bluuebunny/crossref_metadata_2025 huggingface dataset:
Turn a Loss to a Gift: The Final Wishes of Silent Mentors
Authors: Khaing S.L. , Sethi N. , Khoon A.T. Khian , Loo T. Sik , Eng S. Thiam , Aik S.
Published: September 2018

Background: Birth, aging, illness and eventually death are the natural events in the life. As our body is not permanent, we can do something meaningful even after death, such as donating body as a Silent Mentor. This concept was initiated by Dharma Master Cheng Yen from Taiwan at Tzu Chi University in 2002. University of Malaya started this program in 2012 with intention to provide surgical skill training and cultivate humanistic values. In each workshop, 4 to 6 Silent Mentors are initiated and ten medical students are assigned to one mentor. The program includes receiving the Silent Mentor within six hours of death and placing into deep freezer, performing home visits to the relatives to know the life story, medical illness, verbal or written final wish of the donors and their expectation on medical students, preparing their own mentors before, during, and after each workshop, presentation about their mentors before workshop and at gratitude ceremony and sending off their beloved mentors by medical students and relatives after gratitude ceremony. The students have the opportunity to learn anatomy and basic surgical skill on their mentors over three evenings, and also opportunity to take care of their mentors with utmost respect during the program. Until to date, we conducted 21 workshop sessions. Over 800 medical students from local and oversea universities have been trained by volunteer trainers. Within six years, many pledgers with great love have signed up to donate their bodies for medical education and research in this holistic approach. Aim: (1) To study the characteristics of donors for Silent Mentor program. (2) To describe their final wishes and expectation on medical education, training and research. Methods: Retrospective analysis of the demographics, social characteristics and final wishes of donors who had contributed to the Silent Mentors Program of University Malaya, based on information derived from their registration data and home visits. Results: From March 23, 2012 until March 28, 2018, 1174 individuals have signed up for this program, and 84 had already served as Silent Mentors. Most died due to cancer. Among them, 42 were men and 42 were women. Sixty were Buddhists, 13 Christian, 4 Catholic, 2 Hindu, 3 Taoism and 2 from other religion. Their final wishes expressed that medical students and doctors are able to learn procedures from their donated body to become skillful doctors to help suffering patients in future. They also wished that students may become caring doctors and will contribute to the medical field regardless of monetary benefits. They hoped that medical students develop the heart and soul of a holistic doctor. Conclusion: Silent Mentor program offers a different approach in medical education and research. There was no gender difference among the donors. Most of selfless Silent Mentors wished that they can help to train students to become not only competent, but also empathic and compassionate doctors.
Barriers to Cancer Evaluation Follow-Up: Reasons and Predictors of Missed Visits in a Rural Population in Botswana
Authors: Tapela N. , Gabegwe K. , Barak T. , Iyer H. , Botebele K. , Mmalane M. , Lockman S. , Dryden-Peterson S.
Published: September 2018

Background: Missed clinical appointments contribute to delayed cancer diagnosis, treatment, and ultimately poorer outcomes. In Botswana, a middle income sub-Saharan African country where oncology treatment is available for free to all citizens, median time from first facility visit to treatment initiation is 160 days (IQR: 59-653). Aim: To identify patient and visit characteristics associated with missing appointments, and describe reasons for missed visits among adult patients undergoing evaluation for possible cancer at public facilities in a rural district in Botswana. Methods: Patients ≥ 18 years with symptoms or signs suggestive of cancer were enrolled in the Potlako trial, an ongoing prospective health systems pilot seeking to improve timely diagnosis and treatment of cancer. Study staff tracked patient visits and if a patient missed a visit, study staff administered a brief structured phone interview to 1) determine reasons, 2) reschedule visit and 3) arrange transport support if needed. Patients who enrolled and completed follow-up between May 1, 2016 and March 23, 2018 were included in analysis. We used logistic regression (STATA v12) to explore predictors of missed visits (patient as defaulter vs not, visit being missed vs not). All factors significant in univariate analysis ( P < 0.05) were included in final models. Results: A total of 488 cancer suspects completed their cancer evaluation following a median of 7 visits (IQR: 4-11) and 125 days (IQR: 55-228). Breast and cervical cancer were the most commonly suspected malignancies. Median age was 49 (IQR: 33-64), 358 (73.4%) were female, 143 (28.4%) had an ultimate diagnosis of cancer. There were 172 missed visits, involving 94 (19.3%) patients (defaulters), including 20 (21.3%) found to have cancer, of whom 38 (39.6%) missed more than one visit. Defaulters tended to be less than 40 years (aOR 0.49, 95% CI: 0.31-0.79) and had their first visit for cancer evaluation at a general outpatient unit (aOR 2.1, 95% CI: 1.15-3.87). In the adjusted model, we found no statistically significant association between defaulter status and gender, final diagnosis, and patient's next-of-kin. Missed visits were more likely to occur on Fridays (aOR 1.50, CI: 1.05-2.15) and less likely to occur ±1 week around a public holiday (aOR 0.55, CI: 0.33-0.91). Leading reasons for missed visits were: work obligations (18.0%), family duties including child care and attending funerals (16.3%), prohibitive transport fees (10.5%), not remembering appointment date (8.7%). Conclusion: Multiple visits are required to complete evaluation for cancer suspects and missed visits are common. Our findings suggest possible interventions to improve efficiency, which include: simplifying diagnostic cascade, transport support, visit reminders, intensified counseling for younger patients and those seen at general outpatient clinics, and avoidance of Friday scheduling.
Employment Challenges Faced by Breast Cancer Survivors in an Upper Middle–Income Asian Setting
Authors: Kong Y.-C. , Bhoo-Pathy N.T. , Wong L.-P. , Aziz A.F. , Taib N.A. , Yehgambaram P. , Yusof M. Md. , Subramaniam S. , Yip C.-H. , Bhoo-Pathy N.
Published: September 2018

