bluuebunny/crossref_metadata_2025 huggingface dataset:
Global Consensus on Prognosis and Outcomes in Cancer
Authors: Brierley J. , Gospodarowicz M. , O'Sullivan B.
Published: September 2018

Background and context: Prognosis in cancer implies a probability of an outcome, but many factors need consideration to address this: disease type and molecular characteristics, anatomic disease extent (i.e., stage), patient characteristics and comorbidities, and any intervention (treatment) applied. A number of these parameters should ideally be collected by cancer registries as part of an effective cancer control program to promote appropriate care and cancer program planning. The UICC TNM Prognostic Factors Project team has classified prognostic factors according to the context of host, tumor, and environment. These prognostic factors should also be considered within the time setting of a patient's disease (i.e., a specific treatment scenario) and according to what outcome is being predicted. This approach recognizes that there are many different outcomes in oncology, not just survival. These principles need to be understood to avoid confusion in interpreting data and outcomes research. Aim: Consensus is required to understand and support the multifaceted challenges of prognostication, including the means for estimating prognosis, support efforts to standardize recording of factors that effect outcomes, bring consistency in defining paradigms (settings/scenarios) within which to address outcomes, and examine mathematical digital/AI tools for decision support. Strategy/Tactics: In April 2018 the UICC TNM Prognostic Factors Project is holding a global consensus meeting involving key organizations involved in cancer prognosis and cancer registries to discuss these challenges. It will emphasize the value of prognosis in cancer, factors affecting prognosis relevant to the global cancer community, and the importance of outcomes and their applicability to “value based care.” Program/Policy process: It will emphasize the value of prognosis in cancer, factors affecting prognosis relevant to the global cancer community, and the importance of outcomes and their applicability to “value based care.” Outcomes: A commentary and more detailed paper outlining the purpose, results of the discussion, and next steps in implementation will be drafted following the consultation. What was learned: A summary of the consensus discussion and conclusion will be presented.
Immunotherapy in Advanced Melanoma: Patient and Informal Caregiver Perspectives
Authors: Milne D. , Hyatt A. , Billett A. , Gough K. , Krishnasamy M.
Published: September 2018

Background: Immunotherapy has dramatically changed the treatment landscape and survival outcomes for patients with advanced melanoma. However, the success rates for immunotherapy are varied, and unpredictable. Immunotherapy can result in a range of treatment related toxicities, many of which can impact significantly on quality of life (QoL); or become life-threatening. Immunotherapies are administered in an ambulatory setting and as such, much of the responsibility for side-effect recognition, reporting, and monitoring falls to patients and their informal caregivers. Given the importance of early side-effect identification and management, it is important to understand the patient and caregiver experience of immunotherapy to facilitate patient safety. Aim: To: Explore the experiences of patients with advanced melanoma who received immunotherapy, and their informal caregivers Investigate the impact of immunotherapy treatment (in particular toxicities) on QoL of patients and their caregivers Identify behaviors and strategies patients and caregivers' used to manage immunotherapy treatment and toxicities. Methods: This cross-sectional, exploratory study used qualitative interviews with patients with stage IV melanoma who had completed, or were receiving nivolumab, pembrolizumab or ipilimumab as monotherapy, and their caregivers. Analysis used interpretive description methodology. Results: Twenty three patients and nine caregivers took part. Patients and caregivers discussed feelings of uncertainty regarding immunotherapy efficacy and toxicities; and raised concerns about correctly identifying relevant and reportable symptoms. Some participants did not see the link between symptoms experienced and treatment despite being satisfied with the level of information provided by their healthcare team. This highlights a potential lack of understanding about side-effects and/or deficiencies in the way treatment education is delivered. This was particularly concerning when resulting in delayed nursing or medical intervention. Findings identified the integral role caregivers have in the care of patients receiving immunotherapy. Conclusion: Despite immunotherapy improving survival rates for many patients with melanoma their QoL, and that of their caregivers can be negatively impacted by uncertainty about efficacy and the identification and reporting of potential side effects. Patient and caregiver experience may be improved with better education about what to expect, provided in various formats and at multiple time points, in conjunction with defined pathways for rapid access to the nursing and medical advice.
Time Trend of Liver Cancer Among Subpopulation of Ages Less Than 40 During 2005-2014 in Nghe An, Viet Nam
Authors: Pham O. , Nguyen T. , Le N.
Published: September 2018

