bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Liver Cancer Prevention Messages to Scale up the Diagnosis and Treatment of People Living With Hepatitis B
Authors: Adamson E. , Yussf N. , Schreiber E.
Published: September 2018

Background and context: Chronic hepatitis B (CHB) is a major public health issue in Australia, affecting an estimated 238,000 people. If not appropriately managed, chronic hepatitis B infection can cause cirrhosis and liver cancer. Liver cancer has the fastest increasing incidence rate of all cancers in Australia, and its survival is among the lowest. To reduce the burden of liver cancer, more people with CHB need to be diagnosed and treated. The majority of people living in Australia with CHB (61%) were born overseas, and research indicates people have low levels of understanding about hepatitis B, and its link to liver cancer. Cancer Council Victoria developed several communication campaigns to increase testing and diagnosis for hepatitis B in the Vietnamese and south Sudanese communities living in Victoria. Aim: •To raise awareness about hepatitis B and the link to liver cancer in the Vietnamese and south Sudanese community •To increase understanding about diagnosis, vaccination and management •To mobilize the community to talk to their trusted GP about hepatitis and to be tested. Strategy/Tactics: The campaign strategy was designed to address the knowledge barriers to testing for these two communities. To inform the strategy, qualitative focus groups and community interviews were used to identify perceptions of hepatitis B and liver cancer, as well as the barriers and motivators to testing. Both communities identified their local doctor as a trusted source of health information. Two media campaigns were developed featuring a known doctor from each community. An additional campaign was tailored specifically for young south Sudanese people using hip hop music as method of disseminating key messages about liver cancer prevention. Program/Policy process: The campaigns were designed by the Screening, Early Detection and Immunization Team at Cancer in Council Victoria, Australia. Outcomes: Digital metrics and face to face interviews with community members, nurses and doctors were used to assess the impact of the campaigns. Evaluation results also indicated people did visit their doctor to talk about hepatitis B. The success in motivating people to see their doctor was attributed to the campaigns featuring a message about liver cancer being caused by hepatitis B, and it being led by a known and respected doctor from their own community. What was learned: Cancer organizations can target liver cancer prevention efforts to · increase awareness about liver cancer and hepatitis B in at risk communities; · motivate at risk people to visit their doctor for hepatitis B testing, vaccination and treatment by linking the prevention of liver cancer to hepatitis treatment; · tailor communications to the specific needs of different culturally diverse communities; · collaborate closely with communities from culturally diverse backgrounds to ensure campaign messages and calls to action are culturally appropriate.
AA Homozygous Genotype of GSTP1 I105V Polymorphism in Oral Cancer: In Silico Screening, Molecular Dynamics Simulation and Activity Studies of Wild and Mutant GSTP1
Authors: Chatterjee A. , Banerjee A. , Yadav P. , Singh C.S. , Boruah N. , Dkhar H. , Nongrum H.B. , Bhattacharyee A.
Published: September 2018

Background: Highest incidence of oral squamous cell carcinoma (OSCC) has been reported in north-eastern India and causal association between cancer and raw areca-nut (RAN) consumption are well evident. Earlier studies revealed that monitoring the occurrence of precocious anaphase and expression of securin in blood lymphocytes can be a good biomarkers for cancer risk in RAN+lime chewers. Glutathione S-transferases (GSTs) are considered an important cellular detoxification system that provide protection against the effects of toxins and determine individual's cancer susceptibility. Aim: Although GST gene family has been extensively studied, its role as susceptibility factor in oral cancer risk in the RAN chewing population in Meghalaya state, India has not been explored. The association of polymorphisms in GSTP1 (Ile105Val) gene with OSCC risk in Meghalaya, India, was evaluated. Earlier both AA reference and the GG/AG mutant genotype of GSTP1 gene showed an association with different types of cancers. Methods: Genetic polymorphism was evaluated by genotyping 129 cases and 156 controls using PCR-RFLP method and validated by Sanger sequencing in a hospital-based case-control study. GSTP1's interaction status with c-Jun Kinase (JNK) was evaluated through protein-protein docking analysis and this was also validated experimentally by immunohistochemistry and qRT-PCR. Results: Individuals with AA allele of GSTP1 showed significant association with the risk of OSCC compared with individuals with AG/GG mutant genotypes in habit-matched “RAN-only” and “RAN+Tobacco” group. The binding geometry between JNK and GSTP1 was disrupted in mutant combinations. It was demonstrated that AA homozygous genotype of oral epithelial cells showed reduced c-Jun-phosphorylation and proapoptotic genes expression than AG/GG genotypes. In silico docking revealed that homodimeric GSTP1 with AA genotype showed weak catalytic activity in detoxification of RAN and tobacco toxins compared with the AG/GG mutant proteins. Interestingly, the quantitation of 8-Oxo-2´-deoxyguanosine in DNA digests by ELISA-kit showed no differences in these genotypes, however the frequency of sister-chromatid exchanges was significantly higher in individuals with GSTP1 AA genotype than GG genotype. Conclusion: Thus in this population, specific traditional habit along with GSTP1 AA genotype play a significant role in predisposition to oral cancer risk by showing higher DNA-lesions, might be caused by some specific RAN/tobacco metabolites, and lower c-Jun phosphorylation which may inhibit apoptosis.
The Impact of the Rising Colorectal Cancer Incidence in Young Adults on the Optimal Age to Start Screening in the US: A Microsimulation Analysis
Authors: Peterse E.F.P. , Meester R.G.S. , Siegel R.L. , Chen J.C. , Dwyer A. , Ahnen D.J. , Smith R.A. , Zauber A.G. , Lansdorp-Vogelaar I.
Published: September 2018

