bluuebunny/crossref_metadata_2025 huggingface dataset:
Treating EGFR-Mutated Oncogene-Addicted Advanced Non–Small-Cell Lung Cancer in the Era of Economic Crisis in Greece: Challenges and Opportunities
Authors: Fountzilas Elena , Levva Sofia , Mountzios Giannis , Polychronidou Genovefa , Maniadakis Nikos , Kotoula Vassiliki , Fountzilas George
Published: September 2018

Purpose

Because of the profound financial crisis that commenced in Greece in 2010, severe cuts in health care spending and other restriction measures led to significant delays in the reimbursement of novel antineoplastic agents. In 2011, the Hellenic Society of Medical Oncology initiated a program of early access to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors for the treatment of patients with advanced, EGFR-mutant non–small-cell lung cancer (NSCLC). We evaluated treatment patterns and clinical outcomes in patients with EGFR-mutant or wild-type disease treated at a large center in Greece throughout the period of financial crisis.

Patients and Methods

From 2011 through 2015, 252 patients with newly diagnosed advanced NSCLC were treated at the Department of Medical Oncology of the Papageorgiou Hospital, a tertiary cancer center in northern Greece. We retrospectively reviewed patient medical records to obtain clinicopathologic characteristics, EGFR mutation status, and follow-up data. The primary end point was time to treatment failure.

Results

Of the 198 evaluable patients, 25 (12%) had EGFR mutations. All patients with EGFR mutations except one received treatment with an EGFR tyrosine kinase inhibitor. Median times to treatment failure for patients with EGFR-mutant and wild-type disease were 15.8 and 7.1 months, respectively (hazard ratio, 0.58; 95% CI, 0.35 to 0.95; P = .031). There was no difference in overall survival between the two groups ( P = .293). No deviation from treatment guidelines or discontinuation of treatment regimens occurred because of logistic reasons or drug shortages.

Conclusion

Despite restrictions in the reimbursement policy and accompanying controls in the use of high-cost medicines, the national program enabled treatment of patients with EGFR-mutant NSCLC according to established guidelines. Therefore, the clinical outcomes of such patients treated in Greece during the economic crisis were in accordance with international standards.
Cervical Precancer Treatment Planning Tool
Authors: Herrick T. , Gannon S. , Gowda B. , Harner-Jay C. , Cummings R. , Tsu V.
Published: September 2018

Background and context: Cervical cancer is a largely preventable disease, yet kills about 260,000 women each year, mostly in low- and middle-income countries (LMIC). Cervical screening is a proven technique for reducing the incidence of cervical cancer, but only if screen-positive women receive timely, effective precancer treatment. As planning efforts to scale up cervical precancer treatment programs to reach more women are occurring in many high-burden countries, tools to determine what and how much equipment to procure and how to deploy it could help decision-makers make better use of scarce resources. Aim: To assist decision-makers, PATH developed the Cervical Precancer Treatment Planning Tool, with the aim of increasing access to lifesaving treatment while optimizing the use of scarce resources. This tool contains a scenario-based Excel model and Tableau data visualization mapping tool, which enable users to examine various strategies for deployment of ablative cervical precancer treatment equipment. The tool evaluates the number of women treated, the number of treatment devices needed, associated start-up costs, and cost of gas across five different scenarios. Strategy/Tactics: The model contains baseline data, gathered from a literature review and PATH fieldwork, for nine countries in sub-Saharan Africa, but it can be adapted to generate data for any LMIC. Users can also adjust baseline values to reflect the most current local data. The Tableau data visualization, which uses Uganda as an illustrative example, provides results at a district level. The tool's parameters, baseline inputs, and outputs were vetted with cervical precancer experts from eight African countries in 2017. Program/Policy process: The tool is available to country decision-makers who want to weigh the tradeoffs when trying to balance patient convenience and access with efficient utilization of equipment, skilled personnel, and financial resources. Results from the tool can inform national precancer treatment program strategies and decisions about device procurement and deployment. Outcomes: The country-level tool is publicly available ( https://sites.path.org/marketdynamics/ ) for decision-makers to make informed strategic decisions about their country's cervical precancer treatment programs. What was learned: The single-visit approach (SVA) for screening and treatment leads to treatment of the most women, but the financial costs for this scenario are on average more than 7 times greater than the next most costly scenario. In addition, treatment devices are underutilized in the SVA. While reducing the number of devices in each country reduces costs and improves equipment utilization, many women would require a second visit for treatment. Depending on the equipment deployment scenario (e.g., one treatment device per hospital), some women may need to travel long distances for this follow-up visit, potentially reducing treatment completion rates for those in need.
Female Reproductive Hormones and Biomarkers of Oxidative Stress in Postmenopausal Women With Breast Cancer
Authors: Nsonwu-Anyanwu A.C. , Usoro A. , Offor S.J. , Usoro C.A.O.
Published: September 2018

