bluuebunny/crossref_metadata_2025 huggingface dataset:
Nature-Based Supportive Care Opportunities: Responding to Health and Recovery Needs of People With Cancer
Authors: Blaschke S.-M. , O'Callaghan C.C. , Schofield P.
Published: September 2018

Background: Human health and nature is an emerging research field exploring nature's impact on health and well-being. Given preliminary evidence for positive health outcomes related to nature engagement in cancer populations, research is warranted to ascertain strategies for incorporating nature-based care opportunities as additional support care strategies for addressing multidimensional aspects of patients' health and recovery needs. Aim: To consolidate findings from a comprehensive research program investigating opportunities for nature-based supportive care interventions and oncology setting design and discern relevant applications in oncology and palliative care contexts. Methods: Drawing on findings from a program of mixed-method research that investigated nature-based engagement in oncology contexts, a 2-step analytic process was used to construct a conceptual framework for informing and guiding future nature-based oncology design. Firstly, concept analysis methodology was applied to generate new insight into the needs of people with cancer by extracting and synthesizing qualitative data describing participants´ own appraisal of nature´s role in their experiences of health and recovery. Next, patient-reported and expert-developed recommendations generated in an international Delphi study were aligned with the newly formulated concepts and incorporated into a guiding framework for nature-based supportive care. Results: Five theoretical concepts were formulated describing the reasons for why people with cancer engage with nature and the underlying needs these interactions address. These included: meaningful connections, distancing from the cancer experience, meaning-making, finding comfort and safety, and vital nurturance. Eight shared patient and expert recommendations were compiled, which correspond with the identified patient needs and propose nature-based initiatives to address them. Eleven additional patient recommendations arose as important when attending to the experiential qualities patients value when using nature for addressing their health and recovery needs. Conclusion: The proposed framework outlines salient findings about helpful nature-based care opportunities for ready access by healthcare practitioners, designers, researchers and patients themselves. Research collaboration that includes patient and expert engagement is critical for bringing together personal, practical and clinical perspectives that can ensure successful design and clinically safe delivery of nature-based supportive care solutions that are meaningful to people with cancer.
The Prevalence of Metabolic Syndrome Among Newly Diagnosed Malaysian Breast Cancer Patients
Authors: Kiew S.J. , Islam T. , Taib N.A. , Majid H.A. ,   MyBCC Study Group
Published: September 2018

Background: The incidence of breast cancer has increased in South East Asian (SEA) women. Malaysia has the highest obesity rates in SEA. Malaysian Breast Cancer Survivorship Cohort (MyBCC) study is a hospital-based prospective cohort study that aims to study the association between lifestyle factors and overall survival and quality of life of Malaysian breast cancer patients. Metabolic syndrome (MS) is associated with increasing levels of inflammatory cytokines and leptin that can stimulate cell proliferation through various mechanisms, hence indicating both an increased risk of developing breast cancer and a poorer prognosis. However, there is very scarce information available on the presence of MS among the newly diagnosed breast cancer patients. This is an early report of the presence of MS in the MyBCC study. Aim: We aim to evaluate the presence of MS among newly diagnosed breast cancer patients and to determine the association of MS and sociodemographic factors. Methods: 370 newly diagnosed breast cancer patients were interviewed at baseline. The anthropometric data (waist circumference, hip circumference, body weight, body height and body fat percentage) and also blood for lipid profile and glucose profile were collected. The MS status of the patients was defined using a modified International Diabetes Federation worldwide definition; presence of central obesity (waist circumference ≥ 80 cm) and any of two or more of the following criteria: (i) raised triglyceride with ≥ 1.7 mmol/L, (ii) reduced HDL-cholesterol that < 1.3 mmol/L, (iii) diagnosed with hypertension and (iv) diagnosed with diabetes. Results: Among the 370 breast cancer patients, most were aged 51 years and above (258, 69.7%), were Chinese (180, 48.6%), had secondary school education level (168, 45.4%), had less than RM3500 household income (193, 52.2%) and were postmenopausal (250, 67.6%). Most of the patients were obese or overweight (268, 72.4%) and around half of the patients (190, 51.4%) had high body fat percentage. 140 patients had MS (37.8%). MS was significantly higher among patients aged 61 years and above (59, 42.1%) and 51 to 60 years (50, 35.7%) compared with 20 to 50 years of age group (31, 22.1%) ( P < 0.05). The patients with MS were significantly higher among Chinese ethnicity (57, 40.7%), unemployed (95, 70.4%), and postmenopausal (108, 77.1%) ( P < 0.05). Conclusion: The prevalence of MS is high in newly diagnosed Malaysian breast cancer patients. With longer follow-up, further analysis will be done to look at association with outcomes.
Current Achievement and Challenges of Food, Cooking Methods and Cancer Control: A Pooled Multivariable-Adjusted Analysis for the Association Between Meat Mutagens Intake and Colorectal Adenoma and Cancer
Authors: Le N. , Pham O. , Cao T.
Published: September 2018

