Cancer-related Issues Research Articles

Impact on social and communication processes in a colombian cancer entity

espanolLa entidad oncologica donde se realizo el estudio tiene como objetivo efectuar programas educativos de prevencion y deteccion temprana en temas relacionados con el cancer. En esta entidad, las areas Social y de Comunicaciones son fundamentales para lograr dicho objetivo, ya que desarrolla cada funcion entorno a la sociedad para asi potencializar estrategias que permitan la difusion a la comunidad y el acercamiento con familiares y pacientes, de tal manera que se promueve el intercambio de la informacion en temas de salud, prestandole mayor atencion al cuidado, proteccion y la implementacion de estilos de vida saludables. Dado lo anterior, se ha generado la necesidad de incorporar diferentes metodologias que permitan estandarizar los procesos que se llevan a cabo, midiendo el impacto y obteniendo como resultado oportunidades de mejora y eficacia.Para este caso de estudio, se utilizaron herramientas de tipo ingenieril, obteniendo un diagnostico inicial que parte desde la recoleccion de la informacion hasta la tabulacion de la misma, con respecto a lo anterior, se toman decisiones estableciendo riesgos, factores, actividades y procedimientos que requieren mayor atencion, no obstante, se realiza la respectiva documentacion, incluyendo anexos e instructivos que permite entender a fondo el procedimiento y llevar un control del mismo mediante el analisis de tiempos no estructurados de cada actividad, por otro lado, se logra mitigar las diferentes amenazas e impactos negativos que puede tener frente a los cambios realizados, ademas, una mayor organizacion y control del proceso, generando un sistema de medicion basado en indicadores que dara mayor soportey control a lo desarrollado con su respectivo seguimiento, para finalizar se realizo un estudio de impacto que determina la viabilidad del proyecto, de acuerdo a lo anterior se pudo contemplar que la estandarizacion cuenta con varios factores positivos que ayudan al funcionamiento y cumplimiento de los objetivos misionales de la entidad oncologica y se vera reflejada en la atencion a pacientes y apoyo a sus familiares, este proyecto respalda no solo la gestion documental sino la bonita labor que desarrolla. DOI: http://dx.doi.org/10.21017/rimci.2020.v7.n13.a79 EnglishOncological entities aim at training, prevention and education programs on cancer-related issues; the Social and Communications areas are fundamental to achieve this objective, since it exploits each function around society to thus potentiate strategies that can be dissemination, approach with family and patients, in such a way that the exchange of information on topics is promoted of health, paying greater attention to the care, protection and implementation of healthy lifestyles, given the above, the need to incorporate different methodologies that can standardize the processes that are carried out has been generated, resulting in opportunities for improvement and effectiveness. For this case study, use engineering tools obtaining an initial diagnosis, starting from the collection of information to the tabulation of the same, with respect to the above, making decisions establishing risks, factors, activities and procedures that diagnose more attention , however, the respective documentation is made, including annexes and instructions that allow a thorough understanding of the procedure and carry out a control of the same by analyzing unstructured times of each activity, on the other hand, it is possible to mitigate the different threats and negative impacts that may have to face the changes made, in addition, a larger organization and control of the process, generating a measurement system based on indicators that have greater support and control to what has been developed with their respective monitoring according to the stipulated to finalize an impact study was determined to determine the viability of the project or. DOI: http://dx.doi.org/10.21017/rimci.2020.v7.n13.a

Improving Care Coordination for Comorbidity and Cancer: A Necessity for Patients With Cancer.

