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A paper analytic device, the chemoPAD, was developed and validated to visually detect methotrexate, doxorubicin, cisplatin, and oxaliplatin at concentrations commonly found in injectable dosage forms. By testing residual solution after patient treatment, the chemoPAD can be used to monitor drug quality without restriction of patient access to medication. The chemoPAD is produced by wax printing on Ahlstrom paper to create separate reaction areas and deposits small amounts of chemicals to create color changes in response to different active pharmaceutical ingredients (APIs). This creates a unique color bar code to identify each medication. Internal validation studies show that the chemoPAD has excellent sensitivity and specificity to differentiate between samples of 100% and 0% API, which is the distinction relevant to the majority of reported falsified chemotherapy cases. The platinum-containing drugs, cisplatin and oxaliplatin, can be detected semiquantitatively. The cards can be read either visually by comparison with a standard image or by using computer image analysis. Dosage forms were collected from the Ethiopian health care system and analyzed with the chemoPAD followed by high-performance liquid chromatography. A substandard sample was discovered and reported to the Ethiopian Food Medicine and Healthcare Administration and Control Authority. [ABSTRACT FROM AUTHOR]

Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology. [ABSTRACT FROM AUTHOR]

Background: Cigarettes are the biggest threat in the world, including Indonesia. According to The Health Ministry of Indonesia 2017 , Indonesia is one the country with the highest number of smokers. More than one-third (36.3%) of Indonesia's population, 20% are adolescents aged 13-15 years old. In Indonesia, cigarettes caused more than 200,000 deaths per year. It has been recorded that the amount of cigarettes consumed in Indonesia increases from 182 billion in 2001 to 260.8 billion in 2009. In addition to the increasing number of the smokers and the age of smoking, there is another factor which is adolescents deceit for their smoking behavior, therefore screening is necessary to prevent the complications from smoking. Aim: To find out changes in salivary pH as a smoking behavior screening tool in adolescents. Methods: : Results: Distribution of data in 85 samples with 50 nonsmokers and 35 smokers, got the youngest age of smoking is in fourth year of elementary school, with the highest number of cigarettes consumed per day is more than 2 boxes. The salivary pH in smokers was significantly (P < 0.005) lower than nonsmokers. This can be seen also through since the smoke, the last time smoking and the number of cigarettes consumed per day. The younger age of smoking, the last time smoking (<24 hour) and the more the number of cigarettes consumed per day, that all can significantly decrease salivary pH. Conclusion: Salivary pH measurement using litmus paper is a potential screening for smoking behavior in adolescents. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including oncology, health care reform, and health care system in the U.S.

Purpose: To assess and develop solutions for an ultrasound-based breast cancer early detection program in rural South Africa 1 year after implementation. Methods: A WHO-endorsed RAD-AID Radiology Readiness Assessment was used to evaluate clinic resources. In addition, 5 weeks of observation identified resource deficiencies and reviewed existing documentation methods. On the basis of stakeholders’ input and the BI-RADS, we developed new documentation systems. Training was followed by a survey that assessed feasibility and provider acceptance. Results: Resource limitations included lack of computers, unpredictable electrical supply, and inconsistent Internet. The assessment revealed incomplete documentation of breast clinical examinations and history, breast lesions, and follow-up. Furthermore, limitations negatively affected communication among providers. Three solutions were developed: a paper patient history form, a paper clinical findings form, and a computerized patient-tracking data base compliant with BI-RADS. Three nurses, three nursing assistants, and one counselor completed the survey. Seventy-one percent indicated positive general attitudes, and 100% agreed that the documentation system is easy and useful and improves overall quality of care, follow-up, decision making; access to clinical information; and communication between clinicians and patients. Five of the seven providers reported that the system increased visit time, but three of those five believed that the process was valuable. Conclusion: Implementation of a breast cancer early detection program in resource-limited regions is challenging, and continual assessment is essential. As a result of identified needs, we developed a documentation system that was broadly accepted. Future steps should focus on increasing efficiency, evaluation of provider attitudes long term, and clinical effect. [ABSTRACT FROM AUTHOR]

PURPOSE: Radiotherapy (RT) is an essential component of cancer treatment. There is a lack of RT services in sub-Saharan Africa as well as limited knowledge regarding clinical practices. The purpose of this study was to identify and describe the patterns for RT treatment in Ethiopia. METHODS AND MATERIALS: We performed a retrospective analysis of 1,823 patients treated with cobalt RT at a large referral hospital in Addis Ababa, Ethiopia, from May 2015 through January 2018. Paper charts were reviewed for patient and treatment characteristics. Descriptive statistics were computed using SPSS (IBM, Armonk, NY). RESULTS: Among patients treated for cancer, 98% (n = 1,784) were adults, 78% (n = 1,426) were female, 5% (n = 85) were HIV positive, 30% (n = 555) were from Addis Ababa, and the median age was 48 years (interquartile range [IQR], 38-58 years). Cervical cancer was the most frequent cancer treated (47%, n = 851), followed by breast cancer (15%, n = 274) and head and neck cancer (10%, n = 184). Seventy-three percent of patients (n = 1,339) presented at a late stage, and 62% (n = 1,138) received palliative RT. The wait times were the shortest for patients receiving palliative treatment (median, 0 days; IQR, 0-15 days; n = 1,138), whereas wait times were longer for patients receiving curative treatment (median, 150 days; IQR, 60-210 days; n = 685). Three percent of patients (n = 56) had documented grade 3 or 4 acute toxicity; of these, 59% (n = 33) were patients with head and neck cancer. CONCLUSION: Cervical cancer accounted for half of patients treated; thus, a majority of patients were adult females. Most patients had advanced-stage cancer, and goals of care were palliative. Wait times were long for patients with curative-intent cancer as a result of low capacity for RT services. [ABSTRACT FROM AUTHOR]

Purpose: To assess and develop solutions for an ultrasound-based breast cancer early detection program in rural South Africa 1 year after implementation. Methods: A WHO-endorsed RAD-AID Radiology Readiness Assessment was used to evaluate clinic resources. In addition, 5 weeks of observation identified resource deficiencies and reviewed existing documentation methods. On the basis of stakeholders' input and the BI-RADS, we developed new documentation systems. Training was followed by a survey that assessed feasibility and provider acceptance. Results: Resource limitations included lack of computers, unpredictable electrical supply, and inconsistent Internet. The assessment revealed incomplete documentation of breast clinical examinations and history, breast lesions, and follow-up. Furthermore, limitations negatively affected communication among providers. Three solutions were developed: a paper patient history form, a paper clinical findings form, and a computerized patient-tracking data base compliant with BI-RADS. Three nurses, three nursing assistants, and one counselor completed the survey. Seventy-one percent indicated positive general attitudes, and 100% agreed that the documentation system is easy and useful and improves overall quality of care, follow-up, decision making; access to clinical information; and communication between clinicians and patients. Five of the seven providers reported that the system increased visit time, but three of those five believed that the process was valuable. Conclusion: Implementation of a breast cancer early detection program in resource-limited regions is challenging, and continual assessment is essential. As a result of identified needs, we developed a documentation system that was broadly accepted. Future steps should focus on increasing efficiency, evaluation of provider attitudes long term, and clinical effect. [ABSTRACT FROM AUTHOR]

Purpose The goal of this study was to evaluate the feasibility, reliability, and validity of a computer-based geriatric assessment via two methods of electronic data capture (SupportScreen and REDCap) compared with paper-and-pencil data capture among older adults with cancer. Methods Eligible patients were ≥65 years old, had a cancer diagnosis, and were fluent in English. Patients were randomly assigned to one of four arms, in which they completed the geriatric assessment twice: (1) REDCap and paper and pencil in sessions 1 and 2; (2) REDCap in both sessions; (3) SupportScreen and paper and pencil in sessions 1 and 2; and (4) SupportScreen in both sessions. The feasibility, reliability, and validity of the computer-based geriatric assessment compared with paper and pencil were evaluated. Results The median age of participants (N = 100) was 71 years (range, 65 to 91 years) and the diagnosis was solid tumor (82%) or hematologic malignancy (18%). For session 1, REDCap took significantly longer to complete than paper and pencil (median, 21 minutes [range, 11 to 44 minutes] v median, 15 minutes [range, 9 to 29 minutes], P < .01) or SupportScreen (median, 16 minutes [range, 6 to 38 minutes], P < .01). There were no significant differences in completion times between SupportScreen and paper and pencil (P = .50). The computer-based geriatric assessmentwasfeasible. Few participants (8%) needed help with completing the geriatric assessment (REDCap, n = 7 and SupportScreen, n = 1), 89% reported that the length was "just right," and 67% preferred the computer-based geriatric assessment to paper and pencil. Test-retest reliability was high (Spearman correlation coefficient ≥ 0.79) for all scales except for social activity. Validity among similar scales was demonstrated. Conclusion Delivering a computer-based geriatric assessment is feasible, reliable, and valid. SupportScreen methodology is preferred to REDCap. [ABSTRACT FROM AUTHOR]

