bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategy for Effective Cancer Awareness Program?
Authors: Maskor N.A. , Muhamad M. , Anuarudin A.A.S.
Published: September 2018

Background: Cancer awareness among the public should be enhanced in line with the increased cancer occurrence. Such program is still limited at local community in Malaysia. Thus, a registered cancer society KanWork has taken an initiative to organize awareness program in collaboration with the local community. The community based approach was guided by The Interactive Model of Program Planning (Caffarella & Daffron, 2013). The program objective was to promote healthy lifestyle and encourage early detection. For further improvement, there is a need to evaluate the program's effectiveness and strategy. Aim: 1. To determine the relationship between program strategy and cancer awareness program effectiveness. 2. To determine predictors that contribute to cancer awareness program effectiveness. Methods: A customized instrument to measure a program effectiveness constructs guided by The Interactive Model of Program Planning was developed. The questionnaire was administered to 628 participants of five program carried out by KanWork in collaboration with and at five local communities in Selangor, Malaysia between 2015 and 2017. 321 (51%) returned the questionnaire. Descriptive statistics, Pearson product-moment correlations and multiple linear regression were used to analyze the data. Results: Majority (91%) participants of the community cancer awareness program was women and public (90%). Majority (66%) learned about program from the community. The findings showed positive and moderate relationships between short lecture and program effectiveness (r = .625, P = 0.00), sharing session with survivor (r = .577, P = 0.00), awareness exhibition (r = .376, P = 0.00), facilities program (r = .246, P = 0.00), and health screening (r = .192, P = 0.00). Short lecture (β = .773; P < .000) showed a major contribution to cancer awareness program effectiveness. There were five factors that contributed namely; short lecture, sharing session with survivor, awareness exhibitions, health screening, and appropriate facilities. The short lecture on general cancer was done by experienced, proficient oncologist. Participants were engaged in a two-way communication session. Transfer of learning was facilitated during the sharing session (panel discussion) with cancer survivors of different cancer journeys. Participants were convinced hearing from the “horses´ mouth”. The learning was further reinforced with related culturally appropriate cancer education material (poster, books and brochures) on display at the awareness exhibition. To promote participants to practice early detection, they were also given opportunities to do breast clinical examination, Papanicolaou test and health screening at the venue. The program's venue with appropriate facilities further encouraged the community to be engaged in the program. Conclusion: Appropriate program strategy contributes toward effective cancer awareness program. The findings support some elements of the Interactive Model of Program Planning.
Expanding Progress for the Metastatic Breast Cancer Community: The SPARC MBC Challenge Reaches New Milestones
Authors: Teahon M. , Donaldson S. , Zucchello S. , Samson M.
Published: September 2018

Background: An estimated 1.6 million women are diagnosed with breast cancer globally each year, and approximately one-third of these women will develop advanced disease (stages III and IV). The Seeding Progress and Resources for the Cancer Community (SPARC): Metastatic Breast Cancer Challenge was created with support from Pfizer Oncology to address the unique needs of women and men living with metastatic breast cancer (MBC) by offering grants to organizations initiating novel ways to fill gaps in support and services. Now in its second round, the program is building momentum to further support the MBC community. Aim: SPARC empowers advocacy groups, hospital networks, support groups and other organizations worldwide, addressing four key priorities: Closing the gap on patient information and navigation of care options; Raising awareness of specific needs and challenges faced by women with MBC; Ensuring MBC is embedded in national breast cancer policies; Helping to reduce the incidence of MBC at first diagnosis. Strategy: SPARC was first launched on World Cancer Day 2015 with a second call for proposals announced on International Women's Day 2017 . Proposals were assessed by an external Selection Advisory Group. Selection criteria focusing on impact included: Project's potential to improve the lives of women diagnosed with MBC Organization's ability to deliver the project Feasibility of project goals Sustainability of the project beyond the grant period. UICC provided ongoing monitoring and support including dedicated mentors and online training covering key topics to maximize projects' success. Grantee workshops at the start and end of projects (during ABC3/4-Advanced Breast Cancer Consensus conference and the World Cancer Congress) provided critical networking and knowledge sharing. Second round grantees are linked to first round grantees with similar projects for additional mentoring. Outcomes: UICC received over 80 initial applications from 46 countries in the first call, and 83 applications from 42 countries in 2017 demonstrating continued demand for MBC support. Altogether 40 organizations in 30 countries have benefited from SPARC grants. As well as mentorship and UICC support, grantees gained unparalleled access to both the UICC community and other MBC advocates. Grantees measured the reach of their projects, including numbers of patients supported, healthcare workers trained, institutional collaborations formed and awareness raised. Two years on, 1st round projects have trained 1500 healthcare workers, involved 400 institutions, created online support in 7 countries and continue to reach new MBC patients. Work to embed new practices in national policy and medical curricula is expanding in Brazil, Nigeria, Bulgaria and Uganda. What was learned: Results from 2nd round grantees and key learnings from the two rounds, including grantee to grantee mentorship and WhatsApp support, will be available to be presented at WCC.
WCD: An Opportunity for Raising Awareness and Advocacy
Authors: Cecagno L. , Gomes A. , Johnson G. , Venturela P. , Caleffi M.
Published: September 2018

