bluuebunny/crossref_metadata_2025 huggingface dataset:
Inequities of Access, Utilization and Clinical Outcome of Lung Cancer in Indonesia
Authors: Ramadani R.V. , Thabrany H. , Putri A.E.
Published: September 2018

Background: Indonesia integrated all social health insurance and social assistance program into the National Health Insurance Scheme (NHIS) aiming to achieve universal health coverage by 2019. Currently, 194 million people are registered in the NHIS. Lung cancer absorbed a significant amount of the NHIS Indonesia and one of the leading cause of deaths among men in Indonesia. Lung cancer is rising major public health concern due to a high prevalence of smokers yet most lung cancer is diagnosed at late stage leading to short survival rate in Indonesia. Aim: This study aimed at investigating access, utilization, and clinical outcomes of lung cancer's patients. The second aim is to investigate differences in access to treatments of lung cancer patients among different member groups of the NHIS. Methods: The data were drawn from a 2014-2015 claim of the NHIS. The number of lung cancer patients of the outpatient's care was 5939 in 2014 and was 6595 in 2015. The number of inpatients diagnosed with lung cancer was 8969 and 9455 respectively for 2014 and 2015. Descriptive analysis was performed to investigate the differences in access, utilization (consumption), and in clinical outcome across class and membership. Results: Access to treatment of lung cancer patients was 0.5 for outpatient care and 0.7 for inpatient care per 10,000 members. This prevalence was higher compared with the national reported prevalence of lung cancer which was 0.3 per 10,000 populations. However, access and utilization among poorer members (third class and PBI membership) were only 0.1 for outpatient and 0.2 for inpatient per 10,000 members. The quality of treatment mortality and self-discharges were 6.04% and 5.68% compared with the higher class of members which account for 0.48% and 2.31% in 2015. Conclusion: There were inequities in access, utilization, and clinical outcomes among lung cancer patients suggesting disparities of supplies side and nonfinancial barriers among lower socioeconomic groups. The authors suggest the national and local governments should accelerate to produce oncologists and subnational cancer centers to ensure access among NHIS members.
Addressing the Lack of Psychosocial Supportive Services for Cancer Patients in Low-Resource Settings: Adaptation of a Peer Mentoring Program in Vietnam
Authors: Le P. , Taylor C.
Published: September 2018

Background and context: In limited resource environments such as Vietnam, there is a severe lack of informational and instrumental support offered to newly diagnosed cancer patients. As a result, patients and caregivers are often left uninformed, frightened and confused about their treatment and future. Additionally, due to the stigma that surrounds cancer in many countries, patients are often discouraged from openly discussing their disease, even among family and friends. This can have a tremendous psychological impact on patients and interfere with their ability to seek and receive the medical care they need. Aim: Provide psychosocial support for newly diagnosed breast cancer patients in Vietnam. Strategy/Tactics: Adapt a well-established peer-to-peer mentoring program (Woman to Woman) to three major oncology hospitals in Vietnam. Program/Policy process: - Conduct interviews and group discussions with key stakeholders to assess feasibility and acceptability of adapting the Woman to Woman program to the Vietnam context. - Develop resource-appropriate, culturally-relevant, and context-specific materials (training modules, cancer information and resources, assessment scales and questionnaires). - Launch the adapted program, with commitment from local stakeholders. - Monitor progress and evaluate program effectiveness. - Advocate for scale-up of the program through local organizations and government entities. Outcomes: - Reduced patient distress. - Increased cancer awareness among patients and caregivers. - Reduced burden on hospital staff. - Increased skills and self-efficacy among peer mentors. What was learned: - Engagement of local stakeholders in initial assessments is key to ensure buy-in. - Program adaptation must consider the different needs of the local policy and environment contexts, not just national-level and cultural issues. - Empowering cancer survivors requires the incorporation of their diverse voices and experiences.
Music for Wellness: An 8-Week Study of the Psychosocial Effects of Music Therapy on Cancer Patients
Authors: Tynan D. , Skaczkowski G. , Hedigan J. , Wilson C.
Published: September 2018

Background: Music therapy offers patients a way to address the psycho-social impacts of a cancer diagnosis and treatment. Research suggests that complementary therapies, such as music and art therapy, provide an opportunity for patients to express their emotions and make meaning of their experiences, as well as providing social connections to other patients. A better understanding of the specific benefits that may be achieved from these programs and the mechanism through which this might occur will help us better tailor services to patients' needs. While an increasing number of cancer care centers now offer complementary therapies as a way to support patients with cancer, there are few prospective evaluations that examine the benefits derived from program completion beyond patient satisfaction measures. Aim: The aim of this project is to examine the impact of music therapy on specific patient reported outcomes and the factors that influence how and why this occurs. Methods: Participants in an 8-week group music therapy program will be asked to complete a suite of measures prior to program commencement, and at 1-week and 1-month postprogram completion. Measures include core constructs of well-being such as distress, quality of life and symptom severity, as well as constructs specifically targeted by the music therapy program, such as meaning making, emotional expression and social connectedness. A waitlist control will provide comparison data at comparable time-points. Results: The music therapy program will run from April-May 2018, with the postprogram evaluation being completed in June 2018. Preliminary data will be presented and the suitability of this method will be considered. Conclusion: In the context of a comprehensive cancer center in Victoria, Australia, we will present data on the effectiveness of a music therapy program for addressing patients' well-being. We will discuss implications for the provision of supportive care for cancer patients and survivors and how the design of future programs might be tailored to achieve key outcomes.
Effectiveness of a Mobile Image Based Teledentistry Tool to Screen Oral Potentially Malignant Lesions Among a Rural Population in Tamil Nadu, India
Authors: Poorni S. , Srinivasan M.R.
Published: September 2018

