bluuebunny/crossref_metadata_2025_split huggingface dataset:
Report on the Treatment of Hodgkin Lymphoma With ABVD Chemotherapy at Two Rural District Hospitals in Rwanda
Authors: DeBoer Rebecca J. , Driscoll Caitlin D. , Butera Yvan , Bigirimana Jean Bosco , Muhayimana Clemence , Fadelu Temidayo , Park Paul H. , Shyirambere Cyprien , Uwizeye Frank Regis , Mpunga Tharcisse , Lehmann Leslie , Shulman Lawrence N. 
Published: July 2016

Abstract 34 Background: While Hodgkin lymphoma (HL) is highly curable with standard chemotherapy in high resource settings, there are few reports of HL treatment in low resource settings. In Rwanda, a treatment protocol using six cycles of ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine) without radiotherapy has been implemented at two rural district hospitals. Here we report on the feasibility of this approach, our patient characteristics, and preliminary outcomes. Methods: We conducted a retrospective cohort study of all patients with biopsy confirmed HL seen at Butaro and Rwinkwavu hospitals between June 2012 and August 2015. Data was extracted from clinical charts and analyzed using descriptive statistics. Results: 43 HL patients were seen at Butaro (n=38) and Rwinkwavu (n=5); 58% male, median age 17 (range 4-54). Five (12%) were HIV positive. Of 22 patients with biopsy specimens evaluated for EBV, 12 (55%) were positive, 9 (41%) negative, and one indeterminate. Most patients were staged with chest x-ray (79%); fewer had liver ultrasound (33%) or CT (9%). With that, Ann Arbor stages were I (28%), II (23%), III (21%), IV (21%), and undetermined (7%). Of 39 patients who started ABVD, 25 (64%) completed all 6 cycles. Median time to completion of the 24 week ABVD regimen was 26.1 weeks (IQR 25-27); 26 patients (67%) experienced at least one treatment delay. Dose reductions were rare. At the time of data extraction, 5 (12%) were still on treatment, 18 (43%) in remission, 2 (5%) alive with relapse, 15 (35%) deceased, and 2 (5%) lost to follow up. Conclusions: Here we demonstrate the feasibility of treating HL with standard chemotherapy in a low resource setting through international partnership. Our preliminary results suggest that a majority of patients who complete treatment may experience a clinically significant remission with this approach. Further data analysis will identify areas for improvement with the hope of increasing sustained remissions. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
Cohort Profile: African Collaborative Center for Microbiome and Genomics Research (ACCME)
Authors: Adebamowo Sally N. , Dareng Eileen O. , Famooto Ayotunde O. , Bakare Rasheed A. , Adebamowo Clement A. ,   ACCME Research Group
Published: July 2016

Abstract 65 Background: Cervical cancer is the second most common cancer in Africa. Much remains unknown about the prevalence and pathogenicity of human papillomavirus (HPV) types and the mechanism of disease, and there is a need for new biomarkers for screening programs. Methods: ACCME is a multicenter prospective cohort study of host germline, somatic and HPV genomics and epigenomics, and vaginal microenvironment; and their association with cervical cancer in 10,000 HIV negative women in Nigeria. Data on demographic, lifestyle, medical history, serum, germline DNA, HPV genotype, and vaginal pH are collected at baseline and during follow up visits every 6 months. Samples of exfoliated cervical cells are analyzed for high risk HPV with Roche LINEAR ARRAY and vaginal bacterial composition and abundance are characterized by deep sequencing of barcoded 16S rRNA gene fragments (V4) on a Illumina MiSeq platform. Colposcopies and biopsies are conducted on participants with clinical lesions and those with persistent high risk HPV infections. Results: By December 2015, 10,000 participants had been enrolled in the ACCME cohort. The mean (SD) age of the study participants at baseline was 40 (10) years. Most of the participants were married (76%), attended university (44%), and had professional jobs (37%). All the study participants have had vaginal sex, 17% have had oral sex, and only 2% have ever had anal sex. We found 30% of the study participants were HPV positive and 70% were HPV negative. The mean (SD) vaginal pH in the study population was 5.2 (0.5). Further analyses to characterize high-risk HPV types and determine persistence will be conducted at each follow up visit. Also, characterization of cervical cytokines and vaginal microbiome will be conducted after the follow up visits for all participants have been conducted. Conclusions: ACCME is a paradigm for translational research in biomarker discovery that addresses high impact public health challenges affecting women's health in Africa and the rest of the world. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
Palliative Care in the Kyrgyz Republic
Authors: Shaimbetov Bakyt , Arzymatova Astra 
Published: July 2016