Background: Liver cancer has been leading cancer mortality nationwide in Viet Nam. Aim: The aim was to examine time trends of liver cancer mortality by performing population-based mortality registration in Nghe An province, 2005-2014. Methods: We yearly collected data from all 480 Commune Health Stations from 2005 to 2014 using the designed form of “Mortality Registration” with a guideline of underlying-, immediate, - and contribute cause of death. Five variables were included name, age, sex, date of death and cause of death. Average residents of each commune were also yearly reported. All cases were coded ICD-10, then liver cancer (C22) was derived. Age-standardized rate (ASR) was estimated. Trend of liver cancer was observed by estimated mortality rates ratio and 95% confident interval (MRR) for 5-period of 2005-2006 (reference), 2007-2008, 2009-2010, 2011-2012, 2013-2014, adjusted for total mortality rate and proportion of cases with unknown causes of death, for total, subgroup of ages 40 or older, and ages less than 40. Results: Among registered 7,667 cases of liver cancer, there were 855 cases aged less than 40. Mortality rates per 100,000 (ASR) were increased from 37.4 to 52.8 in men and 9.2 to 12.6 in women, from 2005 to 2014, respectively. The increased trends were significantly seen for the subpopulation ages 40 or older only, MRR=1.56, 95% CI: 1.38-1.76 in men and MRR=1.67, 95% CI: 1.36-2.04 in women, all P trend < 0.05. In contrast, the decreased trends were significantly observed for the subpopulation ages less than 40, MRR=0.72, 95% CI: 0.54-0.97 in men and MRR=0.47, 95% CI: 0.22-0.99 in women, all P trend < 0.05. Conclusion: The significant decline risks of death from liver cancer for the subpopulation ages less than 40 during 2005-2014 might be explained by HBV vaccine nationwide from 1998 to date and reduction of environmental factors induced this cancer sites in improving healthy environments after the war ended in 1975. Key-words: Liver-cancer, population-based mortality registration, Viet Nam, HBV-vaccine.
Psycho-Social Factors Influencing Cervical Cancer Screening and Human Papilloma Virus Vaccination Acceptance Among Female Civil Servants in Delta State, Nigeria
Authors: Ohaeri B. , Ebunu P. , Ndikom C.
Published: September 2018

Background: Cervical cancer is the fourth most common cancer affecting women worldwide and most notable in low and middle income countries of sub-Saharan Africa. There are 528000 new cases estimated globally every year. The crude incidence rate of cervical cancer is 5.8% worldwide, 19% in West Africa, and 19.3% in Nigeria. In Nigeria, uptake of cervical cancer screening and HPV vaccination has been demonstrated in different studies to be very low, out of thirteen studies, nine show cervical cancer screening uptake of less than 5.3%. Psycho-social factors such as anxiety, stigmatization, poor health seeking behaviors and lack of family and social support among others, have been implicated. Therefore, this study assessed the psycho-social barriers to utilization of cervical cancer screening services and uptake of vaccination among female civil servants in Delta state. Aim: To assess the psycho-social factors that impede the utilization of cervical cancer screening and HPV vaccination among female civil servants in Delta state. Methods: A descriptive, cross-sectional, nonexperimental design was used for this study. Multi-stage sampling technique was used in selecting 437 women who consented, based on a calculated sample size. Thereafter, 437 self-administered structured questionnaires with a reliability coefficient of 0.7, were administered to participants, out of which 435 were retrieved. This gave a response rate of 99.5%. Data collected were analyzed with the aid of Statistical Package for Social Sciences (SPSS) using descriptive statistics and χ2. Results: Many participants (55.4%) knew about cervical cancer; 93.6% had never been screened for cervical cancer, while 94.7% had not vaccinated their teenage girls against human papilloma virus. Among the psycho-social factors highlighted that impeded the utilization of services were, costs of the screening tests (54.5%) and HPV vaccine (51.3%), while 58.2% reported inaccessibility. However, majority (73.6%) were willing to go for the cervical cancer screening and vaccination of their teenagers (68%). Conclusion: Cervical cancer screening and subsequent vaccination are strategies focused at ensuring reduction in the incidence of cervical cancer in the society to the barest minimum. Creating awareness about cervical cancer could be a means to help tackle the lack of knowledge issue, thereby increasing knowledge. In addition, subsidization will go a long way in lessening the financial burden, as well as increase utilization. Subsequently, global burden of cervical cancer will be reduced, with a consequent reduction in mortality.
Clinical Breast Examination Campaign: Experience From Thiruvananthapuram, South India
Authors: Jose R. , Augustine P. , . Bindhu S A , Sebasitan S. Rose , VA D. , John S. , Haran J.C.
Published: September 2018

