bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in Incidence of Primary Liver Cancer in the Elderly (Aged 65+ Years) in England, 1971-2010
Authors: Bannister P. , Memon A.
Published: September 2018

Background: About 45% of the cases of liver cancer in England are diagnosed in the elderly. Since the 1990s, there has been a substantial increase in the incidence of liver cancer, and it has been projected that the incidence of rates will continue to increase to 15/100,000 by 2035. Aim: To determine the trends of incidence of liver cancer in the elderly in England during the period 1971-2010. Methods: Population-based national cancer registration data (obtained from the Office for National Statistics) were analyzed to determine the incidence of liver cancer (ICD-9 code: 155, ICD-10 code: C22) by age, gender, morphologic subtype and level of deprivation. Microsoft Excel and SPSS software were used for the analysis. Results: During the 40-year period, a total of 42,800 cases of liver cancer in the elderly were registered in England (58% male, 42% female). The number of cases increased by 462% - from 2,019 in 1971-75 (404 cases/year) to 11,345 in 2006-10 (2269 cases/year). The incidence rate (per 100,000) increased from 9.0 in 1971-75 to 37.4 in 2006-10 in males (316% increase); and from 4.6 to 19.6 in females (326% increase). In males, the incidence rates of liver cell carcinoma (ICD-10 code: C22.0) increased by 140% and the intrahepatic bile duct carcinoma (ICD-10 code: C22.1) by 2467%; whereas in females the incidence rates increased by 22% and 2260%, respectively. As for level of deprivation, the largest increase in incidence was observed in the least deprived population (721% in males, 690% in females). Conclusion: During the past four decades, there has been a remarkable increase in the incidence of liver cancer in the elderly in England. The relatively large increase in liver cell carcinoma in males, those in the least deprived category, and substantial increase in intrahepatic bile duct carcinoma in both genders warrant further investigation. These findings are also relevant for the planning of oncology services, resource allocation, screening for early diagnosis and public health education for primary prevention of liver cancer.
Role of Gynaecology Oncology Specialist Nurses in Improving Patient Follow-Up and Integration With the Health Care Team
Authors: Mondal S. , Ghosh B. , Atreya S. , Bhaumik J. , Mukhopadhyay A.
Published: September 2018

Background: All advanced gynecologic cancers treated initially with a curative intent should also be referred to palliative care at the outset for symptom management. Specialist nurses can play an integral role in this process as patients feel more comfortable to relay their symptoms to nurses rather than busy clinicians. The concept of specialist nurses has been introduced in June 2016 in the Gynecologic Oncology Department in Tata Medical Center. We aim evaluate our services through this prospective audit. Aim: i: To assess whether pre and posttreatment counseling and follow-up by gynecologic oncology specialist nurses lead to better patient care in the following areas. Increased patient participation in self-reporting of PROM (patient reported outcome monitoring) and uptake of follow-up methods via e-mail, telephone etc. ii: Coordinate administration of intraperitoneal chemotherapy and follow-up. iii: Detection of posttreatment complications and symptoms by telephonic follow up and coordination with the treating team including quality of life data collection. iv: Communicating MDT decisions to patients and arrange appropriate follow-up. v: Reduction of patient follow-up appointments and distress by coordinating with other departments i.e., palliative care team and gynae/medical oncology at same visit. vi: Develop patient information leaflets and providing preoperative education Methods: Prospective audit for service evaluation. Patients follow-up was done by face to face, telephone, e-mail in the pre and postoperative period, during chemotherapy and follow-up visits by 4 specialist nurses. Results: Between June 2016 and December 2017, specialist nurses conducted follow-up of 225 patients both in preoperative and postoperative period and collected 30 day morbidity data. Preoperative health education was given to all. 36 patients were coordinated with palliative care team on same day with gynecologic visit to reduce harassment/repeat appointments. Postchemotherapy follow-up was done for 80 patients after each cycle of chemotherapy. Coordination for 19 intraperitoneal chemotherapy was done by nurses during a 9 month period. As a result of regular follow-up visits, women were more comfortable in self-reporting of symptoms to the nurse including sensitive issues like body image and sexuality even by nonface to face methods including telephone calls/e-mails and postal mails. This has led to early detection of recurrences in 4 women, participation in multicentric national/international quality of life studies (SOCQER2/ SOCQER IND) and successful organization of survivorship programs in gynecologic oncology. Conclusion: Counseling, education and building up of interpersonal relationship with specialist nurses can improve patient participation. The role of CNS is vital to the advancement of nursing practice.
Cervical Cancer Screening Knowledge and Behavior Among Female Undergraduate Students in a Nigerian University
Authors: Agboeze J. , Nwali M. , Ezeani N.
Published: September 2018