Background and context: Since 2013, FEMAMA organizes a World Cancer Day (WCD) campaign from UICC in Brazil. Besides that, FEMAMA sought to devise innovative actions aimed at raising awareness and advocacy, aligning UICC´s global campaign with local needs. FEMAMA wondered how the campaign and its related actions could have a larger resonance and impact. Currently, Brazil has been facing an important patient rights issue: the Ministry of Health was supposed to start providing an important drug for HER2+ MBC treatment to public health care (SUS) units, and this was a great opportunity to exercise social control. Aim: Raising awareness on the reduction of the impact caused by cancer in Brazil, in addition to assuring access to appropriate MBC treatment in the SUS. Strategy/Tactics: FEMAMA´s main strategy was to engage and encourage the participation of all 73 associate NGOs. FEMAMA realizes the strength of its network and its ability to adapt a global campaign so it can meet local needs. Program/Policy process: Planning: Define a focus point for actions/activities aimed at raising awareness and advocacy Activities carried out: Web site: Portuguese Web page about WCD at FEMAMA's Web site Social media: Several informative content Press: Press releases, opinion article and interviews Advocacy mobilization: Mobilization for trastuzumab access and for public hearings about BC Local actions: Landmark lightning, NGO actions Partnership and networking: landmark lightning, associated NGOs, partners and invited cancer digital influencers Outcomes: Reach - FEMAMA´s Facebook page: 194,854 people Partners and influencers: More than 1,300 interactions in #RecadosContraoCâncer action on their networks Web site: Over 450 accesses to the Web site regarding the campaign Direct mail: Over 3700 contacts activated via e-mail Press: Almost 100 mentions in the press related to FEMAMA and WCD Advocacy: 16 Brazilian states involved on mapping the access of trastuzumab on SUS for MBC patients and 3 Brazilian states involved so far on scheduling public hearings about cancer. Landmarks lightning: At least 8 landmarks illuminated around the country. Events: The NGOs associated to FEMAMA organized activities and events in reference to WCD in all regions of the country. The Ministry of Health indeed delayed the provision of treatment drugs to Brazilian patients, but FEMAMA was able to act beforehand, taking advantage of WCD to map out the situation and take action. What was learned: We learned that it is important to take advantage of moments when cancer is in evidence, when communities are paying attention and when authorities are more aware, so that necessary changes in scenario can be within our reach and take place. The WCD campaign served as a window where we were able to display a relevant agenda for Brazil, also being able to take action so that the rights of thousands of patients could be enforced.
Chronic Pain Management in Palliative Patients
Authors: Ninashvili N. , Shavdia M.
Published: September 2018

Introduction: Chronic pain presents a public health priority, however its assessment and management remains problematic in the country posing serious obstacles in effective pain relief and improving quality of life in pain patients, in general, and in palliative patients, in particular. We aimed to study chronic pain relief quality and pain assessment and management knowledge level in primary health care institutions, being a gateway to palliative care. Methods: Cross-sectional survey was conducted in 2013-2014 on 232 randomly selected patients in palliative care clinic and 304 physicians in primary health care institutions in different regions of the country. Pain assessment tools such as Visual Analog Scale (VAS) and numeric pain rating scale along with questionnaires, composed of 20 (for patients) and 40 (for physicians) with both: open and closed questions were used. Study results were processed in SPSS software. Results: Response rates were 83% for patients and 87% for physicians. The vast majority of patients suffered of unrelieved pain at the admission to the clinic. Almost all patients (98%) were coming from primary health care institutions. Perception and expression of pain by majority of patients (85%) didn't correspond to the pain intensity, measured by the VAS and consequently, by the numerical scale (t=3.4). Pain intensity was in linear correlation with the disease stage (r=0.6). It was increasing along with the disease progression. Fifty percent of physicians in the selected primary health care facilities were unaware of WHO pain leader, 90% of them didn't use tools for evaluating of pain intensity. 89.8% prescribed opioids without a prior determination of causes and risk factors. None of the physicians knew about the role of patients in chronic pain management, resulted in the unawareness of patients toward self-management and preventive potential of chronic pain. Conclusion: 1: Majority of palliative patients are admitted to specific tertiary clinic with unrelieved pain; 2: Chronic pain assessment and management level is mainly inadequate in primary health care institutions; 3: Chronic pain education along with the enhancement of knowledge level of family physicians is of critical importance for effective pain relief.
Toward a Smoke-free Generation: The Dutch Strategy
Authors: van Bladeren F. , Muller G.
Published: September 2018