Background and context: Thiruvananthapuram has the highest breast cancer incidence in India and majority of cases are detected late pointing to the inefficiency of early detection programs. Primary health care providers do not advise regarding regular screening and most women never resort to any screening practices. Mammogram is not cost-effective and clinical breast examination (CBE) is not popular as a screening modality in our population. Aim: To describe the conduct, utilization and outcome of mass screening program conducted in Thiruvananthapuram. Strategy: A mass screening program with media publicity to motivate organizations and residential associations was planned. CBE was conducted by one of the five lady doctors who were trained by an expert breast surgeon at a tertiary care center to detect suspicious lumps. All suspicious cases referred to experts who would further evaluate the cases at a clinic outside the tertiary care center. Advocacy and expert service at accessible sites and availability of expert service outside the tertiary care center at convenient timings improved the acceptance of screening. Intersectoral coordination, community participation, accessible expert services and appropriate technology were followed. Program/Policy process: 9942 women had CBE along with breast awareness in 101 camps over 66 days and it was probably “the first ever marathon breast cancer screening campaign” in the world. Sociodemographic variables, details regarding previous screening, breast symptoms and known risk factors were collected. Anyone with suspicious findings was referred to experts. Outcomes: 868 (8.73%) women with suspicious findings were referred to experts who advised 258 mammograms and confirmed breast cancer in 16 women (1.61 per 1000 women). Mean age was 45.46 years. 82.5% had screening for the first time. Uniformity in examination, three levels of screening and minimum utilization of diagnostic procedures makes this campaign distinct from others. All participants are kept on follow-up through a free clinic maintained by a nonprofit NGO in Thiruvananthapuram. Effective planning and selfless service along with coordinated effort of an apex institution (Regional Cancer Centre, Thiruvananthapuram), a private medical college (Sree Gokulam Medical College, Thiruvananthapuram) and media partners were the key to success. What was learned: Early detection of breast cancer is possible by CBE, provided women can be motivated for regular screening and adequate expertise is available. CBE campaigns can improve screening behavior and breast awareness among women. Primary health care providers and mass media could educate women regarding the benefits of breast awareness and motivate them for regular screening. Proper referral system including certified intermediate referral centers should be in place to ensure the success of early detection by CBE.
Colorectal Cancer Awareness and Beliefs in Malaysia: A Population-Based Survey
Authors: Paramasivam D. , Schliemann D. , Donnelly M. , Somasundaram S. , Tamin N.S. Ibrahim , Loh S.Y. , Su T.T.
Published: September 2018

Background: Colorectal cancer (CRC) is the third most common cancer and the fourth major cause of cancer deaths globally; in Malaysia, CRC is the second most common cancer in both males and females. Low awareness of cancer delays help-seeking and contributes to late presentation, poor detection and survival. Aim: We aim to investigate the level of colorectal cancer awareness and beliefs among the Gombak district population of Malaysia as part of a larger study designed to evaluate a cancer awareness-raising campaign. Methods: A survey of colorectal cancer awareness was conducted in Rawang (Gombak district, Selangor) between January and March 2018. This district is representative of a mix of ethnicities, age groups, education levels and income groups. A total of 4000 households were selected randomly from a list of all households by the Government Department of Statistics Malaysia to attain a sample size of 730 adults as indicated by our power calculation and taking potential refusals into account. Trained enumerators randomly selected eligible adults aged over 40 years old from each household and conducted an interview that included sociodemographic information as well as the Bowel Cancer Awareness Measure (CAM), the Attitudes and Beliefs about Cancer questionnaire (ABC) and the Champion Health Belief Model Scale (CHBMS) which were validated in Malaysia. Results: Data collection for this part of the larger study was completed in March. Currently, we are cleaning and entering the survey data into a database in preparation for statistical analysis including χ2 tests of association and logistic regression. The results of the analysis will be presented at the conference. Conclusion: This analysis will provide the first profile of awareness and beliefs about colorectal cancer among the Gombak district population of Malaysia.
Dietary Patterns and Unhealthy Behaviors in Brazil: The Current Scenario
Authors: Monteiro dos Santos J.E. , Crispim S.P. , De Almeida L.M. , Cancela M. De Camargo
Published: September 2018

