bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonsmoked Tobacco Addiction Playing a Major Role in Oral Mucosal Changes in Northern Indian Population Over Smoked and Alcohol Use
Authors: Chaudhuri S. , Gupta S.K. , Kumar N. , Panda D. , Radia A. , Chaurasia A. , Kumar N.
Published: September 2018

Background: Oral cavity is prone for myriad of changes with advancing age as well result of environmental and life style related factors like consumption of tobacco (smoke or smokeless) and alcohol. Aim: The aim of this study was to quantify and compare the association of oral mucosal changes (OMC) with nonsmoked tobacco over smoked tobacco and alcohol. Methods: Data of 11,145 subjects from 106 health screening camps, organized in Uttar Pradesh and Rajasthan between April 2015 to June 2017 was analyzed to unveil and determine the mode of addiction and prevalence of OMC. Bivariate and multivariable models were tested for comparison and identification of factors associated with an increasing risk of developing OMC. Results: The primary symptoms were mouth ulcer in 5.6% and trismus (1.0%). The overall proportions of tobacco chewing, smoking and alcohol addiction were 12.5%, 10.7% and 2.5% respectively. The highest prevalence of smoking noted in the age-group 55-64 years (14.4%), for tobacco chewing and alcohol consumption in the age-group 25-34 years was 15.6% and 4.2% respectively ( P < 0.001). The prevalence of mouth ulcers were 20.7% among smokers and 27.8% among tobacco chewers ( P < 0.001) while the percentage of trismus 26.1% among smokers and 53.0% among tobacco chewers ( P < 0.001). Conclusion: Results of this study can be used for creating awareness among the population regarding the hazards of tobacco use. More number of studies needs to be conducted all over India to understand the prevalence and the biologic behavior of these oral premalignant lesions and its progression to invasive diseases.
Geographical Distribution of Fast Food and CRC Incidence in Young Adults
Authors: Ku M.-S.K.
Published: September 2018

Background: There is an increasing trend of colorectal cancer (CRC) in young adults who also used to take fast food. However, little is known about the association between fast food and the occurrence of CRC in young adults. Aim: To investigate the impact of fast food diet on the incidence rate of CRC in terms of geographic distribution. Methods: Geographic distribution of fast food diet was measured by the density of fast food stores (numbers of fast food stores/population per 105) according to each county. We summed up total numbers of the fast food stores ranking the top 3 in Taiwan from the corresponding official Web sites. The incidence of CRC from 2004 to 2013 for young adults aged 15 to 49 years old was computed from Interactive Information System of the National Cancer Registry, provided by Health Promotion Administration, Ministry of Health and Welfare. Multilevel random-effect regression model was applied to estimating the effects of geographical location of fast food stores at city/county level on incidence of CRC with adjustment for age and gender at individual level. Results: The incidence rate of CRC in young adults aged 50 years or below was in parallel with the distribution of fast food stores in geographical pattern. After adjusting for age and sex, the results show that an increase in the growth of 1 unit of density in fast food store led to an increase in incidence of CRC by 2%. Approximately 87% accuracy was noted in predicting the highest one-third percentage of incident CRC cases in young adults. Conclusion: The density of fast food stores was highly associated with the increased risk of colorectal cancer incidence in young adults. This may account for the increasing trend of CRC in young adults in Taiwan.
Perception of Tobacco in Young Adults of Urban India: A Qualitative Exploration and Health Policy Analysis
Authors: Ghose S. , Datta S.S.
Published: September 2018

Background: Tobacco is the single largest cause of preventable death globally. An emerging body of evidence shows that tobacco is 1 of the identified causes of cancer contributing to 50% of cancers in men and 20% in women and the same is estimated to kill 10 million people by 2030. The epicenter of this epidemic is the low and middle income countries with 80% of the 1 billion smokers in the world coming from there. India is home to 275 million tobacco users and is the second largest producer and user of tobacco products after China. Many of the users demonstrate a very early smoking debut and a significant proportion of India's population falls in this group. Prevention of early tobacco debut and use of tobacco in youth is 1 of the critical ways of reducing the burden of noncommunicable diseases in the world. There is very limited information on how today's youth perceive using tobacco products, and what they think of the anti-tobacco campaigns and legislative measures. Aim: The qualitative arm aims to bridge some of the knowledge gaps related to tobacco use in today's urban youth; to understand the perceptions of the youth about tobacco. The policy piece evaluates relevant tobacco control legislations in India using a prevalidated policy analysis framework. It critically analyses the gaps of the national tobacco control mechanisms responsible for impacting the tobacco use in the youth. Methods: A qualitative grounded theory approach was followed. In a university in India, 30 young undergraduate students were recruited. Data were collected through in-depth interviews, focus groups and participant observations. The policy section critically analyzed relevant parts of the India's tobacco control law taking its lead from the qualitative data, compared it with the WHO Framework Convention of Tobacco Control (FCTC), and identifies barriers and gaps to understand how its impacting the use of tobacco in youth. Results: Peer influence and social desirability emerged as major influencers for tobacco debut. Stress, exams, depression, family problems and symptoms of stress for example headache, sleeplessness etc. were other influencers for debut. The other major theme was the perceptions and concepts on tobacco addiction and quitting. Knowledge among youth on available quitting or cessation support was very little. Most of the study participants believed that the current tobacco control measures are not effective. The policy analysis of national tobacco control measures revealed significant gaps that are currently being exploited by the tobacco industry as they continue to promote tobacco products and increase production capacity. Conclusion: This study recommends amending the Indian tobacco control law to address the gaps and implement a more stringent legislation commensurate to the tobacco use patterns and existing barriers.
Using Social Media as an Effective Tool for Motivating Cancer Prevention
Authors: Chandan K. , Yadav A. , Chandra A. , Mehrotra R.
Published: September 2018

