1
|
Azadnajafabad S, Saeedi Moghaddam S, Mohammadi E, Rezaei N, Rashidi MM, Rezaei N, Mokdad AH, Naghavi M, Murray CJL, Larijani B, Farzadfar F. Burden of breast cancer and attributable risk factors in the North Africa and Middle East region, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Front Oncol 2023; 13:1132816. [PMID: 37593096 PMCID: PMC10431599 DOI: 10.3389/fonc.2023.1132816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/10/2023] [Indexed: 08/19/2023] Open
Abstract
Background Breast cancer (BC) is the most common cancer in women globally. The North Africa and Middle East (NAME) region is coping hard with the burden of BC. We aimed to present the latest epidemiology of BC and its risk factors in this region. Methods We retrieved the data on BC burden and risk factors from the Global Burden of Disease Study 2019 to describe BC status in the 21 countries of the NAME region from 1990 to 2019. We explored BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to seven risk factors of female BC, namely, alcohol use, diet high in red meat, low physical activity, smoking, secondhand smoke, high body mass index, and high fasting plasma glucose. Decomposition analysis on BC incidence trend was done to find out the contributing factors to this cancer's growth. Results In 2019, there were 835,576 (95% uncertainty interval: 741,968 to 944,851) female and 10,938 (9,030 to 13,256) male prevalent cases of BC in the NAME region. This number leads to 35,405 (30,676 to 40,571) deaths among female patients and 809 (654 to 1,002) deaths in male patients this year. BC was responsible for 1,222,835 (1,053,073 to 1,411,009) DALYs among female patients in 2019, with a greater proportion (94.9%) of burden in years of life lost (YLLs). The major contributor to female BC incidence increase in the past three decades was found to be increase in age-specific incidence rates of BC (227.5%), compared to population growth (73.8%) and aging (81.8%). The behavioral risk factors were responsible for majority of attributable female BC burden (DALYs: 106,026 [66,614 to 144,247]). High fasting plasma glucose was found to be the risk factor with the largest effect (DALYs: 84,912 [17,377 to 192,838]) on female BC burden. Conclusion The increasing incidence and burden of BC in the NAME region is remarkable, especially when considering limited resources in the developing countries of this region. Proper policies like expanding screening programs and careful resource management are needed to effectively manage BC burden.
Collapse
Affiliation(s)
- Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Pace LE, Hagenimana M, Dusengimana JMV, Balinda JP, Benewe O, Rugema V, de Dieu Uwihaye J, Fata A, Shyirambere C, Shulman LN, Keating NL, Uwinkindi F. Implementation research: including breast examinations in a cervical cancer screening programme, Rwanda. Bull World Health Organ 2023; 101:478-486. [PMID: 37397178 PMCID: PMC10300777 DOI: 10.2471/blt.22.289599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To evaluate whether integrating breast and cervical cancer screening in Rwanda's Women's Cancer Early Detection Program led to early breast cancer diagnoses in asymptomatic women. Methods Launched in three districts in 2018-2019, the early detection programme offered clinical breast examination screening for all women receiving cervical cancer screening, and diagnostic breast examination for women with breast cancer symptoms. Women with abnormal breast examinations were referred to district hospitals and then to referral hospitals if needed. We examined how often clinics were held, patient volumes and number of referrals. We also examined intervals between referrals and visits to the next care level and, among women diagnosed with cancer, their initial reasons for seeking care. Findings Health centres held clinics > 68% of the weeks. Overall, 9763 women received cervical cancer screening and clinical breast examination and 7616 received breast examination alone. Of 585 women referred from health centres, 436 (74.5%) visited the district hospital after a median of 9 days (interquartile range, IQR: 3-19). Of 200 women referred to referral hospitals, 179 (89.5%) attended after a median of 11 days (IQR: 4-18). Of 29 women diagnosed with breast cancer, 19 were ≥ 50 years and 23 had stage III or stage IV disease. All women with breast cancer whose reasons for seeking care were known (23 women) had experienced breast cancer symptoms. Conclusion In the short-term, integrating clinical breast examination with cervical cancer screening was not associated with detection of early-stage breast cancer among asymptomatic women. Priority should be given to encouraging women to seek timely care for symptoms.
