1005 Cancer and Cannabis in Denmark B.A. Rix1, B. Rix 1 Danish Cancer Society, Patient Support, Copenhagen, Denmark Background and context: From 2018, the Danish Parliament has allowed doctors in Denmark to prescribe cannabis sativa as medicin for certain patient groups, including cancer patients. The law on a pilot scheme regarding cannabis for medical use has resently been extended. The law was passed after pressure from various patient groups. Aim: The aim of the legislation was to give cancer patients and other patients the opportunity to get cannabis treatment by doctor's order, as some patients would otherwise access cannabis on the black market. Strategy / Tactics: The Danish medical establishment opposed the scheme. The Danish Cancer Society supported the scheme, but partnered with the Danish Medical Association to argue for research of effects and side effects of the scheme and limited prescription by specialist doctors to specific conditions such as cancer pain and nausea. Programme / Policy process: The scheme was implemented with some research funding but without a comprehensive plan for data collection. Also, family doctors were allowed to prescribe cannabis. Danish nurseries were allowed to produce cannabis for medical use. Outcomes: The scheme has allowed Danish cancer patients to get access to doctor prescribed cannabis. However the access to various cannabis sativa products is limited due to difficulties to bring cannabis products to the market. Many doctors do not want to prescribe cannabis, and patients do not feel supported by doctors, as doctors have no medical guidelines for use. Several years into the scheme, data on use, indications for use, effects and side effects is not in place. Have you got a Conflict of Interest?: No
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1006 Fearless and significant life after cancer S. Shah1 1 Cancerwinnershrenik, Ahmedabad, India Background and context: Life of success to a life of significance by extending hands of hope to cancer patients, survivors & caregivers by illustrating contributions from my Invictus, Resilient, Seeder Life 2.0 with Courage Confidence & Dedication by using electrolarynx with distinctly Audible UNIQUE VOICE being a stage IV Ca-larynx victim of the year 1997, currently in my 25th year Invictus, Resilient life after cancer as a stage IV Ca-larynx survivor in my 25th year
Aim: Ignore self-medication if you are not qualified as a doctor for leading a quality life 2.0 & saving precious human lives Strategy / Tactics: Some decades back cancer was known as a dreadful disease~end of life but thanks to the spectacular innovations in the onology field, technology, latest equipment, pathological advances, need-based treatment protocols & last but never the least in-depth expertise & experiences of oncologists, trust them as they are human with hearts & always keen to cure patients irrespective of the stage of cancer. It needs timely diagnosis, following treatments with courage & a positive mindset & most importantly never seeking any sympathy. Programme / Policy Process: Digital platforms are the ultimate sources of reaching out to the global community in a jiffy by sharing the knowledge & experiences online about cancer awareness, prevention, tobacco control, treatment protocols, etc. by oncologists, cancer patients survivors & advocates. As a Ca-larynx survivor, I was the first to conceptualize, coordinate & stream a live e-health series on popular social platforms for knowledge sharing with the global community. Anchored Facebook & YouTube live e-health series by inviting renowned organ & treatment specific oncologists, viewed by tens of thousands of individuals
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Publicly & privately managed cancer centers can coordinate the availability of oncologists & paramedical staff members to educate patients regularly & these will be of huge support as patients won't have to solely rely upon browsed data as treatment protocols & outcomes vary from patient to patient & at least they don't get self-misguided. Cancer support groups are also the best source of guidance & extending the hope in the first place followed by sharing own experiences. My relentless contributions since 2011: World cancer day 2021, 9 back-to-back interviews & live sessions on the GSTV news channel. Overwhelmed with the appreciation certificate from UICC.
Outcomes: Cancer is not the end of life but the beginning of life 2.0 with courage, confidence, compassion & giving back significantly & relentlessly to the community. Such initiatives are most desired to save precious lives of human beings for which, UICC & its team members are always at the front foot. What was learned: (if relevant, please also detail here the potential of replicability) Life after cancer can be innovated significantly with courage & grit into exceptional opportunities to inspire millions of lives
Have you got a Conflict of Interest?: No
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1007 DEVELOPMENT AND ROLL OUT OF CHILDHOOD CANCER DATA COLLECTION SYSTEM IN SUB SAHARAN AFRICA E.A. Adongo1, P. Freccero2, J. Rosser2, L.A. Renner3, C. Segbefia3, N. Salifu4, S. Gupta5, A. Denburg5, A. Fowokan5, V. Paintsil6 1 World Child Cancer, Accra, Ghana, 2World Child Cancer, UK, London, United Kingdom, 3Korle Bu Teaching Hospital, Child Health, Accra, Ghana, 4Greater Accra Regional Hospital, Child Health, Accra, Ghana, 5The Hospital for Sick Children, Department of Child Health and Evaluative Sciences, Toronto, Canada, 6Komfo Anokye Teaching Hospital, Child Health, Kumasi, Ghana Background World Child Cancer (WCC), founded in 2007, works with partners in Sub Saharan Africa, Asia and Central America to improve diagnosis, treatment, and support for children with cancer and their families. According to the World Health Organization, childhood cancer data systems are needed to drive continuous improvements in quality of care, and to inform policy decisions. In Sub Saharan Africa, there is paucity of data on childhood cancer which affects quality of care. Aim To describe the development and roll out of a childhood cancer hospital-based data collection system in two Sub Saharan African countries, using the Kobocollect (ODK) platform, with support from WCC and PERCC. Strategy Experts were assembled to inform the selection of registry indicators. Several rounds of a modified Delphi were conducted to arrive at a consensus list of indicators to be included in the registry. A three-part training session, covering relevant topics was delivered. After the training session, full roll-out of the registry was implemented at the three treatment sites in Ghana and Sierra Leone. Periodic data quality checks and feedback were organised to ensure data quality. Results The tool is currently in use at Korle Bu Teaching Hospital (KBTH) in Accra, Komfo Anokye Teaching Hospital (KATH) in Kumasi, and Tamale Teaching Hospital (TTH) all in Ghana and Ola During Children’s Hospital (ODCH) in Sierra Leone. From August 2020 to January 2021, 1,066 data elements were entered in three treatment centres in Ghana and 46 data elements also entered in one treatment centre in Sierra Leone (KBTH =660 (62.1%), KATH=385 (36.2%), TTH =2 (0.2%), other=16= (1.5%), and ODCH in Sierra Leone=46(100%). Lesson learnt Hospital-based childhood cancer registries can be developed and rolled out in Low- and Middle-Income Countries. Challenges encountered during the roll out of the hospital-based registry included poor access to timely and effective diagnoses resulting in poor diagnosis and staging, poor capacity on data capture by some clinicians resulting in poor data capture and inadequate capacity of junior residents to stage childhood cancer. This was resolved by utilizing lead Paediatric Oncologist and Senior Paediatric Oncology Residents to oversee data entry and engaging consultants at PERCC to conduct data validation meetings with facilities. Conclusion It is possible to deploy online tools for hospital-based childhood cancer registry in limited-resource settings. With the right support, data systems can improve quality of care by driving continuous improvements and help inform policy decisions. References https://www.who.int/news-room/fact-sheets/detail/cancer-in-children Have you got a Conflict of Interest?: No
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1011 BMI, height, weight change, and lung cancer risk: The JPHC Study S. Abe1, S. Narita2, E. Saito3, N. Sawada1, T. Shimazu1, A. Goto1, T. Yamaji1, M. Iwasaki1, M. Inoue1, S. Tsugane1 1 National Cancer Center Institute for Cancer Control, Tokyo, Japan, 2The University of Tokyo, Tokyo, Japan, 3National Center for Global Health and Medicine, Tokyo, Japan Background: Body mass index (BMI) is inversely associated with lung cancer risk, while residual confounding by smoking or weight change is controversial. Evidence on height and lung cancer is scarce. Aim: To investigate the associations between anthropometric measurements, namely, BMI, height, and body weight change and lung cancer risk. We further examined the associations by histologic subtypes and comprehensive stratification of cigarette smoking. Methods: We investigated the associations between anthropometrics, BMI, and height, and incidence of lung cancer among 92,098 study subjects (44,158 men and 47,940 women) in the Japan Public Health Center-based Prospective Study. Cox proportional hazards regression was performed with adjustment for potential confounders and by cancer subtypes and smoking status. Information on weight and height was self-reported at baseline, and validated using measured health check-up data. Results: During follow-up between 1990 and 2013 (average, 19.1 years), a total of 2,152 lung cancer cases were newly diagnosed. In a multivariate regression model, lower BMI was positively associated with overall lung cancer risk [<19 kg/m2; hazard ratio (HR) = 1.48; 95% confidence interval (CI) = 1.18-1.85 and 19-22.9 kg/m2; HR = 1.19; 95% CI = 1.05-1.35;Ptrend= <0.001] in men. The risk estimate was also elevated for adenocarcinoma in the BMI <19 kg/m2category and for squamous cell carcinoma among men in the 19-22.9 kg/m2BMI category. An association was also observed between low BMI, weight decrease, and squamous cell carcinoma in women. No significant associations were observed for other weight categories, height, weight change and lung cancer, adenocarcinoma, squamous and small cell carcinoma. Conclusion: Our prospective study suggests that lower BMI may be associated with an increased risk of smokingrelated lung cancer in Japan, irrespective of gender. Have you got a Conflict of Interest?: No
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1015 Care pathway delays and contributing factors among breast cancer patients in Morocco: A cross-sectional study F. Selmouni1, H. Mrabti2, A. Benider3, K. Bendahhou4, C. Sauvaget1, L. Abousselham5, R. Muwonge1, E. Lucas1, R. Bekkali6, P. Basu1 1 Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France, 2National Institute of Oncology, CHU Ibn Sina, Rabat, Morocco, 3Mohammed VI Centre for Cancer Treatment, CHU Ibn Rochd, Casablanca, Morocco, 4Cancer Registry of the Greater Casablanca Region, Casablanca, Morocco, 5Cancer unit, Epidemiology and Disease Control Department, Ministry of Health, Rabat, Morocco, 6Lalla Salma Foundation, Prevention and Treatment of cancers, Rabat, Morocco Background: Significant efforts were made by the Moroccan Ministry of Health as part of the National Cancer Control Plan launched in 2010 to improve access to early detection, diagnosis and treatment services, particularly for breast cancer. Aim: The purpose of this study is to measure delays in the breast cancer care continuum and describe their temporal trends and associated determinants. Methods: A retrospective study was conducted at two largest publicly funded oncology centres in Morocco. Data were abstracted from the case records of breast cancer patients registered over a two-month period of each year from 2008 to 2017. A total of 2120 breast cancer patients were registered. Descriptive statistics was used to summarize socio-demographic and clinical characteristic of the patients. Care intervals were presented as medians together interquartile range (IQR) and stratified by the period of diagnosis (2008-2012 and 2013-2017). Results: The median age at registration at either centre was 49 years [IQR: 42-57 years], without any significant change observed over time. Approximately 55% of the patients presented at stage I/II, without appreciable temporal variation. Overall median interval between onset of symptoms and first medical consultation (access delay) was 6 (IQR: 3-12 months) with a significant reduction over time (P-value <0.001). Patient sociodemographic characteristics, other than high parity, had no significant effect on access delay when all patient characteristics were adjusted in the regression model. Younger women were more likely to seek early consultation, although the difference between age groups was not statistically significant. Median interval between disease confirmation and initiation of treatment was 1.8 (IQR: 1.0-3.2 months) and median interval between the date of surgery and initiation of radiation therapy for patients who did not receive chemotherapy in between was 7.3 (IQR: 4.9 - 9.3 months), with no significant change over time: p value = 0.45 andp value = 0.51, respectively. Conclusion: Breast cancer care pathway delays are high in Morocco. Continued efforts are needed to improve women’s awareness and access to breast cancer treatment. Have you got a Conflict of Interest?: No
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1016 Socioeconomic status and lung cancer incidence: An analysis of 17 prospective cohorts from 4 continents J.U. Onwuka1, H. Zahed1, K. Alcala1, M. Johansson1, H.A. Robbins1 1 International Agency for Research on Cancer, Genomic Epidemiology Branch, Lyon, France Background: Lung cancer is the leading cause of cancer death worldwide, with established risk factors including smoking, air pollution, and a family history of lung cancer. Lower socioeconomic status (SES) has also been reported as a risk factor for lung cancer in some contexts. Aim: To assess whether and how the relationship between SES and lung cancer varies in different world regions. Methods: Our study analyzed the harmonized database of the Lung Cancer Cohort Consortium (LC3), including more than 2 million participants from 16 countries. The LC3 database includes detailed information on demographics, smoking, and educational level at baseline, and lung cancer incidence and mortality during followup. Using educational level as a proxy for individual SES, we estimated the association of SES with incident lung cancer using Cox proportional hazards models with follow-up time as the timescale. Education was modeled as an ordinal variable in 3 or 4 categories and models were adjusted for participant age, sex, and smoking status (never, former, current). We estimated associations stratified by cohort, world region, and joint sex and smoking status. Results: The LC3 study population included 2,423,574 participants and 58,535 lung cancer cases from 16 countries, with median follow-up of 12.5 years. Lung cancer incidence was lower among groups with higher SES in all countries after adjustment for age, sex, and smoking status, with adjusted HRs ranging from 0.64 per 1-unit increase in educational level (95%CI 0.55-0.76) in the EPIC-Netherlands cohort to 0.95 (95%CI 0.89-1.02) in the Australian MCCS cohort. When grouping by world region, the association between SES and lung cancer incidence was similar for the USA (aHR=0.85, 95%CI 0.84-0.86), Europe (aHR=0.84, 95%CI 0.83-0.85), and Asia (aHR=0.86, 95%CI 0.82-0.90), but weaker in the Australian MCCS cohort (aHR=0.95, 95%CI 0.89-1.02) (Figure 1). When stratifying by sex and smoking status, SES was most strongly associated with lung cancer among people with a smoking history, regardless of sex (p<10-93), while there was a weaker association among males who never smoked (p=10-8), and no association among females who never smoked (p=0.29) (Figure 2). Conclusion: Higher educational level was independently associated with decreased risk of incident lung cancer in each of 17 different cohorts across 4 continents, with stronger associations among people who ever smoked. Increasing the engagement of disadvantaged groups could increase the impact of interventions to reduce the burden of lung cancer such as tobacco prevention and low-dose CT screening. In future analyses, we plan to incorporate additional dimensions of SES other than education and adjust for more detailed risk factors.
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1017 The circ_0084043-miR-134-5p axis regulates PCDH9 to suppress melanoma. G. Cai1, S. Li1, R. Zou1, J. Xie1, C. Zheng1, X. Chen1, S. Liu1, S. Luo1, N. Wei1, R. Chen1 1 Dermatology Hospital of Southern Medical University, Guangzhou, China Background:Malignant melanoma (MM), a type of skin cancer, is not sensitive to radiotherapy and chemotherapy with a tendency for early distant metastases. The combination of BRAF and MEK inhibitors is the main treatment for BRAF mutant melanoma. The clinical effect is remarkable, but there have been a large number of drug-resistant cases. Hence, low survival rates, poor responses, and drug resistance of melanoma patients make it urgent to screen new therapeutic targets. Aim: This study investigated whether the circ_0084043-miR-134-5p axis regulates the antitumor effect of PCDH9 in melanoma. Methods: Ectopic expression or KD of PCDH9 with a lentivirus vector, we explored its effects on the proliferation, invasion, and apoptosis of melanoma and verified its regulatory effect on RAC1, Pyk2, Cyclin D1, MMP2, and MMP9. We further observed the effect of KD circ_0084043 on the malignant behavior of melanoma and studied whether circ_0084043 sponged miR-134-5p and regulated PCDH9. Results: We found that circ_0084043 was overexpressed in melanoma and associated with a malignant phenotype. PCDH9 was less expressed in human melanoma tissues, and overexpression of PCDH9 inhibited melanoma progression. In melanoma, qRT-PCR and Western blotting results showed that overexpression of PCDH9 could downregulate RAC1, MMP2, and MMP9 and upregulate Pyk2 and Cyclin D1. Circ_0084043 KD inhibited invasion and promoted apoptosis in melanoma cells. Circ_0084043 could sponge miR-134-5p and thus indirectly regulate PCDH9. Furthermore, we discovered that inhibiting circ_0084043 had an anti-PD-Ll effect. In vivo, PCDH9 overexpression inhibited melanoma tumor growth, but PCDH9 KD promoted it. Conclusion: PCDH9, which is regulated by the circ 0084043-miR-134-5p axis, can suppress malignant biological behavior in melanoma and influence the expression levels of Pyk2, RAC1, Cyclin D1, MMP2, and MMP9. Figures:
Figure 1. Effects of PCDH9 overexpression in melanoma cells measured by qRT-PCR. The expressions of PCDH9 were significantly upregulated by lentivirus infection (A, B). Overexpressed PCDH9 significantly upregulated the gene expressions of Pyk2 and Cyclin D1 and downregulated RAC1, MMP2, and MMP9 except for FAK in A375 (C) and G361 (D) cells. *p<0.05, ***p<0.001 compared groups using one-way ANOVA followed by least significant difference post hoc tests.
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Figure 2. Effects of PCDH9 overexpression and KD in melanoma cells measured by Western blot. Overexpressing PCDH9 significantly upregulated levels of Pyk2 and Cyclin D1 and downregulated RAC1, MMP2, and MMP9 in A375 (A) and G361 cells (B). KD of PCDH9 downregulated levels of Pyk2 and Cyclin D1 and upregulated RAC1, MMP2, and MMP9 in A375 (C) and G361 (D) cells. nsP>0.05, *p<0.05, **p<0.01, ***p<0.001 compared groups using one-way ANOVA followed by least significant difference post hoc tests. Have you got a Conflict of Interest?: No
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1026 Targeted rehabilitation reduces self-reported symptom burden in hospitalised cancer patients J. Wade1, G. Jones1, S. Aldrich2, R. Marshall2, S. Penfold2, N. Peat1 1 Guy's and St Thomas' NHS Trust, Physiotherapy Department, London, United Kingdom, 2Guy's and St Thomas' NHS Trust, Occupational Therapy Department, London, United Kingdom Background: Cancer patients admitted to hospital often present with multiple undesirable symptoms as a consequence of the cancer and its treatments. An individual’s cancer related symptom burden may vary depending on treatment type, age, sex and cancer type. Nonetheless, cancer survivors report a mean symptomcount of 8-14 symptoms which interfere with physical function, quality of life, and meaningful occupations (1,2). Rehabilitation offers a countermeasure for symptom burden [3]. But it cannot always be delivered in a timely way, by experts, in a meaningful dose. Aim: We aimed to determine whether the provision of optimal specialist rehabilitation delivered at a meaningful dosage and frequency reduces symptom count in hospitalised cancer patients. Methods: Inpatients with complex rehabilitation needs requiring Physiotherapy and Occupational Therapy input across 2 cancer wards (n=57 beds) were eligible. Early, dose-specified, high frequency (≥2x daily), specialist rehabilitation interventions were provided by a dedicated Cancer Rehabilitation Transition Service (CaRTS; 1 x whole time equivalent Physiotherapist, Occupational Therapist and Therapy Assistant) over a 5-day week. A locally adapted self-reported Holistic Needs Symptom profile tool was offered to sequential patients at admission between January 2020 to July 2021, and at discharge from CaRTS, to assess patients’ physical, emotional, practical, and familial symptom profile. Cumulative symptom counts reported at admission and discharge from CaRTS were collected and the change in mean symptom-count was assessed using a paired -test. Results: Symptom profiles were reviewed in 44 patients (21(48%) F, mean(±SD) age 65(±11) years). Primary cancer types were solid tumours 24(55%), haematological 18(41%) and unknown 1(3%). Metastatic disease was present in 24(55%) of patients. There was a cumulative total of 634 symptoms reported at admission (a mean of 14 (±6) per patient). The most frequent symptoms observed in patients, were those associated with walking 39(86%), stairs 36(82%), balance 31(70%), dressing 31(70%) and domestic tasks 29(66%). While overall, symptom count remained unchanged at discharge in 4(9%) patients, and increased in 6(14%), they were reduced in the majority (34(77%)) of patients. Mean symptom count was significantly higher at admission (14.1(±5.8)) compared to discharge (10.3 (±6.3)), a mean (95%CI) difference of 4.1 (2.3 to 5.9) symptoms per patient [(43) = 4.520; <0.001]. Conclusion: These results show that the provision of targeted and specified rehabilitation at a meaningful dosage reduced symptom count as a surrogate for perceived symptom burden in cancer inpatients. Further experimental work is required to determine the minimum effect that a specialist rehabilitation model has on cancer symptom burden compared to typical rehabilitation models. Have you got a Conflict of Interest?: No
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1027 Investigating the contribution of cancer-associated fibroblasts in colorectal cancer metastasis Y. Yang1 1 Health Management Centre, The First Affiliated Hospital of Army Medical University, Chongqing, China Background: Although colorectal cancer (CRC) therapy is widely implemented, there is still a limitation of survival time. Metastasis is the major cause of death in CRC patients. Inhibition of metastasis will prolong the survival of patients with CRC. Cancer cells bring their own soil, cancer-associated fibroblasts (CAFs), to metastasize together, promoting the survival and colonization of circulating cancer cells. Aim: To explore the method to which cancer-associated fibroblasts contribute to CRC metastasis and provide new insights for CRC treatment. Methods: Circulating CAFs were distinguished in the peripheral blood of patients with CRC. The migration and invasion of CAFs were evaluated by transwell in vitro. The metastasis of CAFs and its effect on colorectal cancer metastasis were evaluated in nude mice subcutaneous xenograft model. Western Blot, RT-PCR, CHIP, et al. were used to explore the mechanism of up-regulation of the migration and invasion ability in CAFs. The effect of interference signal path on both CAFs and CRC metastasis was verified in nude mice subcutaneous transplantation model. The effect of CAFs on the colonization of metastatic colorectal cancer cells was also detected in mice model. Results: Circulating CAFs had stronger migration and invasion ability. In xenograft assay, CAFs could metastasize from primary tumor to lung and promote the formation of more colorectal cancer metastasis. CRC cells could regulate the migration and invasion of CAFs by the HIF-1α/miR210/VMP1 pathway. Inhibition of the pathway could inhibit the migration and invasion of CAFs. In Mice with subcutaneous tumor, metastases were observed at the CAFs injection site. And the number of lung metastases was more when CAFs were injected into caudal vein, indicating that CAFs could promote the colonization of cancer cells in CRC. Conclusion: 1. 2. 3.
In the subcutaneous transplantation model of colorectal cancer, part of the CAFs in metastatic sites were derived from the primary lesions. CRC cells maybe regulate the migration and invasion of CAFs and induce CAFs metastasis to the peripheral blood of patients. Reducing CAFs metastasis might decrease colorectal metastasis. CAFs in the nude mice model might have the ability to promote colonization of cancer cells and form the metastatic sites in CRC.
Have you got a Conflict of Interest?: No
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1031 An Analysis of Survivorship Care Strategies in National Cancer Control Plans in Africa E.M. Garton1, M.K. Cira1, P.B. Jacobsen2, Y. Romero3, Z. Tittenbrun3, L. Haskins4, M. Mutebi5, M. Mollica2 1 National Cancer Institute, Center for Global Health, Rockville, United States, 2National Cancer Institute, Division of Cancer Control and Population Sciences, Rockville, United States, 3Union for International Cancer Control, Geneva, Switzerland, 4Johns Hopkins University, Baltimore, United States, 5Aga Khan University, Nairobi, Kenya Background: In 2017, the World Health Organization urged member states to develop and implement national cancer control plans (NCCPs) and to anticipate and promote cancer survivor follow-up care, which is a critical yet often overlooked component of NCCPs. A working group of Africa-based cancer control experts and researchers are conducting a comprehensive analysis to understand and address the follow-up care needs of people living with cancer in Africa. Aim: As part of the comprehensive analysis, the aim of this project is to examine the inclusion ofcancer survivorshiprelated strategies and objectives in NCCPs of countries in Africa. Methods: The most recently published NCCPs of African countries on the International Cancer Control Partnership’s NCCP Portal1 were coded by two independent reviewers. Coders extracted strategies, interventions, activities, or actions related to survivorship within the plans and their associated indicators (if available) and categorized them according to an adapted version of the ten recommendations for comprehensive survivorship care detailed in the 2005 Institute of Medicine (IOM) report2, which is regarded as a key reference for the implementation of cancer survivorship plans. The adaptations involved fitting the report recommendations to a non-US context, including adding an additional domain, “Access to Medicine”. Results: 21 NCCPs were reviewed and a total of 202 survivorship-related strategies were identified, with all NCCPs including between 1 and 23 references to survivorship. 83 (41%) strategies were linked to measurable indicators, and 128 (63%) of the survivorship-related strategies were explicitly focused on palliative care and not inclusive of other aspects of cancer survivorship. The most frequent IOM domains referenced were Models of Coordinated Care (65 strategies), Healthcare Professional Capacity (45) and Utilizing Evidence Based Guidelines (23). The leastreferenced domains were and Survivorship Care Plan (4) and Adequate and Affordable Health Insurance (0). Conclusion: This study identified and categorized survivorship-related strategies prioritized in current NCCPs in Africa, including strengths and areas for growth. Survivorship-related strategies in NCCPs should include more detail and related indicators, and should extend beyond palliative care to encompass all aspects of survivorship. Stakeholders can use this baseline analysis to identify and address gaps in survivorship care at the national policy level.
https://www.iccp-portal.org/map Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in transition. Washington: The National Academies; 2006. 1 2
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1034 High WTAP expression correlates with worse prognosis and abiraterone effectiveness in prostate cancer patients Z. Liu1, F. Wan1, B. Dai1 1 Fudan University Shanghai Cancer Center, Department of Urology, Shanghai, China Background: Individualized treatment of prostate cancer depends on an accurate stratification of patients who are sensitive to various treatments. N6-methyladenosine modification, as known as m6A methylation, is one of the most common mRNA epigenetic modifications in tumor, and is becoming one of the hallmarks of cancer. WTAP (Wilms Tumor 1-associated protein) is an important component of m6A methylated transferase, but its clinical significance in prostate cancer is still unknown. Aim: We here aim to find the clinical significance of WTAP, and to explore its correlation with treatment effectiveness in patients with prostate cancer. Methods: We evaluated WTAP expression in The Cancer Genome Atlas database, and retrospectively enrolled 162 treatment-naïve metastatic prostate cancer patients diagnosed in our institute between June 2012 and December 2014. WTAP was stained and evaluated via immunohistochemistry. Further survival and multivariate Cox regression analyses were conducted to explore the prognostic value of WTAP. Results: We found that WTAP mRNA expression correlated with disease progression in TCGA-PRAD cohort, and WTAP protein were clearly stained within prostate cancer tissue. Survival analyses showed that patients with higher WTAP expression had significantly worse overall survival (hazard ratio (HR) =2.442, 95% confidence interval (95% CI): 1.430–4.101; P=0.001) and a higher risk of developing castration resistance (HR=1.848, 95% CI: 1.421–2.737; P=0.002). Moreover, subgroup analyses showed that when patients progressed to a castrationresistant status, the prognostic value of WTAP was observed only in patients treated with abiraterone instead of docetaxel. Conclusion: We showed that high WTAP expression is an independent prognosticator in patients with metastatic prostate cancer. WTAP expression may correlate with abiraterone effectiveness in castration resistant prostate cancer patients.
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Figure Legends Figure 1. WTAP expression correlated with disease progression. (A) Kaplan–Meier plots for overall survival and (B) comparison of events in the TCGA-PRAD cohort according to WTAP mRNA expression. (C) The flowchart of study population enrolment. (D) Representative pictures of WTAP in prostate cancer tissues. (top, high expression of WTAP; bottom, low expression of WTAP). Figure 2. High WTAP expression could predict unfavourable prognosis in metastatic prostate cancer patients. Kaplan–Meier plots for overall survival (A) and CRPC-free survival (B) in patients with metastatic prostate cancer according to WTAP expression. Forrest plots show various potential prognosticators for overall survival(C) and CRPC-free survival(D). Multivariate Cox proportional hazards regression models were used. Figure 3. WTAP could predict abiraterone effectiveness in metastatic prostate cancer. Kaplan–Meier plots show the prognostic value of WTAP expression in CRPC patients treated with abiraterone (A) and docetaxel (B). Have you got a Conflict of Interest?: No
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1041 GRASSROOTS TO GLOBAL: WORLD OVARIAN CANCER DAY AND THE PAYOFF OF PARTNERSHIP IN GLOBAL ADVOCACY C. MacKay1, E. Baugh1, P. Charlton1 1 World Ovarian Cancer Coalition, Toronto, Canada Context In 2013, inspired by the success of breast cancer advocates, a group of 5 ovarian cancer leaders organized the first World Ovarian Cancer Day on May 8, to bring attention to one of the world’s deadliest female cancers. Aim The aim of the campaign was to raise awareness of ovarian cancer, foster the development of a unified, global community committed to improving outcomes for women with ovarian cancer and highlight why it should be a global priority. Strategy World Ovarian Cancer Day has built on the engagement of local patient advocacy groups and their supporters around the world. This is a core element of the success and impact of the campaign. Messages and resources are developed centrally, in consultation with advocacy groups but the global reach is amplified through local advocacy efforts to great effect. By tapping into the strengths of participating organizations, the campaign is able to reach a much wider audience. Process The core objective and messages of the campaign changes little from year to year, as key awareness messages remain the same, barring any scientific breakthroughs. Consequently, in the past 3 years, the focus has shifted onto providing as many different tools for participating organizations as possible based on one-on-one conversations and feedback. The provision offree of charge, co-branded translated materials is a simple but highly effective tool for many. To date, materials are available in over 20 languages. Outcomes In its 10th year World Ovarian Cancer Day has become a flagship awareness raising event with interest and participation from partners and individuals in over 150 countries and over 40 languages. It also led to the formal adoption of the World Ovarian Cancer Coalition in 2016 and the start of major international policy work including the largest ever study of the experiences of women with ovarian cancer: The Every Woman Study™️ (2018). Consequent vital policy work notwithstanding, the greatest outcome of World Ovarian Cancer Day has otherwise been the coalescence of the global ovarian cancer community behind a single goal every May 8. While the 2021 campaign reached over 18 million people on the Coalition social media channels, the engagement of participating organizations multiplied that to well over 100 million. Learnings The exponential growth of World Ovarian Cancer Day in the last three years, combined with the formation of the World Ovarian Cancer Coalition and its collaborative initiatives and activities, has clearly demonstrated that partnerships are a highly effective mechanism for change. With global advocacy efforts ongoing, there is tremendous potential to leverage each other’s strengths for the good of the whole while respecting the local environment by adapting to the situation on the ground. Have you got a Conflict of Interest?: No
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1044 Psychological distress in Portuguese cancer patients during the COVID-19 pandemic: A cross-sectional study F. Pacheco1, S. Silva1, T. Paredes1, N. Amaral1, V. Rodrigues1, B. Sousa2, C. Pires2 1 Liga Portuguesa Contra o Cancro, Coimbra, Portugal, 2Universidade de Coimbra, Coimbra, Portugal Background and aim: Cancer diagnosis and treatment always affects patients’ lives, impacting directly in mental health. Distress is a multifactorial unpleasant experience that mediates the ability to cope with cancer, affecting one third of cancer patients.COVID-19 has become a worldwide pandemic. It has caused a strain in health-care systems, namely oncology services. Considering the lack of studies exploring the psychological impact of COVID-19 on patients living with and beyond cancer, the aim of this study was to explore how COVID-19 affected a sample of cancer patients and survivors, and to identify who is at greater risk of being psychologically impacted. Methods: This cross-sectional study was based on a sample collected through an online questionnaire. Data was obtained using a self-report questionnaire and Hospital Anxiety and Depression Scale (HADS). Statistical analysis was carried out with R – version 4.1.1. Descriptive statistics and linear regression models were carried out to characterize the sample and to identify the determinants of emotional distress, depression, and anxiety. The stepwise method was applied for the selection of independent variables with significant effect on distress. Results: The sample included 940 cancer patients and survivors. Participant´s mean age was 49.7 years old and most of them were female (87.1%). 55.1% were cancer survivors, and the majority (56.7%) were diagnosed with breast cancer. 35.0% of the sample had another chronic disease. 53.9% perceived having a higher likelihood of being infected with COVID-19 and having more complications if infected (76.7%). Almost half of the sample (49.3%) revealed significant emotional distress, 18.1% significant depression, and 29.2% significant anxiety. Sex, age and education levels and professional status were highly associated with psychological distress. Comorbidity with another chronic disease or taking care of another person with chronic disease were associated with higher levels of distress, depression, and anxiety. Finally, risk perception also influenced emotional distress, depression, and anxiety, with patients who perceived a higher likelihood of being infected with COVID-19 showing higher emotional distress. Conclusions: Our findings provide useful information regarding the impact of the COVID-19 pandemic on mental health of cancer patients and survivors, showing an increased number of patients with significant emotional distress during pandemic. It also provides valuable insights to help in decision making based on effective health strategies and implement actions that substantially can improve mental health of cancer patients. Have you got a Conflict of Interest?: No
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1045 A human rights based approach to tobacco control K. A Romeo-Stuppy1, L. Huber1 1 Action on Smoking and Health, Washington, United States Background and context: A human rights approach to ending the tobacco epidemic is unique, because it implores or requires governments to advance human development by implementing measures that decrease smoking. The Framework Convention on Tobacco Control (FCTC) has brought significant progress, but lacks enforcement mechanisms. Using human rights obligations potentially forces the hands of governments, empowers tobacco control advocates, brings new allies to tobacco control, and suggests innovative policy solutions. Aim: This panel will build the capacity of public health professionals to use human rights law, language and norms to advance their tobacco control goals in their home countries and at the global level. Strategy / Tactics: Presenters will discuss the global (top down) approach which aims to encourage the inclusion of tobacco control objectives among global human rights bodies and the local (bottom up) approach, which involves engaging in the reporting processes associated with their country’s human rights treaty obligations. Outcomes/ What was learnt: (if relevant, please also detail here the potential of replicability) : Participants will learn how advocates in France, Germany, and other localities use the human-rights based approach and how they can use global human rights norms to further tobacco control. Have you got a Conflict of Interest?: No
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1046 Elimination of cervical cancer among First Nations, Inuit and Métis in Canada: Priorities and Actions A. Muirhead1, M. Halligan1 1 Canadian Partnership Against Cancer, Prevention, Toronto, Canada Background and context: The inequities experienced by First Nations, Inuit, and Métis are rooted in historic and ongoing racism, colonization, and trauma. First Nations, Inuit, and Métis in Canada have experienced three times more diagnoses and four times more deaths from cervical cancer than the population overall. First Nations, Inuit and Métis organizations, governments and communities worked with the Canadian Partnership Against Cancer (the Partnership) to identify priorities and actions specific to each Indigenous population for inclusion in theAction Plan for the Elimination of Cervical Cancer in Canada, 2020–2030 (the Action Plan), Canada’s response to the call by the World Health Organization to eliminate cervical cancer worldwide within the century. Aim: Recognizing the value and importance of self-determined priority identification and solutions, the Partnership engaged directly with First Nations, Inuit, and Métis partners, to collaboratively identify priorities and actions that would build on the strengths of Indigenous partners to address the specific challenges related to HPV immunization and cervical screening and follow-up faced by Indigenous populations. Strategy / Tactics: Since forming in 2007, the Partnership has partnered with First Nations, Inuit, and Métis organizations, governments, and communities to implement distinctions-based and self-determined solutions to improve the cancer experiences of First Nations, Inuit, and Métis. Building on these relationships, the Partnership engaged First Nations, Inuit, and Métis partners regarding their priorities and proposed actions related to the elimination of cervical cancer. The circle of engagement has grown as implementation plans are developed, with broad interest and enthusiasm from First Nations, Inuit, and Métis partners across Canada. Outcomes: The Action Plan includes three priorities specific to First Nations, Inuit, and Métis: culturally appropriate care closer to home; People-specific, self-determined cancer care; and First Nations-, Inuit-, and Métis-governed research and data systems. With funding from the Partnership, partners across Canada are beginning to implement the actions associated with these priorities. For example, the Urban Public Health Network is working with First Nations, Inuit, and Métis partners to determine the availability of HPV immunization data, along with barriers and facilitators to vaccine uptake. This information will inform future HPV immunization efforts among First Nations, Inuit, and Métis populations in Canada. What was learnt: By engaging First Nations, Inuit, and Métis partners in the development of the Action Plan, the Partnership has built a foundation of trust, respect, and reciprocity, strengthening efforts to eliminate cervical cancer. Have you got a Conflict of Interest?: No
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1049 Palliative Care and Cancer S.M. Razavi1, S.N. Razavi2, E. Ebadian3, N. Saeidi Yeganeh4, S. Sarnami5 1 Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of, 2SMH Charity, CEO Dept., Tehran, Iran, Islamic Republic of, 3Iran University of Medical Sciences, School of Medicine, Tehran, Iran, Islamic Republic of, 4SMH Charity, Tehran, Iran, Islamic Republic of, 5SMH Charity, International Relations Dept., Tehran, Iran, Islamic Republic of Background When a patient is diagnosed with cancer, he/she and their close relatives face a sudden wave of emotional stress, alongside an economic burden that defines the treatment method and his/her future. Furthermore, chemo and its side effects add more challenges to this crisis. Meanwhile, handling all of these issues related to each patient as an oncologist who visits various cancer patients each day, would exhaust the physician to a level that could eventually lead him/her into abandoning his duties. Aim This study aimed to give a brief report on the situation, activities, and responsibilities of the palliative care unit at Firoozgar university hospital in its first 2 years of establishment. Methods The authors reviewed hospital documents and payment bills along with interviewing the unit staff to investigate its activities. A referring physician satisfaction survey was conducted for each patient. The survey focused on the timeliness and information of the reports, and the impact of palliative care services on their patients’ quality of life. Information collected and interviews were gathered and integrated to give the report on the activity of the unit, then analyzed descriptively, using SPSS. Result In Iran, the palliative care has been operative since August 2008 with the following goals: 1. Offering overall care for cancer patients from the time of diagnosis till remission or death 2. Preventing oncologists from exhaustion and incapability 3. Reducing costs of frequent hospitalization At Firoozgar university hospital, this unit started with 35 beds and multiple clinics for primary visits, psychology, psychiatry, pain, and general management. Teams of general physicians, nurses, social assistants, psychiatrists, psychologists, spiritual helpers, pain specialists, oncologists, and radiotherapists have been trained in the fundamentals of palliative care in an intensive 36-hour course. In the first 2 years of this unit's operation, around 650 patients have been registered in the clinics, and around 350 patients have been hospitalized and discharged with good general conditions. About 125 patients in the "end of life care" section have expired in presence of the palliative care crew and their family members, without being transferred to the ICU. 120 patients who requested the "home care" service, have been visited 700 times at home by the palliative care team, general physicians, and nurses, during the first 2 years of this unit's operation. According to questionnaires handed out to the physicians who have referred their patients to this unit after the patient's discharge from the treatment field, 95% were satisfied with the referral to this service. Conclusion Palliative care has been capable of offering supportive and palliative care services till the last minute of a patient's life, in addition to full-time call service, frequent home visits, clinical care during the patient's treatment period, and consequently earning their trust. Have you got a Conflict of Interest?: No
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1050 Communicating Progress together: The Canadian Strategy for Cancer Control’s Progress Reporting Tool C. Velasco1, N. Fitzgerald1, A. Coronado1, C. Hally1, E. Saxena1, K. Tran1, J. Chadder1, S. Fung1, M. Cernigoy1, R. Rahal1 1 Canadian Partnership Against Cancer, Toronto, Canada Background and context: In 2019, the Canadian Partnership Against Cancer (CPAC) released the Canadian Strategy for Cancer Control (CSCC), a 10-year roadmap to deliver world-class cancer care to people living in Canada, families and caregivers affected by the disease. It includes 8 priorities, 3 of which are Peoples-specific, self-determined priorities, tackling the most pressing challenges for the next decade. Aim: In collaboration with Canadian provincial and territorial cancer agencies/programs, as well as First Nations, Inuit and Métis partners, data have been collected for actionable indicators to measure progress on advancing the CSCC. These indicators are accompanied by qualitative narratives and examples of innovative initiatives, showcasing progress across the country. The collaborative nature of this Progress Reporting Tool is the first of its kind in Canada and presents the opportunity to meet a unique need for people in Canada, as well as the international cancer community. Strategy / Tactics: Over 80 diverse partners were engaged using an online platform to provide ideas on areas of measurement for the Canadian cancer system and to identify possible indicators; this included cancer agencies/programs, policymakers, health care professionals, subject matter experts, patient and family representatives and First Nations, Inuit and Métis representatives. Engagement efforts culminated in an in-person summit, where consensus was reached on a final list of indicators. Additionally, over the past year, CPAC has further collaborated with First Nations, Inuit and Métis partners to identify indicators to measure progress for the 3 Peoples-specific, self-determined priorities of the CSCC. Programme / Policy process: Twenty-five actionable indicators are in development by jurisdictional cancer agencies/programs, covering topics related to cancer prevention, screening, diagnosis, delivery of high-quality care, equitable care, and person-centred care. Additionally, 16 Peoples-specific indicator concepts have been identified for development and reporting on the Peoples-specific priorities. The Progress Reporting Tool will go live in 2022 and will be updated as new data is made available. Outcomes: No one organization has the resources or ability to report on the CSCC by themselves, but by working together, its promisecan be realized — by measuring and communicating progress such that better cancer outcomes can be achieved for all people in Canada. What was learnt: Collaboration with diverse partners throughout the process allowed for co-development of a cancer system performance reporting approach that truly represents the priorities of all people in Canada, including First Nations, Inuit and Métis. Showcasing the progress of implementing the CSCC’s priorities and actions will allow for continuous learning and improvement across the country. These efforts will ultimately improve the quality of care experienced by cancer patients and their families. Have you got a Conflict of Interest?: No
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1051 developing a national deployment of the CCCL HPV Vaccine program for better future and health for all I. Elhajje1 1 Children's Cancer Center of Lebanon, Public relations and external Affairs, Hamra, Lebanon Background: Lebanon, has no national strategy for the elimination of cervical cancer, nor any plans for awareness of the virus and access to the Human Papillomavirus (HPV) vaccine. The vaccine is not covered by government nor by any third party payer in Lebanon, thus creating an access barrier for a lot of children and adolescents, especially with the current economic crisis and the Covid-19 pandemic. With the launch of the WHO Global Strategy for the Elimination of Cervical Cancer in 2020 and beyond the CCCL's mission of treating Children's with cancer at no cost and without discrimination, have a network of children, adolescents, young adults and their families that could benefit from available tools to safeguard their lives and achieving the targets of the WHO strategy. Thus, the CCCL developed and launched the CCCL HPV Vaccine Program in 2021: Aim: to provided awareness, access, and coverage of the HPV vaccine to young girls and boys in Lebanon and childhood cancer survivors since its launch. with long term aim to protecting the community and reduction of mortality caused by cervical and other HPV related cancer, The program will continue to provide children and adolescents with ways to learn about the HP virus, the HPV vaccine, its benefits and offer it to them free of charge. Strategy / Tactics: There are three specific components of CCCL HPV program strategic and tactics approach to sustain and effectively implement the program. including full-fledge awareness campaign, innovative solution for better managing, governance and monitoring the program , registration and delivery of the vaccine. Programme / Policy process: a national awareness campaign, interactive application for education and registration and appointments for delivering vaccines and provide data to present cases and measure the impact of the program on the community, in addition, to prepare young generation in Lebanon for their healthy lives free of cervical and other HPV related cancers, this program will provide the public educational and research materials to base their papers and government to shape policies. These justifiable reasons are crucial for success in our approach to eliminate cervical cancer under the WHO guidelines and reaching the SDG3. Outcomes: a clear procedure, process and flow of tasks of the program over 200 registrants to the program, over 150 took the vaccine in its soft and pilot launch, a partnership with pharma company for a full fledge awareness sessions worth $9000, design and commencing the implementation of developing smart application, a ministry of Health full collaboration, pediatric referrals, 3 targeted awareness sessions in 8 months and most importantly protecting children and youth from developing cervical or HPV related cancer. What was learnt: - multi-sectorial/stakeholders collaboration is necessary education/awareness must include health workers and children affordability and accessibility following post awareness Have you got a Conflict of Interest?: No
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1052 Physical inactivity and cancer: Using policy to get people moving B. Rempel1, R. Urquhart-Ducharme1 1 Canadian Partnership Against Cancer, Prevention, Toronto, Canada Background and context: Cancer is one of the leading causes of morbidity worldwide, accounting for ~16% of all deaths. Physical activity is linked to a decreased risk of several cancers including colorectal, kidney, and stomach. During the COVID-19 pandemic, rates of physical activity significantly decreased in many countries including Canada. This is of concern as physical inactivity is one of the most common risk factors for cancer, contributing to ~5% of all cases in Canada. Aim: To identify effective policy actions across Canada that encourage physical activity, contribute to cancer prevention, and offer adaptation opportunities for other countries. Strategy / Tactics: A 2021 report produced by the National Collaborating Centre for Methods and Tools and the Canadian Partnership Against Cancer included a review of current physical activity and cancer evidence along with a scan of policies that impact physical activity at local, regional, and national levels. Programme / Policy process: Results were analyzed and assessed against the International Society for Physical Activity and Health (ISPAH) investment domains for physical activity. Five ISPAH investment domains were identified as effective areas for policy action to increase physical activity: active transportation, active urban design, sport and recreation, school environments, and public education. Outcomes: During the COVID-19 pandemic, several Canadian jurisdictions enacted innovative policies to encourage physical activity. Examples include implementation of physical activity tax credits at the provincial/territorial level and increased bicycling roadways at the municipal level. What was learnt: (if relevant, please also detail here the potential of replicability): Different levels of government can respond to decreases in physical activity by enacting policies which encourage movement. Innovative policies across Canada that encourage physical activity could be adapted to other countries. As we emerge from the COVID-19 pandemic, the ISPAH investment domains can guide policy decisions at multiple jurisdictional levels to promote healthy populations and prevent cancer. Have you got a Conflict of Interest?: No
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1054 Knowledge Attitude Practices about Cervical cancer screening among Healthcare professionals of North India A. Pandey Mishra1, A. Sharma2, K. Pandey1 1 King George's Medical University, Obstetrics & Gynaecology, Lucknow, India, 2SGPGI, Maternal Reproductive Health, Lucknow, India Background: Cervical cancer is second commonest cancer among women in India despite being preventable. Most cases are diagnosed late leading to poor outcomes. Lack of knowledge & awareness about screening strategies results in their underutilization in community. Healthcare professionals play a central role in influencing beliefs & practices of public. Aim: To study the knowledge, attitude & practices of cervical cancer screening amongst female healthcare professionals working in community health centres of North India. Methods: A cross-sectional study of knowledge, perception & practices of 1689 female healthcare professionals regarding cervical cancer screening using a predesigned, tested, self-administered questionnaire. Participants were educated about cervical cancer screening after data collection. Data analysis was done using descriptive statistics. Results: Majority of participants were nurses (69%) with a mean age of 31.3 yrs. Only 19% had knowledge about risk factors & signs/symptoms of cervical cancer; 13% about role of HPV infection in causation; 16% about availability of vaccine for prevention. Although 57% believed that PAP smear is a useful tool for early detection of cervical cancer, only 9% had undergone PAP test themselves. Conclusion: Most cervical cancer screening in developing countries is opportunistic. Hence there is an urgent need to assess gaps in knowledge & practice of cervical cancer screening among healthcare workers in the community. Continuing formal educational programs would improve their knowledge and empower them to educate women in the community & promote cervical cancer screening and prevention. Have you got a Conflict of Interest?: No
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1067 The association between microsatellite instability and microbiota in esophageal squamous cell carcinoma W. Rao1, J. Zhou1, J. Zhang1, S. Zhang1, Z. Lin1, Z. Lin1, Z. Hu1,2 1 Fujian Medical University, School of Public Health, Fuzhou, China, 2Fujian Medical University, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fuzhou, China Background: Esophageal squamous cell carcinoma (ESCC) is one of the serious gastrointestinal malignancies worldwide. It is now reported that the dysbiosis microbiota had been linked to an increased risk of developing ESCC and host genetic background may affect the microbiota by changing its compositional and functional profiles. Aim: To illustrate the association between host genomic alteration and esophageal microbiota in ESCC. Methods: We collected esophageal neoplasia tissues and paired adjacent normal tissues from patients with ESCC(n=50). Microbial profiling was performed using 16S ribosomal RNA gene sequencing and the microsatellite instability(MSI) was evaluated by whole exon sequencing. Results: The MSI scores ranged from 0.093 to 0.191. ESCC cases were divided into MSI-high(MSI-H) and microsatellite stable(MSS) groups based on the median MSI scores. The Faith phylogenetic diversity index in MSIH was significantly lower than MSS(P=0.026, Figure 1A). Besides, PCoA displayed that MSI-H grouped separately from MSS samples (PERANOVA: Bray Curtis distance P=0.043, Figure 1B; unweighted Unifrac distance P=0.013, Figure 1C). According to the ANCOMBC algorithm, at the genus level, the differential microbiota including B-42, Finegoldia, Ruminococcus, Coprococcus, Devosia, Kaistobacter,andWolinellawerehigher in MSI-H, whereas Candidatus Arthromitus and Flexispira increased in MSS(Table 1). Moreover, the ecological network analysis performed by SparCC showed that the MSI-H had a more complex network with more interaction among microbiota than that in MSS group(Figure 1D-E). Conclusion: Host genomic microsatellite instability plays a role in affecting the composition and interaction of esophageal microbiota in ESCC. Table 1 The differential microbiota between MSI-H and MSS group in ESCC
Genus
W
B-42 -1.07 Finegoldia -0.63 Candidatus Arthromitus 1.61 Ruminococcus -0.64 Coprococcus -0.48 Devosia -0.29 Kaistobacter -0.50 Flexispira 1.65 Wolinella 0.58
Relative abundance MSI-H MSS 1.52E-04 3.77E-05 1.81E-04 5.99E-05 3.32E-05 1.36E-04 1.71E-04 7.94E-05 2.04E-04 2.42E-05 9.01E-05 3.35E-05 1.57E-04 5.62E-05 2.46E-04 5.14E-04 1.17E-04 7.15E-05
Fold change* FDR 4.03 3.03 0.24 2.16 8.42 2.69 2.80 0.48 1.64
* Fold change=the relative abundance of MSI-H/ the relative abundance of MSS.
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<0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
Figure 1. The esophageal microbiota landscape affected by MSI. (A) The alpha diversity based on Faith phylogenetic diversity index. (B-C) The PCOA plots based on Bray Curtis distance(B) and Unweighted unifrac distance(C). (D-E) The microbiota co-occurrence network of different MSI groups in ESCC. Separate network plots were constructed for MSI-H(D) and MSS(E). The color of each node indicates the phylum of the microbiota and the size denotes the relative abundance. The edges indicate the correlations and line thickness corresponds to the strength of the association. "Undefined" means the unclassified microbiota according to the database. Have you got a Conflict of Interest?: No
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1068 Improving cancer information: a national online survey to determine preferences, gaps, and online challenges A. Hyatt1,2,3, A. Shelly4, R. Cox1,5, E. Humphries6, G. Lock7, M. Varlow1 1 Cancer Council Australia, Cancer Control Policy, Sydney, Australia, 2Peter MacCallum Cancer Centre, Health Services Research, Melbourne, Australia, 3The University of Melbourne, Sir Peter MacCallum Department of Oncology, Melbourne, Australia, 4Cancer Council Victoria, Strategy and Support Division, Melbourne, Australia, 5Cancer Council Tasmania, Cancer Prevention and Support Services, Hobart, Australia, 6Cancer Council NSW, Finance, Strategy and Operations, Melbourne, Australia, 7Cancer Council Queensland, Cancer Support and Information, Brisbane, Australia Background: Providing patients with high quality and easily understandable health information has been demonstrated to directly improve knowledge, promote involvement in decision making, and has a positive effect on health behaviours and experiences of healthcare. Health disparities are reduced and medical outcomes improved when patients are able to understand with their disease and care needs. Therefore determining patient and carer preferences regarding cancer information provision is important, along with identifying remaining gaps and barriers to information access and understanding. As oncology health information provision increasingly moves online, understanding how service users experience or avoid misinformation is likewise needed. Aim: This study aimed to understand the information preferences and perceived informational gaps identified by people affected by cancer. Specifically, preferred topics, formats, timing, and mediums were explored, along with challenges to information access, particularly with regard to online information provision, and perceived trust and safety. Methods: This study utilised a purpose-built national cross-sectional survey distributed via social media to assess perspectives regarding cancer information in Australia. Both quantitative and qualitative (open text) items assessed respondents’ experiences and perspectives. Results: A total of 491 people affected by cancer completed the survey. Respondents highlighted a preference for information that better addresses the diversity of cancer experience, and is more timely and responsive to personal situation and context. Despite increasing attention to health literacy standards, complex medical jargon and terminology remains prevalent. Many respondents have concerns about accessing information online, particularly with regard to misinformation. Improved mechanisms or skills/training to assist individuals in determining the trustworthiness and relevance of information found online were requested. Conclusion: Survey responses identified current gaps in information provision for people affected by cancer. Education and resources to target and improve digital health literacy and combat health misinformation are needed. Personalised information in formats which are more flexible, accessible, and responsive to user needs are required. Have you got a Conflict of Interest?: No
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1079 Cancer mortality among employed Japanese women from 1980 to 2015 B. Dhungel1,2, K. Wada3, S. Gilmour1 1 St. Luke's International University, Graduate School of Public Health, Chuo, Japan, 2National Center for Child Health and Development, Department of Health Policy, Setagaya, Japan, 3International University of Health and Welfare, Department of Public Health, Minato, Japan Background: The prevalence of cancer mortality and morbidity in Japan has increased over the past decade. Cancers of the lung, stomach, pancreas, and colon are leading causes of cancer-related death for Japanese women between the ages of 25 and 64, who account for around 70% of the female workforce. Traditionally research on occupationrelated health in Japan has focused on men, even as the number of working women continues to increase. Research on whether occupations and industries increase the cancer risk among Japanese working women is lacking. Aim: This study aims to assess patterns of and trends in mortality due to key cancers among women and the effect of the economic crisis in the mid-1990s separately for occupational and industrial categories. Methods: A repeated cross-sectional study was conducted with five-yearly mortality data from the Japanese Population Census and the National Vital Statistics from 1980 to 2015. For 1980, 1985 and 1990, we used the ninth revision of the International Classification of Disease and the tenth revision for 1995, 2000, 2010 and 2015. We examined the four leading cancers–lung, stomach, pancreas, and colorectal cancer– in Japanese women aged between 25 and 64 years. The age-standardised rates were computed across occupations and industries using the population of 1985 as a reference to analyse patterns in cause-specific mortality rates. We used Poisson regression analysis to measure mortality risk and changes in mortality trends across occupations and industries separately by cause of death after 2000. Results: The trends in age-standardised rates of lung, pancreatic and colorectal cancer increased among managers from 1980 to 2015. Similarly, trends in age-standardised lung and pancreatic cancer mortality among workers in the fishing and electricity industry increased during the same period. Mortality risk among managers is higher than among sales workers for lung (Incident rate ratio (IRR), 2.34; 95% CI, 1.67–3.28), stomach (IRR, 1.87; 95% CI, 1.52– 2.29) and colorectal cancer (IRR, 2.04; 95% CI, 1.50–2.77). Similarly, workers in the mining and fishing industries had quite high mortality rates for all cancers compared with wholesale and retail workers. The trend in pancreatic cancer mortality among female transport workers increased by 11% on or after 2000 compared to before. Similarly, stomach cancer mortality increased by 4.8% among workers in the transportation and communication industries after 2000. Conclusion: The mortality among female workers in Japan differed considerably by occupation and industry from 1980 to 2015. The trends in cancer mortality, however, declined over the study period in most occupations and industries. It is vital to monitor cancer mortality trends for improving the health and well-being of employed Japanese women. Have you got a Conflict of Interest?: No
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1081 Fundamental Discoveries for Prostate Cancer in Sub-Saharan Africa: The MADCaP Network T. Rebbeck1, The Men of African Descent and Carcinoma of the Prostate (MADCaP) Network 1 Harvard University and Dana_Farber Cancer Institute, Boston, United States Background: In the past century, fundamental discoveries in cancer genetics and biology have driven the accumulation of knowledge that have led to translatable tools, technologies, and strategies for improved health. The generation of this knowledge has been a major driver of social and economic development. These activities form the building blocks for the biotechnology and pharmaceutical industries, health systems, and policy decisions related to disease prevention, screening, and treatment. However, the majority of fundamental and applied research has occurred in high-income countries. Aim: The Men of African Descent and Carcinoma of the Prostate (MADCaP) Network (www.macapnetwork.org) is a transnational alliance to inform science and clinical practice globally, inform public health and policy needs locally, and be led in a sustainable manner by local SSA researchers involved in global collaborative teams. MADCaP’s mission is to understand cancer causation, screening, early detection, and treatment; and to translate this knowledge into actions and policy that impacts on the health of Africans. Methods: The MADCaP network includes 24 centers in the USA, Senegal, Ghana, Nigeria, Rwanda, Kenya, Botswana, and South Africa. Each center collects biosamples, including blood and tissue using vetted protocols, data collection instruments and surveys, a common database, and protocols for resource sharing. Common data collection, processing, and storage protocols have been developed and tested to ensure that data collected at each can be integrated for network-wide research. Results: In SSA, MADCaP has collected nearly 10,000 prostate cancer (CaP) cases and controls with germline DNA and related biosamples, epidemiological risk factors, detailed pathology evaluation, medical records extraction, nutritional data; subsets of cases also have tumor tissue available. A genomic array has been developed by MADCaP to capture the African genome for genome-wide association studies as well as population and evolutionary genetics research. Using these data, we have identified unique loci associated with CaP risk, including loci with unique admixture and evolutionary selection features that may in part explain the unique disease etiology and natural history of CaP in African descent men. We have evaluated dietary and nutritional patterns in African men and will relate these to disease risk and lifestyle modifications that may be used to reduce CaP risk. MADCaP’s work includes evaluation of genetic testing and counseling protocols in SSA. Conclusions: The MADCaP network provides a rich collaborative resource that facilitate discoveries relevant to cancer in SSA and other low resource environments. Its work will foster the development of tools and technologies that build on this knowledge, and translate this knowledge to drive health, social, and economic change in SSA. Have you got a Conflict of Interest?: No
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1082 Genomic Classification of Esophageal Squamous Cell Carcinoma and Its implication of therapy Z. Mai1,2,3, J. Xie4, J. Wen2,3, J. Fu1,2,3 1 Sun Yat-sen University Cancer Center, Department of thoracic surgery, Guangzhou, China, 2Guangdong Esophageal Cancer Insititute, Guangzhou, China, 3Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, 4Renmin University of China, School of Statistics, Beijing, China Background: Identification of molecular subtypes (MS) that reflect prognoses and treatment responses in esophageal squamous cell carcinoma (ESCC) is far from clinical practice. Aim: We aim to discover genomic biomarkers to recognize MS of ESCC. Methods: We analyzed genomic data in 201 ESCC patients from Sun Yat-sen University Cancer Center, and validated our findings in 483 patients from published datasets. Two gene mutation signatures were chosen as genomic biomarkers based on co-occurrence. The Cox trend test was used to evaluate the prognostic value of the MS. Results: AHNAK and AHNAK2, involved in DNA repair, were co-mutated in ESCC (OR: 3.17, P=0.0003, Fisher’s exact test). As core members of the Hippo pathway, FAT3 was frequently co-mutated with FRY (OR: 3.10, P=0.021) and FAT1 (OR: 2.59, P=0.057). We devised hierarchical rules to classify ESCC patients into three MS: AHNAK1/2 mutant, FAT/FRY mutant but without AHNAK1/2 mutations, wild type (Figure 1A). We used the Cox trend test to validate the survival differences of the MS in our cohort and published datasets (Fig 1B/C/D). Across multiple datasets, the MS separated patients with different OS (P<0.01, Fig 1E). Results from multi-omics data of TCGA indicated both the AHNAK1/2 and FAT/FRY subgroups had more infiltration of CD8+ T lymphocytes (TILs) than the wild-type group (P<0.05, Wilcoxon test). The TILs enrichment was confirmed in the SYSUCC cohort by immunohistochemistry (Fig 1F). Furthermore, we sought the integration of the pTNM stage and MS to better stratify ESCC patients. As the FAT/FRY mutations exerted distinct prognostic values in pN+ and pN0 patients (Pinteraction<0.05), we devised our MS to subdivide patients based on the pN stage, as displayed in Fig 2A. Figure 2B showed that in datasets that all were pN+ patients, our devised MS (dMS) showed a more significant stratification than the pTNM stage (Plogrank:3.4X10-9<9.2X10-7). We also validated our dMS in pN0-3 datasets and again the dMS achieved a more significant prognosis partition and more accurate prediction (P: 2.6X10-9<1.6X10-7, C-index:0.684>0.653, Fig 2C). Post-adjuvant therapy (ADT) information was available in two datasets (271 pN+ patients). Among them, we found that ADT only improved DFS and OS in patients with AHNAK1/2 mutations, but not other subtypes (Fig 2D/E/F/G). The interactions between ADT and AHNAK1/2 mutations were significant for OS (P interaction=0.028) and marginal significant for DFS (Pinteraction=0.089), according to the Cox model (Table 1). Conclusion: We established a molecular classification of ESCC, among which patients in the AHNAK1/2 mutant subtype might benefit from ADT, whereas other patients might not beneficiaries.
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Figure 1 (A) sketch of MS. (B/C/D/E) Survival curves of MS in SYSUCC (B), TCGA (C), 4 Chinese WES datasets (D), and whole ESCC populations (E). (F) CD8+ TILs infiltrations in TCGA and SYSUCC cohort.
Figure 2 (A) Integration of MS and pN stage. (B/C/D/E) Survival curves of dMS in pN+ datasets (B), pN0-3 datasets (C). (D/E/F/G) Validation of AHNAK1/2 mutations as a predictive biomarker of efficacy of ADT in two pN+ datasets.
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Table 1 Outcome of adjuvant chemotherapy for ESCC patients stratified by mutation status of AHNAK1/2 Overall survival AHNAK1/2 No. of events/patients Hazard ratio (95% CI) P-value Genotype (adjuvant therapy VS not) AHNAK1/2 11/47 VS 31/56 0.34 (0.17 to 0.67) 0.0021 mutant Wild type 41/69 VS 69/99 0.79 (0.53 to 1.16) 0.23 P =0.028 Disease-free survival AHNAK1/2 No. of events/patients Hazard ratio (95% CI) P-value Genotype (adjuvant therapy VS not) AHNAK1/2 15/47 VS 34/56 0.43 (0.23 to 0.79) 0.0063 mutant Wild type 43/69 VS 76/99 0.77 (0.53 to 1.12) 0.18 P =0.089 interaction
interaction
Have you got a Conflict of Interest?: No
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1086 Does Surgical Treatment of Early-Stage Breast Cancer in New Zealand Women Vary by Region? S. Abrahimi1, S. Tin Tin1, J. Zhao1, I. Campbell2, R. McNeill3, M. Elwood1 1 The University of Auckalnd, Epidemiology and Biostatistics, Auckland, New Zealand, 2Waikato Hospital, General Surgery, Hamilton, New Zealand, 3The University of Auckalnd, Health Systems, Auckland, New Zealand M.S. Abrahimi1, S. Tin Tin1, J. Zhao1, I. Campbell2, R. McNeill3, M. Elwood1 1 Epidemiology and Biostatistics, School of Population Health, The University of Auckland. 2 Breast and General Surgeon, Waikato Hospital, Hamilton, New Zealand. 3 Health Systems, School of Population Health, The University of Auckland. Background Treatment of early stage (I-IIIa) primary invasive breast cancer generally includes surgery and radiation therapy. The choice is often between breast conserving surgery (BCS) or mastectomy (MTX), either of which may be coupled with (RT). Over time, BCS has generally increased in most countries, but substantial variations are often seen. Aim To assess variations in the surgical treatment (BCS±RT vs. MTX±RT) of early stage (I-IIIa) primary invasive breast cancer across New Zealand regions (Auckland, Waikato, Wellington, Christchurch). Methods Data from 8,686 women diagnosed with early stage (I-IIIa) primary invasive breast cancer were used to examine surgical treatment variations (BCS/BCS+RT vs. MTX/MTX+RT) in regions using their respective breast cancer registers.Logistic regression was conducted in a stepwise fashion controlling for demographic, clinicopathological and systemic treatment factors.Logistic regressionwas used to adjust for demographic, clinicopathological and systemic treatment factors. For womendiagnosed between 2010-2015, four regions Auckland, Waikato, Wellington or Christchurch were compared. Comparisons were also made between Auckland and Waikato for women diagnosed between 2000-2009. Results During 2010-15, the receipt of BCS± RT(vs. MTX± RT) was much higher in Waikato (91%) than in the other 3 regions, which had similar lower rates (75, 74 and 72%). After adjustments fordemographic, clinicopathological and systemic treatmentfactors, the odds ratio (OR) for BCS±RT receipt in Waikato was 6.48 (95% CI:4.54-9.25), relative to Auckland. In the earlier period 2000-2009, the OR for Waikato compared to Auckland was 2.24 (95% CI:1.86-2.69), with no data available for the other regions. Demographic factors had a greater influence than clinicopathological or systemic treatment factors. Conclusion The use of BCS±RT (vs. MTX±RT) has been much higher in Waikato than in 3 other regions of New Zealand in 2010-2015. Earlier, in 2000-09, it was used more often in Waikato than in Auckland, but the difference was not as great. The different usage is seen even after control forrecorded demographic, clinicopathological and systemic treatment factors. Other factors such aspatient and physician choice, and resource and workload issues, need to be investigated further. Have you got a Conflict of Interest?: No
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1087 Funding the Elimination of Cervical Cancer T. Harper1, K. Broun1, K. Doucouliagos1 1 Cancer Council Victoria, Melbourne, Australia Amount raised: AUD$1,137,052 Background and context: With one of the lowest cervical cancer incidence rates in the world, Victoria is on track to eliminate cervical cancer However inequities in cancer screening, timely diagnosis and treatment and HPV immunisation mean there is a risk of cervical cancer becoming a disease of the disadvantaged Aim: Raise AUD$1.45 million to accelerate the equitable elimination of cervical cancer in Victoria (Australia) by 2030. Strategy / Tactics: In developing a fundraising strategy for Cancer Council Victoria’s Eliminating Cervical Cancer Fund we drew inspiration from traditional capital campaigns, with quiet and public phases and communication resources such as https://conqueringcancercampaign.com/ Phase One focused on securing a $1M lead gift from a philanthropic partner and develop impact stories about cervical cancer prevention and early detection in communications sent to major donors In Phase Two we introduced the Eliminating Cervical Cancer Fund to more major donors and prospects through 1:1 conversations and featured the fund in our Christmas letter with a call to action to contribute to the Fund In Phase Three we introduced the Eliminating Cervical Cancer Fund to a group willing to become advocates for the Eliminating Cervical Cancer Fund and promote the Fund through their networks. These advocates have hosted two events. The first event was a 20-minute Digital Briefing in December 2021. This was designed to get a group of 50 prospective donors excited about our goal to contribute to the elimination of cervical cancer prior to an inperson event in early 2022. The second event, A Melbourne Moment, took place in March 2022 at an iconic Melbourne CBD building with a dinner of 60 influential guests. This raised $56,000 for the Fund through an auction and pledges. Over the coming years, we will work with our Advocates to identify prospective donors to the fund and build relationships with them Programme process: Cancer Council Victoria established the Eliminating Cervical Cancer Fund to close the inequity gap through a fiveyear elimination roadmap to: 1. Increasing cervical screening 2. Investigating and uncovering patient-level issues relating to vulnerable women and people at risk being lost to follow-up in the cervical screening management pathway. 3. Sustaining HPV vaccination confidence through media, community engagement and advocacy about efficacy and safety of vaccination
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Costs and returns: What was learnt: A strong alignment with our mission project team and ensuring these experts were in the room when securing gifts, helped to establish trust and credibility As a project that largely impacts women, female voices has been important, ensuring that it was largely women making the donation ask, or female experts in the room As donors and foundations became advocates and spokespeople for our work, it was important to develop shared messaging about the program to eliminate cervical cancer Have you got a Conflict of Interest?: No
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1089 Strategic Training Achievements for Research Success (STARS): Increasing cancer research capacity in Africa T. Rebbeck1 1 Harvard University and Dana-Farber Cancer Institute, Boston, United States Background: Addressing cancer in SSA involves two necessary components: strategic capacity and operational capacity. Strategic capacity in research involves each project’s specific aims, objectives, research questions, and research design. Operational capacity supports project-specific policies and procedures, including pilot studies and assorted quality control checks, and may utilize electronic management systems to help track evaluation project progress. Aims: We have developed the STARS training to maximize the rigor of cancer research in SSA and address strategic and operational capacity needs in SSA. This training will 1) Develop and disseminate best practices to enable the highest quality cancer research in SSA; 2) Teach fundamental skills to those who conduct research in SSA, and 3) Create a cadre of individuals to lead and support cancer research in SSA. Methods: Funded by a grant from the US National Cancer Institute (D43-CA260640), eligible trainees will fall into two groups. The Principal Investigator Track (PI-STARS) are doctoral-level investigators who will become proficient in research oversight and governance and build the skills and a scientific project focus toward independent extramural grant funding. Project Management Track (PM-STARS) support the conduct of research by helping research projects within SSA health and regulatory settings. Training will involve bilateral interactions between mentors and trainees in both SSA and the US to develop and implement best research practices. Results: Individuals participate in a nine-month training program in three modules.ThePROjectManagementOversightTraining andEducation (PROMOTE) Core Curriculum consists of ethical, regulatory, logistical, and fiscal content. PI-STARS training includes didactic lectures and mentor-led small group project development sessions culminating in a grant application. These grants will be reviewed by a mock study section in preparation for a formal grant submission. PM-STARS training includes didactic lectures and small group training sessions that will lead to a Certified Associate in Project Management (CAPM) designation by the Project Management Institute (www.pmi.org). The first class of 8 PI-STARS and 15 PM-STARS trainees was selected in April 2022. Conclusions: The African Cancer STARS program provides a structured approach to training of individuals who will lead future cancer research in SSA. Moreover, the STARS program provides a paradigm by which a cadre of African principal investigators and project managers can be created to meet the needs of cancer research in SSA. Have you got a Conflict of Interest?: No
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1095 The role of non-government cancer organizations in cancer control innovation and policy over time T. Kehoe1, A. May2, R. Barker3, C. Holbrook4, H. Jones5, R. Moodie6, A. Varnava7, A. Westmore2 1 Cancer Council Victoria, Melbourne, Australia, 2University of Melbourne, Historical Studies, Parkville, Australia, 3Deakin University, Communications, Burwood, Australia, 4Deakin University, Historical Studies, Burwood, Australia, 5McCabe Centre for Law and Cancer, Melbourne, Australia, 6University of Melbourne, Public Health, Parkville, Australia, 7Flinders University, Historical Studies, Bedford Park, Australia Background: Non-government organisations (NGOs) have historically played an important role in global disease control. But the precise mechanisms and processes employed for affecting legal, policy, and cultural change are poorly understood. Through research, program delivery, and advocacy Cancer Councils in Australia have played a major role in reducing Australian smoking prevalence through tobacco control policies and changing a committed sun-loving culture to reduce exposure to ultra-violet radiation and skin cancer. Explainingwhy Cancer Council Victoria was so successful could help other cancer NGOs to become more effective. Aim:To apply a historically-oriented humanities approach to understand how institutional attributes, governance structures, key volunteer and paid personnel, cultural, political and legislative contexts synergised for significant advances in cancer control. Strategy:This paper assesses the benefits of integrating the discipline of history into public health to create a “public health humanities” that illuminates the longitudinal impact of NGOs. Programme:It does so by: 1) consulting with relevant experts and stakeholders within and external to Cancer Council Victoria; 2) assessing archival and oral sources; 3) identifying key metrics for comparison; 4) reviewing the relevant literature. Outcomes:This case study shows how a historically-oriented public health humanities can illuminate the connections between past and current activities of a disease-focused NGO, and provide a deeper understanding of how such NGOs can achieve public policy and population behaviour change to reduce the impact of cancer on the community. What was learnt and replicability:To identify historic lessons for future policy change,preservation of an organisation’s history through curation and access to its archives, products, and past and current staff and volunteers is necessary. These are platforms for understanding why past initiatives succeeded or failed and are a foundation for continuous improvement of institutional effectiveness.Co-design of such evaluations with an interdisciplinary team that includes historians is important. Have you got a Conflict of Interest?: No
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1098 Mobile screening campaigns in rural areas: a solution to detect breast cancer and colorectal cancer M.F. Bin Md Taib1 1 MAKNA, Kuala Lumpur, Malaysia Cancer has a massive economic and social impact in Malaysia. According to the Malaysian National Cancer Registry Report 2012-2016, cancer cases rose 11% from 2007-2011. There is an increase of 28.5% in deaths attributed to cancer, largely due to the late detection of cancers in Malaysia. 63.7% of cancers in Malaysia are detected in the stages three and four. MAKNA introduced the Digital Mobile Mammogram Unit (DMMU) in 2011 to address the issue of late detection, accessibility and screenings efficiency. It provides free mammogram and clinical breast examinations for women with household income below RM3500 (approximately USD830). The programme targets rural communities across Malaysia. To date, the DMMU have conducted 32,172 mammograms and 19,494 CBEs. In 2022, the Ministry of Health Malaysia launched the white paper "Cancer Care Challenges, Gaps and Opportunities in Malaysia", that recommends more cancer screening, effective cancer treatment, and optimisation of financing and governance of cancer care. Currently, the Ministry of Health Malaysia has introduced immunochemical faecal occult blood test (IFOBT) for those between 50 and 75 years, free of charge and in selected government clinics. However, in 2019, a study from University Malaya found that while 51.4% of participants said they were willing to undergo the IFOBT test, only 7.5% performed the test. Among reasons given for not undergoing IFOBT, 59% said they had no symptoms, 15% said they were not recommended by doctors, 5% attributed it to lack of knowledge on the IFOBT, and deeming the screening process unhygienic. This study shows that the public’s perception and knowledge on colorectal cancer, behaviour, and lack of advice by healthcare professionals, result in the low uptake of the IFOBT test. As a response to these challenges and barriers, MAKNA is introducing colorectal cancer awareness and IFOBT to the existing screening program. Women coming for mammogram already fall in the age group for IFOBT and already have an interest to perform cancer screening. They also frequently come with husbands or sons who might fall in the IFOBT age group. The cost of adding IFOBT to the DMMU service is negligible: in Malaysia it costs RM5 per IFOBT kit as compared to RM150 per mammogram. Staffing costs and logistic costs are also negligible as we choose to capitalise on existing resources and proven best practices. Breast cancer is the most prevalent cancer in the world and colorectal cancer is the third most prevalent one. While mobile breast cancer screening initiatives are not rare across the globe, a two-cancer approach in mobile screening has been explored only in few countries. Such an innovative service has a high replicability potential, as mobile screening units have proven to be impactful, especially for rural areas or urban poor. By combining mammogram and IFOBT, we focus on detecting at early stages two types of cancer instead of just one, and reduce the cancer burden in our communities. Have you got a Conflict of Interest?: No
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1101 Chai for Cancer - Raise a Cup, Drink to a Cause V. Venkatesh1, A. Paul2 1 Friends of Max, Managing Trustee, Mumbai, India, 2Friends of Max, Communications Manager, Mumbai, India
Amount raised: USD 29,000 (May 2021 – April 2022) Background and context: Launched in 2014, Chai for Cancer is the fundraising and awareness initiative for Friends of Max, the support group arm of The Max Foundation in India. It is the brain-child of Viji Venkatesh, Region Head (South Asia) – The Max Foundation, and the Chairperson & Managing Trustee of Friends of Max, a registered charitable public trust. The eighth season of the Chai for Cancer Campaign was launched on 9th May 2021, at the height of the COVID-19 pandemic in India. Aim:1. To raise awareness about rare cancers 2. To offer a safe platform for cancer patients and their families to share their story 3. To de-stigmatize the term “cancer” 4. To raise funds for support the seemingly insignificant yet unmet needs of cancer patients such as their diagnostics costs, travel costs and their children’s education cost. Strategy / Tactics:Chai for Cancer deploys informal hangouts or ‘Addas’ complete with a cup of chai and refreshments that will bringtogether like-minded donors and supporters of the cause. A Chai for Cancer Adda creates an atmosphere of an extended family which fulfils the important need of understanding the struggle of cancer patients through their perspective. Chai for Cancer Addas are ideal to reach out to families coping with cancer as well as for emotional support that is necessary in what can be an arduous journey.
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Programme process:
Costs and returns:
Sr. No. Cost Incurred 1. Printing of literature 2. Manufacturing & Distribution of Merchandise: • • •
3.
Benefit Realized Awareness Generation Sales Generation: • •
T-shirts - ₹330/Mugs - ₹225/Courier - ₹50/-
T-shirts - ₹1000/Mugs - ₹500/-
Funds raised - ₹100/cup of tea Incentive for hosts and volunteers
Tea & Snacks
What was learnt: (if relevant, please also detail here the potential of replicability) No one knows what someone is going through unless they are going through it themselves.The Friends of Max Patient Support Group recognizes the need for sharing and learning from each other’s experiences. A Chai for Cancer Adda creates a conducive and safe space for cancer patients and caregivers to share their personal stories and help each other heal and grow. The Chai for Cancer Adda is a simple model based on the idea of like-minded individuals getting together to raise awareness and funds for cancer patients in need. It is very easy to scale and replicate and adapt such a model to suit the needs of the host and venue – both physical and virtual.