Background: Cancer is among leading cause of death (8.8 million) worldwide. Around 14.2 million new cases were recorded in 2012 and increasing each year. On the other hand there are about 2.8 billion users of different social media platforms (i.e., 37% of the world population). This tremendous power of social media can be used for disseminating effective information and communication on cancer prevention more efficiently (i.e., in less time to more people) to create awareness against the disease. Tobacco, alcohol and food industry have been using social media for aggressive advertising and marketing of their products. There is an urgent need to maximally use this medium of communication for advancing cancer prevention globally. Aim: To assess the role of social media in implementing effective health promotion strategies to advance cancer prevention. Methods: Extensive Web search has been done on the way social media (e.g., Facebook) is used for advancing public health communication and how it has been leveraged in the field of cancer prevention. Several Facebook pages and groups, YouTube channels were analyzed thoroughly. Various reports and articles on social media have been reviewed and analyzed. Results: Social media has been found very effective in terms of engaging greater number of population globally. Many Facebook pages and groups are available that provide information regarding specific cancer or provide support for cancer survivors. Several informative videos related to cancer prevention and survivors' stories are broadcast on various YouTube channels run by individuals, government, and nongovernment organizations. There have been many Instagram accounts on cancer but many of them don't provide relevant information on cancer prevention. However, genuine and relevant information are available through several Twitter handles. These social media platforms have very high penetration power. Facebook, YouTube, Instagram and Twitter have monthly reach to more than 1871, 1000, 500 and 263 million users respectively. This large number of user base can become a great source of spreading information on various aspects of cancer prevention through a comprehensive social media campaign. Conclusion: Social media platforms improve outreach and can also help carrying the relevant preventive health messages on cancer prevention, not only for the cancer patient but the public at large. Social media will help in amplifying the messages to the global mass while motivating prevention and health promotion to achieve public health objectives.
Attitude and Practice of Breast Self-Examination in Women in Morocco
Authors: Condé P. , Kava A.C. Filankembo , El Fakir S. , Tachfouti N. , Nejjari C. , Diakité D.O. , Khazraji Y.C. , Bekkali R. , Belakhel L. , Aboussalham L.
Published: September 2018

Background: Breast cancer is characterized in Morocco, by the delay in diagnosis, with a high rate of metastatic extension which leads to the difficulty of treatment and an increasement of mortality. It is often the woman who detects breast abnormalities through self-examination. Self-examination alone does not diagnose the breast cancer. Despite it is accessible method in developing countries because it is easy, convenient, private, safe and requires no specific equipment. Aim: The objective was to study the practice of breast self-examination in women in Morocco. Methods: This was a cross-sectional observational study that was conducted in July 2011 based on early detection programs in basic health centers. A total of 1444 women aged from 17 to 86 years were included on the eligibility basis for early detection of breast and cervical cancer in Morocco. For each participant we collected sociodemographic data, information on breast cancer factors, data on the level of knowledge of breast cancer, and information on breast self-examination practice. Results: The average age was 41 years old. The information on breast self-examination came mainly from the media (57, 28%). The practice of the breast self-examination in 56.9%. In our study population, we had 76.6% multiparous, 7.8% nulliparous and 15.6% primiparous. Among the 36 participants, 3% were illiterate, 23% had primary education, 26.4% secondary education and 201 (14%) had a higher education level. The breast self-examination practice was associated with participants´ level of education (OR = 1.69) ( P = 0.000). Membership in the different age groups had no effect on the practice of breast self-examination ( P = 0.182). Conclusion: It is imperative to increase awareness of the practice of breast self-examination and its methods through health education campaigns.
Cancer Before, During and After Pregnancy
Authors: Ndlela B. , Sandhu S. , Lai J. , Lavelle K. , Elliss-Brookes L. , Poole J.
Published: September 2018

