bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of Nutrition Educational Materials for Pediatric Oncology Patients in Tanzania
Authors: Gillespie Anna , Raveendran Yadurshini , Monko Dafrosa , Gisiri Robert , Schroeder Kristin 
Published: July 2020

PURPOSE More than 30% of children in sub-Saharan Africa are malnourished at baseline. Patients with cancer become further malnourished by metabolically active tumors and starvation during extended hospital stays when parents cannot afford food. If cancer outcomes could be improved by optimizing nutrition, then this would provide a cost-effective intervention for future implementation and research. The current study targeted caregiver nutrition knowledge, attitudes, and practices to develop educational materials for children who are diagnosed with cancer at Bugando Medical Centre in Mwanza, Tanzania. METHODS A quantitative survey developed using UN Food and Agriculture guidelines was used to assess the knowledge, attitudes, and practices of nutrition among caregivers of children with cancer presenting from June to August 2019. On the basis of responses, targeted education materials—A2 posters, A4 posters, and 50 pamphlets—were developed in collaboration with a local nutritionist to address gaps in caregiver nutrition knowledge. RESULTS A total of 36 caregivers and 21 stakeholders completed surveys. The majority of caregivers reported food insecurity (94%) and limited knowledge on nutrition (92%). Identified key knowledge gaps included appropriate food selection, understanding of macronutrients, and food safety. Specific media—posters and pamphlets—were designed to be simple and targeted for specific symptoms, as well as to encourage positive eating habits among patients and families. CONCLUSION This study developed a targeted intervention to improve nutrition knowledge for caregivers of children with cancer. The multiple media sources created can be used alongside verbal education sessions by nutritionists to increase exposure and the likelihood of retention and application. Although this was developed at a single institution, the media created targeted consensus nutrition information for children with cancer and is mostly pictorial, so it can be used regardless of literacy or language. Implementation evaluation is ongoing, with plans to share these materials with pediatric cancer centers throughout Tanzania and sub-Saharan Africa.
Mixed-Methods Evaluation of Multiple Perspectives on Breast Cancer Control to Guide Stakeholder Selection of Implementation Strategies: The Time to A.C.T. Study in Mwanza, Tanzania
Authors: Rositch Anne F. , Chao Christina , Passaniti Anna , Mwakatobe Kisa , Visvanathan Kala , Masalu Nestory 
Published: July 2020

PURPOSE Tanzania recently developed national guidelines for early diagnosis of breast cancer to combat increasing incidence and mortality. The aim of this multiphase, adaptive implementation science study was therefore to assess the local context, couple implementation strategies with identified barriers, and test these strategies to improve breast cancer control, creating an adaptive A.C.T. framework with broad applicability to other low- and middle-income country settings. METHODS The assessment phase was made up of a broad medical chart review of women seeking care for breast concerns (n = 664); a knowledge, attitudes, and practices survey of community women (n = 1,129); and a knowledge, attitudes, and practices survey of health care providers (n = 114), followed by in-depth interviews (n = 15). RESULTS Women presented to the Zonal Hospital with swelling (45%) or a palpable lump (31%), with an average symptom duration of 6 months. Most diagnoses were based on clinical exam only (54%) and included 16% breast cancer. Of these, 43% had no treatment recorded, 50% had surgery at a median of 2.5 months, and 7% had chemotherapy only. Knowledge surveys indicated that 59% of women had heard of breast cancer, but only 14% felt they knew any signs or symptoms. Encouragingly, 56% were fairly to very confident that they would notice breast changes, and 74% said they would be somewhat to very likely to seek care, with 96% noting the severity of symptoms as a motivator. Providers indicated that barriers to care included low community knowledge and repeated misdiagnosis at the primary level. The majority of providers (95%) believe clinical breast examination is feasible to implement for symptomatic patients, yet only 65% feel they have sufficient training. CONCLUSION In all, 8 larger barriers were synthesized and linked to evidence-based interventions as potential solutions. All barriers and solutions were ranked by key stakeholders on the basis of feasibility, importance, and sustainability. These were incorporated into a 3-component intervention to improve breast cancer care at the Zonal Hospital and rollout is underway.
Geographic Variation in Access to Pathology and Laboratory Services in Tanzania: A Cross-Sectional Geospatial Analysis
Authors: Iyer Hari S. , Wolf Nicholas G. , Vuhahula Edda , Massambu Charles , Shah Devanshi , Schroeder Lee F. , Castro Marcia C. , Fleming Kenneth , Flanigan John S. 
Published: July 2020