Cancer does not occur in isolation of people’s other chronic issues. Fifty-eight percent of patients with cancer have at least one other chronic or comorbid condition1; thus, cancer is only one of the diagnoses and treatments they have to deal with. Although patients with cancer often experience issues with long-term functional, psychological, and physical adverse effects from cancer treatment that negatively affect their quality of life,2,3 it is important to remember that chronic illnesses also add to patients’ cancer-related issues.4,5 In order to ensure quality patient outcomes, care needs to be continuous, consistent, and unique to each patient’s healthcare needs including existing comorbid conditions.6 This means that care coordination between oncologists and primary care providers (PCPs) who manage the existing chronic conditions is essential for comprehensive cancer care. Coordination of care is critical in ensuring that all of the healthcare needs of the patient are met including ensuring that all chronic conditions are under control during cancer treatment.7 Currently, care for patients with cancer is fragmented—siloed with very little interaction between the oncologist and PCP.8–10 The lack of care coordination increases the risk for poor outcomes and limits the patient’s quality of life.1 Lack of care coordination can lead to inadequate care as the care becomes fixated on the cancer while other health issues go unattended.11,12 This lack of coordination can also lead to fragmented care, polypharmacy, adverse drug reactions, toxicity, unplanned hospitalizations, uncontrolled chronic illnesses,13 and higher healthcare costs. With increasing survival rates, new models of care, and longer life, the role of the PCP becomes even more important and should be integrated into the cancer care trajectory from the point of diagnosis forward. Patients trust their PCP, and they can provide valuable support during diagnosis, selecting of treatment options, treatment phase, stability, recurrence, palliative care, and end-of-life care.1 Primary care providers have important roles during these phases such as managing comorbid conditions, managing depression, establishing do-not-resuscitate status, and discussing/referring patients to hospice. Having the PCP involved throughout the entire care trajectory allows them to be involved in care and better understand the patient’s needs.1 About 20% of survivors report they did not see a PCP in the second year following their cancer diagnosis.1 Survivors who report having both an oncologist and PCP involved in their care perceived higher quality of their care.1 Improved outcomes and higher quality of care occur when both PCP and oncology specialist are involved in the care.1 Guidelines need to be developed that consider both the treatment of the comorbidities and the cancer simultaneously. Such guidelines could assist providers (oncologists and PCPs) in understanding when cancer treatment guidelines take precedence over other chronic illnesses and vice versa. Currently, most treatment guidelines exist within the silo of the specialty in which they were developed and thus become problematic when they contradict each other and cause confusion for the patient.14,15 A standard model of care coordination during and after cancer treatment for patients with comorbidities is needed. There is little research on best models of care, or agreement on the roles of each type of provider. What is the best model for comanaging the patient with cancer and a preexisting comorbidity? Is formalized care coordination cost-effective? Does coordinated care result in improved patient care metrics, such as quality of life, patient satisfaction, and outcomes?4 Solutions need to be developed that address the existing challenges and barriers and prevent us from coordination of care at the provider level. Barriers include knowledge and skills (patients and providers), communication (between providers and between patients and providers), and financial cost/resources.16 In order to address each of the barriers and ensure continuity of care, many research questions need to be asked and answered. These include the following: (1) What is the ideal shared care model between oncology and primary care? What would it look like? (2) How do we ensure communication and coordination between providers about their roles starting at the point of diagnosis? How do we include the PCP as a part of the cancer care team? (3) How best can we utilize the electronic health record for this comprehensive patient care? (4) How can cancer care plans be shared with primary care? (5) How do we provide clarity regarding the role each provider plays to the patients so they understand whom to contact about various issues and so that patients understand their preferences are considered? It is important that nurses take the lead in trying to improve the care coordination between primary care and oncology providers. Only then can we have patient-centered cancer care.

Silver-Copper Oxide Heteronanostructures for the Plasmonic-Enhanced Photocatalytic Oxidation of N-Hexane in the Visible-NIR Range.

Volatile organic compounds (VOCs) are recognized as hazardous contributors to air pollution, precursors of multiple secondary byproducts, troposphere aerosols, and recognized contributors to respiratory and cancer-related issues in highly populated areas. Moreover, VOCs present in indoor environments represent a challenging issue that need to be addressed due to its increasing presence in nowadays society. Catalytic oxidation by noble metals represents the most effective but costly solution. The use of photocatalytic oxidation has become one of the most explored alternatives given the green and sustainable advantages of using solar light or low-consumption light emitting devices. Herein, we have tried to address the shortcomings of the most studied photocatalytic systems based on titania (TiO2) with limited response in the UV-range or alternatively the high recombination rates detected in other transition metal-based oxide systems. We have developed a silver-copper oxide heteronanostructure able to combine the plasmonic-enhanced properties of Ag nanostructures with the visible-light driven photoresponse of CuO nanoarchitectures. The entangled Ag-CuO heteronanostructure exhibits a broad absorption towards the visible-near infrared (NIR) range and achieves total photo-oxidation of n-hexane under irradiation with different light-emitting diodes (LEDs) specific wavelengths at temperatures below 180 °C and outperforming its thermal catalytic response or its silver-free CuO illuminated counterpart.