Background and context: In 2013, Dutch society was polarized on the tobacco topic. Sense of urgency was low among most stakeholders. Therefore, the Dutch Cancer Society, Heart and Lung foundations created a coalition with a mutual goal and joined efforts in realizing it. The common strategy resulted in a stepwise roadmap toward a smoke-free generation. According to their capacities and fields of interests, coalition partners were allocated subthemes to focus on as part of the one common overall strategy. In addition new coalition partners were sought and found among stakeholders in sectors with high influence on society and politics with respect to the main priorities following from the roadmap. In this way, the smoke-free movement grows like a rolling snowball. Aim: To realize a smoke-free generation by 2035 by working together. Strategy/Tactics: By striving for a smoke-free generation, we are protecting youth against tobacco. We aim for a society in which parents of children born from now onward will be able to raise them without any exposure to tobacco smoke and the temptation to start smoking. So that they never decide to start smoking. We developed a roadmap toward the smoke-free generation that holds a low threshold for people to start participating and is positively framed. It's consistent with all political colors, takes away polarization and opens conversation. This presentation will discuss the basic principles of the frame, the stepwise roadmap and the instruments we use to achieve our goal: lobby, communication and stakeholders activation, including the results of our approach. And we will show practical examples of how a rapid growing number of parties contribute, such as playgrounds, sports clubs and hospitals that become smoke-free and local governments. Program/Policy process: A roadmap toward a smoke-free generation was created and the efforts of the 3 NGOs were combined to become more effective and efficient in realizing the goal together. Outcomes: More than 100 organization are working together toward a smoke-free generation, environments where children recreate/are are becoming smoke free, the % of smokers is declining, the government is taking its responsibility, the support from society for tobacco control is increasing, and tobacco has been reframed into a positive movement. What was learned: A mutual goal works, positive framing leads to more and more partners that work toward the smoke-free generation and it is possible to turn a negative or neutral tobacco control climate into a climate that is more positive toward effective tobacco control.
Knowledge and Attitude to Breast Cancer Screening and Risk Factors Among Women in Southwest Nigeria
Authors: Falowo T. , Salako O. , Alabi W. , Olukiran G.
Published: September 2018

Background: Breast cancer is the commonest cancer among women in Nigeria. There are several reasons why over 60% of breast cancer patients present with advanced disease. Some of which are lack of awareness and poor uptake of cancer screening methods. Aim: This study aims to assess the knowledge of breast cancer risk factors and practice of screening modalities among a cross-section of women in 5 different local government areas in Lagos. Methods: This is a descriptive and cross-sectional study conducted among women during a breast cancer awareness and screening program in 5 local government areas of Lagos. A self-administered questionnaire was administered to assess the knowledge of breast cancer risk factors and practice of screening methods. Results were analyzed with SPSS version 21. Results: A total of 1113 respondents were surveyed across various communities. Distributions among semi-urban communities include: 29.7% from Mushin, 22.4% from Somolu, 18.2% from Ikeja, 15.8% from Kosofe and 13.8% from Idi-Araba. Mean age ± SD of respondents was 43.6 ± 12.6 years. Even though 78.5% have heard about breast cancer and screening only 29.3% had been screened. Breast screening modalities used were clinical breast examination (19.9%), mammogram (5.8%) and breast ultrasound (3.6%). Conclusion: This study shows that there is a low uptake of breast cancer screening practices and the high knowledge of screening methods did not translate to higher screening practices among the studied population. There is a need to create more awareness on the risk factors identification and emphasize the importance of regular screening for breast cancer as essentials for early diagnosis and survival.
Important Steps in Cancer Prevention: Improving Population Whole-Grain Intake—The Danish Show Case or How Was the Danish Whole-Grain Intake Doubled in Less Than 10 Years?
Authors: Toettenborg S.
Published: September 2018

Background and context: Dietary whole grain (WG) intake helps prevent noncommunicable diseases (NCDs) such as cancers. However, 92.4% of the global adult population does not meet WG recommendations, and WG intake even decreased between 1990 and 2010. In Denmark, WG intake was similarly decreasing during the 1990s and 2000s, and the Whole Grain Partnership (WGP) was established in 2009 to counteract this development. Aim: To describe the development of this public-private partnership (PPP), the results achieved so far, lessons learned and implications for future initiatives. Strategy/Tactics: The strategy is twofold: increasing availability of WG and campaigning about the health benefits of WG. Program/Policy process: · Research and documentation of WG health benefits · Initiate partnership and functioning of organization and secretariat · Ensure clear WG definitions and dietary guidelines · Set targets and success criteria and monitor progress · Create incentives for industry to reformulate and develop new WG products and make it easy for consumers to identify WG product by developing and endorsing a WG logo · Gradually enriching all bread and flour with WG · Develop education materials for chefs, waiters, bakers, in-store personnel and health professionals · Yearly consumer campaigns. Outcomes: Mean WG intake has near doubled in less than 10 years (from 32 in 2009 to 61 g/day 2017). The increment in intake were also significant among the population groups eating the least WG. The number of WG products increased in this period from 150 to currently 800. Continuous monitoring of consumer behavior show a high knowledge, trust and use of the WG logo has increased during the period. What was learned: · To make the PPP work effectively it is crucial to work evidence based, set realistic targets, reinforce the reasons and advantages for partnering, measure and celebrate progress · The impact on population dietary habits is primarily due to the increased availability of WG product combined with a long-term campaigning activity promoting WG health benefits.
The Burden of HER-2 Positive Patients in Sub-Saharan Africa: A Caregiver Perspective
Authors: Oriaku N. , Orji M.-G. , Agbi R. , Gimba S. , Banwo-Fatai K. , Nwosu T. , Emezue P. , Dantsoho S.A. , Okoro N. , Nwagboso E.J. , Abdulazeez J. , Orjiako T.C. , Chidebe R.C.W.
Published: September 2018

