bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Girl Adolescents' Immunization in Eradicating Cervical Cancer in Rwanda by 2020
Authors: Nimbabazi O.
Published: September 2018

Background: Cervical cancer is one of the cancers that highly affect women today, and human papilloma virus is the virus that causes this cancer. By WHO 1 million of women is estimated to have this cancer and more than 80% of them live in low and middle income countries where Rwanda belongs. Even though this cancer is preventable at early age by immunization and can be treated at early stage. With this the government of Rwanda aimed at eradicating cervical cancer by 2020 by immunizing all adolescent girls with age between 11 and 15. Aim: The aim of this study was to assess the role of Rwanda initiative of adolescent girls' immunization will have toward cervical cancer eradication by 2020 in Rwanda and prevention for future generations. Methods: Scientific literature review has been used with the WHO report, Ministry of Health and recent publications on cervical cancer. Results: HPV vaccination for girls reduces the possibility of developing cervical cancer later in life, in the initiative of adolescent girls' immunization aged between 11 and 15 started in 2011 by the Ministry of Health and in 2013 about 97% of girls were immunized. The program is eased by distributing vaccines through schools to minimize time going to hospitals. By the ministry statistics indicates that in 2011 and 2012 eligible girls vaccinated with three doses were 93.2 and 96.6% respectively and 2013 were 99.3% and are always recommended to be vaccinated and older ladies are recommended for early screening. With this showed that in 2020 Rwanda will be able to achieve the goal of cervical cancer eradication. Conclusion: Cervical cancer is preventable and treatable by early vaccination to young adolescents and screening to others, with the statistics indicates that Rwanda is achieving the eradication by 2020 and this will be by recommending young girls to be immunized and others screened early and this is an important initiative that can be used globally in low and middle income countries that is mostly affected.
Challenges in a Newly Established Cancer Centre in Tanzania: Staff’s Perspectives
Authors: Henke O. , Alwash Z.
Published: September 2018

Background: Cancer is a growing public health issue in low and middle income countries (LMIC). From estimated 14 million new cases each year, 8 million are diagnosed in LMIC. Case fatality rate is 75% in comparison with 46% in high income countries. Causes are low literacy levels, lack of awareness and knowledge about cancer among the population as well as limited education of health care providers leading also to late detection and diagnosis. In Tanzania, one of the poorest economies in the world, cancer incidences will double in the year 2030. To address the needs of cancer patients, the tertiary hospital of northern Tanzania established a new chemotherapy center in December 2016. However, there is limited knowledge about perceptions of professional staff toward chemotherapy treatment and cancer care in general in East Africa. This study aims to understand attitudes and perspectives of health care professionals and treatment related spectrum of challenges in the newly established center to assist future efforts in this field. Aim: This study aims to understand and analyze the attitudes and perspectives of the health care staff at the newly established Cancer Care Centre toward chemotherapy and the challenges they face on daily basis at their workplace. This understanding will assist future efforts to further apprehend the possible cancer treatment related spectrum of challenges that occur in low resource settings. Methods: As the research field is widely unknown, qualitative methods using in-depth interviews were chosen for inductive conceptualization of the topic. Analysis of data was performed according to qualitative content analysis. Results: 11 interviews were conducted with 3 males and 8 females with an average working experience was 7 years. 6 main categories were found: training and education of staff, interaction with the patients, availability of financial support, challenges in management, interests in future development and job satisfaction. Subcategories elaborated further within the main categories. Conclusion: Limitations in staffing, in training and education about chemotherapy were a major concern among the interviewees. The importance of sustainable funding and the needed cooperation of the government with international aid were mentioned as a key to avoid shortage of medication and equipment. Beside these concerns, the health care workers expressed their satisfaction with the new possibilities of treating cancer and the rewarding feedback of the patients. Misconceptions and poor knowledge on the patient side were mentioned as a reason for delayed health seeking behavior. Screening and awareness programs were mentioned as possible useful interventions.
Colorectal Carcinoma Below 50 Years of Age: A Data Review on The National Colorectal Cancer Data Registry
Authors: Ibrahim N.R. Wan , Soelar S.A. , Chan H.K. , Azmi A.N. , Said R.
Published: September 2018