Background: Cancer survivorship as an area, which focuses on the health and life of an individual following cancer diagnosis and treatment is increasingly being recognized as an important component of the cancer control continuum. Advances in breast cancer detection and treatments have resulted in a growing number of patients experiencing a breast cancer diagnosis at an age when career plays an important role in their lives. Yet, very little is known on how breast cancer affects employment and return to work among survivors, particularly in low- and middle-income settings. Aim: This qualitative study aims to gain an in-depth understanding on employment challenges and motivators/barriers in return to work faced by breast cancer survivors in an upper-middle income Asian setting. Methods: Eleven focus group discussions (FGDs) were conducted with breast cancer survivors representing various ethnicities and socioeconomic backgrounds in Malaysia. Patients diagnosed one to two years prior to the study were recruited from a general public hospital, a public academic hospital and two private hospitals. Data from the FGDs were examined using thematic content analysis from the NVivo software. Results: The major themes relating to impact of cancer diagnosis on employment were “decreased work ability”, “job loss”, “long absenteeism” and “hostile work environment”. Coping strategy themes frequently mentioned to offset income loss from employment changes were “savings”, “part-time work” or financial support from “family/friends” or “social security”. However, participants were quick to highlight the insufficiency and unreliability of these strategies to cope financially in the long run. When describing their decision in choosing to return to work, participants mentioned themes such as “need money”, feeling “more happy” or having a “supportive work environment”. Nonetheless, participants emphasized the “discrimination” they faced in finding a job after active treatment. Specifically, participants' frequent need to take time-off from work for their cancer follow-ups as well as their older age were perceived as disadvantages in seeking employment when compared with younger, healthy applicants. Conclusion: It is evident that a breast cancer diagnosis severely disrupts employment and return to work in middle income settings. Multisectoral interventions are urgently required to improve the employment status of our cancer survivors, including legislative reforms to prevent discrimination. Programs supporting employment and return to work among cancer survivors should be developed and integrated in the provision of a holistic survivorship care.
Reduction of Breast Cancer Treatment Delay as a Result of Efforts Carried Out by Two Brazilian NGOs
Authors: Andrade M. , Santos T. , Andrade L. , Oliveira M. , Gomes K. , Araujo C. , Oliveira T. , Weller M.
Published: September 2018

Background: Brazilian breast cancer patients present disease often at advanced stages (III, IV). Previous studies indicated that system delay is a causal factor of bad prognosis and increased mortality rate. In the state of Paraíba, northeast of Brazil, two non-governmental organizations (NGOs) Américas Amigas and Mulheres de Peito de Campina Grande (MLDP), promote faster access to treatment by donating diagnostic mammography and biopsies as well as anatomo-histopathological and immunohistochemical analysis. Aim: The current study aimed at evaluating the effectiveness of the assistance provided by both NGOs and comparing patient flow between HNL and FAP, two reference cancer centers in João Pessoa and Campina Grande, respectively. Methods: Time-to-treatment was analyzed for different time intervals between first medical consultation and initiation of treatment. Comparison was performed between three groups of patients: 40 patients from Hospital Napoleão Laureano (HNL) in João Pessoa; 80 patients from Fundação Assistencial da Paraíba (FAP) in Campina Grande and 15 patients from FAP, who received support from the NGOs. Kaplan-Meier analysis was performed to compare time-intervals among the groups. To estimate the impact of socioeconomic variables Cox regression analysis was performed. Results: Mean time-interval between first medical consultation and hospital admission was 135 (SD=21.0), 370 (SD=73.7) and 515 (SD=36.6) days, for patients of HNL, MLDP and FAP, respectively ( P = 0.0021). Time intervals analyzed for patients within the FAP hospital, between first medical consultation and hospital admission, tended to be shorter for patients who were assisted by the NGOs, compared with those who did not receive any assistance from the NGOs. Patients who had consulted specialized oncological health services beforehand had an increased chance (HZ=2.32; 95% CI: 1.17-4.60; P = 0.016) of being admitted at the reference hospital within 90 days after the first medical consultation, compared with those who had not consulted such specialized services. There were no significant differences between HNL and FAP, regarding the time interval between hospital admission and treatment initiation ( P = 0.21). Conclusion: The assistance to patients provided by the two NGOs, aimed at speeding up the diagnosis process, accelerated patient flow between first medical consultation and admission at the hospitals. Regarding HNL, patients from the inland had been sent by primary health units in their municipalities, directly to the cancer reference hospital in João Pessoa, without being referred to an in-between health service. Such procedure explains the variation of time intervals when admissions at FAP and HNL are compared. The results of the current study indicate that by providing faster breast cancer diagnosis, the NGOs’ mediation can significantly improve patient flow.
Palliative Care Initiative for Cameroonian Women With Metastatic Breast Cancer
Authors: Nkegoum B. , Mboumtou L. , Nguedia A. , Ndjangueli L.H. , Tiaya L. , Dongmo A. , Christian T.
Published: September 2018