Background: Considering the vast landscape, and the huge in-country disparity among the distribution of dental manpower, the role played by nonprofessionals is pivoted in the delivery of dental care, especially among the rural Indian population. Traditionally dental professionals have been involved in the screening of oral cancers and oral potentially malignant lesions (OPML) which precede most oral cancer lesions. The recent advent of videographic enabled mobile Internet technology provides an opportunity to be used as tele-dentistry based screening tool involving nonprofessional health providers for screening of OPML. Aim: This study was aimed to determine the effectiveness of a mobile based oral cancer screening program among a rural population in Tamil Nadu, India using nonprofessional health providers. Methods: The study was conducted among 300 Dravidian adults (35 to 44 years) who were part of a rural oral health screening program. During the first phase, a trained male health worker (MHW) graphically recorded the oral cavity of those subjects who had any alteration in the color or surface characteristic of the oral mucosa and/or restriction in mouth opening. Recordings were done in a systematic manner using a Moto G smart phone with 8 megapixel camera and flashlight. Images with file size of maximum 20 MB were saved in Jpeg format and transferred to a hard disk. After the first phase, a calibrated dentist (SP) examined the subjects under standard lighting using a type 3 examination. A punch biopsy was taken and histologic examination was done for confirmation of the diagnosis. Results: Among the 300 subjects examined, 23 subjects were identified as having mucosal alterations by MHW. When cross assessed by the dentist, 19 out of the 23 were clinically diagnosed as having OPML, which were histologically confirmed. Leukoplakia was the most common lesion (12/19) followed by erythroplakia and oral submucous fibrosis. Conclusion: The results of the current study throws light on the effectiveness of a mobile image based screening tool, which could be used for early assessment of OPML by nonmedical personnel, especially for those risk populations who lack access to primary dental care.
Monitoring and Evaluation of Union for International Cancer Control (UICC) Fellowships on Cancer Control
Authors: Donaldson S. , Samson M.
Published: September 2018

Background: UICC provides international fellowships to cancer professionals, with over 6000 to date, allowing them to learn new skills they can implement at home. It is crucial to monitor and evaluate the fellowship program so it remains in tune with the cancer community's needs and has a long term impact. Aim: To monitor and evaluate UICC fellowships to ensure they serve to reinforce the cancer care workforce worldwide. Methods: An online survey was performed in December 2017 as part of a larger mixed methods study to evaluate long term impact. 154 UICC fellows who had completed a fellowship between 2013 and 2016 were invited to take part. Participants were asked questions on their fellowship experience and more in depth interviews will be performed to further investigate impact. Results: The survey response rate was 75%, with 117 respondents. The vast majority of fellows work in hospitals, treatment centers and research institutes; 67% are academic cancer professionals and 35% clinicians, with most working in the fields of cancer detection, diagnosis and cancer treatment. Over 57% of respondents rated the training received as “extremely effective”, and 95% were still in contact with their host supervisors one year after their fellowship, with 28% copublishing with them. Over 80% estimated that their skills in cancer control had improved “a lot” or “a great deal” thanks to the fellowship training, with 12% saying “a moderate amount” and 1% “a little” or “none at all”. Initiatives taken by fellows upon returning home include the launching of a new cervical cancer screening program, the founding of a national cancer society and the organization of a conference with the host supervisor as an invited speaker. Challenges included the perceived short duration of one month to achieve all the objectives and the language barrier. 28% of respondents were able to apply the skills they learned on their fellowship “extremely effectively”, 44% “very effectively”, 28% “effectively” and 9% “slightly effectively”, with most giving a presentation to members of the home organization, or organizing a workshop or by personal demonstration. Over 43% were able to establish new collaborations in their country, 45% experienced professional growth and 27% increased their supervision of students “a great deal”. Over 90% of respondents would apply for another fellowship and would recommend it to their colleagues. Further results from in depth interviews with fellows will be presented. Conclusion: The majority of respondents were satisfied with their fellowship experience, and have been able to apply the knowledge gained and disseminated it to colleagues at their institutions. Fellowships have resulted in long term collaborations and have allowed fellows professional growth. Overall, the UICC fellowship program is successful in providing successful knowledge transfer to cancer professionals. Long term impact will be assessed in the next steps of the study.
Strengthening the Evidence Base of Cancer Symptom Awareness Campaigns: A Conceptual Framework
Authors: Koo M.M. , Rubin G.P. , Lyratzopoulos G.
Published: September 2018