Background: Colorectal cancer remains a notable source of mortality and morbidity across the globe. It is the second commonest cancer in Malaysia. Robust screening program has exponentiated worldwide in last few decade especially in the western countries. Interestingly, there are more worrying reports of late to show that the incidence in younger patients, below 50 years of age are increasing. Aim: This study is aimed to look at clinical characteristics and survival outcome of this group in our local context. Methods: The National Colorectal Cancer Registry, The Northern Report 2008 - 2014 was reviewed retrospectively into the data to determine the number and clinical characteristics in patients with colorectal cancer in patients aged below 50 and in patients of 50 years and above. Results: A total of 3117 patients were included in the registry. 477 patients were younger than 50 years of age. Majority of the patients with colorectal cancer in the registry were from the Chinese ethnic group (59%), followed by the Malays (35%), Indian (5%) and others (1%). However, the younger patients' cohort seem to have more Malays diagnosed (54%), followed by the Chinese (36%), Indian (9%) and others (1%). Only 11% of the younger adults have family history of colorectal cancer. 68.1% of these patients, falls into the 40-49 age group. Sadly, majority of them (69.4%) are already in stage III or stage IV on presentation. The survival rate at 5 years however are significantly better in the younger patients with 45.49% as compared with the older group with 37.42% ( P = 0.015). Conclusion: Patients below 50 years with colorectal cancer presents with a different clinical characteristic as compared with the older patients. A review on a bigger national registry would be beneficial. Perhaps advocating a surveillance screening program for populations at an earlier age may be warranted in the future.
Improved Transnasal Ileus Tube Technique for Intractable Adhesive Small Bowel Obstruction
Authors: Li E.-S.
Published: September 2018

Background: Although up to 90% of patients experienced full recovery following long-tube decompression, without the need for surgical intervention, the remaining patients do not yield any benefit from the use of long nasointestinal tubes and require surgical intervention. Aim: To introduce an improved transnasal ileus tube technique for intractable adhesive small bowel obstruction (ASBO), and evaluated its efficacy in the management of intractable ASBO. Methods: 54 patients with intractable ASBO were treated with the improved transnasal ileus tube technique. The obstructions were passed through by balloon relay, and the adhesions were resolved by repeated to-and-fro movements of the ileus tube. Enterographic results were categorized as complete or incomplete resolution of the obstructions. Data on the technical success, final enterographic results, mortality, morbidity, and the final clinical outcome were collected, and follow up was performed at 1, 3, 6, and 12 months, and then yearly after the procedure. Results: Transnasal ileus tube placement was successful in all patients. Navigation and passage of the ileus tube through the obstructions to the colon were successful in 87% of the attempted tubes (47/54) and failure in 7 patients (4 patients due to severe obstruction and 3 patients due to the presence of a true stricture in the small bowel). Follow-up enterograms over 3-38 months indicated smooth passage of the contrast medium through the small bowel, without any difficulty, in 48 patients. Full recovery from ASBO was achieved in 48 patients (mean duration, 20.16 ± 10.04 months; range, 6-45 months). Six patients died of multiple organ failure without recurrent ASBO, and the clinical symptoms of small bowel obstruction recurred 2 patients. Conclusion: The improved transnasal ileus tube technique is a novel, safe, and effective technique that enables intractable ASBO resolution.
Medical Plants Oils and Extracts Are an Antiproliferative Agent for Cancer Cells
Authors: Harputluoglu H. , Taştekin D.
Published: September 2018

Medical plants are consumed fresh, dried or decocted in herbal tea and they containing various products such as alkaloids have healing activity of folkloric remedy. The topic of this study was to assessment pharmacological activity, cell cytotoxicity and morphologic alteration of valuable oils and extracts from certain plants used traditionally in Anatolia. The antiproliferative activity for all natural products was conducted following the European Pharmacopoeia 8.0 protocol. According to this protocol, we investigated these natural products for in vitro antiproliferative activity against HeLa (human cervix carcinoma) and HT29 (human colorectal adenocarcinoma) cells using a cell proliferation assay, cytotoxicity assay (LDH), and phase-contrast microscopic image evaluation techniques. Strong antiproliferative activity in 27.5% of the samples was found. The lowest cytotoxicity values were obtained with low or mild effective ones. Almost all samples altered the morphologic shape of the cells from being cell shrinkage and rounding to being decreased cell elongation and volume. Solvent oil system used in solving natural products samples exhibited potent antiproliferative activity at all concentrations. Hence, a synergistic effect of solvent oil was obtained with the combination of notably antiproliferative natural products, but not for the combination rest of products with low or mild. The results of this study support the efficacy of these valuable oils and extracts as an antiproliferative agent for cancer cells, and it suggests that they may be provided as a potential huge source to current chemotherapeutic researches.
Prevalence of Psychological Distress, Anxiety and Depression in Metastatic Breast Cancer Patients
Authors: Travado L. , Reis J.C. , Antoni M.H. ,   Distressbrain
Published: September 2018