Have you got a Conflict of Interest?: No
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1108 Equitable and Affordable Cancer Care in Assam: A Joint Initiative of Tata Trusts and Government of Assam S. Chanda1, S. Sen1, V.P.B. Koyyala2, S. Gupta2 1 Assam Cancer Care Foundation, Guwahati, India, 2Assam Cancer Care Foundation, Tezpur, India Background and context: Low and Middle Income Countries (LMICs) including India, contribute about 70 % of cancer related deaths worldwide. In India, high cancer burden is observed in northeastern states including Assam, where challenge is mostly due to only two government treatment centers restricted to state capital for 34 million population of the state. Consequently, the patients are compelled to travel a long distance, incurring a huge out-of-pocket expenditure. These facilities also get overburdened resulting into late diagnosis and treatment. To address these issues, Tata Trusts, a philanthropic organization, in collaboration with Government of Assam, established Assam Cancer Care Foundation (ACCF) and developed a four-level Distributed Cancer Care Model (DCCM) to provide quality and affordable cancer care. Aim: To deliver equitable and affordable cancer care closer to patients’ homes, while reducing the current mortality to one-third in 10 years. Strategy: Government expenditure in health in India is only 1.2% of Gross Domestic Product (GDP) and only 20% of Corporate Social Responsibility (CSR) funds spent in 2019-20. Considering this scope of mustering funds, Tata Trusts under its CSR initiative established ACCF. Equipment donated by Tata Trusts , while the infrastructure developed through Government of Assam funds. Hence, there is no Return on Investment (RoI) needed and makes cancer care affordable and accessible. Most patients are covered under government insurance schemes and those who pay out of pocket are charged nominally. Programme process: Level 1 facility is an apex centre at Guwahati, providing all advanced cancer care services including research. Level 2 facilities established in four districts- Barpeta, Dibrugarh, Diphu and Silchar, which provide comprehensive oncology services. Level 3 facilities established in five districts- Kokrajhar, Jorhat, Lakhimpur, Darrang and Tezpur, which provide diagnostic and day care services. While the hospitals are near completion, three day care centres, offering chemotherapy and radiotherapy services started at Barpeta, Dibrugarh and Diphu. Level 4 consists of community-based awareness and prevention of cancers in all nine districts. Outcomes: From August 2020 to March 2022, 28841 consultations done in three-day care centres, where 4029 chemotherapy sessions and 11660 radiotherapy fractions delivered. Additionally, out of 2148 patients registered, 1027(47.81%) doing fine after treatment completion while 362 (16.85%) patients expired till March’2022. From August 2020 to March 2022, 97184 people reached for awareness generation.
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What was learnt: CSR funds can be tapped for incremental investment in cancer care. Government schemes should be extended to cover diagnostics. This model is unique and with government initiative complimented by CSR funding, this can be replicable in any geography of interest.
References: 1. 2. 3. 4. 5. 6.
7.
WHO International Agency for Research on Cancer. Estimated number of deaths in 2020, all cancers, both sexes, all ages. Cancer today. 2020. India State level Disease Burden Initiative Cancer Collaborators: The burden of cancers and their variations across the states of India: The Global Burden of Disease Study 1990-2016, 2018. Lancet Oncology.19:1289-1306. ICMR-NCDIR.2021. Cancer and related health indicators in the northeast region of India. NE_ profile of cancer NCDIR.pdf. Pramesh CS, Badwe RA, Bortahkur BB. Delivery of affordable and equitable cancer in India,2014. Lancet Oncology. 15: e223e233,2014. Rajpal S, Kumar A, Joe W. Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014. PLoS One. 2018 Feb 26;13(2): e0193320. doi: 10.1371/journal.pone.0193320. Joe W. Distressed financing of out-of-pocket healthcare payments in India: incidence and correlates, 2015.Health Policy and Planning;30: 728–741. doi:10.1093/heapol/czu050 Government of India. 7th Annual Report. 2021. Ministry of Corporate Affairs. Available from:https://www.mca.gov.in/content/mca/global/en/data-and-reports/reports/annual-reports/companies-2013.html
Have you got a Conflict of Interest?: No
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1111 Nepal Cancer Relief Society and Cancer Control in Nepal S. Shrestha1,1,1 1 Nepal Cancer Relief Society, Lalitpur, Nepal Background and context: Ever since 1982, Nepal Cancer Relief Society (NCRS) has been helping to fight against the spread of cancer in Nepal, establishing branches in 45 districts and mobilizing 15,000 volunteers nationwide. As a community-based organization, NCRS has developed extensive programmes throughout the country and led initiatives in the field of tobacco control, cancer prevention and cancer control. NCRS has been in the vanguard of tobacco control for over three decades. Aim: In a country with little knowledge and limited access to information on cancer, NCRS aims to provide easy access to information on cancer, make the cancer treatment more affordable, and make early cancer detection and prevention more common to the public. Strategy / Tactics: 1. 2. 3. 4. 5. 6. 7.
Collaboration with like-minded organizations for organizing advocacy campaigns, seminars. Initiation of the only Quit helpline and Cancer Helpline services in Nepal for quitting tobacco. Yearly tax advocacy with the government of Nepal to raise excise duty on tobacco products. Organization of monthly Tumor board conferences to discuss the issues with cancer incidences. Organization of free health camps for cancer screening. Organization of various awareness activities in educational institutions and other platforms. Collaboration with the media for advocacy, awareness and enforcement of the policy.
Programme / Policy process: 1. 2. 3. 4. 5.
Providing the Tobacco Quit Line counselling services and cancer helpline services to people who are willing to quit tobacco. Advocacy collaboration with think tanks for making the government accountable in enforcing tobacco policies and for tax interventions to reduce tobacco use. Won the case in High Court against the tobacco Industries regarding the policies for the display of at least 75% of health warning pictures and text on cigarette packages. Supporting curative programs delivered by Bhaktapur Cancer Hospital (BCH) and Lahan Cancer Care Center. Creating a platform as Tumor board for discussing cases of cancer among various specialized doctors like pathologist, radiologist, surgeons and radiotherapists etc. NCRS held its 128th Tumor Board Meeting in March 2022.
Outcomes: The only Quit line counselling services have been able to provide counselling to around 5000 smokers in the last 10 years.Our collaborative advocacy has been able to increase 25% of excise duty in the budget Fiscal Year 2077/78 BS and our advocacy is continuing. After we won the case against tobacco industries, 75% of pictorial and textual health warnings on the tobacco packets are in implementation. Along with that, enactment of a national level tobacco control law in Nepal is in implementation. The yearly awareness program in schools is helping to create new generation leaders in tackling tobacco pandemic and cancer incidences. Overall the comprehensive approach of NCRS in cancer control has been effective in Nepal and we look forward to continuing the work. Have you got a Conflict of Interest?: No
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1113 Feasibility study on the repeated using 3D printed applicator in brachytherapy treatment of cervical cancer x. zhao1, h. wu1, D. Zou1 1 Chongqing University Cancer Hospital, Chongqing, China Background: Intertissue insertion is highly difficult and affected by skilled operators. Different operators have different efficacy and poor repeatability . It has been reported that the difference between the pre-plan and actual treatment plan of 3D printing mold before assisted particle implantation of head and neck has been reported. However, BT cervical cancer routine requires 4-6 treatments or even more, and there is no relevant report on whether the same 3D printing mold can be used repeatedly. In this study, the feasibility of repeated use of 3D printed moulds in the same patient's close treatment was explored by comparing the dosimetric data of the pre-plan of 3D printed moulds with the actual multiple treatment plans. Aim: To explore the feasibility of repeated use of the same mold in the brachytherapy of cervical cancer by comparing the dosimetry of the 3D-printed personalized applicator in the pre-plan and actual treatment plan in the brachytherapy of cervical cancer. Methods: A total of 10 patients with cervical squamous cell carcinoma who received radical radiotherapy in our hospital from November 2019 to July 2020 were collected. All patients received concurrent radiotherapy and chemotherapy combined with 3D printed applicator assisted brachytherapy. Dosimetric parameters, including target volume, CI, HR-CTV D90, and organs at risk D2CC, were compared with those of the actual treatment plan. The two plan parameters were compared using statistical paired T test, and the patient survival outcome was analyzed using Kaplan-Meier survival analysis. Results: 10 applicators with 3D printed were designed, and a total of 47 practical treatments were completed. The same patient needed 4-5 times of brachytherapy. Only the target volume and CI of the first actual treatment plan were similar to those of the pre-plan, and the difference was not statistically significant (P> 0.05), the more times of close treatment, the greater the difference between actual treatment plan and pre-plan (P<0.05); The higher the HR-CTV D90dose, the higher the OARs dose, but all of them could meet the clinical requirements. The median follow-up was 23.5 months, and the 2-year LCR, DFS and OS were 100%, 90% and 80%, respectively. Conclusion: The 3D-printed personalized applicator can be used repeatedly for the close treatment of the same cervical cancer patient, but the needle depth needs to be adjusted by CT positioning.
Table1Comparison of dosimetric parameters between 3D-printed individualized mouldassisted near treatment preplanning and actual treatment planning Actual treatment plan Preliminary The second The fourth plan The first plan The third plan The fivth plan plan plan Patients 10 10 10 10 10 7 (N) CI 0.66±0.32 0.66±0.37* 0.68±0.31 0.69±0.03 0.69±0.02 0.70±0.03 volume 40.50±14.64 40.06±14.79* 36.91±13.03 32.94±12.52 29.43±10.77 29.20±12.54 of HR1
CTV（ cm ） HRCTV 636.18±54.3 669.86±46.72 622.53±28.46 675.44±49.10 692.73±37.60 671.41±42.41 D（ 0 * * cGy） Bladder 303.01±50.7 343.17±36.84 D （ 382.83±52.36 372.82±63.29 367.28±47.34 374.97±29.19 2 * cGy） Rectum D （ 332.19±60.9 359.55±55.48 371.92±30.64 325.76±71.41 335.35±65.75 327.39±48.70 7 * * * * cGy） Sigmoi 164.36±36.1 231.59±65.72 dD （ 257.51±78.39 247.75±78.82 252.79±77.04 284.85±58.65 7 * cGy） * The actual treatment plan was not statistically significant compared with the preplan, p>0.05 3
90
2cc
2cc
2cc
Supported by the Chongqing Science and Health Joint medical scientific research project (The general project: 2021MSXM172). Corresponding author: ZOU Dongling, E-mail: 13570049@qq.com Have you got a Conflict of Interest?: No
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1122 EHF promote liver cancer cell metastasis by IL-6 through regulating the transcription level of KDM2B in TAMs S. Wei1, S. Zhao1, Y. Ma1 1 Nanjing First Hospital, Nanjing Medical University, Nanjing, China Background: Macrophages are key immune cell types in liver, which are thought to be involved in tumor development. Recent studies indicated that TAMs (tumor associated macrophages) exhibit M2 phenotypes. However, the mechanism of macrophages promoting tumor progression in liver cancer is largely unknown. Aim: To investigate the the mechanism of EHF (E26 transformation specific homologous factor) in TAMs promoting liver cancer cell metastasis. Methods: The induction of M2 , M1, and M0 macrophages was verified by flow cytometry. The differently expressed genes of M2 and M1, M0 macrophages were analyzed by RNA sequencing. The expression of EHF in TAMs of liver cancer tissue was investigated by double-labeling immunofluorescence. Cytokine array was used to detect the differently expressed cytokines in M2 macrophages. We performed CUT-Tag (Cleavage Under Targets and Tagmentation) analysis for the identification of promoter regions that interact with EHF protein. ChIP (Chromatin Immunoprecipitation) and luciferase analysis were used to verify the interaction between EHF and KDM2B (lysine-specific demethylase 2B). Transwell assay was used to investigate the migration and invasion ability of MHCC97-L cells co-cultured with M2 macrophages. Results: EHF was overexpressed in M2 macrophages compared to M1 and M0 macrophages. Knockdown of EHF in M2 macrophages could inhibit migration and invasion of MHCC97-L cells co-cultured with M2 macrophages. The level of IL-6 was decreased in M2 macrophages with lower expression of EHF. EHF could bind the promoter region of KDM2B. The transcription level of KDM2B was downregulated by the knockdown of EHF in M2 macrophages through ChIP and luciferase analysis, which resulted in lower expression of KDM2B in M2 macrophages. Overexpression of KDM2B in M2 macrophages with lower expression of EHF could rescue the migration and invasion ability of MHCC97-L cells co-cultured with M2 macrophages, which also up regulated the level of IL-6 in M2 macrophages with lower expression of EHF. The results of this study indicated that EHF could promote liver cancer cell metastasis by IL-6 through regulating the transcription level of KDM2B in M2 macrophages. Conclusion: Our study revealed a novel aspect of macrophages in liver cancer and showed EHF could be a promising therapeutic target of liver cancer. Have you got a Conflict of Interest?: No
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1123 Steps for CancerSupport: Fundraising and awareness building in a hybrid environment E. Viitaniemi1, T. Miller1, S. Wells1 1 ESCA CancerSupport, Grand-Saconnex, Switzerland Many cancer support NGOs rely on fundraising events and individual donations as a major source of funds. Popular fundraisers include sponsored competitions, teambuilding challenges or cultural events, all of which severely compromised by the COVID pandemic. This was the case for ESCA CancerSupport (ESCA CS), a Genevabased organization providing emotional and physical support in English to people affected by cancer. In previous years, a large part of tESCA CS' funds came from one large event: an annual dragon boat event that attracted at best over 50 corporate and open teams in the competition, with over 3,000 people in attendance. This event brought in over CHF100,000 annually, a significant part of the organization’s budget. With the 2020 dragon boat event cancelled due to COVID, ESCA CS had to quickly react to fill the potential funding gap. The organization wanted to maintain corporate and individual engagement, continue to raise awareness, and bring in the needed funds, all while operating under COVID restrictions. Steps for CancerSupport (Steps for CS) was first run as a 20-day fundraising and fitness challenge in 2020, and has since taken place annually, with the latest edition running in March-April 2022. It gathers corporate teams, open teams and individuals to compete in the number of steps taken and in fundraising. Funds are brought in initially through registrations: corporate and open teams of 10 participants pay CHF1,000 and CHF 250 respectively, and individual competitors pay CHF 30. Donations are accepted during the challenge, many of which come from donors sponsoring a particular team or individual. Steps are counted through the Pacer Health smartphone app, which allows teams and individuals to track their daily ranking and overall totals. The app also works as a communication platform, with ESCA CS able to share messages about its services, set short-term challenges, and encourage people to donate, whilst participants connect by sharing photos and messages. In its first year, with 370 participants, Steps for CS brought in nearly CHF80,000 through registrations and donations, which increased to over CHF107,000 in 2021 with 875 participants. The cost of organizing the event included paying for the app and hiring an event coordinator, who managed a team of volunteers covering the rest of the tasks such as tech support, outreach, registration, and donation tracking. In 2022, the numbers of teams and participants registered grew again, with nearly 1,000 people signing up.
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Steps for CS has been a great success. Its hybrid model enables online community engagement through physical activity. As COVID restrictions ease, more in-person group walks can be organised while keeping the competition virtual. It has increased awareness of the work of ESCA CS, brought in significant funds and united participants from around the world. This model could be replicated by other organizations with a lot of space for flexibility and innovation. Have you got a Conflict of Interest?: No
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1124 The expression of SNRPD family associates with prognosis, immune infiltration in lung adenocarcinoma Y. Yang1, A. Shen1, J. Shao1, C. Wu1, S. Wei1, Cancer Research Center Nantong 1 Cancer Research Center Nantong, The Affiliated Tumor Hospital of Nantong University, Nantong University,, Nantong, China Background: Lung cancer is the primary cause of cancer-related deaths in the world, and lung adenocarcinoma is the most common histological type. The small nuclear ribonucleoproteins-D (SNRPD) family were spliceosomeassociated proteins in tumor progression, but the role in immunity is unknown. Aim: This study aims to explore the prognostic value of the SNRPD family, and comprehensively analyze the relationship between the SNRPD family and clinical significance, methylation, and immune infiltration in LUAD. Methods: TIMER2.0 was used to explore the expression of the SNRPD family in pan-cancer.The survival analysis and prognosis value were evaluated by GEPIA2, Cox regression analysis, and nomogram. The relationship between SNRPDs expression and immune infiltration levels was analyzed by TIMER2.0 and SNRPDs related enrichment gene sets were revealed by GESA. Results: The high expression of the SNRPD family could predict an undesirable prognosis in LUAD. Cox regression demonstrated that the SNRPD1 was an independent prognostic factor of OS. The SNRPD family mRNA expression is associated with DNAmethylationpositively. Furthermore, the SNRPD family expression correlates with immune infiltration levels significantly, especially in T cell differentiation progression. Finally, SNRPD family enrichment analysis revealed that they could regulate biological processes, cellular components, and molecular function. Conclusion: Our finding suggests that the SNRPD family may play a significant role in LUAD prognosis, immune infiltration and cell line, especially inT cell differentiation progression and autophagy. Taken all into account, in our study, SNRPD1 may be the most potential prognostic marker for improving the survival rate, prognostic accuracy, and immunomodulation of LUAD. Have you got a Conflict of Interest?: No
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1132 Supporting employers in handling cancer at the workplace: Development of a digital toolkit D.M. Bruun1 1 Danish Cancer Society, Department of Patient Support & Volunteering, København Ø, Denmark Background and context: The number of people diagnosed with cancer and living with its long-term consequences is rising. Annually, about 45,000 persons are diagnosed with cancer in Denmark and 40% receive the diagnosis at working age (Mehnert, 2013). As mortality rates from cancer have declined steadily over the past two decades because of developments in cancer screening and treatment options, return to work rates among cancer survivors in Western countries have successively increased. Therefore, resuming work during or after cancer treatment has become an important target in cancer rehabilitation (Stapelfeldt, 2020). However, cancer survivors experience a lack of support at workplace level; i.e. poor communication, a non-adjustable work environment requested due to reduced work ability, and discrimination, have been shown to hinder return to work (van Muijen, 2013). Thus, employer support in vocational rehabilitation may help cancer survivors to resume work. Aim: The aim was to develop and disseminate a campaign embedding a digital toolkit of information and practical advice targeting employers in order to support them in handling cancer at the workplace. Strategy: In order to meet the challenges and needs of employers handling cancer at the workplace, inspiration to the content of the toolkit was derived from workshops with managers and Human Resource professionals from over 200 companies in different industries. Inputs from the workshops were structured in topics and six overarching themes were selected. Finally, the themes were qualified by the Confederation of Danish Industry companies and the Central Organisation of Industrial Employees in Denmark. Programme: The six overarching themes of the content of the toolkit were:
• • • • • •
The first conservations with your employee about cancer Align expectations for the communication Adjustments of work demands and tasks Development of policies and procedures Information about professional counselling Learn about cancer
The campaign consisted of the website www.taghåndom.dk embedding the digital toolkit, printed campaign materials (flyers, post cards and posters), and campaign videos in which employers share experiences with cancer at the workplace.
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Outcomes: On launch day, the campaign had a reach of 105,906 persons at the official Facebook site of the Danish Cancer Society. The website embedding the digital toolkit has a stable number of visitors (approximately 70 visitors per month). A survey among visitors indicates that above 90 % gets useful information from the toolkit. What was learnt: Our work reveals that employers have an unmet need for knowledge about cancer and the potential late effects of the disease and treatment as well as for practical advice about how to provide better support for employees with cancer. To improve opportunities for cancer survivors in the labor market, more interventions targeting employer’s needs and challenges handling cancer at the workplace, are needed. Have you got a Conflict of Interest?: No
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1135 How to Establish, Create and Promote a National Preventive Health Strategy: Implications for Cancer T. Slevin1, A. Dessaix2 1 Public Health Association of Australia, Canberra, Australia, 2Cancer Council New South Wales, Cancer Prevention & Advocacy, Sydney, Australia Background and context: Leading into a federal election, a conservative Australian government with limited and uncoordinated engagement in prevention was encouraged by public health advocates to commit to advancing preventive health as a key "pillar" of national health policy Aim: To establish a contemporary Australian public health policy environment in which investment in chronic disease prevention and the implementation of evidence-based preventive health policies was more likely to progress and achieve successful health outcomes. Strategy: To advocate for and influence the content of an Australian National Preventive Health Strategy required trusted engagement at the highest levels of government. Persistent, coordinated, and patient presentation of public health best buys was coupled with demonstrating political popularity of prevention. Behind-the-scenes advocacy was undertaken to ensure evidence drove the policy process, including key underpinning public health drivers such as the social and commercial determinants of health. We sought to minimize competition for scarce resources by focusing competing public health voices on a shared goal, to see all commitment to an increase in preventive health funding. This allowed key public health stakeholders to see the potential benefit for their areas of interest. Working closely with influential stakeholders to bring a focused voice and message to government was key, particularly through phases of the COVID pandemic.
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Policy process: Contribute to and influence the selection of the “Expert Advisory Panel” who drove the policy development process. Work with government staff, political leaders, academics and civil society stakeholders to build support for the policy and agreed long-term targets within. A push for key principles such as protecting this policy from the influence of commercial vested interests. Establishing a trusted relationship, supporting and providing practical timely advice to government officials leading the strategy development was vital. Outcomes: A strong National Preventive Health Strategy for Australia 2021-2030 has now been launched. It presents a powerful opportunity to build a prevention system for the future and boost action across key focus areas including cancer screening and prevention, reducing tobacco use and nicotine addiction. It seeks to gain momentum, address the increasing burden of disease and reduce health inequity. The challenge remains to ensure the policy then drives meaningful investment and genuine reform. What was learnt: Persistent and patient contributions while urging "brave reform" and a constant "sales job" of promoting constructive but ambitious content for a National Preventive Health Strategy offers a model that may be useful to cancer prevention professionals to promote and advance prevention funding and policy even in a COVID context. It allows a basis for preventive health policy that spans changes in the political landscape. Have you got a Conflict of Interest?: No
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1137 THE OMIFAC INITIATIVE H. Timson1, M. Animashaun1 1 St Cyril Cancer Treatment Foundation, Surulere, Nigeria Background and Context Nonprofit organizations (NGOs) play a central role in public administration by delivering public goods and services (Young,2006). Governments and philanthropists support NGOs but the constraints upon which the funding depends will affect the type and quality of the services provided by NGOs (Lipsky&Smith,1993; Marwell&Calabrese,2014). NGOs are founded to support government entities, such as schools (Nelson&Gazley,2014) and healthcare facilities (Feldman&Schipper,2007). The NGO sector is experiencing increased competition for donations: the number of organizations is growing, and also government grants and contracts are becoming increasingly competitive (Bhati,2018). These trends prompted scholars across the social sciences and public administration to study different aspects of fundraising as it affects the success of NGOs (Kim, Mason & Li,2017). This abstract on fundraising focuses on the OMIFAC (One Million Individuals Fighting Against Cancer) innovation of St. Cyril Cancer Treatment Foundation AIM The main objective of the OMIFAC Initiative by St. Cyril Cancer Treatment Foundation (SCCTF) is for one million people to donate ₦1,000 (about $3) monthly for 12 months to build a Brachytherapy Unit and a Comprehensive Cancer Treatment Center in Nigeria. There are 6 functional centres in Nigeria against the 200 recommended for 200 million people (proposed by International Atomic Energy Agency) STRATEGY Secondary to planning a strategy, creating a viable name is critical for impact. This is an important strategy. We have various committees to implement the project. Our strategy includes: Project timeline; Partnership with reputable PR firms in Nigeria; Outline budget; Create calendar; Create a database; Task assignment. PROGRAMME PROCESS One donor connects 10 others to the initiative. Easy donation-local and global.Donor master list. Documentation STAKEHOLDERS OMIFAC incorporates so many individuals and corporate bodies. The stakeholders involved include; family and friends, volunteers, influencers, extensive media coverage and rural community involvement. COSTS AND RETURN 90% of our cost will be through pro bono services from corporate donors and volunteers. The amount to be raised will be ₦12billion ($29million). The benefit to the community will be saving the lives of thousands of indigent patients and preserving their family lives. INNOVATIVE METHOD Corporate and private donors have dwindled. The facet that can be leveraged is the population. SCCTF is requesting minimum financial outlay by many people leading to a hugely significant outcome. Rural community involvement also gives a sense of ownership. WHAT WE ARE LEARNING Though at an early stage in the programme, 8 out of 10 individuals approached are donating and informing others. We are documenting this process because of its replicable potential. Its success and global yet locally inclusive nature will ensure replicability in many low and middle-income economies. Have you got a Conflict of Interest?: No
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1146 A digital health approach to facilitate continuity of care in a refugee population with advanced cancer E. Namisango1, E.B. Luyirika1, S. Burke2, E. Namukwaya3, M. Allsop4 1 African Palliative Care Association, Kampala, Uganda, 2University of Leeds, School of Biomedical Sciences, Leeds, United Kingdom, 3Makerere University, Kampala, Uganda, 4University of Leeds, Academic Unit of Palliative Care, Leeds, United Kingdom Background: There is an urgent need for feasible approaches to support continuity of care for palliative care patients in refugee populations with advanced cancer. The COVID-19 pandemic exacerbated existing challenges to care delivery in the Bidi Bidi Refugee Settlement in Uganda, prompting the novel co-design and testing of a digital health approach to facilitate continuity of care whilst delivering services at a distance. Aim: To co-design and pilot test a mobile phone application and clinician dashboard to support continuity of care for patients with advanced cancer in a refugee population in Uganda. Methods: A mixed-methods study design was used. Research phases included: i) co-design workshops gathering requirements for the digital health intervention (DHI) with patients with advanced cancer and their caregivers; ii) DHI design and refinement of prototypes led by patient and staff feedback at Bidi Bidi Refugee Settlement; iii) pilot study at Bidi Bidi Refugee Settlement including qualitative interviews with patients with advanced cancer (n=35) routinely reporting outcomes data (African Palliative Care Association African Palliative Outcome Scale (APCA POS)) alongside COVID-19, tuberculosis and hepatitis B symptoms via the mobile phone application over a 6-week period shared to a palliative care team staff online dashboard. Data analysis includes descriptive analysis of sample characteristics, tabulated and trend analysis of APCA POS data over the 6-week study period, summaries of intervention uptake and usage, and framework analysis to explore patient and staff experiences in intervention usage and factors influencing engagement. Hospice Africa Uganda Research and Ethics Committee and Uganda National Council for Science and Technology provided ethical approval for the study. Results: Co-design sessions generated requirements to guide intervention content and implementation. Intervention testing launched in April 2022, with data collection underway. Data collection will be completed by July 2022. We will present an overview of the DHI development process, digital health intervention content (including real-time, tailored self-management guidance in response to symptom reports), and key findings relating to changes in patient outcomes data, patient and palliative care staff engagement, and experiences of interaction with the intervention. Conclusion: Our study builds on earlier work of the team that determined digital technology approaches are an acceptable approach to augmenting palliative care provision in Uganda. This study and its findings will provide novel data to inform optimal DHI content and implementation that is tailored to the needs of a refugee population in Uganda to support the provision of palliative cancer care. Have you got a Conflict of Interest?: No
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1148 ACOT7 augments oxidative phosphorylation to facilitate tumorigenesis of breast cancer by p53/PGC1α X. Sun1, Y. Xu1 1 the first affiliated hospital of China medical university, Shenyang, China Background: Metabolic reprogramming is an emerging hallmark of tumor cells and commonly observed during tumor development to confer tumor cells the capability to proliferate and metastasis under nutrient-deprived conditions. Acyl-CoA thioesterases (ACOTs) constitute a family of enzymes that hydrolyze fatty acyl-CoAs to form free fatty acids and CoA. Aim: To elucidate the molecular mechanism by which ACOT7 participates in the tumorigenesis of breast cancer. Methods: A high-throughput RNA sequencing assay was carried out to identify differentially expressed mRNAs between breast cancer tissues and adjacent normal tissues. Our clinical samples and TCGA database were analyzed to evaluate the clinical value of ACOT7 in breast cancer. Functional experiments were performed in breast cancer cell lines with ACOT7 overexpression and knockdown. Results: In the present study, we initially determined the oncogenic roles for ACOT7 in breast cancer by evaluating its expression pattern and clinical significance in breast cancer patients. Next, we explored the role of ACOT7 on malignant behaviors of breast cancer in vitro and vivo. Mechanistically, we found that ACOT7 could upregulate PGC1α expression by inhibiting P53 activation to enhance oxidative phosphorylation and ATP production, eliminate ROS production and reduce DNA damage, which thereby facilitates malignant behavior of breast cancer. Conclusion: This work elucidates the molecular mechanism by which ACOT7 mediates mitochondrial respiration to promote tumorigenesis of breast cancer, and provides new insights into the interplay between cancer and tumor metabolism . Have you got a Conflict of Interest?: No
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115 The ALI is the optimal inflammatory biomarker of overall survival in patients with lung cancer M. Song1, H. Shi1 1 Capital Medical University, Beijing, China Background:Malnutrition and systemic inflammatory responses are associated with poor overall survival (OS) in lung cancer patients, but it remains unclear which biomarkers are optimal for predicting their prognosis. Aim: This study investigated the association between nutrition/inflammation-based indicators and OS in lung cancer patients to determine which indicator was the most accurate predictor. Methods:There were 16 nutrition or systemic inflammation-based indicators included in this study. The cut-off points for the indicators were calculated using maximally selected rank statistics. The OS was evaluated using the Kaplan-Meier estimator, and univariate and multivariate Cox proportional hazard models were used to determine the relationship between the indicators and OS. A time-dependent area under the receiver operating characteristic curve (time-AUC) and C-index were calculated to assess the predictive ability of the different indicators. Results:There were 1,772 patients with lung cancer included in this study.In univariate analysis, all 16 indicators were significantly associated with OS of the patients (all P < 0.001). Except for platelet-lymphocyte-ratio, all other indicators were independent predictors of OS in multivariate analysis (all P < 0.05). The results of the time-AUC andC-index analyses indicated that the advanced lung cancer inflammation index (ALI; 5-year C-index: 0.611) had the best predictive ability on the OS in patients with lung cancer. In different subgroups, the ALI was the best indicator for predicting the OS of lung cancer patients regardless of sex or smoking status and in patients aged <65 years. However, the modified Glasgow prognostic score was superior to the other indicators in non-small cell lung cancer patients or patients aged > 65 years, and the glucose-to-lymphocyte ratio performed better prognostic ability in patients with small cell lung cancer. Conclusion:The prognostic ability of the ALI is superior to the other inflammation/nutrition-based indicators for all patients with lung cancer. Have you got a Conflict of Interest?: No
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1154 Study of qi-blood biochemistry on symptom clusters of postoperative adjuvant chemotherapy lung cancer patients Y. Zhang1, L. Jiao2, J. Yao1, Y. Yao1, C. Qian1, Q. Wang1, L. Wang1, D. Zhou1, Y. Gong1, L. Xu1,3, J. Xu4, Z. Chen5 1 Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Oncology, shanghai, China, 2Institute of Clinical Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Oncology, shanghai, China, 3Institute of Traditional Chinese Medicine in Oncology, Longhua Hospital, Shanghai, China, 4Shanghai Pulmonary Hospital, Tongji University, Shanghai, China, 5Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China Background: Lung cancer is one of the most common malignancies worldwide. Surgery is the primary treatment for early-stage lung cancer, and postoperative adjuvant chemotherapy causes 75% of lung cancer patients to experience grade 3 or 4 toxic reactions, which occur synergistically and interrelatedly in the form of symptom clusters and seriously affect patients' quality of life and prognosis. Currently, most studies on symptom clusters in lung cancer patients are focused on advanced stages, and the formation of treatment strategies for symptom clusters in patients with postoperative chemotherapy for lung cancer is of great clinical importance to improve the overall level of lung cancer. Aim: To analyze the effect of "qi-blood biochemistry" staged treatment on the symptom clusters associated with postoperative adjuvant chemotherapy lung cancer patients. Methods: A multicenter, randomized, controlled, double-blind trial was designed to observe postoperative adjuvant chemotherapy patients with stage Ib-IIIa lung cancer. They were admitted to five hospitals in Shanghai from December 2016 to August 2020, randomly divided into treatment and control groups according to a 2:1 ratio, with a total of 173 cases completing treatment, 116 cases in the treatment group (staged Chinese medicine+chemotherapy) and 57 cases in the control group (staged Chinese medicine placebo+chemotherapy) , every 21 days for 1 cycle, a total of 4 cycles of treatment. Results: The total effective rate of the TCM clinical evidence was 40.59% in the treatment group better than that of the control group by 5.77% (P<0.01); the fatigue-appetite loss-insomnia symptom cluster improved in the treatment group compared with the control group (P<0.01); the fatigue-appetite loss-insomnia symptom cluster improved in the treatment group compared with the control group on the 14th day of the 1st cycle of chemotherapy (P<0.01), and the lung cancer-specific symptom cluster improved on the 14th day of the 3rd cycle of chemotherapy (P<0.05) Conclusion: Results: The total effective rate of the TCM clinical evidence was 40.59% in the treatment group better than that of the control group by 5.77% (P<0.01); the fatigue-appetite loss-insomnia symptom cluster improved in the treatment group compared with the control group (P<0.01); the fatigue-appetite loss-insomnia symptom cluster improved in the treatment group compared with the control group on the 14th day of the 1st cycle of chemotherapy (P<0.01), and the lung cancer-specific symptom cluster improved on the 14th day of the 3rd cycle of chemotherapy (P<0.05) Have you got a Conflict of Interest?: No
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1156 The application value of dVPCT for one-stop preoperative examination of pancreatic carcinoma. X. Yu1, B. Ming2, L. Yang1, J. Peng1 1 North Sichuan Medical College, School of Medical Imaging, Nanchong, China, 2Deyang People's Hospital, Department of Radiology, Deyang, China Objective: To explore the clinical application value of dynamic volume perfusion CT (dVPCT) as one-stop preoperative examination of pancreatic carcinoma (PC). Methods: A retrospective study was performed on 56 patients with pathologically confirmed PC and underwent preoperative epigastric dVPCT in Deyang People's Hospital from January 2017 to August 2021. Arterial phase, pancreatic parenchymal phase, portal phase, volume-rendering (VR) and maximum-intensity-projection (MIP) images of CT angiography, and fusion VR images of vessles and lesions were reconstructed based on dVPCT primary data to characterize PC. PC T staging referred to the standard of the eighth edition of the American Joint Committee on Cancer. The agreement between dVPCT T staging and postoperative pathological T staging was analyzed by Cohen’s weighted Kappa (Kw), and the accuracy of dVPCT for PC T staging was calculated. Computed tomographic perfusion imaging was performed in 42 patients. The values of blood flow (BF), blood volume (BV), surface permeability (PS), average transit time(MTT) of the whole tumor, the center of tumor and normal pancreatic parenchyma from each patient were obtained and the Friedman M test was used to differentiate the perfusion parameters among the three groups. Results: The detection rate of PC was 100%. There are excellent agreement for dVPCT and postoperative pathological T staging (Kw 0.95,95% CI 0.89-1.00). The accuracy of dVPCT T staging is 94.6%, and 98.2%, 96.4%, 96.4%, 98.2% for T1, T2, T3, T4 respectively. The values of BF, BV, PS, MTT of whole and central tumor were lower than those of normal pancreatic parenchyma (P＜0.05). The values of BF, BV, PS of central tumor were lower than those of whole tumor (P＜0.05), but the values of MTT levels between whole and central tumor were not statistically significantly different. Conclusion: dVPCT can obtain high-quality morphological images and stable function parameters simultaneously, which enables lesion characterization, T staging and quantitative auxiliary diagnosis of PC. Have you got a Conflict of Interest?: No
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1161 A web-based free-access training for HPV-based cervical cancer screening implementation L. BRUNI COCOOZ1, C. ROBLES HELLÍN1, D. MORENO-ALONSO2, S. DE SAN JOSÉ3, A. COMPANY SERRAT2, M. MONTSERRAT MORENO2, F.J. RUIZ CARRASCO2, F.X. BOSCH JOSE1 1 CATALAN INSTITUTE OF ONCOLOGY, Cancer Epidemiology Research Programme, L'Hospitalet de Llobregat (Barcelona), Spain, 2CATALAN INSTITUTE OF ONCOLOGY, Training Department, L'Hospitalet de Llobregat (Barcelona), Spain, 3Senior Consultant en National Cancer Institute (NCI), Barcelona, Spain Background: Many countries and international agencies recommend introducing HPV testing as primary cervical cancer screening test followed by triage of screen positive. Screening is a complex intervention and involved professionals can benefit from adequate training. Aim: We aim to provide a thorough updated training in English on new modalities and critical issues to deliver an optimal HPV-based screening program to facilitate its implementation. Methods: The Catalan Institute of Oncology (ICO) and the e-oncology platform, in partnership with the Open University of Catalonia (UOC), are developing a course as part of the EU funded project RISCC (Risk-based screening for cervical cancer, grant 847845) The online course consists of 8 modules with approximately 40 hours of workload requirement to complete. It includes natural history of disease, basic concepts of screening, screening tests, triage, clinical management of positive cases and implementation of population-based screening programs, use of self-sampling, screening in immunocompromised women and impact of HPV vaccination in screening. The materials have been peer revied by a panel of international experts. It has been formatted in multi-device so that students can both follow it in big screens or smaller ones. Its modular structure allows for its translation and/or the adaptation to specific settings by including additional modules with local data.
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A preliminary pilot course was launched in Spanish (September to December 2021) to test for difficulty, length and content. Results: Over 90% of 213 participants who have finished the course are satisfied with the relevance, usefulness, and length. All participants have graded it as good or above and 99% of them would recommend it to other professionals.By the end of the RISCC project (year 2024), an additional module with its main results (risk estimations based on vaccination status, screening history results and risk factors as well as the recommended clinical actions for each risk level based on modelled data) will be incorporated. Conclusion: This course updates the state-of-art screening progress in Europe and aims to expand worldwide using modern e-learning techniques. It is designed to support the WHO Global Strategy for Cervical Elimination. Have you got a Conflict of Interest?: No
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1167 TOMORROW IS ANOTHER DAY I. JASUJA1 1 INDIAN CANCER SOCIETY, CANCER SAHYOG, NEW DELHI, India Background and context: Patients with progressive medical illness like cancer experience numerous physical and psychosocial symptoms which do not end with recovery, creating a maladjusted return to normalcy. There is a strong preoccupation with the body changes which are an integral part of recovery. There is a constant fear of recurrence. Lance Armstrong wrote that “I would rather have the title of cancer survivor than the winner of the “Tour de France”, as cancer makes a person more compassionate and intelligent and therefore more alive. There are hidden unrealized capabilities in us which emerge in crises. Aim: In the journey to cancer recovery the aim is to meet with multi-disciplinary care and need of people which includes mental, emotional and social skills. The realization of positive things in life help build faith and hope in the survivors. The Support one gets from family and friends brings to the fore the faith in humanity and confidence in God. Strategy / Tactics: With recovery comes positivity but it is unfair to expect upbeat all the time. Negative feelings will at times assail one as they do in all human beings. Only in survivorship one needs help at more frequent intervals. Putting one’s life in order, generates happiness and does away fears and anxieties. Taking control of your financial, personal, domestic and medical affairs will bring about confidence of controlling one’s life. As survivors cancer patients are unable to reconcile to the doing away of the special status they enjoyed while fighting cancer. The pressures of the outer world in terms of job, behavior, magnify tenfold once they come out of the cocoon. One must live everyday as it comes. Survivorship does not mean that one does not need help, all one has to do is to stretch a hand and ask for it. Look to your psyche and soul and draw out the positivity to make you a healthier and stronger person.
Programme / Policy process: In one private hospital the volunteers of ICS held a fun day for cancer patients, survivors and caregivers. Event “Break-Free from cancer”, included dancing, Zumba, painting, makeover, singing, clowns performing. The end result was the happiness on the faces of all present. Interacting with other people brought a feeling of friendship and realization that there are others who are facing the same dilemmas. They made new friends exchanged phone numbers to keep in touch with us. It is from here that we picked up some volunteers. Outcomes: It is from here that we picked up some volunteers. What was learnt: (if relevant, please also detail here the potential of replicability) Look to this day for it is life, there is growth, there is splendor of action. Every tomorrow is a vision of hope. Have you got a Conflict of Interest?: No
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1168 Clinicopathologic characteristics and genetic alterations in gastric neuroendocrine neoplasm L. Sun1, Y. Sun1 1 Tianjin Medical University Cancer Institute and Hospital, Tianjin, China Background: Gastric neuroendocrine neoplasms (gNEN) constitute a diverse group of tumors, and welldifferentiated neuroendocrine tumor (NET) grade 3 was divided from neuroendocrine carcinoma (NEC) in the 5th WHO classification. Aim: We analyzed the clinicopathologic characteristics and genetic alterations of gastric NENs to get a better understanding of these tumors, compared the commonalities and differences among gastric NENs. Methods: We analyzed the clinicopathologic characteristics of gNEN, retrospectively. After that, we performed high-resolution copy number (CN) profiling and whole exome sequencing (WES) of formalin-fix and paraffinembedded (FFPE) tissues from eight gastric NET G3 and compared the genetic alterations with gastric NEC and NET G2. Results: The most frequent high-level CN variant was a gain of 19q12 in four cases of NET G3, followed by gains of 5p15.2-p12, 5q11.1-q31.3, 7p11.2, 19p13.3-p11, 19q11-q13.32, 20p11.22-p11.21 and losses of 1p36.13-p31.2, 17p13.1, 17p12 in three cases. Amplifications of DLL3 located in 19q13.2 were demonstrated by FISH, qPCR and immunohistochemistry. We found that G3 and G2 represented less CN gains in both chromosome regions and genes than that in NEC (P=0.019 and P=0.004, P=0.029 and P=0.006, respectively), while there was no difference in number of CNVs between G3 and G2. The CN characteristics of NET G3 were different from NEC in hierarchical clustering analysis, while NET G3 and NET could not be distinguished, suggesting that NET G3 is a separate entity from NEC basing on the CNV characteristics. WES showed frequent somatic mutations of TP53 (37.5%, 3/8) in NET G3. Comparing with NEC and NET G2, NET G3 and NEC presented with less predisposing genes than NET G2 (P=0.004 and P=0.036), while there was no difference between NET G3 and NEC. The average number of significantly mutated genes in NET G3 and G2 were less than that in NEC (P=0.038 and P=0.005). WES analysis prompted that NET G3 might showed a great difference from NET G2 in germline mutation, while a great difference from NEC in somatic mutation. An integrated KEGG pathway analysis showed that 14 significant enrichments were identified, including endocrine resistance, JAK-STAT, etc. We also researched the heterogeneity Ki67 index in gastric NEC, found early events of tumorigenesis and explored the mechanism of tumor progression. Conclusion: In summary, our study revealed that NET G3 was a separate entity with unique CN and mutation characteristics from gastric NEC and NET G2, and provided a foundation for further studies on the development and progression of G3 as well as a potential therapeutic targets. Have you got a Conflict of Interest?: No
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1169 Lessons learnt from 5 years of prioritising bowel screening, 2017-2021 K. Broun1, S. Durkin1, K. Lotfi-Jam1, T. Andersson1, O. Osman1, A. Ghosh1 1 Cancer Council Victoria, Melbourne, Australia Background and context: Bowel cancer is the third most commonly diagnosed cancer and the second biggest cause of cancer deaths in Australia. In 2021, an estimated 15,540 new cases of bowel cancer will be diagnosed in Australia and cause 5,295 deaths[1]. However, if detected early over 90% of bowel cancer cases can be successfully treated[2]. In response to this and a low Victorian 2015-16 screening rate of 41.9%[3], in 2017-2021 Cancer Council Victoria prioritised increasing bowel screening participation among those eligible for the National Bowel Cancer Screening Program (NBCSP). [1] Australian Institute of Health and Welfare 2021. Cancer in Australia 2021. Cancer series no. 133. Cat. no. CAN 144. Canberra: AIHW. [2] Department of Health. About bowel screening. Canberra, Australia: Australian Government Department of Health, 2014. [3] Australian Institute of Health and Welfare 2018. National Bowel Cancer Screening Program: monitoring report 2018. Cat. no. CAN 112. Canberra: AIHW. Aim: Increase participation in the NBCSP to 60% for Victorians aged 50-74. Strategy / Tactics: Cancer Council Victoria delivered four media campaigns targeting the eligible population, with additional emphasis on population groups less likely to screen (those who hadn’t screened previously, males aged 50-59, those from a low socio-economic background). Tailored initiatives were developed and delivered for people from culturally and linguistically diverse backgrounds, including in-language advertising and community-led grant activities. Outcomes: Cancer Council Victoria’s media campaigns led to significant increases in bowel screening participation among Victorians aged 50-74. Campaigns were equally effective in reaching under-screened target groups. This evidence informed advocacy efforts that investment in mass media campaigns saves lives and health care costs, which led to federal government funding of two national campaigns (AUD$10m each). Tailored initiatives for multicultural groups were also effective, with in-language print, radio and social media advertising reaching 138,000 Arabic and 250,000 Mandarin speaking community members, with notable increases in bowel screening (6-26%) coinciding with campaign activity in 2019. Community-led grant activities demonstrated increased knowledge, confidence and intention to screen. What was learnt: Significant investment in a multi-year strategy by cancer control organisations can lead to successful outcomes in increasing bowel screening participation overall and make important inroads to addressing inequities and delivering value for money. Repeated media campaigns are needed throughout the year to reach those who are recently invited to screen. Tailored interventions for multicultural groups, while resource intensive, are effective in educating eligible people about bowel cancer risks and benefits of screening. Have you got a Conflict of Interest?: No
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1171 Digitalizing Childhood Cancer Awareness N. Turyaki1, N. Chaar1 1 Children's Cancer Center of Lebanon, Marketing and Communication, Beirut, Lebanon Background When the pandemic hit worldwide, everything paused. As societies applied urgent social distancing actions and closed workplaces, this demanded even field staff to work from home. With the rapidly developing technologies, we had the opportunity to globally transform the way we work, learn, and live. That is when we decided to completely shift digital. We converted all our physical work and presence into online and digital formats. When COVID-19 hit, the world panicked. Aim To CCCL, we took this challenge and continued serving the community with our mission and it did not stop us from reaching our goals, of which is education to create better understanding and cancer awareness. In a way, we benefited from this period and took advantage of spreading awareness virtually. CCCL created a digital representation to its name and took immediate action, shifting all its in-person awareness sessions to virtual ones, through zoom meetings, webinars and workshops. Strategy Internet technology has emerged as an essential platform, promoting us to reach a wider audience and connect more globally with our supporters, target audiences, interested parties and expats. Digital technology is the future. For any vision to improve, it must live up to the latest trends and models. CCCL adopted working in a more digital way, as the Marketing and Communications department engaged in new technologies and joined all different social media platforms (such as Facebook, Instagram, Twitter and so on), where campaigns and awareness sessions are being boosted to acquire the contribution of mass audiences, while connecting with them on a personal level. Programme/Policy With our shift to digitalization, the first hosted virtual session was our HPV vaccine program. Soon after, zoom meetings became easier to schedule and invitees globally were able to join. We contacted our Champions’ Circle and had an online meeting with them, as part of our Bus of Hope awareness episodes. On November 19, 2021, CCCL organized a virtual session as part of the London Global Cancer Week 2021. For International Childhood Cancer Day, our virtual awareness sessions varied between St. John Church Youth Club’s and Rotaract Club of Sahel Matn’s. Outcomes We created online fundraising campaigns and utilized our social media presence, where we reached an increased followers of 30%, spreading awareness on a larger scale. What was learnt CCCL gained proactive strategies, learned new developed technologies, and implemented new practices. By digitalizing our methods, we learned the value of adaptation to make the most out of the opportunities and always think ahead of our time. With all the changes that took place, CCCL is up to its mission, and values its friends and partnerships whom without we couldn’t have achieved what we had. Effective use of digital tools and technologies, in this time, is necessary because lives are on the line. When there is a will, there is always a way! Have you got a Conflict of Interest?: No
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1172 Risk and Prognosis of Second Corpus Uteri Cancer after Radiation Therapy for Primary Pelvic Cancer G. Yu1, R. Wei1, S. Li1, Z. Jiang1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Colorectal Surgery, Beijing, China Background: Radiation therapy (RT) is a standard treatment for the local control of primary pelvic cancers (PPC), yet the risk of second corpus uteri cancer (SCUC) in PPC patients undergoing RT is still controversial. This study investigated the impact of RT on the risk of SCUC and assessed the survival outcome. Methods: We queried nine cancer registries for PPC cases in the Surveillance, Epidemiology, and End Results (SEER) database. The cumulative incidence of SCUC was analyzed using Cox regression and Fine & Gray competing risk regression analysis. The Poisson regression analysis was employed to assess the standardized incidence ratios (SIRs) and radiation-attributed risk (RR) for SCUC. We evaluated the overall survival of patients with SCUC using the Kaplan-Meier method. Results: In a total of 70,214 PPC cases, the primary pelvic cancers were located in the rectum and rectosigmoid (39.0 %), cervix uteri (17.0 %), ovary (15.0 %), bladder (27.0 %), anus, anal canal, and anorectum (2.0 %). Receiving radiotherapy was strongly associated with a higher risk of developing SCUC for PPC patients in Fine-Gray competing risk regression (No-RT vs. RT, adjusted HR= 1.77, 95%CI: 1.40-2.28, P＜0.001). The incidence of SCUC in PPC patients who received RT was higher than the US general population (SIR, 1.66; 95% CI, 1.41-1.93, P<0.05), but the incidence of SCUC in patients who did not receive RT was lower than with the US general population (SIR, 0.68; 95% CI, 0.61-0.75, P<0.05). The dynamic SIR and RR for SCUC decreased with decreasing age at PPC diagnosis and decreased with time progress. In terms of overall survival, 10-year survival rates with SCUC after No-RT (NRT) and SCUC after RT were 45.9% and 25.9% (HR= 1.82, 95%CI: 1.46-2.29, P＜0.001), respectively. Conclusion: Radiotherapy for primary pelvic cancers is associated with higher risk of developing SCUC than patients unexposed to radiotherapy. We suggest that patients with pelvic RT, especially young patients, should receive long-term monitoring for the risk of developing SCUC. Have you got a Conflict of Interest?: No
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1174 Evaluation of a state-wide campaign to increase cervical screening participation among young people K. Broun1, K. Lotfi-Jam1, T. Andersson1, L. Temminghoff1 1 Cancer Council Victoria, Melbourne, Australia Background: Australia’s renewed National Cervical Screening Program (NCSP) was introduced in 2017, with changes to screening test, interval and commencement age. In Victoria, Australia, recent data shows that 51% of those aged 25-34 years participated in cervical screening in 2018-2020 compared to the state average of 55.6%[1]. To address this, Cancer Council Victoria delivered a state-wide communications campaign targeting young people, informed by research to examine knowledge and awareness of the renewed NCSP, barriers and enablers to cervical screening, as well as how best to reach and motivate young people to screen. The 6-week campaign, delivered in May 2021, included digital and audio advertising through social media, radio, music streaming and podcast platforms. [1] Australian Institute of Health and Welfare (2021)Cancer screening programs: quarterly data, AIHW, Australian Government, accessed 13 April 2022. Aim: Increase awareness, knowledge and participation in the NCSP among women and people with a cervix aged 2534. Methods: To inform the development of the campaign, a literature review, online focus groups and a baseline survey (n=98) of young Victorians explored NCSP knowledge and awareness, barriers and enablers to cervical screening and testing of campaign materials. Post campaign, reach and engagement was tracked and compared to industry benchmarks, a follow-up survey (n=187) measured campaign recall and NCSP knowledge and awareness, and an analysis of monthly data on the number of Cervical Screening Tests completed by this cohort was undertaken. Results: Young people reported that seeing more stories of young people’s cervical screening experiences, including diversity in gender and sexual identity, and a focus on practitioner choice were important considerations for this campaign. Social media advertising reached 306,640 young people and radio more than 308,000 young people. 43% of post-survey respondents recalled the campaign and most could describe specific elements, suggesting the campaign was memorable and engaging. Those exposed to the campaign scored substantially higher on knowledge items compared to the baseline cohort. The strongest increases were observed for knowing the screening commencement age (from 23% to 47%) and screening interval (from 76% to 88%). While the COVID-19 pandemic impacted cervical screening participation, a small but notable increase was observed for the target group in the period immediately following the campaign, whilst most other age groups remained stable or decreased slightly. Conclusion: This cervical screening campaign was highly effective at reaching the younger target audience and increasing cervical screening knowledge. Modest increases to screening participation were observed. These results demonstrate how comprehensive formative research laid the groundwork for a creative, evidence-based, targeted and effective campaign. Have you got a Conflict of Interest?: No
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1175 Deep learning-enabled precise recurrence detection in nasopharyngeal carcinoma: a multicentre study Y. Huang1, Y. Deng2, C. Li2, X. Guo1, X. Lv1 1 Sun Yat-sen University Cancer Center, Nasopharyngeal Carcinoma, Guangzhou, China, 2Sun Yat-sen University Cancer Center, Artificial Intelligence Laboratory, Guangzhou, China Background Precise recurrence detection facilitates timely intervention and prolongs survival in survivors with cured nasopharyngeal carcinoma (NPC). We presented an aide simultaneously reconciles dynamic risk probabilities profile and precise recurrence detection utilizing longitudinal magnetic resonance (MR) scans in NPC. Methods In this multicentre observational study, the Artificial Intelligence in detection of Recurrent Nasopharyngeal carcinoma (RAIN) was constructed by recurrent neural network on the basis of time-series head and neck MR scans from a retrospective development cohort from the Sun Yat-Sen University Cancer Center (SYSUCC), Guangzhou, China. The accuracy of RAIN was validated in one internal (SYSUCC) and two external cohorts (set 1: the Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou, China; set 2: the Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, China), and a prospective set (SYSUCC).A reader comparison study between RAIN and three oncologists from the Fujian Provincial Cancer Hospital (Fujian, China) in interpreting scans was conducted in the prospective cohort. Performances were evaluated using area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value and negative predictive value. This study is registered with the Chinese Clinical Trial Registry (ChiCTR2200056595), and is closed. Findings Between May 28, 2008, and Nov 24, 2020, 1183 patients with 6474 scans were retrospectively recruited in training cohort, 147 with 709 scans in tuning cohort, 147 with 780 scans in internal validation cohort, 403 with 3043 scans and 96 with 519 scans in external validation cohort 1,2; 248 eligible patients with 1780 scans were enrolled in the prospective cohort between Jan 5 and Dec 1, 2021. RAIN presents sound performance in internal validation cohort (AUC 0·805 [95% CI 0·780–0·830]), and external validation cohorts (1: 0·794 [0·746–0·842]; 2: 0·772 [0·734–0·810]).In the prospective validation cohort, RAIN achieved sensitivity similar to that of the expert oncologist (0·729 [95% CI 0·705–0·744] vs0·712 [0·698–0·726]; p=0·529) and superior to that of competent (0·610 [0·589–0·628]; p<0·0001) and trainee (0·424 [0·410–0·440]; p<0·0001) oncologists. Interpretation RAIN was able to identify scan-detected recurrences with robustness and could therefore be implemented in clinical practice to optimize recurrence surveillance in NPC. Funding This study was supported by the National Natural Science Foundation of China (grant numbers 81872375, 82172862, and 82172863), and the Natural Science Foundation of Guangdong Province, China (No. 2021A1515010118). Have you got a Conflict of Interest?: No
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1176 Race For Life A. Fernandes1, C. Fonseca1, V. Veloso1, P. Dias1 1 Liga Portuguesa Contra o Cancro - Núcleo Regional do Norte, Health Education Department, Porto, Portugal Amount raised: Two editions (2020 and 2021): €25,975.00 + €50.815,44 = €76,790.44 Background and context: At the beginning of 2020, the Portuguese League Against Cancer – Northern Branch had already scheduled several fundraising events, but the severe restrictions imposed by the Covid-19 pandemic led to the cancellation of all planned initiatives, as they implied the gathering of people. However, the pandemic did not stop the need to raise funds for the fight against cancer and, in the fundraising department, the idea of organizing a physical activity promotion event in a virtual version emerged, in the sense of having to respect the social distance. In other words, the key idea was to carry out an initiative that appealed to the practice of physical exercise and also to the solidarity translated into the delivery of a donation as a way of inscription, in which people, even if exercising at a distance from each other, each one in their place of residence, were all united in the fight against cancer, on an announced date and during a period of two hours. Strategy / Tactics: Call for everyone to participate without gathering people; Publicity campaign on social networks and in the media. Programme process: In the first edition, with a publicity campaign on social networks and in the media and with the help of public figures from various areas of intervention of Portuguese society, especially sports, who became ambassadors of the event, in just two weeks of preparation and comunication, 2,600 people participated and €25,975.00 was obtained in donations resulting from registrations, made online on a digital platform created for this purpose by a computer company partner, in a totally free way. In view of the success achieved in an unplanned initiative, the “Race for Life” was held again in 2021, this time with more preparation time and a more comprehensive communication and marketing strategy. In addition to the means used in the first edition, support was obtained from 85 Municipalities in the northern region of Portugal, from several sports clubs and from cultural and recreational associations, which helped to publicize the initiative. On the other hand, instead of one day, the period for holding the event and for people to participate was extended to two weeks. With this evolution, in the 2nd edition much better results were achieved: 7,181 people registered and the fundraising of €55,686.57. The costs of the communication and marketing compaign, carried out by a specialized company, amounted to €4,871.13. Costs and returns: €4.871,13 spent on marketing and communication campaigns, im the second edition; €81,661.77 obtained in donations resulting from registrations. What was learnt: (if relevant, please also detail here the potential of replicability): This event enables the participation of people from an entire region in the same fundraising initiative, without the gathering of people. So, our institution is already preparing the 3rd edition. Have you got a Conflict of Interest?: No
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1177 CERVICAL CANCER PREVENTION AND CARE INDICATORS FOR WOMEN LIVING WITH HIV IN SUBSAHARAN AFRICA: DELPHI METHOD M. Davidović1,2,3, S. Lem Asengbeh1,2,4, K. Taghavi5, T. Dhokotera1,2,4, A. Jaquet6, B. Musick7, K. Wools-Kaloustian8, K. Anastos9, S. N Duda10, J. Bohlius1,2,5 1 Swiss Tropical and Public Health Insititute, Epidemiology and Public Health Department, Allschwil, Switzerland, 2University of Basel, Basel, Switzerland, 3University of Bern, Graduate School of Health Sciences, Bern, Switzerland, 4University of Bern, Graduate School Cellular and Biomedical Sciences, Bern, Switzerland, 5Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland, 6University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France, 7Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, United States, 8Indiana University School of Medicine, Department of Medicine, Indianapolis, United States, 9Albert Einstein College of Medicine, Medicine and Epidemiology, Bronx, United States, 10Vanderbilt University Medical Center, Nashville, United States Background: HIV clinics in sub-Saharan Africa (SSA) offer on- or off-site cervical screening for women living with HIV (WLHIV). It is unknown how many WLHIV receive cervical screening and treatment. A Cascade approach, measuring linked steps in the continuum of screening and care, may help to monitor and scale-up cervical screening in WLHIV in SSA; eventually contributing towards WHO cervical cancer (CC) elimination strategy. Aim: To develop a standardized, internationally agreed-upon set of indicators to monitor cervical screening in WLHIV attending HIV care in SSA using a Cascade approach. Methods:We systematically reviewed literature to identify indicators for monitoring cancer screening programs. We used a modified e-Delphi method to reach consensus on indicators to include in the Cascade for WLHIV. Utilizing infrastructure and partnerships developed with the International epidemiology Databases to Evaluate AIDS (IeDEA) Network, we invited stakeholders from SSA and international organizations to participate. Through an iterative process (03/2021 – 06/2021), they anonymously rated indicators for predefined criteria (feasibility, understandability, reliability, relevance, comparability) on a 5-point Likert scale (1–very low, 5–very high) using QualtricsXM. Consensus was reached when ≥70% of respondents rated an indicator as high/very high. We present results from rating Round 2 as heat map and spidergram. Results: We identified 359 indicators from 30 publications and tailored 30 indicators to needs of WLHIV in SSA for rating in the e-Delphi consensus process. We invited 85 stakeholders from 22 countries in 4 IeDEA African regions (Central, East, Southern and West Africa; Figure 1, Table 1). Response rates were 54% and 49% in rounds 1 and 2, respectively. Of 30 indicators, 5 reached consensus in all 5 criteria: number of women screened, cervical screening rate, screening test positivity rate, treatment rate of precancerous lesions and CC incidence rate. 12 indicators reached consensus for ≥3 criteria (Table 2, Figure 2). Conclusion: Using an e-Delphi consensus process, we identified internationally agreed-upon indicators that can be used to inform the CC prevention and care Cascade in WLHIV in SSA in a standardized way. The variables needed to inform the Cascade will be integrated into the IeDEA data exchange standard format and could allow monitoring cervical screening provision in WLHIV at site level. The Cascade has the potential to increase quality and usability of data and facilitate evidence-based scale-up of CC screening in WLHIV attending HIV clinics in SSA.
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Figure 1. Map of countries participating in the African regions of the International Epidemiology Databases to Evaluate AIDS(IeDEA)
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Table 1. General characteristics of participants in round 1 and 2 Number of participants (n, %) Round 1 Round 2
Characteristics Gender Female
23 (51%)
Male
22 (49%)
IeDEA collaborator Yes
31 (69%)
No
12 (27%)
Uncertain
2 (4%)
IeDEA Region Central Africa
4 (9%)
East Africa
10 (22%)
West Africa
8 (18%)
Southern Africa
16 (36%)
Other (Global)
7 (16%)
Professional role Public health expert
5 (11%)
Researcher with focus on cervical cancer prevention or HIV/AIDS
21 (47%)
Health care professional / clinician
11 (24%)
Representative of Ministry or governance at national, regional or district level Representative of international health care organization
1 (2%)
Other
4 (9%)
Level of experience No experience
1 (2%)
Less than 5 years
12 (27%)
5-10 years
9 (20%)
10-20 years
20 (44%)
20+ years
3 (7%)
Main expertise Cervical cancer prevention and care
16 (36%)
HIV/AIDS care and treatment
10 (22%)
Other
13 (29%)
Main role Clinician
15 (33%)
Researcher
22 (49%)
Other
8 (18%)
3
3 (7%)
21 (54%) 18 (46%) 30 (77%) 8 (20%) 1 (3%) 4 (10%) 8 (20%) 7 (18%) 16 (41%) 4 (10%) 2 (5%) 18 (46%) 11 (28%) 1 (3%) 3 (8%) 4 (10%) 0 (0%) 11 (28%) 9 (23%) 18 (46%) 1 (3%) 15 (38%) 9 (23%) 6 (15%) 14 (36%) 18 (46%) 7 (18%)
Table 2. Rating results and % of agreement in round 2 (n=39)
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Figure 2. Level of agreement for indicators that reached consensus for 3 or more criteria in Round 2
Have you got a Conflict of Interest?: No
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1179 Cancer Control Training in a Global Pandemic: Digital Training Platforms in Kenya V. Mwenda1, J. Chepchumba1, J.-P. Bor1, C. Mugambi2, M. Nyangasi1 1 National Cancer Control Program, Ministry of Health, Nairobi, Kenya, 2School of Computing and Informatics, University of Nairobi, Nairobi, Kenya Background: As cancer burden rises globally, low and middle-income countries (LMIC) continue to have poor outcomes, due to late detection attributable to low public awareness, scarce early detection facilities and inadequate cancer information among primary healthcare workers (PHC). Equipping PHC with cancer knowledge and information could improve timely cancer diagnosis and referral. The COVID-19 pandemic disrupted in-person training of PHC. Therefore, the National Cancer Control Program, Kenya Ministry of Health (MoH) developed two digital training platforms for PHC on cancer early detection:
1. 2.
Web-based training platform: Ministry of Health virtual academy. Android-based mobile application: M-Saratani
Strategy: development of the platforms involved four steps:
1. 2. 3. 4.
Prioritization of cancer control topics: through a wide consultative process, 12 cancer topics were selected, based on disease burden and cancer control policies and strategies. Content development: technical working groups produced drafts for each of the selected topics comprising the content and assessments, which underwent external review and further improvement. Quality assurance: relevant MoH and content experts certified the materials based on set standards, and set completion criteria. Content upload and launch: the materials were then uploaded into the platforms and launched.
Process: the applications were launched in November 2021, and awareness created using multiple channels. The content is primarily targeted to clinicians, nurses and community health extension workers. The web-based version runs on an existing MoH platform, while the android application is available on Google play. The platforms have inbuilt system for awarding certificates and Continuous Professional Development (CPD) points upon completion. The platforms have content experts who engage learners through the discussion forums. Outcomes: Over the last four months, over 2000 healthcare workers have enrolled into these platforms. Numerous teacher-learner interactions have occurred though the platforms. Additional content, on ChemoSafe practices; community health workers and cancer health information system are in the process of being included in the platforms. Lessons learnt: digital training platforms enabled PHC training on cancer prevention and early detection sustainably. Such an innovation is timely, especially during health system disruptions or where resources to support in-person training are lacking. Online training platforms also free time for skills mentorship during physical engagements. LMICs can utilize such initiatives to increase capacity of PHCs to diagnose cancer early and link to management. Have you got a Conflict of Interest?: No
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1181 Ox-LDL/LOX-1 promotes migration and invasion in NSCLC cells X. Ge1, D. Zhang1 1 Affiliated Hospital 2 of Nantong University, Clinical Medicine Research Center, Nantong, China Background: Lectin-like oxidized low density lipoprotein receptor 1 (LOX-1) is significantly up-regulated and participated in the regulation of atherosclerosis andcancer. Although research reported that LOX-1 promotes Epithelialmesenchymal transition (EMT) in cancer, but the expression and the underlying molecular mechansims of LOX-1 in non-small cell lung cancer (NSCLC) require further elucidation. Aim： Investigate the expression of LOX-1 in lung cancer tissue and the effect of ox-LDL/LOX-1 on the migration and invasion of NSCLC cells. Methods: 1. Western blot and immunohistochemistry were used to confirm the protein expression of LOX-1 in lung cancer tissues and adjacent tissues of NSCLC patients. 2. A549 cells were stimulated with ox-LDL at the indicated time points, and the expression of EMT-related proteins (E-cadherin, N-cadherin and Slug) was detected by Western blot. Moreover, we analyzed the migration and invasion of NSCLC cells by Transwell assay. 3. A549 cells were stimulated with ox-LDL and western blot was used to detect the expression of LOX-1, NF-κB P65 and MAPK signaling pathway. 4. Knocked down LOX-1 expression in A549 cells by transfecting sh-LOX-1 plasmids. The interference efficiency of LOX-1 shRNA was detected and the protein expressions of E-cadherin, N-cadherin and Slug were determined by Western blot. Furthermore, Transwell assay and Scratch wound healing assay were used to determine the migration and invasion of A549 cells. 5. Employing NF-κB P65 inhibitor BAY11-7082, to block the activation of NF-κB p65 in A549 cells and Western blot confirmed the protein expressions of P-P65, P65 and LOX-1. Results: 1. Western blot and immunohistochemical analysis results indicated that the expression of LOX-1 protein significantly up-regulated in lung cancer tissues of NSCLC patients compared with adjacent tissues. 2. Ox-LDL promoted the expression of EMT-promoting proteins (N-cadherin and Slug) in A549 cells, and inhibited the expression of EMT-inhibiting (E-cadherin) protein. Transwell assay results showed that ox-LDL promoted the migration and invasion of NSCLC cells. 3. Western blot results found that ox-LDL promoted the expression of LOX-1 protein in A549 cells, and activated NF-κB P65 and MAPK signaling pathway. 4. After transfection of sh-LOX-1 plasmids in A549 cells, Western blot results discovered that the expression level of E-cadherin protein was increased, and the expression of N-cadherin and Slug protein was decreased. Transwell assay and Scratch wound healing assay indicated that interfering LOX-1 decreased the migration and invasion of A549 cells. 5. Inhibiting the P65 signaling pathway decreased the expression level of LOX-1 protein in A549 cells by Western blot. Conclusion: The above results showed that ox-LDL/LOX-1 promoted the migration and invasion by NF-κB P65 and MAPK signaling in NSCLC. Have you got a Conflict of Interest?: No
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1184 Nationwide survey on the awareness rate about core knowledge on cancer prevention and treatment in China S. He1, W. Chen1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Office for Cancer Screening, Beijing, China Background: The health literacy of cancer control comprehensively reflects the individual's cognition and attitude on cancer, which helps reduce the disease burden through promotion of tertiary prevention. However, national survey has not been carried out in China. Aim: This study aims to evaluate the Awareness Rate about Core Knowledge on Cancer Prevention and Treatment (CKC-rate) and explore its possible factors. Methods: A multi-center phased survey was conducted in mainland China in 2021 based of Probability Proportionate to Size Sampling. Each province was classified into the urban and rural layer, and corresponding number of sample units were selected sequentially. This survey targets on local residents at the age range of 1574 years, and excluded collective households. The questionnaire applied was independently designed by the National Cancer Center of China. The awareness rate was defined as the proportion of correct answers to the overall answers. The rates were weighted by the distributions of age, gender and household registration type in the 2010 population census of China and compared by t-test or chi square test. Multiple logistic regression analysis was applied to detect the main factors after dividing the rates by the quartiles. Results: A total of 84,136 questionnaires were collected, and 80,350 valid questionnaires were included (95.5%). The national CKC-rate was 74.60%, and rates in aspect of recognition on the basic concept, prevention, early diagnosis and knowledge, knowledge and rehabilitation were 70.03%, 77.23%, 72.21%, 80.54% and 77.28% respectively. There were obvious regional and population imbalances in CKC-rates among Chinese population. The rates of eastern and central China were significantly higher than the Western’, and increased with the increase of education level. It reached the top in the 25-34 years group, and the elderly showed lower performance. Female, people in the urban, with a family history of cancer, never smoking and medical staff tended to have higher recognition. However, there was no significant trend for marital status. Multivariate analysis confirmed the effects of the above variables. Conclusion: The overall CKC-rate has achieved national target value set for 2022 (70%), but the awareness of the basic concept and early diagnosis and treatment needs to be improved urgently. Besides, targeted health education should be provided for key groups to promote health equity. Have you got a Conflict of Interest?: No
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1185 Bone pain from spinal metastases: Iodine-125 brachytherapy H. Shao1, H. Zou1 1 Harbin Medical University,cancer hospital, Heilongjiang, China Background: The spine is the most common involved site of bone metastasis, which significantly diminish their quality of life. Recently, efforts have been made to introduce the use of computed tomography (CT)-guided iodine-125 (125 I) seed implantation into the field of spine tumor treatment with encouraging results. However, few studies have focused on CT-guided iodine-125 (125I) brachytherapy outcomes in patients with spinal metastasis. Aim: This study evaluated the analgesic efficacy and safety of CT-guided iodine-125 (125I) brachytherapy in patients with spinal metastasis-induced pain who were not suitable to receive radiotherapy. Methods: A cohort of 68 patients with spinal metastasis induced pain not fully relieved by opioids and did not receive external beam radiation therapy due to poor general status were enrolled and underwent CT-guided 125I brachytherapy for analgesic treatment. Results: Patients were followed for 8 weeks after brachytherapy. Mean Numerical Rating Scale score before brachytherapy was 7.3±1.3 and decreased to 3.3±0.9, 2.6±0.8, 2.7±0.8, 2.9±0.9 and 3.3±1.1 at weeks 1, 2, 4, 6 and 8, respectively, after brachytherapy. Daily dose of morphine equivalent was 105.1±28.0 mg before brachytherapy and decreased to 45.3±13.7, 39.9±14.2, 40.4±14.9, 48.5±18.0 and 62.4±17.5 mg at weeks 1, 2, 4, 6 and 8, respectively, after brachytherapy. Patients had fewer daily episodes of breakthrough pain after brachytherapy (p<0.001). Patients had improvement in pain-related functional interference and in hospital anxiety and depression score after brachytherapy. Conclusion: CT-guided 125I brachytherapy is an effective and safe intervention for patients with spinal metastasis-induced pain who are not able to receive radiation therapy. Have you got a Conflict of Interest?: No
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1188 Assessment of Palliative Care Needs in a Kenyan Intensive Care Unit Using a Trigger-Based Model. L. Barasa1, J. Shah1, J. Weru1, S.K. Ali1 1 Aga Khan University Hospital, Nairobi, Kenya Background:Palliative care triggers have been used in the Intensive Care Unit (ICU) setting, usually in high income countries, to identify patients who may benefit from palliative care consults. Palliative care trigger points are clinical screening criteria that, if met, point towards the need for palliative care service consultation. It has been demonstrated that the use of the trigger points to prompt proactive palliative care is effective in enabling early palliative care consults and better utilisation of ICU resources (1).The utility and benefits of palliative care triggers in the ICU has not been previously studied in sub-Saharan Africa. Aim: The primary objective of this study was to estimate the prevalence of ICU admissions who met the criteria for one or more palliative care triggers. The secondary objectives were to determine an association between palliative care consults and length of ICU stay, mortality and time to do-not-resuscitate (DNR) order. Methods: We conducted a prospective observational cohort study within the ICU at The Aga Khan University Hospital, Nairobi between December 2019 and August 2020. Data including initiation of a palliative care consult, length of ICU stay, mortality and time to DNR order was collected. Results: During our study period,72 of 159 (45.9%) recruited patients met at least one palliative care trigger point. See Figure 1 for the distribution of the different triggers met. Of the patients who met the palliative care triggers, only 29.2% received a palliative care consult. Patients who received palliative care consults had higher rates of DNR orders signed (52.3%) versus those who did not (P=0.009). There was no statistically significant difference between the consult and non-consult groups in regards to length of ICU stay, time to DNR order and mortality.
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Conclusion: In this study, we found the use of palliative care triggers identified a large proportion of ICU patients with palliative care needs. Involvement of palliative care was associated with higher rates of completion of DNR orders in patients who met palliative care triggers. Some of the reasons for inadequate or late palliative consults could be inaccurate assessment of patient’s prognosis by the primary physician or inadequate understanding of what palliative care involves (2). A trigger-based model, geared to the needs of the specific ICU, may be one way of improving integration of palliative care into the ICU, especially in sub-Saharan Africa. References: 1. Nelson JE, Curtis JR, Mulkerin C, et al. Choosing and using screening criteria for palliative care consultation in the ICU: a report from the Improving Palliative Care in the ICU (IPAL-ICU) Advisory Board. Crit Care Med 2013;41: 2318e2327 2. Baker M, Luce J, Bosslet GT. Integration of Palliative Care Services in the Intensive Care Unit: A Roadmap for Overcoming Barriers. Clinics in chest medicine. 2015;36(3):441-8. Have you got a Conflict of Interest?: No
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1196 Single-cell sequencing of organoids uncovered MUC5AC-intestinal and MUC6-diffuse lineage of gastric cancers R. Yang1, Y. Yu1 1 Department of General Surgery of Ruijin Hospital, Shanghai, China Background: Gastric cancer is a highly heterogeneous malignancy with a complex morphological phenotype and divergent prognosis. These properties may closely relate to the complexity of the gastric mucosa components. However, the solid evidence of cell origin for different types of cancer remains insufficient. Aim: Using paired gastric organoids for a single-cell transcriptome study, the single cell components and the evidence of cell origin for different types of gastric cancer were analyzed. Methods: In this study, a single-cell transcriptome study was conducted on six gastric organoids from different types of gastric cancer and paired normal gastric mucosa (one case of diffuse type, and two cases of intestinal type). Several marker genes of cell clusters were verified on 439 cases of surgical resected gastric cancers. Results: As results, a total of 25,803 high-quality cells were captured for transcriptomic analysis. Two different transformed lineages of gastric cancer were found. One is MUC5ACposi-PMC-intestinal metaplasia-dysplasiaintestinal type route, and another is MUC6posi-Stem like cell-PGC-SPEM-diffuse type route. There are either shared cell clusters or heterogeneous cluster in different types of gastric cancer. The drug-resistant /angiogenesis (R or A) cluster was identified in both types of gastric cancers. Compared with paired normal gastric mucosa, the differential genes of R or A cluster were enriched in autophagy and neutrophil activation pathways. One of the differential genes PIM3 was validated on large cohort of gastric cancer. PIM3 revealed higher expression level in both types of gastric cancer. The PIM3-high group demonstrated poor overall survival compared to PIM3-low group (p=0.0082). Conclusion: The paired gastric organoids have pure epithelial components without the mixture of mesenchymal cells. They are suitable for decipher the cell origin, tumor heterogeneity and evolution process of various subtypes. Figure. Two transformation routes of MUC5AC-intestinal and MUC6-diffuse lineage of gastric cancers.