Background and context: Among the 1.6 million women diagnosed with breast cancer each year worldwide, 1500 cases occur in Cameroonian women, 99% of which arise at advanced stage as there is no organized screening program in the country. Most of the women die because of lack of good diagnostic technique, lack of good treatment and medical insurance. 99% of Cameroonian women with breast cancer probably need palliative care and this is only well established in three medical centers. Most of these women are abandoned and will die in rural areas where they are managed by marabous and traditional healers. Our team has 22 years of experience in cancer screening, diagnosis, treatment and research in Cameroon. This year, SPARC METASTATIC BREAST CANCER CHALLENGE (SPARC MBC) is offering a unique opportunity to enhance our skills, particularly for women with metastatic breast cancer through this pilot initiative. Aim: To establish a pilot palliative care initiative for Cameroonian women with metastatic breast cancer and improve their quality of life. Strategy/Tactics: Using social media and an ambulatory patient care program, we plan to: 1) Establish a holistic palliative care pilot program; establish home visits and perform regular telephone calls to patients. 2) Introduce collaborations with traditional healers 3) Initiate training for health professionals. 4) Develop communication strategies for patients and provide them with psychosocial support. 5) Implement strategies for the provision of pain relieve drugs such as morphine. Program/Policy process: Advocacy visits to communities, hospitals and universities; training of community health professionals, social workers and traditional healers; and mobilization of breast cancers patients. Outcomes: It is expected that through this project, we will improve number of breast cancers detected, increase accessibility to treatment and palliative care for women diagnosed with breast cancer, reduce progression to advanced stages and mortality due to breast cancer, improve treatment outcome particularly among women with advanced stages of breast cancer, trained health professionals on palliative care and breast cancer control. What was learned: SPARC MBC is now offering a unique opportunity for Cameroonian women. We have started a sustainable palliative care program. Health professionals and social workers are now following training, mostly using social media for long distance training, or onsite in our institution. Unfortunately, we overadvertised during the first phase of this program and we are afraid we may not be able to cover the whole country and this may be discriminating or frustrating for some patients. On the other hand, some patients are now coming to our center from some neighboring countries with other cancer subtypes like prostate, cervix, liver, etc. as advertisement with WhatsApp and other social media is widespread and we are afraid we will be unable to cover this epidemic.
Characterization of Research Priorities Among LMICS: A Qualitative Content Analysis of Cancer Control Plans
Authors: Das I. Prabhu , Kostelecky B.
Published: September 2018

Background: The Cancer Resolution approved at the 2017 World Health Assembly highlighted the need to improve the evidence base for cancer prevention and control through research. Research priorities articulated in national cancer control plans can promote effective cancer control, especially in low and middle-income countries (LMIC) that bear a significant cancer burden and where local research is scarce. Understanding how LMICs address research in their cancer control plans may enhance integration of research and control efforts. Aim: We sought to systematically identify and characterize the research priorities in select LMIC cancer control plans. Methods: LMIC plans published in English and in 2016 or later, that met World Bank and Human Development Index criteria and were identified. Key terms were used to identify relevant research-related content. A systematic, inductive approach was used to examine for clusters of concepts or topics, and codes were applied to characterize the research priorities into categories, phases, types, dimensions and aspects. Results: A total of 12 LMIC plans were deemed to be eligible for the analysis. Two overarching categories of research-related content were identified: Establishing a Research Agenda (ERA), where specific types and topics of research were articulated, and Building Research Capacity (BRC), for content describing intention to plan or facilitate research. Six LMICs included a total of 67 ERA priorities involving five types of research. Health Services Research was the most frequently reported type of research (31%). The research topics in the treatment/management phase were most frequently identified (30%). Three of the six countries had the most number of ERA research priorities. A total of 126 BRC priorities were identified across five dimensions. Two BRC dimensions were most frequently proposed: Enhance Cancer Surveillance (44%) and Establish Research Infrastructure (24%), and subsequent aspect codes elucidated a range of activities. Five aspects characterized focal areas in cancer surveillance while two aspects revealed focal areas for research infrastructure. Country-specific variation in ERA and BRC priorities were seen. Priorities were mapped to illustrate the breadth and depth of research priorities in LMICs' plans. Details of the distribution of research by country and by dimensions will be discussed. Conclusion: This first comprehensive examination of research priorities in LMIC cancer plans revealed countries' commitment to incorporate research into their cancer control efforts. The extent of research-related priorities demonstrates promise for transnational research collaborations. Next steps include improved understanding of key factors in achieving successful integration of research and control efforts through cancer control plan implementation.
The Effects of Empowerment-Based Intervention on Self-Management in Patients Under Cancer Treatment
Authors: Huang H.P. , Hsu Y.M. , Su L.Y. , Chi C.L.
Published: September 2018