PURPOSE Increasing noncommunicable disease burden in sub-Saharan Africa requires the urgent scale-up of pathology and laboratory medicine (PALM) services. To identify service gaps at the district level, we studied geographic variation in the correlation between travel time to health facilities and population density. METHODS We linked geospatial data for Tanzania from multiple sources. Facility locations were extracted from a comprehensive facility list in Africa. Data on geographic factors, demographics, and roads were collected from government and nonprofit databases. We classified facilities assuming increasing PALM service readiness by level: dispensaries, health centers, district hospitals, and regional/referral hospitals. We input these data into the AccessMod 5 algorithm to estimate travel time across Tanzania with 1-km resolution for each PALM classification. We then calculated district-level averages of population and travel time for each PALM category. Associations between these variables were estimated using a bivariable local indicator of spatial autocorrelation, specifying immediate contiguity neighborhood definition. Spatial analysis was restricted to 172 contiguous districts (islands not included). Significance tests were two sided, with an α of .05. RESULTS Analysis included 5,342 dispensaries, 667 health centers, 185 district hospitals, and 34 regional/referral hospitals. Maps revealed clusters of estimated travel time in excess of 6 hours in less populated western and southern districts. More districts reported an average travel time of less than 1 hour to the nearest dispensary (69%) than to regional/referral hospitals (16%). Bivariable local indicators of spatial autocorrelation revealed few significant clusters of spatial correlations; however, significant correlations between low population density and longer travel times in neighboring districts were obtained for 13%, 16%, 15%, and 13% of districts for dispensaries, health centers, district hospitals, and regional/referral hospitals, respectively. CONCLUSION Limited variability of district-level spatial correlations suggests somewhat equitable geographic allocation of PALM services in Tanzania, with small areas of low population density and long travel times that demand additional intervention. Limitations include a lack of ascertainment of specific PALM services.
Facilitating Adoption of Evidence-Based Cervical Cancer Screening Strategies in the Peruvian Amazon Using a Novel Methodology: The Integrative Systems Praxis for Implementation Research (INSPIRE)
Authors: Paz-Soldan Valerie A. , Meza Graciela , Carillo Lita , Jurczuk Magdalena , Rositch Anne , Soto Sandra , Kosek Margaret , Zevallos Karine , Jeronimo Jose , Ladron de Guevara Gabi , Brown Joanna , Kohler-Smith Anna , Vasquez Javier , Lopez Renso , Rios Reyles , Gravitt Patti E. 
Published: July 2020

PURPOSE The aim to this work was to develop an operational research methodology for context-appropriate selection, adaptation, and evaluation of the implementation of novel cervical cancer screening and treatment methods. METHODS We developed the Integrative Systems Practice for Implementation Research (INSPIRE) methodology, a multifaceted strategy that blends existing theoretical implementation research frameworks and defines specific research methods for use at each phase. INSPIRE is a participatory, iterative process involving 4 phases: system understanding, finding leverage, acting, and learning/adapting. Mixed methods were used to meet the objectives of each INSPIRE phase. Qualitative methods were grounded in soft systems methodology and CFIR, and quantitative methods in RE-AIM. Pathway and scenario analyses supplemented standard research methods. RESULTS We engaged more than 90 multilevel stakeholders in the design of a new and improved screen-and-treat system. Elaboration of system process maps through triangulation of the mixed-methods data served to create a shared reference of the current system in participatory discussions. Significant leverage opportunities were identified, including reducing fragmentation, inefficiency, and a lack of standardization to increase women’s acceptability of screening and adherence to the continuum of care. A variety of interventions were evaluated using a multiple scenario analysis tool and, ultimately, stakeholders recommended adoption of human papillomavirus testing/self-sampling to increase coverage and ablative treatment of all human papillomavirus–positive women to reduce loss to follow up. Implementation was launched in July 2019, and iterative application of INSPIRE to early implementation challenges is being used to ensure real-time adaptation to emerging system behaviors and the acceptability and sustainability of the program. CONCLUSION Continued success in the engagement of stakeholders in shared decision making suggests that using the INSPIRE methodology in designing implementation strategies increases a sense of ownership in the process, which may lead to more sustainable screening programs in low- and middle-income countries compared with top-down approaches.
Female Breast Cancer in Suriname: Pathways to Treatment—A Patient’s Perception
Authors: Irving Euridice R. , Mans Dennis R. A. , Dams Els Th. M. , Lichtveld Maureen Y. 
Published: July 2020