Background and context: Several studies showed that the use of the recombinant monoclonal antibody trastuzumab, in addition to adjuvant chemotherapy, for breast cancer with overexpression of the HER-2 protein or amplification of the HER-2/neu gene reduced the risk of recurrence by 50% in women irrespective of nodal status. In Nigeria, breast cancer is the leading and the most common cancer in women. A trastuzumab brand known as Herceptin is the popular brand usually prescribed by the oncologist in Nigeria. Once a histopathology/immune-chemistry result shows HER-2 positive and oncologist informs that patient of the diagnosis being HER-2 positive; most patients emotionally breaks down due to cost of the drugs. In Nigeria, as at 2015 the cost of herceptin 455mg was N650,000 ($1857). As at June 2016 that same drug increased in cost to N1,100,000 ($3142) due to the unstable exchange rate in Nigeria. In Nigeria 90% of patients pay-out of pocket for treatment and drugs as the health insurance system in my country does not cover chemotherapy drugs. Several cancer patients with HER-2 patients face serious financial challenges in Nigeria, as so many experience spread of the cancer to vital organ when they are unable to get finance to purchase the life-saving drug for their HER-2 positive breast cancer subtype. Aim: To understand the burden of HER-2 diagnosis in Nigeria and stimulate advocacy for the reduction of the cost of Herceptin in Nigeria and other sub-Saharan Africa where finance is a serious impediment to accessing medical care. Strategy/Tactics: The study will present case studies of three Nigerian women who were diagnosed of HER-2. Interview was used as a method of data collection, informed consent were also completed by the patients before the interview. Program/Policy process: Our study reveals that there is a need to engage the federal and state governments, corporate organizations, insurance schemes and most importantly pharmaceutical companies to reduce cost of cancer drugs and particularly Herceptin. HER-2 breast cancer patients need to lead the advocacy for reduction in cost of drug at all levels. Outcomes: Our qualitative findings reveal that caregivers are mostly affected by the cost of drugs such as Herceptin. In some cases caregivers, sell valuables, take loan and go public to raise funds for the cancer drugs. What was learned: Most HER-2 positive breast cancer patient could not afford Herceptin and some waited for several months to raise funds, which is probably a factor in metastasis and low-survival.
Huellas: Making Strides for Breast Cancer Awareness
Authors: De Cima A.
Published: September 2018

Amount raised: Annual, approximately 1.5 million Mexican pesos (MP) in sponsors and roughly the same in entrance fees. In the last 11 years, Huellas has raised over 15 million pesos. Background and context: For the past 11 years, Fundación Cima has organized an annual run/walk to raise awareness and fundraise for breast cancer. Huellas was the first coed breast cancer run walk in Mexico when it was first launched in 2008. It started out with 2750 participants and a cost of 1,246,000 MP. Through the years, Huellas has raised over 15 million pesos to support educational programs in six states of Mexico. 61 private companies and institutions from many sectors have sponsored Huellas. Aim: The more participants we have, the more interesting it is for the companies to sponsor it. Thanks to a 10 year success streak, we have set us the objective of reaching the 5000 participants in the 2018 edition to be held on May 13. This years' funds will be destined to 3 different branches of the educational program: training workshops in two states and the launching of the “Cimabus”, a transportation service provided by Fundación CIMA for women living in rural areas to get to their diagnostic exams or to their treatment appointments. The Cimabus will be working 5 days a week, 8 hours and will be placed in the state where the workshops are taking place. Strategy/Tactics: Fundación CIMA has managed to negotiate with media outlets a very interesting brand placement for our sponsors in all the printed publicity for Huellas so that their image is exposed as socially responsible companies at no expense to the company itself. This makes the sponsorship agreements a lot easier for our organization. To ensure the 5000 participants at the event we have developed strategies such as offering generous prizes for the winners, free samples of food and beauty products and our signature prize, a car. Huellas has become a powerful and emotional grass root movement to raise awareness, celebrate life, honor and remember patients and loved ones and call attention to patients´ needs. Program process: Huellas is not an isolated event that happens annually, it is a 12 month program. The process of planning, organizing, selling and most importantly, reporting to our donors, both individual and corporate ones, about the results of the run/walk and the results of the educational program implemented goes on throughout the year. Work for the following year, starts right after the run ends. Costs and returns: Investment: 2,061,354.77 MP Returns: Registrations 1,800,000.00 MP Sponsorships 1,115,000.00 MP This represents a ROI of 41.4% What was learned: Huellas started as a dream of bringing families together to raise awareness on breast cancer, while fundraising to support educational and early detection programs. We now need transform our Huellas community into a grass root movement that will come together to fight for access to quality care for every woman diagnosed while raising funds.
Strategies for Increasing Participation in Mail-out Colorectal Cancer Screening Programs. A Systematic Review and Meta-Analysis
Authors: Goodwin B. , Ireland M. , March S. , Myers L. , Crawford-Williams F. , Chambers S. , Aitken J. , Dunn J.
Published: September 2018

