype DGC into 3 protein subtypes that were linked to distinct patterns of molecular alterations and prognosis. The prediction model need to be further verified in more clinical cohorts.
The HERO Project: Inspire Awareness, Strengthen Radiotherapy, Deliver Equitable Access
Authors: Lievens Y. , Gasparotto C. , Defourny N. , Grau C.
Published: September 2018

Half of all cancer patients in Europe should receive radiotherapy (RT) during the treatment of their disease. But there is a remaining gap in RT provision, leading to suboptimal access. Additionally, healthcare budgets are tight, and economic evaluations are key to support decision making. The HERO project (Health Economics in Radiation Oncology) is developing a knowledge base for health economic evaluation of RT at the European level. It aims to provide solid data to engage with decision makers; it empowers the RT community to advocate for better resource planning and ultimately better care for patients, closing the gap in RT access. The project assessed the availability of RT in Europe, in terms of equipment, staffing and guidelines. Then, it investigated the need for RT in Europe. Applying available EU data to the CCORE group (Collaboration for Cancer Outcomes Research and Evaluation) decision trees of evidence-based indications, the RT optimal utilization proportion, existing gap and growing needs have been calculated. Finally, knowing the cost of treatment is needed for budget planning and reimbursement settings, HERO developed a cost accounting model, applying a time-driven activity-based costing (TD-ABC) methodology. The model gives insight on the national cost of RT: per treatment, on average and for various tumor types and techniques, on the resources required based on national patterns of care. Regarding availability of human and capital resources, there are big discrepancies in Europe, with sixfold variations across European countries for some of the resources. Looking at the need, while on average 51% of all cancer patients should receive RT, we miss out 30% of these. The need is further expected to increase with an average of 16% by 2025. Lastly, the HERO costing model is accessible online. Preliminary results are available for a fictitious country (Europalia), whose RT scenario is based on standard European practices: to serve a hypothetical cancer patient cohort of 100,000, the model computes an annual RT budget of 173,192,960€, an average RT treatment cost of 3518€ and, for common cancer types, an average breast and prostate treatment cost of respectively 3785 and 6092€. Currently, the model is used in Belgium, to help defining resource recommendations, and other countries are setting up task forces for the implementation of the tool nationally. HERO allows to advocate for RT and negotiate with decision makers, who need data on availability, needs and costs, when planning RT resources within their country. In addition, knowledge of the RT cost will promote and further ease cost-effectiveness analyses as well as the development of value-based health care oncology programs. Overall, the HERO project creates a movement of awareness within the cancer community, encourages national RT data collection and supports the promotion of optimal access to care with the ultimate aim of better outcome for the cancer patient.
Long-Term Outcomes of Laparoscopic Versus Open Gastrectomy With D2 Lymph Node Dissection for Advanced Gastric Cancer
Authors: Li Z.
Published: September 2018

Background: Technical safety and short-term surgical outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC) have been investigated in many clinical trials. However, studies with large sample size and sufficient follow-up comparing LAG and open gastrectomy (OG) for AGC have seldom been reported. Aim: The purpose of this study was to compare the long-term outcomes of LAG vs open OG for AGC using a propensity score matching analysis. Methods: We retrospectively evaluated 459 and 856 patients who underwent LG or OG with D2 lymph node dissection, respectively, for AGC between June 2007 and June 2012. One-to-one propensity score matching was performed to compensate for heterogeneity between groups. We compared long-term outcomes between the 2 groups after propensity score matching. Results: In the propensity score-matched cohort, no significant differences were observed in 5-year overall survival (OS) (52.0% vs 53.4%; P = 0.805) and disease-free survival (DFS) (46.8% vs 47.3%; P = 0.963) between the LAG group and OG group. Stratified analysis showed that the 5-year OS and DFS rates were comparable between the 2 groups in each tumor stage ( P > 0.05). Multivariate analysis revealed that the operation method was not an independent prognostic factor for OS or DFS. Further analysis showed that the recurrence pattern was similar between the LAG group the OG group ( P > 0.05). Conclusion: LAG is a feasible surgical procedure for AGC in comparison with OG in terms of long-term prognosis, although the results should be confirmed by the ongoing randomized controlled trials.
Use of Oral Sildenafil in Treatment of Pediatric Head and Neck Lymphatic Malformations
Authors: Wang S. , Zhang J. , Ge W. , Liu Y. , Guo Y. , Liu Y. , Tai J. , Zheng L. , Chen J. , Ni X.
Published: September 2018

