bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge Against Cancer: The Second Step
Authors: Ristic S. , Jovicevic A. , Aksentijevic S. Pantic , Kocic S. , Pirkovic M. Stanojevic , Mandic V.
Published: September 2018

Background and context: The Institute of Oncology and Radiology of Serbia (IORS), supported by the Ministry of Health, launched the project Knowledge Against Cancer in 2015, whose aim was to prepare educational material for cancer patients. Thirteen brochures were presented on WCC in Paris in 2016. The IORS conducted a survey among oncology patients in January 2017 for them to evaluate the distributed brochures and suggest the topics for new educational material. Aim: This paper aims at evaluation of brochures for cancer patients which were created during the project and its primary goal is to define new topics for future educational material. Strategy/Tactics: The study includes 348 respondents (92% women, 8% men) with average age of 54.77 ± 13.26 and predominantly highly educated (45.4%). 90% of the respondents has evaluated this kind of educational material as significant. The study has also examined the choice and relevance of topics and the quantity and usage potential of new data. The analysis has shown that most patients are interested in including psychological aspects of cancer treatment as a new topic (76%) and in including topics concerning healthy lifestyles (69%). As the majority of the respondents are women, the significant interest has been shown for topics concerning lifedem and tumor radiation of female genital organs (over 85% of female respondents). Based on the results obtained through survey and consultations and interviews with patient support group and patients associations the educational brochures were created. Program/Policy process: In 2017, nine new topics were prepared by multidisciplinary teams from IORS: Brochure: psychological support for oncology patients, the manual for family and friends, the manuals for patients on radiation of tumors on female genital organs, for head and neck tumors, lymphoedema - prevention and treatment, treatment of thyroid gland cancer with radioactive iodine, tumor markers and laboratory diagnostic, prevention of malign illnesses and quitting smoking. Outcomes: Brochures are currently available both in paper and on the Web site free of charge. The design of mobile phone application is planned for the future. The educational material is not only presented and distributed to cancer families and the public but also to health professionals and medical workers. What was learned: The research has shown that this educational material is very important for cancer patients and that with adequate information and data such patients can improve life quality predominantly through the reduction of fears and anxiety, development of coping mechanisms to deal with the cancer diagnosis and treatment and encouraging them to take active part in cancer treatment.
Oral Microbiome of Tobacco Smokers: A Shift in Composition
Authors: Ogba O. , Ewa J. , Olorode O.
Published: September 2018

Background: The use of tobacco may affect the human oral microbiome resulting in numerous diseases including cancer. There are more than 1.3 billion tobacco smokers worldwide with 4.5 million adult Nigerians addressed as tobacco addicts. Tobacco smoking causes oral cancer, color change on the teeth, halitosis, periodontitis and other health implications. Aim: The study was aimed at determining the changes caused by tobacco smoking on the oral microbiome of cigarette smokers and the shift toward organisms that may cause oral cancer and lung diseases. Methods: One hundred and twenty subjects made of 60 tobacco smokers and 60 nonsmokers were enrolled for the study. Oral swabs were collected from the oral cavity of the subjects using sterile swab sticks under standard aseptic methods. The specimens were subjected to microscopy and culture. Organisms were identified using standard microbiological techniques. Results: The mean age of the subjects was 26.9 ± 3.4 years, with minimum age 18.0 years. There was a higher rate of bacterial colonization 86.7% among smokers than nonsmokers (χ2 = 299.0, P = 0.0002). Most members of the oral biofilm belonged to the Enterobacteriaceae with Klebsiella pneumoniae being the most prevalent isolate among smokers while Pseudomonas aeruginosa 4 (20.0%) were the most prevalent bacterial isolates among the control subjects. Tooth decay 19 (36.5%) was the oral cavity disorder among smokers associated with the highest number of isolates, followed by halitosis 18 (34.6%) and mouth ulcer 7 (13.4%). Halitosis was mostly associated with Candida species 5 (71.4%). There was a statistically significant association between oral cavity conditions and microbial isolates among smokers (χ2 = 299.0, P = 0.002). Conclusion: Smoking may have altered bacterial acquisition and oral mucosal colonization in favor of periodontal pathogens. This study have shown that smoking predisposes to oral cavity diseases which may predispose to oral cancer or lung diseases. The campaign against smoking should therefore be intensified as this may help to improve the oral health of smokers.
Enhancing Quality of Life Through an Innovative, Multidisciplinary Model of Supportive Cancer Care and Rehabilitation
Authors: Anderson A. , Verrill K. , Hughes S. , Harenwall S. , Howells L. ,   Maggie's Centres
Published: September 2018

