bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost and Cost-Effectiveness of Childhood Cancer Treatment in El Salvador: A Collaborative Budget Model
Authors: Fuentes-Alabi Soad , Vasquez Roberto Franklin , Bhakta Nickhill , Rodriguez-Galindo Carlos , Frazier A. Lindsay , Atun Rifat , Gupta Sumit , Horton Susan 
Published: April 2017

Abstract 32 Background: Cure rates for childhood cancer in El Salvador (ES) have increased from 5% in 1991 to 68% today as a result of national and international support. Approximately 200 new cases of pediatric cancer are diagnosed annually in ES—all are treated centrally at the National Children’s Hospital Benjamin Bloom. The cost of childhood cancer treatment in low- and middle-income countries (LMICs), such as ES, has not been well investigated. Such data are integral to inform national childhood cancer treatment plans. We undertook this work to determine the cost of operating a national childhood cancer treatment center in ES and to provide an analytic model framework for similar cost analyses in other LMICs. Methods: We conducted a cross-sectional study to evaluate the cost of childhood cancer treatment covered by a collaborative budget model in ES. We calculated costs on the basis of annual cases diagnosed and admitted to National Children’s Hospital Benjamin Bloom, and captured supportive expenses for families that are essential to reducing abandonment. Cost-effective analyses were performed and compared with traditional thresholds. Results: Initial estimates indicate an annual total operating budget of $5.3 million to treat 200 new cases annually. When combined with current survival outcomes, this represents a cost-effective model using WHO-CHOICE thresholds. Conclusion: Providing the first such comprehensive, institution-based estimate for the cost of treatment of childhood cancer in LMICs, we show that a childhood cancer treatment center represents a cost-effective intervention. This baseline information can be used to prioritize future treatments and interventions in ES. This methodology also allows similar studies to be conducted in other LMICs. Together, these data will inform a case for investment in global access to childhood cancer treatment. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Soad Fuentes-Alabi No relationship to disclose Roberto Franklin Vasquez No relationship to disclose Nickhill Bhakta No relationship to disclose Carlos Rodriguez-Galindo Honoraria: Novimmune A. Lindsay Frazier Consulting or Advisory Role: Decibel Therapeutics Rifat Atun No relationship to disclose Sumit Gupta No relationship to disclose Susan Horton No relationship to disclose
Impact of a Patient Navigator on Time to Diagnosis Among Pediatric Oncology Patients in Tanzania
Authors: Alvi Fatima , Mafwimbo Judy , McHenry Kathryn , Masalu Nestory , Schroeder Kristin 
Published: April 2017

Abstract 12 Background: Oncology patient navigation programs have been successfully implemented at hospitals throughout the United States and have enhanced the quality of care through financial guidance, treatment coordination, and psychosocial support. In low-resource settings, barriers to receiving cancer care are increased and a patient navigator in this setting has the potential to significantly impact outcomes; however, there is limited research on the efficacy of such programs in these settings. At Bugando Medical Centre in Mwanza, Tanzania, a patient navigation program was established to identify potential pediatric oncology patients, then assist these patients and their families throughout the diagnosis and treatment process with the goals of reducing time to oncology evaluation and diagnosis and, ultimately, improving survival outcomes. Methods: A retrospective analysis of hospital records was conducted of all pediatric oncology patients who were evaluated at Bugando Medical Centre from 2010 to 2016, separated by presentation date before or after establishment of the navigation program. Collected data include demographics, diagnosis, and time from presentation to oncology evaluation and diagnosis. Results: A total of 238 patient files were reviewed, with 169 patients pre- and 69 patients postprogram initiation. Patient groups did not differ by age or gender ( P = .329 and .744, respectively) or diagnosis distribution. After establishing a patient navigator program, average time to oncology evaluation decreased from 49.7 days to 16.6 days ( P = .015), and time to diagnosis decreased from 49.1 days to 23.6 days ( P = .07). Conclusion: In pediatric cancer, early diagnosis is critical for initiation of chemotherapy and improvement of outcomes. This study has shown that a patient navigation program has the potential to significantly impact patient outcomes through reductions in time to evaluation and diagnosis and should be included in comprehensive pediatric cancer care programs. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Historical Evolution of the Malawi National Cancer Registry: A Collaborative Effort to Develop and Sustain an Impactful Cancer Control Resource in a Low-Income Country
Authors: Chasimpha Steady , Horner Marie-Josèphe , Dzamalala Charles , Gopal Satish 
Published: April 2017