Background: Female reproductive hormones have been implicated in the etiology of breast cancer, while oxidative stress induced by reactive oxygen species have been linked to various steps involved in carcinogenesis including cellular transformation, proliferation and metastasis. Aim: This study assessed the serum levels of estradiol (E2), prolactin (PRL) and some biomarkers of oxidative stress in relation with clinical staging in postmenopausal women with breast cancer. Methods: One hundred postmenopausal women aged 50 to 70 years comprising of 50 women with breast cancer (with clinical staging II-IV) and 50 healthy women without breast lump or cancer were recruited into this case control study. Estradiol and prolactin were determined by enzyme linked immunosorbent assay, total antioxidant capacity (TAC), total plasma peroxides (TPP), malondialdehyde (MDA), glutathione (GSH) and nitric oxide (NO) were estimated by colorimetric methods while oxidative stress index was determined by calculation. Sociodemographic data and anthropometric indices (body mass index (BMI)) were obtained by standard methods. Data were analyzed using Student t-test, ANOVA and Pearson's correlation at P < 0.05. Results: The percentage of women with breast lump, breast pain, nipple discharge, high alcohol and fat intake were higher in women with breast cancer compared with women without breast cancer ( P < 0.05). The mean age at menarche, TAC, TPP, OSI, NO and E2 levels were significantly lower and BMI higher in controls compared with breast cancer subjects ( P < 0.05). Women without breast cancer had lower TPP, OSI and E2 compared with stage II; lower TAC, TPP, NO and E2 compared with stage II; and lower MDA, NO and E2 compared with stage 4 respectively ( P < 0.05). Positive correlations were observed between PRL and TAC (r=0.336, P = 0.011); PRL and E2 (r=0.296, P = 0.037) and negative correlation between NO and E2 (r=-0.295, P = 0.038), NO and MDA (r=-0.302, P = 0.033) only in women with breast cancer. Conclusion: Breast cancer is associated with increased lipid peroxidation, nitric oxide and oxidative stress index which may be involved in the progression of the disease.
Trastuzumab As an Adjuvant Therapy for Early Breast Cancer: Economic Evaluation From a Malaysian Perspective
Authors: Hanin F.K. , Wai L. Sit , Sabirin J. , Ezat W.P. Sharifa , Maznah D.
Published: September 2018

Background: In Malaysia, breast cancer is the most common cancer in females and also the first most common cancer among population regardless of gender. The percentage of breast cancer detected at stage I and II was 61%, another 27% with locally advanced cancer and 11% with late stage metastatic cancer. From the total, 28% are human epidermal growth factor receptor 2 (HER2) positive and access to targeted therapy (trastuzumab) was very limited; only 19% of eligible patients could be treated. Aim: To determine the incremental cost-effectiveness ratio (ICER) between chemotherapy plus trastuzumab and chemotherapy alone as adjuvant treatment of early breast cancer from Malaysian perspective. Methods: A Markov cohort simulation was developed using Microsoft Excel Workbook 2007 to estimate the cost-utility of adjuvant trastuzumab compared with chemotherapy alone for treatment of early breast cancer with HER2 positive status. Two adjuvant treatment strategies were evaluated: 1) chemotherapy plus trastuzumab and 2) chemotherapy alone as adjuvant treatment. This Markov model was projected to lifetime horizon. All costs and outcomes were discounted at 3% and the cost-effectiveness result was expressed in ICER. One-way sensitivity analysis was performed to address the uncertainty. Results: The base case analysis indicated that 1-year adjuvant trastuzumab treatment generates a deterministic ICER of RM 83,544.59 per QALY gained. Over the lifetime, there is a marginal cost increase of RM 85,659.10 and a marginal benefit of 1.025 QALYs per patient when trastuzumab is added to standard chemotherapy compared with no trastuzumab strategy. Based on one-way sensitivity analysis, these components have shown to be a sensitive parameter for ICER determination: discount rate, disease-free state utility, route of trastuzumab administration and cost of trastuzumab. Conclusion: Addition of 1-year treatment with trastuzumab on top of standard adjuvant chemotherapy is considered as a cost-effective strategy for early breast cancer with HER2 positive, yielding an ICER of RM 83,544.59 per QALY gained, which is within the suggested value of cost-effectiveness threshold by WHO (1-3 times GDP per capita). However, if suggested threshold for Malaysia is taken into consideration, this treatment may not be a cost-effective strategy.
An Economic Evaluation of Sunitinib Versus Pazopanib As First Line Treatment of Metastatic Renal Cell Carcinoma
Authors: Nurhasni K.A.R. Ku , Sabirin J. , Puteh S.E. Wan , Dahlui M.
Published: September 2018