Background: Advancements in diagnosis and cancer treatment mean survival rates have improved but as a consequence many people are living with the adverse physical effects of complex treatments, financial hardship, work and relationship stress, and fear of recurrence. Person-centered, holistic care is required to help people maximize all aspects of their quality of life when living with and beyond their cancer, but debate continues around which models are economically sustainable and effective in achieving the desired outcomes. Maggie's ( www.maggiescentres.org ) is an innovative, multidisciplinary model of holistic supportive cancer care, widely regarded as an exemplar of best practice in cancer rehabilitation and supported self-management. In 2017 Maggie's received 249,247 visits across the network of centres in the UK, Hong Kong and Tokyo. The Maggie's program is designed to incorporate evidence based psychoeducation techniques delivered by multidisciplinary oncology professionals; offer personalised and understandable treatment and lifestyle information; and maximize the opportunity for social-support. Outcome evaluation is embedded within the model of care. Aim: To illustrate the holistic Maggie's model using outcome data from “Managing Stress” and “Living with and after Prostate Cancer (LWAPC)” courses to provide examples of the impact Maggie´s makes in enhancing quality of life. Methods: A subset of participants in “Managing Stress” and “Living with and after Prostate Cancer” courses across the network of UK Maggie´s Centres completed pre and post course standardized questionnaires. Results: Participants in “Managing Stress” found significant improvements in overall psychological well-being and quality of life (QoL) (t(40)=3.28, P = .002) and significant improvements in their ability to tolerate uncertainty (t(47) = 3.23, P = .002). Participants in the LWAPC found significant improvements in overall prostate cancer specific QoL ( t(37)=3.603, P = .001), general well-being ( t(37)=2.61, P = .013), and emotional well-being ( t(37)=2.62, P = .013). Also, significant reductions were found in overall negative appraisal of life (t(52)=2.96, P = .005), overall health worries (t(52) 2.28, P = 0.27), worries about the future (t(52) = 2.85, P = .006) and uncertainty (t(52) = 3.89, P < .001). Conclusion: Globally, the supportive care needs of people affected by cancer are changing but the Maggie's model of care offers valuable lessons that can be generalized across varied support settings to meet these emerging needs.
Incidental Prostate Cancer in Radical Prostatectomy Specimens of Patients Treated for Benign Prostatic Hyperplasia (BPH): Histopathology Analysis
Authors: Oluwole O.
Published: September 2018

Background: The incidence of prostate cancer (Pca) is the first in malignant tumors among men in the United States, and mortality rate is the second cause of deaths. Incidental prostate cancer is defined as clinically inapparent tumor that is neither palpable nor visible by imaging. Incidental carcinoma is found in 3%-16% of pathology specimens of patients undergoing BPH surgery and it involves less than 5% of resected tissue. Aim: To identify incidentally detected prostate cancer in benign prostatic specimens submitted for histopathology Methods: This is a ten-year retrospective histopathology study of all prostate cancer cases diagnosed between 1991-2000 in the department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Haematoxylin & eosin stained histology slides were retrieved and studied. Institution review board (IRB) approval was obtained from the Teaching Hospital to undertake this study. Results: A total of 67 patients had benign prostatic hyperplasia; the patients' age ranged from 30-75 years with a mean age of 52.5 years. The peak age at diagnosis was in the fifth decade. 26 (38.8%) patients had incidental carcinoma. All the tumors were adenocarcinoma and moderately differentiated. Two patients in their fourth decade were found to have incidental prostate cancer. Conclusion: Incidental prostate cancer is common in patients' undergoing radical prostatectomy for BPH, a high index of suspicion, adequate histopathology training and histopathologic evaluation is critical to diagnosis.
Bridging the Funding Gap for Oncology Services in LMIC: The BWS Cancer Patient Treatment Intervention Fund Project
Authors: Nnamani A. , Iloanusi N. , Okwuosa C. , Lasebikan A. , Okoye I.
Published: September 2018

Amount raised: #1,627,000 (Nigerian Naira) Background and context: With a large population and very limited resources, the economic burden of cancer in our country is enormous and cannot be tackled solely by the government. A high mortality rate among newly diagnosed patients is a direct result of poverty and lack of an effective health insurance coverage for cancer, among other reasons. Breast cancer accounts for two out of five women cancers, with a 70% mortality. Aim: To alleviate the financial burden of cancer treatment on indigent patients. Strategy/Tactics: We constituted the Cancer Patient Treatment Intervention Fund (CPTIF) board of partners and funders. We also inaugurated a fundraising event, the annual Go Pink Day Ball, and instituted crowd-funding schemes. Program process: Indigent patients diagnosed at BWS and designated health facilities are referred to CPTIF for financial support. The patient is reviewed for eligibility by the medical board. If approved by the CPTIF Board of Directors, the required funds are paid directly to the designated tertiary health facility where patient will be receiving the oncology services. Costs and returns: Between December 2017 and March 2018 a total of #1,627,000 (Nigerian Naira) was raised, a total of #750,950 has been spent on 7 patients at different levels of oncology services. The cost covered included laboratory tests, ultrasounds, biopsies chemotherapy and radiotherapy. What was learned: Financial assistance gave these patients a lifeline and zeal to go through the usually overwhelming cancer treatment process.
What Is the Justification for the Practice of Examination Under Anesthesia Plus Biopsy for Suspected Cervical Cancer?
Authors: Lawal I. , Olatunji G. , Adeyemo K.O.
Published: September 2018