Background: Cancer control strategies in different countries increasingly encompass public health education campaigns that aim to promote earlier presentation and diagnosis of cancer by raising awareness of possible cancer symptoms. However, the theoretical understanding that underpins these complex early diagnosis interventions remains underdeveloped. Aim: To propose a theoretical framework to guide the design, implementation, and evaluation of cancer symptom awareness campaigns and motivate further relevant research. Methods: Informed by Wilson and Junger's principles of early disease detection for screening (1968) and existing conceptual frameworks for early diagnosis of cancer, we considered the logic model underlying cancer symptom awareness campaigns and relevant emerging evidence from disciplines including health psychology, cancer epidemiology, and health services research. Real-world examples across high-/low-income settings were used where possible to illustrate discussions of implications for practice. Results: We identified four major factors that contribute to the logic model of cancer symptom awareness campaigns beyond contextual and practical factors. Disease burden statistics (cancer site-specific incidence, survival, mortality) could be used to gauge relative need for raising awareness. This should be triangulated with symptom epidemiology (including existing levels of awareness, symptom prevalence, the associated predictive value for cancer, symptom-specific diagnostic timeliness, and whether the symptom is a sign of early stage disease) to motivate selection of individual symptoms in a campaign. Psychosocial factors (such as cancer fatalism or fear and health literacy) and their interaction with symptom awareness should also be considered as they affect symptom appraisal. Further, an understanding and awareness of system factors (availability and access to healthcare, investigation processes, and clinical capacity) will be important for assessing campaign feasibility and knock-on effects in the health system. Based on the above, campaigns should ideally target symptoms that are strongly predictive of early stage (treatable) cancer for which there is low awareness in the target population, and are associated with long intervals to help-seeking. Campaign impact should be amplified by targeting psychosocial barriers to prompt presentation. Additionally, campaigns should be accompanied by downstream capacity planning for potential cancer investigation and subsequent treatment. Conclusion: The proposed framework considers the logic model of cancer symptom awareness campaigns, acknowledging key factors that should be taken into account beyond contextual factors. This could help identify evidential gaps in early diagnosis research, and improve campaign design and evaluation.
Promoting Responsible Lung Cancer Screening Across the United States: Lessons From The Lung Cancer Alliance Screening Centers of Excellence
Authors: Criswell A. , Ciupek A. , Copeland A. , King J.
Published: September 2018

Background and context: In 2010, the National Lung Screening Trial was halted in the United States after showing a 20% reduction in mortality for high risk individuals when three years of annual lung cancer screening was performed by low dose computed tomography (LDCT). Many questions remained about whether this type of screening could be properly implemented in nonacademic, community settings. Aim: Our aim was to promote high-quality, responsible lung cancer screening throughout the United States, including in community settings where most lung cancer is diagnosed. Strategy/Tactics: Lung Cancer Alliance developed a National Framework for Excellence in Lung Cancer Screening and Continuum of Care in 2012 and began a nationwide network dedicated to responsible lung cancer screening. The Screening Center of Excellence designation requires a center to ensure shared decision-making, comply with best practice standards, work with a multidisciplinary care team, refer for smoking cessation, provide results in a timely manner, and meet standards set by the American College of Radiology. Program/Policy process: From 2012 through 2016, over 500 centers were designated as Screening Centers of Excellence. These centers represented 42 states and more than 60% were from community/nonacademic community centers. High-risk individuals who come to the Lung Cancer Alliance Web site or contact the organization by phone to find a screening center are directed to a Center of Excellence. A data collection effort in 2017 collected comprehensive information about the state of lung cancer screening and care at their institution. Nearly 70% of centers responded to the survey. Outcomes: This program has helped promoted high quality lung cancer screening throughout the United States. Our program data shows that screening is being performed widely across the United States, including in nonacademic centers. For centers who were able to provide numbers of screenings performed and diagnoses, we identified a clear trend in diagnosis of Stage 1 lung cancer, indicating these screenings are able to find lung cancer early. We also identified a number of implementation challenges around referral patterns, insurance and billing, and determining appropriate risk criteria. What was learned: We have shown that a patient advocacy group working with medical professionals can help deliver high quality care to a broad population. Data collection from the Screening Centers of Excellence provides a snapshot of the state of lung cancer screening in the United States that underscores the success of LDCT and the importance of early detection but also identifies barriers in implementation that still need to be addressed.
Cancers With Bad and Good Survival Among Male Population of Northeast India
Authors: Kalita M. , Sharma J.D. , Baishya N. , Kataki A.C.
Published: September 2018