Background: Cancer patients experience high levels of cancer-related distress, which may negatively impact on their clinical outcomes, such as survival and quality of life. Distress involves a range of feelings from vulnerability and sadness to depression, anxiety, adjustment disorders, panic and isolation. Importantly, pervasive severe distress has impact on cancer progression. This type of distress dysregulates the hypothalamic pituitary adrenal (HPA) axis and activates the sympathetic nervous system (SNS), impacting the cardiovascular, immune, and endocrine systems. These alterations contribute to biologic activities (e.g., changes in circadian cortisol levels, catecholamine production, activation of proinflammatory cytokines, regulation of leukocyte and tumor cell gene expression, and cellular immune suppression) that can promote cancer growth and metastasis. International standards for quality in cancer care recommend that distress should be recognized, regularly monitored, and treated promptly at all stages of disease, to optimize patients' clinical outcomes. Aim: As part of a larger study, Distressbrain, which aims to examine the associations between psychosocial variables, alterations in specific brain regions, and alterations on HPA axis, SNS activation and proinflammatory cytokines production, the present investigation was conducted to examine specifically the prevalence of distress, anxiety, depression and psychological morbidity in metastatic breast cancer (MBC) patients. Methods: We used the Distress Thermometer (DT), the Hospital and Anxiety Depression Scale (HADS), Brief Symptom Inventory (BSI) for the assessment of these variables. Results: The study is now running with the recruitment of 100 eligible MBC patients under treatment at the Breast Unit, Champalimauld Clinical Center, Lisbon, Portugal. We will present preliminary data about the levels and prevalence of psychological distress, anxiety, depression and psychological morbidity in this population. Conclusion: The results of this study will help to better understand the psychosocial needs of this population for better planning of care and inform cancer policy to allocate human resources to provide it.
Implementation of Population-Based Cancer Registry in Georgia: Results of the Appeared Requirements to NCCP
Authors: Maglakelidze M. , Abuladze M. , Jokhadze N. , Maglakelidze D.
Published: September 2018

Background: The current cancer patterns in Georgia indicate that a significant proportion of cancer cases and deaths are preventable if appropriate actions are undertaken. The estimates from IARC indicate 12,361 new cancer cases per annum in 2012. The estimated number of deaths from cancer in 2012 was 7319. Objectives: The aim of the project was to: Implement modern cancer registration system in Georgia; Ensure compliance of reporting standards; Create registry that will meet international data standards; Reveal the main national trends of incidence and mortality in Georgia. Methods: In 2011-2014 as a result of active work with Ministry of Health Care (MOH) preliminary actions were taken under the State Program of Modern Cancer Registry Implementation, including: translation and publishing of ICD-O-3; translation of CanReg5 software and training of registrars; translation and filling of dictionaries: topography, morphology, administrative units, and institutions providing oncology services; participation in international training and courses organized by International Agency for Research on Cancer (IARC). Results: According to the schedule I stage of the program has been completed successfully. New model of cancer registry has been developed The first results of the register are received 8731 new cases of cancer have been diagnosed in Georgia in 2017 (234.8-291.6 per 100,000). Incidence of almost every type of cancer (in all localizations) is less than the incidence in European region and in EU countries. This number is closer to the CIS average data. Almost all localization cancer incidence in both men and women is less compared with the indicators of the European region and EU countries and is closer to the CIS average data. Collectively accounting for > 60% of all new cancers and half of all cancer deaths. Second most common cancer type in registered new cases among females is thyroid cancer. From 2015 there is a gradual increase in newly registered cases of thyroid cancer and its incidence among 100,000 females (2015 - 33.5, 2016 - 42.8, 2017 - 40. In 2017, there was 55 new thyroid cancer cases among females younger than 25 years (in 2015 this number was 41, in 2016 -50); this number corresponds to 50% of all newly registered cancer cases among this age group. By the end of the next year Cancer Registry will be linked to EMR notification system that itself will be linked to public and death registry and data on every cancer patient will automatically appear in the cancer registry database. Conclusion: Developed model of Cancer Registry will serve as a basis for clinical, epidemiologic, and health care services research and for the assessment of their efficacy in Georgia.
Benefits of Etoposide Maintenance Therapy for Patients With Extensive SCLC Who Experienced PR/CR/SD After 4-6 Cycles of First-Line Chemotherapy With Etoposide Plus Cisplatin/Carboplatin
Authors: He Z. , Zhang C. , Wang Q. , Xu C.
Published: September 2018