Background: In 2016, the MISCAN-Colon model was used to inform the US Preventive Services Task Force (USPSTF) colorectal cancer (CRC) screening guidelines, which recommend screening from ages 50 to 75 years for average risk individuals. However, these models did not take into account the increase in CRC incidence below the age of 50 years. Aim: In this study, we reevaluated the optimal age to start screening, age to end screening and screening interval in light of the increase in CRC incidence observed in young adults. Methods: We adjusted the simulated lifetime CRC incidence in the MISCAN-Colon model to reflect the observed increase in young onset incidence. In line with the strong birth cohort effect, the current generation of 40-year-olds was assumed to carry forward escalated disease risk as they age. Life-years gained (benefit), the number of colonoscopies (burden) and the ratios of incremental burden to benefit (efficiency ratio) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start screening (40, 45, 50), ages to stop screening (75, 80, 85), and screening intervals (depending on screening modality). We then determined the model-recommended strategies in a similar way as we did for the USPSTF, using similar efficiency ratio thresholds to the previously accepted efficiency ratio of 39 incremental colonoscopies per life-year gained. Results: The life-years gained and the number of colonoscopies for each colonoscopy strategy are plotted in Fig 1. Because of the higher CRC incidence, model-predicted life-years gained from screening increased compared with our previous analyses for the USPSTF. Consequently, the balance of burden to benefit of screening improved, with colonoscopy screening every 10 years starting at age 45 years resulting in an efficiency ratio of 32 incremental colonoscopies per life-year gained. Conclusion: This decision-analytic modeling approach suggests that based on the increase in young-onset CRC incidence, screening initiation at age 45 years has a favorable balance between screening benefits and burden. Screening until age 75 years with colonoscopy every 10 years, fecal immunochemical testing annually, flexible sigmoidoscopy every 5 years, and computed tomographic colonography every 5 years was recommended by the model as these strategies provided similar life-years gained at an acceptable screening burden.[Figure: see text]
Breast Cancer Survivorship in Ghana: Peace and Love Survivors´ Association (PALSA)
Authors: Addai A. , Addai B.W.
Published: September 2018

Background and context: About 10 years ago in Ghana, you couldn´t find a woman to say I had breast cancer, went through the treatment and I am still alive and a survivor now. Today Breast Care International (BCI) has breast cancer (bc) survivors who not only share their stories but show their postmastectomy scars. Aim: To create a community of bc survivors reintegrating into society emotionally, physically, psychologically healed/content and by so doing demystify bc in Ghana. PALSA has over 800 survivors. Strategy/Tactics: 2 years after completion of active treatment, our patients are absorbed into PALSA where they continue to receive counseling and postcancer reviews. Some PALSA members were trained in 2013 by Carries´ Touch from California, USA on how to share their stories, counsel and navigate newly diagnosed bc patients. Program/Policy process: Survivorship is complex. Our survivors need to be filled and content to genuinely impact their audience when they share their stories and navigate bc patients. a) Survivors in our HOPE (Helping Others through Personal Experience) program counsel and walk the treatment journey with newly diagnosed patients. b) Showcasing survivorship with > 300 survivors parade during BCI Ghana walks for the cure. c) Survivors join all BCI outreach programs to share their stories, with postmastectomy survivors boldly showing their external prosthesis and framed photos of their scars. d) 2017 Dress Campaign - 5 bc survivors with pink tailor made clothes shared their stories through art. This year 20 survivors will participate thanks to donation in kind from GTP. e) September 30th 2017, survivors´ children and their mothers danced at the African Regent Hotel and the arrival hall of Kotoka International Airport to usher in the pink month. f) For the first time Kotoka International Airport was decorated in pink for the month of October to celebrate breast cancer awareness. Outcomes: Before the HOPE project PLH had 70% defaulting treatment especially mastectomy, compared with 10% default rate now. More women are ready and eager to be screened because they see and hear women survive bc and mastectomy for years. Flash mobs and the dress campaign are new and fun ways to take breast cancer awareness to the youth. What was learned: Building a strong survivorship program is an important part of life after bc. Not only do we maximize impact in advocacy and awareness creation with survivors, our survivors care/support each other and find a place to heal and integrate in society (either reintegrating or find something new like being used at PLH in HOPE, decorating airports for the pink month). Our survivors are ready and eager to share their stories and help change bc in Ghana in their own unique ways. We just need to create all the different ways they can do this and save as many lives as possible.
Breast Cancer Education and Screening in Indonesian Rural Community: A Programme Trial
Authors: Widjaja D. , Kurniawan A. , Baskoro B.A.
Published: September 2018