Primary Care Physician Perspectives on Caring for Adult Survivors of Hematologic Malignancies and Hematopoietic Cell Transplantation

BackgroundPrimary care physicians (PCPs) may face barriers to caring for hematologic malignancy and hematopoietic cell transplantation (HCT) survivors. MethodsA Web-based survey consisting of 40 questions and 2 case scenarios was administered to 302 PCPs at 2 large integrated health care systems. The questionnaire assessed perceived barriers to delivery of care to hematologic malignancy/HCT survivors, resources available to care for cancer survivors, practices for care coordination with hematologist-oncologists, and preferred models of care delivery. ResultsOverall response rate was 30% (n = 86). PCPs reported several barriers such as lack of resources to facilitate care (69%), lack of awareness of screening/prevention guidelines (55%) and psychosocial needs of survivors (65%), inadequate time (65%), and patient preference to follow up with their oncologists (66%). They expressed confidence in caring for general medical issues (84%) and general cancer screening (73%), but they preferred that oncologists manage cancer-related medical issues (42%) as well as screen for cancer recurrence (52%) and secondary cancers (55%). In multivariable analysis, PCPs who had previously cared for a large number of hematologic malignancy/HCT survivors and those with a longer time since graduation from medical school had greater confidence in managing cancer-related medical issues. ConclusionPCPs report several barriers in providing care to hematologic malignancy/HCT survivors. Clinical experience with this patient population is associated with greater confidence in providing survivorship care. Several barriers identified by PCPs in providing survivorship care to hematologic malignancy/HCT survivors are potentially addressable by education and clinical decision support tools and guidelines, thereby enhancing the patients’ clinical experience and care coordination with hematologist-oncologists.

So Close, yet so Far: Discrepancies between Uveal and Other Melanomas. A Position Paper from UM Cure 2020.

Despite much progress in our understanding of uveal melanoma (UM) over the past decades, this rare tumour is still often misclassified. Although UM, like other melanomas, is very probably derived from melanocytes, it is drastically different from cutaneous melanoma and most other melanoma subtypes in terms of epidemiology, aetiology, biology and clinical features, including an intriguing metastatic hepatotropism. UM carries distinctive prognostic chromosome alterations, somatic mutations and gene expression profiles, allowing an active tailored surveillance strategy and dedicated adjuvant clinical trials. There is no standard systemic treatment for disseminated UM at present. In contrast to cutaneous melanoma, UMs are not BRAF-mutated, thus curtailing the use of B-Raf inhibitors. Although these tumours are characterised by some immune infiltrates, immune checkpoint inhibitors are rarely effective, possibly due to a low mutation burden. UM patients across the world not only face rare cancer-related issues (e.g., specific management strategies, access to information and to expert centres), but also specific UM problems, which can be exacerbated by the common misconception that it is a subtype of cutaneous melanoma. As a European Consortium dedicated to research on UM and awareness on the disease, “UM Cure 2020” participants urge medical oncologists, pharmaceutical companies, and regulatory agencies to acknowledge UM as a melanoma with specific issues, in order to accelerate the development of new therapies for patients.

Evaluation of a risk-based approach to follow-up care for breast cancer survivors: From oncology specialist to primary care provider (PCP).

6529 Background: The number of cancer survivors in the Unites States is expected to exceed 18 million by the year 2020. Predicted care demands coupled with an anticipated shortage of oncologists have led to alternate follow up care models and providers. This nurse practitioner- (NP) led survivorship team was charged with developing a risk-based discharge plan for the > 8,000 breast cancer survivors in our survivorship clinic at this NCI-designated cancer center. Methods: In collaboration with breast oncologists and surgeons, a risk-based strategy to identify and transition eligible survivors to their PCPs was developed. Low risk was determined by: stage, absent disease and significant late-effects, and time since diagnosis. Interventions: Evidence supporting the willingness, availability and expectations of PCPs to provide follow-up care to cancer survivors was reviewed. Criteria for eligibility were developed; patient and PCP educational documents were created. Continued breast cancer screening at our center was offered with results sent directly to PCP. Outreach educational programs were provided to local PCP groups to build relationships and provide breast specific follow up recommendations. To promote communication and collaboration between NP and PCP prior to and at the time of transition, clinic notes were shared after each survivorship visit. A comprehensive transition note including detailed follow-up recommendations was provided at the time of transition. Patients were assured of rapid return to the oncology provider in the event of recurrence or cancer related issue. Results: 5080 patients were offered transition, with 3642 accepting. Mitigating factors and facilitators to transition for both patients and PCP will be discussed and educational strategies to overcome barriers will be described. Conclusions: Transition of breast cancer survivors’ care to PCPs is successful approximately 56% of the time. Key factors include seamless communication among providers and early discussions with patients to set expectations and normalize the transition early in the care pathway.

