National Cancer Control Program Research Articles

Governing the Slovenian National Cancer Control Programme - Key Lessons Learnt

Abstract Issue Strategic documents addressing major public health concerns should extend beyond health sector. Cancer control is commonly perceived only as a health issue, thus involving diverse stakeholders is challenging. Description of the problem The inclusion of stakeholders within and beyond the health sector is crucial in the preparation, and through implementation of National Cancer Control Programmes (NCCP). Lessons learned on how to involve and maintain fruitful collaboration with diverse stakeholders in Slovenian NCCP are presented. Results Over the past 14 years Slovenia’s NCCP has built a reliable and reputable partnership with diverse stakeholders, a collaboration that continues to evolve. Efforts extend across multiple sectors, encompassing health, education, employment, research, environment, technology, and non-governmental organizations. NCCP has set up multistakeholder governance structures: an advisory board, board of experts, specialised expert groups, and a group of representatives of cancer hospitals. These groups engage a diverse range of experts and institutions nationwide. Whenever feasible, representatives of patient organizations are included. All these structures hold regular meetings, complemented by an annual event that convenes all stakeholders and also provides an invaluable platform for informal networking. To ensure seamless coordination of all activities, a dedicated team is essential. Our approach has evolved to embrace a dual leadership, comprising both a public health specialist and a clinical expert. Additionally, we benefit from the expertise of communication experts, who offer valuable insights into effectively reaching diverse audiences. Lessons Governing Slovenia’s NCCP by involving diverse stakeholders in planning and implementation activities has demonstrated its effectiveness. Furthermore, we are witnessing an increasing number of new stakeholders actively seeking out to participate in the NCCP. Key messages • Slovenia’s NCCP is recognized for its credibility and strategic approach. • Involving diverse stakeholders in cancer control endeavours has proven effective, fostering trust and partnerships.

The role of communication in the successful implementation of the Slovenian NCCP

Abstract Issue Cancer remains a significant global public health challenge, necessitating comprehensive strategies for effective control and management. Slovenian National Cancer Control Programme (NCCP) addresses this challenge by prioritizing proactive communication with various stakeholders engaged in cancer care planning, delivery and advocacy. The communication strategy within this programme plays a pivotal role in its successful implementation. Description of the problem Active engagement and collaboration among stakeholders is crucial for achieving the programme’s objectives. NCCP seeks to address this challenge through various communication activities by fostering dialogue, sharing best practices, and facilitating networking opportunities among oncology professionals throughout Slovenia. Additionally, it seeks to strengthen partnerships with sectors beyond health and prioritizes engagement with cancer patient advocacy groups. Results The programme has devised a long-term communication strategy, guiding annual communication plans to engage stakeholders and foster support for its objectives. Notable communication activities in the period 2022-2024 include: organizing annual meetings for different oncology stakeholders including cancer patient associations, hosting impactful professional events, conducting visits to regional cancer hospitals, distributing e-newsletters and managing a NCCP website. Initial outcomes indicate strengthened communication and collaboration among professionals and institutions in the field of oncology nationwide. Engagement with patient advocacy groups has facilitated discussions on topics important to patients. Lessons Effective communication with diverse stakeholders is crucial for comprehensive cancer control. Collaborating across sectors enhances the impact of cancer control initiatives. Enhanced networking fosters innovation and synergy among oncology professionals, positioning Slovenia for greater success in cancer control. Key messages • Slovenia’s NCCP prioritizes proactive communication, fostering collaboration among stakeholders. Annual events, newsletter, and partnerships strengthen awareness and drive comprehensive cancer control. • Long-term communication strategy of Slovenia’s NCCP drives stakeholder engagement, and supports strategic objectives. This proactive approach strengthens comprehensive cancer control efforts.