Collapse
Affiliation(s)
- Lydia E Pace
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA02115, United States of America (USA)
| | | | | | | | | | | | | | - Amanda Fata
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA02115, United States of America (USA)
| | | | | | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, USA
| | | |
Collapse
|
3
|
Eid MK, Abu-Odah H, Wehedi DT, Su JJ, Abed Y. Policymakers' and patients’ perspectives on breast cancer management in the Gaza Strip-Palestine: A qualitative study. Eur J Oncol Nurs 2022; 61:102223. [DOI: 10.1016/j.ejon.2022.102223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022]
|
4
|
Bagdasaryan AA, Chubarev VN, Smolyarchuk EA, Drozdov VN, Krasnyuk II, Liu J, Fan R, Tse E, Shikh EV, Sukocheva OA. Pharmacogenetics of Drug Metabolism: The Role of Gene Polymorphism in the Regulation of Doxorubicin Safety and Efficacy. Cancers (Basel) 2022; 14:cancers14215436. [PMID: 36358854 PMCID: PMC9659104 DOI: 10.3390/cancers14215436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Simple Summary The effectiveness and safety of the anti-cancer agent doxorubicin (anthracycline group medicine) depend on the metabolism and retention of the drug in the human organism. Polymorphism of cytochrome p450 (CYP)-encoding genes and detoxifying enzymes such as CYP3A4 and CYP2D6 were found responsible for variations in the doxorubicin metabolism. Transmembrane transporters such as p-glycoproteins were reported to be involved in cancer tissue retention of doxorubicin. ATP-binding cassette (ABC) family members, including ABCB1 transporters (also known as Multi-Drug Resistance 1 (MDR1)) proteins, were determined to pump out doxorubicin from breast cancer cells, therefore reducing the drug effectiveness. This study critically discusses the latest data about the role of CYP3A4, CYP2D6, and ABCB1 gene polymorphism in the regulation of doxorubicin’s effects in breast cancer patients. The assessment of genetic differences in the expression of doxorubicin metabolizing and transporting enzymes should be explored for the development of personalized medical treatment of breast cancer patients. Abstract Breast cancer (BC) is the prevailing malignancy and major cause of cancer-related death in females. Doxorubicin is a part of BC neoadjuvant and adjuvant chemotherapy regimens. The administration of anthracycline derivates, such as doxorubicin, may cause several side effects, including hematological disfunction, gastrointestinal toxicity, hepatotoxicity, nephrotoxicity, and cardiotoxicity. Cardiotoxicity is a major adverse reaction to anthracyclines, and it may vary depending on individual differences in doxorubicin pharmacokinetics. Determination of specific polymorphisms of genes that can alter doxorubicin metabolism was shown to reduce the risk of adverse reactions and improve the safety and efficacy of doxorubicin. Genes which encode cytochrome P450 enzymes (CYP3A4 and CYP2D6), p-glycoproteins (ATP-binding cassette (ABC) family members such as Multi-Drug Resistance 1 (MDR1) protein), and other detoxifying enzymes were shown to control the metabolism and pharmacokinetics of doxorubicin. The effectiveness of doxorubicin is defined by the polymorphism of cytochrome p450 and p-glycoprotein-encoding genes. This study critically discusses the latest data about the role of gene polymorphisms in the regulation of doxorubicin’s anti-BC effects. The correlation of genetic differences with the efficacy and safety of doxorubicin may provide insights for the development of personalized medical treatment for BC patients.
Collapse
Affiliation(s)
- Alina A. Bagdasaryan
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Vladimir N. Chubarev
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Elena A. Smolyarchuk
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Vladimir N. Drozdov
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Ivan I. Krasnyuk
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Junqi Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Ruitai Fan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Edmund Tse
- Department of Hepatology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Evgenia V. Shikh
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), 8-2 Trubetskaya Str., 119991 Moscow, Russia
| | - Olga A. Sukocheva
- Department of Hepatology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
- Correspondence:
| |
Collapse
|
5
|
Traboulssi M, Pidgeon M, Weathers E. My Wife Has Breast Cancer: The Lived Experience of Arab Men. Semin Oncol Nurs 2022; 38:151307. [DOI: 10.1016/j.soncn.2022.151307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 12/24/2022]
|
6
|
Ramos Herrera IM, Lemus Flores MG, Reyna Sevilla A, González Castañeda ME, Torres Gutiérrez FA, Crocker Sagastume RC, Robles Pastrana JDD, Vázquez Castellanos JL. Public Policies and Programs for the Prevention and Control of Breast Cancer in Latin American Women: A Scoping Review (Preprint). JMIR Cancer 2021; 8:e32370. [PMID: 35793130 PMCID: PMC9301550 DOI: 10.2196/32370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/13/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Breast cancer has positioned itself worldwide as one of the main public health problems, especially in Latin America. In some countries, several programs for the prevention and control of breast cancer in women have been developed and implemented on a permanent basis, but there are no public reports on the policies that originated such programs. Objective A scoping review of scientific publications that identify the type, extent, and scope of policies and programs for the prevention and control of breast cancer in Latin American women was performed, and