Background: Heterocyclic amines (HCAs), a group of dietary carcinogens, have been hypothesized to increase risk of colorectal adenoma (CRA) cancer (CRC). However, previous findings have been inconsistences. Aim: The aim was to pool analysis of multivariable-adjusted relative risks from published articles for the association between HCAs intake and the risk of CRD and CRC. Methods: We used all available 34 published articles to access the multivariable-adjusted relative risk (hazard ratio or odds ratio) and their 95% confidence interval (95% CI) to estimate ln(RR) and se(ln(RR)). The HCAs 2-amino-3,8-dimethylimidazo[4,5,-f]quinoxaline (MeIQx), 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), 2-amino-3,4,8-trimethylimidazo[4,5,-f]quinoxaline (DiMeIQx), and meat-derived mutagenicity (MDM) were examined. The random pooled RR, 95% CI was analyzed in using ln(RR) and se(ln(RR)) for separated prospective cohort studies and case-control studies by STATA-10. Results: Prospective cohort studies have examined for 5,684 CRC occurred among 528,111 registered participants; and for 2,484 CRA occurred among 136,902 registered participants. Case-control studies have examined for 12,753 CRC and 17,152 matched controls; and for 10,821 CRA and 45,099 matched controls. PhIP was majority contributed by cooked chicken (54%–74%). MeIQx was mainly contributed by red meat (83%–92%). For prospective cohort studies on CRC, fifth versus first-quintile, the random pooled RR, (95% CI) was 1.11, (1.00, 1.23), P = 0.052 for MDM; 1.00, (0.91, 1.09), P = 0.958 for PhIP; 1.12, (1.03, 1.22), P = 0.009 for MeIQx; 1.03, (0.87, 1.22), P = 0.763 for DiMeIQx. For CRA, third versus first-quintile, the random pooled RR, (95% CI) was 1.13, (0.92, 1.39), P = 0.237 for MDM; 1.11, (0.96, 1.29), P = 0.169 for PhIP; 1.14, (1.00, 1.30), P = 0.048 for MeIQx; 1.00, (0.87, 1.15), P = 0.999 for DiMeIQx. For case-control studies, the null association was observed for PhIP, DiMeIQx and CRC. A positive association was significantly seen for MeIQx, MDM and both CRC and CRA. Conclusion: Because intake of MeIQx significantly increased the risk of both CRC and CRA in both prospective cohort and case-control studies, the findings support to the hypothesis of the role of underlying mechanisms of red meat induced CRC.
Cancer in Patients of and Above 90 Years: A Hospital-Based Retrospective Study
Authors: Krishnatreya M.
Published: September 2018

Background: Cancer in a nonagenarian patient is rarely seen and there is always a moral dilemma for the family members and the patient as well of whether to opt for the treatment or not. Aim: The main aim was to identify the survival differences between treated and not treated nonagenarian cancer patients. Methods: This was a retrospective study of hospital-based cancer registry data from 2010 to 2016. The data of all nonagenarian cancer patients were analyzed for gender distribution, leading sites of cancer, stage distribution, types of treatment received, and survival. The survival was calculated from the date of first diagnosis. Descriptive statistics was used to present the results and presented up to single decimal place. Kaplan-Meier analysis was done to present the overall survival results and Cox-regression analysis was done to estimate the unadjusted HR. The P value for significance was set at < 0.05. SPSS v17.0 was used for carrying out the analysis. Results: Of 60,087 cancer patients registered during the study period, 146 (0.2%) patients were of 90 years and above. In males, hypopharynx in 19 (20.5%), lungs in 11 (10.3%), and esophagus in nine (8.4%) patients were top three leading sites. And in females, tongue in eight (20.5%), mouth in five (12.8%), and hypopharynx in four (10.3%) patients were the top leading sites. 60% patient data were in stages III and IV. Thirty seven (25.3%) patients received treatment, and 32 (86.4%) patients received radiotherapy alone. Five patients (13.5%) received combined modality of treatment. Two (5.4%) patients each received chemotherapy alone and surgery followed by radiotherapy for their cancer. Only one (2.5%) patient received concurrent chemo-radiotherapy. The median survival was nine months [confidence interval (CI) = 4.5-13.4]. The overall survival (OS) was 14.3% and the survival in the treatment group was 21.3% versus 7.7% in the Not Received, Abandoned, and Incomplete (NRAI) group (log rank (Mantel-Cox), P = 0.001). The unadjusted HR for NRAI group was 3.8 ( P = 0.003, CI=1.5-9.7). Conclusion: This analysis gives us some insight into the various types of cancer in the very old patients in our population. Selected nonagenarian cancer patients from our population with a favorable performance status should receive curative treatments in all possible ways. The improved overall survival and lower risk of death in nonagenarian cancer patients who received treatment in comparison with the NRAI group should aware the oncologist of the weighted benefits of curative treatment instead of plain palliation.
Determining Potential Target Groups for Oral Cancer Screening by Investigating Risk Behaviors Among Occupations
Authors: Huang Y.-T. , Wang Y.-W. , Chen R.-C. , Wu C.-Y. , Yang Y.-H.
Published: September 2018