Background and context: Breast cancer has the highest incidence and prevalence among cancers in Indonesia. Indonesian rural society has low level of breast cancer knowledge and self examination practice. Difficulty for accessing breast cancer primary health care screening also caused negligence. Furthermore, ignorance and economy situation made patients chose alternative treatments. Hence, most cases are detected at late stages, in which late diagnosis and treatment resulted in high mortality. Aim: Decrease breast cancer mortality by increasing breast cancer knowledge level, monthly self-examination practice awareness, and mass screening for early detection of breast cancer. Strategy/Tactics: In conjunction with National Cancer Control Committee event at 2017, we did a one day social occasion of education and early detection screening for breast cancer in Indonesia rural communities. Participants were gathered with mass announcement from primary health care workers. An expert brought an education class, then parallel screening rooms were provided for all participants. Program/Policy process: Phase one (2017) consists of establishing a good basic education and screening system. We gave free invitation to district health office to be distributed to a local primary health care and participate in a small education class brought by breast cancer specialist. Materials consist of basic knowledge and risk factors, self-examination awareness, diagnostic and treatment procedure, and referral process. Afterward, participants got breast physical exam screening by general clinicians. In phase two (2018), we added questionnaires to assess the effectiveness of education class in increasing knowledge level and self-practice awareness. An ultrasonography examination was added to narrow the diagnosis. Participants with higher risk factor or positive findings were given extra consultation. All participants were referred to our secondary referral General Hospital at Karawaci district, Tangerang, Banten, Indonesia. Outcomes: In 2017, 10% of participants had positive results and referred for further tests. In 2018, education class significantly increase knowledge and breast self-exam practice awareness. Moreover, ultrasonography examination narrowed positive diagnosis from 13% to 7%. What was learned: Education and early detection screening to primary health cares across Indonesia are needed to gather breast cancer cases at earliest stadium, hopefully could decrease breast cancer mortality. Feedbacks from participants showed that feeling of importance played important role and can only be developed internally after the disease became personal. Mobile mammography examination will help establishing breast cancer diagnosis. Budget is an issue, participants must be filtered beforehand based on risk factors for positive diagnostic results. A follow up and reminder system is needed to ensure participants follows proper management steps.
Action Research: Benevolence and Barriers of Reciprocal Career Plan for Cancer Community
Authors: Cheng K.Y. , Chi C.L. , Chen Y. , Wang Y.W. , Tseng L.Y. , Huang Y.C. , Liu H.F.
Published: September 2018

Background: There are 106 cancer communities organized by cancer patients and their family members as volunteers. Mutual help between patients and family members, according to practical experiences and researches, is more important and irreplaceable than professional help. Hence all service projects set off by Hope Foundation for Cancer Care aims at helping to bridge mutual help and coping skills among patients. In recent years, cancer patients are getting younger and younger, and their financial status for medical and daily expenses become heavy weight. In addition, cancer is proven to be a chronic disease. It is inevitable for cancer patients to return to workforce. Therefore, supporting cancer patients for employment is one of the major ways we can help patients to maintain their quality of life. Namely, being used acts bifacade to family financial sources and self-identifications. Aim: In response to their need for financial support and identity empowerment, Hope Foundation for Cancer Care offers reciprocal career plan for cancer community through action researches to support cancer patients build up active plans for participation in working fields. Hope Foundation also encourages patients to take part in the decision making process, so that the foundation can offer its service in accordance to patients' needs. Methods: Action research was carried out for one year. 3 patient-workers and 3 full-time workers were included in this plan. Results: Staff members' workload reduced since the patients joined the team. Together they went through nine meetings to improve the space and the procedure of the service they are offering. These meetings and discussions not only facilitated management of the organization, but also allow the patients to express their ideas and creativity as well as enhance their own authority at work. However, due to bureaucracy of the organization, ideas proposed by the patients often took a long period of time to receive response, which potentially caused them to hold back. Therefore, they were at best partly empowered at work. On the other hand, they who'd gone through cancer themselves, helped the staff to optimize the service to others by bridging their own experiences and participating in discussions with staffs of the organization. Such reciprocal relationship between the patients and the organization embodies the very aim of this project. Conclusion: Two among the three patient-workers were officially recruited as employees in 2018. From patients to paid staffs, they transformed from receiving help to giving help. After the project ran for a year, all the staffs agreed that these patient-workers made a big contribution to the foundation. Not only did they help build the working space more friendly because of their physical conditions, but challenge the foundation to adapt more flexible management tactics, which reflects our core value - to serve for the rights of the patients.
Improving Metastatic Breast Cancer Care in Kenya Using Information Technology
Authors: Shaikh A. , Sayed S. , Cathomi C. , Chite F.
Published: September 2018