Background: Early diagnosis of cancer and improved therapeutic effect supports better survivorship for cancer patients. Quality of life and other health status has become more important nowadays. Assisting cancer patients to acquire self-management (SM) behavior during and after treatment are helpful to maintain a healthy status. Aim: This interventional study aims to evaluate the effectiveness of empowerment strategy which provides knowledge of disease and coping strategy. The objects are assessed before and after the empowerment strategy, including patients' awareness of disease and treatment plan, physical condition (laboratory examination data and image results), empowerment, SM, and physical/emotional distress. Methods: Patients diagnosed within 3 months with cancer undergoing treatment were recruited. Participants will be given 5 interviews and telephone follow-up while a 6 months' empowerment strategy of SM will be used in all participants. Results: A total of 384 participants were recruited between January 2016 and March 2017. At baseline, 304 participants (99.7%) were receiving treatment, and over 94% of all participants kept receiving treatment during the following 12 weeks. Awareness of the disease: In the 12-week trial, proportion of participants' understanding of their disease improved to over 95% in many aspects, including size of tumor (88.2%), stage (94.4%), genetic tests (51.0%) and their chronic disease history (91.8%). And about the cell type of tumor, it increased from 65.1% to 81.4%. Awareness of the treatment: A 25% of participants didn't know the date and type of surgery at baseline and the proportion reduced to 11.3% at the 12th week. At baseline, part of the participants didn't know the date and plan of radiotherapy (30.9%), chemotherapy (6.6%) and target therapy (15.9%). After the 12 weeks of trial, the proportion reduced to 19.2%, 0.6% and 4%. To sum up, participants knew their disease better during this 12-week trial. Awareness of laboratory examination and image: The number of participants who used handbook to follow image and laboratory data increased from 60.9% to 83.1% in 12 weeks. By recording examination results on their handbook voluntarily, participants knew their disease status better. Empowerment, self-management and physical/emotional distress: In the 24-week trial, empowerment and self-management ability of participants increased from 45.7% and 65.8% to 52.6% and 74.5%. This strategy also gradually reduced the physical and emotional disturbance. The average distress thermometer score decreased from 4.1% to 1.8%. Conclusion: This project aims to raise patients' knowledge of treatment strategy and build up SM ability, further improve emotional and physical disturbance.
Maximal Strength Training for Breast Cancer Patients Undergoing Adjuvant Treatment
Authors: Cešeiko R. , Tomsone S. , Srebnijs A. , Vētra A. , Timofejevs M. , Purmalis E. , Eglītis J.
Published: September 2018

Background: Breast cancer (BC) patients lose muscle strength during adjuvant treatment, thus affecting physical functioning. Maximal strength training (MST), with an emphasis on velocity in the concentric phase, improves maximal strength and walking efficiency. However, the effect of MST for BC patients undergoing treatment remains elusive. Aim: The aim of this study was to examine the feasibility and effects of such training in BC patients during clinical treatment on maximal muscle strength and functional performance. Methods: Thirty patients (46 ± 9 yr) with stage I-III BC were randomized to training group (TG) or control group (CG). TG performed MST twice a week for 3 months and CG followed prescribed BC treatment without strength training. TG performed four sets of four repetitions (4×4) of dynamic leg press with an emphasis on the maximal mobilization of force in the concentric action and with a progressively adjusted intensity corresponding to 85%–90% of one repetition maximum (1RM). Results: After the MST period, TG displayed significant 25 ± 7 kg (23%) increase in leg press 1RM ( P = 0.001). The strength improvements led to a significant increase in 6 minute walk distance (8%), 30-second chair test (23%), stair climb test (17%), and to a significant increase in walking performance of (8%) measured on an incremental treadmill test to exhaustion. In 3 months' posttest CG displayed significant 10 ± 8 kg (9%) decrease in 1RM ( P = 0.006). Reduced muscle strength leg to a significant decrease in 6 minute walk distance (6%), 30-second chair test (14%), stair climb test by (8%), and walking performance reduced significantly by (17%). Significant changes from pre to 3 months' posttest were observed between TG and CG in all functional performance measured variables. Conclusion: Maximal strength training was feasible during treatment and increased maximal muscle strength in BC patients. Increased strength led to improved functional performance after 24 training sessions each lasting only 20 min. Our results suggest that application of MST could accompany clinical training as a part of the treatment of BC patients. This training form showed excellent improvements in physical function tests and, thus should be implemented as a part of the breast cancer rehabilitation programs.
Alexithymia in Breast Cancer Patients and Their Sisters in Seoul
Authors: Maudgal S. , Han W. , Mishra V. Shukla
Published: September 2018