Profiling cancer-related distress and problems: A latent class analysis approach.

e23191 Background: Psychological distresses, emotional troubles, social difficulties as well as both physical and practical issues are all among oppressive problems that oncological patients have to face almost every day. On one hand, these problems seem to have a strong impact on quality of life; and to the other hand, these issues seem to be related to specific cancer-related variables ( e.g.: type and localization of the tumor). Thus, the aim of the study was to use a Latent Class Analysis (LCA) approach to profile a latent structure accounting for the covariance between psychological distress and everyday problems due to cancer. A one-factor model with three classes was hypothesized, which comprised distress and cancer-related problems as indicators and age, type of medical treatment as well as type and localization of tumor as external variables that moderate the latent structure. Methods: Patients ( N = 264, 62.3% female, mean age = 65.3, SD = 12.4) were enrolled at the Oncology Day Hospital, “Presidio Ospedaliero” of Saronno, ASST Valle Olona, Italy. Using the standardized Distress Thermometer and Problem List (TD&PL; NCCN, 2015) patients were tested for: (A) distress; (B) practical problems (Cronbach’s α = .63); (C) social difficulties (Cronbach’s α = .65); (D) emotional issues (Cronbach’s α = .86) and (E) physical problems (Cronbach’s α = .77). Results: First of all, a CFA was performed to test the original factorial structure of the DT&PL. The original five factor solution was supported by adequate fit indices: RMSEA = .063; CFI = .924. Then, the LCA (10000 bootstrap resampling) shows the goodness-of-model fit [χ2 = 10.01; p = .11; LRχ2 = 9.30; p = .09] and the goodness-of-classification quality [Entropy = .80 ( > .7); Average-Latent-Class-Assignment-Probability: .975, .900, and .902 for Class1, Class2, and Class3, respectively]. The LCA identified a latent variable with three classes (VLMR = 193.38; p < .001; Class1 = .49%; Class2 = .23%, and Class3 = .28%). In addition, interactions with the latent variable were found for age ( β = .12; p = .039), type of medical treatment ( β = .29; p = .009), as well as type and localization of tumor ( β = .20; p = .025). Conclusions: These results provided a better understand of psychological distress and cancer-related issues: each class represents a specific “profile” – moderated by age, type of medical treatment, and type and localization of tumor. These results recommend paying more attention to the specific profile expressed by the patient suggesting new ways to improve their quality of life.

Nutritional and metabolic derangements in Mediterranean cancer patients and survivors: the ECPC 2016 survey.

BackgroundThe prevalence of nutritional derangements in patients with cancer is high. This survey assessed patients' awareness of cancer‐related nutritional issues and evaluated how important they perceive the impact of nutrition on cancer and treatment to be.MethodsA structured questionnaire was developed to determine: presence of feeding problems, perception of nutrition importance, and perception of physicians' approach to nutrition. The European Cancer Patient Coalition disseminated the questionnaire to its members in 10 countries. The Mediterranean cluster (Italy, Spain, and Greece) was analysed separately to further determine specific patterns in answers.ResultsIn total, 907 respondents completed the questionnaire (68.8% female participants; 51.7% with cancer; 48.3% cancer survivors; 59.3% diagnosed with cancer ≤3 years ago; 46.2% receiving treatment for <1 year). Feeding problems during illness/therapy were experienced by 72.5% (628/867) of all respondents (Italian: 90.0%, 117/130), although up to 53.9% (467/867) reported that physicians did not check their feeding status. Overall, 69.6% (586/842) of respondents reported weight loss after cancer diagnosis (moderate to severe: 36.7%, 309/842). For Italian respondents, the percentages of overall weight loss and moderate‐to‐severe weight loss were 85.1% (109/128) and 70.3% (90/128), respectively. Only 35.0% (295/842) of all respondents reported having their weight measured regularly during treatment; 45.7% (385/842) believed their physician considered cancer‐related weight loss unimportant. Respondents [all: 56.9% (472/830); Italian: 73.0% (92/126); Spanish: 68.9% (42/61); Greek: 79.7% (47/59)] were unaware of supplements' negative effects during therapy or the need to inform their physician about these supplements [all: 43.6% (362/830); Italian: 55.6% (70/126); Spanish: 47.5% (29/61); Greek: 49.2% (29/59)]. The term ‘cachexia’ was generally unknown to respondents [all: 72.9% (603/827); Italian: 64.3% (81/126); Spanish: 68.9% (42/61); Greek: 47.5% (28/59)] and most respondents [all: 92.4% (764/827); Italian: 91.3% (115/126); Spanish: 91.8% (56/61); Greek: 86.4% (51/59)] received no cachexia‐related information.ConclusionsPatients reported differences in perspective between them and physicians on cancer‐related nutritional issues and the specific nutritional approaches available for cancer treatment. Increasing physician focus on nutrition during treatment, particularly among Italian physicians, and providing information on optimizing nutrition to patients are essential factors to improving patients' quality of life.