Background: Population mail-out bowel screening programs are a convenient, cost-effective and sensitive method of detecting colorectal cancer (CRC). Despite increased survival rates associated with early detection of CRC, in many countries 50% or more of eligible individuals do not participate in such programs, resulting in a substantial amount of cancers progressing undetected and wasted public health resources. Aim: The current study aimed to systematically review all of the interventions that have been applied internationally to increase fecal occult blood test (FOBT) kit return, specifically in population mail-out programs, to make recommendations to policy makers and program organizers as to the most effective methods of increasing uptake. Method: Six electronic databases (PubMed, PsycINFO, Scopus, InformIT, CINAHL, and ProQuest Dissertations and Theses) were searched for articles published in English before 10th of March 2018. Studies were included if they reported the results of an intervention designed to increase the return of FOBT kits that had been mailed to individuals' homes. Results: PRISMA systematic review reporting methods were applied and each study was assessed using Cochrane's risk of bias tool. The quality of evidence was assessed using GRADE guidelines. The review identified 53 interventions from 30 published studies. Nine distinct intervention strategy types were identified and pooled risk ratios and confidence intervals were estimated for each intervention type. Four key effective intervention strategies were identified including telephone contact, GP endorsement, simplified test procedures, and advance notification with small to moderate effect sizes. Conclusions: Interventions that combine program-level changes incorporating the issue of advance notification and alternative screening tools with the involvement of primary health professionals through endorsement letters and telephone contact should lead to increases in kit return in mail-out CRC screening programs. Future research should examine the benefit of combining intervention strategies and tailoring to specific populations.
Future of Global Cancer From the Perspective of Young Oncology Leaders
Authors: Tamamyan G. , Tervonen H. , Mendoza L. , Batmunkh T. , Yap M.L. , Rodin D. , Moraes F.Y.
Published: September 2018

Background: Oncology organizations and professional associations (OA) across the cancer control continuum have developed Young Leader (YL) programs to engage promising members of their organizations and to facilitate opportunities for their advancement. Although these groups share common aims, there has been little synergy across YL programs and limited understanding of the shared perspectives, experiences, and challenges of YLs. Aim: To understand the profile, activities and challenges facing YLs worldwide from the perspective of global cancer control. Methods: The survey was generated by a task force of YLs and was pilot-tested among 10 international physicians. The final survey was composed of four sections: baseline characteristics, challenges in cancer control, building a career in cancer control and networking in cancer control. The survey was sent out in 2018 to 867 people, who were identified as potential YLs by 7 OA, with 2 reminder e-mails within 2-4 weeks interval. The final responses were summarized using descriptive analysis method. Results: A total of 139 survey responses were received from 61 countries (per region - 38.4% Europe, 29.6% America, 22% Asia-Pacific, and 10% Africa). Median response rate was 62.2% (range 5%-100% per organizational group, overall 16%). The majority of respondents were < 39 years old (64%), female (53.6%), with a higher degree (Ph.D. 43.1%), and in academic positions (68.1%). Clinicians made up 65.2% of the sample, followed by researchers (20.2%), and advocacy leaders (5.1%). YLs believed that the most important priorities to the future of cancer control were 1) to make cancer care available globally (47.5%), 2) to provide value based cancer care (27.5%) and 3) to transform cancer care through technology (10.5%). To address these aims, 70% of YLs believed that the most important next step was to improve screening and early diagnosis. YLs identified the lack of financial resources (65.2%), increasing treatment costs (64.5%) and late diagnosis (61.6%) as important barriers to achieving these aims. YLs reported that their greatest obstacles to engaging in global cancer control were lack of funding (46%), lack of opportunities (42%) and toxic political/academic environments (46%). 70% reported that mentorship and network development followed by academic success (51.4%) and leadership training (42%) were the most important factors in support of their future goals. Conclusion: YL experience similar challenges and aspiration concerning global cancer control. The need to make cancer care available globally, and to receive mentorship and training were highlighted. Our findings also suggest that oncology groups should aim to ensure a global agenda, promote collaboration and mentorship and rediscuss program objectives to guarantee sustainability of current organizational plans and to better support the YLs’ future goals.
Home Palliative Care for Advanced Cancer: PC Can Be Introduced at Diagnosis or at Relapse in Thai Society, Independent of Oncology Service
Authors: Nuchprayoon I.
Published: September 2018