Background: Oral cancer is a major public health burden in Taiwan. Studies have suggested that habits of betel quid chewing, tobacco smoking and alcohol drinking as well as their interaction effects are important risk factors for oral cancer and oral potentially malignant disorders (OPMD). A population-based oral cancer screening program has been implemented by Health Promotion Administration, Ministry of Health and Welfare, Taiwan. People with betel quid chewing and/or cigarette smoking habits are recommended for biennially screening. Previous studies found that majority of betel quid chewers were in labor intensive occupations. Given the fact that high risk groups of oral cancer are often reluctant to attend screening, targeted approach should be applied to improve the effectiveness of screening program. Aim: The aims of this study are to identify occupations with high prevalence of betel-quid chewing and also to investigate changing trends using the National Health Interview Survey (NHIS) database. Methods: The NHIS database of 2009 and 2013 were used to conduct this study. We identified current users of betel quid and/or cigarette from adults with aged 20-64 years old and working on jobs. Occupations were classified using the International Standard Classification of Occupations (ISCO-88). Statistical analyses included indirect standardized rate ratios and cluster analysis of chewing/smoking habits. Results: From the total survey participants (2009: 19,201, 2013: 17,249), we extracted 11,507 and 10,760 persons for the study. In the year of 2013, using the 2-digit code of ISCO-88, drivers and mobile-plant operators (code 83 in ISCO-88) had the highest prevalence of betel quid chewing habit (30.9%), followed by extraction and building trades workers (code 71 in ISCO-88, 29.6%). These two groups also had the 2 highest smoking prevalence (61.2% and 62.2%). The betel quid chewing prevalence decreased from 2009 to 2013 slightly (32.3%-30.9%). However, the prevalence of smoking increased (60.0%-62.2%). Among the betel quid chewers of the two focused occupations, the corresponding rates of receiving oral cancer screening were rather low (35.47% and 21.52%). The indirect standardized ratios using the total sample as the reference showed 6 occupations (2 digit of ISCO-88) with significantly higher ratios (larger than 2). Cluster analysis demonstrated that the group with high prevalence of betel quid chewing also had high prevalence of cigarette smoking habit. Conclusion: The betel quid chewing prevalence has been decreased in all occupations. While at the same time, prevalence of cigarette smoking did not largely decrease. We analyzed the NHIS databases and found that workers in some occupations tend to have higher prevalence in both betel quid chewing and smoking. The oral cancer screening and cancer awareness need be targeted on certain occupations.
Prevalence of Known Risk Factors of Breast Cancer and Breast Cancer Screening Practices Among Women in Thiruvananthapuram, Kerala, India
Authors: John S. , Jose R. , Dhanuja V.A. , Haran J.C. , Augustine P.
Published: September 2018

Background: Breast cancer rates are rising both in the developed and the developing world, probably due to increase in life expectancy, increasing urbanization and adoption of western lifestyles. Incidence of breast cancer is reported to be increasing in India and it has become the most common cancer among women. Kerala and its capital city Thiruvananthapuram are also following the same pattern. Early detection and treatment of breast cancer is highly beneficial as it leads to increased survival rates and better quality of life to the patient. By identifying the risk factors and through regular and proper screening practices, we can detect the high risk population for this disease and contribute to its prevention and early treatment. Aim: 1. To study the prevalence of known risk factors of breast cancer among women aged 20 years and above in Thiruvananthapuram, Kerala, India. 2. To describe the breast cancer screening practices prevalent in the study population and to find out the proportion of high risk individuals using breast cancer risk calculator. Methods: A community based cross sectional survey was conducted among 2000 women hailing from Thiruvananthapuram. General population was invited through mass media to attend breast cancer screening camps. 2000 women aged more than 20 years who attended the camps and gave informed consent were included in the study. Data were collected from 40 participants each from 50 camps out of a total of 150 screening camps. A semi structured pro forma was used to collect the data regarding the sociodemographic profile, the various known risk factors of breast cancer according to research literature and breast cancer screening methods undergone. Descriptive statistics was done using SPSS version 16. Results are expressed in proportions with 95% confidence interval, wherever appropriate. Results: The mean age of the study population was 45.67 years. Majority of the women 82.5% had never undergone any sort of breast cancer screening. Clinical breast examination alone was undergone by 9.8%. Breast cancer risk calculator showed that 65% of the women screened had normal risk, 22.2% had moderate risk and 12.9% had high risk. Conclusion: Increased prevalence of major known risk factors of breast cancer like positive family history, low breast feeding duration, late age at menopause, are found. Also the prevalence of modifiable risk factors like obesity and low physical activity are high. Majority of the study participants have never undergone any breast cancer screening. Breast cancer risk calculator showed a fairly high prevalence of study participants in high risk and moderate risk category and therefore women need to be motivated to undergo regular screening.
Spectrum of Primary Cancer Diagnoses Among Patients at Uganda Cancer Institute in 2015 and 2016
Authors: Angucia B.S. , Nabwana M. , Asasira J. , Mulumba Y. , Mutyaba I. , Jackson O.
Published: September 2018

