Extending the patient navigator research program from Harlem to the nation

6096 Background: Low-income persons face barriers when attempting to seek cancer diagnostics tests and treatment. In 1990, Harold Freeman implemented a novel patient navigator program for women with abnormal mammograms, resulting in earlier presentations and better survival. Identified barriers included lack of insurance, poor social support, coping styles, health beliefs such as fatalism, and poor health literacy skills. Single-site navigator programs have been subsequently implemented. Building on these experiences, the National Cancer Institute is supporting navigator programs at 9 sites. Methods: At 9 sites, the skill set of the navigators, community partnerships, target patient populations were reviewed for information regarding cancer type, number of patients seen, and navigator type. Common data elements include time to diagnosis and time to initiation of treatment, navigation costs, cost-effectiveness of the intervention (in order to address sustainability), and navigation satisfaction. Results: See Table . Conclusions: While programs such as the Breast and Cervical Cancer Treatment Act, the Department of Veterans Affairs, and the Indian Health Board provide financial support to pay for diagnostic/treatment services, the Patient Navigator Research Program will provide medical, social, and psychosocial services for 5,295 patients with positive breast cancer screens, 3,528 patients with positive cervical cancer screens, 5,507 patients with colorectal cancer screens, and 1,167 patients with prostate cancer screens. Diversity of sites, navigator skill sets, patient eligibility, sociodemographics, and study design in conjunction with common data elements, outcomes, and analytic plans will allow us to assess the efficacy and costs of a range of navigation programs. [Table: see text] No significant financial relationships to disclose.

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Quantifying the under-estimation of cervical Cancer in remote regions of Tanzania

BMC Cancer ◽

10.1186/s12885-020-07439-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mariah P. Gesink ◽

Robert M. Chamberlain ◽

Julius Mwaiselage ◽

Crispin Kahesa ◽

Kahima Jackson ◽

...

Keyword(s):

Cervical Cancer ◽

Low Income ◽

Population Based ◽

Capital City ◽

Low Income Countries ◽

Treatment Center ◽

Large Country ◽

Number Of Patients ◽

Sub Saharan ◽

Radiotherapy Treatment

Abstract Background Cervical cancer is the most common cancer among women in Sub-Saharan countries, including Tanzania. While early detection and diagnosis are available in some parts of this large country, radiotherapy has been only available at the Ocean Road Cancer Institute (ORCI), in the capital city of Dar es Salaam and is just starting in a few regions. Methods The objective of this study was to compare the observed incidence of cervical cancer for the two remote regions of Mwanza in western Tanzania and Mbeya in southern Tanzania, based on their patients treated at the ORCI from 2011 to 2014. Results: The number patients referred and treated at ORCI were (120 from Mwanza, and 171 from Mbeya, representing 24.6 and 32.8% of the patients histopathologically confirmed in the two sites, respectively. The results showed significant underestimation of cervical cancer in the two regions. The vast majority of patients who were histopathologically-confirmed in their local regions (73.92% from Mwanza and 65.1% from Mbeya), but did not receive the needed radiotherapy treatment at the ORCI. The estimated incidence for the two regions based on the number of patients treated at the ORCI were underestimated by 53.9% for Mwanza and 68.9% for Mbeya. Conclusions Local establishment of radiotherapy treatment facilities in remote regions in Tanzania and similar other low-income countries is essential for providing effective treatment and improving survival of diagnosed cervical cancer patients. Linkage between the records of local remote hospitals and the main cancer treatment center in the capital city can also help support the emerging the population-based cancer registry at ORCI.

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Cancer in Africa: The Untold Story

Frontiers in Oncology ◽

10.3389/fonc.2021.650117 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yosr Hamdi ◽

Ines Abdeljaoued-Tej ◽

Afzal Ali Zatchi ◽

Sonia Abdelhak ◽

Samir Boubaker ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Cervical Cancer ◽

