bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 57: Experiences and Beliefs Regarding Shared Decision-Making About Treatment of Incurable Cancer in Tanzania
Authors: Casey Megan , Athanas Raymond , Dharsee Nazima , Jazza Anna , Julius Kalunde , Semwaza Francis , Mushi Beatrice , Kadhim Emilie , Van Loon Katherine , Ho Anita , Deboer Rebecca 
Published: July 2021

Abstract
Purpose: Treatment decision-making in the setting of advanced cancer is often complex and culturally embedded. Potential benefits of treatment must be weighed against toxicities, economic burden, and social consequences. The standard of shared decision-making (SDM) between doctor and patient, rooted in the Western principle of patient autonomy, may not be readily transferable to other cultural and socioeconomic contexts, where different values and considerations may take precedence. This study aims to characterize the decision-making experiences and beliefs of stakeholders at Ocean Road Cancer Institute (ORCI) in Tanzania in order to inform communication guidelines and improvement strategies.
Methods: We conducted semi-structured interviews with a purposive sample of oncologists and nurses (n=13) and patients with advanced cancer (n=11) at ORCI. A diagram depicting paternalistic, informed, and shared approaches to decision-making was referenced during interviews. Interviews were recorded, transcribed verbatim, translated to English, coded using MAXQDA software, and analyzed using framework thematic analysis.
Results: Patients and providers reported heterogeneous decision-making experiences and preferences, with a trend toward greater patient engagement in recent years. Providers believed SDM is especially important when treatment goals are palliative and when out-of-pocket costs are significant, but favored paternalistic decision-making in the context of curative treatment and lower patient health literacy. Patients generally placed greater importance on providers' communication style and the quality of clinical care than engagement in SDM. Several participants perceived SDM to increase patient adherence to treatment. Barriers and facilitators of SDM were identified at the patient, provider, and healthcare system levels. Community misperceptions about cancer treatment was commonly cited as a barrier. Practical suggestions included communication skills training for providers, implementation of a clinical tool for decision-making, and increased patient and public education about cancer treatment.
Conclusion: Understanding the nuanced views regarding SDM is important for development of culturally informed communication guidelines, tools, and training.
Citation Format: Megan Casey, Raymond Athanas, Nazima Dharsee, Anna Jazza, Kalunde Julius, Francis Semwaza, Beatrice Mushi, Emilie Kadhim, Katherine Van Loon, Anita Ho, Rebecca Deboer. Experiences and Beliefs Regarding Shared Decision-Making About Treatment of Incurable Cancer in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 57.
Abstract 63: Barriers and Facilitators of Cervical Cancer Screening Access in Belize: A Qualitative Analysis of Stakeholder Perspectives
Authors: Mittal Avni , Neibart Shane , Kulkarni Abha , Anderson Taylor , Tsui Jennifer , Hudson Shawna , Einstein Mark , Beer Natalia Largaespada , Kohler Racquel E. 
Published: July 2021

Abstract
Purpose: Cervical cancer is the fourth most common cancer among women worldwide. Belize has among the highest cervical cancer incidence and mortality rates of Latin American and Caribbean countries despite current programs to increase access to secondary prevention services. This study evaluates the perspectives of key stakeholders in the cervical cancer screening system in Belize to elucidate barriers and facilitators of cervical cancer screening services.
Methods: In 2018, semi-structured interviews discussing challenges and successes in cervical cancer screening were conducted with key stakeholders across the 6 districts of Belize. Interviews were transcribed and coded using thematic content analysis to identify salient themes. Themes were organized by levels of the Tappan model.