Abstract 26 Background: Population-based cancer registration is essential to inform cancer control, yet high-quality cancer registration is absent in much of Africa. We undertook this work to initiate and sustain the Malawi National Cancer Registry (MNCR) to: collect high-quality, population-based cancer data to describe the national burden; inform national cancer control programs and policies; provide a rich national resource for epidemiologic cancer research; and develop collaborations with other partners to increase MNCR impact. Methods: MNCR began in 1989 as a hospital-based pathology registry in Blantyre, Malawi. A population-based component was introduced in 1993 that initially covered the Blantyre district with active case finding. By using this platform, regular national surveys were initiated in 2005 and are carried out every 5 years. Building on this surveillance program, MNCR has pursued collaborations with the Malawi HIV unit to conduct a national HIV-Cancer Match Study to assess the evolving cancer burden in the antiretroviral scale-up era. MNCR has also collaborated with other regional registries through the African Cancer Registry Network. Results: MNCR has published descriptions of the cancer burden in Malawi and is one of few African data sources to contribute to the WHO’s Cancer Incidence in Five Continents. Kaposi sarcoma and cervical cancer are the most common cancers in men and women, respectively. Approximately 93,000 records from MNCR and the two largest HIV cohorts in Malawi have been linked, with preliminary data demonstrating 3,499 cancers among 15,920 antiretroviral initiators in Lilongwe. MNCR has also contributed to regional studies that have described the high incidence and young age for esophageal cancer in Africa. Conclusion: We must continue to improve the quality and coverage of population-based cancer registration throughout Malawi, update the HIV-cancer record linkage at regular intervals, and pursue further opportunities for collaboration. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Knowledge and Practices About Cervical Cancer and Screening Among Married Men in Traditional Authority Nkhumba, Phalombe District
Authors: Mthepheya Chimwemwe Cealla Lita , Chepuka Lignet 
Published: April 2017

Abstract 37 Background: Cancer of the cervix is one of the reproductive cancers that are claiming the lives of women worldwide, and Malawi has not been spared. Of the 16 countries with the highest incidence of cervical cancer in Africa, Malawi has been rated the highest, with an incidence of 75.9. Being a reproductive disease, male involvement is critical as men control approximately 95% of sexual relationships in Malawi, but their role in cervical cancer prevention is not known. This study was carried out to investigate the knowledge and practices of married men regarding cervical cancer and screening. Methods: A cross-sectional study recruited 396 married men. Collected data were analyzed by using SPSS for Windows version 16 (SPSS, Chicago, IL). Results: The majority of respondents were not knowledgeable about cervical cancer and cervical cancer screening, as 84.1% did not know the cause, nor did 88.9% know the signs or symptoms of cervical cancer. Only 4% of respondents knew the risk factors, whereas 75.5% had no knowledge. On prevention, 76.5% had no knowledge, and 68.2 % had some knowledge on cervical cancer treatment. Almost all respondents (99%) said they would encourage their spouses to undergo screening, and 71.7 % said that men, as heads of families, are responsible for deciding whether their spouse should access screening services or not. Conclusion: Men have a stake in taking part in cervical cancer prevention. This is a window of opportunity that the Ministry of Health can use to develop strategies that are tailored toward men to participate fully in cervical cancer prevention to reduce its burden. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from either author.
Breast Cancer Patient Navigation Program in a Resource-Constrained Health Care Setting in Asia
Authors: Jaganathan Maheswari , Hai Dhiauddin , Zainal Nur Hidayati , Rajaram Nadia , Yusof Mohamed , Teo Soo-Hwang 
Published: April 2017