Background: The incidence of breast cancer has more than doubled in South Korea since 1999. Breast cancer in the family affects other members such as first degree relatives. Alexithymia is a psychological construct related to an inability to express ones feelings and has been found to be useful in identifying individuals who might benefit from targeted counseling to address distress. Aim: The purpose of this study was to examine the levels of alexithymia in breast cancer patients, their sisters and healthy controls in South Korea with the aim of identifying individuals who will benefit from targeted counseling. Methods: The Korean version of the alexithymia questionnaire was used to compare the groups. The study group consisted of 98 breast cancer in-patients, out-patients, follow-up cases and lymphedema clinic attendees undergoing treatment at the Breast Care Center, Seoul National University Cancer Hospital, 50 sisters and 43 healthy controls. Results: The highest level of alexithymia was reported in patients, followed by their siblings. Healthy controls reported the lowest level of alexithymia. Difficulty in describing feeling scores has shown significant negative correlation with age and marital status among women with breast cancer. Women 51 years and above and married women have lower scores than those below 50 years aged women and those who are single, in a live-in relationship, widowed or divorced. No such significant correlation was observed among siblings and control group. The intensity of cancer was a significant predictor of the alexithymia score. Patients with T4 stage disease reported the highest levels of alexithymia. No significant differences were found among patients with lower staging. Conclusion: Not only breast cancer patients, but also their sisters show significantly more alexithymia than their healthy counterparts. Counselors can use the alexithymia questionnaire to identify persons who require support to prevent or reduce psychological problems in patients and siblings.
The Value of Contrast Enhanced Ultrasound in the Location of Sentinel Lymph Node in Breast Cancer
Authors: Luo J. , Feng L. , Wu C. , Luo J. , Chen J. , Chen Q. , Liu J.
Published: September 2018

Background: Sentinel lymph node (SLN) location and biopsy was designed to minimize side effects of axillary dissection with equivalent outcomes. Aim: To evaluate the feasibility of periareolar injection of contrast agent SonoVueTM followed by ultrasound (US) for identification and localization of SLN in breast cancer patients with clinically negative node. Methods: From July 2017 through January 2018, 130 women were enrolled in the study. SonoVueTM was injected periareolarly and followed by US to detect enhanced sentinel lymphatic channels (SLCs) and SLNs 1 minute later after massage. The patients were randomly divided into two groups to locate the first enhanced SLN: 1) US-guided marker placing; 2) US-guided nano-carbon (N) injection into SLN. Compare the number of SLNs detect by CEUS with blue dye (B) or N mapping, and the coincidence rate of the first SLN located by CEUS with those traced by the B and N. Lymph nodes that were dark, blue, with marker or clinically positive were considered sentinel nodes and to be biopsied. Results: 121 of 130 patients with breast cancer patients injected with ultrasound contrast agents had detected a total of 254 enhanced SLNs (range 1-5, 2.1 ± 1.05) compared with total of 342 SLNs (range 1-5, 2.83 ± 1.10) mapping with B or N. 42 of 45 first SLNs located with marker matched with first SLNs stained with N (42/45, 93.33%); 70 of 76 first SLNs using N injecting directly guided by CEUS matched with first SLNs stained with B (70/76, 92.1%). In another 9 cases without enhanced SLN, 4 of them didn't stained with N or B, and 5 were stained. The sensitivity of SLNs detection by CEUS was 96.03% (121/126), and the accuracy of locating the first SLN was 92.56% (112/121). Conclusion: CEUS has good accuracy in the detection and localization of SLNs in patients with breast cancer.
Kick Cancer: Utilizing the Force of Football as a Catalyst to Effect Positive Change and Awareness About Prostate and Testicular Cancer in UAE and Globally
Authors: Merai H.
Published: September 2018