PURPOSE: We know little about how increased technological sophistication of clinical practices affects safety of chemotherapy delivery in the outpatient setting. This study investigated to what degree electronic health records (EHRs), satisfaction with technology, and quality of clinician-to-clinician communication enable a safety culture. METHODS: We measured actions consistent with a safety culture, satisfaction with practice technology, and quality of clinician communication using validated instruments among 297 oncology nurses and prescribers in a statewide collaborative. We constructed an index to reflect practice reliance on EHRs (1 = "all paper" to 5 = "all electronic"). Linear regression models (with robust SEs to account for clustering) examined relationships between independent variables of interest and safety. Models were adjusted for clinician age. RESULTS: The survey response rate was 68% (76% for nurses and 59% for prescribers). The mean (standard deviation) safety score was 5.3 (1.1), with a practice-level range of 4.9 to 5.4. Prescribers reported fewer safety actions than nurses. Higher satisfaction with technology and higher-quality clinician communication were significantly associated with increased safety actions, whereas increased reliance on EHRs was significantly associated with lower safety actions. CONCLUSION: Practices vary in their performance of patient safety actions. Supporting clinicians to integrate technology and strengthen communication are promising intervention targets. The inverse relationship between reliance on EHRs and safety suggests that technology may not facilitate clinicians' ability to attend to patient safety. Efforts to improve cancer care quality should focus on more seamless integration of EHRs into routine care delivery and emphasize increasing the capacity of all care clinicians to communicate effectively and coordinate efforts when administering high-risk treatments in ambulatory settings. [ABSTRACT FROM AUTHOR]

PURPOSE: The main objective of this systematic review was to identify whether mass and small media interventions improve knowledge and attitudes about cancer, cancer screening rates, and early detection of cancer in Asia. METHODS: The review was conducted according to a predefined protocol. Medline, EMBASE, CINAHL, Web of Science, Cochrane Library, and Google Scholar were searched in September 2017, and data extraction and rating of methodologic study quality (according to Joanna Briggs Institute rating procedures) were performed independently by reviewers. RESULTS: Twenty-two studies (reported across 24 papers) met the inclusion criteria. Most studies (n = 21) were conducted in high or upper-middle income countries; targeted breast (n = 11), cervical (n = 7), colorectal (n = 3), or oral (n = 2) cancer; and used small media either alone (n = 15) or in combination with mass media and other components (n = 5). Studies regarding cancer screening uptake were of medium to high quality and mainly reported positive outcomes for cervical cancer and mixed results for breast and colorectal cancer. The methodologic strength of research that investigated change in cancer-related knowledge and the cost effectiveness of interventions, respectively, were weak and inconclusive. CONCLUSION: Evidence indicated that small media campaigns seemed to be effective in terms of increasing screening uptake in Asia, in particular cervical cancer screening. Because of the limited number of studies in Asia, it was not possible to be certain about the effectiveness of mass media in improving screening uptake and the effectiveness of campaigns in improving cancer-related knowledge. [ABSTRACT FROM AUTHOR]

PURPOSE: This investigation was undertaken to define the barriers to indigenous peoples participating in biobanking and genomic research. METHODS: A literature review was conducted to identify studies reporting on the experience of indigenous peoples with biobanking, tissue banking, and genomic research. Studies pertaining to organ transplantation or blood donation for transfusion were excluded. The databases searched were MEDLINE, EMBASE, PubMed, Web of Science, and Google Scholar, with all literature available until the search date of June 1, 2018, included. The reference lists of all included papers, as well as related review articles, were manually searched to identify additional relevant studies. An inductive approach was used to identify common themes. RESULTS: Seventeen publications discussed the experiences of New Zealand Māori (n = 2), Aboriginal and Torres Strait Islanders (n = 3), Native Hawaiian (n = 4), Native Alaskan (n = 2), American First Nation (n = 2), or multiple ethnicities (n = 4). Across all indigenous peoples, four themes emerged: land, ancestors, culture, and bodily substances are powerfully interconnected and can act on each other; tissue and blood can provide important information (both Western and traditional) about a person; the ownership of specimens—custodians, trustees, or guardians; and the beneficence of the researchers and research team. CONCLUSION: Indigenous communities, like Western populations, are concerned with issues pertaining to handling, treatment, and ownership of tissue as well as knowledge gained from specimen analysis. Unlike many Western populations, indigenous communities have retained a strong sense of cultural connection to ancestors and traditional lands and view biologic specimens as inseparable from these things. [ABSTRACT FROM AUTHOR]

Purpose There is a paucity of data about current usage of oncology guidelines in low- and middleincome countries (LMICs), specifically in terms of the availability and quality of those guidelines. Our objective was to determine usage of oncology guidelines and the barriers and facilitators to their usage among radiation oncologists in LMICs. Methods An online cross-sectional survey was conducted among practicing radiation oncologists in Nigeria via e-mail and the social media database of the Association of Radiation and Clinical Oncologists of Nigeria. In addition, paper questionnaires were administered at regional clinical meetings. Results The survey response rate was 53.4% in a sample of 101 radiation oncologists from the database. Sixty-nine percent of respondents were consultants and 30% were residents. Approximately 43% had < 5 years' experience. All of the respondents were involved in administering chemotherapy during the treatment of patients with cancer, whereas approximately half were involved in diagnosing cancer. Ninety-three percent reported using guidelines in treating patients, the top two guidelines being those from the National Comprehensive Cancer Network (90%) and the American Society of Clinical Oncology (50%). The two major barriers to guideline usage were that facilities were inadequate for proper guideline implementation and that the information in guidelines were too complex to understand. Potential facilitators included providing adequate facilities, developing local guidelines, and increasing awareness of guideline usage. Conclusion Our study shows that clinicians involved in the treatment of patients with cancer in LMICs are aware of cancer treatment guidelines. However, implementation of these guidelines hinders their usage because the facilities are inadequate, guidelines are not applicable to the local setting, and the information in the guidelines is too complex. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the epidemiology of breast cancer in developing countries, and Haiti has perhaps the least data of any country in the Western Hemisphere. Methods: We conducted a retrospective review of all patients enrolled in an ongoing breast cancer treatment program in Port-au-Prince, Haiti, from July 1, 2013, through June 30, 2017. Data were drawn from each patient's electronic medical record, paper chart, and biopsy results. Results: The records of 525 women with breast cancer were reviewed for this study. The median age at presentation was 49 years (n = 507). The risk factors observed were as follows: postmenopausal, 50.8% (n = 354); nulliparity, 15.7% (n = 338); hormonal contraception use, 35.0% (n = 309); never breastfed, 20.6% (n = 316); family history of any cancer, 22.0% (n = 295); overweight, 51.5% (n = 332); and smoking, 5.0% (n = 338). Of all those staged, 83.9% (n = 447) of the patients presented with stage III/IV disease and more than half delayed care for > 12 months after first noticing a breast mass. For the subset of tumors for which estrogen receptor (ER; n = 245) and human epidermal growth factor receptor 2 (HER2; n = 179) status was available, the prevalence of ER-positive tumors was 51.8%, of HER2-positive tumors was 19.6%, and of triple-negative tumors was 38.5%. The 12-month mortality rate (n = 425) was 18.4% overall and 27.5% for those who presented with stage IV disease. Median survival was not reached. Conclusion: Breast cancer in Haiti presents at an early age and advanced stage. Triple-negative, ER-negative, and high-grade tumors are common. Delays in seeking care and incomplete treatment likely contribute to the high mortality rate; however, as in black women in the United States, the distribution of tumor types may contribute to disparate outcomes. [ABSTRACT FROM AUTHOR]

Purpose: There is a paucity of data about current usage of oncology guidelines in low- and middle-income countries (LMICs), specifically in terms of the availability and quality of those guidelines. Our objective was to determine usage of oncology guidelines and the barriers and facilitators to their usage among radiation oncologists in LMICs. Methods: An online cross-sectional survey was conducted among practicing radiation oncologists in Nigeria via e-mail and the social media database of the Association of Radiation and Clinical Oncologists of Nigeria. In addition, paper questionnaires were administered at regional clinical meetings. Results: The survey response rate was 53.4% in a sample of 101 radiation oncologists from the database. Sixty-nine percent of respondents were consultants and 30% were residents. Approximately 43% had < 5 years' experience. All of the respondents were involved in administering chemotherapy during the treatment of patients with cancer, whereas approximately half were involved in diagnosing cancer. Ninety-three percent reported using guidelines in treating patients, the top two guidelines being those from the National Comprehensive Cancer Network (90%) and the American Society of Clinical Oncology (50%). The two major barriers to guideline usage were that facilities were inadequate for proper guideline implementation and that the information in guidelines were too complex to understand. Potential facilitators included providing adequate facilities, developing local guidelines, and increasing awareness of guideline usage. Conclusion: Our study shows that clinicians involved in the treatment of patients with cancer in LMICs are aware of cancer treatment guidelines. However, implementation of these guidelines hinders their usage because the facilities are inadequate, guidelines are not applicable to the local setting, and the information in the guidelines is too complex. [ABSTRACT FROM AUTHOR]