the main results were presented in this paper. Methods This scoping review was carried out according to the method by Arksey and O’Malley based on 3 fundamental questions about breast cancer prevention and control policies in Latin America: their type, extent and scope, and reference framework. The search period was from 2000 to 2019, and the search was carried out in the following databases: MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost), ISI Web of Science (Science Citation Index), and Scopus in English, Spanish, and Portuguese, and Scielo, Cochrane, and MEDES-MEDicina in Spanish and Portuguese. Of the 743 studies found, 20 (2.7%) were selected, which were analyzed using descriptive statistics and qualitative content analysis. Results The selected studies identified several Latin American countries that have generated policies and programs to prevent and control breast cancer in women, focusing mainly on risk communication, prevention and timely detection, effective access to health services, improvement of the screening process, and evaluation of screening programs. Evaluation criteria and greater participation of civil society in policy design and program execution are still lacking. This could undoubtedly help eliminate existing barriers to effective action. Conclusions Although several Latin American countries have generated public policies and action programs for the prevention and control of breast cancer, a pending issue is the evaluation of the results to analyze the effectiveness and impact of their implementation given the magnitude of the public health problem it represents and because women and civil society play an important role in its prevention and control. International Registered Report Identifier (IRRID) RR2-10.2196/12624
Collapse
|
7
|
Pham DX, Ho TQH, Bui TD, Ho-Pham LT, Nguyen TV. Trends in breast cancer incidence in Ho Chi Minh City 1996-2015: A registry-based study. PLoS One 2021; 16:e0246800. [PMID: 33566857 PMCID: PMC7875422 DOI: 10.1371/journal.pone.0246800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/26/2021] [Indexed: 12/09/2022] Open
Abstract
The burden of breast cancer in Vietnam has not been documented. This study sought to estimate the incidence of breast cancer in Ho Chi Minh City, the largest economic center of Vietnam, from 1996 to 2015. This was a population-based study using the Ho Chi Minh City Cancer Registry as a source of data (coverage period: 1996-2015). The Registry adopted the International Classification of Diseases for Oncology, 3rd Edition for the classification of primary sites and morphology, and guidelines from the International Agency for Research on Cancer and the International Association of Cancer Registries. Using the population statistics from census data of Ho Chi Minh City, the point incidence of breast cancer for 5-year period was estimated. Based on the national population, we calculated the age-standardized rate (ASR) of breast cancer between 1996 and 2015. Overall 14,222 new cases of breast cancer (13,948 women, or 98%) had been registered during the 1996-2015 period; among whom, just over half (52%) were in the 2nd stage and 26% in the 3rd and 4th stages. In women, the median age at diagnosis was 50 years and there was a slight increase over time. The ASR of breast cancer during the 2011-2015 period was 107.4 cases per 100,000 women, representing an increase of 70% compared to the rate during the 1996-2000 period. In men, there was also a significant increase in the ASR: from 1.13 during the 1996-2001 period to 2.32 per 100,000 men during the 2011-2015 period. These very first data from Vietnam suggest that although the incidence of breast cancer in Vietnam remains relatively low, it has increased over time.
Collapse
Affiliation(s)
- Dung X. Pham
- Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
- Department of Oncology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thao-Quyen H. Ho
- Department of Training and Scientific Research, University Medical Center, Ho Chi Minh City, Vietnam
| | - Tung D. Bui
- Department of Healthcare Directions, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Lan T. Ho-Pham
- BioMedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Bone and Muscle Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- * E-mail:
| | - Tuan V. Nguyen
- Bone and Muscle Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
8
|
Looking beyond the Lamppost: Population-Level Primary Prevention of Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238720. [PMID: 33255309 PMCID: PMC7727708 DOI: 10.3390/ijerph17238720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022]
Abstract
Although innovative and impactful interventions are necessary for the primary prevention of breast cancer, the factors influencing program adoption, implementation, and sustainment are key, yet remain poorly understood. Insufficient attention has been paid to the primary prevention of breast cancer in state and national cancer plans, limiting the impact of evidence-based interventions on population health. This commentary highlights the state of primary prevention of breast cancer and gaps in the current literature. As a way to enhance the reach and adoption of cancer prevention policies and programs, the utility of dissemination and implementation (D&I) science is highlighted. Examples of how D&I could be applied to study policies and programs for chronic disease prevention are described, in addition to needs for future research. Through application of D&I science and a strong focus on health equity, a clearer understanding of contextual factors influencing the success of prevention programs will be achieved, ultimately impacting population health.