Amount raised: Funding will be through public donation and corporates participating in campaign. Background and context: Kick Cancer, a new campaign from Shanab, a men's health initiative by Friends of Cancer Patients' (FOCP) UAE that addresses prostate and testicular cancer. Launched March 20, 2018, Kick Cancer aims to tap into the emotive force of football as a catalyst to effect positive change and awareness about prostate and testicular cancer. It highlights the importance of early detection and endeavors to eliminate stigmas surrounding both types of cancer. The campaign will run from 20 March until the 15 May 2018. Aim: The innovative and global Kick Cancer campaign aims to empower men of all ages to speak up in relation to the issue by harnessing and amplifying football's power as a force for good. Combining a relevant, purposeful and powerful social message with the influence of football celebrities to bring people together for a common cause. The campaign utilizes the power of the sport to communicate the positive message “from good football, to football for good.” Strategy/Tactics: The community is encouraged to participate in the Kick Cancer campaign and spread the message by completing the #BinChallenge. With the participation of Barcelona FC striker Luis Suarez whom participated in the campaign by starring in a public awareness ad launching the #BinChallenge. Furthermore, the F2 Freestylers are spreading the message to their substantial online following, demonstrating the #BinChallenge on their channels, which include over 7 million YouTube subscribers and 4.8 million followers on Instagram, and encouraging everyone to take part. The #BinChallenge encourages the public to kick a football symbolizing cancer into a bin, post on social media and tag three friends calling them to accept the challenge and visiting the Web site to learn the signs and symptoms of prostate and testicular cancer. Furthermore, Kick Cancer aims will have 15 school outreach programs to educate kids on the early sign and symptoms of testicular cancer and to empower their fathers to get screened and learn the sign and symptoms of prostate cancer. The school outreach program will also give the children an opportunity to do the #BinChallenge. Program process: •Press conference launch of the Luis Suarez Video and challenge - March 20, 2018 •The F2 Freestyler demonstrating the #BinChallenge to community in the UAE - March 20 until 22, 2018 •School outreach programs - April 15 until May 3, 2018 •Gala Dinner - May 4, 2018 Costs and returns: Production cost of the TV ad of Luis Suarez and marketing production costs. What was learned: Kick Cancer was launched in a movie theater as a movie premiere to release the video and challenge, where media and local social media influencers were invited to view the TV ad and meet the F2 Freestylers. It was very well accepted and adopted by Sharjah Sports Council, Dubai Sports Council, UAE FA and Proleague in the UAE.
Call For Life, 2017 by the Children's Cancer Center of Lebanon
Authors: Tannous N.
Published: September 2018

Call for Life is a mini-telethon aims to spread awareness and calls for the support and instant donations from the community. Amount raised: The last campaign in 2017 raised: $1,463,018.84 with total expected revenues over the period of 3 years: $2,003,018.84. Background and context: The idea first started in year 2008. Four campaigns were done in the past years (2008, 2012, 2014 and 2017). The campaign has developed through the years in donation means, awareness, funds raised, partners, national engagement and has successfully become more efficient and successful due to the process adopted. The 4th edition was in celebration of the 15th anniversary, hence the slogan “Where We Were and Where We Have Become” and focusing on success stories. A special recognition wall was launched at the 4th edition, the “Guardians' Wall”, fitting 18 guardians' names who pledged to donate 15,000 USD yearly over 3 years period. At the D-day we had a special episode hosted by the famous talk show Kalam El Nas by Marcel Ghanem offered for free to CCCL along with all the air time whether for TVC or interviews and reports and outdoor media. A professional call center was activated during the special TV episode. Donation means: calling to register pledges and partner courier company to collect/money transfer company/online/at the center/banks. Aim: Call for Life is a nationwide campaign aims to spread awareness and calls for the support and instant donations from the community so CCCL continues its mission of saving children's lives. Strategy/Tactics: Reviewing previous campaigns exit reports to benefit from remarks Study the best means/mechanism of donations Free and strong media campaign Positive content of promotional material and reports of the episode Send letters to big donors prior to the launching; trying to ensure big donations prior Facilitating the donation means Full special episode on the D-day broadcasted live at peak hour of viewership. Program process: Brainstorming Deciding on means/mechanism and sponsorship packages Setting media campaign's concept, idea and promotional plan set Preparing campaign´s project details and project plan Ensuring call center, short code, and proper dissemination of campaign's information to agents Coordination and preparation of all material and content of a special episode Trying to ensure donations prior to the d-day. Costs and returns: Costs: $6484 Revenues: $1,463,018.84 with total expected revenues over the period of 3 years: $2,003,018.84 What was learned: Call For Life has to have easy and varied donation means. Massive free media campaign is a must with episode at night peak viewership hour. Patient and survivors involvement has an added value. Innovative Guardian´s Wall ensures an appealing recognition which encourages donations. A one week campaign with one main telethon day gives sense of urgency for quick responses. Expenses shall remain minimal.
Let the Data Serve the Patient: Using Big-Scale Data Collection to Improve Small-Scale Patient Interactions
Authors: Rayne S. , Meyerowitz J. , Even-Tov G. , Rae H. , Tapela N. , Klipin M. , Mare I.
Published: September 2018

Background and context: Breast cancer is one of the most common cancers in most resource-constrained environments worldwide. Although breast awareness has improved, lack of understanding of the diagnosis and management can cause patient anxiety, noncompliance and ultimately may affect survival through compromised or delayed care. South African women attending government hospitals are diverse, with differing levels of income, education and support available. Often there is a lack of access for them to appropriate information for their cancer care. Aim: A novel bioinformatics data management system was conceived through an innovative close collaboration between Wits Biomedical Informatics and Translational Science (Wits-BITS) and academic breast cancer surgeons. The aim was to develop a platform to allow acquisition of epidemiologic data but synchronously convert this into a personalised cancer plan and “take-home” information sheet for the patient. Strategy/Tactics: The concept of a clinician “customer” was used, in which the “currency” in which they rewarded the database service was accurate data. For this payment they received the “product” of an immediate personalised information sheet for their patient. Program/Policy process: A custom software module was developed to generate individualized patient letters containing a mixture of template text and information from the patient's medical record. The letter is populated with the patient's name and where they were seen, and an personalised explanation of the patient's specific cancer stage according to the TNM system. Outcomes: Through a process of continuous use with patient and clinician feedback, the quality of data in the system was improved. Patients enjoyed the personalised information sheet, allowing patient and family to comprehend and be reassured by the management plan. Clinicians found that the quality of the information sheet was instant feedback as to the comprehensiveness of their data input, and thus assured compliance and quality of data points. What was learned: Using a consumer model, through a process of cross-discipline collaboration, where there is normally poor access to appropriate patient information and poor data entry by overburdened clinicians, a low-cost model of high-quality data collection was achieved, in real-time, by clinicians best qualified to input correct data points. Patients also benefitted from participation in a database immediately, through personalised information sheets improving their understanding of their cancer care.
Do Age at Diagnosis, Tumour Thickness and Tumour Site Explain Sex Differences in Melanoma Survival? A Sequential Causal Mediation Analysis Using Cancer Registry Data
Authors: Afshar N. , Dashti S.G. , Thursfield V. , Farrugia H. , Giles G.G. , Milne R.L. , English D.R.
Published: September 2018