Results: A total of 47 interviews were conducted with healthcare providers (45%), administrators (17%), government officials (25%), and other stakeholders (13%). 78% of interviews were conducted in the public sector. Perceived barriers to cervical cancer screening were identified across 5 levels: (1) Individual (expectation of delay in Pap smear results and fear of a cancer diagnosis, reduces participation in screening); (2) Provider (responsibilities beyond the provision of screening service prevents clinics from offering services daily); (3) Organizational (insufficient space and training engenders diagnostic delays and possible misdiagnoses); (4) Community (screening limitations are more pronounced in rural vs. urban areas); and (5) Policy (limited budget allocated to equipment and staff restricts screening coverage). Salient facilitators were identified at the community and policy levels. At the community level, facilitators included resource-sharing between public and private sectors and the designation of personnel for rural outreach. Facilitators at the policy level included government coverage of screening costs and establishment of population-based screening targets.
Conclusion: Despite no-cost cervical cancer screening in Belize, barriers still exist. Overloaded provider responsibilities, geographic inaccessibility, and insufficient funding are insights that serve as potential areas for system strengthening.
Citation Format: Avni Mittal, Shane Neibart, Abha Kulkarni, Taylor Anderson, Jennifer Tsui, Shawna Hudson, Mark Einstein, Natalia Largaespada Beer, Racquel E. Kohler. Barriers and Facilitators of Cervical Cancer Screening Access in Belize: A Qualitative Analysis of Stakeholder Perspectives [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 63.
Abstract 71: Accelerated Epigenetic Age among HIV-infected Nigerian Women with Invasive Cervical Cancer
Authors: Musa Jonah , Kim Kyeezu , Zheng Yinan , Qu Yishu , Joyce Brian , Wang Jun , Travis Lois , Gursel Demirkan , Silas Olugbenga , Abdulkareem Fatimah , Imade Godwin , Akanmu Alani , Wei Jian-Jun , Kocherginsky Masha , Kim Kwnag-Youn , Wehbe Firas , Achenbach Chad , Anorlu Rose , Simon Melissa , Sagay Atiene , Ogunsola Folasade , Murphy Robert , Hou Lifang 
Published: July 2021

Abstract
Purpose: Invasive cervical cancer (ICC) is one of the HIV-associated cancers with a high burden in Nigeria. ICC occurs at relatively younger age in HIV infected women, with HIV known to promote aging and related diseases, including cancer. DNA methylation changes with increasing age, various health-related exposures, and age-related health outcomes, suggesting a role of DNA methylation in biological aging and disease. We sought to understand the effect of HIV infection on epigenetic age acceleration (EpiAgeAccel) in Nigerian women with ICC.
Methods: Epigenetic age (EpiAge) was estimated by Horvath's calculator using genome-wide methylation data in 116 cervical tissue samples from three groups of women: a) HIV positive with ICC (n=39); b) HIV positive and cancer-free (n=53); and c) HIV negative with ICC (n=24). EpiAgeAccel was computed as the regression residuals of EpiAge against chronological age (ChronAge), representing the independent deviation of EpiAge from ChronAge. We compared EpiAgeAccel across the 3 HIV/ICC groups using multiple linear regressions adjusting for ChronAge, education, parity, employment, cancer stage, body mass index, and study site. Among the ICC women, we compared EpiAgeAccel between 26 tumor tissues and their surrounding normal tissues using paired t-tests, stratified by HIV status.
Results: EpiAgeAccel among HIV positive women with ICC was 4.5 years higher than HIV positive and cancer-free women (p=0.019). We did not find substantial differences in EpiAgeAccel between HIV-positive women with ICC and HIV-negative women with ICC. EpiAgeAccel was 7.9 and 2.9 years higher in tumor tissues compared to the surrounding normal tissues among HIV positive women (p=0.021) and negative women (p=0.295), respectively.
Conclusion: EpiAge is accelerated in cervical tissue of HIV-infected women with ICC. EpiAgeAccel may be a potential biomarker for ICC screening and early detection for women living with HIV in low- and middle-income countries.
Citation Format: Jonah Musa, Kyeezu Kim, Yinan Zheng, Yishu Qu, Brian Joyce, Jun Wang, Lois Travis, Demirkan Gursel, Olugbenga Silas, Fatimah Abdulkareem, Godwin Imade, Alani Akanmu, Jian-Jun Wei, Masha Kocherginsky, Kwnag-Youn Kim, Firas Wehbe, Chad Achenbach, Rose Anorlu, Melissa Simon, Atiene Sagay, Folasade Ogunsola, Robert Murphy, Lifang Hou. Accelerated Epigenetic Age among HIV-infected Nigerian Women with Invasive Cervical Cancer [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 71.