Background: The clinical remission period of small cell lung cancer was shorter after the first-line treatment. Aim: To observe whether oral etoposide maintenance therapy can improve the progression-free survival (PFS) in patients with lung cancer who experienced complete remission (CR), partial remission (PR), and disease stabilization (SD) after 4-6 cycles of first-line chemotherapy with etoposide plus cisplatin/carboplatin. Methods: A retrospective analysis was performed on patients with ED-SCLC who were treated with etoposide (100 mg/d, iv.gtt days 1-5 with a cycle length of every 21 days) plus 4-6 cycles of cisplatin/carboplatin chemotherapy during the period from 1 January 2014 to 31 December 2016 at the Cancer Hospital affiliated with Zhengzhou University. All the patients were divided into 2 groups based on the criteria whether they had gone through maintenance therapy with etoposide: nonmaintained treatment group (NT), and maintenance treatment group (TH). The maintenance treatment group was further subdivided into the 25 mg subgroup (group A) and the 50 mg subgroup (group B) according to the maintenance dose. Analysis of 1-year progression-free survival (PFS) was conducted using the Kaplan-Meier method and Cox proportional hazards model. PFS1 was defined as the first day of first-line treatment until the disease progressed or the last follow-up time. PFS2 was defined as the first day of etoposide capsule treatment until disease progression or the last follow-up time. Results: A total of 85 patients were enrolled in this study; there were 50 patients in the NT group (58.8%) and 35 patients in the TH group (41.2%). In the TH group, there were 10 (28.6%) in the 25 mg subgroup (group A) and 25 (71.4%) in the 50 mg subgroup (group B). Detailed patient information and tumor-related parameters are shown in Table 1. For all patients, the median PFS1 in the first-line regimen with either the cisplatin or carboplatin group was 6.5 months (95% CI: 5.870-7.130) and 6.4 months (95% CI: 5.970-6.970) respectively ( P = 0.0551). Median progression-free survival for all patients and the median PFS for patients of the TH group were 6.5 months (95% CI: 6.138-6.861) and 7.2 months (95% CI: 6.702-7.698) respectively; the median PFS for the NT group, subgroup A, and subgroup B were 5.7 months (95% CI: 4.862-6.478), 6.7 months (95% CI: 6.390-7.010), and 7.4 months (95% CI: 6.386-8.474), respectively ( P = 0.0043). Median PFS2 was 2.400 months for maintenance treatment patients; the median PFS2 in the 25 mg and 50 mg groups was 2.100 months (95% CI 1.690-2.510 months) and 3.030 months (95% CI 1.937-4.123 months), respectively ( P = 0.0309). Conclusion: Use of etoposide capsules to maintain chemotherapy can significantly prolong the progression-free survival (PFS) of CR, PR, and SD in patients with extensive SCLC and improve 1-year survival; a 50-mg dose is better than 25 mg.
Effects of Geographic and Economic Variations on Global Cancer Burden
Authors: Hsu J.C. , Chua I. , Chang S.-M. , Lo J. , Tseng Y.-C. , Lin P.-C.
Published: September 2018

Background: Previous studies have stated that high-income countries tend to have the highest incidence and mortality for all types of cancer, while geographical factors are also linked to the prevalence of cancer. Only a few studies have explored the relevance of economic/geographical factors to the cancer epidemic integrally. Aim: This study aims to explore the diversities of the overall cancer epidemic rates made by geographic and economic variations respectively and their interaction effects, after adjusting gender, population structure. Methods: We collected 170 countries' epidemic data from WHO's 2012 GLOBOCAN project and economic classifications data from the World Bank in 2012. We applied generalized linear model to make 2-way ANOVA and to analyze the variations of 3 epidemic rates (age-standardized incidence, age-standardized mortality and prevalence) between 6 regions (Asia, Africa, Europe, North America, South America, and Oceania) and 4 income levels (high income, upper-middle income, lower-middle income and low income). We identified extreme rates and discuss their reasons and implications, and make suggestions regarding the situations. Results: Both geographic variation and economic variation were key factors for incidence and prevalence of global cancer burden, and the interaction between geographic and economic variations on incidence and prevalence was very strong. However, there was no significant association between income and mortality, and the interaction between geographic and economic variations on mortality was not obvious either. Using South America as the reference, only North America had significant higher incidence rate of cancer; no significant variation of mortality rates between regions was observed; North America and Europe had significant higher prevalence rates. Using low income as the reference, only high and upper-middle income had significant higher incidence rates; no significant variation of mortality rates between regions was observed; only high income had significant higher prevalence rates. Among high-income countries, incidence, mortality and prevalence rates in Europe were significantly higher than them in South America, Asia and Africa. Among countries in Europe, high-income country had significantly higher incidence rate than that in upper-middle cancer, and it also had significant higher prevalence rates than them in upper-middle and lower-middle countries. Conclusion: Overall, the cancer incidence and prevalence are significantly different due to the country's geographical location and economic level, but the mortality rate is not. Understanding the differences in geographical location and economic levels between countries and their interactions on the cancer epidemic would benefit the future global cancer prevention and treatment policy planning.
Supporting Endgame Strategy in Tobacco Control
Authors: Lipponen S. , Hara M.
Published: September 2018