Background: Previous research has shown that women diagnosed with melanoma have better survival than their male counterparts, but little is known about the underlying mechanisms by which sex affects melanoma survival. Aim: The aim of this study was to quantify the contribution of age at diagnosis, tumor thickness and tumor site to sex differences in 1-year and 5-year melanoma-specific survival. Methods: We conducted a population-based study using cancer registry data including 6,009 men and 5,232 women aged 15-70 years with first primary melanoma diagnosed between 2007 and 2015 in Victoria, Australia. We excluded cases notified via death certificate only. Deaths to the end of 2015 were identified through linkage to the Victorian and national death registries. We decomposed the total effect of sex on melanoma-specific survival into three possible pathways, examining the mediating role of age at diagnosis, tumor thickness and tumor site. The natural indirect effects through the mediators were assessed using weighted, sequential causal mediation analysis. Results: Compared with women, there were 60 (95% confidence interval (CI) 34 to 91) and 201 (95% CI 135 to 267) additional deaths per 10,000 in men within 1 year and 5 years following diagnosis, respectively. Within 1 year following diagnosis, the indirect effect through age at diagnosis was estimated to be 4 (95% CI -2 to 9) additional deaths per 10,000 in men compared with women, explaining 7% of the total effect of sex, while a considerable proportion of the total effect (79%) explained by melanoma thickness [47 (95% CI 32 to 66) additional deaths per 10,000 in men], excluding the potential influence of age at diagnosis on thickness. Similarly, within 5 years after diagnosis, about 13% of the total effect was estimated to be explained by age at diagnosis [26 (95% CI 15 to 38) additional deaths per 10,000 in men] and 86% by tumor thickness [174 (95% CI 142 to 207) additional death per 10,000 in men]. There was no indirect effect through tumor site within 1 year and 5 years postdiagnosis. Conclusion: The lower survival from melanoma of men relative to women appears to be explained primarily by tumor thickness rather than age at diagnosis. Our findings highlight the need for earlier detection of melanoma in men.
4 Good, for Good, for Living Better and Healthier!
Authors: Su L.Y. , Wu C.Y. , Wang C.L.
Published: September 2018

Background and context: Since 1982, cancer has become the leading cause of death in Taiwan. According to a survey done by Ministry of Health and Welfare Taiwan, the death rate of patients diagnosed of cancer without treatment in 3 months is three times higher than those under proper treatment. Aim: To focus on patients education and encourage self-management. To improve relationship between patients and medical professionals. To improve the patients' awareness of their own rights. To make sure that patients go through the entire treatment phases so as to increase the survival rate of cancer patients. Strategy/Tactics: Good 1: Understand it- to know the cancer stage and cell type. Good 2: Face it- to receive proper information about treatment and to take initiative during discussion and decision making process about treatment. Good 3: Treat it- to understand the specific treatment of cancer and to reach out for help regarding soothing side-effects and self-care strategies so as to maintain better quality of life while lowering impact of the disease. Good 4: Beat it- to go through the entire treatment phases, while following principles such as balanced diet, regular exercise etc. to boost energy for the fight. Program/Policy process: HOPE PASSPORT as a self-management tool Short films Advertisements in MRT trains. Press conference and broadcast Official Web site and Facebook page Outcomes: 4806 copies of HOPE PASSPORT were issued (2017/7-2017/11) Short films: 340,000 views on YouTube and 150,000 views in the movie theater. Posters in 66 cancer resource centers and 134 hospitals in Taiwan (2017/6-2017/12) were displayed. Additionally, advertisements on METRO Tamsui-XIngyi Line (2017/6/14-2017/7/12) and short film on platforms were displayed (2017/11/1-2017/11/30). Press conference: 6 reports on newspaper, 2 on TV, 99 on Internet news and 1 on magazine. Official Web site and Facebook page: 509,421 visits on official website (2017/6-2017/12) and 5,620,019 views on Facebook (2017/6-2017/8). What was learned: Using the “HOPE PASSPORT” as a self-management and communication tool, patients' awareness of the disease, the treatment and results of the examination were improved. It also showed both empowerment and self-management ability of patients increased. “4 Good” as a positive and strong slogan brought the main 4 steps for patients to fight their cancers.
What Proportion of Cancers in the UK and Its Constituent Countries Could Be Prevented? An Updated Analysis
Authors: Brown K. , Rumgay H. , Dunlop C. , Ryan M. , Quartly F. , Cox A. , Deas A. , Elliss-Brookes L. , Gavin A. , Hounsome L. , Huws D. , Ormiston-Smith N. , Shelton J. , White C. , Parkin D.M.
Published: September 2018