Background: The northeast region of India has an overall high incidence, mortality and lower survival rate of cancer in the country, an annual expected of around 40,000 were diagnosed with cancer every year in this region. Mortality rate due to cancer in northeastern India is increasing mainly because of difficulties in accessing the facilities for cancer diagnosis and treatment, socioeconomic conditions, lack of awareness, taboo, misconception and wide disparity in both diagnosis and treatment of cancers among the eight different states (regions) within northeast India. Furthermore, affordability of cancer care remains a major challenge in this part of India for effective cancer control. Aim: This study was conducted with a vision to provide an idea about the cancer survival pattern of 45 million of people living in the northeastern region of India with correlation to time at diagnosis and treatment competition status. Methods: All the cases registered with a history of cancer in between 2010-2014 calendar years. Five year observed survival was calculated based on all the followed up until 2017. Three categories were made for treatment-wise survival analysis, 1) those that have completed cancer treatment 2) those that did not completed treatment 3) those who have not taken any cancer directed treatment. The 5-year survival rates were generated by using the SPSS V19 software. Kaplan-Meier method was used to generate the statistics. Results: The five years overall survival for all cancers in men is 24.3% with earlier stage at diagnosis has a better survival (Stage I, 52.1%) than later stage (Stage IV, 18.8%) at diagnosis. Completed course of cancer directed treatment found to be playing a significant role in enhancing the survival among the patients. The five-year survival for completed cancer directed treatment is 27.5% followed by 12.5% for incomplete and 8.5% for those with no cancer directed treatment group. Inequality in survival was observed among different sites of cancer, as some cancers harm younger people more than others. The five year observed survival for all sites was ranges from 0% to 75.8%. Cancer of liver (0%), pancreas (0%), lung (2.4%), gallbladder (7.9%) and stomach (10.3%) is found as more lethal than other cancers as the five years survival was in-between the range 0%-10%. Cancer of Hodgkin lymphoma (75.8%) has the highest five year cancer survival rate followed by testis (60.1%), breast-male (55.3%), penis (49.7%) and skin cancer (49.1%). The prostate cancer (19.0%) rate is very low compared with other global parts of the world where it reaches around 100% in many countries. Advances in early detection and treatment can enhance the survival rate in these regions. Conclusion: The 5-year survival showed an increasing survival with decreasing in stage at the time of diagnosis and decreasing in number of decline treatment percentage among northeastern population.
Association of Immunohistochemically Defined Molecular Subtypes With Clinicopathologic Factors in Indonesian Women With Breast Cancer
Authors: Purnomosari D. , Rahmawati Y. , Judistira J. , Widodo I.
Published: September 2018

Background: Breast cancer is a heterogeneous disease. It is classified into various subtypes based on molecular difference, primarily through gene expression profiling (GEP) and immunohistochemistry (IHC) techniques. GEP is able to reveal gene signatures that predict clinical outcomes, and can discern prognostically relevant breast cancer subtypes, but it is not yet used routinely in the clinical practice, especially in the developing countries. On the other hand, IHC analysis is commonly used for breast cancer subtyping and provides critical prognostic and predictive information. Aim: The current study was aimed to established a comprehensive outline of Indonesian breast cancer subtypes distribution and their associations with the clinicopathologic factors based on a standard routinely used biomarker panel, i.e., estrogen-receptor (ER), progesterone-receptor (PR), and human epidermal growth factor receptor 2 (HER2). Methods: A retrospective cross-sectional study was conducted of 390 breast cancer cases in Dr. Sardjito General Hospital Yogyakarta, Indonesia from 2010 to 2015. Breast cancer subtypes were classified based on the expression of ER, PR, HER2 and histologic grade. The association of Indonesian breast cancer subtypes with clinicopathologic factors was evaluated using χ2 tests. Results: The majority of Indonesian breast cancer patients were older than 50 years, have larger tumor size (> 2 cm), high grade and absence of lymph node metastases. Among 390 cases, 32.1% were luminal A, 24.6% were luminal B, 17.9% were HER2+ and the remaining 25.4% were triple negative breast cancer (TNBC). High association was found in breast cancer molecular subtypes with regard to patients age, tumor size, histologic grade and lymph node metastases. Conclusion: Luminal A is the most common Indonesian breast cancer subtypes, followed by TNBC, luminal B and HER2. Immunohistochemistry-based subtyping is essential to classify breast cancer into subtypes that vary in clinicopathologic characteristics, which implies distinct prognosis and therapy response. Further studies are needed to clarify the mechanisms associated with development of each subtype.
Lifestyle Factors and Health Related Quality of Life in Vietnamese Women After Cancer
Authors: Nguyen T.H.H. , Seib C. , Anderson D. , Yate P.
Published: September 2018