Background: Management of suspected cervical cancer involve diagnosis by way of histologic evaluation of biopsy specimen and subsequent staging to determine spread to guide the choice of treatment modality. It is not uncommon to find examination under anesthesia plus biopsy as a single procedure in an operating theater list in Nigeria. The rationale for combining diagnostic procedure with staging procedure is hereby queried. Aim: To understand the rationale for the practice of combining examination under anesthesia with biopsy of suspected cervical cancer in Nigeria and project possible impact of such practice on quality of care to the patient. Methods: The study adopted combination of structured questionnaire and key informant interview. Structured questionnaires were administered to doctors below the level of consultants in departments of obstetrics and gynecology of 2 tertiary health institutions where examination under aneasthesia plus biopsy is being practiced. The questions were in four domains to assess the following; 1. Demographics 2. Any difference between knowledge and the practice of evaluation of suspected cervical cancer 3. Why combine examination under anesthesia with biopsy 4. Willingness to perform outpatient biopsy while key informant interview was conducted on randomly selected 10 consultants with interest in gynae-oncology. Results: Fifteen doctors from 2 departments of obstetrics and gynecology in 2 tertiary health institutions completed the questionnaire. Majority of the respondent were male 12/15 (80%), with average year of practice experience of 4.7 years (SD 3.5). While 100% of the respondents are duly aware of the role of cervical biopsy in confirming diagnosis of cervical cancer, none, 0% have done or witnessed cervical biopsy as an outpatient procedure. Majority 87% were not comfortable to perform outpatient biopsy of the cervix mainly because of fear of bleeding. While all the consultants were willing to perform outpatient cervical biopsy none routinely does it because of logistics. Conclusion: There is no evidence to support routine combination of examination under anesthesia and biopsy of suspicious cervical lesion. Unfounded fear of uncontrollable bleeding and lack of outpatient biopsy services are the major factors promoting the practice. Consequently, there is need for sensitization of gynecologic departments on safety of outpatient biopsy services.
Challenges of Planning a Sustainable Comprehensive Cervical Cancer Prevention Program in Low-Resource Settings
Authors: Lawal I. , Bagudu Z. , Suleiman K.O. , Yusuf Z. ,   Gynaecology Oncology Working Group of Nigerian Cancer Society Kebbi
Published: September 2018

Background and context: Advancement in science and technology has been appropriately applied in the prevention of cervical cancer that it is not unreasonable to conclude that cervical cancer is potentially an eradicable disease. While there is significant reduction in both incidence and mortality from cervical cancer in developed countries that have instituted organized cervical cancer prevention programs, the incidence and mortality from cervical cancer in developing countries are either static or on the rise. This has been reported to be largely due to lack of organized cervical cancer screening program in developing countries despite the availability of effective screening methods appropriate for low resource settings. The challenges of planning a sustainable comprehensive cervical cancer control program in low resource settings are hereby highlighted based on experience from execution of Global Scholar's seed grant of American Cancer Society. Aim: To document innovative approach to overcoming challenges of planning a comprehensive cervical cancer care and control in low resource settings. Strategy/Tactics: The strategy recommended by Alliance for Cervical Cancer Prevention in Planning and Implementing Cervical Cancer Control Program: A guide for manager was adopted in planning of a comprehensive cervical cancer prevention program for Kebbi state. Program/Policy process: Learning from HIV program implementation, the program adopted policy of integration into existing health structure rather than creating a vertical program. Conscious effort was being made at every stage not to create impression of a special intervention program deserving extra pay for the healthcare professionals nor incentives other than good health for the clients. Outcomes: A local guideline was developed based on a trade-off consideration of evidence of efficacy, cost-effectiveness and sustainability within the context of prevailing local challenges. What was learned: Literature on cervical cancer prevention seems to be skewed in favor of search for appropriate screening method for low resource settings rather than programmability of cervical cancer prevention and control strategies. No individual component of cervical cancer prevention will impact on the burden of cervical cancer independent of the other components. For a cervical cancer program to be impactful, all the components; awareness creation, acceptable screening method, treatment and follow-up of screen positive women, call and recall of clients, treatment of invasive lesions must not only all be available (albeit at different levels of sophistications) but must also be linked. Rapidly evolving science ironically could pose a significant challenge to sustainable execution of a comprehensive cervical cancer prevention program in low resource settings if there is no guideline to guide interfacing of program with evolving science.
Improving Cancer Outcomes for Vietnamese Speaking Migrants: A Mixed Methods Study
Authors: Licqurish S. , Huynh M. , Qama A. , Emery J.
Published: September 2018