Abstract 23 Background: Breast cancer incidence is rapidly increasing in Asia as a result of changes in life expectancy and lifestyle factors. In Malaysia, incidence is expected to double in the next decade and survival is poor (50% to 75%) because of late presentation and poor adherence to treatment. This burden is greater for women in underserved communities, but few studies have examined systematic approaches to reduce late presentation and poor treatment adherence. We sought to determine whether a patient navigation program (PNP) could be a community-based solution to improve outcomes of patients with breast cancer, particularly in a resource-constrained setting. Methods: PNP was implemented in a secondary hospital that serves a suburban area near Kuala Lumpur. A decision aid, which incorporated local key messages, was developed. Nurses and community workers in the program received skills training in navigation, communications, patient management, and resource identification and utilization. Data were retrieved from baseline questionnaires and a patient tracking system and was analyzed by using descriptive statistics. Results: In the first year of the program, 225 women were served, of whom 137 were patients with breast cancer. Compared with the prior year, more patients in the PNP received diagnoses within 14 days of their first visit (67.7% v 62.4%; P = .516) and had surgery within 28 days from diagnosis (68.4% v 61.3%; P = .487). There were also fewer reported patients who experienced default in the PNP (4.4% v 6.6%; P = .797). Conclusion: This 1-year evaluation showed that patient navigation is feasible in a resource-constrained setting, but longer follow-up is required to determine the impact on outcomes. Moving forward, we seek to increase the efficiency of patient navigation by increasing access to palliative care and improving interdepartment coordination and patient tracking systems. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Maheswari Jaganathan No relationship to disclose Dhiauddin Hai No relationship to disclose Nur Hidayati Zainal No relationship to disclose Nadia Rajaram No relationship to disclose Mohamed Yusof No relationship to disclose Soo-Hwang Teo Honoraria: AstraZeneca Consulting or Advisory Role: AstraZeneca Speakers' Bureau: AstraZeneca Research Funding: AstraZeneca Travel, Accommodations, Expenses: AstraZeneca
Awareness and Knowledge of Human Papillomavirus and Cervical Cancer Among Female Medical and Health Science Students at University of Gondar
Authors: Tesfaye Zelalem Tilahun , Gebreyohannes Eyob Alemayehu , Bhagavathula Akshaya Srikanth , Getaneh Melaknesh Minda , Tegegn Henok Getachew 
Published: April 2017

Abstract 6 Background: Cervical cancer is causing a burden in sub-Saharan Africa, with human papillomavirus (HPV) identified as the necessary cause of cervical cancer. HPV mainly affects young women, which puts female university students at risk of cervical cancer. Knowledge and awareness of cervical cancer and HPV in sub-Saharan Africa, including Ethiopia, is poor. The aim of this study was to assess the knowledge and awareness of cervical cancer and HPV in University of Gondar medicine and health science female students. Methods: This cross-sectional study was conducted from April 1 to May 30, 2016, at University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia. Undergraduate female students from 11 different health-related departments at the College of Medicine and Health Sciences were included in the study. A 14-item, paper-based, self-administered questionnaire was provided to each of the participants to measure her level of knowledge and awareness of cervical cancer and HPV. Results: A total of 267 female students participated in the study, with ages ranging from 18 to 24 years (mean age, 20.58 ± 1.22 years). More than one half of participants (59.6%) stated that they did not know the main cause of cervical cancer, whereas only approximately one fifth (19.5%) identified HPV as the main cause of cervical cancer. As many as 83.9% of participants did not know other causes of cervical cancer. Binary logistic analysis revealed that students from midwifery (adjusted odds ratio [AOR], 14.14; P < .05), anesthesiology (AOR, 9.66; P < .05), and medicine (AOR, 5.84; P < .05) departments were associated with knowledge of the main cause of cervical cancer. Furthermore, fifth-year students (AOR, 16.94; P < .05) and fourth-year students (AOR, 8.32; P < .05) were found to have better knowledge of the main cause of cervical cancer. Only a few students (15%) had been vaccinated for HPV or had had a cervical smear test performed in the past. Conclusion: Cervical cancer mainly affects young women, which puts female university students at risk of cervical cancer. Hence, assessing the knowledge and awareness of these students will be of paramount importance to designing effective measures to increase their knowledge and awareness of the disease. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
T-Cell Receptor Sequencing of Kaposi Sarcoma Tumors to Identify Candidate Tumor-Reactive T Cells
Authors: Phipps Warren T. , Towlerton Andrea M.H. , Coffey David G. , Niyonzima Nixon , Warren Edus H. 
Published: April 2017