Dismay and disparities - economic development and cancer incidence

The distribution and determinants of cancerous diseases in specified populations attempts to prevent and control cancer-related public health issues, and is an essential step in epidemiological studies. During economic growth, every society undergoes several substantial structural changes in healthcare demand and supply. In this paper, we discuss the relationship between economic growth and cancer incidences. The purposes is to describe and measure the influence of an increasing per capita income on the overall incidence of cancer. By using worldwide cross-sectional data from 162 countries, regression results with crude and age-standardised rates, allows us to measure the elasticity of cancer incidences with respect to per capita income and to decompose the elasticity coefficient into two components: age-effect and lifestyle-effect. In this article we sketch a macroeconomic theory of cancer incidence. We introduce some basic hypotheses about how demand-side economic structural changes may affect the evolution of cancer incidence. Finally, we try to develop a basic framework in order to explain how economic structural changes on the demand-side can affect the evolution of cancer incidence.

Comprehensive cancer control in the U.S.: summarizing twenty years of progress and looking ahead.

In order to celebrate the accomplishments of the Centers for Disease Control and Prevention's (CDC) National Comprehensive Cancer Control Program (NCCCP), the Comprehensive Cancer Control National Partners (CCCNP) developed this Special Issue on Cancer Causes and Control. This, the third Special Issue on Comprehensive Cancer Control (CCC), is a reflection of 20years of building successful partnerships to prevent and control cancer; planning and implementing strategic cancer control; collaborating to address national cancer prevention and control priorities; evaluating efforts; sharing successes; and, in later years, serving as a model for global cancer control planning and implementation. The CDC currently supports cancer control planning and implementation in all 50 states, the District of Columbia, eight tribes or tribal organizations, and seven Pacific Island Jurisdictions and U.S. territories through the NCCCP. CCC is an approach that brings together multi-sector partners to address the cancer burden in a community collectively by leveraging existing resources and identifying and addressing cancer related issues and needs. The Comprehensive Cancer Control National Partnership (CCCNP), a partnership of national organizations, has been committed to supporting comprehensive cancer control efforts since 1999. We summarize the efforts described in this Special Issue. We also describe opportunities and critical elements to continue the momentum for comprehensive cancer control well into the future.