Background: The occurrence of cancer during pregnancy is uncommon with an incidence rate of ∼1 in 1000 pregnancies. The rate of pregnancy-associated cancer is increasing and this is partly caused by a trend in delaying child bearing to an older age. Aim: With little data in the UK concerning the number of women diagnosed with cancer during pregnancy, the purpose of this study was to compare incidence of cancer in pregnant women to the general female population. Methods: Cancer registry data for England were linked to hospital activity data to establish pregnancy-associated cancers. For this study, women aged 15 to 44 years diagnosed with a malignant cancer between 2012 and 2014 and a pregnancy or delivery code 1 year before or up to 1 year after diagnosis were defined as pregnant women. Age-standardized and age-specific incidence rates of cancer in pregnant women and the general female population in England were compared by 5-year age-group, geographic region of residence, income deprivation quintile and stage of cancer diagnosis. Results: A total of 3272 pregnancy-associated cancers were identified in 2,503,174 pregnancies. The age-standardized incidence rate (ASIR) of cancer in pregnant women was 48% higher than the equivalent ASIR of cancer in the female population aged 15-44 nationally (173 vs 117 per 100,000). This trend of higher incidence of cancer among pregnant women persisted for most regions, ages and stages, and was particularly high in the most deprived quintile. The most common cancers diagnosed around the time of pregnancy were breast (n = 784), melanoma of skin (n = 504), cervical (n = 498), hematologic (n = 286), ovarian (n = 240) and colorectal (n = 188). Comparing the ASIR of cancer in pregnant women with the female population, by site, rates were over 30% higher for breast cancer (55 vs 41 per 100,000 respectively) and around double those for melanoma (26 vs 13 per 100,000). Conclusion: The higher rates of pregnancy-associated cancers compared with the general female population may be due to frequent obstetric examinations which increases the chances of cancer detection. Further work using a more robust maternity dataset would be required to ascertain timing of cancer diagnosis in relation to delivery.
Retrospective Clinical Research Comparing the Value of the Superficial Mark Guided Localization Technique With the Hook Wire Guided Localization Technique for Nonpalpable Breast Microcalcifications
Authors: Qiu Y. , Jiang Y.
Published: September 2018

Background: Early diagnosis and treatment is essential for curing breast tumors. In recent years, the number of diagnosed nonpalpable breast lesions has risen rapidly following increased breast cancer awareness and the broad promotion of mammography (MMG) screening. Aim: A comparison of the effect and accuracy between the superficial mark guided localization technique (SGL) and the hook wire guided localization technique (WGL) for nonpalpable breast microcalcifications. Methods: Retrospective research was conducted to compare SGL and WGL techniques. These techniques were performed on 51 patients with nonpalpable breast microcalcifications from the months of Jan 2015 to May 2016. Results: A total of 51 patients with ages ranging from 32 to 72 years were included in the study; 25 (49.01%) patients were randomly selected for the WGL group, while the other 26 (50.99%) patients were randomly selected for the SGL group. One case in the WGL group was treated with the SGL technology due to technical difficulties with the localization procedure. No statistically significant association was found between the 2 groups within the specified diameter of excised tissue. For the WGL group and SGL group, the average diameter of excised tissue was 78.4 mm and 78.9 mm, respectively. No complications were observed for patients in the SGL group, whereas 4 patients in the WGL group experienced complications. Two patients had a vasovagal reaction and another 2 experienced ecchymoma or shifting of the hook wire. According to the paraffin result, we found 3 (12%) malignant cases in the WGL group and 6 (23%) malignant cases in the SGL group. Conclusion: The superficial mark localization technique is as accurate as the hook wire guided localization technique. The procedure has the advantages of being less expensive and causes less complications.
Evaluation of Secondary Malignancies in Chronic Lymphocytic Leukemia
Authors: Aladag E. , Okay M. , Ciftciler R. , Heziyev T. , Sayinalp N. , Buyukasik Y. , Demiroglu H. , Goker H. , Haznedaroglu I.C. , Ozcebe O.I.
Published: September 2018

Background: Chronic lymphocytic leukemia patients have an increased risk of secondary malignancy. Aim: The aim of the current study was to evaluate secondary malignancy in patients with chronic lymphocytic leukemia. Methods: Patients with chronic lymphocytic leukemia were screened and their diagnosis and last visit data, treatment protocols, the existence of secondary malignancy, if present, diagnosis date of secondary malignancy and its treatment were recorded from hospital system retrospectively. Results: One hundred thirty-four patient (134) followed in Hacettepe University Hospital Hematology Department were enrolled. Of 134, 88 (66%) were male and 46 (34%) were female. A total of 32 patients (23.9%) had a secondary malignancy. Of 32 patients, 8 were genito-urinary system (vulva - vagina - ovary - endometrium - prostate and renal) malignancies, 5 were dermatological system malignancies, 3 were thyroid, 2 were breast, 2 were lung, 1 was gastric and 9 were hematologic system malignancies. Mean age of patients with secondary malignancy were 64.2 ± 2.3 years and those without secondary malignancy were 64.1 ± 1.0 years ( P = 0.943). Mean overall survival in patients with secondary malignancy was 110 months and in those without secondary malignancy was 140 months ( P = 0. 531). 17 of the patients with secondary malignancy had a history of chemotherapy. 11 of these patients received chlorambusil-based treatments. Conclusion: Immune deficiency and chemotherapeutic agents used in the management of chronic lymphocytic leukemia are thought to be responsible for the appearance of secondary malignancies. Although there is no significant difference in terms of survival, these patients should be closely followed for secondary malignancies.
The Expression of PRL-3 Correlates With Chromosomal Instability in Colon Cancer and Thyroid Cancer
Authors: Lian S. , Meng L. , Yang Y. , Qu L. , Shou C.
Published: September 2018