Using the innovative tool to prepare a quality national cancer control programme

Abstract Issue National cancer control programmes (NCCPs) are key documents in European Member States (MSs) used for the management of cancer policy. While some countries still have not prepared their NCCPs, there are several others, whose NCCP is not of high quality or not implemented. Description of the problem There is frequently a lack of knowledge in countries on how to prepare a quality NCCP or how to improve the existing one. Our objectives were: 1. To provide help in the preparation of an NCCPs and in cancer control to EU MSs 2. To enhance the availability of all the documents needed and provide best practices from other MSs. The development of an innovative tool was therefore the main objective of iPAAC Joint Action (JA). Streamlining of all NCCP-related documents prepared by the three JAs in cancer policy (EPAAC, CanCon, iPAAC) was central to the deliverables. Results The solution lied in the preparation of the interactive innovative tool called Roadmap on the Implementation and Sustainability of Cancer Control Actions (Roadmap). It was developed in a joint effort and collaboration between EU MSs and the European Commission. It is available online and can be used by all countries, including countries that are not part of EU, and who aim at preparing a high quality NCCP. The extensive content of the tool covers primary prevention, health promotion, screening, diagnosis, treatment, and health care, as well as a number of sub-areas with important contents, and over a hundred one-pagers, which include national and regional experiences. Among the latter, the European Guide for Quality NCCPs with instructions how to prepare a quality NCCP is presented as one pager. Lessons As the result of over 10 years of joint work in cancer control at EU level MSs have now both, the opportunity to learn from each other and the opportunity to access all key information they need for controlling cancer, including the instructions on the preparation of the key document, their NCCP. Key messages • Using the Roadmap countries have access to instructions and guidance for the preparation of a quality NCCP. • The Roadmap enables the access to all key documents for the management of cancer control in one place to all countries.

Co-designed study with the Traveller Community in Ireland to determine cancer awareness & attitudes

Abstract Background Irish Travellers are a distinct ethnic minority group (formal recognition March 2017). They experience higher mortality than the general population at all ages for all causes of death. Study Aim To determine cancer awareness and attitudes among the Traveller Community in Ireland, and to identify barriers/enablers to cancer risk reduction behaviours and early diagnosis of cancer. Methods A co-designed multi-method study was developed in collaboration with Pavee Point, a national NGO for Travellers, the National Social Inclusion Office (NSIO) and the National Cancer Control Programme (NCCP) including: 1. Consultation with Pavee Point and NSIO representatives to inform the study proposal and methodology. 2. Co-design of methodology for ethics applications and subsequent data collection plan including interview topic guides and the development of a culturally appropriate version of the NCCP’s 2022 National Survey on Cancer Awareness, adding questions on social determinants of health and screening participation. 3. Collaboration with 12 peer-led Primary Health Care for Travellers Projects (PHCTPs), to provide in-person training for Traveller Community Health Workers to undertake a cross-sectional survey of 380 adult Travellers. 4. Collaboration with PHCTPs to undertake 20 semi-structured interviews with Travellers. 5. Conduct of semi-structured interviews with healthcare professionals to explore perceptions of barriers/enablers for Travellers engaging with the health system. Lessons Learned Working closely and collaboratively with our study partners, we gained valuable insights which enabled effective and efficient data collection across 8 counties, while exceeding our survey target sample size. Implications for Research: Collaborative, trusting, and respectful relationships are critical for all studies, but particularly when working with minority groups. Conclusions The study findings will inform policy for improved cancer outcomes among Travellers in Ireland. Key messages • Formation of a collaborative and respectful relationship with the Traveller community has facilitated successful research. • Traveller Community Health Workers (peer researchers) were key to the success of data collection.

Uptake of cervical screening and acceptability of HPV self-sampling in Irish Traveller women

Abstract Introduction Irish Travellers are a minority ethnic group. The 2010 All-Ireland Traveller Health Study noted the life expectancy of Traveller women was 11 years shorter than women in the general population. Coverage of the CervicalCheck, the Irish cervical screening programme, is 78.7% overall, however, there is no recently published data on the attendance of Traveller women. This study sought to determine participation by eligible Traveller women in CervicalCheck and the acceptability of HPV self-sampling. Methodology A face-to-face cross-sectional survey, adapted from the National Cancer Control Programme’s 2022 National Survey on Cancer Awareness, was disseminated to Irish Travellers via Primary Health Care Travellers Project peer researchers, following ethical approval, May to December 2023. Results 451 Travellers participated; 286 (63.4%) were female. Of these, 178 (62.2%) were in the eligible age group for cervical screening. 134 (75.3%) advised they had received an invitation to screening; 121 (68% of all eligible; 90% of all receiving an invitation) advised they had attended at least once (regular attenders 88 (49.4%); 27 (15.2%) irregular attenders). Of all responders in the screening eligible age group, 36 (20.2%) reported HPV self-sampling as acceptable; 18 (50%) of these were non or irregular attenders at screening. Similar proportions of 25-45 year-olds (20.4%) and 46-65 year-olds (20%) reported HPV self-sampling as acceptable. Conclusions Irish Traveller women face barriers to accessing mainstream health services. Uptake of cervical screening overall is lower compared to the general population in this study; one issue may be unreliable postal service to Travellers and non-receipt of invitations. While the overall acceptability of HPV self-sampling was low at 20.2%, half of those who would self-sample did not attend or attended irregularly. HPV self-sampling has the potential to improve cervical screening rates among Traveller women. Key messages • Irish Traveller women’s uptake of cervical screening is lower than general population. • HPV self sampling has potential to improve cervical screening rates in Travellers.