Background and context: Finland has set itself the goal of ending the use of tobacco and other nicotine products by 2030. This would mean that <5% of the adult population would use tobacco and nicotine products daily. This goal has been set out in the Tobacco Act (2016). To help realize the goal, a working group appointed by the Ministry of Social Affairs and Health proposed 31 May 2018 a roadmap of measures. How does the Cancer Society of Finland best support these actions? Aim: Tobacco control is at the core focus of cancer prevention. The Cancer Society's strategic purpose is beating cancer. Strategy/Tactics: The Cancer Society of Finland supports advocacy work for tobacco- and nicotine-free Finland 2030 within several networks. The society has identified its strategic position in tobacco-control activities. Both its strategy and its communications need to be responsive and flexible. When creating awareness on societal level of cancer burden, we must not forget the role of the tobacco industry. Analyzing tobacco industry arguments and use of media is part of our strategic planning. Because tobacco industry strategies are global, the arguments it deploys can be anticipated. In Europe, third-party strategies and criticism toward regulation are among the usual industry tactics and are well documented. Program/Policy process: Tobacco-control legislation in Finland has been well received. One role for NGOs like the Cancer Society is to create critical awareness of industry tactics, especially among stakeholders, in the media, and in decision-making. Article 5.3. of the WHO Framework Convention on Tobacco Control needs better implementation and guidelines in Finland. Outcomes: Collaborative networks both nationally, regionally and globally are bases of tobacco control advocacy. Engaging the cancer community in tobacco control is a unique role for cancer societies. What was learned: 1. Experience sharing within network structures nationally and on the Nordic, European and global level is essential for effective advocacy. 2. In the field of communication analysis of industry arguments can spur effective media strategies to support tobacco control.
The Government Willingness to Legislate Tobacco Control and Government Income From Tobacco Taxes in Brazil
Authors: Teixeira A.P.
Published: September 2018

Background and context: The government willingness to legislate tobacco control, as part of the complex tobacco landscape developed by the Initiative on the Study and Implementation of Systems (ISIS), is directly related to tobacco taxes and government income. According to the NCI,1 “The willingness of government to take actions against tobacco interests depends on the balance of forces created by the protobacco and antitobacco constituencies and the government's perceptions of health risks associated with tobacco use. Increased taxes on tobacco are an early result of this growing government willingness to act against tobacco interests”. Aim: Demonstrate that the implementation of Article 6 of the WHO Framework Convention on Tobacco Control (FCTC) is a cost-effective measure that results in reduced prevalence and increased tax revenues. Strategy/Tactics: In December 2011, the Brazilian government established a new taxation system and a minimum price policy for cigarettes, aligned to the Article 6 of the WHO FCTC to reduce the demand on tobacco products. Program/Policy process: The new federal taxation system on tobacco products started in 2012 and defined progressive and annual increases by 2016. The reduction in prevalence followed this trend, as did the increase in tax revenue. Some federal states also increased their taxes to tobacco products in the same period, but were not accounted for in this study. Outcomes: This new policy has raised the level of total taxes and, even contributing to the reduction of cigarette consumption, the government income has increased 19% since 2011, and 130% from 2007 to 2016. According to the Risk and Protective Factors Surveillance for Chronic Diseases Telephone Survey (VIGITEL), the total prevalence rate decreased from 15.6% in 2007 to 10.4% in 2015. The national cigarette production decreased from 5,701,586 million packs with 20 units to 2,660,457 in 2016, reflecting the reduction in consumption. [Figure: see text] What was learned: Brazil´s experience shows that there is no economic or revenue risk by raising the tobacco taxes, an argument used by the tobacco industry. In the long term, when consumption is brought to very low levels, there may be a reduction in the revenues, but also the spending on tobacco-related diseases shall decline. Reference 1. National Cancer Institute. Greater Than the Sum: Systems Thinking in Tobacco Control. Tobacco Control Monograph No. 18. Bethesda, MD, U.S. Department of Health and Human Services, 2007.
Advocacy Campaign: Breast Care International Approach
Authors: Wiafe H.E. , Addai B. Wiafe
Published: September 2018

Background and context: Breast cancer is the leading cause of cancer deaths among Ghanaian women, but it has been identified as 1 of the neglected noncommunicable diseases (NCDs). In 2012, GLOBOCAN reported that ∼2260 people were diagnosed with breast cancer in Ghana with a high age standardized mortality rate of 11.7 per 100,000. Although, it is acknowledged that early detection and prompt action reduces mortality, 80% of newly diagnosed breast cancer patients delay presentation. It is a well-known fact that cancers are now killing more people in Africa than HIV/AIDS, tuberculosis and malaria combined. Due to lack of awareness about cancers and late reporting of the cases, a lot of cancer patients get very little intervention and support and that explains why most cancer deaths occur in Africa, especially women in rural areas. Breast Care International (BCI), a nongovernmental organization in Ghana, established in 2002, is a leading breast cancer advocacy organization in Africa providing an enabling environment to enhance early detection and reduce the late-stage presentation of breast cancer. Aim: To maximize personal and community wellness through community participation, excellence in public health education, empowering people to save lives and to end late-stage presentation of breast cancer in Ghana. Strategy/Tactics: To enhance early detection and reduce late-stage presentation of breast cancer in Ghana by disintegrating the myths and misconception about breast cancer. Program/Policy process: BCI has been conducting outreach awareness programs in Ghana to women groups, educational institutions, churches and social groups, especially those in deprived communities, educating them on breast self-examination (BSE) and then clinically screening the women. The involvement of breast cancer survivors to share their testimonies on various platforms to demystify breast cancer as an incurable disease and the misconceptions of it being from ancestral curses. Community-based nurses trained in basic oncology are to be deployed to the district level to create awareness about breast health and other NCDs at the grass root level with the aim of detecting breast cancer early for a prompt referral to health facilities for further management. Outcomes: BCI’s demand-driven outreach awareness campaigns and screening programs have been empowering women to perform their BSE and as a result most patients report to the hospital with lumps and abnormalities that were detected during their BSE. What was learned: Although, BCI has been intensively involved in breast cancer advocacy programs in Ghana, a concerted effort is required from opinion leaders, political figures, health service providers, organized groups and business organizations to assist to control the incidence of breast cancer in Ghana.
Governing the Commercial Determinants of Noncommunicable Diseases: Maintaining the Regulatory Power of Governments
Authors: Patay D.
Published: September 2018