Background: Sunitinib and pazopanib have been shown to benefit the metastatic renal cell carcinoma patients as evidence suggested that these treatments have a comparable clinical effectiveness. However, no local economic evaluation was known to determine the value of these treatments in Malaysia. Aim: To estimate the financial implication of sunitinib and pazopanib as first line treatment of metastatic renal cell carcinoma in Malaysia by conducting a cost minimization analysis. Methods: A state transition model was developed using Microsoft Excel® 2010 with a hypothetical cohort modeled over 148 week's time-horizon with a four-weekly cycle. There were five treatment groups; pazopanib, conventional 4/2 sunitinib, 2/1 sunitinib, attenuated sunitinib and continuous sunitinib. Three health states were included in this model as progression free, disease progression and dead. A discount rate was applied as 3% as recommended in the Pharmacoeconomic Guidelines for Malaysia. The transition probabilities were derived from the published Kaplan-Meier curves. Frequencies of the adverse events were sourced from published literatures. Costs were estimated using the local data. Uncertainty analyses were conducted as one way and scenario analysis. Results: Average total cost per patient were approximately between RM51,000 to RM70,000 for various dosing schedules of sunitinib and RM61,000 for pazopanib. Variability in the treatment mix demonstrated a range of incremental cost per patient between RM 9600 to RM 8500. One way sensitivity analysis revealed that the average total cost per patient was within RM 50,000 to RM 72,000. Conclusion: Sunitinib and pazopanib have considerably comparable average healthcare cost per patient; thus supporting the access of both treatments. Attenuated dosing schedule has been shown to be the most cost saving treatment with relatively fair differences compared with pazopanib. This result was expected as attenuated dosing schedule reduced the dose of the sunitinib.
Impact of the Number of Lymph Nodes Examined on Differences in Survival for Surgically Treated Gastric Cancer Patients Between the US and Japan Using Nationwide Databases
Authors: Miyashiro I. , Ito Y. , Ishikawa T. , Akazawa K. , Katai H. , Nunobe S. , Oda I. , Isobe Y. , Tsujitani S. , Ono H. , Tanabe S. , Fukagawa T. , Suzuki S. , Kakeji Y. ,   Registration Committee of the Japanese Gastric Cancer Association
Published: September 2018

Background: Although incidence and mortality have decreased, gastric cancer (GC) is still a public health issue globally. The international collaborative study for cancer survival using population-based cancer registry showed that the survival of GC was higher in Korea and Japan than other countries, including the United States of America (US). Aim: We examined the determinant factors of the high survival in Japan, compared with the US, with particular focus on the impact of the number of lymph nodes (LNs) examined for surgically treated patients. Methods: We obtained data on 88,447 cases from the nationwide GC registration project, the Japanese Gastric Cancer Association (JGCA), from 2004-2007. We also obtained 18,995 GC cases from US population-based cancer registry data from the Surveillance, Epidemiology, and End Results Program (SEER), diagnosed from 2004-2010. We estimated five-year relative survival and applied a multivariate excess hazard model to compare the two countries. We considered the effect of LNs examined on differences in survival. Results: Five-year relative survival in Japan was 79.8%, compared with 40.1% in the US. After controlling for confounding factors, we still observed significantly higher survival in Japan. The distribution of number of LNs examined showed notable differences between two countries. In over 50% of patients in the US, only 1 to 15 LNs were examined. A higher number of LNs examined showed better survival in both countries. The differences in excess death from cancer between countries were reduced in the category when more than 30 LNs were examined. Conclusion: Although it is difficult to remove biases to compare the two countries, stage migration, related to the more detailed retrieving strategy for LNs in Japan, is a key explanation for high survival in Japan.
Assessment of Betel Quid Habits and Risk of Precancerous Oral Lesions Among Paniya Tribes of Wayanad, India - A Cross-Sectional Study
Authors: Palliyal S.
Published: September 2018

Background: Betel quid habits in India is widely prevalent and responsible for increased incidence of head and neck cancer in the country. Head and neck cancer is a major public health problem among Paniya tribes, a marginalized tribal group in Kerala state, India. Previous studies among Paniya tribals in Wayanad have documented a high prevalence of betel quid habit. Oral leukoplakia (OL) and oral submucous fibrosis (OSF) are the most common oral mucosal diseases that have a very high malignant transformation rate. Aim: Aim of this study was to evaluate the risks imposed by betel quid habits in the development of oral leukoplakia and oral submucous fibrosis among Paniya tribes of Wayanad. Methods: A cross-sectional study was carried out in 300 residents between September 01, 2009 and March 31, 2017 using a structured questionnaire containing details of betel quid habits and socio-demographic details. Descriptive statistics and testing of hypothesis were used for the analysis using EPI INFO and SPSS 16 software. Results: In the 300 subjects, the mean age was 32.4 ±SD 11.4 years, gender distribution (57.5% males vs. 42.5% females). 32.5% out of the study population were betel quid chewers (46.5% of males and 14.6% of females). The prevalence of OL and OSF was 12.9% and 13.02%, respectively among betel quid chewers. Conclusion: Awareness of head and neck cancer by betel quid habits varied with socioeconomic status among Paniya tribes of Wayanad. Despite their awareness of tobacco chewing as a risk factor for head and neck cancer, most of them still continue to chew. There is an urgent need to develop and implement culturally appropriate awareness-raising activities to target betel quid habit.
VIA (Visual Inspection With Acetic Acid) Service Goes to Public to Make Jakarta Free From Cervical Cancer
Authors: Sirait L.M.F. , Anggreni L.A. , Prasetyo W.E. , Susantyo W. Kendar , Priharto R.K.
Published: September 2018