Background: Lymphatic malformation (LMs) is a low flow vascular malformation, with a morbidity rate of 1/2000 in neonates. Most of the LMs were found in the head and neck. Compared with the macrocrystic ones, the microcrystic LMs show stronger invasiveness and wider involved range, which leads to higher treatment difficulty and recurrence rate as well as a serious impact on patients´ health and quality of life. Aim: To evaluate the efficacy and safety of oral sildenafil in treatment of pediatric head and neck LMs. Methods: In total, 21 children diagnosed with LMs were given oral sildenafil and stopped at week 24. Therapeutic outcome was evaluated by comparing lesions' volume change with baseline. In addition, symptoms improvement and adverse effects were also recorded during the follow-up period. Results: Eight patients (38.0%) showed excellent improvement (>75%-100%), 1 patient (4.8%) had good (>50%-75%), 2 patients (9.6%) had fair (>25%-50%), 3 patients (14.3%) had minimal (0%-25%), and 7 patients (33.3%) had no improvement. The snoring or stridor completely disappeared in 2 subjects, although there was no apparent decrease in LMs size. Moreover, all 3 patients with macrocystic lesions displayed a positive response to sildenafil treatment, followed by mixed type (9/12, 75%). Only 2 out of 6 patients with microcystic lesions had minimal clearance. Only 4 patients showed transient mild diarrhea, there was no other adverse effect in this series. Conclusion: Our study showed that low-dose oral sildenafil citrate tablets are safe and effective to decrease the lesions volume in some LMs children, especially with macrocystic lesion or mixed type.
The Optimal Surgical Approach Selection for Papillary Thyroid Carcinoma With Pathological N1 Metastases: An Analyses on SEER Database
Authors: Chen J. , Tai J. , Ji T. , Mou J. , Ni X.
Published: September 2018

Background: The definition of large-volume pathologic N1 metastases has been changed in the 2017 version of National Comprehensive Cancer Network (NCCN) guidelines, leading to a controversy over the optimal surgical approach selection for patients with papillary thyroid carcinoma (PTC). Aim: The aim of this study was to investigate the therapeutic efficacy of total thyroidectomy (TT) and thyroid lobectomy (TL) for these patients. Methods: In total 906 consecutive PTC patients with metastases ≤ 5 mm were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database, and divided into 2 groups (≤2 mm, >2 to 5 mm) based on the size of extend of disease (EOD). The overall survival (OS) was then compared between patients treated with TT and TL, followed by Cox-proportional hazards regression analysis to explore multiple prognostic factors. Results: OS favored TT compared with TL in patients with more than 5 involved nodes and metastases > 2 to 5 mm in largest dimension ( P < 0.05). Meanwhile, Cox analysis showed that the TL was not an independent factor associated with poorer OS than TT in these patients ( P > 0.05). TT showed better survival than TL for patients with metastases > 2 mm to 5 mm. For patients with metastases ≤ 2 mm, either TT or TL should be recommended because of no discrepancy in survival. Conclusion: TT does offer slight survival advantage over TL for PTC patients with metastases > 2 mm to 5 mm; TT may be recommended for these patients to improve disease-special survival and reduce the risk of recurrence.
Smooth Transitions and Good Deaths: Unique Palliative Needs of Early Deaths Oral Squamous Cell Carcinoma
Authors: Banoo S. , Ganigapenta L. , Mani C.S.
Published: September 2018