Background: Cervical cancer is a highly preventable disease that affects women especially in developing countries. Over the years awareness and uptake of cervical cancer screening services have remained poor in developing countries. Lack of knowledge and poor attitude toward the disease and risk factors can affect screening practice and development of preventive behavior for cervical cancer. Aim: This study assessed the level of knowledge and barriers toward cervical cancer screening among female university students. Methods: We conducted a cross-sectional survey of 234 female students selected by stratified random sampling techniques at Ebonyi State University Abakaliki Nigeria. A pretested questionnaire was administered to assess knowledge, attitude and screening history. Data were analyzed with Epi info version 7.1.4. Results: Participants' mean age was 22 years (SD=3). Majority of the respondents 79.5% have not heard of screening, 58.9% knew that it can be prevented, 78.5% have not heard about HPV vaccine and only 4.0% have had Papanicolaou test. Common barriers include lack of centers where such services are obtainable (88%) and fear of cancer being discovered (9%). Reported risk factors were multiple sexual partners (24.2%) and early onset of sexual intercourse (19.8%). A significant association was found between institutional and personal barriers and having a Papanicolaou test. Conclusion: Comprehensive education on cervical cancer screening in universities is critical in reducing the morbidity and mortality associated with cervical cancer. Few screening centers have also contributed to poor cervical screening uptake.
Practice Cervical Cancer Screening and Treatment in FGAE Clinics
Authors: Hailemariam A.S. , Haile G.M.
Published: September 2018

Background and context: In 2010, it was estimated that 20.9 million women were at risk for developing cervical cancer in Ethiopia and the estimated annual number of cervical cancer cases and deaths was 4648 and 3235, respectively. The Family Guidance Association of Ethiopia (FGAE), established in 1966 has been working with solid commitment to contribute to the national effort to improve the reproductive health of women, men and young people through providing quality and integrated sexual and reproductive health (SRH) services. Cervical cancer screening services using Papanicolaou test, FGAE began in 1990 and in 1994 the service was expanded to eight higher clinics. Aim: To integrate single visit approach with visual inspection with acetic acid (VIA) screening and cryotherapy to the existing SRH services. Strategy/Tactics: FGAE has provided an integrated quality SRH services through 42 service delivery points, 222 outreaches and 324 franchised clinics. Based on this, this strategy is developed to ensure that VIA and cryotherapy can be successfully integrated to the current SRH service package, such as demand generation, improve access to integrated quality SRH services, capacity building, strengthening partnership and quality assurance system and scaling up SRH/CCP service to private and public facilities. Program/Policy process: FGAE continued Papanicolaou test services, and promoted single visit approach, which combines visual inspection with acetic acid (VIA) screening and cryotherapy. In 2013, this approach was introduced to 5 higher FGAE clinics following the pilot study. Since 2015, all eight higher FGAE clinics and its GYN/OB specialty clinics have successfully integrated single visit approach to the exiting SRH services. Facility readiness was assessed and gaps were filled. Partnership with FMoH and other government institutions public and private health facilities and companies were established to scale up services and set up referral pathways. Data on service utilization were recorded using manual and electronic tools and national algorism for screening and treatment was applied. Regular mentoring and supervision was carried out to ensure quality and performance. Outcomes: Data for a period of 2010-2017 on cancer screening and treatment by FGAE were analyzed and shows that a total of 79,286 women were screened. The overwhelming majority of the screened women (96.2%) were age 25 and above. For women who chose VIA, 10.3% of them received positive result. 6164 were treated with cryotherapy while 12 women was referred as a suspected case of invasive cancer. The number of women screened has increased from 805 in 2010 to 79,286 in 2017. What was learned: The proportion of women tested positive for precancerous cervical lesion in FGAE clinics is high and comparable with national estimates of 12.3%. Integrating single visit approach into SRH services is feasible and effective in identifying and treating precancerous cervical lesions.
The IAEA Human Health Campus: Online Educational Resource for Health Care Professionals in Radiation Medicine
Authors: Miller R. Núñez , Gray T. , Pascual T. , Estrada E. , Giammarile F. , Paez D.
Published: September 2018