Purpose Despite the considerable impact of neuroendocrine tumors (NETs) on patients' daily lives, the journey of the patient with a NET has rarely been documented, with published data to date being limited to small qualitative studies. NETs are heterogeneous malignancies with nonspecific symptomology, leading to extensive health care use and diagnostic delays that affect survival. A large, international patient survey was conducted to increase understanding of the experience of the patient with a NET and identify unmet needs, with the aim of improving disease awareness and care worldwide. Methods An anonymous, self-reported survey was conducted (online or on paper) from February to May 2014, recruiting patients with NETs from > 12 countries as a collaboration between the International Neuroendocrine Cancer Alliance and Novartis Pharmaceuticals. Survey questions captured information on sociodemographics, clinical characteristics, NET diagnostic experience, disease impact/management, interaction with medical teams, NET knowledge/awareness, and sources of information. This article reports the most relevant findings on patient experience with NETs and the impact of NETs on health care system resources. Results A total of 1,928 patients with NETs participated. A NET diagnosis had a substantially negative impact on patients' personal and work lives. Patients reported delayed diagnosis and extensive NET-related health care resource use. Patients desired improvement in many aspects of NET care, includingavailability of a wider range of NET-specific treatment options, better access to NET experts or specialist centers, and a more knowledgeable, better-coordinated/-aligned NET medical team. Conclusion This global patient-reported survey demonstrates the considerable burden of NETs with regard to symptoms, work and daily life, and health care resource use, and highlights considerable unmet needs. Further intervention is required to improve the patient experience among those with NETs. [ABSTRACT FROM AUTHOR]

Purpose: Computerized physician order entry (CPOE) in electronic health records (EHR) has been recognized as an important tool in optimal health care provision that can reduce errors and improve safety. The objective of this study is to describe documentation completeness and user satisfaction of medical charts before and after implementation of an outpatient oncology EHR/ CPOE system in a hospital-based outpatient cancer center within three treatment sites. Methods: This study is a retrospective chart review of 90 patients who received one of the following regimens between 1999 and 2006: FOLFOX, AC, carboplatin + paclitaxel, ABVD, cisplatin + etoposide, R-CHOP, and clinical trials. Documentation completeness scores were assigned to each chart based on the number of documented data points found out of the total data points assessed. EHR/CPOE documentation completeness was compared with completeness of paper charts orders of the same regimens. A user satisfaction survey of the paper chart and EHR/CPOE system was conducted among the physicians, nurses, and pharmacists who worked with both systems. Results: The mean percentage of identified data points successfully found in the EHR/CPOE charts was 93% versus 67% in the paper charts (P<.001). Regimen complexity did not alter the number of data points found. The survey response rate was 64%, and the results showed that satisfaction was statistically significant in favor of the EHR/CPOE system. Conclusion: Using EHR/CPOE systems improves completeness of medical record and chemotherapy order documentation and improves user satisfaction with the medical record system. EHR/CPOE requires constant vigilance and maintenance to optimize patient safety. [ABSTRACT FROM AUTHOR]

Hypercalcemia has been reported to occur in up to 30% of patients who have a malignancy. Hypercalcemia is most common in those who have later-stage malignancies and predicts a poor prognosis for those with it. The most common causes include humoral hypercalcemia of malignancy mediated by parathyroid hormone-related peptide, osteolytic cytokine production, and excess 1,25-dihydroxy vitamin D production. However, the etiology is not always mediated by malignancy. Hypercalcemia can occur in those with malignancy and an additional etiology for hypercalcemia such as primary hyperparathyroidism or granulomatous diseases. This paper reviews the cancers associated with hypercalcemia and their proposed mechanisms, nontumor-mediated hypercalcemia, as well as diagnosis and treatment strategies for each condition. [ABSTRACT FROM AUTHOR]

Purpose To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1year without increasing direct personnel costs. Methods Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Results Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. Conclusion This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery. [ABSTRACT FROM AUTHOR]

Oncology practice increasingly requires the use of molecular profiling of tumors to inform the use of targeted therapeutics. However, many oncologists use third-party laboratories to perform tumor genomic testing, and these laboratories may not have electronic interfaces with the provider's electronic medical record (EMR) system. The resultant reporting mechanisms, such as plain-paper faxing, can reduce report fidelity, slow down reporting procedures for a physician's practice, and make reports less accessible. Vanderbilt University Medical Center and its genomic laboratory testing partner have collaborated to create an automated electronic reporting system that incorporates genetic testing results directly into the clinical EM R. This system was iteratively tested, and causes of failure were discovered and addressed. Most errors were attributable to data entry or typographical errors that made reports unable to be linked to the correct patient in the EMR. By providing direct feed back to providers, we were able to significantly decrease the rate of transmission errors (from 6.29% to 3.84%; P < .001). The results and lessons of 1 year of using the system and transmitting 832 tumor genomic testing reports are reported. [ABSTRACT FROM AUTHOR]

The article reports on a 2015 study of health care provider (HCP) and patient perceptions on oral anticancer medications (OACM) adherence, toxicity reporting, and patient educational needs. Results show that only 40% of HCPs believe their patients were adherent, that 61% of patients reported toxicities sometimes or often, and that both groups favored paper-based educational materials. The article notes the differences in patient and HCP perceptions on OACM adherence and toxicity reporting.

Amount raised: During 2017, funds from Chai for Cancer Addas totaled approximately US$ 28,000 (IRS 18 lacs). Background and context: Chai for Cancer (www.chaiforcancer.org) is in a sense, a satellite brand of Friends of Max (www.friendsofmax.info). Friends of Max is a registered Public Charitable Trust and the support group arm of The Max Foundation in India. In India chai or tea is a household drink. At its best in an informal setting, an Adda serves a dual purpose as a fund-raiser and advocacy platform. It is based on the concept of an informal gathering among well-wishers and caregivers supporting underserved cancer patients suffering from chronic myeloid leukemia (CML) and gastrointestinal stromal tumor (GIST). The chronic condition is made manageable by life-long treatment. Aim: Chai For Cancer is a dynamic fundraiser and advocacy model for CML/GIST patients and caregivers in India. Strategy/Tactics: In 4 years, now on the cusp of the 5th year, Chai for Cancer has built up a creditable legacy of trust and an extended family of volunteers that networks throughout the year with the ability to attract new segments of donors/well-wishers and patient/caregiver participants. Funds thus raised support patient group meetings which facilitate various patient-related activities and patient–physician interactions which form the bedrock of FOM's dictum "Together We Share And Learn". Potential donors are approached and educated informally about how to host an Adda. Once the host expresses interest, support is provided to the host in terms of tea bags and paper cups (from Society Tea), literature (printed leaflets, brochures elaborating the concept, newsletters) and receipts (U/s 80 G of the Indian Income Tax Act, 1961). Program process: An Adda is usually hosted by members/volunteers belonging to Friends of Max although it is not unusual for persons who have simply heard of Chai for Cancer to get in touch and express interest in hosting an Adda. The emergence of new hosts like D Y Patil University and IDEAL (Institute of Design Expression Art and Learning) in Ahmedabad, Jayanth Jayaprakash's India To Excellence 2020 in addition to long-time supporters Society Tea, Being Human-The Salman Khan Foundation, Manish Mandhana Retail Ventures, Mahotsaav Entertainment, Radio One and Red FM is testimony to the strength of the fundraising/advocacy model and a platform to encourage openness, empowering patients and caregivers. HNIs from various industries have also been donors. Costs and returns: The entire process is manned by senior, experienced people who volunteer their time and professional skills. Year-long publicity is generated through social media (FM radio stations, Web site www.chaiforcancer.org Twitter, Instagram and Facebook). What was learned: This is a personalised and intimate approach to raising funds for patient-related activity. This approach ensures known and accepted sources of funds within a growing family. It is different from crowd-funding techniques. [ABSTRACT FROM AUTHOR]