Background: Thailand is a resource-limited country with universal health care. Cancer services are available for everyone for free, but the system has been overloaded due to limited number of qualified specialist physicians, nurses, radiology technicians, and growing demand from ageing population. Patients with advanced cancer are often not referred to a palliative care (PC) service until multiple treatment failure. Aim: To provide a better access to PC, we initiated an independent palliative care counseling and home service, focusing on families of patients with advanced cancer. Methods: The families of patients with advanced cancer were referred to our home palliative care service through cancer patient support groups, self-referral or from other physicians. Eligibility for PC was guided through a Thai national guideline of cancer treatment as well as by NCCN guideline. Early stage cancer were excluded from the service and referred to oncology service of patient's choice. For each family, we arranged a family meeting/counseling session at patient's home or a designated place and introduce palliative care as well as cancer therapy options. If the patient choose palliative care, then we provide home PC. Patients are followed at home by home visits, and continually communicated online and by phone. Family members visits palliative clinic for morphine and other medications. Results: In the first 3 years of operation, 53 adult patients with advanced or recurrent cancer and their families were counseled. Fifty chose home palliative care service, exclusively (30) or along with a hospital oncology service (20), while 3 patients preferred life-prolonging cancer therapy. The average age (±SD) of patients were 60 (±16) years. The most common cancers were stage IV or metastatic breast (7), lung (6), colorectal (6), and leukemia/lymphoma (6). The median survival time of this PC cohort was 3.1 months, with 16 (32%) living > 6 months, and 10 (20%) > 1 year. Of 36 patients who had died, 22 (61%) died at home, 13 (36%) at a local hospital, and 1 (3%) at a cancer center. Conclusion: For advanced cancer patients, palliative care can be introduced early and efficiently by PC team and most people would prefer PC. PC counseling may serve as an entry point to cancer care system. For patients who choose early palliative care, it can reduce burden on the existing busy oncology service, while providing satisfaction on patients and family.
Road Map to Setting Up a Palliative Care Service in a Tertiary Center Gynecologic Oncology Unit in Egypt
Authors: Abdelbadee A. , Abou-Taleb H. , Abbas A. , Ali S. , Fakie N. , Adams T. , Gwyther L. , Krause R.
Published: September 2018

Background and context: Developing countries struggle with high cancer mortality and low resources. Cancer patients experience pain and physical symptoms in addition to psychological, social and spiritual worries that increase as the patients' conditions progress. Palliative care (PC) primary goal is to help people live as well as they can for the duration of their illness, with the finest physical and emotional well-being possible despite complex problems. However, there are considerable barriers to PC service implementation in developing countries. Aim: Our goal is to set up a PC service and integrate it as a standard of care for gynecologic cancer patients managed at Assiut University Hospitals, Egypt. The objective of this study is to investigate the tools needed to integrate a PC service in any oncology service in developing countries. Strategy/Tactics: A capacity building and local provision PC development framework was laid. Strategies included expanding the gynecologic oncology unit, assessment of PC knowledge among health providers and medical students, assembling a multidisciplinary PC team, overseas PC training, establishing international links, providing essential medicine and addressing PC education. Program/Policy process: The gynecologic oncology unit capacity was expanded to accommodate long term admissions. PC knowledge among physicians, clinical nurse practitioners (CNPs) and medical students in Assiut University Hospitals was assessed using the modified Palliative Care Knowledge Test (PCKT). A multidisciplinary team that will deliver the PC service to our gynecologic cancer patients was assembled based on motivation and individual expertise in the aspects of PC from relevant departments as clinical oncology, surgery, pain and anesthesiology, psychiatry, physical therapy and rehabilitation and nutrition. The hospital leadership worked with the pharmacists to increase opioids quota and facilitate dispensing measures. The PC team leader engaged in a certified online PC course and arranged overseas training with the reputable Palliative Medicine Division at University of Cape Town well known for its legacy in delivering PC education. Outcomes: Ninety two physicians, 14 CNPs and 116 medical students completed the PCKT. The PCKT was composed of 20 questions and each correct answer was given 1 point. The overall total correct score was 7.41 ± 2.48 (Fig 1). Poor knowledge about PC was a strong indicator to acknowledge the gap in PC postgraduate training and undergraduate education. What was learned: Integration of a PC service for cancer patients in Egypt is feasible in spite of local resources constraints. A PC multidisciplinary team can be assembled from skilled specialists. Modifications of undergraduate and postgraduate curricula to include PC is crucial. Our model can be transferred to other low resource settings.