Abstract 55 Currently, there are 22,984 cancer patients registered in the Kyrgyz Republic. In 2014, 5,552 new patients were diagnosed with malignant tumors and 3,219 of them died the same year. Total cancer rates in the country are steadily growing with 89.1 cases/100,000 population in 2012, 89.6 cases/100,000 population in 2013 and 95.1 cases/100,000 population in 2014. With growing cancer prevalence, need for accessible and sustainable palliative care system is rapidly increasing. In 2012, a Strategy of Palliative Care Development in the Kyrgyz Republic for 2012-2016 was proposed to address provision of patient palliative care in the country. As a result, the Kyrgyz government accepted a policy of referring patients to Palliative care facilities based on medical diagnosis and, therefore, these services must be monitored for quality control. We examined developmental progress of palliative care system in the Kyrgyz Republic and its outcomes. Data were collected from 453 terminal cancer patients registered in the Department of Palliative Care of the National Oncology Center. We used the average length of stay and the subsequent place of care as process indicators, as well as changes in the mean pain score as outcome measurements. There were considerable variations among services with regards to the mean length of stay (i.e., 6 to 28 days for each admission) and subsequent place of care, even after stratification by service level. The mean change in average pain score varied from −1.5 to 2.1, and remained significant after case-mix adjustment. We discovered significant variations in palliative care services quality in relation to the average length of stay, subsequent places of care as well as alterations in the average pain score. Continuous evaluation of changes in the establishment and outcomes of palliative care services will assist in the development of comparative analysis and evaluation of public policies of the national Palliative Care system. In accordance with the Soros Foundation-Kyrgyzstan, a new initiative is currently being implemented by the National Center of Oncology: “Creating an integrated palliative care service model at home.” The purpose of this project is expansion of home-based end-of-life services provided by a multidisciplinary team for terminal patients in the city of Bishkek. As a part of the initiative, 87 patients have already received home-based palliative care assistance. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from either author.
Public-Private Partnerships for the Development of New Devices for Screening and Treatment of Cervical Precancer for Emerging Economies
Authors: Holme Francesca , Slavkovsky Rose , Jeronimo Jose 
Published: July 2016

Abstract 74 PATH is a nonprofit organization involved in the development of new technologies for screening and treatment of precancerous lesions of the uterine cervix for the last 25 years. PATH had private-public partnerships with four private companies for the design, development, improvement, and/or field validation of two new technologies for screening (careHPV and OncoE6 Cervical Test) and two devices for treatment (CryoPen and the Liger Thermal Coagulator). This experience allows us to identify some commonalities among those companies: they all had the technical or scientific background for developing or improving the technologies needed, they were committed to creating technologies suitable for emerging economies, and their knowledge or presence in low-resource countries was limited. The characteristics of our collaboration with the private companies varied depending on the initial status of the technology. Two of the companies already had marketed technologies that required adaptation for suitability in low-resource settings, and the role of PATH was to support the planning and modification of the technology, bench and field testing of the prototypes, and/or clinical validation of the product. Meanwhile, the other two companies had the technological capacity and expertise for developing the required technologies, but they did not have a working prototype; therefore, the role of PATH involved supporting the design and development of the new technology, as well as the required bench testing and validations. The financial support required was variable; in some cases PATH provided technical support for developing a “proof of concept” prototype, which later extended to financial support from PATH or other organizations. In other cases, the complexity of the initial work required financial support to start the development of that “proof of concept.” In conclusion, public-private partnerships are very effective for the development of new, affordable, and suitable technologies for screening and treatment of cervical precancer in emerging economies. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Francesca Holme Travel, Accommodations, Expenses: Qiagen Rose Slavkovsky No relationship to disclose Jose Jeronimo No relationship to disclose
Using 3D Neuroanatomy Educational Resources as a Neurosurgical Teaching Tool in LMICs
Authors: Griswold Dylan , Tabani Halima , Tayebi Meybodi Ali , Benet Arnau 
Published: July 2016