Collapse
|
9
|
Dynamics of Breast Cancer under Different Rates of Chemoradiotherapy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:5216346. [PMID: 31611927 PMCID: PMC6755298 DOI: 10.1155/2019/5216346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/21/2019] [Indexed: 12/30/2022]
Abstract
A type of cancer which originates from the breast tissue is referred to as breast cancer. Globally, it is the most common cause of death in women. Treatments such as radiotherapy, chemotherapy, hormone therapy, immunotherapy, and gene therapy are the main strategies in the fight against breast cancer. The present study aims at investigating the effects of the combined radiotherapy and chemotherapy as a way to treat breast cancer, and different treatment approaches are incorporated into the model. Also, the model is fitted to data on patients with breast cancer in Tanzania. We determine new treatment strategies, and finally, we show that when sufficient amount of chemotherapy and radiotherapy with a low decay rate is used, the drug will be significantly more effective in combating the disease while health cells remain above the threshold.
Collapse
|
10
|
Bodolica V, Spraggon M. Toward patient-centered care and inclusive health-care governance: a review of patient empowerment in the UAE. Public Health 2019; 169:114-124. [PMID: 30877962 DOI: 10.1016/j.puhe.2019.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 01/14/2019] [Accepted: 01/31/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The purpose of this article was twofold. We aimed to both clarify the multidimensional notion of patient empowerment (PE) and conduct a comprehensive survey of PE-related literature in the specific context of the United Arab Emirates (UAE). STUDY DESIGN The study objectives were achieved by means of a two-phased systematic review of the literature on PE and associated dimensions. METHODS The first phase consisted in the database search for recent review articles on the construct of PE that were published in the past five years. The second phase focused on the identification of extant empirical research on PE and related concepts in UAE settings. In total, 13 review articles and 17 empirical studies were eligible and included in our analysis. RESULTS The retained PE review articles pointed to two major themes and four topics on 'conceptual clarification' and 'contextual embeddedness', where PE was tackled in relation to national health-care system, health-care governance, information technology, and therapeutic continuum. Our analysis of UAE-based PE studies unveiled three themes on 'chronic disease care' (with three topics of 'general inquiries', 'diabetes management', and 'diabetic complications'), 'self-medication with drugs', and 'non-therapeutic interventions'. By juxtaposing the identified PE themes and topics, we derived three promising opportunities for researchers, practitioners, and policymakers to consolidate, expand, and initiate relevant PE interventions in the UAE. CONCLUSION This review article found that PE represents an emergent and underexplored notion in the UAE health-care system. As UAE ambitions to become a sought-after medical hub in the global arena, the design and implementation of adequate PE strategies and reforms play a critical role in the development of a world-class patient-centered health care in the country.
Collapse
Affiliation(s)
- V Bodolica
- American University of Sharjah, School of Business Administration, P.O. Box 26666, Sharjah, United Arab Emirates.
| | - M Spraggon
- Mohammed Bin Rashid School of Government (MBRSG), Convention Tower, Level 7, P.O. Box 72229, Dubai, United Arab Emirates.
| |
Collapse
|
11
|
de Cerqueira JC, de Lima Moreira JP, dos Santos Brito A, Raggio Luiz ER. [Women's health prevention indicator: a proposal for combining mammography and Papanicolaou smear]. Rev Panam Salud Publica 2017; 41:e99. [PMID: 28902282 PMCID: PMC6660848 DOI: 10.26633/rpsp.2017.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This article proposes a women's health prevention indicator (WHPI) reflecting the combined status of mammography and Papanicolaou (Pap) smear according to the recommendations for age and considering the time elapsed since the last exam/test. The WHPI classifies prevention status into desirable, alert, or risk categories. The risk category includes women of all ages who never had a Pap smear, those aged >60 years who had a Pap smear more than 3 years ago but never had a mammography, and those aged ≥71 years who are up to date with the Pap smear but never had a mammography. The desirable category includes women with a Pap smear in the past 3 years, except women aged ≥41 who never had a mammography and those aged ≥51 years who had a mammography more than 2 years earlier. The alert category includes women whose Pap smear is more than three years old with the exception of those ≥61 years who never had a mammography and those aged ≥71 years whose mammography is more than 2 years old. For women who had experienced a Pap smear in the past 3 years, the alert category includes those aged 41-50 years who never had mammography, those aged 51-70 years with mammography older than 2 years or no mammography, and those aged ≥71 years with mammography older than 2 years. Applying the WHPI to data from the National Household Sample Survey of 2008 revealed that 24.8% of Brazilian women were at risk and 24.2% were in the alert category. The Northeast and the North had the highest risk rates (31.5% and 29.6% respectively). Of those >70 years old, 49.5% were in the risk category. The WHPI can be used to assess public initiatives and compare preventive status within and across regions.