Background and context: According to GLOBOCAN data 2012, cervical cancer in Indonesia was in 2nd rank of cancer incidence for women in Indonesia. Aim: To raise public awareness toward cervical cancer and to increase the number of citizens who go through the early detection procedure of cervical cancer in Jakarta. Strategy/Tactics: In January 2017, Department of Health of Special Capital Region of Jakarta issued a new policy to increase the rate of cervical cancer screening in the city. The new policy includes: 1. A new reporting system in which all the patients who are subjected to cervical cancer screening to be recorded in a special form, so it can be well reported and traced. 2. The changes in the conventional way of cervical cancer screening in primary health centers into mobile service to make the medical staffs able to easily reach patients who live in peripheral areas in Jakarta. Program/Policy process: The enhancement of health education on cervical cancer and health promotion regarding the importance of cervical cancer screening using public transportation (Transjakarta bus), Papanicolaou test, and VIA test socialization in primary health centers. The results were obtained and assessed between January 2017-December 2017. Early detection rates were expected to increase by 50% compared with 2016. Outcomes: The results obtained include: 1. The new reporting system works as expected, tracing the patient with a positive VIA value becomes easier to monitor. 2. Medical teams are more active on introducing the early detection cervical cancer screening to society. 3. Various innovations were carried out, among others, by using public transportation, motorcycles to carry the medical tools and devices, a modified car that is equipped with mobile health services, and a house of citizens and the community hall that were turned into a place for examination. The number of people who have started to realize to do early detection after being educated with the knowledge of VIA test and cervical cancer is increased. The number of citizens who joined the cervical cancer early detection in 2016 was 48,960. After the policy and innovation was applied, the number increased into 105,060 citizens (increased by 114% from the previous year). What was learned: The increase of early detection rate of cervical cancer is quite significant from the previous year. For patients with positive result in their VIA test, cryotherapy was included as the part of treatment and follow-up. Costs incurred due to the treatment of cervical cancer can be reduced. With the result of this study, we can learn that there is an improvement in the quality of health services so that the number of deaths and morbidity from cervical cancer in Jakarta can be reduced.
Capacity Building in Cancer Screening Using ECHO (Extension for Community Healthcare Outcomes): Innovative and Cost-Effective Model
Authors: Hariprasad R. , Babu R. , Arora S. , Mehrotra R.
Published: September 2018

Background and context: Three most common cancers in India are breast, uterine cervix and oral cavity, together accounting for approximately 34% of all cancers. Ministry of Health and Family Welfare, India has released an operational guidelines for cancer screening last year and has urged all the states to roll out population based cancer screening at various health care levels. As per these guidelines, the existing health care providers (HCPs) at various facilities would be rolling out the population based cancer screening in the country. However, the existing HCPs lack the skills and are not trained in cancer screening. Considering the size of the country, it is neither a feasible nor economically viable to provide in-person training for all cadres of HCPs. The limitation is comprehensively overcome by ECHO (Extension for Community Healthcare Outcomes) model provides a cost effective way to exponentially expand the capacity to mentor and train these HCPs in cancer screening best practices. ECHO as per the motto to “move knowledge rather than patients or doctors”, uses widely available one to many video-conferencing technology, didactic presentations and case based learning techniques to mentor and support HCPs to implement best practices in the field. In teleECHO clinics expert teams at an academic “hub” partner with willing participants to participate in knowledge networks in which all teach and all learn. Aim: To train the health care providers in cancer screening through technology assisted learning. Strategy/Tactics: A structured training program was designed using ECHO platform for all HCPs in separate batches that included, gynecologists, dentists and community health workers (CHWs), by virtual training to address all issues while they roll out cancer screening in their communities. Program/Policy process: A structured course of 20 week-sessions' virtual (online) cancer screening training program for various cadres of health care providers was undertaken. A typical one hour of ECHO session consisted of 25-30 minutes of didactics by the expert followed by 2 case presentations by the spokes. A “Beginner´s program” was well received by the participants who requested us to take it ahead with “Advanced training program” for specialists. Outcomes: 58 participants completed the course in cancer screening. The pre- and posttraining knowledge evaluation demonstrated a significant increase in the knowledge gained by participants. What was learned: In a resource constrained environment it is feasible to develop a basic curriculum in cancer screening program and train and support, all cadres of HCPs. Rolling out a technology enabled model such as ECHO for teaching and training can enable the development of a population based cancer screening program.
Egyptian Health Map: A Road for Evidence-Based Decision Making
Authors: Radwan G. , Adawy A.
Published: September 2018