Abstract 41 One of the Millennium Development Goals is to reduce childhood mortality; over 200,000 children currently develop cancer worldwide each year. 80% of those children live in Lower-Middle Income Countries (LMICs), which account for 90% of deaths (1). Nervous system (CNS) tumors are the most frequent solid tumors in children and adolescents (2). However, the median number of neurosurgeons per 100,000 population across different income groups is extremely variable (range: 0.01 - >1). In East Africa only 27 neurosurgeons are available to treat 270 million people, a 1:10 million ratio of neurosurgeons to inhabitants. Many countries do not even have one neurosurgeon (3). Even in low-resource areas where neurosurgery is an option, the high complexity of care for brain tumors often leads to suboptimal outcomes (4). As outlined by Rodriguez-Galindo et al., one of the first steps to improving outcomes in pediatric oncology is to both improve access to high-quality education as well as educational resources (1). Therefore, in order to improve access to neurosurgical educational resources we have generated a virtual library of 25,000 3D neurosurgical anatomical photographs (60% microsurgical, 40% endoscopic) and we have recorded 180 skull base and cerebrovascular cases in 3D in the operating room. In addition, we have presented the setup for producing a training operating room for residents and junior faculty to practice their surgical skills. With increasing opportunities to access and upload large amounts of data to cloud based servers, the surgical classroom of the future, especially in areas without the necessary personnel to train neurosurgical residents, may consist of a library of nearly every surgical approach recorded in three dimensions. This technology not only provides the student with the opportunity to develop a more thorough anatomical basis of key landmarks and features within the surgical window as compared to current 2D educational resources, but allows efficient self-learning. With the reported method, experienced neurosurgeons of the developed world can capture and build into this 3D virtual library to generate a global effort to improve neurosurgical education worldwide. Rodriguez-Galindo C, Friedrich P, Morrissey L, et al. Global challenges in pediatric oncology. Curr Opin Pediatr 2013; 25:3-15. Ezzat S, Kamal M, El-Khateeb, N, et al. Pediatric brain tumors in a low/middle income country: does it differ from that in developed world. Neuro-oncology 2015; Oct 29. Fuller A, Tran T, Muhumuza M, et al. Building neurosurgical capacity in low and middle income countries. eNeurologicalSci 2016; 3:1–6. Qaddoumi I, Unal E, Diez B, et al. Web-based survey of resources for treatment and long-term follow-up for children with brain tumors in developing countries. Childs Nerv Syst 2011; 27:1957–1961. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
Oncology Institute of Guatemala: Experience With NK/T-Cell Lymphomas
Authors: Valvert Fabiola , Flores Diana 
Published: July 2016