Reaching Out to Public Libraries to Help Reduce Cancer Information Disparity

In light of growing interest in people taking more proactive roles in managing the course of long term illnesses, ensuring ready access to cancer information supporting programs has become one of the paramount mandates, for many national cancer control programs. In Japan, the Center for Cancer Control and Information Services, a division of the National Cancer Center Japan (NCC-CIS), is tasked with dissemination of reliable and comprehensive cancer information for all citizens including patients and their families. NCC-CIS compiled cancer information has long been delivered via both dedicated portal “Ganjoho (Cancer Information) Service” ( https://ganjoho.jp ) as well as brochures. As majority of cancer patients and their carers tend to be seniors who are not net-savvy, the portal has its limitations as dissemination channel. A more personalized support is provided by a nationwide network of Cancer Information and Support Centers (CISCs), collocated within 434 state-designated cancer hospitals. CISCs offer both information and counseling support to anyone who has cancer related issues, even if they have never been treated at the given facility. While CISC is a public service, subsidized with national and prefectural funding, many of those in need, remain unaware of the CISCs - at least in part, due to its very location, within a hectic acute care settings. To reach a wider audience, NCC-CIS and CISCs have started to collaborate with public libraries which have traditionally been a neighborhood source of reference information for both the young and old, and clearly more approachable than medical professionals in large hospitals. We have begun by disseminating a “starter-kit” of NCC-CIS publications to public libraries that have signed up with “Cancer Information Gift” project, a donor funded effort launched last summer. To date, almost 60 libraries have taken up this opportunity to either launch a new “Cancer Information Corner”. We have also brought the participating libraries and local CISCs together in regional workshops settings, to explore ways to mutually complement the information services offered by both parties. Collaborative initiatives that have come out of such explorations include “Book Talk on Disease in Library”, an interactive session in relaxed settings, where participants can feel more at ease, raising a wide range of personal concerns, around an issue highlighted in a given book, with both librarians and cancer counselors mediating the discussion. Referrals to CISCs from libraries are also beginning though in low volumes. While the “Cancer Information Gift” project, and its related initiatives are still very much at a nascent stage, we believe this collaboration could potentially go a lot further, to make reliable cancer information (and CISCs) more accessible to a wider segment of those in need, and in the process, help reduce the cancer disparity across the nation.

Global Health Strategy for Cancer: Think Globally, Act Locally! Building a Collaborative Partnership Between Manitoba (Canada) and Jaffna (Sri Lanka)

Background and context: The number of people diagnosed with cancer worldwide is estimated to double by 2035. The greatest increase is expected in low- and middle-income countries (LMIC) due to demographic changes, such as ageing and growing populations, and increasing exposure to risk factors. Approximately 8.8 million people die each year of cancer, or one in 6 deaths globally. The Canadian government has recently renewed its commitment as a progressive global citizen with efforts including improvement of global health equity. CancerCare Manitoba is the provincial agency responsible for cancer and blood disorders, including the delivery of a wide range of clinical services from prevention to screening to treatment and supportive services, as well as cancer surveillance, research, and education. CancerCare Manitoba has identified potential partnerships with governments, nongovernmental organizations, academic institutions, and funders to address current and future challenges related to global cancer control. This includes several LMIC partners who have expressed an interest in working with Manitoba on cancer-related issues. In this presentation, we will describe our plans and early experience with a team from the University of Jaffna, the northern region of Sri Lanka. With a focus initially on surveillance and cancer control planning, there is an excellent opportunity for mutual learning and advancement of programs for cancer surveillance and planning. Aim: To establish a local partnership by connecting Manitoba, Canada with an engaged team from the University of Jaffna, Sri Lanka to advance cancer surveillance and planning, and contribute to the “global war on cancer”. Strategy/Tactics: A phased approach is being taken to address locally identified needs for cancer control. CancerCare Manitoba staff will be part of the mentorship team working with local partners in Jaffna to ensure development of local capacity. Specifically, we will: initiate cancer surveillance and establish a cancer registry in Jaffna (building from a cross-sectional study → hospital based registry → regional registry); analyze data and report on patterns; and establish a strategic plan for cancer control. Program/Policy process: Early planning is underway, involving collaborators from Manitoba and Jaffna. A project proposal has been developed to provide scope and acquire seed funding. Outcomes: Success will be determined based on the context of each program, including: establishing a framework for cancer surveillance; satisfaction of local and international partners (e.g., the Global Cancer Surveillance unit at the International Agency for Research in Cancer); and production of reports as a basis for cancer control. What was learned: Early learnings include the importance of local engagement and dedicated mentorship to advance global health equity, manage challenges around (sustained) funding, and establish a foundation of motivated partners.

An insight into the health benefits of fermented soy products

The current review was aimed to summarize the nutritional values and various health benefits of fermented soy products. Several previous researches proved that soy products rich in protein can reduce the serum concentrations of total cholesterol, low-density lipoproteins (LDLs), and triglycerides if consumed instead of animal protein. Apart from these lipid-lowering effects, fermented soy products also proved to be effective in attenuating the effects of diabetes mellitus, blood pressure, cardiac disorders and cancer-related issues. The nutritional value of the fermented soy products gains much attention due to its increased levels compared to the non-fermented ones. The origin, compositions, nutritional values of different fermented soy products and health-promoting benefits of fermented soy products were systematically reviewed. Hence the in-depth analysis of the various research findings on fermented soy products, beneficial activities may help the future researchers to derive a conclusion on its beneficial effects on health.