Background: Cognizant of the educational needs of the member states, and taking advantage of the current technological advances in this digital age, the International Atomic Energy Agency (IAEA) officially launched in 2010 the Human Health Campus (HHC; http://humanhealth.iaea.org ), which is an online educational resource initiative geared toward enhancing professional knowledge of health professionals in radiation medicine. Aim: Determine how and by whom the IAEA HHC is being visited and used since its inception in October 2010. Methods: Using the information provided by Google Analytics, determine the overall key performance indicators (KPIs) such as total sessions, total users, total page views, session duration, including daily number of visits to the HHC, county of origin, evaluation of the most popular sections and source of the traffic. Results: Since its launch on October 6th, 2010, KPIs are as follows: total sessions 374,279, total users 243,195, total page views 1,393,310, pages/session 3.72, average session duration 00:03:08. % of new sessions 64.92%. The HHC has witnessed continual growth year on year (YoY) in total sessions (visits) since its inception in October 2010, and total users. For 2016 (the highest performing year so far) there were 201 visits/day, 40% increase in traffic YoY and 20% user growth. Traffic to the Webinar content has seen sustained growth in the number of YoY since being introduced to the HHC in 2013. 2016 saw the largest increase of over +600%. E-Learning modules have also seen growth in the traffic YoY since being introduced to the HHC in 2011. The year 2015 saw a large increase in total traffic with over +95%. E-Learning traffic accounts for almost 25% of all traffic to the Nuclear Medicine section. Visits by mobile devices have increased YoY exponentially since the launch of the HHC, with the mobile traffic growing strong through 2015-2016 with an increase of 5482 sessions, or an 81% uplift YoY. For 2017, it represented 18% of the total traffic (from 3% in 2012). There is a clear prevalence of desktop users (85.5%), as the preferred method of browsing the HHC. A total of 210 countries and overseas territories have visited the HHC. The United States is the largest contributor of traffic from a global perspective with 16.31% of total traffic, almost double the next largest which is the UK with 9.10%. India with 5.45% and Australia with 3.27% of total traffic, respectively, round out the top 4. Not surprisingly, more than 60% of users are from English-speaking countries. Spanish is the second most popular language of users with just over 6% of total traffic. Conclusion: The HHC is an IAEA open access Web based educational resource for professionals in the field of radiation medicine being visited by as many as 210 countries. The upward trend in its use suggests that the IAEA HHC will continue to be an important player in providing educational resources for professionals worldwide.
Impact of an Innovative Patient Navigation Project in Nigeria: Preliminary Results
Authors: Okon K. , Eguzo K. , Ekanem U. , Udo I.
Published: September 2018

Background: Cancer patients in Nigeria are known to present late and have poor awareness of their disease. Among the factors which limit early presentation are aversion for orthodox medicine due to perceived complexity of health institutions, and belief in superiority of traditional medicine. Patient navigation has been shown to improve patient treatment adherence. There is limited evidence on the impact of PN in Nigeria, and other resource-limited settings. Aim: Study sought to introduce a hospital-based patient navigation program (PNP) and evaluate its impact. Methods: PNP was initiated at the University of Uyo Teaching Hospital in June 2016 with focus on breast cancer patients. A young, male public health officer, who spoke the local language was recruited and trained to guide cancer breast patients through the hospital. Training focused on hospital services, sensitive communications, patient management process, confidentiality and resource identification. The service was announced to the hospital community, and his contact information was advertised. Patients and hospital community could contact the navigator via phone calls and text messaging. Impact data collection included services provided, patient characteristics and feedback on services. Data analysis included descriptive statistics and thematic analysis. Results: In the first year of the PNP (June 2016-17), 202 breast cancer cases were seen, and 137 connected with the navigator; service utilization rate was 67.8% (137/202). More patients in the PNP received diagnosis within 90 days of their first visit, 58.4% (80/137) presented with stage 4 disease, and 20 had mastectomy. Most patients had low income and low education. Two patients died after completing three courses of chemotherapy. Finance, transportation and poor social support were the most common barriers to access. Health care providers positively reviewed the PNP, often saying that “it made their work” and “added value to hospital care and cancer management”. Physicians who did not speak the local language often used the navigator as a translator. Most patients echoed “God bless you” in prayers offered to appreciate the navigator. They agreed that the PNP reduced some barriers to hospital service utilization, although 32 patients (23%) expressed frustration over unmet expectations financial support from the navigator. Physicians who manage other cancers have started referring patients to the PNP since its initiation. Conclusion: This evaluation showed that PNP program was well used and led to improvements in breast cancer patient management. It proves that patient navigation is feasible in a resource-limited setting. Funding to sustain and expand the program is a limitation. More patient satisfaction and outcome studies are needed to evaluate PNP impact.
Colorectal Cancer Awareness and Screening Guideline for African American Populations
Authors: Omenukor K.
Published: September 2018