Background: Phosphatase of regenerating liver (PRL-3) promotes cell invasiveness, but its role in genomic integrity remains unknown. We have reported that PRL-3 recruits to telomeric DNA by RAP1/TRF2 protein. Overexpression of PRL-3 in colon cancer cells and primary fibroblasts promotes structural abnormalities of telomere, telomere deprotection, DNA damage response, chromosomal instability. Aim: To substantiate the previous results and further assess the physiologic relevance of PRL-3 in tumorigenesis, also to explore the prediction role PRL-3 in clinical patients. We detected the expression of PRL-3, telomere length, H3K9me and p-H2AX in the colon cancer and thyroid cancer samples. Methods: We collected 273 colorectal cancer patients and stained with PRL-3 antibody and counterstained with HE. Semiquantitative scoring was performed. Microscopic analysis was done by 2 of the authors. Tissues-chips were obtained from Alenabio (Th802a, thyroid). Results: We retrospectively analyzed a cohort of colorectal cancer tissues (n = 269) stained with anti-PRL-3 (clone 3B6). Although the majority of mitotic cells were bipolar, more multipolar mitoses, an indicator of chromosomal missegregation and chromosomal instability, was observed in PRL-3 positive tissues than in negative tissues (Fig 1A). Also in the PRL-3 positive tissues, more anaphase bridges were detected ( Fig 1A ). These results suggest that PRL-3 levels positively correlate with chromosomal instability in colon cancer tissues. Next, we analyzed 12 freshly dissected colon cancer tissues, with WI38 control and PRL-3-overexpressing cells as reference samples. We detected varying levels of PRL-3 proteins in these tissues, and the level of stably overexpressed PRL-3 in WI38 cells was comparable to some of these tissues. An inverse correlation between PRL-3 and telomere length was revealed, while PRL-3 showed positive correlations with gamma-H2AX and H3K9me3 ( Fig 1B ). We also performed quantitative FISH (qFISH) analysis of telomere length and immunohistochemical staining of PRL-3 with thyroid tissue chips containing 80 samples. We found decreased telomere staining in adenocarcinoma tissues (n = 40) with positive PRL-3 expression, particularly in those of stage I (n = 23) ( Fig 1C ). No correlation was observed in thyroid adenoma (n = 40) or stage II/III/IV adenocarcinoma (n = 17) ( Fig 1C ). With the same thyroid tissue-chip, we evaluated association between PRL-3 and senescence. In stage I thyroid adenocarcinoma tissues, positive staining of PRL-3 correlated with positive H3K9me3 staining, but such correlation was not observed in thyroid adenoma or Stage II/III/IV adenocarcinoma ( Fig 1D ). Conclusion: These results raise the possibility that PRL-3-promoted telomere deprotection and senescence are early events during the development and progression of cancer. Our results uncover a novel role of PRL-3 in tumor development through its adverse impact on telomere homeostasis.[Figure: see text]
A Treatment of Metastatic Renal Cell Carcinoma: The Cost Effectiveness of Axitinib From a Malaysian Perspective
Authors: Nurhasni K.A.R. Ku , Sabirin J. , Puteh S.E. Wan , Dahlui M.
Published: September 2018

Background: Axitinib has been suggested to be effective as a second line treatment of metastatic renal cell carcinoma. However, its adoption may be limited by its financial consequences. Therefore, a cost-utility analysis was conducted to estimate the economic value of axitinib as a second line treatment of metastatic renal cell carcinoma. Aim: This analysis will informed the decision makers on the potential use of axitinib in this population within the Ministry of Health facilities. Methods: A state transition model was developed using Microsoft Excel 2010 to simulate a hypothetical cohort of patient receiving axitinib or best supportive care over 5 years of time horizon. A monthly cycle was chosen without a half cycle correction. Three health states were included in the model as progression free, disease progression and dead. A 3% discount rate was applied as recommended in the Pharmacoeconomic Guidelines for Malaysia. Total costs were estimated using unit costs from local sources and published data. The clinical and utility parameters were derived from the published literatures. Results: The mean probabilistic incremental discounted cost and QALY for axitinib were RM 113,576.29 and 0.35413 respectively, yielded a probabilistic incremental cost-effectiveness ratio (ICER) of RM 320,719. Unavailability of the local price for axinitib may play a part in the higher estimation of ICER. Conclusion: Axitinib may not be considered as a cost-effective second line treatment of metastatic renal cell carcinoma as the ICER is beyond the value of 3 GDP per capita.
Information System of Nationwide Population-Based Cancer Screening in Taiwan
Authors: Lin J.-Y.
Published: September 2018