Background: Most recent cancer registry data suggests a change in cancer occurrence in Uganda with a decrease in incidence of Kaposi sarcoma (KS) but an increase in cervical, prostate and breast cancer. Anecdotal data suggest that KS, non-Hodgkin's lymphoma and breast cancer were the most common cancers among patients at Uganda Cancer Institute (UCI) by 2006. Aim: To describe the spectrum of cancer diagnoses among new patients that presented for care at UCI over the past 2-years. Methods: We conducted a cross sectional study of patients admitted into care at UCI with a histologic or clinical diagnosis of cancer from January 2015 to December 2016. Cancer diagnoses were reported as proportions by gender and age - children (0-14 years) and adults (above 14 years). Results: Overall, 8279 new patients were registered during the study period but only 7588 (92%) were recorded in the electronic database and had information on cancer diagnosis. Of these, 53% were admitted in 2015, and 55% were females. Median age was 48 years (IQR: 34-62). Among 2997 female adults, 30% had cervical, 17% breast, 5% Kaposi sarcoma (KS), 4% leukemia and 3.9% esophageal cancer. Among 2136 male adults, 17% had KS, 12% prostate, 10% esophageal, 6% leukemia and 4% colorectal cancer. Among the 486 children, 17% had leukemia, 16.7% nephroblastoma (Wilms tumor), 15.9% Burkitt lymphoma (BL), 8% rhabdomyosarcoma, and 6% Kaposi sarcoma. Conclusion: The distribution of cancer diagnoses among patients seen at UCI reflects the population level cancer incidence with cervical, breast, KS, prostate, esophageal, and colorectal cancer in adults, and nephroblastoma in children as the leading cause of cancer related morbidity. The overrepresentation of leukemia may be due to referral bias but warrants further study. The correlation of our findings with incidence data suggests that missing information did not significantly skew our findings. However more investments are needed to improve the quality of data captured electronically.
Tobacco Smoking and Trends in Histological Subtypes of Female Lung Cancer at The Cancer Hospital of The Chinese Academy of Medical Sciences Over 13 Years
Authors: Zeng Q. , Vogtmann E. , Jia M. , Parascandola M. , Feng Q. , Zou X.
Published: September 2018

Background: Smoking among Chinese women accounts for a small proportion, but the incidence and mortality rates of female lung cancer is increasing in recent years. Studies found that there were changes in histologic subtypes of lung cancer patients in China. Aim: This study investigated the tobacco smoking and trends in histologic subtypes of female lung cancer in a cancer hospital in China. Methods: Demographic, smoking history and histologic information about female lung cancer patients diagnosed or treated from 2000 to 2012 was collected from Cancer Hospital, Chinese Academy of Medical Science (CHCAMS). Trends of histologic subtypes calculated with annual percentage change (APC). The distribution differences of adenocarcinoma (ADC), squamous cell carcinoma (SCC), small cell lung cancer (SCLC) and the other subtypes between smokers and nonsmokers were calculated by 7th AJCC cancer staging. Results: Totally of 5,870 female cases of lung cancer, including 630 with history of smoking and 5,240 without, were analyzed. The number of female lung cancer patients increased from 509 (2000-2002) to 1744 (2012-2013). The main histologic type of lung cancer was adenocarcinoma (ADC) (72.93%), followed by small cell lung cancer (SCLC) (11.06%), squamous cell carcinoma (SCC) (8.38%) and the other (7.63%). Among smokers, the proportion of SCC decreased from 40.5% to 23.7% (APC = -11.68%, P = 0.005), however, the ADC increased from 35.7% to 50.7% (APC = 8.63%, P = 0.009). In nonsmokers, the ADC was 76.1%, and SCC was 5.9%. ADC increased from 63.1% to 80.6% (APC = -21.33%, P = 0.006), SCC decreased from 13.6% to 4.5% (APC = 3.86%, P = 0.016). Among squamous cell carcinoma, the cases with history of smoking were more likely diagnosed at early stages (I/II: 47.1%) than those at late stages (III, 34.3%; IV, 18.6%). Conclusion: The number of female lung cancer patients was increased in CHCAMS by year of diagnosis. In both smoking and nonsmoking cases, the proportion of adenocarcinoma was increasing. Among the squamous cell carcinoma, smokers seem to find in early stages.
The Unmet Supportive Care Needs of Nigerian Patients With Cancer
Authors: Fatiregun O. , Okediji P. , Awofeso O. , Sowunmi A. , Habeebu M. , Fatiregun O. , Alabi A. , Adeniji A.
Published: September 2018

Background: Cancer is an important cause of morbidity and mortality globally, and its incidence has been on the increase in Nigeria, and the rest of the world. The diagnosis and treatment of cancer is associated with significant psychological distress and patients face a broad range of challenges which create a huge vacuum of “unmet needs” that patients feel as a loss of personal control and frustration. This impacts negatively on their quality of life and other care outcomes. Aim: This study was aimed at determining the magnitude, distribution, and predictors of unmet needs in Nigerian cancer patients. Methods: Using a descriptive cross-sectional approach, 205 cancer patients attending oncology outpatient clinics at Lagos University Teaching Hospital (LUTH), Idi-Araba, were assessed for unmet needs. Eligible patients were given the self-administered Supportive Care Needs Survey - Short Form (SCNS-SF34) questionnaire with focus on five domains of need - psychological, health system and information, physical and daily living, patient care and support, and sexuality. Data analysis was carried out with SPSS version 20, and the level of significance was set at < 0.05. Results: The mean age of the 205 cancer patients was 47.4 ± 12.3 years, who are predominantly females (96.6%). The most common diagnosis was breast cancer (92.2%), and the mean duration since diagnosis was 20.9 ± 21.9 months for all the patients. The mean SCNS score was 83.9 ± 24.8, and at least 46% of the participants indicated unmet needs in 15 items of the SCNS. The most frequent unmet needs were related to the health information (53.4%), physical and daily living (49.4%), and psychological (48.5%) need domains. The most frequently met needs were in the sexuality, and patient care and support need domains. None of the factors considered (age, gender, marital status, family type, educational attainment, employment status, economic status, presence of financial support, social support, and cancer type) were significantly predictive of unmet needs in these patients ( P > 0.05). Conclusion: Nigerian cancer patients experience high levels of unmet needs, particularly in the areas of health information, physical and daily living, and psychological health. Hence, there is an urgent need to provide sustainable and long-term interventions and support for these patients to help them achieve increased care satisfaction, improved treatment outcomes, and a better quality of life.
An Apple a Day, Helps Keep Cancer Away!
Authors: Hansen R.-J.
Published: September 2018