PURPOSE Delays across the entire cancer care continuum are not uncommon. This cross-sectional study explored the health care trajectories of Surinamese women with breast cancer and identified predictors of timely diagnosis and treatment initiation. METHODS One hundred women age 30 years or older who were newly diagnosed with breast cancer in 2017 to 2018 were recruited from all 4 hospitals in Paramaribo. Data on their demographics, lifestyle, reproductive and medical history, health status, and family history of breast cancer and other malignancies were collected using a validated semistructured questionnaire. Using Anderson’s Model of Pathways to Treatment, we defined a patient interval (from detection to first consultation), diagnostic interval (from consultation to histopathologic diagnosis), and treatment interval (from diagnosis to first treatment). Log-transformed data were analyzed using linear regression, and variables with P ≤ .05 were considered statistically significant predictors of intervals. RESULTS All participants had health insurance and access to health care. Eighty-five percent of patients presented with early-stage disease. Ninety percent of patients had self-detected their disease, with 70% finding a lump. Average age was 55.6 years (± 11.8 years). Median durations of patient, diagnostic, and treatment intervals were 13 days (interquartile, range, 4-63 days), 40 days (IQR, 21-57 days), and 18 days (IQR, 8-38 days), respectively. Median duration of the entire interval was 95 days (IQR, 59-272 days). Patient-related factors associated with the intervals were religion (β = −530; P = .003), being employed (β = 149.4; P = .007), and age 50 years and older (β = −195.8; P = .037). Disease-related factors were lump as first symptom (β = −175.6; P = .038) and late-stage disease at diagnosis (β = 213.5; P = .004). CONCLUSION Given the limited-resource setting, delays in Suriname’s health care can be minimized by programs aimed at increasing breast cancer awareness and education; however, delays may have been underestimated as a result of the over-representation of early-stage disease and recall bias regarding the first symptom detected.
Moving Toward an Evidence-Informed Cancer Control Strategy: A Scoping Review of Oncology Research in Kenya
Authors: Manduku Veronica , Akhavan Mina , Asiki Gershim , Brand Nathan R. , Cira Mishka K. , Gura Zeinab , Kadengye Damazo T. , Karagu Alfred , Livinski Alicia A. , Meme Helen , Kyobutungi Catherine 
Published: July 2020

PURPOSE In 2017, the Kenya Ministry of Health launched the National Cancer Control Strategy 2017 to 2022. A scoping review of oncology research in Kenya was conducted to understand the scope of—and gaps in—existing research and inform the development of the national cancer research agenda. METHODS We searched PubMed/MEDLINE, Embase, Scopus, and Global Health databases using controlled vocabulary and keywords to identify oncology research with a study site in Kenya, published in English, from 2007 to 2017. Fifteen journals and additional gray literature sources were hand searched. Screening of titles, abstracts, and full text was completed by pairs of 2 reviewers, with a third reviewer reconciling discrepancies. From included studies, data were extracted and coded using Google Forms. Microsoft Excel was used for descriptive statistics. RESULTS Of the 284 included articles, a majority were analytic observational studies (66.9%). The top 5 cancers studied were cervical cancer (n = 106; 35.9%), breast cancer (n = 25; 11.9%), Burkitt lymphoma (n = 23; 8.5%), esophageal cancer (n = 15; 5.1%), and pediatric cancers (n = 12; 4.1%). Primary focus areas were early detection, diagnosis, and prognosis and cancer control, survivorship, and outcomes research. Kenyatta National Hospital, Moi Teaching and Referral Hospital, and University of Nairobi were most often cited as research host institutions. One hundred twenty-three unique funding sources were reported, with the most prevalent study funding sources by region being North America (48%), Europe (28.8%), and Middle East/Africa (17.6%). The US National Institutes of Health was cited as the leading funding source of cancer research in Kenya. CONCLUSION This scoping review provides an overview of the published literature on cancer research conducted in Kenya. It highlights cancer research by cancer type, location, and focus area. It also focuses attention on research gaps, as well as the need for rigorous, well-conducted population-based studies, longitudinal studies, and randomized controlled trials aligned with the cancer burden in Kenya.
Awareness of and Preference for Disease Prognosis and Participation in Treatment Decisions Among Patients With Advanced Cancer in Myanmar: Results From the APPROACH study
Authors: Mon Ssu Wynn , Zu Wah Wah Myint , Maw Myo Myint , Win Han , Thant Kyaw Zin , Yang Grace , Malhotra Chetna , Teo Irene , Finkelstein Eric , Ozdemir Semra 
Published: July 2020