Assessment of sun protection factors in the Irish adult population following the SunSmart Campaign 2023.

SunSmart is the National Cancer Control Programme's annual skin cancer prevention awareness campaign. This study aimed to assess sun protection attitudes following the 2023 campaign, and compare findings to 2022. An online survey was conducted in September 2023, a repeat of the 2022 survey. Data were collated and analysed in Excel. In 2023, 48% (n=480) adults reported being sunburnt that summer. Younger adults were more likely than older adults to report sunburn (62% v 28% p<0.001). In assessing the "SunSmart 5s": 94% rated sunscreen, 88% rated shade, 84% rated hats, 71% rated long sleeves, and 70% rated sunglasses as important. Older adults were more likely than younger adults to rate each factor as important. A higher proportion reported each factor as important compared to 2022. Awareness of the campaign increased, 32% having heard of SunSmart, compared to 21% in 2022 (p<0.001). Awareness was higher in older adults (39% v 21% p<0.001), and in those who reported no sunburn (34% v 30% p=0.023). Awareness of SunSmart and perceived importance of the sun protection factors have improved since 2022, with perceived importance of the "SunSmart 5s" reasonably high. Reaching younger adults and improving their sun protection behaviours remain areas for progress.

The regional cancer spectrum in Uganda: a population-based cancer survey by sub-regions (2017-2020).

Accurate estimation of the burden of cancer in developing countries is a major public health concern for cancer prevention and control because of the limited coverage of population-based cancer registries (PBCRs). The cancer registration coverage status of Uganda was 11.90% and was not uniformly distributed in all regions of Uganda. This population-based survey was conducted to assess the burden of cancer in all the sub-regions of Uganda by site, sex and age group to accurately determine the cancer profile of Uganda by sub-region for a tailored intervention to mitigate cancer risk factors and burden. This study used existing administrative units of Uganda from which 55 districts emerged, forming 10 sub-regions as satellite population-based cancer registry study sites. Data on newly diagnosed cancer cases were retrospectively collected for the period 2017-2020 using a cancer notification form, entered into CanReg5 Software, exported to spreadsheets and univariate analysis was performed to determine the cancer spectrum, their proportions and crude rates by site, sex, age group and geographical location. A total of 25,576 cancer cases were registered, up to 14,322 (56%) were in females and, male cancers were 11,254 (44%). The top five female cancers in all the sub-regions included cervical cancer (43%, n = 6,190), breast (22%, n = 3,200), esophagus (5.6%, n = 800), ovary (5.2%, n = 746), Kaposi Sarcoma (KS) (4.7%, n = 666) and other less common cancers (18.5%, n = 2,720). In males, the top five cancers included prostate cancer 25.1 % (n = 2,820), esophagus 15.1% (n = 1,704), KS 12.4% (n = 1,395), liver 8.8% (n = 989) and stomach 4.8% (n = 539), with other less common male cancers accounting for 33.8% (n = 3,807).In all the sub-regions of Uganda, cancers of the esophagus, liver and KS are common in both males and females, but the number of males with these cancers is twice that of their female counterparts. In Rwenzori, Kigezi and Bugishu sub-Regions, there seems to be an increased risk of developing other skin cancers in females, while stomach cancers have been reported in both males and females. Most of the other sub-regions register emerging cases of only ovarian cancer in females. In children, the top three cancers included lymphoma, 33.9% (n = 653); soft tissue sarcomas, 20.8% (n = 400); malignant bone tumors, 15.8% (n = 305); myeloid-type leukemia, 13.8% (n = 265); and the other less common childhood cancers combined, 15.7% (n = 303). The proportion of childhood cancers is higher in the male child compared to the female at a ratio of 1.3:1. The sub-regional cancer spectrum in Uganda ranges from cervical cancer to breast, esophageal, ovarian and KS in females. Male cancers include prostate, esophageal, KS, liver and stomach cancers. Although the cancer profile is similar in most sub-regions of Uganda, except Ankole subregions with mountainous topography (Rwenzori, Kigezi, Bugisu), there has been significant variation in cancer profile, especially for males, where Non-Hodgkins Lymphomas is one of the cancers reported for Uganda by PBCRs in Gulu, and Kampala has been replaced by stomach cancers as one of the common male cancers in the sub-regions. These findings emphasize the need for the establishment and support of additional regional PBCRs and periodic population-based cancer surveys to accurately determine the burden of cancer, inform the establishment of regional cancer centers and guide national and sub-national cancer control programs in Uganda. Cancer surveillance systems using PBCRs should be part of the national cancer control program. Periodic population-based cancer surveys should also be conducted as part of Uganda's demographic and health surveys in areas without PBCRs to inform the country comprehensively and accurately on the cancer burden to design robust cancer mitigation measures.