Background and context: Egyptian health system is characterized by the multiple entities in charge of service regulation, financing and provision. In addition, health outcomes in Egypt mirror epidemiologic transition; with increasing prevalence of noncommunicable diseases (NCDs) and persistent high levels of selected communicable diseases (CDs), which put a huge financial burden on the health system's limited resources. This together with financial inefficiencies aggravates inequality in health services coverage and health outcomes. Aim: We aimed to map and link health services with key health outcomes to support efficient utilization of scarce resources and achieving Universal Health Coverage (UHC). Program/Policy process: Data on health services and health outcomes were obtained from Ministry of Health and Population (MOHP) and key national surveys. Data on health services' availability and coverage were compared in the different geographical regions. Correlation analysis was used to test “the relation” between selected service availability indicators and mortality rates from key NCDs and MMR. Outcomes: There was generally poor achievement of service availability national targets with wide geographical disparities. Cardiovascular diseases and cancers were the leading causes of death. There was a significant correlation between mortality from key NCDs and service availability indicators. Key risk factors such as tobacco use, obesity and high blood pressure are on the rise which was particularly evident among women. What was learned: Wide geographical disparities and increased burden of NCDs and their risk factors are identified as key challenges facing the health care system in Egypt. Priority setting in the light of these findings is crucial to support national efforts to attain health equity and UHC.
Making Partnerships Work for All: The SPARC Metastatic Breast Cancer Challenge Example
Authors: Teahon M. , Thrift-Perry M. , Debbane N. , Zucchello S. , Samson M.
Published: September 2018

Background: With an increasing global cancer burden governments and NGOs alike are struggling to meet current and future cancer patient needs. Public–private partnerships (PPPs) are suggested as a way to improve outcomes but receive a mixed welcome due to differing working practices between partners and conflict of interest concerns. While Pfizer is a long term Union for International Cancer Control (UICC) supporter, the two organizations had not developed a large project together until inception of the Seeding Progress and Resources for the Cancer Community (SPARC) Metastatic Breast Cancer Challenge. SPARC is an example of how a carefully managed PPP can avoid major issues and deliver positive benefits for all involved. Aim: SPARC is a global program created to address gaps in the services and support available to women and men with metastatic breast cancer (MBC) by offering grants to local organizations initiating novel ways to address unmet patient needs. Strategy: The program leverages UICC's strong history of grant making, capacity building, and diverse network of members and experts. As well as funding, Pfizer provided in-kind support for grant promotion and event coordination. Process: Prior to launch, UICC and Pfizer agreed on the program concept, support gap types, and selection advisory group (SAG) leadership. UICC ran the application process with an independent SAG to select grantees and managed postaward activities. Public communications and events were coled. Pfizer compliance approval for joint communications required sharing knowledge of selected awardees before public announcement. This stage needed careful discussion to maintain UICC's independent processes. Outcomes: Forty organizations from 30 countries have received SPARC grants since 2015. Grantees benefited from UICC's close monitoring and support, dedicated mentors and unparalleled access to UICC, Pfizer, and MBC advocacy communities. Pfizer was able to increase MBC patient engagement, and expand their commitment to patients and organizations globally. Through this PPP, UICC offered a holistic capacity building program for awardees to increase their project success, and share knowledge gained with the UICC community at the World Cancer Congress. What was learned: UICC has had a relationship with Pfizer for many years. SPARC enabled both parties to understand each other more fully and develop shared project goals. The level of trust built over time enabled frank and transparent discussions when dealing with sensitive issues. The balance of strong information boundaries to avoid actual or perceived conflicts of interest as well as the independent and transparent selection process drove SPARC's success. Additionally, the collaboration gave grantees networking and communication opportunities from both organizations they may not have had otherwise. PPPs are a novel and important way to address unmet patient needs in an increasingly complex healthcare environment globally.
“Illicit Use of Tobacco” - A Street Play to Spread Antitobacco Awareness Among the General Public Attending Tagore Dental and Medical College & Hospitals, Chennai, India
Authors: Francis D.L.
Published: September 2018

Background: Tobacco is the foremost preventable cause of death and disease in the world today, killing half of the people who use it. In the south-east Asia Region (SEAR), smoking prevalence ranges from 29.8% to 63.1% among men and 0.4%–15% among women. The practice of tobacco needs attention. World No Tobacco Day is the event dedicated to call attention toward the impact of tobacco use on public health and reduce individual tobacco dependence. The day is further intended to draw attention to the widespread prevalence of tobacco use and to negative health effects. Aim: · To assess the effectiveness of street play in creating awareness of tobacco hazards among rural population of Chennai.⋅ To evaluate the knowledge gained by the rural population about tobacco hazards from street play using a closed ended questionnaire. Methods: The study was a cross sectional and community based study. The target population for this study was the outpatients attending Tagore Medical and Dental Hospitals, Rathinamangalam, Chennai. The current study was conducted between 19th May 2017 to 26th May 2017, among the outpatients attending Tagore Medical and Dental Hospitals, Rathinamangalam, Chennai. Mainly, the awareness is created by stressing the ill effects and illicit use of any form of tobacco through street play conducted daily for a week in the hospital premises. Result: The preintervention assessment revealed poor knowledge scores on various aspect of harmful effects of tobacco, which significantly improved after intervention. It is conceptual that rural population is not aware of passive smoking or second hand smoke, but our study group accounted to 86% of awareness. Feedback received after street play: after any street play or role play it's good to have feedback from community members to know how effective our play was in spreading the message among them. We were fortunate enough to get good response from community members post play. Overall the feedback of the street play excelled with a score of 96% gaining new knowledge about tobacco hazards, enlightening the thought process in this regard. Conclusion: As a result, the street play in local language and pictorial posters proved to be an effective health educational tool among illiterates and repeated use, before the transition season, for maximum impact.
Smoking Habits and Awareness About Antismoking Acts Among General Public in Gurgaon, Haryana, India
Authors: Francis C.J.
Published: September 2018