Background: Prompt diagnosis of symptomatic cancer has been shown to improve survival and quality of life. The time from noticing a bodily change and seeking medical help has been termed the 'symptom appraisal interval'. The processes people undertake during symptom appraisal are impacted by numerous factors, including culture. Aim: We aimed to explore culturally specific factors that impact symptom appraisal and help seeking for a cancer diagnosis in Vietnamese-speaking Australians and to develop a culturally relevant community-based symptom awareness campaign. Methods: We used a mixed methods approach to survey and interview people who had not experienced cancer and interviewed people with a recent diagnosis of cancer. We also tested campaign materials in focus groups and interviews with community members. Results: 28 people participated in the interview study and 65 completed surveys. We found poor symptom recognition and a prevailing Taoist or traditional Eastern model of health and illness. There was also a strong emphasis on being healthy for your family and fatalistic beliefs. Home remedies and Eastern medicine were commonly used for cancer symptom management and the people with cancer were shocked at their cancer diagnosis. Conclusion: The study findings were used to tailor a symptom awareness campaign for Vietnamese speaking communities to raise awareness of cancer symptoms and to prompt people to discuss symptoms with family and their general practitioner sooner to facilitate timely diagnosis and better outcomes.
The VCCC Research & Education Lead Program: Collective Leadership in Cancer Across Multiple Organisations
Authors: Layton M. , Johnson E. , Hall S. , Cross H. , Bishop J. , McArthur G. , Lacey K.
Published: September 2018

Background and context: The Victorian Comprehensive Cancer Centre (VCCC) is Australia´s first formally constituted comprehensive cancer center, based on NCI principles. It is an alliance of 10 organizations: 7 hospitals, 2 medical research institutes and a university, based in Melbourne, Australia. A key goal for the VCCC is to create meaningful collaborations across partner organizations. Aim: The VCCC established the Research & Education Lead (R & E Lead) Program to build leadership capability who can harness the critical mass of talent across the VCCC alliance to work toward optimal integration of cancer research and education into routine patient care. Strategy/Tactics: This VCCC Research & Education Lead Program manifests the foundational principles of the VCCC by systematising and normalizing collaborative activities across the VCCC alliance. The program is a vehicle that allows the VCCC to address its strategic priorities to enable: - better integration of research, education and clinical care - sharing of ideas and knowledge to improve patient outcomes - shared education and training across member organizations Program/Policy process: Clinicians-scientists were appointed to each tumor stream as VCCC R & E Leads (approx. 0.2 EFT). Their role is to build networks of expertise and to drive change that is evidence-based, strategic and agreed across the VCCC alliance, with a focus on the end goal of better outcomes for cancer patients. The program provides the basis for a model of distributed leadership, wherein champions invested in the VCCC concept are embedded in partner organizations. Outcomes: Three R & E Leads were initially appointed as a pilot for 2 years, with a further three leads appointed during this period. Following the pilot, the program has been expanded to encompass 10 tumor streams as well as leads in primary care integration and cancer nursing. Achievements to date have included the development of a Massive Online Open Course in Cancer Survivorship, conduct of numerous symposia and events that upskill the cancer workforce in niche areas identified by the leads as needs, and consensus on the clinical challenges and research priorities to be tackled collectively within each tumor stream. Overarching program benefits included increased engagement and collaboration across partner organizations, more sharing of knowledge, and more participation in collaborative efforts including VCCC strategy development and advocacy. What was learned: A key finding of an interim program evaluation identified that the appointment of clinician-scientists as the leads was an important factor in their ability to cross the boundaries between research and clinical practice and between organizations, and to work closely and cohesively with clinical service leads for the tumor streams.
The Experiences of Early Detection, Early Diagnosis and Early Treatment of Cancer in Rural Areas of China
Authors: Li J. ,   Group of Expert Committee of Cancer Foundation of China
Published: September 2018

Background: The cancers of the lung, liver, stomach, esophagus, colorectum and nasopharynx account for more than 70% of the causes of cancer death, making them the major cancer burdens in China. The early detection and treatment of cancers including lung, liver, stomach, esophagus, colorectum and nasopharynx was supported by the central government special financial transfer payment in the rural areas in 2006-2017. Aim: To improve the efficiency of early diagnosis and early treatment to reduce cancer mortality and incidence in the population in China. Methods: Cancer screening methods developed by Group of Expert Committee of Cancer Foundation of China were used, including digestive tract endoscopy for stomach and esophageal and colorectal cancer, LDCT for lung cancer, AFP and abdominal ultrasound for liver cancer, EB virus antibody detection and nasal endoscopy for nasopharyngeal carcinoma. Results: Among the cancers of lung, liver, stomach, esophagus, colorectum and nasopharynx, the screening high risk population were 55,363; 126,443; 103,3036; 1,425,642; 252,911; and 79,726 respectively; and the screening detection rates of precancerous lesions and cancer were 0.62%, 0.66%, 0.87%, 1.62%, 5.29% and 0.49% respectively; and the early diagnosis rates were 47.80%, 60.86%, 71.24%, 73.38%, 91.85% and 64.43% respectively; and the treatment rates were 83.28%, 90.33%, 87.94%, 82.91%, 94.04% and 95.88% respectively. Conclusion: The programs for early detection and early treatment of colorectal cancer and esophageal cancer demonstrated a promising benefit, which should be generalized to broad population implementation.
Alterations in Expression of Cell Surface and Cell Cycle Signaling Molecules in Recurrent Nonmuscle Invasive Bladder Cancers: A Tissue Microarray Expression Analysis
Authors: Agrawal V. , Bharti N.
Published: September 2018