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Halting the Comeback of “Kiddie Packs”: Defeating an Invisible Enemy
Authors: Thoo M. , Abdullah M.S. , Nor M.A. Mohd , Azmi M.F. Mohamad , Somasundaram S.
Published: September 2018

Background and context: “Kiddie packs”–packs of 10 or fewer cigarettes–have been banned in Malaysia in 2010. In August 2017, however, tobacco control civil society organizations (CSOs) were informed that the tobacco industry had approached the Malaysian government on this issue, claiming that a “return” would increase the government’s tobacco tax revenue. Unfortunately, this news was not formalised and CSOs were not allowed to reveal the source. We thus could not implement direction action organizing, and the media is much less likely to respond to “smoke without fires”. Aim: To stop the return of kiddie packs. Strategy/Tactics: Through discussions on a WhatsApp group, CSOs launched a “divide and conquer” battle. After a CSO took the risk and leaked the information to media (without revealing its source), many groups built on the voice, and “smoked out” the enemy. A few CSOs tackled a different front, including using social media to gather voices, rallying the support of policymakers, other ministers, and nonhealth civil societies, and coordinating a visit to the government. Program/Policy process: After a CSO disclosed the “kiddie pack” news to the largest selling daily newspaper, many groups followed up with interviews, media statements and letters. Meantime, another CSO reached out to its network of policymakers and nonhealth CSOs for support, and sent briefing points or draft “letters to the government” with key messages that tailored to the senders´ specialty (human rights, environment, etc.) When a protobacco retailer announced it had 3200 signatures from their members, one CSO launched an online petition on its Facebook page, shared the effects of kiddie packs on adolescents, and gathered 10 times the signature within a month. The final effort was a visit to the government - a tactic used by the e-cigarette industry previously - to submit the signatures and statement. Outcomes: The “leak” resulted in a front page coverage, allowing the Health Minister to state his views, and other CSOs to use it as a platform to voice their protest. It was also publicised in mainstream as well as online news in different languages. Within two weeks, the tobacco industry finally revealed its intention, and coordinated its media responses through its supporters. Each of these responses were met - point by point–by CSOs, resulting in at least 20 published “letters”. Nearly 40,400 (online and offline) signatures were gathered, representing 57 CSOs. To date, kiddie packs have not made a “return”. What was learned: Instant messaging applications and social media tools can replace meetings and on-the-ground efforts, especially when CSOs lack funds, time, and human resources. Also, great campaigns should consist of general (e.g., writing to the media) as well as specialized (social media, networking with policymakers) efforts. This allows different CSOs to focus their strengths, avoid redundant tasks or “working in silos”, and have every contribution count.
Evaluation of Web Portal for Improving Cancer Awareness in General Population in India
Authors: Khare A. , Agarwal J. , Hariprasad R. , Gupta S. , Mehrotra R.
Published: September 2018

Background: With details on various cancers and recent advances in cancer prevention, a Web portal was developed to create awareness and value added education among Web-users in general population in villages, small towns and large cities of India. Aim: The Web portal aims at bringing awareness at the 3 levels of health related education program delivery success/efficacy triangle. The 1st level is cognitive learning of just being aware of cancer & basic knowledge. The 2nd level is a positive effect to be able to adopt life style changes that will lead to habit changes in diet, substance abuse and other life style habits and adherence to prescribed treatment. The 3rd level is actual behavioral change. Methods: A mixed methods study design incorporating etic-emic & qualitative research methodology and quantitative cross-sectional methods. We also used focused group discussions and in-depth interviews as part of qualitative study designs. Results: On the basis of data from the 100 participants, the Web portal was found to have improved attitudes toward accessing information related to cancer in participants. There was also an increase in the knowledge of the people, both general population and level 1 healthcare worker as compared with their previous knowledge about cancer. Also found was improvement in knowledge about the prevalent cancers, their screening procedures and general measures of prevention and treatment. Conclusion: On the basis of participants evaluated, we found that the Web portal may have a positive effect on cancer awareness of general population. Participants found the Web portal as a relevant tool to access information in the feedback. The comprehensive data which will be available after feedback from all participants, will help in understanding the nature of user´s response to Web based resources and its implications in improving lifestyle choices and promoting early screening & early detection of cancer.
Dietary Carcinogens and Cancer Risk: Findings From Japanese Studies
Authors: Iwasaki M.
Published: September 2018