Purpose: The American Society of Clinical Oncology and the Oncology Nursing Society have proposed a set of standards for safe chemotherapy administration. The state of implementation of these standards in oncologic practices in India is not understood properly. Methods: An anonymized survey was designed that consisted of items from all 37 standards that were described in the 2013 update of the standards. The survey was distributed via e-mail as well as in paper format among oncologists working in various oncology practices in the country. A standard was considered as fully implemented if more than 90% of the items beneath it had the most positive response (Yes/ Always). Results: Responses were obtained from 75 of 114 (65.8%) of the institutions surveyed. Only one institution had fully implemented the standards, whereas only six (8.0%) institutions had implemented more than 90% of the standards fully. The general chemotherapy administration-related domain was implemented fully by the least number of institutions. Although characteristics such as location, funding, and type of institution (teaching or not) failed to influence implementation rates, institutions of respondents who were aware of chemotherapy practice–related standards reported full implementation of a larger number of standards. Lack of national-level guidelines/ policies was identified as the most common difficulty in implementing standards. Conclusion: This survey indicates that there is an urgent need to formulate national-level guidelines for safe chemotherapy administration. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of distress and well-being of patients with cancer is not always documented or addressed in a clinical visit, reflecting a need for improved psychosocial screening. Methods: A multidisciplinary team completed process mapping for emotional distress assessment in two clinics. Barriers were identified through cause-and-effect analysis, and an intervention was chosen. Patient-reported outcomes were collected over 6 months using the validated National Comprehensive Cancer Network Emotional Distress Thermometer (EDT) paper tool. The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) measures were compared before and after intervention. Results: During 6 months, a total of 864 tools were collected from 1,344 patients in two ambulatory clinics (64%). Electronic medical record documentation of distress increased from 19.2% to 34% during the 6 months before and after intervention. QOPI measures showed an increase in emotional well-being documentation. Of 29 new and 835 return patients, 62% indicated mild distress (EDT, 0 to 3), 18% moderate (EDT, 4 to 6), and 11 % severe (EDT, 7 to 10). The average distress score of new patients was significantly higher than that of return patients (5.39 [n = 26] v 2.52 [n = 754]; P < .001). The top problems for patients with moderate and severe distress were worry, fatigue, pain, and nervousness; depression and sadness were particularly noted in patients reporting severe distress. Eleven percent of patients were referred to the social worker on site. Conclusion: A pilot intervention collecting Patient-reported outcomes in two ambulatory clinics led to increase in psychosocial distress screening followed by sustained improvement, indicated by both process and QOPI measures. [ABSTRACT FROM AUTHOR]

The article focuses on the paper Fertility Preservation and Sexual Health After Cancer Therapy published in this issue. It highlights overview of the fertility preservation options in women before cancer therapy and reproductive risks associated with cancer therapies. It refers to the results of Childhood Cancer Survivorship Study (CCSS).

The article discusses research paper on options for fertility preservation for female cancer survivors, published in this issue. It highlights the limitation of time available for assisted reproductive strategies due to the urgency of initiation of the cancer treatment. It refers to health provider knowledge gaps about fertility-sparing and ovarian function-sparing options.

Purpose: The Quality Oncology Practice Initiative (QOPI) relies on the accuracy of manual abstraction of clinical data from paper-based and electronic medical records (EMRs). Although there is no "gold standard" to measure manual abstraction accuracy, measurement of inter-annotator agreement (IAA) is a commonly agreed-on surrogate. We quantified the IAA of QOPI abstractions on a cohort of cancer patients treated at Beth Israel Deaconess Medical Center. Methods: The EMR charts of 49 patients (20 colorectal cancer; 18 breast cancer; 11 non-Hodgkin lymphoma) were abstracted by separate physician abstractors in the fall 2010 and fall 2011 QOPI abstraction rounds. Cohen's kappa (κ) was calculated for encoded data; raw levels of agreement and magnitude of discrepancies were calculated for numeric and dated data. Results: One hundred two data elements with 2,035 paired entries were analyzed. Overall IAA for the 1,496 coded entries was κ = 0.75; median IAA for n = 85 individual coded elements was κ = 0.84 (interquartile range, 0.30 to 1.00). Overall IAA for the 421 dated entries was 73%; median IAA for n = 17 individual dated elements was 67% (interquartile range, 61% to 86%). Conclusion: This study establishes a baseline level of IAA for a complex medical abstraction task with clear relevance for the oncology community. Given that the observed κ is considered only fair IAA, and that the rate of date discrepancy is high, caution is necessary in interpreting the results of QOPI and other manual abstractions of clinical oncology data. The accuracy of automated data extraction efforts, possibly including a future evolution of QOPI, will also need to be carefully evaluated. [ABSTRACT FROM AUTHOR]

Great strides have been made in computerization of ordering processes for general medications and chemotherapy agents. However, systems for ordering, processing, and administration of cellular therapies continue to be largely paper-based, without the safety features of computerized order entry. To address this deficit, Partners Healthcare System Information Services (PHSIS; Boston, MA) has worked with oncologists and staff in the cell processing laboratory at the Dana-Farber Cancer Institute (Boston, MA) to develop and implement a novel, comprehensive computerized system for physician ordering and management of cellular products. A multidisciplinary team was formed to accomplish the task of developing a cellular product management system. This team identified the unique characteristics of cellular therapies and sought to develop a comprehensive computerized system that addressed these needs. The biotherapy order entry system developed and implemented by PHS-IS includes a suite of three interrelated applications that addresses all requirements of a traditional computerized provider order entry system, as well as features unique to cellular therapies. The biotherapy suite of applications has addressed patient safety concerns, streamlined the ordering of cellular therapy products, and has reduced opportunities for error and delay in product administration. [ABSTRACT FROM AUTHOR]

Implementation of a computerized provider order entry system for complex chemotherapy regimens at a large cancer center required intense effort from a multidisciplinary team of clinical and systems experts with experience in all facets of the chemotherapy process. The online tools had to resemble the paper forms used at the time and parallel the successful established process as well as add new functionality. Close collaboration between the institution and the vendor was necessary. This article summarizes the institutional efforts, challenges, and collaborative processes that facilitated universal chemotherapy computerized electronic order entry across multiple sites during a period of several years. [ABSTRACT FROM AUTHOR]

The article discusses the potential of geriatric assessment in enhancing evaluation of breast cancer among senior female adults. Topics covered include fundamental elements of geriatric assessment like functional status, daily living activities and history of falls, the need for reforms in clinical trials to extract data on factors like polypharmacy, social supports and comorbidity, and the position paper issued by the American Society of Clinical Oncology on enhancing cancer care evidence.

Purpose: Of breast cancer–related deaths worldwide, 62.1% occur in low- and middle-income countries (LMICs). Mammography, the gold standard for screening, is largely infeasible in limited-resource settings, predominantly because of unavailability. Recent data show a dismal 0 to 12 mammography units per one million women age 50 to 69 years in most of sub-Saharan Africa. Breast ultrasound, which is used in high-resource settings to supplement mammography in certain clinical scenarios, offers a potentially viable alternative for early breast cancer detection in resource-limited areas because it is portable, economical, and a versatile technology. Methods: We conducted a review of the literature to assess the potential for ultrasound alone in the detection of breast cancer. PubMed and Scopus queries with terms "breast neoplasms" and "diagnostic imaging" were systematically filtered to n = 33. Inclusion criteria were peer-reviewed studies in human participants, retrospective or prospective reviews, and a reference standard of biopsy/histopathology. Each paper was required to have extractable data with which to calculate true positives, false positives, true negatives, and false negatives. Breast imagers reviewed each paper using QUADAS and reached consensus for inclusion. Results: Heterogeneity analyses confirmed a high diversity of all included studies. Pooled weighted analyses of all included studies demonstrated that the sensitivity of ultrasound for the detection of breast cancer ranged from 17% to 100%, with a 69% mean. This is higher than the known reported sensitivity of mammography for breast cancer detection of 67.8%. The specificity of ultrasound ranged from 28% to 100%, with a pooled total specificity of 97%, which is higher than the known specificity of mammography of 75%. In addition, ultrasound performed with superior sensitivity to mammography in the studies performed in LMICs that directly compared ultrasound with mammography (six of 11 studies). In the remaining five studies in LMICs, the sensitivity of ultrasound for breast cancer detection was high and ranged from 62% to 100%. Stratified analyses by age, breast density, presenting symptoms, and high-risk factors maintained the high sensitivities and specificities of ultrasound. Conclusion: Sensitivities and specificities of ultrasound are comparable to mammography for the detection of invasive breast cancer. Handheld ultrasound may offer a viable alternative where mammography is not widely available as a primary detection modality for breast cancer. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. No COIs from the authors. [ABSTRACT FROM AUTHOR]

Purpose: Across the Caribbean, too many women are presenting with advanced breast cancer and dying with little or no access to palliative care. No comprehensive assessment of the current capacity to deliver palliative care in the region exists, largely because of limited data. Cancer is the second leading cause of death, and significant numbers of patients present with advanced disease. Breast cancer is no exception, with an incidence rate of more than 26% and a mortality rate accounting for 17% of all cancer-related deaths in women. In this paper, we assess the challenges and opportunities that are faced by small island states in delivering palliative care through the lens of women with breast cancer. Methods: We performed a systematic review of the literature on palliative care provision in the region. Background information and country statistics were obtained from recognized databases, such as GLOBOCAN and Pan American Health Organization country cancer profiles, and information on opioid usage from the Pain and Policy Study Group. Much of the detailed information gleaned for this paper was through personal communication. Results: Palliative care provision in the Caribbean exists in isolated pockets throughout the region. Capturing data on the palliative care capacity in the Caribbean was challenging, as electronic health records and robust data collection is not yet the norm. Challenges included insufficient health care infrastructure to support the spectrum of cancer care, tremendous unmet need for palliative care, pervasive opiophobia that resulted in limited access to opioids for pain relief, patients' reluctance to engage early with clinical care, and widespread use of complementary and alternative medicines before the acceptance of conventional care. Conclusion: This is the first study to our knowledge to examine the extent of palliative care service provision across the Caribbean. We conclude that there is an urgent need to improve access to palliative care and pain relief for patients with cancer in the region. Our proposed solutions include strengthening regional collaboration through policy and guideline development, human resource training, improved availability and accessibility of opioid medicines, and in-country development of information technology infrastructure to support patient care and research. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. No COIs from the authors. [ABSTRACT FROM AUTHOR]