Abstract 72: Slow Progress in Low-Resource Environments: Is Lack of Education and Training in Cancer Prevention Key?
Authors: Varon Melissa , Shine Chang , Pimple Sharmila , Shastri Surendranath 
Published: July 2021

Abstract
Purpose: Explore attitudes about education and training in cancer prevention research and practice on dissemination and implementation of cancer prevention practices in India.
Methods: Conduct focus groups to understand how cancer prevention education and training – or their absence – influence dissemination and implementation of cancer prevention and control strategies from stakeholder groups: o Professionals with leadership responsibilities in cancer and public health, managing people and resources, and with experience working with patients and communities, clinicians and public health professionals, health administrators, government agencies, and non-profits; and o Patients with cancers for which prevention and early detection strategies exist.
Results: In focus group discussion guides, we consider how to appropriately probe aspects of individual and professional responsibility, leadership style, public and system capacity, cultural and educational influence, and surface other aspects important to the influence of education and training of professionals, leaders, and the public in cancer prevention and control. We expect to gain rich insight from leaders and professionals with knowledge of cancer prevention and control success achieved in developed countries and lived experience managing cancer resources for patients and systems in India. We also anticipate rich insight from survivors about their expectations of and experiences with oncology care for contrast and alignment of themes from leaders and professionals.
Conclusio:n Slow progress in dissemination and adoption of proven cancer prevention and control initiatives in LMICs creates critical opportunities missed. Through focus groups, we hope to unearth foundational barriers to cancer prevention in low-resource settings related to cancer prevention education and training for fuller NCI R01 dissemination science investigations in India and other low-resource settings that share the experience of preventable cancers diagnosed at advanced stage but are culturally different for comparison. Insight from such studies may reveal new directions for achieving high impact, long-term implementation of cancer prevention strategies.
Citation Format: Melissa Varon, Chang Shine, Sharmila Pimple, Surendranath Shastri. Slow Progress in Low-Resource Environments: Is Lack of Education and Training in Cancer Prevention Key? [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 72.
Abstract 74: Stakeholder Selected Strategies to Improve Breast Cancer Care in East Africa: Preliminary Implementation Outcomes and Impact Of COVID-19
Authors: Rositch Anne , Chao Christina , Kirahi Matogoro , Masalu Nestory , Faustine Lucas , Amango Leonard Washington 
Published: July 2021

Abstract
Purpose: Beyond limited resources, disparities in global breast cancer outcomes can be attributable to gaps in translating evidence-into-practice. Therefore, the novel “A.C.T.” framework aimed to Assess the local context, Couple evidence-based strategies to identified barriers, and then Test these strategies to improve breast cancer care practices.
Methods: Strategies to improve breast cancer care were selected by stakeholders based on feasibility, importance, and potential sustainability. The selected interventions focus on 1) delivery of clinical breast examinations; 2) workflow for diagnostic evaluations; and 3) initiating a breast cancer–specific multidisciplinary tumor board. The interventions were launched on January 31st, 2020 at the Zonal Hospital in Mwanza, Tanzania, which serves 14 million people. Here we present the 6-month interim pre- (August, 2019-January, 2020) vs. post- (March-August, 2020) implementation outcome analysis.
Results: An average of 20 vs. 37.2 women per month presented with breast concerns in the pre- vs. post-implementation period. Women receiving diagnostic testing (84% vs. 86%) and initiating treatment (29% vs. 30%) did not change from pre- to post-implementation. However, average time to first diagnostic test (11 vs. 4 days) and to first treatment (62 vs. 26 days) decreased from pre- to post-implementation. These improvements in breast care can likely be attributed to the CBE training workshop with 51 attendees, the training of 6 departments on the new clinical pathway for breast patients, and the creation of a multidisciplinary tumor board which held 20 meetings over 6 months, with an average of 4 specialties and 14 clinicians.