Southern Africa ◽

Medical Devices ◽

Low Income ◽

Cancer Type ◽

Preventive Strategies ◽

Incidence And Mortality ◽

Liver Cancers

BackgroundDespite rising incidence and mortality rates in Africa, cancer has been given low priority in the research field and in healthcare services. Indeed, 57% of all new cancer cases around the world occur in low income countries exacerbated by lack of awareness, lack of preventive strategies, and increased life expectancies. Despite recent efforts devoted to cancer epidemiology, statistics on cancer rates in Africa are often dispersed across different registries. In this study our goal included identifying the most promising prevention and treatment approaches available in Africa. To do this, we collated and analyzed the incidence and fatality rates for the 10 most common and fatal cancers in 56 African countries grouped into 5 different regions (North, West, East, Central and South) over 16-years (2002–2018). We examined temporal and regional trends by investigating the most important risk factors associated to each cancer type. Data were analyzed by cancer type, African region, gender, measures of socioeconomic status and the availability of medical devices.ResultsWe observed that Northern and Southern Africa were most similar in their cancer incidences and fatality rates compared to other African regions. The most prevalent cancers are breast, bladder and liver cancers in Northern Africa; prostate, lung and colorectal cancers in Southern Africa; and esophageal and cervical cancer in East Africa. In Southern Africa, fatality rates from prostate cancer and cervical cancer have increased. In addition, these three cancers are less fatal in Northern and Southern Africa compared to other regions, which correlates with the Human Development Index and the availability of medical devices. With the exception of thyroid cancer, all other cancers have higher incidences in males than females.ConclusionOur results show that the African continent suffers from a shortage of medical equipment, research resources and epidemiological expertise. While recognizing that risk factors are interconnected, we focused on risk factors more or less specific to each cancer type. This helps identify specific preventive and therapeutic options in Africa. We see a need for implementing more accurate preventive strategies to tackle this disease as many cases are likely preventable. Opportunities exist for vaccination programs for cervical and liver cancer, genetic testing and use of new targeted therapies for breast and prostate cancer, and positive changes in lifestyle for lung, colorectal and bladder cancers. Such recommendations should be tailored for the different African regions depending on their disease profiles and specific needs.

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Global cervical cancer research: A scientometric density equalizing mapping and socioeconomic analysis

PLoS ONE ◽

10.1371/journal.pone.0261503 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0261503

Author(s):

Dörthe Brüggmann ◽

Kathrin Quinkert-Schmolke ◽

Jenny M. Jaque ◽

David Quarcoo ◽

Michael K. Bohlmann ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Research ◽

Low Income ◽

The United States ◽

Scientific Quality ◽

Cancer Type ◽

Research Activity ◽

Socioeconomic Analysis ◽

Research Activities ◽

Density Equalizing Mapping

Cervical cancer has caused substantial morbidity and mortality for millions of women over the past decades. While enormous progress has been made in diagnosis, prevention and therapy, the disease is still fatal for many women—especially in low-income countries. Since no detailed studies are available on the worldwide research landscape, we here investigated the global scientific output related to this cancer type by an established protocol. The “New Quality and Quantity Indices in Science” platform assessed all relevant cervical cancer research published in the Web of Science since 1900. A detailed analysis was conducted including country-specific research productivity, indicators for scientific quality, and relation of research activity to socioeconomic and epidemiologic figures. Visualization of data was generated by the use of density equalizing map projections. Our approach identified 22,185 articles specifically related to cervical cancer. From a global viewpoint, the United States of America was the dominating country in absolute numbers, being followed by China and Japan. By contrast, the European countries Sweden, Austria, and Norway were positioned first when the research activity was related to the population number. When the scientific productivity was related to annual cervical cancer cases, Scandinavian countries (Finland #1, Sweden #4, Norway #5, Denmark #7), the Alpine countries Austria (#2) and Switzerland (#6), and the Netherlands (#3) were leading the field. Density equalizing mapping visualized that large parts of Africa and South America were almost invisible regarding the global participation in cervical cancer research. Our data documented that worldwide cervical cancer research activity is continuously increasing but is imbalanced from a global viewpoint. Also, the study indicated that global and public health aspects should be strengthened in cervical carcinoma research in order to empower more countries to take part in international research activities.

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Global Access to Radiotherapy Services: Have We Made Progress During the Past Decade?