Abstract 60 Background: Development of Kaposi sarcoma (KS) is strongly associated with immune dysfunction in the context of HIV infection, but little is known about T-lymphocyte responses against KS tumor cells or human herpesvirus-8, the viral cause of KS. Increasing evidence suggests that treatment response in KS is attributable in part to an antitumor immune response that is mediated by tumor-infiltrating lymphocytes (TIL). The aim of this work was to identify TIL characteristics that are associated with tumor regression in patients with KS who were treated with antiretroviral therapy and chemotherapy as well as to identify a molecular signature of response. Methods: High-throughput sequencing of the T-cell receptor β chain ( TRB) was used to define the repertoire of T cells that infiltrate up to two pretreatment and two post-treatment KS tumors and matched normal skin obtained from HIV-infected adults with KS who received care at the Uganda Cancer Institute. We compared TRB repertoire in serially collected tumors to identify TRB sequences carried in candidate tumor-reactive T cells. Results: TRB sequencing was performed on KS tumor and matched normal skin samples from 12 HIV-infected adults with KS who collectively demonstrated a range of treatment responses. Unique populations of T cells were identified in pretreatment tumors but not in normal skin in all patients, which suggested the presence of KS-specific T-cell responses. Durable complete response to treatment in one patient was associated with significant expansion of a small number of T-cell clones, one of which carried a TRB sequence that was associated with a public CD8+ Epstein-Barr virus–associated T-cell receptor. Conclusion: Understanding the immune response to KS through cellular and molecular dissection of TIL will provide important insights into KS biology and may ultimately guide new immune-based strategies to stage and treat this often-refractory cancer. Funding: Solid Tumor Translational Research Transformative Team Grant, Fred Hutchinson Cancer Research Center; National Institutes of Health/National Cancer Institute Grant No. K23-CA150931. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Comparing Cancer Mortality Estimates in Mexico By Using Two National Death Registries
Authors: Lozano-Esparza Susana , Stern Dalia , Hernandez-Avila Juan Eugenio , Morales-Carmona Evangelina , Lozano Rafael , Lazcano-Ponce Eduardo , Lopez-Ridaura Ruy , Lajous Martin 
Published: April 2017

Abstract 49 Background: Mexico has low cancer mortality compared with other Latin American countries and high-income economies. The National Institute of Geography and Statistics (INEGI) uses an automated coding system that has been adapted from the Centers for Disease Control system to process death certificates. In contrast, the System for Epidemiologic Death Statistics (SEED) relied on a standardized manual process. We hypothesized that the low cancer mortality could be explained by processing procedures. We undertook this work to compare cancer mortality rates from two national death registries that independently code and attribute cause of death from death certificates. Methods: We calculated age-standardized cancer mortality rates for all cancers and specific sites by sex for 2010 to 2014 by using data from INEGI and SEED. We calculated stroke mortality rates for comparison. We obtained age-adjusted mortality rates and 95% CIs by using direct method and World Population Prospects 2010 as a standard. Results: Age-standardized mortality rate per 100,000 women for all cancers was 74.8 (95% CI, 74.0 to 75.6) in INEGI and 74.1 (95% CI, 73.3 to 74.9) in SEED for 2010. In contrast, for men, cancer mortality rate was 69.0 (95% CI, 68.2 to 69.7) in INEGI and 68.4 (95% CI, 67.7 to 69.7) in SEED. We did not observe substantial differences across cancer sites and years; however, when analyzing cases with cancer as a contributing condition, INEGI reported approximately 50% more compared with SEED. In contrast, stroke mortality significantly differed between registries for all years. For women, in 2010, INEGI reported 29.4 (95% CI, 29.0 to 29.9) compared with 26.5 (95% CI, 26.0 to 26.9) in SEED. Corresponding estimates for men were 36.6 (95% CI, 36.0 to 37.1) and 33.0 (95% CI, 32.4 to 33.5), respectively. Conclusion: Cancer mortality estimates were minimally affected by use of distinct processing procedures. Death certification in Mexico should be further evaluated. Funding: AstraZeneca, GlaxoSmithKline, and Merck. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Susana Lozano-Esparza No relationship to disclose Dalia Stern No relationship to disclose Juan Eugenio Hernandez-Avila No relationship to disclose Evangelina Morales-Carmona No relationship to disclose Rafael Lozano No relationship to disclose Eduardo Lazcano-Ponce Consulting or Advisory Role: Merck Sharp & Dohme Research Funding: Roche, Roche (Inst), BD, Qiagen (Inst) Travel, Accommodations, Expenses: GlaxoSmithKline, Merck Sharp & Dohme, Qiagen Ruy Lopez-Ridaura Research Funding: AstraZeneca Martin Lajous Research Funding: AstraZeneca
Resection of the ilium in patients with a sarcoma
Authors: Laitinen M. K. , Parry M. C. , Albergo J. I. , umathi V. S , Jeys L. M. , Grimer R. J. 
Published: April 2017