Amount raised: N$19,948,000/U$1,672,509 Background and context: The Cancer Association of Namibia presented the project “An apple a day can keep cancer away” to one of the local commercial banks close to 2 decades ago. The concept of “Eat Healthy. Live Healthy. Prevent Cancer” became a massive hit and in subsequent years the “Bank Windhoek Cancer Apple Project” has become a flagship fundraiser for the association. For 1 month of the year (usually June or July - winter in Namibia) we convert all Bank Windhoek branches nationwide into “apple stores” with bank employees, CAN volunteers and school learners marketing and selling apples to raise funds for CAN, raise awareness on cancer and support screening interventions to promote earlier detection to save lives. Aim: Create awareness and educate on cancer, support the Cancer Association of Namibia financially to fund the National Cancer Outreach Program and the 2 interim homes operated by the association. Strategy/Tactics: National endeavor - for 1 month a year, the entire commercial bank is “converted” into apple stores, selling apples! Program process: An executive planning committee between Bank Windhoek as facilitator and the Cancer Association of Namibia plan and coordinates the annual event, sourcing one million red apples (the bank´s official color) from the Western Cape apple farms. Numerous project partners support the program from transport, cold storage, package and delivery, to media and sales partners. An “Apple Roadshow” kicks off the marketing and PR of the annual event, and then for one month a year the bank staff, CAN volunteers and especially high school learners (as part of the school challenge) promote bulk orders, while loose apple sales are conducted in bank branches country-wide. Costs and returns: All project partners offer their “time” and “manpower” as a donation in support of CAN through their CSI portfolio. Apples are sourced at a bulk reduced rate (± N$2, 50 each) and resold to the public at a N$5 donation per apple. What was learned: Logistics and supply chain management is a profession that must be highly respected! But, education, awareness and community collaboration makes one of the strongest support chains imaginable. Communicating “why” are we doing this, then taking the funds and “showing” what we the money goes (through the medical outreaches and sustaining the interim homes) speak to the heart of the nation. Transparency, accountability and inclusive community interaction is key when it comes to community driven fundraising.
Delays on Treatment and Associated Factors in a Cohort of Women Diagnosed With Breast Cancer in Rio De Janeiro, Brazil
Authors: Silva I.F.d. , Monteiro S.D.O. , Koifman R.J.
Published: September 2018

Background: The majority of breast cancer death occurs in developing countries. Mortality reductions achieved in the last decades in developed countries have not been reached in developing countries mainly because of a lack of access to early medical attention and delays on treatment. There are very few research studies on the reasons behind delayed medical attention for breast cancer in women in developing countries. Aim: To estimate the treatment delay, and associated factors, among women diagnosed with breast cancer treated on the National Cancer Institute in Rio de Janeiro, Brazil. Methods: A retrospective study on a cohort of 3220 women newly diagnosed with breast cancer between 2011 and 2013 was accomplished. Times from diagnose to treatment initiation were analyzed according to the Brazilian law for cancer patient treatment (≤ 60 > days). Association between sociodemographic, life style, clinical and treatment variables, and delays on treatment were estimated using X2-test and logistic regression model, with 95% confidential interval. Results: Over 50% of women was 50-69 years old, white (50.5%), presented early stage at diagnosis (63.8%), and refereed from public health service (76.9%). From those who had a histopathological diagnosis on the first visit at NCI (N=2,554), median time from diagnose to 1st treatment was 108 days, varying from 97 days (stage T0-2N>1-X/T3-4N0/X) to 133 days (stage Tis). Among those, prevalence of treatment delay was 89.1%; time interval > 30 days from diagnosis and 1st visit at NCI (OR=29.84; CI: 19.80-44.97) and age (50-69: OR=1.61; CI: 1.24-2.11, ≥70 years: OR=1.91; CI: 1.27-2.89) were statistically associated with treatment delay; while high education (OR=0.31; CI: 0.13-0.73) and late stage at diagnosis (OR=0.63; CI: 0.49-0.80) were negatively associate with treatment delay. Among those who arrived without diagnosis (n=666), prevalence of treatment delay was 34.7%. Considering the whole cohort (N=3220) age ≥70 years old (OR=1.42; 1.04-1.94), living outside Rio city (OR=1.53; 1.26-1.87), and chemotherapy (OR=1.44; 1.06-1.95) were positively associated with delay; while college education (OR=0.73; 0.57-0.94) and late stage (OR=0.71; 0.53-0.96) were negatively associated with treatment delay. Conclusion: Increased breast cancer treatment delay was observed among women who arrived with histopathological diagnosis. Time interval from diagnosis on the 1st visit at cancer center was the main factor associated to treatment delay, followed by old age; while high education level and late stage at diagnosis were negatively associated with treatment delays. Considering the whole cohort, old age, living outside Rio and chemotherapy were positively associated to delays on treatment, while college education level and late stage were negatively associated with treatment delay.
Better Health Durham: Community Engagement in a Cluster RCT of a Prevention Practitioner Intervention in Low-Income Neighbourhoods
Authors: O'Brien M.A. , Lofters A. , Wall B. , Pinto A.D. , Elliott R. , Pietrusiak M.-A. , Snider C. , Riordan B. , Grunfeld E. , Makuwaza T. , Sivayoganathan K. , Manca D. , Sopcak N. , Donnelly P. , Selby P. , Kyle R. , Baxter N. , Rabeneck L. , Cornacchi S. , Paszat L.
Published: September 2018