Background: Along with the epidemiologic transition that Brazil has experiencing in the last decades, the adoption of unhealthy lifestyle habits, such as excessive consumption of alcoholic beverages, diet westernization and physical inactivity, are also observed. It is well known that those factors, alone or combined promote the increase of cancer incidence. Aim: The aim of this study was to identify the main dietary patterns in Brazilian population and to measure their association with unhealthy behaviors as physical inactivity, binge drinking and smoking. Methods: The study was based on the National Health Survey data, representing the adult Brazilian population, conducted in 2013. A questionnaire containing 22 dietary intake questions was applied. Dietary patterns were identified through principal components analyses (PCA). Factor scores were divided into quartiles from lower to higher (Q1-Q4) and included in specific models as dependent variables. Poisson regression with robust error variance model were fitted to perform the association between Q1-Q4 and physical inactivity, binge drinking and smoking. The multivariate models were adjusted for socio-demographic and health-related variables. P value of < 0.05 was considered statically significant. Results: Total of survey's respondents was 60,202 (estimated population size=146,308,458). PCA identified three distinct dietary patterns: so called healthy - fruits, vegetables and natural fruit juice; protein - beans and meats; western - snacks, sweets and sugary beverages. Physically inactive individuals, smokers and binge drinkers were respectively 15%, 27% and 12% significantly less likely to adopt the healthy pattern when compared with active individuals, nonsmokers and nondrinkers. Younger individuals (18-24) were 52% (95% CI: 50%–55%) significantly less likely to adopt this pattern, compared with the oldest (60 and older). Younger individuals were 64% (95% CI: 57%–71%) more likely to adopt the protein pattern compared with their older counterparts (60 and older). Being physically inactive, smoker and binge drinker significantly increased the risk of adopting the protein pattern in 12%, 17%, 13% respectively, when compared with active individuals, nonsmokers and nondrinkers. The western pattern was significantly twice (101%, 95% CI: 92%–110%) more common among individual aged 18-24 than in the elderly (60 and older). Being a binge drinker increased significantly in 16% the likelihood of adopting the western pattern compared with nondrinkers. Being physically inactive and smoker was not significantly associated to this pattern. Conclusion: We identified significant associations between the 3 dietary patterns and unhealthy behaviors in the Brazilian adult population. However, the main risk factor related was younger age and the association was stronger for the western pattern. Our study shows that young adults must be targeted in the context of public health nutrition campaigns.
Human Library
Authors: Fonseca C.
Published: September 2018

Background and context: In spite of the fact that cancer is a common disease on our days, there are still a lot of myths and misconceptions concerning it. In addition, many times the strategy that community asks for is a lecture or a conference and sometimes public (if it happens in schools, specially) has no interest to be there or feels uncomfortable to speak about it with a big group of people. Human Library is a different strategy that has been applied with success and in which public may talk with different persons/books that have different perspectives about cancer. Aim: Dispelling myths and misconceptions about cancer offering an innovative approach and giving the public the possibility of actually talk about their concerns Strategy/Tactics: We have identified different perspectives about cancer and people that could impersonate them. We then had a workshop with them, presenting the “Human Library” idea, inspired in the one created in Copenhagen in the spring of 2000. What we ask them is to think about their story with cancer and to be available to answer questions about it. Afterward, as our main target was to encourage dialogue, increase knowledge about cancer and help to build positive feelings concerning fighting cancer, public is invited to talk with this volunteers/books and to ask them whatever they want/need to know. We currently have 5 types of books: survivor, volunteer, scientist, health professional and caregiver. Program/Policy process: After being publicized, the Human Library may be requested by institutions of the community (e.g., schools, associations, enterprises). We then mobilize our human books to answer this request. Once in the institution, each “book” may talk with a group of 6 people maximum. After delivering a brief description of its perspective concerning cancer, the “book” should be available for questions and the idea is that books should only talk if there are questions. After sometime, the “readers” are invited to change “books” and start all over again. Outcomes: This has been a very successful experience as far as we realized this is a strategy that engage people and allow them to really have their questions answered. In that way, we may assure that we are addressing those people myths and misconceptions, in a much more personalized approach. What was learned: Further to identifying good “books” to realize the project, engaging and empowering them, the Human Library it´s not expensive as far as the biggest resource needed is time. Otherwise, is important to stress that this kind of activity is very flexible and can be organized anywhere.
Building Evidence for Advocacy: Improved Services for MBC Patients in Romania
Authors: Farcas R. , Pop F. , Melnic A.
Published: September 2018

Background and context: More than 9000 women are diagnosed each year with breast cancer in Romania and one third of them will develop advanced disease. The metastatic breast cancer (MBC) management aims to optimize disease control while ensuring the best possible quality of life (QoL). In Romania, the new MBC treatments made possible longer survival, but social and psychological support is still extremely limited, and specific guidelines and standards for these services have not been developed. No study regarding distress level, quality of life and specific unmet need of metastatic breast cancer (MBC) patients in Romania was ever carried so no data are available to substantiate introduction of support services for these patients. An evidence based standard of care for support services, based on specific MBC patients needs, has to be developed to ensure an harmonization of support services in Romania. Aim: To improve quality of care for metastatic breast cancer (MBC) patients through the implementation of a standard of care for support services. Strategy/Tactics: The project uses an action research approach that starts with a qualitative study to identify both metastatic breast cancer (MBC) patients' specific needs (regarding information and support services when facing the challenges of diagnosis, treatment, and prognosis) and also their health and social providers' knowledge, experiences and perceptions about MBC. In-depths interviews will be performed with both patients and providers followed by data analysis. Based on the identified needs and literature, specific information materials for metastatic breast cancer (MBC) patients and support services guidelines will be developed. To build support, the materials (the study report, the information materials and the guidelines) will be disseminated among providers and patients through a Web page, a workshop with medical providers representatives from hospitals in the northwest region of Romania, presentation in different scientific events and collaboration with the other cancer patient associations in Romania. A policy proposal regarding the introduction and use of specific support services guidelines within the standard of care for metastatic breast cancer patients in Romania will be developed and presented to the Ministry of Health. Outcomes: An evidence based standard of care for support services and adequate information materials will create a basis for improved service provision for MBC patients; implementing a standard of care in the daily routine of service provision for MBC patients will support health and social providers to ensure better communication and patient empowerment that will have a direct impact on the treatment's efficiency as it increases patients' participation; it will also help MBC patients to better cope with the disease, to make personal decisions regarding treatment options and also to participate to the improvement of their quality of life.
Working With the Commercial Motorists to Promote Cancer Awareness
Authors: Ekudo J. , Bwembo D. , Agwang A.
Published: September 2018