Background: Pap smear screening was the first nation-wide population-based organized screening since 1999 in Taiwan. After that, nationwide screening programs for breast cancer, colorectal cancer, and oral cancer have been launched since 2004. The national online information system was built for the infrastructure, monitoring, delivery, evaluation, and management of health care services in our nationwide screening program. Aim: To develop a comprehensive health information system for cancer screening to assist health professionals in processing screening with quality assurance and evaluation. Methods: A Web-based solution combining data gathering and processing capabilities was developed. Application design in a server was based on the ASP, HTML, DHTML, Java Script, Java Applet technology and SQL-SERVER relational database. Web-based software programs were developed to facilitate the structure, process, and outcome for screening. Individual screening data were transferred to centralized databases via the Internet. The client-users now include 25 health bureaus, 369 health centers and over 6500 clinics or hospitals. Results: The Taiwanese cancer screening system incorporates nationwide breast cancer screening with mammography, colorectal cancer with fecal immunochemical test, oral cancer with visual inspection. The key performance index for screening including screening rate, positive rate, referral rate, positive predictive rate, detection rate, and interval cancer rate were provided in the system. The system allows for the flow of information among different health services and country areas to monitor participants in the whole process screening. It has an alert system to prevent delayed referral for cases in need of diagnosis and treatment. A total of 2.27 million women aged 45-69 years have attended biennial mammography screening program at least once between 2004 and 2014. More than 4.6 million subjects with the exposure of betel quid and/or cigarette have attended the biennial oral cancer screening. Around 3.8 million subjects aged 50-74 years have attended the biennial FIT screening. Information on organized features appertaining to screening, diagnosis, and outcomes after long-term follow up were collected for the systematic evaluation. The proposed health information system for cancer screening is centered on modules that would allow for the computerization, process, update of screen data, and link with other registry data (e.g., population registry, cancer registry, and mortality). Conclusion: A nation-wide information system for breast cancer, colorectal cancer, and oral cancer screening was successfully developed to support health professionals and health decision makers for planning, delivery, management, and evaluation in population-based cancer screening program.
Effectiveness of Population-Based Cancer Screening Only Based on Survival Data Considering Latent Lead-Time and Truncation Biases
Authors: Chang W.-J.
Published: September 2018

Background: When evaluating the effectiveness of population-based screening program (comparison of survival between screen-detected and clinically detected cases), latent lead time and truncation are both inherent biases from screen-detected cases. Following the disease natural history, the time spent in preclinical screen-detectable cases (PCDP) called sojourn time is an important factor to determine these 2 biases, lead-time bias and length bias. The first is the time from diagnosis at screen to hypothetical diagnosis (entering clinical phase) depending on the sojourn time should be subtracted from the overall survival time to achieve a fair comparison. The second is pertaining to oversampling cases with long sojourn time at prevalent screen. The survival benefit is often overestimated without considering these 2 biases. Aim: To unbiasedly estimate the effectiveness of population-based screening in terms of hazard ratio between screen-detected and clinically detected cases. Methods: Walter and Stitt (1985) has already proposed a parametric approach to adjust lead-time bias. However, lead-time bias and truncation biases are correlated as both have shared information on sojourn time in common, and therefore we aim to consider these 2 biases at the same time. Both parametric and semiparametric approaches are proposed to address the hazard ratio of risk of cancer death adjusting for lead-time and truncation biases based on data from the Swedish W-county trial. The estimation of parameters computer algorithms was also adopted with non-Bayesian and Bayesian approaches using SAS and R. Results: By using parametric approach, the hazard ratio was inflated from 0.26 (0.18-0.36) without adjustment to 0.38 (0.25-0.55) with lead-time adjustment and 0.43 (0.27-0.60) with both lead-time and truncation adjustments. The use of semiparametric model led to 0.59 (0.49-0.70) of adjusted hazard ratio. After considering tumor attributes, the hazard ratio was inflated to 0.76 (0.45-1.11) and 0.87 (0.71-1.04) separately under parametric and semiparametric approaches. Conclusion: Unbiased evaluation of effectiveness of population-based screen with adjustment for lead-time and truncation biases based on survival data are efficient and feasible.
Development of Bespoke and Sustainable 2-Day Cancer, Palliative, End of Life, and Bereavement Care Educational Workshops for Health Care Professionals in Nigeria
Authors: Simon-Hart A.A.F. , Adekeye N.A. , Atter L. , Cost S. , Siddall J.
Published: September 2018

In Nigeria there is a consensus that in-country cancer services lack strategy, focus and coordination of care. This is magnified by poverty and by cultural and religious issues, resulting in the majority of patients presenting late and deemed palliative at the time of diagnosis. The Bricon Foundation, a Nigerian nongovernmental organization joined forces with Macmillan Cancer Support, a well-known established UK cancer charity to design an interactive teaching package for Nigerian health care professionals. The aim of the workshops was to share best practice in basic cancer, palliative and end of life care including bereavement support. The project concentrated on facilitating open discussions among Nigerian health care professionals about these topics including communication challenges and how to take care of themselves. The four two-day workshops were designed to identify challenges and obstacles health care professionals faced in delivering cancer and palliative care in Nigeria. They empowered participants to realize their own potential in improving the cancer experience for the patients and themselves. The cancer sessions were adapted from Macmillan cancer awareness materials that have been well evaluated in the UK. Additionally, the team developed a palliative, end of life and bereavement care study day as day two of the workshops to give participants a basic holistic overview. A team of Macmillan Alumni volunteers traveled to Nigeria to work with The Bricon Foundation team in delivering this training, which had sponsorship from NNPC, Total EPNL and partners. After each day participants completed an evaluation form. This enabled the team to adapt subsequent presentations to the Nigerian context using the feedback. The training was delivered to 91 participants from 26 government and private facilities with all 4 workshops evaluating positively. Attendees specifically valued the group work as it facilitated an exchange of ideas ensuring their voice was heard. Most expediently we were able to identify professionals drawn from different areas of healthcare who are interested in delivering future sessions on a regular basis keeping education at the forefront of cancer, palliative care and health care practice development. With further educational sessions anticipated in the near future, evaluation is on-going.
Trends in Sales Volumes of Cancer Medicines in Six Asian Countries Working Toward Universal Health Coverage
Authors: Ferrario A. , Stephens P. , Ross-Degnan D. , Wagner A.
Published: September 2018