Have you got a Conflict of Interest?: No
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1198 Bioinformatics analysis of prognosis and immune infiltration of PTTG family and Gastric cancer X. Li1, Y.h. Tai2, S.y. Liu1, Y.t. Gao1, K.n. Zhang1, J.r. Yin1, H.j. Zhang1, X. Wang1, X.f. Li1, D.f. Zhang1 1 Linfen Central Hospital, lin fen, China, 2Shanxi medical university, Taiyuan, China Background: Gastric cancer is the fifth most common malignant tumor in the world and the third leading cause of cancer deaths. Although the current treatment methods are diverse, the prognosis is still poor, and PTTGs are significantly related to the prognosis of a variety of tumors. Aim: Clarify the relationship between PTTGs and gastric cancer gene expression, clinical data analysis, prognosis analysis, immune infiltration analysis, etc. through Bioinformatics analysis. Methods: The transcriptional expression levels of PTTGs were analyzed through the Oncomine and GEPIA, respectively. The correlation between PTTG mRNA expression and tumor stage in STAD patients was studied by GEPIA. The expression level of PTTGs members and the individual tumor stage and lymph node status were analyzed using the UALCAN database. The Kaplan Meier plotter was used to evaluate the relationship between overall survival (OS), first progression (FP) and post-progression, survival (PPS) and the expression level of PTTG family members. The Kaplan Meier plotter was also used to analyze the correlation of PTTGs expression and clinical prognosis in gastric cancer with different clinic opathological factors. The transcriptional expression correlation, gene mutation rate and survival time of PTTGs members STAD patients were explored by cBioPortal. The co-expression networks of PTTGs are identified using STRING and Gene MANIA to predict their potential functions. The correlation between PTTGs expression and tumor-infiltrating immune cells and correlation analysis between PTTGs and markers of immune cells was tested by TIMER. Co-expression data from cBioPortal were downloaded to assess the correlated pathways with PTTG gene family members using DAVID. Results: The expression of PTTG1/2/3P was up-regulated in STAD tumor tissues. Survival analysis showed that overexpression of PTTG1/3P is associated with better overall survival (OS), (FP), and post-progressive survival (PPS). Overexpression of PTTG2 is associated with poor OS, (FP), and post-progressive survival (PPS). Analysis of clinical data shows that increased expression of PTTG1/3 leads to better OS related to gender, stage, T2/3 stage, M stage and Lauren classification, and high PTTG2 expression level is related to gender, stage 1/3 and N0 stage and poorer OS Related. In addition, the genetic changes of PTTG were studied, and the change group was associated with shorter disease-specific survival (DSS). GO and KEGG analysis showed that PTTG1/2/3P is involved in the regulation of cell cycle, oocyte meiosis and progesterone-mediated oocyte maturation. In addition, the expression of PTTG1/2 is negatively correlated with the infiltration of a variety of immune cells with anti-tumor effects and positively correlated with the expression of immune checkpoint molecules. Conclusion: PTTGs are related to Gastric cancer. This provides a basis fo further clarify the mechanism of gastric cancer, and provides new treatment directions. Have you got a Conflict of Interest?: No
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1201 Association of socioeconomic position with cancer incidence and mortality in a large European cohort (EPIC) D. Singh1, V. Lorenzoni2, P. Veneis3, M. Jenab1, S. Vaccarella1 1 International Agency for Research on Cancer, Cancer Surveillance Branch, Lyon, France, 2CNR Institute of Clinical Physiology, Pisa, Italy, 3Imperial College London, London, United Kingdom Background: Socioeconomic inequalities (SES) in cancer mortality may arise from inequalities in the incidence of the disease (predominantly reflecting the distribution of risk factors across socioeconomic groups) and from inequalities in lethality (likely reflecting availability/access to timely diagnosis, and effective treatments). Aim: To describe and compare the association between socioeconomic position (as measured by education) with both cancer incidence and mortality for total cancer and 19 major cancer types, and to estimate the contribution to inequalities in cancer mortality due to inequalities in incidence and inequalities in lethality of the disease. Methods: We used prospective multi-centric dataset of more than 500,000 participants enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort for the analysis. Sub-distributional hazard models (Fine and Gray) were used to analyse the risk of cancer incidence and mortality, accounting for competing events. A previously developed methodology was adapted to our individual data to estimate the contribution to inequalities in cancer mortality due to inequalities in incidence and that due to inequalities in lethality. Results: Educational inequalities in incidence and mortality were found for several cancer types. Primary educated men had significantly increased risk of cancer incidence and mortality of lung (HRincidence, 2.4-fold, and HRmortality 2.4-fold) fold, oral (HRincidence, 1.6-fold, and HRmortality 1.7-fold), bladder (HRincidence, 1.5-fold, and HRmortality 2.2-fold), colorectum (HRincidence, 1.3-fold, and HRmortality 1.3-fold), stomach (HRincidence, 2fold, and HRmortality 2-fold), liver (HRincidence, 1.7-fold, and HRmortality 2.2-fold), and as compared to higher educated counterparts. In women, risk was significantly higher for cancer of lung (HRincidence, 2.7-fold, and HRmortality 2.1-fold), oral (HRincidence, 2.2-fold, and HRmortality 3.2-fold), stomach (HRincidence, 2.7-fold, and HRmortality 2-fold), liver (HRincidence, 2.3-fold, and HRmortality 2.7-fold), and kidney (HRincidence, 1.9-fold, and HRmortality 2.4-fold). Similarly, excess death in low educated participants (versus highly educated) due to inequality in incidence and lethality was found in those diagnosed with lung (52% excess death in both sexes), liver (53%), stomach (45%), bladder (60% in men), and kidney (53% in women) cancer. Conclusion: We showed that SES in cancer incidence and mortality are large and depend on the specific cancer types considered. Inequality in cancer does not stops at diagnosis, but rather continues till the end of life. Our study helps identify areas of SES in cancer along the different stages of the cancer continuum. Have you got a Conflict of Interest?: No
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1203 Impact of COVID-19 on cancer screening behaviours: findings from one of the world's most locked-down cities K. Lotfi-Jam1, M. Murphy2, N. McGrath3, S. Durkin1, K. Broun4 1 Cancer Council Victoria, Centre for Behavioural Research in Cancer, Melbourne, Australia, 2MMResearch, Melbourne, Australia, 3Victorian Department of Health, Public Health Division, Melbourne, Australia, 4Cancer Council Victoria, Prevention Division, Melbourne, Australia Background: Throughout the COVID-19 pandemic, Victoria’s capital, Melbourne, the second most populous city in Australia, has been amongst the most locked-down cities in the world, spending 262 days under stay-at-home orders over 2020 and 2021. Despite well-established National Cancer Screening Programs for cervical, breast and bowel cancer, screening participation has significantly decreased across Victoria during the pandemic. There has also been a significant reduction in notifications for breast and bowel diagnoses. It is unclear how much is due to changed screening behaviours because of COVID-19 compared to other factors including changing screening guidelines, fluctuating invitation patterns, and service capacity issues. Aim: To investigate how the pandemic has changed cancer screening and health seeking behaviours, the needs of those disproportionately affected by COVID-19 and recovery strategies to reengage people with cancer screening and preventive health. Methods: Nine focus groups were undertaken with 49 women who were overdue/never screened, segmented by age and location (metropolitan/ regional/highest COVID-19 areas). Interviews were undertaken with ten general practitioners and screening service providers and five culturally diverse community organisations. Results: COVID-19 significantly changed how people prioritise cancer screening. Women reported only doing what was necessary, putting off anything perceived as non-essential, including screening. COVID-19 public health messaging to only engage in essential activities was misinterpreted as a reason to delay screening, as were restrictions to face-to-face doctor appointments and limited screening promotion. Many were reluctant to book screening appointments, assuming appointments weren’t available. Perceived transmission risk and burdensome COVID-safe processes were also reasons to delay. Health professionals reported greater focus on acute care, limited opportunities to discuss screening via telehealth, and significant capacity issues, reducing ability to promote screening or carry out recall/reminder strategies. Conclusion: Many Victorians have delayed cancer screening during COVID-19 and will continue to do so without intervention. It is critical that governments, cancer agencies, screening services, primary care and community organisations work together to ensure these behaviour changes do not lead to permanent reductions in cancer screening rates, more late-stage diagnoses and worsening cancer outcomes. State-wide and targeted communications should emphasise that cancer screening remains a priority and address perceptions that it isn’t urgent or essential. Messages should avoid contributing to further fear in the community, normalise returning to GP clinics and reassure some cultural groups about safety and hygiene. Direct communications are needed to remind health professionals to prioritise cancer screening, actively promote service availability and support capacity issues. Have you got a Conflict of Interest?: No
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1208 Effect of electrical stimulation biofeedback in patients after orthotopic neobladder H. Wang1, . 刘1 1 Cancer Hospital Affiliated Huazhong University of Science and Technology, WUHAN, China Background: A new bladder is formed after the patient's bladder is completely removed and the patient's own bowel segment is catheterized. Because it is closer to the patient's own physiological state and can help maintain the patient's image, IONB has become the preferred surgical method for bladder cancer patients. However skin incision and Bricker ileal ureter and bladder surgery compared with Orthotopic ileal neobladder(IONB) resection of the prostatic urethra and bladder neck, blocking the normal neural circuits, together with the new bladder and the original bladder physiological anatomy, and urethral muscle no cooperative relationship, and the cerebral cortex new store urine micturition reflex has not been established, Therefore, urinary incontinence is a major postoperative problem for patients with IONB. At present, the bladder function training and pelvic floor muscle training of patients with INOB are mainly used to strengthen the contraction function of urethral sphincter, so as to improve urinary incontinence, however there is less training on pelvic floor muscle, and patients can still have severe urinary incontinence. Studies have shown that electrical stimulation biofeedback can establish a new urination mode of intestinal replacement bladder and reduce the complications caused by using abdominal pressure urination mode. Based on this, this study explored the combination of pelvic floor muscle training and electrical stimulation biofeedback for patients with urinary incontinence after IONB, which effectively improved the patients' urinary control ability. Aim: To explore the effect of Pelvic floor muscle training combined with electrical stimulation biofeedback in patients with urinary incontinence after orthotopic ileal neobladder reconstruction Methods: 97 patients admitted to urology department were divided into control group (n=46) and observation group (n=51). The control group received routine pelvic floor muscle training; On the basis of the control group, the observation group was treated with pelvic floor electrical stimulation combined with biofeedback. Urine flow dynamics, the effective rate and urinary diary indexes were observed after intervention Results: After intervention the bladder volume, urine flow rate, bladder detrusor pressure, the effective rate, urination interval time and average urine volume per session in observation group were significantly higher than those in control group (allP<0.05) Conclusion: Pelvic floor muscle training combined with electrical stimulation biofeedback can effectively improve urinary incontinence and improve urinary control ability in patients with urinary incontinence after orthotopic ileal neobladder reconstruction. Have you got a Conflict of Interest?: No
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1211 Give Your Locks, Give Them Hope Fundraising Campaign D. Wee1 1 Society for Cancer Advocacy and Awareness Kuching (SCAN), KUCHING, Malaysia
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Amount raised: RM 49, 078 (Goal is RM150, 000) Background and context: Society of Cancer Advocacy and Awareness Kuching (SCAN) held a hair donation fundraiser from 15th January 2022 – 31st March 2022, titled “Give Your Locks, Give Them Hope”. This is a first fundraiser in Sarawak where locks of hair are collected with the purpose to make wigs for cancer patients who lost their hair. We collaborate with Locks of Hope Association as our co-organizer. This association focuses on collecting donated locks of hair to a factory in China that turns the hair to wigs. Aim: The objective was to raise public awareness for cancer patient support by collecting donated locks of hair to make wigs for patients undergoing chemotherapy. Funds raised were to be used to support SCAN’s patient support service (our helpline and training of our peer counsellors), advocacy and awareness activities. Part of the funds raised will go to Locks of Hope Association to help bear some of the manufacturing costs of turning donated hair into wigs. Strategy/ Tactics: This event was launched through SCAN’s Facebook and highlighted through local newspapers, and social media. From here we were able to engage with a few hair salons who provided a free haircut and helped SCAN collect and keep the donated locks until collection day. Apart from personal fundraisers who registered with SCAN, we also collaborated with a private international school, a 4-star hotel, Lions Club and other organizations who participated to help raise funds and donate hair. Programme process: To participate hair-donor fundraisers registered online with SCAN through a link which was provided, they will proceed to collect monetary donations. When they reach their targeted amount, they will cut their locks at selected hair salons as pledged and bank in the donation to SCAN. With the use of email, Google forms, we were able to keep track and stay in phone contact with the donors. Costs and return The start-up of this project was minimum, and the expenses were for tokens of appreciation and printing of certificates for all registered hair donors and Salon partners. Estimated cost will be less than RM2000 and 20% of collected donations will be given to Locks of Hope Association. We have registered 49 hair donor fundraisers and 14 hair donors. The revenue generated was close to RM50K, a 2400% return on investment (ROI). What was learnt: We hope we will be able to reach out to more corporate donors if the duration of the fundraiser was lengthened. If a physical launch was able to be carried out at shopping malls, publicity and awareness will be increased with better impact for this fundraiser. We believe that this will allow this fundraiser to be easily scaled up in the future. Have you got a Conflict of Interest?: No
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1214 The Diversity of Vaginal Microbiota Predicts Radiotherapy Responsiveness in Locally Advanced Cervical Cancer L. Zhang1, Y. Wang2, Y. Liu2 1 Lei Zhang, Shenzhen city of guangdong province, China, 2Shenzhen Hospital of Peking University, Shenzhen city of guangdong province, China Background: The vaginal microbiota is involved into HPV infection and chemotherapy responses; however, its relationship with radiotherapy responsiveness in patients with locally advanced cervical cancer(LACC)remains scarce. Aim: The study aimed to investigate the vaginal microbiota diversity of women with locally advanced cervical cancer (LACC) and compare the differences between responders and nonresponders. Methods: We collected the 16S rRNA gene sequencing of vaginal microbiome of 14 cervical tissues, including 7 LACC patients before radiotherapy and 7cervical tissues after radiotherapy respectively. Results: Compared with the nonrdsponders, alpha diversity was significantly increased in CC patients (p <0.05) with more unconventionality bacterial colonization. Beta diversity also significantly differed between radiotherapy responders and nonresponders (p <0.01). Within the CC patients, alpha diversity in cervical tissue was significantly higher in the responders versus the nonresponders (p <0.01), and the Rhodococcus and Enterococcus were negatively correlated with mass reduction (p<0.001). Compared with partial responders, the vaginal microbiota differed significantly in complete responders after radiotherapy. Conclusion: The study suggests the vaginal microbiota in LACC patients is associated with radiotherapy responsiveness. Alpha diversity and Bacteroides abundance have the potential of identifying patients at an early time. These findings provide a basis for further research on the relationship between vaginal microbiome and radiotherapy effect in LACC.
Have you got a Conflict of Interest?: No
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1216 Closing the care gap by building the house of hope "DAR AL AMAL" B. Gouimi1 1 Bahija Gouimi, Marrakech, Morocco BACKGROUND: In Marrakech, AMAL decided to create a patient hotel as no structure is offered by the health care system to limit the treatment abandon risks. Since the specialized and biggest cancer care centre is just in Marrakech (gathers patients from all the south of Morocco), AMAL has as well took its part to fix this problem and its outcomes, the problem of more than 30% of cancer patients living far from the hospital, discontinuing and abandoning their treatment because they cannot afford repetitive transit fees, pay hotel and have no family nearby to stay with. PROJECT: AMAL is building a patient hotel called "DAR AL AMAL" or House of hope to welcome 30 people (patients with their companion, or alone) where they can stay for the entire treatment period prioritizing patients most in need, coming from rural areas or living far from the hospital. Dar Al AMAL will provide accommodation, food, psychological support and transportation from and to the hospital as soon as the house will open its doors in May-June 2022. The transfer of cancer patients from the hospital to the patient hotel is done in the framework of a hospital/AMAL agreement which determines the responsibilities of the stakeholders and will be executed following decisions by medical staff(physician, radiologist, social worker) based on the social situation of the cancer patient. AMAL organized many fundraising campaigns and received private donations. We spent 6 years talking about the project in media, with public and private partners, with donors to convince them to collaborate and help us to achieve this project. Finally, we succeeded to find a private partner who started the construction works. Our advocacy work really paid off because we were able to get in-kind collaborations (architect, construction plan, design office, reinforced concrete laboratory, etc). AMAL bought the land in October 2017 and was authorized to start constructions in March 6, 2020. OBJECTIVES: This project will play a big role in patient wellbeing and recovery because it will reduce the financial burden of cancer, help patients and caregivers to overcome cancer together by doing activities and sharing stories. Basically, patient hotels are not only a new way of accommodating patients and caregivers, but also has changed the practices of care around the world and has led to significant efficiency gains for health care systems, contribute to education and cancer prevention. CONCLUSION: Patient hotel is an effective solution allowing patients to keep up their treatment and not abandon it especially if it is a basic human right. The generalization of such practice in Morocco would have a huge impact and would support the healthcare system managing patient issues, appointments, and it will help treat and recover more patients mostly those living far from care centres, hospitals, pharmacies, hence moving towards social equity.
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Keywords: patient hotel, patient home, cancer, closes the care gap, Morocco
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1217 Preferred therapeutic management strategies for patients with early-stage mucinous ovarian cancer Y. Zhang1, N. Li1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Department of Gynecologic Oncology, Beijing, China Background: Mucinous ovarian cancer (MOC) is an uncommon type of ovarian neoplasia. Currently, the therapeutic strategies of MOC are similar to those used for other common histological types of epithelial ovarian cancers and are based on International Federation of Gynecology and Obstetrics (2014) staging system. For patients at early stages (I-II), hysterectomy/bilateral salpingo-oophorectomy (BSO)，together with comprehensive staging procedure, including omentectomy, pelvic and para-aortic lymph nodes dissection (LND), is typically used as standard surgical operation. However, MOC at early stage is less aggressive than other histologic subtypes, so less invasive surgical procedures may be considered among these cohorts. Aim: Since neither cogent clinical guidelines base on clinic trails, nor an unique consensus of MOC are currently available, this study aims to explore the appropriate treatment strategies for MOC at early stage by analyzing retrospectively the data on the managements of MOC in our institution. Methods: Data were extracted from the medical records of patients with stage I/II ovarian cancer from 1999 to 2010 at our institution (National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital). Patients were classified into two cohorts: MOC group (n=45) and non-MOC group (n=159). Clinicopathologic characteristics and survival status were compared among these groups. The Kaplan-Meier method was used for survival analysis. Prognostic factors were determined using a Cox proportional-hazards regression model. Results: The 5-year progression free survival (PFS) of patients with early stages MOC was significantly better than those with non-MOC (91.0% vs. 75.1%, P = 0.01), especially with serous adenocarcinoma (SAC) (n = 88) and endometrioid carcinoma (EC) (MOC vs. SAC, 91.0% vs.73.2%, P = 0.01; MOC vs. EC, 91.0% vs. 67.6%, P = 0.01 respectively). While among the population of patients with MOC, 40.0% underwent systematic LND, but there was no significant differences in recurrence rate no matter they received systematic LND or not. 35.6% patients of MOC underwent fertility sparing surgery (FSS) and none of them experienced recurrence. 68.8% of MOC patients received adjuvant chemotherapy post-operation. Conclusion: Patients with MOC had better PFS than those with SAC and EC histologic types. Systematic LND may be omitted among the populations with MOC at early stage. The FSS was safe for carefully selected patients with MOC at early stage.
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Have you got a Conflict of Interest?: No
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1219 THE BURDEN AND PATTERNS OF CANCER IN UASIN GISHU COUNTY, WESTERN KENYA REGION FOR THE PERIOD 2016-2020 G.C. CHESUMBAI1,2, N.G. Buziba3 1 Moi University School of Medicine, Pathology-Haematology and Blood Transfusion, ELDORET, Kenya, 2AMPATH, The Eldoret Cancer Registry, ELDORET, Kenya, 3Moi University Shool of Medicine, Pathology-Haematology and Blood Transfusion Eldoret Cancer Registry, ELDORET, Kenya Background: Cancer is a leading cause of morbidity and mortality worldwide, with approximately 18.1 million new cases and 9.5 million cancer related deaths 2018 alone. The burden of cancer is increasing in Africa. The Eldoret Cancer Registry covers the community of Uasin Gishu County in the Western Region of Kenya, whose population of 1,163,186 (582,889 females, 580,269 males and 28 Intersex). Aim: The aim of this study is to is to determine the burden of cancer for this community for a 5-year period (20162020) and generate age standardized rates (ASR) to be used for cancer control and planning and research. Methods: Trained cancer registrars were involved in active case finding and data collection of cancer cases in health facilities and vital statistics within a defined population. Confirmed cancer cases were abstracted and filled into case notification forms; Topography and Morphology coding done using the International Classification of Disease for Oncology (ICDO-3); Data quality checks, Data entry, Analysis done using the CANREG5 software. Results: A total of 2,782 cancer cases were registered: 1,331(48%) men and 1,451 (52%) women. In men, prostate and esophagus were the most commonly diagnosed malignancy with an age standardized rate (ASR) of 24.1 and 18.9, followed by lymphoma 7.8 per 100,000. In women, cervix and breast were the most commonly diagnosed malignancy with an ASR of 17.4 and 16.3, followed by esophagus at 10.4 per 100,000. The most burdened ages were 50-80years in males (63.5%) and 30-69 in females (73.2%). Conclusion: Overall, there was a high cancer burden in Uasin Gishu is on the productive members of the society (30-69 years). Cervical and breast cancers, affected women in their reproductive years while cancers of the prostate and esophagus the older male populations. Cancer control interventions like accessible HPV vaccines, free screening services, cancer awareness campaigns, community screening campaigns, affordable healthcare should be widely availed to the community in order to ensure equitable access to information and care for all cancer patients and the general public. Have you got a Conflict of Interest?: No
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123 Potential biomarkers for early-stage pancreatic cancer based on tissue and serum metabolomics analysis S. Ren1, R. Zhao1, Z. Wang1 1 Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Radiology, Nanjing, China Background: Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) is essential for the improvement of the prognosis and quality of life of patients. Currently, the early diagnosis of PDAC remains a formidable challenge in clinic. Carbohydrate antigen 19-9, the only diagnostic biomarker approved by FDA, has insufficient diagnostic ability for early-stage PDAC due to its limited specificity. Novel effective biomarkers are critically needed for diagnosis of this deadly disease. Aim: To identify metabolic featuresand to discover early detection biomarkersforpancreatic ductal adenocarcinoma (PDAC) by metabolomicsprofiling. Methods: We conducted non-targeted metabolomics analysis intissue samples of 51 PDAC tumors, 40 noncancerous pancreatic tissues (NT) and 14 benign pancreatic neoplasms (BP) as well as serum samples from 80 patients with PDAC, 36 with BP and 48 healthy controls (Ctr). The candidate metabolites identified from the initial analysis were further quantified using targeted analysis in serum samples of an independent cohort of 22 resectable PDAC, 27 BP and 27 Ctr subjects. Unconditional binary logistic regression analysis was used to construct the optimal model for PDAC diagnosis. Results: Up-regulated level of fatty acids and lipids and down-regulated amino acidswere observed in tissue and serum samples of PDAC patients. Proline, creatine and palmitic acid were identified as a panel of potential biomarkers to distinguish PDAC from BP and Ctr (Odds ratio = 2.17 [95% Confidence interval 1.34-3.53]). The three markers showed area under the receiver-operating characteristic curves (AUCs) of 0.854 and 0.865, respectively, for the comparison of PDAC versus Ctr and PDAC versus BP. The AUCs were 0.830 and 0.852 in the validation set and were improved to 0.949 and 0.909 when serum CA19-9 was added to the model. Conclusion: The novel metabolite biomarker panel identified in this study exhibited promising performance in distinguishing PDAC from BP or Ctr, especially in combination with CA19-9. Have you got a Conflict of Interest?: No
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1239 Mutagen sensitivity and risk of second cancer in younger adults with head and neck cancer: 15-year results B. Bukovszky1,2,3, J. Fodor1, G. Székely1, Z. Kocsis S1, F. Oberna1, T. Major1,2, Z. Takácsi-Nagy1,2, Z. Jurányi1, C. Polgár1,2 1 National Institute of Oncology, Budapest, Hungary, 2Semmelweis University, Department of Oncology, Budapest, Hungary, 3Semmelweis University, Department of Oral Diagnostics, Budapest, Hungary Background: Head and neck cancer patients are at high risk for secondary primary cancer (SPC) development. Mutagen hypersensitivity may be associated with elevated risk of SPC. SPC is a negative predictor of cancerspecific survival. Aim: To evaluate the mutagen sensitivity phenotype on the risk of second primary cancer (SPC) in patients with head and neck squamous cell carcinoma (HNSCC), and to estimate the long-term rate of SPC and the outcome with SPC. Methods: A survey was made regarding SPC among 124 younger (≤ 50 years)smoking and drinkingadults with HNSCC who were enrolled in a pretreatment mutagen sensitivity investigation during 1996-2006. Mutagen sensitivity was assessed by exposing lymphocytes to bleomycin in vitro and quantifying the bleomycin-induced chromatid breaks per cell (b/c). Patients were classified as hypersensitive (> 1 b/c) or not hypersensitive (≤ 1 b/c). Results: Mean follow-up time for all patients was 68 months (range: 5-288 months), and the 15-year cancerspecific survival was 15%. Twenty patients (16%) developed a SPC (15-year estimated rate: 41%), and half of them was hypersensitive. The crude rate of SPC for hypersensitive (n = 65) or not hypersensitive (n = 59) patients were 15 and 17%, respectively (p = 0.4272). The 15-year estimated rate of SPC for hypersensitive and not hypersensitive patients was 36 and 48%, respectively (p = 0.3743). Gender, UICC stages, anatomical sites of index cancer did not prove to be a significant risk factor for SPC. Forty-five percent of SPC developed after the 10-year follow-up. The 3-year cancer-specific survival was 23% with SPC. Conclusion: According to our findings, mutagen hypersensitivity was not associated with an increased SPC risk in HNSCC patients. Patients are at a lifelong risk of developing a SPC. Survival with SPC is very poor.
Fig. 1 Second cancer-free survival by mutagen sensitivity. The 15-year estimated rate of second primary cancer of not hypersensitive or hypersensitive patients was 48 and 36%, respectively (p= 0.3743)
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Fig. 2 Cancer-specific survival with second primary cancer (n= 20). The estimated rate of 2- or 3-year survival was 38 and 23%, respectively
* Results were published in Strahlentherapie und Onkologie, 2022. DOI: 10.1007/s00066-022-01917-2 Have you got a Conflict of Interest?: No
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1240 Assessment of health-related quality of life and distress in a community-based cancer rehabilitation program H.Z. Aw1 1 Singapore Cancer Society, Cancer Rehabilitation Services, Singapore, Singapore Background: With improving cancer mortality, quality of life and psychological wellbeing is increasingly important to cancer patients after treatment. A substantial number of cancer survivors have to deal with physical, psychological and social problems during and after active treatment, which reduces health related quality of life (HRQOL). As part of cancer survivorship, understanding these needs are important for the coordination and quality of outpatient care for this group of patients. However, data on the HRQOL of cancer survivors undergoing community-based rehabilitation is currently lacking. Aim: We aim to address this gap by assessing the HRQOL and distress, and clinical associations in a communitybased cancer rehabilitation center. Methods: This was a retrospective cohort study of Asian cancer survivors who had presented at a national community-based cancer rehabilitation center. All cancer survivors were referred from primary care physicians from any local healthcare institutions after they had completed their acute oncological treatment. The national outpatient community cancer rehabilitation program provides comprehensive rehabilitation services with a physician-led multidisciplinary team, which includes physiotherapists, occupational therapists, nutritionists and medical social workers. Eligible patients were adults ≥21 years old and enrolled in the rehabilitation program. Patients were excluded if they had terminally ill conditions or had major psychiatric illness. The primary outcome measure was HRQOL, as measured by the Functional Assessment of Cancer Therapy-General (FACT-G7). Patient's distress level and problem lists are captured by Distress Thermometer Problem List (DTPL). Results: The mean FACT-G7 total score was 11.68 (4.17), with 267 participants (87.8%) displaying a low FACT-G7 score. The mean distress thermometer score was 3.51 (2.45) with 188 (61.8%) of participants indicating significant distress (rated as ≥5). Ethnicity and cancer stage were significantly associated with HRQOL. Those with metastatic disease were more likely to have a low HRQOL (OR=2.98, 95% CI = 1.15-7.72, p=0.025) Conclusion: There were significant proportion of patients with impaired HRQOL presenting at a first visit at a community rehabilitation center, with a practical and emotional problems playing a key role. This underscores the need for early identification of the physical and psychosocial needs of cancer survivors, so that a holistic and multi-focused rehabilitation program can enhance their HRQOL. Have you got a Conflict of Interest?: No
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1241 Enhancing the efficiency of philanthropic support through use of AI: Experience of Indian Cancer Society N. Khanna1, T. Vora2, S. Patkar1, M. Bhandare1, G. Shrivastava3, N. Ramarajan3, V. Bamne4, R. pagare4, S. Chawhan4, K. Swami5, R. Thippeswamy6, V. Dhamankar4, A. Rawat4, A. Gokarn7, U. Thorat4 1 Tata Memorial Hospital, Radiation Oncology, Mumbai, India, 2Princess Margaret Cancer Centre, Medical Oncology, Toronto, Canada, 3Navya Network, Cambridge, United States, 4Indian Cancer Society, Mumbai, India, 5Aster CMI Hospital, Bengaluru, India, 6HCG Hospital, Bengaluru, India, 7Tata Memorial Hospital, Medical Oncology, Mumbai, India Background and context: Since inception (2011), Indian Cancer Society Cancer Cure Fund (ICS-CCF) has contributed $24 million to cover the treatment costs of ~ 11500 underprivileged patients across 17 empanelled hospitals in India. A Due Diligence Team (DDT) of clinical experts review every beneficiary application for compliance with standardized treatment guidelines, cure rates and applied cost as per the ICS-CCF approval criteria. The applications are then forwarded to the Governing Advisory Council (GAC) for final decision. GAC panel consists of medical and non-medical members. Aim: To augment and scale up this process, ICS-CCF evaluated the use of Artificial Intelligence (AI) in reviewing the applications for recommendation (Prior-Authorizations). Strategy / Tactics: Navya Al platform is a clinically validated Al model that matches clinical data of beneficiary applicants (Navya Al Input) with available clinical evidence and expert recommendations/ guidelines, adapted to the ICS-CCF approval criteria (Navya Al Output). The applications where the input and output match are approved. Applications with insufficient clinical information (inadequate Input), input/output mismatch or inability to fulfil the ICS-CCF approval criteria are referred to the DDT for a case by case review. Programme / Policy process: The DDT, after review of referred cases, would recommend further action. Concordance is assessed between Navya and GAC decisions. DDT’s time to review an application is recorded. The DDT review is weekly and GAC review is bi-monthly. Outcomes: From February 2021 to March 2022, 2388 beneficiary applications were reviewed by Navya.Of these 78.8% (1872/2388) of applications were “recommended”, 0.8% (18/2388) were “rejected” and 20.9% (498/2388) were “referred to DDT” by Navya. The concordance between Navya and GAC was 99.7% (1867/1872) for authorizing and 94.4% (17/18) for rejecting a beneficiary application for sanction.DDT spends an average of 3 minutes on each application referred by Navya. On an average, Navya forwards 32 applications to GAC directly, potentially saving 96 minutes/week of the DDT clinician’s time. What was learnt: (if relevant, please also detail here the potential of replicability) Navya, a clinically validated AI system can review and assess majority (~80%) of beneficiary applications for recommendation or rejection with 99% concordance with the GAC, thus saving DDT expert’s time. As the way forward, the AI model and its role should be assessed in improving the quality and efficacy of authorization process for philanthropic funding and health insurance organizations prospectively. Have you got a Conflict of Interest?: No
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1244 Strategies for Accelerating Access to Treatment for Advanced Cervical Cancer in Sub-Saharan Africa C. Cazier1, P. Chilwesa2 1 The George W. Bush Institute, Dallas, United States, 2Roche Pharmaceuticals, Johannesburg, South Africa Background and context: Screening for cervical cancer and treatment for precancers continues to expand, especially through increased funding from PEPFAR as part of the Go Further partnership. But women in subSaharan Africa (SSA) are still dying from the disease at disproportionately high rates. Tools and resources exist to close this gap. Aim: To identify innovative solutions to barriers preventing access to treatment for advanced cervical cancer in SSA from the perspectives of diverse stakeholders. Strategy / Tactics: In June 2021 the Bush Institute, together with partners, hosted a two-day virtual meeting to discuss accelerating access to treatment for cervical cancer. It included over 100 stakeholders working from the global to the community level, including ministries of health, cancer survivors, advocates, multilaterals, US government agencies, international and local NGOs, healthcare providers, program implementers and the private sector. Expert facilitators led one of five topic discussions on the patient journey continuum (patient support, linkage to treatment, optimization of existing treatment options, harmonized in-country guidelines and policy, and innovative finance) and participants joined the same discussion for both days. Policy Process: The ideas articulated during the meeting were distilled in a report and disseminated. Solutions identified have been shared in private meetings, public gatherings, and other outlets. Outcomes: In addition to possible topic-specific solutions, overarching recommendations include short term suggestions: using COVID-19 awareness platforms to increase cervical cancer messaging, improving cervical cancer awareness and literacy, encouraging countries to disclose the budget allocation for their cervical cancer elimination strategy, including technical experts in decision-making discussions, and engaging with first ladies as advocates. Medium term recommendations include working transparently and in coordination among all stakeholders to avoid duplication, enhancing South-to-South collaboration, including patient navigators within programs to ease the patient journey, and developing business cases for ministries of health to finance cancer care.Long term solutions include setting up dedicated national cancer control units within ministries of health that have the full support of the treasury and ministry of finance and developing country-specific costed and financed policy and guidelines reflective of the national context. What was learnt: Utilizing virtual platforms to convene participants in facilitated dialogue allowed inclusion of diverse perspectives, bringing to light innovative and sustainable step-wise solutions. To further ensure the adoption or adaptation of key strategies, country-specific follow-up is planned. Have you got a Conflict of Interest?: No
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1256 Cervical Cancer: A step-wise approach to developing best practices in audit, communication and legal framework A. Chandran1, A. Carvalho1, C. Chauvet1, K. Pitak1, W. Prendiville1, P. Basu1 1 International Agency for Research on Cancer, Early Detection, Prevention & Infections Branch, Lyon, France Background: Cervical screening programme (CSP) globally aims to reduce the incidence of, and deaths from, cervical cancer. Unfortunately, despite the effectiveness of the programme, women still develop cervical cancer. An audit of cervical screening histories may help to identify why a cancer has occurred, despite the individual having previously had cervical screening. However, there is lack of international consensus and guidance on best practices on audits, communications and legal framework for CSP. Aim: This project aims to develop international best practices for conducting cancer audits in cervical screening programmes, to develop good practices and key considerations including a checklist for transparent & pragmatic communication with key stakeholders (related to benefits, inadequacies & harms of cervical cancer screening) as well as to develop best practices and a legal framework that will better safeguard the interests of screening participants, providers, and managers. Strategy: Three Technical Working Groups (TWGs) have been formed by the International Agency for Research on Cancer (IARC) to address the three main aims. A mixed-methods approach which consists of three work packages for each of these TWGs will be undertaken: a scoping review, interviews with stakeholders and documentary analysis of screening information materials, and a consensus principles workshop that includes international participant representation Policy Process: The lack of standardization process in auditing of cervical cancers was identified as a key issue internationally. IARC will define the goals and standards for audits of cervical cancers through the convening of expert stakeholder groups. Once the best practice is formulated, policymakers and programme managers can adopt, implement, evaluate and maintain these best practices in their respective setting. Outcomes: The international standards and best practice developed by the TWGs will inform cervical screening policymakers and programme managers internationally and be an important addition to benefits of quality assurance in all aspects of cervical care. However, the best practice strategies identified by the TWGs will need to be contextualised to the level of screening programme organisation, barriers and facilitators (at the levels of service users, service providers, and health system), resource limitations and stakeholders’ expectations in different settings. What was learnt: Scientists are in a position to strengthen the policy cycle’s structure through expert advice and assistance. Although the process of convening of expert stakeholders is lengthy, the international best practice is important as a benchmark for CSP to maintain quality assurance. Have you got a Conflict of Interest?: No
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1259 Costs of Cancers in Malaysia: Building an evidence base for priority setting for NCD policymakers A. Chandran1, F. Mustapha1, H.N.Q. Tran2, J. Ananthapavan2, N. Zakariah1, T. Tanaka3, Y.-R.J. Lo3, M. Moodie2 1 Ministry of Health Malaysia, Disease Control Division, Putrajaya, Malaysia, 2Deakin University, Deakin Health Economics, Burwood, Australia, 3World Health Organization, Representative Office for Malaysia, Brunei Darussalam and Singapore, Cyberjaya, Malaysia Background: Cancers are the leading cause of disability and death in Malaysia. Aim: This project aimed to assess the direct and indirect cost of cancers in Malaysia to support the development of an evidence-based cancer control strategy. Strategy: Direct healthcare costs related to prevention, diagnosis, treatment, and management of cancers were examined. The cost estimates were based on top-down and bottom-up approaches and analysed for seven cost categories: hospitalisations, primary care and outpatient attendances, medication, medical tests, medical consumables, traditional and complementary medicine, and health promotion. Indirect costs associated with main risk factors for cancers (unhealthy diet, physical inactivity, smoking, and alcohol consumption) were estimated. The calculation of indirect costs included: (1) productivity losses related to presenteeism, absenteeism, and early retirement due to premature death, and (2) monetary valuation of healthy life lost due to disability. These cost categories were estimated using human capital and friction cost approaches. All costs were expressed in 2017 Malaysian ringgit (RM). Policy Process: The lack of economic arguments was identified as a key issue that limited the prioritisation of effective cancer prevention policies. A working group consisting of experts from the Ministry of Health Malaysia, World Health Organization, and Deakin University was formed. Relevant stakeholders were invited to provide input. These findings can be used to support prioritisation exercises for the control of NCDs including cancers and as an advocacy tool for policymakers. Outcomes: In 2017, the estimated total healthcare cost for cancers was RM 1.34 billion. Majority of the cost was due to hospitalisation expenditure (RM 727.73 million or 54.30% of total cancer costs) followed by medication costs (RM 408.10 million or 30.45%). Cancers also accounted for substantial productivity losses, estimated to be RM1.8 billion using the human capital approach and RM374.6 million using the friction cost approach. Apart from productivity losses, the health burden of cancers was also considerable accounting for approximately 717,318 Disability Adjusted Life Years (DALYs) lost in the 2017 Malaysian population. The DALY burden of cancers primarily occurs in the 50 to 69 age group (47.9%), and primarily occurs because of years of life lost due to premature death. Largest losses resulted from trachea, bronchus, and lung cancer, followed by breast cancer, and cancer of colon and rectum. What was learnt: The health and economic burden of cancers in Malaysia highlight the urgent need to invest in preventive and early detection initiatives. However, this work package constitutes a cost-of-illness study, highlighting the burden but not the potential solutions to address it. To develop a prioritised list of interventions to prevent cancers and other NCDs, further evidence of the cost-effectiveness of potential interventions is required . Have you got a Conflict of Interest?: No
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1260 Improving cancer control for the Northern Province, Sri Lanka through effective collaboration with partners S. Navaratnam1,2, A. Ketheswaran3, R. Surenthirakumaran3, S.B. Sutcliffe4,5 1 University of Manitoba, Department of Internal Medicine, Winnipeg, Canada, 2CancerCare Manitoba, Winnipeg, Canada, 3University of Jaffna, Jaffna, Sri Lanka, 4University of British Columbia, Vancouver, Canada, 5Two Worlds Cancer Collaboration, Vancouver, Canada Background and context: Sri Lanka’s (SL) Northern Province (NP) is one of 9 provinces with a population of approximately 1.1million where cancer is one of the leading causes of death. Cancer control efforts have been hampered in NP-SL due to limited resources and the devastation of 30 years of civil war. CancerCare Manitoba (CCMB) and its Research Institute, one of the oldest provincial cancer agencies in Canada, has been engaged in global cancer control efforts; one of these is a collaboration with NP-SL. Aim: In 2017, CCMB had the opportunity to initiate collaboration with NP-SL, along with other partners (Two Worlds), with the aim of improving cancer control for the population of NP-SL. Strategy / Tactics: Through this collaboration, the first step was the creation of a Northern Province Cancer Council with representation from national and provincial health authorities of SL, University of Jaffna, oncologists and community care providers of NP-SL, with CCMB CEO assigned as Strategic Advisor. The Council led stakeholder engagement and created a mutually-determined strategic plan in alignment with the National Cancer Control Program SL. Four priorities were identified: Cancer Registry and Surveillance, Screening and Early Detection, Development of a Multi-Disciplinary Approach to Care, and Palliative Care. Programme / Policy process and Outcomes: The strong support of NGOs [(International Medical Health Organization (IMHO), Jaffna Medical Faculty Overseas Alumni (JMFOA), and Cancer Aid for North East (CANE)] has helped to advance the priorities. With the expert advice of Two Worlds, there has been a significant advancement made in providing palliative care services to cancer patients both in the hospitals and in the communities by primary care providers. While the cancer registry was being built, a hospital-based study was also conducted which identified oral, esophageal, and breast cancers as the leading cancers in NP-SL. Cancer workshops led by the local oncologists to educate frontline staff and their subsequent engagement with the communities has begun and is progressing well. With the support of government and the engagement of partners, diagnostic clinics for breast and oral cancer have been established in 2 locations. With the support of the NGOs, a pilot project is being planned to screen for breast cancer by mammography which is not currently available in SL. Similarly, efforts for early detection of oral cancer are being approached through research collaboration. What was learnt: (if relevant, please also detail here the potential of replicability) A local environment ready with dedicated champions, committed partners and NGO support can bring significant advances in lower-resourced countries. Have you got a Conflict of Interest?: No
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1261 Socioeconomic and geographic inequalities of keratinocyte carcinomas in Tasmania, Australia B.S Ragaini1,2, L. Blizzard1, P. Baade3, A. Venn1 1 University of Tasmania, Menzies Institute for Medical Research, Hobart, Australia, 2Tasmanian Cancer Registry, Hobart, Australia, 3Cancer Council Queensland, Brisbane, Australia Background: Where people live can influence their risk of developing cancer [1]. Keratinocyte carcinomas (KCs) – namely basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin – are the most common cancers. While the latitude gradient for KCs is well-established [2], the influence of other geographic factors remains virtually unknown. Aim: To examine the cross-sectional and temporal associations between area-level socioeconomic status (SES), geographic remoteness, and the incidence of KCs in the southernmost Australian state of Tasmania, where incidence is high by international standards [3] using data from the only Australian population-based cancer registry to register KCs. Methods: KCs registered by the Tasmanian Cancer Registry were assigned to an area-level SES and remoteness area. Incidence rate ratios (IRRs) for 2014-2018 were estimated using Poisson regression. Average annual percentage changes (AAPC) in the age-standardised incidence rates between 2001-2018 were estimated using the Joinpoint Regression Program. Results: Incidence of BCC increased with increasing area-level socioeconomic advantage (p-value for trend <0.001). For SCC, incidence was higher in outer regional, remote or very remote areas than inner regional areas (IRR; males: 1.11, 95% CI: 1.04, 1.18; females: 1.25, 95% CI: 1.16, 1.35). Between 2001-2018, incidence increased over time across all areas. AAPCs were most pronounced for inner regional areas for BCC but least pronounced for inner regional areas for SCC, and more pronounced for areas of socioeconomic advantage for both. Conclusion: BCC was associated with area-level SES, while SCC was associated with geographic remoteness.Efforts to control KCs in Tasmania should consider targeting populations at the area-level. References: 1. Wilkinson, R., M. Marmot, and World Health Organization,Social determinants of health: the solid facts. Second edition ed. 2003, Copenhagen: World Health Organization. Regional Office for Europe. 2. Pandeya, N., C.M. Olsen, and D.C. Whiteman, The incidence and multiplicity rates of keratinocyte cancers in Australia. The Medical Journal of Australia, 2017.207(8): p. 339-343. 3. Ragaini, B.S., et al., Temporal trends in the incidence rates of keratinocyte carcinomas from 1978 to 2018 in Tasmania, Australia: a population-based study. Discover Oncology, 2021. 12(1): p. 1-11. Have you got a Conflict of Interest?: No
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1263 Results from the 2021 Global Oncology Survey of NCI-Designated Cancer Centers E.M Garton1, M.K Cira1, L. Eldridge1, T. Estes1, P.J. Loehrer1, M. He2, H. Ciolino2, K. Duncan1 1 National Cancer Institute, Center for Global Health, Rockville, United States, 2National Cancer Institute, Office of Cancer Centers, Rockville, United States Background: A key priority of the U.S. National Cancer Institute (NCI) Center for Global Health is to support the 71 NCIDesignated Cancer Centers (NDCCs) in their international activities. One important approach is to regularly survey NDCCs about their global oncology programs and research projects. The survey results complement data about global oncology research funded by the U.S. National Institutes of Health (NIH) and serve as a comprehensive view of global academic oncology research activities at NDCCs. The survey has been previously conducted in 2012, 2014, and 2018. Aims: The 2021 survey aimed to document NDCC’s global oncology activities, track trends in academic global oncology, facilitate partnerships between NDCCs and with international institutions, better understand NDCC’s definitions of global oncology, inform the development of NCI initiatives, and understand the impact of COVID-19 on global oncology research activities. Methods: The NCI and several partners designed and fielded three surveys from July 2021 through January 2022: a survey to NDCC Directors to understand their prioritization of global oncology; a survey to NDCCs to understand their programs and training opportunities; and a survey to principal investigators (PIs) to catalogue their non-NIHfunded global oncology projects. Surveys were fielded and submitted online. Preliminary analysis was conducted in Microsoft Excel, and further analyses will generate summary reports and data visualizations for distribution to NCI, NDCCs, and others in the global oncology field. Results: Sixty nine of 71 NDCC Directors and 67 of 71 global oncology leaders responded to the survey. 28 responding NDCCs (42%) reported having a formal global oncology program and 33 responding NDCCs (49%) reported faculty and/or trainees participating in global oncology activities, despite not having a formal global oncology program. Funding levels, collaboration structures, geographic priorities, and proportion of staff or trainees involved in global oncology varied across NDCCs. NDCCs engaged in over 440 non-NIH-funded global oncology projects with 425 collaborating institutions in 84 countries, including 57 low- and middle-income countries. Further data analysis and comparison to 2018 survey results will be presented. Conclusions: Initial analysis of the 2021 global oncology survey of NDCCs shows a decrease in funded research projects, but an increase in informal activities and trainee interest at NDCCs despite negative impacts of the COVID-19 pandemic on research progress and partnerships. The survey findings can facilitate knowledge sharing and collaboration for Cancer Centers and partners and inform the development of NCI initiatives. Have you got a Conflict of Interest?: No
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1271 STATISTICAL STUDY ON AFRICAN WOMEN WITH CANCER C.C. Nwagwu1 1 Norwegian University of Science and Technology, Energy and Process Engineering, Trondheim, Norway Background: The bane of poor healthcare systems and policies in the African continent is a cause for real concern, especially concerning life-threatening ailments like cancer. This is even more troubling when it is accompanied by a lack of quality research to support policymaking and external support. The author finds that no recent study exists that critically assesses cancer numbers in Africa from a statistical and quantitative perspective, particularly about issues like survivorship. Aim: This research aims to provide concrete insight into the dynamics of cancer prevalence and survivorship among African women between 2014 and 2018 as a way of providing a useful tool for policymaking for the continent. Methods: To meet the project’s objectives, data obtained from the World Health Organization's Global Health Observatory and the Cancer Atlas were cleaned to remove extraneous features and then merged into a single file for ease of computation and presentation. The final data has Mortality and Incidence as the response variables, and six predictor variables, including Alcohol prevalence, Smoking prevalence, Obesity prevalence, Breastfeeding, Outdoor Air Pollution, and Indoor Air Pollution. The predictor variables were carefully selected based on existing research showing some links between them and cancer incidence in other parts of the world. Exploratory data analysis was carried out to further understand the data. The study computes the Mortality-to-Incidence Ratio (MIR) for the 53 countries in Africa with available data. It goes further to make use of relevant Life Tables to obtain the 5-year Relative Survival rate for women in different age cohorts in each of the 53 countries. All analysis and computation are done using the Python programming language. Results: The results of the initial data analysis show that women in the top economies in Africa (like Nigeria, Egypt, and South Africa) have the highest cancer incidence and mortality. This result also corroborates the results from the correlation analysis showing that Obesity, Alcohol prevalence, and Outdoor Air Pollution are key influencers. However, from the MIR results, poorer countries like Guinea, Somalia, The Gambia, and South Sudan top the list. The relative survival at five years was found to be an average of 45% across all age groups within the continent, with some countries lying well outside the average value. Conclusion: Given the noticeable trend as seen in the results, the study can conclude that while cancer prevalence in Africa is linked to affluence, the chances of survival from it is very challenging, especially for the least developed economies. The study also notes that even the better economies have MIR values of up to 0.6, indicating the need for crucial intervention in the continent concerning awareness, medical equipment and care, research apparatus, and data collection methodology. Have you got a Conflict of Interest?: No
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1275 Analgesic Effects of rTMs in Patients With Advanced Non-SmallCell Lung Cancer Y. Tang1, Y. Li1 1 Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing, China Background and context: Although the WHO three-step ladder for cancer pain effectively relieve the symptoms of cancer patients to some extent, there were still 50% patients whose pain is undertreated. In the past two decades, neuromodulation technique has gradually become a new direction of pain treatment. Repetitive transcranial magnetic stimulation (rTMS) is one of the most commonly used non-invasive neuromodulation techniques in clinic. It has been reported that rTMS relieves various types of pain, such as neuropathic pain, migraine, fibromyalgia and chronic musculoskeletal pain. Until now, Food and Drug Administration (FDA) in the United States has officially approved the use of rTMS in the treatment of depression and migraine. However, less clinical study has been done on the application of rTMS in patients with cancer pain. Aim: The aim of this study was to explore whether repetitive transcranial magnetic stimulation (rTMS) could be an effective adjuvant therapy to reduce pain in patients with advanced non-small cell lung cancer (NSCLC). Strategy / Tactics: This was a randomized, sham–controlled study. A total of 41 advanced NSCLC patients with uncontrolled pain (score≥4 on pain intensity assessed with an 11-point numeric rating scale) were randomized to receive active (10 Hz, 2000 stimuli) (n = 20) or sham rTMS (n = 20) for 3 weeks. Programme / Policy process: This study was approved by the Ethics Committee of Chongqing Cancer Hospital and was registered (ChiCTR.org.cn identifier: ChiCTR 2000029130). Outcomes: Pain was the primary outcome and was assessed with the Numeric Rating Scale (NRS). Secondary outcomes were oral morphine equivalent (OME) daily dose, quality of life (WHO Quality of Life-BREF), and psychological distress (the Hospital Depression and Anxiety Scale). What was learnt: The pain intensity in both groups decreased gradually from day 3 and decreased to the lowest at the week 3, with a decrease rate of 41.09% in the rTMS group and 23.23% in the sham group. The NRS score of the rTMS group was significantly lower than that of the sham group on the week 2 (p < 0.001, Cohen’s d =1.135) and week 3(p=0.017, Cohen’s d = -0.822). The OME daily dose, physiology and psychology domainsof WHOQOLBREF scores, as well as the HAM-A and HAM-D scores all were significantly improved at week 3 in rTMS group. In conclusion, our results support the use of rTMS as a promising adjuvant therapeutic tool for cancer pain, with its dual beneficial effect in decreasing pain intensity and psychological distress in advanced NSCLC patients. If this effect can be confirmed in future larger sample studies, it will undoubtedly have a better clinical application prospect for patients with cancer pain. Have you got a Conflict of Interest?: No
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1277 Age at initial diagnosis and prognosis of breast cancer：A Nation-wide Multicenter Retrospective Study in China J.-H. Fan1, h. Yang1, J.-Y. Wang1, Y.-L. Qiao2, B.-h. Xu1 1 Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China, 2You-Lin Qiao, Beijing, China Background: As previous studies were lacking high-quality evidence from hospital-based clinical research, the treatment of ABC still has limitations. Aim: This study aimed to explore the associations between age at initial diagnosis with breast cancer (BC) and risk of recurrence or metastasis among Chinese women newly diagnosed with advanced breast cancer (ABC). Methods: Medical records of patients newly diagnosed with ABC were obtained from 21 hospitals of seven geographic regions in China from 2012-2014. Patients’ general information, clinicopathological features at first diagnosis, treatment information, and prognosis were retrospectively collected based on the self-designed case report form (CRF). Results: A total of 1852 cases were included in the final analysis. Age at initial diagnosis was shown to be significantly related to hormone receptor (HR) status, human growth factor receptor-2 (HER2) status, molecular subtypes, and the number of lymph node metastasis (All P<0.05). Patients aged＜35 years were more likely to have bone metastasis (45.6%). Patients aged≥65 years had a lower percentage of receiving surgery (87.1%), adjuvant chemotherapy (61.3%), adjuvant radiotherapy (35.5%), and adjuvant endocrine therapy(30.6%) than that of the other groups(All P<0.05).Compared with patients aged＜35 years, the risk of recurrence or metastasis in those aged 55-64 years was significantly higher (HRage 55-64=1.24, 95%CI: 1.04-1.47), while the risk of bone metastasis and lung metastasis in those aged 35-44 years was lower (HRbone metastasis=0.74, 95%CI: 0.59-0.93, HRlung metastasis=0.70, 95%CI: 0.53-0.93). After adjusting for stage, grade, and molecular subtype, surgery, neoadjuvant chemotherapy, adjuvant chemotherapy, adjuvant radiotherapy, adjuvant endocrine therapy, and family history of BC, aged 35-44 years could still significantly reduce the risk of bone metastasis and lung metastasis by 31% and 52%, respectively (HRbone metastasis=0.69, 95%CI: 0.48-0.98, HRlung metastasis=0.48, 95%CI: 0.31-0.74). Conclusion: Age at initial diagnosis is related to the clinicopathological characteristics and treatment pattern. Although the risk of site-specific metastasis varies by age, age is not an independent factor independent factors influencing the risk of total recurrence and metastasis. In accordance with current clinical practice guidelines for breast cancer, however, precised treatment shall be chosen personally for patients whose ages of initial diagnosis are different. Have you got a Conflict of Interest?: No
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1283 Access to liver cancer screening and surveillance in populations in China: an exploratory analysis J.-F. Shi1, M.-D. Cao1, X.-X. Yan1, W. Chen1 1 National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Office of Cancer Screening, Beijing, China Background: Access to health services includes availability and other sub-indicators. series of cancer screening handbooks by IARC lists availability as one of the important evaluation indicators. Liver cancer presents heavy burden in China and higher access to screening/surveillance is needed. However, evidence of extent of access/availability of liver screening/surveillance are still limited. Aim: To systematically quantify the access to screening/surveillance of liver cancer in China, especially subindicators of the availability. Methods: Following the specific indicators applied by IARC, information about the access/availability of liver cancer screening/surveillance in China’s population were collected; the content/indicators included local policies/guidelines, procedures most commonly recommended, population coverage and participation rate, compliance and related factors, treatment rate, acceptability, equity and others. Systematic review approach was used, combined with searching core literatures/monograph, government websites and available program reports. Results: A total of 34 journal articles were included and most of which were about the participation of secondary liver screening or surveillance compliance; additional information were mainly obtained from the other sources. Overall, there were clearly recommended screening and surveillance procedures for liver cancer in the three major cancer screening programs funded by the central government of China. It was estimated that 0.09% of the population aged 35-74 years were covered by liver cancer screening in 2019 in China. The overall participation rates of secondary screening ranged from 37.5% to 62.3% in three major programs, the median compliance rate of surveillance was reported as 26.9% (Q1-Q3:23.5%-41.0%) in the 6 included studies. Two studies reported the factors affecting the participation and compliance. A large-scale multicenter analysis showed that the subject acceptability to alpha fetoprotein test combined with ultrasound screening was as high as 99.3% in high-risk population in urban area. The treatment rate of liver cancer founded by screening, surveillance or follow-up was estimated to be ≥90% in rural population. No studies of equity were obtained via the systematic review. Conclusions: The major public health service screening programs in China all recommend specific procedures for liver screening in general population and surveillance for high-risk individuals. However, the overall availability needs to be improved, particularly in the indicator of population coverage. Participation rates of screening and compliance rates of surveillance varied among the included programs/studies, suggesting that the influencing factors need to be further identified. Relatively high subject acceptability suggests the potential demands for screening. More efforts are needed to address the access to screening/surveillance of liver cancer in populations in China. Have you got a Conflict of Interest?: No
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1285 Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer B.-J. Luo1, M.-C. Zheng1, X. Yang1, Y. Zhu1, J.-H. Peng1, L.-R. Li1, Z.-Z. Pan1, H.-Y. Qin1 1 Sun Yat-Sen University Cancer Center, Colorecatal Surgery Department, Guangzhou, China Background: Patients with mid-to low-rectal cancer can have various dysfunctions of defecation after sphinctersaving resection. Defecation dysfunction can manifest as incontinence, urgency, or frequent bowel movements, and is called low anterior resection syndrome (LARS). Several scoring systems have been created to measure LARS. Due to its regrouping, the LARS score is considered the most comprehensive assessment method, and it was validated as the LARS assessment by the Danish Colorectal Cancer Group in 2012. However, this and other scoring systems are based purely on patients'self-reported symptoms and do not consider the impact of surgery on anal and rectal physiological function. Several studies have assessed defecation function after rectal cancer surgery using objective metrics such as anorectal manometry (Ihnat ´ et al., 2018). Hou et al. (2015) examined the reliability and validity of the LARS score in Chinese patients with rectal cancer after translating it into Chinese. Currently, most studies investigating the current status of defecation function after the surgery for rectal cancer rely on questionnaires or interventional studies with small samples (Keane et al., 2017), while on the other hand, comprehensive examinations of defecation function combined with objective indicators of post-anal defecation kinetics are rarely documented. Aim: This study aimed to examine LARS score and objective anorectal function indices in Chinese patients receiving sphincter-saving surgery for mid-to low-rectal cancer. Methods: It was a single-center cross-sectional study of patients undergoing sphincter-saving resection for lowor mid-rectal cancer and had restoration of trans-anal defecation for at least 1 month seen between January 2019 and June 2020. Patients completed a questionnaire regarding clinical characteristics, and Low Anterior Resection Syndrome (LARS) score and high-resolution anorectal manometry (HR-ARM) were used to assess defecation function. Multivariable analysis was used to identify variables significantly associated with defecation dysfunction. Results: 146 patients completed and returned the questionnaires. 25 healthy adults also participated as control group for the anorectal manometry. Approximately 76% of patients developed LARS after surgery, of which 35.6% had major LARS. In these patients, anorectal manometry indices including initial rectal sensory capacity and rectal fecal sensory capacity, were significantly lower than normal. Logistic regression analysis showed that preoperative chemo-radiotherapy and the tumor inferior margins being close to the dentate line, especially 2–5 cm, were independent risk factors for defecation dysfunction after surgery. Conclusion: Defecation dysfunction is a frequent occurrence after sphincter-saving resection for mid- and lowrectal cancer. Preoperative chemo-radiotherapy and a shorter tumor inferior margins distance to the dentate line are independent factors for defecation dysfunction. Have you got a Conflict of Interest?: No
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1289 Risk of a subsequent keratinocyte carcinoma among people with a first diagnosis in Tasmania, Australia B.S Ragaini1,2, L. Blizzard1, A. Venn1 1 University of Tasmania, Menzies Institute for Medical Research, Hobart, Australia, 2Tasmanian Cancer Registry, Hobart, Australia Background: Keratinocyte carcinomas (KCs) – namely basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin – are the most common cancers in fair-skinned populations [1]. UV exposure is the largest contributor to skin cancer [2], but evidence suggests that a history of KC is a substantial risk factor for the development of further KCs [3]. In Australia, where the incidence of skin cancer is the highest in the world [1], population-based studies quantifying the risk of subsequent KCs are lacking. Aim: To describe the risk of a subsequent KC in people with a first KC episode (i.e., diagnoses within three months of an index diagnosis) in the island state of Tasmania using data from the only population-based cancer registry to register KCs in Australia. Methods: Tasmanians identified in the Tasmanian Cancer Registry with a first histologically confirmed basal cell carcinoma (BCC) and/or squamous cell carcinoma (SCC) between January 1985 and December 2013 were followed-up for five years for the development of a subsequent KC of any histological type. Cumulative risk, incidence rates and standardised incidence ratios (SIRs) were calculated according to the histological type(s) of the lesions diagnosed during the first episode. Results: Those diagnosed with a first episode of BCC only, SCC only, or both, had a 5-year cumulative risk of a subsequent KC of 32%, 29% and 51%, respectively. The annualised 5-year incidence rate was 8,100/100,000 person-years at risk (PYR) after a first BCC only, 7,747/100,000 PYR after a first SCC only, and 16,634/100,000 PYR after a first BCC and SCC. The SIR was 10.55 (95% CI: 10.49-10.62) after a first BCC only, 12.46 (95% CI: 12.3512.57) after a first SCC only, and 312.97 (95% CI: 305.20-321.10) after a first BCC and SCC. Conclusion: In Tasmania, around one in three persons diagnosed with a KC will experience a subsequent KC within 5 years. The findings can help with service planning, clinician education, and informing patients of their risk of a subsequent diagnosis. References: 1. Lomas, A., J. Leonardi‐Bee, and F. Bath‐Hextall, A systematic review of worldwide incidence of nonmelanoma skin cancer. British Journal of Dermatology, 2012.166(5): p. 1069-1080. 2. Olsen, C.M., et al., Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use. Australian and New Zealand Journal of Public Health, 2015.39(5): p. 471-476. 3. Flohil, S.C., et al., Risk of subsequent cutaneous malignancy in patients with prior keratinocyte carcinoma: a systematic review and meta-analysis. European Journal of Cancer, 2013. 49(10): p. 2365-2375. Have you got a Conflict of Interest?: No
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1290 Application of the Prostate Cancer Survivorship Essentials Framework in clinical practice: A mapping project. N. Heneka1, S.K Chambers2, T. Costello3, H. Crowe3, J. Crowe3, P. Dundee3, E. Stijnen3, J. Dunn4,5 1 University of Technology Sydney, NHMRC Centre for Research Excellence in Prostate Cancer Survivorship, Sydney, Australia, 2Australian Catholic University, Brisbane, Australia, 3Australian Prostate Centre, Melbourne, Australia, 4Prostate Cancer Foundation of Australia, Brisbane, Australia, 5University of Southern Queensland, Brisbane, Australia Background and context: Accessible prostate cancer survivorship care is a critical component of quality cancer care, however, prostate cancer survivorship care remains fragmented with best practice models of care, until recently, largely undefined. In 2020 the Prostate Cancer Survivorship Essentials Framework (‘Essentials Framework’) was developed by leading clinical, nursing, allied health and consumer groups in Australia and New Zealand, to guide the provision of integrated quality prostate cancer survivorship care in a variety of settings. The Essentials Framework defines six key domains of prostate cancer survivorship care [Fig 1] which can be applied in numerous policy and programme initiatives to align with differing clinical, community and patient scenarios. Aim: The aim of this project was to ‘map’ the current model of prostate cancer survivorship of a medical facility in metropolitan Australia (‘service’), which provides specialist prostate cancer treatment and care, to the Essentials Framework to determine alignment with the six framework domains and inform future quality improvement initiatives. Strategy/Tactics: A mixed-methods approach was employed to undertake the model of care mapping, comprising: a tailored patient data set to scope prostate cancer patients’ service engagement; online survey to determine patients’ health status and survivorship care experience at the service (2018-21) (n=61); and interviews with clinical and managerial service stakeholders to explore experiences of providing/facilitating prostate cancer survivorship care (Nov 2021-Jan 2022) (n=14). Programme/Policy process: Data integration was undertaken to connect the data from all sources. Inferences generated during data integration were thematically coded to align with the six domains of the Essentials Framework and further categorised into service strengths and areas for improvement. Outcomes: The mapping project identified a strong alignment of the service's current model of survivorship care with the Essentials Framework and generated recommendations across the six framework domains. Priorities for quality improvement initiatives have been identified with one project currently underway. What was learnt: Key strengths of the service's model of survivorship care included: co-location of 13 clinical survivorship care services; short patient waiting times from referral compared to the public sector; a multidisciplinary approach to patient-centred prostate cancer survivorship care which is highly valued by patients; a subsidised fee and billing model to facilitate access to evidence-based interventions; and a dedicated focus on continuity of care and clinical surveillance. Areas of improvement related primarily to streamlining existing clinical and administrative processes and integrating tools to support research in clinical practice. The mapping methodology for this project was effective with strong potential for replicability across multiple service types.
1
Have you got a Conflict of Interest?: No
2
1294 VITAMIN D INTAKE AND GASTRIC CANCER M. Nguyen1, N. Huynh1, N. Le1 1 School of Medicine, International University of Health and Welfare, Japan, Narita, Japan Background: Most recent laboratory studies have suggested a promising role of vitamin D and its analogs as novel chemotherapeutic agents for the treatment of cancer. However, epidemiological evidence, especially regarding the effects of vitamin D on gastric cancer is still inconsistent. Aim: Our research aimed to evaluate the associations between vitamin D intake and the risk of developing gastric cancer in the Vietnamese population. Methods: A case-control study consists of 1,182 incident gastric cancer cases and 2,995 controls selected from hospitals in Hanoi from 2003 to 2019. Vitamin D intake was computed by multiplying the food intake with nutrient content based on the Viet Nam Food Composition Tables updated in 2019. Data were collected through face-to-face interviews by trained interviewers using the validated semi-quantitative food frequency and demographic lifestyle questionnaires. The odds ratio and 95% confidence interval (OR and 95%CI) were estimated using unconditional logistic regression analysis. Results: We observed a continual decline in gastric cancer risk according to the level of Vitamin D intake in both genders, men, and women [Fifth vs. bottom quintile, OR, 95%CI: 0.68 (0.53, 0.86), OR, 95%CI: 0.72 (0.53, 0.97), OR, 95%CI: 0.58 (0.38, 0.89), respectively. Per increment quintile, the statistically significant decreased risk was seen by 7% in men and 13% in women. Conclusion: Our study suggested that sufficient vitamin D intake was associated with a lower risk of Gastric Cancer in the Vietnamese population. Have you got a Conflict of Interest?: No
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1295 Abnormal methylations promote progression within 24 months of Hepatitis B virus-related follicular lymphoma J. Ma1, W. Su2, H. Zhang3, Y. Deng4, L. Liu5,6, X. Wang3, Z. Zhang5, C. Liu5, Q. Zhang4,7, J. Yu1 1 Shandong University Cancer Center, Radiation Oncology, Jinan, China, 2the First Affiliated Hospital of Harbin Medical University, Hematology, Harbin, China, 3Tianjin Medical University Cancer Institute and Hospital, Lymphoma, Tianjin, China, 4Harbin Medical University Cancer Hospital, Medical Oncology, Harbin, China, 5The Fourth Hospital of Hebei Medical University, Hematology, Shijiazhuang, China, 6Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hematology, Shijiazhuang, China, 7Heilongjiang Cancer Institute, Medical Oncology, harbin, China Background: Hepatitis B virus (HBV) infection (surface antigen positive, HBsAg+) has been linked to the increased risk for B-cell lymphoma. The influence from the methylation of immune-related genes on early progression in HBV-associated follicular lymphoma (FL) are seldom elucidated. Aim: This study aimed to explore the influence of HBV infection on the progression in FL. The research was devoted to explore the methylation changes of immune-related genes owing to the HBV-infection, to elucidate certain issues related to early progression in HBV-associated FL. Methods:This study retrospectively investigated the clinical correlations of HBsAg-positive status. Methylation of immune-related genes in the tumor tissues was identified using Illumina DNAm EPIC Analysis. Results: Compared with patients who were HBsAg-, those with HBsAg+ FL exhibited a higher incidence of disease progression within 24 months (POD24) (30.3% vs. 22.3%). HBsAg+ FL with POD24 had longer period accompanying virus than those without POD24 (85.0% vs. 67.3%). Univariate analysis showed that patients who were HBsAg+ also had significantly shorter disease-free survival (DFS, P= 0.004) and poorer overall survival (OS, P= 0.039). In the POD24 subgroup, HBsAg-positivity had no prognostic impact on OS (P= 0.692). Methylation analysis showed that compared with HBsAg- FL with POD24, HBsAg+ FL with POD24 had more methylated gene regions, such as KMT2A,EP300-AS1,andARID1B, which implied a higher risk for the disease. The proportions of CD4+ T-cells, monocytes, neutrophils, and natural killer cells were higher, whereas those of CD8+ T-cells were less, which indicated impaired antitumor immunity. Hypermethylated immunerelated ITGAM significantly contributed to the progression of HBsAg+ FL negatively, whereas hypermethylatedLTA exerted a positive effect. Conclusion: HBsAg seropositivity is associated with the adverse clinical outcomes in FL. Methylation of the immune-related genes may contribute to the early progression of HBV-associated FL. Table 1. Univariable and multivariable Cox regression analysis with respect to disease-free survival of clinicopathological variables in patients with follicular lymphoma.
1
patients
Number Number Median 95%CI Actuarial Of Of DFS patients event n=276 n=90 1. Years
Univariate analysis HR(95% CI)
p
Multivariate analysis HR(95%CI) p
77.354- 58.3 99.876 54.817- 44.1 78.312
1
0.073
-
62.609- 48.6 85.428 64.791- 53.3 92.462
1
68.868- 53.4 92.661 46.134- 49.4 61,745
1
69.145- 52.8 91.005 42.729- 47.3 61.182
1
63.101- 52.9 90.785 61.348- 43.8 85.363
1
67.913- 55.0 87.258 39.316- 30.9 82.570
1
67.263- 51.4 87.637 50.187- 53.8 71.089
1
83.352- 62.7 109.710 46.897- 59.4 56.623 34.341- 36.5 60.561
1
-
1.435(0.789-2.611)
0.236
71.555- 50.4 91.477 55.242- 47.1 86.789
1
37.924- 41.8 80.796 71.479- 52.5 90.238
1
28.390- 40.0 94.877 70.479- 51.9 89.101
1
Disease -free survival(%) Age, years ≤60
165
43
88.6
>60
111
47
66.5
Sex male
132
43
74.0
female
144
47
78.6
Grade 1-2
163
50
80.7
3a
87
33
53.9
Ann Arbor stage I/II 49
22
80.1
III/IV
64
60.0
217
Number of extranodal sites ≥5 Absent 118 50 76.9 Present
154
40
73.4
B symptoms Absent 218
67
77.6
Present
52
20
60.9
BM involvement Absent 218
76
77.4
Present
55
13
60.6
FLIPI risks Low
62
19
96.5
Intermediate 98
28
51.8
High
116
43
42.5
LDH Normal
211
65
81.5
Elevated
65
25
71.0
Serum albumin <3.5 g/dL 21
9
59.4
≥3.5 g/dL
254
80
80.8
ALC <1000 /μL
10
5
61.6
≥1000 /μL
266
85
79.8
1.457(0.963-2.205)
-
0.529
0.876(0.578-1.325)
-
0.221
1.315(0.847-2.042)
0.347
0.141
-
0.054
1.628(0.986-2.687)
-
0.215
0.690(0.383-1.244)
-
1
-
2.000(1.066- 0.031 3.753) ＜0.001 10.315(6.430- ＜0.001 16.546) 0.242
1.317(0.829-2.092)
-
0.004
2.633(1.315-5.270)
2
-
0.732(0.483-1.110)
1.581(0.641-3.898)
-
0.793(0.488-1.288)
3.417(1.931-6.046)
-
1
0.002
3.433(1.589-7.419)
0.316
-
HBsAg positivity Absent 145
47
86.1
Present
131
POD24 Absent Present
1
43
62.3
75.307- 56.9 96.819 46.496- 40.9 78.013
193
34
1
62
52
100.1 90.334- 67.1 109.894 29.3 21.377- 11.9 37.210
1.850(1.209-2.833)
8.186(5.269-12.718)
0.004
1
0.052
1.576(0.996-2.494)
＜0.001 1
＜0.001
10.315(6.430-16.546)
Table 2. Univariable and multivariable Cox regression analysis with respect to overall survival in all baseline parameters among the Miller-Payne 4 TNBC subgroup. patients Number Number Median 95%CI Actuarial Univariate analysis Multivariate Of Of event OS 5-Years analysis patients n=42 overall HR(95% CI) p HR(95%CI) p n=276 survival(%) Age, years ≤60 165 15 115.6 106.832- 85.2 1 0.007 1 0.151 124.401 >60 111 27 90.1 79.504- 66.7 2.346(1.246-4.418) 1.740(0.817100.773 3.704) Sex male 132 22 97.0 86.822- 72.7 1 0.368 107.184 female 144 20 106.9 95.860- 79.4 0.758(0.413-1.389) 117.934 Grade 1-2 163 18 112.8 104.073- 83.7 1 0.016 1 0.082 121.655 3a 87 18 66.2 58.923- 69.4 2.234(1.145-4.358) 1.927(0.92073.387 4.037) Ann Arbor stage I/II 49 10 107.4 98.350- 79.6 1 0.888 116.390 III/IV 217 30 92.7 78.144- 77.2 0.950(0.463-1.950) 107.178 Number of extranodal sites ≥5 Absent 118 25 106.7 98.689- 78.3 1 0.275 114.829 Present 154 17 98.1 86.323- 73.8 0.709(0.382-1.319) 109.823 B symptoms Absent 218 28 101.9 94.082- 80.6 1 0.008 1 0.005 109.808 Present 52 13 89.3 69.333- 56.8 2.395(1.236-4.641) 3.161(1.418109.327 7.045) BM involvement Absent 218 35 105.3 96.788- 77.2 1 0.560 113.773 Present 55 6 95.3 84.495- 65.9 0.773(0.325-1.840) 106.042 FLIPI risks Low 62 6 121.6 113.092- 93.8 1 1 130.049 Intermediate 98 8 101.3 91.390- 78.8 2.040(0.665-6.260) 0.213 1.662(0.435- 0.457 111.318 6.347) High 116 28 51.4 43.466- 48.5 13.724(4.823-39.055) ＜0.001 8.683(2.340- 0.001 59.264 32.215) LDH Normal 211 27 106.5 97.159- 79.5 1 0.024 1 0.798 115.781 Elevated 65 15 94.7 81.685- 69.8 2.045(1.087-3.850) 1.110(0.498107.805 2.477) ALC
3
<1000 /μL
10
1
104.8
≥1000 /μL
266
41
105.9
HBsAg positivity Absent 145
21
110.7
Present
131
21
85.1
POD24 Absent
193
18
113.6
Present
62
20
82.1
96.695- 63.8 112.886 80.361- 77.6 131.473
1
102.000- 82.6 119.429 71.721- 68.1 98.408
1
104.509- 85.4 122.733 68.918- 60.3 95.206
1
0.508
0.518(0.071-3.766)
-
0.039
1.915(1.024-3.580)
-
1 1.451(0.6693.149)
＜0.001 1
3.026(1.599-5.727)
4
0.346
2.813(1.3715.773)
0.005
Figure 1. Kaplan-Meier Survival Curve
5
Figure 2. Differential Methylaton Positions
6
Figure 3. Copy Number Variation Have you got a Conflict of Interest?: No
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1300 Population-level economic burden of liver cancer in China 2019-2030: prevalence-based estimations M.-D. Cao1, C.-C. Liu1, H. Wang1,1, L. Lei2, Y.-J. Li1, J. Peng2, C. Qu3, E. Feletto4, J.-F. Shi1, W. Chen1 1 Office of Cancer Screening, National Cancer Center (NCC) / National Clinical Research Center for Cancer (NCRCC) / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China, 2Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, China, 3State Key Lab of Molecular Oncology and Department of Immunology / National Clinical Research Center for Cancer (NCRCC) / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China, 4The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia Background: Good quality benchmark data on population-level economic burden are critical in informing future policymakers in liver cancer control and related budget allocation; however, comprehensive data are currently limited in China. Aim: To quantify the current and estimate future population-level economic burden of liver cancer in China. Methods: A prevalence-based approach was used to quantify annual economic burden of liver cancer in China’s population, 2019-2030. Detailed per-case data on medical/non-medical expenditure and work-loss days were extracted from a China’s multicenter survey. Numbers/rates of new/prevalent cases and deaths, survival and population related parameters were extracted from Global Burden of Disease 2019 and literatures. All expenditure data were in 2019 Chinese Yuan (CNY). Results: The overall economic burden of liver cancer was estimated as CNY76.7 billion in China in 2019 (0.047% of local GDP). The estimated direct expenditure was CNY21.6 billion, including CNY19.7 billion for medical expenditure and CNY1.9 billion for non-medical expenditure. The estimated indirect cost was 55.1 billion CNY (71.8% of the overall burden), including CNY3.0 billion due to disability and CNY52.0 billion due to premature death. The total burden would increase to CNY84.2 billion, CNY141.7 billion, and CNY234.3 billion in 2020, 2025, and 2030, accounting for 0.102%, 0.138%, and 0.192% of China’s GDP, respectively. However, if China reached the goals of ‘Healthy China 2030’ or United Nation’s Sustainable Development Goals for non-communicable diseases, the burden in 2030 would then be <CNY144.4 billion. Conclusion: The population-level economic burden of liver cancer in China is currently substantial and would consistently increase in the future, sustainable efforts in primary and secondary interventions in liver cancer need to be further strengthened. Have you got a Conflict of Interest?: No
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1303 ICIs plus chemotherapy in patients with pulmonary sarcomatoid carcinoma: A multi-center, retrospective study F. Zhou1, C. Su1, C. Zhou1 1 Shanghai Pulmonary Hospital, Shanghai, China Background: Pulmonary sarcomatoid carcinoma (PSC) is a rare subset of non-small-cell lung cancer (NSCLC), characterized by poorly differentiated tumors with a component of sarcoma or sarcoma-like elements and highly aggressive biological behaviors. PSC has been reported to be associated with poor prognosis and low responsiveness to first-line chemotherapy. Therefore, developing novel therapeutic strategies to improve the poor prognosis of patients with this malignance is in high demand. Immune checkpoint inhibitors (ICIs) have demonstrated promising efficacy as monotherapy in patients with PSC. Aim: We performed the current multi-institutional, retrospective study to assess the efficacy of ICIs plus chemotherapy in patients with PSC.Methods: All consecutive patients with locally advanced or metastatic PSC from 3 centers treated with ICIs between January 2018 and July 2021 were enrolled. PD-L1 expression was stained and evaluated using immunohistochemical with 22C3. Single cell RNA sequencing (scRNA-seq) was performed in 2 patients with PSC and 2 patients with adenocarcinoma to understand the cell type-specific transcriptome landscape of cancer cells and tumor microenvironment (TME) of PSC. Results: A cohort of 42 PSC patients was identified. In the overall population, the objective response rate (ORR) was 73.8%, median progression-free survival (mPFS) was 10.3 months and median overall survival (mOS) was not reached and 2-year survival rate was 51.2%. For34 treatment-naïve patients who received first-line ICIs plus chemotherapy, the ORR was 70.6%, mPFS was 10.3 months and 2-year survival rate was 57.8%. In patients with PD-L1 TPS < 1%, 1-49%, and ≥ 50%, the ORRs were 33.3%, 72.7% and 85.7%. While, mPFS was 6.0 months, 6.7 months, and 10.3 months, respectively. Intriguingly, two patients with transformedPSC from lung adenocarcinoma after EGFR-TKI treatment also responded well toICIs plus chemotherapy. scRNA-seq revealed immune-cellinflamed TME, lower intratumoral heterogeneityandactivated immune response pathwayin PSC. Conclusion: Our study demonstrated remarkable efficacy of ICIs plus chemotherapy as first-line therapy for patient with locally advanced or metastatic PSC.