Background and context: Colorectal cancer is the 3rd leading cause of cancer-related deaths. Early screening provides the best prospects for preventing the morbidity and mortality associated with the disease. Nurses have the duty to promote health and prevent diseases. However, low rates of colorectal cancer screening continue to be reported, especially among African Americans who continue to suffer disproportionately from the disease. A local clinic reports low CRC screening and high incidence of late stage CRC diagnoses. Aim: To develop a culturally-sensitive clinical practice guideline that nurses can use to educate patients appropriately on colorectal cancer. Strategy/Tactics: The health belief model informed the background, development, and implementation of this project. Evidence from peer-reviewed nursing literature was synthesized in a literature review matrix and then used to develop a clinical practice guideline to increase colorectal cancer screening. Program/Policy process: The AGREE II framework was used to develop the clinical practice guideline considering the 6 domains and the related 23 items. Outcomes: The low rates of CRC screening and disproportionately high rates among African Americans were linked to several problems that could be grouped into three classes: patient obstacles, provider issues, and system-level problems. Patient obstacles to CRC screening included fear, inadequate knowledge of CRC risk, and low apparent benefit of colonoscopy. Provider-level issues included failing to recommend screening and insufficient knowledge regarding guidelines and impediments to screening. Examples of system barriers included financial problems, lack of insurance, and the inability to access care. What was learned: Implementation of the clinical practice guideline when providing patient education to African American populations will eliminate disparities in colorectal cancer screening in this population.
Reducing Dermal Exposure to Agrochemical Carcinogens Using a Fluorescent Dye-Based Intervention Among Subsistence Farmers in Rural Honduras
Authors: Flynn T.G. , Altamirano C.M. Dunaway , García H.S. Reyes , Campos R.J. Barahona , Moya J.C. Zuniga , Larochelle E.P. , Romano M. , Cervinski M. , Lyons K. , Spaller M. , Kennedy L. , Bejarano S. , Tsongalis G.J. , Huyck K.
Published: September 2018

Background: Occupational exposure to agrochemicals, some of which are known or suspected carcinogens, is a major health hazard for subsistence agricultural workers and their families. These impacts are more prevalent in low-and-middle income countries (LMICs) due to weak regulations, lack of awareness of the risks of contamination, general lack of personal protective equipment (PPE), and low literacy about proper agrochemical application techniques. Fluorescent tracer dyes have been described as a means of visualizing and quantifying dermal exposure to agricultural chemicals, and dye techniques adapted for LMICs have been developed previously. These tracer dyes have also been used in educational demonstrations about pesticide safety. However, studies evaluating the efficacy of these educational dye interventions in reducing exposure have been lacking. Aim: To evaluate whether observing one's own chemical contamination after applying agrochemicals changed the amount of occupational dermal exposure during a subsequent chemical application. Methods: We used a multimodal community intervention in a rural village in Honduras that incorporated chemical safety education and use of a fluorescent tracer dye during pesticide application and compared dermal exposure between the intervention group (previous dye experience and safety education) and the control group (safety education only). Results: Mean total visual score (TVS) of the tracer dye, which accounts for both extent and intensity of contamination, was lower among those who had previously experienced the dye intervention (mean TVS=41.3) than among participants who were dye-naïve (mean TVS=78.4), with a difference between means of -37.10 (95% CI [-66.26, -7.95], P = 0.02). Conclusion: That workers who had experienced the dye demonstration once before were significantly less contaminated on average when compared with the dye-naïve group indicates that a multimodal community intervention that utilizes fluorescent dye visualization may be effective in reducing dermal exposure to carcinogenic agrochemicals among subsistence farmers in LMICs.
Tailoring Therapies: Improving the Outcome of Breast Cancer in a Comprehensive Cancer Center in West Africa—The University of Nigeria Teaching Hospital Experience
Authors: Lasebikan N. , Iloanusi N. , Onyeka T. , Ilo C. , Nwankwo K. , Okwor V. , Chigbo N. , Okoye I. , Olusina B. , Echendu I. , Ezeome E.
Published: September 2018

Background and context: Early detection and improved treatments are associated with a reduction in breast cancer mortality and morbidity. UNTH is a leading comprehensive cancer center in Nigeria with referrals from the entire southeast and south south regions. Our goal is to offer high quality comprehensive cancer care services across the cancer care continuum from public health awareness campaigns and provision of screening services all the way to palliative care and survivorship. This is the first attempt by any institution in the country to standardize and harmonize available treatment options for breast cancer. Aim: To optimize, standardize and harmonize treatment options and management strategies for breast cancer using a multidisciplinary approach by developing guidelines adapted to our peculiar infrastructure and health system. Strategy/Tactics: The practice guideline was specifically developed for UNTH using a multidisciplinary approach and taking into consideration circumstances peculiar to UNTH, including the following: UNTH's specific patient population; UNTH's services and structure; and UNTH's clinical information. Program/Policy process: The process used recognized methods that are robust, objective, scientifically valid, consistent and adaptable to UNTH and engaged all identified multisectoral and multidisciplinary stakeholders involved in the care of patients with breast cancer. Outcomes: We reviewed substantial evidence on documented and proven strategies for community screening and prevention, less expensive and only marginally less effective diagnostic tools, locoregional and systemic therapies for the management of breast cancer. The team also recommended all patients receive psycho-oncology support through a dedicated team and through the breast cancer support group. It was agreed that palliative care be incorporated within the first 8 weeks of commencing treatment in line with the current ASCO guidelines and receive consultation from the exercise immunology unit. What was learned: Institutionalized care offers better management strategies and standardized treatment in line with best global practices of care for patients with breast cancer across the cancer care continuum which will ultimately translate to better treatment outcomes.
Determinants of Early Cancer Screening Behaviour in Nigeria
Authors: Chidebe R.C.W. , Orjiako T.C. , Atakere D.K. , Arowosegbe O.O. , Onu D. , Okoro N. , Dantsoho S.A. , Nwagboso E.J. , Emezue P. , Abdulazeez J.
Published: September 2018