Collapse
Affiliation(s)
- Juliana Calazans de Cerqueira
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.,Correspondência: Juliana Calazans de Cerqueira,
| | - Jessica Pronestino de Lima Moreira
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Alexandre dos Santos Brito
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - e Ronir Raggio Luiz
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| |
Collapse
|
12
|
Harbeck N, Gascon P, Jones CM, Nixon A, Krendyukov A, Nakov R, Li Y, Blackwell K. Proposed biosimilar pegfilgrastim (LA-EP2006) compared with reference pegfilgrastim in Asian patients with breast cancer: an exploratory comparison from two Phase III trials. Future Oncol 2017; 13:1385-1393. [DOI: 10.2217/fon-2017-0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: This is a pooled subgroup analysis of Asian patients enrolled in two Phase III confirmatory studies comparing proposed biosimilar LA-EP2006 with reference pegfilgrastim in women receiving chemotherapy for breast cancer. Patients & methods: Women were randomized to LA-EP2006 (n = 90) or reference (n = 84) pegfilgrastim (Neulasta®, Amgen, Inc., CA, USA) for ≤6 cycles of TAC chemotherapy. Primary end point was duration of severe neutropenia during Cycle 1 (number of consecutive days with absolute neutrophil count <0.5 × 109/l) with equivalence confirmed if 95% CIs were within a ±1-day margin. Results: Mean duration of severe neutropenia (days) in Cycle 1 was 1.36 ± 0.98 (LA-EP2006) versus 1.35 ± 1.06 (reference) (difference 0.01 days; 95% CI: -0.30–0.32, indicating equivalence). Conclusion: LA-EP2006 showed similar clinical efficacy and safety compared with reference pegfilgrastim.
Collapse
Affiliation(s)
- Nadia Harbeck
- Brustzentrum, Frauenklinik & CCCLMU der Universität München (LMU), Munich, 81337, Germany
| | - Pere Gascon
- Servicio de Oncologia Médica, Fundacio Clinic, Barcelona, 08036, Spain
| | | | - Allen Nixon
- Fowler Family Center for Cancer Care, Jonesboro, AR, 72401, USA
| | | | | | - Yuhan Li
- Sandoz Inc, Princeton, NJ, 08540, USA
| | | |
Collapse
|
13
|
Scheel JR, Molina Y, Patrick DL, Anderson BO, Nakigudde G, Lehman CD, Thompson B. Breast Cancer Downstaging Practices and Breast Health Messaging Preferences Among a Community Sample of Urban and Rural Ugandan Women. J Glob Oncol 2017; 3:105-113. [PMID: 28503660 PMCID: PMC5424549 DOI: 10.1200/jgo.2015.001198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Among a community sample of Ugandan women, we provide information about breast cancer downstaging practices (breast self-examination, clinical breast examination [CBE]) and breast health messaging preferences across sociodemographic, health care access, and prior breast cancer exposure factors. METHODS Convenience-based sampling was conducted to recruit Ugandan women age 25 years and older to assess breast cancer downstaging practices as well as breast health messaging preferences to present early for a CBE in the theoretical scenario of self-detection of a palpable lump (breast health messaging preferences). RESULTS The 401 Ugandan women who participated in this survey were mostly poor with less than a primary school education. Of these women, 27% had engaged in breast self-examination, and 15% had undergone a CBE. Greater breast cancer downstaging practices were associated with an urban location, higher education, having a health center as a regular source of care, and receiving breast cancer education (P < .05). Women indicated a greater breast health messaging preference from their provider (66%). This preference was associated with a rural location, having a health center as a regular source of care, and receiving breast cancer education (P < .05). CONCLUSION Most Ugandan women do not participate in breast cancer downstaging practices despite receipt of breast cancer education. However, such education increases downstaging practices and preference for messaging from their providers. Therefore, efforts to downstage breast cancer in Uganda should simultaneously raise awareness in providers and support improved education efforts in the community.
Collapse
Affiliation(s)
- John R Scheel
- University of Washington; Seattle Cancer Care Alliance
| | | | | | - Benjamin O Anderson
- University of Washington; Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | |
Collapse
|
14
|
Quality of Breast Cancer Information on the Internet by African Organizations: An Appraisal. Int J Breast Cancer 2017; 2017:2026979. [PMID: 28168059 PMCID: PMC5266799 DOI: 10.1155/2017/2026979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/18/2016] [Accepted: 12/18/2016] [Indexed: 11/18/2022] Open
Abstract
Objective. The aim of this study was to appraise the quality of information on BC available at websites run by organizations in Africa. Methods. Three searches were conducted using Google search engine to generate a list of websites. The identified websites were assessed using European Commission (EC) quality criteria for health-related websites, which comprises different assessment areas including, completeness, transparency and honesty, authority, privacy and data protection, updating of information, accountability, and accessibility. Results. Thirteen (13) websites were included in the evaluation. Majority of the websites evaluated had low scores on the completeness and transparency of their websites. Scores on accessibility were however moderate and high for most of the websites. Breast cancer-specific organizations provided the highest quality information, particularly in terms of completeness. The overall lowest and highest quality scores were 9 and 43 out of 63, respectively, and 77% of the included websites scored less than 50% of the total quality score. Conclusion. This review has provided evidence of inadequate and inaccurate BC information provided by some cancer organizations in Africa. Considerable effort is required to make BC information on the Internet a valuable and up-to-date source for both professionals and patients.
