bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Technology (Breast Self Examination Animation Video) in Breast Cancer Screening in Indian Tribal Rural Women
Authors: Mayilvaganan S. , Agarwal G. , Agarwal A.
Published: September 2018

Background: The Lifeline Express or Jeevan Rekha Express is World´s first hospital train run by the Impact India Foundation. It was developed in collaboration with the Indian Railways and Health Ministry and has been funded by Impact UK, international charitable sources, Indian corporate houses and individuals. It started on July 16, 1991; as of 2016 the service had completed almost 200 projects, benefiting over 900,000 rural Indians. Aim: This study aimed to study the role of superspeciality doctor (endocrine and breast surgeon) in this setting. Methods: The specialist surgeon was assigned a task screen and teach the importance of breast self examination in the rural setting. The women were divided into batches of 50 and were shown a PowerPoint presentation with a video on breast self examination. The screening was done by 2 female general surgeons and any kind of abnormal finding was consulted to the endocrine and breast surgeon. At the end of 15 minutes lecture on screening and breast self examination, the ladies were provided a pamphlet on breast self examination in their native language and also advised and requested to teach another 5 women in the community. Results: 1000 ladies were screened and taught them the importance of breast self examination. Each lady was requested to teach another 5 women in the community. Patients with breast cancer (6 ladies) were appropriately referred and treated in a tertiary referral hospital. 120 patients had mastalgia, treated with dietary measures and first line drugs evening primrose oil and vitamin E. 1 month telephonic follow-up revealed 60% ladies taught on a average 4 other ladies and was compliant. 2 patients who had abscesses was aspirated. Out of 6 patients with breast cancer 5 were locally advanced breast cancer (1 fungating breast cancer). The average duration of tumor was 34 ± 12 weeks. Other cancers like thyroid cancer and oral cancer were detected and treated appropriately. Conclusion: Technology with the intent to serve the rural community should be the motto to provide improved health care to the neglected rural women.
Perspectives of Nurses in Africa and Canada Regarding Having Conversations About Sexuality With Cancer Patients
Authors: Fitch M.
Published: September 2018

Background: Cancer treatment can have a significant impact on an individual's quality of life. In particular, body image and sexuality can be compromised. There is increasing evidence that conversations about these specific consequences are not happening often between cancer patients and health care providers, especially in busy clinical settings. Aim: This work will contrast the perspectives of nurses caring for cancer patients in Canada and in Africa regarding having conversations about the topic of sexuality with patients and family members after a cancer diagnosis. Methods: Data were collected through interviews with nurses (n=34) in Canada and through small group discussions with nurses (n=25) in Africa. Data were reviewed using a descriptive qualitative approach, identifying significant themes. Results: Overall, participants acknowledged treatment can have an impact on a patient's sexuality. If conversations occurred, it was during consent processes before treatment began or when a patient raised a question about a specific side effect. These conversations rarely covered more than the physical changes and did not focus on the impact of changes on emotional and personal relationships or intimacy. Most providers waited for patients to raise any concerns or questions. Most participants expressed their own personal discomfort and lack of training for holding these types of conversations. They perceived the conversations as difficult for themselves as well as for patients. The topic of sexuality was often described as a taboo topic, especially in Africa, and one that was influenced strongly by cultural perspectives. Having time and privacy to hold the discussions were also seen as barriers. Conclusion: The findings support the need to clarify role responsibilities for cancer nurses, as well as other members of the cancer care team, about patient care regarding the area of sexuality, and the provision of education.
Cancer-Free Drive in Rural India: Constituency Wise Initiatives by Member of Legislative Assembly
Authors: Hazarey V. , Deshmukh A.
Published: September 2018