Abstract 24 Background: NK/T-cell nasal type lymphoma is an aggressive non-Hodgkin lymphoma that destroys the palate and nasal anatomy. The incidence in the US and Europe is very low; however, Asia and South America have reported incidence up to 10-15%. This study was done to assess the incidence of this type of lymphoma in our institution, outcomes of treatment efficiency, and to explore demographic, clinical and biological characteristics associated with poor outcomes. Methods: Seventeen NK/T-cell lymphoma patients were diagnosed between 2014-2015, who were treated with radiotherapy plus weekly cisplatin 3-5 doses and consolidation with gemcytabine, oxaliplatin y L-asparaginase 1-4 doses or cisplatin, etopóside, ifosfamide and dexamethasone by 3 doses. Results: The incidence of NK/T-cell lymphoma was 9% of all lymphomas. Median age was 35 years (range: 20-64). The nose is the most frequent location (94.1%,16/17), and 23.5% (4/17) presented with high tumor burden. 100% of these patients presented with palate perforation. One patient presented with stage IV disease. All patients with high tumor burden and stage IV disease died with an overall survival (OS) of 5 months. Three of the deceased were Mayan people (75%). Guatemala's region with the highest incidence was Central (58%) and West (35.3%) vs. North, South and East (5.8%). 65% of the cases were Mayan people vs. 35% of mestizos. All patients had a poor or very poor socio-economic status. Twelve patients achieved complete response (70.6%). After a median follow-up time of 11 months, 1-year event-free survival and OS were 64.7%. Conclusions: The results of this study lead us to the conclusion that Guatemala's indigenous population in the west and center of the country are the most vulnerable population, which include mainly people with a poor socio-economic status. High tumor burden was associated with poor outcomes. Results achieved with radiotherapy plus cisplatin and consolidation with chemotherapy was effective. We recommend the development of educational programs to encourage early diagnosis of this lymphoma in areas of the population that are at risk. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Fabiola Valvert Travel, Accommodations, Expenses: Kedrion Biopharma, Asopharma Diana Flores No relationship to disclose
Raising Awareness About Women’s Cancer and Increasing Local Engagement With Healthcare Services in Haiti
Authors: Tillyard Grace , Cornely Jean Renald , Santamaria Estefania , Surena Gerty , Casimir Mita Alcindor , Deudina Gabrielle , DeGennaro Vince 
Published: July 2016

Abstract 37 Background: Project Medishare launched a breast cancer program in Port-au-Prince in 2013. In 2015, the program was expanded as part of a national breast cancer treatment program. Project Medishare is currently implementing a women’s cancer awareness campaign funded by the Union for International Cancer Control (UICC). The program will explore and address the complex social and cultural narratives around women’s cancer in Haiti. This will be accomplished using human-centered design to build a communications tool-kit for community health workers. The program was conceived with local partners and the Haitian government. Both parties sought to increase breast and cervical cancer screening, as well as reduce the number of late-stage presentations. Methods: Project Medishare has adopted methods from Community-Based-Participatory-Research (CBPR) in order to identify and foster a community of actors involved in women’s health, and cancer screening and treatment in Haiti. Since September 2015, a group of 8 distinct Haitian organizations, including the government, make up a Community Advisory Board that conducts research and explores different programmatic approaches in the fight against breast and cervical cancer in Haiti. Results: Through creation of the advisory board and equitable partnerships with local organizations, the group has had success in fostering engagement and ownership over challenges presented by screening and treating cancer in a low-resource setting. The group designed and implemented a nationwide survey to document reasons why communities and individuals in Haiti do not engage with healthcare services provided until cancer is at an advanced stage, despite a basic awareness of the disease and visible symptoms. Once collected, the group will work towards a collective interpretation of the data and will determine how it should be used. Conclusions: Like academic institutions, CBPR methods can be invaluable to organizations researching barriers to care and addressing health inequalities in low-resource settings. Creating a community advisory board encourages local ownership of research outcomes and projects. Future endeavors will consist of sharing the resources created by CBPR and human-centered design, to build a network of partners and implement a national cancer awareness program to parallel our national comprehensive cancer program efforts. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
Pre-Enucleation Chemotherapy in Advanced Intraocular Retinoblastoma. Central America Follow Up: AHOPCA II
Authors: Luna-Fineman Sandra , Alabi Soad L. , Castellanos Mauricio E. , Gamboa Yessika , Fu Ligia , Chantada Guillermo , Rodriguez-Galindo Carlos 
Published: July 2016