Collapse
|
15
|
Fan L, Goss PE, Strasser-Weippl K. Current Status and Future Projections of Breast Cancer in Asia. Breast Care (Basel) 2015; 10:372-8. [PMID: 26989355 PMCID: PMC4789872 DOI: 10.1159/000441818] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Asia is the world's largest continent comprising about 3/5 of the human population. Breast cancer is the most common type of cancer and the second leading cause of cancer-related deaths among women in Asia, accounting for 39% of all breast cancers diagnosed worldwide. The incidence of breast cancer in Asia varies widely across the continent and is still lower than in Western countries, but the proportional contribution of Asia to the global breast cancer rates is increasing rapidly in parallel to the socioeconomic development. However, the mortality-to-incidence ratios are much higher for Asia than for Western countries. Most Asian countries are low- and middle-income countries (LMICs) where breast cancer presents at a younger age and a later stage, and where patients are more likely to die from the disease than those in Western countries. Moreover, diagnostic workup, treatment and palliative services are inadequate in most Asian LMICs. In this review, we present an overview of the breast cancer risk factors and epidemiology, control measures, and cancer care among Asian countries.
Collapse
Affiliation(s)
- Lei Fan
- Breast Cancer Institute, Cancer Hospital, Department of Oncology, Shanghai Medical College, Institutes of Biomedical Science, Fudan University, Shanghai, China
| | - Paul E. Goss
- Global Cancer Institute, Boston, MA, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
16
|
Bridges JFP, Paly VF, Barker E, Kervitsky D. Identifying the Benefits and Risks of Emerging Treatments for Idiopathic Pulmonary Fibrosis: A Qualitative Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 8:85-92. [DOI: 10.1007/s40271-014-0081-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
17
|
Luyeye Mvila G, Postema S, Marchal G, Van Limbergen E, Verdonck F, Matthijs G, Devriendt K, Michils G, Van Ongeval C. From the set-up of a screening program of breast cancer patients to the identification of the first BRCA mutation in the DR Congo. BMC Public Health 2014. [PMID: 25070656 DOI: 10.1186/1471-2458-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Breast cancer incidence in African population is low compared to western countries but the mortality rate is higher and the disease presents at a younger age and at a more advanced stage. The World Health Organisation and the Breast Health Global Initiative concluded that in low and middle income countries early breast cancer detection can be achieved by informing women on symptoms of breast cancer, on the practice of breast self-examination and clinical breast examination by trained health care workers. Based on these recommendations, we set up a breast cancer awareness campaign in Kinshasa, Democratic Republic of Congo (DRC). This paper describes the strategy that was established and the results that were achieved. METHODS A breast cancer awareness campaign was started in 2010 and data were collected until the end of 2012. Clinicians (expert group) trained nurses and health care workers (awareness groups) on clinical, technical and social aspects of breast cancer. Different channels were used to inform women about the campaign and clinical data (on medical and family history) were collected. The participating women were investigated with clinical breast examination by the awareness group. Women in whom a palpable mass was detected were referred to the hospital: they received a mammography and ultrasound and--in case of suspicious findings--additionally a core needle biopsy. In case of a positive family history, a blood sample was taken for genetic investigation. RESULTS In total, 4,315 women participated, resulting in 1,113 radiological breast examinations, performed in the General Hospital of Kinshasa of which 101 turned out to be malignant lesions. Fifty six percent of the women with breast cancer were less than 50 years old and 75% (65/87) were stage III tumors. A BRCA gene mutation was identified in a family with a severe history of breast cancer. CONCLUSIONS Even without financial support, it was possible to start an awareness campaign for breast cancer in Kinshasa. This campaign increased the awareness on cancer of the women in Kinshasa. The results demonstrate that this campaign had an immediate impact on patients and their families.