Background and context: In Africa, up to two thirds of breast cancer patients have been reported to present with an advanced stage of III or IV at diagnosis leading to a disproportionately higher mortality. In Kenya, breast cancer is the most common cancer in females in terms of diagnosis and mortality. Metastatic breast cancer (MBC) patients are an ignored part of the breast cancer community as they are marginalized in many of the breast cancer related initiatives. MBC suffer from clinical depression, anxiety and four out of five of these women do not receive any services, referral or guidance to help them with their emotional distress. Preferred evidence based methods of support desired by women with MBC, include online support. International resources are not always applicable to the local context thus making them unattractive for people from diverse cultures and background, such as those from Africa. Kenya has a high percentage of literate females and highest Internet usage in the area. This provides a unique opportunity in an otherwise limited resource country to reach out to a significant population of MBC patients. The patients voices are a valuable and trustworthy assessment of their actual needs. They have been used frequently in the area of cancer as a first step in designing needs-tailored interventions. We propose to develop a virtual online forum with the aim of providing patients with MBC, and their caregivers an interactive forum for psycho social support, addressing stigmas, seek relevant clinical advice, find links to the nearest healthcare facilities, download helpful information, participate in support group activities and receive links to other important helpful sites that are locally relevant. We also propose that such forum should also reflect the needs of our patients as described by themselves. Aim: Primary aim of this project is developing a virtual online interactive support forum where MBC patients and their caregivers can access information on social, psychological, spiritual, religious and clinical needs. The purpose is to be partly achieved by assessing the patient needs by needs assessment survey and to evaluate the impact of such intervention on patient knowledge and satisfaction with care. Strategy/Tactics: Web site development is the key component of the project. Patients would be asked to fill out the Supportive Care Needs Survey/The Knowledge Assessment Tool. The surveys will take place at four major cancer treatment hospitals in Kenya. Postlaunch promotion and awareness about Web site will be made and, usage data and knowledge tool to be used to assess the impact and acceptability. Web site updated regularly to address issues identified. Program/Policy process: Information gathered would be made part of policy on national cancer strategy, recommendations to factor in identified patient needs in policy. What was learned: Ongoing process.
Improving Breast Cancer Patients Survival and Quality of Life by Targeting Traditional and Religious Leaders in Northern Nigeria
Authors: Mohammed S. , Bagudu Z. , Lawal I.
Published: September 2018

Background and context: Breast cancer is the most common cancer among Nigerian women, mostly aged 35 years and older. The survival rate of breast cancer patient in northern Nigeria is 40% and below as compared with that of developed countries at 95% and above. The rising incidence of breast cancer in northern Nigeria is complicated, mainly due to cultural beliefs for incision by traditional rulers, poverty, illiteracy and fear of high cost of treatment. Aim: Breast cancer is the most common cancer among Nigerian women, mostly aged 35 years and older. The survival rate of breast cancer patient in northern Nigeria is 40% and below as compared with that of developed countries at 95% and above. The rising incidence of breast cancer in northern Nigeria is complicated, mainly due to cultural beliefs for incision by traditional rulers, poverty, illiteracy and fear of high cost of treatment. Strategy/Tactics: We made contact with two tertiary health facilities in Kebbi state to determine the baseline prevalence of stage 3 and 4 breast cancer in the hospitals. Organized cancer sensitization workshops for religious bodies to incorporate breast cancer awareness into sermons and also capacity building for nurses and traditional healers. Engaged the media through delivery of radio and television jingles on dangers of refusing medical care and also telling the stories of cancer survivors to enable the populace to be strong and brave to take charge of their health and quality of life. Program/Policy process: The entire communities were carried along. Tertiary health facilities provided support in giving access to relevant data. Permission from local government chairmen were sorted to interact with members of the communities. The general public were engaged through media. Outcomes: There was 30% increase in percentage of male participation especially spouses in encouraging women to seek appropriate help for breast cancer. Traditional healers and religious leaders had a positive impact in sensitizing women on need to attend hospitals for any breast changes early so as to reduce the incidence of late detected cases. They also alleviated avenues of stigmatization among the populace. Survivors were able to tell their stories via various media channels. What was learned: Majority of the target population lack access to basic health care. They patronize unorthodox medicine rather than clinical medicine. Cancer education and advocacy made a huge difference in health care perspective of this population. There is great need for continued cancer education and awareness to improve patients' survival and quality of life.
Health Related Quality of Life of Women With Cervical Cancer in the University College Hospital Ibadan, Nigeria
Authors: Fadodun O. , Ohaeri B. , Oluwatosin O.A. , Adebimpe B. , Oluwasola T. , Adenipekun A.
Published: September 2018