Purpose: More than one half of breast cancer deaths occur in low- and middle-income countries, where survival rates are 60% at best. Appropriate programs that improve detection, diagnosis, and treatment in low- and middle-income countries are essential to improving breast cancer outcomes. The sustainability of such programs requires ongoing efforts, yet there remains a lack of literature on follow-up to assure long-term program success. Our study aimed to understand what needs developed in the year after the implementation of an early detection program and to evaluate potential solutions. Methods: A WHO-endorsed RAD-AID Radiology Readiness Assessment evaluated clinic resources. In addition, in 5 weeks of observation we identified resource deficiencies and reviewed existing documentation methods. On the basis of stakeholders' input and the Breast Imaging Reporting and Data System, we developed new documentation systems. Training was followed by a survey that assessed feasibility and provider acceptance. Results: Resource limitations included a lack of computers, unpredictable electrical supply, and inconsistent Internet. Assessment revealed incomplete documentation of breast clinical examinations and history, breast lesions, and follow-up. In addition, limitations negatively impacted communication between providers. Three solutions were developed: a paper patient history form, a paper clinical findings form, and a computerized patient-tracking database that was compliant with the Breast Imaging Reporting and Data System. Three nurses, three nursing assistants, and one counselor completed the survey. Seventy-one percent (five of seven respondents) indicated positive or very positive general attitudes. One hundred percent of respondents agreed or strongly agreed to the following statement: the documentation system is easy, useful, and improves overall quality of care, follow-up, decision making, access to clinical information, and communication between clinicians and patients. Five of seven providers reported that the system increased visit time, but three of these five felt that the process was valuable. Conclusion: Implementing a breast cancer early detection program in resource-limited regions is challenging and continued assessment is essential. As a result of identified needs, we developed a documentation system that was broadly accepted. Potential future steps should focus on increasing efficiency, evaluating provider attitudes on a long-term basis, and clinical impact. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. No COIs from the authors. [ABSTRACT FROM AUTHOR]

Background and context: The Framework Convention on Tobacco Control (FCTC) is the world's first public health treaty enacted under the World Health Organization (WHO). It is the biggest global initiative in tobacco control. India is a signatory to this treaty since 2004. India is home to 275 million tobacco users and is the second largest producer and user of tobacco products after China. The country is also known for widespread production and consumption of many smokeless forms of tobacco. India's progress in complying with the Framework Convention treaty had been inconsistent. While few states (provinces) are making significant progress, larger parts of the country struggles with gaps in the law, weak regulatory surveillance and overall noncompliance. The protobacco lobbies in India argue against the legislation by forecasting that banning tobacco production would lead to huge loss of employment and significant negative impact on the economy. These issues act as big deterrents to the country's tobacco control initiatives. Aim: There are very few published policy analyses on compliance with the FCTC treaty and identifying gaps in Indian tobacco control laws. This paper looks at India's tobacco use behavior, the national tobacco control laws, and its gaps and barriers. Strategy/Tactics: Using a policy triangle framework developed by Walt and Gilson (1994), it analyzes the national tobacco control policies and laws against the current scenario to identify areas of improvement and policy reform. Program/Policy process: The Indian tobacco control regulations and the National Tobacco Control Plan is evaluated in light of the WHO FCTC treaty to identify gaps and barriers to its implementation using published evidence. Outcomes: The analysis revels significant gaps and legal complexities that are currently being exploited by the tobacco industry as they continue to promote tobacco products and increase production capacity. There are also important ethical issues related to the use of child labor in tobacco trade in India. What was learned: This paper recommends to amend the Indian tobacco control law to address the gaps and implement a more stringent legislation commensurate to the tobacco use patterns and existing barriers. This also recognizes the political-economic aspects and reflects on the contextual variables and stakeholders that play a significant role in deciding the fate of tobacco production, use and control in India. [ABSTRACT FROM AUTHOR]

Background: Cancer, which accounts for 7% of deaths per year in Kenya, is the third highest cause of death after infectious and cardiovascular diseases. Awareness campaigns have tended to focus on leading cancers including breast and cervical for women as well as prostate and esophageal for men. Consequently, less common cancers such as acute myeloid leukemia (AML) are rarely properly understood by the general population and a section of the medical fraternity. Diagnoses of AML results in shock, denial and confusion to the diagnosed, family and friends as they receive contradicting information about the condition from diverse sources. The situation is handled differently by different people with many resorting to prayer. This paper, written from the lens of a caregiver, is based on data collected from a case of AML in a 32-year-old male Kenyan who lost his life within 6 weeks of diagnosis. Aim: The aim of the paper is to share experiences on the advantages and disadvantages of prayer as support to cancer patients, their family and friends. Methods: A purposively selected sample of 16 people (5 male and 11 female) of Christian Protestant orientation who participated in prayers was used. Data were collected by the researcher through participant of observation and interviews. Results: Findings discuss how prayers were conducted individually and in groups both physically and through social media platforms. Prayer items that included healing, peace and strength to the diagnosed and family, financial breakthrough and doctors' work are discussed. The immense benefits of prayer and its disadvantages to the diagnosed, his family and friends are discussed. Conclusion: The paper concludes that prayer goes a long way in cancer support. [ABSTRACT FROM AUTHOR]

Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps and limitations in care still exist, especially in oncology care in rural areas. Telemedicine provides a lower cost, practical method to maximize physician resources and limit cost and stress to families with socioeconomic limitations in rural Kenya. The following paper seeks to discuss the importance of developing a telemedicine model in western Kenya and the many advantages telemedicine can bring, as well as discuss the telemedicine model being developed by AMPATH Oncology. Aim: Integrate paper-based medical records into the AMPATH AIDS EMR; Identify sustainable telemedicine tools to integrate into the EMR; Establish networking in rural clinics; Budget in IT personnel at each clinic to assist in patient setup with central site; use solar as primary power source for devices to aid in power issues. Only 45% of Kenyans have access to power; Use cellular networks for communication; Maximize time allocated for physicians to see patients; Decrease travel time to clinics as only 32% of Kenyans live in urban environments. Methods: Cost analysis of remote clinic locations and associated costs; Clinic budget estimate for networking and telemedicine support position; Cost summary and savings Results: Estimated costs for the operations budget for the 17 rural outreach clinics include the costs of hardware, solar networking setup, and internet at a total $3400/wk. This will decrease after the first year to $1700 for maintenance costs of equipment. Personnel consists of 1 local person to support the system and will be a weekly cost of $1870. Lost time for physicians due to road travel totals ∼100 hours weekly. Estimated salaries for an oncologist at $30/h leads to a cost of $3007/wk in lost productivity. It should be noted that lodging and per diem expenses are not included in the estimated expenses that total $6114/wk. By doing telemedicine at the rural clinics in an ideal 48 workable week situation. The savings of $528,000 is a clear evidence that this is financially feasible solely based on travel savings over 5 years. For this reason, the actual savings is ∼$264,000 and still makes a strong argument for this being the right move. Conclusion: Telemedicine is a viable and necessary resource for developing oncologic care in rural Kenya. We believe that telemedicine represents a natural evolution in healthcare in Kenya to support its rural population. Telemedicine helps maximize the limited physician resources and allows them to reach a larger audience without tying up their time in lengthy commutes. Last, telemedicine should assist patients to overcome the barriers of cost and time that limit their treatment. Future challenges and gains will be made with the evolution of the newly formed national health insurance system. Gaining support and reimbursement from telemedicine visits will be crucial to ensuring the success of telemedicine. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is one of the leading cause of mortality among women worldwide. The Breast Cancer Resource Centre (BCRC) of University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, started the Malaysian Breast Cancer Survivorship Cohort (MyBCC) study in 2012. Aim: As a further enhancement of the research, the MyBCC database has been developed to conduct the survey in a convenient way, which aims to predict the factors influencing different survival rate among patients from multiethnic origin using data science techniques. Methods: The database comprised of life style related data of the patients including demographic factors, information on other illness, clinical factors, quality of life, psychosocial support, physical activity, work related questions, depression score, family background, type of medication consumed and financial status of the patients. This paper presents an approach to build an automated workflow using the MySQL database management system and PHP, integrated with R and HTML for web display. Results: A relational database comprising 816 breast cancer patients' data were developed for the MyBCC cohort study. This database serves as the backend for the MyBCC application where researchers can register new patients' records, update and view the information of recruited patients by using the system in a more commodious environment than before. Besides, the MyBCC database has been integrated with R programming tool by deploying the RMySQL package to perform audits. A few important analysis using plotly package, leveraging the integration of R with database are presented. Conclusion: In this paper, the development of the MyBCC database is presented, with the aim to automate the manual process of data entry, storage and analysis for performing audits for the breast cancer cohort study. The integration of database with R for automated analysis of data are also shown using examples of predictions that can be generated using functions in R. This fully automated workflow reduces the workload and time taken in performing manual predictions using data sources stored in flat files. [ABSTRACT FROM AUTHOR]