Background: The Building on Existing Tools to Improve Chronic Disease Prevention and Screening (BETTER) intervention has improved uptake of chronic disease prevention and screening activities in primary care. The BETTER intervention consists of 1:1 visits between prevention practitioners (PPs) and patients (40-65 years). It is unknown if an adapted BETTER could be effective in the community with public health nurses as PPs. Aim: The presentation objective is to describe community engagement strategies in a cluster RCT in low income neighborhoods with low cancer screening rates and low uptake of primary care. Methods: Principles of community-based participatory research were used to design the community engagement strategy in Durham region, Ontario. Key elements included close collaboration with public health partners to identify stakeholders and creating a community advisory committee (CAC) and a primary care engagement group to provide advice. Results: We identified 15 community stakeholder groups (∼47 subgroups) including service organizations, faith groups, and charitable organizations representing diverse constituents. Community outreach activities included in-person meetings and information displays at local events. The CAC is comprised of members of the public and representatives from primary care, social services, and community organizations. The CAC and primary care engagement groups have provided advice on trial recruitment strategies and on the design of the PP visit. Conclusion: The partnership between public health, primary care, and the study team has been crucial to connect with community stakeholders. Community engagement is essential in raising awareness about the study and will contribute to successful recruitment. Trial Registration: NCT03052959
Delays on Treatment Initiation and Associated Factors in a Cohort of Brazilian Women Diagnosed With Cervical Cancer at the National Cancer Institute in Rio De Janeiro
Authors: Silva I.F.d. , Silva I.F.d. , Koifman R.J.
Published: September 2018

Background: Cervical cancer is still a major public health problem in developing countries, where are observed high mortality rates and poor survival rates. Treatment delays may influence survival and have been associated to poor health care access and quality of care. Aim: To estimate treatment delays, and associated factors among women diagnosed with cervical cancer, treated on the main cancer center in Rio de Janeiro, Brazil. Methods: A retrospective cohort study comprising 865 women newly diagnosed with cervical cancer between 2012 and 2014 was accomplished. Times from diagnose to treatment initiation (≤ 60 > days), and from diagnose to treatment ending (< 120 ≥ days) were analyzed according to the Brazilian law for cancer patient treatment. Association between delays on treatment and sociodemographic, economic, life style, clinical and treatment variables were estimated using logistic regression model, with 95% confidential interval. Results: Mean age was 48 (± 13.7) and median was 47 years old; 36.2% had stage IIIB-IVA. Median time from diagnose to treatment initiation was 114 days, being statistically lower among women with stage IIB-IVA (205.5 days) as compared with those with earlier stages (119 days). Delay at treatment initiation was 92.8%. Median time from diagnose to treatment ending was 274 days, with a delay (> 120 days) of 92.6%. Median time interval from diagnosis to 1st visit at cancer center was 28 days, with a delay over 30 days of 46.6%. Age (OR=1.05; 95% CI:1.02-1.08), stage IIIB-IVA (OR=0.38; 95% CI: 0.16-0.90), time to first visit at cancer center (OR=11.52; 95% CI: 4.32-30.66), chemo radiation treatment (OR=4.56; 95% CI: 1.81-11.47) and adequate treatment (OR=2.57; 95% CI: 1.26-5.40) were independently associated with delay on treatment initiation. Conclusion: Increased treatment initiation and ending delays were observed in this studied population. Delay on treatment initiation was positively associated with age, time interval over 30 days from diagnosis to 1st visit at the cancer, treatment with chemo radiation, and adequate treatment.
Brazil Needs Organized Breast Cancer Screening: Pilot Project in Rio De Janeiro
Authors: Gioia S. , Torres C. , Cavalcanti J. , Heringer A.
Published: September 2018