Background: Early deaths in oral squamous cell carcinoma (OSCC) patients and their unique palliative needs are underresearched. Despite strict selection criteria for curative treatment a substantial proportion undergo transition to palliative intent treatment with early relapse and death within 12 months. There have not been many studies on their transition to palliative care and their supportive care. Aim: Analyze the palliative needs of early relapse and deaths of OSCC patients 1. Assess the most distressing symptom in this cohort of patients 2. Factors contributing to satisfactory death in this group Methods: Retrospective cohort study involving 22 oral squamous cell carcinoma patients who had died between January 2016 to December 2017 within 12 months of being diagnosed and treated with intent to cure. The demographic, staging, treatment, their symptoms, the physician-patient contact time in terms of family meetings, preferred place of death and advanced directives were extracted from the existing database. We also collected the family members opinions about factors that influenced the quality of death of the loved ones. Results: Evaluation of the symptoms that required urgent intervention in this group comprised of pain (76.3%), dyspnea (41%), poor nutrition (23%) and communication difficulties (40%). 14 (60%) required opioids for the pain control. High doses of morphine was used in patients noted to have distant metastasis. 50% of the patients in the group agreed that their preferred place of death was home. And 80% of them had all their advanced directives in place. Factors that greatly contributed to the graceful acceptance of death among the care givers are, distress management, scrupulous management of pain and symptoms during end of life and facilitating their preferred place of death. Among the various factors that we observed that contributed to caregiver satisfaction: the number of physician–family meetings were significant ( P = .0001). Conclusion: Our study confirmed the role of joint family meetings with the treating team and the palliative care with increased frequency has positive impact on the quality of death of this unique cohort of patients with short interval between relapse and death. The complex challenges in early relapse OSCC can be addressed by (1) joint care by primary treating physician and palliative care team. (2) family meetings to be initiated early and conducted more frequently with both treating team and palliative care team. (3) reduced threshold to control of symptoms by potent medication or hospitalization (4) managing the factors that give a satisfactory death in this group in terms preferred place of death, advanced directives, management of distressing symptoms in the end of life. With a more comprehensive understanding of this cohorts unique palliative needs helps the oncology and palliative teams to provide improved patient care, quality of life, smooth transition to palliative care and a good quality of death.
A Landscape Analysis of U.S. National Cancer Institute's Cancer Stigma Research Portfolio
Authors: Vedham V.
Published: September 2018

Background: Successful characterization of cancer stigma among various populations has the potential to inform effective interventions targeted at combatting the social ignominy. Instances of social discrediting range from misconceptions about cancer treatment that prevent early detection to biases due to physical changes of cancer survivors, such as alopecia, mastectomy or colostomy. Cancer stigmas not only pose substantial challenges to disease control, they also exacerbate global disparities in health outcomes. To understand the current landscape of domestic and global cancer stigma research funded by the National Cancer Institute (NCI), a portfolio analysis of active awards between FY10-FY17 was conducted. Aim: This portfolio analysis aims to define the scope of NCI-funded research related to cancer stigma. Methods: The National Institutes of Health IMPAC II database was queried to retrieve NCI-funded grants related to cancer stigma using iterations of the term 'stigma', as well as other key words such as 'social isolation', 'shame' and 'disgrace', between FY10-FY17. After removing grant supplements and competitive renewals, grant abstracts and specific aims were reviewed to confirm projects fell within the parameters of cancer stigma research. Grants were then stratified by Common Scientific Outline (CSO) code; cancer site; and international components. Results: Forty-eight distinct NCI-funded projects that addressed cancer stigma were identified. Of those, 90% (n = 43) were coded to CSO code 'Cancer Control, Survivorship and Outcomes.' Additionally, over half (54%) of the projects focused on breast (13) or lung (13) cancer. All grants were awarded to US institutions, 6 of which included foreign collaborators. Four (8%) NCI-funded grants focus on the development of measures or instruments to uniformly quantify experiences of cancer stigma. Extramural grants with a cancer stigma component represented 0.1% of NCI's total FY 2008-2017 investment of over $25 billion USD. Conclusion: Building a knowledge base of the major contributors to cancer stigma and its impact on the illness experience is critical to improved treatment outcomes. A substantial proportion of NCI-supported stigma grants have been funded as smaller, exploratory projects. This may suggest that larger investments in time and resources are needed to fully comprehend the impact of stigma along the cancer continuum. A lack of NCI-funded tools to measure stigma across contexts and cultures is representative of the broader scientific literature, and poses challenges to the production of standardized data which could highlight global disparities. A comprehensive cancer stigma literature review and NCI portfolio analysis will illuminate research gaps and provide an avenue for recommendations of culturally tailored, evidence-based measurement tools, studies, or interventions.
Children Exposed to the Death of a Relative by Cancer
Authors: Ben Soussan P.
Published: September 2018