Collapse
Affiliation(s)
- Gertrude Luyeye Mvila
- Kinshasa General Hospital, Kasavubu University, University of Lubumbashi, Lubumbashi, DR, Congo.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Luyeye Mvila G, Postema S, Marchal G, Van Limbergen E, Verdonck F, Matthijs G, Devriendt K, Michils G, Van Ongeval C. From the set-up of a screening program of breast cancer patients to the identification of the first BRCA mutation in the DR Congo. BMC Public Health 2014; 14:759. [PMID: 25070656 PMCID: PMC4133620 DOI: 10.1186/1471-2458-14-759] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 07/03/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Breast cancer incidence in African population is low compared to western countries but the mortality rate is higher and the disease presents at a younger age and at a more advanced stage. The World Health Organisation and the Breast Health Global Initiative concluded that in low and middle income countries early breast cancer detection can be achieved by informing women on symptoms of breast cancer, on the practice of breast self-examination and clinical breast examination by trained health care workers. Based on these recommendations, we set up a breast cancer awareness campaign in Kinshasa, Democratic Republic of Congo (DRC). This paper describes the strategy that was established and the results that were achieved. METHODS A breast cancer awareness campaign was started in 2010 and data were collected until the end of 2012. Clinicians (expert group) trained nurses and health care workers (awareness groups) on clinical, technical and social aspects of breast cancer. Different channels were used to inform women about the campaign and clinical data (on medical and family history) were collected. The participating women were investigated with clinical breast examination by the awareness group. Women in whom a palpable mass was detected were referred to the hospital: they received a mammography and ultrasound and--in case of suspicious findings--additionally a core needle biopsy. In case of a positive family history, a blood sample was taken for genetic investigation. RESULTS In total, 4,315 women participated, resulting in 1,113 radiological breast examinations, performed in the General Hospital of Kinshasa of which 101 turned out to be malignant lesions. Fifty six percent of the women with breast cancer were less than 50 years old and 75% (65/87) were stage III tumors. A BRCA gene mutation was identified in a family with a severe history of breast cancer. CONCLUSIONS Even without financial support, it was possible to start an awareness campaign for breast cancer in Kinshasa. This campaign increased the awareness on cancer of the women in Kinshasa. The results demonstrate that this campaign had an immediate impact on patients and their families.
Collapse
Affiliation(s)
- Gertrude Luyeye Mvila
- />Kinshasa General Hospital, Kasavubu University, University of Lubumbashi, Lubumbashi, DR Congo
- />Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Sandra Postema
- />Department of Radiology, UZ Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Guy Marchal
- />Department of Radiology, UZ Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Erik Van Limbergen
- />Leuven University Centre for Cancer Prevention (LUCK), Leuven, Belgium
| | | | - Gert Matthijs
- />Center for Human Genetics, UZ Leuven and Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Koen Devriendt
- />Center for Human Genetics, UZ Leuven and Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Genevieve Michils
- />Center for Human Genetics, UZ Leuven and Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Chantal Van Ongeval
- />Department of Radiology, UZ Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| |
Collapse
|
19
|
Schuster ALR, Aslakson RA, Bridges JFP. Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study. BMC Palliat Care 2014; 13:32. [PMID: 25067908 PMCID: PMC4110535 DOI: 10.1186/1472-684x-13-32] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/12/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. METHODS Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. RESULTS Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. CONCLUSIONS Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.
Collapse
Affiliation(s)
- Anne LR Schuster
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca A Aslakson
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John FP Bridges
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
20
|
Knaul FM, Bhadelia A, Gralow J, Arreola-Ornelas H, Langer A, Frenk J. Meeting the emerging challenge of breast and cervical cancer in low- and middle-income countries. Int J Gynaecol Obstet 2012; 119 Suppl 1:S85-8. [DOI: 10.1016/j.ijgo.2012.03.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
21
|
Lopes LV, Conceição AV, Oliveira JB, Tavares A, Domingos C, Santos LL. Cancer in Angola, resources and strategy for its control. Pan Afr Med J 2012; 12:13. [PMID: 22826737 PMCID: PMC3396859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 05/08/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Cancer is an increasingly important health problem in Africa. The number of cancer cases in this region could double, ranging between 700 000 and 1 600 000 new cases in 2030. The mortality rate is higher than 80% and is explained, mainly, by a lack of early detection, diagnostics and treatment resources. In Angola, about 7,000 patients die of cancer every year. METHODS Data were derived from open-ended interviews conducted in 2010-11 with health authorities, clinicians, nurses and Administration of Hospitals. According Angola epidemiological data, results of interviews and international published advocacy for cancer control we develop a potential strategy for its control. The objectives are to identify existing resources for cancer control and describe the needs thereto, in order to establish an oncological program to guide the development of Angola cancer control strategies. RESULTS Malaria remains the leading cause of illness and death in Angola, and other communicable diseases remain a public health problem. However, 9 000 new cases of cancer are diagnosed each year.The most common types of cancer are: cancer of the cervix, breast, prostate, esophagus, stomach and head and neck, as well as cancers with infectious origin, such as Kaposi's sarcoma and liver and bladder cancer. The foundation for developing national cancer control strategies includes: oncological data; investment and training; identifying and removing barriers; guidance and protection of the patient. Angolan National Cancer Centre, Sagrada Esperança Clinic and Girassol Clinic are now developing a cancer program. CONCLUSION Improving the economic situation of Angola creates conditions for an increase in life expectancy which in itself is associated with an increased risk of oncological diseases. On the other hand, infectious diseases, associated with the risk of malignant tumors, are endemic. Thus, an increase in patients with malignant disease is expected. A plan is therefore necessary to organize the response to this old but less visible nosologic situation.