S02-3: Slovenian Approach to Enhance Physical Activity Among Vulnerable Populations

Abstract Purpose These policy documents foster physical activity and sports that empowers every individual, regardless of their age, health status, or background, to lead healthier, more active lives. Methodology was based on desk research, analysis and synthesis of Slovenian policy documents. Policy Description In Slovenia, policy documents significantly influence the landscape of physical activity and sports, reflecting the nation's commitment to a healthier and more active society for all, including vulnerable populations. The National Sports Program (2014-2023), outlines a strategic direction for sports development, with a focus on enhancing participation and excellence in sports. This program affects a wide range of populations, including children, adults, individuals with disabilities, and those with chronic diseases. The National Nutrition and Physical Activity Programme (2015-2025), places strong emphasis on the importance of nutrition and physical activity in improving public health and overall well-being. The impact of this program extends to all citizens, with a particular emphasis on children, pregnant women, adults, and individuals with chronic diseases. 3. The Strategy for the Health of Children and Adolescents (2012; still ongoing), prioritizes the well-being of young generations by considering their environment, including opportunities for physical activity. This strategy primarily targets children and adolescents, addressing concerns related to obesity, health inequalities, and chronic non-communicable diseases. The Action Programme for Persons with Disabilities (2022-2030), promotes accessibility to sports and physical activities for individuals with disabilities. Strategic plan for the Development of the Cycling Network with Action Plan (Acceptance Predicted in 2024), aims to enhance active transportation options and promote physical activity, including people with disabilities. The National Diabetes Prevention and Care Development Programme (2020-2030), have a significant impact on raising awareness about health and physical activity, primarily targets residents with diabetes and those at risk. 7. The National Cancer Control Programme (2022-2026), focusing on prevention and care. Conclusion The impact of these policies extends to children, adults, and vulnerable populations, including those with disabilities and chronic non-communicable diseases. These policies create a framework that empowers all citizens, regardless of age or health status, to lead healthier, more active lives.

Accuracy Analysis of Topographical and Morphological Code in the RSUP Dr. Sardjito Cancer Registry, Indonesia

In cancer cases, a cancer registry functions as a national cancer control program to analyze cancer severity and risk factors in specific areas, aiming to reduce morbidity and mortality. Accurate coding is essential for producing a high-quality cancer database. This study aims to analyze the accuracy of the cancer registry at RSUP Dr. Sardjito in assigning topography and morphology codes. A mixed-methods approach was employed to evaluate code accuracy and identify factors influencing accuracy and inaccuracy based on the 5M framework. Data were sourced from the Hospital-Based Cancer Registry at RSUP Dr. Sardjito, with a total population of 4500 patients in 2021. A sample of 1000 cancer patients was selected using a simple random sampling technique. Each sample was analyzed as true or false based on verifier notes, revealing that 904 topography codes were accurate (90.40%) and 96 were inaccurate (9.60%). For morphology codes, 913 were accurate (91.30%) and 87 were inaccurate (8.70%). Researchers conducted in-depth interviews with registrars and verifier doctors and observed all cancer registry activities, focusing on topography and morphology codification. Observations and interviews indicated no obstacles in codification activities, but inaccuracies occurred, possibly due to case complexity. In conclusion, the study demonstrates high accuracy in the coding of cancer cases at RSUP Dr. Sardjito. The complexity of cases may contribute to inaccuracies. The study suggests continuous evaluation to enhance coding accuracy, which is crucial for effective cancer control programs.

Successful Establishment of a National Cancer Control Program (NCCP) and Cancer Registry in Eswatini: Lessons to Inform NCCPs in Low- and Mid-Income Countries

Successful Establishment of a National Cancer Control Program (NCCP) and Cancer Registry in Eswatini: Lessons to Inform NCCPs in Low- and Mid-Income Countries

Prostate cancer: A review paper of the evidence in relation to prostate cancer screening in the Irish Defence Forces

The lack of national guidelines for prostate cancer (PCa) screening in Ireland has historically led to ad-hoc screening practices among healthcare providers. This review focuses on evidence for and against prostate cancer screening among military personnel in Ireland, set against the backdrop of evolving guidelines and practices both in Ireland and internationally. A review of published literature was conducted, incorporating data from various studies and guidelines relevant to prostate cancer screening. To assess the risk specific to the Defence Forces Ireland, both civilian and military sources were cited. This included national surveys, landmark trials, and guidelines from the Irish College of General Practitioners (ICGP), the National Cancer Control Programme (NCCP), and international bodies like the UK National Screening Committee (NSC) and the American Urological Association (AUA). Synthesising these numerous, high quality, resources, led to a conclusion that the evidence does not support prostate cancer screening in the Irish military as there is no reduction in overall mortality from this process.