Objectives: First cause of death in France, cancer affects many young subjects, in parental situation. Since 2003, Institut Paoli-Calmettes (IPC), a French Comprehensive Cancer Centre, has set up a welcome and meeting time dedicated to families and specifically to children whose parents are undergoing or have undergone cancer treatment. The project of ”Les Gouters de l´IPC” (IPC snacks) is to allow children and parents to talk about cancer and death, expected or lived. The framework of this research-action consists of an evaluation of this approach: How to support children through this event, define and evaluate proposals for support and care, refine and disseminate them? Methods: 1500 children, from few months to teenagers, were met in 15 years. Families welcomed in “Les Gouters de l´IPC” were contacted by post and phone and asked for a home or IPC research interview, conducted individually. More than 1200 answered and 870 interviews were realized. Data collection was recorded using participant observation and free interview technique. Results: The results of this research are communicated here for the first time. Children hesitate between hypermaturity and regressive tendencies, resigned and impulsive conducts, need of power and guilt. Misunderstanding and communication breakdown are real risks, sometimes isolation and withdrawal. Conclusion: Children can´t cross these dramas smoothly and painless. But those concerned will not suffer for the rest of their lives. The death of a parent is a wound. In this unimaginable ordeal, children must be able to count upon our unqualified solidarity.
Finding Your Way When You Have Metastatic Breast Cancer: Codesigning Resources With Consumers for Consumers. The Signpost Study
Authors: Devereux C. , Salamanca P. , Lam R. , Moloczij N. , Krishnasamy M.
Published: September 2018

Background: In Australia, women with metastatic breast cancer are not systematically made aware of or helped to access supportive care resources. Finding resources tailored to their needs can be challenging as they spread across several healthcare and advocacy organizations. Furthermore, resources assume varying levels of knowledge about the disease and its treatments, are fragmented and are dispersed across multiple organizations. Aim: The aim of our study was to codesign a signpost resource to direct women to key supportive care organizations that provide relevant, timely and comprehensive support for them; ensure women are made aware of and know how to access support they need, as and when they need it; and ensure that health professionals are aware of the resource, support its use, and distribute it to women. Methods: Using a codesign framework, initial development of the resource was guided by consumer representation on the study Steering Group. The resource was then presented to women living with metastatic breast cancer, and their advice obtained about its relevance and functionality during semistructured interviews. Purposive sampling based on age, time since diagnosis and geographical location (metro/regional), was used to obtain a variety of perspectives. Open-ended questions explored what the resource should contain, look like, and how it could best be introduced and distributed. An iterative descriptive analytical approach was applied. Results: Seven women aged 40-61 years were interviewed. Time since their metastatic breast cancer diagnosis ranged from 5 months to 19 years. Women told us about their preferences for style, content and format for the resource. They also guided discussion about how best to promote the resources in a way that both informed health professionals but also empowered women to find and express a need for support. As a result, 2 videos were produced. In the first 3-minute video for health professionals, consumers powerfully convey messages about the impact of their diagnosis, their need for support and how important it is for health professionals to “value and believe there are emotional, social and material aspects of coping with the disease” (this video will be shared in the presentation). In the second 4-minute video, consumers endorse the need for information and support, and women and consumers watching the video are introduced to the services provided by supportive care organizations profiled on the resource. Conclusion: Resources created and tailored by consumers for consumers are powerful and important. Consumer-led interventions that demonstrate to health professionals the importance of supportive care as a cornerstone of excellent cancer care may have a considerable impact but require empirical testing.
Biomarkers of Metabolic Syndrome in Male Cigarette Smokers in Calabar
Authors: Akpan U.
Published: September 2018