Collapse
Affiliation(s)
| | | | | | | | | | - Lucio Lara Santos
- Sagrada Esperança Clinic, Angola,Portuguese Institute of Oncology, Portugal,Corresponding author: Lucio Lara Santos, Portuguese Institute of Oncology – Porto, Portugal
| |
Collapse
|
22
|
Bridges JFP, Gallego G, Kudo M, Okita K, Han KH, Ye SL, Blauvelt BM. Identifying and prioritizing strategies for comprehensive liver cancer control in Asia. BMC Health Serv Res 2011; 11:298. [PMID: 22047535 PMCID: PMC3227633 DOI: 10.1186/1472-6963-11-298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 11/02/2011] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Liver cancer is both common and burdensome in Asia. Effective liver cancer control, however, is hindered by a complex etiology and a lack of coordination across clinical disciplines. We sought to identify strategies for inclusion in a comprehensive liver cancer control for Asia and to compare qualitative and quantitative methods for prioritization. METHODS Qualitative interviews (N = 20) with international liver cancer experts were used to identify strategies using Interpretative Phenomenological Analysis and to formulate an initial prioritization through frequency analysis. Conjoint analysis, a quantitative stated-preference method, was then applied among Asian liver cancer experts (N = 20) who completed 12 choice tasks that divided these strategies into two mutually exclusive and exhaustive subsets. Respondents' preferred plan was the primary outcome in a choice model, estimated using ordinary least squares (OLS) and logistic regression. Priorities were then compared using Spearman's Rho. RESULTS Eleven strategies were identified: Access to treatments; Centers of excellence; Clinical education; Measuring social burden; Monitoring of at-risk populations; Multidisciplinary management; National guidelines; Public awareness; Research infrastructure; Risk-assessment and referral; and Transplantation infrastructure. Qualitative frequency analysis indicated that Risk-assessment and referral (85%), National guidelines (80%) and Monitoring of at-risk populations (80%) received the highest priority, while conjoint analysis pointed to Monitoring of at-risk populations (p < 0.001), Centers of excellence (p = 0.002), and Access to treatments (p = 0.004) as priorities, while Risk-assessment and referral was the lowest priority (p = 0.645). We find moderate concordance between the qualitative and quantitative methods (rho = 0.20), albeit insignificant (p = 0.554), and a strong concordance between the OLS and logistic regressions (rho = 0.979; p < 0.0001). CONCLUSIONS Identified strategies can be conceptualized as the ABCs of comprehensive liver cancer control as they focus on Antecedents, Better care and Connections within a national strategy. Some concordance was found between the qualitative and quantitative methods (e.g. Monitoring of at-risk populations), but substantial differences were also identified (e.g. qualitative methods gave highest priority to risk-assessment and referral, but it was the lowest for the quantitative methods), which may be attributed to differences between the methods and study populations, and potential framing effects in choice tasks. Continued research will provide more generalizable estimates of priorities and account for variation across stakeholders and countries.
Collapse
Affiliation(s)
- John FP Bridges
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health 624 N. Broadway, Room 689 Baltimore, MD 212105 USA
| | - Gisselle Gallego
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health 624 N. Broadway, Room 689 Baltimore, MD 212105 USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology Kinki University School of Medicine 377-2 Ohno-Higashi, Osaka-Sayama Osaka, Japan
| | - Kiwamu Okita
- Yamaguchi University Shimonoseki Kohsei Hospital Kamishinchi-cho 3-3-8 Shimonoseki City, Japan
| | - Kwang-Hyub Han
- Division of Gastroenterology Department of Internal Medicine Chief, Liver Cancer Special Clinic Severance Hospital Director, Liver Cirrhosis Clinical Research Center Yonsei University College of Medicine 134 Shinchon-dong, Seodaemun-gu Seoul, Korea
| | - Sheng-Long Ye
- Liver Cancer Institute Zhongshan Hospital Fudan University 136 Yixueyuan Road Shanghai, PR China
| | - Barri M Blauvelt
- Institute for Global Health, University of Massachusetts, 102 Hasbrouck, University of Massachusetts Amherst, MA 01035, USA
| |
Collapse
|