Background: Red meat and processed meat consumption are established risk factors for colorectal cancer. One hypothesized mechanism for this association is through exposure to heterocyclic aromatic amines (HAAs), which are formed when meat is cooked at high temperature for a long duration. Although they are mutagenic and carcinogenic in nonhuman primates, the findings of epidemiologic studies that have specifically examined the association between HAA intake and colorectal cancer risk have been inconsistent. Moreover, since N-acetyltransferase 2 (NAT2) has been shown to play a critical role in the bioactivation of HAAs, an interaction between HAA intake and NAT2 on colorectal cancer has been hypothesized and the findings in the previous studies have been inconsistent. Aim: To investigate the association of meat- and fish-derived HAA intake, which were estimated by our validated food frequency questionnaire and population-specific data on HAA contents in meat and fish items with the risk of colorectal adenoma, precursor of colorectal cancer, among middle-aged and elderly Japanese in Japan and Japanese Brazilians in Sao Paulo. In addition, to test the modifying effect of NAT2 on the association of HAA intake on colorectal adenoma risk. Methods: Tokyo adenoma study includes 738 patients with adenoma and 697 controls who underwent total colonoscopy in National Cancer Center, Japan. Brazil adenoma study includes 316 patients with adenoma and 403 controls who underwent total colonoscopy in 2 hospitals in Sao Paulo. HAA intake was estimated from meat and fish intake based on an HAA database that was validated against 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) values measured in human hair. NAT2 acetylation genotype was inferred using 2 SNPs in the NAT2 gene. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence interval (CI) for the association between HAA intake and colorectal adenoma risk after adjusting for potential confounders. Results: Tokyo adenoma study showed that high intake of 2-amino-3,4-dimethylimidazo[4, 5-f]quinoline (MeIQ) and total HAA was significantly associated with an increased risk of colorectal adenoma in women but not in men. No clear association with PhIP or 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) intakes and no effect modification by NAT2 genotype was observed. Brazil adenoma study found no association for HAAs and no effect modification by NAT2 genotype. Conclusion: Tokyo Adenoma Study suggests that high MeIQ and total HAA intakes are positively associated with colorectal adenoma risk among Japanese women in Japan. However, Brazil adenoma study failed to observe positive associations. The possible explanations of inconsistent findings and the difficulty of the studies will be discussed.
Hiking Is a Great Way to Enjoy Having a Healthy Lifestyle. This Campaign Was Created to Raise Prostate Cancer Awareness
Authors: Aquino S.L.
Published: September 2018

Amount raised: $1500.00 Background and context: Evidence for the role of physical activity in cancer incidence is well known and increases cancer survivorship. Cancer survivors as well as new patients would like to have a more active role in their health care, including what diet and lifestyle changes they should make. Since physical exercise has attracted increasing interest in our country we decided to do and experience the first hiking activity suggested by the Honduran Urology Society as an excellent way to raise awareness about prostate cancer and how to prevent it. Aim: The key aim was to raise awareness among men and their families and therefore organize the Prostate Cancer Association for Patients since there is none in Honduras. Strategy/Tactics: We started an alliance with the doctors from Honduran National Society of Urology so they could be the official spokesman for this activity. We contacted radio stations and TV health programs in order for the physicians to educate and publicized the event. Networking the activity on social media and decided on a Sunday as the day of the event since most people were off from work and school. November was chosen as it commemorates Prostate Cancer Awareness Month. A public facility was the place chosen since it had been shortly renovated and would be an attraction for men and their families. Program process: Since prostate cancer is the most common type of cancer among men, we felt the need to get involved in this activity. We contacted town officials to find out if a permit was needed. We also requested local businesses to donate T-shirts, drinks and food for the participants. We asked businesses to place campaign publicity on visible areas of shopping centers. We contacted a fitness instructor to donate an hour of his time for this cause. Once the T-shirt donation arrived we had printed a logo as a symbol for our campaign. Costs and returns: Since the very beginning we decided to get the most from this campaign by getting almost everything donated and the outcome was surprisingly a positive reaction. Donated kits with a T-shirt and a water bottle were given in exchange of a registration fee of $10, there was no fee from the hiking park. What was learned: With proper tools, educating patients for early detection may be the key to successful treatment. We all can better understand the facts about prostate cancer, who it affects and what you can do about it. We learned that we made such a great team working together as one and looking forward to our 2nd hiking event for 2018.
The Future Excess Fraction of Cancer Attributable to High Body Mass Index in Australia
Authors: Carey R. , Norman R. , Whiteman D. , Reid A. , Neale R. , Webb P. , Fritschi L.
Published: September 2018

Background: High body mass index (BMI > 25 kg/m2) has been found to be associated with an increased risk of many cancers, including cancers of the colon and rectum, liver, and pancreas. Aim: This study aimed to estimate the future burden of cancer resulting from current levels of overweight and obesity in Australia. Methods: The future excess fraction method was used to estimate the future burden of cancer among the proportion of the Australian adult population who were overweight or obese in 2016. Calculations were conducted for 13 cancer types, including cancers of the colon, rectum, kidney, and liver. Results: The cohort of 18.7 million adult Australians in 2016 will develop ∼7.6 million cancers over their lifetime. Of these, ∼402,500 cancers (5.3%) will be attributable to current levels of overweight and obese. The majority of these will be postmenopausal breast cancers (n = 72,300), kidney cancers (n = 59,200), and colon cancers (n = 55,100). More than a quarter of future endometrial cancers (30.3%) and esophageal adenocarcinomas (35.8%) will be attributable to high body mass index. Conclusion: A significant proportion of future cancers will result from current levels of high body mass index. Our estimates are not directly comparable to past estimates of the burden from overweight and obesity because they describe different quantities - future cancers in currently exposed vs current cancers due to past exposures. The results of this study provide us with relevant up-to-date information about how many cancers in Australia could be prevented.