Background: A range of lifestyle factors and health related quality of life (HRQoL) influence cancer survivors' health, wellbeing, and survival. Some women who have received treatment of breast and gynecologic cancer (BCG) report lifestyle practices and HRQoL at lower levels than the general community. However, the impacts of factors such as socio-demographic characteristics and health status on lifestyle factors and HRQoL, and the interactions between these variables in terms of their influence on HRQoL are not fully understood. Aim: This study aimed to provide a comprehensive understanding of the relationships between lifestyle factors and HRQoL and to identify the socio-demographic factors, health status, and behavioral determinants of these variables among Vietnamese women following treatment of BGC. Methods: A cross-sectional study design was used. Data were collected from 330 Vietnamese women who had received treatment of BCG using both online and paper-based methods. Descriptive statistics, bivariate and multivariate statistics were used to examine associations and structural equational modeling was used to identify the interactions between the study's variables. Results: Although the majority of the study participants had a normal range of BMI ( n=260, 81.2%) with the mean BMI was 22.02 ( SD=2.52), engagement in a range of healthy lifestyle behaviors was low at. More than 75% of the study participants had a deficit in physical health and mental health compared with the norms. Participants' cancer-specific HRQoL score was 80.61 ( SD= 15.81) which is lower than that of normal population (85.9). Sleep impairment had a significant indirect effect on mental health ( indirect effect= -.030, P < .05) and cancer-specific HRQoL ( indirect effect= -.017, P < .05). Exercise self-efficacy significantly and indirectly influenced mental health ( indirect effect= .022, P < .05). Conclusion: This study highlights that there are deficits in the HRQoL of Vietnamese women following BGC and they had lower than recommended levels of engagement in healthy lifestyle behaviors. Participants also had high levels of sleep impairment and low levels of self-efficacy to follow a healthy diet or exercise. The indirect effects identified in this study indicate that health care professionals should provide information and community support focused on improving HRQoL and improving sleep impairment and self-efficacy.
CA125 Value As an Indicator for Imaging for Detection of CA Ovary Recurrence After Primary Treatment
Authors: Lucksom P. , Mathai S. , Bhaumik J. , Ghosh A.
Published: September 2018

Background: GCIG states that CA125 value double of upper limit of normal during follow-up after primary treatment is a criteria for further intervention. However, in our institution we found that significant number of women with a CA 125 > 35 u/mL have recurrent disease on imaging. Aim: To compare values of CA125 rise as an indicator for imaging for detection of recurrence after primary treatment. Methods: It was retrospective observational study. 64 women with stage III and IV epithelial ovarian cancer who had normal CA125 on completion of primary therapy from January 2012 to December 2016 at Tata Medical Center, Kolkata, India were included in the study. These women were followed up with Ca125 three monthly for 2 years then six monthly. CA 125 doubling from posttreatment baseline or exceeding 35 u/mL were investigated with CT imaging. Data were collected from hospital management system electronic medical records. Results: Out of 146 patients who underwent IDS 64 (43.8%) had normal CA125 post treatment. 2 patients with doubling of Ca125 but < 35 u/mL had recurrence, all of whom had R0 during IDS. 1 patient with normal CA 125 had clinical recurrence and this patient had R2 disease during IDS. 2 patients with normal CA 125 had recurrence on radiology only and they had R0 during IDS. 18 (24%) had radiologic recurrence when CA125 was > 35 u/mL out of which14 patients had R0 and 4 patients R1 disease during IDS. 41 patients had recurrence detected on radiology when CA125 was > 70 u/mL. Out of these 27 had R0, 11 patients had R1 and 3 patients had R2 disease on IDS. 78% of R0 patients had disease recurrence when CA125 was > 35 u/mL. Conclusion: Imaging should be considered when CA125 rises > 35u/mL, rather than waiting for it to double the upper limit of normal, so that early detection of recurrence can initiate timely treatment. Rise of CA125 above 35 u/mL is a good criteria for imaging to detect recurrence even in women with R0 resection. CA125 can be used as a good tool for follow-up especially in low resource setting where people cannot afford routine imaging.
Missing Evidence: Exploring Unpublished Trials in Victoria, Australia
Authors: Allan C. , Chapman A. , Parker C. , Boltong A. , Millar J.
Published: September 2018