Background and context: Motorcycle transport system also known as “BodaBoda”' is one of Uganda's commonest means of transport with over 10,000 motorists ridding on the streets of Kampala on daily basis according to the statistics from Kampala City Authority. HealthAid Uganda (HAU) strategically engaged the above group in to promotion of cancer awareness, screening and blood donation for cancer patients following the lack of blood at the cancer institute for cancer patients. The process was strengthened by working in partnership with the Uganda Bodaboda Association 2010, an umbrella association that brings all the motorists together. It also included the Uganda Police Services, Ministry of Health and the private sector. Aim: To use motorists to deliver cancer education, awareness and facilitate blood donation for cancer patients in Uganda. Strategy/Tactics: The event was branded with the theme “Know your health, donate blood, save life”. It involved mobilization of the motorcycle riders through the BodaBoda 2010 association, a cancer awareness motorcycle ride across Kampala City, led by the head of traffic Uganda police as the chief rider. This was conducted along Kampala road and finally convened on the Uganda railway grounds, where the event was crowned with cancer education, screening and blood donation for the cancer patients. Program/Policy process: Community involvement and advocacy. Outcomes: There were large number of motorcycle riders 1000 who passionately turned up for the community event, high expectations to know about cancer and being able to go with cancer education materials for their families and communities. Blood bank collection team declared collecting 400 units of blood. The head, Department of Non Communicable Diseases at the Ministry of Health appreciated the efforts of HAU and pledged that the MOH will strongly work and support HAU on the initiative. The event attracted over 1500 individuals both the motorcycle riders and the community. What was learned: Using popular service groups has a high success rate in delivering cancer awareness and screening services to the least households in the community. HAU's success in this strategy was accelerated by the principle in which it focuses on working with organized groups so as to reach the households with cancer information and empower them to be able to make best choices. HAU looks further to extending the same activities to other communities of similar nature.
The Power of Storytelling As a Tool for Fundraising
Authors: Mohamed A.
Published: September 2018

Amount raised: 300,000 Emirati Dirhams (81,675 U.S. Dollars). Background and context: Friends of Cancer Patients came to learn about the case of a 3-year-old boy with leukemia, whose parents required financial support to be able to afford to continue his treatment. To accomplish this, we approached the employees of a company, with whom we had a prior relationship. 30 employees of the company agreed to climb the Mount Everest base camp, to drive their friends and families to donate. Aim: The aim of the event that took place was to fundraise to cover the child's entire treatment journey, as well as to make sure extra funds are in place, in case the child needs future support in treatment. Strategy/Tactics: To fund raise the amount of 300,000 which was needed by the child, we attempted to do so through storytelling, however, we decided to not only focus on the child´s medical condition, but we also tried to tell it in such a way that would make people get to know him, and his family better. Further, each climber from the company also told a story in their own way, they all explained how each and every one of us has been affected by cancer in one way or another, and they also specified how it affected them personally. Program process: The fundraising campaign took part over the period of three months, and as a result of the attention, and the reach that the climbers were able to achieve, we were receiving emails from places such as Saudi Arabia, U.S.A., and the U.K. from people who have heard about the story of the child and wished to help. Overall, by the time the climbers had returned from Mount Everest, we had fundraised 100,000 more than what we expected, all through the word of mouth, and storytelling. Costs and returns: Costs to Friends of Cancer Patients: 0 Returns: 300,000+ AED What was learned: By moving people emotionally, and by telling a good genuine story, we were able to carry out a campaign, that would not have been possible otherwise. Furthermore, after the conclusion of this event, we have started utilizing a similar model of fundraising, which has brought much greater returns to Friends of Cancer Patients.
Does Care for Australians With Pancreatic Cancer Compare Favourably to a Consensus-Based Standard of Optimal Care?
Authors: Drosdowsky A. , Gough K. , Grewal M. , Dabscheck A. , Tebbutt N. , Philip J. , Spruyt O. , Michael M. , Krishnasamy M.
Published: September 2018