Journal of Global Oncology ◽

10.1200/jgo.2015.001545 ◽

2016 ◽

Vol 2 (4) ◽

pp. 207-215 ◽

Cited By ~ 33

Author(s):

Mei Ling Yap ◽

Eduardo Zubizarreta ◽

Freddie Bray ◽

Jacques Ferlay ◽

Michael Barton

Keyword(s):

Low Income ◽

Low Income Countries ◽

Utilization Rate ◽

International Agency ◽

Cancer Type ◽

Middle Income ◽

Middle Income Countries ◽

The Past ◽

Number Of Patients ◽

Low And Middle Income

Purpose The global incidence of cancer is rising, particularly in low- and middle-income countries. Radiotherapy is an important cancer treatment in the curative and palliative setting. We aimed to estimate the global demand for and supply of radiotherapy megavoltage machines (MVMs) and assess the changes in supply and demand during the past decade. Materials and Methods Cancer incidences for 27 cancer types in 184 countries were extracted from the International Agency for Research on Cancer GLOBOCAN database. The Collaboration for Cancer Outcomes Research and Evaluation radiotherapy utilization rate (RTU) model was used to estimate the number of patients in each country with an indication for radiotherapy for each cancer type and estimate the demand for MVMs. The radiotherapy supply data were accessed from Directory of Radiotherapy Centres database maintained by the International Atomic Energy Agency. Results RTU varied by country, from 32% in Mongolia to 59% in Comoros. The average optimal world RTU was 50%, equating to 7 million people in 2012 who would benefit from radiotherapy. There remains a deficit of more than 7,000 machines worldwide. During the past decade, the gap between radiotherapy demand and supply has widened in low-income countries. Conclusion RTU varies significantly between countries. Approximately half of all patients with cancer worldwide should receive radiotherapy; however, more than 2 million people are unable to access it because of a lack of MVMs. Low- and middle-income countries are particularly disadvantaged by this deficit.

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Low-income minority women at risk for cervical cancer: a process to improve adherence to follow-up recommendations

Public Health Reports ◽

10.1016/s0033-3549(04)50094-8 ◽

2001 ◽

Vol 116 (6) ◽

pp. 608-616 ◽

Cited By ~ 20

Author(s):

Virginia A Cardin ◽

Richard M Grimes ◽

Zhi Dong Jiang ◽

Nancy Pomeroy ◽

Luther Harrell ◽

...

Keyword(s):

Cervical Cancer ◽

At Risk ◽

Low Income ◽

Minority Women

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The Influence of Health Literacy on Knowledge of Cervical Cancer Prevention and Screening Practices among Female Undergraduates at a University in Southwest Nigeria

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/6615 ◽

2020 ◽

Vol 22 (1) ◽

Author(s):

Sunday Joseph Ayamolowo ◽

Lydia Feyisayo Akinrinde ◽

Monisola Omoyeni Oginni ◽

Love Bukola Ayamolowo

Keyword(s):

Cervical Cancer ◽

Health Literacy ◽

Cancer Screening ◽

Cancer Prevention ◽

Cervical Cancer Screening ◽

Low Income ◽

Cervical Cancer Prevention ◽

Screening Practices ◽

Cancer Prevention And Screening ◽

Southwest Nigeria

The global incidence of cancer is rising, and low-income and lower-middle-income countries have the worst figures. However, knowledge of cervical cancer prevention and cervical cancer screening practices remains poor in these regions. This study assessed the concept of health literacy as a potential determinant of knowledge of cervical cancer prevention and screening practices among female undergraduates. A descriptive cross-sectional study was conducted among 385 female undergraduates at a university in southwest Nigeria. A validated questionnaire composed of subscales on nine components of health literacy, knowledge of cervical cancer prevention, and cervical cancer screening practices was used for data collection. The majority of the respondents obtained a high score on most of the components of health literacy and 66% had good knowledge of cervical cancer prevention. Only 11% demonstrated good practices of Pap smear testing. Of all the components of health literacy, “feeling understood and supported by healthcare providers” (OR = 0.075; 95% CI [0.036–0.115]; p = 0.015) and “understanding health information well enough to know what to do” (OR = 0.055; 95% CI [0.006–0.104]; p = 0.029) were significantly associated with knowledge of cervical cancer prevention. Out of the major challenges related to cervical cancer screening among undergraduates, the feeling of being at risk (OR = 4.71; p < 0.05) and uncomfortable experiences from past screening (OR = 0.12; p < 0.05) were significantly associated with going for cervical cancer screening. The study concluded that levels of health literacy influenced knowledge of cervical cancer prevention among female undergraduates, but it did not affect their engagement in cervical cancer screening practices.