Background: In low- and middle-income (LMIC), medicines represent an important proportion of total out-of-pocket expenditures on health care and should therefore be a key target for financial protection through inclusion in benefit packages under universal health coverage (UHC). For antineoplastic medicines, this need will become even more urgent with the increasing incidence of cancers in LMIC and the availability of new, highly priced cancer. Previous studies have shown that countries have listed cancer medicines recommended in the World Health Organization (WHO) essential medicines list (EML) in their national EMLs. However, little is known about use of these medicines at country level and changes in use over time as countries work toward UHC. Aim: To analyze trends in sales volumes of cancer medicines in China, Indonesia, Kazakhstan, Malaysia, the Philippines and Thailand between 2006 and 2017. Methods: Using quarterly data from IQVIA (former IMS and Quintiles) on sales volumes in 6 middle-income Asian countries of cancer medicines (ATC-L01/02) included in the 2017 WHO EML, we estimated annual sales by international nonproprietary name, year and country. Sales volumes were estimated in total milligrams and total defined daily doses (DDD) per new cancer case. The reference DDD were taken from the German Institute of Medical Documentation and Information. We adjusted total mg and DDD by the total number of new cancer cases per country in 2012 ( Globocan 2012 ). Results: The 2017 WHO EML contains 49 medicines in the antineoplastic section; 40 of them were used in 1 or more countries included in the study. Availability of these 40 medicines ranged from 33 in Indonesia to 40 in the Philippines. The median percentage increase in sales volumes between 2006 and 2017 ranged from 42% in Thailand to 94% in Indonesia. Use of new, high-priced medicines such as trastuzumab and rituximab increased more than 90% and 72% in all countries, respectively, during the study period. Limitations: National sales volumes are extrapolated from standardized audits of procurement and sales data in sample facilities and/or distribution data supplied by wholesalers in each country and may underestimate actual sales. Given different indications for which a cancer medicine can be used and highly individualized antineoplastic treatment regimens and dosages, standardized DDD do not represent actual prescribed daily doses. Growth rates will reflect the place of the medicine within the national treatment guidelines and healthcare delivery capacity. Conclusion: This study provides evidence that use of WHO-recommended essential medicines for cancers increased in 6 Asian countries working toward UHC. Many factors are likely to have contributed to this outcome, including improvements in diagnosis and treatments. The next step in this study will be to assess the role of insurance coverage changes as a factor contributing to changes in utilization of cancer medicines.
Availability, Prices and Affordability of Selected Essential Cancer Medicines in a Middle-Income Country: The Case of Mexico
Authors: Holz D. Moye , Ewen M. , Dreser A. , Bautista S. , Soria R. , van Dijk J. , Reijneveld S. , Hogerzeil H.
Published: September 2018

Background: More alternatives are becoming available for the diagnosis and treatment of cancer in low- and middle-income countries. Yet, because of increasing demands, many governments are now facing the dilemma of making essential cancer medicines available to all while keeping them affordable. Precise information about current access to these medicines is limited, and there's no systematic methodology in place to do so. Aim: To assess the availability and affordability of essential cancer medicines in Mexico, and compare their prices (public sector procurement and patient prices) against those in other countries of the region. Methods: We adapted the WHO/HAI methodology. We surveyed 21 public hospitals and 19 private pharmacies in 8 states of Mexico. Data were collected on the availability and prices of 49 essential cancer medicines (each strength and dose-form specific). Prices were compared against those in Chile, Peru, Brazil, Colombia and PAHO's Strategic Fund. Results: Of the various medicines, mean availability in public and private sector outlets was 61.2% and 67.5%, respectively. In the public sector, medicines covered by the public health insurance “People's Health Insurance” (SPS) were slightly more available. Only 7 (public sector) and 5 (private sector) out of 49 medicines were deemed affordable. Overall, public sector procurement prices were 41% lower than in other countries of the region. Conclusion: The availability of essential cancer medicines, in the public and private sector, falls below WHO's 80% target. The affordability remains suboptimal as well. A national health insurance scheme could serve as a mechanism to improve access to cancer medicines in the public sector. Comprehensive pricing policies are warranted to improve the affordability of cancer medicines in the private sector.
Successful Treatment With Granulocyte Transfusion and Early Neutrophil Engraftment in Allogeneic Transplant Patients With Febrile Neutropenia: Does Granulocyte Transfusion Effect on Neutrophil Engraftment?
Authors: Unal A. , Birekul A. , Kaynar L. , Eser B. , Cetin M.
Published: September 2018