Background: There is an increasing but controversial evidence that smoking is associated with metabolic syndrome. Metabolic syndrome has recently attracted much attention due to increasing knowledge of its relationship with cardiovascular mortality and morbidity and other associated problems. Aim: This study assessed the biomarkers and frequency of metabolic syndrome as defined by the World Health Organization (WHO), International Diabetes Foundation (IDF) and the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) in adult male smokers. Methods: One hundred and forty one (141) apparently healthy male cigarette smokers and sixty (60) apparently healthy nonsmokers aged 18 to 45 years were recruited for the study. The smokers were subdivided into light (< 8 pack years), moderate (8-30 pack years) and heavy (> 30 pack years) smokers. Body mass index (BMI), waist circumference (WC), hip circumference, waist-hip ratio, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Fasting blood sugar (FBS), total cholesterol (TC), triglycerides (TG) and high density lipoprotein-cholesterol (HDL-C) were estimated using colorimetric test methods while low density lipoprotein-cholesterol (LDL-C) and very low density lipoprotein (VLDL-C) were calculated using the Friedewald's equation. Serum insulin was estimated using enzyme linked immunosorbent assay. Insulin resistance was calculated using homeostasis model assessment of insulin resistance (HOMA-IR). Data were analyzed using Student's t-test and analysis of variance; P < 0.05 was considered statistically significant. Results: The smokers had significantly higher diastolic BP ( P = 0.0001), TC ( P = 0.008) and LDL-C ( P = 0.0001) and significantly lower HDL-C ( P = 0.0001) compared with the controls. There were no significant differences in the other parameters. Fasting blood sugar was significantly higher in the light smokers ( P = 0.001) than in the moderate and heavy smokers whereas, serum TC and LDL-C levels were significantly higher in heavy smokers ( P = 0.001) than in the light and moderate smokers. There were no significant variations in the other parameters among the groups. The percentage of smokers with metabolic syndrome was significantly higher than nonsmokers using the IDF ( P = 0.022) and NCEP-ATP III ( P = 0.032) criteria with dyslipidaemia being the most prevalent metabolic abnormality. Conclusion: The unfavorable changes in the lipid profile and blood pressure observed in this study may predispose smokers to a higher risk of cardiovascular disease and there is a higher frequency of metabolic syndrome among smokers in Calabar compared with the nonsmokers.
Men on Blue: Knowledge, Belief, Fear, Perceived Attitude of Men to Prostate Cancer Screening and Awareness in Sub-Saharan Africa
Authors: Chidebe R.C.W. , Emelumadu O. , Lounsbury D. , Orjiakor T.C. , Okoye I.O. , Anunobi C.D. , Hafees A. , Ikuerowo S.O. , Dogo H. , Moraes F. , Achor G. , Eguzo K. , Atakere D. , Ezeama N. , Ugwuoke C. , Dantsoho S.A. , Okoro N. , Abdulazeez J. , Iriyo I. , Emeralds O. , Okwuegbunam N.
Published: September 2018

Background and context: In Nigeria, cancer leads to >72,000 deaths per annum (30,924 for male and 40,647 for female). This number is set to increase given that there are 102,000 new cases of cancer every year. The estimated incidence for prostate cancer is (12%) and estimated mortality prostate (13%). Prostate cancer is the third leading cancer death in Nigeria and the leading cause of cancer deaths in Nigerian men. However, very little or nothing is said about prostate cancer in Nigeria. Every October, virtually all cancer NGOs roll out their drums of awareness focused on breast cancer, prostate cancer is always missing, while several men die in silence and pain because their prostate cancer was discovered at late stages. Men on Blue is a health intervention focused on closing the gap of awareness, education and screenings for prostate cancer in rural communities of Lagos, Abuja and Enugu. The intervention will use 3 core strategies, such as: prostate cancer awareness, prostate cancer screenings and social media campaigns. Our target is to screen 2000 men, reach 20,000 men directly, reach 30,000 women and youth directly in rural communities of Lagos, Abuja and Enugu and 5 million indirectly through traditional and social media in Nigeria. Aim: To reduce the incidence of prostate cancer through the creation of a platform for prostate cancer awareness, screening and support in Nigeria. Program/Policy process: The program use focused on phasing out late diagnosis of prostate cancer through screenings outreaches in local communities in Nigeria. Men are always missing in cancer awareness and programs, hence, the program will bring men to the fore of cancer awareness. Outcomes: It is expected that this program will increase the level of prostate cancer awareness in Nigeria through the translation of information materials in local languages, engage men to lead the campaign and the use of strategic social media campaign. What was learned: Preliminary results of the planning process of the program, showed that several men are battling with prostate cancer, however, very few is said about them and they are dying in silence. Their voice need to be heard in sub-Saharan Africa.
Evaluate the Impact of Breast Cancer Treatment on the Quality of Life of Women With Nonmetastatic Breast Cancer
Authors: Aouras H. , Bouzbid Sabiha
Published: September 2018