Background: Cancer worldwide accounts for 13% annual death with 8.2 million deaths. Cancer and cancer treatment affects different domains of functioning and the quality of life (QoL) of affected clients. However, there is dearth of information on impacts of cancer and cancer treatment on the different domains of functioning. Aim: This study assessed the health related- QoL of women diagnosed with cervical cancer at the University College Hospital (UCH) Ibadan, Nigeria to provide more information on the impact of cervical cancer treatment on the health status of the women. Methods: The study adopted a descriptive, cross sectional design. A consecutive sampling method was used for data collection from consenting participants over a period of three months. Ethical approval was obtained from the Joint University of Ibadan/UCH ethical review committee. Subsequently, permission was sought from heads of department and charge nurses. Two standardized research instruments (EORTC QLQ30 and EORTC CX24) and a self-structured sociodemographic page were used for data collection. Management of data were performed using SPSS version 20. The levels of QoL and functioning were calculated using EORTC QLQ30 and EORTC CX24 formulae and these levels were categorized as low (0-49) and high (50-100). χ2 statistics was used to determine the association between level of functioning and QoL at 5% level of statistical significance. Results: A total of 57 respondents participated fully in the study. With mean age of 55.0 ± 11.2 years. Overall, 28 (49.1%) had high QoL score while 21 (36.8%) had a high level of functioning. Furthermore, frequencies of women with high level of functioning scores in the different domain are as follows: physical functioning 29 (50.9%), emotional functioning 30 (52.6%), cognitive functioning 37 (64.9%), role functioning 17 (29.8%) and social functioning 15 (26.3%). There was significant association between overall functioning and QoL at P < 0.05. Conclusion: In view of the findings, with very few people having high level of role functioning and social functioning, specific attention should be given to specific domains of level of functioning in planning interventional strategies for management of treatment effects.
Developing Palliative Care in Low-Resource Countries in Asia
Authors: Goh C.
Published: September 2018

Background and context: According to the World Health Organization (WHO) global atlas which maps palliative care needs worldwide, just over 50% of the palliative care needs reside in Asia. Development of palliative care services in Asia is patchy, with a few high income countries, such as Singapore and Japan, with palliative care services integrated into the health system. In the vast majority of countries, particularly low-income and middle-income countries (LMICs), such services are lacking or only available in a few centers. Aim: To develop palliative care services in countries with no services. Strategy/Tactics: The Asia Pacific Hospice Palliative Care Network (APHN) is a nongovernmental organization which supports the development of palliative care in the Asia Pacific region. Since 2012 , it has developed a comprehensive program to build capacity for palliative care in several countries in the region, including Myanmar, Sri Lanka and Bangladesh. Program/Policy process: Coconceptualized and funded by the Lien Foundation, the APHN sends interdisciplinary teams of volunteer faculty to these countries to run a training of trainers program over a period of three years. Major tertiary institutions were chosen as partners, with the understanding that palliative care services would be set up once a team had been trained. An interdisciplinary team of doctors, nurses, social workers and pharmacists from each institution went through the training program together. Individuals with potential to become champions for palliative care in these countries were given further training through a clinical fellowship program at established institutions in the region. During the training participants would be expected to start palliative care services in their institutions, which will become training centers for palliative care in the future. Concomitantly, a program of advocacy for medications essential for palliative care, such as oral morphine, was also undertaken. Outcomes: Six modules of the training course were completed in each of the three countries. A corps of 20 to 30 master trainers completed the training. In each of those countries, one or more palliative care services were started in major tertiary teaching hospitals. Oral morphine availability was greatly enhanced. The master trainers organized training within their hospitals, and also for the public. Other outcomes include the recognition of palliative care as a specialty, the introduction of palliative care into undergraduate medical and nursing curricula, and development of postgraduate courses in palliative care. What was learned: It was important to target institutions which were willing establish palliative care services. An interdisciplinary group of faculty was able to teach and inspire the trainees to take up the discipline. A drug availability program was essential to provide the tools to work with.
Detection of High Oncogenic Risk Human Papilloma Virus With CareHPV Test in Women Attended in Health Units in Copán Honduras
Authors: Membreño E.L. , Regalado C.M. , Peña N.D. , López E.J. , Bejarano S. , Crespin M.A.
Published: September 2018