Have you got a Conflict of Interest?: No
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1306 Lycopene intake and stomach cancer N. Huynh1, N. Le1 1 School of Medicine, International University of Health and Welfare, Japan, Narita, Japan Background: Stomach cancer incidence and mortality is important public health worldwide to date. Objective: To examine the association between dietary intake of Lycopene and stomach cancer in Northern Viet Nam. Methods: A case-control study including 1,182 stomach cancer cases and 2,995 hospital controls were examined. A validated semi-quantitative food frequency and demographic lifestyle questionnaires were designed, and venous blood samples were collected to determineH. pyloristatus by IgG ELISA. Nutrient intake was converted using the data of SQFFQ and the Nutritive Composition Table of Vietnamese Foods, updated in 2019. The respective associations between Lycopene and stomach cancer were examined using unconditional logistic regression analysis with adjustments for possible cofactors. Results: Lycopene intake and stomach cancer showed a significantly inverse association, tertile-5 versus tertile-1, OR (95%CI): 0.62 (0.49, 0.77) for both gender, and OR (95%CI): 0.69 (0.53, 0.91) in men, OR (95%CI): 0.50 (0.34, 0.75) for women. Conclusions: Lycopene intake showed a strong protective effect against stomach cancer. The findings suggest that this fat-soluble micronutrient would be considered an anti-cancer therapy for both primary and secondary prevention of stomach cancer. Daily intake of organic natural fresh foods rich in lycopene, especially tomato is highly recommended. Have you got a Conflict of Interest?: No
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1309 RIPK3 orchestrates fatty acid metabolism in tumor-associated macrophages and hepatocarcinogenesis l. wu1, Y. Li1 1 Chongqing University Cancer Hospital, Department of Medical Oncology, Chongqing, China Background: Metabolic reprogramming is critical for the polarization and function of tumor associated macrophages (TAMs) and hepatocarcinogenesis, whereas the underlying mechanism remains elusive. Aim: This study aim to study the expression and function of RIPK3 in TAMs. Methods: The choline deficient amino acid defined (CDAA) diet hepatocellular carcinoma (HCC) models was established to investigate the role of RIPK3 during tumor progression. Ripk3−/− (KO) mice, Metabolic flux analysis and flow cytometry analysis were used to assess the role of Ripk3 on immunosuppressive activity and hepatocarcinogenesis . Results: Here we show that receptor-interacting protein kinase 3 (RIPK3), a central factor in necroptosis, is downregulated in hepatocellular carcinoma (HCC)-associated macrophages, which correlates with the promoted tumorigenesis, as well as the enhanced accumulation and M2 polarization of TAMs. Mechanistically, RIPK3 deficiency in TAMs reduces reactive oxygen species (ROS) and significantly inhibits and caspase1-mediated cleavage of peroxisome proliferator-activated receptors (PPARs) that enables PPAR activation and facilitates fatty acid metabolism including fatty acid oxidation (FAO), as well as induces M2 polarization in the tumor microenvironment (TME). RIPK3 upregulation or FAO blockade significantly reverses the immunosuppressive activity of TAMs and dampens HCC tumorigenesis. Conclusion: Our findings provide the molecular basis for RIPK3 regulating lipid metabolic reprogramming of TAMs and highlight a potential strategy for targeting the immunometabolism of HCC. Have you got a Conflict of Interest?: No
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1318 The Respiratory Health Care Workers in Fujian Province Could Provide Good Support for Smoking Cessation M. Liu1, P. Huang2, J. Zhuang1, Y. Liu1, S. Yang1, X. Xu1, Z. Chen1, X. Chen2,3, F. He1,2,4,5 1 Fujian Medical University, Department of Epidemiology and Health Statistics, School of Public Health, Fuzhou, China, 2The Second Affiliated Hospital of Fujian Medical University, Respirology Medicine Centre of Fujian Province, Department of Pulmonary and Critical Care Medicine, Quanzhou, China, 3Jinjiang Municipal Hospital, Department of Pulmonary and Critical Care Medicine, Quanzhou, China, 4Fujian Medical University, Fujian Provincial Key Laboratory of Tumor Microbiology, Fuzhou, China, 5Fujian Digital Tumor Data Research Center, Fuzhou, China Background: China is the world’s largest producer and consumer of tobacco products and is home to 341 million smokers (a quarter of the global total). According to2018 China Adult Tobacco Survey Report, the current smoking prevalence among the Chinese population aged 15 and above was 26.6%, with 50.5% among males and 2.1% among females, and was 25.3%, with that of male (48.9%) higher than that of female (0.9%) In Fujian province. To reduce the burden of disease caused by tobacco, China released the Healthy China 2030 strategy, specifying the targets of tabocco control, including reducing smoking rates to 20% by 2030. Hospitalization is an ideal time to provide smoking cessation intervention measures for smokers. Health care workers are counsellors and educators in tobacco control activities, playing an important role in tobacco control activities. Aim: To determine the smoking status and cognition of tobacco and smoking cessation knowledge among respiratory health care workers in Fujian province, and to explore their ability to provide smoking cessation assistance. Methods: In this cross-sectional study, 1028 respiratory health care workers from 89 hospitals at provincial, municipal and county levels in Fujian province were surveyed by a self-designed electronic questionnaire from March to April 2021. Their smoking status, cognition of smoking hazards and knowledge related to smoking cessation were collected and described. Results: Smokers were observed in 35 (3.4%) of the 1028 health care workers surveyed in Fujian province, all of whom were male. In terms of the cognition of cancer types caused by cigarettes, the awareness rate of lung cancer caused by smoking was the highest (99.4%), while the awareness rate of non-respiratory cancer caused by smoking was relatively low (< 60.0%). The awareness rate of all smoking cessation behavioral and pharmacotherapy support reached more than 90%. Conclusion: The respiratory health care workers in Fujian province are capable of providing good support for smoking cessation. More publicity should be given to smokers that they can seek help from hospitals when they want to quit smoking in Fujian province, so that health care workers can play a better role in tobacco control. Have you got a Conflict of Interest?: No
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1321 New training mode in swallowing rehabilitation training of patients after laryngectomy under Network Era N. Li1 1 Beijing Tongren Hospital, Capital Medical University, Beijing, China Background: At present, active surgical treatment is still advocated for supraglottic laryngeal cancer. Patients have swallowing dysfunction in the early stage due to tumor occupation and invasion of swallowing muscles and swallowing related nerves. The incidence of long-term dysphagia remained high due to the removal of relevant throat tissue and the change of swallowing structure, which seriously affected the quality of life of patients. With the improvement of patients' pursuit of quality of life, clinicians' focus has gradually transitioning from complete removal of lesions to the preservation of laryngeal function on this basis. In the field of ERAS (enhanced recovery after surgery), early rehabilitation training is helpful to the recovery of swallowing function after laryngectomy. With COVID-19 sweeping the globe, many patients lose the conditions to visit the hospital frequently, which leads them losing the opportunity of treatment on time. Aim: To explore the effect of Tele-rehabilitation training mode on swallowing function rehabilitation training of patients after supraglottic partial laryngectomy under the background of network era. Methods: The patients with supraglottic laryngeal cancer treated in Beijing Tongren Hospital Affiliated to Capital Medical University from January 2020 to December 2021 were collected and divided into endoscopic laser operation group and open operation group according to the operation scheme. The patients received remote video connection swallowing guidance or video assisted text function guidance. Combined with the M.D. Anderson Dysphasia Inventory and the Kubota drinking test, the swallowing function of the patients was evaluated at 1, 2 and 4 weeks after surgery. The rehabilitation of swallowing function was compared. Results: Postoperative patients with supraglottic laryngeal cancer often fear the recovery of oral feeding due to structural changes, resulting in related dysfunction. Through remote functional guidance, the current swallowing ability of patients can be fully evaluated, a guiding training program can be given, the current demands of patients can be understood, the anxiety of patients can be relieved, and finally a satisfactory rehabilitation effect can be achieved. Conclusion: For patients with supraglottic laryngeal cancer undergoing partial laryngectomy, early postoperative swallowing function rehabilitation training and remote guidance are helpful to obtain satisfactory swallowing function. Have you got a Conflict of Interest?: No
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1329 Coordinated state-wide cancer response during the COVID-19 pandemic G. McArthur1,2, S.-A. McLachlan3, Z.W. Wong4, A. Haydon5, P. Parente6, S. Evans7, L. Te Marvelde7, K. Whitfield8, S. Athan1, J. Williams9, A. Weir1, D. Spence10, A. Kilgour11, M. Barrett1 1 Victorian Comprehensive Cancer Centre Alliance (VCCC Alliance), Melbourne, Australia, 2Peter MacCallum Cancer Centre, Melbourne, Australia, 3St Vincent's Hospital Melbourne, Melbourne, Australia, 4Peninsula Health, Frankston, Australia, 5Alfred Health, Melbourne, Australia, 6Eastern Health, Box Hill, Australia, 7Cancer Council Victoria, Victorian Cancer Registry, Melbourne, Australia, 8Victorian Government, Department of Health, Melbourne, Australia, 9Monash Health, Consumer advocate, Clayton, Australia, 10Cancer Council Victoria, Melbourne, Australia, 11Monash Partners Comprehensive Cancer Consortium, Clayton, Australia The Victorian COVID-19 Cancer Network (VCCN) was established in March 2020 as a coordinated, real-time response to the challenges of managing cancer care in Victoria, Australia, amid the global pandemic. The VCCN is led by the Victorian Comprehensive Cancer Centre Alliance and Monash Partners Comprehensive Cancer Consortium, in collaboration with Victorian Integrated Cancer Services, Cancer Council Victoria and Victorian Cancer Registry (VCR) with support from the Victorian Government. Aims The VCCN aims to: 1) Empower health professionals, services and policy makers to deliver optimal care; 2) Support the cancer workforce; 3) provide patients and carers with a platform to ensure a holistic approach to managing cancer care, during the pandemic. Strategy Multi-faceted, coordinated response including:
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Taskforce to prioritise and drive the activities– 22 members representingmedical/tumour specialties, cancer service directors (regional & metro), nursing, allied health, primary care, ethics, consumers,not-forprofits, epidemiologists, data scientistsand government Expert specialist clinical working groups - respond rapidly to trending health service issues Current data on cancer pathology– monitor diagnoses of cancer Patient information group – two-way informing of priorities and approaches Secure online communications platform - enable sharing of information and peer support Expert led webinar series –share knowledge and support discussion Representation on Victorian governmentbodies– provide cancer-specific policy advice Regular communication to public and workforce– provide information on key issues re cancer in the pandemic
Outcomes
• • • • •
800 multidisciplinary members subscribed from 150 organisations Contemporaneous consideration of the impact of COVID-19 on cancer pathology notifications and delayed diagnoses (VCR data) Targeted public health campaigns promoting safe cancer care, ongoing health checks and vaccination recommendations Shared clinical service strategies to inform rapidly changing situations (eg. staff shortages, vaccinations, PPE) Strategies for workforce wellbeing including peer support and ethical frameworks for managing moral distress
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Research addressing barriers to clinical trials, telehealth consultations and clinical ethics resulting in peer reviewed publications Consistent public messaging re COVID-19 and cancer Advocacy and consultation with government/s and hospital leadership on key issues such as workforce impacts, hospital visitation and priority for vaccinations, providing a timely and credible source of information to decision makers Planning for anticipated post-pandemic surge in cancer diagnoses
Learnings A coordinated, state-wide response, critically connected to government and patient groups can effectively support and enable better care, consistent messaging and enhanced workforce wellbeing during a crisis. The VCCN model could be adapted for other jurisdictions and used to inform future pandemic planning. Have you got a Conflict of Interest?: No
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1331 Preoperative combining ultrasonic-cytopathology-BRAFV600E mutation test of thyroid nodules C. Cui1,2, X. Liu1,2, D. Yuan1,2, X. Wang1,2, B. Zhu1,2, R. Liu1,2, H. Sun1,2 1 Division of Thyroid Surgery, China–Japan Union Hospital of Jilin University, Changchun, China, 2Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China Background: The risk stratification assessment and precision management of thyroid cancer (TC) have always been the major problems for thyroid surgeons and will be the main research directions in the future.At present, there is still controversy regarding the application value of ultrasound (US), FNA and BRAFV600E mutation test in preoperative diagnosis of TC. Aim: To separate and combined investigate the application value of US, FNA, BRAFV600E mutation test in the diagnosis of TC.To explore the independent predictors of capsule invasion and lymphatic metastasis of TC. Methods: We retrospectively analyzed the clinical data of 332 thyroid nodules in 274 patients accepted surgery from February 2019 to December 2021. All nodules were underwent preoperative US, FNA and BRAF V600E mutation test. The Receiver Operating Characteristic (ROC) curves were used to evaluate the diagnostic value according to postoperative pathology. Univariate and multivariate regression analysis were performed to investigate the relationship between the clinical features of TC and capsule invasion and lymph node metastasis. Results: The sensitivity, specificity and area under the ROC curve of thyroid nodule diagnosed by different diagnostic modes were as follows:BRAFV600E mutation test: 72.1%, 84.6% and 0.784; FNA:93.4%, 76.9% and 0.852; US: 99.1%, 7.7% and 0.534; FNA or BRAFV600E mutation test: 96.9%, 76.9% and 0.869; FNA and BRAFV600E mutation test:68.7%, 84.6% and 0.766; Univariate and multivariate analysis showed that: tumor diameter d>1cm and BRAFV600E mutation were independent predictors for high prevalence of capsule invasion of TC(P<0.05); tumor diameter d>1cm, capsule invasion, BRAFV600E mutation, calcification were independent predictors for high prevalence of lymphatic metastasis of TC(P<0.05). Conclusion: The combination of FNA and BRAFV600E mutation test is more diagnostic effective than separate detection. If cytologically benign and BRAFV600Ewild type, active surveillance will be recommended; if double positive, will go to surgery. The risk of capsule invasion is increased with tumordiameter d>1cm and BRAFV600E mutation, and the possibility of capsule invasion should be preoperative considered. The risk of lymphatic metastasis is increased with BRAFV600E mutation, tumor diameter d>1cm, capsule invasion and calcification, and prophylactic neck dissections should be underwent. Have you got a Conflict of Interest?: No
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1332 The Prognostic Value of PIK3CA Mutations in Neoadjuvant Anti-HER2 Therapy of Breast Cancer: A MetaAnalysis Z. Zou1, X. Yu1, F. Jin1 1 The First Affiliated Hospital of China Medical University, Department of Breast Surgery, Shenyang, China Background: The activation of downstream pathways such as PIK3CA mutation plays an important role in antiHER2 resistance. However, researchers have failed to conclude the predictive value of PIK3CA mutation in HER2positive breast cancer. Moreover, the update in anti-HER2 regimens and the lack of a recent large meta-analysis evaluating the association between PIK3CA mutations and the efficacy of anti-HER2 therapy led us to conduct more extensive research. Aim: To assess the value of PIK3CA as a prognostic biomarker in anti-HER2 neoadjuvant therapy, we performed a meta-analysis of published studies that examined the correlation between PIK3CA mutations and the pathologic complete response (pCR) rate. We also estimated the role of PIK3CA mutations in patients treated with different anti-HER2 regimens to address the heterogeneity among therapeutic agents and to investigate the underlying mechanism of anti-HER2 resistance. Methods: We searched PubMed, Web of Science, and Cochrane online databases for trials that compared PIK3CA wild-type and mutated patients who were treated with neoadjuvant anti-HER2 therapy, which included pCR as the primary outcome. Statistical analysis results were reported as risk ratios (RR), its 95% confidence intervals (CI), and the two-tailed P values, with the PIK3CA mutated (MT) group designated as experimental and the wild-type (WT) group as control. Results: Fourteen studies were finally pooled into analysis, with a total of 1921 patients included. In the general population treated with anti-HER2 neoadjuvant therapy, PIK3CA mutations were associated with a significantly decreased pCR rate (RR=0.68; 95% CI:0.58-0.80; P<0.00001). Besides, PIK3CA MT were associated with lower pCR rate in patients treated with trastuzumab monotherapy (RR=0.71; 95% CI: 0.54-0.94; P=0.02) or trastuzumab plus pertuzumab (RR=0.72; 95% CI: 0.53-0.99; P=0.04). However, the MT and WT group demonstrated no significant difference in pCR rate in patients who received trastuzumab plus lapatinib (RR=0.67; 95%CI: 0.34-1.32; P=0.25) or lapatinib monotherapy (RR=0.82; 95% CI:0.43-1.54; P=0.53). Conclusion: PIK3CA mutations significantly reduced the benefit of neoadjuvant anti-HER2 therapy, with a more pronounced impact on trastuzumab-containing regimens.
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Have you got a Conflict of Interest?: No
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1339 Defining the social return on investment of telephone cancer information & support services: Theory of Change N. McCaffrey1,2, J. Bucholc1,2, D. Spence2, C. Hutchinson3 1Deakin University, Deakin Health Economics, Geelong, Australia, 2Cancer Council Victoria, Melbourne, Australia, 3Flinders University, Nursing and Health Sciences, Adelaide, Australia
Background: Non-government organisations around the world, including cancer charities such as Cancer Council Victoria, provide Cancer Information and telephone Support Services (CISS) to address unmet information and psychological support needs of people living with cancer. These services provide reliable, evidenced-based, individualised, emotional, informational and practical support to people affected by cancer and the broader community. Currently, there is no international evidence on the social return on investment (SROI) of CISS to inform the future funding, direction and delivery of these services. Developing the Theory of Change (TOC) is the first, critical stage in SROI and clarifies assumptions, explicitly identifies the resources needed to provide CISS, activities and outcomes, and describes how the service brings about change and creates social value for the wider community. Aim: The aim of this study is to develop a Theory of Change (TOC) to underpin the SROI analysis of Cancer Council Victoria’s CISS (‘131120’) Methods: The TOC is being developed in three phases. First, convenience sampled, key stakeholders (n=7) participated in a facilitated, online group discussion to identify the inputs into 131120, activities and outcomes, and describe how the service brings about change. The initial TOC was circulated to a broader range of stakeholders for feedback (researchers n=8, community representative n=1, service providers n=2). Second, the TOC will be presented to a second group of invited stakeholders (n=15) across three online focus groups, discussions will be qualitatively analysed and the TOC will be further refined. Finally, the TOC will be circulated to all participants for member checking to enhance trustworthiness. Results: The initial TOC hypothesizes that contacting CISS enhances the callers’ (general public, people living with cancer, informal carers, healthcare professionals) knowledge on how to prevent, detect, diagnose, treat, survive and live with cancer and provides support on how best to do this. Increased knowledge, greater empowerment, and reduced unmet need promotes healthy behaviours and leads to improved health and wellbeing and more targeted and appropriate use of healthcare services. Conclusion: Thus far, the TOC suggests data on knowledge and empowerment levels, unmet needs, wellbeing and healthcare resource utilisation are needed to inform a rigorous SROI of 131120. Validation of the TOC with a broader range of stakeholders will further increase rigour of the findings. This is the first stage in a multi-study program of research defining the economic and social return on investment of CISS for all Australians. Have you got a Conflict of Interest? No
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1341 Tumor Immune Infiltration Phenotype Predicts the Efficacy of Neoadjuvant Therapy in HER2+ Breast Cancer Y. Wang1, Y. Xu1 1 The First Affiliated Hospital of China Medical University, Department of Breast Surgery, Shenyang, China Background: Patients with human epidermal growth factor receptor 2 positive breast cancer (HER2+ BC) have poor prognosis, and neoadjuvant therapy (NAT) is the preferred approach to this kind of patients nowadays. Not only can NAT optimize surgical options, but also obtain therapeutic and prognostic information, and develop adjuvant therapy strategies based on residual disease. The tumor immune microenvironment, such as tumor infiltrating lymphocytes (TILs) is known to impact the efficacy of NAT in HER2+ BC. But the correlation between immune infiltration or its subpopulations and NAT response in HER2+ BC remains largely unknown, and the efficient immune-related biomarkers are still lack. Methods: Four gene expression datasets from the Gene Expression Omnibus, including 295 samples, were integrated to identify significant biomarkers by bioinformatic analyses including single sample gene set enrichment analysis, weighted gene co-expression network analysis, and spline regression. Individual clinical samples were used as external validations to examine the predictive value and subtype-specificity of the selected indicators via Reverse Transcription-quantitative Real Time PCR (RT-qPCR). Results: Immune infiltration status was divided into “immune-rich” and “immune-poor” phenotypes, which were significantly related to pathological complete response (pCR) (p=0.02). We filtered 80 differentially expressed genes according to immune phenotype and obtained two gene modules correlated with both pCR and immune phenotype. CCL5,CD72,PTGDS,CYTIP,PAX5, and estrogen receptor status were significantly related to pCR via linear multivariate analysis. In spline regression, non-linear aspects of MAP7,IL2RB,CD3G,PTPRC,TRAC were identified to be relevant to pCR. Similar expression trends were observed in clinical samples based on RT-qPCR results. Innovatively, we constructed a signature combining linear and non-linear effects of genes and validated its predictive efficacy using an internal validation set with a 5-fold cross validation framework (AUC=0.81), an external validation cohort (AUC=0.797), and a clinical set (accuracy=0.75). Conclusion: In HER2+ BC, the “immune-rich” phenotype led to better therapeutic outcomes for NAT, thus immune infiltration status should be considered for designing optimal and precise therapy regimens. The generalized non-linear signature could predict the efficacy of NAT. Have you got a Conflict of Interest?: No
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1343 Water-soluble vitamin B1, B2, B6 intake and risk of gastric cancer H. Dang1, N. Le1 1 School of Medicine, International University of Health and Welfare, Japan, Narita, Japan Background: The association between vitamin intake and gastric cancer has been widely investigated. Low doses of vitamins, especially antioxidant vitamins such as vitamin C and vitamin E have been shown to decrease the risk of gastric cancer. However, previous studies about the association between vitamin B intake and gastric cancer risk have been inconsistent. Methods: We investigated the association between vitamin B and gastric cancer using data from a case-control study, including 1182 cases of histologically confirmed gastric cancer and 2995 controls. Energy-adjusted dietary intake of B vitamins (B1, B2, B6) was estimated from a food frequency questionnaire using residual methods. In statistical models, the lowest quintile of intake was used as the reference group. Odds ratios and 95% confidence intervals OR (95%CI) were estimated using conditional logistic regression after adjusting for Helicobacter pylori infection and other potential confounding factors. Results: Higher vitamin B1 intake was significantly associated with decreased gastric cancer risk in both men and women combined with adjusted OR (95%CI): 0.64 (0.51-0.79), 0.54 (0.43-0.69), 0.57 (0.44-0.74), 0.42 (0.31-0.55), respectively, for the quintiles, 2 to 5 intake groups compared with the lowest quintile (P for trend = 0.000). The same association was observed in men and women separately. Higher intake of vitamin B6 intake was an inverse association with the risk of gastric cancer too, 5th verse 1st quintiles, with an adjusted OR (95%CI): 0.46 (0.33-0.63), (P for trend = 0.000). Vitamin B2 intake has decreased the risk of cancer, 5th verse 1st quintiles, with an adjusted OR (95%CI): 0.85 (0.65-1.11), (P for trend = 0.318) but not statistically significant. Conclusions: These results suggest that vitamin B1 and B6 intake contributed from fresh natural foods may reduce the risk of gastric cancer. Daily consumption of foods rich in these vitamins is strongly needed to prevent gastric cancer. Have you got a Conflict of Interest?: No
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1345 An Immune Model to Reflect Efficacy of Neoadjuvant Therapy in Breast Cancer: Based on Machine Learning Y. Wang1, Y. Xu1 1 The First Affiliated Hospital of China Medical University, Department of Breast Surgery, Shenyang, China Background: Triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2 positive (HER2+) breast cancer usually leads to a lack of effective therapeutic strategies and poor prognosis. As an essential treatment for especially TNBC and HER+ breast cancer, neoadjuvant therapy has been widely implemented to improve the patients' clinical outcome. Additionally, the role of immune system playing in the pathological progression and chemotherapy is still unclear. The study aimed to explore the relation between dynamic changes of immune components in peripheral blood and therapeutic response during the neoadjuvant therapy period. Methods: The study collected peripheral immune indexes data before and after neoadjuvant therapy of 101 patients. Synthetic Minority Oversampling Technique was utilized to improve the balance of the dataset, and logistic regression and machine learning algorithms were applied in the feature selection and model construction process. Results: CD16 + CD56 +NK cell percent or absolute value before and after neoadjuvant therapy or the ratio of CD16 + CD56 +NK cell percent after and before NAT were significantly related to the therapeutic efficacy. Based on the results of logistic regression, totally fourteen independent predictors were selected to construct the machine learning model and random forest model presented excellent predictive power. Conclusion: Statistic significant relations between several specific immune indexes and the efficacy of neoadjuvant therapy were revealed. Dynamic changes of peripheral immune indexes, especially NK cells, deserve more concentrated attention. Have you got a Conflict of Interest?: No
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1349 Feasibility of passive follow-up method in retrieving vital status of cancer patients in Dalian, China R. Fu1, D. Mei2, X. Wang2, L. An1, S. Zhang1, R. Zheng1, L. Li1, S. Wang1, R. Chen1, K. Sun1, X. Ran1, T. Shan1, N. Kang3, H. Lin3, H. Mu4, W. Wei1, H. Zeng1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2Dalian Center for Disease Control and Prevention, Liaoning, China, 3College of Public Health, Zhengzhou University, Department of Epidemiology and Biostatistics, Henan, China, 4Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China Background China has established the Vital Statistic System and the Civil Registration System nationally. These can be of great value to obtain the vital status of cancer patients. Aim We aimed to determine the sensitivity and specificity of the passive follow-up method in a population-based follow-up study in an urban area of China. Methods We used population-based data from the Dalian cancer registry, China. We included newly diagnosed cancer patients in 2015 and followed them until June 2021. We conducted a passive follow-up by linking cancer patients to the Dalian Vital Statistic System and the Dalian Civil Registry System. We further actively followed those cancer patients using telephone calls. We determined the vital status of cancer patients through active and passive follow-up, named mixed follow-up as a golden standard. We calculated the sensitivity and specificity of passive follow-up. We further estimated 5-year observed survival overall, and by cancer site using life table method. Results This study finally included 11 918 eligible cancer patients. We obtained 6033 deceased cancer cases and 5885 alive cancer cases through mixed follow-up. The passive follow-up identified 6021 deceased cases, with a sensitivity of 99.8% and specificity of 100%. The 5-year observed survival was 50.7% by using mixed follow-up method and 50.8% by using passive follow-up method. The absolute change in observed survival between the two methods in each cancer site ranged from 0 to 0.3%. Conclusion Our study indicated that the passive follow-up method enabled estimation of reliable cancer survival in Dalian, China. Passive follow-up by linking the cancer data with the Vital Statistic System and Civil Registration System in China have the potential to transform cancer survival studies in urban area of China through high-quality followup data. Have you got a Conflict of Interest?: No
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135 Preliminary study on the influencing factors of osteoporosis in prostate cancer patients R. Liu1,2, S. Wu1,2 1 The Second Hospital of Tianjin Medical University, Department of Urology, Tianjin, China, 2Tianjin Institute of Urology, Tianjin, China Background: Prostate cancer (PCa) is a malignant tumor with a high incidence. Osteoporosis may occur in patients with PCa, especially those who have received androgen deprivation therapy(ADT). If osteoporosis occurs, the quality of life of PCa patients will be reduced or even death due to skeletal related event (SRE). Therefore, the prevention and treatment of osteoporosis in PCa patients is particularly important, but the factors that cause osteoporosis in PCa patients are still unclear. Aim: Our research is to find the risk factors for osteoporosis in PCa patients and seek a reliable treatment regimen. Methods: We conducted a retrospective study of the patient population admitted to the Second Hospital of Tianjin Medical University from April 2020 to November 2021. We first compared the incidence of osteoporosis between PCa and non-PCa patients.Then, we further compared the clinical features between osteoporosis and non-osteoporosis group in PCa patients to find the risk factors of osteoporosis. Finally, the ability of zoledronic acid treatment to improve bone mass in patients undergoing ADT was evaluated. All data were analyzed by SPSS 25.0 software, categorical variables were analyzed by chi-square test; continuous variables or rank variables are analyzed using the Mann-Whitney nonparametric test. Finally, variables with statistical differences were included in logistic regression analysis, and the P value < 0.05 was considered statistically significant. Results: We collected data from a total of 240 patients, including 140 PCa patients and 100 non-PCa patients. There were 51 cases (36.4%) of osteoporosis in the PCa group and 31 cases (31%) in the non-PCa group, with no significant difference (p=0.41). Further subgroup analysis was performed within the PCa group, and the multivariate logistic regression results showed that the lower the body mass index (BMI) level, the higher the risk of osteoporosis (odds ratio, OR: 0.845, 95% confidence interval, CI 0.742-0.961, p < 0.001); similarly, patients with ADT ≥ 6 months had a greater risk of osteoporosis (OR 6.972, 95%CI 2.41-20.171, p < 0.001). Finally, we analyzed 13 patients who completed 6 zoledronic acid and 6 months of ADT. The results confirmed that after half a year of zoledronic acid treatment, the lumbar spine [0.988(0.949-1.234) vs 1.078(0.992-1.339), p=0.004], the femoral neck [0.755(0.657-0.87) vs 0.766 ( 0.669-0.872), p=0.008] and hip [0.960 (0.863-1.115) vs 0.967 (0.870-1.14), p=0.03] bone mineral density values were significantly increased. Conclusion: This study found that there was no significant difference in the incidence of osteoporosis between PCa patients and non-PCa patients. Among them, in the PCa patient population, the risk of osteoporosis was significantly increased when the patients had lower BMI or prolonged ADT. Adding zoledronic acid to long-term ADT-treated PCa patients significantly improved bone mass. Have you got a Conflict of Interest?: No
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1353 Impact of COVID-19 for cancer screening and cancer treatment in Japan H. Takahashi1 1 National Cancer Cener Japan, Institute for Cancer Control, Tokyo, Japan The COVID-19 pandemic has had a major impact on cancer screening and medical care in many countries. In Japan, with regard to cancer screening, less urgent medical services have been refrained from due to notifications from the Ministry of Health, Labor and Welfare and related medical societies. As a result, the number of cancer screenings, cancer patients, and less urgent surgery decreased in 2020. The number of cancer screenings decreased significantly in April-May 2020, after that recovered and decreased by about 20% in the annual comparison. The number of cancer patients decreased significantly in cancer screening-related cancers and areas where the infection spread. Surgery was significantly reduced in cancer screening-related cancers, asymptomatic elective surgery, and areas of widespread infection. These tendencies improved in 2021, but there are concerns about an increase in the number of cancer patients and death from cancer in the near future. Behavioral restrictions, such as a state of emergency, reduce the chances of early diagnosis, so it is desirable to minimize them in consideration of the infection situation. Have you got a Conflict of Interest?: No
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1357 Pain management of newly diagnosed sarcoma patients at a single center P. Yang1, Y. Su1, W. Zhao1, C. Duan1, Y. Li2, Y. Zhou1, L. Wang3, S. Cai4, X. Zhou5, X. Ni6, X. Ma1 1 Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Medical Oncology Department, Pediatric Oncology Center, Beijing, China, 2Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Department of Pharmacy, Beijing, China, 3Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Nursing Department, Beijing, China, 4Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Center for Clinical Epidemiology and Evidence-based Medicine, Beijing, China, 5Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Stem cell Transplantation Department, Beijing, China, 6Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Pediatric Oncology Center, Beijing, China Background: Systematic pain management of children is not enoughin China, and there is no summary of pain in children with sarcoma. Aim: To summarize the occurrence and characteristics of pain in newly diagnosed sarcoma patients in a single center, and analyze the necessity, effectiveness and safety of analgesics. Methods: Clinical data of 188 patients with newly diagnosed sarcoma admitted to the Medical Oncology Department of Beijing Children's Hospital was collected from October 2018 to December 2020. Children experiencing pain received analgesic treatment and regular assessment. Results: Thirty-seven patients (19.7%) suffered from pain. Six cases (16.2%) had mild pain, 17 (46.0%) moderate, and 14 (37.8%) severe. Daily lives of 31 patients were affected by pain. Twenty-six cases had bone invasion. The analgesic rate was 54.1% before admission and 89.2% after admission. Nine cases were treated with oral morphine regularly, and their pain was relieved before chemotherapy; the dose of morphine was 0.14±0.034mg/kgQ4H when the target was reached. No serious adverse reactions were observed. The period of morphine application after chemotherapy was 5–9 days, and there was no withdrawal reaction. Conclusion: Pain in children with newly diagnosed sarcoma was mainly moderate to severe, and the incidence of pain in sarcoma with bone invasion was higher, with greater intensity. Patients who received standardized pain assessment and regular analgesics reached pain relief quickly, and no serious adverse reactions were observed within the recommended dosage. Have you got a Conflict of Interest?: No
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1360 Impact Evaluation of Cachexia in aggressive cancer of B-cell D. Njenga1, T. Vik2, G. Olbara3, F. Njuguna3, P. Mbengei1 1 Ampath, Hemato-Oncology, Eldoret, Kenya, 2Riley Hospital for Children, Riley Pediatric Cancer & blood diseases, Indianapolis, United States, 3Moi Teaching and Referral Hospital, Hemato-Oncology, Eldoret, Kenya Background: Burkitt lymphoma is an aggressive cancer of B-cell with high mortality in low-income countries with poor prognosis. Aim: We aim to evaluate the implication of BMI-for-age and weight loss on treatment outcome as a prognostic factor in the survival of patients with aggressive lymphoma in Ampath Kenya. Methods: Retrospective review to examine the impact of weight loss severity using BMI on treatment outcomes in patients diagnosed with and treated for aggressive NHL in children between 2018 to 2021 (n=63). Patient characteristics including weight, height, and BMI-for-age was given as centile (percentile) were collected at the time of diagnosis. The severity of weight loss was graded using BMI which was used to cluster patients into underweight (47.62%, n=30), healthy weight (47.62%, n=30), and overweight (4.76%, n=3) groups at the time of diagnosis. The changes in weight loss were monitored from the index of diagnosis to the landmark which was at the end of the treatment. Patients who survived to the landmark were followed to determine the association between weight loss and treatment outcomes. Subgroup analysis was used for comparative analysis of Progression-free survival (PFS) and overall survival (OS) rates. Results: Thirty-two patients (50.79%) reached the landmark point, 28 patients (44.44%) were deceased and 3 patients (4.76%) were lost to follow up (LTFU). The BMI-for-age clusters for the 32 patients presented 6 patients (18.75%) with underweight, 3 patients (9.38%) with overweight, and 20 patients (62.5%) with a healthy weight. Among the healthy weight group, 14 patients (70%) had a complete response (CR), 3 patients (15%) had a partial response (PR) and 3 patients (15%) had progressive disease (PD). The overall survival was 336 days (95% CI, 225) while the PFS was 324 days (95% CI, 298-539). The OS based on the index at diagnosis was 298 days (95% CI, 167) for the healthy weight(n=30), and 322 days (95% CI, 145) for the overweight(n=3). After the landmark, the PFS was 371 days (95% CI, 294-727) for the healthy weight (n=17), 815 days (95% CI, 791) for the overweight(n=2), and 310 days (95% CI, 294) for the underweight. Conclusion: BMI-for-age and weight loss are associated with treatment outcomes both from PFS and OS. Patients in the underweight cluster had a worse survival rate compared with overweight and the healthy weight groups. In conclusion, assessing cancer cachexia in aggressive lymphomas together with BMI-for-age and weight loss will improve the approach to identifying poor prognoses in oncology. Have you got a Conflict of Interest?: No
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1363 A multimodal imaging-guided nanoreactor for combination of tumor starvation and mild temperature phototherapy J. Cao1 1 chongqing university, Chongqing, China 背景：Phototherapy, including photodynamic therapy (PDT) and photothermal therapy (PTT), has shown great promise for cancer treatment in many preclinical studies. 目的：This study reports a nanoreactor designed for an enhanced mild temperature phototherapy which utilizes multiple mechanisms including simultaneous glucose consumption, oxygen supply, glutathione (GSH) depletion and heat-resistance relief. 方法：The nanoreactor is prepared using an Fe-doped polydiaminopyridine (Fe-PDAP) nanozyme with an intrinsic catalase-like activity coloaded with glucose oxidase (GOx) and indocyanine green (ICG). 结果：Evidence shows that glucose plays a vital role in tumor progression. Initiated by the breakdown of glucose into gluconic acid and H2O2 by GOx, Fe-PDAP promotes reoxygenation by catalyzing the reaction-supplied and tumor cell- supplied H2O2 into O2, which then enhances the O2-dependent PDT. Moreover, Fe-PDAP depletes GSH in tumor cells for more efficient reactive oxygen species (ROS) production. Meanwhile, the heat resistance of tumor cells is relieved by GOx-induced glucose exhaustion and heat shock protein (HSP) reduction, improving the efficiency of PTT. In particular, the nanoreactor also serves as a contrast agent for fluorescence, photoacoustic, and magnetic resonance multimodal imaging. 结束：Consequently, this nanoreactor efficiently inhibits tumor growth through mild temperature phototherapy under multimodal imaging gui- dance, resulting in successful tumor ablation with minimal systemic toxicity. Have you got a Conflict of Interest?: No
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1364 Community engagement, feasible screening test to strengthen ecosystem of cervical cancer prevention in India N Surenthiran1, B. Paul1, H. Prashanth1, A. Oommen2, V. Sadan3, R. Isaac1 1 CHRISTIAN MEDICAL COLLEGE, RUHSA, VELLORE, India, 2CHRISTIAN MEDICAL COLLEGE, CHAD, VELLORE, India, 3CHRISTIAN MEDICAL COLLEGE, College of Nursing, VELLORE, India Background and context: Despite the launch of evidence supported, visual inspection methods (VIA) for screening of cervical cancer, India has made limited progress towards building a functional national screening programme. One of the major obstacles has been misconceptions and fear about the gynaecological examination for VIA test. It is critical to understand the ecosystem operating at the community level to translate evidence into policy and practice. Christian Medical College (CMC) Vellore carried out a one-year study to assess the people’s perceptions regarding screening, VIA versus HPV test on self-collected samples and map the impact of the community engagement using range of tools within the diverse, resource limited health system Aim: The research aimed to generate evidence for the feasibility of HPV test on self-collected samples for screening to inform policy-making and advocacy for cervical cancer prevention programme in India. Strategy: one of strategies was stakeholders’ engagement to address the challenges of HPV based screening. Programme process: A partnership is made with other community hospitals under CMC serving women in underserved rural, urban poor and tribal areas. Descriptive research through workshops for research team and interviews and focus group discussions (FGD)with the community explored the challenges of introducing HPV test. The community was approached through the key people including village leaders, self-help women groups, school teachers, ‘Anganwadi’(village nursery) workers. The interactive discussions using educational tools like video shows, posters, pictorial charts were held at facilities offered by the community. Outcomes: Interviews, FGDs and survey revealed little to poor understanding about cervical cancer. More than 30% of the people were happy with the video shows for education. The number of eligible women to be screened was 727, 1876, 1021 in the respective rural, urban and tribal sites. About 630 (17.4%) women have willingly given the samples over 4 months. Annual rate of VIA screening in the study site is less than 5%. Of the 630 women, 294(40.4%), 188(10%) and 148(14.5%) were from rural, urban slum and tribal sites respectively. Learnings: Empowering community through education, providing access to acceptable screening test certainly is a feasible strategy to roll out functional cervical cancer screening programme in India. However, a cost benefit analysis needs to be done to make recommendations to policymakers in India. Have you got a Conflict of Interest?: No
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1365 Development and Validation of an Integrated Model to Predict Pathological Complete Response in Rectal Cancer L. Feng1, Z. Liu2, L. Shao2, X. Lou3, Y. Wang1, J. Tian2, X. Wan1 1 The Sixth Affiliated Hospital, Sun Yat-sen University, Radiation Oncology, Guangzhou, China, 2Institute of Automation, Chinese Academy of Sciences, CAS Key Laboratory of Molecular Imaging, Beijing, China, 3The Sixth Affiliated Hospital, Sun Yat-sen University, Pathology, Guangzhou, China Background: Accurate prediction of tumor response to neoadjuvant chemoradiotherapy (nCRT) enables personalized perioperative therapy for locally advanced rectal cancer (LARC). Medical images contain heterogenous characteristics of tumor which could be utilized to precisely predict tumor response by artificial intelligence (AI) technology. Aim: We aimed to develop and validate an integrated AI model to predict pathological complete response (pCR) for LARC patients using pretreatment MRI and haematoxylin and eosin (H&E)-stained biopsy slides. Methods: Eligible participants who had undergone nCRT followed by radical surgery were recruited, with their pretreatment pelvic MRI (T2-weighted imaging, contrast-enhanced T1-weighted imaging, and diffusion-weighted imaging) and whole slide images of H&E-stained biopsy sections collected for annotation and feature extraction. The RAdioPathomics Integrated preDiction System (RAPIDS) was constructed by machine learning on the basis of three feature sets associated with pCR: 9 radiomics MRI (rMRI) features, 12 pathomics nucleus (pNUC) features, and 18 pathomics microenvironment (pMENV) features from a retrospective training cohort (TC). The accuracy of RAPIDS for the prediction of pCR in LARC was verified in two retrospective external validation cohorts (VC) and further validated in a multicenter, prospective observational study (ClinicalTrials.gov, NCT04271657). Model performances were evaluated using area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: In the retrospective study, 303 patients were enrolled in TC, 480 in VC1, and 150 in VC2 between Sept 25, 2009, to Nov 3, 2017. RAPIDS had favorable accuracy of pCR prediction in the TC (AUC=0.868, 95% CI 0.825– 0.912), VC1 (0.860, 95% CI 0.828–0.892) and VC2 (0.872, 95% CI 0.810–0.934). In the observational prospective trial, 100 eligible patients were recruited between Jan 10 to June 10, 2020. RAPIDS maintained a high AUC of 0.812 (95% CI 0.717–0.907), with sensitivity of 0.888 (0.728–0.999), specificity of 0.740 (0.593–0.886), NPV of 0.929 (0.862–0.995), and PPV of 0.512 (0.313–0.710). Moreover, RAPIDS significantly outperformed single-modality prediction models (pMENV model, AUC=0.630, 95% CI 0.507–0.754; rMRI model, 0.716, 95% CI 0.580–0.852; pNUC model, 0.733, 95% CI 0.620–0.845; allP<0.0001). Conclusion: RAPIDS was competent for pCR prediction with high accuracy and robustness, and therefore could serve as a reliable tool to assist in individualized management of LARC patients. Besides, we proposed a novel modeling strategy of combing radiomics and pathomics to comprehensively interpret tumor features and efficiently improve model performance. Have you got a Conflict of Interest?: No
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1366 “1000 Cancer Voices” – Australian attitudes and experiences with cancer & the COVID-19 vaccine C. Allan1, A. Piper1, D. Spence1, A. Hyatt2,3, A. Appathurai4,5, M. Crane4,5, B. Teh3,4,5 1 Cancer Council Victoria, Melbourne, Australia, 2Peter MacCallum Cancer Centre, Department of Health Services Research, Melbourne, Australia, 3University of Melbourne, Sir Peter MacCallum Department of Oncology, Parkville, Australia, 4Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, Australia, 5Peter MacCallum Cancer Centre, Department of Infectious Diseases, Melbourne, Australia Background: COVID-19 has led to more than 6 million deaths worldwide. People with cancer and other chronic conditions are at increased risk of severe morbidity and mortality compared to the general population. In Australia, the national roll out of COVID-19 vaccines commenced in February 2021 and people with cancer and other chronic conditions were given priority access from March 2021. At this time, Australia had relatively low cases of COVID-19 compared to the rest of the world and vaccine hesitancy in the general population was as high as 30%. Research into the attitudes of people with cancer toward the COVID-19 vaccine is limited, particularly in the time following the establishment of community vaccination programs, wider availability of vaccines and emergence of new variants. As a trusted provider of cancer information and support in Australia, Cancer Council Victoria, in partnership with the National Centre for Infections in Cancer at Peter MacCallum Cancer Centre, commenced a study to determine key factors associated with COVID-19 vaccination for people affected by cancer and inform strategies to better facilitate vaccine access and uptake in this cohort. Aim: To understand the attitudes and experiences of people affected by cancer in Australia towards the COVID19 vaccine, with the aim of informing tailored information, communications, and strategies to help people with cancer understand and access the vaccine appropriately. Strategy: National online survey of people affected by cancer in Australia, capturing attitudes and experiences associated with COVID-19 vaccination between August and September 2021. Programme/policy process: A marketing campaign was developed, seeking “1000 cancer voices” to participate in a survey via digital and social media. The survey was developed collaboratively, with input from community representatives, as well as clinical and non-clinical members of the cancer sector. Outcomes: Case studies and survey results were used to inform an information campaign, urging people to “Get the facts on all things cancer and COVID-19”. This was particularly important as Australian case numbers increased, preparing the sector to meet the information and support needs of people affected by cancer. What was learnt: Overall, respondents had positive attitudes toward COVID-19 vaccination and thought it was safe. Findings supported the role of cancer organisations and health professionals as trusted providers of information about the COVID-19 vaccine. Respondents wanted credible information that was disease-specific and could help them make informed decisions about the timing of cancer treatment and getting the COVID-19 vaccine. Have you got a Conflict of Interest?: No
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1369 Advancing dignity-conserving care in oncology: a qualitative analysis of dignity therapy documents Q. Guo1, J. Lin1 1 Capital Medical University, School of Nursing, Beijing, China Background: Dignity therapy, as a brief and individualized psychotherapy, provides terminally ill patients with an opportunity to review life memories, convey important discourses to loved ones, and finally generates a generativity document. Previous studies have analyzed the generativity documents to explore terminally ill patients' common discussing topics. However, few studies have analyzed the generativity documents of advanced cancer patients receiving chemotherapy in mainland China. Aim: To examine the thematic features and shared narrative dimensions of generativity documents of dignity therapy for advanced cancer patients receiving chemotherapy in mainland China, thus providing insights into dignity-conserving care in palliative cancer care in Chinese culture. Methods: This is a qualitative descriptive study. Twenty-four generativity documents derived from a quasiexperimental trial of dignity therapy for advanced cancer patients receiving chemotherapy in a daycare center at a cancer hospital in northern China were analyzed using content analysis. Results: Among the 24 advanced cancer patients whose generativity documents were analyzed in this study, 14 were male; ranged in age from 26 to 78 years (Average =50.3 years). Four main narrative dimensions emerged from the analysis of these documents: (1) Patients were more likely to review and find meanings from their rich life experiences and achievements but dismiss their bad memories; (2) Patients found the origin of hope in life from their loved ones and the relationships with significant others in their lives; (3) The life tasks of expressing love, thanks and apologies to family were completed in dignity therapy, which was considered as an important approach for emotion release; (4) The virtue and values of life, such as honesty, kindness and modesty, were shared by patients as their life wisdom and guidance to loved ones. Conclusion: The shared narrative dimensions of generativity documents demonstrated that advanced cancer patients receiving chemotherapy in mainland China were willing to shared their life achievements, considered their family as the origin of life hope as well as highlighted the virtue and values of life. This information could help healthcare providers understand common features of patients' dignity and care needs, which provided insights into advancing dignity-conserving care for patients receiving chemotherapy in palliative cancer care in Chinese culture. Have you got a Conflict of Interest?: No
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1376 A meta-analysis on the association between serological Helicobacter pylori infection and gastric cancer J. Gu1, S. Wang1, F. He1, G.M Clifford2, W. Wei1 1 Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2International Agency for Research on Cancer, Lyon, France Background: Best estimates of the association between Helicobacter pylori (H. pylori)infection and gastric cancer (GC) are key for predicting the potential for GC prevention through HP eradication. However, this association varies by gastric subsite and geographical region, as well as being affected by study design issues. Aim: We aimed to provide pooled, updated estimates of the strength of association between H. pylori and GC development, and their determinants, with the intent of providing a reference for futureH. pylori-targeted GC prevention programs. Methods: We searched PubMed, Embase, and Cochrane Library up to 30 November 2021 to identify prospective studies, i.e., nested case-control or case-cohort studies, reporting the association betweenH. pylori infection and GC. Random-effects meta-analyses were performed. Heterogeneity was explored by subgroup analyses and meta-regression. Results: A total of 27 studies were included. H. pylori infection was strongly associated with non-cardia gastric cancer (NCGC) (OR=4.07, 95%CI:3.08-5.37), both in Europe/North America (OR=5.40, 95%CI:4.04-7.22) and in Asia (OR=2.51, 95%CI:1.67-3.78). H. pylori infection was also positively associated with cardia gastric cancer (CGC) in Asia (OR=1.73, 95%CI:1.21-2.47), but not in European/American populations, where the association was inverse (OR=0.64 95%CI: 0.46 to 0.87). Furthermore, the strength of association was greatly increased in studies that detected H. pylori by immunoblotting in comparison to ELISA, both for NCGC (OR=10.56, 95%CI:5.82-19.17 vs. OR=3.42, 95%CI:2.61-4.49) and for CGC in Asia (OR=3.06, 95%CI:1.54-6.09 vs. OR=1.58, 95%CI:1.10-2.28 ), and also in studies testing for H. pylori detection further back in time prior to cancer diagnosis (NCGC: OR <5 years=1.76, 95%CI:1.08-2.88; OR5-10 years=3.62, 95%CI:2.35-5.58; OR>10 years=5.78, 95%CI:3.08-5.37; Ptrend<0.05). Conclusion: This meta-analysis summarizes prospective evidence for the association between H. pylori infection and GC around the world, providing robust estimates for estimating the preventable fraction and potential impact ofH. pylori-targeting GC prevention programs. Funding:This work was supported by grants from the Beijing Nova Program (No. Z201100006820069), National Key R&D Program of China (2016YFC0901400, 2016YFC0901404, 2018YFC1311706), CAMS Innovation Fund for Medical Sciences (grant number: 2021-I2M-1-023) Have you got a Conflict of Interest?: No
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1382 The analysis of genetic aberrations in FFPE tissues by next-generation sequencing and digital PCR K. Skorepova1, J. Manakova1, Z. Kubova2, Z. Slobodova3, J. Savara1, T. Papajik2, E. Kriegova1 1 Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Department of Immunology, Olomouc, Czech Republic, 2Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Department of Hemato-Oncology, Olomouc, Czech Republic, 3Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Department of Clinical and Molecular Pathology, Olomouc, Czech Republic Background: Genetic analysis of numerical and structural genetic aberrations in formalin-fixed paraffin-embedded (FFPE) tissue samples become essential for clinical decision-making in oncology. However, genetic diagnostics from FFPE samples is challenging. Aim: To compare different methods of DNA extraction from FFPE samples in regards to suitability for downstream analysis by targeted next-generation sequencing (NGS) and digital PCR (dPCR). Methods: Four different DNA and DNA/RNA extraction methods, all from Qiagen and Purigen Biosystems, were used for DNA extraction from FFPE tissue samples (n=8, 3 diffuse large B-cell lymphoma (DLBCL), 2 follicular lymphoma, 3 reactive lymph nodes). Reparation of formalin-induced damage was performed with a repair enzyme cocktail (NEBNext® FFPE DNA Repair Mix). Samples were analysed for structural and numerical aberrations in a 16-panel of clinically relevant genes by NGS and dPCR. Results: High variability in DNA yield across sections was observed for all methods, as shown by quadruplicate extractions. The highest yields of extracted dsDNA per section (1.8-7.1ug/10µm section) were observed using the Purigen DNA kit; DNA/RNA methods from both suppliers and the Qiagen DNA kit delivered ~2 times less amount of DNA (0.1-2.5ug/10µm section). Amplicons up to 200 bp were amplified from all isolations, one sample had lower amplification efficiency. Regarding NGS, the enzymatic reparation of DNA resulted in elimination of formalin-induced sequence artefacts (C>T/G>A), present in all unrepaired samples (variant allele frequency (VAF) 4.9-92.1%). Purification on column after DNA reparation increased the yield 2.5 times compared to purification on beads recommended by the supplier. The artefacts were solved by NGS analysis in duplicates. Two missense variants inMYD88 gene were detected in two DLBCL patients (p.V204F, VUS predicted pathogenic, VAF 10.7%; p.L252P, pathogenic, 35.8%) in all repeated extractions. The detection of structural aberrations by dPCR requires optimisation of PCR conditions compared with the peripheral blood analysis and is ongoing. Conclusion: Best DNA quality metrics were obtained by the DNA Purigen extraction. Our data showed that enzymatic repair of DNA isolated from FFPE samples is highly recommended for downstream applications. Grant support: NU21-06-00370, IGA_LF_2022_011, CZ.02.2.69/0.0/0.0/19_073/0016713, and MH CZ-DRO (FNOL, 00098892) Have you got a Conflict of Interest?: No
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1385 Risk prediction for the death due to esophageal cancer: A 35-year follow-up of the Linxian cohort x. wang1, h. yang2, J. FAN1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Cancer Epidemiology, Beijing, China, 2National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Background: Several previous studies have identified risk factors associated with death due to esophageal squamous cell carcinoma (ESCC), but a comprehensive evaluation of these multiple risks is difficult. We sought to develop a simple system to predict the risk of death due to ESCC based on exposure to risk factors before the onset of ESCC. Methods: The study participants were 3298 esophageal squamous dysplasia (ESD) cases from Linxian, and data collection was done by scientists in the Linxian Nutrition Intervention Trial. This trial has been a follow-up for more than 30 years and all participant deaths were reviewed by an endpoint assessment panel of Chinese and American medical experts. Several factors associated with the risk of long-term death of ESCC were included in this study to create a simple risk-scoring model. The score values were estimated based on β coefficients and the risk prediction score for the death due to ESCC was the sum of these individual scores. Results: During 30 years of follow-up, a total of 541 ESCC-related deaths occurred. results of the Cox multifactorial analysis indicated that high age (HR=1.05; 95%CI: 1.03–1.07), men (HR=1.37; 95%CI: 1.07–1.76), abnormally low body mass index (HR=1.02; 95%CI: 1.01–1.04), a low education level (HR=1.45; 95%CI: 1.21–1.63), less fresh vegetable intake (HR=1.29; 95%CI: 1.08–1.53), and family history of cancer (HR=1.15; 95%CI: 1.13–1.17) predicted ESCC-related deaths (P<0.05). The range of scores was 0-13, and the risk of ESCC-related death was 1.0% for those scoring 0-5, 1.23% for a score of 6–7, 1.58% for a score of 8–9, 2.33% for a score of 10–13. When the cut-off of 6 points or more was applied the sensitivity was 0.77, the specificity was 0·63, and the negative predictive value was 0·98. The risk score predicted the death due to ESCC well (area under curve 0·77). Conclusion: The risk prediction score for the death due to ESCC performs well in the Linxian dysplasia nutrition intervention trial cohort. However, because of the specificity of this population, this risk score still needs to be validated and refined in other populations. This research method of establishing risk scores helps to identify highrisk individuals without relying on medical tests easily and can be used to avoid deaths due to ESCC through interventions. Have you got a Conflict of Interest?: No
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1386 Oncology Patient Support Line-Social and psychological intervention in times of the COVID19 pandemic L. Monteiro1, M. Leal1 1 Liga Portuguesa Contra o Cancro do Núcleo Regional do Norte, Apoio ao Doente, Porto, Portugal The Oncology Patient Support Line project was created at the beginning of the COVID-19 pandemic, with the main objective of giving effective support to the main needs of cancer patients and their families who were prevented from having access to a series of responses in the social and health areas. Consequently, the Northern Regional Center of the Portuguese League Against Cancer quickly implemented a response that became a pioneer in the provision of essential care and goods. The Oncology Patient Support Line project became fully operational in mid-April 2020 and has been a response to this day, reinforcing recognition, trust and the Institutional mission. Thus, this project was and is a crucial means to help all cancer patients and their families at all stages of the disease, in the social, psychological, legal and voluntary fields. For the development and implementation of the project, several resources were mobilized, such as the creation of a toll-free telephone line for cancer patients, where the subject/need was tracked in a call center. Consultations were scheduled for Social and Legal Supports, Psychology, Home Visits, and Community Volunteer Scholarship. A survey of oral chemotherapy medication needs was also carried out in hospitals and medication sent to the patient's home. In this project, 1197 patients were supported, with the following results: - 375 patients in economic support for medication, transport for consultations, food supplements and others; - 98 technical aid loans; - 54 psycho-oncology consultations; - 22 home visits; - 7931 meals served at home; - 206 home medication deliveries. In times of a pandemic, the Northern Regional Center of the Portuguese League Against Cancer, reinforced its social importance, realizing that many of the rights of patients and access to goods and services were socially guaranteed and demanded. The articulation with the community responses has to be reinforced, becoming an active driver of social construction in the life processes of cancer patients. Keywords: social intervention, cancer patient, Covid-19 pandemic Have you got a Conflict of Interest?: No
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1387 Conserving the Dignity of children with incurable cancer needs early integration of palliative and cancer care J. Lin1, Q. Guo1, S. Cai2, C. Deng1, X. Zhou3 1 Capital Medical University, School of Nursing, Beijing, China, 2Children’s Hospital, Capital Medical University, Center for Clinical Epidemiology and Evidence‐based Medicine, Beijing, China, 3Children’s Hospital, Capital Medical University, Hematology Center, Beijing, China Background: Dignity conservation is one of the central pillars of holistic and humanistic care. Researchers have explored how adults with terminal illnesses perceived dignity and developed a series of dignity-conserving strategies based on the Model of Dignity in the terminally ill. However, there is little empirical research on the phenomenon of dignity conservation in caring for children with incurable cancer. Aim: To explore the phenomenon of dignity conservation for children with incurable cancer from the perspectives of parents of sick children and pediatric healthcare providers. Methods: This is a qualitative descriptive study. Eleven parents (5 fathers and 6 mothers) and 10 healthcare providers (8 nurses and 2 physicians) caring for children with incurable cancer were recruited from a tertiary Children's hospital in northern China using purposive sampling. Semi-structured interviews were used for data collection. Data were analyzed using content analysis. Results: Three categories of dignity-conserving care for children with incurable cancer were emerged from the data. First, the significance of dignity conservation for children with incurable cancer was reflected in the children's daily living, pain and symptoms control, and psychological and spiritual wellbeing. However, children frequently experienced dignity violations when receiving cancer treatment, including illness- and treatmentrelated distress, privacy violation,loss of autonomy and control, and overtreatment. Notably, the tradeoff between cancer treatment and maintenance of dignity for children with incurable cancer is a struggle for the parents as they expected to save children's life at all costs but meanwhile were concerned about the children's dignity and quality of the rest of their lives. Conclusion: To reduce children's symptoms burden and emotional distress thus conserving children's dignity as well as relieving their parents' psychological sufferings, palliative care can be introduced at diagnosis and incorporated into care throughout the course of cancer treatment, thus advancing high-quality and holistic care to children. Therefore, early integration of palliative and cancer care is critical to attend to the dignity of children with incurable cancer and their families. Have you got a Conflict of Interest?: No
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1391 AN UPDATED ELECTRONIC STAGING TOOL FOR POPULATION-BASED CANCER REGISTRIES: CANSTAGING+ I. Soerjomataram1, M. Ervik1, S. Lardner2, J. Aitken3, A. Gordon, R. López-González4, N. Aragonés4, A. Jeyaraj2, F. Bray1, A. Gavin2 1 International Agency for Research on Cancer, Lyon, France, 2Northern Ireland Cancer Registry, Belfast, United Kingdom, 3Cancer Council Queensland, Brisbane, Australia, 4Cancer Surveillance and Registry Unit, Madrid, Spain Background: While cancer staging is important for treatment planning and likely prognosis, discussion with patients is also important to facilitate monitoring of cancer outcomes at population level. Population based cancer registries (PBCRs) are key partners in assigning stage at diagnosis while adhering to internationally agreed, complex and regularly updated staging rules. Aim: to develop and provide an electronic staging tool publicly available for cancer registries online and offline to enhance the completeness and comparability of cancer staging internationally. Methods: In a collaborative international collaboration, we developed a user-friendly electronic staging tool, CanStaging+, for PBCRs based on UICC TNM classifications for adult cancers and on Toronto Paediatric Cancer Stage guidelines for childhood cancers, publicly available both online and as an offline tool, which will be demonstrated during the presentation. We also assessed variations in staging data collection across PBCRs from submissions to Cancer Incidence in 5 continents. Results: 346 registries out of 464 (75%) reported having collected cancer staging information between 2008 and 2012. The proportion varied greatly by world region, with 96% of some North America and Europe registries reporting collecting any staging information to only 52% in Latin America and the Caribbean. The collection of staging data also varied by cancer site, being higher for breast and cervix and lower for lung cancer. CanStaging+ with anatomical drawings is designed to help maximise availability, standardisation and comparability of cancer staging internationally. The tool provides automatic calculation of the international TNM staging classification editions 7 and 8 for a variety of tumour sites. CanStaging+ now provides the two-tiered approach of Toronto childhood cancer staging for fifteen childhood cancer types. In addition it also hosts guideline for the Essential TNM including its diagram. In the future we aim to expand the tool to include translation in multiple languages. Conclusion: Specifically, for this conference we will present the new updates in particular on the childhood cancer staging tool. The project has been a true international collaborative effort, and continued collaboration is seek to join different sub-works of CanStaging+ e.g., expansion, implementation or capacity building. Have you got a Conflict of Interest?: No
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1392 Circulating Tumor Cell cluster phenotype and response to treatment and predicts survival in lung cancer G.B. kanakasetty1, P. Kumar2, A. Rangarajan3 1 Kidwai Memorial institute of oncology,HCG Hospital, Mediacal oncology, Bangalore, India, 2Institute of Bioinformatics, Cell biology, bangalore, India, 3Indian Institute of Science, Cell Biology, bangalore, India Background: Metastasis contributes to 90% of cancer deaths. Circulating tumor cells (CTCs) are cancer cells disseminated in blood and are considered to be pivotal in the metastatic cascade. cluster phenotype as a predictive indicator of treatment response and to determine the therapeutic efficacy of the drugs Aim: To study CTC cluster formation and use the same to assess response to treatments Methods: Blood samples were obtained from 52 lung cancer patients. The whole blood was separated by centrifugation and the remaining cell fraction was subjected to RBC lysis. Nucleated cells were re-suspended in Dulbecco’s modified Eagle medium (DMEM) (Sigma) supplemented with 10% fetal bovine serum (FBS) (Life Technologies) and 1% penicillin-streptomycin. The nucleated cells from patient samples were cultured in ellipsoidal microwells made on agar plates. Cultures were maintained for 3 weeks and imaged on day 7, 14, 21 with phase contrast microscope (Olympus IX71) and analyzed the images using ImageJ (NIH, Bethesda, MD).The threshold values to classify the clusters were calculated from the median of grey values from each cluster in a microwell, which reflects the fluorescent intensity of DAPI in clusters. The median grey score obtained from the CTC clusters, were more than 100, which were categorized as very tight clusters, followed by grey score ranging between 10–100 as tight clusters, score was below 10 and was classified as loose clusters. Results: The tight cluster formation correlated with shorter patient survival as against the loose clusters. We were able to correlate the same with prospective follow up on these patients with treatment and the imaging modalities. The dynamic change in cluster characteristics also correlated with response to ongoing treatment and development of resistance. The findings were consistent for the targeted therapies and chemotherapies. Conclusion: CTC cluster characterization and serial follow up with the same can be conveniently used as a tool to predict responses and identification of resistance to ongoing therapies in lung cancer patients. Have you got a Conflict of Interest?: No
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1395 Introduction of new cancer medicines (NCMs) in Finland – How to ensure maximum added value E. Ollila1, V. Kataja2, L. Sailas3 1 Cancer Society of Finland, Health Department, Helsinki, Finland, 2University of Eastern Finland and Kaiku Health, Kuopio, Finland, 3Joint Municipal Authority for North Karelia Social and Health Care Services (SiunSote), Oncology, Kuopio, Finland Background: Developing NCMs is a high priority. Numerous NCMs have been approved for marketing in the European Union (EU) often in accelerated processes and based on limited scientific evidence. After having acquired market approval, the decisions to purchase and reimburse NCMs are made in the individual EU countries. Despite significant advances, the overall added value of NCMs has been questioned. The very high prices of most NCMs are a concern. Aim: This study explored the views of experts and stakeholders on the significance and price of NCMs, and on the systems to assess NCMs and to decide on their purchase or reimbursement in Finland. Methods: Thematic interviews with twenty-six civil servants, hospital employees, scientists, and representatives of nongovernmental cancer organisations (NGOs) and of the pharmaceutical industry were conducted, transcribed and analysed qualitatively using the Atlas.ti software. Results: The experts and stakeholders agreed that NCMs had significantly improved care of many cancer types. However, not all NCMs added value. Prices were often considered extremely high, especially with respect to the treatment results. Methods to identify patients most likely to benefit from NCMs need improvements. The national systems and processes for deciding on the introduction of NCMs are fragmentary, involving separate systems for outpatient care and hospital medicines and under-resourced evaluation bodies. The system is unable to assess all NCMs meant for hospital use. As a consequence individual hospital districts at times introduce NCMs without prior proper assessment leading to geographical inequity in access to NCMs and consequently pressures for nation-wide introduction. Reimbursement decisions for medicines for outpatient care are made in a national process. Many stakeholders feel that the system is too rigid for modern cancer care, especially as off-label use is not reimbursed. Some called for improved methods to ensure best use of outpatient medicines. Rapid increase of market entry agreements (MEAs) has increased asymmetry of information between the negotiators as prices are mainly secret. Conclusion: Robust reform of the national systems is needed to create a uniform process with adequate resources for assessment of new medicines and ensuring shift uptake of most cost-effective medicines, while rejecting those of little value. Funding for outpatient and hospital medicines should be from the same sources. Increased transparency of prices and improved practices with MEAs are essentially needed. Increased international cooperation in research, price negotiation and purchasing would be welcome, while retaining the final decisionmaking concerning introducing NCMS in countries. Have you got a Conflict of Interest?: No
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1400 Predictive value of baseline dynamic whole-body FDG PET in local advanced non-small cell lung cancer Y. Mo1, X. Zhang1, H. Liu1, W. Fan1 1 Sun Yat-sen University Cancer Center, Guangzhou, China Background: Lung cancer leads the highest death rate in the world. In recent years, immunotherapy has become an effective treatment for advanced lung cancer, but a significant proportion of patients do not benefit from it. Therefore, it is an urgent clinical problem to explore reliable non-invasive indicators to identify the population who do not benefit from immunotherapy. Whole-body dynamic FDG PET imaging combined with pharmacokinetic technology can provide dynamic process of FDG, and obtain sufficient quantitative information of glucose metabolism in various organs and tumor tissues noninvasively. As a glucose analogue, FDG enters the cell through glucose transporter (GLUT) and is phosphorylated by hexokinase (HK). Studies have shown that GLUT and HK are closely related to various biological behaviors of tumor. Besides, the growth, proliferation and differentiation of activated immune cells, such as CD8+T lymphocytes, depend on the increase of glucose metabolism. In conclusion, FDG metabolism can directly evaluate the glucose metabolic response and immune response of tumor cells, and further study on glycolysis of tumor may be an important entry point to explore biomarkers for the efficacy of chemotherapy and immunotherapy. Aim: To investigate risk factors for poor response of chemoimmunotherapy with local advanced non-small cell lung cancer (LA-NSCLC) by dynamic whole-body18F-FDG PET/CT. Methods: We prospectively analyzed 31 patients with LA-NSCLC who underwent dynamic whole-body18F-FDG PET/CT before treatment between August 2020 and August 2021. Dynamic whole-body PET was acquired between 0-60minutes. PET images were analyzed semi-quantitatively and quantitatively. Semi-quantitative metabolic parameters were acquired by measuring the maximum standardized uptake value(SUVmax), mean standardized uptake value(SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Quantitative kinetic parameters were acquired by irreversible two-compartment model. All patients received 2 cycles of chemoimmunotherapy and the response was evaluated according to RECIST 1.1 criteria. The peripheral blood lymphocyte subsets and inflammatory status were also assessed. Independent sample T test, MannWhitney U test, logistic regression analysis were used. Results: After chemoimmunotherapy, Patients were divided into two groups [respond group (17/31) vs nonrespond group (14/31)]. Responders showed significantly higher SUVmax, SUVmean, k3, and Ki than nonresponders in primary lung lesion (SUVmax: 20.94 vs 14.16, p=0.028; SUVmean: 11.65 vs 8.19, p=0.025; k3: 0.323 vs 0.220, p=0.012; Ki：0.060 vs 0.045, p=0.048). Univariate analysis showed that SUVmax, SUVmean and k3 of primary lung lesion and CD4+/CD8+ were the predictors for response evaluation of chemoimmunotherapy in LANSCLC. Multivariate analysis showed that k3 of primary lung lesion and CD4+/CD8+ were the independent predictive values for chemoimmunotherapy response evaluation. The model for predicting the risk of poor response in LA-NSCLC was established: logit (P) = 1.259-2.873*k3+1.762*CD4+/CD8+. Subsequently, we calculated the risk scores of all LA-NSCLC patients. ROC test showed that the area under the curve (AUC) of prediction model is 0.872, and when P≥0.411, the sensitivity was up to 90.9% and specificity of 88.2%. Conclusion: Baseline SUVmax, SUVmean, k3, Ki and CD4+/CD8+ in primary lung lesions were the prognostic factors for response evaluation of chemoimmunotherapy in LA-NSCLC. And k3 (which reflects the activity of HK) of primary lung lesion and CD4+/CD8+ were the independent predictive values. The prediction model combining k3 and CD4+/CD8+ rate could help predict the risk of poor response in LA-NSCLC.
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age sex TNM stage ECOG score
univariate analysis p OR（95CI%） 0.762 1.013（0.930-1.103） 0.999 25875（0.019-145876） 0.269 0.605（0.249-1.473） 0.204 0.389（0.090-1.673）
LDH
0.774 0.999（0.991-1.007）
CD3+ CD3+CD4+ CD3+CD8+
0.728 1.009（0.959-1.062） 0.142 1.073（0.977-1.179） 0.247 0.947（0.864-1.038）
CD4+/CD8+
0.032 7.319（1.190-45.031）
variables
multivarite analysis p OR（95CI%）
5.824（0.93936.147）
0.049
SUVmax 0.043 0.888（0.792-0.996） SUVmean0.036 0.802（0.654-0.985） K1 0.361 0.385（0.050-2.983） primary lung k2 0.354 0.861（0.628-1.181） lesion k3 0.005 0.074（0.012-0.465） Ki
0.065 0.000（0.000-13.983）
SUVmax 0.089 0.948（0.891-1.008） SUVmean0.124 0.908（0.803-1.127） 0.938 0.939（0.193-4.565） metastatic K1 lymph node k2 0.785 0.966（0.751-1.241） k3 0.144 0.081（0.003-2.353） Ki 0.143 0.000（0.000-173.973）
Have you got a Conflict of Interest?: No
2
0.057（0.0060.511）
0.011
1403 Impacts of the smoke-free law on indoor cigarette smoking and heated tobacco products use in Japan K. Togawa1, G.T. Fong2,3,4, A.C.K. Quah2, G. Meng2, S.S Xu2, J. Ouimet2, Y. Mochizuki5,6, I. Yoshimi7, S. Odani8, T. Tabuchi8, K. Katanoda1 1 National Cancer Center Institute for Cancer Control, Division of Surveillance and Policy Evaluation, Tokyo, Japan, 2University of Waterloo, Department of Psychology, Waterloo, Canada, 3University of Waterloo, School of Public Health Sciences, Waterloo, Canada, 4Ontario Institute for Cancer Research, Tronto, Canada, 5Shinmachi Clinic and Health Care Center, Tokyo, Japan, 6National Cancer Center Institute for Cancer Control, Division of Cancer Information Service, Tokyo, Japan, 7National Institute of Infectious Diseases, Centre for Emergency Preparedness and Response, Tokyo, Japan, 8Osaka International Cancer Institute, Cancer Control Center, Department of Cancer Epidemiology, Osaka, Japan
Background: In 2020, the revised Health Promotion Act which includes indoor smoke-free regulations came into effect in Japan. While considered a major milestone in providing for protection from secondhand smoke exposure in indoor public places, the revision had a few substantial exceptions where smoking is still allowed in small restaurants and bars and in designated smoking rooms in larger sized restaurants and bars. Aim: The present study aimed to assess the impacts of the revised smoke-free regulations on indoor cigarette smoking and heated tobacco products (HTPs) use using data from the International Tobacco Control (ITC) Japan Surveys, a web-based longitudinal panel survey of Japanese adults. Methods: Data were from Waves 1-4 of the ITC Japan Surveys conducted annually between 2018 and 2021 among a national cohort of cigarette smokers, HTP users, dual users of cigarettes and HTPs, and non-users (n = 9,384). We used generalized estimating equations logistic regression models adjusted for age, sex, education, region, and number of surveys completed to estimate changes in the following outcomes over time: indoor smoking and HTP use in key venues—restaurants/cafés, bars/pubs, and workplaces—, in smoke-free places, and at home. In particular, we estimated the impact of the revised regulations implemented in Japan between Waves 2 and 3 by additionally including Wave in the models and comparing each outcome before (Waves 1-2) and after (Waves 3-4) the implementation. Results: The implementation of the revised smoke-free regulations led to declines in reported indoor smoking and HTP use in all venues, including restaurants/cafés (cigarette: 50% to 24% of cigarette smokers, p < 0.001, HTP: 63% to 29% of HTP users, p < 0.001), bars/pubs (cigarette: 81% to 53% of cigarette smokers, p < 0.001, HTP: 85% to 50% of HTP users, p < 0.001), and workplaces (cigarette: 70% to 61% of cigarette smokers, p = 0.01, HTP: 39% to 34% of HTP users, p = 0.11); however, it remained common after the implementation, and the decline was modest for workplaces. In contrast, non-users reported noticing increased HTP use in indoor public places where smoking is prohibited (26% to 30% of non-users, p = 0.02). No substantial change was observed in reported HTP use inside homes after the implementation (75% to 73% of HTP users, p = 0.30).
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Conclusion: These findings demonstrate that non-comprehensive smoke-free regulations in Japan were only partially effective. Smoking and HTP use remained at high levels, despite reductions. In other countries, comprehensive smoke-free laws, with strong enforcement, have led to much more dramatic reductions in smoking in indoor public places, e.g., Ireland, whose policy reduced smoking in pubs from 97% to 5%. Such comprehensive smoke-free laws in Japan could lead to substantial gains in reducing secondhand smoke exposure. Have you got a Conflict of Interest?: Yes If yes please specify:: Funding: the Japan National Cancer Center and Research Development Fund (28-A-24), the Canadian Institutes of Health Research Foundation Grant (FDN-148477), a Senior Investigator Grant from the Ontario Institute for Cancer Research Conflict of Interest: KK received a JMWH Bayer Grant from Sep. 2017 to Aug. 2019 via the Japan Society for Menopause and Women's Health. GTF has served as an expert witness or consultant for governments defending their country’s policies or regulations in litigation.
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1406 Partnership approaches and advocacy for access to cervical cancer prevention and care in Burkina Faso. W.C. YOUGBARÉ1, n. Lahmidi1, K.T. BAKANHO1, I. GONZALEZ;1, L. DESPRAT2, S. TORCHE2, A. CHEYRON1 1 Médecins du Monde, seine saint denis, France, 2Médecins du Monde, Ouagadougou, Burkina Faso Background and context:Cervical cancer (CC) is common in Burkina Faso, accounting for 23% of all cancers and 22% of mortality from all cancers combined. The lack of implementation of public policies and health recommendations for the prevention and management of CC also leads to a lack of awareness and poor community mobilisation, which negatively impacts women's access to services. Through its project, MdM was able to build a partnership for advocacy from 2018 to 2021, which boosted the fight against CC in Burkina Faso. Aim:
• • •
To influence the introduction of HPV vaccine in the Expanded Programme on Immunisation calendar, To bring the authorities in charge of coordinating the fight against HIV to integrate early detection of CC in favour of HIV+ and STI women, To advocate for the revision and adoption of plans and guidelines on the provision of quality care in relation to CC.
Strategy / Tactics:Based on the diagnosis of the institutional environment of the fight against cancer in Burkina Faso, the strategy is articulated around 6 axes:
• • • • • •
Mobilisation of citizens and strengthening of civil society organisations, Lobbying towards political authorities, Dissemination of messages by young activists on social networks, Technical and financial support for the revision of the country Strategic Plan on cancer, Support for the development of a plan to introduce HPV vaccination, Testimonies and media work for dissemination of evidence. Programme / Policy process: Outcomes:The key results are as follows:
• • • •
1 Strategic Plan on cancer incorporating the revised CC priorities for the country, 1 CC standards and guidelines document adopted, 1 Plan, strategy and inter-ministerial order on the introduction of HPV vaccination adopted, 1 National Strategic Framework for the fight against HIV/AIDS and STIs (2021-2025) integrating the fight against CC in HIV+ women, Increased involvement of networks of actors, press and champions against CC in Burkina Faso, Strengthened dynamics of regional alliances.