Background: Early detection and improvements/advancements in medicine have contributed to an overall decrease in mortality and morbidity rates resulting from cancer diagnoses. Despite this improvement in national and global health status, Nigerians continue to be diagnosed at a later stage, with a more aggressive disease state. This is an important observation given the impact cancer has on the abilities of individuals to function physically, psychologically, and socially within the context of their environment. It is important therefore to identify and target specific groups that may be less willing to present for early cancer screening. Aim: To understand the characteristics of people who are likely or not likely to present for early cancer screening among Nigerians, and to address the use of mechanisms by which to ensure a timely diagnosis of preventable cancers among Nigerians. Methods: Adult Nigerians (N=144), 18-71 years of age who presented for clinical breast exam (CBE), visual inspection with acetic acid (VIA) and prostate specific antigen test (PSA) screenings after an awareness exercise; completed survey forms which included a personality inventory, early cancer detection behavior scale and a demography profile. Multiple regression and ANOVA were used to examine predictive patterns as well as differences between and within groups. Results: Results showed income ( b = 0.18, P < .05) to be a significant determinant of early cancer detection behavior, such that higher income earners were more likely to go for screening. There were also significant gender differences in current cancer detection behavior between males (M = 0.15, SD = 0.51) and females (M= 0.47, SD = 0.80); males are less likely to engage in early detection behavior ( F(1,145) = 4.76, P = .03). Data further show differences between older (≥ 41) and younger (≤ 40) participants in intention to screen for cancer, with older participants reporting more willingness to engage in cancer screening. Conclusion: Our finding enhances our understanding of the profile of the groups who are less likely to screen for cancer. Also, it suggests that awareness campaign and free screening exercises should target these at-risk groups in Nigeria.
Effect of Population-Wide Hepatitis B Vaccination in Preventing Liver Cancer Among Children and Young Adults in the United States
Authors: Shams A.Z. , Winkler V. , Pohlabeln H. , Arndt V. , Haug U.
Published: September 2018

Background: Liver cancer is the second most common cause of death from cancer worldwide1. In 2013, 79,2000 new cases of liver cancer and 818,000 deaths occurred globally2,3. Chronic infection with HBV accounts for at least 50% of liver cancer globally4. In the United States (US), liver cancer constitute the ninth leading cause of cancer death. The incidence of the cancer has persistently increased in the recent decades. Universal HBV vaccination was introduced in 1992 in the US. However, incidence trends of liver cancer among US children is poorly researched or relevant studies are not up-to-date5. Aim: This study aims to explore the effect of HBV population-wide vaccination program in reducing liver cancer incidence in the vaccinated children and adolescents in the US. Methods: Liver cancer incidence data were obtained from Cancer Incidence in Five Continents (CI5) databases (volumes I to X) from International Agency for Cancer Research (IARC). Data acquisition and analysis covered available incidence data between 1978-2007 from 9 cancer registries from Surveillance, Epidemiology, and End Results Program (SEER) from the US presented in the CI5 databases. Age-specific incidence rates of liver cancer (based on 5 year age groups ie 5-9 year, 10-14 year and 15-19 years) were calculated using age and sex-disaggregated incidence and population data from the SEER cancer registries. Stata software version 14.0 (StataCorp, USA) was used to calculate age-specific incidence rates, using number of liver cancer incident cases in each age group by the number of population in the respective age group. Age-specific rates were analyzed by period of diagnosis and by birth year. Rate ratios were estimated from age-group-specific Poisson regressions. Results: A total of 140 liver cancer incident cases were registered in the 9 SEER registries between 1978 to 2007 in the US. The incidence rate of liver cancer in children 5 to 9 years of age from 1978-1982 was 0.10 per 100,000 children. The incidence increased to 0.16 for the period from 2003-2007. The same trend is seen for the age group 10-14 and 15-19 years of age. Overall, age-specific incidence rates for liver cancer increased across age groups of 5-9, 10-14 and 15-19 year in the population covered by the 9 SEER registries in the US. However, risk estimates (incidence rate ratios, resulted from age-group-specific Poisson regressions did not show statistical significant effects. Conclusion: While the global response to implement population-wide HBV vaccination program is out of question, efforts to establish processes to evaluate the effect of such programs seems to be incomparably limited. Estimating the effect of HBV vaccination will relatively improve with time as further incidence data become available eg upon publication of data from new volume of CI5 databases.
A Limited Time to Act: Cervical Cancer Stage Progression Prior to Treatment
Authors: Dryden-Peterson S. , Bvochora-Nsingo M. , Tapela N. , Iyer H. , Koheler R.K. , Suneja G. , Grover S. , Lockman S.
Published: September 2018