Background: Febrile neutropenia is very severe and urgent early complication after bone marrow transplantation before engraftment. Infection delays engraftments in these periods. Aim: In this study we evaluated the effect and outcome of granulocyte transfusion on febrile neutropenia and neutrophil engraftment in patients receiving allogeneic transplantation. The reasons for the use of the granulocyte transfusion were prolonged febrile neutropenia episode. Methods: Between 2015-2017, 16 patients receiving allogeneic bone marrow transplantation (BMT) were treated with granulocyte transfusion at the time of febrile neutropenia before engraftment. Sixteen patients (9 AML, and 7 ALL) underwent allogeneic transplantation. Nine of them transplanted from match sibling donors, 1 from unrelated donor, and 6 from mismatch family donor (haploidentic transplantation). They had febrile neutropenia after transplantation, before engraftment. They were given antimicrobial therapy. Granulocyte was collected from unrelated and same blood groups donors. We started granulocyte transfusion for 3-4 days. Results: Mean infused granulocyte counts were 3 × 1010 (1.2-4.8 × 1010)/d, and about 15%-20% of transfused granulocyte was monocyte. Before the granulocyte transfusion, on the 12th to 19th days of transplantation, their neutrophil counts were 0.02-0.09 × 103/dL. Twenty-four hours after granulocyte transfusion, mean neutrophil counts were 0.7 × 103/dL (0.4-1.2 × 103/dL). Neutrophil counts were 2.2 × 103/dL (1.7-2.6 × 103/dL) after 48 hour. After 72 hours, neutrophil counts were 3.2 × 103/dL (2.0- 4.6 × 103/dL). After 4th days of granulocyte transfusion, neutrophil counts were normal level (>0.5 × 103/dL) in 12 patients, and less than normal level (<0.5 × 103/dL) in 4 patients. Conclusion: Granulocyte transfusions during the febrile neutropenia, helped to better overcome febrile neutropenia periods in allogeneic transplant patients before engraftment. In addition, granulocytes transfusion also may help early neutrophil engraftments. The useful effect of granulocyte transfusion on neutrophil engraftment may be cause of cytokine (G-CSF) injection to donor before collection of granulocyte. Increased cytokine (G-CSF–GM-CSF–IL-3) level of transfused neutrophil and monocyte can also effect the neutrophil engraftment.
Delivering Cervical Cancer Screening and Treatment to Women Living With Human Immunodeficiency Virus
Authors: Kaneza A. , Uwimana D. , Mbonyindavyi R.
Published: September 2018

Background: More than 80% of cervical cancer cases happens in the developing world. The same trend is seen in Burundi, where cervical cancer is the first gynecological cancer and the leading cause of female cancer deaths. In addition to this, Burundi presents high human immunodeficiency virus (HIV) prevalence rate. It is believed that there were 2200 new diagnosed clients in 2016. In spite of this, not all people can have access to desired services due to financial and geographical barriers. To increase access to cervical cancer information and screenings in resource-limited settings, Association Burundaise pour le Bien Etre Familiale (ABUBEF) introduces visual inspection of the cervix with acetic acid (VIA) and Lugol’s Iodine (VILI) plus cryotherapy to vulnerable populations, especially women living with HIV. Aim: To provide VIA/VILI and cryotherapy to women living with HIV in resource-limited settings. Methods: ABUBEF also conducted a training to ensure health providers can independently carry out VIA/VILI and cryotherapy. ABUBEF organized a campaign to raise people's awareness and deliver services to vulnerable populations. Results: Seventeen doctors were trained to perform VIA/VILI. They can also confidently make diagnosis and provide relevant treatment, such as cryotherapy or referral. 337 women were screened during the campaign and 4 of them received positive VIA/VILI results (1.1%). For women living with HIV, the VIA/VILI positivity rates was 4% and 2 of them presented suspicious cervical cancer lesions. All clients received essential treatments. This can be cryotherapy or be referred to specialists for further evaluation and cancer treatment. Conclusion: According to ABUBEF’s operational experience, VIA/VILI and cryotherapy is feasible in resource-limited settings. It is also noticed that women living with HIV has higher VIA/VILI-positive rate and even cancer lesions.
Long-Term Consequences of Exenterative Surgery for People With Pelvic Cancer
Authors: Young J.M. , Steffens D. , Venchiarutti R.L. , Koh C.E. , Solomon M.J.
Published: September 2018

Background: For people with recurrent or locally advanced pelvic cancer with no evidence of metastatic spread, pelvic exenteration (PE) surgery that achieves clear (R0) resection margins is the only potentially curative treatment option. This extensive, radical surgery can involve removal of the pelvic organs, muscles, nerves and bone, resulting in significant impairment for patients. Aim: The aim of this study was to describe the long-term quality of life outcomes for this procedure, specifically to investigate levels of pain, vitality and depression among survivors 3 or more years after surgery. Methods: The Royal Prince Alfred Hospital in Sydney is a national referral center for PE in Australia. Patient-reported outcome measures, including generic (SF36) and colorectal cancer-specific (FACT-C) measures of quality of life (QoL), pain, vitality and depression were assessed presurgery, every 6 months to 3 years and then annually. Consecutive patients who were 3 or more years after PE comprised the sample for this study. Trajectories for patient-reported outcomes were plotted and the proportion of survivors who experienced ongoing pain, vitality and depression at each time point were calculated. Results: Among 251 patients who were 3 years post-PE, 131 (52%, 95% CI: 46%-58%) had died and 3-year QoL assessments were completed by 69 (58%) of survivors. Three years after surgery, mean QoL scores were similar to baseline and remained fairly stable among survivors to 5 years. There was a small decrease over time in the proportion of survivors reporting ongoing pain. From 3 years onwards, ∼77% (95% CI: 67%-87%) of survivors reported ongoing pain and 44% (95% CI: 32%-56%) reported some level of depression. However, SF-36 vitality scores increased slightly from a mean of 47.2 pre-PE to 49.0 at 3 years. Conclusion: Despite the extensive nature of PE surgery, the majority of survivors achieved reasonable long-term quality of life. However, high levels of chronic pain and depression indicate ongoing needs for supportive care in this patient group.
Risk of Suicide After a Cancer Diagnosis in England: A Population-Based Study
Authors: Henson K. , Brock R. , Charnock J. , Wickramasinghe B. , Will O. , Elliss-Brookes L. , Pitman A.
Published: September 2018