• •
What was learnt: Advocacy efforts have made it possible to strengthen the capacity of beneficiaries to act and to mobilise new allies on the issue in Burkina Faso, but also in regional dialogue frameworks such as the «Ouagadougou Partnership» and the Generation Equality Forum. These alliances beyond the national level are reinforced by the global strategy "90-70-90". They will create more alliances and support the scaling up of good practices at the national and regional level in order to address other issues in the fight against CC. Have you got a Conflict of Interest?: No
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1412 Risk factors and prognostic implications of cancer diagnosis as an emergency presentation: an ICBP study G. Lyratzopoulos1, S. McPhail2, S. Johnson3, M. Barclay1, R. Swann3, I ICBP M9 Emergency Presentations Study group1 1 University College London, Epidemiology of Cancer Healthcare and Outcomes (ECHO), London, United Kingdom, 2National Disease Registration Service, NHS Digital, Leeds, United Kingdom, 3Cancer Research UK, London, United Kingdom Background: Greater understanding of international differences in cancer survival is needed. Variation in the percentage of patients diagnosed through emergency presentation is a likely explanatory variable. Aim: To identify the predictors and consequences of cancer diagnosis through emergency presentation in different international jurisdictions and possible associations with jurisdiction-level cancer survival. Methods: Using a federated analysis model, we analysed cancer registration and linked hospital admissions data from 14 jurisdictions in Australia, Canada, Denmark, New Zealand, Norway, and the UK, on patients with oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer, 2012-2017. This was an International Cancer Benchmarking Partnership (ICBP) study. Emergency presentation was defined as diagnosis of cancer within 30 days after an emergency hospital admission. We examined variables associated with emergency presentation and associations between emergency presentation and mortality. We meta-analysed estimates across jurisdictions and explored jurisdiction-level associations between cancer survival and the percentage of patients diagnosed as emergencies. Results: In 857,068 patients with the studied cancers, there was consistent variation in the percentage of emergency presentations by cancer site. Pancreatic cancer diagnoses had the highest percentage of emergency presentations on average (46.1% [30,972/67,173]), while rectal cancer had the lowest such percentage (12.1% [10,051/83,325])). Across jurisdictions, older age (i.e., 75-84 years and 85 years or older), and advanced stage at diagnosis, were consistently associated with greater risk of emergency presentation. Across jurisdictions, emergency presenters consistently had substantially greater risk of 12-month mortality than non-emergency presenters (odds ratio >1.90 for 100% (112/112) jurisdiction-cancer site combinations. There were negative associations between jurisdiction-level percentage of emergency presentations and jurisdiction-level 1-year survival for colon, stomach, lung, liver, pancreatic, and ovarian cancer, with a 10% increase in percentage of emergency presentations in a jurisdiction being associated with a decrease in 1-year net survival of between 2.5% (95%CI 0.28-4.7) and 7.0% (1.2-13.0). Conclusion: Internationally, large proportions of patients with cancer are diagnosed through emergency presentation. Specific types of cancer, older age, and advanced stage at diagnosis are consistently associated with an increased risk of emergency presentation, which strongly predicts 12-month mortality and probably contributes to international differences in cancer survival. Future research is needed to examine the frequency of this diagnostic routes in other countries. Policy implications are to improve diagnostic pathways for symptomatic patients, increase participation in bowel screening and improve prevention of lung cancer, will be discussed. Have you got a Conflict of Interest?: No
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1414 Application of modified electric toothbrush in oral diseases of patients with radiotherapy and chemotherapy h.j. xu1 1 chong qing university of cancer hospital, chonqing, China Background: Oral ulcers caused by radiotherapy and chemotherapy seriously affect the quality of life of patients, and some refractory patients are difficult to benefit from traditional oral care and drug therapy. To explore the application of improved electric toothbrush in patients with oral mucosal injury. Aim: Objective To investigate the application effect of modified electric toothbrush in oral diseases of patients with radiotherapy and chemotherapy. Methods: Choose between January 2020 and October 2020 in hospitalized patients with 60 patients of oral diseases, by using random Numbers are divided into research group and control group 30 each, the control group were treated by traditional oral care care, oral care team patients using modified electric toothbrush care, Modified electric toothbrush brush head with gauze, electric toothbrush through the high frequency motion, increase surface in oral cavity tissue resistance ability, promote saliva secretion, increased the oral self-cleaning effect, reduce dental plaque and oral mucosa, and the stimulation of gums, bleeding, to shorten the time of oral care, improve the work efficiency. WHO oral mucositis (OM) grading standard and modified Beck oral score standard were used in 2 groups. The improvement of oral problems in 2 groups on day 3, day 5 and day 14 after intervention was compared, and the intervention effect was compared between 2 groups. Results: there was no statistically significant difference in oral mucosa status between OM grading standard (P=0.937) and modified Beck oral score (P=0.363), but patient comfort and satisfaction were significantly improved. On day 5, there were 5 patients in the study group with OM grade 3 or above, and the modified Beck oral score was 12.69±2.21. There were 6 patients in the control group with OM grade 3 or above, and the modified Beck oral score was 14.78±1.76. The difference was statistically significant (P<0.05). On day 14, there were no patients with GRADE 3 or above OM grade in the study group, and the modified Beck oral score was 10.69±1.21; there was 1 patient with grade 3 or above OM grade in the control group, and the modified Beck oral score was 13.78±1.86. The difference was statistically significant (P<0.05). Conclusion: Through the patients with thrombocytopenia can not grasp the intensity and frequency, patients with self-use mouthwash can not achieve the purpose of oral cleaning, etc., which brings great pain to patients with oral diseases. Improved electric toothbrush gauze brush head can effectively solve the above problems, the improved electric toothbrush has the advantages such as simple operation, strong flexibility, in the application of radiation and chemotherapy patients of oral diseases, can effectively reduce plaque, reduce to the stimulation of oral mucosa and gums, reduce bleeding, promote the secretion of saliva, increased the oral self-cleaning effect, reduce the occurrence of complications。 Have you got a Conflict of Interest?: No
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1417 Circulating small extracellular vesicles microRNAs plus CA-125 for treatment stratification in ovarian cancer J. Tang1, M. Liu1, X. Zhao2 1 Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Gynecologic Oncology, changsha, China, 2Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, changsha, China Background: No residual disease after debulking surgery is the most critical independent prognostic factor for advanced ovarian cancer (AOC). There is an unmet clinical need for selecting primary or interval debulking surgery in AOC patients using existing prediction models such as CA-125, CT, PET-CT, or laparoscopy. Aim: To determine a multivariate prediction model of residual disease in AOC patients based on circulating small extracellular vesicles (sEVs) microRNA (miRNA) profile and serum biomarkers. Methods: In this multiphase cohort study, 348 pre-treatment plasma and postsurgical tissue consecutive samples, and 272 patients were collected from four clinical centers. Circulating sEVs miRNAs profile associated with residual disease was revealed by RNA sequencing in AOC patients. MiRNAs expression was measured via TaqMan quantitative real-time PCR. The prediction model was established via the least absolute shrinkage and selection operator (LASSO), and logistic regression analysis based on the discovery-validation set. Plasma and tissue sEVs were captured by the magnetic bead sorting system (MACS) using cell-type-specific proteins as markers (EpCAM, FAP, CD45, CD235a, CD31). Results: After analyzing a comprehensive plasma sEVs miRNAs profile in AOC, we identified and optimized a risk prediction model consisting of plasma sEVs-derived 4-miRNA (miR-320a-3p, miR-378a-3p, miR-1307-3p, let-7d3p) and CA-125 (AUC:0.903; sensitivity:0.897; specificity:0.910; PPV:0.926; NPV:0.871). The quantitative evaluation of Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) suggested that the additional predictive power of the combined model was significantly improved contrasted with CA-125 or 4miRNA alone (model vs CA-125, NRI=0.471, P<0.001; IDI=0.538, P<0.001; model vs 4-miRNA panel, NRI=0.122, P=0.001; IDI=0.185, P=0.003). Tumor cells-derived sEVs captured on EpCAM+ magnetic beads were the major vehicles affecting circulating sEVs 4-miRNA expressions. Moreover, the model index scores were significant differences between AOC and other confusable diseases (e. g., advanced colorectal cancer). Conclusion: A reliable and stable model of circulating tumor-derived sEVs 4-miRNA plus CA-125 was established for preoperatively anticipating the high-risk AOC patients of residual disease to optimize clinical therapy. Have you got a Conflict of Interest?: No
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1418 Projected incidence and mortality of cervical cancer in China, 2017-2030 M. Yuan1, X. Zhao1, H. Wang1, S. Hu1, F. Zhao1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Cancer Epidemiology, Beijing, China Background: Cervical cancer (CC) incidence and mortality remains increasing in China, with a divergence between age groups in urban and rural areas. Therefore, projecting future incidence and mortality stratified by age and region is essential for public health service planning to curb the consistently increasing disease burden. Aim: To project the truncated age-standardized rate, age-specific rate, and corresponding cases of incidence and mortality of CC of 15-84 females across urban and rural areas in China from 2017 to 2030. Methods: We applied multivariate age–period–cohort models with piecewise linear regression within a Bayesian framework to incidence and mortality data from the Chinese Cancer Registry Annual Report to project the future incidence and mortality rates of CC from 2017 to 2030. These rates were applied to Chinese population data from the National Bureau of Statistics to estimate the corresponding cases and deaths. Results: The overall truncated age-standardized incidence rate of 15-84 females of CC is projected to ascend from 17.40 per 100,000 in 2017 to 23.89 women in 2030, from 16.85 to 21.63 in city areas, from 18.22 to 27.96 in rural areas. The incidence tends to increase in all age groups in rural areas, with higher rates than in urban areas for almost all age groups, except for the 60-75 age group. Conversely, the incidence rate in urban areas tends to decline for the under-54 age group and increase for the over-55 age groups. By 2030, new cancer cases are expected to surge from 121,312 in 2017 to 213,019 in females aged 15-84 years in China, from 66,833 to 12,964 in urban areas, and from 54,484 to 88,063 in rural areas. The number of cases is steadily greater in rural areas than in urban areas under the age of 45, in contrast among females aged 45 years or older. Consistent with the incidence, the truncated age-standardized mortality rate escalates from 4.82 in 2017 to 9.22 in 2030 overall, from 4.00 to 8.91 in cities, from 5.29 to 10.01 in rural. The mortality rates are projected upward in all age groups, with higher rates in rural areas, other than the 60-74 age groups. The death cases augment from 35,153 in 2017 to 92,638 in 2030 overall, from 17,925 to 53,323 in city areas, from 17,238 to 39,321 in rural areas. In contrast to mortality rates, the number of deaths in urban areas is greater than in rural areas for huge populations, except for the 65-79 age group. Conclusion: The incidence and mortality of CC are projected to keep climbing in China with accruing urban-rural gap, especially among young women. It is urgent to enhance cervical screening and vaccination and obliterate the rural-urban gap to curb the soaring disease burden of CC over the next years.
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Table1 Projected cervical cancer incidence cases in China, 2017-2030 Age grou 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 p 1518 18 19 20 22 24 26 28 31 33 37 39 41 45 19 20259 277 270 275 290 311 330 363 400 442 494 558 623 688 24 251288 1311 1171 1154 1244 1252 1335 1299 1311 1380 1476 1563 1716 1890 29 304248 4037 4267 4783 4464 3721 3789 3399 3348 3618 3667 3925 3837 3904 34 356722 6436 6203 6662 7890 7910 7468 7959 8984 8466 7046 7195 6609 6508 39
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Table1 Projected cervical cancer incidence cases in China, 2017-2030 40130661160711154 10907 10606 10904 10553 10141 1095613073 13131 12354 13225 14987 44 45233562187021078 21478 20531 18385 17154 16434 1662215248 15765 15913 15778 15950 49 50260052557826228 25882 25615 28064 27283 25439 2357722322 21804 19435 18683 18378 54 55126401596519566 22939 28114 30088 29604 30359 2996529656 32499 31583 29450 27292 59 60133451388313917 14057 13451 15205 19216 23664 2765933726 35932 35415 36347 35954 64 658918 1043012488 13610 14987 15958 16667 16792 1710816435 18571 23497 29082 33880 69 705963 6680 8009 9204 10190 11874 13950 16782 1844120317 21885 22913 23151 23719 74 753279 3469 4090 4679 5294 6244 7000 8414 9715 10770 12593 14820 17867 19702 79 802205 2523 2557 2833 3139 3383 3587 4220 4838 5482 6466 7252 8736 10122 84 Tota 121311240813101 13848 14583 15332 15796 16529 1729518096 19136 19646 20514 21301 l 2 4 7 3 7 3 2 3 5 8 6 2 5 9
Table2 Projected cervical cancer deaths in China, 2017-2030 Age 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 group 15-19 8 9 10 11 12 14 16 18 21 23 26 28 30 34 20-24 40 40 38 36 38 72 79 89 100 112 128 148 168 190 25-29 218 204 198 203 207 200 196 185 170 174 313 338 377 422 30-34 624 625 662 737 753 718 668 642 655 658 626 605 563 505 35-39 1211 1233 1256 1354 1478 1644 1644 1722 1909 1935 1849 1727 1671 1707 40-44 2375 2350 2340 2365 2422 2623 2663 2714 2935 3217 3572 3567 3688 4068 45-49 4983 5026 5083 5094 5020 4691 4549 4468 4496 4576 4891 5073 5269 5576 50-54 6148 6361 6653 7039 7254 7791 7808 7624 7356 7134 6944 6882 6870 6956 55-59 3625 4486 5598 6672 7935 8428 8724 9122 9648 9938 10667106911044110075 60-64 4555 4796 4835 4886 4826 5271 6535 8150 9688 1148112168125641316013967 65-69 3925 4623 5295 5888 6576 7012 7420 7512 7613 7540 8256 102601278815169 70-74 3020 3601 4256 4892 5494 6205 7325 8427 9409 1052411264119721216412358 75-79 2535 2695 3051 3376 3751 4307 5132 6078 6996 7854 8886 105001211013550 80-84 1886 2074 2194 2413 2657 2882 3073 3469 3849 4276 4916 5847 6969 8061 Total 3515338123414694496648423518585583260220648456944274506802028626892638 Have you got a Conflict of Interest?: No
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1421 Relay For Life Mobile Application B. AL Jaaidi1 1 Preston University, SHAJRJAH, United Arab Emirates Amount Raised: 130,000 USD Background and context MENA Region History: The region’s first-ever Relay For Life launched in 2017, with the second edition in 2019 where we introduced the Relay By FOCP Mobile application. Relay by FOCP Mobile application launched in 2019 is a smart app that works on generating donations and support beneficiaries by engaging the public in a fun and interactive challenges while highlighting the importance of a healthy lifestyle thus encouraging the participants to change their daily routine to a more healthy and productive one. Aim: Relay by FOCP app aims to raise the awareness of all types of cancer and spread the importance of a healthy life style, raise funds to support the Friends of Cancer Patients mission against cancer. Strategy / Tactics: Relay by FOCP is developed in a very smart and easy way to allow participants from all ages and across the world to join hand in a journey to battle cancer and spreading awareness by simply downloading a mobile application available on both (Apple & Android operated) devices, join our monthly challenges that are usually linked to a certain international or local theme, invite their friends, family members and even colleagues to join them in a fun yet challenging activities. The app counts step, Kilometers and Calories for each user and display the achievements of each participants in a leader board in a fun and competitive way The participants also have the option within the app to create their own private challenges, invite their friends and family members to join the challenge. Organizations also can create their own challenge for their employees. Relay by FOCP uses the push notification to spread awareness about cancer to all the participants and inviting them to make a donation for the cancer patients. Relay by FOCP can also be linked with a crowdfunding platforms for fundraising. Program process: Download the application from (Apple Store, Google Store) Register as an individual or an organization Select the counting steps mechanism (Apple health kit, Google fit, Fit Bit) Customize your home page with the info you wish to display Select your preferred language (Arabic or English) Start walking and count your steps, KM and Calories Join the public challenges Create your own private challenge Cost and return: Cost for developing the app: 56,000 USD Return: 130,000 USD
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What was learned: Relay by FOCP application was established for solve a challenge which is the high temperature weather in the region for most of the year which makes our physical events limited to certain period of the year therefore, we introduced the Relay by FOCP mobile app to allow our Relay For Life participants engage and donate throughout the year. Total achieved steps overall in the app are 913,600,000 million steps with an overall users more than 2600. Annual 6 to 8 challenges and we hope for more in the coming future. Have you got a Conflict of Interest?: No
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1422 Third Party and Guarantors role under the form of civil society in coverages and Universal Health Coverage D. El-Mekkawi1 1 Children Cancer Center of Lebanon, Patient Relations Department, Beirut, Lebanon Background and context: Lebanon in the past couple of years has been passing through a rough time. The COVID-19 pandemic hit with a lot of lockdowns. Then a major financial crisis hit with many protests and road closures. Add to it the Syrian conflict since 2011 which was the major factor in increasing the number of pediatric cancer patients that needed treatment in Lebanon. This put a lot of strain on the medical sector hindering services and stopped many patients in receiving the necessary treatments. In Lebanon, several guarantors and third parties exist to help the Lebanese and the non-Lebanese with their cancer treatment cost. However, the extreme fluctuation of the exchange rates, and the central bank running out of reserves to subsidize many commodities, but most importantly, medication. Alone the government and third party guarantors cannot support these patients. That being said, the Children Cancer Center of Lebanon, and many other Civil societies had to increase its efforts and support more cancer patients requiring treatment. Aim: At CCCL, we aim to: Support the maximum number of pediatric cancer patients without any cost to their families and allow access to safe, effective and quality cancer treatment Strategy/tactics:
• • • • •
Checking the patient’s guarantor and its scope and network of coverage. Coordinating closely with guarantors for maximum coverage. Covering the difference of guarantors to avoid any out of pocket expenses on the families of the patients. Expanding to cover patients at more than 10 hospitals across Lebanon. Securing un-available medications that are essential for their treatment.
Program process:
• • • • •
Set the rules of coverage for each difference of guarantor Set cost containment strategies Set guidelines for enrollment of patients Searching for funds and grants that can support our aim Coordinate with pediatric oncologist to provide patients with best care
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Outcomes:
• •
•
We currently have around 350 patients under treatment covered by CCCL, from few months to 18 years old. We were able to support more than 1000 patients in the past 3 years as follows:
The tough situation in Lebanon resulted in the decrease of the percentage from the treatment cost covered by guarantors (Ministry of Health, National Social Security Fund, Army, Private insurance, etc…) from around 40% to 15% in some cases and from 100% to 50% in others. CCCL was able to cover this difference.
What was learnt:
• • •
Civil society and guarantors play a key role in the coverage of pediatric oncology patients Adapt quickly to the changing circumstances More fund are continuously needed in order to support the maximum number of patients
Have you got a Conflict of Interest?: No
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1426 Up-regulation, not down-regulation, of Y chromosome genes is associated with gender difference in liver cancer L. Voirol1, S. Orso1, G. Bakalli2, S. Guerrier1,3, N. Mili1 1 University of Geneva, Research Center for Statistics, Geneva School of Economics and Management, Genève, Switzerland, 2Auburn University, Department of Mathematics and Statistics, Auburn, United States, 3University of Geneva, School of Pharmaceutical Sciences, Faculty of Science, Genève, Switzerland Background: Liver cancer (LC) is the fourth most common tumor worldwide, with an estimated incidence of 1 million cases. LC exhibits a gender imbalance, with a three-fold higher incidence among males. The hypothesis currently favored to explain the gender difference is the extreme down-regulation of the Y chromosome (EDY) during liver cancer pathogenesis. In a recent study, Cáceres et al.[1] found that EDY is strongly associated with cancer risk in men (odds ratio [OR] = 3.66, 95% confidence interval [CI] = 1.58 to 8.46) across 19 cancers (n = 9336). EDY variability was explained by six genes of the non-recombinant region (DDX3Y, EIF1AY, KDM5D, RPS4Y1, UTY, and ZFY) whose chromosome X homologs showed loss-of-function mutations that co-occurred with EDY (OR = 2.82, 95% CI = 1.32 to 6.01). Aim: The aim of our study is to question the existence of EDY in the gender imbalance in LC. Methods: We performed a Support Vector Machine (SVM) and a Generalized Linear Model (GLM) analysis on the The Cancer Genome Atlas (TCGA) data set (Liver Hepatocellular carcinoma - TCGA, US; n=294) [2]. Y chromosome gene's ability to differentiate male from female patients was evaluated by 10-fold cross-validation. Results: Table 1: Y chromosome genes discriminating male from female patients in LC.
GLM coefficients
Cross Validation accuracy SVM
RPS4Y1 0.993 (ENSG00000129824)
5.645 E5
0.993
KDM5D 0.99 (ENSG00000012817)
1.51 E7
0.993
DDX3Y 0,989 (ENSG00000067048)
1.36 E7
0.986
USP9Y 0.981 (ENSG00000114374)
1.36 E8
0.983
ZFY 0.977 (ENSG00000067646)
5.35 E7
0.981
UTY 0.976 (ENSG00000183878)
3.56 E7
0.983
Gene Identity
Cross Validation accuracy GLM
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PRKY 0.976 (ENSG00000099725)
6.87 E7
0.980
TXNLGY 0.975 (ENSG00000131002)
4.92 E7
0.99
EIF1AY 0.963 (ENSG00000198692)
7.1 E6
0.983
TMSB4Y 0.957 (ENSG00000154620)
4.78 E7
0.96
Ten genes with positive GLM coefficients can discriminate male from female LC with an accuracy > 95% in the TCGA US dataset. Conclusion: The six genes mentioned by Cáceres et al. (DDX3Y, EIF1AY, KDM5D, RPS4Y1, UTY, and ZFY) are all up-regulated, and not down-regulated, in men with LC in the TCGA US data set. Four other genes (USP9Y, PRKY, TXNLGY, TMSB4Y) are also up-regulated and appear to play a key role in gender difference. Our results suggest that EDY is not a key factor in LC gender imbalance. Further studies are needed to understand the role of the Y chromosome in the gender differentiation in liver cancer. References: [1] Cáceres A, Jene A, Esko T, Pérez-Jurado LA, González JR. Extreme Downregulation of Chromosome Y and Cancer Risk in Men. J Natl Cancer Inst. 2020;112(9):913-920. doi:10.1093/jnci/djz232. [2] TCGA Program Directors: Jean C. ZenKlusen, M.S., Ph.D. (NCI) and Carolyn Hutter, Ph.D. (NHGRI). https://dcc.icgc.org/projects/LIHC-US. Have you got a Conflict of Interest?: No
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1428 Screening and management of pre-cancerous cervical lesions in Burkina Faso N. LAHMIDI1, K.T. BAKANHO2, G. HIEN2, C.L. BONKIAN2, L. DESPRAT2, S. TORCHE2, A. CHEYRON1, I. GONZALEZ1 1 Médecins du Monde, seine saint denis, France, 2Médecins du Monde, Ouagadougou, Burkina Faso Background and context: Cervical cancer (CC) is common in Burkina Faso: 23% of all cancers and 22% of the mortality rate of all cancers combined. The country has a 2020-2024 strategic plan against cancer, which includes the management of CC. The screening interventions for precancerous lesions currently implemented in the country are based on visual inspection of the cervix with acetic acid (VIA), followed by cryotherapy for treatment for precancerous lesions. This screening method is still not very effective compared to some more efficient methods that are not widely used. Aim: To implement an innovative cervical cancer screening and precancer treatment project in Burkina Faso, from May 2019 to December 2021 Strategy / Tactics: screening approche : DNA screening for Human Papilloma Virus (HPV) followed by VIA and thermo coagulation for treatment) in 9 health centres, including different services (laboratory service, HIV screening and gynaecological-obstetric consultation). Programme / Policy process: The project was implemented gradually from August 2018 to November 2019. A significant amount of preparatory time was required, particularly for a socio-anthropological study but also for workshops, reflection and training with the various stakeholders in order to propose a project that was best suited to the context. MdM also set up action research during the implementation of the activities to ensure that they were properly implemented. Finally, the analysis of the difficulties encountered enabled us to propose solutions to improve patient care. Outcomes: Training of care providers was carried out on VIA, HPV testing, counselling, palliative care and loop electrosurgical excision procedure (LEEP). These training sessions involved 103 midwives, 90 auxiliary midwives, 18 nurses, 11 laboratory technicians and 17 doctors. In addition, partnerships were set up with various structures and institutional and non-governmental actors. Several tools were developed with the mobilization of the actors concerned: training modules, orientation diagram of the patient care pathway, quality protocols to ensure the traceability and quality, registers for data collection, development etc. Finally, the overall experience was very positive for both care providers and patients: 98.8% of users were satisfied with the services provided. What was learnt: Thanks to the mobilization around this innovative pilot project, several operational tools were developed and adjusted as the activities were implemented. The results and good practices identified in the framework of this program can thus be used to help the replication on other projects. Have you got a Conflict of Interest?: No
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1430 Effect of linkage to the national death index on net survival for women with cervical cancer in Saudi Arabia E. Alkhalawi1,2, M.P Coleman2, C. Allemani2, A. Al-Zahrani3 1 King Abdulaziz Univeristy, Department of Family and Community Medicine, Jeddah, Saudi Arabia, 2London School of Hygiene and Tropical Medicine, Non-communicable disease epidemiology, London, United Kingdom, 3King Faisal Specialist Hospital and Research Centre, Gulf Centre for Cancer Control and Prevention, Riyadh, Saudi Arabia Background: Population-based cancer survival is a key metric for the assessment of cancer control strategies. Accurate estimation of cancer survival requires complete follow-up data for all patients. Aim: To explore the impact of linking national cancer registry data to the national death index on net survival estimates for women diagnosed with cervical cancer in Saudi Arabia during 2005-2016. Methods: We acquired data from the Saudi Cancer Registry for 1,250 Saudi women diagnosed with invasive cervical cancer during the 12-year period 2005-2016. The registry data include the woman’s last known vital status (alive, dead, not known) and the date of last known vital status, but the source was restricted to clinical records and death certificates that mention cancer as a cause of death (“registry follow-up”). We then submitted available national ID numbers to the National Information Center (NIC) of the Ministry of Interior, to ascertain the date of death, from any cause of death, for women who had died up until 31 December 2018 (“NIC follow-up”). Registry follow-up was used for women with no available ID number (24%). We estimated age-standardised 5-year net survival using the Pohar-Perme estimator, which estimates the excess hazard of death in the cancer population compared to the age- and sex-matched general population from life tables, and accounts for increasing background mortality in older age. Results: 1,219 women were eligible for survival analysis. With registry follow-up alone, 18.3% of women were dead. One-year and five-year net survival estimates were 88.4% (95% CI 86.3-90.2%) and 78.3% (75.5-80.9%), respectively. With NIC follow-up, 44.5% of women were found to be dead. One-year and five-year net survival estimates were 82.3% (80.0-84.6%) and 57.2% (54.0-60.4%), respectively. A sensitivity analysis restricted to women with follow-up from NIC record linkage (n=928) did not affect the results: one-year and five-year net survival were 82.0% (80.0-84.6%) and 56.8% (53.4-60.1%). Conclusion: Reliance solely on information from deaths certified as due to cancer and clinical records leads to a high proportion of missing deaths in the national cancer registry. This is probably due to low quality of certification of the cause of death in Saudi Arabia. Linkage of the national cancer registry to the national death index at the NIC identifies virtually all deaths, providing more reliable survival estimates, and it eliminates the ambiguity in determining the underlying cause of death. Linkage of the cancer registry to the NIC should become the standard approach to estimating cancer survival in Saudi Arabia.
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Have you got a Conflict of Interest?: No
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1431 Telemedicine: Bridging the Gap Between Poor Health Infrastructures and Access to Quality Healthcare in Nigeria O. Atariata1, O. Salako2, A. Momodu-Enyi1, S. Oyibo3, S. Ekundayo1 1 Oncopadi Technologies Ltd, Lagos, Nigeria, 2University of Lagos, Radiation Oncology, Lagos, Nigeria, 3University of Ibadan, Ibadan, Community Medicine, Ibadan, Nigeria Background: Telemedicine can resolve the complications that affect quality healthcare in a double burden diseased environment like Nigeria. The overall goal of telemedicine is to improve patients’ outcomes through increasing access to healthcare and medical information. Poor health coverage due to lack of access to healthcare facilities and inequitable distribution of health workers have severely worsened the health indices. About 70% of the Nigerian population lack access to healthcare services, and Nigeria currently has less than 90 oncologists despite an incidence rate of 100,000 new cancer cases every year. The application of telemedicine in improving health indices has shown promising potential in sufficiently closing the gaps that have made it difficult for individuals to access quality healthcare geographically, socially, and economically; mitigating the delay mechanism that affects adequate and quality health delivery. Aim: To evaluate the perception of the general population. And assess factors that limit the adoption of telemedicine. Methods: A cross-sectional study design was used for this study. Data collection was done by distributing the study instrument on social media platforms. A total of 130 persons participated in this study. Respondents who are not residents of Nigeria and below age 18 were excluded from the study. Results: Out of 130 participants; 64, 49.2% were males; and 66, 50.8% were females with a mean age and standard deviation of 27.2±4.4. 68.5% of participants were in the age range of 18 – 29, and in addition, 44.6% of the respondents were economically independent. Quality of care (34.2%), delay in receiving care (26.2%), and physical access to the care facility (16.4%) were the most common factors respondents will consider to choosing virtual consultations. The factors that could affect the utilization of virtual consultations in this study are as follows: poor internet (42%), generalized belief that virtual consultation is not effective (28.8%), professionalism of the physicians on the telemedicine platforms (15.9%) and costs more over time (13.3%). However, 61.3% of the respondents believed that virtual consultation should be done to complement physical consultations. Conclusion: Telemedicine can improve the overall indices with proper application and support, although much needs to be done to educate the general population about its usefulness. Have you got a Conflict of Interest?: No
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1439 The predictive value of systemic inflammation response index in patients with advanced lung adenocarcinoma. P. Yue1, R. Zuo1, P. Chen1 1 Department of Thoracic Oncology, Lung Cancer Diagnosis and Treatment Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China 背景：Inflammation plays an important role in the development and progression of lung cancer. The study aimed to assess the response predictive and prognostic values of different peripheral blood cell biomarkers in patients receiving first-line chemo- or targeted therapy for andvanced lung adenocarcinoma (LUAD). 目的：Our study aim to explore better predictive facors for advanced LUAD and promote the administration of them after treatment. 方法：A retrospective review of the clinicopathological data of 307 advanced LUAD between January 2011 and December 2019, was performed. At the same time, we collected 410 healthy controls and 415 patients with benign pulmonary diseases as control groups. The optional cut-off values of the hematological parameters were determined with receiver operating characteristic curve for distinguishing prognosis. Survival curves were estimated using the Kaplan-Meier method, and the Cox proportional hazard model was used to assess the prognostic factors. 结果：Compared with control groups, the level of peripheral blood leucocyte, neutrophil, monocyte, platele and neutrophil to lymphocyteratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), systemic inflammation response index (SIRI) were higher in LUAD patients, while lymphocyte count was lower, with statistical significance (all p=0.000). Partial inflammatory markers decreased at the time of optimal response and then increased again as the disease progressed. Univariate analysis showed that the gene mutation status (p=0.041), treatment (p=0.000), optimal treatment response (p=0.000) and the mode of disease progression (p=0.046) as well as pretreatment NLR (p=0.000), MLR (p=0.000), SIRI(p=0.000) and LDH (p=0.030) were prognostic factors. Moreover, multivariate analysis revealed that treatment options (p=0.009), optimal response (p=0.000), SIRI (p=0.047) and LDH (p=0.014) were independent prognostic factors. Patients with simultaneous elevation of SIRI and LDH had the worst prognosis. The area under the curve of SIRI and LDH to distinguish prognosis of LUAD patients was, respectively, 0.617(95%CI: 0.549-0.685, p=0.001) and 0.586(95%CI: 0.5150.656, p=0.019). When SIRI and LDH were combined, it increased to 0.636 (95%CI: 0.568-0.704,p=0.000). 结论：Pretreatment SIRI was found to be a simple independent prognostic factor of PFS in advanced LUAD patients who underwent first-line chemo- or targeted therapy. Dynamic monitoring of changes in inflammatory index during treatment could help predict therapeutic efficacy. The combination of SIRI and LDH could be a better prognostic stratification factor for LUAD patients. Have you got a Conflict of Interest?: No
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1440 Implementation of an organized community-based cervical cancer screening in Abidjan,Ivory Coast J.J. KOUADIO1, M. DIOMANDE1, E. ASSI1, M. DIENZOU1, S.T. NIANGORAN1, R. Kouawo N’ZAN1, M. BONNEFOIS1, A. DE SAPORTA1, N. LAHMIDI2 1 Médecins du Monde, Abidjan, Cote D'Ivoire, 2Médecins du Monde, seine saint denis, France Background and context:In Ivory Coast, cervical cancer (CC) is the 2nd most frequent cancer among women: . Since 2020, Médecins du Monde (MdM) has been implementing a pilot project in Abidjan for the prevention, screening and management of precancerous cervical lesions using an organized community-based approach. Aim: To contribute to the reduction of mortality and morbidity from CC, through patients screening, care and treatment. Strategy / Tactics: The project supports the National Cancer Prevention Program (PNLCa) in the fight against CC, by testing a new approach: organizing screening through door-to-door community health campaigns. The goal is to screen women aged from 25 to 49 years. The screening interventions are based on WHO recommendations: DNA screening for human papilloma virus (HPV), proposing self-sampling at home by women themselves, followed by visual inspection with acetic acid (VIA) and thermo coagulation for treatment. This approach is complementary to the SUCCESS project. MdM’s project relies on a strong involvement of Community Health Workers (CHWs), community leaders, women's associations, civil society organizations (CSO) and institutional actors. Programme / Policy process:The activities implemented for community mobilization consisted in:
• • • • • • • •
Setting up focal points in every health program involved in the project, notably the Community Health Department and the PNLCa, Presenting the project to community leaders and representatives of women's associations and collecting their suggestions, Defining operational and community strategies with all stakeholders, Adapting outreach tools, Identifying and training 25 CHWs within the community, Signing agreements with 3 local radio stations to broadcast information, Training CSO representatives, community leaders and representatives of women's associations on CC and advocacy Conducting population census, then screening identified women.
Outcomes:The health area census of the population allowed to estimate the target population (6,802 women). Preparatory activities ensured the mobilization of 4 CSOs, 20 community leaders and 20 women's associations representatives. After 1.5 months of screening (November - December 2021) 1,817 home visits were conducted by CHWs, allowing the screening of 1,077 women (95% of them chose self-sampling) resulting to 226 HPV positive cases. What was learnt: The success of this community-based screening strategy mainly depends on strong community mobilization and commitment of all stakeholders. The results of this community-based approach can thus be used to help the replication of other projects. and be a lever to achieve WHO objectives for 2030. Have you got a Conflict of Interest?: No
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1441 Long-term prognostic of traditional Chinese medicine in postoperative patients with lung cancer Y. Wang1, L. Jiao1, X. Ye1, J. Yao1, L. Bi1, Y. Gong1, L. Xu1 1 Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China Background: Traditional Chinese medicine (TCM) is an important part of the treatment system for lung cancer in China. However, few high-quality clinical trials were conducted to confirm the effect of TCM, especially the longterm prognostic efficacy. In 2015, we completed a randomized double-blind clinical trial on the effect of TCM treatment combined with adjuvant chemotherapy in non-small cell lung cancer (NSCLC) postoperative patients’ quality of life and long-term survival (NALLC, ClinicalTrials.gov, No. NCT01441752). We reported here updated data. Aim: The main observation was DFS. The secondary observations were OS and 3rd, 5th, and 8th year survival rate. Methods: A total of 334 postoperative patients with stage ⅠB-ⅢA NSCLC were enrolled in this randomized, controlled, double-blinded trial during 2012 to 2015 and were randomly assigned to receive 4 cycles of vinorelbine + cisplatin/carboplatin + TCM granules (n=167) or TCM placebo granules (n=167). Long-term followup was then entered until recurrence, metastasis or death. Results: The last follow-up was August 31, 2021, with a median follow-up time of 97.07 months (range, 3.30 to 113.57; 17 lost to follow-up). A total of 179 cases (53.59%) progressed, and 122 (36.53%) deaths occurred. TCM treatment showed a benefit in both DFS (71.83 vs. 45.10 months, P= 0.38, HR= 0.88, 95%CI: 0.65-1.18; Figure 1) and OS (the median OS was not reached in both groups; average OS: 90.25 vs. 85.16 months, P=0.25, HR=0.81, 95% CI: 0.57-1.16; Figure 2). There was a trend for interaction with disease stage (P=0.03) and TCM resulted in significantly prolonged DFS of stage ⅠB patients (P= 0.02, HR= 0.51, 95%CI: 0.28-0.90). The 3rd, 5th, and 8th year survival rate were 84.85% vs. 82.04%, 76.26% vs. 70.00%, 65.05%vs. 59.60% respectively. Conclusion: Prolonged follow-up of patients from the NALLC trial showed a benefit in survival for TCM combined with adjuvant chemotherapy, especially in stage ⅠB patients.
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Have you got a Conflict of Interest?: No
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1443 The expression and prognostic study of biomarkers in TAE/TACE-treated hepatocellular carcinoma D. Tseeleesuren1, H.-H. Hsiao2, R. Kant3, Y.-C. Huang4, H.-P. Tu5, C.-C. Lai6, S.-F. Huang7, C.-H. Yen6 1 Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung, Taiwan, 2Kaohsiung Medical University, Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung, Taiwan, 3Kaohsiung Medical University, Natural Product Libraries and High-Throughput Screening Core Facility, Kaohsiung, Taiwan, 4China Medical University, School of Chinese Medicine, Taichung, Taiwan, 5Kaohsiung Medical University, Department of Public Health and Environmental Medicine, Kaohsiung, Taiwan, 6Kaohsiung Medical University, Graduate Institute of Natural Products, Kaohsiung, Taiwan, 7National Health Research Institutes, Institute of Molecular and Genomic Medicine, Miaoli, Taiwan Background: Intermediate and advanced stage hepatocellular carcinoma (HCC) is treated with transcatheter arterial embolization (TAE) and/or transcatheter arterial chemoembolization (TACE), which aim to reduce the growth of HCC by stimulating hypoxic environment via restricting blood supply to the tumor. Nuclear factor E2related factor 2 (NRF2) activation is correlated with cytoprotective effects against oxidative stress, and its target genes are associated with malignant tumor behavior, metastasis, and poor survival of HCC. Moreover, NRF2 signaling mediates cancer stem cell (CSC)-like properties in HCC cells. The onset and unfavorable prognosis of HCC are associated with CSCs. However, the effects of NRF2 signaling and CSC marker CD133 have not been reported in the context of HCC prognosis. Aim: Therefore, the aim of this study was to determine the possible role of the expression of CSC markers CD133, EpCAM and NRF2, its target genes in the survival of HCC patients who had undergone TAE/TACE prior to resection. Methods: Tumor (T) and adjacent non-cancerous liver (N) RNA samples wereobtained froma total of 120patients.RT-qPCR was performed for EpCAM, CD133, NRF2, NQO1, HO-1, GCLC, and GCLM to test whetherexpressionof asingle marker or a combination of these markers is associated with survival of HCC patients after TAE/TACE. Results: Among the tested HCC clinicopathological characteristics age younger than sixty (p=0.001); lower serum AFP levels (p=0.007), multiple tumors (p=0.036), and HBV-infected HCC (p=0.015) were associated with EpCAM expression. Low AFP levels (p=0.043), multiple tumors (p=0.013), vascular invasion (p=0.039), and HCC without cirrhosis (p=0.013) were associated with CD133 expression. Multivariate Cox regression analysis showed poor survival was associated with vascular invasion (HR, 1.821;p=0.015), metastasis (HR, 2.033;p=0.049) and overexpression of CD133 (HR, 2.013;p=0.006). Log-rank analysis identified thathigh expression of CD133 was significantly associated with overall survival (OS) of post-TAE/TACE HCC (p<0.001). Conversely, NRF2 and its target genes did not correlate with OS. Analysis of the combination of markers showed that the co-expression of NQO1 and CD133 was associated with poor outcome. Conclusion: These results suggest that evaluating CD133 alone and co-expression of NQO1 and CD133 may have additional value for the outcome of TAE/TACE-treated HCC patients. Have you got a Conflict of Interest?: No
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1448 On track to eliminating cervical cancer: An Australian case study T. Harper1, K. Broun1, A. Bastable1, C. Feng1 1 Cancer Council Victoria, Melbourne, Australia Background and context The World Health Organisation (WHO) define cervical cancer elimination as a country having fewer than 4 cases of cervical cancer diagnosed for every 100,000 women in its population. With one of the lowest cervical cancer incidence and mortality rates in the world, Australia is considered a leader in cervical cancer control and aims to reach the goal of elimination by 2035. However, not everyone in Australia has equitable access to cervical cancer prevention initiatives. Cervical screening is low among Aboriginal and/or Torres Strait Islander peoples, the LGBTIQ+ community, those from culturally diverse backgrounds, who experience socioeconomic disadvantage, live in regional or remote areas or live with a disability. Inequities also exist in access to timely diagnosis and treatment and uptake of HPV vaccination. Concerted and strategic effort is required to ensure cervical cancer elimination is achieved equitably. Aim Reduce the incidence and mortality of cervical cancer among women and people with a cervix in Victoria, with a focus on populations that bear the greatest burden of the disease. Strategy/tactics Cancer Council Victoria brought together expertise from state and federal government, philanthropic partners, peak health bodies, health services and research agencies with the aim to co-develop a comprehensive and multifaceted 5-year cervical cancer elimination strategy. Environmental scans, literature reviews, data analysis and stakeholder consultation were all employed to develop and inform the strategy. Outcomes Cancer Council Victoria’s 5-year elimination strategy acknowledges the broader collective body of work at a state, national and international level, and identifies where the organisation can invest resources that align with its strengths, that fill an existing gap and that will have the greatest impact. Philanthropic groups, donors and government have contributed over $1.2M to date towards the implementation of the strategy. The strategy focuses on the key pillars of work as identified by the WHO, screening, treatment and vaccination. What was learnt (develop any replicability potential) While many countries are on track to reach elimination of cervical cancer by 2035, concerted and strategic effort is required to address equitable elimination to avoid cervical cancer becoming a disease of the disadvantaged. Cancer control organisations have an important role in ensuring equity remains a driver of cervical cancer elimination activity. Philanthropic groups, donors, peak health bodies, health services, research agencies and government are motivated to partner on this ambitious goal. Have you got a Conflict of Interest?: No
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1451 5 conditions mechanism and change of Fujian tumor patients with different MS-status under COVID-19 isolation J. Lin1,2, J. Kang1,2, L. Yang1,2, Z. Zhu1, M. Luo1, D. Zhou*3, F. Ye*1,2, W. Tang*1,2 1 Department of Medical Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, The Third Clinical Medical College of Fujian Medical University, Xiamen, China, Xiamen, China, 2Xiamen Key Laboratory of Antitumor Drug Transformation Research, Xiamen, China, Xiamen, China, 3Institute of Cosmetology and Dermatology, Application Technique Engineering Center ofNatural Cosmeceuticals, Collegeof Fuijan Province, Xiamen Medical College, Xiamen, China, Xiamen, China, Xiamen, China Background In September 2021, a patient who tested COVID-19 positive was foundin Xiamen, Fujian, and medical services were suspended. Tumor patients cannot be timely treated, which will have a series of impacts on their nutrition, psychology, sleep, cognitive function and skin condition. It is importance to analyze and evaluate the above five comprehensive conditions of cancer patients during the epidemic, explore the predictors of thefive comprehensive conditions of tumor patients. Aim Exploring 5 conditions change and mechanism of Fujian tumor patient with different microsatellite status under COVID-19 isolation. Materials and Methods Questionnaire were included PG-SGA scored, HADS, PSQI, FACT-Cog scale andDLQI.Pearson or Spearman correlation analysis and Logistic regression were used to study the correlation.Absolute value of eosinophil, apoA1, apoB, PD-1 expression and TH1/TH2 subgroup were analyzed and detected to explore the mechanism of cognitive dysfunction in tumor patients. Results (1)age ≥65 ([OR=5.306, 95% [CI] 1.352-20.817, P =0.017), high school education or higher ([OR=2.939, 95% [CI] 1.085-7.966, P =0.034), patients with advanced cancer ( [OR=5.882, 95% [CI] 2.128-16.256, P =0.001) and patients with MSS ( [OR=5.306, 95% [CI] 1.352-20.817, P <0.01) were more likely have malnutrition. (2) MSS patients ([OR=2.853, 95% [CI] 1.009-8.062, P =0.048) were more likely to develop sleep disorders. (3) Patients with advanced cancer ([OR=2.396, 95% [CI]1.135-5.059, P =0.022) and patients with MSS ([OR=12.149, 95% [CI]1.49598.732, P =0.019) were more likely to develop skin disorder. (4) MSS patients ([OR=5.768, 95% [CI] 1.214-27.413, P =0.028) were more likely to develop psychological disorder. (5) Female patients ([OR=3.742, 95% [CI]1.39610.033, P =0.009) were more likely to have cognitive function disorder.Sleep score was negatively correlated with the percentage of helper T-cell (Pearson correlation coefficient = -0.239, P =0.046). Nutritional score was negatively correlated with the absolute value of apoA1, (Pearson correlation coefficient = -0.196, P =0.032) andapoB (Spearman correlation coefficient = -0.268, P =0.003). Conclusions Microsatellite status may be helpful to understand the nutrition, psychology, sleepand skin condition of tumor patients.Sleep score was negatively correlated with the percentage of helper T-cell.Nutritional score was negatively correlated with the absolute value of apoA1andapoB.The results indicate that the percentage of helper T-cell may be related to the sleep status of cancer patients,and the decrease of apolipoprotein may be related to the occurrence of malnutrition in tumor patients,which may be helpful for understanding the nutrition or sleep status of cancer patients and judging the prognosis and can effectively guide clinical measures to prevent the occurrence of disorders.
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*Correspondence Email: (Weiwei Tang)weiweitang008@xmu.edu.cn; (Feng Ye) yefengdoctor@xmu.edu.cn; (Dan Zhou) dzhou@xah.xmu.edu.cn Have you got a Conflict of Interest?: No
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1453 STIM1 Deficiency Potentiates Hepatocellular Carcinoma Metastasis via Reprogramming Metabolism H. Zhao1, Y. Li1 1 Chongqing University Cancer Hospital, Medical Oncology, Chongqing, China Background: Metastasis is the leading cause of death of hepatocellular carcinoma (HCC) patients, and epithelialmesenchymal transition (EMT) is the key process to obtain the ability of metastasis in HCC. Literature has indicated that EMT HCC cells show a down-regulated glycolysis, but an enhanced fatty acid oxidation (FAO). However, the reprogramming mechanism involving glucose and lipid metabolism during EMT remains unknown. Aim: It has been shown that calcium-mediated signaling pathways are implicated in tumor invasion and metastasis. Stromal-interaction molecule 1 (STIM1) triggered the activation of store-operated Ca2+ entry (SOCE) is the major route of Ca2+ influx for non-excitable cells including cancer cells. This study aims to investigate the STIM1 function in regulating the metastasis of HCC cells as a metabolic checkpoint by reprogramming glucose and lipid metabolism. Methods: The expression of STIM1 and Snail1 in invaded edge and corresponding central zone of human HCC tissues were examined by immunohistochemistry. The expressions of STIM1 and Snail1 during EMT induction process were measured by WB and qPCR. Gain- and loss-of function studies were applied to explore the relationship between STIM1 and Snail1 and their roles in HCC metastasis and metabolism. Genomic STIM1 knockout (KO) SMMC7721 and HepG2 cells were generated by using a CRISPR-Cas9 system. The glucose and lipid metabolism were determined by Seahorse XFp cellular flux analyzer and micro-arry. The metastatic features of HCC cells were assessed by anoikis sssay, transwell and wound healing assay in vitro, and HCC metastasis to lung was determined in vivo. Results: STIM1 was down-regulated in metastatic HCC cells rather than in proliferating HCC cells, and low STIM1 levels were associated with poor outcome of HCC patients. During tumor growth, STIM1 stabilized Snail1 protein by activating the CaMKII/AKT/GSK-3β pathway. Subsequently, the upregulated Snail1 suppressed STIM1/SOCE during metastasis. STIM1 restoration significantly diminished anoikis-resistance and metastasis induced by Snail1. Mechanistically, the downregulated STIM1 shifted the anabolic/catabolic balance, i.e., from aerobic glycolysis towards AMPK-activated FAO, which contributed to Snail1-driven metastasis and anoikis-resistance. Conclusion: Our results present evidence that STIM1 is a metabolic checkpoint that orchestrates EMT and anoikis-resistance of HCC via switching the aerobic glycolysis towards FAO, suggesting that targeting STIM1Snail1 signaling circuit is a potential therapeutic regimen for HCC metastasis. Have you got a Conflict of Interest?: No
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1456 Advocacy for early diagnosis of breast cancer through DearMamma mobile application N. Zongo1, D. Yameogo2, w.R.B. Kaboré3, S. Dinner4 1 joseph ki-zerbo, UFR/SDS, departement of surgery, Ouagadougou, Burkina Faso, 2AMPO, Ouagadougou, Burkina Faso, 3Joseph Ki-Zerbo, Ouagadougou, Burkina Faso, 4the dear foundation, geneva, Switzerland Abstract Background: The DearMamma application is the first mobile application dedicated to the fight against breast cancer. Its goal is to reduce breast cancer mortality in poor areas through early diagnosis. Aim: To assess the impact of the DearMamma mobile application on the knowledge, attitudes and practices of Burkinabes regarding breast cancer. Methods: Cross-sectional and descriptive study from October 1 to December 31, 2021. We surveyed 468 people drawn from those who used the application via Google Forms and in person. Based on the number of knowledge, attitudes or practices acquired or improved, we defined 5 impact groups ranging from no impact to very high impact. Student's t-test and Chi2 test were used to compare means and proportions. A significance level of 5% was used. Results: 26.2% of respondents acquired at least some knowledge about screening, 75.6% of whom were women, thanks to the Dearmamma mobile application. The Dearmamma mobile application improved respondents overall knowledge of breast cancer with a very strong impact in 45.7% of cases. It enabled the acquisition or improvement of good attitudes by the respondents towards breast cancer with a very strong impact in 56% of cases. It allowed the acquisition or improvement of good practices by the respondents with a very strong impact in 57.3%. The impact was very strong among illiterate people in 58.4%, 59.8% and 64.5% respectively for knowledge, attitude and practices. The acquisition and improvement of knowledge, attitudes and practices were all associated with age, gender and level of education in a statistically highly significant manner (p< 0.001). Conclusions: the DearMamma mobile application is a real tool for early diagnosis. A wide dissemination of the DearMamma mobile application will help to reduce the rate of breast cancer deaths in the population thanks to a good mastery of self-examination, a true vector of early diagnosis by women. Keyword: DearMamma, breast selfexamination, awareness, early diagnosis Have you got a Conflict of Interest?: No
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1458 Effects of evidence-based enhanced recovery in surgical nursing in robot-assisted radical cystectomy Y. LIU1, H. Wang1 1 Cancer Hospital Affiliated Huazhong University of Science and Technology, WUHAN, China Background: Bladder cancer is one of the most common and expensive malignancies to manage. Radical cystectomy (RC) with urinary diversion is the standard of care for muscle invasive (MIBC) carcinoma of the bladder and an increasing proportion of patients with high-risk non-muscle invasive (NMIBC). ERAS represent a multimodal perioperative care pathway designed to expedite postoperative recovery and improve morbidity by minimising organ dysfunction and reducing the metabolic stress response secondary to surgery. More researches have shown a faster bowel function recovery, a shorter LOHS, and a lower overall complication rate for ERAS patients compared to standard perioperative care. RARC aligns itself with the original stated principles of enhanced recovery that MIS is advantageous to aid quicker patient recovery. A systematic review demonstrated that patients undergoing robotically assisted radical cystectomy (RARC) have decreased peri-operative complications, less estimated blood loss, lower transfusion rates, greater lymph node yields and a reduced LOS. However, we also sought the consensus view of a panel of experts on whether an optimized robotic surgical ERAS might differ from the current Expert consensus on ERAS for RC and urinary diversion in China. Therefore, the effect of ERAS based on evidence-based nursing practice for RARC were explored in this study. Aim: To explore the effect of enhanced recovery after surgery (ERAS) based on evidence-based nursing practice for robot-assisted radical cystectomy (RARC) . Methods: 58 patients with RARC admitted to urology department were divided into control group (n=33) and observation group (n=25). The control group adopted ERAS nursing practice based on Expert consensus on ERAS for RC and urinary diversion in China; the observation group constructed and implemented standardized ERAS nursing practice by searching relevant clinical practice guidelines, systematic reviews and evidence summary related to ERAS for RARC. The first postoperative anal exhaust time, first defecation time, postoperative length of stay, incidence of major postoperative complications and 90-day readmission rate were compared between the two groups. Results: The time of first postoperative anal exhaust, time of first defecation, incidence of major postoperative complications, postoperative length of stay and 90-day readmission rate in the observation group were significantly lower than those in the control group (all P<0.05). Conclusion: ERAS based on evidence-based nursing practice can promote gastrointestinal recovery, reduce complications, shorten postoperative length of stay and further improve clinical outcomes of patients with RARC. Have you got a Conflict of Interest?: No
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1459 Young Health Promotors: raising awareness about the European Code against Cancer C. Fonseca1, P. Pinto1, V. Veloso1 1 Portuguese League Against Cancer - Northern Branch, Porto, Portugal Background and context: The Young Health Promoters (YHP) is a project with about 20 years, invigorated by the Portuguese League Against Cancer – Northern Branch. Its target group are young people between 13 and 18 years old, motivated through peer education to promote healthy lifestyles in their own contexts. Over the years, the Young Health Promoters have investigated the most relevant health problems at their school contexts and tried to find a solution for them, supported by mentoring/coaching monthly sessions. Their investigations and their solutions are often inspired by the European Code Against Cancer (ECAC) as contains all the key messages about cancer prevention that the Young Health Promotors want to disseminate. Aim: YHP project provides young people with skills to develop health education activities autonomously and in context and empowers them in what concerns cancer prevention. As most of their activities have the ECAC as framework, this project has also the aim of increase health literacy, promoting more reliable and informed decisions, namely the adoption of healthy behaviors. Strategy / Tactics: Due to the relevance of this problem and the strengths of the Young Health Promoters project, in the scope of this paper we have analyzed the activities that were developed and evaluated by the YHP in the past ten years: 2012 to 2022. Using a SWOC analysis, it´s possible to identify the strengths, weaknesses and opportunities of the project, but also stress the future challenges as the ECAC is currently in a revision process and YHP will continue to be a core project of the Portuguese League Against Cancer - Northern Branch. Outcomes: Studies revealed that in spite of ECAC's 30 years of history, it continues to be unknown of the general population. The projects developed by the Young Health Promotors have the ability of improve this outcome as they use methods and language very close to their public. Besides that, this is a truly motivational approach that have a replicability potential as far as there are human resources available to work closely with this groups in their local environments. Have you got a Conflict of Interest?: No
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1460 The Future Cancer Pathway –Needs and Predictions for 15 years from now R. Simcock1, G. Davenport1, A.-M. Hamilton2 1 Macmillan Cancer Support, Centre of Clinical Expertise, London, United Kingdom, 2Macmillan Cancer Support, Strategy Development, London, United Kingdom Background and context: The social, epidemiological, and technological forces that shape the cancer pathway undergo constant change. Political and healthcare policies are also evolving in response to these forces and the pandemic. Understanding changes is vital in designing services to meet the needs of people living with cancer (PLWC). As a leading cancer support charity, we have sought proactively to understand shifts in healthcare services and workforce and their impact, to influence and advocate best outcomes for PLWC of the future. Aim: To clarify likely key trends in the cancer pathway and the impact these will have for PLWC and professionals delivering care to them in all parts of the UK in a 15 year future horizon; and from this to articulate policy and strategies for national and local discussion so PLWC experience high quality, personalised care. Strategy / Tactics: Macmillan Cancer Support’s key strategic aim is to help everyone with cancer live life as fully as they can. This work analyses what is likely to be necessary at the societal, educational, workforce, governmental and charity level to meet this strategic aim across important times and types of need in the cancer pathway, using scenarios considered either highly likely or impactful. Programme / Policy process: Through 2020-21 we developed a range of key themes about the forces impacting on the future cancer pathway through discussion with interviewees including people within, and affiliated to, the NHS in the UK. Key emerging themes include: advances in genomics, changing skills, roles and ways of working for the workforce, the ageing population, the development of digital innovation, cancer in the context of multimorbidity and promoting equity, diversity, and inclusion for PLWC. Through 2022 we have now developed a work plan to develop and further expand these themes to understand their impact on the future experience of people with cancer and the workforce delivering care to them. Components include: -Review UK and international cancer forecasts and plans -Research and review of epidemiological trends and innovations -Structured interviews and engagement with a diverse range of stakeholders including professional experts and those with lived experience of cancer. Experts will come from the cancer workforce, digital innovators, and health system leaders across the UK. Outcomes: Our pathway work is engaging broadly to develop key strategic insights into future needs for PLWC placed in a system-wide context. The final output will consist of representative future cancer personas, narrative reflections on significant trends and strategic recommendations. Macmillan will share these outputs externally to advocate for and advise on how the healthcare system will need to adapt to meet the needs of PLWC. The outputs will also shape Macmillan’s strategic direction to work proactively for the benefit of PLWC. What was learnt: Our evolving findings will be presented at the conference. Have you got a Conflict of Interest?: No
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1472 Providing cancer tissue diagnosis to remote hospitals: The experience of Butaro Cancer Centre in rural Rwanda. D. Ruhangaza1, L. Ng’ang’a2, P. Uwamahoro2, M. Kubwimana2, V. Nsabimana2, C. Shyirambere2, E. Kayitare1 1 Butaro Hospital, Butaro, Rwanda, 2Partners in Health/Inshuti Mu Buzima, Butaro, Rwanda Background: Tissue diagnosis is crucial for cancer screening, early detection, diagnosis, treatment follow up and disease prognosis. Access to tissue diagnosis is still a challenge in resource-limited setting, due to lack of adequate laboratory infrastructures, equipment, pathologists, and local reagents suppliers. Many remote public hospitals in resource-limited setting cannot afford the cost of sustaining tissue diagnosis services. Butaro Cancer Center of Excellence (BCCOE) in Rwanda has been supporting remote district hospitals in the country to access tissue diagnosis since early 2012. Despite the support being provided, the turnaround time (TAT) for samples from remote institutions is still long due to challenges related to logistics of sample transportation from hospitals to BCCOE laboratory. The aim of this study was to assess the delay in tissue diagnosis and to create an electronic sample tracking and reporting system that would improve the TAT. We describe the current transportation mechanism of samples from hospitals across the country to BCCOE and quantify TAT over a period of 5 years
Methods: We conducted a retrospective review of all tissue samples received at the BCCOE between 2015 and 2020. We assessed the time from when tissue samples were collected from the patient’s primary hospital of origin to when the samples were received at BCCOE (T1) and the time from when the sample was received at BCCOE to when the results were signed out (T2). We used STATA software to analyze the study data and descriptive statistics to report the findings Results: 4,637 tissue samples were received at BCCOE, from ten remote hospitals and four teaching hospitals. Of the total samples processed at Butaro laboratory, 66% were from the remote hospitals. 51% (n=2326) of samples from remote hospitals were malignant. The most common diagnoses were breast cancer (20%) and cervical cancer (18%). The median TAT for time 1 was 14 days (IQR: 6, 26) and 31 days (IQR:13, 66) for the remote hospitals and the teaching hospitals respectively. The median TAT for time 2 was 6 (IQR:3, 10) and 5 (IQR:1, 8) days for the remote hospitals and teaching hospitals respectively. Conclusion: There are significant delays in accessing tissue diagnosis at Butaro for samples transported from remote hospitals across Rwanda. Creating an electronic sample tracking systems could reduce these delays and improve communication between the laboratory and clinicians at remote hospitals. Final data on the use of the electronic system and its effect of TAT will follow in next phases. Have you got a Conflict of Interest?: No
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1475 Addressing barriers to electronic data capture in a cancer center: A case of OpenMRS in Rural Rwanda P. Uwamahoro1, L. Ng'ang'a1, V. Cubaka1, T. Anderson1, A. niyigena1, T. Fadelu2, J.B. Bigirimana1, P. Bihizimana1, s. Lawrence3, L. Buswell2, C. Shyirambere1 1 Partners In Health, Kigali, Rwanda, 2Dana-Farber Cancer Institute, Boston, United States, 3University of Pennsylvania, University City, United States Background: Electronic medical record (EMR) has the potential to improve timely access to information and has been shown to improve patient safety, outcome and efficiency of care in high-income countries. Previous research conducted at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, using secondary data from oncology EMR system, indicated missing and incomplete data as a limitation to fully estimate the findings. Aim: In this study, our aim was to assess and explore barriers to openMRS utilization as well as collate suggestions to improve data capture. Methods: We conducted exploratory in-depth semi-structured interviews and surveys with oncology clinicians to elucidate barriers to electronic data recording and to collect suggestions for improvement. Frequency and percentages were computed for survey data using STATA; and thematic analyses was conducted for the interviews using MAXQDA. Results: Forty-four (44) oncology clinicians were surveyed including 29 nurses, 7 doctors, 2 data clerks and 4 others, and of 44 clinicians, 14 were interviewed. They reported several barriers to timely data recording including: lack of adequate training/skills (82%), poor network connectivity (55%), poor data quality monitoring (55%), insufficient IT equipment (52%), workload /time constraint (45%), few OpenMRS users (41%), complex data collection forms (39%), partial or lack of patients’ information (32%), and double data entry on paper files and electronic system. Suggestions for improving electronic data capture were proposed including: simplifying complex clinical forms and adding missing data elements to existing forms; providing training and orientation to OpenMRS to more oncology staff; synchronizing data entry systems to minimize recording data to different platforms, enhancement of team collaboration, and personal accountability; regular patients’ calls to complete the missing information. Conclusion: Addressing the barriers highlighted by the EMR end users would improve data completeness and patient care. Further studies are recommended to evaluate the effectiveness of intervention to improve data completeness as well as continuous system improvement. Have you got a Conflict of Interest?: No
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1480 Establishing a Next generation Tumor Biobank : Fuelling cancer research in India J. Tayal1, A. Mehta2, A. sharma1, S. Tiwari1, D. Soni1 1 Rajiv Gandhi Cancer Institute and Research Centre, Biorepository, New Delhi, India, 2Rajiv Gandhi Cancer Institute and Research Centre, Laboratory Services, New Delhi, India Background: Cancer incidences and mortality data from India has drawn attention to the genetic complexities which underlie this dreaded disease. Disease recurrences and treatment failures pose challenges to treating oncologists. The new age research is now directed towards understanding tumor heterogeneity at a single cell level by using 3D in vitro platforms for drug testing, gene therapy and immune-oncology. A paradigm shift in the requirements of the biosamples types has been observed from researchers globally. Their experimental needs have changed from the traditional biosamples like Frozen tissues, Formalin fixed paraffin embedded (FFPE) blocks to live cell preparations. RGCIRC has established a next generation biobank to cater to these needs to accelerate basic, clinical and translational research primarily in India . Aim: 1) To establish a state -of-art Next generation Biobank to provide high quality and well annotated biosamples to both academic researchers and commercial entities in need. 2) To provide a bio-nest facility to start-ups working in the arena of cancer detection, prevention and screening. Methods: The unfulfilled biospecimens requests received in the past 3 years were assessed and reanalyzed for feasibility and biosamples requirement types. The most frequently requested special biosample types included, Peripheral Blood mononuclear cells (PBMC’s), Viable Tissues (VT), Dissociated Tumor Cells (DTC’s), Primary Tumor cultures and Organoids. The hospital management was approached with a proposal to build a state –of-art BSL-2 cell culture facility and a Basic Research Lab to prepare the aforementioned samples .Multiple departments such as the organization’s maintenance , finance ,IT and Tissue release Board worked collaboratively and assisted in establishing the facility. The five pillars of RGCIRC biorepository were- specimen acquisition, storage, distribution workflows, quality assurance and the critical informed consent process . We comply with the current Best Practices for Biorepositories as recommended by the NCI’s Office of Biorepository and Biospecimen Research , ISBER and also follow ICMR Ethical norms .This hospital integrated Biorepository has pathology as its operational core . Results: We have recruited more than 1000 patient donors across various cancer indications like breast, ovary, thyroid, kidney, head and neck, colorectal, Upper GI and processed their biosamples for PBMC’s, DTC’S,VT and Primary tumor cultures. We have stored, processed, and distributed these biosamples in accordance with international standard operating procedures. This new age development has led us to engage in national level programmes like - Indian Cancer Genome Atlas (ICGA) which requires highly sophisticated biobank infrastructures. Conclusion: We reported the establishment of a next generation biobank in our tertiary cancer care hospital and its crucial role in supporting cancer research in India. Have you got a Conflict of Interest?: No
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1481 IARC Handbooks Vol 19: Impact of quitting exposure to risk factors on the incidence of oral cancer V. Bouvard1, S. Nathan1, B. Lauby-Secretan1 1 International Agency for Research on Cancer, IARC Handbooks Programme, Lyon, France IARC Handbooks Volume 19: Impact of quitting exposure to risk factors on the incidence of oral cancer Véronique Bouvard, Suzanne Nethan, Béatrice Lauby-Secretan International Agency for Research on Cancer (IARC), IARC Handbooks Programme, 150 cours Albert Thomas 69372 Lyon Cedex 8, France On behalf of the Working Group of IARC Handbooks Volume 19 The IARC Handbooks of Cancer Prevention series provide comprehensive reviews and consensus evaluations of the scientific evidence on the effectiveness of interventions that may reduce cancer incidence or mortality. TheIARC Handbooks are widely used by national and international health agencies to implement evidence-based interventions or develop policy recommendations to reduce cancer risk at the population level. Cancer of the oral cavity is the most common cancer type of the head and neck, with an estimated 378 000 new cases and 170 000 deaths worldwide in 2020. Cancer burden is highest in South-East Asia and the Western Pacific where cancer incidence rates represent more than half of the incidence rates worldwide. The main established risk factors for oral cancer are tobacco smoking and alcohol consumption. However, in South-East Asia and the Western Pacific, the major cause of oral cancer is chewing of smokeless tobacco or areca nut. The 19th Volume of theIARC Handbooks conveneda Working Group of 25 international experts from 14 countries to take a comprehensive approach to oral cancer prevention by evaluating strategies and interventions for primary and for secondary prevention. This presentation will report on the impact of quitting exposure to risk factors on the incidence of oral cancer, an important information for primary prevention. The Working Group systematically reviewed and assessed all publicly available observational studies reporting on oral cancer incidence or mortality following cessation of tobacco smoking, alcohol consumption, smokeless tobacco use and, areca nut products (including betel quid) with or without added tobacco chewing. When available, data on the effect of cessation of use on the risk of oral potentially malignant disorders (OPMDs) were used as supporting evidence. Additionally, for areca nut products with or without tobacco chewing, given the scarcity of evidence, the Working Group undertook primary analyses of data on time since cessation, supported by the comparison of risk of oral cancer between former and current users and age at quitting. Background and context: Have you got a Conflict of Interest?: No
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1482 Cancer Financing: Innovation Towards Sustainability K. Saqri1 1 King Hussein Cancer Foundation, Amman, Jordan Background 6000 new cancer cases are registered annually among Jordanians, making it the 2nd leading cause of death. And due to lack of resources, competing priorities, and the increasing demand for health services, cancer treatment is a burden on the national health system and budget, no single entity can bear alone. Sadly, these numbers are forecast to double over the next 10 years, according to the World Health Organization, meaning that the financial burden will double, expanding the current gap between available resources and requirements of comprehensive equitable cancer treatment While Universal Health Coverage (UHC) remains among top national health concerns, and cancer coverage most intricate among all, work on fragmented temporary solutions that threaten the justice in providing equal quality cancer treatment to citizens from all socioeconomic backgrounds or the sustainability and capacity of health system is still needed. As any relief effect on national health budgets requires a sustainable cancer financing model. In 1997, part of its leading role in cancer care in Jordan, King Hussein Cancer Foundation (KHCF) proactively introduced an innovative, social, sustainable cancer coverage solution through the Cancer Care Insurance Program (CCI) Aim In light of apparent gaps in Jordan’s health systems and cancer care financing methods, KHCF forecasting the growth of financial gaps, introduced CCI as a pilot to bridge them. As a National Cancer Insurance scheme based on the principles of solidarity and justice is a prerequisite of our path towards the attainment of Cancer Care Coverage and UHC Strategy Based on its successfully proven model, and its scientific based statistics that reflect the successful role of its participatory approach. CCI engages a total of 178,000 willing members (individuals 19%, companies 81%) in sharing the responsibility of the coverage of their cancer care
Age Group 0-59 60+
$28,249 Coverage $57 $283
Annual Membership Fees Annual Subscription Value $42,373 Coverage $56,621 Coverage $85 $113 $424 $565 Premiums, membership fees
$70,621 Coverage $142 $848
Process CCI is a nonprofit social insurance program that provides cancer care coverage and guaranteed quality treatment at KHCC, one of the top cancer centers in the world, in return for minimal annual subscription fees Outcomes
• •
CCI Program treated more than 2,671 beneficiaries with 59,656,872$ Based on its success, as a natural progression step, KHCF is scaling it up nationally. Thus an agreement with Social Security Corporation was established in 2020 to avail to wider pool of citizens as a transitional step until it’s enforced nationally.
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Lessons learnt
• • • •
Citizens, private sector entities willing to contribute for proper cancer financing CCI proved the validity of participatory approach in cancer financing Progressive cancer financing based on scientific evidence is a potential solution to financing gaps CCI is easily replicable in other countries
Have you got a Conflict of Interest?: No
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1486 FGF19/SOCE/NFATc2signaling circuit facilitates the self-renewal of liver cancer stem cells H. Zhao1, Y. Li1 1 Chongqing University Cancer Hospital, Medical Oncology, Chongqing, China Background: Liver cancer stem cells (LCSCs) mediate therapeutic resistance and correlate with poor outcomes in patients with hepatocellular carcinoma (HCC). Aim: Fibroblast growth factor (FGF)-19 is identified as an oncogenic driver gene in HCC and correlates with poor prognosis. However, whether FGF19 signaling related to self-renewal of LCSCs is unknown. Methods: LCSCs were enriched by serum-free suspension. Self-renewal of LCSCs were characterized by sphere formation assay, clonogenicity assay, sorafenib resistance assay and tumorigenic potential assays. Ca2+image was employed to determine intracellular concentration of Ca2+. Gain- and loss-of function studies were applied to explore the role of FGF19 in the self-renewal of LCSCs. Results: FGF19 is up-regulated in LCSCs and correlates with self-renewal related genes in HCC. Silencing FGF19 suppresses self-renewal of LCSCs, whereas overexpressing FGF19 facilitates CSCs-like properties in none-LCSCs. Mechanistically, FGF19/FGFR4 signaling enhances store-operated Ca2+entry (SOCE) through both the PLCγ and ERK1/2 pathways. Subsequently, SOCE-evoked CaMKII promotes the activation of nuclear factors of activated T cells (NFAT)-c2, which transcriptionally activates the expression of stemness-related genes (e.g., NANOG, OCT4 and SOX2), and FGF19. Furthermore, blockade of FGF19-NFATc2 significantly signaling suppresses the selfrenewal of LCSCs. Conclusion: FGF19/FGFR4 axis promotes the self-renewal of LCSCs via activating SOCE/NFATc2 pathway; in turn, NFATc2 transcriptionally activates FGF19 expression. Targeting this signaling circuit represents a potential strategy for improving the therapeutic efficacy of HCC
Have you got a Conflict of Interest?: No
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1487 Comprehensive Molecular Characterization of the Forkhead-Box Transcription Factor Family in Breast Cancer L.y. Chen1, X. Bi1, D. Zheng1, D. Xu1, S. Zheng1, K. Li1 1 Hainan Medical University, College of Biomedical Information and Engineering,Key Laboratory of Tropical Translational Medicine of Ministry of Education, Cancer Institute of the First Affiliated Hospital of Hainan Medical University, Haikou, China Background: Forkhead box(FOX) proteins belong to a family of transcription factors with essential functions in a variety of biological processes including tumorigenesis, cell proliferation, and immune regulation.Breast cancer is one of the most common malignancies in female with a high degree of clinical heterogeneity. The dysfunction of a few FOX proteins has been strongly demonstrated in breast-cancer initiation and metastasis. However, a global perspective on the functional roles of FOX family remains largely elusive in breast cancer. Aim: To comprehensively characterize the heterogeneity of FOX proteins among breast cancer subtypes at singlecell resolution. Methods: We conducted the differential gene expression analysis of 49 FOX genes across five subtypes of breast cancer, with further investigation of immune infiltrates. Cellular heterogeneity was explored using single-cell transcriptome analysis.Gene set enrichment analysis were performed for interpreting the pivotal target genes and pathways regulated by FOX genes. Results: Comparative transcriptome analysis revealed that 46.9% (23 out of 49) of FOX genes were significantly differentially expressed in breast cancer patients. Eight FOX genes exhibit dysregulation in all breast cancer subtypes, while six were only markedly expressed in basal-like subtype, suggesting the heterogeneity of FOX family members across subtypes. Additionally, FOX gene expression presented a significant negative correlation with immune cell infiltration. Single-cell transcriptome analysis reveals cell-type-specific molecular signatures of FOX genes in breast cancer, withFOXA1 and FOXD1 preferentially expressed in cancer cells and cycling PVL cells, respectively. Functionally, target proteins regulated by essential FOX genes in breast cancer were highly enriched in biological processes responsible for transcription and cell proliferation. Conclusion: Our findings highlight the cell-type-specific molecular signatures and heterogeneity across FOX gene family and demonstrate that dysregulation of FOX transcription factors may contribute to the development of breast cancer. Have you got a Conflict of Interest?: No
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1490 The COMT Val158Met polymorphism is associated with oxycodone requirements in cancer patients S. Xu1 1 Jiangsu Cancer Hospital, Nanjing, China Background: The catechol-O-methyltransferase (COMT) participated in the regulation of dopaminergic and adrenergic neurotransmission. COMT Val158Met polymorphism would influence the efficacy and safety of opioids, but the association with oxycodone treatment in cancer pain patients was unknown. Aim: The main aim of the study was to investigate the influence of COMT Val158Met polymorphism on oxycodone requirements, oxycodone adverse effects and pain sensitivity among cancer patients. Methods: Patients with moderate to severe cancer pain who were treated with oxycodone were enrolled and 101 patients completed the study. All patients were genotyped for the COMT Val158Met polymorphism using a blood sample of DNA and then been divided into the wild-type group (n=50) composed of individuals with the Val/Val genotype and the mutant group (n=51) composed of individuals with the Val/Met or Met/Met genotype, comparisons on numerical rating scale (NRS) scores, oxycodone requirements and the incidence of oxycodonerelated adverse drug reactions between the two groups were conducted. Results: The patients in the mutant group had higher NRS scores before the oxycodone treatment compared to the patients in the wild-type group. Patients in wild-type group had more oxycodone requirements compared to patients in the mutant group. The incidence of dysuria and fatigue in the mutant group were significantly lower than those in the wild-type group. The patients with at least one Met allele showed a lower risk of suffering from oxycodone-related side effects when in comparison with the patients with the wild homozygote. Conclusion: These findings prompted that COMT polymorphism would influence oxycodone requirements, adverse effects and pain sensitivity in cancer pain patients. Table 1 COMT Val158Met genotype and allele frequencies in the total of 101 cancer patients
N Relative frequencies
Genotype frequencies Val/Val Val/Met Met/Met 50 43 8 0.495 0.426 0.079
Allele frequencies Val Met 143 59 0.708 0.292
Table 2 NRS scores for COMT Val158Met genotype groups
All patients (n=101) NRS score before treatment 5.83(1.50) NRS score after treatment 1.61(1.07)
Val/Val (n=50) 5.48(1.54) 1.52(1.05)
All numbers are mean(SD). † Significant (P<0.05)
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Val/Met or Met/Met (n=51) 6.18(1.40) 1.71(1.08)
p-Value 0.017† 0.365
Table3 Oxycodonerequirementsfor COMT Val158Met genotype groups
All patients (n=101) Oxycodone requirements (mg/24h)
Val/Val (n=50)
Val/Met or Met/Met (n=51) 86.53(118.66) 96.00(146.19) 77.25(83.91)
All numbers are mean(SD). Have you got a Conflict of Interest?: No
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p-Value
0.0365
1492 Occupational exposure to styrene, formaldehyde and wood dust, and sinonasal cancer in the Nordic countries. K. Hadkhale1,2, J.I. Martinsen3, E. Weiderpass4, K. Kjaerheim5, E. Lynge6, P. Sparen7, L. Tryggvadottir8, K. Straif, K. Straif9, E. Pukkala10 1 Tampere University, Faculty of Social Sciences, Tampere, Finland, 2Univerisity of Turku, Faculty of Medicine, Turku, Finland, 3Cancer registry of Norway, Department of Research, Oslo, Norway, 4International Agency for Research on Cancer, Director at the IARC, Lyon, France, 5Cancer registry of Norway, Oslo, Norway, 6University of Copenhagen, Center for Epidemiology and Screening. Institute of Public Health, Copenhagen, Denmark, 7Karolinska Institute, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden, 8Icelandic Cancer Registry, Reykjavik, Iceland, 9Boston College, The Schiller Institute for Integrated Science and Society, Massachusetts, United States, 10University of Tampere / Finnish cancer registry, Faculty of Social Sciences, Tampere, Finland Background: Occupational exposure has been identified as the most important risk factor for cancer in the workplace, second to smoking. Epidemiological studies have established workplace carcinogenic exposure has an increased risk of sinonasal cancer as compared to the general population. However, the studies are limited, and findings are rather inconsistent. Aim: This study observes the association between exposures to hazardous chemicals and estimates the risk of sinonasal cancer in the workplace. Methods: This is a population-based case-control study in four Nordic countries. The study comprises the working-age population from Nordic countries. Exposure information was obtained from the population-based registry. The original occupational codes were then reclassified into 54 categories for the NOCCA study. Cancer cases were obtained from the Nordic cancer registries. Quantitative exposure to solvents and other agents in the Nordic dataset was measured using Job Exposure Matrix (JEM) to estimate the risk. Results: There are altogether 4,597 cases and 22,985 controls in this study. More than half of the study participants are from Sweden. About 63.42% of the cases were diagnosed before the age of 50 years. A slight increase but the statistically insignificant risk (HR > 1.05) was observed on exposure to styrene, chromium, and nickel at the highest (except for formaldehyde at medium) exposure category compared to the reference group. A dose-response association was observed between wood dust exposure to the risk of nasal adenocarcinoma. The univariate model observed 34 folds increased risk of nasal adenocarcinoma while the risk was about 13 folds in a multivariate model. Conclusion: This study provides strong evidence of an association between occupational exposure to wood dust and the risk of sinonasal cancer. Have you got a Conflict of Interest?: No
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1494 Laparoscopic surgery outcome in low-risk cervical cancer: a 10-year multicenter retrospective study J. Tang1 1 Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Gynecologic Oncology, changsha, China Background: More evidences revealed that the oncological outcomes of open abdominal radical hysterectomy (OARH) were superior to those of laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer (CC). However, limited by the number of CC patients with IA and low-risk IB1, some aspects still needed more study to clarify. Aim: The aim of this retrospective study was further to estimate the outcomes of LRH for IA1-IB1 cervical cancer patients with low-risk, which was defined as tumor<2cm, less than one third stromal invasion, no lymph node involvement. Methods: By carefully studying the results of Laparoscopic Approach to Cervical Cancer (LACC) Trial, we were surprised to find that the number of early-stage CC patients with low-risk was relatively insufficient. Therefore, we retrospectively reviewed the medical records to identify the low-risk patients with FIGO 2018 stage IA1, IA2, and IB1 cervical cancer, and who received laparoscopic or abdominal radical hysterectomy from January 2010 to December 2020 at three hospitals. The Mann-Whitney U test and the χ2 test were used for the comparison of categorical variables. Progression-free survival and overall survival are compared between matched groups using Kaplan-Meier survival analysis and log-rank tests, along with univariable and multivariable regression analysis. Results: Of 5360 patients selected, 1850 (35%) met the inclusion criteria for this study from January 2010 to December 2020. Of these, 1090 patients underwent open surgery and 760 patients had laparoscopic surgery. In the entire cohort, the two groups were similar regarding clinical characteristics, such as age, body mass index (BMI), International Federation of Gynecology and Obstetrics (FIGO) stage, histologic type and grade, pelvic lymph nodes, positive margins, stromal invasion, LVSI, and adjuvant therapy. LRH had better outcomes compared with OARH in term of blood loss, transfusion rates, and the length of hospital stay. And in the subgroup analysis, when it referred to those patients with low-risk factors (tumor<2cm, superficial stromal invasion, negative LVSI and no lymph node involvement), the LRH group was equivalent to the OARH group with respect to both disease-free survival (DFS) and 5-year overall survival (OS) rates. What’s more, when tumor≧2cm or accompanied by other medium and high risk factors, the LRH group showed a significantly shorter DFS and OS than OARH, which was consistent with the LACC Trial. Conclusion: Among FIGO 2018 stage IA1-IB1 CC patients with low-risk: tumor<2cm, superficial stromal invasion, negative LVSI and no lymph node involvement, there was no detrimental effect on survival between LRH and OARH. And it also needed more prospective study to explore the oncological outcomes of low-risk CC patients with stage IA1-IB1. Besides, LRH was closely associated with worse oncological outcomes than OARH in patients with risk factors. Have you got a Conflict of Interest?: No
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1496 Navigating genomic profiling complexity to inform cancer treatments: A virtual Molecular Tumour Board (vMTB) J. Antonio López1, M. Thomas1, M. Hazar-Rethinam2 1 F. Hoffmann La-Roche Ltd, Basel, Switzerland, 2Foundation Medicine, Inc., Cambridge, United States Background: Next-generation sequencing (NGS) has paved the way for precision oncology; however, it remains daunting, as NGS reports are often extensive and complex, precluding clinicians from using them for treatment decisions.1,2 MTBs can help by providing guidance on the use of NGS reports, improving diagnosis, supporting tailored treatment and increasing the identification of eligible clinical trial options,2,3 while bringing diseasespecific molecular expertise and allowing cancer teams to communicate independently of time and location and collaborate on decision making.4 Aim and process:We present our multinational, educational vMTB, aimed at supporting Foundation Medicine, Inc. (FMI) reports’ interpretation. The format is aligned with local data privacy regulations. Patient-level data (i.e. genomics, patient characteristics) are integrated into a cloud-based platform. Patient cases are prepared and submitted 2 weeks in advance of the vMTB session (1 hour video calls). A genomicist and medical oncologist highlight the key genomic findings and their clinical implications, enabling physicians to discuss and obtain insights from FMI experts and peers, and to improve their awareness of cancer genomics to guide precision oncology. Design does not allow for outcomes tracking. A survey is applied to monitor quality. Outcomes and learnings:From Q1 2019 to December 2021, 1,569 cases (3 regions & 40 countries) have been discussed (Figure 1), from general and paediatric vMTBs, accounting for 5,264 participants from 213 medical centres. In our survey, 41% of respondents confirmed that the vMTB discussions helped them to modify or change their treatment plans. This vMTB has helped to build a network of experts beyond institutions and facilitate cross-border knowledge sharing, operating uninterruptedly during the pandemic and supporting evidence-based medicine and medical education. Figure 1: Global presence of the vMTB.