Background: In Rio de Janeiro there is only the opportunistic screening program for women with breast cancer who arrive at health facilities and with a 14% rate of mammography coverage. In countries that have implemented effective screening programs, with coverage of the target population, quality of screening, and adequate treatment, breast cancer mortality has declined. Evidence of the impact of screening on mortality by this neoplasm justifies its adoption as a public health policy, as recommended by WHO. 80% of the population use the public health system (Sistema Unico de Saude - SUS), provided by the government. This system mainly provides conventional mammography. The private insurance system covers the remaining 20%, who have access to modern technologies such as digital mammography or MRI. Aim: The breast cancer organized screening program in the community of the Andaraí, RJ is committed in assisting women asymptomatic 50-69 years from SUS. Methods: The program foresees the participation of these women for an indefinite period, free of charge, and the accomplishment of biennial digital mammography, going through the stages of early detection and diagnosis. In case of positivity for malignant disease, it will be treated properly. Results: Since April 2014 have been 350 women with an average age of 54 years. 100% of them were asymptomatic and 49% had never done before mammography. Only 1 woman presented clinical suspect aged 44 years. The screening program organized by breast cancer in the community of Andaraí, RJ presented a mammographic coverage rate of 70%. The program is contemplated in the healthcare plan of the SUS. Conclusion: Preliminary results of the study suggest that population based organized screening are feasible and age of onset mammography screening should be 50 years in Rio de Janeiro.
Treatment of Massive Bladder Hemorrhage of Cancerous Etiology Using Selective Embolization
Authors: Ząbkowski T. , Piasecki P. , Bodnar L. , Syryło T. , Zieliński H. , Brzozowski K. , Zięcina P.
Published: September 2018

Background: Massive and intractable bladder hemorrhage of cancerous etiology are very dangerous and directly life-threatening. Its treatment is very difficult and complicated because of the severity of bladder tumor and the general poor condition of the patient which does not enable a radical surgical treatment. Aim: To evaluate the efficiency of the treatment of massive bladder hemorrhage of cancerous etiology using internal iliac artery selective embolization of anterior division. Methods: From January 2006 through June 2015, 23 patients (17 male and 6 female) were admitted to Urology Department as a matter of urgency because of massive bladder hemorrhage of cancerous etiology secondary to muscle-invasive bladder cancer (MIBC) - 14 patients, rectal cancer (RC) with invading bladder - 2 patients, bowel cancer with invading bladder - 2 patients, prostate cancer (PC) with invading bladder - 3 patients and cervical cancer with invading bladder - 2 patients ( Fig 1 ). The mean age of patients was 63.5 (range 37-80). In all patients, internal iliac artery selective embolization of anterior division was performed. The baseline mean hematocrit level during admission of patients to hospital was 23%, after embolization - 27.5%. In 14 patients it was necessary a mean of 6 transfusion units of packed red blood cells (PRBCs), range 2-16 transfusion units of PRBCs. 6 patients also required a mean of 8 transfusion units of fresh frozen plasma (FFP), range 2-27 transfusion units of FFP. Results: In 20 (86.96%) patients, therapeutic success was achieved after the first procedure. In 3 (13.04%) patients who developed hematuria after 12-38 days from the first endovascular procedure, the next successful embolization was performed bilaterally. It was not developed any major complications after embolization. Conclusion: Embolization of internal iliac artery is considered as a highly effective and minimally invasive method in case of massive bladder hemorrhage of cancerous etiology.[Figure: see text]
GeoCancer: A Tool Designed in the SUS Manager
Authors: Scaff A. , Reis R.
Published: September 2018

Background and context: Nowadays, there is a great amount of information to analyze the situation of care and the accomplishment of the SUS procedures for diagnosis and treatment of cancer. The tool GeoCancer will enable the manager (state and/or municipal) to analyze this assistance situation and the performance of SUS procedures for oncology, based on the public information available in DATASUS, in an agile, direct and specific way. Aim: The Cancer Foundation technical team has developed an online platform to organize the public databases of information on provider registration and procedures performed. This tool was called GeoCancer®. Strategy/Tactics: The GeoCancer® tool compiles and displays information on hospital admission procedures and high complexity procedures (SIH and APAC) and SADT (diagnostic and therapeutic support services) in the public databases of DATASUS. In addition, it organizes the providers and procedures performed in oncology on a georeferenced basis, making the results available in electronic address. Program/Policy process: This tool can be useful to the manager. With this, the manager will be better acquainted with the cancer profile of his specific area, so he can propose more effective measures throughout the cancer care line. Outcomes: The tool allows the choice of map visualization by procedures or SADT, in addition to being able to make analyzes by age, sex, type of cancer and health regionals. Information can be quantitative or by population distribution. What was learned: It is hoped that the tool fulfills the role of structuring, in a dynamic and georeferenced way, the assistance information on oncology in Brazil.
Acculturation, Biculturalism and Cancer Risk and Preventive Behaviors Among Pacific Islander Immigrant Youths in Hawaii
Authors: Lee H.-R. , Lee H.E. , Cassel K. , Hagiwara M. , Somera L.
Published: September 2018