Background: Previous research has identified an increased risk of suicide among cancer patients, however this has not been investigated at a population level in England. Those subgroups of patients most at risk need to be identified to ensure appropriate access to psychological support. Aim: To examine the variation in suicide risk among individuals diagnosed with cancer in England. Methods: We identified 4,453,547 individuals (21 million person-years at risk) aged 18 to 99 years at diagnosis of cancer during 1995 to 2015 from the national cancer registry, and followed them up until 31 August 2017. The outcomes of interest were both suicide and open verdicts (ICD-10 X60-X84, Y87.0, Y10-Y34 [excluding Y33.9, Y87.2]). Population-based expected deaths were as published by ONS [2]. We calculated standardized mortality ratios (SMRs) and absolute excess risks (AERs), and explored variation in suicide risk by cancer type, age at death, sex, deprivation, ethnicity, and years since cancer diagnosis. Results: 2352 cancer patients died by suicide. This was 0.08% of all deaths. The overall SMR for suicide was 1.19 (95% CI 1.14-1.24) and AER per 10,000 person-years was 0.18 (0.13-0.22). The risk was highest among individuals diagnosed with mesothelioma, with a 4.34-fold risk corresponding to 4.00 extra deaths per 10,000 person-years. This was followed by pancreatic (3.94-fold), esophageal (2.53-fold), lung (2.52-fold), and stomach (2.14-fold) cancer (all significantly elevated). Suicide risk was highest in the first 6 months following cancer diagnosis (SMR: 2.64 [2.42-2.89]), but a significantly increased risk persisted for 2 years (SMR: 1.21 [1.08-1.35]). Conclusion: Despite low numbers, the elevated risk of suicide in patients with certain cancers is a concern, representing potentially preventable deaths. The increased risk in the first 6 months after diagnosis, which is consistent with previous studies, highlights unmet needs for psychological support delivered alongside cancer diagnosis and treatment. Our findings suggest a need for improved risk stratification across cancer services, followed by targeted psychological support.
Malaysian Northern Region Cancer Support Effort: Education and Empowerment - Building Hope, Strengthening Lives
Authors: Oon C.E. , Kaur G. , Zulyardain H. , Hassan A. , Abdullah A.
Published: September 2018

Background: The agenda of the United Nations Sustainable Development Goals (SDGs) calls for unanimous actions to end poverty, battle against inequalities, protect the earth and to promote inclusive well-being. Today, the impact of cancer on societies threatens the ambitions of the SDGs. In developing nations, public awareness campaigns often focus on controlling the spread of communicable diseases, overlooking the rise of cancer afflictions. As a nation of multiethnic populations with different cultural and educational backgrounds, the views pertaining cancer treatment in Malaysia are often hampered by cultural beliefs. Cancer is often linked to bad luck or black magic, particularly among rural communities. The lack of knowledge in diagnostics and cancer therapeutics, in addition to many firm believers in alternative medicine may contribute to late detection and treatment only at the advanced stages of cancer. Aim: This project aims to tap into the pool of skills and expertise of the staff at the Universiti Sains Malaysia (USM) to help educate and raise public awareness on cancer causes, diagnosis and treatment among cancer survivors and the general public. Methods: My role as a scientist is to ensure that my research addresses the key problems faced in cancer therapies and that this information trickles down to the less informed traditional societies who have very different perceptions toward modern medicine. Workshops on cancer awareness highlighting cancer causes and treatment options, cancer diagnosis and holistic approaches while living with cancer were organized in partnership with MAKNA National Cancer Council Malaysia between the years 2015-2017. Support groups led by MAKNA, were also organized in a bid to educate cancer survivors who may lack important knowledge which could impinge on daily informed decisions concerning cancer diagnosis and treatment. Results: Through working hand in hand with MAKNA, a nonprofit organization with a duty 'to pool and use every effort, expertise and welfare from every faction of society to fight cancer', this project has successfully drawn knowledge and expertise from USM staff to come together as one to raise awareness and support cancer survivors. Members have also traveled to remote regions of Malaysia for home visits and cancer group meetings to support the cancer survivors and to raise awareness. Cancer survivors have been able to obtain personal advice from the university's cancer pathologist on their diagnosis, and have their queries answered pertaining to western medicine vs alternative medicine from academic research point of view. Conclusion: Working together with MAKNA has enabled cancer researchers and university staff to relate to real-life adversities so that we can continue to translate our research and knowledge to benefit the society.