References 1. Prasad V, Fojo T, Brada M. Precision oncology: origins, optimism, and potential. Lancet Oncol 2016;17:e81-e86. 2. Huang B, Chen Q, Allison D, et al. Molecular Tumor Board Review and Improved Overall Survival in Non–SmallCell Lung Cancer. JCO Precision Oncology 2021:1530-1539. 3. Charara RN, Kreidieh FY, Farhat RA, et al. Practice and Impact of Multidisciplinary Tumor Boards on Patient Management: A Prospective Study. J Glob Oncol 2016;3:242-249. 4. Pishvaian MJ, Blais EM, Bender RJ, et al. A virtual molecular tumor board to improve efficiency and scalability of delivering precision oncology to physicians and their patients. JAMIA Open 2019; 2:505-515. Have you got a Conflict of Interest?: Yes
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If yes please specify:: Jorge Antonio López and Marlene Thomas are employees of and have stocks/shares in F. Hoffmann-La Roche Ltd, Basel, Switzerland. Mehlika Hazar-Rethinam is an employee of Foundation Medicine, Inc. and has stocks/shares in F. Hoffmann-La Roche Ltd, Basel, Switzerland. All authors have received research (medical writing) support for this abstract, furnished by Stephen Salem, BSc, of Health Interactions, which was funded by F. Hoffmann-La Roche Ltd.
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1498 Gene complexity and clinical outcomes of ALK positive non small cell lung cancer in Chinese patients M. Guan1, J. Xu1, Q. Shi1 1 Anhui Chest Hospital, Hefei, China Background: Anaplastic lymphoma kinase (ALK) gene rearrangement is a unique molecular subtype of non–small cell lung cancer (NSCLC) that was first discovered in 2007.ALK tyrosine kinase inhibitors (TKIs) have significantly improved patient survival and have become the first-line standard treatment. However, responses to ALK-TKIs vary from person to person. Some studies have reported the heterogeneity of the underlying molecular mechanisms, such as uncanonical fusion partners, different break points in exons, and concomitant mutations. Aim: We investigated the gene complexity of Chinese patients with anaplastic lymphoma kinase (ALK)–rearranged non–small cell lung cancer (NSCLC), compared survival outcomes between different variants, and determined factors associated with real-world mortality risk. Methods: We reviewed the medical records of patients with NSCLC between September 2015 and December 2020 at Anhui Chest Hospital. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Descriptive analyses of demographics, baseline characteristics, variants, and co-mutation were reported. Using multivariate Cox proportional hazards analysis, we determined correlations between genomic or clinical features and PFS or OS. Results: Overall, 105 patients with ALK-rearranged NSCLC were included. Echinoderm microtubule-associated protein-like 4 (EML4) was the predominant partner (96.2%). Non-EML4 fusion partners were found in 5 patients (4.8%); among them, three were novel partners. EML4-ALK variant 3 (36.5%) was the predominant variant type. One patient harbored the coexistence of three subtypes (E13:A20, E6ins33:A20, and E20:A20). There was a significant difference in the median PFS between patients with the v3 and v1 variants (p=0.0252)but not in the median OS (p=0.2914). TP53 mutations were the most common concomitant mutations (21.4%). There was a significant difference in the median PFS between patients with TP53 mutations and ALK rearrangements only (p=0.0046) but not in the median OS (p=0.2156). Patients with concomitant oncogene mutations had shorter OS (p=0.0061) and PFS (p=0.0000) than those with ALK rearrangement only. Multivariate Cox analysis showed that concomitant oncogene mutations(p=0.022) and V3 variant(p=0.032) were independent prognostic factors for PFS. Baseline brain metastasis (BBM) (p=0.004) was an independent prognostic factor for OS. Conclusion: ALK patients with variant V3 and concomitant oncogene mutations had shorter PFS. Presence of TP53 mutations shortened the PFS of patients regardless of treatment. A better understanding of ALK gene complexity will help to optimize therapeutic strategies. Have you got a Conflict of Interest?: No
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1507 miR-590-3P Functions as a Tumor Suppressor by Targeting MDM2 in Hepatocellular Carcinoma J. Khaled1, A. Amleh1,2 1 The American University in Cairo(AUC), Biotechnology, Cairo, Egypt, 2The American University in Cairo(AUC), Biology, Cairo, Egypt Background: miRNA 590-3P is a small non-coding RNA that has previously been associated with the occurrence and progression of several cancer types. However, its expression pattern and biological function in Hepatocellular carcinoma (HCC) are still controversial. For instance, a recent study reported a tumor-promoting function of miR590-3p in HCC by targeting tumor suppressors, such as PDCD4 and PTEN, to promote HCC cell proliferation and survival. On the contrary, a tumor suppressive function of miR-590-3p in HCC via regulating TEAD1 was also demonstrated. Similarly, a previous study in our lab revealed a tumor suppressing effect of miR-590-3p in HCC and identified the MDM2 gene as the miR590-3p downstream-target gene. Aim: This study aimed to knock down the expression of MDM2 in HepG2 cells to understand how the inhibition of MDM2, as a validated downstream target of miR-590-3p, would affect different functional pathways in HCC. In addition, we aimed to identify further downstream targets in the “mir-590-3p -MDM2” pathway and understand their role in the development of HCC. Methods: RNAi-mediated knockdown was used to inhibit mRNA and protein levels of MDM2. Clonogenic cell survival assay was utilized to assess HepG2 cell proliferation, while transwell assay was carried out to evaluate the migratory behavior of these cells. miR-590-3p mimics transfected HepG2 cells were used to detect the effect of miR-590-3p overexpression on downstream target genes. Insilco analysis was performed to identify further downstream targets in the “mir-590-3p -MDM2” pathway. Potential target genes predicted by bioinformatics tools were subjected to quantitative reverse transcription PCR (RT-qPCR). Results: In clonogenic cell survival assay and transwell assays, MDM2 gene silencing was shown to inhibit cell proliferative and migratory behavior of HepG2 cells. Gene expression analysis revealed that this miRNA functions, at least in part, by influencing the expression of genes that regulate epithelial-mesenchymal transition, which was also downregulated following MDM2 knockdown in HepG2 cells. Conclusion: Our findings not only reveal novel targets for miR-590-3p in HCC but also shed light on the important function of the miR590-3p/MDM2 pathway in HCC. Moreover, these findings demonstrate a crucial role for MDM2 in the regulatory mechanism of EMT in HCC. References Ge, X., & Gong, L. (2017). MiR-590-3p suppresses hepatocellular carcinoma growth by targeting TEAD1. Tumor Biology,39(3), 1010428317695947. https://doi.org/10.1177/1010428317695947 Yang, H., Zheng, W., Zhao, W., Guan, C., & An, J. (2013). [Roles of miR-590-5p and miR-590- 3p in the development of hepatocellular carcinoma]. Nan Fang Yi Ke Da Xue Xue Bao = Journal of Southern Medical University, 33(6), 804–811. Have you got a Conflict of Interest?: No
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1523 Addressing key factors hindering Cancer Prevention in Cameroon S. Chikeh1, N. Wifred2 1 PRESBYTERIAN HEALTH SERVICES, PRESBYTERIAN CHURCH IN CAMEROON, Health Services Department, Buea, Cameroon, 2Harvard University, Global Health Catalysts, USA, United States Background: Cancer is widely recognized as a global public health problem. Breast, prostate, and cervical cancer are among the most frequent types of cancer among men and women in developing countries. Breast, cervical and prostate cancers summed up to over 49.7% of cancer incidence and 42.6% of cancer mortality and the top three cancer incidence and mortality in Cameroon. The incidence and mortality can be reduced by vaccination of young girls against HPV as well as early detection and treatment among the population of Cameroon, but there are key factors associated with low update, screening and treatment of these cancers. This study aim to address key factors hindering the prevention the three most prevalence cancers ( Breast, Cervical and Prostate cancers), in Cameroon. Methods: A cross sectional survey of women attending Out-Patient Department (OPD) of some health facilities of the Presbyterian Health Services in Cameroon and with a number of outreach activities from 2017 to 2021 was conducted. The activity of raising knowledge about the prevention and early detection of these cancers was carried out through community counseling to more than 100,000 male and females in five regions of Cameroon. After the community counseling from, 2017 t0 2021, a total of 13508 participants were screened for these cancers, collectively. Women were screened for breast cancer using clinical palpation followed by breast ultrasound, mammography, biopsy in case of abnormalities; women screened for cervical cancer using VIA and VILI followed by punch biopsy, for suspicious cases; and for prostate cancer, using rectal examination, followed by prostate ultrasound, PSA and biopsy for those with positive findings Results: Only 537 women screened in 2017 compared to 5913 women screened in 2021 due to increase and strategized community sensitization, thus creating more awareness. Mean screening age of the study population was 40.45 ± 12 years and vaccination age range is 9-13years. Over 3.3% and 9.3% of women were diagnosed with breast abnormalities and cervical precancer, respectively. 4.6 % of men screened for prostate cancer were diagnosed positive with confirmation from biopsy results. Only 63.4% of women diagnosed for cervical precancerous lesions were treated. Only 9(47.4%) of out of the 19 women and 15(33.3%) out of the 45 women diagnosed for invasive breast and cervical cancer respectively, were able to afford for immediate treatment. Over 140women treated for genital warts caused by HPV types 6 and 11, which could be prevented with Gardasil vaccine. Over 94% of girls vaccinated, age 9-13year, received all two does. Conclusions: Our findings are important to improve screening coverage, early detection, and treatment, thereby reducing the incidence of breast, cervical and prostate cancers in Cameroon. Factors hindering the prevention of these cancers can the subdivided into two subgroups: Population orientated problem; and providers orientated problem. Have you got a Conflict of Interest?: No
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1533 Tea Consumption and Esophageal Cancer: A Two-Sample Mendelian Randomization Study j. Zhou1, Z. Qiaoyan1, s. Jianyu1, H. Zhijian1 1 Fujian Medical University, Fujian Province, China Background: Previous epidemiologic studies revealed the controversial results of the association between tea consumption and the risk of esophageal cancer. Mendelian randomization (MR) refers to an analytic approach to use genetic variants as instrumental variables to analyze the unbiased causal effects of exposures and outcomes, which avoids the limitations of observational studies. Aim: This study aimed to investigate a possible causal relationship between tea consumption and the risk of esophageal cancer by using a two-sample MR study. Methods: Sixteen single nucleotide polymorphisms were used as instrumental variables for tea consumption. Genetic association estimates for esophageal cancer were obtained from a genome-wide association study comprising 740 cases and 372,756 controls of European ancestry. Analyses were conducted using the inverse variance weighted, weighted median analysis and MR-Egger regression. The leave-one-out analysis method was implemented as sensitivity analyzing approaches to ensure the robustness of results. Results: Genetically predicted tea consumption was consistently associated with risk of esophageal cancer across the different analyses. There was some evidence for positive associations of genetically predicted tea consumption with esophageal cancer [odds ratio (OR) = 1.006; 95% confidence interval (CI): 1.001-1.011; P = 0.019)] in inverse variance weighted analysis. Similar results were observed in weighted median analysis (OR = 1.010; 95% CI: 1.003-1.017; P = 0.005) and MR-Egger regression (OR = 1.025; 95% CI: 1.011-1.039; P = 0.004). The results were stable in the sensitivity analysis. Conclusion: This study provides evidence of a causal relationship between higher tea consumption and increased risk of esophageal cancer. Have you got a Conflict of Interest?: No
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1534 Overview of the Cancer experience in the small Caribbean island of Saint Lucia A. Auguste1,2, S. Cox3,4, J. Oliver5,2, D. Phillip6, O. Gabriel7,8, J. St.Catherine1, C. Radix9, D. Luce3,2, C. Barul3 1 Sir Arthur Lewis Community College, Vaughan Arthur Lewis Institute for Research and Innovation (VALIRI), Castries, Saint Lucia, 2African-Caribbean Cancer Consortium (AC3), Philadelphia, United States, 3Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) – UMR_S 1085, Pointe-à-Pitre, Guadeloupe, 4Université des Antilles, Pointe-à-Pitre, Guadeloupe, 5The University of Alabama, Capstone College of Nursing, Tuscaloosa, United States, 6Faces of Cancer Saint Lucia, Castries, Saint Lucia, 7Owen King European Union Hospital, Department of oncology, Castries, Saint Lucia, 8Caribbean Association for Oncology and Hematology (CAOH), Port of Spain, Trinidad and Tobago, 9Organisation of Eastern Caribbean States, Castries, Saint Lucia Background: Cancer disproportionately affects small islands compared to larger, and developed countries due to fewer resources, and vulnerability to natural disasters. Data on patient experiences accessing cancer care in Saint Lucia are lacking. Community-based cancer research can inform care. Aim: We studied for the first time, access-to-care of cancer services in Saint Lucia and the views of cancer survivors on their overall care experience. Methods: We used a novel patient-centered model for cancer research appropriate for our under-resourced settings involving a local cancer support organization. Purposive and snowball sampling was used to constitute a sample of adult cancer survivors residing in Saint Lucia between 2019 and 2020. We used a structured questionnaire to ascertain socio-demographics, clinical characteristics, health services accessed, and personal appraisal of experience. We performed a thematic analysis to derive themes from open-ended questions. Results: Of the 50 survivors recruited, the majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average 3 years after diagnosis. Travel overseas for health services was common among survivors (56%). Mean turnaround times for biopsies overseas were 70% shorter than that of Saint Lucia (p = 0.0013). Despite better having access to better services, survivors expressed emotional distress during travels due to isolation from family. Family support was one of the main themes which emerged. This is typical among island populations and is distinct from existing patient experience framework. Conclusion: Reinforcing inter-personal relationships during care (e.g. with patient navigation) could improve considerably the quality of life of survivors in small islands. Our research also showed that patient support organizations are an integral part of the research process in our under-resourced setting. Have you got a Conflict of Interest?: No
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1535 Chemotherapy-Induced Remodeling of Receptor Positive Breast Cancer Revealed by Single-Cell RNA Sequencing C. Ni1, j. li2, F. Jia2 1 Zhejiang Univerdity, Second Affiliated Hospital, hangzhou, China, 2Zhejiang University, Second Affiliated Hospital, Hangzhou, China Background: Hormone receptor-positive breast cancer (HR+ BC), accounting for approximately 70% of cases, is the most common subtype of breast cancer. As the standard treatment, neoadjuvant chemotherapy (NAC) is the first choice for local advanced breast cancer. However, hormone receptor (HR) -positive patients were significantly less responsive to neoadjuvant chemotherapy than other types. Therefore, for HR+ patients, predicting the efficacy of neoadjuvant chemotherapy and exploring the transformation of tumor microenvironment (TME) during chemotherapy are of great importance for finding a plan to improve the efficacy. Aim: There are several aims in our study: 1. To provide a comprehensively dynamic atlas of HR+ breast cancer patients during NAC through single‐cell transcriptome analysis. 2. To better reveal the programs that determine chemotherapy response. 3. To nominate targets and time points of combining ICBs to improve treatment strategy in HR+ breast cancer. Method: We performed single-cell RNA sequencing from 13 paired tumor samples from 8 HR+ BC patients before and after neoadjuvant chemotherapy. Multiplexed immunofluorescence (mIF) staining of ten markers panel were applied in a second HR+ BC cohort with 42 paired FFPE samples for validation and exploration of the spatial distribution. Results: Sensitive patients were characterised by high levels of several immune cell subpopulations featured with more immune active status. CD4-Tem-ATP1B3 with CD8-Tcm-LMNA and CD8-Teff-FGFBP2 in the sensitive tumor microenvironment and increased significantly after chemotherapy, exhibiting promising signatures associated with the robustly effector memory and cytotoxic T cells. We also identified MΦ-CD52 with strong phagocytic capacity coherently shift toward a pro-inflammatory phenotype in response to TNF signaling and chemokines in sensitive patients. Strikingly, the tumor cells that specifically increased after therapy harbored distinct evolving account for tumor dormancy, drug resistance and stemness. Expression signatures for cancer cell subpopulations, immune status as well as spatial location are associated with therapy response in HR+ breast cancer. Conclusion: Our study to some extent disclosed the effect of neoadjuvant chemotherapy on the TME of HR+ breast cancer, providing a rich resource for fully understanding the prediction and improvement of the efficacy of neoadjuvant chemotherapy, which may have significant clinical implications in the use of immunotherapy.
Have you got a Conflict of Interest?: No
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1537 Patient-reported outcomes for quality of life in elderly patients with advanced breast cancer in China X. Guan1, F. Ma1 1 National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Background: Due to the fact that elderly cancer patients usually suffer from the medical complications of cardiovascular and cerebrovascular diseases, respiratory diseases, diabetes, etc, they lack of the tolerance to surgery and chemotherapy. For advanced breast cancer (ABC) patients, the prolongation of survival and maintenance of quality of life (QoL) are the primary goals in clinical practice. The study aimed to investigate the QoL of elderly ABC patients receiving third-line and beyond chemotherapy-based regimens via patient-reported outcomes (PROs) in China. Methods: This national cross-sectional study enrolled ABC patients receiving third-line and beyond chemotherapy-based regimens in 59 centers all over China from March to April in 2021. Each patient filled out a questionnaire containing demographic information, medical history, and EORTC-QLQ-C30. The range method was used for the linear conversion of the PRO scores, which were converted into standardized scores of 0 to 100. Results: Valid data from totally 1015 patients were analyzed, including 226 elderly patients (aged≥60) and 789 young patients (aged＜60) . Compared to the young population, significantly more elderly patients suffered from the medical complications of hypertension (38.5% vs 16.6%, χ2=56.459, P<0.001), diabetes (19.9% vs 8.4%, χ2=30.717,P<0.001) and heart disease (11.1% vs 4.6%, χ2=23.266,P<0.001). The standardized scores of physical function, role function and cognitive function in elderly patients receiving third-line and beyond chemotherapybased regimens were significantly lower than those in the young population (mean 49.2 vs 54.8, P=0.004; 47.3 vs 53.4, P=0.004; 44.2 vs 50.4, P=0.002, respectively). However, no statistically significant differences were observed in the standardized scores of overall health status, emotional function, social function, economic status, family support and treatment cooperation between the two groups (P > 0.05). As for the dimension of symptoms, the standardized scores of fatigue, pain, dyspnea, insomnia, anorexia, constipation, and limb numbness for the elderly patients were significantly higher than those in the young population(60.6 vs 56.0, P=0.019; 55.8 vs 50.6, P=0.009 ；53.4 vs 47.3, P=0.006；61.2 vs 56.0, P=0.033；59.6 vs 53.1, P=0.002；52.4 vs 46.3, P=0.004；56.3 vs 51.4, P=0.028), while no significant differences were observed in the standardized scores of nausea, vomiting, diarrhea, hair loss and fever between the two groups (P > 0.05). Conclusions: Owing to larger proportion of medical complications, lower standardized scores in physical function, role function and cognitive function, and significant differences in a variety of symptom dimensions in elderly patients, the treatment decision making for elderly patients should take their own characteristics into consideration. Have you got a Conflict of Interest?: No
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154 Experience implementing a cancer care quality improvement program at Rwanda’s first public cancer hospital D. Tuyisenge1, L. Buswell2, F. Sebahungu3, L. Haskins1, T. Fadelu2, O. Habimana4, E. Benemariya1, F. Mugabo3,5, A. Ndayisaba1, C. Shyirambere1, H. Tuyishime1, A. Fata6, J. Cleveland2, S. Kadish2, S. Potiris2, D.A. Gundersen2, J.B. Bigirimana1, A. Manzi1, L. Pace6 1 Partners in Health, Kigali, Rwanda, 2Dana-Farber Cancer Institute, Boston, United States, 3Butaro Cancer Center of Excellence, Burera District, Rwanda, 4City Cancer Challenge, Kigali, Rwanda, 5Rwanda Ministry of Health, Burera District, Rwanda, 6Brigham and Women's Hospital, Boston, United States Background:There is scant literature on interventions to improve care quality for cancer in sub-Saharan Africa. Aim: We sought to develop and evaluate an initiative to build a culture of quality improvement (QI) at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer facility. Methods:The initiative started with a 1-day didactic QI training for all oncology staff. An additional 2-day training and longitudinal coaching by Rwanda- and US-based QI coaches was provided to 3 clinicians (2 nurses, 1 doctor) chosen as QI mentors. Mentors assembled teams to identify quality challenges and led projects on safe chemotherapy administration, chemotherapy wait times, and use of indicated imaging for breast cancer staging. Project administration and data collection was supported by a dedicated QI staff person. Teams then presented their projects to hospital staff and shared lessons learned. We evaluated the initiative through paper surveys assessing QI knowledge and attitudes immediately before and after didactic training and 15 months later (after project completion), and key informant interviews. Results:40 staff members (70% nurses) received didactic training and took the pre-training survey; 37 took both pre- and post-training surveys; 26 took pre-training and post-project surveys. The mentors and QI coordinator (n=4) served as key informants in post-project interviews. Compared with participants’ mean knowledge scores pre-training (67%, SD 1.2), scores improved modestly following training (76%, SD 1.2, p=0.008) and project implementation (77%, p=0.02). After project implementation, 16(61.5%) of the respondents felt the training program had impacted patient care at Butaro “a lot.” Staff who were QI team members (n=24) found the most valuable components of the initiative were teamwork (91.7%) and use of QI knowledge to solve problems (79.2%). In free-text survey responses, participants described the project as meaningful and useful to their work and building a culture of QI at BCCOE. Suggested improvements included allocating more time for training, refresher trainings, including hospital leadership in the projects, involving all staff in trainings, providing staff incentives for participation, and hiring a permanent QI coach. In interviews, mentors felt the initiative was successful and teams were motivated and enthusiastic. Dedicated staffing, teamwork, and support from hospital leadership were perceived as key to project success. Mentors recommended continued investment in a dedicated QI staff person. Conclusion:A QI curriculum including mentored projects was successfully led by local staff and enthusiastically received by clinicians at a Rwandan cancer facility. Dedicated support staff and leadership engagement were perceived as critical for sustainment. Strategies to measure QI culture adapted to and validated in settings like BCCOE would facilitate ongoing program evaluation. Have you got a Conflict of Interest?: No
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1540 New quality indicators for measuring cancer performance - a Delphi study in low- and middle-income countries J. Torode1, A. Aagarwal1, M. Mcleod2, K. Leung1, R. Sullivan1 1 Institute of Cancer Policy, Kings College London, Research Oncology, Bermondsey Wing, London, United Kingdom, 2London School of Economics & Political Science, London, United Kingdom Background: Health systems performance is key to delivery of sustainable quality cancer care and incremental improvement of patient satisfaction and ultimately patient outcomes. While the increasing scale of cancer services in low- and middle-income countries (LMIC) is welcomed, there is a paucity of country-generated evidence on the most feasible and relevant quality indicators (QI) a cancer centre should be collecting to shape these services and identify important areas of locally relevant research. Competing interests impose pressures to collect and report a wide range of data on already stretched clinical teams, with poor return in terms of value to service provision. Aim: A Delphi study conducted by the Global Oncology Group aims to achieve consensus with LMIC-cancer leaders on an evidence-based “critical path” of QIs that are fit for purpose. Our approach is to identify a core set of tier-1 measures spanning diagnosis, surgical, radiotherapy and systemic therapy services including palliative care. Once this foundation is in place, the expanded tier-2 and tier-3 measures provides more depth in each of these domains. Regular review of these datasets is a mechanism to generate systems level signals on weaker performing areas for further assessment. Critically, the package of QIs incorporates key governance mechanisms to institutionalize quality assessment. Methods: A literature review generated an initial listing of relevant cancer QIs. A steering group reviewed these for both feasibility of collection in LMICs and relevance in the clinical settings via two roundtable discussions and a Likert scale survey. Further, a set of bellwether or priority cancers were identified, to ensure targeting of the most relevant measures that reflect quality of care outcomes and offer the best opportunity for completeness of datasets in a routine manner. The resulting draft set of tiered QIs were then transformed into Delphi statements. Feedback will be collated over two rounds in the period May-August 2022. Results: The literature review confirmed the gap in publications on QIs in LMICs. With more published work in radiotherapy, then surgery and little in the field of medical oncology. The full results of the Delphi project will be reported with recommendations for their adoption in LMICs. Conclusion: A critical path approach was able to be developed and received support from cancer centre directors. Have you got a Conflict of Interest?: No
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1541 Drp1-mediated mitochondrial fission promoted cancer recurrence after liver ischemia reperfusion injury L. Shang1, Y. Ma1 1 Nanjing First Hospital, Nanjing, China Background: Hepatocellular Carcinoma (HCC) is the sixth most common cancer and the fourth most common cause of cancer-related death in the world. Liver resection and liver transplantation are the best means for the treatment of HCC, but the high incidence of cancer recurrence after surgeries severely limits the survival prognosis of HCC patients. The inevitable ischemia reperfusion injury (I/R) during liver surgery is considered to be one of the major factors leading to postoperative cancer recurrence. Aim: Our study focus on Drp1- mediated mitochondrial dynamics during liver I/R, and further explore the specific mechanisms of liver injury and cancer recurrence after I/R. Methods: Clinical samples undergoing liver surgery were collected to detect the expression of Drp1, and determine the correlation between Drp1 and ischemia duration. The mouse I/R model was established to clarify the changes in mitochondrial dynamics mediated by Drp1 after I/R. Mdivi-1 was injected intraperitoneally to evaluate the effects of inhibiting Drp1 on alleviating liver injury and oxidative stress, as well as on the formation of the pre-metastatic niche. The model of HCC recurrence after I/R was established to verify the important role of I/R in HCC recurrence and explore the protective effect of Drp1 inhibition on cancer recurrence after I/R. Results: First of all, we found that the expression of Drp1 increased with the prolongation of intraoperative ischemia time in clinical samples undergoing liver surgery by WB and IHC. Then we demonstrated Drp1-mediated mitochondrial fission enhanced in mouse model of liver I/R. Furthermore, Mdivi-1, inhibitor of Drp1, shown protective effects on liver injury. Moreover, we established a mouse model of HCC recurrence after I/R. We found that I/R could promote the recurrence of HCC, and Mdivi-1 could reduce the recurrence level of HCC after I/R. Subsequently, we clarified that I/R mainly caused the formation of tumor-promoting microenvironment, while the use of Mdivi-1 could reverse the formation of tumor-promoting microenvironment. Further exploration shown that the underlying mechanism by hepatocytes promoting HCC recurrence is more accumulation of mtROS in hepatocytes caused by mitochondrial fission, the mtROS promoted the synthesis and secretion of macrophage migration inhibitory factor (MIF), which mediates the hepatocytes promoting cancer recurrence. Conclusion: Liver I/R increased Drp1-mediated mitochondrial fission and thus then resulted in mitochondrial dysfunction. Utilizing Mdivi-1, the inhibitor of Drp1, could ameliorate liver injury and inhibit I/R-induced cancer recurrence significantly. The protective effects were predominately associated with decreased mitochondrial fission, which lead to less production of mtROS and thus reducing the release of MIF from damaged hepatocytes. The repression of MIF modulated both the inflammatory environment and the proliferation of CTCs, working together to suppress cancer recurrence. Have you got a Conflict of Interest?: No
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1543 Experimentation of screening and management of pre-cancerous cervical lesions in Burkina Faso K.T. BAKANHO1, G. HIEN1, F. SANGUISSO1, C.L. BONKIAN1, L. DESPRAT1, S. TORCHE1, A. CHEYRON2, I. GONZALEZ2, N. LAHMIDI2 1 Médecins du Monde, Ouagadougou, Burkina Faso, 2Médecins du Monde, seine saint denis, France Background and context: Cervical cancer (CC) is common in Burkina Faso: 23% of all cancers and 22% of the mortality rate of all cancers combined. It is the number one preventable cancer in women. The country has a 2020-2024 strategic plan against cancer, drawn up in December 2019, which includes the treatment of CC. Since 2018, Médecins du Monde has developed a project to support the prevention and management of CC in 9 health centres in the Baskuy health district in Ouagadougou. Aim: Theproject aims to contribute to the reduction of mortality and morbidity due to CC by screening and treating patients through a "screen and treat" approach in a single visit, in order to avoid loss to follow-up. Strategy / Tactics:The project supports the Ministry of Health in the fight against CC, by promoting early management of lesions in 9 health centres. Four of these centres have a laboratory allowing a "screen and treat" approach in one visit, recommended by the WHO. Programme / Policy process: The proposed algorithm is a DNA primary screening for human papilloma virus (HPV) followed by visual inspection with acetic acid (VIA) and the use of the thermo-coagulation technique for the treatment of precancerous lesions (PCL) (as an alternative to cryotherapy). Outcomes: The project screened 10,975 women aged 25-55 years, from May 2019 to December 2021, of whom 79.70% were screened for the first time and 65.20% chose the self-sampling method. Approximately 20% of women were screened HPV positive. 96% of women with a positive visual inspection with acetic acid and eligible for thermo-coagulation were treated. We found it difficult to implement a one-visit approach without disrupting the operation of the health centre, so only 15% of women benefited from this approach; yet the number of loss of sight was less than 15%, which was equivalent in the centres offering the one-visit approach and those that could not offer it. When sampling was done by health workers, the risk of loss to follow-up was higher than when self-sampling was used. What was learnt: (if relevant, please also detail here the potential of replicability) Thus, the "screen and treat" approach in one visit, could not be achieved but had little impact on the number of women lost to followup. These results show the importance of other determinants and contextual factors on the effect of loss to follow-up. Have you got a Conflict of Interest?: No
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1547 A multimodal deep learning model to predict regional lymph node metastasis of cervical squamous cell carcinoma Y. Li1, Q. Zhou1 1 Chongqing University Cancer Hospital, Chongqing, China Background: Lymph node metastasis is an important factor affecting the staging、prognosis and treatment options of cervical cancer patients. But no method has been found that can better predict preoperative lymph node metastasis. Aim: To develop adeep learning model based on multimodal information fusion of preoperative magnetic resonance imaging to predict regional lymph node metastasis in cervical squamous cell carcinoma. Methods: A total of 312 patients with cervical squamous cell carcinoma with lymph node metastasis and nonlymph node metastasis confirmed by histopathology after surgery were retrospectively analyzed. Patients were randomly assigned to the training group and the validation group in a ratio of 2:1, with 208 cases in the training group and 104 cases in the validation group. The central level of cervical lesions was selected, and highthroughput radiomics features were extracted from T1WI, T2WI, DWI, and DCE multi-sequence images of each patient using random forest and logistic regression methods. The results of the 5-fold cross-validation are used to select the best classification model, ROC curve was used to evaluate the diagnostic performance of the model. The AUC value, cutoff value, specificity and sensitivity were calculated respectively, and the optimal radiomics model was selected. Squamous cell carcinoma antigens were selected from the clinical data of patients to establish a clinical model, and a multivariate regression model based on radiomics-clinical characteristics was established. The ROC curve was also used to evaluate the diagnostic performance of the model, and the AUC value, cutoff value, specificity of the model were calculated. Results: We selected 16 radiological features to construct the LNM prediction model. The AUC of the T2WI model in the training group and the validation group were 0.893 and 0.856, respectively, and the AUC of the DWI model in the training group and the validation group were 0.861 and 0.842, respectively. Both models showed better performance in predicting benign and malignant lymph nodes. performance. The T2WI model of mixed SCC showed better ability to predict the differential diagnosis of LNM with AUCs of 0.954 and 0.935 in the training and testing groups, respectively. Conclusion: A clinical-imaging multimodal deep learning model based on magnetic resonance imaging can predict regional lymph node metastasis in cervical squamous cell carcinoma. Have you got a Conflict of Interest?: Yes If yes please specify:: The research may be submitted to other academic journals in the near future.
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1549 Cancer-related HTAs in England and Germany: A comparison of outcomes and evaluation criteria R. Schaefer1,2,3, D. Hernández1, M. Schlander1,2,3 1 Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany, 2Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany, 3Institute for Innovation & Valuation in Health Care (InnoVal-HC), Wiesbaden, Germany Background: The creation of official health technology assessment (HTA) agencies for the systematic evaluation of innovative medical interventions has been accompanied by controversial debate, in particular with regard to their methodological choices to inform health care decision-making. Aim: To explore outcomes (overall / cancer) and primary evaluation criteria of two influential HTA jurisdictions; the National Institute for Health and Care Excellence (NICE) in England, which relies heavily on health economic evaluations using cost-effectiveness, and, the Federal Joint Committee (GBA) in Germany as an exemplar for a rigorous application of evidence-based medicine (EBM). Methods: Data were extracted from all published NICE single technology appraisals (STAs) and GBA early benefit assessments (EBAs) from January 2011 – when the AMNOG legislation was introduced in Germany – to June 2018. We then identified matched condition-intervention pairs to systematically compare outcomes between the two agencies. Finally, the role of the assessment criteria on HTA outcomes was measured by means of regression analysis, including incremental cost-effectiveness ratios (ICERs) and the consideration of end-of-life (EoL) criteria (NICE) as well as comparative effectiveness (CE) and study design in terms of randomized-controlled trials (GBA). Results: NICE recommended 164/207 STAs (80%; cancer: 79/107, 64%), whereas GBA reported additional benefit in 151/262 EBAs (58%; cancer: 73/99, 74%). Matched pairs (n=119) support these findings; first, NICE (98/119, 82%) tends to evaluate drugs overall more favourably than GBA (80/119, 67%) and, second, cancer therapies seem to be assessed more positively by GBA (55/69, 80%) compared to NICE (49/69, 71%). Furthermore, regression results show that an increasing ICER raised the probability for a negative recommendation by NICE significantly (p<.01), and that EoL considerations were positively associated with cancer-related STAs (p<.01). In contrast to clinical study design (p>.1), CE based on patient-relevant endpoints (p<.01) had a significant positive impact on GBA EBAs. Conclusion: Our study confirms that NICE STA recommendations are driven by the incremental cost per qualityadjusted life year gained, and that GBA EBAs strictly focus on the principles of EBM. However, variations in cancer-related outcomes exist, which can be primarily explained by exceptional regulations such as Cancer Drugs Fund reconsiderations in England or the orphan drug status in Germany. Have you got a Conflict of Interest?: No
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1552 Deciphering a broad molecular signatures of the forkhead-box gene family across 33 human cancers D. Zheng1, X.m. Bi1, L. Chen1, D. Xu1, S. Zheng1, K. Li1 1 Hainan Medical University/College of Biomedical Information and Engineering,Key Laboratory of Tropical Translational Medicine of Ministry of Education, Cancer Institute of the First Affiliated Hospital of Hainan Medical University, Haikou, China Background: The forkhead box (FOX) transcription factor family is a group of evolutionarily conserved proteins that play crucial roles in cancer development and progression. Several FOX genes including FOXA1 and FOXM1 have been previously shown to be related to cancer development and progression. However, the overall picture of FOX gene family across human cancers is far from clear. Aim: To investigate the broad molecular signatures of the FOX gene family and yield potential insights into carcinogenesis. Methods: We performed analysis on multi-omics data (including genomics, epigenomics and transcriptomics) from The Cancer Genome Atlas to explore the mutation landscape and expression pattern of 49 FOX genes in 33 human cancers. We calculated the Pearson's correlation coefficient between FOX gene pairs (or target genes) based on gene expression both in cancer and normal samples, with co-expression network constructed. Results: Genomics analysis revealed that mutations in FOX genes can be detected in 18.06% of tumor patients and FOXP2 is the most frequently mutated gene. Additionally, the FOX gene family exhibited a strong cancer type-dependent CNV alteration pattern, with a higher amplification frequency in gynecological cancers. Gene expression profiling revealed a heterogeneous expression pattern of FOX genes across cancer types. Decreased number of co-expressed FOX genes were observed in tumor patients, thus suggesting the functional consistency of FOX gene family members. FOX target genes exhibited the same expression pattern with their corresponding FOX genes. Conclusion: Collectively, our findings explored the expression patterns of FOX genes across 33 human cancer types by integrating multi-omics data. These data may provide a better understanding of roles of FOX genes played in tumor progression and help to offer new avenues for uncovering tumorigenesis and unprecedented therapeutic targets. Have you got a Conflict of Interest?: No
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1555 Nomogram of hypothyroidism after IMRT and anti-PD-1 immunotherapy for NPC J.-Y. Tan1, Z.-R. Lu1, H. Liu1, C.-X. He1, K. Liao1, Y.-W. Yuan1, R.-H. Zheng1 1 Departmentof Radiotherapy ， Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China Background: Intensity modulated radiotherapy (IMRT) is the main treatment for patients with nasopharyngeal carcinoma（NPC）,causes acute and chronic damage to the surrounding normal tissues. With the wide application of immunotherapy(I) in the field of cancer, HT became a common immune related adverse reaction in the endocrine system. Purpose: Toexplore the possible risk factors of HT after treatment. Materials and methods: NPC patients who received IMRT±anti-PD-1 in the Affiliated Cancer Hospital & Institute of Guangzhou Medical University from January 2017 to June 2021 were collected. Patients were required to have continuous monitoring of thyroid function around treatment. GTV and organs at risk(OAR) were outlined with reference to the MRI images before treatment.The 3D conformal IMRT planning system (Pinnacle: TPS, Philips) was used to develop the RT plan. The clinical data and dosimetric parameters of patients were retrieved from the medical record system and IMRT planning system respectively. General clinical data, hematological indexes before treatment and radiation dose parameters were collected, and thyroid function indexes (TSH, FT3, FT4) were dynamically followed up. The optimal predictors of HT after treatment were determined by LASSO regression analysis and multifactor logistic regression analysis, so as to construct the nomogram prediction model. The prediction performance of nomogram was evaluated by ROC curve and calibration curve, and the generalization analysis ability of the model was verified internally. Results: A total of 463 patients with NPC were included in the study,331 received radiochemotherapy(RCT) alone,132 received RCT+I,and the median follow-up time was 19 months.HT occurred in 146 patients,with an overall incidence of 31.5% and a median follow-up time from the end of RT of 13.5 months.The incidence of HT at 3, 6, 9 and 12 months after the end of RT was 0.8%, 6.3%, 9.5% and 15.1%, respectively.The incidence of HT at 3, 6, 9, and 12 months after the beginning of I was 9.1%, 11.2%, 12.3%, and 13.4%, respectively. Among the 331 patients treated with RCT alone, HT occurred in 78 cases, with an overall incidence of 23.6%.Among 132 patients treated with RCT+ I, HT occurred in 68 cases, with an overall incidence of 51.5%(P＜0.001).After 1:1 propensity matching, the incidence of HT was 26.6% in the non-immunotherapy group and 44.3% in the I group (P=0.020).Six risk factors for HT were identified by nomogram: thyroid nodules, M-stage, chemotherapy cycles, I, V50 of thyroid, and EBVEA-IgA.The risk of HT was significantly higher in patients in NPC with thyroid nodules, distant metastases, chemotherapy cycles>7, with I, V50 ≥73.88% and EBVEA-IgA<4.10.The area under the ROC curve (AUC) for Nomogram was 0.828 (95% CI 0.776-0.880).The calibration curve and DCA curve showed that the nomogram was in good agreement with the actual observation and had a high clinical utility.In 331 patients treated with RCT alone, the independent risk factors for HT were thyroid nodules, M stage, chemotherapy cycles, V50, EBVEA-IgA.In 296 patients with non-metastases treated with RCT, the independent risk factors for HT were N stage,V45,chemotherapy cycles, thyroid nodules and EBVCA-IgA.Among 132 patients with NPC treated with I, the independent risk factors for HT were thyroid nodules, M-stage and EBVCA-IgA. Conclusion: The addition of I in patients with NPC treated with RCT increases the risk of HT.The risk of HT was significantly higher in the presence of thyroid nodules, distant metastases, with I, chemotherapy cycles >7, thyroid V50 ≥73.88% and EBVEA-IgA <4.10.The nomogram proposed in this study provides a valid assessment tool for the risk of HT in patients with NPC after IMRT+anti-PD-1, and provides theoretical guidance for individualized thyroid protection in patients at high risk of HT. Have you got a Conflict of Interest?: No
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156 Hazards of Smoking and Benefits of Smoking Cessation by Sex and Pancreatic Cancer: the Multiethnic Cohort I.T. Gram1, S.-Y. Park2, L.R. Wilkens2, L. Le Marchand2, V.W. Setiawan3 1 UiT The Arctic University of Norway, Community medicine, Tromsø, Norway, 2University of Hawai'i Cancer Center, Population Sciences in the Pacific Program, Honolulu, United States, 3University of Southern California, Population and Public Health Sciences, Los Angeles, United States Background: In the US, pancreatic cancer (PC) ranks as number ten among men and eight among women for incidence, while PC ranks as number four for cancer deaths in each sex. In 2019, the PC incidence burden was predicted to increase from 2018 to 2040 by as much as 50% in the US. Smoking was established as a cause of PC already in the 1980’s. In the US, the smoking epidemic in women lagged 10-20 years behind that in men during the last century. In 2000, smoking prevalence was 25.7% for men and 21.0% for women in the US. Aim: To examine whether the risk of PC due to cigarette smoking and the benefits of smoking cessation differed by sex. Methods: We analyzed data from 192,035 participants aged 45-75 years, enrolled in the Multiethnic Cohort Study in 1993-1996. We identified PC cases via linkage to the Hawaii and California Surveillance, Epidemiology, and End Results Program cancer registries through December 2017. Results: During a mean follow-up of 19.2 years, we identified 1,936 incident PC cases. Compared with female current smokers, male current smokers had smoked for more years, smoked more cigarettes per day and, consequently, had smoked more pack-years. It was likewise for former smokers. In multivariate Cox regression models, as compared with sex-specific never smokers, current smokers had for men a 48% [hazard ratio (HR)=1.48, 95% confidence interval (CI): 1.22,1.79] and for women a 49% (HR=1.49, 95% CI: 1.24,1.79) elevated risk of PC (Pheterogeneity: 0.64). Compared with their sex-specific current smokers, former smokers showed for men a 26% (95% CI: 0.57, 0.97) and for women a 13% (95% CI: 0.66, 1.15) decrease in risk of PC within 5 years after quitting. After more than ten years of quitting, both sexes had a PC risk comparable to that of never smokers. Both sexes showed a dose-response association with PC for the three measures (duration, number of cigarettes per day, number of pack-years) of smoking exposure among current- and for years after quitting among former smokers and PC risk (all Ptrend <0.001). Conclusions: Our results suggest that although women smoke on average less than men, the smoking related increase in PC risk and the benefits of cessation, do not differ by sex. Possible sex difference in the smoking related risk of PC and the benefits of smoking cessation should be further in larger studies. Have you got a Conflict of Interest?: No
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1560 The exploration of optimizing IMRT clinical target volume in lower neck to protect the thyroid gland in NPC J.-H. Feng1, H. Liu1, K. Liao1, W.-Z. Qiu1, J.-Y. Tan1, Y.-W. Yuan1, R.-H. Zheng1 1 Departmentof Radiotherapy ， Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China Background: With the continuous application of immunotherapy, thyroid function injury is more serious , protecting thyroid in nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy(IMRT) becomes much more important. Purpose: To explore the optimization of clinical target volume (CTV) delineation in lower neck to protect the thyroid gland in NPC treated with IMRT. Materials and methods: Part I: With researching the magnetic resonance imaging(MRI) of 670 NPC patients who were newly treated in the Department of Radiotherapy, Affiliated Cancer Hospital & Institute of Guangzhou Medical University from February 2010 to September 2020, the lower cervical lymph nodes were divided into 6 subregions from inside to outside (shown in the figure below) taken by the boundaries as follows: the inner lines, midlines and the outer lines of the common carotid arteries as well as the midlines and the outer lines of the jugular veins (these five lines are perpendicular to the target sketch),then we analysed the positive rate of subclinical metastasis lymph nodes (≥4mm) to find out the extremely low area with positive rate.
Part II: A total of 40 patients with NPC who received radical radiotherapy from June 2019 to January 2020 in the Department of Radiotherapy, Affiliated Cancer Hospital & Institute of Guangzhou Medical University were collected, all of which had positive metastasis lymph nodes (N1 or N2, AJCC 8th edition) and were needed to delineate the lower neck necessarily. When delineating the CTV of the lower neck region, namely CTV2, we omitted the delineation of the area with a low positive rate of subclinical metastasis of cervical lymph nodes found in Part I of our research , and then we made a new radiotherapy planning which was compared with the one made by conventional CTV2 without omitting the target area (the other factors were the same). Then we evaluated the irradiation dose of thyroid in the new radiotherapy planning at length.
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Result: In Part I, our research showed that there was a correlation between the N stages and the distribution of metastatic lymph nodes in IV level of the patients with NPC (P<0.05). Further stratified analysis of N stages found that there was no any positive metastasislymph node ≥ 4mm in the patients' 1-5 subregions with N0 disease, 1-4 subregions with N1 disease and the patients' 1-3 subregions with N2 disease, which may be ignored when outlining the CTV2. InPart II , N1 patients were omitted to delineatethe 1-4 subregions and N2 patients were omitted to outline 1-3 subregions for the 40 patients (N0 patients were not included in the study due to routinely rejecting irradiation of the lower neck area). The dosimetric analysis of radiotherapy planning showed that compared with before target reduction, the median thyroid dose V50 with N1 disease after shrinking lower neck was 35.3% was less than the one before reduction which was 54.1%（P=0. 000）；The median value of V50 in patients with N2 diseasewas 36.9% was less than the one before shrinking the fieldwhich was58.3%（P=0. 000）. Regardless of the patients with N1 or N2 staging, the irradiation dose of common carotid artery (V60), esophagus (Dmean) and trachea (Dmean) decreased as well after the reduction of CTV2 in the lower neck target volume, while the optimized target area would not cause significant changes of the irradiation doseand target dose of other organs at risk (OAR) ,such as spinal cord +5mm, brainstem+1mm, optic nerve, optic chiasm, eye, lens, hypophysis, mandible, temporomandibular joint, temporal lobe and cochlea (P>0.05). Conclusion: The CTV of the lower neck of NPC has a reduced space. On the basis that patients with N0 disease are exempted from irradiation, it can be omitted the delineation of 1-4 subregions in patients with N1 disease and 1-3 subregions in patients with N2 disease in view of the absence of definite positive subclinical metastasislymph nodes. In this case, it not only protects the thyroid, but also protects the common carotid artery, esophagus and trachea without affecting the target dose and other OARs’ protection after reducing and optimizing the lower neck target area. However, further clinical researches remain needed to confirm the result that the benefit of dose protection can be transformed into the clinical benefit. Have you got a Conflict of Interest?: No
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1563 Challenges and Opportunities for Pediatric Cancer Surveillance: US National Childhood Cancer Registry B. Kohler1, L. Penberthy2 1 North American Association of Central Cancer Registries, Springfield, United States, 2National Cancer Institute, Surveillance Research Program, Bethesda, United States Background and context: Childhood cancer surveillance presents many unique challenges and opportunities including confidentiality issues, release of data involving rare cancers, parental concerns, residential history ascertainment, research ethics, etc. Aim: Develop a comprehensive childhood cancer data base for research based on cancer registry surveillance data supplemented by key clinical and socio-demographic information. Strategy / Tactics: The US has recently launched the Childhood Cancer Data Initiative to build a community centered around childhood cancer care and research data. Through enhanced data sharing we can improve our understanding of cancer biology to and enhance preventive measures, treatment, quality of life and survivorship as well as ensure that researchers learn from every child with cancer. Programme / Policy process: A key component of this initiative is the National Childhood Cancer Registry (NCCR)which expands core cancer surveillance data to include elements specific to childhood cancer and critical to pediatric cancer research.. The NCCR shall: (1) facilitate the linkage of confidential Central Cancer Registry databases with existing patient data, (2) build and support a broader connected data infrastructure to enable sharing of childhood cancer data from multiple data sources, (3) monitor and assess quality of data through automated and manual processes, (4) develop processes for data utilization by qualified investigators, and (5) assist in development of an administrative and governance plan for long term operations. Through linkage with external data sets such as radiology and imaging reports, pathology slides and digitation, pharmacy data, residential histories, social determinants of health, measures of financial toxicity, recurrence, subsequent primaries and other relevant data, we will build a comprehensive depiction of clinical research data for children and AYA diagnosed with cancer. Outcomes: We anticipate that this database will become an unprecedented resource for research into pediatric cancers and rare tumors. What was learnt: (if relevant, please also detail here the potential of replicability); A full discussion of barriers, challenges and opportunities will be presented with solutions and descriptions of appropriate tools. Many of the solutions developed could address issues encountered in LMICs and assist in developing comparable systems for international pediatric cancer research. Have you got a Conflict of Interest?: No
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1564 Identification of Metabolism-Related Genes for Predicting Peritoneal Metastasis in Gastric Cancer C. Tian1, J. Zhao1, D. Liu1, J. Sun1, C. Ji1, Q. Jiang1, H. Li1, X. Wang1 1 Zhongshan Hospital,Fudan University, General Surgery Department, Shanghai, China Background: Gastric cancer is the fifth most common cancer and the third most common cause of cancer-related death globally. It is also one of the most common cancers in China.Peritoneal metastasis is very common in gastric cancer, while metabolism is a significant factor to promote the metastasis of tumor. Aim: In our study, we intended to investigate the predictive value of metabolism-related genes (MRGs) in recurrent gastric cancer patients with peritoneal metastasis. Methods: The sequencing data of mRNA of GC patients were obtained from Asian Cancer Research Group (ACRG) and the GEO databases (GSE53276). The differentially expressed MRGs (DE-MRGs) between a cell line without peritoneal metastasis (HSC60) and one with peritoneal metastasis (60As6) were analyzed with the DEseq2 package. According to the LASSO regression, eight MRGs were identified as crucially related to peritoneal seeding recurrence in patients. Then, disease free survival related genes were screened using Cox regression, and a promising prognostic model was constructed based on 8 MRGs and verified in an ACRG cohort. Results : We confirmed 713 DE-MRGs and the enriched pathways. Pathway analysis found that the MRG-related pathways were extremely related to tumor metabolism development. With the help of Kaplan-Meier analysis, we found that the group with higher risk GC patients had worse rates of peritoneal seeding recurrence than the group with lower risk in the cohort. Conclusion: This study developed an eight-gene signature correlated with metabolism that could predict peritoneal seeding recurrence for GC patients. This signature could be a promising prognostic model, providing better strategy in treatment. Have you got a Conflict of Interest?: No
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1568 Empowerment of primary health care system in cancer control: Experience from India and Kenya. D. Pendharkar1, F. Asirwa2 1 Sarvodaya Cancer Institute, Medical Oncology, Faridabad, India, 2International Cancer Institute, Medical &Haemato-Oncology, Eldoret, Kenya Background and context: Majority of the health systems in lower and middle income countries generally have a similar administrative health structure. Village as the lowest primary health care point but district or county headquarter is the lower most technologically organized health unit offering some level of multi- specialty integrated health service. Often times, this unit is devoid of many equity and financial challenges because of its direct control from state administration. Empowerment of this level is the key to improvement of cancer control . Aim: This model is established to decentralise sustainable replicable cancer care at scale, bringing it to periphery through empowerment of alternate oncology workforce via task sharing, capacity building and continued mentoring. Strategy / Tactics: The Programme is based on fundamentals of using existing health care system, existing infrastructure, existing workforce using minimal financial outlays. Programme / Policy process: Medical officers or equivalent were trained for a short period of time and were given continued technical support for looking after varied cancer related activities. States were asked to offer necessary administrative backups like delineating space, notifying personnel, modifying essential drug list to include anti cancer drugs.States were empowered to create and publicly announce operational guidelines for cancer Programme. Outcomes: District cancer care programme was launched in 2014 in India in one star and replicated by five more..In 2019 a similar programme was launched in Kenya through EMPOWER clinics in county hospitals.In India 198 physicians and 400 nurses have been trained in cancer care in eight states. More than 150 district hospitals have distinct identifiable areas designated as cancer ward, allocated for care of -cancer patients. Dedicated physician and nurses assist patients in navigating diagnostics, therapies, follow ups, end of life care, palliative care.In Kenya more than 14 County hospitals have distinct cancer care unit offering similar services, including assistance in diagnostics, therapeutics, follow up. Kenyan units additionally are engaged in outreach services related to early detection and prevention activities through mentorship from the hub-organization. More than 300 health care workers trained and over 2000 access multi-diciplinary TumorBoards on a weekly basis in addition to cancer preceptorship courses offered. Over 30,000 women screened for breast and/or cervical cancer and 4,000 linked to care. What was learnt: District Cancer Care Programme and Empower clinic is a sustainable , replicable model of cancer care delivery at scale.This model optimizes resources, reduces redundancies and enhances access to cancer care. Partnerships with private organizations and other strategic local and international organizations is key to success and sustainability of the model. Have you got a Conflict of Interest?: No
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1570 Genome-wide classification of mutation events in somatic whole-genome sequencing data of 19 cancer types F. Dietlein1,2,3, A.B. Wang3, C. Fagre3, A. Tang2,3, N. Besselink4, E. Cuppen4,5, C. Li6, S.R. Sunyaev7,8, J.T. Neal3, E.M. Van Allen2,3 1 Boston Children's Hospital, Harvard Medical School, Computational Health Informatics Program, Boston, United States, 2Dana-Farber Cancer Institute, Harvard Medical School, Department of Medical Oncology, Boston, United States, 3Broad Institute of Massachusetts Institute of Technology and Harvard, Cancer Program, Cambridge, United States, 4University Medical Center Utrecht, Center for Molecular Medicine and Oncode Institute, Utrecht, Netherlands, 5Hartwig Medical Foundation, Amsterdam, Netherlands, 6St. Jude Children’s Research Hospital, Department of Tumor Cell Biology, Memphis, United States, 7Brigham and Women's Hospital, Harvard Medical School, Division of Genetics, Boston, United States, 8Harvard Medical School, Department of Biomedical Informatics, Boston, United States Background: Somatic mutations are a crucial part of tumor diagnostics and tumor classification. Our current understanding is mainly limited to mutations in 2% of the genome that encodes for proteins, whereas the role of somatic mutations in noncoding regions is not well understood. Aim: To expand our understanding of somatic mutations from protein-coding regions toward the remaining 98% of the genome and establish a classification of noncoding mutation events across the genomes of 19 cancer types. Methods: We harmonized somatic whole genomes of 3,949 patients with 19 cancer types from the publicly available PCAWG and HMF sequencing consortia. We developed and combined three methods for detecting recurrent mutation events and classified them by their position in the cancer genome. Results: We found an average of 7.5 events per tumor type in protein-coding regions, which largely corresponded to known driver mutations. In noncoding regions, we found an additional 3.7 events per cancer type near genes with unique expression in a specific cancer type, including ALB in liver, KLK3 in prostate, SFTPB in lung, SLC5A12 in kidney, and TG in thyroid cancer. These tissue-specific events were associated with a mutagenic process that introduces long insertions and deletions in genomic regions surrounding these tissue-specific genes. Comparing mutation patterns in whole genomes with single-cell expression data from matched normal tissue revealed that these events reflect possible imprints of the expression programs of the tumor cells of origin. Moreover, we found 3.8 noncoding events per cancer type in regulatory regions of expression, many in the promoters and enhancers of cancer-relevant genes, including BCL6, FGFR2, RAD51B, SMC6, TERT, XBP1, and many others. As a proof-of-principle follow-up experiment, we characterized the role of breast cancer mutations near XBP1 that mainly accumulated in a regulatory region outside of its promoter and the canonical regulator enhancer regions from normal tissue. We validated the effects of these mutations on gene expression by combining a CRISPR-interference screen with luciferase reporter assays, illuminating the potential of genomewide approaches paired with harmonized sequencing cohorts to capture mutation patterns in both known and unknown regulatory regions of the noncoding genome. Conclusion: While somatic mutations in coding regions are dichotomously classified into drivers versus passengers, our study indicates that a different paradigm is needed for understanding mutation events in the rest of the genome, where they are associated with a more diverse set of biological processes. By establishing a genome-wide compendium of mutation events in 19 cancer types, our study fosters the informational value of whole-genome sequencing, ultimately paving the way for advancing genome-based tumor classifiers in the clinical setting. Have you got a Conflict of Interest?: No
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1575 Experience in Keep Maintain Cancer Parients With COVID-19 in Outpatient Setting e. zaenal1 1 Dharmais Cancer Hospital, Medical Services, Jakarta, Indonesia Background and context: COVID-19 cases in Indonesia began in March 2019, as did the COVID-19 cases at Dharmais Cancer Hospital, Jakarta, Indonesia. There were still few references to COVID-19 in cancer patients at that time and also the limited number of laboratories that could carry out COVID-19 RT PCR, causing hospitals to be in a state of confusion for few moments. However, our Director immediately loking for funds to build a laboratory for RT PCR and then it operational in July 2019. After that, we were more confidence to make a decision so that patients who will undergo aerosol procedures, long-term contact procedures and cancer therapy (surgery, systemic therapy and radiation) are screened for COVID-19 by naso and oropharynx swab aims to protect patients and also employees. Many patients with confirmed COVID-19 results. Because there are no symptom, our pulmonologist instructed to do self-isolation or centralized isolation. At first, we thought that the responsibility for monitoring patients was by nearest primary care, so for confirmed COVID-19 patients, we reported them to the local health office and also to primary care according to the patient's domicile. We also ordered to immediately refer back to us after the isolation is complete. Within a month we felt the patient had delayed cancer therapy and we were unable to monitor the patient. So we made a decision so that we can continue to monitor patients. Aim: Continue to monitor cancer patients with COVID-19 in outpatient settings, so that if there are symptoms they can be immediately directed to handle them and if they have recovered from COVID-19 they can immediately continue cancer therapy. Strategy / Tactics: Patients whose COVID-19 PCR results are positive, will be contacted by our case manager by phone, confirmed whether there are indeed no complaints or there are, then educated on what to do if they are isolated. One of the family members is expected to come for further education, then take medicines. Then the patient is scheduled to be swab again according to the pulmonologist's instructions. If it is negative, the patient will immediately be rescheduled to the doctor then continue therapy. The limited manpower made us reorganize the role of health workers in management. The case manager and general practioner who previously only managed patients at the hospital, then participated in monitoring the condition of patients who were self-isolating at home. Outcomes: Screening for patients who are about to undergo procedures has resulted in a high number of COVID19 patients with cancer, but the incidence of death is not as high as the references we have seen What was learnt: With good screening and monitoring of patients, the incidence of death due to COVID-19 in cancer is not too high if we compare it with existing references. The COVID-19 era teaches that hospitals have to adapt quickly for the safety of patients and employees Have you got a Conflict of Interest?: No
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1580 Developing sustainable infrastructure for international cancer comparisons: Holistic approaches from the ICBP H. Hall1, S. Harrison1, M. Vithyananthan1, C. Lynch1 1 Cancer Research UK, Stratford, United Kingdom Background: The ICBP is an international collaborative partnership seeking to improve patient outcomes globally across 7 high income countries. All partners have a similar spend on health care, universal access to healthcare and population-based cancer registries to ensure research is comparable and insights are relevant and actionable to all partners. However, comparing cancer data and intelligence can be complex. Aim: Highlight data standardisation and harmonisation challenges as well as local barriers to international collaboration, share examples of local best practice, and identify a new sustainable model for conducting international comparisons. Methods: Recruitment of key informants, representing cancer data expertise from Denmark, Norway, the United Kingdom, Australia, Canada, New Zealand to provide insights on challenges, best practises, and recommendations via questionnaire and interviews. Themes will be categorised to develop a new framework for international data comparison. Results: Complexity and challenges exist in international cancer data comparisons. Variation exists in the priorities, barriers and infrastructure across countries. Informed discussions provide evidence and insights for the development of a new international cancer data comparison model. Conclusion: The ICBP draws upon 12 years of international collaboration experience and the knowledge of key cancer data experts to develop a framework for more efficient, sustainable international data comparisons. Have you got a Conflict of Interest?: No
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1581 Healthcare strengthening towards Optimum Outcomes for Women’s Cancers in Kenya through the EMPOWER program D. NYONGO1,2, J. WAMBUA3, F. CHITE4 1 Africa Cancer Foundation, NAIROBI, Kenya, 2County First Ladies Association, NAIROBI, Kenya, 3Roche Kenya, Health Policy, NAIROBI, Kenya, 4International Cancer Institute, Oncology, ELDORET, Kenya Background and context: With the growing burden of women cancers in East Africa, integrating cancer screening and treatment to optimize horizontal care delivery models is a paramount approach to strengthening women-centered and cost-effective primary healthcare. EMPOWER is a unique partnership with the Kenyan County Governments and partners in the public and private sectors. Aim:To demonstrate integration of cancer prevention and treatment within primary healthcare across the country, with the power to shape and direct policy towards women’s cancer programs. Strategy/Tactics:Building a self-sustaining and seamless cancer patient journey requires an understanding of the main ecosystem policy stakeholders and creation of a well equilibrated triangle of access, quality and cost to society. The entry point with the highest number of eligible women and ease of acceptance is identified and the clinics are set up with the understanding of the local context. Policy Process: We leverage the power of partnership of key policy influencers in the counties. The fundamental value proposition of EMPOWER clinics is to enhance processes in health care, offering an integrated way of organizing women’s centric cancer clinics, and getting a buy-in from the policy makers. Outcomes: 14 EMPOWER clinics have been set up since 2019 (12 of them during the COVID-19 pandemic). Over 300 health workers have been trained to provide facility and community-based screening and early detection for breast cancer, cervical cancer, hypertension and diabetes through an integrated health system with patient navigation. 25,502 women have been screened and educated about minimizing the intergenerational effects of breast and cervical cancer, with a cost effective hub-and-spoke oncological mechanism. Central government policy makers have been incorporated after successful demonstration of these clinics and official funding mechanisms have been set up by the Council of Governors for CFLA to ensure program sustainability. What was learnt:Understanding the local policy framework and key stakeholders made the realization and implementation of a woman-centered health and cancer clinics possible, with the co-defined problem, codesigned solution and a well-orchestrated co-created implementation. A functional health eco-system depends on a well calibrated engagement and identification of policy key stakeholders (makers, influencers, implementers). Have you got a Conflict of Interest?: No
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1582 Comparisons of radiation-induced acute toxicities from external beam radiotherapy during breast irradiation K.A. Kyei1, F. Pratt-Ainooson2 1 University of Ghana, Oncology, Accra, Ghana, 2Korle-Bu Teaching Hospital, Radiotherapy, Accra, Ghana Background:Background: The common toxicities of breast irradiation include dermatitis, fatigue, breast/chest wall pain, sore throat, nausea, dysphagia, and arm edema. Specific dosimetry and physical differences exist between the toxicities of patients on different teletherapy machines. These differences may influence the incidence and severity of the acute toxicities experienced by breast cancer patients undergoing breast irradiation. Aim: To compare the acute radiation toxicities between 6 MV LINAC and Co-60 teletherapy machines during breast irradiation. Methods: Hundred and twenty female breast cancer patients undergoing treatment participated in the study. Sixty-four (64) of these patients were on the Co-60 teletherapy machine while 56 were on the 6 MV LINAC. Weekly assessments were made through the CTCAE grading scale version 4.0. Descriptive and inferential statistics using an independent two-sampled t-test, ANOVA, Pearson’s Chi-square and Fisher’s exact tests were performed. Results: Dermatitis, fatigue, sore throat, and breast (chest) pain were the radiation toxicities found among the breast cancer patients undergoing treatment on the two machines. The mean predominant radiation doses associated with the onset of dermatitis, fatigue, sore throat, and chest pain in the breast cancer patients were 22.32Gy, 22.48Gy, 13.59Gy, and 19.27Gy respectively for treatment with a statistically significant (p=0.0173). Radiation dermatitis was the most dominant acute radiation toxicity recorded, and its incidence and severity. The range of Fisher’s p-values (0.689 – 0.999) between the acute radiation toxicities with both machines revealed no statistical significance. Conclusion:Radiation dermatitis was the dominant acute toxicity, both in incidence and severity for patients treated. There was no statistical significance in the incidence and severity of acute radiation side effects. Have you got a Conflict of Interest?: No
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1584 Lipid metabolic reprogramming of HSCs can be detected in AML patients by single-cell RNA sequencing X. Xu1, S. Chen1, Y. Zhao1 1 The First People’s Hospital of Foshan, Hematology, Foshan, China Background Lipid metabolic reprogramming is now a hallmark of cancer. Tumor cells have the capacity for uncontrolled cellular proliferation, and they must efficiently produce energy and biomass components in order to expand and metastasize. The changes required for the metabolic phenotype are directly driven by oncogenic events and the hypoxia and nutrient deprivation imposed by the tumor microenvironment. As a result, cancer cells exhibit a broader metabolic profile, which increases the ability of tumor cells to cope with harsh living environments. However, studies on the lipid metabolism of hematopoietic stem cells (HSCs) in acute myeloid leukemia (AML) patients are currently inadequate. Objective The purpose is to reveal the genes and signal pathways related to lipid metabolism and explore the clinical application value of lipid metabolism remodeling in AML. Methods We performed single cell sequencing of peripheral blood samples from untreated patients and patients in remission. Single-cell capture and cDNA synthesis were performed by the BD Rhapsody Single-Cell Analysis System. The resulting libraries were sequenced via multiple runs on an Illumina Next-Seq instrument. Result Single cell sequencing reveals a higher proportion of HSCs in the peripheral blood of untreated AML patients than in relief patients After quality control, a total of 6758 high-quality cells were further analyzed from the AML(M5) patients. The cells were classified into 15 clusters using the Harmony algorithm, with 19–2441 cells per cluster. A total of 15 cell types were identified based on the established set of marker genes for 7 cell types, including HSCs, Monocytes (CD16- and CD14+), NKT cells, T cells, Erythroids and Neutrophils (Fig.1 A B) proportion of HSCs was up to 67.1% in the untreated group and 1.4% in the relief group (Fig.1 D).For untreated patients, HSCs in the peripheral blood is mostly abnormal proliferation of cancer cells, in fact, this is also in line with the actual condition. However, it is a scientific question and challenge to precisely identify HSCs in peripheral blood, and our results suggest high CD34 expression in HSCs, but this is not a very specific marker (Fig.1 C). Differential genes are enriched in lipid metabolism related signaling pathways in AML patients. We found that differential genes in newly diagnosed untreated samples were enriched in lipid metabolism pathways (Adipocytokine signaling pathway and Lipid and atherosclerosis), suggesting that the imbalance of lipid metabolism may promote the proliferation of malignant cells (Fig.2 A). The differential genes included NFKBIA, TNF, ACSL1, SOCS3, TNFRSF1B, CCL3, NFKBIA, NCF2, TLR2, HSPA6, IL1B, CXCL8 and HSP90AB1(Fig.2 B). Conclusion Abnormal lipid metabolism exists in HSCs in the peripheral blood of AML patients, implying that genes involved in lipid metabolism reprogramming can be serve as targets for therapy and markers for prognosis evaluation. Fig1 Fig2
Have you got a Conflict of Interest?: No
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1587 SKIN ONCOPLASTIES : O-TO-Z TECHNIQUE A TECHNIQUE OF CHOICE ? N. Zongo1, N.M. Ouédraogo1, M. Windsouri1 1 joseph ki-zerbo, UFR/SDS, departement of surgery, Ouagadougou, Burkina Faso Abstract Background: In developing countries, the long delays in consultation lead to a delay in diagnosis and management of the skin tumours. The lesions are often large and brings the problem of skin coverage after their resections.Several reconstruction techniques allow skin coverage. The objective of this study is to describe the place of O-to-Z techniquein the surgical treatment of skin cancers in Ouagadougou. We hypothesized that O-toZ techniquereduces healing times and the number of dressings compared with directed wound healing. Patients and methods: It was a two-centre, retrospective, descriptive study on O-to-Z techniquein skin cancers. It included patients who underwent surgery betweenJanuary 1st, 2013 andMarch 30th, 2021 in Ouagadougou. Scar quality and healing time in Z-plasty were compared with those of secondary healing. We used the student’s T test Results: In 8 years and 3 months, 171 skin cancers were identified. The mean time to consultation was 13.6 months.The average size of the tumours was 9 cm. An O-to-Z techniquewas performed in 42 cases, being 58.3% of the patients operated on. The average healing time was 15 days. It was four and a half times shorter in O-to-Z techniquethan in secondary healing. Ischaemic necrosis of the Z-corner was noted in 7 cases. The recurrence rate in O-to-Z techniqueand secondary healing was 7.1% and 9.1% respectively. Hypertrophic or keloidal scars were noticed in 7 cases and hypochromia in 2 cases. Conclusion: O-to-Z techniqueis a technique of choice for skin coverage after large resections in surgical oncology. It reduces the healing time and the cost of postoperative care without increasing the risk of tumour recurrence. Key words: cancer-skin - O-to-Z technique–healing Have you got a Conflict of Interest?: No
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1593 Integrating Indigenous Ways of Doing and Knowing with Western Evaluation Approaches K. Quiambao1, G. Mitchell1, M. Cernigoy1, T. Hammond1, D. Keen1, N. Fitzgerald1, S. Didic1 1 Canadian Partnership Against Cancer, Toronto, Canada Background and context: With funding support from the Partnership, 29 First Nations, Inuit and Métis organizations, governments, and cancer agencies are working on theFirst Nations, Inuit and Métis Strategy Development and Practice Change Implementation Initiative (the Initiative)to develop and implement Peoplesspecific, self-determined priorities as part of the Canadian Strategy for Cancer Control. The Partnership acknowledges the distinct Indigenous nations of First Nations, Inuit and Métis and is committed to reconciliation. Aim: The Partnership seeks to gather and share lessons learned throughout the Initiative using a developmental evaluation approach. There are key learnings relevant for others in assessing and describing the progress towards outcomes for cancer health systems; gathering evidence to inform future work; and sharing lessons learned among First Nations, Inuit and Métis partners to advance and sustain a culture of authentic collaboration in service of reconciliation and Indigenous self-determination within cancer care settings. Strategy / Tactics: The Partnership developed an evaluation approach through collaboration and engagement with First Nations, Inuit and Métis partners. In February 2021, we partnered with an Indigenous-led evaluation group. The evaluation seeks to integrate western and First Nations, Inuit, and Métis ways of knowing and doing. Key to the inclusion of an Indigenous perspective is the building of collaborative, open, and trusting relationships with the partners as they reflect on their implementation journey. Programme / Policy Process: Participatory methods were used including key informant interviews, collective sense-making workshops, and engaging with a partner advisory committee. Thus far, an Interim Evaluation Report has been developed, marking the halfway point of the evaluation. Engagement is underway to share back and validate early findings with partners and to seek guidance to inform the next phase of the evaluation. A final evaluation report is scheduled for August 2023. Outcomes: This evaluation demonstrated an innovative approach of engagement through collaborative and ongoing relationship-building with First Nations, Inuit and Métis partners. There is an opportunity to learn from the process and outcomes of the evaluation to inform future work of the Partnership and partner organizations. Early discussions are occurring around how to mobilize and apply early findings at the Partnership. What was learnt: Building trusting relationships is the first and most important step in developing a strong evaluation approach. In our continued engagement, it is important to ensure that partners remain at the center and to surface these perspectives in the development, implementation, and reporting of the evaluation. The findings also shed light into actions that the Partnership could take to advance reconciliation and Indigenous selfdetermination. Have you got a Conflict of Interest?: No
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1594 Surveillance Systems for Monitoring Cervical Cancer Elimination efforts in HIV clinics across SSA S. Asangbeh1,2, M. Davidovic1,3, K. Taghavi4, T. Dhokotera1,2, K. Wools-Kaloustian5, K. Anastos6, S.P. Boni7,8, J. Bohlius1,4 1 Swiss Tropical and Public Health Institute, University of Basel, Epidemiology and Public Health, Basel, Switzerland, 2Graduate School for Cellular and Biomedical Sciences, University of Bern, Public Health and Epidemiology, Bern, Switzerland, 3Graduate School for Health Sciences, University of Bern, Public Health and Epidemiology, Bern, Switzerland, 4Institute of Social and Preventive Medicine, University of Bern, Public Health and Epidemiology, Bern, Switzerland, 5Indiana University School of Medicine, Medicine, Indianapolis, United States, 6Albert Einstein College of Medicine, Medicine and Epidemiology, Bronz, New York, United States, 7Programme National de Lutte contre le Cancer, Abidjan, Cote D'Ivoire, 8Programme PAC-CI, Site ANRS, Cote D'Ivoire, Abidjan, Cote D'Ivoire Background: Measuring progress towards the WHO 90-70-90 targets for the elimination of cervical cancer (CC) requires surveillance systems for the systematic collection, analysis, interpretation and dissemination of data. Women living with HIV (WLHIV) require frequent screening to treat pre-cancer and avert CC development. Aim: We assessed surveillance systems available for CC prevention in WLHIV in sub-Saharan Africa (SSA). Methods: We conducted a cross-sectional survey in HIV clinics across SSA to identify and describe data systems and global indicators for monitoring CC prevention efforts. Sites were eligible if they participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) (https://www.iedea.org/) consortium in the subSaharan African region and offer CC prevention services on- or off-site. We developed a survey with guidance from the International Agency for Research on Cancer (IARC) CANscreen5 tool (https://canscreen5.iarc.fr/) and the WHO Toolkit for Cervical Cancer prevention and control programmes (https://www.who.int/publications/i/item/9789241514255). We assessed the availability of data systems, data aggregation and reporting; and key indicators reported by sites. Results: We surveyed 30 HIV clinics in 14 countries (table 1). The majority of sites (83%) were from the public sector and located in urban areas (73%). All sites had data systems that were mostly electronic (93%). Half of them (50%) collected data on CC prevention (figure1). Systems for CC data aggregation and reporting were present in 37% of sites. Several sites had WHO global monitoring indicators in place: number of girls vaccinated by age 15 (13%), number of women screened (47%), number screened positive (47%), number further assessed (13%) and number treated (40%). About a third of the sites (37%) specifically linked HIV status to existing indicators (figure 2). CC data was linked either to hospital-based registries (17%), or population-based registries (10%). Conclusion: Data systems for collecting individual client level data were widely available. However, CC data collection, aggregation and reporting for key CC elimination pillars are on-going in only about half of the sites. Efforts for data availability should be harnessed particularly for WLHIV, and effectively scaled-up to improve monitoring of CC elimination targets.