Background: When global health and cancer care are discussed, it is usually in the context of underserved communities, inadequate resources, standards of care below that in the developed world, loss of talented individuals to upper-income countries and the inability to recruit and retain a robust regional workforce. While such conditions may now exist, they are by no means "guaranteed" to be so in the future. Aim: To consider a visionary future for the radiation sciences to encourage investment by individuals in their careers and countries in their cancer care resources such that the current resource-limited facilities will be on the leading edge of accurate, precision radiation medicine. Such a change in perspective can greatly impact recruiting and retaining expertise. Methods: As part of building a visionary strategic plan for radiation oncology and the radiation sciences for the next few decades, a personal opinion paper was prepared by authors from the US National Cancer Institute, Conseil Européen pour la Recherche Nucléaire (CERN)/European Organization for Nuclear Research and the International Conference on Translational Research in Radio-Oncology/Physics for Health in Europe. Considering the critical role for global involvement in the future of radiation sciences, the paper provides a path forward via "win-win" sustainable partnerships formed by current resource-limited and resource-rich countries, as envisioned by the International Cancer Expert Corps (www.iceccancer.org). Results: The manuscript " Accurate, precision radiation medicine: a meta-strategy for impacting cancer care, global health, nuclear policy, and mitigating radiation injury from necessary medical use, space exploration and potential terrorism " is in press. A figure (the Radiation Rotary) illustrates that there are a number of crossroads facing the radiation sciences best addressed as part of a rotary. Four sets of issues are illustrated: 1) cancer care with radiation therapy as both technology and biology, 2) global collaboration in technology development ranging from improved linear accelerators for resource-challenged environments to particle therapy for highly specialized uses, 3) nuclear policy, from energy to the potential for nuclear terrorism and conflagration, and 4) mitigating radiation injury including enabling long-term space exploration, helping reduce the fear of radiation and producing drugs to mitigate radiation injury. Conclusion: Many of these technology, research and development issues must involve LMICs. This is in addition to understanding the differences between upper- and lower-income regions in cancer biology and the environment, including infectious etiologies, diet and the microbiome. The talent and capability of radiation oncologists and related professionals within LMICs are essential to global health and economic development and provide incentives and unique opportunities for world-leading careers and contributions. Disclaimer: The content is the personal opinion of the authors and not their organizations [ABSTRACT FROM AUTHOR]

Background: Cancer is also referred to as malignant tumor or neoplasm. It is one of the leading causes of death on the global scale. The knowledge and tools to manage and even cure cancer patients exist in developed countries but are unavailable to many who live in the developing world, resulting in unnecessary loss of life. Strategies are needed to close the gap between developed and developing countries in cancer survival and the effects of the disease on human suffering. It is also pertinent to bridge the gap to ensure universal health coverage which is very important to achieve the sustainable development goals. Aim: The aim of this abstract is to review the barrier to cancer control in developing world especially the low-and middle-income countries. Method: Selected papers amounting to 79 papers in PubMed from 2007 to 2017 were used from peer-reviewed literature and relevant publicly available documents with the appropriate keywords searched. Results: In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries and also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. Cancer is low or absent on the health agendas of low- and middle-income countries (LMCs) despite the fact that more people die of cancer in these countries than from AIDS and malaria combined. International health organizations, bilateral aid agencies, and major foundations which are instrumental in setting health priorities also have largely ignored cancer in these countries. Conclusion: and recommendations: There is an urgent need to improve health services for cancer control in developing countries to ensure health equity which is one of the key areas to be addressed in other to achieve sustainable development goals. Current resources and much-needed investments must be optimally managed. To achieve this, recommended investment should be focused in the following key priorities: capacity building in oncology health services research, policy and planning relevant to developing countries, development of high-quality health data sources, more oncology-related economic evaluations in developing countries, exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) is the most common cancer among women in developed and developing countries. In Poland during last three decades BC incidence has doubled. Accordingly to the latest epidemiologic data from the National Cancer Registry in Poland, 2015 was another year with BC incidence increase - 18 106 new cases of BC (age standardized rate/100 000 - 90.9). Moreover, BC is the second leading cause of cancer mortality among women in Poland (14.1% of deaths). As we still don't have sufficient knowledge about BC origin, it is crucial to limit well-known risk factors of BC to reduce number of new cases. To achieve this significant public health goal there is a need to identify and understand women's attitudes and measure their knowledge about protective and risk factors in BC, especially among women in the age of 45 years old and older, which is the most prone group. Aim: To analyze women's attitudes and investigate their knowledge about BC risk and protective factors in the age group 45 years old and older in Poland. Methods: Data from 380 women were collected from May to August 2017 in Poland. Women from this cohort were randomly selected from whole country and included healthy women, women with BC and convalescent women after BC and other types of cancer. The basic inclusion criterion was age of the women - at least 45 y.o. at the moment of the study. As a tool for data collection, original questionnaire has been projected and implemented, both in electronic and paper version. Questionnaire has been divided into following sections: BC completed treatment, education about BC and prophylaxis (BC risk factors) and consisted from 26 questions single and multiple choice. Collected data has been preliminarily analyzed by Microsoft Excel (v. 14.0.7173.5000), taking also into account sociodemographic profile of women from the research group. Results: 43% (166) of women had completed higher education, 49% (187) secondary education (eg high school) and 2% (8) basic education. Among women with the highest level of education 40% (67) had BC, 60% (99) didn't. In the group of women with secondary education it was respectively 72% (137) and 26% (50) and in the group with basic education 87.5% (7) and 12.5% (1). 52% (196) of women completed education about BC risk factors prophylaxis in the past (lectures, courses, etc.). In this group 70% (135) of respondents claim that this education improved their level of knowledge. Among this women, 28% (38) claim that alcohol consumption contributes to BC, 37% (50) - hormonal replacement therapy, 47% (63) - overweight and obesity and 64% (87) - gene mutations - BRCA1 and BRCA2. Conclusion: Study results suggest that there is a need to create and implement coordinated actions aiming education about BC risk factors among women 45+, which is the most prone group. As we still don't have all answers about BC origin, efficient health education seems to be the best way to decrease BC incidence. [ABSTRACT FROM AUTHOR]

Background and context: The Institute of Oncology and Radiology of Serbia (IORS), supported by the Ministry of Health, launched the project Knowledge Against Cancer in 2015, whose aim was to prepare educational material for cancer patients. Thirteen brochures were presented on WCC in Paris in 2016. The IORS conducted a survey among oncology patients in January 2017 for them to evaluate the distributed brochures and suggest the topics for new educational material. Aim: This paper aims at evaluation of brochures for cancer patients which were created during the project and its primary goal is to define new topics for future educational material. Strategy/Tactics: The study includes 348 respondents (92% women, 8% men) with average age of 54.77 ± 13.26 and predominantly highly educated (45.4%). 90% of the respondents has evaluated this kind of educational material as significant. The study has also examined the choice and relevance of topics and the quantity and usage potential of new data. The analysis has shown that most patients are interested in including psychological aspects of cancer treatment as a new topic (76%) and in including topics concerning healthy lifestyles (69%). As the majority of the respondents are women, the significant interest has been shown for topics concerning lifedem and tumor radiation of female genital organs (over 85% of female respondents). Based on the results obtained through survey and consultations and interviews with patient support group and patients associations the educational brochures were created. Program/Policy process : In 2017, nine new topics were prepared by multidisciplinary teams from IORS: Brochure: psychological support for oncology patients, the manual for family and friends, the manuals for patients on radiation of tumors on female genital organs, for head and neck tumors, lymphoedema - prevention and treatment, treatment of thyroid gland cancer with radioactive iodine, tumor markers and laboratory diagnostic, prevention of malign illnesses and quitting smoking. Outcomes: Brochures are currently available both in paper and on the Web site free of charge. The design of mobile phone application is planned for the future. The educational material is not only presented and distributed to cancer families and the public but also to health professionals and medical workers. What was learned: The research has shown that this educational material is very important for cancer patients and that with adequate information and data such patients can improve life quality predominantly through the reduction of fears and anxiety, development of coping mechanisms to deal with the cancer diagnosis and treatment and encouraging them to take active part in cancer treatment. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the second most common cancer affecting women worldwide. There is an increased risk of breast cancer among the first degree relatives. Perceived risk relates to an individual's belief about the probability or likelihood of developing some specified illness. Cancer fatalism is the belief that cancer is predetermined, beyond individual control, and necessarily fatal. Aim: To assess the self-perceived risk of breast cancer and screening and risk reduction behaviors among the first degree female relatives of breast cancer patients. Findings from this study can inform interventions to increase uptake of breast cancer screening services among relatives of breast cancer patients in low- and middle-income countries (LMICs). The results formed a baseline for designing a study on risk perception and risk reduction practices among first degree female relatives of patients diagnosed with breast cancer at Uganda Cancer Institute, Kampala, Uganda. Methods: Review of literature on risk perception and risk reduction practices of first degree relatives of breast cancer patients. We searched through various literature published in PubMed and oncology journals in HINARI published in English. All the studies were conducted among female relatives of breast cancer patients from world. All eligible papers were included in the review. The papers were carefully appraised to identify key outcomes of the studies. Results: Women were engaged in risk reduction behaviors like smoking cessation, reduction in alcohol intake, physical activity and screening for breast cancer. Women aged 54 years and below had a higher perceived lifetime risk of breast cancer (39.5%) compared with those aged ≥ 55 years (30.6%) who perceived themselves at lower risk. Levels of education have also been found key in determining an individual's perceived risk. Being unrealistically optimistic was significantly associated with high level of educational attainment while women who did not know their risk were less educated. Socioeconomic status has also been seen to influence breast cancer perceived risk. Unrealistic pessimism was frequent among women with a higher income status although a greater proportion of women who accurately perceived their 5-year risk of breast had a higher annual income. There was a significant association of the stage of breast cancer, time since diagnosis and perceived breast cancer risk among the relatives. Fatalistic beliefs about cancer prevention influenced prevention behaviors by promoting a sense of external locus of control changing beliefs about the value of specific behaviors, or reducing self-efficacy and motivation to perform prevention behaviors. Conclusion: High risk perception is associated with increase need to engage in risk reduction behaviors. Fatalism among women was the primary reason not to engage in breast cancer screening. [ABSTRACT FROM AUTHOR]