PURPOSE The aim of this study was to investigate prognostic awareness, preference for prognostic information, and perceived and preferred roles in decision making among patients with advanced cancer in Myanmar. METHODS A cross-sectional survey was administered at Yangon General Hospital to patients with stage 4 cancer who were at least 21 years old and aware of their cancer diagnosis. Patients were asked questions about their prognosis, treatment decisions, and sociodemographic and clinical information. Data from 131 patients were analyzed using descriptive and comparative statistics. RESULTS Only 15% of patients surveyed were aware that their cancer was advanced, and only 26% knew that it was terminal. One third of patients (34%) had prognostic awareness, defined as the knowledge that treatment intent is noncurative. The likelihood of awareness was higher among patients who were male, high income, and aware that they had advanced cancer. Approximately 60% of patients reported playing an active or collaborative role in treatment decisions, with a strong preference (59%) for the latter. For the majority of patients (69%), perceived and preferred roles in decision making were the same. Sociodemographic characteristics did not predict perceived and preferred roles in decision making. CONCLUSION To our knowledge, this is the first effort to analyze prognostic awareness and decision-making practices among patients with advanced stage cancer in Myanmar. Patients had inadequate knowledge of their disease progression and intent of treatment. Yet, a majority of them were keen to be involved in treatment decisions. Thus, physicians should effectively communicate prognosis and treatment intent, encouraging patients to participate in decisions whenever possible.
Democratizing Access to Best Practice Cancer Care in Low-Resource Settings: Project ECHO
Authors: Bouchonville Matthew F. , Cirolia Lucca 
Published: July 2020

PURPOSE The aim of this study was to understand how telementoring and training through the ECHO model can build the cancer workforce and bring best practice cancer care to low-resource settings. METHODS The ECHO Institute launched a 5-year project to expand the use of the ECHO model to improve the capacity of local providers to bring cancer prevention, diagnostic, treatment, and survivorship knowledge to rural and underserved populations. The ECHO model leverages technology, telementoring, and case-based learning to connect rural populations to specialty cancer care, improve access to evidence-based therapies and practices, and provide state-of-the-art training and mentorship to build the cancer workforce, particularly in underserved regions. Through the ECHO model, local providers are paired with experts and doctors at National Cancer Institute–designated Comprehensive Cancer Care Centers and academic medical centers for ongoing training, technical assistance, and mentorship. Although originally developed to bring best practice care for hepatitis C to rural communities, the ECHO model is now being used to treat 70 conditions or topics globally. RESULTS Since 2016, the ECHO model has been replicated by 73 partner hubs in 13 countries that are operating 130 cancer programs focused on diverse cancer prevention and treatment topics, including increasing clinical trial enrollment, cancer control and best practices, cervical cancer prevention and treatment, tobacco cessation, and more. To date, 21 peer-reviewed publications have documented the ECHO model’s efficacy in improving the use of best practices in cancer care and expanding access to care in low-resource settings. CONCLUSION Use of the ECHO model to train and mentor local providers is building the cancer workforce and increasing capacity to address critical topics in cancer screening, diagnosis, care, and survivorship. The ECHO Institute is successfully strengthening the cancer health system and accelerating the transmission of best practice cancer care from cancer centers to health care workers in underserved communities.
Setting Up Telemedicine: Internet of Things to Support Rural Oncology Clinics in a Low- and Middle-Income Country—A Pilot Project in Kenya
Authors: Sigu Lamech , Chite Fredrick , Achieng Emma , Koech Andrew 
Published: July 2020