Background: Cervical cancer is the leading cause of cancer death for women in sub-Saharan Africa where access to timely diagnosis and treatment remains a major challenge. Several investigators have documented the adverse impact of delays during curative chemoradiation on survival: 2%-5% decreased survival per week delay. However, the clinical impact of delays in initiating treatment has not previously been estimated and is key to direct allocation of resources and patient care. Aim: To estimate the duration treatment initiation delay leading to a one-stage progression in cervical cancer. Methods: Radiation is available in Botswana from a single linear accelerator and services are provided free of cost to Botswana citizens. Two prolonged service interruptions (late 2014 due to mechanical failure/upgrades, and late 2015 for machine replacement) contributed to substantial additional delays in accessing treatment of several months after service resumed. Using these natural experiments and the prospectively enrolling Thabatse Cancer Cohort (included cases enrolled from September 2014 to January 2018), we used instrumental variable methods to estimate the mean number of weeks to progress one stage (e.g., IIIA to IVA). Our instrument was a binary variable indicating treatment initiation occurred during service interruption. We used inverse probability weighting to adjust for possible bias in exposure to the instrument by HIV status, age, and income. Cancer stage was considered ordinal and we used Poisson regression to calculate weeks for stage progression. We calculated confidence limits using bootstrapping from 500 samples. Analyses were performed in SAS 9.4. Results: A total of 301 cervical cancer cases were included with 138 (46%) exposed to service disruption and 163 (54%) not exposed. The majority, 217 (72%), were HIV-infected with 86% on ART prior to cancer diagnosis. At time of treatment, 27 (9%) stage I, 108 (36%) stage II, 113 (38%) stage III, and 53 (18%) stage IV. Median time from diagnosis to initiation of treatment of all patients was 9.7 weeks (IQR 6.3-13.7), and was longer in those exposed to service disruption (11.0 weeks [IQR 7.7-15.1]) than those not exposed (8.0 weeks [IQR 5.3-11.7]. Time for progression of one cancer stage was 8.9 weeks (95% CI 4.6-15.8). Among HIV-infected women, estimated time for one-stage progression was 6.5 weeks (95% CI 2.3-12.3), significantly faster than HIV-uninfected women ( P < 0.001). The small number of HIV-uninfected women prevented separate estimation. Conclusion: Stage progression is rapid in locally advanced cervical cancer with typical treatment delays of two months associated with a full stage increase. These estimates may not generalize to contexts with lower HIV prevalence; however add urgency to effort to improve efficient access to treatment and avoidance of waiting lists.
The Impact of a Breast Cancer Diagnosis on Women´s Work Status
Authors: Fisher M. , Barry L. , Pitcher M. , Storer L.
Published: September 2018

Background: Many women diagnosed with breast cancer are of working age at the time of diagnosis, so the impact of a diagnosis and treatment regimen on their lives can cause financial stress-partly by impacting on their ability to continue in paid employment. The financial fallout from not working, changes in employment status and the hidden costs associated with cancer treatment can add to financial toxicity. Aim: Our aim was to identify changes in work status after a diagnosis of breast cancer. Our secondary aim was to determine if there was a correlation between different treatment modalities and work status at 12 month follow-up. Finally, we wanted to consider the role of treatment and change in work status on the financial stress experienced by patients after their diagnosis and treatment. Methods: An audit of the medical record of women who present to Western Health with a diagnosis of early breast cancer and consequently attended the nurse led breast cancer survivorship clinic (SC) between October 2015 and October 2016 was performed to identify employment status at diagnosis and at review in SC 12 months later. Results: 114 patients attended the SC in a 1 year period- 2 were males and both retired at diagnosis. The records of 111 women were reviewed. 46 of the 84 women < 65 years, were in paid employment at diagnosis. 38 of these 46 women were working in some capacity at 12 month review though only 28 were working the same, having decreased hours since diagnosis. 17 of the 111 (15%) women reported financial stress at the 12 month review. 9 of the 19 (42%) women with changed work status reported financial stress. 2 of the 28 (7%) women working the same hours reported financial stress. 14 of the 19 (74%) women who had changed work status had chemotherapy. 65% of those who reported financial stress (11/17) had chemotherapy as part of their treatment. 10/19 (53%) had changed or stop working since axillary dissection. Conclusion: Our data suggest that 83% of women returned to work in some capacity- most at the same level, and these women were unlikely to report financial stress. Women who returned to work at reduced hours, increased hours, or did not return to work at all were more likely to report significant financial concerns at one year postdiagnosis. Health care professionals as part of ongoing care should be aware of the financial impact a cancer diagnosis and its treatments, and should aim to refer appropriately.
Bridge of Support: A Collaborative Approach to a Peer Support Program
Authors: Fisher M. , McRae F. , Pitcher M. , Hornung I. , Spence J.
Published: September 2018