Background: Understanding population-level exposure to cancer risk factors is vital when devising risk-reduction policies. By reducing exposure to cancer risk factors, many cancers could be prevented. But what impact on cancer incidence do these risk factors have? And what proportion of cancers could be prevented if these risk factors are avoided? Aim: The aim of this analysis was to update the estimates of the number and proportion of theoretically preventable cancers in the UK to reflect the changing behavior as assessed in representative national surveys, and new epidemiologic evidence. Separate estimates were also calculated for England, Wales, Scotland, and Northern Ireland because prevalence of risk factor exposure varies between them. Methods: Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. Results: Around four in ten (38%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (39%) than UK females (37%). Comparing UK countries, the attributable proportion for persons was highest in Scotland (41%) and lowest in England (37%). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight and obesity, accounting for 15% and 6%, respectively, of all cases in the UK in 2015. Conclusion: Around four in ten (38%) cancer cases in the UK could be prevented. Tobacco and obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to reduce the level of harm associated with exposure or reduce exposure levels - both approaches may be effective in preventing cancer. The variation in PAFs between UK countries is affected by sociodemographic differences which drive differences in exposure to theoretically avoidable 'lifestyle' factors. PAFs at UK country level have not been available previously and they should be used by policymakers in the devolved nations to develop more targeted public health measures. This analysis demonstrates the importance of nationally representative exposure prevalence data and cancer registration in informing evidence-based public health policy.
Primary Cutaneous T-Cell Lymphoma in Hospital Kuala Lumpur, Malaysia
Authors: Affandi A. Mohd
Published: September 2018

Background: Primary cutaneous T-cell lymphoma (CTCL) is a group of disorder characterized by proliferation of malignant T lymphocytes primarily in the skin. The frequency and clinicopathological characteristics of CTCL vary in different countries. Aim: The objective of this study was to determine the clinical pattern of CTCL in the Department of Dermatology, Hospital Kuala Lumpur, Malaysia. Methods: A retrospective review of all patients diagnosed with CTCL between January 2005 and December 2017 was conducted in the Department of Dermatology, Hospital Kuala Lumpur. The diagnosis was confirmed histologically and classified based on WHO-EORTC classification. Results: A total of 102 patients were identified. Mean age at presentation was 43.2 ± 20.8 years. 62.7% of patients were male and 37.3% female (male:female ratio 1.7:1.0). 50.0% of patients were Malay, 28.4% Chinese, 15.7% Indian and 5.9% from other ethnic groups. The commonest type of CTCL was mycosis fungoides (MF), which accounted for 82.4% of patients. This was followed by primary cutaneous CD30+ lymphoproliferative disorder (primary cutaneous anaplastic large cell lymphoma in 7.8%, and lymphomatoid papulosis in 2.9% of patients). Subcutaneous panniculitis-like T-cell lymphoma was seen in 3.9% of patients and Sézary syndrome seen in 2.9% of patients. 36.9% of patients with MF had hypopigmented MF variant. Other variants of MF were not common (erythrodermic MF in 6.0%, poikilodermatous MF in 6.0%, granulomatous MF in 3.6% and pagetoid reticulosis in 1.2% of patients). Majority of patients (68.7%) were in early stages of disease (Stage IA-IIA). Most patients had skin directed therapy, which included topical steroids in 79.2%, NBUVB in 39.6% and PUVA in 31.7% of patients. Commonest systemic agent used was methotrexate (10.8%), followed by acitretin and interferon (5.0% each). Only 2.0% of patients had localized radiotherapy and 1.0% of patients had total skin electron beam therapy. Chemotherapy was given in 6.9% of patients. Data on outcome was available for 81 patients. 19.8% of patients had complete remission at last follow-up, 48.1% had partial remission, 17.3% had refractory or progressive disease and 14.8% died of the disease. 19.8% of patients were lost to follow-up. Conclusion: Patients with CTCL from our institution were younger, with a mean age at presentation of 43.2 ± 20.8 years. This is in contrast with data from Surveillance, Epidemiology and End Results (SEER) registries between 1973 and 2009, which indicated that CTCL tends to occur in an older age group, above 55 years of age. Similar to other studies, we also found CTCL to be commoner in male patients (male:female ratio 1.7:1.0). The commonest type of CTCL in our patients was mycosis fungoides (MF). 36.9% of patients with MF had hypopigmented MF variant, which is consistent with other studies where hypopigmented MF were found almost exclusively in persons of color.