Background: The quality of life related to health has become an important part of the medical decision at the same time as the effectiveness and safety of treatments. Clinicians should consider the quality of life of women at each clinical phase of the care trajectory. Indeed, the physical, functional, psychological, and social difficulties that women live may affect their quality of life, hence the need to assess it. Aim: To evaluate the quality of life of women with breast cancer using a previously validated tool. Methods: This is a prospective cohort study with a longitudinal follow-up of patients treated and followed for breast cancer at the Gynecology Department of EHS El Bouni and medical oncology service, over a period of one year from April 1, 2013 until March 31, 2014. 196 patients were selected for the study according to specific inclusion criteria. Both questionnaires QLQC30/BR23 were informed after diagnosis (T1), after surgery and about a month after the end of chemotherapy (T2), and one month after the end of radiotherapy and the beginning of hormonal therapy (T3). Results: ANOVA analysis shows that the quality of life related to the health of women with breast cancer changes over time, overall, it is worse during the time 2 “treatment period” including chemotherapy. The alteration scores are concerned with both generic and specific functional dimensions. The same happens at the level of symptoms where we note an increase in different symptoms during the treatment. During time 3, women have a better score for “emotional” “role” functioning and overall health; they have fewer side effects and symptoms for radiotherapy and follow-up. We observe a decrease in sexual functioning during the diagnosis; it then slightly improves after the end of chemotherapy and decreases during hormonal therapy. Regarding the socio-demographic factors, we have found a significant association on the one hand, between the age of the patient and the importance of “body image” in the quality of life, and on the other hand, between the socio-economic level and the symptoms in the breast. Conclusion: This study emphasizes the importance of evaluating longitudinally the quality of life related to the health of women with breast cancer at different times of the care trajectory, particularly during chemotherapy and radiotherapy. Thus, better psychosocial resources can be developed to help these groups of women.
Developing a Model of Distributed, Decentralized Digitally Connected Cancer Control Program
Authors: Kuriakose M. , Sebastian P. , Balasubramanian S. , Sadanandan R.
Published: September 2018

Background and context: Traditional method of managing cancer through establishing large comprehensive cancer centers are ineffective in developing country setting that has poorly developed primary health care facilities. These larger cancer centers become victims of their success and attract increasing number of patients from distant places, overstretching the resources and increasing out-of-pocket expenses for the patients. Increasing the number of cancer centers also is not effective as each unit by itself will not have the critical mass of expertise to offer comprehensive cancer care. In addition, for sustainability and improved resource utilization, the cancer care needs to be integrated with the existing health care system. The state with a population ∼ 33.3 million has 19 cancer treatment facilities distributed throughout the coastal districts. The cancer incidence rate of the state is 128 per 100,000, which is the fourth highest in the country. Aim: To develop a model for distributed, decentralized digitally connected cancer control program for the state of Kerala, India. Strategy/Tactics: A model for distributed, decentralized digitally connected cancer care that offers resource stratified cancer care and integrate with the existing health care. Program/Policy process: The distributed cancer care network for the state that will be digitally connected using a recently introduced e-health program to interconnect the cancer care as well as to integrate with the existing healthcare network. The cancer centers will be stratified in 4 levels. Level 1 would be 3 apex cancer centers with most advanced infrastructure and serves as quaternary centers and coordinate cancer care in 3 zones. The Level 2 cancer centers established at medical colleges and cancer centers in major private medical hospitals offer comprehensive cancer care in a geographic area and serve as tertiary cancer referral centers. Level 3 centers are located in the district and Taluk hospitals that offers primary cancer care for common cancers including palliative daycare chemotherapy. Level 4 units are established as part of the national health mission in primary and family health centers which provide the important task of cancer surveillance and improving cancer literacy for the public with peoples participation. Outcomes: The expected outcomes are downstaging of cancer, developing a resource-stratified referral pathway that minimize treatment delay, provide cancer care within 90 minutes of travel and lowering out-of-pocket expenses. What was learned: Planning of the program involved participation of major stakeholders of cancer and health care of the state as well as NGO.
Supporting Cancer Patients Who Are Also Parents: Establishment of a Cross-Sector Service for Families With Adolescent and Young Adult Children
Authors: Patterson P. , Orchard P. , Friedsam J. , Schiena E. , Ellis S.
Published: September 2018