Conclusions: Program adaptation and monitoring are still ongoing, but it will be difficult to evaluate the differing effects of the intervention and the COVID-19 pandemic on breast cancer care. This highlights the need to better study program interruptions and develop re-implementation criteria and protocols to better ensure program sustainability in light of ‘real world' challenges.
Citation Format: Anne Rositch, Christina Chao, Matogoro Kirahi, Nestory Masalu, Lucas Faustine, Leonard Washington Amango. Stakeholder Selected Strategies to Improve Breast Cancer Care in East Africa: Preliminary Implementation Outcomes and Impact Of COVID-19 [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 74.
Abstract 77: Health Care Providers and Traditional Healers Perspectives on Late Diagnosis of Breast Cancer in Tanzania: A Qualitative Study
Authors: Msoka Elizabeth F. , Gutnik Lily , Cyril Agnes M. , Kitali Brenda C. , Saria Vivian F. , Kwayu Jackline C. , Kavishe Adellaida A. , Msoka Perry C. , Herman Ayesiga , Serventi Furaha , Masenga Gilleard G. , Fayanju Oluwadamilola , Fish Laura , Mmbaga Blandina Th. 
Published: July 2021

Abstract
Purpose: In Tanzania, women are diagnosed at advanced breast cancer stages. The reasons for this are multifactorial and have not been systematically investigated in the Kilimanjaro Region. This study aimed to identify reasons for advanced stage breast cancer at time of diagnosis.
Methods: Four focus group discussions and 8 semi- structured in-depth interviews were conducted among health care providers (HCP) and traditional healers from five health care facilities (1 regional and 2 district hospitals) and two urban and rural communities in Kilimanjaro, Tanzania. Thematic coding via grounded theory technique was done by two independent reviewers.
Results: Twenty HCP (10 doctors and 10 nurses) and 8 traditional healers participated in the study. The average ages for doctors were 38, nurses 33, and traditional healers 50. Among HCP, the most common reasons for advanced stage breast cancer at time of diagnosis were patients initially seeking care from traditional healers, and patient distrust of conventional medicine. Among traditional healers, the most common reasons were: delayed initiation of biomedical treatment due to long turnaround of pathology results, inability to pay for diagnostic workup and treatment, and transportation issues. Both groups stated lack of patient breast cancer knowledge.
Conclusions: There was agreement that lack of adequate breast cancer knowledge and awareness as a very common reason for advanced disease presentation among HCP and traditional healers. Community health education must be designed to adopt socio-cultural and religious doctrines to alleviate the misconceptions and knowledge gap. Health system interventions are also needed to facilitate access to timely, affordable, and quality breast cancer diagnosis and treatment
Citation Format: Elizabeth F. Msoka, Lily Gutnik, Agnes M. Cyril, Brenda C. Kitali, Vivian F. Saria, Jackline C. Kwayu, Adellaida A. Kavishe, Perry C. Msoka, Ayesiga Herman, Furaha Serventi, Gilleard G. Masenga, Oluwadamilola Fayanju, Laura Fish, Blandina Th. Mmbaga. Health Care Providers and Traditional Healers Perspectives on Late Diagnosis of Breast Cancer in Tanzania: A Qualitative Study [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 77.
Abstract 86: Cancer Update in Rwanda (2009-2018)
Authors: Businge Lydia , Uwinkindi Francois , Hagenimana Marc , Murenzi Gad , Kubwimana Gallican , Musabyimana Francoise , Ingabire Charles , Munyaneza Athanase , Ingabire Cecile , Randall Thomas C , Anastos Kathryn , Castle Philip E 
Published: July 2021

Abstract
Purpose: In Rwanda, cancer prevalence and death have not been accurately documented up to 2018. In response, Rwanda, through the Ministry of Health and supported by Albert Einstein College of Medicine with funding from the U.S. National Cancer Institute, established a National Cancer Registry (NCR) in July 2018 to collect national cancer data. We aimed to determine the number of cancers by type, the distribution of cancers in the Rwandan population, and cancer trends over the last ten years in Rwanda. Methods: Registry data were collected over a ten-year period (2009-2018) from public and private health institutions and the National Institute of Statistics. Cancers were coded using the third edition of the International Classification of Diseases for Oncology (ICD-O3). Data entry and analysis were performed using CanReg5 system and IARCcrg quality control. The National Institute of Statistics of Rwanda provided an estimate of the country's population census for 2012 by age and sex, and the annual population was estimated assuming constant rates of change within age-sex groups.