The Structure and Function of Oral Cancer Control in Kerala, India: A Narrative Review of Cancer Control Policy Documents from 1988 to 2020

The government of Kerala was the first state in India to come out with a comprehensive plan for cancer control based on National Cancer Control Program. The purpose of this review was to identify the structure and function of cancer control in Kerala, India with specific reference to oral cancer. A systematic search was done in PubMed using the keywords “Health Policy”, “Cancer”, “Oral cancer”, “Guiding document” and “Kerala”. All government of Kerala health-related websites were searched electronically for cancer-related policy documents. The medical library catalogs of the two government Comprehensive Cancer Care Centres in the state were searched. All available Government documents, institutional documents, other online resources related to cancer prevention were collected. A checklist was prepared to review the documents. Out of 18 documents identified, two cancer-specific policy documents and two health policy documents were included in the review.The cancer control strategies outlined in the reviewed documents presented a pragmatic vision for cancer control in low-resource settings. The concept called the ‘Kerala Cancer Care Grid’ outlined in one of the documents is a novel strategy to address the geographical inequality in access to cancer care. It recognized interdepartmental coordination and partnership with private sector institutions and community organizations as crucial for achieving comprehensive cancer control. In the reviewed documents, oral cancer was discussed mainly in the context of early detection, health education, and capacity building at the primary care level.

Greening Ireland’s oncology practice: Reducing climate toxicity and improving sustainability in a national chemotherapy formulary.

e13557 Background: Climate change has been acknowledged by the World Health Organisation (WHO) as a “fundamental threat” to healthcare delivery. However, healthcare now accounts for more than 5% of global emissions. Over 25% of the oncology services contribution to this relates to the development, transport and administration of systemic anticancer therapies (SACT), and represents a modifiable factor. In Ireland, the National Cancer Control Programme (NCCP) determines the standard of care systemic anticancer therapy (SACT) protocols. This study proposes to review existing protocols and assess for and highlight nationally implementable climate toxicity mitigation strategies. Methods: NCCP SACT protocols (available at https://www.hse.ie/eng/services/list/5/cancer/profinfo/chemoprotocols/) were reviewed for impact reduction potential under the following headings: 1) Baseline and regular tests and investigations; 2) Pre-medications; 3) De-escalation, and 4) ESMO Magnitude of Clinical Benefit. Results: A total of N = 333 protocols were reviewed. N = 32 protocols had multiple indications across more than one tumour stream. Overall, N = 702 opportunities were identified where the protocol impact could be reduced, either by consolidation of pre-medication and pre-hydration to oral administration, regimen or investigation de-escalation, dose banding, switching non-oral to equivalent oral SACT alternative or re-considering regimen use where clinical benefit is measured as non-substantial. In addition, there were a further N = 507 opportunities identified where baseline and regular investigations required by the protocol could be incorporated into routine visits, minimising hospital travel and time toxicity to patients. Conclusions: This study considered just one aspect of oncology care in Ireland, the delivery of SACT, and identified over 1200 opportunities across standardised national protocols where associated climate toxicity could be reduced without compromising standard of care. A sustainability matrix to promote identified action points is proposed for inclusion within all protocols and could be used in other jurisdictions. Further work to consider impact reduction opportunities in other areas of cancer care, including radiology and diagnostics should be considered.

Association between patient tumour characteristics and five-year survival in Nigerian patients with breast cancer.

e13504 Background: Breast cancer is a heterogeneous disease. The sociodemographic features and biological profile of breast cancer differ globally, especially in women of African descent. In Nigeria, limited studies explore the impact of these breast cancer-related factors on survival. This study evaluated the association between patients' tumour characteristics and survival in breast cancer patients in three regional tertiary cancer treatment centres across Nigeria. Methods: Data were extracted from patients' case files with a histopathologic diagnosis of breast cancer from January 1, 2005 - January 1, 2019. Patients' sociodemographic and clinical features were presented, and survival probabilities were reported; the Log-rank test was used to determine the association between time to death and categorical variables. Results: The study included 1020 patients across the three centres. Five-year survival probability was 0.65; 95% C.I: 0.60- 0.69. Most patients were between ages 30 and 49, and 49% presented with left-sided breast cancer. Patients aged&gt;70 had significantly better survival. Only 40% had Immunohistochemistry (IHC) done, out of which HR+ breast cancer accounted for 43% while triple-negative breast cancer was 30%. Patients who received Herceptin and had molecular subtyping (immunohistochemistry) done had a higher survival probability. Conclusions: Most breast cancer patients in Nigeria present at earlier ages with advanced disease. Regardless of patient tumour characteristics, 5-year survival rates are lower than global rates. Only a few patients have access to optimal breast cancer management, molecular subtyping and targeted treatment inclusive. There is an urgent need to fund the National Cancer Control program to aid in implementing its strategic framework for breast cancer screening and management to improve access to cancer care in Nigeria.