Background: Nonmuscle invasive bladder cancers (NMIBC) are one of the most common urological cancers having a high risk of recurrence and progression. Recurrent tumors may acquire certain molecular alterations responsible for progression of the tumors. Identification of these alterations is important to understand the pathobiology and guide further management. Aim: We studied the differences in expression of cell surface proteins and cell cycle signaling molecules in primary and recurrent NMIBC by immunohistochemistry (IHC) on tissue microarrays (TMA). Methods: Using FFPE tissue, TMA of 82 tumors (40 primary NMIBC and 47 recurrences) were constructed. IHC for growth factor receptors [epidermal growth factor receptor (EGFR), HER2/neu and FGFR3], cell adhesion molecules (E-cadherin and beta-catenin) and cell cycle pathway molecules (p53, p21/WAF1/Cip1 and Ki-67 proliferation index) was performed. A semiquantitative H-score (Histo-score; range 0-300) was calculated according to the intensity (0, negative; 1, weak; 2, moderate; and 3, strong) and percentage of cells stained. < 10% cells showing nuclear p21 expression was considered p21-loss. The differences in expression between the primary and recurrent tumors were analyzed using paired t test. Results: The mean age at presentation was 65.3 ± 13.6 years with a male predominance (n=36). The mean time to recurrence was 33.4 months (range 3-109). Progression in grade and/or stage was seen in 30 (75%) tumors. Time to recurrence was shorter in primary tumors with ≥ 5% Ki-67 proliferation index. There was no significant difference in expression of cell surface proteins between primary and recurrent tumors. Significant p21 loss was seen in recurrent tumors ( P = 0.03) and significantly correlated with loss of surface beta-catenin and nuclear p53 positivity ( P = 0.002). Ki-67 index was higher in recurrent tumors and also correlated with p53 positivity ( P = 0.007). Conclusion: We found no significant differences in expression of cell surface molecules in primary nonmuscle invasive bladder cancers and their recurrences. However, there were significant alterations in expression of molecules of cell cycle signaling pathway and cellular proliferation in recurrent tumors suggesting the role of cell cycle regulators as promising targets in these cancers.
Collection and Reporting of National Cancer Stage at Diagnosis Data in Australia (STaR Project)
Authors: Long R. , Woods A. , Biondi C. , Luzuriaga J. , Anderiesz C. , Jackson P. , Giles C. , Zorbas H.
Published: September 2018

Background: Stage at diagnosis is an important prognostic factor for cancer, providing contextual information for interpreting population health indicators such as mortality from cancer and cancer survival. Australian population-based cancer registries (PBCRs) routinely collect information on cancer incidence and mortality. The need for high quality, comprehensive national data on stage at diagnosis to supplement these data are widely recognized in Australia. The collection and dissemination of quality national stage data will enhance the: • ability to better monitor cancer outcomes, inform cancer control policy; • understand variations across different populations; and • identify where further research and targeted strategies may be required to improve cancer outcomes. Linking data on cancer stage at diagnosis with other administrative cancer data will also allow for a better understanding of the relationship between stage at diagnosis, treatments received, patterns of cancer recurrence, and survival outcomes. Aim: To strengthen national data capacity by collecting and reporting cancer stage at diagnosis for Cancer Australia's Stage, Treatment and Recurrence (STaR) project. Methods: Working with state and territory population-based cancer registries (PBCRs) and the Australian Pediatric Cancer Registry, Cancer Australia supported the development and testing of Business Rules for the collection of national cancer stage at diagnosis for: • The top 5 incident cancers based on the Tumor, Node, and Metastasis (TNM) staging system. These rules were endorsed by the Australasian Association of Cancer Registries (AACR) as a national standard in May 2016; and • Childhood cancers, with a separate set of Business Rules for 16 childhood cancer types based on the Toronto Pediatric Cancer Stage Guidelines. These rules were supported by the AACR as a national standard. Results: Using the AACR-endorsed Business Rules, comprehensive national cancer stage at diagnosis data for the top 5 incident cancers (for 2011) have been collected in Australia for the first time. Over 90% of incidence cases were able to be assigned a value for registry-derived (RD) stage at diagnosis for melanoma (97%), prostate (97%), and female breast (94%) cancers. Lower staging completeness was found for colorectal cancers (88%), and for lung cancers (72%). Business Rules for the collection of stage at diagnosis data for pediatric cancers have also been developed; 93% of sample cases diagnosed in the period 2006-2010 were able to be staged, ranging from 84% for nonrhabdomyosarcoma to 100% for hepatoblastoma. Conclusion: The Business Rules enabled the uniform collection of cancer stage at diagnosis data for the first time in Australia. The collection of these data will allow for the linkage of stage at diagnosis to other sources of information, including patterns of treatments applied, and enable reporting of survival and recurrence outcomes by stage.
Upskilling the Primary Care Workforce in Cancer Survivorship
Authors: Emery J. , Smith K. , Shibaoka M. , Barrett M.
Published: September 2018