Jimmie Holland: The founder, developer, and the soul of the International Psycho-Oncology Society.

Jimmie Holland: The founder, developer, and the soul of the International Psycho-Oncology Society.

The current state of prostate cancer treatment in Trinidad and Tobago.

Prostate cancer mortality in the Caribbean region is among the highest in the world and prostate cancer is the most common cancer in Trinidad and Tobago. There is a two-tiered healthcare system in Trinidad and Tobago, and prostate cancer related issues account for a significant percentage of urologists’ workload. Delivery of care is sometimes constrained by limited financial resources. Prostate-specific antigen testing is widely available but there is no national guideline. Treatment options available include active surveillance, radical prostatectomy, external beam radiotherapy and brachytherapy. Patients have access to androgen deprivation, chemotherapy and palliative care for the management of advanced disease. Generally, the infrastructure for treatment in Trinidad and Tobago is satisfactory but would benefit from further investments in technology and human resources.

Real-life feasibility of home-based pulmonary rehabilitation in chemotherapy-treated patients with thoracic cancers: a pilot study

BackgroundPatients with advanced lung cancer (LC) or malignant pleural mesothelioma (MPM) exhibit limitation of exercise capacities and alteration of quality of life (QoL) induced by cancer and its treatment. Few studies assessed pulmonary rehabilitation (PR) in these chemotherapy-treated patients, and none evaluated a home-based PR program.MethodsIn this prospective uncontrolled observational pilot study, patients treated by chemotherapy for LC or MPM were screened for a home-based PR program combining exercise training with global cares including therapeutic education and psychosocial management. Feasibility and safety were evaluated by attendance and adherence to PR program. Various exercise tolerance tests, including 6-min walk test (6MWT) and 6-min stepper test (6MST), were performed before and after PR associated with, QoL and psychological assessment (VSRQ and HAD, respectively).Results243 patients were considered eligible but only 71 (60.6 ± 8.8 years) started a PR and 47 completed the program. Refusals to participate were mostly related to lack of motivation whereas withdrawals to PR were related to cancer-related medical issues. No adverse event related to PR was observed. Baseline 6MWT distance was associated with performance status (r = − 0.45, p = 0.001) and mMRC dyspnea scale (r = − 0.49, p < 0.001) but not with lung cancer stage. Post-PR reassessment showed 6MWT stability and 6MST improvement in patients who completed the program. Daily physical activity (p = 0.007) and anxiety (p = 0.02) scores were significantly improved.ConclusionsHome-based PR was feasible and safe in patients with advanced LC or MPM. Exercise capacities stability in patients who completed the PR program suggests that PR might be beneficial. Further studies are warranted to confirm and to improve the potential value of PR in these patients.

Cancer Rehabilitation: Impact of Physical Activity on Initial Clinical Assessments

ABSTRACT Background: Preconditioning and prehabilitation have been reported to ameliorate a host of health- and cancer-related issues, yet few studies have examined implications of past physical activity (PA) on physiological and psychological parameters in cancer survivors. Implications of prior PA on physiological and psychosocial variables in cancer survivors were acquired during an initial assessment prior to participation in a cancer rehabilitation program. Methods: Cardiorespiratory fitness (VO2peak), fatigue (Piper Fatigue Scale, PFS), and depression (Beck Depression Inventory, BDI) were measured (N = 807; 67 ± 13 years). PA groups were divided by self-reported prior PA history (Group 1 = none; Group 2 &amp;lt; 150 min/week; Group 3 ≥ 150 min/week). Results: Significant (P &amp;lt; 0.05) main effects for PA were observed among all variables except the PFS affective subscale. Groups 1 and 3 were significantly (P &amp;lt; 0.05) different for BDI. Groups 1 and 3 were significantly (P &amp;lt; 0.05) different for the total, sensory, and cognitive subscales of the PFS. Finally, Groups 1 and 3, and Groups 2 and 3 differed significantly (P &amp;lt; 0.05) for the behavioral, sensory, and cognitive subscales of the PFS. Conclusion: Cancer survivors with prior PA levels ≥ 150 min/week performed better on measures of VO2peak, were significantly less fatigued and depressed at initial assessment.