Background and context: The Bridge of Support Program (BOS) is adapting a successful community based model of peer support to an acute setting, at the Sunshine Hospital Breast Clinic, to meet the cultural and socioeconomic diverse needs of women with breast cancer. This two year project was funded by LUCRF Community Partnership Trust. Aim: To improve the experience of women undergoing treatment of breast cancer at Western Health. To improve access to psych-social, emotional and practical support for women by extending the reach of CounterPart- a state-wide service of women´s Health Victoria, funded by the Victorian Department of Health and Human Services to provide peer support and information to people affected by breast or a gynecologic cancer. Program/Policy process: Peer support volunteers actively guided women to current and credible evidence-based information, support decision making and provide emotional support. Peer support volunteers are rostered once a week at Sunshine Hospital to coincide with breast clinic and include access to the day oncology unit and radiotherapy center. Detailed contact information is recorded and women receive follow-up contact (with consent) from the peer support volunteers at the CounterPart Resource Centre in Melbourne. A CounterPart staff member oversees the project and provides direct support and supervision to the volunteers on site at the hospital. Women can self refer. Outcomes: Between February and December 2016 the BOS program had 159 separate contacts with patients and their families. 82 contacts were with men and women who were new to CounterPart and 77 were follow-up contacts. 90 individuals treated for breast cancer at Western Health accessed the program, which represent 53% of the women seen by the breast service. 48% of the contacts were follow-up contacts with the CounterPart volunteers indicating that once engaged with the service many men and women continue to make contact. 38% of contacts were with women diagnosed with metastatic disease, a group who often have higher levels of unmet or more complex needs. 49% were born in a nonmain English speaking country (compared with the overall state of Victoria average of 19.6%) thus reflecting an accessible service to the non-English speaking community. What was learned: At a time when peer support is being increasingly recognized as a key part of effective supportive care in cancer services, the BOS program offers a model of integrated peer support that is respected, reliable, well supported and safe within the acute setting. This acute-community sector partnership demonstrates how the medical and social models of health care can work together to provide a connected and quality service for men and women diagnosed with breast cancer. An active research approach is enabling the project to be responsive to issues and challenges as they arise including the ongoing recruitment of women as volunteers from the local community to work within the acute setting.
All Together Against Cancer Movement - TJCC
Authors: Loggetto S.R.
Published: September 2018

Background and context: Created in 2014 by an ABRALE (Blood Cancer Society) initiative, the annual congress is part of the TJCC movement and its goal is to gather all the oncology network debates aligned with the National Policy of Cancer Prevention and Control. It is already a reference in the Brazilian oncology area and it allows the mapping of demands and discussions of group proposals for improvements in the system. Aim: The movement has proposed a collaborative agenda aiming to influence health policy in the oncology area to improve health care assistance, prevention, treatment access and palliative care to cancer patients in Brazil. Strategy/Tactics: -Disseminate knowledge, trigger collaborative actions for a health system to become more effective, offering higher quality of life to cancer patients; -Point out priorities for prevention, diagnosis and treatment of cancer in Brazil; -Monitors and helps implementation of national cancer prevention and control policy program and the policy process. Outcomes: -Over 60 organizations including government, patient advocacy organizations, oncologists, medical societies, media, layers, sponsors and companies - working on an unique agenda. -120 oncology professionals engaged in the movement, -4 TJCC congresses organized, engaging more than 9000 health leaders; -19 million micro data crossed and analyzed by data scientists; -ABRALE registry with more than 30,000 patients; -48 studies published in a dynamic online platform. What was learned: The movement has gained recognition and respect from authorities and communities directly involved. However the challenges are great to keep improving the articulation with all the organizations involved in this process to create and converge in an unique agenda.
Knowledge and Perception of Human Papillomavirus Vaccine Among Women Attending Antenatal Clinic at Federal Medical Center, Abeokuta, Ogun State, Nigeria
Authors: Adejimi A. , Akanbi A.K.
Published: September 2018