Introduction/background: There is a rapidly increasing population of people living with and beyond cancer due to ageing and improvements in detection and treatment. This has impacted on the complexity of the primary care practitioners' role in managing cancer survivorship. The Massive Open Online Course (MOOC) was developed to address this need for a sustainable education model. Aim/Objectives: The Cancer Survivorship for Primary Care Practitioners program aims to enhance the knowledge and skills in the transition of survivors from oncology treatment into shared care. The Victorian Comprehensive Cancer Centre's (VCCC) goal was to develop a freely accessible, relevant, flexible, evidence based and sustainable resource for a global audience. Methods: Aimed at primary healthcare practitioners including general practitioners, nurses (general practice nurses, community nurses and nurse practitioners) and allied health professionals; the program was developed to adhere to best practice survivorship care in the areas of: survivorship fundamentals; communication and coordination of care; promoting self-management, psychosocial and community-based support; surveillance, long term and late effects; and new and emergent technologies. The MOOC is contextualised in the narrative of a patient story and includes a series of real patient stories, interactive presentations, interviews, readings, online discussions, quizzes and peer reviewed assessments. Alumni from the program will contribute to a growing community of practice and contribute to the teaching and quality improvement of the program. An online survey will be distributed to all participants before and after their completion of the program. Paired tests will be conducted and compared for the participant craft groups that attend the MOOC. We will measure the effect of participation in either the MOOC and/or workshop on confidence, knowledge and intention to change practice. Results: A description of the sustainable MOOC delivery model and evaluation results from the first cohort will be presented. Conclusion: The program will deliver an innovative and sustainable professional development opportunity for PCPs in response to the evolving population health landscape. Alumni from the program will contribute to a growing community of practice and contribute to the teaching and quality improvement of the program.
Early Detection of Breast Cancer in Gulf Cooperation Council Countries: Case Studies
Authors: Fadhil I. , Alkuwari M. , Al Tahan F. , Alsaleh K. , Alsaadoon D.
Published: September 2018

Background: Breast cancer is the most frequently diagnosed cancer among women in Gulf countries. Although breast cancer incidence rates in the Gulf are substantially lower than rates in developed countries, yet an increasing trend is evident. Most breast cancers are diagnosed at an advanced stage, only 23.3% of patients presented with localized tumors and less than 2% with in situ, making improvements to early detection of breast cancer a priority. There has been good progress and investment in early detection of breast cancer program in Gulf countries based on augmenting breast cancer awareness through public education, investing in mammographic based screening and improving infrastructure. Nevertheless, development of breast cancer early detection programs in most of the Gulf countries has been based on sporadic investments and actions rather than on a planned, approved and resource-linked national control plan. In many instances the scientific evidence-base for such investments has not been obtained and the evaluation of implemented programs is lacking. Aim: To review breast cancer screening, early detection practices in Gulf region, outlines enablers and identifies priorities for scaling up early detection programs in Gulf countries. Methods: The study relies heavily on review of published literature and data gathered through interview and discussion with key informants from government and nongovernment institutions at the studied countries. Results: Four case studies will be discussed from Bahrain, UAE, Kuwait and Saudi Arabia. Conclusion: Breast cancer is a major and increasing problem in Gulf countries, but it is still largely diagnosed at an advanced stage. While mammography based screening programs have been initiated in Gulf countries, however they generally have limited uptake, with very little evidence to support their effectiveness, largely because their attempts at education on the curability of breast cancer, and their endeavors to dispel the prevalent myths on breast cancer, have not been sufficiently successful. Thus, it is essential that the highest priority in each country should be improving awareness, early diagnosis of breast cancer, by public and professional education. This will require considerable investment in training primary care professionals, organizing referral mechanisms and setting up multidisciplinary breast cancer diagnosis and treatment facilities across the countries. While population-level screening for breast cancer is feasible in Gulf countries, yet careful consideration for available resources is critical for success. Moreover, it is important to pilot any screening programs prior to national roll-out.
Implementing a Fee-for-Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities
Authors: Muffih T.P. , Claudettea C. , Manjuha F. , DeGregoriob G. , Mangaa S. , Nulaha K. , Kiyanga E. , Bradfordb L. , Sandoc Z. , Welty T. , Welty E. , Gordon J.
Published: September 2018