PURPOSE The Internet of Things (IoT) is a technology that involves all things connected to the Internet that share data over a network without requiring human-to-human interaction or human-to-computer interaction. Information collected from IoT devices can help physicians identify the best treatment process for patients and reach accurate and expected outcomes. METHODS The International Cancer Institute is partnering to set up remote oncology clinics in sub-Saharan Africa. Medical oncologists and expert teams from across the world connect with oncology clinics in other Kenyan counties—Kisumu, Meru, Makueni, Garissa, Kakamega, Bungoma, Siaya, and Vihiga counties. The furthest county is Garissa, approximately 651.1 km from Eldoret, and the nearest is Vihiga at 100.4 km from Eldoret. This study began July 2019, and as of November 30th, the team has hosted 21 sessions with an average of 11 participants attending a session led by a medical oncologist. RESULTS IoT devices have become a way by which a patient gets all the information he or she needs from a physician without going to the clinic. Patient monitoring can be done in real time, allowing access to real-time information with improved patient treatment outcomes and a decrease in cost. Through IoT-enabled devices, the International Cancer Institute has set up weekly virtual tumor boards during which cancer cases are presented and discussed by all participating counties. An online training module on cancer is also offered. Furthermore, remote monitoring of a patient’s health helps to reduce the length of hospital stay and prevents readmissions. CONCLUSION In our setting, which has a few oncologists, use of IoT and tumor boards has helped to improve patient decision support as well as training for general physicians.
Improving Access to Vitally Important Chemotherapy Treatments in Northern Nigeria Through the African Access Initiative
Authors: Faruk Mohammed , Olasinde Tajudeen , Adamu Abdullahi , LeJeune-Stodieck Analise , Hunthausen Noah , Graef Katy , Dent Jennifer 
Published: July 2020

PURPOSE Cancer now kills more Africans than malaria. Without intervention, the number of cancer deaths in Africa is projected to double by 2040. BIO Ventures for Global Health (BVGH) launched the African Access Initiative (AAI) to address Africa’s cancer crisis by establishing sustainable access to cancer medicines. Through AAI, BVGH and the Ahmadu Bello University Teaching Hospital (ABUTH) are piloting a first-of-its-kind program focused on improving Nigeria’s access to affordable, gold-standard cancer drugs manufactured by multinational pharmaceutical companies. METHODS BVGH, the Federal Ministry of Health, and Nigerian oncologists held a stakeholder meeting to prioritize cancers and their associated drugs. After the meeting, pharmaceutical companies were invited to submit proposals outlining the terms by which the prioritized drugs could be made available. In parallel, Nigeria’s regulatory agency, the National Agency for Food and Drug Administration and Control, was engaged to discuss expediting its review and approval of priority drugs. RESULTS Forty-one priority cancer drugs covering 8 of Nigeria’s most prevalent cancers were selected for this program. Requests for proposals were sent to 14 multinational pharmaceutical companies. Companies responded with deeply discounted access prices, the majority of which were more affordable than cancer drugs available through ABUTH’s current procurement structure. On the basis of the companies’ proposed prices, BVGH crafted a budgeting tool tailored to the cancer treatment protocols offered at ABUTH. Using this tool, ABUTH, together with 7 northern Nigerian teaching hospitals and under the leadership of Ahmadu Bello University, calculated the number of patients they could treat and drug quantities they could purchase with their current budget. The relevant funds will be placed in an externally managed escrow account to ensure oversight of the drug procurement process. BVGH is working with the pharmaceutical companies and National Agency for Food and Drug Administration and Control to hasten approval of priority drugs. CONCLUSION The AAI drug access model is not donation based. Instead, it is an innovative, demand-driven program that is uniquely positioned to ensure affordable and sustainable access to cancer drugs in Africa.