Background and context: Reducing the rate of cancer through awareness and prevention programs as well improvements in screening and treatment techniques is paramount. Citizen especially in rural India tend to neglect health due to routine chores of family life. The nonavailability of facilities worsen the issue. Tobacco habits leads to potentially malignant disorders and oral cancers. There is increasing trend of breast cancer, uterine and cervical cancers and also oral cancers. In India oral cancers are main cancers in males. Member of legislative assembly is public representative to represent state of Maharashtra. Cancer Free Constituency Drive was for creating awareness and screening for villagers. Katol is a rural constituency. There are 288 constituencies in Maharashtra state. Aim: 1) To create public awareness of all types of cancers. 2) To provide diagnosis and investigations and treatment to affected population. 3) Capacity building of young medical and dental professionals in cancer diagnosis and paramedical workers in screening all types of cancers. Strategy/Tactics: 72,056 house visits by 220 Asha workers and 129 nursing students and 30 dental interns to sensitize about 3,00,000 people through well designed brochure for all cancers. Self-Mouth mirror examination was designed for oral cancers and awareness against tobacco. The persons with complaints were told to visit camps on scheduled dates at 10 primary health centers. Program/Policy process: The mammography facilities and Papanicolaou test examination, dental examination in mobile vans and self-mouth mirror examination for oral cancers with trained professional carried out diagnosis in 10 primary health centers with the help of experts in medical and dental professionals. Suspeced cases were referred to tertiary referral medical hospitals. Outcomes: 5100 (males 2216 and females 2954) with complaints visited. Total 813 patients suspected to have cancers were examined by specialists from gynecology(84) general surgery (374) otorhinolaryngology (77) pediatrics (37) dermatology (19) and dentistry (131). 38 abnormal on mammography in 132 females, 55 abnormal reports from Pap smears in 472 females were evaluated, however no cancer detected in three months span. Twelve cases of oral cancers were detected and treated. Six breast cancers were detected and treated. Seven other cancers were reported by medicine and pediatric specialists. 150 cases of potentially malignant disorders were also identified. 90 had the oral submucous fibrosis (inability to open the mouth) caused due to areca quid chewing. The self-mouth mirror examination helped to create awareness against tobacco. What was learned: Awareness of cancer leading to early detection and treatment is possible in rural areas through “Cancer-Free Constituency”. The concept will help to pave the way for improved strategies and policies to better control occurrence and treatment of cancer and to address tobacco related health disparities across cancer care continuum.
Development of a Nurse Navigator Programme for the Care of Breast Cancer Patients
Authors: Rawther S. Chillakunnel Hussain , Pai M. Shivananda , Fernandes D.
Published: September 2018

Background: Breast cancer incidences in India are rapidly rising, amounting to a significant percentage of all cancers in women. The diagnosis and expenses for treatment make the patient to thrust on a journey that disorganizes their daily function and family roles with much fear and uncertainty. The care of the patients requires a comprehensive individualized care from a pivotal nurse to meet their informational and educational needs, support, and care coordination throughout their illness trajectory. Limited studies have been reported from developing countries on specific nursing roles in cancer care. Therefore, the researcher felt the need for developing a nurse navigation program for the care of breast cancer patients. Aim: The aim of the study was to develop, validate and assess the usefulness of the program in women with breast cancer. Methods: The content of Nurse Navigator Program was prepared by reviewing literature pertaining to nurse/patient navigation programs. The program has been validated by an expert committee consisting of experts from various fields. The program consists of preoperative education on surgery and postmastectomy care, progressive muscle relaxation training, information booklets on post mastectomy care, chemotherapy and radiation therapy, telephonic follow-up sessions and ONN visits. Readability testing of the information booklets was checked online by Flesch reading ease and Flesch Kincaid-Grade level. The educational program and information booklets were translated into Kannada and retranslated into English with help of 2 experts. Researcher had undergone training in progressive muscle relaxation. Finally the usefulness and acceptability of the program was tested in 60 breast cancer patients undergoing surgery followed by chemo/radiation therapy in surgery, chemo and radiotherapy wards of a tertiary care hospital in Karnataka. After obtaining ethical permission from institutional ethical committee written informed consent was obtained from participants before conducting study. Results: The mean ICVI, SCVI/UA and mean expert proportion of the Nurse Navigator Program was found to be −1.00 for each. Flesch reading ease was 77.3 and Flesch Kincaid-Grade level achieved was 4.8. 83.3% of women strongly agreed that information booklets were useful, 80% strongly agreed the user friendliness of this program & 70% of people reported that their emotional needs were taken care seriously and got additional emotional support. 90% strongly agreed navigation services are necessary and would recommend navigation service. Conclusion: The validated Nurse Navigator Program was found acceptable and useful for patients. The whole program may give evidence on the effectiveness of a nurse navigator program for the care of women with breast cancer. If significant effects are detected this program could be implemented in the hospital setting to improve cancer care.
Life Keychain: Prevention on Your Hands
Authors: Gomez T. , Bublitz G.G.
Published: September 2018