Background and context: “Through the manufacture, sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of noncommunicable diseases (NCDs)” (Moodie et al., 2013). Furthermore, the impact of trade and investment liberalization has been correlated with the rapidly increasing prevalence of some cancers, diabetes and cardiovascular diseases in developing countries. Reaching the SDG targets is a challenging task for governments of low- and middle-income countries who face constraints in regulating the commercial determinants of NCDs due to the increasing influence of unhealthy commodity industries in policy making. Although the literature recommends various approaches to maintain or strengthen the regulatory power of governments, the impact of these strategies on the governance of commercial determinants of NCDs remains unclear. Aim: Identifying the strategies which have been successfully applied in strengthening the governance of commercial determinants of NCDs in regard to tobacco. Strategy/Tactics: The strategies for strengthening the governance of unhealthy commodities recommended by the literature mostly target the issues of fragmentation of governments and the constraints on regulatory capacity. This research examines the way the governments of Fiji and Vanuatu applied these strategies for the sake of implementing tobacco control policies. The methods involve literature review, document analysis and in-depth interviews with key informants across government departments, NGOs and development agencies in these countries. The document analysis and in-depth interviews are currently ongoing in Fiji and Vanuatu. The results and conclusions will be available by early September.
Inequities in Genetic Testing for Hereditary Breast Cancer: Implications for Public Health Practice
Authors: Sayani A.
Published: September 2018

Background and context: The Ontario Breast Screening Program for women with a genetic predisposition to breast cancer is 1 of the first international models of a government-funded public health service that offers systematic genetic screening to women at a high-risk of breast cancer. However, since the implementation of the program in 2011, enrolment rates have been lower than anticipated. While there may be several reasons for this to happen, it does call into consideration the 'inverse equity law', whereby the more advantaged in society are the first to participate and benefit from universal health services. An outcome of this phenomenon is an increase in the health divide between those that are at a social advantage vs those that are not. Aim: Using an intersectionality lens this review illuminates the role of the social determinants of health and social identity in creating possible barriers in the access to genetic screening for hereditary breast cancer, and the implications for public health practice in recognizing and ameliorating these differences. Strategy/Tactics: Although it remains too early to understand the exact cause for underenrolment in the OBSP high-risk screening program, this review serves to illuminate how screening programs that are used as targeted interventions to improve health outcomes must take into consideration the complexities associated with utilization and need across the entire population. A failure to do so may further disenfranchise socially disadvantaged individuals and widen the health equity gap that currently exists between population groups based on social location. Program/Policy process: The Ontario Breast Screening Program (OBSP) for High Risk Women is funded by the government; therefore, financial barriers in terms of access to care do not exist for individuals seeking screening. Despite this, the program has had low levels of enrolment based on their population targets (Cancer Care Ontario, 2012). Outcomes: While access to health care services is an important social determinant of health (Whitehead, 1992), the structure and design of health services can render them structurally unavailable and socially inacceptable to certain population groups (Gilson et al., 2007). Indeed, recent studies clearly demonstrate how socially disadvantaged individuals, such as those with lower levels of education, and those from ethnic minority groups consistently underuse health services despite the lack of a financial barrier to care (Maddison, 2011). What was learned: The way in which genetic testing is both accessed and used follow similar trends, such that higher levels of both income and education correlate with an increased awareness of genetic testing, a greater likely hood of receiving referrals for genetic testing, appropriateness of genetic counseling and the final decision to proceed with genetic testing.
Patient Navigation: Breaking the Barriers of Care While Empowering Patients to Fight Cancer in Nigeria
Authors: Chidebe R.C.W. , Tauriainen L. , Orjiakor T.C. , Okoro N. , Zhinnamie D.G. , Nwagboso E.J. , Abdulazeez J. , Nwaneri M.O. , Emelumadu O.
Published: September 2018