Results: Over ten years (2009-2018), a total of 18,562 cancers were registered; 11,034 (59%) in women and 7,528 (41%) in men. Breast and cervical cancers were most common among women [n=2283 (21%) and n=2330 (21%), respectively] while prostate and stomach cancers were most common among men [n=976 (13%) and n=772 (10%), respectively]. Most cases were diagnosed in women aged 50-54 (n=1381) and 45-49 (n=1189) and men aged 60-64 (n=794) and 55-59 (n=756). Cancers diagnosed in Rwanda increased from 759 cases in 2009 to 2,862 cases in 2018.
Conclusion: In Rwanda, Cancers are more common in women and are diagnosed at an earlier age in women than in men. There has been a significant increase in documented cancers over 10 years, potentially related to significant improvements in diagnostic capacity within the Rwandan health system.
Citation Format: Lydia Businge, Francois Uwinkindi, Marc Hagenimana, Gad Murenzi, Gallican Kubwimana, Francoise Musabyimana, Charles Ingabire, Athanase Munyaneza, Cecile Ingabire, Thomas C Randall, Kathryn Anastos, Philip E Castle. Cancer Update in Rwanda (2009-2018) [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 86.
Abstract 89: National Cancer Control Committee (NCCC) as Cancer-Related Non-Governmental Organizations (NGOs) Alliance: Strengthening Partnerships among the NGOs as Part of the Cancer Control Program
Authors: Permata Tiara Bunga Mayang , Octavianus Steven , Gondhowiardjo Soehartati 
Published: July 2021

Abstract
Purpose: Cancer control efforts in any level need to be coordinated, as we know that we cannot defeat cancer with a single weapon or modality. This translates also for actions in the national level, which most ideally written in a comprehensive National Cancer Control Program (NCCP). As most commonly the NCCP is led by the government or Ministry of Health in the country, unfortunately resources are often found lacking. Therefore, partnerships from non-governmental institutions become crucial for the success of the NCCP.
Methods: The National Cancer Control Committee (NCCC) of Indonesia in the year 2014 – 2019 has cultivated strong partnerships with Non-Governmental Organizations (NGOs) working in cancer-relevant fields or survivors' groups in the country. Over the years, a total of 39 organizations were invited to participate in Focus Group Discussions (FGDs), Training of Trainers and Speakers (TOT and TOS), and various public awareness campaigns. These activities were spanned throughout the years but were always highlighted in the World Cancer Day February 4th annually.
Results: The NCCC has successfully served as a platform for cancer-related NGOs' alliance. All the organizations stated their support and gratitude that with the presence of NCCC, their work was more goal-oriented and reports were accounted in the national level. The NCCC had collected data from 24 NGOs of their activities and noted that there were more than 700 activities/events held by these various organizations in 1 year all over the country, which included activities on public awareness campaigns, cancer treatment services, supportive care services, human resource development, and data-based advocacy.
Conclusion: The NCCC might be the ideal platform to strengthen partnerships between cancer-related NGOs. It worked well to create equal partnerships between the organizations, connect them to the governments, and to be able to align the activities with efforts from the ministry and the NCCP.
Citation Format: Tiara Bunga Mayang Permata, Steven Octavianus, Soehartati Gondhowiardjo. National Cancer Control Committee (NCCC) as Cancer-Related Non-Governmental Organizations (NGOs) Alliance: Strengthening Partnerships among the NGOs as Part of the Cancer Control Program [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 89.