Amount raised: The amount raised is $170,000 composed of the cost of kits, which serve as teaching material for the realization of awareness about prevention and cure of breast cancer, called Life Keychain. With this amount, it was possible to teach 100,000 women from all over Brazil who participated and 1 mi people who received this knowledge. Background and context: The late detection of cancer tumors is still the main challenge faced by physicians. In breast cancer, the later the disease is discovered, the lower the chances of cure, causing the patient to receive palliative rather than curative treatment. In Brazil 58,000 new cases are estimated per year, leading to 14,000 women suffering from the disease to death - 60% of cases are diagnosed in advanced stages. It can be considered that in Brazil 134 cases are diagnosed per day - 5 cases per hour. In this scenario, actions can be taken in two instances: curative and preventive. Tactics/Strategy: Development of lectures focused on how to detect and prevent breast cancer; target audience: women; each participant receives the kit and build it, appropriating the knowledge that represents each piece that is part of the key ring, becoming a MULTIPLIER; and participants have a counterpart to retransmit to other people. Program process: The program process starts from a need to develop a volunteer event, composed by and represents: Ring - focus on the breast cancer; Line - the trajectory of fight, chemo, radio, surgery, medicines taken for 5 years and the balance we need to have to overcome; 1st knot - the prevention; 1st smaller ball - the early diagnosis, through mammography, can detect tumors up to 1 mm, chance of cure up to 95%; 2nd knot - the courage; 2nd ball - the self examination, being able to touch and feel a lump and if diagnosed, the possibility of cure is up to 70%; 3rd knot - the determination; 3rd ball - the Brazilian reality, around 50% of Brazilian women arrive at an advanced stage and the possibility of cure is around 30% or even less; 4th knot - the faith; and heart - life and hope let us embrace life. Costs and returns: The Life Keychain, a social product, is sold for US$ 1.71. The project is self-sustaining by the bravery and power of volunteer work, by the sensitivity of the theme and by the financial cost of the kit. This investment ends up generating an impactful return to society with people better prepared to prevent one of the major diseases. The greatest result is the return and recognition of the population. What was learned: The greatest learning is to always want to do good to women and be rewarded by a smile, a successful treatment and a sincere thank you from people who have recovered. The echo of this chain of good has worldwide recognition with the presentation of this case in World Congress in Poland, Paris and Colombia. And finally, each new case brings a series of learning, because each person is different and has different needs.
Passive Smoking Has the Same Negative Effects on Reproductive Hormones in Adult Males as Active Smoking
Authors: Bassey I. , Akpan U.O. , Isong I.K.P. , Udoh A.E.
Published: September 2018

Background: Smoking is an extremely lethal act and is associated with many illnesses. Lately, major concerns that passive smokers face the same health risks if not higher as active smokers have been raised. Some studies have shown that active smoking is associated with low levels of vitamins and testosterone. Are these facts also valid in passive smokers? Aim: The aim of this research was to estimate the levels of cotinine, testosterone, follicle stimulating (FSH) and luteinizing hormone (LH), prolactin, vitamin E and catalase and compare these parameters in male active and passive smokers. Methods: Serum levels of cotinine, testosterone, FSH, LH, prolactin and vitamin E and catalase were estimated in 60 cigarette smokers, 60 passive smokers and 60 nonsmokers recruited from Calabar metropolis. The hormones were assayed using ELISA and vitamin E using HPLC. Sociodemographic and anthropometric indices were obtained and data analyzed using PAWstatistic 18. The level of significance was set at P < 0.05. Results: Cotinine levels were significantly ( P = 0.0001) higher in active smokers than in passive smokers and controls. Vitamin E and testosterone was significantly lower in active ( P = 0.003 and P = 0.0001) and passive smokers ( P = 0.0001 and P = 0.0001) when compared with nonsmokers. The mean catalase level of active smokers only was significantly ( P = 0.043) lower than that of the controls. The FSH of the active smokers were significantly higher ( P = 0.034) than those of the controls while the passive smokers had the highest LH values ( P = 0.0001). However, there were no significant variations in the prolactin levels among the three groups. About 3% of the active smokers had testosterone levels less than 3 ng/mL (hypogonadic) but none of the passive smokers or controls had testosterone levels less than 3 ng/mL. Conclusion: Passive and active smoking depletes vitamins E and lowers testosterone levels. This may be a contributing factor to male infertility both groups of smokers.
Kythe Flying: A Strategy for Donor Retention
Authors: Lorenzo M.F.
Published: September 2018

Amount raised: $21,765.00 (2016 to 2018/$1:Php51.00). Background and context: Kythe Foundation Inc. is an NGO which supports the Child Life Program for children with cancer in eight partner-hospitals. Aside from acquiring grants, the foundation needs to raise unrestricted funds to support operation costs. It is a challenge to recruit donors, but what is more challenging, is how to retain these donors. Aim: Kythe Flying was conceptualized in 2016 to retain corporations who have engaged Kythe in previous years. The corporations who participate in Kythe Flying have either donated cash, or conducted corporate social responsibility activities in and out of the hospital. Strategy/Tactics: The strategy is to invite corporations to buy a big corporate kite for $295.00. Prior to flying the kites, they are given an opportunity to play outdoor games with the children, which serves as a team-building activity for the corporation as well. Program process: The Kythe team gets a list of corporations from its database. Marketing letters are sent, and upon receiving $295.00 with their company logo, the Kythe team forward the logo to the kite manufacturer. Other corporations are invited to give away their products (e.g., water bottles). On the day itself, 60 children from partner-hospitals go to Amoranto stadium, and are given lunch and snacks. After which, they are assigned to each corporation. Kythe core volunteers facilitate the games. After an hour of outdoor activity, each corporation is called, and given the go signal to fly their corporate kites, together with the children. Photos of each corporation´s activities are then posted on Kythe's social media platforms. Costs and returns: There are at least 20 corporations who join the event per year. An average cash amount of $6274 is raised annually, less $2940.00 to cover logistical costs, for a total of $3334. In-kind donations like water bottles, ice cream, toys, etc. amount to $3921. We are therefore able to raise an average of $7255 a year. What was learned: In 2016, we implemented the project in July. There was a typhoon and we almost cancelled the event. We have moved up the event to the first quarter of the year ever since. Here are some feedback from our participating donors in the 2018 Kythe Flying event: “Our synchrony volunteers who joined last Saturday are still raving about the wonderful time they had with the kids at the kite-flying event”- Christine Briones Plata, AVP Synchrony Financial. “I look forward to seeing you and the team next year, but hopefully before, for a hospital visit”- Ian Wilson Country Manager, Cormant Technology. To enjoin more corporations, Kythe in the future, will collaborate with hot air balloon festival organizers. This will entail at least one year planning due to its scale. This is challenging but quite exciting!
A Comparative Study on the Levels of Anxiety of Pediatric Oncology Patients With and Without Exposure to the Kythe Child Life Program
Authors: Fernandez A.S.
Published: September 2018