Background and context: Through the UICC and Pfizer Oncology SPARC MBC grant, Project PINK BLUE - Health and Psychological Trust Centre implemented Breast Cancer Navigation and Palliative Program (BCNPP) with strategic activities focused on metastatic breast cancer with the goal “to empower women at risk of, or living with advanced breast cancer and to reduce incidence of stage III or IV breast cancer”. The project established Nigeria´s first patient navigation program which trained 138 health workers and social workers across the 6 area councils of Abuja and connected 116 breast health facilities, 58 in Abuja and another 58 across Nigeria (diagnostic centers and hospitals) in a Web-based navigation map application. The program was designed to train only 18 patient navigators for Abuja only, however, we trained 44 patient navigators from National Hospital Abuja, Enugu and Kebbi states whom are currently working on establishing BCNPP programs in their respective states. The trained oncology nurse navigators are providing optimum palliative care and navigation to patients across the mapped health facilities in Abuja. While 72 institutions have been engaged through diverse partnerships, 27 resources were produced including videos, documents, and palliative/navigation book for healthcare workers; 10 ECHO palliative care training were organized for nurses and pain doctors, with additional 8 face-to-face workshops on palliative care and patient navigation and 5 patient support group meetings. Seventy-two news articles were published including TV, radio, and interviews. Aim: To empower women at risk for, or living with advanced breast cancer and to reduce incidence of stage III or IV breast cancer. Strategy/Tactics: The program used training of nurses, cancer survivors and nurses to become patient navigators at National Hospital Abuja and across the 6 area councils of Abuja. Currently, Niger state and Enugu state have also been trained on patient navigation and more cancer patients have been tracked and followed up through their journey with cancer in Nigeria. Outcomes: The program has transited to lead national advocacy at Nigeria's Parliament for the establishment of National Institute on Cancer Research and Treatment and has also establish some initiatives, such as Abuja's first cancer support group and patient-led advocacy and campaign. Several metastatic breast cancer patients were navigated through their journey with cancer. What was learned: Metastatic breast cancer patient needed more support to live a quality life, they needed more than just pain drugs. They need listening ear and caregiver who would show their care and love. Patient navigation is an emerging area of oncology, hence, there is a need to support the patient navigators to devote more time for the impact.
Using The Rotary International´s Platform to Create Long-Term Skills Transfer and Vocational Training Opportunities for Cancer Care in Bangladesh
Authors: Rasheed S. , Khan S. , McLellan E.
Published: September 2018

Background and context: Rotary International (RI) is an international service organization whose stated purpose is to bring together business and professional leaders to provide humanitarian services, encourage high ethical standards in all vocations, and to advance goodwill and peace around the world. The Rotary Club of Dhaka Mavericks, with the notion to work on cancer care has partnered with an US-based organization to bring cancer care specialists from the US. These 2 partners mainly work with the National Institute of Cancer Research and Hospital, the government-owned tertiary level cancer care and research institute in Bangladesh, to transfer the skills and provide vocational training to Bangladeshi oncologists, nurses and allied health professionals by oncologists, nurses and allied health professionals from the US. Aim: The overall aim of this project is to create a cadre of cancer care professionals - oncologists, nurses and allied health professionals - in Bangladesh who would have the vocational skills through on-the-job training and skills transfer session from experienced and skilled oncologists, nurses and allied health professionals from the US. Strategy/Tactics: The international platform of RI has been used to reach out to a US-based not-for-profit organization Partners for World Health. This US-based organization has sourced in cancer care professionals from the US and brought them to Bangladesh using the partnership of 1 rotary club in the US and another rotary club in Dhaka. Later on, these 2 Rotary Clubs and Partners for World Health collaborated with the National Institute of Cancer Research and Hospital, where this long-term skills transfer and vocational sessions are taking place. Program process: In this partnership, the Rotary Clubs and the US-based organization arranged all necessary funding and relevant permission and accreditation, while the National Institute of Cancer Research and Hospital patients - who were served - and oncologists, nurses and allied health professionals - who were trained. Outcomes: This partnership is currently for 5 years starting from October of 2017. The plan is to have 2-week vocational and skills transfer session every 6 months. The first session took place in October of 2017 and the second one on March of 2018. The third session will take place on October of 2018. In the October 2018 session, total 100 doctors and 35 nurses were trained on US standard cancer treatment protocols and chemotherapy administration. Number of complicated surgical techniques were also taught to the Bangladeshi surgeons by the US team. During the March session, the focus was on radiation oncology. A total of 100 radiation oncologists were trained on March of 2018.
Impact of Induction Chemotherapy on Nodal and Distal Disease Control in Locally Advanced Buccal Mucosa Cancer
Authors: Merja M. , Kasbekar P. , Pandya S.
Published: September 2018