Breast self-examination in Greek midwives and midwifery students.

The aim of this study is to assess breast self-examination (BSE) practice in a representative sample of Greek midwives and midwifery students. Breast self-examination (BSE) is infrequent in healthcare professionals, including physicians and nurses. All midwives (n=245) and graduating midwifery students (n=165) who attended a congress of midwives were eligible to participate in the study, and a self-administered, anonymous questionnaire was developed to assess BSE practice. Midwives performed BSE more frequently than students (p<0.001). In addition, 27.0% of students performed BSE less frequently than every year whereas the midwives' rate is 14.0% (p<0.001). The proportion of subjects searching for specific signs of breast cancer during BSE and the BSE technique did not differ between midwives and students. In midwifery students, higher perceived knowledge of breast cancer-related issues was associated with more frequent BSE. Only a minority of Greek midwives and midwifery students practice BSE every month, and therefore implications for nursing management in BSE education should be included in midwifery school curricula to ensure increased BSE frequency, improved BSE accuracy and the promotion of BSE teaching to patients.

Living with incurable cancer: what are the rehabilitation needs in a palliative setting?

Background: Increasing numbers of people are living with incurable cancers. Symptoms, side effects, and treatment burdens impact on physical functioning, yet little is known about the impact on people’s lives and how best to provide rehabilitation.Materials and methods: A qualitative study employing a phenomenological approach explored the lived experience of incurable cancer. A purposive sample of six people participated in semi-structured interviews. The data were analysed thematically at a semantic level to identify the functional difficulties experienced by people living with incurable cancer, the meanings of those difficulties, and participants perceived rehabilitation needs.Results: People living with incurable cancer described cancer-related issues spanning all five domains of the International Classification of Functioning, Disability and Health (ICF). Although highly valued amongst study participants, rehabilitation services were difficult to access, poorly utilised, and referrals were sporadic and consequential; indicative of poor awareness of rehabilitation for people with incurable cancer amongst potential referrers.Discussion: Participants valued a change in terminology away from “palliative” towards more positive language in line with enhanced supportive care movements. Validated tools such as the Palliative Care Therapy Outcome Measure, which align with the ICF, would allow rehabilitation professionals to demonstrate maintenance or improvement in participation and wellbeing.Implications for RehabilitationIncurable cancer leads to a fluctuating multifactorial disability.People living with incurable cancer can benefit from rehabilitation input throughout their illness.Offering flexible and varied rehabilitation options for people living with incurable cancer will increase physical and emotional well-being, function, and coping.Allied health professionals should take and create opportunities to promote rehabilitation for people living with incurable cancer and their services to other potentially referring healthcare professionals to increase understanding of benefits and utilisation of available services for people living with incurable cancer.

Cancer Survivorship Care Plan Utilization and Impact on Clinical Decision-Making at Point-of-Care Visits with Primary Care: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

Every cancer survivor and his/her primary care provider should receive an individualized survivorship care plan (SCP) following curative treatment. Little is known regarding point-of-care utilization at primary care visits. We assessed SCP utilization in the clinical context of primary care visits. Primary care physicians and advanced practice providers (APPs) who had seen survivors following provision of an SCP were identified. Eligible primary care physicians and APPs were sent an online survey, evaluating SCP utilization and influence on decision-making at the point-of-care, accompanied by copies of the survivor's SCP and the clinic note. Eighty-eight primary care physicians and APPs were surveyed November 2016, with 40 (45%) responding. Most respondents (60%) reported discussing cancer or related issues during the visit. Information needed included treatment (66%) and follow-up visits, and the cancer team was responsible for (58%) vs primary care (58%). Respondents acquired this information by asking the patient (79%), checking oncology notes (75%), the SCP (17%), or online resources (8%). Barriers to SCP use included being unaware of the SCP (73%), difficulty locating it (30%), and finding needed information faster via another mechanism (15%). Despite largely not using the SCP for the visit (90%), most respondents (61%) believed one would be quite or very helpful for future visits. Most primary care visits included discussion of cancer or cancer-related issues. SCPs may provide the information necessary to deliver optimal survivor care but efforts are needed to reduce barriers and design SCPs for primary care use.