Background: In the Philippines, there is a growing number of young children diagnosed with life-limiting illnesses. A survey conducted by the Philippine Cancer facts and estimates (2006) found out that some 3500 Filipino children are diagnosed with cancer yearly. However, there is a dearth of hospital-based programs that aim at addressing the psychosocial needs of pediatric chronically ill patients and their families. Aim: The study looked at the level of anxiety of school-aged children with hematologic and oncologic illnesses exposed to a hospital-based child life program for at least six months, as well as, those of school-aged children with hematologic and oncologic illnesses who have not had any exposure to a hospital-based child life program. A comparison was made between the levels of anxiety of the two groups. The study aims to show the value of a hospital-based psychosocial program and hypothesized that chronically ill children exposed to the services of a hospital-based child life program have lower levels of anxiety compared with the children who have not had any exposure to such. Methods: This quantitative, quasi-experimental study employing a posttest only group design, compared the levels of anxiety of 80 children ages 5-11 years old diagnosed with hematologic and oncologic illnesses who were exposed to a hospital-based child life program for at least six months against those of children with hematologic and oncologic illnesses who have not had any exposure to such a program. The Child Drawing: Hospital, a validated and reliable tool used to provide a measure of the anxiety level of the hospitalized child as expressed by the child himself was used. Results: Using independent t-test to analyze the data, the levels of anxiety between the two groups show a significant difference. Results show that children who have been exposed to a hospital-based child life program had low levels of anxiety while those who have not had exposure to the such a program had average to high levels of anxiety. Conclusion: Children who have access to the services of a hospital-based child life program experienced significantly lower levels of anxiety as compared with their counterparts who are not exposed to such a program. The results support the value of child life services and, as such, should be considered an integral part of quality pediatric health care and essential in family-centered care and best-practice models of health care delivery for children.
The Impact of in Intervention Program on Oral Cancer Awareness and Practice of Preventive Behaviors in High-Risk Indigenous Community in Sarawak, Malaysia
Authors: Maling T.H. , Doss J.G. , Low W.Y.
Published: September 2018

Background: Oral cancer is highly prevalent among indigenous people in Sarawak as this population lacks awareness and is known to practice high-risk habits. Aim: This study aimed to develop and evaluate the impact of an educational intervention to improve oral cancer awareness and practice of preventive behavior among high-risk indigenous communities in Sarawak, Malaysia. Methods: A quasi-experimental study was undertaken involving adults in a Bisaya community (with high risk habits) in Limbang, Sarawak. The intervention group received a structured, Health Beliefs Model (HBM) theory-based oral cancer education module, while the control group was exposed to the conventional oral cancer education method during Ministry of Health's community oral cancer and precancer screening program. Face-to-face interviews using a validated structured questionnaire were conducted to obtain baseline information prior to intervention and after one and three months. Descriptive and multivariate statistics were used for analyzing the data using SPSS software. Results: The overall response rate was 99.5%. The final sample comprised of 204 respondents (89 in the control group and 115 in the intervention group). At baseline, 75.1% of respondents had heard about oral cancer, however their in-depth knowledge on risk factors, signs and symptoms and prevention were lacking. The control group had better awareness than the intervention group. Smoking and alcohol drinking were more prevalent in the intervention group, whereas betel quid chewing and practice of mouth self-examination (MSE) were more evident in the control group. At 1-month and 3-month follow-up, there were significantly higher mean scores in all aspects of oral cancer awareness among respondents in the intervention group and these improved levels of awareness were maintained over a period of 1- and 3-months. There were higher proportion of smokers, alcohol drinkers and betel quid chewers in the intervention group who reported quitting their habits or reducing the number of cigarettes smoked per day, frequency of alcohol drinking and betel quid chewing than the control group. The respondents in the intervention group also had significant increase in uptake of MSE and higher proportions who performed it once a month. Conclusion: The structured HBM-based oral cancer health education intervention was shown to have significant impacts on oral cancer knowledge and awareness, cessation and reduction of risk habits and increased the uptake of MSE among respondents in the intervention group of this indigenous community. Therefore, the introduced structured health education intervention is recommended for other communities in Malaysia that practice the same oral cancer risk habits. Considering this indigenous community is of lower socioeconomic status (SES), the introduced intervention could also be extended to other lower SES groups in Malaysia.
Minding the Gap: Addressing the Lack of Awareness and Supportive Services for Cancer Patients and Caregivers in Limited-Resource Settings
Authors: Taylor C.
Published: September 2018