Background: Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health Services, a large faith-based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. Trained nurses provide fee-for-service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment of reproductive tract infections (RTI) and refer for further tests and treatment indicated. Methods: We retrospectively reviewed and analyzed WHP medical records from women who presented for cervical cancer screening from 2007-2014. Results: In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees-for-service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment of RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model. Conclusion: The WHP's experience using a cost-recovery model and offering multiple services in a single clinic rather than stand-alone cervical cancer screening may be a practical model to make cervical cancer screening services accessible, comprehensive and sustainable. Integrating other women's health services enabled women to address additional health care needs.
Female Leadership in the Fight Against Cancer
Authors: Gomes A.L. , Venturela P. , Cecagno L. , Johnson G. , Caleffi M.
Published: September 2018

Background and context: According to INCA (National Cancer Institute), over 300,000 women would be diagnosed with cancer in 2017 in Brazil. There are many obstacles for full autonomy of Brazilian women. However, their contribution to the growth of the Brazilian GDP has been increasingly more significant. Access to prevention, diagnosis and health care have an impact on those levels because, the more healthy women are, the more they can be economically active. The engagement of female political leaders for the promotion of public policies is a major opportunity. Aim: Promoting the engagement of female political leaders in the fight against BC in terms of promoting local public policies and actions to provide access to diagnosis and treatment of the disease. Strategy/Tactics: Was established that, to participate in the event organized by the project, only teams comprised of NGOs and female political representatives from their respective locations could apply. Therefore, we can expect joint and combined actions in the long run. Program/Policy process: Planning: Define the schedule of the event and goals of the dynamics applied for collectively building a plan. Engagement: NGOs associated to Federação Brasileira de Instituições Filantrópicas de Apoio à Saúde da Mama (FEMAMA) organized local meetings to encourage political leaders to participate in the event. Implementation: Lectures to align knowledge and expertise on: female empowerment, social costs of cancer and advocacy; Collective construction dynamics to be used to draft a guideline document, specifying the main local issued regarding female cancer and actions proposed to solve those issues. Promotion: Social media and press. Feedback: Various improvements right after the event, due to the closeness established between the NGOs and political leaders. Main outcomes: Participation in the event: 36 NGOs from 15 states and 28 female political leaders (State Governors, Mayors, First Ladies, federal Congresswomen, City Councilor, etc.); 1 guideline document specifying the main local issued regarding female cancer and actions proposed to solve those issues; Reaching over 207,000 people, with key messages from the event posted on social media, as well as 100 insertions in the press; Drafting and proposing a bill, which is to be done by the federal Congresswoman who participated in the event, petitioning for the implementation of a Mandatory Cancer Registration service in the country (PL 8470/2017); Purchasing and repairing digital mammography devices for public hospitals in 2 Brazilian states; Implementing a cancer registration system (which was out of operation since 2013) and creating a Special Oncology Committee at the City Councils of cities in northeastern Brazil. What was learned: The engagement of female political leaders by the NGOs was essential to the success of the project. FEMAMA believes that this relationship needs to be maintained so that the actions proposed in the guideline document can actually be carried out.
Active Monitoring Versus Immediate Treatment of Women With Localised, Low-Risk Ductal Carcinoma In Situ: Does It Make Economic Sense?
Authors: Bromley H.L. , Roberts T.E. , Petrie D. , Mann B.G. , Rea D. , Nickson C.
Published: September 2018

Background: Controversy persists about the overdiagnosis of low risk breast cancers identified by breast cancer screening programs. Low risk ductal carcinoma in situ (DCIS) is a noninvasive breast condition with an uncertain risk of invasive progression. Standard management consists of immediate surgical treatment, with or without radiotherapy and adjuvant therapy. Active monitoring of low risk DCIS via annual mammography is proposed as an alternative strategy to immediate surgery to reduce the harm of overdiagnosis, whereby the disease is only treated upon disease progression. However, the costs and benefits of active monitoring are not well researched in the breast cancer setting. Aim: To assess the cost-effectiveness of active monitoring versus immediate surgical management in women diagnosed with low grade ductal carcinoma in situ (DCIS). Methods: A Markov state transition model was constructed for a theoretical cohort of women aged 50 years and over with low risk DCIS over a lifetime horizon. A cost-utility analysis was performed to compare a strategy of observation (active monitoring) versus immediate surgical treatment using an annual time cycle. Transition probabilities, costs and utilities were obtained from national mortality and cost data, published meta-analyses, primary data collection of utilities and expert opinion. A healthcare perspective was adopted to present the results. Primary outcomes were assessed in terms of cost per quality-adjusted-life-year (cost per QALY). Multiple sensitivity analyses were undertaken to determine effect of parameter uncertainty on results. Results: The cumulative costs and QALYs for each age cohort are presented. Active monitoring is a cost-effective strategy for the management of low risk breast cancer in older women with comorbid conditions. Sensitivity analyses revealed the ICERs for all women to be affected by baseline probability of disease progression, age, cost of surgery and utility. Conclusion: Conservative management of ductal carcinoma in situ via active monitoring may be cost-effective compared with immediate surgical treatment in a selected cohort of older women with low risk disease.
Sexual Well-Being After Breast or Pelvic Cancer Treatment: A Guide for Women
Authors: Murphy H. , McCarthy T. , Lyng A. , Doherty K. , Mullen L. , Bonas F.
Published: September 2018