Background: India is the world's third largest tobacco-growing country. The Indian scenario as far as tobacco consumption is concerned is far worse because of the prevalence of the tobacco chewing habit which covers a wide spectrum of socioeconomic and ethnic groups and is spread over urbanized area as well as remote village. Tobacco use is alarming in terms of its current and projected future impact on global mortality. Recent shift in global tobacco consumption to developing countries indicate that an estimated 930 million of the world's 1.1 billon in India alone. Despite the facts, that the harmful effects of tobacco chewing and smoking are widely known, many young people start smoking during adolescence, largely because they believe that smoking will boost their social acceptability and image. This study was contemplated with an aim to assess tobacco/smoking habits and awareness about antismoking act among general public in Gurgaon, Haryana, India. Method: A structured questionnaire consisting of 14 questions related to tobacco/smoking habits and awareness about antismoking act were asked to general public and their response was recorded. Random sampling method was used and data were collected from a cross-sectional survey. Antitobacco counseling was given on the spot and followed. Results: The study population consisted of total 430 individuals, male 364 (84.65%) and females 66 (15.34%) . Then the questionnaires were asked and statistically analyzed. Around 286 (78.57%) from 364 male were indulged in some form of tobacco usage (smoker = 32.86%, tobacco chewer = 16.78%, both = 11.18%, alcohol + tobacco user = 21.67%). In the current study, most common cause of tobacco use was pleasure 40.5%, inducing factor were friends 53.1% followed by parents and siblings. 36.20% patients used tobacco as second hand exposure in job places. 54.8% were aware about the antismoking act in public places, so only 8.6% people from all males enrolled, were smoking in public places.
Knowledge, Attitudes and Smoking Behaviours Among Dental and Medical Students in Chennai, Tamil Nadu, India
Authors: Ramesh A.
Published: September 2018

Background: Healthcare professionals have an important role to play both as advisers influencing smoking cessation and as role models. However, many of them continue to smoke. Several studies have demonstrated the efficacy of smoking cessation programs and the importance of physician's advice to their patients. The aims of the current study are as follows: (i) to evaluate smoking prevalence, knowledge and attitudes, and tobacco cessation training (ii) to examine the difference between smokers and nonsmokers. Methods: A structured questionnaire consisting of 14 questions related to tobacco/smoking habits, cessation training and role of health professionals in tobacco control were asked to the study population and their response was recorded. Random sampling method was used and data were collected from a cross-sectional survey. The survey was conducted between January and February 2015. Statistical analysis was done using SPSS version 17 and logistic regression model was used to identify possible associations with tobacco smoking status. The level of significance was p ≤ 0.05. Results: A total of 259 answered the questionnaire of which 29% declared to be smokers. About 53% of the males have smoked at least once in their life and the age of cigarette initiation was 16-17 years for 28% of the sample. 76% considered health professionals as behavioral models for patients, and 96% affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 87% heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. 93% of the sample agreed that health professionals should receive specific training on smoking cessation according to while 6% were of the opposite opinion. Conclusion: All healthcare professionals play an important role in the process of smoking cessation both as advisers and behavioral models for the general population. The current study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in medicine and dentistry, their key role both as advisers and behavioral models, and the limited tobacco training offered in the curriculum. In the field of public health, tobacco screening, and intervention is one of the most effective clinical preventive services. Planning and implementing smoking cessation training and cessation tailored to these young health professionals is therefore strongly recommended.
Breast Disorders and Africultural Coping Strategies: An Exploratory Study Among Breast Cancer Patients in Ghana
Authors: Yvonne O.
Published: September 2018

Background: The psychological cannon highlights on a new paradigm shift from the traditional models such as the bio-psychosocial model to disease and treatment to the inculcation of spirituality (Bio-psychosocial-S) in holistic treatment plan. Breast cancer is the second leading malignancy in Ghana and appears to be on the ascendency in recent times. Emerging studies have documented increasing diagnosis in premenopausal women which conflicts with previous findings. However, an attempt to handle the disease has been crippled with logistic and structural challenges. Breast cancer patients have adopted various strategies over the years in attempt to handle the structural challenges inherent in the diagnosis, treatment and post treatment plan. Using qualitative research methodology, twelve participants were conveniently sampled and interviewed. This preliminary study explored views and perceptions of breast cancer patients on breast cancer and how they have coped with the condition. Results: were analyzed using Interpretative Phenomenological Analysis (IPA) to explore how participants make meaning of their experiences. Findings showed that socio-cultural factors play an integral role in participants' interpretations of the disease and this also informed the culture-specific coping ties which were used respectively. Implications for psychological models, treatment, and research are discussed.
Quantifying the Immense Burden of OPMDS and of Oral Cancer in South Asia: Time for Action
Authors: Johnson N.
Published: September 2018