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Table 1: Summary of results
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Figure 1: Distribution of countries included in survey stratified by data collection status. Have you got a Conflict of Interest?: No
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1596 Every Day Counts: a randomized pilot lifestyle intervention for women with metastatic breast cancer P. Sheean1, L. Matthews2, A. Visotcky3, A. Banerjee3, A. Moosreiner4, K. Kelley5, C. Chitambar6, P. Papanek7, M. Stolley8 1 Loyola University Chicago, Applied Health Sciences, Maywood, United States, 2University of North Carolina at Chapel Hill, Center for Gastrointestinal Biology and Disease, Chapel Hill, United States, 3Medical College of Wisconsin, Institute for Health and Society, Division of Biostatistics, Wauwatosa, United States, 4Medical College of Wisconsin, Milwaukee, United States, 5Kelly Kinetics, LLC, West Allis, United States, 6Medical College of Wisconsin, Froedtert Clinical Cancer Center, Milwaukee, United States, 7Marquette University, Department of Physical Therapy, Milwaukee, United States, 8Medical College of Wisconsin, Division of Hematology and Oncology, Wauwatosa, United States Background: Traditionally, women with metastatic breast cancer are excluded from nutrition and/or physical activity (PA) intervention trials under the assumptions that: 1) exercise could be unsafe or pose additional burdens, 2) changes in lifestyle habits would have little impact on quality of life (QOL) or disease trajectory, or 3) women with MBC lack interest in such trials. Aim: We designed Every Day Counts,a randomized pilot trial framed by the American Cancer Society nutrition and PA guidelines, to challenge these assumptions and to explore feasibility, adherence, safety and potential program efficacy. Methods:Women with clinically stable metastatic breast cancer were recruited to complete an interview, dual energy x-ray absorptiometry imaging and phlebotomy at baseline and post-intervention. Multidimensional quality of life, symptom burden, lifestyle behaviors (nutrition and PA) and biomarkers of prognosis were procured and quantified.Women were randomized to the immediate intervention or a waitlist control arm. The 12-week intervention included a curriculum binder, lifestyle coaching (in-person and telephone-based sessions) and intervention support (activity monitor, text messaging, cooking classes.) Women in the waitlist control were provided monthly text messaging. Results: Forty women were recruited within 9 months (feasibility). Women in the immediate intervention attended 86% of all 12 weekly coaching sessions (adherence) and showed significant improvements in general QOL (p=0.001), and QOL related to breast cancer (p=0.001), endocrine symptoms (p=0.002) and fatigue (p=0.037), whereas the waitlist control did not (all p values ≥ 0.05) (efficacy). PA significantly increased for women in the intervention compared to control (p<0.0001), while dietary changes were less evident across groups due to high baseline adherence. No significant changes in biomarkers or lean mass were noted, yet visceral adipose tissue declined (p=0.001). No intervention-related injuries were reported (safety). Qualitative feedback strongly supports the desire for a longer intervention with additional support. Conclusion: Lifestyle interventions are of interest, safe and potentially beneficial for women with clinically stable metastatic breast cancer. A larger trial is warranted to better support these findings and to explore the mechanisms underlying how lifestyle interventions impact quality of life. Have you got a Conflict of Interest?: No
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16 Surviving Breast Cancer in Nigeria: Beyond awareness and treatment N. EJEDIMU1 1 The Judah Foundation for Breast Cancer, Patient Navigation and Community Engagement, Lagos, Nigeria Background and context: Breast Cancer awareness in Nigeria is still focused on awareness and treatment. The Issues: Young women below 40 are not factored into screening guidelines and most women dying from breast cancer in Nigeria are below 40. A lot of women being treated for breast cancer in Nigeria are not treated by oncologists. After a biopsy is done , the doctors start treatment without waiting for the immunohistochemistry report therefore ensuring that treatment is done blindly and not based on the type of cancer patient has. There is inadequate information and course of treatment for Stage 4 Metastatic Breast Cancer. Recurrence is high because aftercare is not explained properly to the women, that is if of course they were treated properly. There is a need to ensure that patients are empowered with enough information that ensures they can ask questions and understand their treatment plan. Health literacy after diagnosis is non-existent when it comes to breast cancer care in Nigeria. Doctors are constantly capitalising on the patients by using fear as a weapon. Disease recurrence, progression and spread are hardly discussed. There is a dearth of information on breast cancer in terms of survivorship as focus is always more on treatment and surgery. This study is based on data from a breast cancer support group as well as information gotten from social media via instagram Aim: Encourage community engagement to ensure accountability. Bring these issues to light so that adequate training and knowledge exchange programs can be done for healthcare professionals. Empowering women with the right information and guidance so they can ask questions. Strategy / Tactics: Constant desemination of information in various forms - art, pictures, music and story telling in easy and understandable formats. I call it Art meets Breast Cancer. Patient Advocacy as a tool for awareness in reaching women especially in the area of screening Programme / Policy process: The ARUTA PROJECT- Awareness, read ,understand, take action. This program is aimed at understanding how constant messaging spurs the community to be proactive about their health and take action. There are various ways of taking action: Going for screening, Knowing what questions to ask the healthcare professional to ensure you are in safe hands, it also aims at encouraging survivorship, dispelling misinformation that stops the women from taking back control after breastcancer. Outcomes: Empowerment, a better understanding of breast health which is the focus. If you understna dthe importance of breast health, awareness in every area of breast cancer from diagnosos to aftercare is more effective What was learnt: (if relevant, please also detail here the potential of replicability) The power of breaking down information to a level the community understands that helps them to take action without fear . Technology is a game changer in aiding awareness as it makes it easier to reach more people. Have you got a Conflict of Interest?: No
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1605 How international collaboration has accelerated cancer outcomes and policy: Lessons Learned from ICBP H. Hall1, S. Harrison1, G. Lyratzopoulos2, E. Nolte3, S. McPhail4, S. Johnson1, I. Soerjomataram5, C. Lynch1, M. Vithyananthan1 1 Cancer Research UK, Stratford, United Kingdom, 2University College London, London, United Kingdom, 3London School of Hygiene and Tropical Medicine, London, United Kingdom, 4Public Health England, London, United Kingdom, 5International Agency for Research on Cancer, Lyon, France Background: The International Cancer Benchmarking Partnership (ICBP) is a collaboration of researchers, data experts, clinicians and policy makers seeking to improve patient outcomes globally through its translation of evidence into policy and practice in high-income countries. Aim: Showcase how the ICBP assesses cancer control from different lenses across the cancer care continuum by triangulating incidence, mortality and survival to potential population-level, cancer policy, and health care system factors. Highlight changes in national cancer policy strategies that have contributed to improvements in cancer outcomes and the factors preventing progress being made. Methods: Data is collected through cancer outcome analyses, novel data linkage and analysis exploring patient pathways, key informant interviews and literature review of health system organisation structure. Policy impacts are derived from semi-structured interviews with key informants from Denmark, Norway, the United Kingdom, Australia, Canada, New Zealand. Results: International variation exists in cancer outcomes, health system structures, and in configuration and movement through cancer patient pathways. Challenges in data comparability have been mitigated with novel data harmonisation tools. Novel cancer indexes and data linkages have been developed to better identify factors contributing to observed variations. Collaboration with international stakeholders has contributed to policy, practise and clinical change across multiple jurisdictions. Conclusion: Narrowing cancer differences internationally requires a multi-pronged, multi-disciplined approach. The ICBP is in a unique position to bring together cancer experts and key decision-makers from across the world to identify variations as well as share knowledge and best practice. Have you got a Conflict of Interest?: No
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1608 The burden of health-related out-of-pocket cancer costs in Canada- a case-control study using linked data B. Essue1,2, T. Bushnik3, S. Fung2, R. Garner3, Z. Sun2, E. Gomez Navas2, C. de Oliveira1,2,4 1 Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 1. Toronto, Canada, 2Canadian Partnership Against Cancer, Toronto, Canada, 3Statistics Canada, Ottawa, Canada, 4York University, Heslington, United Kingdom Background: The burden of out-of-pocket costs among cancer patients/survivors in Canada is not well understood. The objective of this study was to examine the health-related out-of-pocket cost burden experienced by households with a cancer patient/survivor compared to those without, examine the components of healthrelated costs and determine who experiences a greater burden. Data and methods: This study used a data linkage between the Survey of Household Spending and the Canadian Cancer Registry to identify households with a cancer patient/survivor (cases) and those without (controls). The out-of-pocket burden (out-of-pocket costs measured relative to household income) and mean costs were described and regression analyses examined the characteristics associated with the household out-of-pocket burden and annual out-of-pocket costs. Results: Households with a cancer patient/survivor had a non-significant association with health-related out-ofpocket burden and a marginally significant association with annual costs compared to control households (b: 0.24; 95% CI: -0.14,0.62 and b: 0.06; 95% CI: -0.005,0.1 respectively). Cases with colorectal cancer patient/survivor had a significantly higher out-of-pocket burden compared to controls (mean difference: 1.0%, 95% CI: 0.18,0.46). Among cases and controls, the lowest income quintile households experienced the highest burden. Interpretation: Despite a universal health care system, Canadian households incur a burden from health-related out-of-pocket costs and lower income households experienced the highest burden. We demonstrate the feasibility of measuring the disparities in out-of-pocket burden between socioeconomic groups using routinely collected data, providing a novel, system-level, equity-informed performance indicator. Routine monitoring of this indictor could enable a better understanding of the role of the cancer system in advancing equity. Have you got a Conflict of Interest?: No
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1610 Together Equitable Accessible Meaningful (TEAM) Cancer Care for Sexual and Gender Minorities M. Pratt-Chapman1, R. Brazinskaite1, S. Adler1, S. Shirima1 1 GW Cancer Center, Washington, DC, United States Background: Sexual and gender minorities (SGM) have unique healthcare needs that are not being met adequately by healthcare professionals. Experienced past and anticipated discrimination prevent these individuals from seeking care, resulting in detrimental health outcomes. LGBTQI-competent care is sparsely covered in the medical curriculum or not covered at all. The Together, Equitable, Accessible, Meaningful (TEAM) Cancer Care for SGM Patients Training aimed to address the unique health care needs of SGM cancer patients. Aim: A pilot study was conducted to assess feasibility of conducting an educational intervention to increase provider competence and advance organizational changes for SGM-supportive care, and to explore impact of the intervention at patient, provider, and organizational levels. Methods: Seven teams of four healthcare professionals (n=28) were invited to participate in the training. Feasibility was assessed by completion of the 17.5 hour TEAM SGM training and completion of all evaluations. The training included self-paced online content and live webinars. Percent achievement of action plans were assessed at 3- and 6-months post-intervention. Paired sample t tests were used to assess learner change in individual knowledge, attitude and clinical preparedness and organizational change based on assessment of factors for affirming care. Independent samples t-tests were used to assess patient experience changes from baseline to 6-months post-test. Action plans reported on progress at 6 months post-intervention. Results: Of the 28 participants who started the training, 27 participants completed the training, for a 96.4%. All learners (n=28) completed baseline assessments, and n=22 completed post-intervention assessments. For patient experience, n=86 baseline surveys were collected across three healthcare settings and n=141 post-intervention surveys were collected. All teams submitted action plans for change with measurable goals. Data analyses showed statistically significant improvements to learner outcomes. Patient experience data and action plan progress are currently being analyzed. In addition to the above primary findings, teams identified the following implementation facilitators to accomplish action plan goals: resources, introduction of inclusion training, and buy-in from leadership. Teams identified the following barriers to implementation: limited and delayed communication between stakeholders/workgroup members, limited staff engagement, complications setting up in-person trainings due to pandemic, lack of consistency in data collection, and provider de-valuing of the relevance of changes to practice. Conclusion: Affirming care for sexual and gender minorities is critical to address health disparities and improve care for these populations. Have you got a Conflict of Interest?: No
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1654 Seven field 3-Dimensional Conformal Radiotherapy to spare critical structures in Cervical carcinoma. K. PERUMAL1, S. RAJ2, A. SAHA3, R.K. NARAYANASAMY2 1 Sri Ramachandra Institute of Higher Education and Research, Chennai, India, 2CBCC-Saveetha University,, Chennai, India, 3Apollo Gleneagles Cancer Hospital, Kolkatta, India Background: Cervical Cancer is leading cancer in young females of developing nations, most likely to be treated by definitive radiation due to advanced stage at presentation precluding surgery. Aim: This study explores the utility of Seven fields- Three Dimensional Conformal Radiotherapy (7F-3DCRT) Vs 7 field Intensity Modulated Radiotherapy (7F-IMRT)using6 Mega Voltage (6 MV) Linear accelerator (LINAC) in locally advanced Cervical cancer (LA-CC) patients. Methods: Five consecutive LA-CC patients were planned with 7F-3DCRT and 7F-IMRT with same dataset using XiO version 4.8.0 planning system.The mean of the 10 patients were calculated for percentage of volume covering 56Gy (and volume in cc) to GTV and 50.4 Gy to PTV, mean and max dose of rectum and bladder. Results: The mean values of dose volume histogram of 5 patients were compared. Comparing 7F-IMRT vs. 7F3DCRT – 56 Gy isodose line covered 98.37% of GTV & 24.95 cc vs. 97.17% of GTV and 24.25 cc.50.4 Gy isodone line covered 97.56% of PTV & 1644.165 cc vs.96.35% of PTV & 1630.24 cc. Rectum mean and maximum dose were 44.02 Gy & 70.27 Gy vs. 46.24 Gy & 72.07 Gy. Bladder mean and maximum dose were 47.38 Gy & 65.17 Gy vs. 48.53 Gy & 66.37 Gy. Conclusion: 7F-IMRT achieves better sparing of critical structures compared to 7F-3DCRT.The clinical impact of reduced acute and chronic toxicity needs further evaluation.Given the simplicity of planning and dose delivery, 7F-3DCRT can be used in high volume centers instead of conventional 3DCRT and unaffordable patients. Have you got a Conflict of Interest?: No
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1641 Risk factors and implications of colon and rectal cancer diagnosis as an emergency presentation: an ICBP study G. Lyratzopoulos1, S. McPhail2, S. Johnson3, M. Barclay1, R. Swann3, I.M. Emergency Presentations Study Group1 1 University College London, Epidemiology of Cancer Healthcare and Outcomes (ECHO), London, United Kingdom, 2National Disease Registration Service, NHS Digital, Leeds, United Kingdom, 3Cancer Research UK, London, United Kingdom Background: Greater understanding of international cancer survival differences is needed, particularly for common cancers with effective screening methods, such as colon and rectal cancer. Aim: To identify the predictors and consequences of colon and rectal cancer diagnosis through emergency presentation in different international jurisdictions, and possible associations with jurisdiction-level cancer survival. Methods: Using federated analysis, we examined cancer registration and linked hospital admissions data from 14 jurisdictions in Australia, Canada, Denmark, New Zealand, Norway, and the UK on patients with colon and rectal cancer during 2012-2017. This was an International Cancer Benchmarking Partnership (ICBP) study. Emergency presentation was defined as diagnosis of cancer within 30 days after an emergency hospital admission. We examined predictors of emergency presentation and associations between emergency presentation and shortterm mortality. We meta-analysed estimates across jurisdictions and explored jurisdiction-level associations between cancer survival and the percentage of patients diagnosed as emergencies. Results: In 305,954 patients with the 2 studied cancers, there was consistent cross-jurisdictional variation in the percentage of emergency presentation by cancer site, colon cancer having the highest overall percentage on average (29.4% [65,547/222,629]), and rectal cancer the lowest (12.1% [10,051/83,325])). Older age (i.e., 75-84 years and 85 years or older, and advanced stage at diagnosis, were consistently (across jurisdictions) associated with increased emergency presentation risk for both cancers. A J-shaped association for colon cancer was also apparent, whereby the youngest age group (15-64) had greater risk compared to that immediately older (65-74). Across the jurisdictions, emergency presenters had substantially greater risk of 12-month mortality than nonemergency presenters for both cancers. A 10% increase in jurisdiction-level percentage of emergency presentations was associated with a decrease in jurisdiction-level 1-year survival for colon cancer (−7.0% [−13.0 to −1.2, p=0.022]), though no such association was apparent rectal cancer (p=0.89). Conclusion: Internationally, large proportions of patients with colon cancer are diagnosed through emergency presentation. Older age, and advanced stage at diagnosis are consistently associated with an increased risk of emergency presentation for both colon and rectal cancer, which strongly predicts mortality and probably contributes to international differences in colon cancer survival. Future research is needed to examine the frequency of emergency presentation, particularly of colon cancer, in other countries. Improving screening participation or introducing population-based bowel cancer screening programmes in countries where no such programmes currently exist, can help to reduce emergency presentations from colon and rectal cancer, and reduce associated mortality. Have you got a Conflict of Interest?: No
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1642 THE BENCHISTA PROJECT: INTERNATIONAL BENCHMARKING OF CHILDHOOD CANCER SURVIVAL BY TUMOUR STAGE K. Pritchard-Jones1,2, A. Lopez Cortes1, L. Botta3, F. Didonè3, A. Cañete4, C. Stiller5, L.L. Hjalgrim6, Z. Jakab7, B. Zeller8, G. Gatta3, BENCHISTA Project Working Group 1 UCL GOS Institute of Child Health, Developmental Biology & Cancer Research Department, London, United Kingdom, 2International Society of Paediatric Oncology, SIOP President, Meierskappel, Switzerland, 3Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Evaluative Epidemiology, Milano, Italy, 4Hospital UiP La Fe, Valencia, Spain, 5National Cancer Registration and Analysis Service, Oxford, United Kingdom, 6University of Copenhagen, Department of Pediatrics and Adolescent Medicine, Copenhagen, Denmark, 7Semmelweis University, 2nd Department of Pediatrics, Budapest, Hungary, 8Oslo University Hospital, Division of Pediatric and Adolescent Medicine, Oslo, Norway Background: Significant disparities in childhood cancer (CC) survival rates are reported across geographical regions. More advanced tumour stage at diagnosis may contribute to this observed variation. Comparable data recording at a population-level is required to analyse these variations and highlight the need for earlier diagnosis and improvements in treatment. Aim: To test the hypothesis that variation in tumour stage at diagnosis underlie variations in childhood cancer survival rates between countries and to stimulate use of the internationally recognised consensus “Toronto Staging Guidelines” for paediatric cancers (TG) by participating Population Based Cancer Registries (PBCRs). Lastly, the project aims to further enhance working relationships between PBCRs, clinical services and tumour-specific clinical study groups. Methods: PBCRs apply TG at diagnosis to six specific tumours (Neuroblastoma, Wilms Tumour, Medulloblastoma, Rhabdomyosarcoma, Ewing Sarcoma and Osteosarcoma) diagnosed 2014-2017. Variables related to relapse, treatment and other non-stage prognostic factors will be also collected where feasible. A depersonalised patientlevel dataset is transferred to the INT for analysis of survival by stage and stage distribution, with international comparisons between large geographical regions comparable to previous EUROCARE studies. Results: Sixty-six PBCRs from twenty-four European countries, Australia, Brazil, Canada, Japan, and USA have joined the project. Forty-four PBCRs require a Data Transfer Agreement (DTA) whereas for twenty-one PBCRs the project’s ethical approvals are sufficient. The DTA has required >15 months to be finalised between legal parties. To standardise application of TG, on-line training workshops have been held and are available publicly (https://bit.ly/Training-and-Workshops). A total of >8,000 staged cases are expected, with datasets already flowing to the INT. Regular updates are provided at https://bit.ly/BENCHISTA. Conclusion: Differences in interpretation of data protection laws and definitions of anonymous versus depersonalised for data sharing have been found. Despite this, a strong collaborative effort has been established between the participating PBCRs to comply with data protection and information governance. This project makes effective use of PBCRs’ capabilities to enrich registry data with information to understand reasons for variation in outcomes at a population level. Have you got a Conflict of Interest?: No
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1645 Using meta-analysis in international cancer epidemiology studies – an example from ICBP Module 9 EP project G. Lyratzopoulos1, M. Barclay1, S. McPhail2, R. Swann3, S. Johnson3, I ICBP M9 Emergency Presentations Study group1 1 University College London, Epidemiology of Cancer Healthcare and Outcomes (ECHO), London, United Kingdom, 2National Disease Registration Service, NHS Digital, Leeds, United Kingdom, 3Cancer Research UK, London, United Kingdom Background: International comparisons of cancer control measures traditionally focus on jurisdictional-level estimates (e.g., cancer survival, by country). However, it is often important not only to compare the average differences between jurisdictions, but to additionally examine the consistency of within-jurisdiction differences (e.g., by age group) across countries. Meta-analysis is a useful tool to achieve this objective. Aim: Across jurisdictions participating in the International Cancer Benchmarking Partnership (ICBP) Module 9 study, to examine the degree of consistency in the risk of cancer diagnosis within 30 days from an emergency hospital admission (i.e., emergency presentation) by cancer site, sex, and age group; and to examine the degree of cross-jurisdictional consistency in mortality risk associated with emergency presentation. Methods: We used random effect meta-analysis to pool estimates of associations and used the I-squared statistic (representing the proportion of total variation between jurisdictions not explained by sample variation) to measure statistical heterogeneity. Associations were examined for each of cancer site, age group and sex, for their association with risk of emergency presentation; and between emergency presentation and risk of 12-month mortality. Results: There was overall concordance across the jurisdictions in the direction and strength of adjusted associations with emergency presentation, particularly regarding the associations with age group and sex. Associations with cancer site (treating colon cancer as the reference group) were generally concordant across the jurisdictions, with occasional variability in direction.Meta-analysis indicated that emergency presentation was strongly associated with increased 12-month mortality across all jurisdictions. Although associations were qualitatively concordant, their size differed by jurisdiction (I2=93%, tau2=0.01). Conclusion: We have shown that there are consistently strong associations between cancer site or age group and emergency presentation risk, across the participating jurisdictions. Further, the association between emergency presentation and mortality are also strong and consistent. The findings illustrate how meta-analysis can be used to describe both within- and between-jurisdiction inequalities in the context of international cancer epidemiology studies. This approach can help to identify health systems with greater / lesser degrees of disparity, thereby helping to target and guide local interventions. Have you got a Conflict of Interest?: No
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1649 Associations between older age and risk of cancer diagnosis through emergency presentation: an ICBP study G. Lyratzopoulos1, S. Johnson2, M. Barclay1, R. Swann2, S. McPhail3, I ICBP Module 9 Emergency Presentations Study gruop1 1 University College London, Epidemiology of Cancer Healthcare and Outcomes (ECHO), London, United Kingdom, 2Cancer Research UK, London, United Kingdom, 3National Disease Registration Service, NHS Digital, Leeds, United Kingdom Background: Greater understanding of international cancer survival differences is needed. Contributing factors such as age-related variation in diagnostic routes associated with worse prognosis need to be better described. Aim: To describe age-related disparities in the frequency of emergency presentations in different jurisdictions. Methods: Using a federated analysis model, we analysed cancer registration and linked hospital admissions data from 14 jurisdictions in Australia, Canada, Denmark, New Zealand, Norway, and the UK, on patients with oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer during 2012-2017. This was an International Cancer Benchmarking Partnership (ICBP) study. Emergency presentation was defined as diagnosis of cancer within 30 days after an emergency hospital admission. Using logistic regression, we examined associations between age group and risk of emergency presentation. We meta-analysed estimates across jurisdictions, particularly focusing on associations with age. Results: In 857,068 patients with the eight studied cancers, there was consistent variation in the percentage of emergency presentations by age group. Across the jurisdictions, older age (i.e., 75-84 years and 85 years or older, was consistently associated with increased emergency presentation risk. The percentage of emergency presentations was highest in the oldest age group (85 years or older) for 110 (98%) of 112 jurisdiction-cancer site strata. Meta-analysis confirmed these findings, though highlighting a degree of variability (I-squared=70%) in age disparities in risk of emergency presentation across the jurisdictions. Conclusion: Internationally, large proportions of patients with eight common cancers are diagnosed through emergency presentation, and older age is consistently associated with an increased risk of emergency presentation, though with some variability within jurisdictions. Future research is needed to examine the degree to which age differences in emergency presentation risk reflect tumour or other factors such as patient behaviour or health system factors. Have you got a Conflict of Interest?: No
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1651 Exploring the link between cancer policies and cancer survival across ICBP countries E. Nolte1, M. Morris1, S. Landon1, M. McKee1, M. Seguin1, J. Butler2, M. Lawler3 1 London School of Hygiene & Tropical Medicine, London, United Kingdom, 2The Royal Marsden Hospital, London, United Kingdom, 3Queen's University Belfast, Belfast, United Kingdom Background: Cancer survival has improved globally, but there remain substantial differences between countries. This continued disparity has been linked to variation in progress in cancer control in different countries but there is lack of empirical evidence that has established the impact of cancer control policies on cancer outcomes. Aim: To systematically trace the evolution of cancer policies in seven ICBP countries since 1995, and present the findings of an exploratory analysis which links cancer policy consistency cancer survival. Methods: We systematically searched and analysed national or regional cancer plans and strategies and reports of plan implementation and evaluation from 20 ICBP jurisdictions. We first mapped timelines of cancer policy evolution for all 20 jurisdiction and, for a sample of 10 jurisdictions, synthesised the information into five categories: dedicated institute or oversight function; cancer plan; action/implementation plan; explicit budget for plan implementation; and plan evaluation. We then assigned scores of between 0 and 1 to whether a given category was present or absent, and weighted scores for consistency. Summed scores were then correlated with trends in survival from seven cancers (colon, lung, oesophagus, ovarian, pancreas, rectum, stomach) between 1995-2014. Results: All ten jurisdictions had implemented some form of high-level structure tasked with overseeing, steering or delivering cancer control policies or strategies between 1995 and 2014; all had also published at least one major cancer plan. However, there was great variation in oversight mechanisms, ranging from institutionalising cancer control (such as in New South Wales and Ontario) to cancer steering groups or taskforces (Denmark, Northern Ireland, Wales). Frequency and consistency of cancer plans also varied, from a succession of plans that build on each other (Denmark, New South Wales, Ontario) to the publication of isolated plans (New Zealand, Northern Ireland). We found a a positive, albeit weak, correlation of cancer policy consistency and improvements in survival over time for six of the seven cancer sites. Jurisdictions that score highly on cancer policy consistency also showed large improvements in survival for most cancer sites over time. Conclusion: Jurisdictions that have implemented cancer control policies that are consistent over time tended to be more successful in improving survival for a wide range of cancers Our analysis provides an important first step to systematically capture and evaluate what are inherently complex policy processes. Nevertheless, the findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes. Have you got a Conflict of Interest?: Yes If yes please specify:: The study was supported by a grant from the International Cancer Benchmarking Partnership (ICBP). Mark Lawler is Chair of the ICBP Programme Board, John Butler is the Lead ICBP Clinical Advisor.
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1654 Seven field 3-Dimensional Conformal Radiotherapy to spare critical structures in Cervical carcinoma. K. PERUMAL1, S. RAJ2, A. SAHA3, R.K. NARAYANASAMY2 1 Sri Ramachandra Institute of Higher Education and Research, Chennai, India, 2CBCC-Saveetha University,, Chennai, India, 3Apollo Gleneagles Cancer Hospital, Kolkatta, India Background: Cervical Cancer is leading cancer in young females of developing nations, most likely to be treated by definitive radiation due to advanced stage at presentation precluding surgery. Aim: This study explores the utility of Seven fields- Three Dimensional Conformal Radiotherapy (7F-3DCRT) Vs 7 field Intensity Modulated Radiotherapy (7F-IMRT)using6 Mega Voltage (6 MV) Linear accelerator (LINAC) in locally advanced Cervical cancer (LA-CC) patients. Methods: Five consecutive LA-CC patients were planned with 7F-3DCRT and 7F-IMRT with same dataset using XiO version 4.8.0 planning system.The mean of the 10 patients were calculated for percentage of volume covering 56Gy (and volume in cc) to GTV and 50.4 Gy to PTV, mean and max dose of rectum and bladder. Results: The mean values of dose volume histogram of 5 patients were compared. Comparing 7F-IMRT vs. 7F3DCRT – 56 Gy isodose line covered 98.37% of GTV & 24.95 cc vs. 97.17% of GTV and 24.25 cc.50.4 Gy isodone line covered 97.56% of PTV & 1644.165 cc vs.96.35% of PTV & 1630.24 cc. Rectum mean and maximum dose were 44.02 Gy & 70.27 Gy vs. 46.24 Gy & 72.07 Gy. Bladder mean and maximum dose were 47.38 Gy & 65.17 Gy vs. 48.53 Gy & 66.37 Gy. Conclusion: 7F-IMRT achieves better sparing of critical structures compared to 7F-3DCRT.The clinical impact of reduced acute and chronic toxicity needs further evaluation.Given the simplicity of planning and dose delivery, 7F-3DCRT can be used in high volume centers instead of conventional 3DCRT and unaffordable patients. Have you got a Conflict of Interest?: No
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1656 Lung cancer screening in Canada – projected impact Z. Sun1, J.H.E. Yong1, OncoSim team 1 Canadian Partnership Against Cancer, Toronto, Canada Background Low-dose CT (LDCT) screening has been shown to reduce lung cancer mortality and is now recommended for high-risk individuals. Aim The study objective was to project the impact of lung cancer screening using a mathematical model. Methods The analysis was conducted using OncoSim-Lung, a Canadian mathematical simulation model of lung cancer. The model simulates the smoking history and lung cancer cases of the Canadian population over time. To estimate the impact of screening, we simulated two scenarios: (i) no screening and (ii) biennial screening for individuals aged 55-74 years that have at least a 1.5% risk of developing lung cancer in the next 6 years. We assumed screening starts in 2022, reaches a 40% participation rate in the subsequent 10 years and a rescreening rate of 70%. In sensitivity analysis, we simulated two other commonly considered eligibility criteria: (i) 30 pack-years of smoking history; and (ii) risk threshold of 2% to develop lung cancer in 6 years. We also varied the screening age criteria to start screening at age 50 years. Results In a cohort of high-risk individuals eligible for lung cancer screening (PLCOm2012 risk >=1.5%) in the next 20 years, lung cancer screening could detect lung cancer earlier, which could lead to 13,000 fewer lung cancer deaths in Canada. Lung cancer screening would require additional healthcare resources: 150,000 more low-dose CT scans per year and 16,000 more respirologist visits per year. The impact on surgery and radiotherapy would be small. All three criteria were shown to be highly cost-effective. The 30 pack-years criteria would lead to more younger individuals eligible for screening, while the 2% criteria would screen fewer individuals. Reducing the start age would not increase screen volume much because few individuals under age 55 years meet the screening eligibility criteria. Conclusion Commonly considered lung cancer screening strategies appeared to be highly cost-effective, compared with no screening. Some groups start smoking earlier; reducing start age could reduce disparities in screening without significant impact on screening resources. Have you got a Conflict of Interest?: No
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1657 Planning for resilient screening operations using discrete event simulation: Example of HPV testing in Peru A. Rositch1, A. Singh2, N. Lahrichi3, V. Paz-Soldan4, A. Kohler-Smith5, P. Gravitt6, E. Gralla2 1 Johns Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore, United States, 2George Washington University, Engineering Management and Systems Engineering, Washington, United States, 3Polytechnique Montreal, Mathematics and Industrial Engineering, Montreal, Canada, 4Tulane School of Public Health and Tropical Medicine, New Orleans, United States, 5Asociación Benéfica Prisma, San Miguel, Peru, 6University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, United States Background: The World Health Organization (WHO) has called for the elimination of cervical cancer. Unfortunately, implementation of cost-effective prevention and control strategies has faced significant barriers, such as insufficient guidance on best practices for resource and operations planning. Aim: We aim to demonstrate the value of discrete event simulation (DES) in implementation science research and practice, particularly to support the programmatic planning for sustainable and resilient delivery of healthcare interventions. Our specific example shows how DES models can inform planning for operations of a new human papillomavirus (HPV)-based screen and treat program in Iquitos, an Amazonian city in Peru. Methods: Using data from a time and motion study, a cervical cancer screening registry, and in conjunction with multilevel stakeholder engagement, we developed a DES model to conduct virtual experimentation with “what-if” scenarios that compare different workflow and processing strategies under resource constraints and disruptions to the screening system. Results: Our simulations show how much the screening system’s capacity can be increased at current resource levels, how much variability in service times can be tolerated, and the extent of resilience to disruptions such as curtailed or diverted resources. The simulations also identify the resources that would be required to scale up for larger target populations or to increase resilience to disruptions, illustrating the balance between resilience and efficiency. Thus, our results demonstrate how DES models can inform specific resourcing decisions but can also highlight important tradeoffs and suggest general “rules” for resource and operational planning. Conclusion: Multilevel planning and implementation challenges are not unique to sustainable adoption of cervical cancer screening programs but represent common barriers to successful scale-up of many preventative health interventions worldwide. DES represents a broadly applicable tool to address complex implementation challenges identified at the national, regional, and local levels across settings and health interventions – how to make effective and efficient operational and resourcing decisions to support program adaptation to local constraints and context so that they are resilient to changing demands, promoting maintenance with fidelity over time. Have you got a Conflict of Interest?: No
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1658 Laparoscopic vs open surgery for colon cancer: a population-based comparison of mortality S. Benitez Majano1, M. Quaresma1, C. Maringe1, C. Leyrat1, A. Exarchakou1, S. Ling1, M. Smith1, A. Kostouraki1, B. Rachet1 1 London School of Hygiene and Tropical Medicine, Non-Communicable Disease Epidemiology, London, United Kingdom Background: Comorbidity, older age and socioeconomic deprivation are associated with suboptimal cancer outcomes. Undertreatment of comorbid and older patients partly relates to their higher risk of complications. With comparable oncologic results, laparoscopic surgery may be particularly beneficial for disadvantaged cancer patients. Aim: We aim to contrast the effect of laparoscopic vs open surgery for colon cancer on one-year mortality by patient characteristics at population-level. Methods: We used national cancer registration data linked to secondary care records on patients diagnosed with colon cancer in England, 2015-16. We focused on non-emergency patients diagnosed with stage I-II disease surgically treated at 26 hospitals that performed both surgical procedures. We compared the odds of death with traditional logistic regression, and estimated the average treatment effect of using laparoscopic vs open surgery on death within one year using inverse-probability weighs with regression adjustment, from the potential outcomes framework to identify treatment effects from observational data. Results: Out of 16,365 patients included in the analysis, 8,833 (54%) underwent laparoscopic resection for colon cancer. Older age, higher socioeconomic deprivation, frailty, comorbidity and stage III were independently associated with lower odds of undergoing laparoscopic resection. Overall, patients undergoing laparoscopic resections had 58% lower odds of dying within one year than those undergoing open surgery, accounting for patient and tumour characteristics. Using IPWRA to ensure comparability of the treatment groups, we estimated that the average treatment effect of using laparoscopic surgery rather than the open approach was a reduction in 1-year mortality from 8.0% to 3.6%. Absolute reductions of mortality were particularly large in the 85+, frail, and most socioeconomically deprived. Conclusion: Using population-based observational data, findings indicate that the laparoscopic approach is associated with lower 1-year mortality than the open approach, even in patient groups that generally have higher mortality (older, frail, and socioeconomically deprived), probably because of lower complication rates. Despite requiring specialised training and longer operation time, using the laparoscopic approach for surgical resection of colon tumours may improve cancer outcomes, particularly in disadvantaged groups, and save resources associated longer hospital stays and managing complications. Have you got a Conflict of Interest?: No
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1662 Clinical Characteristics and Outcomes of Male Breast Cancer: Preliminary Results from a Case Series in Rwanda N. Nsabimana1, C. Villaverde2, D. Ruhangaza3, L.E. Pace4, T. Fadelu5 1 Partners In Health, Kigali, Rwanda, 2University of Washington, Seattle, United States, 3Butaro District Hospital, Butaro, Rwanda, 4Brigham and Women's Hospital, Boston, United States, 5Dana-Farber Cancer Institute, Boston, United States Background: Male breast cancers (MBCs) are relatively rare compared to the prevalence of female breast cancers. The epidemiology of MBC in Rwanda, and the East African region, is largely unknown. Aim: To describe the epidemiologic, clinical, pathologic features, and outcomes of MBC at the Butaro Cancer Center of Excellence (BCCOE) in rural northern Rwanda over a 7-year period. Methods: Retrospective cohort study of all male patients with pathologically confirmed breast cancer aged 18 or older presenting to BCCOE between July 2012 and June 2019. Data sources included electronic medical records and physical paper charts. We described risk factors, patient demographics, disease characteristics, and treatment using frequency and percentage for categorical data and median and interquartile range (IQR) for continuous data. Results: Over the study period, 38 patients with pathologically confirmed MBC were identified. The median age at diagnosis was 58.5 years (IQR 52-69). Thirty-four patients (89.5%) were from Rwanda, evenly distributed amongst the country’s provinces, and 4 patients (10.5%) were from the Democratic Republic of Congo. Patients were most referred from referral hospitals (14/38) or other district hospitals (14/38). The most common presenting symptoms were a breast mass (20/38), breast pain (8/38), ulceration (4/38), or other breast skin changes (4/38). The median duration of symptoms prior to presentation at BCCOE was 12 months (IQR 4.8-27, n=20). There was a high prevalence of alcohol and tobacco use with 89% of patients reporting current or past alcohol use and 53% of patients reported current or past tobacco use. Only 3 patients noted a family history of cancer. Of 25 patients with pathology reports available, 22 patients had invasive ductal carcinoma and 3 had papillary carcinoma. Of 24 patients with hormone receptor status, 22 were estrogen receptor (ER) positive. Of 30 patients with initial clinical staging information, 4 had early-stage disease, 14 locally advanced, 10 metastatic, and 2 were recurrent. Treatment included endocrine therapy (25 patients), chemotherapy (22 patients), and curative surgery (13 patients). At the time of data extraction, 10 patients (26.3%) were alive, 14 patients (36.8%) were dead, and 14 patients (36.8%) had unknown vital status. Conclusion: Patients with MBC were older compared to published historical cohort female breast cancer patients at BCCOE. Patients had a long duration of symptoms prior to presentation. Of note, only a minority of patients endorsed a family history of malignancy. Most MBCs were ER positive invasive ductal carcinomas, with 80% of those with known stage presenting with advanced-stage disease. Preliminary outcome results reveal most patients were dead at the time of data collection. More research is needed to characterize MBC in sub-Saharan Africa and guide interventions to improve early diagnosis and quality treatment. Have you got a Conflict of Interest?: No
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1663 The Economic Burden of Cancer in Canada from a Societal Perspective R. Garaszczuk1, J.H. Yong1, Z. Sun1, C. de Oliveira2,3,4 1 Canadian Partnership Against Cancer, Toronto, Canada, 2University of Toronto, Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, 3University of York, Centre for Health Economics and Hull York Medical School, Heslington, York, United Kingdom, 4Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada Background: Cancer patients and their families experience considerable financial hardship; however, current published literature on the economic burden of cancer at the population level has typically focused on the costs from the healthcare payer’s perspective. This approach only covers one component of the total economic burden of cancer. It is also important to understand the economic burden from the perspective of patients and their families, which can be considerable. Aim: This study aims to estimate the economic burden of cancer in Canada from a societal perspective (i.e., direct health system costs, direct out-of-pocket costs, direct time costs and indirect costs). Methods: The analysis was conducted using the OncoSim-All Cancers model, a Canadian cancer microsimulation model. OncoSim simulates cancer incidence and deaths using incidence and mortality data from the Canadian Cancer Registry and demography projections from Statistics Canada. Using a treatment phase-based costing framework, we estimated the economic burden of cancer in Canada in 2021 by incorporating published direct health system costs and patients’ and families’ costs (out-of-pocket costs, time costs, indirect costs). Direct health system costs included all physician services, inpatient hospitalization, chemotherapy, radiation therapy, and all other institution-based care. Out-of-pocket costs included drugs/supplements, homecare, equipment, and all other expenses incurred by the patient. Time costs included the time to travel to care, waiting for care, and receiving care. Indirect costs included lost earnings from employment from the patient’s perspective. Results: From the societal perspective, cancer cost $26 billion in Canada in 2021; 30% of the costs were borne by the patients and their families. The economic burden of cancer on patients and families varied across the cancer trajectory. They experienced the highest burden during the first year after cancer was diagnosed (initial care). During this time, patients and families’ costs amounted to $5 billion. Overall, the most significant cost for patients and families was out-of-pocket costs, this totaled almost $3 billion. Conclusion: This study provides a comprehensive estimate of the economic burden of cancer. Our findings show that a large proportion of the burden is borne by patients and families. Studies that only include cancer costs from the health system’s perspective would have missed a considerable portion of cancer costs. These estimates can be used to inform policies concerning health insurance coverage and resource allocation decisions. Have you got a Conflict of Interest?: No
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1664 Results from Pilot Testing of a Remote Sensing System to Support Pain Management for Rural Cancer Patients V. LeBaron1, R. Bennett1, L. Blackhall2, N. Homdee3, R. Jones1, Y. Martinez4, E. Ogunjirin4, N. Patel4, J. Lach5 1 University of Virginia School of Nursing, Charlottesville, United States, 2University of Virginia School of Medicine, Charlottesville, United States, 3Mahidol University Faculty of Medical Technology, Bangkok, Thailand, 4University of Virginia School of Engineering & Applied Science, Charlottesville, United States, 5The George Washington University School of Engineering & Applied Science, Washington, D.C., United States Background: Untreated, or under-treated, cancer pain continues to be a critical problem for both patients and family caregivers. Managing cancer pain in the home setting can be particularly difficult, especially for rural populations. Aim:To pilot test a remote sensing system, Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C), to holistically understand contextual factors that can influence cancer pain. The long-term goal of BESI-C is to inform tailored, real-time interventions to reduce pain and distress and support patients with cancer and their family caregivers. Methods:This was a multi-phase, descriptive pilot study. Dyads of patients with cancer and family caregivers were recruited from an outpatient palliative care clinic. In Phase I, semi-structured interviews and surveys gathered design input. In Phase II, BESI-C was deployed in dyad homes for 10-14 days. Environmental sensors collected home context data (e.g., light, noise, temperature); concurrently, smartwatches worn by patients and caregivers allowed participants to record and describe pain events. Anonymized data were analyzed to summarize pain events, explore correlations between pain events and contextual variables, and create data visualizations. Technical feasibility was assessed by quantifying fidelity of data capture; accessibility was assessed by postdeployment surveys and semi-structured interviews with participants. Results: A total of 32 participants were recruited (n=17 patients; n=15 caregivers); 88% (n=15) of patients were rural. Phase I confirmed importance of privacy, data sharing, and minimizing burden. During Phase II, 5 deployments were completed and over 250 pain events were recorded. The overall system technical feasibility score was 86.4/100 and participants rated BESI-C as low-burden (1.7/5) and helpful (4.6/5). There was variability in the degree and direction of correlations between environmental variables and pain reports; correlations between light and pain were most frequent. Feedback from data visualizations emphasized need for simplicity. Conclusion: BESI-C is feasible and acceptable and can advance oncology care by leveraging technology to promote equitable access to cancer pain management for rural populations and honoring patient preferences to receive care at home. Have you got a Conflict of Interest?: No
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1667 SUSTAINABLE MOBILE UNIT DELIVERY DESPITE FUNDING COMPLEXITIES ARISING FROM COVID-19 PANDEMIC N. Kotschan1, N. Kotschan2 1 University of Cape Town, Colorectal, Cape Town, South Africa, 2University of Cape Town, Oncology, Cape Town, South Africa Amount Raised:R10 million In a world where location acts as a preventative measure to restrict one's access, healthcare represents vectors of meaning and structure in the perspective of patients in South Africa. The Covid-19 pandemic has pushed PinkDrive NPC to innovate, adapt and modernize to implement tools, structures, processes, strategies, tactics, and infrastructure that considers the specificity of good healthcare programs, driving healthy lifestyles. PinkDrive NPC’s major challenge is securing funding. PinkDrive's aim is to have a sustainable funding pot that increases its service delivery to include COVID-19 pandemic tests, screening and the rollout of two country selected types of vaccinations, through Push & Pull Strategies, Social Media Strategies, Crowdfunding strategies, Grant funding strategies, Corporates events and Stakeholder Engagements. Marketing Plans were reworked for a successful Funding Plan to be developed. Demand management and Pipeline management applied to attract and retain.
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Funding report intelligence processes applied: 1. Reviewing Donor activity by month, year and quarterly to ascertain success given funding. 2. Identified success stories and pain points with configurable charts, graphs and diagrams. 3. Analyzing data to measure, monitor and manage data to meet successful funding strategies for sustainable growth. 4. Leveraged strategic partnerships where resources were pooled and directed at specific health initiatives (Cancer, NCD and Covid-19) implementing financial strategies and partnerships including, public and private resource pooling alliances, corporate service linked donations, global health investors and fundraising partnerships.
Costs: PinkDrive normal Cancer offerings showed realistic costs but with the COVID-19 pandemic, it became realistic costs afterwards. Maintenance of mobile units are of primary concern due to diagnostic breakdowns, arriving at a ratio of not more than 40% with overhead expenses. Innovative Methods:
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Introduced an innovative culture. Operational efficiency an imperative as it unlocks innovation. Mobile units are built with “state of the art” innovative tools and testing equipment which is the differentiator for PinkDrive NPC.
Learnings:
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At the onset of COVID-19 pandemic, technology was a must for stakeholder engagement but at a cost. The financial structures in the pandemic do not have the same objectives, the same scope of action, the same financial means, or the same political weight.
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The consequences of the COVID-19 pandemic have far-reaching implications for the role that NGOs, NPOs, PBOs play in the lives of millions of South Africans. Funds were secured to cover at least 55%-60% of Cancer screening services, if this was lower, the organization would have lost its mandate, but the leadership was focused and two steps ahead. Sustainability is key for PinkDrive, as the wheels are continuously moving after SA Government lifts COVID-19 pandemic ruling in April 2022. Have you got a Conflict of Interest?: No
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1670 Tobacco Cessation - Having the Quit Conversation S. Flynn1 1 University College Dublin, Psychology, Dublin, Ireland Tobacco kills more than 8 million people each year. More than 7 million of those deaths are the result of direct commercial tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke. Without cessation support only 4% of attempts to quit tobacco will succeed. Professional support and proven cessation medications can more than double a tobacco user's chance of successful quitting.(1) Smokers' Helpline is a free, confidential service operated by the Canadian Cancer Society offering support and information about quitting smoking, vaping and other commercial tobacco use by phone, text and live chat Smokers' Helpline is evidence-based, non-judgmental and personalized. Interpreter services in over 100 languages are also available by phone. Smokers' Helpline currently serves four provinces and one territory in Canada and is part of a network of provincial and territorial cessation support servcies. This presentation will focus on the Smokers' Helpline Quit Connection program which provides resources, tools and training to health care providers to initiate conversations with their clients and patients about quitting or reducing smoking, vaping and other commercial tobacco use. These conversations are especially important to have with cancer patients. Many health care providers do not have the knowledge or skills to have a conversation with clients and patients about quitting or reducing commercial tobacco use. Having a brief conversation and providing a referral to relevant cessation servcies can increase uptake of cessation servcies and supports. The Smokers' Helpline Quit Connection Program is a referral program that can be used on its own or as a positive adjunct to clinician intervention. The Quit Connection Program eliminates the need for patients or clients to call Smokers' Helpline. Instead, a Smokers' Helpline Quit Coach will contact the tobacco user to provide counselling support. The healthcare provider simply needs to explain the program to their client, encourage them to register for the service by signing a consent form and then the provider submits the signed form. Within 3 days the client will receive a phone call from a Quit Coach at Smokers’ Helpline. Evaluation of this program indicates that 60% of those contacted by Smokers’ Helpline would not have called, had they not been directly referred for proactive service. Health care providers will be introduced to the Smokers' Helpline referral program, will learn about the importance of having quit conversations, and will gain skills and knowledge to implement referral processes and to have those vital quit conversations. Participants will use this information to initiate/enhance cessation conversations with their clients or patients and will increase their capacity to implement and evaluate referral programs and processes. (1)https://www.who.int/news-room/fact-sheets/detail/tobacco Have you got a Conflict of Interest?: No
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1672 Integrated KT for the Canadian Population Attribution Risk of Cancer (ComPARe) study: initial evaluation E. Holmes1, A. Jeyapalan1, Z. El-Masri2, P. De2, C. Friedenreich3,4, D. Brenner4,3 1 Canadian Cancer Society, Cancer Information and Policy Department, Toronto, Canada, 2Ontario Health, Cancer Care Ontario, Toronto, Canada, 3Alberta Health Services, Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Calgary, Canada, 4University of Calgary, Departments of Oncology, and Community Health Sciences, Cumming School of Medicine, Calgary, Canada Background The Canadian Population Attribution Risk of Cancer (ComPARe) study estimated the current (2015) and future (2042) number and percentage of new cancer cases in Canada due to about 20 modifiable risk factors. The ComPARe study results inform future cancer prevention research, guide health promotion program development and support the case for new healthy public policies in Canada. Aim The ComPARe study used an integrated knowledge translation (iKT) approach in which knowledge users were integrated into the study team and engaged in an advisory capacity as members of a KT advisory committee. This approach capitalized on both researchers’ and knowledge users’ expertise leading to findings that are contextually relevant, as well supports the ongoing uptake of the study findings. Tactics The integrated knowledge users developed aKT Blueprint consisting of four phases: planning, knowledge product development, dissemination and evaluation. Knowledge products for launch included peer-reviewed publications, website, video, a data visualization tool and infographics. Dissemination included traditional and social media, webinars, newsletters and more targeted strategies for key audiences. The KT advisory committee advised on the KT strategy, including how to discuss research results, how best to disseminate methods and appropriate channels to use, what knowledge products to develop and how to evaluate the KT strategy. Process An evaluation is underway to assess the overall effectiveness of the iKT approach and theKT Blueprint. A mixedmethods approach is being used to collect data on the following domains: process, collaboration and capacity building, reach, engagement, use and usefulness. Outcomes Initial evaluation results show a positive response to both the iKT approach and theKT Blueprint.Following the launch, there were 320 media stories which resulted in 58.8 million impressions across Canada. Since the launch in 2019, there have been over 53,000 page views on the ComPARe study website with over 15,000 unique visitors, showing great reach and interest. A survey completed by the KT advisory committee found that 100% of the members felt engaged as a partner in the study and were satisfied with the time they spent. A survey completed by the study team shortly after the study’s release showed positive responses in satisfaction, knowledge change in KT and iKT and engagement in the entire research process. Overall, the study team felt the approach was worth the investment in time, energy and resources. What was learnt Initial evaluation of the study knowledge translation approach so far demonstrates an effective model for maximizing the potential impact of ComPARe study results on cancer prevention planning and decision-making in Canada. The ComPARe study's iKT approach contributes to iKT science research and could be used a model by others interested in collaborative research. Have you got a Conflict of Interest?: No
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1676 Impact of facilitating continued access to cancer care on wellbeing of cancer patients in Rwanda. A. Niyigena1, V. Cubaka1, P. Uwamahoro2, R. Mutsinzi2, B. Uwizeye2, B.J. Turinimana2, B. Mukamasabo2, C. Shyirambere2, B.J. Bigirimana2, J. Mubiligi2, D. Barnhart2,3 1 Partners In Health, Research, Kigali, Rwanda, 2Partners In Health, Kigali, Rwanda, 3Harvard Medical School, Boston, United States Background: During COVID-19, the Butaro Cancer Center of Excellence (BCCOE), Rwanda sought to mitigate disruptions to cancer care by providing patients with free transportation to treatment sites and medication delivery at patients’ local health facilities Aim: To describe the wellbeing of cancer patients who were enrolled in cancer care at the Butaro Cancer Center of Excellence in Rwanda at the start of the COVID-19 pandemic and assesses the association between receipt of facilitated access to care during COVID-19 lockdowns and patients’ wellbeing. We also evaluate whether the association between facilitated access to care and wellbeing differed by patients’ baseline socioeconomic status. Methods: This cross-sectional telephone survey included cancer patients receiving treatment at BCCOE at the start of COVID-19 pandemic on March 22nd,2020. We used linear regression to compare six dimensions of quality of life (EORTC QLQ-C30), depression (PHQ-9), anxiety (GAD-7), and financial toxicity (COST) among patients who did and did not receive facilitated access to care. We also assessed access to cancer care and whether patient wellbeing and its association with facilitated access to care differed by socioeconomic status. Results: Of 214 respondents, 34.6% received facilitated access to care. Facilitated patients were more likely to have breast cancer and be on chemotherapy treatment. Facilitation was significantly associated with more frequent in-person clinical encounters, improved perceived quality of cancer care, and reduced transportation-related barriers to accessing care. Facilitated patients had significantly better general health status (β=9.14, 95% CI: 2.3, 16.0, p <0.01) and less financial toxicity (β=2.62, 95% CI: 0.2,5.0, p=0.03). However, over half of patients reported missing or delaying appointment. Patient wellbeing was low overall, and wellbeing differed by patient socioeconomic status, with poor-middle patients consistently showing worse outcomes. Socioeconomic status did not modify the association between facilitated access to care and wellbeing indicators. Further, facilitation did not lead to equitable wellbeing outcomes between richer and poor patients. Conclusion: Facilitated access to care during COVID-19 was associated with some improvements in access to cancer care and patient wellbeing. However, cancer patients still experienced substantial disruptions to care and reported low overall levels of wellbeing, with socioeconomic disparities persisting despite facilitated access to care. Implementing more robust equity-minded care continuum facilitation and better patient outreach programs may strengthen patient care overall and effect better patients’ outcomes. Have you got a Conflict of Interest?: No
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1679 Inuusinni Aqqusaaqtara | Using e-learning modules to engage Inuit patients and healthcare providers T. Torchetti1, R. Uriarte2, C. Giesel2, S. Enuaraq2 1 Canadian Cancer Society, Toronto, Canada, 2Pauktuutit Inuit Women of Canada, Ottawa, Canada Background and context:Cancer is the 2nd leading cause of death among Inuit in Canada. The rate is nearly twice as high as the rest of the country. Inuit face many cultural, linguistic, geographic and systemic barriers while trying to navigate the cancer system. The Canadian Cancer Society (CCS) and Pauktuutit Inuit Women of Canada have partnered to create culturally and linguistically appropriate cancer resources calledInuusinni Aqqusaaqtara My Journey. Aim: To increase cancer knowledge, improve communication between Inuit cancer patients and non-Inuit healthcare providers, enhance culturally appropriate care and improve overall quality of care for Inuit. Strategy / Tactics:Two e-learning modules were created to increase awareness of the resources and support the overall goals of improving communication and enhancing quality of care for Inuit and their families. The modules were designed with Inuit for Inuit and have been reviewed by experts and regional representatives through an advisory committee. One module engages patients and caregivers through videos, what to expect during the cancer journey and other helpful information. The other module engages healthcare providers around cultural sensitivity, how to include the patient resources into their practice and other key learnings. It has been accredited by Canadian Nurses Association. A variety of dissemination tactics are being employed and evaluated. While both modules are available in English, the patient and caregiver e-module will be translated into Inuktut, South Baffin dialect and will be distributed on USB flash drives to accommodate remote learners. Programme / Policy process: Pauktuutit is working with the University of Ottawa on an implementation strategy pilot to test the most effective methods of disseminating the cancer resources to community health representatives and other health providers. It is also working with secondary education institutions to include the e-learning module in nursing curricula. There are currently several pilots in progress. Pre and post surveys are administered as part of the healthcare module. Outcomes: The e-modules were launched July 2021. Evaluation is underway to assess the effectiveness of the emodules using the results of the surveys. Initial feedback from nursing students who completed the modules is positive, with many saying the modules made them feel more empathetic for and confident about supporting Inuit patients. What was learnt: (if relevant, please also detail here the potential of replicability) It’s imperative to improve communication and cultural safety for Inuit and their providers. While the resources and accompanying emodules show great promise, dissemination challenges remain. Integrating them into healthcare provider education is a critical component of ensuring they are disseminated more widely. Have you got a Conflict of Interest?: No
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1681 Seven field 3D-CRT in place of IMRT in Locally Advanced Prostate malignancy. K. PERUMAL1, S. RAJ2, R.K. NARAYANASAMY2 1 Sri Ramachandra Institute of Higher Education and Research, Chennai, India, 2CBCC-Saveetha University,, Chennai, India Background: Prostate Cancer is leading cancer in elderly male population, most likely to be treated by definitive radiation due to co-morbidities precluding surgery. Aim: This study explores the utility of Seven fields- Three Dimensional Conformal Radiotherapy (7F-3DCRT) Vs 7 field Intensity Modulated Radiotherapy (7F-IMRT)using6 Mega Voltage (6 MV) Linear accelerator (LINAC) in locally advanced prostate cancer (LA-PC) patients. Methods: Ten consecutive LA-CC patients were planned with 7F-3DCRT and 7F-IMRT with same dataset using XiO version 4.8.0 planning system.The mean of the 10 patients were calculated for percentage of volume covering 80Gy (and volume in cc) to GTV and 50.4 Gy to PTV, mean and max dose of rectum and bladder. Results: The mean values of dose volume histogram of 6 patients were compared. Comparing 7F-IMRT vs. 7F3DCRT – 80 Gy isodose line covered 98.37% of GTV & 42.9 cc vs. 97.17% of GTV and 44.26 cc.50.4 Gy isodose line covered 97.17% of PTV & 1117.97 cc vs. 96.14% of PTV and 1119.27 cc. Rectum mean and maximum dose were 46.58 Gy & 80.89 Gy vs. 47.65 Gy & 81.53 Gy. Bladder mean and maximum dose were 15.84 Gy & 55.07 Gy vs. 16.22 Gy & 56.78 Gy. Conclusion: 7F-IMRT achieves non-significant sparing of critical structures compared to 7F-3DCRT.The clinical impact of reduced acute and chronic toxicity needs evaluation in larger studies. Due to the simplicity of planning and dose delivery, 7F-3DCRT can be used in high volume centers catering unaffordable patients. Have you got a Conflict of Interest?: No
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1682 Awareness, knowledge and acceptability of self-collected Cervical Screening: An Australian population survey K. Lotfi-Jam1, M. Ross1, A. Bastable2, S. Durkin1, T. Andersson1, K. Broun2 1 Cancer Council Victoria, Centre for Behavioural Research in Cancer, Melbourne, Australia, 2Cancer Council Victoria, Prevention Division, Melbourne, Australia Background: Australia is on track to eliminate cervical cancer by 2035. Population-wide screening is critical to this success however participation remains suboptimal, particularly in some priority communities. Self-collection (SC) provides an alternative pathway for women and people with a cervix to take their own vaginal sample with a swab instead of the clinician-led speculum cervical screening test (CST). It has potential to overcome many screening barriers and to increase participation and equity. Universal SC access is commencing in Australia, however little is currently known about community awareness, knowledge and attitudes to inform effective SC promotion and plan for service delivery. Aim: To measure awareness, knowledge and attitudes to self-collection in Victorian women and people with a cervix, as well as screening pathway preferences and likelihood of future uptake. Methods: A cross-sectional, population-based survey of Victorian women and people with a cervix aged 25-74 years was administered by phone using a random digit dialling sample frame of listed mobile numbers. Data was weighted by age, geographical location, SES and language spoken to reflect population distribution. Differences in outcomes were examined across sociodemographic variables and screening status. Results:725 respondents completed the survey (avg. age=46 years, metropolitan= 76%, English first language=88%). 38% were overdue/never screened. Most respondents had heard of Pap test (97%), less had heard of CST (59%) and very few had heard of SC (11%). Only 6% had undertaken SC. High acceptability and interest were reported, with 67% likely/very likely to speak to their healthcare provider about SC, 61% moderately-extremely confident to undertake SC and 59% intending to do a self-collected test when next due. When asked which they would prefer, 51% preferred CST, whilst 39% preferred SC. Main reasons for preferring a CST included not feeling confident to collect the sample themselves, and not trusting the accuracy of the test. Reasons for preferring SC included being more convenient, private and less embarrassing. Compared to those up-to-date, respondents who were overdue/never screened were significantly more likely to report intentions to self-collect (73% cf. 52%) and to prefer SC (54% cf. 31%). There were no notable differences between age or location groups. Conclusion: There is very low awareness of SC, highlighting the need for widespread public health campaigns to promote access and uptake. There is good acceptability and intention to seek further information, and it is the preferred option for many who are under screened, suggesting SC options may help to engage some hard to reach groups. Targeted interventions and messaging should be developed to improve knowledge and confidence to undertake SC. It is also critical that healthcare providers are knowledgeable, routinely offer SC and are confident with guidelines & supporting women through the pathway. Have you got a Conflict of Interest?: No
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1684 Reducing barriers to information and support for people living with advanced cancer S. Krueckl1 1 Canadian Cancer Society, Mission, Vancouver, Canada Background: In 2019, the Canadian Cancer Society (CCS) identified the opportunity to gain a deeper understanding of how it could better support a larger cohort of Canadians who were experiencing barriers to accessing cancer information and support programs. A series of “roadmaps” were developed to understand the common gaps and challenges some communities faced and make high-level recommendations about the actions CCS should take to address these. “People living with advanced cancer” (PLWAC) was a key area examined along with seven others. The results of this work are helping to guide organizational decision making and prioritize the removal of barriers to access that have been unintentionally introduced. The roadmap set the foundation for conducting a more in-depth study of the needs for information and support during the advanced cancer experience. Aim: To reduce barriers to information and support for people living with advanced cancer Methods: The Advanced Cancer Project is based on two phases: Phase I: to generate recommendations and to guide strategic decisions on how to enhance CCS programs for PLWAC and their caregivers, including the publication of the next edition of the CCSAdvanced Cancer booklet. The research methodology comprised 4 parts: detailed literature review, key informant interviews with PLWAC and their caregivers on a pan-Canadian level, 22 ethnographic interviews, 2 virtual co-design workshops to explore how best to use the research findings to share the content, structure, and tone of theAdvanced Cancer publication update. Phase II: looked at the Key Findings, analyzed how best to enhance existing Support Services, and tested 3 prototypes with the highest perceived impact. These prototypes were shown to both PLWAC and their caregivers during a 90-minute workshop to solicit feedback. Results: Two major themes emerged from the research, the need to be seen, without judgement in a safe and supported way, and help navigating complicated information. Recommendations included the need to focus services for the advanced cancer community using a balance between digital solutions and human interactions. PLWAC clearly articulated feelings of isolation, difficulty in making decisions, the stigma associated with an advanced cancer diagnosis, information needing to be specific to their unique situation, needing support navigating changing relationships and wanting to learn to live well with cancer. Conclusion: As cancer treatments continue to evolve, a growing number of patients are living longer with advanced cancer. This population has unique needs and seeks to access information, support and practical resources that specifically address their experience. These 2 completed phases have informed the re-design of an Advanced Cancer publication, a customized training on Advanced Cancer for CCS and will inform the development of a pan-Canadian Advanced Cancer Strategy Have you got a Conflict of Interest?: No
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1685 Mortality from cancer and Covid-19 in cancer patients Y. Santos1, A. Scaff1,1, R. Reis1, J.P. Cavalcante1, L.A. Maltoni1 1 Fundação do câncer, Rio de Janeiro, Brazil Background: The pandemic caused by Covid-19 has impacted the world population on several levels. In the health area, assistance for other illnesses was limited and of low quality, or ceased to exist. In Brazil, the lack of control of the pandemic has generated even greater impacts and mortality from the disease is one of the highest in the world. When it comes to cancer, screening policies and patient care have been affected, and the mortality of these individuals is still lacking information. Thus, it is necessary to assess the profile of this group. Aim: To assess differences in sociodemographic profile between individuals who had cancer and died from Covid19 with those who died of cancer. Methods: Secondary data from the Brazilian Mortality Information System (SIM) from 2011 to 2020 were used. All patients whose death certificate (DC) mentioned a diagnosis of cancer were selected. To identify the reason for death, the underlying cause present in the DC was used. Frequencies of mortality from cancer, other causes and Covid-19 were made, the latter being only for the year 2020. For the 2020 population whose death was cancer or Covid-19, the sociodemographic profile was evaluated: sex, age group, geographic region, race/color, education and marital status. The R software, version 4.1.0 was used. Results: A total of 251,541 people who had cancer died during the study period. Cancer was the primary cause in approximately 94.0% of deaths between 2011 and 2019. In 2020, this percentage was 89.8%, and the remaining 4.2% were deaths from Covid-19. Deaths from other causes remained at approximately 6.0%. Individuals who died from Covid-19 were male (54.5%), aged 65 years or older (63.1%), married (47.4%), with higher education (42.9%) and of Southeast region (53.4%). Conclusion: It was observed that individuals who would die from cancer died from Covid-19. The profile found in this population reflects the same profile found in Covid-19 deaths in Brazil in 2020, a population with a higher income. More research is needed on the link between cancer and Covid-19. Have you got a Conflict of Interest?: No
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1686 Developing a Patient Navigation Program Design and Implementation Toolkit for Low- and MiddleIncome Countries H. Freedman1, K. McComb1, E. Krisel1, A. Chybisov1, S. Umar1 1 American Cancer Society, Global Capacity Development and Patient Support, Kennesaw, United States Background and context: Patient navigation refers to individualized assistance offered to patients, families, and caregivers to help overcome health care system barriers and facilitate timely access to quality health and psychosocial care. Despite the well-established benefits of patient navigation, it is under-utilized in low- and middle-income country (LMIC) settings. There is also a lack of resources to support the design and implementation of patient navigation programs in LMICs. Since 2015, the American Cancer Society (ACS) has leveraged its patient navigation expertise to support the development and implementation of comprehensive navigation programs in two countries in East Africa. In 2018, ACS sought to expand navigation to other LMICs and address the dearth in globally-applicable patient navigation resources by developing a global patient navigation program design and implementation toolkit (the “Toolkit”) as part of its Building Expertise, Advocacy, and Capacity in Oncology Navigation (BEACON) Initiative. Aim: ACS aimed to develop a comprehensive, engaging, and freely accessible toolkit to support interested health facilities and cancer organizations in LMICs to design, implement, strengthen, and sustain oncology patient navigation programs. Strategy/Tactics: To inform toolkit design, ACS surveyed the global patient navigation landscape. We identified and reviewed existing patient navigation resources for accessibility and applicability to global audiences and interviewed global practitioners to identify gaps. We constituted an Advisory Committee of 13 experts from 11 countries to review and contribute to content. We employed subject matter experts and an instructional designer to develop engaging content for our global audience that filled gaps identified in our formative research. Program: Toolkit content is packaged into three thematic phases from conceptualization and design through implementation, sustainability, and program refinement. Each phase has three sections made up of 4-12 activities. Figure 1. Toolkit Schematic
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Activities support users to achieve specific objectives and outputs using various resources, including educational handouts, guides, worksheets, customizable templates, and samples from existing programs. Users can preview activities before downloading and engaging with resources with stakeholders offline. The Toolkit also features the design and implementation journey of a fictitious hospital. Characters narrate their progress alongside users, showcasing work that aligns with expected activity results. All Toolkit content is designed and presented using creative and innovative approaches in an online platform. Outcomes: Through a formal pilot with 10 health institutions and cancer organizations in eight countries, we are learning how well the content resonates and guides users through processes for building and implementing responsive and effective patient navigation programs across diverse LMIC settings. Have you got a Conflict of Interest?: No
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1687 Evaluation of the Quality of Life and Symptoms Among Breast Cancer Survivors S.Z. Ergöz1, T.N.M. SALAMEH2, M. Seven3,2 1 İzmir University of Economics, Faculty of Health Sciences, İzmir, Turkey, 2Koç University, School of Nursing, İstanbul, Turkey, 3University of Massachusetts, Amherst College of Nursing, Boston, United States Background:The survival rates for women with breast cancer treatment has increased due to advances in early diagnosis and treatment. However, cancer survivorshave experiencedsymptoms impairing their quality of life. Effective symptom management is vital for managing long term effects of cancer and cancer treatment, therefore it is important to understand quality of life challenges and symptoms among cancer survivors. Aim: This study was conducted to examine the quality of life and factors affecting the quality of life of breast cancer survivors who completed the medical breast cancer treatment. Methods: The sample of this descriptive study consisted of 141 women who completed breast cancer treatment and agreed to participate in the study. The data were collected using the "Personal Data Collection Form" containing the sociodemographic and clinical characteristics of women and the "EORTC QLQ-C30 Quality of Life Scale". Mann-Whitney U test, One-Way ANOVA, Kruskal Wallis Variance Analysis, and Multiple Linear Regression Analysis were used to analyze the data. Results: The mean score of the Functional Scale of the EORTC QLQ-C30 Quality of Life Scale of women was 68.65±19.15 (Max = 100, Minimum = 17.78), the mean score of the Symptom Scale was 29.58±20.57 (Max = 79.49, Minimum=0) and the mean score of the General Health Score was 65.89±23.12 (Maximum= 100, Minimum=0). Conclusion: Survivors with high Body Mass Index (BMI), those who used pain medications, and survivors who completed their medical treatment within the last year had lower quality of life functional scores and worse symptom experiences. In addition, women with advanced cancer stage (Stage 3) had worse quality of life symptom experiences than those who had early-stage cancer. The study shows that women who have completed breast cancer treatment had a low quality of life. It is recommended that interventions aiming to increase the quality of life should be planned to meet particularly the needs of women with a high BMI, who used pain medication, have advanced cancer stage, and are in the first year of cancer treatment completion. Have you got a Conflict of Interest?: No
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1690 Photodynamic therapy for Cervical and Vaginal intraepithelial neoplasia. z. chen1, x. wang2, w. zhao2 1 The First Affiliated Hospital of USTC, University of Science and Technology of China,, Department of Obstetrics and Gynecology, Hefei, China, China, 2The First Affiliated Hospital of USTC, University of Science and Technology of China, Department of Obstetrics and Gynecology, Hefei, China, China Background :Photodynamic therapy (PDT) is a novel strategy for the treatment of cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia(VAIN). Irradiated acts in three ways: apoptosis, autophagy and ischemic necrosis. PDT has the function of targeting and aggregating pathological tissues, and has little damage to normal tissues. Object: The purpose of the study was to reveal the efficacy of PDT in treatment for CIN and VAIN. Methods: Between Jan 2021 and Dec 2021, 37 patients aged 21-58 years with CIN and VAIN. (primary CIN1 25 cases; primary CIN2 3 cases; VAIN 7cases; CIN1 and VAIN1 2 cases) were treated by Photodynamic Therapy. Infection with high-risk genotypes of HPV (16, 18, 31, 33, 35, 39,45, 51,52,56,58,59,68) was detected in 30 (81.1%) women neoplasia. All patients received PDT with 5-Aminolevulinic Acid (ALA) photosensitizers. 37 patients with routine treatment failure were treated with 5-ALA-PDT. A 20% ALA was applied to the lesions and sealed with plastic film for 3 h. Patients were irradiated with a red light at a wavelength of 635±15 nm. The sizes of the irradiation fields varied from 1.5 to 2 cm, the light dose 80mw/cm2. The irradiation field necessarily included an area of normal tissue 3-5 mm surrounding the lesion. The duration of a PDT session varied from 25 min. All patients completed 3 to 6 treatment cycles. The interval of treatment was 7-14 days. No severe adverse events or systemic side effects were observed in treatment. The main adverse effects of ALA-PDT were pain, increased vaginal discharge, ventral belly, and swelling. These adverse effects were temporary. All of the patients follow-up was done every 3 months after PDT. Cervical cytology, HPV testing, colposcopy, and histopathology were performed 3, 6 months after PDT. The criteria for efficiency included normalization of cervical cytology, HPV and histopathology. Results: 83.7% of patients were biologically normal and HPV-negative at 6 months after PDT treatment. In 30 out of 37 patients (81.1%), HPV was detected and high-risk HPV (16 + or 18+) was detected in 17 patients before treatment. No serious adverse events occurred in the patient. Conclusions: The results of PDT in the treatment of patients with CIN and VAIN demonstrated its few adverse reactions and good efficacy. PDT is not only an effective procedure for CIN, but also for VAIN. PDT is treatment of the preservation of the cervix functional integrity.
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Have you got a Conflict of Interest?: No
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1691 Financial Impact on Cancer Patients in Germany during the COVID-19 Pandemic R. Eckford1, A. Gaisser2, E. Kludt2, S. Weg-Remers2, M. Schlander1,3 1 German Cancer Research Center, Health Economics, Heidelberg, Germany, 2German Cancer Research Center, German Cancer Information Service, Heidelberg, Germany, 3University of Heidelberg, Mannheim, Mannheim Medical Faculty, Mannheim, Germany Background: Globally, the COVID-19 pandemic has affected populations and healthcare delivery. Cancer patients may be particularly vulnerable in terms of both physical health and mental well-being. Moreover, patients are susceptible to financial burden as a result of cancer treatment. In the context of the pandemic, financial stress is potentially exacerbated. Aim: Our goal was to examine the financial impact of a cancer diagnosis on affected individuals during the COVID-19 pandemic in Germany. Methods: This results presented here are a sub-analysis of a larger cross-sectional study examining the impact of the COVID-19 pandemic on cancer patients. An anonymized, online questionnaire was completed by cancer patients who had contacted the Cancer Information Service of the German Cancer Research Center in Heidelberg with email inquiries. The survey ran from July 2020 to June 2021 and generated 621 evaluable cases. Survey content included socio-demographic and clinical features, employment and financial impact questions. Symptoms of depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Results: Respondents had a mean age of 59.5 years, were predominantly women (76.3%); highly educated (63.8% having a university entrance qualification), with breast cancer the most frequently reported cancer type (50.1%). More than 65% of patients reported having additional healthcare expenses due to cancer treatment, of whom more than a quarter (26.1%; 15.6% of sample) reported these expenses exceeding 200 euros per month. Over half (51.1%) were employed or self-employed, and nearly a third (31.8%) were unable to work due to their cancer treatment. For those with jobs or self-employment, inability to work was associated with both symptoms of anxiety (57.1%; p < 0.001) and of depression (65.8%;p < 0.001). Specific to the pandemic, 20% of patients reported having additional healthcare expenses. Furthermore, 16.5% of the sample reported income loss due to the pandemic, and of those working, 21.9% reported worry over their job and the possible financial consequences. Conclusion: Our results show that many patients, despite being residents of a country which provides universal healthcare coverage, nevertheless, have out-of-pocket expenses. Loss in income as a result of cancer treatment is another factor affecting patients, with the pandemic further amplifying this issue. Results underscore the importance of outreach for both psycho-oncological services and financial assistance, where needed. Have you got a Conflict of Interest?: No
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1692 Supporting young adults in navigating their cancer experiences A. Edwards1, C. Harris1, J. Avery2, A. Gupta3, E. Wong4, L. Burnett5 1 Canadian Cancer Society, Centre for Cancer Prevention and Support, Toronto, Canada, 2University of British Columbia, Vancouver, Canada, 3Princess Margaret Hospital, Adolescent and Young Adult Oncology Program, Toronto, Canada, 4Canadian Cancer Society, Centre for Cancer Prevention and Support, Vancouver, Canada, 5Canadian Cancer Society, National Support Programs, Toronto, Canada Background and context: Adolescents and Young Adults (AYAs) with lived experience of cancer in Canada are a growing population with a high degree of unique and unmet needs. AYAs experience challenges accessing relevant information and supportive care as they navigate their cancer journey. Aim: Our project asks ‘how might we help young adults between the ages of 19 and 39 living with or beyond cancer access information and support services (with a focus on oncofertility) relevant to their unique needs?’ Strategy / Tactics:
• • •
Engage AYAs in research and co-design to understand and address their needs Prototype an intervention Develop an implementation plan for the intervention
Programme / Policy process:
• • • • • • •
A literature review to learn about the challenges AYAs face in accessing information and supportive care. An audit of cancer programs and services in Canada which serve AYAs. A national survey about AYA care experiences, health concerns, and support issues. Focus groups to discuss experiences, challenges, and ideas to address them. Co-design workshops to collaborate on the design development process. Designing, testing, and revising the prototype of an intervention. Developing an implementation plan for the intervention.
Outcomes: AYAs are unable to access relevant and timely information and supports, resulting in them not feeling prepared or well-supported throughout their cancer experience. The table shows how our learnings translated into ‘must have’ requirements for the intervention we will design:
‘Must haves’
What we heard Unique and changing context I couldn’t find information related to my age or situation. My providers asked me about my life situation, but only once (and it changed). Need for tailored and timely information/supports 1
•
Provide information and care specific to AYA experiences
•
Support AYAs’ ever-shifting needs
•
Help prepare AYAs for their experience
•
Provide timely support
•
Give AYAs control over the information they consume
•
Provide trusted and credible information
•
Allow AYAs to connect and support one another
I wish I knew what to expect. I was overwhelmed with information at diagnosis but didn’t get support at other times. It would be nice to feel a bit more in control over the information I receive. I would like a place to get the right information. Desire to connect with community I wish I could learn from the experience of someone like me.
What was learnt: (if relevant, please also detail here the potential of replicability) We are designing the prototype of a web app offering AYAs tailored support for their changing needs throughout the cancer experience. Features being explored in the app to address 'must haves' include:
• • • •
User profile capturing relevant identity and contextual information, and changing needs; drives the tailoring of supports. Library of reputable information, and national resources and services (AYA-relevant and/or -specific) from various organizations. Dashboard delivering timely, curated content from the app’s library; populated based on user profile and responses to prompts about current concerns. Section for AYAs to build community.
Have you got a Conflict of Interest?: No
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1694 Using telemedicine to train and screen for cervical cancer in Honduras M.A. Crespin1, M. Rosales1, C. Alas-Pineda1, E.J. Borjas1, V. Arita-Tábora1,2,3, A. Durón-Rivera1,2, K. GaitanZambrano1,2, S. Bejarano1, O. Herrera1 1 Liga contra el cáncer, Programa de prevención y educación en cáncer PESCA, San Pedro Sula, Honduras, 2Universidad Católica de Honduras, ASOCEM-UnicahSPSP, San Pedro Sula, Honduras, 3Universidad Autónoma del Estado de México, Health Sociology, Amecameca, Mexico Table1. Efficacy of the test performed by students and gynecologist in relation to the Gold standard (colposcopic biopsy) in patients attended in Honduras, 2018.
Gold Pos 17
Pos 17
Neg
415 Neg
PT* Pos VIAA (Students) 45
NT* Neg VIAA (Students) 387
Sen+ 100 % (81,57-100)
Spe 93,2 (90,
Pos VIAA (GO 18
Neg VIAA (GO) 414
88,24 % (65,66-96,71)
99,2 (97,
415 +Values in crosses represent 95% confidence intervals. * PT = positive test, NT = negative test; + Se predictive value, DA = Diagnostic accuracy. Source: Own elaboration, 2019 Table 2.Concordance between volunteer and gynecologist by VIA method in patients attended in Ho Test-concordance between volunteer and gynecologist V+ + G+ 45 387 IVAA (V) 45 414 18 414 IVAA (G) 18 +Kappa Interpretation (Landis & Koch Criteria) <0.0Poor 0.01-0.20Slight 0.21-0.40Fair 0.41-0.60Moderate 0.61-0.80Substantial 0.81-1.0 Almost Perfect Source: Own elaboration.