Background and context: As part of the National Cancer Strategy 2017-2026, the NCCP aims to improve the experience and care for cancer survivors. A key objective of survivorship care is to empower patients to achieve their best possible health outcomes while living with and beyond a diagnosis of cancer. Aim: To develop a guide to provide a support on sexual well-being for women who have completed cancer treatment of breast cancer; gynecologic cancer; bowel, rectal and anal cancer; or bladder cancer. Strategy/Tactics: A project design team was established with stakeholders including healthcare professionals and patients. Program/Policy process: The guides were designed to facilitate conversation around what is a sensitive subject for many people. Having cancer may change the relationships a cancer survivor has with their family and friends; it is natural to need some time to adjust. But while cancer treatment may affect sexuality, sex life doesn't have to end. The guide was reviewed by patient groups prior to printing. It is approved by National Adult Literacy Agency (NALA). The guide was nationally distributed to all clinical areas and is available on the Web. Outcomes: The final publication is entitled Sexual Well-Being After Breast or Pelvic Cancer Treatment: A Guide for Women. It gives details of treatments that may help improve sexual well-being and encourages women to be their own strongest resource. It includes advice on how to talk about sexual well-being, how to create physical and emotional intimacy, and what to do if you are not in a sexual relationship but would like to be. The guide is a companion to the previously published Information for Men on Sexual Well-Being After Pelvic Cancer Treatment, which has been widely used by men to understand the sexual changes caused by cancer treatment. The guide was launched in January 2018. With support from HSE communications it was promoted across social media. It received a positive response with the guides requested nationally. The guide was also distributed to all the cancer centers, support services, and primary care centers. What was learned: Healthcare professionals find it difficult to discuss sexuality with their patients and this booklet allows sexuality to be discussed. Workshops will be required with healthcare professionals to empower themselves and their patients to address the issue of sexuality in survivorship.
Determinants of Uptake of Breast and Cervical Cancer Screening by Users in Lagos, Southwestern Nigeria
Authors: Salako O. , Okunade K. , Okediji P. , Agaga L.A. , Olajiga O.
Published: September 2018

Background: Breast and cervical cancer are the two most common cancers in Nigerian women with a huge morbidity and mortality burden in those affected. Previous Nigerian studies indicate a wide variation in the knowledge and perceptions of women, which significantly impacts on their willingness and motivations to make use of available cancer screening services. The result of this is late presentations and poor treatment outcomes. This study assessed the factors affecting the uptake of breast and cervical cancer screening services in Lagos, Nigeria. Methods: This cross-sectional study was conducted among female users of a breast and cervical cancer screening service in Lagos, Nigeria. Data were collected using a self-administered questionnaire and analyzed with the level of significance set at < 0.05. Results: A total of 491 women were screened between October and December 2017 for breast and cervical cancer. The mean age was 38.3 ± 12.7 years, with majority married (60.3%), educated up to tertiary level (47.7%), and were professionals (30.8%). Majority knew about cervical cancer screening (61.3%) ( Table 1 ), with 23.6% having a previous cervical cancer screening and 9.8% had vaccination for cervical cancer. Older (42.3 ± 10.8 years), married professionals with tertiary education who have heard about cervical cancer were more likely to have had a previous cervical cancer screening ( P < 0.05) ( Fig. 1 ). About 65.9% of the total sample population knew about breast cancer screening ( Table 2 ) and 62.0% of these do periodic breast self-examination. However, many of the women sampled had never had a clinical breast examination (64.2%) nor a screening mammogram (74.3%) ( Fig. 2 ). Determinants of breast self-examination were tertiary education and those in professional occupations ( P < 0.05). Conclusion: In line with the goal of ensuring that every eligible woman is screened for breast and cervical cancer, there is an urgent need to improve knowledge and awareness of breast and cervical cancer, as well as the need for screening, among Nigerian women with little or no education, who are involved in unskilled or semiskilled occupations.[Figure: see text][Figure: see text][Table: see text][Table: see text]