Background: In limited resource settings, physicians, particularly oncologists, are overburdened and there is an enormous health literacy gap between patients, caregivers and their doctors. Additionally, patients and caregivers are often required to travel great distances to unfamiliar cities to access cancer care. As a result, these patients and caregivers who require instruction and education about their illness are often overlooked and left uninformed, frightened and confused about their treatment and future. Aim: To fill gaps in education, navigation and awareness for cancer patients and caregivers during treatment. Provide practical information specific to their disease and treatment, encourage patient compliance with treatment and to equip them with the knowledge and resources that could have a positive impact on the patient's outcome as well as ease burden on the overtaxed hospital staff. Methods: Working in partnership with local and international cancer control experts, health ministries, clinicians, advocates and caregivers to build and introduce a program consisting of 2 components; patient/caregiver information/navigation support, at 5 sites in Colombia and Vietnam in 2018. The information component will comprise of a series of short videos/info-graphics providing culturally and resource appropriate information about cancer, its treatment, risk factors, treatment options, side effects and precautions including advice on hygiene, nutrition/diet. The navigation component engages hospital staff to map and provide local information and resources on affordable lodging, food and transportation services. Both components will be easily adaptable for each location, and accessible to varying levels of literacy via TV/video monitors/kiosks located in key areas of the hospital and via printed materials. If available, we will network to vetted local social media and Web based resources. Results: We will document the project through conference calls and site visits. We will convene stakeholders and beneficiaries to provide feedback on the implementation and effectiveness of the project. In the absence of a specific advocacy body to apply to for certification, we will use our advisory board, comprised of clinical experts in the field to provide feedback, guidance and critique in the development/evaluation of the materials. The feedback, along with analyses of the project outcomes, will be included in a final report, presented at appropriate conferences and published in relevant professional publications. Conclusion: Expected results: Increased patients' and caregivers' knowledge of cancer and cancer treatment Improved patient's and caregiver's levels of perceived support Reduced stress for patients and caregivers Increase compliance to treatment Reduced patient support burden for hospital staff
Approaches and Strategies for Habit Intervention in Smokeless Tobacco/Arecanut/ Betel Quid and Non-Starting
Authors: Shrestha A.
Published: September 2018

Background: Although adequate research has been conducted regarding smoking and smokeless tobacco, there is a dearth of research exploring reasons for chewing areca nut and betel-quid. Global epidemiology of areca nut and betel-quid shows distinct ethnic and cultural preferences. Areca nut is chewed for its psychological stimulating effects and perhaps, a medicinal value. To develop empirically supported treatments and to promote nonstarting, healthcare workers and researchers must first understand the reasons people engage in the behavior. Aim: To discuss evidence based approaches and strategies for habit intervention in smokeless tobacco/arecanut/betel-quid and nonstarting. Methods: Data were collected from published national and international research, conference reports, WHO reports, tobacco control guides, Clinical Best Practice Guidelines and Cochrane database systematic reviews. Results: Individual behaviors are largely determined by complex range of factors beyond the control of the most individuals. Behavior change is complex and most people are well-informed about the basic health messages. Most people will have extensive experience of attempting to change their health career including quitting tobacco products. It is therefore essential to know a detailed history of a person's previous experiences of change and learn from this. Interventions need to match individuals' desire and ability to change. Encouragement, understanding, support, and empathy are all essential to enable clients achieve their goals. The most effective preventive intervention that a clinician can provide for tobacco-using patients against is an empathic, personalized smoking cessation intervention program with extended assistance and follow-up. The goal of the intervention must be complete cessation. Reduction provides no direct health benefits to the individual. Oral examination by a dental professional who points out tissue damage from smokeless tobacco use in a user´s own mouth, advice to quit, and brief problem solving and supportive counseling are effective in promoting smokeless tobacco cessation. There is also a need to develop culturally tailored areca nut and betel-quid cessation and risk reduction programs, the first step in reducing the public health burden associated with betel-quid chewing worldwide. Interventions are available, but underutilized, in part due to lack of clinician training and organizational support. Conclusion: Although the deleterious effects of smokeless tobacco/areca nut/betel-quid are well known by both users and healthcare workers, the knowledge has not translated effectively into cessation. Proven, brief, repetitive, directed interventions tailored to the needs of the patients can increase successful cessation. Controlling sociodemographic, environmental and personal factors may promote nonstarting.
Experience and Impact of a Locally-Based Peer, Volunteer Cancer Support Programme in Hospital Melaka, Melaka Malaysia
Authors: Chua M. , Silvathorai V. , Muniasamy M. , Hashim H.S. Mohd , Lim C. , Junazli N.I. Binti , Choo S.L. , Low K.Y.
Published: September 2018