Abstract PO1-09-09: The journey of HR positive, HER2 negative metastatic breast cancer’s patients: heterogeneities and barriers in Brazilian public health system- a national survey

Abstract Background: Breast cancer is the most common neoplasm in Brazilian women, with high percent of patients diagnosed in advanced stages. Metastatic breast cancer (mBC) is a challenge in the country, where 75% of the population is covered by public health system (Sistema Único de Saúde, SUS). We conducted an on-line survey to describe the journey of human epidermal growth factor receptor 2-negative (HER2-), hormone receptor positive (RH+) mBC patients across public scenario in Brazil. Methods: An on-line survey comprised of 39 to 48 (depending on the kind of some questions, which could open another question in case of affirmative answer) objective questions were sent by e-mail to180 oncologists working in public and private health care system. Questions were focused on assessing wait time for first treatment after admission in the hospital in both systems, availability of oncological drugs within SUS according to essential medicines list by World Health Organization, and presence of palliative and multidisciplinary teams in both systems. Continuous variables were measured by median and mean. The level of statistical significance adopted was 5% with Teste p two-sided. Analyses were performed using SAS statistical software (version 25.0). Results: We had 150 respondents working in SUS and private health system, which fulfilled the inclusion criteria to participate in this survey. The other 30 respondents were excluded from the study because they worked exclusively in SUS or exclusively in the private system, and their answers were not analyzed. Median wait time for surgery was 60 days in the SUS (N=150) and 30 days in the private health system (N=150) e (p &amp;lt; 0,0001). Regardless of chemotherapy provided, median waiting time was 30 and 15 days in the SUS (N=150) and the private health system (N=150), respectively (p &amp;lt; 0,0001). Most oncologists in the SUS (N=125, 83.3%) pointed to endocrine therapy as their first-choice treatment in mBC. Concerning endocrine therapy in the SUS, Gonadotropin-Releasing Hormone Agonist (GnRHa) was available, and it was prescribed by 54 (36.0%) and Fulvestrant for 72 (48.0%) of respondents. Considering chemotherapy, weekly paclitaxel alone or combined with platin were available and they were prescribed by 124 (82.6%) and 109 (72.6%) of oncologists respectively. Vinorelbine was available and it was prescribed according to oncologists’ report by 109 (72.6%) and Pegylated liposomal doxorubicin (PLD) by 38 (25.3%) of oncologists. Oncologists answered agree or strongly agree that they had a multidisciplinary care team in SUS 77,3% (N =116) versus 87,3% (N=131) in the private system (p=0.022). Concerning palliative care 66,09% (N= 99) in the SUS versus 82,0% (N=123) in the private system answered that they agreed or strongly agreed that this service was available (p=0.001). Conclusions: The Brazilian government has continuously improved delivery of services and medicines via the public system (SUS), but there are still significant differences within this system and versus the private sector. Unavailability of endocrine therapy agents as GnRHa and Fulvestrant, and some chemotherapy agents as PLD and Vinorelbine for high percentage of patients, raises the existence of disparities within SUS. Also, longer waiting times for treatment in the SUS, lower availability of support teams such multidisciplinary and palliative care, they point out disparities between SUS and private health systems. The lack of a National Cancer Control Program and low health investment by Brazilian government might explain the difference in cancer patients’ access. Citation Format: Heloísa Resende, Igor Soares, Angélica Renó, Ana Cunha, Vinícius Aguiar, Letícia Tureta, Viviane Pereira. The journey of HR positive, HER2 negative metastatic breast cancer’s patients: heterogeneities and barriers in Brazilian public health system- a national survey [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-09.