Abstract 57a Purpose: A significant percentage of patients in Central America present with buphthalmos, carrying a high risk of globe rupture and orbital contamination. In 2007, AHOPCA introduced chemotherapy before enucleation in children with buphthalmos. Methods: Patients with advanced intraocular disease were considered standard-risk and underwent enucleation. Those with diffuse invasion of choroid, postlaminar optic nerve, or anterior chamber invasion received 4-6 cycles of adjuvant chemotherapy (vincristine, carboplatin, etoposide). Patients with buphthalmos or perceived to be at risk for abandonment were considered high-risk, given 2-3 cycles of chemotherapy before enucleation to compete 6 cycles regardless of pathology. All cases were discussed via online meetings. Results: From 2007 to 2014, 396 patients were enrolled; 240 had IRSS stage I (174 unilateral). 143 had upfront enucleation, 95 had pre-enucleation chemotherapy, 1 is pending enucleation and 1 abandoned before enucleation. The standard-risk group 69 had risk pathology and 76 had no risk factors; 125 had no events, 5 abandoned 11 relapsed/progressed and 2 died of toxicity. Of 95 high-risk group, 8 abandoned, 20 relapse/progressive, 6 had toxic deaths and 61 are alive at last follow-up (median time of 4 years). Of high risk group, 55 were unilateral, 82% are alive. At 7 years OS (abandonment-censored) was 95±0.02 and 79±0.04 for standard-risk and high-risk (p=0.008). Conclusion: AHOPCA addressed advanced intraocular disease with an innovative approach. In eyes with buphthalmos and patients with risk of abandonment, neo-adjuvant chemotherapy is effective, when followed by post-enucleation chemotherapy. This approach avoids ocular rupture and intensified therapy, and reduces refusal/abandonment rate. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.
The Program for Cancer Detection, Diagnosis, and Treatment Technologies for Global Health: A Pathway for the Translation of Affordable, Minimally-Invasive Point-of-Care (POC) Technologies to Less-Resourced Settings
Authors: Gwede Michael , Tandon Pushpa , Pai Vinay , Ossandon Miguel , Baker Houston , Lash Tiffani , Divi Rao , Agrawal Lokesh , Pearlman Paul C. 
Published: July 2016

Abstract 9 Cancer kills more people worldwide than HIV/AIDS, tuberculosis, and malaria combined, and low- and middle-income countries (LMICs) bear the majority of this burden. While success in detection, diagnosis, and treatment has been reported in LMICs through the use of low-cost, point-of-care (POC) technologies, this area has been largely overlooked by the medical device industry and venture capital communities, as low-cost solutions offer less financial incentive for investment. The program presented here aims to simplify the pathway to market by funding investigation teams to adapt and validate existing technologies in low-resource settings. This program specifically supports the translation of these technologies, prioritizing patient outcomes in a manner not typically seen. This program, currently in its second year, will soon support 15 technologies for cancer detection, diagnosis, and treatment (e.g., in vitro assays, imaging devices, ablation devices). It is anticipated that by year seven of the program, at least nine projects will have progressed through optimization, clinical validation, and business planning for dissemination and commercialization. Each project consists of an adaptation phase (two years: $500k total costs/year) and validation phase (three years: $1M total costs/year). Projects are selected through the National Institutes of Health peer review process by a special emphasis panel briefed on the goals of the program. Projects are competitively vetted for Phase II funding based on completion of Phase I milestones. All teams contain expertise in engineering, oncology, and business/manufacturing, uniquely leveraging their devices for success in translation. The seven preliminarily funded projects are making strides in optimization, and the projects range from an LED-based photodynamic therapy device for oral cancer to POC tests for Hepatitis C viral antigen level and viral load detection. This program is funded by the National Cancer Institute and the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.