Background: Melaka is a small southern state in Peninsular Malaysia. On average, the state has an annual incidence of 200 odd breast cancer patients, largely treated out of its public, subsidized, single tertiary treatment center of Hospital Melaka. Hospital Melaka is an 800-bedded hospital with multiple specialties including surgery and radiology. Though the hospital does not have a dedicated oncology department, cancer treatment is carried out via phone consultations and visiting oncologists as well as a team of on-site nursing staff who are trained to initiate and monitor treatment. Feedback from Hospital Melaka staff highlighted that there was a drop-out rate of about 30% of patients from the treatment journey. Qualitative interviews with different stakeholders including patient revealed that the drop-out may be driven by factors such as: i) fear of surgery, ii) fear of chemotherapy, iii) fear of disfigurement, iv) loss of spouse v) emotional distress and shock; and vi) delay in waiting times for different levels of diagnostics and treatment. Aim: The aim of the initiative was to reduce the rate of patients who defaulted out from the cancer treatment journey via a three-pronged approach: a) improving understanding about cancer and treatment by patients and family members; b) integrating peer-support into the clinical treatment pathway at the hospital and reduction of waiting times; and c) maintaining a continuous interaction with the patient throughout the treatment journey. Methods: The inception and deployment of a locally-based peer, volunteer support program for breast cancer patients and families as part of the formal cancer treatment process in Hospital Melaka. Volunteers were consisted of a trained mix of cancer survivors, current and retired healthcare practitioners and provided information pertaining to treatment and care aspects of breast cancer as well as emotional support and follow-up of patients via phone or in person to ensure compliance to treatment. In this study, we engaged with various stakeholders including hospital management and clinicians. Then, support group's services were formalized into the care pathway for all patients with breast cancer; with both volunteers able to send and receive patient referrals. Results: Statistically significant reductions in patient delays in decision-making to seek treatment as well as a significant decrease of 12.5% in the number of defaulters. Conclusion: A support program built with support from all stakeholders and run by volunteers and embedded within the formal care process acts as a catalyst to enhance both service delivery as well as keeping patients engaged on the cancer care journey.
Prevalence and Characteristics of Smoking Among School-Going Adolescents in Kuala Lumpur, Malaysia
Authors: Low K.Y. , Singh S.J. Jag , Hashim H.S. Mohd , Lim C. , Junazli N.I. , Choo S.L. , Munisamy M.
Published: September 2018

Background: According to the World Health Organization (WHO) (2014), noncommunicable diseases (NCDs) such as cancer, cardiovascular disease and respiratory disease account for a majority of premature deaths in the Malaysian population. Tobacco smoking remains a leading risk factor for these diseases. Although there have been previous population-level studies which have highlighted adolescent smokers in Malaysia, little has been done to specifically ascertain smoking prevalence within a school-going population using objective measurement tools. Aim: This study aimed to identify the prevalence of school-going adolescent smokers in Kuala Lumpur via an objective measurement - expired carbon monoxide (CO) in parts per million (ppm). Methods: This study was a cross-sectional study that involved 2,679 high school-going adolescents aged between 13 to 18 years old in Kuala Lumpur, Malaysia. The level of exhaled CO (Smokerlyzer test) of all the participants was measured. Participants were also administered with a survey conducted right after the Smokerlyzer test to determine i) whether they smoked or not; ii) type of tobacco products used if smoked; iii) vaping or shisha usage; and iv) exposure to secondhand smoke. The categorization of smoking status was based on CO-ppm reading: ≤ 3 ppm (nonsmoker); 3 < ppm ≤ 6 (light smoker or nonsmoker breathing in poor air quality or passive smoke inhalation); ≥ 7 ppm (regular smoker with higher levels of CO in blood). Descriptive analysis was conducted to determine the demographics of the study population. Inferential analysis was carried out utilizing χ2 tests or Student t-tests to test associations between smoking status and other independent variables. One-way ANOVA test was conducted to compare the differences in CO-ppm readings. Results: The mean age of the adolescents (n=2,679) was 14.5 ± 1.2 years old (median: 14) and 55.1% were male. Interestingly, vaping was the most commonly used method of tobacco use among the studied adolescents, regardless of gender, followed by cigarettes and shisha. The mean CO-ppm reading for male adolescents was significantly higher than female adolescents. Passive smoke inhalation (exposure to secondhand smoke) was significantly associated with higher readings of CO-ppm. A significant association was determined between status of exposure to secondhand smoke and a history of usage of any form of tobacco products. Conclusion: The prevalence of smoking adolescents, regardless of gender, in Kuala Lumpur remains at a worrying state. Objective measurements such as Smokerlyzer test can be coupled with self-reported questionnaire in targeting adolescent smokers within a structured setting such as a school and can help form part of an effective school-based smoking cessation intervention program targeting adolescents in Malaysia. This is in line with efforts to make Malaysia a smoke-free nation by 2045.
Interventions for Maximizing Quality Communication in Cancer Care: A Systematic Review of Systematic Reviews
Authors: Licqurish S. , Pattuwage L. , Chima S. , Qama A. , Emery J.
Published: September 2018