Planning the implementation of a new oncology compounding information system in an aseptic compounding unit: a mixed methods study

Abstract Introduction Systemic anti-cancer therapy (SACT) compounding is a high-risk process. Traditional mixed method systems for workflow management in aseptic compounding units (ACUs) are inherently prone to risk. Workflow management systems (WFMSs) are recognised internationally to improve safety, reduce costs, and increase ACU capacity.[1] Planning of the implementation of a WFMS has not been characterised before. In our ACU, Clinichemo® will be replaced with BD-CATO®. BD-CATO® is a WFMS and is the vendor for the National Cancer Information System (NCIS), implemented by the National Cancer Control Programme (NCCP).[2] Aim The aim of this study was to demonstrate how the implementation of a new WFMS can be safely planned, managed, and assessed. This aim was achieved using the following objectives: 1. Describe and risk assess the current workflows for SACT compounding. 2. Investigate agreed and published standards for SACT compounding. 3. Define the change management process. 4. Describe and evaluate the benefits, challenges and risks associated with the introduction of a new SACT compounding system. 5. Interview adopters of NCIS/BD-CATO® to assess their experience of the barriers encountered, how challenges were overcome, risks identified, mitigated, and eliminated through the change management process and ongoing. Methods The current workflow and future workflow for SACT compounding were characterised and current process risk assessed. Semi-structured interviews were carried out to evaluate pharmacist and pharmacy technicians’ attitudes and opinions towards the implementation of BD-CATO® in their organisations and the system itself. Participants were recruited by means of purposive and snowball sampling from ACUs across the country that had implemented/were in the process of implementing BD-CATO®/NCIS. Themes identified in interviews were compared to those found in the literature and guidelines. Interviews, a review of guidelines, published standards and the literature were used to guide and risk assess future process development. The change management plan was also defined. Results Nine participants (8 pharmacists and 1 pharmacy technician) were interviewed in June-August 2023. The interviews were conducted across 7 ACUs in Ireland. Thematic analysis of interview data yielded four key themes: 1. Participants discussed the importance of planning activities, such as communication with key stakeholders, discussions around phased implementation, and development of training material. 2. Having a designated individual tasked with change implementation improved outcomes of the implementation project. 3. Participants also discussed benefits and risks associated with BD-CATO®. 4. Participants discussed their reasons for perceived complexity of the system. A combination of interview data, review of guidelines, published standards and the literature were used to devise future process workflow and the change management plan. The future process workflow was also risk assessed using bowtie analysis. Conclusion The introduction of WFMSs has been interpreted both in the literature and within the Irish healthcare setting to increase efficiencies, reduce error rates, and improve the accuracy of SACT compounding. A formal change management strategy devised with resourcing, training, and obtaining stakeholder engagement is key to successful implementation.

Early age at menarche and history of sexually transmitted infections significantly predict cervical cancer screening uptake among women aged 25–49 years: evidence from the 2021 Côte d’Ivoire demographic and health survey

IntroductionCervical cancer is the second dominant type of cancer among Ivorian women with an estimated age-standardised incidence and mortality rate of 31.2 cases and 22.8 deaths per 100,000 women in 2020, respectively. The Ivorian government through its Ministry of Health implemented the National Cancer Control Programme (NCCP) in 2003 with the aim of improving the prevention, early detection and treatment of cancers in Côte d’Ivoire. Yet, there is a low uptake of CCS (1.2%). Thus, making CCS uptake an important public health concern in the country. Understanding of the extent to which reproductive factors predict CCS uptake is limited in literature. This study aimed to investigate reproductive factors as a predictor of women’s uptake of CCS in Côte d’Ivoire.MethodsData from the 2021 Côte d’Ivoire Demographic and Health Survey. A sample of 9,078 women aged 25–49 years were analyzed. The outcome variable was CCS uptake while other variables considered included age at menarche, history of STI, sexual debut, parity, age, educational level, wealth index, health insurance, place of residence, and media exposure. A multivariable logistic regression model was fitted to examine the association between the outcome of interest and predictors at 95% confidence interval.ResultsApproximately, 7.52% of women aged 25–49 years had ever undergone testing for cervical cancer by a healthcare provider. Early menarche was associated with lower odds of CCS uptake [AOR = 0.78; CI = 0.65–0.95]. Compared to those who had no STI, women with a history of STI were more likely to screen for cervical cancer [AOR = 2.63; CI = 2.02–3.42]. Increasing age, higher educational attainment, having health insurance, and being exposed to media were significantly associated with CCS uptake.ConclusionIn Cote d’Ivoire, age at menarche and STI history constitute reproductive factors that were significantly associated with women’s uptake of CCS. It is imperative for public policy to focus on increasing CCS in these higher-risk women (i.e., women who experienced early menarche, women with early sexual debut and higher parity) through increased sensitization on cervical cancer risk factors.

Analyzing Global Cancer Control: Progress of National Cancer Control Programs through Composite Indicators and Regression Modeling.