Background: Cervical cancer is preventable though human papillomavirus (HPV) vaccination but yet the leading cause of death among women in developing countries including Nigeria. It is important to understand the level of awareness about HPV vaccine in developing the strategies for an effective intervention. Aim: The objectives of this study were to assess the knowledge and perception of HPV vaccine among women attending antenatal clinic in Abeokuta, Ogun State, Nigeria. Methods: A cross-sectional study was conducted using systematic sampling technique. A pretested, semistructured and interviewer administered questionnaire was used to assess the knowledge and perception of HPV vaccine. Data were analyzed using SPSS version 16 and χ2 statistics was used to test for association between variables at level of significance of 5%. Results: A total of 104 women were interviewed. The mean age of the respondents was 29.8±7.8 years. About 77.9% were married and 55.8% of the respondents had tertiary education. However, 41.0% had good knowledge of HPV infection, 30.7% had good knowledge cervical cancer and 39.4% had good knowledge of HPV vaccine. About 45.9% of the respondents had good perception of HPV vaccination as a preventive method for cervical cancer. Age, level of education, household size and level of income were significant factors that determined the level of knowledge of the respondents about HPV vaccine whereas age, occupation, settlement area and household size were the significant factors that determined the level of perception of the respondents about HPV vaccine. Conclusion: There is a very low level of knowledge and poor perception about human papillomavirus (HPV) vaccine among this sample of women. Effective information, education and communication strategies are required to improve the level of knowledge and perception of these women with different educational levels and settlement areas about HPV vaccine.
Addressing NCDs in the National Development Agenda - United Arab Emirates Experience
Authors: Fadhil I. , bin Belaila B.
Published: September 2018

Background and context: NCDs represent the major health burden in UAE, accounting for 65% of all deaths in UAE. At national level, UAE national agenda 2021 signified the high level commitments toward NCD prevention and control. The national agenda includes a set of national targets that aims on reducing NCD mortality and burden. Those targets are aligned well with WHO global targets for 2025 and the 2030 for sustainable development goals and targets. Aim: To draw on the experiences of UAE that had made good progress in integrating NCDs into national development agenda and developing national accountability mechanism to facilitate engagement of nonhealth sectors. Strategy/Tactics: The national multisectoral action plan for NCD prevention and control for (2017- 2021) provides a clear road map for NCD action. Program/Policy process: there have been various policy interventions and programs to support this agenda, including the inclusion of NCDs with measurable targets and indicators under the third of the Sustainable Development Goals (SDGs) in 2015. Outcomes: Taking into account the vital role of nonhealth sectors, key performance indicators were assigned for each sectors and a regular in-house reporting system has been institutionalized to allow effective progress, which was monitored by a committee lead by Prime Minister office. A number of fast track initiatives has been undertaken to reduce the NCD burden, such as screening and health promotion programs conducted by the primary healthcare, taxation on sugary drinks and tobacco, national periodic health and cancer screening initiatives, smoking cessation, and breast cancer screening campaigns. What was learned: Ensure full engagement of national stakeholders, during development and implementation of NCD action plan is critical. The role and responsibilities of each sector has to be agreed upon. Developing national targets and indicators with accountability scheme is essential to monitor progress.
Global Consultation on Cancer Staging (GCCS): An International Survey Evaluating the Understanding and Use of the Cancer Stage Classification Terminology
Authors: Moraes F.Y. , Huang S. , O'Sullivan B. , Gospodarowicz M. , Brierley J.
Published: September 2018

Background: The UICC TNM classification of malignant tumors is an internationally agreed standard to describe and categorizes cancer stage. It allows for collecting both clinical and pathologic TNM information where available. However, complex changes have emerged, such as an explosive growth in knowledge about cancer in particular regarding other prognostic factors for outcome resulting in confusion regarding the uniform taxonomy of cancer stage around the globe. Aim: To evaluate the understanding and use of the cancer stage classification terminology. Methods: The GCCS Staging Working Group (under the UICC TNM Committee) designed a survey to appreciate the current status quo in understanding and application of TNM classification terminology on cancer within common users of TNM classification. An online survey was developed and piloted within 10 TNM users. The survey was refined for clarification of language and content. The finalized survey was sent to common TNM users across the world. The survey comprised 35 question using Likert Scale on 4 critical domains. A reminder was sent after 2 weeks of initial e-mail for online survey. The final responses were summarized using descriptive analysis method. Results: A total of 376 surveys invites were sent and 136 (36.2%) full replies received. From 136 responders, age (half < 56 years old) and gender was balanced. North America and Europe were the most commonly represented regions. About 65% were clinician and 40% reported to work in academic centers. Reporting on the study aims: (1) more than 80% very frequently use TNM information to determine a patient prognosis and/or treatment, (2) 85% state that anatomic disease extent should be reported separately from other factors and only half of the responders believe that use of TNM staging terminology is consistent or uniform. In addition, 81% agree that tumor markers have been shown to provide valid additional impact (in addition to extent of disease) on prognosis. However, the majority (55% overall or 70% if clinicians only) don't believe that an overarching framework for classifying genetic makers is available. Finally, there was no consensus on how anatomic extent of disease and other prognostic factors should be combined. Conclusion: Our results show that majority use TNM information to determine prognosis and treatment and that anatomic extent of disease should remain reported separately. Tumor markers have been shown to provide valid additional impact on prognosis. However, there is no consensus on how anatomic extent of disease and other prognostic factors should be combined. In addition, 50% believe that the application of the TNM staging terminology is not consistent or uniform in the literature.