Background: Clinical trial registries were established to improve the transparency and completeness of clinical trial reporting and a number of policies have been introduced to encourage or mandate their use. While prospective trial registration has been endorsed in Australia, there is currently no legal requirement for researchers to register or communicate findings from clinical trials. There has also been, to the best of our knowledge, no analysis previously undertaken on publication rates for clinical trials performed in Australia. Aim: We aimed to determine the proportion of clinical trials that remain 'unpublished' in Victoria, Australia´s second most populous state, between 2009 and 2013. Methods: We used data reported to Cancer Council Victoria's Cancer Trials Management Scheme (CTMS) between 2009 and 2013, to identify trials that had recruited a new patient or recorded any follow-up patient activity in the specified time period. Using this data, we conducted a systematic search of ClinicalTrials.gov , the Australia and New Zealand Clinical Trials Registry (ANZCTR), PubMed and Google for records of the trial. Trial registration numbers, acronyms and scientific titles were used as primary search terms. Results were characterized by type of publication (i.e., whether it was an accredited scientific paper or other) and source location. Results: Of the trials reported to the CTMS between 2009 and 2013, 777 trials were included in this investigation; the majority (58.8%) were randomized controlled trials (RCTs). Compared with previously published findings, communication of trial results in this study was high; 70% of trials published results in an accredited scientific journal and a further 10% in alternate form, such as a conference abstract or media release. Publication rates were higher for trials with a commercial sponsor (85%) compared with trials sponsored by a cooperative group (77%). Nearly 8% of trials in this study had not been registered on an international clinical trials register. Only 39% of unregistered trials had published results. Of the registered trials, those registered on ClinicalTrials.gov were more likely to be published (86%) compared with trials listed on ANZCTR (68%). Between 2009 and 2013 , 8% of trials registered on ClinicalTrials.gov , in our data set, were terminated; 70% of these trials published results. Conclusion: Although the rate at which clinical trial findings were published in Victoria was higher in this investigation compared with equivalent overseas data, trials registered on ClinicalTrials.gov were more likely to publish results than unregistered trials or trials registered on ANZCTR. This suggests a potential need for trial registration and publication guidelines in Australia, similar to that of the United States where the requirements and procedures for submitting registration and summary result information for clinical trials on ClinicalTrials.gov have been compulsory for the last decade.
Hi, I Have Cancer, What Can I Do? An Analysis of Caller Characteristics of a Malaysian Cancer-Specific Information Hotline
Authors: Lim C. , Ho T.L. , Stephen M.T. , Hashim H.S. Mohd , Junazli N.I. Binti , Choo S.L. , Low K.Y. , Muniasamy M.
Published: September 2018

Background: Despite the advancement of technology in information dissemination, patients and caregivers often cite difficulties in getting the right cancer information, care and psychosocial support. It is crucial to optimize the availability of cancer information to increase knowledge among the public and for better decision making by patients and their families. In line with these strategies, the National Cancer Society of Malaysia (NCSM) established a toll-free, Cancer Information Service Helpline (CIS) in 2016 to act as a tool for provision of cancer-related information and psychosocial support. Aim: This study aimed to analyze caller characteristics and trends of calls received by the CIS between January 1 to December 31, 2017. Methods: A cross sectional study was conducted on the CIS call logs for the ascertained study period. Descriptive analysis was carried out to determine characteristics of callers including i) socio-demographics; ii) geographical location; iii) caller's cancer disease status or relationship with cancer patient and iv) reason(s) for calling the helpline. ANOVA was used to determine possible associations between the different variables and reasons for calling the helpline. Results: A total of 1613 calls were received during the study period. Majority of the callers were female (72%) and almost half of the callers were healthcare professionals (43%). 36% of the calls were inquiries on availability of screening services and this was significantly associated with calls from healthcare professionals ( P = 0.04). Callers of Malay ethnicity ( P = 0.03) and newly diagnosed cancer patients ( P = 0.001) were significantly associated with calling to seek for financial help. Conclusion: While being used as a source of some aspects of information pertaining to cancer, the CIS's capabilities in providing psychosocial support is not being maximized as yet. These results provide insight that targeted promotional efforts to raise awareness about CIS's psychosocial support capabilities is required to further maximize its potential among Malaysian patients, families and the public at large.
Decreasing Oncology Patients Length of Stay In Ed Lean Study at King Hussien Cancer Center
Authors: Alkhatib H.
Published: September 2018

Background: Prolonged patient stay in ER is an issue frequently raised with regards to patient safety. In addition to patient complains and dissatisfaction, it increases the risk of healthcare associated infections, increases pressure on ER staff, increases waiting time and eventually impacts bed utilization. Oncology patients frequently visits ER due to their disease nature, progression and treatment protocols (radiotherapy, chemotherapy, and hormonal therapy), in which they come in with multiple serious medical complains that need early and immediate interventions. Septic shock, neutropenic fever and electrolyte imbalance are some of these serious conditions. Aim: To decrease the length of stay of ER patients at an oncology center. Methods: Lean improvement methodology was adopted to eliminate the unnecessary waste during ER workflow. Lean improvement team was trained on lean concepts and methodology by an expert staff. ER value stream map was drawn and an initial data were collected by outside volunteers to eliminate data collection bias, then lean interactions were deployed on multidisciplinary dimensions, followed by quarterly data collection to measure the success of the interventions. It was a cycle of training, collecting data, meeting ER physicians, pharmacy, laboratory, radiology, support services, and nursing. Then implementing the proposed interventions and finally collecting data. Results: ER patients' length of stay gradually decreased by 42% from 377 minutes to 221 minutes. There were remarkable deductions in radiology procedures turn-around time by 62%, and pharmacy by 57%. Improvement in patient flow, decreasing waiting time and ultimately improved patient and family satisfaction were measured outcomes to lean project. Conclusion: Lean improvement methodology is an excellent tool to reduce the nonvalue added time and ultimately improves the patient's safety.
The Design and Implementation of Cancer Patient Support Groups in Rural Haiti
Authors: Deshommes O. , Greenberg L. , Haskins L. , Pierre B.F. , Désameau P.-G.
Published: September 2018