Background: Pancreatic cancer has one of the lowest survival rates of all cancer types, with an incidence to mortality ratio approaching one. People with pancreatic cancer experience a rapid decline in health characterized by pain, nausea, fatigue and weight loss. For most people, the disease is detected at an advanced stage and the focus of treatment is palliative. In Victoria, Australia, knowledge regarding patterns of care for people with pancreatic cancer is out-of-date, but central to quality improvement initiatives targeting unwarranted variations in care and improvement in supports that are consistent with patient preferences. Aim: Our aim was to compare care received by patients with pancreatic cancer with a consensus-based standard representing optimal care to identify deviations from best practice and highlight processes that may improve the quality and safety of care provided. Methods: Eligible patients included those with pancreatic cancer, first treated in 2015, at one of three tertiary hospitals in Victoria, Australia. Once identified, dates and details of events indicated by the optimal care pathway were extracted from the medical record of each patient. Data were summarized using descriptive statistics and process maps: a visualization method that illuminates gaps, duplication, deviations from best practice and processes that may be amenable to improvement. Results: Thirty-two of 165 care pathways have been mapped to date. The nature and timing of care received appears highly variable. Only nine of 32 patients (28%) received all of their cancer care at a single institution; the remainder (n=23, 72%) received care in multiple tertiary and community facilities. Apart from four (13%) emergency presentations, referrals for specialist care came from general/primary practitioners (n=26, 81%). The timeframe for general/primary practitioner investigations ranged from one to 57 days. Once referred to a tertiary setting, most patients (n=23, 72%) were discussed at a multidisciplinary team meeting and received standard therapies. Only four had resectable disease. Nineteen patients (60%) had documented referrals to hospital- or community-based palliative care services. Where observed, deviations from the consensus-based standard tended to be related to the difficult nature of diagnosing pancreatic cancer, and determining appropriate care for patients with an advanced cancer with nonspecific symptoms. Conclusion: Process mapping provided a useful and efficient means of comparing care received with a consensus-based standard; however, the assessment of adherence to optimal timeframes and specific care events was complicated by missing data. Implications for quality improvement activities will be considered in the context of study limitations. We will also emphasize the importance of engaging patients and carers in setting improvement priorities.
Community Insights to Inform the Policy Positioning of Junk Food Marketing Reform in NSW, Australia
Authors: Dessaix A. , Engel A.
Published: September 2018

Background and context: In the lead up to the next state election, Cancer Council New South Wales (CCNSW) will run the “Saving Life 2019” advocacy campaign focused on changing NSW Government policy in cancer control. In developing a policy agenda, three priority areas were identified that required further research to better understand public perceptions, inform messaging and engagement strategies. Reform of current junk food marketing on government owned assets (including public transport) was identified as one of these priorities to reduce childhood obesity. Aim: •Understand how key audiences view overweight and obesity as a public health issue and specifically junk food marketing to children •Find new opportunities to progress CCNSW policy objectives by identifying additional key audiences in the general population; •Build the evidence base for a salient and convincing messaging guide for the advocacy campaign strategy and CCNSW's broader policy engagement and influencing work. Strategy/Tactics: The campaign will seek to demonstrate community support for restricting junk food marketing on government owned assets in NSW to the community, the media and political candidates to achieve policy commitments. CCNSW existing campaign strategy includes tactics across grassroots mobilization, targeted political engagement and securing earned media. The development of strategic research to underpin this campaign, including development of an evidence-based communications strategy, was critical in optimizing communications and public engagement. Program/Policy process: CCNSW commissioned an independent external agency to conduct the research. The research used a mixed methodology that included two facilitated online focus groups of up to 20 people each, followed by polling of the general public. Focus groups were conducted over two days, with participants recruited from a wide geographical spread and constituted a mixture of general population and parents who are the main meal preparer in households. Outcomes: A research and communications report containing an overview of the research, key findings, as well as communications considerations based on the research was used to inform our overall campaign strategy, including policy messaging and communications planning. What was learned: Findings noted that unprompted, overweight and obesity is considered an important public health issue. The specific issue of childhood obesity is seen to be a personal family issue and the responsibility of parents. The provision of junk food by parents to children was seen as a driver of childhood obesity, but the role of junk food marketing and its regulation was not top-of-mind. When prompted, the idea of banning junk food advertising on public transport was an action that could be taken by government to tackle childhood obesity, with children perceived as being vulnerable and requiring protection.
Training for Community Health Agents
Authors: Ramos dos Santos J.
Published: September 2018