Background: Cancer of head and neck is sixth most common malignancy worldwide https://www.ncbi.nlm.nih.gov/pubmed/27245686 . ∼90% are squamous cell carcinomas [HNSCC]. Of H&N sites, mouth is most common [∼300,373 cases pa, cf oropharynx ∼142,387; larynx ∼156,877; nasopharynx 86,691]. Across south Asia, cancer of lip & mouth [oral cancer: OSCC] is a serious public health problem. In many, it is the most common cancer among men, 5th/6th in women, second overall. Five year survival rates are < 50%. Treatment is devastating. It is difficult to get authorities and public to recognize the problem: this is not a “glamorous” cancer. Yet we know the major causes so most disease is preventable. In south Asia, the major causes are tobacco - mostly chewed, areca [erroneously called betel] nut, mostly as component of betel quid, and heavy alcohol use in a background of diets lacking adequate antioxidant vitamins/minerals. To this is added the global epidemic of human papillomavirus [HPV]-driven nonkeratinising squamous epithelial head/neck cancer, particularly in lymphoid tissues of Waldyer's ring. Though data vary by country, high-risk [hr]HPVs are likely associated with up to 30% of OSCC too. We need detailed local information, especially as hrHPV-driven SCC respond well to radio/chemotherapy. Next-generation molecular methods are now examining roles for fungi and bacterial consortia. Across Asia, most OSCC arise from long-standing changes in oral mucosa: oral potentially malignant disorders [OPMD]. Leukoplakia is commonest, though with lowest risk. Risk is greater in red or mixed red/white lesions. Oral submucous fibrosis is prevalent and devastating. It has a high rate of malignant transformation and causes immense suffering: burning mouth, taste disturbances and severe sclerosis of soft tissues resulting in restricted mouth opening. The major etiology is areca nut. There is genetic and inherited propensity: very young children encouraged to chew areca can be seriously affected. There are no truly successful treatments, be it surgery to relieve trismus, physiotherapy to improve mouth opening and dietary supplements with numerous antioxidants, most commonly curcumin. Strategy: Primary prevention is possible. Improve diet; no tobacco; no areca nut [we need a WHO Framework Convention on areca]: to nip in the bud a serious epidemic of HPV-related cancers, sexual hygiene and widespread vaccination of girls - in my opinion also of boys. Public education is key. Legal controls on tobacco, areca & alcohol are needed - a tremendous challenge especially for areca, given the ancient cultural importance of this masticatory in myriad forms. It is time for effective action. Outcomes: In India and Sri Lanka we have made great progress with public awareness and with regulations on advertising and sale of smokeless tobacco and some areca products. Southeast Asia lags behind. HPV vaccination requires greater uptake across the region. What was learned: Both top-down and bottom-up approaches are needed.
Training and Skills-Gaining Fellowship for Cancer Radiotherapy Planning and Treatment With 3D-CRT in Ghana
Authors: Meena S.S. , Chambuso R. , Edusa C.
Published: September 2018

Background: The global incidence of cancer is rising, especially in low and middle income countries. Radiotherapy is important in cancer treatment of curative and palliative care, either alone or in combination with other treatment modalities. However radiotherapy techniques have evolved from two dimensional (2D) to three-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT). In addition, this new image-based treatment planning reduces the volume of surrounding normal tissues to be irradiated unnecessarily and being exposed to high dose of radiation. Thus improves treatment outcome while reducing treatment related toxicities. Aim: To train and gain skills in radiotherapy planning and treatment with modern radiation 3D-CRT technology in Ghana. Methods: Hospital based cross sectional study will be conducted at the Sweden Ghana Medical Centre in Ghana and the Ocean Road Cancer Institute (ORCI), in Tanzania. We will recruit patients with a convenient sample size, from different cancer diagnosis and stages after obtaining their signed consents. The outcome from 2D and 3D planning and treatment techniques will be compared. We will use pretreatment CT scan images to assess tumor size prior to treatment and posttreatment CT scan images to assess treatment response. Furthermore, the WHO toxicity grading criteria will be used to assess early treatment related side effects between 2D and 3D treatment techniques. Results: I have not yet been on the fellowship program, I will go to Ghana on 1st May 2018 and am expecting to finish my fellowship at the end of May 2018. I will have a final report concerning my fellowship project by August 2018, hence I will present the results of my visit to the World Cancer Congress in October 2018. I will also share my skills and knowledge obtained during my fellowship program in Ghana to my home institution and other cancer care hospitals in Tanzania through regular conference meetings, Continuous Medical Education (CME) sessions and during my daily clinical practice while supervising postgraduate students pursuing masters of medicine in clinical oncology. After data analysis, I expect my results will show better treatment outcome with minimal early treatment side effects in 3D than 2D radiotherapy planning and treatment techniques. Conclusion: This training will significantly improve patient's treatment outcomes, care and quality of life due to minimum tissue damage after 3D conformal radiotherapy with intensity modulated radiation.
“You Can Breast Health Club” Empowering Healthy Women of Myanmar to Enhance Breast Cancer Awareness and Take Action
Authors: Soe Y. Shwe Yee , Win Z.N. , Aung T. , Win T. , Htun Y.Y.
Published: September 2018