Background and context: Persistent infection with high-risk human papilloma virus (HR-HPV) is identified as the main cause of premalignant and malignant cervical diseases. The identification of HR-HPV by viral DNA has been used in multiple studies to characterize the infection, the careHPV test presented HR-HPV prevalence in Latin American countries of: Costa Rica (16%), Mexico (14.5%), Colombia (14.9%), and Chile (14.0%). Cervical cancer represents a public health problem in Latin America, and in Honduras is the main cause of cancer in women. Half of Honduran women at risk are not systematically screened for cervical cancer. Aim: Identifying women at risk for premalignant lesions with rapid and efficient tests can guarantee timely treatment. Strategy/Tactics: Retrospective, descriptive, cross-sectional study at Copán health units (La Entrada, Florida, Trinidad and San Juan Planes), where the results of the careHPV test were analyzed to determine HR-HPV genotypes, in 540 women between 30 and 65 year from September 2016 to March 2017. Program/Policy process: Positive patients received VIAA, and colposcopy/biopsy according to national cervical cancer screening guideline 2015. Outcomes: 458 negative women for HR-HPV 85% and 82 positive women 15%. The age group with the highest prevalence of HR-HPV was 30-49 years. Of 69 positive women, 64 received visual inspection with acetic acid (93%), 47 resulted with negative VIAA (73%), 2 with positive VIAA suspected invasive cancer, both were referred to colposcopy/biopsy, and 15 women with positive VIAA (24%) referred to cryotherapy. What was learned: The prevalence of infection by HR-HPV in the study group was 15%, similar to that reported in the literature. Standardizing the use of careHPV as a screening test can guarantee the prevention of invasive stages of cervical cancer.
The Report of an Innovative Electronic Patient Management System in the Oncology Clinic of a Tertiary Institution
Authors: Isibor V. , Salako O.
Published: September 2018

Background and context: Nigeria and most of the low and middle-income countries in West Africa have been unable to successfully transition from a paper based medical health records system to an electronic one. This is due to such constraints as lack of skilled manpower in development and maintenance of electronic records, erratic electric power supply and poor uptake of innovative means of securing and saving medical records. In a tertiary hospital that receives over 1500 new patients per year and manages about 5000 known patients per year, it is important to provide a fast, less cumbersome way of storing data. We need an enabling environment to make app use in healthcare functional. Aim: 1. To show that a mobile application used in a hospital setting can reduce the time spent by patients in accessing healthcare. 2. To show the medical information collected by a mobile medical application is reproducible, and secure. 3. To show that deployment of an electronic mobile health application for patient health care is both possible and necessary. Strategy/Tactics: A Web-based application was developed to be used as an electronic medical record. It was used in the oncology clinic of a tertiary institution in Lagos, Nigeria to take history and record examination findings as well as other aspects of personal medical data from new patients presenting in the clinic. The information so gathered was saved online on a cloud service and a copy was printed and placed in the hospital's paper-based records to reduce the stress of transitioning from paper-based records to electronic records. The application was built using C# for the backend, ASP.Net , HTML5, jQuery, JavaScript, Microsoft SQL database, jQuery Select 2 and jQuery for easy upgradability. Program/Policy process: A pilot study was carried out in which new outpatients were seen first with the application. Their history was taken and entered into the software. The examination findings and a summary of their investigation results were also entered into the software. A pdf file containing a summary of the data so entered into the software was generated automatically and printed. This printed copy of the patients' information was placed in the hospital's folder for review. Outcomes: 1. Stress of capturing and documenting patients data were grossly reduced in the clinic. 2. Time taken for patient assessment was reduced. 3. Data could be accessed anywhere online for the first time. This will facilitate telemedicine and research. What was learned: 1. Oncologists went through less pressure when attending to patients with this application as the intuitive outlook made clerking easy. 2. Access to steady Internet coverage and a stable power supply are issues to be tackled using this system. 3. There is a definite demand for just such a system both among patients and care givers. DOI: https://doi.org/10.1200/jgo.18.40800
Breaking Funding Barriers to Cancer Prevention Communication
Authors: Kabalega M.
Published: September 2018