Background: Buccal mucosa squamous cell cancer is the most common cancer in India. Majority of them presenting in advanced stage whose prognosis after surgery depends significantly upon the regional and distal spread. We studied the impact of neoadjuvant chemotherapy (NACT) on nodal and distal control of disease in operated cases of advanced buccal mucosa cancer. Aim: A retrospective study to evaluate the impact of induction chemotherapy (NACT) on nodal and distal failure in locally advanced buccal mucosa cancer. Methods: A total of 224 patients of advanced buccal mucosal cancer who underwent surgery between 2014 and 2015 were evaluated retrospectively with a follow-up of two years. Total 111 of the above had received NACT prior to surgery while 113 patients underwent upfront surgery. The CT scans and histologic reports were then compared for evaluation and analysis. Results: Among patients with T4a disease, 45.85% in upfront surgery group compared with 54% in NACT group showed metastatic pathologic nodes, while in T4b patients, the rates were 83.33% compared with 49.18% respectively. In patients with clinical/radiologic positive neck nodes at presentation, 87.5% in upfront surgery group as compared with 55.55% in NACT group showed metastatic nodes in histopathologic evaluation. 13.27% patients in the upfront surgery group had nodal and/or distal failure in the two years follow-up, whereas only 3.6% patients in the NACT group. 25% patients with peri-nodal extension in upfront surgery group showed nodal and/or distal failure, while only 6% in NACT group. The results in different nodal-ratio strata was evaluated. It showed that NACT has equal failure rate as in upfront group in nodal-ratio > 50, which is considered as very advanced and aggressive tumor. But in patients with nodal-ratio < 50, NACT group showed lesser failure rate than upfront group. Conclusion: We show regressional effect of NACT on nodal metastases. This study also shows NACT to be having a significantly positive impact on nodal and distal control. Hence role of induction chemotherapy needs to be considered in advanced cases of buccal mucosa cancer with nodal metastases.
Practice Transformation: Early Impact of the Oncology Care Model on Hospital Admissions
Authors: Mendenhall Molly A. , Dyehouse Karyn , Hayes Jad , Manzo Joanie , Meyer-Smith Teresa , Guinigundo Andrew , Bourbeau Brian , Waterhouse David
Published: September 2018

Purpose:

The purpose of the Oncology Care Model (OCM) is to improve quality and reduce cost through practice transformation. A foundational tenant is to reduce avoidable emergency room (ER) visits and hospitalizations. In anticipation of being an OCM participant, we instituted a multidimensional campaign designed to meet these objectives.

Methods:

Prior actions included establishment of phone triage unit, after-hours and weekend calls, and institution of weekend urgent care.

Results:

On the basis of data from the Chronic Condition Warehouse, as provided by the Centers for Medicare and Medicaid Services, we were successful at reducing the acute care admissions rate by 16%. During the baseline period extending from Jan 2016-Mar 2016, the hospital admission rate was 27 per patient, per quarter, at an average cost per admission event of $11,122, translating to an inpatient cost per patient, per quarter, of $3,003. In the year one reporting period of July 2016-July 2017, the hospital admission rate declined to 22.6 per patient, per quarter, at an average cost per admission event of $11,106, translating to an inpatient cost per patient, per quarter, of $2,505. OCM patient survey scores improved. In addition, at Oncology Hematology Care, we achieved improved results compared with the risk-adjusted national averages for the following measures: readmissions (4.9 v 5.6 per 100 patients, respectively), ER use (17 v 18.6 per 100 patients, respectively), and observation stays (2.7 v 3.6 per 100 patients, respectively).

Conclusion:

By implementing a cost-efficient, reproducible, and scalable campaign targeting ER avoidance and hospitalizations, we were able to decrease hospital admissions. Reported Medicare savings amounted to nearly $798,000 in inpatient cost per quarter over 1,600 patients.
One Step Forward, Two Steps Back: Trends in Aggressive Inpatient Care at the End of Life for Patients With Stage IV Lung Cancer
Authors: Mrad Chebli , Abougergi Marwan S. , Daly Bobby
Published: September 2018

Background:

Patients with metastatic lung cancer are treated with palliative intent. Aggressive care at the end of life is a marker of poor-quality care. National trends and factors related to aggressive inpatient care at the end of life for these patients have not been evaluated.

Methods:

Patients with stage IV lung cancer and a terminal hospitalization were identified in the National Inpatient Sample database between 1998 and 2014. Longitudinal analysis was conducted to determine trends in aggressive inpatient care at the end of life and multivariate logistic regression was performed to determine associations with patient and hospital characteristics.

Results:

A total of 412,946 patients met the inclusion criteria. From 1998 to 2014, the proportion of patients admitted to the intensive care unit (ICU) during the terminal hospitalization increased from 13.3% to 27.9% ( P < .001). The ICU stay translated into a higher mean total cost of care (+$18,461; 95% CI, $17,460 to $19,463). Promisingly, palliative care encounters for terminal hospitalizations also increased during this period from 8.7% to 53.0% ( P < .01) and were correlated with a decrease in aggressive care at the end of life. However, this did not offset the trend in increased ICU use; mean total costs for a terminal hospitalization increased from $14,000 to $19,500, adjusted for inflation. A multivariable model demonstrates variation by patient and hospital characteristics in aggressive care use.

Conclusions:

Among patients with metastatic lung cancer there has been a substantial increase in ICU use during terminal hospitalizations, resulting in high cost for the health care system.