Background: In Haiti, cancer is associated with myths that have traumatic effects on patients and families. Cancer diagnoses are drivers of socioeconomic change, with psychological repercussions for an impoverished population. Aware of this reality, the Oncology Service at University Hospital of Mirebalais (HUM) created a dedicated psychosocial team, composed of a social worker, her assistant and a psychologist. Care is provided to patients and families through: individual counseling, support groups, outreach activities, home visits, and mental health consults. This abstract focuses on patient support groups (SG). SGs act as vectors of information and training that are capable of breaking myths, and accompanying patients on their cancer journey. Aim: The primary aim of SGs is to create a space for patients to participate in education and peer counseling. During sessions, the team encourages expressions of emotions and experiences in relation to the disease and its repercussions on patients and caregivers. These discussions encourage participant solidarity and strengthen compliance to treatments. SGs, however, are not static and services are continuously improved by collecting feedback. Methods: To address the psychosocial needs of each cancer patient, SGs were developed with specificity. Patients are categorized in SGs according to the medical treatment they are receiving. Other SGs offered, focus on caregiver experience. SGs have about 12 participants, last 120 minutes and are held in a private space in HUM. In general, discussions relate to patient experience, side effects, relationship implications, and socio-economic impacts. Across all SGs, principles for speaking are negotiated and are always at discretion of participants. Results: The HUM team has provided SG services since 2013. SGs are held often and the majority of oncology patients participate. In 2017, we held 30 SGs with over 380 participants. Therapeutic alliances have improved relationships: patient–patient, family–patient, and patient-clinician - fostering interdisciplinary collaboration. However, all SGs must be performed the same day as the medical appointment due to socio-economic difficulties that can create logistical challenges. Patient needs are also fluid and flexibility is key as SGs evolve. Conclusion: SGs play a critical role in comprehensive cancer care, particularly in Haiti where there are severe social implications for patients. Mental health of cancer patients is critical and SGs are an impactful way to address this need. Arranging SGs by medical treatment, the model used at HUM, is adaptable to other low-income settings. Every SG is different and facilitators approach each session without preconceptions, yet diligent to gather feedback. SGs provide critical information to clinicians about social determinants and implications of cancer diagnoses in Haiti. In the future, we hope to do robust qualitative analysis of SGs, using feedback from cancer patients at HUM.
Cobalamin, Folate and Pyridoxal 5- Phosphate Level of Smokers in Calabar Cross River State
Authors: Okafor I. , Uzoma G. , Nvani L.
Published: September 2018

Background: Smoking among individuals remains a major health problem worldwide as it is associated with certain disease conditions and decrease in concentration of several vitamins. Aim: This study was aimed at providing information on cobalamin, folate and pyridoxal 5-phosphate levels of male cigarette smokers within Calabar, Cross River State, Nigeria. Methods: Ninety adult male subjects participated in the study with 60 as cigarette smokers and 30 as nonsmokers. Serum cobalamin and folate levels were estimated using enzyme linked immunosorbent assay technique while packed cell volume was estimated using microhematocrit method. Vitamin B6 status was determined using fasting plasma concentrations of pyridoxal 5′-phosphate. Plasma PLP was measured by quantification of its semicarbazide derivative using high-performance liquid chromatography with fluorescence detection. Results: Results show that male cigarette smokers had significantly higher packed cell volume ( P = 0.014) and serum cobalamin ( P = 0.005) and there was no significant difference in folate level of cigarette smokers ( P = 0.375) when compared with noncigarette smokers. Pyridoxal 5-phosphate was found to be significantly higher ( P = 0.00) in nonsmokers when compared with smokers. It was also shown that duration of smoking does not have significant effect on the serum level of cobalamin (0.09), folate ( P = 0.06) and pyridoxal 5-phosphate (0.15) respectively. The result also show that there was no significant correlation ( P = 0.095, 0.085 and 0.197) between number of sticks smoked per day and serum cobalamin, folate and pyridoxal 5-phosphate level of male cigarette smokers respectively. Conclusion: While smoking is known to have hazardous effect on health, this study has shown that smoking and duration of smoking does not affect serum cobalamin, folate and pyridoxal 5-phosphate level of male cigarette smokers living within Calabar Cross River State, Nigeria.
Delivering More Effective Lung Cancer Support Groups: Applying Best Practices From the United States, United Kingdom, and Australia to Strengthen Skills and Inspire Facilitators
Authors: Rigney M.
Published: September 2018