Background and context: Nigeria and most of the low and middle-income countries in West Africa have been unable to successfully transition from a paper based medical health records system to an electronic one. This is due to such constraints as lack of skilled manpower in development and maintenance of electronic records, erratic electric power supply and poor uptake of innovative means of securing and saving medical records. In a tertiary hospital that receives over 1500 new patients per year and manages about 5000 known patients per year, it is important to provide a fast, less cumbersome way of storing data. We need an enabling environment to make app use in healthcare functional. Aim: 1. To show that a mobile application used in a hospital setting can reduce the time spent by patients in accessing healthcare. 2. To show the medical information collected by a mobile medical application is reproducible, and secure. 3. To show that deployment of an electronic mobile health application for patient health care is both possible and necessary. Strategy/Tactics: A Web-based application was developed to be used as an electronic medical record. It was used in the oncology clinic of a tertiary institution in Lagos, Nigeria to take history and record examination findings as well as other aspects of personal medical data from new patients presenting in the clinic. The information so gathered was saved online on a cloud service and a copy was printed and placed in the hospital's paper-based records to reduce the stress of transitioning from paper-based records to electronic records. The application was built using C# for the backend, ASP.Net, HTML5, jQuery, JavaScript, Microsoft SQL database, jQuery Select 2 and jQuery for easy upgradability. Program/Policy process: A pilot study was carried out in which new outpatients were seen first with the application. Their history was taken and entered into the software. The examination findings and a summary of their investigation results were also entered into the software. A pdf file containing a summary of the data so entered into the software was generated automatically and printed. This printed copy of the patients' information was placed in the hospital's folder for review. Outcomes: 1. Stress of capturing and documenting patients data were grossly reduced in the clinic. 2. Time taken for patient assessment was reduced. 3. Data could be accessed anywhere online for the first time. This will facilitate telemedicine and research. What was learned: 1. Oncologists went through less pressure when attending to patients with this application as the intuitive outlook made clerking easy. 2. Access to steady Internet coverage and a stable power supply are issues to be tackled using this system. 3. There is a definite demand for just such a system both among patients and care givers. DOI: https://doi.org/10.1200/jgo.18.40800 [ABSTRACT FROM AUTHOR]

Information about several papers discussed at the first American Society of Clinical Oncology (ASCO) Quality Care Symposium held November 30-December 1, 2012 for measuring and improving the quality of cancer care is presented. Topics include mapping the developed quality of outpatient care, testing the American college of surgeons registry, and communication and decision-making tools. The symposium featured Allen S. Lichter, Stephen B. Edge, and J. Russell Hoverman.

PURPOSE: This analysis used a difference-in-difference (DID) fixed effects regression model to evaluate the impact of Medicaid Expansion on the disparity between black and white breast cancer mortality rates. Medicaid Expansion was designed to increase access to health care. Evidence is mixed, but theory and empirical data suggest that lower cost of care, through greater access to insurance, increases health care utilization and possibly improves the health of poor and sick populations. The goal of Medicaid Expansion was to improve equity. However, this major health policy has yet to be thoroughly investigated for its effect on health disparities. Many widely accepted methods exist to evaluate variations in health policy, but few studies have used such quasi-experimental designs to explore health disparities. The current study is motivated by one of today's most stark inequalities: the disparity in breast cancer mortality rates between black and white women. To test the impact Medicaid Expansion had on the black/white breast cancer mortality ratio, a DID analysis calculated the policy's average treatment effect (ATE). METHODS: State-level breast cancer mortality data were obtained from the Centers for Disease Control and Prevention. Each state's Medicaid Expansion status was provided by a Kaiser Family Foundation white paper. Two tests were conducted: one compared all expanding states with all nonexpanding states, and the other compared all expanding states with nonexpanding states that voted to expand (but did not by 2014). Fixed-effects and random-effects regression models were constructed for each specific age group. A Hausman test was calculated to determine which model was most appropriate. The DID regression models considered the year 2014 a wash-out period and compared 2012 and 2013 (pretreatment) to 2015 and 2016 (post-treatment). A graph was presented to test the necessary parallel trend assumption for expanding and nonexpanding states. DID estimators (average treatment effect) and respective P values were reported for each age group. Non–Medicaid-eligible age groups were included as a pseudo-control. RESULTS: Medicaid Expansion did not lower the disparity in breast cancer mortality. Converse to expectations, the black/white mortality ratio increased in states expanding Medicaid for all Medicaid-eligible age groups, with significant effects in younger age groups (P =.01 to.15). CONCLUSION: Investigators should use proven quasi-experimental methods to analyze the effect of policy variation on health disparities. Policy makers must consider institutional factors that may limit minority groups from benefiting from macrochanges in health policy. These results suggest that states cannot solely rely on access to insurance to alleviate disparities in cancer or other chronic conditions. More exploration into the impacts of low-quality health systems remain warranted. [ABSTRACT FROM AUTHOR]

Background: Smokeless tobacco (SLT) is available in many forms in India and is widely used by all social groups. SLT market in India is the world largest market. Over the last 2 decades, the SLT industry in India has grown immensely, mostly in cottage industry sector and unorganized sector. Several SLT products are self-made or mixed by users themselves. This presents a great challenge for regulation of such unbranded and loose products. Cancer of the oral cavity and the pharynx are a major public health problem in India. At least 90% of these cancers are caused by SLT products use. Aim: To study the challenges for unbranded SLT products in implementing the mandated regulatory compliances under the Indian Tobacco Control Law that applies to all tobacco products. Methods: The information on unbranded/loose SLT products was collected through literature search, field trips, discussions with SLT product vendors and with community members of different age group. Results: Several types of unbranded SLT products are sold both in urban and rural India. These unbranded products vary from state to state. In some cases they vary from 1 place to another within a state. Most of the unbranded products do not comply with the legal mandates of the Indian tobacco control (COTPA) and food safety (FSSA) laws that regulate sale of tobacco products. The biggest fall-out of unbranded sale is that there is no pictorial health warnings to warn the users about the ill effects of these SLT products as required under section 7 of COTPA. In addition these products also do not mention the minimum requirement of the packaging and labeling under the legal metrology law. In absence of the pictorial health warnings these SLT products become more accessible and affordable to minors. The FSSA prohibits use of tobacco and nicotine as ingredient in any food item, however, most of the unbranded SLT products are sold with added flavorings, condiments and spices which are classified as food. Conclusion: Strict implementation of the mandated regulatory provisions is needed to check the unrestricted sale of unbranded products. Noncompliant unbranded/loose SLT products should be confiscated as per the prescriptions of the existing tobacco control and food safety laws. Findings from this paper calls for development of policies that will prevent sale of unbranded/loose SLT products in India to protect the unsuspecting youth and other vulnerable group of population from these cancer traps. [ABSTRACT FROM AUTHOR]