Background and context: Cancer still has many stigmas, despite numerous awareness campaigns people are slow to seek health services out of fear, shame or for not believing in healing. With this behavior come late to the diagnosis of many cancers that could have been cured if discovered at first. Community health agents (CHS) are the link between the public health service and the community and on average make 10 visits a day in the community where they work. They are able to translate the demands of the community, thus allowing them to identify and act effectively to solve the major problems: information about care with health and encourage women to seek out the basic health units (BHUs) regularly, to practice healthy habits and to perform the examinations, such as mammography and preventive and seek the results. Faced with this, the need arose to enable the CHS to intensify their actions with the population and to disseminate campaigns of prevention. Aim: 1. Increase the low number of women undergoing cervical and breast cancer screening and access to prevention and/or early diagnosis of cancer mainly in women. 2. Partnership with Health´s Secretary. 3. Qualify and standardize the information carried by CHS in accessible language. 4. Survey on local reality. Strategy/Tactics: 1. Train Community Health Agents on cancer prevention and early detection to qualify and standardize information brought to communities and to encourage healthy living behavior. 2. Partnership with Health´s Secretary for CHA with highly qualified professionals. 3. Promote events with themes that are attractive and relevant to the work of the agents and that maintains the interest of the Health`s Secretary in the partnership. Program/Policy process: AMUCC seeks to sensitize and engage the public health managers and actors of the municipalities in the activities and solutions on a reality that needs to change. It establishes partnerships with the Municipal Health`s Secretary and strengthens links to advocacy actions. Seeks advocacy to influence people, perceptions, policies, decisions, and public opinion on the problem of cancers. Distribution of information material. Outcomes: 1. The training began in 2 municipalities and expanded. Today, it is carried out in seven municipalities, totaling more than 750 trained agents per year and has repressed demand. 2. The project has impact on half a million people per month, considering that each agent contacts 30 people per day. In 20 days of work, one agent reaches 600 people. The 750 trained agents reach 450,000 people per month. 3. Obtain data through survey. What was learned: Importance of appreciating the work of the health agent who works directly with the population is fundamental to achieving positive results in the campaigns. 2. Use the opportunity to obtain data information on health habits through surveys. 3. The information agents bring in the surveys during training events is a valuable source of reality-based data.
An Ecosystem for Comprehensive Cervical Cancer Prevention in India: Formative Study in India
Authors: Krishnan S. , Siddiqui M. , Travasso S. , Schurmann A. , Gurav K.
Published: September 2018

Background: Despite being preventable, cervical cancer is the third most common cancer in India, accounting for the highest number of cancer deaths. India has made limited progress toward introducing the safe and effective vaccine to prevent human papilloma virus (HPV) infections, which has been available for a decade. Aim: Using qualitative research, we examined opportunities for comprehensive cervical cancer prevention, including HPV vaccination in two Indian states - Tamil Nadu (TN) and Karnataka (KA). Methods: We used a socio-ecological framework to identify and map key stakeholders and structures that create the ecosystem for comprehensive cervical cancer prevention. Data were collected through semistructured in-depth interviews and focus group discussions. Key stakeholders included women and men (30-45 years) residing in selected slums/villages, community influencers (village government, self-help group members), district and state-level government health and education officials, specialist doctors, frontline health workers, staff of cancer-related nongovernmental organizations, and journalists. Results: As neither state had initiated public provision of the HPV vaccine, discussions focused on stakeholders' knowledge about the vaccine and factors that could inform a policy decision and facilitate or pose barriers to roll-out. Government officials and specialists in both states were aware of HPV vaccination for primary prevention of cervical cancer. Officials in KA noted concerns about the vaccine's safety and efficacy more emphatically than officials in TN. Specialists, particularly those in leadership positions in the Federation of Obstetrics and Gynecology Societies of India and the Indian Academy of Pediatrics were strong advocates of vaccination. Several specialists contrasted the numerous implementation challenges of cervical cancer screening with India's successes in routine immunization. However, a few specialists also expressed concerns regarding safety of the HPV vaccine. Community members lacked awareness about the vaccine and raised concerns on its safety, side effects and benefits as they would have for any new vaccine. All stakeholders highlighted cost as a major barrier to public provision of the vaccine. Government officials were concerned about how a vaccine program could be financed and sustained. The consensus, particularly in TN, was that the HPV vaccine would need to be introduced through the Universal Immunization Program as a partnership between the health and education departments to ensure widespread access. Conclusion: State-level implementation of comprehensive cervical cancer prevention hinges on the inclusion of HPV vaccination in the national immunization program. Cultivating vaccine champions and identifying appropriate financing mechanisms to implement and sustain comprehensive cervical cancer prevention along with careful planning and implementation has the potential to save the lives of many women.
Free-of-Cost Cancer Awareness Cum Sponsored Program (Raising Funds Voluntarily From Community by Running Advocacy Program on Cancer)
Authors: Katara P.
Published: September 2018