Background and context: The Cancer Communiqué was founded in May 2017 and adopted a Strategic Plan 2017-2022 which defined an effective communications strategy to guide much needed cancer prevention communication in Uganda. The immediate challenge identified in commencing the identified communication activities was funding. The leadership team deliberated and agreed to use social media as a cost effective and impactful initial means of reaching out to the public. Aim: To identify and implement unique cancer prevention communication campaigns that drive strong early detection messages utilizing social media as a primary platform. Strategy/Tactics: The communications strategy adopted the following tactics to support an effective approach to reaching the targeted audiences: building strong external partnerships with private entities to provide support for the social media campaigns through mobilizing staff participation in the campaigns to generate a viral atmosphere and also to magnify the impact of the campaigns by utilizing their social media platforms to spread the key messages. Another tactic was building partnerships with private health care service providers to enable provision of free or highly subsidized screening camps. Utilization of mainstream media primarily radio was used in the form of radio interviews and talk shows to generate awareness about the social media campaigns. Leveraging existing cancer awareness platforms and localizing them to suit local market appeal was also key with campaigns such as #PinkOctoberUG, #MovemberUG and #SmearForSmearUG used. Finally, leveraging existing experiential events like sports tournaments to drive key messages. All the above tactics were implemented simultaneously on various platforms such as WhatsApp, Facebook, Instagram and Twitter. Program/Policy process: The process included the following steps: ideation of the social media activity and its mechanics including clearly ascertaining relevant target audiences and platforms to be used; identification of budget and key campaign resources required; engagement of potential partners to facilitate execution of the campaigns and finally execution of the campaigns. Outcomes: The outcome was a successful set of social media campaigns that were implemented from September 2017 to January 2018. The campaigns were unique as they communicated cancer prevention messages in ways that spoke to the target audiences and stood out from the information clutter as well as enabling people to participate in fun ways like wearing themed colors as well as lipstick smudges, all in support of spreading awareness about different types of cancer within key cancer awareness months. What was learned: This strategy highlighted the fact that even without sufficient funding, social media is an affordable and powerful platform that can be used to effectively spread cancer awareness messages. Something can be done without funding and much more can be done with sufficient funding.
Improving Cancer Outcomes Through International Collaboration in Developing Countries: King Hussein Cancer Center As a Unique Experience
Authors: Khader J.
Published: September 2018

Background and context: The need for international and regional collaboration in cancer care has grown stronger as we have made progress in both cancer treatment and screening. We sought to share our unique and successful experience at King Hussein Cancer Center (KHCC) in Jordan and to identify those efforts already underway, which facilitate such collaboration and lead to raise up the cancer care in Jordan to highest levels. Aim: To strengthen cancer care in Jordan. Strategy/Tactics: Over 15 years, KHCC succeeded in binding with well reputed international cancer centers, like MD Anderson Cancer Center, Princess Margret Hospital, St June Cancer Center, Sick Hospital Cancer Center and Moffit Cancer Center, through twinning programs and collaborative agreements to improve capacity building, holding joint scientific activities like joint telemedicine tumor boards, symposia, workshops, and clinical research. Outcomes: Through such international collaboration, KHCC could reach a highest level of cancer care and considered as a hub in the region for cancer treatment, training and research. This great achievement was not possible without this effective collaboration with these international cancer centers. Many clinical programs have been initiated at KHCC because of this collaboration, which lead to joint clinical research work and publication. What was learned: International collaboration between cancer centers in developing countries and developed countries is very beneficial and can reduce the gap in cancer care. The successful experience of KHCC in this regard should admire cancer centers in developing countries to consider it and adopt it.
Understanding the Breast Cancer Experience of Women in East Africa: A Qualitative Study
Authors: Mutebi M. , Olasehinde O. , Kingham P. , Boutin-Foster C. , Pusic A.
Published: September 2018