Background and context: Routine collection of quality oncology data remains underprioritized in resource limited settings. For breast cancer (BC) care at Princess Marina Hospital (PMH) in Botswana, this hampers its use for oncology program evaluation and clinical research. The Peo Data Acquisition Core (DAC), part of a consortium for planning of a noncommunicable diseases center for research excellence in Southern Africa, engaged relevant stakeholders and departments at PMH to establish health care worker driven processes that support sustained improvements in the quality of routinely collected breast cancer data. Aim: Assess PMH BC care needs to support the improvement of routinely collected data. Strategy/Tactics: Conventional routine data quality assessments guide iterative identification of data quality gaps for improvement, but tend to consume additional human resources to implement and prioritize data quality over existing provider concerns. We undertook a holistic approach to identifying needs challenging the improvement of data routinely collected about PMH BC patients. Program/Policy process: A need assessment began with mapping of patient care process, capturing process steps, including subprocesses, actors, and an inventory of related data capture systems. The assessment also gathered care providers' perceptions of challenges to providing care as well as perceptions of the up-time of an existing electronic health record (EHR). Outcomes: BC patient management involves multiple care providers who attend to patients in different locations within the hospital. Except for EHR captured laboratory data, nearly all other documentation of patient care occurred through paper-based registers, diaries and general clinical forms. Providers indicated the overbooking of patient appointments and use of different formats to manage patient data as key challenges for them. EHR appointment scheduling components appear underutilized by providers, and a brief monitoring of provider perceptions of the EHR's speed and reliability suggests it is poorest in the mornings - at a time when providers are the busiest attending to patients. What was learned: Needs assessment findings suggest several opportunities to respond to provider recognized challenges through greater adoption of EHR usage. Establishment of a Quality Improvement (QI) group that champions improvements in routine BC data quality should integrate standardization of patient data formats and EHR centralized appointment booking. QI group composition should include both care providers and an EHR IT technician. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the highest incident cancer among women in the world today as well as in the Gulf Cooperation Council (GCC) countries. Improving the public awareness is significant in decreasing the overall morbidity and mortality of breast cancer. Social media brings a new dimension to healthcare as it offers a medium to communicate to be used by the public, patients, and health professionals to communicate health-related issues with the possibility of potentially improving health outcomes. According the Arab Social Media Report 2017 , the GCC countries largely dominate the top five spots in terms of penetration rates of key social media platforms among their populations, including Facebook, Twitter, LinkedIn, and Instagram. Social media platforms are now frequently used on a large adoption rate by the public to address health-related issues especially in GCC countries. Compared with the rest of the Arab region, the Gulf countries largely have more balanced age breakdowns of young users who are under 30 and those who are over 30 years old, indicating the maturity of usage across age groups in society. Aim: This paper aims to provide an overview of the available evidence concerning the use of social media platforms in breast cancer awareness campaigns in GCC. Methods: A literature search was conducted using PubMed and Google Scholar databases for articles published between 2010 and March 2018. Several keywords have been used. Search was limited to articles in English and Arabic describing the use of social media platforms in breast cancer awareness campaigns in any of the GCC countries. Results: More than 500 studies have been identified in the initial search. Fifteen articles have been deemed eligible. The majority are discussing the importance of using media (mass and social) as the main source of breast cancer information, however, a multilevel intervention should be considered as many interventions should be used to create culturally appropriate breast cancer awareness campaigns in the GCC countries. Conclusion: Apparently, media have been used to raise breast cancer awareness to promote breast cancer screening programs including self-exam and mammogram, benefits of early detection, and modifiable risk factors. However, social media should not be viewed as a solution to the complexities of behavior change and improved health outcomes; instead, use of social media in health promotion should be valued for its potential to engage with audiences for enhanced communication and improved capacity to promote programs, products, and services. The use of various social media platforms is variable across age, educational, and socioeconomic groups; therefore, breast cancer awareness campaigns utilizing social media should be tailored according to the target group, however public communication in the GCC still considered as a significant challenge due to the cultural diversity and language barriers. [ABSTRACT FROM AUTHOR]

Background: The increased number of reported cases in Yemen is an alarming situation that is considered as an important health problem. The aim of the present paper is to describe the pattern of the cancer among the Yemeni population as regards to age and sex distribution, residency and site of the cancer. Methods: The registered cases of cancer in the abroad treatment office in Al Thawra hospital, Taiz governorate for the year 2012 were revised and analyzed by the author to describe the pattern of cancer. Epi-Info software was used in the analysis of the data. Results: A total of 342 cases were registered for abroad treatment during the period of the study. Sex distribution showed male to female ratio of 48% and 52% respectively. The most leading sites of cancer among females were: breast (20%), musculo-skeletal (16%), digestive and endocrine (12%). Among males they were: digestive system (26%), musculo-skeletal (20%), brain (11%), and respiratory system (9%). 61% of the studied cases were among the age group (21-50) years with a maximum peak between (21-40) years. Most of the cancer cases were from Taiz city (45%). Conclusion: Cancer of the breast among females and digestive system among males comprised the majority of registered cases. Residency distributions showed Taiz city preponderance (45%). However increasing the awareness of the public about the problem of cancer and its risk factors beside improving the facilities for early detection of cancer as well as establishing registration centers for cancer in different parts in Yemen and further studies by health professionals to investigate the risk factors for cancer are mandatory. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors commonly report ongoing physical and psychological needs and adverse effects due to disease and treatment exposures including fatigue, pain, depression and decreased quality of life (QoL). Both relaxation and exercise interventions have demonstrated a positive effect on these symptoms. However these benefits have been relative to a control group, and there has been a call for further intervention studies in survivors to move beyond wait-list control groups and to compare with active control or other empirically supported interventions, such as comparison of relaxation to exercise intervention, to determine which is more beneficial. Aim: This paper presents the REIL (Relaxation and Exercise In Lymphoma) study protocol using recommended SPIRIT 2013 guidelines. The primary aim of the REIL Study is to compare the effect of two interventions - exercise and relaxation on QoL in a sample of lymphoma patients in remission postchemotherapy. Secondary aims are to investigate the effects of the two interventions on body composition, cardiovascular status, pulmonary function, muscle strength, functional exercise capacity, well-being and psychological status; and explore perceptions about participation in the posttreatment intervention program. Methods: Eligible participants (n=36) will be randomized to an exercise or relaxation home-based program to perform at least three times per week. The primary outcome measure is QoL, assessed by the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30). Secondary outcome measures include body composition, cardiovascular status, pulmonary function, strength, functional exercise capacity, well-being and psychological status. Total duration of the study will be 12 weeks and outcome measures will be assessed at baseline, 6 weeks and at the end of the study. Results: Results from this study will inform development of effective care pathways for the increasing population of cancer survivors in general, and lymphoma in particular. It is anticipated that preliminary results from this study will be available by October 2018. Conclusion: Although it is well documented that cancer survivors commonly suffer from consequences of treatment which have a negative impact on their QoL, there are currently no recommended care pathways following completion of primary medical treatment. Evidence suggests that both relaxation and exercise can significantly improve ongoing symptoms in cancer survivors, but there is no consensus on which intervention is more effective. Results from the REIL study will aid in the development of evidence-based survivorship care pathways for cancer and lymphoma survivors, potentially prevent long-term complications, and help in a smooth transition from being a cancer patient to a fully-functioning member of society. This may lead to reduced use of healthcare resources by this population. [ABSTRACT FROM AUTHOR]

Background and context: There is no National Cancer Control Plan (NCCP) in the Maldives. The Health Plan has identified cancer as an area with a need for development of separate policy, strategy paper while it is also reflected in the Multi-Stakeholder Action Plan for NCDs. Aim: The main aim of the project is to produce a policy report to guide the development of an effective National Cancer Control Plan (NCCP) in the Maldives. The objectives are to estimate the total period prevalence of cancer in the Maldives (2013-2014); to understand the views of key stakeholders; and synthesize this to develop a policy report and applying the "Cancer Control, Knowledge into Action: WHO Guide for Effective Programmes - in Low and Middle Income Countries", to the Maldives context to identify priority components in light of the prevalence estimates and views of the key stakeholders. Strategy/Tactics: The policy report will bring together the findings from secondary analysis of quantitative data, analysis of key informant in-depth interviews from stakeholders, using the framework analysis method for qualitative data analysis and applying the "WHO Guide for Effective Programmes - in Low and Middle Income Countries", to the Maldives context and identify priority components in light of the prevalence estimates and views of the key stakeholders. Outcomes: Among a population of 344,023 people, the estimated total period prevalence for all cancers in the period of 2013-2014 in Maldives is 0.92% (920 cases per 100,000 population). The estimated prevalence is 0.84% for males and 1.01% for females. Oral cancers (including lip, tongue, gum, mouth, and palate) is the most common cancer, followed by eye, breast (with carcinoma in situ), sinuses, skin (melanoma and skin cancers and carcinoma in situ). How common eye cancers and sinus cancers could be reflected as an anomaly in the data as these are uncommon when regional prevalences are compared or is an area where further research is warranted. Thyroid, prostate, lymphomas, leukemias and lung cancers are among the top 10 cancers. The key informant interviews, revealed that there are very limited services available for cancer prevention, diagnosis, treatment and care. What was learned: It is evident that there is a substantial amount of work to be done with regard to cancer control in the Maldives. The high prevalence of cancer and the views of the respondents from the study emphasizes the need for developing a National Cancer Control Plan (NCCP) as an initial step toward comprehensive cancer control efforts in the Maldives. A comprehensive cancer prevention strategy with early detection-early diagnosis and screening should be a priority component for the NCCP, with improvement of diagnosis and treatment services and establishment of a comprehensive palliative and psychosocial care program across the cancer care continuum. This policy report will provide guidance to development of an NCCP with priorities identified. [ABSTRACT FROM AUTHOR]