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Women’s knowledge and attitude towards cervical cancer preventive measures and associated factors In South Gondar Zone, Amhara Region, North Central Ethiopia: a cross-sectional study

Archives of Public Health ◽

10.1186/s13690-021-00659-4 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Yilkal Tafere ◽

Tezera Jemere ◽

Tsion Desalegn ◽

Addisu Melak

Keyword(s):

Cervical Cancer ◽

Cancer Prevention ◽

Low Income ◽

Formal Education ◽

Cervical Cancer Prevention ◽

Prevention Measures ◽

Cross Sectional ◽

Women's Knowledge ◽

Women’S Knowledge ◽

South Gondar

Abstract Background Cervical cancer is a leading cause of morbidity and mortality among women in Ethiopia, often due to late disease diagnosis. Early prevention of cancer has been shown to be the most effective measure against the disease. Scientific evidences indicate that lack of awareness towards cervical cancer is a barrier to prevention strategies. Therefore, the aim of the current research was to assess women’s knowledge and attitudes towards cervical cancer preventions in South Gondar zone. Methods A community-based cross-sectional study was carried out in South Gondar zone, Ethiopia. The study sample comprised 844 women ≥ 18 years of age. Participants were selected using systematic sampling technique. Binary and multivariable logistic models were used to assess predictors of women’s knowledge and attitude towards cervical cancer. Results About 66 % of the women had heard about cervical cancer. Regarding the main source of information of respondents, 75.4 % were heard from health professionals. Sixty two point 4 % of women knew at least one preventive measure and 82.6 % of participants knew at least one symptom or sign. Among study participants, 25 and 64 % had good knowledge, and favorable attitude towards cervical cancer prevention measures, respectively. Being reside in rural (AOR = 0.21, 95 %CI; 0.18, 0.34), not attending formal education (AOR = 0.50, 95 % CI: 0.3, 0.75), low income (AOR = 0.57, 95 % CI: 0.43, 0.81) and having < 4 children ((AOR = 0.8, 95 % CI: 0.60–0.86) were negatively associated with knowledge toward cervical cancer prevention measures. Conclusions This study found the majority of the respondents had poor knowledge about cervical cancer prevention measures. The majority of the study participants had favorable attitudes regarding cervical cancer prevention. Living in rural areas, not attending formal education low income and having less than four children was negatively associated with respondents’ knowledge towards cervical cancer prevention measures. There is needed to scale up cervical cancer prevention measures and services .Further studies are needed using strong study design.

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Bayesian adaptive design of early-phase clinical trials for precision medicine based on cancer biomarkers

The International Journal of Biostatistics ◽

10.1515/ijb-2021-0009 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Shinjo Yada

Keyword(s):

Neural Network ◽

Clinical Trials ◽

Precision Medicine ◽

Early Phase ◽

Patient Specific ◽

Specific Gene ◽

Cancer Type ◽

Background Characteristics ◽

Number Of Patients ◽

Early Phase Clinical Trials

Abstract Cancer tissue samples obtained via biopsy or surgery were examined for specific gene mutations by genetic testing to inform treatment. Precision medicine, which considers not only the cancer type and location, but also the genetic information, environment, and lifestyle of each patient, can be applied for disease prevention and treatment in individual patients. The number of patient-specific characteristics, including biomarkers, has been increasing with time; these characteristics are highly correlated with outcomes. The number of patients at the beginning of early-phase clinical trials is often limited. Moreover, it is challenging to estimate parameters of models that include baseline characteristics as covariates such as biomarkers. To overcome these issues and promote personalized medicine, we propose a dose-finding method that considers patient background characteristics, including biomarkers, using a model for phase I/II oncology trials. We built a Bayesian neural network with input variables of dose, biomarkers, and interactions between dose and biomarkers and output variables of efficacy outcomes for each patient. We trained the neural network to select the optimal dose based on all background characteristics of a patient. Simulation analysis showed that the probability of selecting the desirable dose was higher using the proposed method than that using the naïve method.

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