Background: Breast cancer is one of the leading causes of premature death in women in East Africa. The majority of patients are diagnosed with advanced cancers (stage III and IV) which results in more cancer deaths. Even after a diagnosis of breast cancer, many patients do not complete their treatment. The reasons why delays in diagnosis and treatment occur are multilevel, involving a combination of both patient related factors, such as sociocultural reasons like stigma or fatalism, or the use of alternative medicine. Financial factors play a big role as many patients have to pay out of pocket for their health expenditure. System related factors such as a lack of resources for the diagnosis or treatment, lack of health worker knowledge leading to misdiagnosis with inappropriate treatment and poor referral pathways, also contribute to delays in care. Aim: To understand the experience of breast cancer patients in East Africa, to determine the facilitators and barriers to diagnosis, treatment and follow-up of breast cancer. Methods: 28 patients in Kenya and Tanzania who had completed at least a year of initial treatment were invited to participate in the study. A qualitative exploratory study was done using semistructured, in-depth interviews. Grounded theory was then used to analyze and develop themes that emerged from these narratives. Results: For these patients who had completed at least a year of treatment, the cost of treatment and expenses incurred was a major concern. Family disintegration emerged as a significant theme following cancer diagnosis. There was a prevalence of stigma around breast cancer and patients would not disclose their status to others in the community for fear of being ridiculed, pitied or isolated. A number of patients used alternative medicine resulting in delays in treatment. Family support, support groups and spirituality played a major role in facilitating the completion of initial care and in reducing psychological morbidity. System factors such as poor referral pathways, and inappropriate treatment emerged as minor themes. Conclusion: The sociocultural aspects of breast cancer need to be addressed to ensure comprehensive management of breast cancer patients and completion of treatment. As programs in the region, mainly run by governments, aim to improve the financial access to treatment, it would be critical to include efforts aimed at stigma reduction and interventions focusing on the sociocultural reintegration of these patients.
Defining, Measuring and Preventing the Diagnosis of Cancer as an Emergency: A Critical Review of Current Evidence
Authors: Zhou Y. , Abel G. , Hamilton W. , Pritchard-Jones K. , Gross C. , Walter F. , Renzi C. , Johnson S. , McPhail S. , Elliss-Brookes L. , Lyratzopoulos G.
Published: September 2018

Background: Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumor, patient and health-care factors, often in combination. Methods: We searched the literature to identify all population-based studies that examined emergency presentation as a diagnosis or independent variable. Results: Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. Conclusion: In this review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this underresearched aspect of cancer diagnosis.
Smokeless Tobacco: An Etiological Risk Factor for High Incidence of Pyriform Sinus Cancer in Assam, India
Authors: Das A.
Published: September 2018

Background: Cancer incidence in northeast India including Assam state is higher than the Indian national average. The incidence of hypopharyngeal cancer mainly pyriform sinus is high in (14.7/100,000) Assam and other northeastern state like Meghalaya (East Khasi Hills). Recently published Global Adult Tobacco Survey (GATS 2) report has shown that there is a decrease in tobacco consumption in India from 34.6% to 28.6%. However, in Assam the rate has increased from 39.3% to 48.2% mainly in the form of smokeless tobacco. Cigarette smoker reduce from 8.8% (GATS 1, 2009-10) to 6.1% (GATS 2, 2017), but smokeless users increase from 32.7% (GATS 1, 2009-10) to 41.7% (GATS 2, 2017). By now in India we only have gutka and pan masala (Prohibition) act 2015, by which there is ban on gutka but not other smokeless tobacco product. Because of COTPA (Cigarettes-and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, there is reduction of smoking in India as well as in the state of Assam. But as we don't have stringent laws to control the use of smokeless tobacco, the users are increasing. Aim: To study the role of smokeless tobacco as a substantial etiological risk factor for high incidence of pyriform sinus cancer in Assam and to advocate for a strict law to prohibit or ban of smokeless tobacco in Assam. Methods: This is a retrospective study archived from hospital cancer registry database. 708 patients diagnosed with pyriform sinus carcinoma from January 2016 to December 2016 were analyzed. The relation between forms of tobacco use and gender, age group, place of residence and level of education were analyzed using IBM SPSS version 19. P < 0.05 was considered as statistically significant. Results: 584 (82.5%) patients had the habit of tobacco consumption of whom 128 (21.9%) were smokers, 220 (37.6%) consumed smokeless tobacco and the remaining 237 (40.5%) cases consumed both forms of tobacco products. Forms of tobacco use differ significantly with patient's gender ( P < 0.05). The patients in the age group ≥ 50 years or above 50 years, the highest frequency was observed in both forms of tobacco consumption (61/144 = 42.4% and 176/441 = 39.9%) respectively. Most of the patients from rural areas were habituated to both forms of tobacco use (201/499 = 40.3%) and most of them are mainly smokeless tobacco user. Conclusion: The current study shows that the incidence of smokeless tobacco user is alarmingly increasing in Assam and the northeastern part of India leading to high incidence of hypopharyngeal cancers. At present only gutka is banned in the India. So, further policies should be implemented to bring down the use of smokeless tobacco and thus reducing the burden of hypopharyngeal cancer in this part of the country.