Amount raised: Approximately 37,000 lacs individually in past four years. Background and context: Cancer Aid Society an ISO 9001 organization having consultative status of U.N. working since 1987 nationwide in tune with guidelines of World Health Organization and National Cancer Control Program running by government of India. We are organizing cancer awareness lectures at community level in school, colleges, offices, banks, village areas etc. throughout the country. We are also organizing time to time rallies, painting and essay competition on cancer prevention. In school lecture we are addressing on good dietary habits, healthy living habits, active and passive smoking, tobacco abuse, etc. After our program we had appeal with community or school students if they wish they can contribute voluntarily for this noble cause for running advocacy program easily. Aim: As we know the cancer is the biggest killer disease and we diagnosed in early stage the cure is possible but due to lack of knowledge in people we loss the precious human life so by doing awareness we save the human life. After our workshop we provide literatures also in community in which do´s and don´t, early signs and symptoms of cancer are there for public awareness. The fund which is collected voluntarily is used for conducting workshops on cancer prevention, for palliative care treatment and other advocacy programs. Strategy/Tactics: We have our team and we make our tour plan district wise each individual targets min. 20 cities for six months and covered that much of area by doing free of cost cancer awareness program. After that we target the community and mass for awareness program. Program process: It’s just a simple process just to take permission from the institutional head, fix the date and time for program. We have a format of appointment we called it booking means taken permission for conducting workshop. Costs and returns: Costs include salary of social worker there accommodation cost, T.A./D.A., stationery cost, etc. 30% of cost of total fund raised. What was learned: With this work we are exploring our country, daily we are meeting with number of big officials and with this work we are serving the society free of cost without any charges so overall it’s a nice experience for me until now may be in future because saving human life is a work of God.
Implementation of the Results of Laboratory Immunohistochemistry Assay Anti–PD-L1 Using Ventana's Platform: Preliminary Study of NSCLC in 14 Designated National Referral Cancer Hospital in Indonesia
Authors: Riddi V.L. , Suzanna E. , Ramadhaniah F. , Cahyanti D. , Shalmont G.
Published: September 2018

Background: Lung cancer is the most common cancer incidence in population and in hospitals. According to GLOBOCAN 2012 , the incidence of lung cancer in male is 25.8/100,000 with a death rate of 23.2/100,000 while in female 8.1/100,000 with a mortality rate of 7.3/100,000. From the national data, out of 14 provinces (2008-2012) in Indonesia, incidence of lung cancer in male was ranked first, 2.31/100.000. Meanwhile in female was the fifth, 1.08/100.000. Immunotherapy is a novel treatment for many types of malignancy including lung cancer. Currently one of monoclonal antibody against programmed cell death 1 (PD-L1) has been approved for non–small cell lung cancer (NSCLC) with a companion diagnostic by Dako. Ventana's benchmark XT is widely used immunohistochemistry platform. However, data on its reliability and reproducibility with 22C3 antibody in Indonesia are scant. Aim: Immunohistochemistry Dako's anti PD-L1 can be applied in Ventana platform. This protocol could be used in preliminary study for lung cancer in 14 designated national referral cancer hospital in Indonesia. Methods: Lung cancer is the most common cancer incidence in population and in hospitals. According to GLOBOCAN 2012 , the incidence of lung cancer in male is 25.8/100,000 with a death rate of 23.2/100,000 while in female 8.1/100,000 with a mortality rate of 7.3/100,000. From the national data, out of 14 provinces (2008-2012) in Indonesia, incidence of lung cancer in male was ranked first, 2.31/100.000. Meanwhile in female was the fifth, 1.08/100.000. Immunotherapy is a novel treatment for many types of malignancy including lung cancer. Currently one of monoclonal antibody against programmed cell death 1 (PD-L1) has been approved for non–small cell lung cancer (NSCLC) with a companion diagnostic by Dako. Ventana's benchmark XT is widely used immunohistochemistry platform. However, data on its reliability and reproducibility with 22C3 antibody in Indonesia are scant. Results: The Ventana's Ultraview 22C3 optimized protocol stratified the PD-L1 expression. Three out of 10 cases were strongly positive. Some of these had squamous differentiation. Weakly positive was only found in 1 case of adenocarcinoma. The last 6 cases showed negative expression on PD-L1 which 2 of these cases were the specimens from cryosurgery. Conclusion: The results of laboratory immunohistochemistry assay demonstrate than Dako's anti PD-L1 primary antibody can be applied to Ventana's benchmark XT platform. Start conducting study of lung cancer in Indonesia's in 14 designated national referral cancer hospital in provinces profile of PD-L1 expression in Dharmais NCC. The detection of PD-L1 protein expression in NSCLC using Ventana platform can be used to determine which NSCLC patient is eligible for anti-PD1 based immunotherapy.