Aims The aim of the study was to investigate the controversial issue of whether the pelvic ring should be reconstructed following resection of the sarcomas of the ilium. Patients and Methods From our database, we identified 64 patients who underwent excision of a tumour involving the ilium between 1976 and 2015. A total of 35 underwent complete resection, of whom 24 were reconstructed with a non-vascularised fibula graft, and four with extracorporeal irradiation and reimplantation. A total of 29 patients had a partial resection. The mean follow-up was 9.2 years (1.1 to 25.6). Functional outcomes were assessed using the Toronto Extremity Salvation Score (TESS) at final follow-up. In all, 32 patients (50%) had a chondrosarcoma. Results The mean TESS for all patients was 71.6% (17% to 100%). The mean TESS for those who underwent total resection with reconstruction was 72.0% (17% to 100%) and without reconstruction it was 53.3% (20% to 90%) and for those who underwent partial resection it was 76.3% (31.3% to 100%). The rate of local recurrence was 42.2% and this was more common in those treated by partial resection (p = 0.048). The risk of local recurrence was related to the margin achieved at resection. Conclusions Given the high rate of local recurrence following excision of a tumour from the ilium, obtaining wide surgical margins should be a priority even if this requires more aggressive surgery. In young patients, where late recurrence may occur, more radical complete resection should be considered. When total resection of the ilium is considered, reconstruction should also be considered as it confers a higher functional outcome than total resection without reconstruction. Cite this article: Bone Joint J 2017;99-B:538–43.
Decreased and increased relative acetabular volume predict the development of osteoarthritis of the hip
Authors: Weinberg D. S. , Williamson D. F. K. , Millis M. B. , Liu R. W. 
Published: April 2017

AimsRecently, there has been considerable interest in quantifying the associations between bony abnormalities around and in the hip joint and osteoarthritis (OA). Our aim was to investigate the relationships between acetabular undercoverage, acetabular overcoverage, and femoroacetabular impingement (FAI) with OA of the hip, which currently remain controversial.Materials and MethodsA total of 545 cadaveric skeletons (1090 hips) from the Hamann-Todd osteological collection were obtained. Femoral head volume (FHV), acetabular volume (AV), the FHV/AV ratio, acetabular version, alpha angle and anterior femoral neck offset (AFNO) were measured. A validated grading system was used to quantify OA of the hip as minimal, moderate, or severe. Multiple linear and multinomial logistic regression were used to determine the factors that correlated independently with the FHV, AV, and the FHV/AV ratio.ResultsFemale cadavers had smaller FHVs (standardised beta -0.382, p < 0.001), and AVs (standardised beta -0.351, p < 0.001), compared with male patients, although the FHV/AV ratio was unchanged. Every 1° increase in alpha angle increased the probability of having moderate OA of the hip compared with minimal OA by 7.1%. Every 1 mm decrease in AFNO increased the probability of having severe or moderate OA of the hip, compared with minimal OA, by 11% and 9%, respectively. The relative risk ratios of having severe OA of the hip compared with minimal OA were 7.2 and 3.3 times greater for acetabular undercoverage and overcoverage, respectively, relative to normal acetabular cover.ConclusionAcetabular undercoverage and overcoverage were independent predictors of increased OA of the hip. The alpha angle and AFNO had modest effects, supporting the hypothesis that bony abnormalities both in acetabular dysplasia and FAI are associated with severe OA. Cite this article: Bone Joint J 2017;99-B:432–9.