Background and context: Pun Hlaing Siloam Hospital (PHSH), the only Joint Commission International (JCI) accredited hospital in Myanmar, is committed to provide comprehensive breast health services through “You Can Breast Health Club” in accordance with its vision; international quality, reach, scale and compassion. A free of charge membership-based club led by a dedicated medical oncology team that includes health care personnel, family members of breast cancer patients and healthy women of all walks of life. Aim: To promote awareness and take action on breast health and breast cancer so as to empower women to commit to lifelong breast health. Strategy/Tactics: The club executed its strategy through three pillars: 1) hospital-based comprehensive breast cancer care services, 2) community-based breast cancer education programs and 3) partnership with local and international organizations. The theme is “You can prevent the preventable; you can check for early detection; you can survive with effective treatment” with an aim to encourage women to play an active role in their own health. Program/Policy process: As part of a comprehensive approach to breast health, “one stop” hospital-based program provides breast health education on basic breast health and breast cancer facts, teaching breast self-exam, personal risk assessment and advise on risk reduction and to make healthy life choices. Interdisciplinary breast clinic provides clinical breast exam, state-of-the art breast imaging, diagnostic evaluation, referral for surgical and treatment options and patient family education. A training-of-trainers workshop on breast health was conducted for the hospital staff to facilitate program participants in turn to educate other club members and women in the local community. The club was launched in October Breast Cancer Awareness Month campaign held in October 2017 at PHSH. As a strategic partnership supported Shwe Yaung Hnin Si Cancer Foundation to host the World Cancer Day 2018 Community Cancer Awareness campaign held in Yangon. Outcomes: The number of club members increased to (282) within five months. Among the members, (204) women are from the community including family members of breast cancer patients, office staff, industry workers, and housewives reflecting the various socioeconomic status. The outcome was encouraging given that 60% of members are below the age of 40. What was learned: Community outreach breast cancer education programs combined with access to hospital-based services at affordable prices enhanced interest in club membership. The hospital-based strategy readily provides healthy women the facilities for early diagnosis and prompt access to quality care without any delays. Partnership with other advocacy groups accelerated the club process.
Burden of Chemotherapy Induced Febrile Neutropenia in Paediatric Oncology in a Low-Income Country: The Children's Hospital Lahore Pakistan Experience
Authors: Ahmad A.
Published: September 2018

Background: Febrile neutropenia (FN) is one of most common and potentially lethal complications in patients with cancer during chemotherapy. The Oncology Department of the Children's Hospital Lahore Pakistan is a 60 bedded unit providing free treatment to over 1300 new childhood cancer cases each year and over 200 admissions per month with bed occupancy rate around 200%. The department receives childhood cancer cases not only from Pakistan but also from Afghanistan. Therefore it's very challenging to treat cancer and infection parallel with increased burden on the public sector hospital providing free treatment as well as on health professionals managing these patients with advanced stages and frequent infection episodes. Aim: The objective of this study is to evaluate the burden of FN in resource limited settings like a public sector hospital in Pakistan. A prospective review of data of patients treated for febrile neutropenia from October to December 2017 in the Haematology/Oncology Department of The Children's Hospital Lahore after IRB approval. The data were analyzed by using SPSS 20. Results: 250 patients were treated for FN during these three months 59% of them male and mean age 6.27 years. Among diagnoses, 58% had acute lymphoblastic leukaemia, 16% sarcomas, 10% lymphoma and 16% other solid malignancies on different chemotherapy regimens. 53% received their chemo during last 3 days and 35% in the last week prior to FN admission. 84% of them were receiving either induction or intensive phase protocols. 48% had respiratory tract infection followed by AGE 25%, fever alone in 20%, 82% cases had mucositis. 52% cases had symptoms of more than 24 hours before seek treatment of FN. ANC (absolute neutrophil count) was < 100 in 60% and platelets < 50,000 in 56% cases on arrival. 57% cases stayed 1-3 hours drive from the Children´s hospital and only 44% parents had adequate awareness of FN management. Regarding the outcome 81% discharged home, 16% expired (mainly FN and progressive disease) and 3% abandoned treatment. G-CSF (granulocyte-colony stimulating factor) was used in 30% (0.026 for RX cost and 0.043 hospital stay) and blood products in 75%, inotropes used in 16% with mean estimated cost of 15,000 RS/patient (total 3.8 million RS) with 95% staying > 48 hrs. 61 cultures were positive mainly urine, blood, ENT, wound, CSF. 92% were Gram negative with majority Klebsiella followed by Pseudomonas, E. coli and Citrobacter species. There were no central lines used. Conclusion: This study described that FN has been a profound burden in childhood cancer care in public sector hospital in resource limited settings like Pakistan. There is immense need to health educate the parents, nurses and doctors for standard care of febrile neutropenia along with sustainable social support and shared care oncology as being provided in developed countries to share the load of primary treatment centers aiming for decreased morbidity and mortality.