Background and context: Globally, 1.8 million people are diagnosed with lung cancer annually. Compared with other cancers, lung cancer patients experience higher levels of distress and greater unmet physical and emotional needs. A significant unmet need is social support. Face-to-face support groups can meet this need and may also may increase feelings of control and decrease distress. While lung cancer patients tend to prefer lung cancer-specific over general cancer groups, for many reasons these groups can be challenging to start and maintain. As a result, there are not enough groups available to meet the need. Aim: To provide guidance to those with struggling lung cancer groups, facilitators on three continents were surveyed to better understand their challenges and elicit creative ideas, collect practical tips and gather best practices for starting and maintaining successful lung cancer support groups. Strategy/Tactics: To understand the experiences of lung cancer facilitators, direct feedback was needed. To identify facilitators, member organizations of the Global Lung Cancer Coalition (GLCC) were tapped. Comprised of 37 charity organizations, GLCC is the international “voice” of the lung cancer community. Three GLCC organizations (one each from the United States-US, United Kingdom-UK and Australia-AUS) that either directly offer lung cancer support groups or manage networks of groups, agreed to participate. Program/Policy process: A 21 question online survey was sent to 131 support group facilitators, 7 in AUS, 42 in the UK and 82 in the US. Questions included length of time the group had been running, how often it met, average number of participants and other group/facilitator characteristics. Respondents were asked to identify their greatest challenges in group maintenance and solutions used to overcome those challenges. Knowledge gained from the survey and an extensive literature review were incorporated into the Lung Cancer Support Group Troubleshooting Guide. Outcomes: With a 56% completion rate, specific results varied by demographic area. Groups in AUS and the UK tended to have more participants, were more likely to be cofacilitated by nurses and held in public places. More groups in the US were based in hospitals and run by social workers. 75% of facilitators in the UK and AUS and 71% of those in the US said their groups were successful. What was learned: Creative solutions to lung cancer support group challenges were shared and keys to successful groups identified. Suitable for facilitators at all skills levels, the resulting Guide includes creative solutions for overcoming specific barriers and resource constraints. Widely distributed in the US, a small survey found that 91% of Guide users found it somewhat or very helpful. While written for lung cancer groups, any kind of support group, anywhere in the world that is struggling can benefit from the suggestions and ideas offered by the Guide.
Establishment of Structured Preventive Mobile Cancer Care in Nigeria: A Success Story
Authors: Egwuchim K. , Nzelu A.
Published: September 2018

Background and context: Mass medical mission is a nonprofit, public health charity aimed at complementing the effort of government in improving the health indices of Nigerians. Its core initiative is the National Cancer Prevention Program (NCPP), a foremost effort toward national cancer control in Nigeria. In 2007, NCPP spearheaded community-based mass cervical cancer screening in Nigeria, initially known as National Cervical Cancer Prevention Program (NCCPP). This effort has contributed to a 15% reduction of cervical cancer mortality in Nigeria, from 9659 deaths to 8240 deaths, between 2008 and 2012 (GLOBOCAN data). The improvement in cervical cancer survivorship in Nigeria was proof positive that winning the fight against cancer was possible if the effort could be scaled up. Consequently, mass medical mission escalated its advocacy drive, which was tagged the Big War Against Cancer in Nigeria. Aim: The short-term goal was to raise funds toward the provision one Mobile Cancer Centres (MCC) for each state and a Comprehensive Cancer Centre for each of the six geopolitical zones in the long-term. Strategy/Tactics: Mass medical mission initiated the establishment of a fundraising platform known as the Committee Encouraging Corporate Philanthropy (CECP-Nigeria). A private sector led initiative to promote concerted and synergistic philanthropy for the common good through public-social-private partnership. The President of Nigeria is the grand patron while the Vice President, the National Patron. Returns: Through this effort, four of the pilot set of MCC (known as PinkCruise) are now in Nigeria, one of which was donated by the Lagos State Governor. The fixed centers from which the PinkCruise operate have also been set up in four selected cities representing the four old regions of Nigeria. These mobile units are unique as they are multifunctional with state-of-the-art facilities for screening, follow-up and treatment (including mammography, endoscopy, colonoscopy, colposcopy, cryotherapy, laboratory, vaccination and surgeries for precancer and early cancer). The PinkCruise have been deployed to carry out systematic mobile health outreaches, known as Mission PinkCruise, which also have an eye-care aspect known as Mission PinkVISSION. PinkVISSION is also an initiative of mass medical mission (mmm), aimed at achieving the goals of “Vision 2020: The Right to Sight”, by incorporating preventive eye care into cancer prevention and general health promotion. The acronym, VISSION, stands for Voluntary Integrated Sight Saving Initiative Of Nigeria. Both Mission PinkCruise and Mission PinkVISSION are free of charge to the hosts and the beneficiaries. What was learned: The synergy between PinkVISSION and PinkCruise results in improved uptake, impact and cost effectiveness of both the cancer campaign and the eye campaign.