Background: Clinician communication has shown to influence cancer patients' perception of care and satisfaction. Effective communication is therefore a critical aspect of patient-centered care. Health services should be implementing evidence-based communication interventions to improve the provision of cancer care to patients. Aim: We conducted a systematic review of the literature with the aim to identify effective communication strategies and/or interventions to improve clinician-patient communication. Methods: Five electronic databases (MEDLINE, Embase, PsycINFO, the Cochrane Library and CINAHL Plus) were searched for relevant citations from 2005 until October 2015 using search terms related to “cancer”, “information” and “communication”. Titles and abstracts were evaluated by two independent reviewers. Selected full text publications were assessed against the eligibility criteria. Quality was assessed using the AMSTAR guidelines and GRADE. Due to the enormity of the literature, only systematic reviews were included. Results: The database search yielded 2934 unique citations, of which 198 full texts were retrieved. After applying the inclusion and exclusion criteria, 41 systematic reviews were included. The included studies were broadly categorized under six major themes: e-health, technological and telephone-based interventions (n=9); patient education and tools (n=5); communication training (n=9); education interventions to improve cancer pain (n=6); tools to facilitate patients' participation in care/decision making (n=8); nurse delivered interventions (n=6). Conclusion: There are an enormous number of studies of communication interventions for cancer patients. The quality of the evidence to support some of these interventions is low; whereas other interventions have stronger evidence of effectiveness. Therefore, health services and clinicians should carefully consider which interventions they choose to implement. The recommendations from this review will assist clinicians and health services to choose evidence-based interventions which can improve care provision and/or patient outcomes.
Establishing Cancer Information Service in Ghana
Authors: Opoku P.
Published: September 2018

Background: African Cancer Organization (ACO) seeks to establish a Cancer Information Service (CIS) Centre in Accra, Ghana to offer information about cancer prevention to the general public and businesses. The whole idea is to promote awareness of cancer and early detection through culturally sensitive and linguistically appropriate cancer information and education programs. The project will navigate people to appropriate facilities for screening, further diagnosis, management and support. This we believe will help prevent people from getting exposed to avoidable cancer risk factors and also help downstage cancers by early-detecting the disease at stages where cure is often possible, which will ultimately help avert the currently prevailing high incidence of cancers in Ghana. Aim: The goal of the project is to ensure that everyone living in Ghana who is eligible has access easy to free cancer information service. The project will establish the needed infrastructure and also build capacity of personnel required to provide cancer information service to the general public and businesses. Methodology: Trained cancer information specialists will provide a one-on-one interaction by telephone, e-mail, instant messaging, social media, in-person visit or on-site business visit. The service will be free and confidential. The project involves setting up an office, distribution of information, education and communication (IEC) materials to educate businesses and the general public about cancer, its prevention, risk factors associated with the disease, sign and symptoms of cancer, cancer diagnosis, treated, management and support systems available. ACO CIS, tailored to the socioeconomic and cultural context, is to ensure that cancer information is available to everyone who is eligible. Conclusion: There is solid evidence that making cancer information available and diagnosing it at an early stage will reduce deaths from cancer, and the success of interventions intended to detect cancer at an early stage greatly depends on cancer education and awareness and sensitivity to the needs, beliefs and unique circumstance of the target population. Although much remains to be learned about cancer, enough is now known about the causes of cancer and means of control for suitable intervention to have a significant impact. Most Africans cannot currently access curative therapies, state-of-the-art surgery or expensive cancer drugs that are the mainstay of cancer care in developed nations. At the same time between 30% and 50% of cancers are preventable, and a third of all cancers could be cured if detected early. Therefore, scaling up prevention and early diagnosis will be the most cost-effective ways of dealing with cancer. ACO is by this looking for partners with similar mandate to collaborate to establish and sustain the CIS.
The Case of Cyprus: The Psychosocial Needs of Women Living With MBC
Authors: Christodoulidou S.
Published: September 2018