Background: Culture is an important force which affects health behaviors linked to cancer risks among immigrants. Studies have demonstrated the process of acculturation can produce a form of stress that impact health negatively. On the other hand, research suggests that biculturalism, defined as the combining and practicing of customs from two cultures, may be a healthy approach to acculturation. Biculturalism is especially relevant for youth immigrants as their cultural identities are still developing. Pacific Islanders, a fastest growing populations in the US, often experience discrimination in the society at large and in the health care system. Pacific Islander youth in the US navigate between two cultural identities: their native culture as they live in a close-knit community that still maintains strong cultural norms and values, and the dominant American culture that they face once they step outside their community. This is one of the rare studies that examine the relationship between acculturation and cancer preventive behaviors among Pacific Islander youth. Aim: We aim to study the process through which biculturalism influences cancer risk and preventive behaviors such as smoking, sunscreen applications, physical activity and healthy eating among Pacific Islander youth immigrants in Hawaii. Specifically, we map the process of influence that links biculturalism to self-esteem and to these cancer risk and preventive behaviors. Methods: Using survey data from 284 Pacific Islander youth, we developed and tested a theoretically driven model that specifies the relationship among variables listed above. Results: Results show that self-esteem serves as an important mediator connecting biculturalism to cancer preventive behaviors. While biculturalism did not have a direct influence on behaviors and outcomes, it led to increased self-esteem which, in turn, directly influenced attitudes about sunscreen application, physical activity and healthy eating. However, there was neither direct nor indirect link between biculturalism and smoking. Conclusion: While numerous studies have shown links between biculturalism and health, not many studies focus on the specific process through which the influence is exerted. This study provides an important insight into the process through which biculturalism impacts cancer preventive behaviors among minority youth in America. Data from the study showed a clear relationship between biculturalism, self-esteem, their attitudes and behavior related to cancer prevention among Pacific Islander youth living in Hawaii. This study provides insights into potentially novel methods and interventions designed to increase cancer preventive behaviors among migrant youth by dually promoting adoption of U.S. cultural norms, while concurrently embracing an individual´s historic cultural identity.
Assessing the Quality of Life of Breast Cancer Patients Undergoing Treatment at the National Radiotherapy Center, Accra, Ghana
Authors: Opoku S.
Published: September 2018

Background: Quality of life is an important clinical outcome in assessing health care. It is a concept that includes many subjective elements: physical, emotional and social function, attitudes to illness, patient's daily lives-including family interactions. Quality of life is increasingly used as an outcome measure in oncology research studies appearing in a variety of forms in several literatures. Aim: The study was aimed at assessing the quality of life of breast cancer patient undergoing treatment at the Radiotherapy Center, Accra, Ghana. Methods: This cross-sectional descriptive study involved 30 patients over a 3-month period. Functional Assessment of Cancer Therapy (FACT-B) Specific Scale for Breast Cancer Survey Instrument was used to collect the data which was analyzed with SPSS. Results: The peak age range of the patients was between (56-65) years. Out of these, 60% (n=18/30) received triple treatment modalities, namely, surgery, chemotherapy and radiotherapy. Surgery and chemotherapy alone accounted for 16.7% (n=5/30). Further 10% (3/30) had surgery with adjuvant radiotherapy. Three patients 10% had only surgery and one patient (3.3%) received both chemotherapy and radiotherapy. The scores for the quality of life domains were general emotional well-being (18.8+8.4), general physical well-being (16.5+6.1), general social well-being (14.3+7.0) and general functional well-being (10.9+5.7). The quality of life of three patients (10%) was found to be poor, while 70% (n=21/30) had stable quality of life and 20% (n=6/30) with good quality of life. Conclusion: Considering the quality of life domains or subscale scores and the overall quality of life scores, it is concluded that no significant difference exists ( P > 0.05) in the quality of life status of the patients irrespective the treatment modality received.
Narrative Therapy and Hope in Breast Cancer Patients
Authors: Sajadian A.
Published: September 2018

Background: Narrative therapy is one of the most important ways of improving the quality of life and mental health by increasing women's hope in breast cancer. These patients often think that they have many problems, especially with hopelessness, body image, sexuality, and helplessness. It is effective for improving mental and physical health as an effective way of changing behavior. Aim: The purpose of this study was to evaluate the effectiveness of narrative therapy on increasing level of hope in breast cancer patients that was present at the Breast Cancer Research Center of Iran in 2017. Methods: We conducted a clinical pretest and posttest study, with two experimental groups. All of the participants had already received their primary treatments. They response, Hert Hope Index (HHI). Twenty-six patients had individual therapy, 24 patients in 5 groups were treated with group therapy. We had 8 sessions weekly which lasted 100-120 minutes. Narrative therapy was done for two groups. Both groups were reassessed to monitor the changes in hope (posttest) and reported. Results: According to the demographic characteristics of the participants, the mean age in the individual and group therapy was 47 (± 9) and 51 (± 8) respectively. Data analysis showed that according to their marital status ( P = 0.56), occupation ( P = 0.71), education ( P = 0.96), was not statistically significant difference. The hope scores in the individual therapy before and after the treatment were 32 (± 6) and 21.04 (± 5), respectively. And group therapy 29 (± 6) and 27 (± 4) respectively. These results showed that increasing of hope during the study in group therapy ( P < 0.0001), the difference between the two groups (α = 95%, P < 0.001). On the other hand, these results showed, there wasn't significant difference between the hope levels before and after intervention in the individual group ( P < 0.025). Conclusion: This study showed that, the effects of narrative treatment with group therapy on the increasing hope level in breast cancer patients. It suggests that narration can be a psychological recovery of cancer survivors in group therapy and promotion their quality of life.