Cancer is a significant public health concern, and National Cancer Control Programs (NCCPs) are crucial for reducing its burden. However, assessing the progress of NCCPs is challenging due to the complexity of cancer control outcomes and the various factors that influence them. Composite indicators can provide a comprehensive and accurate assessment of NCCP progress. The dataset was compiled for 144 countries and comprised eight composite indices and two high-level comparative indicators (mortality-to-cancer incidence ratio [MIR] and 5-year cancer prevalence-to-incidence ratio [PCIR]) representing NCCP outcomes. Two large databases and six annual composite index reports were consulted. Linear regression analysis and Pearson correlation coefficients were used to establish a relationship between indicators and NCCP outcomes. A multiple regression machine learning model was generated to further improve the accuracy of NCCP outcome prediction. High-income countries had the highest cancer incidence, whereas low-income countries had the highest MIR. Linear regression analysis indicated a negative trend between all composite indicators and MIR, whereas a positive trend was observed with PCIR. The Human Development Index and the Legatum Prosperity Index had the highest adjusted R 2 values for MIR (0.74 and 0.73) and PCIR (0.86 and 0.81), respectively. Multiple linear regression modeling was performed, and the results indicated a low mean squared error score (-0.02) and a high R 2 score (0.86), suggesting that the model accurately predicts NCCP outcomes. Overall, composite indicators can be an effective tool for evaluating NCCP, and the results of this study can aid in the development and keeping track of NCCP progress for better cancer control.

International Society of Paediatric Oncology (SIOP) Global Mapping Programme: Latin American Society of Pediatric Oncology (SLAOP) country-level report.

Latin American countries are improving childhood cancer care, showing strong commitment to implement the Global Initiative for Childhood Cancer, but there are scant publications of the situation at a continental level. As part of the International Society of Paediatric Oncology Global Mapping project, delegates of each country participating in the Latin American Society of Pediatric Oncology (SLAOP) and chairs of national pediatric oncology societies and cooperative groups were invited to provide information regarding availability of national pediatric cancer control programs (NPCCP), pediatric oncology laws, pediatric oncology tumor registries, and training programs and support to diagnosis and treatment. Nineteen of the 20 countries participating in SLAOP responded. National delegates reported nine countries with NPCCP and four of them were launched in the past 5years. National pediatric tumor registries are available in eight countries, and three provided published survival results. Fellowship programs for training pediatric oncologists are available in 12 countries. National delegates reported that eight countries provide support to most essential diagnosis and treatments and 11 provide partial or minimal support that is supplemented by civil society organizations. Seven countries have a pediatric oncology law. There are three international cooperative groups and four national societies for pediatric oncology. Despite many challenges, there were dramatic advances in survivorship, access to treatment, and availability of NPCCP in Latin America. Countries with highest social development scores in general provide more complete support and are more likely to have NPCCP, training programs, and reported survival results.

Ethnobotanical survey and biological activities of plants used for cancer treatment in traditional Senegalese medicine

Female breast cancer is known to be one of the leading causes of death in Senegal. In Senegal, the absence of a national cancer control program, the lack of specialized infrastructure and qualified human resources and the exorbitant cost of care have contributed to the extensive use of traditional medecine, particularly in rural areas. This study aims to inventory the medicinal plants used by these healers and to assess the cytotoxic and antioxidant activities of the most widely used one. Data on healers and their use practices and information on plants were collected through the administration of a structured questionnaire. Based on their citation frequencies during the survey, Antiaris Africana Engler, Hymenocardia Acida Tul. and Halouf Halal (local name) were selected for chemical and biological studies. Their hydroalcoholic extracts were analyzed in terms of antioxidant capacity and cytotoxic effects, again, in the human cancer cell line. The study revealed a total of 65 medicinal plants belonging to 35 different families. The plant parts used by traditional healers are leaves (63.89%), roots (11.11%), bark (15.28%), fruits (2.78%), and others (6.94%). Generally, herbal medicine is prepared as a powder and mixed with water by maceration (55.38%) and administered orally. A. Africana ranked first with a citation frequency of 5.7% and its hydroalcoholic extract had the highest antioxidant activity in TEAC (6533.64±7 μmol ET/g dry plant) and in ORAC (3745.17±4.8 μmol ET/g dry plant) followed by H. Acida in TEAC (3115.6±145 μmol ET/g dry plant) and in ORAC (4105.29±872 μmol ET/g dry plant). The hydroalcoholic extract of A. Africana exhibited the highest cytotoxic activity in MCF-7 (Human mammary) and THP-1 (Human acute monocytic leukemia cell line) but had low activity against HTC-116 (Human carcinoma colorectal) and A-375 (Human skin malignant melanoma). The percentages of proapoptotic cells were, respectively, 68.85±6.22, 58.1±1.90 and 48.58±1.4%. These results provide scientific support for the traditional use of medicinal plants in cancer treatment and constitute a database for biological screening to isolate cytotoxic plant-based molecules.