Background: According to international research, it has been found that women with metastatic breast cancer (MBC) have different needs and live different realities than other women. It has been our observation that this is also the case within the Cypriot community, where these realities are often overlooked and rarely discussed, as ignorance, stigma and cultural taboos make women with MBC hide in the shadows. Even though the Republic of Cyprus offers a high standard of medical services for cancer patients, it has been identified that there is more focus on primary breast cancer. Despite the high level of knowledge and advocacy in Cyprus the number of women living with MBC has not been recorded in the National Cancer Registry, therefore the general incidence of MBC in Cyprus remains unknown. Aim: The project recognizes the research gap in understanding the needs of women with MBC in Cyprus, and therefore aims to raise awareness and voice their experiences. The objective is to generate a databank of the experiences and needs of women with MBC that may be a stepping stone in ensuring that MBC is embedded in national cancer strategies. Also, the project aims to improve accessibility to information on MBC and contribute in the prevention, early detection and treatment of breast cancer in Cyprus. The knowledge obtained from this initiative aims to empower patients and advocacy groups. Methods: The project is based on a collaboration between researchers from Europa Donna Cyprus, the Bank of Cyprus Oncology Centre, and the University of Nicosia. This project will recruit MBC patients from all over Cyprus and will use a mixed methods approach. Initially, researchers will assess the quality of life of MBC patients using the SF-36 Measuring Quality of Life Questionnaire. Data analysis will be performed using IBM SPSS. In the second phase, patients will be invited to take part in a qualitative study based on individual interviews regarding their experience of living with MBC. The data obtained will be analyzed using the interpretive phenomenological analysis method. Results: We are currently in the process of data collection and we expect to obtain results by summer 2018. Conclusion: It is expected that the data analysis will offer insight into the lived experiences of women with MBC, identify any challenges that they might face, and what coping strategies women use to overcome them. This knowledge can then be translated and implemented into awareness campaigns, conferences, electronic and printed information materials, but more importantly used as leverage in advocating and influencing decision makers to take actions and adjust national strategies in relation to MBC. Finally, we expect that this project will motivate other researchers to engage into further research of the experience of MBC in Cyprus. Disclosure: Dr. S. Christodoulidou received grant/research sponsorship for this project by SPARC UICC/PFIZER.
Cancer Treatment Among the Elderly in the United States: Complexities of Aging and Comorbidities
Authors: Pham T. , Jiang S. , Rositch A.
Published: September 2018

Background: As the life expectancy of Americans becomes longer, the number of individuals who are diagnosed with cancer and other comorbidities increases rapidly. Management of these patients can become increasingly complicated as physicians administer multiple combinations of drugs and therapies. However, the complexities of how age and comorbidities affect receipt of cancer treatment are not well understood. Aim: To explore the association between age, comorbidities, and subsequent cancer treatment in the elderly diagnosed with the four most common types of cancer in the United States. Methods: We used SEER-Medicare data, which covers 28% of the U.S. population, to explore the association between age, comorbidities, and receipt of cancer treatment within 6 months of diagnosis in 727,136 individuals over 65 years old and diagnosed with breast, colorectal, lung, and prostate cancer from 1992-2011. Comorbidity burden was measured using the Charlson Comorbidity Index (CCI) and analyzed as four quantities (Q1: lowest CCI score to Q4: highest CCI score). Poisson regression models were used to assess the associations between comorbidities and cancer treatment, and whether age modified this relationship. Results: Cancer treatment proportion declined rapidly with age for all cancers while median CCI scores increased with age among breast, colorectal, prostate cancer patients and appeared stable among lung cancer patients. For example, individuals aged 76-99 had higher CCI scores ( P < 0.001) and were less likely to be treated (69.8% vs. 81.1% of those age 66-75 year; P < 0.001). After adjustment for potential confounders, we found that high CCI scores (Q3-Q4) were associated with substantially lower cancer treatment rates compared to low CCI score (Q1) in all cancer patients aged 76-99. Regarding individuals aged 66-75, high CCI scores (Q3-Q4) were not associated with lower colorectal cancer treatment rates, and only the highest CCI score group (Q4) was associated with a modest reduction in breast and prostate cancer treatment rates compared to low CCI score (Q1) (PR [95% CI]: 0.97 [0.95-0.99] and 0.91 [0.88-0.93], respectively). Additional multivariable analysis showed that older patients (aged 76-99) with low CCI score (Q1-Q2) had equal or lower treatment rates compared to younger patients (aged 66-75) with the highest CCI scores (Q4). Conclusion: Our findings suggested that among those aged 66-75 years, comorbidities are less likely to influence the receipt of treatment when compared to individuals aged 76-99. The potential harms and benefits of treatment given these age by comorbidity interactions are not clear, but using curative interventions that only have a modest benefit in a highly comorbid aging population could potentially decrease patients' quality of life.