Background and context: Traditionally adult hospitals focus on the patient and less on their family. Adolescent and young adult children of cancer patients (AYA offspring) have significant psychosocial burdens associated with their parent's cancer however they are often invisible within hospitals with no clear referral pathways to community-based support. AYA offspring are 3-6 times more likely than peers to have clinically elevated levels of distress which increases with age. Research shows that 1 of the greatest concerns for parents is how to communicate about cancer with their children, and 1 of the greatest needs for AYA offspring is information about their parent's cancer and talking with their parents about it. Aim: CanTeen, a national AYA cancer community support organization, sought to address these needs by embedding a Parent Support Worker within the social work teams of tertiary hospitals for patients who are parents of AYA children. This service aims to assist with specific parenting challenges that arise due to a cancer diagnosis and establish a referral pathway for AYA offspring to CanTeen for support. Strategy/Tactics: Cofunding with philanthropic organizations was sought and CanTeen executives engaged in advocacy work with senior hospital management, demonstrating the need for the service and a plan to embed it within the existing hospital social work team and services. Program/Policy process: A new Parent Support Worker role was established to provide social work care to parents of AYA children following a parent's cancer diagnosis. The service provides support with parenting issues that arise due to the diagnosis as well as staff education, secondary consultations, and referrals of AYA offspring to CanTeen. A service improvement approach has been established with the collection of monitoring data measuring volume of referrals/sessions, capacity building of other staff, information given to young people and referrals to CanTeen. A service evaluation seeking feedback from patients and relevant hospital staff is also underway. Outcomes: To date, philanthropic funding and hospital support was gained to establish a pilot program placing a Parent Support Worker in 3 hospitals. Early indications are that this novel service is integrating well into established hospital teams and processes, and adding considerable value with the provision of this focused family support. What was learned: This advocacy initiative is highlighting the benefits of a model of care in adult hospitals that centrally considers family and the strength of a well-planned cross-sector service initiative.
Cancer Incidence in 12 Major Hospitals of Nepal
Authors: Pradhananga K.K.
Published: September 2018

Background and context: In Nepal, no population based cancer registry program exists to know the incidence, prevalence, morbidity and mortality of cancer. Since 2003 AD we have been conducting hospital based cancer registry program in 7 major hospitals and now we include 12 hospitals in 2014 in the initiation of BP Koirala Memorial Cancer Hospital. Aim: To find out about the burden across a greater proportion of cancer from 12 major hospitals of Nepal. Strategy/Tactics: Coordination with 12 hospitals´ medical record section to abstract the cancer data. The cases were verified by name, age, sex, address, topography and morphology. Repeated cancer cases were excluded from database. Program/Policy process: The total 9036 cancer cases were included in this study to know the cancer incidence in 12 major hospitals in 2014. This was descriptive type of study and all cases were collected from medical record section for data analysis. Outcomes: Among case the mean age of the patients was 53.6 years. The common form of cancer for both sex was bronchus and lung (13.7%) followed by cervix uteri (9.4%) and breast (9.4%). Cancer of the cervix (17.0%) was the top ranking cancer site for female followed by breast (16.4%) and bronchus and lung (10.9%). Similarly, cancer of the bronchus and lung (17.2%) was the commonest cancer for male followed by stomach (7.6%) and larynx (6.2%). Female cases (54.0%) were frequently high than in male (46.0%). What was learned: This type of study shows burden across a greater proportion of cancer from 12 major hospitals, but the coverage may not represent the whole country.
National Home Care Initiative in Jordan: A Demonstration Project
Authors: Shamieh O. , Mansour A. , Harding R. , Tarawneh M. , Payne S.
Published: September 2018

Background and context: The home healthcare market in Jordan is nascent with little service offered. It suffers from a highly fragmented and underregulated landscape. The limited access to qualified trustworthy home care services, lack of professional home care training, and lack of home health care insurance coverage have added to the heavy in-patient bed demand and delayed hospital discharges especially for disabled or terminally ill patients. Aim: To establish a comprehensive national home care program to improve the delivery of palliative and home care services in Jordan, and to conduct a situational analysis and generate policy recommendations. Strategy/Tactics: We used multiple strategies to reach our objectives. 1. Expansion of home care services at King Hussein Cancer Center (KHCC) to create a local demonstration project. 2. Building health care professional capacity by offering variety of educational programs. 3. Improving quality of service delivery by generating clinical practice guidelines, such as standards operating procedures and patient and family educational materials. 4. Use the pilot operational and financial data to generate an economic model to inform the development of similar home health care units in hospitals across Jordan. 5. National advocacy and building effective partnership with all related stakeholders to advance national policy. Program/Policy process: Between May 2016 and May 2017, 7818 home care visits were conducted by KHCC. For capacity building; 678 health care professionals were trained in palliative and home care, out of which 366 participants were females (54%). Palliative care was successfully recognized as a specialty by the Jordan Nursing Council and recognized as a subspecialty by the Jordan Medical Council. The palliative and home care standards of practice were included in the health care accreditation council. The analysis of economic evaluation data suggested that home care services decreased in-patient utilization and costs which is advantageous to a country with limited resources. As a result of the advocacy stream and a collaborative network, the national palliative and home care strategic framework was generated, and endorsed by the Ministry of Health. Outcomes: The NHCI resulted in a very successful pilot project and achieved specialty and subspecialty recognition. Furthermore, we were able to build the capacity of health care professionals and policy makers in the palliative and home care sector from public, private and academic institutions. In the advocacy and policy dimension, the Minister of Health officially approved and adapted the palliative and home care strategic framework that was developed by this initiative. What was learned: Cross-sector collaboration and effective partnership resulted in system change and policy advancement. Developing effective economic systems is essential in low resourced countries. The initiative was supported by a joint grant from the USAID and KHCC.
The Development of Cancer Patient Navigation Program in Taiwan
Authors: Huang C.-W. , Wu C.-Y. , Chen R. , Huang T.-H. , Hsu T.-H. , Tsai Y.-S.
Published: September 2018

Background and context: Cancer has been the leading cause of death since 1982 in Taiwan. Taiwan cancer case management program started from major 4 cancers (breast cancer, liver cancer, colorectal cancer, oral cancer) since 2004. However, only 82% of patients with a confirmed cancer diagnosis received their first cancer treatment within 3 months in 2012. Aim: To increase the navigation coverage for all cancer patients, Health Promotion Administration (HPA) sets the goal that 91% of patients with a confirmed cancer diagnosis should receive their first cancer treatment within 3 months in 2018. Strategy/Tactics: (1) Subsidize cancer hospitals (2) Accreditation for oncology case management (3) Pay for performance (P4P) Program/Policy process: We subsidized hospitals to establish oncology case manager since 2004. Gradually, hospitals in Taiwan accept this new nursing role and recognize its positive impacts on cancer care. Moreover, Taiwan Accreditation Program of Cancer Care mandated all cancer care institutes to establish the program for oncology case management since 2010. However, there were only 4-6 major cancer patients got the case management service. Thus HPA launched P4P Cancer Patient Navigation Program in 2014 and established reporting system. Outcomes: 95% of newly cancer diagnosis patients (including 92 hospitals) in Taiwan receive the service and 96% of patients with a confirmed cancer diagnosis receive their first cancer treatment within 3 months in 2017. Through the implementation of subsidy, accreditation and P4P, the relative survival rate showed significant improved. The 5-year relative survival rate for all cancers increases from 49% during 2003-2007% to 55.8% during 2011-2015. What was learned: A successful program might start small from few trial sites, should be fully supported and well established the systems by government and will move fast by all healthcare professionals.
Cancerpedia: A Framework for Implementing Comprehensive Cancer Centres
Authors: Abdelmutti N. , Chudak A. , Merali M. , Sullivan T. , Escaf M. , Bell B. , Gospodarowicz M.
Published: September 2018

Background and context: Comprehensive cancer centers or programs form a nucleus of cancer care delivery. Although there are frameworks for population cancer control, no similar published framework exists for cancer centers. Aim: We sought to develop a framework for designing and implementing a comprehensive cancer center or program within the context of a population-based model of cancer control that spans diagnosis, treatment, supportive care, and palliative care as well as integration with primary care and the community. Strategy/Tactics: The framework was constructed with the patient at the center and provides a system-level perspective as well as a granular view of the fundamental resources and structures needed to build and maintain individual cancer centers and programs. Due to its breadth, we focused the framework on essential information while linking to a wide range of vetted publications that detail additional standards, guidelines and best practices. Program/Policy process: “Cancerpedia” emerged as a cohesive framework for the delivery of high-quality cancer care within and beyond the cancer center. It provides an overview of the cancer control and care delivery framework, describes cancer care services (e.g., radiotherapy, chemotherapy, palliative care) and details infrastructure and core services (e.g., physical facilities, human resources). In addition to these services, the framework presents guidelines for governance that ensure oversight and quality, describes the critical need for integrating education and research and presents the best practices for engaging in philanthropy. Cancerpedia also outlines the role of the comprehensive cancer center in integration with the community and influencing policy and regulation. Over 30 chapters provide a detailed description of each element and include a description of the service or function, resources requirements such as people, equipment and facilities, management structures, quality performance guidelines and future trends in innovation. Outcomes: To our knowledge, no comparable published framework exists as a reference for developing comprehensive cancer centers. Cancerpedia was designed to serve as a global public good and is adaptable and applicable to diverse contexts and healthcare environments. It is relevant to high-, middle- and low-income countries alike and provides a reference point from which to structure a plan for growth. What was learned: While it is important to describe the various elements required for cancer care delivery, it is critical to consider and address the integration and interdependencies of these various elements. Future opportunities for learning include seeking input from a global audience to gauge the utility and applicability of Cancerperdia to local contexts.