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0.80-1.0Almost Perfect Source: Own elaboration, 2019 Background: Cervical cancer in Honduras represents 15.2% of deaths.Cervical cytology programs have not had a significant impact on mortality rates,.Non official sources report less than 48% coverage of cervical cancer screening with cervical cytology. In 2015 a new protocol was published by national health system.Qualitative HPV-DNA detection + visual inspection with acetic acid VIAA triage of positive women was the innovation. To date, the technology is not available in most of the country, same as training of personnel responsible for cervical cancer screening nationwide. Liga Contra el cáncer LCC has a mature staff of gynecologists (GO) who attend cervical cancer lesions on a daily basis. From 2010 the Program for prevention and early detection and education in cancer PESCA was organized to train volunteer med students in cancer prevention, and in 2019 included volunteer personnel from Metropolitan Health Region of Cortés. Both institutions cover a population over a Million inhabitans in San Pedro Sula city and surrounding areas.In a previous study we demonstrated that trained med students had excellent performance using VIAA to detect suspicions on intraepithelial cervical neoplasia, compared with pap and GO interpretation.Keeping the training programme was limited to monetary issues and dedicated time of the gynecologists because of their busy patient schedules. Positive patients were referred to the LCC for follow up with biopsy and LEEP as needed. No see and treat was attempted at this phase.
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Aim: To determine the acceptance and efficacy of telemedicine using photographs of the cervix for immediate remote interpretation of GO to complete the training of medical students on VIAA for the detection of precancerous lesions of the cervix. Methods: In the context of community based cervical cancer screening of PESCA program; since 2018 all women received VIAA and Pap smear. All women with VIAA positive had a photograph of the cervix according to existing protocol, and uploaded to a WhatsApp Chat identified with the correlative participation number, no personal information of women was shared. A final interpretation by GO was followed. Confirmed positive women followed institutional protocol. The performance of the trainee was recorded. Irrespective of the training status, all positive lesions continued to be uploaded for quality control and statistics. Results:No participant denied to receive the screening methods, In correlation to our previous study, in this population S= 100% SP=89%. for detection of cervical lesions by the trainees. It took aprox 100 screens to achieve the competence (it was completed in 2 visits). The pictures met standards irrespective of the brand of telephone used.Social distancing and mask was observed during visits. Conclusion:The training method was acceptable for trainers and trainees. Saved significant physician time,money and expedited the time to reach competence for cervical cancer screening with VIAA. Have you got a Conflict of Interest?: No
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1696 Postdiagnosis smoking cessation and risk of cancer progression and mortality, a multicancer prospective study M. Sheikh1, A. Mukeriya2, H. Zahed1, X. Feng1, O. Shangina2, P. Brennan1, D. Zaridze2 1 International Agency for Research on Cancer (IARC - WHO), Genomic Epidemiology Branch (GEM), Lyon, France, 2N.N. Blokhin National Medical Research Centre of Oncology, Department of Epidemiology, Moscow, Russian Federation Background:Around 80% and 20% of deaths from lung and kidney cancers are attributable to smoking. While many patients with smoking-related cancers are active smokers at diagnosis, there is limited evidence on whether these patients could still benefit from smoking cessation after diagnosis. Aim:To determine whether quitting smoking after the diagnosis of lung and kidney cancers affects the risk of disease progression and mortality. Methods: This multicancer prospective cohort study recruited 517 smoker patients with stage IA-IIIA non-small cell lung cancer and 212 smoker patients with clear cell renal cell carcinoma, between 2007 and 2016 from two referral centres in Moscow, Russia, and followed them annually through 2020. Using time-dependent Cox proportional hazards and Fine-Gray competing-risks regression models, we compared overall survival, progression-free survival, and cancer-specific mortality among quitters vs. continued smokers with lung and kidney cancers. Results:During an average 7 years of follow-up, 327 cases (63%) of lung cancer death, and 100 cases (47%) of kidney cancer death were recorded. The adjusted probability of 5-year overall survival was higher among smoking quitters than continued smokers (lung cancer: 61% vs. 49%, p=0.001; kidney cancer: 88% vs. 73%, p=0.009). The adjusted median progression-free survival time was 21.6 months higher among smoking quitters with lung cancer (5.7 vs. 3.9 years, p=0.004), and 36 months higher among smoking quitters with kidney cancer (10 vs. 7 years, p=0.002), than continued smokers with similar cancer types. After adjustments, smoking cessation remained associated with decreased risk of all-cause mortality (lung cancer HR: 0.67 (0.53 – 0.85); kidney cancer HR: 0.50 (0.30 – 0.84)), cancer-specific mortality (lung cancer HR: 0.75 (0.58 – 0.98); kidney cancer HR: 0.56 (0.32 – 0.99)), and disease progression (lung cancer HR: 0.70 (0.56 – 0.89); kidney cancer HR: 0.48 (0.31 – 0.86)). Similar effects for postdiagnosis smoking cessation were observed among mild-moderate and heavy smokers, and patients with earlier and later cancer stages. Conclusion: Smoking cessation after diagnosis resulted in a material improvement of overall and progressionfree survival among current smoker patients with lung and kidney cancers. Given that at least 50% of active smokers with lung and kidney cancers are thought to continuing smoking after diagnosis, these results provide an important opportunity to substantially improve survival from these cancers.
1
Have you got a Conflict of Interest?: No
2
1697 Cancer care and health service fragmentation during COVID-19: Canadian patients' and caregivers’ experiences D. Mena1, S. Lee2, H. Bradley2, R. Valentim3, P. Nugus4, R. Passos dos Santos4 1 Canadian Cancer Society, Montréal, Canada, 2Canadian Cancer Society, Hamilton, Canada, 3Canadian Cancer Society, Toronto, Canada, 4McGill University, Department of Oncology and Department of Family Medicine, Montréal, Canada Background: As a national charity the Canadian Cancer Society (CCS) benefits people affected by cancer. CCS efforts have been directed to engaging people at risk of cancer, patients, caregivers and survivors through the complexities imposed by COVID-19 on their cancer experiences. Numerous researchers have documented increased challenges that individuals faced through the pandemic. Aim: To leverage patient and caregiver voice inputs, to understand their experience through the COVID-19 pandemic from February 2020 to January 2022 and to consider the systemic factors on which cancer care relies. Methods:A series of COVID-19 specific surveys was administered intermittently to an expanding panel of patients and caregivers (recruited through CCS programs and publicly via social media campaigns). The client voice was further documented by 3rd party frontline staff for both cancer information helpline (CIH) clients and web-based community forum users (Cancerconnection.ca). A descriptive quantitative analysis of survey responses and associated demographic data was completed. Additionally, a parallel convergent mixed-methods study was conducted, where qualitative data from three sources: a sub-set of free-text responses from 4,295 patient and caregiver surveys; data from 5,223 encounters with CIH; and 540 posts to cancerconnection.ca were thematically analyzed. Results: The analysis revealed five key themes: 1. De-prioritization of cancer care due to the COVID-19 pandemic; 2. Increased fragmentation of health and psychosocial care and support; 3. Heightened impacts of medical uncertainty due to the COVID-19 pandemic; 4. Mental health as a more prominent source of vulnerability; and 5. Community-building among cancer patients and caregivers. Conclusion: The COVID-19 pandemic imposed new challenges for health care users. Results indicate that the strained interrelated health and supportive care systems had a detrimental impact on patients’ medical and psychosocial needs. Caregiver needs focused on the patients’ access to care. COVID-19 produced a unique generation of cancer patients with magnified concerns such as isolation, uncertainty, emotional and financial distress. These issues may be reduced by maintaining cancer care as a high priority, limiting fragmentation and helping to navigate health and social support systems, establishing guidelines for telehealth usage and providing mental health strategies. Additionally, the sense of community i.e., mutual understanding and connection is paramount. Ongoing patient and caregiver engagement can provide timely insights into system strain or disruptions. Have you got a Conflict of Interest?: No
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1698 Addressing Global Prostate Cancer Disparities Through Consortium Science F. Odedina1, P.C.T.C. CaPTC2 1 Mayo Clinic, Hematology/Oncology, Jacksonville, United States, 2Prostate Cancer Transatlantic Consortium, Abuja, Nigeria Background: Black men (BM) are disproportionately affected by prostate cancer (CaP) globally, compared to other racial/ethnic groups. Addressing CaP in BM requires a broad and comprehensive approach. With the problem of CaP disparity persisting, it is crucial that we begin to use new paradigms and look at the problem from new perspectives. Aim: Our primary aim was to explore the effectiveness of establishing a global CaP consortium on CaP research, research funding and research scholarship among African investigators in multiple countries. Methods: A consortium is a group comprised of multiple individuals with complementary expertise and resources in a specific area (scientific/technical) working collaboratively to achieve a common purpose. The Prostate Cancer Transatlantic Consortium (CaPTC) was formed in the United States (US) in 2005 and received US National Cancer Institute (NCI) approval in 2011. Due to the connection of US Blacks to Blacks in West Africa (WA), efforts were made to have a strong consortium presence in WA. Building on the expertise, resources, and relationships of collaborating investigators, CaPTC WA investigators focused on exploring the genetic and environmental etiology of CaP to develop ethnically sensitive, targeted approaches that will eliminate CaP disparities in BM. The success of CaPTC in WA was tracked from 2005 to 2021. Results: The first CaPTC site in West Africa opened in Nigeria in 2006 with one investigator. By 2021, there were 38 sites with over 400 investigators in Nigeria, Cameroun, Liberia, Sierra Leone and Cote d’Ivoire. In 2006, funding for CaPTC research was provided by one US institution with one publication. By 2021, CaPTC WA investigators had been awarded over $7 million extramural grants with funding from the World Bank, US federal grants (NCI and DoD), US consortia, US institutions and Movember Foundation. Funded projects ranged from basic discovery projects to translational research and clinical trials. While most of the funding were for research, investigators also received funding for research capacity and training. These awards have resulted in 111 publications and numerous presentations at national and international conferences. Awards included the US Fulbright awards and Carnegie African Diaspora awards. Centers of Research Excellence have emerged focused on genomics, clinical research, pathology, community-engaged research, behavioral research, implementation science etc. Importantly, the research scholarship has led to focus on downgrading CaP diagnosis and improving patient economic, clinical and humanistic outcomes. Conclusion: The complexity of health disparity and the need for a unique approach to better address complex chronic diseases underscore the need for consortium science research that is multilevel, collaborative, translational, and global. CaPTC provided an effective approach for WA investigators to address scientific problems that cannot be addressed individually. Have you got a Conflict of Interest?: No
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1699 Development of Quality Indicators in the Management of Breast Cancer: A Systematic Review V.D. Atuwo-Ampoh1, E.K. Ofori1, P. Engel-Hills2, M. Gyapong3, M. Boadu4, A. Donkor5, E. Davies6, K. Tetteh7, P. Addo1, 1.K. Yarney8 1 University of Health and Allied Sciences (UHAS), Department of Medical Imaging, Ho, Ghana, 2Cape Peninsula University of Technology, Cape Town, South Africa, 3University of Health and Allied Sciences, Institute of Health Research, Ho, Ghana, 4Ghana Atomic Energy Commission, Radiological and Medical Sciences Research Institute, Accra, Ghana, 5Kwame Nkrumah University of Sciences and Technology, Kumasi, Ghana, 6Kings College London, Cancer Epidemiology and Cancer Services Research, LONDON, United Kingdom, 7Korle-bu Teaching Hospital, Radiology, Accra, Ghana, 8Korle-bu Teaching Hospital, National Radiotherapy and Nuclear Medicine, Accra, Ghana Background: Breast cancer is one of the leading causes of cancer-related death. Current evidence suggests a gap between what is understood to be standard breast cancer management and what happens in clinical practice. The development and implementation of breast quality indicators (QIs) for breast cancer management is one way to achieve better care. This systematic review aimed to identify QIs developed for the management of breast cancer and to summarize the characteristics and range of measures uncovered. Methods: Studies related to the development of QIs for management and monitoring of breast cancer care were systematically searched, extracted and reviewed using four electronic databases (MEDLINE, EMBASE, CINAHL and Cochrane Library) following a Prospero Protocol Registration (CRD42020207945). The study was reported using the Preferred Reporting Items for the Systematic Review and Meta-analysis (PRISMA). This review reported on the development of QIs in the management of breast cancer and Donabedian’s framework was adopted as the analytical framework. Results: Out of 1161 potentially relevant articles identified, eight studies met the inclusion criteria and were directly concerned with QI development for breast cancer care. These included two papers from China and one each from; The Netherlands, Belgium, Scotland and Canada. The remaining two were a collaboration among the European Society of Breast cancer Specialists (EUSOMA). The methods used by these studies to identify and develop QIs included a comprehensive literature review, medical records review, clinical guidelines, and Delphi consensus using an expert panel discussion. A total of 38 QIs were identified and classified as: structure (n = 3); process (n = 30); and outcome (n = 5). Structure indicators included: the availability of Multi-Disciplinary Team Meeting (MDT), medical records and breast cancer research infrastructure. Process indicators included eight diagnostic QIs, 22 treatment QIs and seven follow-up QIs. The outcome indicator focused mainly on the overall five-year survival statistics. Conclusions: The development of QIs appears relevant to monitoring clinical management and performance but is currently limited to higher-income countries. Development and implementation of QIs in LMICs countries will improve practice. Keywords: Breast Cancer, Quality indicator, quality management, clinical management Have you got a Conflict of Interest?: No
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1702 Clinical care and short-term survival outcomes for women with breast cancer in Gaza, oPt S. AlWaheidi1, R. Sullivan1, E. A Davies1 1 King's College London, London, United Kingdom BACKGROUND Healthcare in Gaza has been eroded by decades of conflict. The impact on cancer care has been profound. For example, no radiotherapy provision is allowed so patients must navigate complex procedures to reach hospitals in Jerusalem. Yet we know relatively little about outcomes in cancers such as breast and what other factors in the patient pathway contribute to these outcomes. PURPOSE We aimed to provide robust breast cancer survival estimates for Palestinian women in Gaza, and to identify policies necessary to improve outcomes in this conflict-impacted setting. METHODS A case series of clinical records of women diagnosed with breast cancer from 1 January 2017 to 31 December 2018 in Gaza. Women were followed using clinical and death records until 31 December 2020. Clinical and treatment data were collected from the medical records. Quantitative variables were presented as medians and means (IQR). The one-year and two-year crude survival rates were estimated using the Kaplan-Meier method. Semi-structured interviews with 10 healthcare providers and 20 patients diagnosed during this period were conducted to examine experiences of giving and receiving cancer care. The Framework Approach was used to analyse the interviews. RESULTS 524 new diagnoses of breast cancer were recorded during the study period, giving a crude annual incidence rate of 27 per 100,000 population. The mean age at diagnosis was 53 years, and half of the patients (262/524) were between 40 and 59 years of age. 50% (260/524) had sought healthcare within one month of discovering a breast cancer symptom, while 80% (44/524) sought healthcare between one and three months after symptom discovery, and about 10% (54/524) sought healthcare more than three months after symptom discovery. 35% of the women (185/524) were diagnosed at stage two, 33% (171/524) at stage three, 19% (99/524) at stage four, and 6% (32/524) at stage one. Data on key prognostic factors were available in most cases – stage (93%), ER, PR, HER2 (82%), and slightly less often for tumour grade (77%) and tumour size (70%). 51% of women underwent mastectomy. The one-year crude survival rate was 95·4% and the two-year crude survival rate was 86·6%. During the interviews, many women reported lack of treatment as the main barrier to effective cancer care, especially those receiving Gosorelin or radiotherapy. The huge workload, and the lack of financial and staff support, alongside the lack of diagnostic materials and treatments seem likely to have had a significant negative effect on how the health system operates to improve early diagnosis and treatment in Gaza. CONCLUSION Our findings reflect the remarkable adaption of Palestinian women with breast cancer who have high short-term survival. Whether this translates into longer term survival is unknown. However, our findings that many standard treatments are not available either through diagnostic or treatment pathways is likely to impact long-term outcomes. Have you got a Conflict of Interest?: No
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1705 INCIDENCE OF BRAIN METASTASIS AMONG CANCER PATIENTS AT A LOCAL ONCOLOGY CENTRE IN GHANA E. Fiagbedzi1, D.O. Amanfo2 1 University of Ghana, Department of Medical Physics, Accra, Ghana, 2Komfo Anokye Teaching Hospital, Department of Oncology, Kumasi, Ghana Background: Brain metastasis is the most common type of intracranial tumor that affects adults and is a significant cause of morbidity and mortality. The incidence of brain metastasis has increased significantly over the years due to the increasing cancer cases. Aim: To evaluate the incidence and pattern of brain metastasis among cancer patients at a local oncology center in Ghana. Methods: 835 folders of patients diagnosed with single cancer from January to December 2020 was reviewed. Incidence of brain metastases by primary site and variable of interest (sex, age at diagnosis of primary cancer, and stage of primary cancer) was analyzed with statistical package for social science (SPSS) version 25 with 95% Confidence Intervals. Results: Confirmed brain metastases was identified in 348 patient folders representing 41.7% for all primary sites combined, and highest for Breast (29.3%) and cervix (19.0%) in females, followed by prostate (18.4%) in males, liver (12.6%), colorectal (9.5%), lung (6.6%) and stomach (4.5%) cancers in both sexes. Percentage incidence was significantly higher for female patients with breast cancer, and significantly higher for male patients with prostate. The highest percentage incidence of brain metastases occurred at different ages at diagnoses: both age 30 to 39 and age 40 to 49 years recorded a higher incidence for primary breast, cervix and prostate cancer; followed by age 50 to 59 years and above for stomach, liver, lung and colorectal cancers; age 20 to 29 recorded the least for all cancers. Incidence significantly increased as stage of primary cancer advanced for all primary sites. Conclusion: The total percentage incidence of brain metastases was slightly higher as compared to previous studies. It varied by sex, stage of the primary cancer, age and primary site. Among females, breast cancer had the highest percentage incidence of brain metastases whiles in males it was prostate. Have you got a Conflict of Interest?: No
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1710 Ultra-processed food consumption and risk of head and neck and oesophageal cancers in EPIC F. Morales Berstein1, C. Biessy2, C. Casagrande2, N. Kliemann2, M. Cairat2,3, K. Chang4, F. Rauber5, R. Bertazzi Levy5, E. Vamos4, M. Gunter2, C. Millett4, A. Agudo6, P. Brennan7, C. Borges1, R. Richmond1, T. Richardson1,8, G. Davey Smith1, C. Relton1, I. Huybrechts2, on behalf of the EPIC Network 1 University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom, 2International Agency for Research on Cancer, Nutrition and Metabolism Branch, Lyon, France, 3Paris-Saclay University, Villejuif, France, 4Imperial College London, School of Public Health, London, United Kingdom, 5University of São Paulo, Sao Paulo, Brazil, 6Catalan Institute of Oncology, Unit of Nutrition and Cancer, Barcelona, Spain, 7International Agency for Research on Cancer, Genetics Section, Lyon, France, 8Novo Nordisk Reasearch Centre, Oxford, United Kingdom Background: There is some evidence that ultra-processed food (UPF) consumption may be associated with an increased risk of cancer. Nevertheless, the association between UPF intake and head and neck cancer (HNC) and oesophageal cancer has not been explored in detail. Aim: To investigate associations between UPF consumption and risk of HNC and oesophageal cancer. Methods: The European Prospective Investigation into Cancer and Nutrition (EPIC) cohort recruited 521,323 adult participants across 10 European countries between 1992 and 1998. Our study included 450,111 EPIC participants, of which 814 and 409 were incident cases of HNC and oesophageal cancer, respectively. Food frequency questionnaires were used to obtain dietary data at baseline and the NOVA classification was used to categorise foods into four groups according to their degree of processing. We used multivariable Cox proportional hazard models with age as the underlying timescale to investigate associations between UPF consumption and risk of HNC and oesophageal cancer. Results: A 10% increase in the proportion of grams of UPF in the diet was associated with an increase in the risk of HNC (HR=1.16, 95%CI 1.06–1.27, N events=814) and oesophageal adenocarcinoma (HR=1.26, 95%CI 1.06–1.49, N events=215). Among HNC subtypes, a strong positive association was found for pharynx cancer (HR=1.24, 95%CI 1.08–1.42, N events=264) and larynx cancer (HR=1.21, 95%CI 1.04–1.39, N events=310), but not for oral cancer (HR=0.97, 95%CI 0.82–1.15, N events=277). There was still strong evidence of these associations even after accounting for dietary factors and nutritional status. Conclusion: UPF consumption may be associated with an increased risk of oesophageal adenocarcinoma, laryngeal cancer and pharyngeal cancer. Further research is required to uncover the mechanisms underlying our findings. Have you got a Conflict of Interest?: Yes If yes please specify:: Tom G Richardson is employed part time by Novo Nordisk outside of this work.
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1712 Association of breast and cervical cancer screening with early diagnosis and mortality: an ecological approach G. Fernández-Deaza1, J.A. Hernández Vargas1, S.J. Trujillo Cáceres1, L.A. Acuña Merchán2 1 Fondo Colombiano de Enfermedades de Alto Costo (High-cost diseases fund), Knowledge management coordination, Bogotá, Colombia, 2Fondo Colombiano de Enfermedades de Alto Costo (High-cost diseases fund), Executive director, Bogotá, Colombia Background: Given the preventable condition, cervical and breast cancer screening and early detection interventions are essential to mitigate the burden of the disease. There is evidence that stage at diagnosis and access to health care are associated with mortality; accordingly, an integral approach for an adequate diagnosis and management are key factors for positive outcomes. Aim: To evaluate the effect of breast and cervical cancer screening on general mortality, early mortality, early diagnosis, and TNM staging. Methods:We carried out a multiple-group ecological study, including information reported between January 2019 and January 2020 to the National Cancer Information System (NCIS). We performed descriptive and correlation analyses to evaluate the relation between screening coverage rates (exposure) and four primary outcomes (general mortality, early mortality, early diagnosis, and staging). A Poisson multiple regression analysis assessed the association between exposure and mortality outcomes, and logistic regression was used for early diagnosis and TNM staging. Results:By 2020, national coverage rates for mammograms and cervical cytology were 22% and 49%, respectively. They were higher in women affiliated to the third-party payer than state insurance. Early diagnosis and TNM staging were higher in the first group than in the second one. Early and general mortality for breast cancer were higher in the third-party payer than state insurance; the opposite was observed for cervical cancer. The regression models showed that health insurers with mammogram coverage ≥ 20% had general mortality of 31% lower. Similarly, in health insurers with cervical cytology coverage ≥ 45%, early mortality was 17% lower. Furthermore, there was a direct association between screening coverage rates and early diagnosis for both cancer types. Regarding TNM staging, there was no significant association with screening coverage (Table 1). Table 1. Association between screening coverage and outcomes of interest in breast and cervical cancer in the health system in Colombia, 2020
IRR/OR Type of cancer
Outcome
p-value (CI 95%) 0,69 (0,52 – 0,91) 1,07 (1,06 – 1,09) 1,29 (1,17 – 1,42) 1,09 (0,93 – 1,28) 0,80 (0,59 – 1,09) 0,83 (0,80 – 0,86) 1,78 (1,46 – 2,16) 0,84 (0,63 – 1,13) 3
Breast
1
Cervical
2
General mortality Early mortality Early diagnosis TNM staging General mortality Early mortality In situ (early diagnosis) TNM staging
0,01 <0,01 <0,01 0,29 0,16 <0,01 <0,01 0,25
Mammography coverage as an exposure of interest in the specified models was dichotomized into: <20% y ≥20%. The models compare the outcome between higher vs. lower coverage health insurers. 1
1
Cervical cytology coverages as an exposure of interest in the specified models was dichotomized into: <45% y ≥45%. The models compare the outcome between higher vs. lower coverage health insurers. 2
3
All models were adjusted for age at diagnosis (continuous).
IRR: incidence rate ratio, OR: odds ratio, CI: confidence interval. Conclusions: Screening coverage rates did not reach the standardized goals in the country, with rates lower than 50% in both cancer types. The gap according to health insurance was also evident. The multivariate results are consistent with previous studies, in which a higher screening coverage is associated with lower mortality rates and early diagnosis. Have you got a Conflict of Interest?: No
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1716 Locked down in Victoria –addressing unmet needs in the pandemic K. Lane1, A. Piper1, T. Blackmore1, D. Spence1 1 Cancer Council Victoria, Strategy and Support Division, Melbourne, Australia Background and context:Consistent and equitable access to supportive care is a long-standing issue, compounded by the impact of a pandemic on usual care. In Australia there have been reports of delays in diagnoses and treatment, and reduced access to screening and psychosocial support[1]. [1] Edge R, Meyers J, Tiernan G, Li Z, Schiavuzzi A, Chan P, et al. (2021) Cancer care disruption and reorganisation during the COVID-19 pandemic in Australia: A patient, carer and healthcare worker perspective. PLoS ONE 16(9): e0257420. https://doi.org/10.1371/journal.pone.0257420 Aim: To ensure the voice of those with a lived experience of cancer are at the forefront of support service planning during a pandemic, so that we can best support patients, carers and the health sector. Strategy / Tactics: Cancer Council is Australia’s leading cancer charity working across every aspect of cancer. In Victoria, our nurse-led information and support line provides emotional, informational, and practical support and receives ~9,700 connections annually. In addition, support pages on our website receive ~1.87 million hits per year, demonstrating we are well placed to deliver consistent information and support in a global health crisis. Programme / Policy process: Throughout the pandemic, we’ve heard the experiences of more than 20,000 Victorians affected by cancer. We consulted regularly with the health sector and other cancer organisations to understand the changing pressures and needs over the course of COVID-19 and interrogated our support line data to understand how best to adapt our services in response to the pandemic. Outcomes: Our support line stayed open throughout COVID-19, with our nurses working remotely. In response to need, we transitioned to a fully postal wig service, invested in a nurse-led counselling service to increase access to psychosocial care and increased capacity in our financial counselling service. We promoted our online and phone-based peer support services and upskilled our cancer support group leaders to continue meeting via video. We also partnered with government and co-invested to place nurses in regional areas to improve access and increase local referral pathways to supportive care and plan to scale up this model to assist COVID-19 recovery efforts. What was learnt: (if relevant, please also detail here the potential of replicability) While timely supportive care access and referral is an ongoing issue, this has been compounded by the pandemic, leading to lengthy wait times for specialist support and poorer outcomes. Cancer NGOs can take the lead in responding to changing needs and are vital to collaborative efforts to alleviate pressure on acute services during times of crisis, to support patients and families and improve access to optimal care. Have you got a Conflict of Interest?: No
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1717 Elderly Patients with Cancer Initiative: Advocacy Implications R. Azmi1 1 Fadia Survive and Thrive, Kuwait City, Kuwait Background and context: According to UICC, population ageing will have consequences for cancer control globally. Several research suggests that many of the predictive risk factors for mortality in cancer patients are heavily dependent upon underlying health conditions, including secondary infections, and most common comorbidities. The most critical cases show a progression to conditions like septic shock, metabolic acidosis, and coagulation dysfunction, in which ageing could further complicate such risk factors. Main aim: Cancer, and cancer journey, for any patient are extremely complex with many variables and unpredictables. As mainly a patient advocacy organization, Fadia Survive & Thrive Association, supported by a grant from UICC through the Patient Group Mentoring Programme, launched an initiative to support key awareness campaign for elderly patients with cancer, where the main aim was to identify key issues from patients to support patients that are evidence-based in the same time. The initiative identified as a result nine key pillars and consolidated the campaign into two main advocacy tracks: infection prevention and improving quality of life. Strategy and programs developed: The key nine pillars of advocacy focus are: accurate diagnosis, functional age vs. chronological age, vulnerabilities to treatments, longer-term adverse outcomes, comorbidities challenge, complex needs, different pain and cognitive changes, narrow margin between efficacy and toxicity, and the ability to translate cancer control into improved quality of life aspects. The initial launch of the initiative dedicated organized events to share evidence-based information related to these nine pillars. In practice this was possible by categorizing advocacy into two main domains of preventing infection and improving quality of life. One important highlight is the focus on cancer patients with metastatic cases, who usually suffer from multiple side effects, such as diarrhea, lack of appetite, and difficulty sleeping, which not only compromise their quality of life, but also could be confused as acceptable treatment side effects at a time they might be symptoms for much more fatal complication such as sepsis. Policy process and outcomes: In the elderly patients’ fight against cancer, they should arm themselves with the facts about infection prevention and quality of life. Having cancer and certain treatments for cancer, can put them at higher risk of developing an infection and sepsis. Learning Implications: Many issues related to preventing infections and improving the quality of life for elderly patients with cancer were identified with practical implementation of advocacy campaigns targeting the patients, their medical team and the public. More coordination and empathy are required from all cancer stakeholder to make this a policy priority, where a high potential of replicability is there to sustain progress in improving both prevention of infections and quality of life. Have you got a Conflict of Interest?: No
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1718 Harnessing the voices of clinicians and community to address pandemic disruption A. Piper1, C. Allan1, V. Perera1, T. Blackmore1, K. Lane1, D. Patt1, D. Spence1 1 Cancer Council Victoria, Strategy and Support Division, Melbourne, Australia Background and context:The COVID-19 pandemic significantly disrupted health care services internationally. Modelling by the Victorian Cancer Registry estimates 2,530 cancer diagnoses were missed between April and October 2020[1], with the most recent data analysis suggesting over 5,000 cancers delayed or missed through the course of the pandemic[2]. In addition to delayed diagnosis, restrictions in health services and workforce shortages disrupted access to cancer supportive care. [1] te Marvelde L, Wolfe R, McArthur G, Blake LA & Evans SM. (2021) Decline in cancer pathology notifications during the 2020 COVID-19-related restrictions in Victoria. Med J Aust214(6): 281-283. Doi: 10.5694/mja2.50968 [2] pers. comm. te Marvelde, April 2022 Aim: To promote inclusive health service planning that responds to the needs of consumers even in a global crisis such as the pandemic. Strategy / Tactics: Cancer Council is Australia’s leading cancer charity working across every aspect of every cancer. In Victoria, we speak out on behalf of the community on cancer issues, empower people to reduce their cancer risk, and invest in research into new ways to better detect and treat cancer. Programme / Policy process: Our information and support service received more than 20,000 connections during the pandemic, providing insights into emerging issues. In response, our formal community and clinical advisory groups have informed and shaped our COVID-19 related advocacy activities with policy decision makers, government and health service leaders. Outcomes:Advocacy issues we identified and responded to included: (1) distress around disruption to cancer care including impact of hospital visitor policies, (2) confusion about COVID-19 and implications for those with cancer, (3) isolation and (4) lessons arising from the rapid introduction of telehealth. An emerging theme is the perception that hospitals are no longer open and inviting places further exacerbating risks of delayed cancer diagnoses that will lead to poorer outcomes. Cancer Council played a key role harnessing the experience of people to inform policy and advocacy priorities and advocate for compassionate application of policy. We worked collaboratively with government and clinicians to integrate the perspectives of people affected by cancer into evolving policy and processes. What was learnt: (if relevant, please also detail here the potential of replicability) As we plan for recovery and prepare for future disruptions, it is important to ensure the consumer voice is reinstated at the forefront of health care service planning. Representative and effective community consultation will ensure the issues that matter most to people with cancer are at the forefront of recovery efforts. Have you got a Conflict of Interest?: No
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1719 Supporting patient needs during the COVID-19 ‘infodemic’ A. Piper1, T. Blackmore1, K. Lane1, D. Spence1 1 Cancer Council Victoria, Strategy and Support Division, Melbourne, Australia Background and context: Cancer is hard. COVID-19 made it even harder.The COVID-19 pandemic significantly disrupted health care services in the Australian state of Victoria and the capital city Melbourne endured 262 days of restrictions during six separate lockdowns earning us the title of the most locked down city in the world. Throughout the pandemic, people contacting our information and support service consistently reported difficulties in finding relevant and timely supportive care. Aim: To address the information needs of people affected by cancer and the health professionals caring for them throughout the pandemic. Strategy / Tactics: Cancer Council is Australia’s leading cancer charity working across every aspect of every cancer. We act as a gateway to credible information, practical and emotional support and assist people to navigate the health system. Programme / Policy process: To understand the issues people faced we undertook a nation-wide survey regarding attitudes towards COVID-19 vaccination and combined results with themes from contacts with our 13 11 20 cancer information and support line. We responded with tailored information and a communications campaign incorporating advice from community members, health professionals, and communications experts. Outcomes: Over the past two years in Victorian alone we have heard the experiences of more than 20,000 people diagnosed or affected by cancer, including more than 1,500 responses to our vaccine survey. Information challenges included confusion from rapidly changing prevalence of community transmission and the associated risk to vulnerable people, vaccination messages, treatment and care barriers and misinformation. We developed a marketing campaign encouraging people to “Get the facts on all things cancer and COVID-19”. This was complemented with an online information hub with answers to frequently asked questions and fact sheets addressing: visitor restrictions, telehealth, COVID-19 vaccination, and developing an action plan if COVID-19 positive. In 2021 alone, our web hits totalled 1.6 million visitors to our support pages, including 49,000 visitors to our health professional content. The most popular Cancer and COVID-19 resource was a fact sheet around COVID-19 vaccinations. What was learnt: (if relevant, please also detail here the potential of replicability) Through the course of the pandemic, people affected by cancer and the health professionals supporting them experienced difficulties accessing credible and current information regarding cancer and COVID-19. Community organisations with strong stakeholder relationships with consumers, health professionals and government can be a trusted source to develop and disseminate accurate information and enable people affected by cancer to navigate the impacts of the pandemic on their current and future situation. Have you got a Conflict of Interest?: No
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1721 Lung cancer in the Colombian health system: a review of trends in morbidity and survival S.J. Trujillo Cáceres1, J.A. Hernández Vargas1, G.P. Fernández Deaza1, L.A. Acuña Merchán2 1 Fondo Colombiano de Enfermedades de Alto Costo (High-cost diseases fund), Knowledge management coordination, Bogotá, Colombia, 2Fondo Colombiano de Enfermedades de Alto Costo (High-cost diseases fund), Executive director, Bogotá, Colombia Background: According to the national government, cancer is a high-cost disease and a central public health issue. The Ministry of Health in Colombia has established a regulatory framework to improve access to healthcare, survival, and quality of life for people with cancer, including national surveillance systems. In 2014, the reporting of people with cancer became mandatory for health insurers, and the National Cancer Information System (NCIS) was created. Aim:To describe the epidemiological, clinical situation, and overall survival (OS) in people with lung cancer notified to the NCIS between 2015 and 2020. Methods:People with lung cancer, defined with ICD-10 codes: C33X-C34, D021-D022 (includes trachea), reported by health insurers to the NCIS between January 2014 and January 2021 were included. Survival analyses were based on people notified until January 2020, and a five-year OS was estimated using the Kaplan-Meier method. We also analyzed OS by sex, health insurance, and stage at diagnosis, comparing the curves with the log-rank test. Results:A sustained trend of higher mortality over incidence was observed, and it can be explained by the advanced stages in which most cases were diagnosed. When analyzing the new cases reported to the NCIS in 2021 (n=1,266), 51.6% were male, the median age was 69 years (IQR: 61-76), and 63.4% were affiliated with the third-party payer. Most cases (99%) were invasive (by ICD-10 code). TNM staging was reported in 84.4% (n=1,058), and more than 75% were classified as stage IV. A total of 6,346 new cases were included in survival analyses. They were primarily male, and the median age at diagnosis was 67 years (IQR: 59-74). 57.7% were diagnosed at stage IV. The mean follow-up was 1.9 years (95% CI: 1.8-2.0). There were 3,854 deaths during the period analyzed. Five-year OS was 13.9% (95% CI: 11.7%-16.3%). OS was significantly higher in women (17%) than men (12%). Regarding stage, people diagnosed at early stages had a significantly better OS (30%) vs advanced stages (8%). OS was comparable in health insurance types (thirdparty payer: 14% vs state insurance: 12%) (Table 1).
Table 1. Lung cancer overall survival by groups of interest in the Colombian health system, 2015-2020.
Overall survival (%)
Log-ranktest
(CI 95%)
p-value
Variables Sex Women Men Health insurance Third-party payer State insurance Stage at diagnosis 1
16.76 (13.43-20.40) 11.56 (8.81-14.71)
<0.001
14.19 (11.44-17.23) 12.53 (9.68-15.77)
<0.339
Local early Locally advanced Unknown
30.49 (21.61-39.81) 7.64 (5.34-10.47) 17.13 (13.29-21.39)
<0.001
CI: Confidence interval Conclusion: We found a significantly higher OS in women and people diagnosed at early stages. Our findings are consistent with previous studies that point out that early diagnosis is a direct predictor of survival. Have you got a Conflict of Interest?: No
1724 Partnership in Cancer Survivorship Optimization (PICASSO) Project : An Indian Cancer Society (ICS) initiative V. Dhamankar1, D. Rajkumar1, L. Francis1, J. Sharma1, S. Devadhar1, S. Wani1, M. Prasad2, G. Kapoor3, V. Radhakrishnan4, S. Mudaliar5, S. Sharma6, R. Seth7, S Chandrakala8, F. Guru9, K. Anand10, P. Phad1, V.S Kanwar11, S. Bhat12, P. Kurkure1 1 Indian Cancer Society, Mumbai, India, 2Tata Memorial Hospital, Mumbai, India, 3Rajiv Gandhi Cancer Institute& Research centre, Delhi, India, 4Cancer Institute (WIA), Chennai, India, 5Bai Jerbai Wadia Hospital for children, Mumbai, India, 6Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India, 7All India Institute of Medical Sciences, New Delhi, India, 8KEM Hospital, Mumbai, India, 9Sher-Ikashmir institute of Medical sciences, Srinagar, India, 10Sri Shankara Cancer hospital and Research Centre, Bangalore, India, 11Homi Bhabha Cancer Hospital, Varanasi, India, 12Mazumdar Shaw Cancer Centre, Narayana Health, Bangalore, India Background and context: Cancer care so far has focused on early detection and treatment to achieve better survival. With an exponential increase in the number of cancer survivors, cancer survivorship is now an important component of care across the cancer continuum. Cancer survivors are often lost in transition to the more passive survivorship phase, when treatment related medical issues often emerge. Concept of a true cure envisages not only eradication of the cancer but a survivor at par with peers in growth and development physically, and psychosocio-economically. In India the family has to depend largely on its own resources for follow-up after active cancer treatment ceases, worsening this issue. In addition, Cancer Survivorship Programs do not exist in most of the cancer centres in India.Aim: To develop a standard replicable module for holistic survivorship care to decrease the loss to long term follow up, to improve quality of life and to facilitate support groups.Strategy / Tactics: Inspired from ACT(After Completion of Treatment) clinic at Tata Memorial Hospital andUgam (support group of survivors) at ICS, PICASSO is holistic survivorship module developed by ICS in 2017. The strategy is to implement the module at major paediatric cancer units in India, then scale up for other age groups. Programme / Policy process: Hospitals are selected as per eligibility criteria. Survivors (>two years post treatment & disease free) are registered in Hospital basedACT Clinic run by Hospital Oncologist and ICS psychologist. Survivorship care plan (SCP) is outlined and therapeutic interventions are implemented as per the plan. Rehabilitation is provided by ICS team through counselling, support group meetings, financial support for education, investigation & treatment of late effects.
2
Outcomes: From Nov 2017 to March 2022,1723 survivors registered in nine ACT clinics at five cities in India. Medical & psychosocial evaluation is done for all as per set guidelines. 297 survivors received financial support for education & vocational course. Seventy achieved educational milestones. Late effects support for hearing aid, dental implants, Infertility , prosthesis, Growth hormone initiated this year. Group Health insurance for survivors is another issue which is pursued. What was learnt: (if relevant, please also detail here the potential of replicability) A comprehensive model of survivorship care through partnership with Community Social Organization will ensure holistic care of survivors & improved quality of life. This will be implemented at more centers in India to bring cancer survivorship issues at forefront. This is a replicable model which all the hospitals can adapt and institutionalize the survivorship program as a part of standard care to the cancer survivors. Have you got a Conflict of Interest?: No
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1722 Use of laws and legal mechanisms against cancer in Latin America K. Lopez-Cuevas1 1 Cancer Warriors de Mexico, Mexico City, Mexico Background and context: Every year around 20 million people worldwide are diagnosed with cancer, 10 million of whom lose their lives, mostly due to late diagnosis. In the region of Latin America, the number of cancer cases was estimated at 4 million in 2020 and is projected to increase to 6 million by 2040. In 2020, cancer caused 1.4 million deaths, 47% of them in people aged 69 years or younger. Between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies or public policy. Law occupies a central place, from health system design, implementation and governance to health promotion, disease prevention and delivery of health care at all stages of life. Aim: To share successful legal and legislative practices linked to the field of cancer control in the Latin American region, as well as provide useful information on the implementation of legal mechanisms such as national plans and programs for the defense of the human rights of oncology patients. Strategy / Tactics: Sharing the current context of cancer control in Latin America, as well as the progress that has been made in recent years in the creation of legislative initiatives focused on the timely detection of certain types of cancer. What’s going on with cancer laws in Latin America? -The Republic of Chile established the National Cancer Law 21258, which was published on September 02, 2020, and its regulations were published on April 6, 2021. Its objective is to establish a regulatory framework for the planning, development and execution of public policies, programs and actions aimed at establishing the causes and preventing the increase in the incidence of cancer. -Likewise, the Republic of Peru published Law No. 31336 National Cancer Law on August 10, 2021, and its draft regulations were published on November 19. This law aims to guarantee universal, free and priority coverage of health services for all cancer patients. -In Mexico, on January 7, 2021, we achieved the publication, in the Official Journal of the Federation (DOF), of the General Law for the Timely Detection of Cancer in Children and Adolescents, in the case of this law, it is still pending the publication of its regulations for the application of the same. From civil society, we will continue to support the use of laws to ensure the prevention and timely detection of cancer. -Another example of the use of the law against cancer in Mexico is the initiative promoted in local congresses called #UnDíaContraElCáncer (#A DayAgainstCancer), which consists of granting one day a year with pay to working women and men so that they can go for studies such as mammography, pap smears, prostate antigen, and digital rectal exam, respectively, to detect breast, cervical and prostate cancer in a timely manner. This initiative has been promoted since October 2021 in seven local congresses and has been approved unanimously in two of them. Have you got a Conflict of Interest?: No
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1724 Partnership in Cancer Survivorship Optimization (PICASSO) Project : An Indian Cancer Society (ICS) initiative V. Dhamankar1, D. Rajkumar1, L. Francis1, J. Sharma1, S. Devadhar1, S. Wani1, M. Prasad2, G. Kapoor3, V. Radhakrishnan4, S. Mudaliar5, S. Sharma6, R. Seth7, S Chandrakala8, F. Guru9, K. Anand10, P. Phad1, V.S Kanwar11, S. Bhat12, P. Kurkure1 1 Indian Cancer Society, Mumbai, India, 2Tata Memorial Hospital, Mumbai, India, 3Rajiv Gandhi Cancer Institute& Research centre, Delhi, India, 4Cancer Institute (WIA), Chennai, India, 5Bai Jerbai Wadia Hospital for children, Mumbai, India, 6Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India, 7All India Institute of Medical Sciences, New Delhi, India, 8KEM Hospital, Mumbai, India, 9Sher-Ikashmir institute of Medical sciences, Srinagar, India, 10Sri Shankara Cancer hospital and Research Centre, Bangalore, India, 11Homi Bhabha Cancer Hospital, Varanasi, India, 12Mazumdar Shaw Cancer Centre, Narayana Health, Bangalore, India
Background and context: Cancer care so far has focused on early detection and treatment to achieve better survival. With an exponential increase in the number of cancer survivors, cancer survivorship is now an important component of care across the cancer continuum. Cancer survivors are often lost in transition to the more passive survivorship phase, when treatment related medical issues often emerge. Concept of a true cure envisages not only eradication of the cancer but a survivor at par with peers in growth and development physically, and psychosocio-economically. In India the family has to depend largely on its own resources for follow-up after active cancer treatment ceases, worsening this issue. In addition, Cancer Survivorship Programs do not exist in most of the cancer centres in India. Aim: To develop a standard replicable module for holistic survivorship care to decrease the loss to long term follow up, to improve quality of life and to facilitate support groups.Strategy / Tactics: Inspired from ACT(After Completion of Treatment) clinic at Tata Memorial Hospital andUgam (support group of survivors) at ICS, PICASSO is holistic survivorship module developed by ICS in 2017. The strategy is to implement the module at major paediatric cancer units in India, then scale up for other age groups. Programme / Policy process: Hospitals are selected as per eligibility criteria. Survivors (>two years post treatment & disease free) are registered in Hospital basedACT Clinic run by Hospital Oncologist and ICS psychologist. Survivorship care plan (SCP) is outlined and therapeutic interventions are implemented as per the plan. Rehabilitation is provided by ICS team through counselling, support group meetings, financial support for education, investigation & treatment of late effects. Outcomes: From Nov 2017 to March 2022,1723 survivors registered in nine ACT clinics at five cities in India. Medical & psychosocial evaluation is done for all as per set guidelines. 297 survivors received financial support for education & vocational course. Seventy achieved educational milestones. Late effects support for hearing aid, dental implants, Infertility , prosthesis, Growth hormone initiated this year. Group Health insurance for survivors another issue which is pursued.
1
What was learnt: (if relevant, please also detail here the potential of replicability) A comprehensive model of survivorship care through partnership with Community Social Organization will ensure holistic care of survivors & improved quality of life. This will be implemented at more centers in India to bring cancer survivorship issues at forefront. This is a replicable model which all the hospitals can adapt and institutionalize the survivorship program as a part of standard care to the cancer survivors. Have you got a Conflict of Interest?: No
2
1725 The Action Plan for the Elimination of Cervical Cancer in Canada, 2020-2030 J. Saini1, H. Michelle1 1 Canadian Partnership Against Cancer, Toronto, Canada Background and Context: Each year, more than 1,300 people in Canada are diagnosed with cervical cancer and over 400 die from the disease. Yet cervical cancer is almost entirely preventable and highly curable when found and treated early. As part of the eight priorities under the Canadian Strategy for Cancer Control, there is a focus on decreasing the risk of people getting cancer, including eliminating cervical cancer. The Action Plan for the Elimination of Cervical Cancer in Canada 2020–2030 (the Action Plan) is Canada’s response to the call by the World Health Organization to eliminate cervical cancer worldwide within the century. Aim: The Action Plan for the Elimination of Cervical Cancer in Canada, 2020-2030 aims to eliminate cervical cancer in Canada by 2040. Strategy/Tactics: The Action Plan identifies priorities, targets, actions and key partners to improve HPV immunization rates, implement HPV primary screening and ensure timely follow-up for individuals with abnormal screening results. Within the Action Plan, Peoples-specific actions identified by First Nations, Inuit and Métis partners will further reduce health inequities and drive system-wide changes required for Canada to eliminate cervical cancer. Outcomes: Between 2020-2022, the Canadian Partnership Against Cancer (CPAC) funded initiatives across Canada to understand contexts, readiness, and health inequities, and develop implementation capacity and strategies with partners. This allowed CPAC and collaborating partners to prepare for implementing the Action Plan actions and priorities. Between 2022-2027, CPAC will fund implementation-focused projects with key partners and champions to implement Action Plan, establish mechanisms that support system change, and fund selfdetermined First Nations, Inuit and Métis priorities. This phase will also include monitoring and evaluating progress on indicators and targets of the Action Plan. What was learnt: Collaboration across the cancer control continuum, health system, education system, and civil society will be required to eliminate cervical cancer in Canada. Working with First Nations, Inuit and Métis governments and organizations on self-determined priorities will enable new partnerships and accelerated action towards prevention of cervical cancer across Canada. By starting with understanding remaining gaps in delivery of existing HPV immunization programs, cervical screening programs and follow-up services, the country will be able to reduce inequities and make significant strides towards elimination in the next 10 years. Have you got a Conflict of Interest?: No
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1729 Trends of the population attributable fraction of risk factors for gastric cancer in China from 1990 to 2015 F. He1, J. Gu1, R. Zheng1, S. Zhang1, H. Zeng1, K. Sun1, R. Chen1, L. Li1, S. Lei1, X. Li1, S. Wang1, W. Wei1 1 Office of National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Background: Gastric cardia cancer (GCC) and gastric non-cardia cancer (GNCC) remain as the major cancer types in China, although some important risk factors have evolved in past decades. It’s important to investigate the changing trends of the population attributable fractions (PAFs) of important risk factors associated with GCC/GNCC, to help further targeted cancer prevention and control efforts. Aim: We aim to provide an estimation on the time trend of PAFs of main risk factors associated with GCC/GNCC in China from 1990 to 2015, to provide scientific evidence for future targeted prevention and control of risk factors for gastric cancer in China. Methods: Estimates of the prevalence of main risk factors were obtained from representative national surveys. The relative risks associated with main risk factors and GCC/GNCC were obtained from high-quality metaanalyses of studies in China or Asia. We calculated PAFs by combining exposure prevalence and relative risk data, and the uncertainty was quantified by the 95% confidence interval (CI). We also calculated the annual percentage change (APC) of the PAFs to estimate time trends. Each time period trend of PAFs was described by the estimated APC with corresponding 95% CI by using joinpoint regression analyses. Results: From 1990 to 2015, the PAFs of main risk factors of GNCC in China has fallen from 77.67% to 64.24% and 67.61% to 54.24% in males and females, respectively. Similar trends of PAFs were observed in the GCC, i.e., PAFs decreased from 72.14% to 55.38% in males, and from 61.48% to 45.59% in females. Helicobacter pylori (H. pylori) remains as the leading risk factor over periods, though its PAF decreased in both GNCC (from 47.55% to 38.07%) and GCC (from 34.55% to 26.35%). Moreover, we observed significant decreasing trends of PAFs for alcohol consumption (APC: -2.8, 95%CI: -5.5, 0) and pickled vegetables intake (APC: -1.6, 95%CI: -2.2, -0.9) for GCC and GNCC in males from 1990 to 2015. In females, the declines were mainly attributed to lower exposures of alcohol consumption (APC of PAF: -4.3, 95%CI: -7.6, -0.8) and smoking (APC of PAF: -3.6, 95%CI: -4.2, -3.0) from 1990 to 2015. Conclusion: We observed a 10% reduction of the PAFs of major risk factors of GCC and GNCC, which attributable to continued efforts on the intervention and prevention of these risk factors. However, the remained high PAFs of important risk factors including H pylori infection and smoking, highlighting further attention and control to help reduce the disease burden of gastric cancer in China. Funding information: This study was supported by the grant from the Beijing Nova Program (No. Z201100006820069) Have you got a Conflict of Interest?: No
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173 Influencing factor analysis of targeted therapy on patients with EGFR mutant non-small cell lung cancer P. Huang1 1 Wuxi No.2 Hospital Affiliated to Nanjing Medical University, Wuxi, China Objective: To investigate the influencing factors of the therapeutic effect of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) in patients with advanced epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer. Methods: The clinical data of 104 patients with advanced EGFR mutant non-small cell lung cancer (NSCLC) who received EGFR-TKI treatment in Wuxi Second Hospital from January 2015 to October 2019 were collected. A correlation analysis was made between different types of EGFR mutation and the other clinical indicactors retrospectively, including the clinicopathological characteristics, the hematological examination results and the treatment mode of patients.A Cox proportional hazard model was used to identify independent prognostic factors for PFS of patients receiving EGFR-TKI treatment, including different types of EGFR mutation and the other clinical indicactors, including the clinicopathological characteristics, hematological examination results and treatment mode. Results: The overall disease control rate (DCR) of patients receiving EGFR-TKI treatment was 92.3%. The univariate analysis showed that the levels of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), D-dimer, and previous surgical treatment history of patients were associated with PFS of patients receiving EGFR-TKI treatment (respectively HR=2.464, 95%CI: 1.368-4.438; HR=2.211, 95%CI: 1.329-3.679; HR=1.866, 95%CI: 1.1652.988; HR=0.484, 95%CI: 0.267-0.875; allP<0.05). However, there was no significant influence in the multivariate Cox analysis (HR=1.425, 95%CI: 0.723-2.809; HR=1.727, 95%CI: 0.829-3.594; HR=1.233, 95% CI: 0.6672.280; HR=0.815, 95%CI: 0.364-1.825; all P>0.05). Type of EGFR mutation (HR=2.371, 95%CI: 1.2984.332, P=0.005), combination therapy (HR=0.489, 95%CI: 0.245-0.978, P=0.043) and therapeutic drugs (HR=0.261, 95%CI: 0.113-0.606, P=0.002) were independent factors in the multivariate Cox analysis. After further stratification by EGFR mutation types, it was found that EGFR19 mutant patients receiving EGFR-TKI in first-line treatment could obtain better PFS than those in second-line (median PFS: 14 months vs 9.5 months, HR=2.553, 95% CI: 1.422-4.584, P=0.002). EGFR19 mutant patients with CA125<85U/ml could obtain longer PFS than those with CA125≥85U/ml (median PFS: 14 months vs 6.5 months, HR=2.537, 95 %CI: 1.426-4.512, P=0.002). Conclusion: The therapeutic effect of EGFR-TKI in patients with advanced EGFRmutant NSCLC is positive. EGFR19-mutant NSCLC patients with low-level CA125 receivingEGFR-TKIinfirst linetreatmentcan obtain better PFS. However, the multi-factor impact analysis of OS still needs to be further researched. Have you got a Conflict of Interest?: No
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1734 Profile of women who attend for mammograms in Liga contra el cáncer Honduras 2018-2020. S. Bejarano1, K. Flores2, C. Alas-Pineda1, K. Gaitan-Zambrano3, M.J Ramírez-Arias3, P. Ratliff-Subillaga3, C. López2, S. Gough4,3 1 Liga contra el cáncer, Programa de prevención y educación en cáncer PESCA, San Pedro Sula, Honduras, 2Liga contra el cáncer, Mamografía e imágenes, San Pedro Sula, Honduras, 3Universidad Católica de Honduras, ASOCEM-UnicahSPSP, San Pedro Sula, Honduras, 4Hospital Civil de Guadalajara Fray Antonio Alcalde, Departamento de Imagenología y Radiología, Guadalajara, México., Guadalajara, Mexico Background: In Latin America, around 152,059 breast cancer (BC)cases are diagnosed annually and approximately 52,550 deaths are reported each year (4) (5). Risk factors for breast cancer include diet, sedentary lifestyle, alcohol or tobacco consumption, age, sex, race and genetic predisposition (6) (7). With regard to age, the incidence of breast cancer increases progressively until menopause is reached, after which the probability is reduced (8). The most important genetic predisposition is mutations in BRCA1 and BRCA2, corresponding to 10% of cases (8). Women with early menarche, late menopause and nulliparity are at increased risk of developing breast cancer, due to prolonged exposure to high concentrations of estrogens (7). Mammography allows detection of BC at early stages, thus improving patient survival (9). The WHO recommends for women between 50- 69 years a mammogram every 2 years, if financial resources and access to health services allow it (4).In Honduras, breast cancer is the first cancer in urban women between 36-55 years old (5-protocol). However, the sociodemographic and risk profile of women who undergo a mammography and have a positive result is not known Aim: Examine and describe the sociodemographic and clinical profile of patients who spontaneously attend mammography at the Hospital de la Liga Contra el Cancer LCC. Methods: Observational, cross-sectional study. Population is all women who spontaneously attended for mammogram at tLCC the largest oncology reference center in the north of the country, during the 2018-2020. Data analysis unit were entry forms compiled by the radiology department at LCC. A non-probabilistic sample with convenience sampling was used, recovering a total of 3705 mammography forms and reports. Results: The median age was 52 y, [IQR 46 – 60], with a range between 28 and 88 y. 10.8% had a family history of breast cancer. 66.4% were subsequent, 33.0% first comers with a median age of 47 y, 38% postmenopausal, and 0.6% o had a previous diagnosis of BC.19.7% w multiple pregnancies, 1.1% actual use hormone contraceptives. 58.3% of suspicious mammograms occurred in left side breasts.1% reported BIII and above. 91.3% of previous BC were ductal adenocarcinoma,4.3% medular and 4.3 fibrosarcoma, median age of 54y. 54% had a mammogram in the past 2 years and 72.9% were normal. Conclusion: Public health practices are linked to national guidelines and access, associated to public education processes. Unfortunately, the elements for a population-based (pre-registration-based) mammographic screening programme, such as the workforce, quality assurance, and optimal access to treatment, are unavailable in lowand middle-income countries. In Honduras, several opportunistic programs (personal decision to perform screening) are available, this information would identify information gaps and excluded population at risk and provide evidence for education and information strategies.
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Table1. BIRADS Category .
BIRADS B0 BI BII BIII BIV BV BVI
Total (n = 1223) 417 (34.1%) 138 (11.3) 655 (53.6%) 1 (0.1%) 4 (0.3%) 7 (0.6%) 1 (0.1%)
Source: Have you got a Conflict of Interest?: No
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1735 Analysis of tobacco market in Sri Lanka S.D. De Seram1, A. Tenna1 1 ADIC Sri Lanka, Colombo 05, Sri Lanka Background: Several types of tobacco are consumed in both smoked and smokeless forms in Sri Lanka. Although the most widespread smoked form of tobacco is cigarettes, the use of beedi, traditional betel quid, and commercial and non-commercial preparations of different types of smokeless tobacco is also prevalent. Aim: Analyze the tobacco market in Sri Lanka focusing on sales patterns and purchasing habits. Methods: The analysis was conducted in seven districts in Sri Lanka. Data was obtained from cigarette and other tobacco selling outlets, Observations were conducted on tobacco sales activity surrounding educational institutions. Results: In the 7 districts, 337 cigarettes are sold on average per day in the surveyed outlets. The highest reported total cigarette sales are in Colombo at 662 cigarettes. The Most Sold Cigarette Brand: JPGL 201 sticks, per day, per outlet. Overall 194 beedi sticks are sold on average per day, per outlet in the 7 districts
A majority (76%) of customers buy cigarettes as single sticks.
Cigarette buying pattern
1
JPGL is the most popular cigarette brand among both young and elder people. JPGL is the most popular brand among both white-collar and blue-collar workers. The lower-priced cigarette brand Navy Cut is significantly popular, especially among blue-collar workers. Dunhill is more popular with white-collar workers. The retailers reported incentives being awarded for selling JPGL and Dunhill brands only. The incentives reported were receiving cashier machines, showcases, clocks, t-shirts, light-up boards, and calculators.
81.9% of retailers stated cigarette sale is not profitable. 61 (72%) outlets in the 7 districts had cigarette packs visibly displayed inside the outlets. 93 of the 208 retailers reported tobacco company interventions. These interventions included meeting the owner and providing information, participating in functions, receiving gifts from the company, and intervening in legal issues. 48% of the retailers view smoking as “not good”. However, only 12% of the retailers cited health issues of cigarette smoking This study found the existence of tobacco and mainly cigarette selling outlets within a 3-minute walking distance from educational institutions Conclusion: The tobacco industry directly targets cigarette selling outlets by giving rewords and most of the outlets have tobacco advertisements. The easy availability of tobacco products to educational institutions led to the initiation of underage youth and children smoking. In order to minimize the tobacco prevalence should further strengthen tobacco control tax policy and other policies within the country. Have you got a Conflict of Interest?: No
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1736 CaPTC Prostate Cancer Study of Men of African Ancestry in Nigeria, Cameroon and United States F. Odedina1, P. Fathi1, J. Crook1, E. Kanijning2, C. CaPTC.Africa.Investigators3 1 Mayo Clinic, Hematology/Oncology, Jacksonville, United States, 2Georgia College, Milledgeville, United States, 3Prostate Cancer Transatlantic Consortium, Abuja, Nigeria Background: Based on the WHO estimates, the top ten countries leading prostate cancer (CaP) mortality in the world are all Black nations. CaP is the leading cancer among men within the WHO African region for estimated age-standardized incidence rates, age-standardized mortality rates and estimated 5-year prevalent cases. Addressing CaP disparities in Black men (BM) require a comprehensive understanding of both environmental, behavioral and biological risk factors of CaP. Aim: This study was conducted by members of the Prostate Cancer Transatlantic Consortium (CaPTC) to understand the genetic, environmental and behavioral etiology of CaP in BM of African ancestry. In this report, we compared BM in United States (US), Nigeria and Cameroon on health care access and clinical variables using the standardized C.A.M. CaP measure. Methods: The Familial Cohort study of BM started in 2017 with prospective data collection still ongoing to understand the bio-behavioral etiology of CaP in multiple countries. Using a flier, participants who meet the selection criteria (between the age of 35 and 70 and provide informed consent) are recruited in clinics and diverse community settings. Using a culturally relevant instrument, data on epidemiological, behavioral, clinical and anthropometric variables are collected from participants. In addition, saliva samples are collected for biological analyses. This report focuses on health care access and CaP history of participants. We evaluated study variables using descriptive statistics of means procedure for continuous variables and frequency analyses for categorical variables. Subsequently χ2 analyses was used to compare across countries. Results: 803 BM participated in the study in Nigeria (83.0%), Cameroon (9.6%), and United States (7.4%). Mean age was 51 (±12) years. Most of the participants were married, highly educated, employed at the time of the survey, had no health insurance, pay almost all the bills for their healthcare, do not have annual health examination, reported high health literacy and reported good health. About 15% reported CaP diagnosis, 29% reported previous PSA test, 22% reported DRE test and 15% reported benign prostatic hyperplasia (BPH). BM in the three countries were statistically different on health insurance access, annual physical checkups, and dental checkups with BM in the US having the best access. BM in Cameroon were more likely to report both PSA blood test and DRE compared to BM in Nigeria and the US. BM in Cameroon and Nigeria were more likely to report paying for healthcare, and more likely to report cancer diagnosis compared to BM in the US. Conclusion: Compared to the US, limited-resourced countries in Africa face several challenges in dealing with CaP, including limited healthcare access and out of pocket expenses. It is interesting to note that higher cancer diagnosis were reported in Nigeria and Cameroon, which translates to significant financial toxicity for the BM. Have you got a Conflict of Interest?: No
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1737 Individual Donor Behaviour: views from a non-profit organisation operating in a multi-ethnic society R. Arron1 1 MAKNA, Kuala Lumpur, Malaysia The 10th-anniversary edition of CAF’s World Giving Index presents Malaysia as one of the 4th biggest risers, as it has significantly increased its giving index score between 2010 and 2019. In Malaysia, charities have to rely on individual donors and less on government funds to survive in the competition. As a non-profit organisation, MAKNA receives revenue from a host of sources including corporate donations, Zakat (the Islamic obligatory taxation) and donation boxes. More than any of these mediums, MAKNA relies on individual donors for more than 85% of the total donations. As charities need to depend on individual donors, it is required to study the individual donor characteristics to help identify and describe distinctly the individual donor features. The three main ethnic groups play a major role: different ethnicities have different thoughts and habits, as an example, a Buddhist in Malaysia tends to donate more to temples or pagodas benefits, due to the importance that is given to the preservation of Chinese culture and heritage even though younger generations are more versatile in their philanthropy work. For Muslim Malays, philanthropy work falls under zakat, waqf and sadaqah. Zakat is obligatory taxation required by sharia law, while waqf is more of a voluntary contribution such as gifts of land and property for public use e.g. mosques, religious schools and orphanages. Spontaneous charitable gifts, known as sadaqah, can be cash, property or volunteer service. Based on a study done by Mohammad (2002), the Indian population in Malaysia is the most difficult to garner funds, because the majority of the population is not in a financial position to give. The chart below shows the racial and age cohorts of MAKNA’s donors from 2002 to 2019, which displays a similar view to the study above:
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Identifying the gaps in the giving behaviour is key, hence we work extensively on understanding what is needed to turn the donors' attention towards giving to a specific cause such as cancer which does not see race or skin colour. As a people-focused non-profit, the messaging has always been skewed toward cancer patients and the services we provide, which reflects in our marketing tools. To ensure these messages reach all cohorts in Malaysia, we personalise the content based on the race and age cohorts. This led to a tremendous hike in individual pledges starting in 2002. A strong and consistent retention program was placed to ensure the donors continue their pledge with MAKNA for a longer time. The current average stands at 6.3 years per donor and the donor attrition for our donors is between 4% and 6% for the first year. This attrition rate has been the benchmark for many other charities in Malaysia since the year 2016. In conclusion, the 17-year data shows that MAKNA has succeeded to show its consistency in managing the donor's lifetime value and their continuous pledge by bridging the gap between the races and age cohorts specifically.
Have you got a Conflict of Interest?: No
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1738 Health and economic impact of delayed HPV vaccination programs in China: A modelling study M. Gao1, S. Hu1, X. Zhao1, F. Zhao1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Cancer Epidemiology, Beijing, China Background: WHO called for a global strategy to accelerate cervical cancer elimination and proposed that 90% of girls receive the HPV vaccination. However, HPV has not yet been introduced into the Chinese National Immunization Program. The delay of HPV vaccination would affect the performance of cervical cancer control, and data on what extent changes in disease burden and the cost-effectiveness evaluation with different initial years of vaccination has been limited. Aim: To quantify the numbers of cervical cancer cases and deaths, and the cost-effectiveness of the vaccination strategies initiated in different years in China. Methods: A calibrated hybrid model was used to assess the lifetime costs and effectiveness of alternative vaccination strategies initiated in 2022-2030 with four vaccines (domestic bivalent [Cervarix], imported bivalent [Cecolin], quadrivalent [Gardasil], and 9-valent [Gardasil-9] vaccines). We assumed 90% coverage of HPV vaccination for girls aged 12 years with two-dose regimens routinely. We assumed the screening was targeted at women aged 35-64 years at 5-year intervals, with scaling up coverage by 5% every year from 2022 until 70%. All women living or projected to be born in China during 2022-2100 were considered. Primary outcomes were women with HPV infections, cervical cancer cases and deaths, and incremental cost-effectiveness ratios (ICERs). Optimal strategies were determined by cost-effectiveness efficiency frontiers. We employed a lifetime horizon from a societal perspective. Results: Compared with no vaccination, scenarios involving immediate implementation of four kinds of vaccination in 2022 averted 1,413,729,106-4,494,187,075 women with HPV infections, 3,321,888-4,604,944 cervical cancer cases and 1,052,054-1,520,081 deaths. Each year of delayed vaccination would additionally result in 21,212,816-62,997,811 women with HPV infections, 53,243-70,362 cases of cervical cancer, and 17,107-23,542 deaths (Table 1). Under the vaccination initiated in 2022 and scaling up of screening coverage to 70%, domestic bivalent, imported bivalent, quadrivalent, and 9-valent vaccines could lead to cervical cancer elimination by years 2068, 2063, 2065, and 2060, respectively. In contrast, vaccination initiated in 2030 would achieve cervical cancer elimination 8-10 years later than that observed with vaccination initiated in 2022 (Figure 1). With the GDP per capita ($12,458) as the threshold, domestic bivalent vaccination initiated in 2022 would be the optimal strategy, with discounted ICERs of $5,604 per QALY (Figure 2). Conclusion: The delay in the HPV vaccination programs would result in substantial excess infections, morbidity, and mortality. Implementing HPV vaccination programs earlier was cost-effective and would accelerate cervical cancer elimination. Table 1.Estimated excess women with HPV infections, cervical cancer cases, and deaths with vaccination initiated in different years compared with initiated in 2022
Initial years of vaccination Cervarix 2022 vs. no vaccination 2023 vs. 2022 2024 vs. 2022 2025 vs. 2022 2026 vs. 2022
Women with HPV infections
Cervical cancer cases
Cervical cancer deaths
-1,413,729,106 19,848,996 41,083,523 63,645,959 84,746,814
-3,321,888 52,123 106,726 164,043 217,207
-1,052,054 16,950 34,570 52,960 70,074
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Initial years of vaccination 2027 vs. 2022 2028 vs. 2022 2029 vs. 2022 2030 vs. 2022 Excess number per year Cecolin 2022 vs. no vaccination 2023 vs. 2022 2024 vs. 2022 2025 vs. 2022 2026 vs. 2022 2027 vs. 2022 2028 vs. 2022 2029 vs. 2022 2030 vs. 2022 Excess number per year Gardasil 2022 vs. no vaccination 2023 vs. 2022 2024 vs. 2022 2025 vs. 2022 2026 vs. 2022 2027 vs. 2022 2028 vs. 2022 2029 vs. 2022 2030 vs. 2022 Excess number per year Gardasil-9 2022 vs. no vaccination 2023 vs. 2022 2024 vs. 2022 2025 vs. 2022 2026 vs. 2022 2027 vs. 2022 2028 vs. 2022 2029 vs. 2022 2030 vs. 2022 Excess number per year
Women with HPV infections 105,087,147 126,502,932 148,258,966 169,702,527 21,212,816
Cervical cancer cases 267,889 320,689 373,883 425,945 53,243
Cervical cancer deaths 86,393 103,287 120,257 136,856 17,107
-2,921,185,578 36,415,556 75,154,886 116,132,359 155,117,750 193,137,494 232,976,265 273,498,786 313,683,988 39,210,499
-3,967,817 59,015 120,818 185,685 246,188 304,104 364,422 425,275 484,998 60,625
-1,296,048 19,692 40,164 61,532 81,553 100,743 120,607 140,598 160,218 20,027
-1,931,663,720 25,887,876 53,438,978 82,582,819 110,127,784 136,865,692 164,892,256 193,355,884 221,499,492 27,687,437
-3,529,668 54,576 111,717 171,667 227,412 280,652 336,084 391,947 446,678 55,835
-1,131,354 17,937 36,576 56,018 74,167 91,513 109,460 127,496 145,161 18,145
-4,494,187,075 58,191,133 120,658,446 187,268,637 249,842,428 310,390,609 374,327,953 439,505,457 503,982,488 62,997,811
-4,604,944 68,260 139,876 215,235 285,432 352,560 422,621 493,401 562,898 70,362
-1,520,081 23,065 47,088 72,229 95,758 118,288 141,658 165,209 188,335 23,542
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1745 FcγRIIB promotes differentiation of myeloid-derived suppressor cells to mediate tumor immunoescape l. wu1, Y. Li1 1 Chongqing University Cancer Hospital, Department of Medical Oncology, Chongqing, China Background: FcγRIIB, the sole inhibitory receptor of the Fc gamma receptor family, plays pivotal roles in innate and adaptive immune responses. However, the expression and function of FcγRIIB in myeloid-derived suppressor cells (MDSCs) remains unknown. This study aimed to investigate the mechanism by which FcγRIIB regulates the immunosuppressive activity of MDSCs during cancer development, and explore new anticancer therapeutic approaches. Aim: This study aimed to investigate the mechanism by which FcγRIIB regulates the immunosuppressive activity of MDSCs during cancer development, and explore new anticancer therapeutic approaches. Methods: The MC38 and B16 tumor-bearing mouse models were established to investigate the role of FcγRIIB during tumor progression. FcγRIIB-deficient mice, adoptive cell transfer, mRNA-sequencing and flow cytometry analysis were used to assess the role of FcγRIIB on immunosuppressive activity and differentiation of MDSCs. Results: 1. Increased FcγRIIb expression on tumor-infiltrating MDSCs.
2. Tumor cell-derived granulocyte-macrophage colony stimulating factor (GM-CSF) increased the expression of FcγRIIB on hematopoietic progenitor cells (HPCs) by activating Specificity protein 1 (Sp1), subsequently FcγRIIB promoted the generation of MDSCs from HPCs via Stat3 signaling.
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3. Blockade of Sp1 dampened MDSC differentiation and infiltration in the TME and enhanced the anti-tumor therapeutic efficacy of gemcitabine.
Conclusion: These results implicate an unrecognized regulatory role of the FcγRIIB in abnormal differentiation of MDSCs during cancer development and suggest a potential therapeutic target for anti-tumor therapy. Have you got a Conflict of Interest?: No
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1746 Natural history of HR-HPV infection clearance or progression to cervical lesion in Chinese young women T. Wen1, X. Xu2, F. Chen1, Q. Pan1, W. Zhang1, Y. Hong3, S. Hu1, F. Zhao1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Epidemiology, Beijing, China, 2Beijing Friendship Hospital, Capital Medical University, Department of Clinical Epidemiology and EBM Unit, Beijing, China, 3Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Department of Gynecology, Nanjing, China Background:Cervical cancer is one of the most common malignancies in Chinese women[1]. Persistent infection with high-risk human papillomavirus (HR-HPV) is a prerequisite for the development and progression of cervical cancer[2]. However, the natural history of HR-HPV infection in Chinese women remains unclear. Aim:To analyze the natural history of HR-HPV infection in Chinese young women. Methods:Our study included 2985 women aged 18 to 25 years from the placebo group of a randomized clinical trial of the bivalent (CERVARIX®) HPV vaccine (NCT00779766). The clinical trial methodology has been described previously[3]. Endpoints included type-specific HPV prevalence and incidence, 6-month persistent HPV infection (6MPI), 12-month persistent HPV infection (12MPI), clearance, and progression to cervical intraepithelial neoplasia grade 2 or greater (CIN 2+). The Kaplan-Meier estimate was used to calculate the median time to clearance of HPV infection; The multivariable Cox regression model was used to analyze the adjusted effects of different types of HPV, incident or prevalent infection, and co-infection on HPV clearance and progression from 6MPI to CIN 2+. Results:Among different HR-HPV types, HPV 52 showed the highest prevalence at baseline (4.12%) and the highest cumulative incidence during follow-up (12.07%). HPV 16 showed the longest median clearance time (12.57 months, 95% CI : 11.93-15.50); The chances of clearance of HPV 16, HPV 31, and HPV 52 infections were 0.67 (95% CI : 0.57-0.79), 0.77 (0.62-0.96) and 0.78 (0.69-0.89) times lower than those of other HR-HPV types, respectively. The risks of progression to CIN 2+ of HPV 31, HPV 16, and HPV 58 were 17.82 (6.04-52.53), 16.11 (6.24-41.61), and 10.31 (3.09-34.40) times higher than those of other types, respectively. In addition, prevalent infection was associated with a higher risk for progression to CIN2+ than incident infection, and co-infection was more likely to be cleared than single-type infection. Conclusions:HPV16 and HPV31 have the lowest chance of clearance and highest risk of progression to CIN2+. Attention also needs to be given to HPV 52 since its high prevalence and incidence and low clearance chance. Our study provides evidence for the development of HPV prophylactic and therapeutic vaccines and optimization of cervical cancer screening strategies. References: 1.Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016.Journal of the National Cancer Center2022. https://doi.org/10.1016/j.jncc.2022.02.002 2.Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide.J Pathol1999, 189(1):12-19. 3.Zhu FC, Chen W, Hu YM, et al. Efficacy, immunogenicity and safety of the HPV-16/18 AS04-adjuvanted vaccine in healthy Chinese women aged 18-25 years: results from a randomized controlled trial.Int J Cancer2014, 135(11):2612-2622.
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: Have you got a Conflict of Interest?: No
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1748 Application of [18F]FDG PET/MR in the Prognosis of Primary Central Nervous System Lymphoma M. Chen1, X. Zhang1, C. Zhou1, W. Fan1 1 Sun Yat-sen University Cancer Center, Nuclear Medicine, Guangzhou, China Background: Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal nonHodgkin's lymphoma, limited to the central nervous system without lymph node or other system involvement. At least four courses of chemotherapy based on high-dose methotrexate have become the standard induction therapy, but the imaging evaluation after treatment could be interfered with by the changes after surgery. The combination of PET and MR may provide supplementary information for post-treatment evaluation and the early prognosis prediction of PCNSL. Aim: The purpose of this study is to report the clinical data of [18F] FDG PET/MR of 17 patients with PCNSL after two courses of High-dose Methotrexate + Ibrutinib + Temozolomide (MIT) chemotherapy, and to analyze the prognosis values of clinical characteristics and [18F] FDG PET/MR in patients with PCNSL. Methods: Seventeen patients with PCNSL who underwent [18F] FDG PET/MR brain imaging in the Department of Nuclear Medicine at Sun Yat-sen University Cancer Center from July 2020 to December 2021 after two courses of MIT chemotherapy were retrospectively analyzed. The clinical characteristics, pathological characteristics and follow-up therapy of PCNSL were recorded and summarized. Besides, the results of [18F] FDG PET/MR brain imaging were analyzed, then interpreted by qualitative and quantitative methods (including visual analysis, SUVmax, T/B ratio, ADC value and etc.), divided into groups and performed with the Kaplan-Meier survival analysis. Results: A total of 17 patients with PCNSL after two courses of MIT chemotherapy were analyzed. The median age was 51 years old, and the pathological types are all diffuse large B-cell lymphoma (DLBCL). All patients received at least four courses of therapy before the end of the follow-up. The median follow-up time was 16.51 months and 6 of 17 disease progressions occurred during the follow-up. The PFS of 6,9,15 months were 76.0%, 69.1% and 51.8% respectively. Kaplan-Meier survival analysis showed that age ≤ 50 years old(P<0.01), male(P=0.01), lesions SUVmax > 3.42(P<0.01), T/B ratio > 0.56 (P=0.03) and the positive result of PET/MR visual analysis (P=0.03) were the adverse prognostic factors of PFS. Conclusion: Qualitative and quantitative evaluation of [18F] FDG PET/MR after two courses of MIT chemotherapy have good predictive value for the prognosis of patients with PCNSL. Have you got a Conflict of Interest?: No
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1765 Development and validation of a model to identity high-risk individuals for esophageal cancer screening R. Chen1, J. Zhou2, B. Li3, D. Zhao4, Y. Li4, C. Hao3, W. Wei1, G. Wang1 1 Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China, 2Xi’an Jiaotong University Health Science Center, Xi'an, China, 3Linzhou Cancer Hospital, Linzhou, China, 4Feicheng People’s Hospital, Feicheng, China Background: Risk stratification prior to endoscopy is an effective strategy to improve the efficiency of esophageal cancer (EC) screening. However, such prediction tools are limited in the current screening program in China. Aim: To develop a risk prediction model for EC and precancerous lesions to identify individuals at high risk for endoscopic screening. Methods: This was a multicenter cross-sectional study. From 2005 to 2015, a total of 86853 Individuals aged 4069 years who participated in the endoscopic screening in high-risk areas of esophageal cancer was included in the analysis. Eligible participants in were assigned into the derivation cohort (Feicheng) and validation cohorts (Linzhou) according to regional distribution. Predictors for EC and precancerous lesions were selected by univariate and multivariate analyses and logistic regression model was used for model development. Discrimination was estimated using the area under the receiver operating characteristic curve (AUC). Calibration was assessed using Hosmer-Lemeshow test (H-L test). The model was internally validated by 10-fold crossvalidation and externally validated in the validation cohort. Results: A total of 832 patients with high-grade intraepithelial neoplasia(HGIN) and 332 patients with EC were diagnosed through the baseline screening. The final prediction model for HGIN and EC contained 6 variables, including age, sex, smoking, drinking, body mass index and family cancer history. This model generated an AUC of 0.778 (95% confidence interval(CI):0.761-0.794) in the development set, with an AUC of 0.775 after crossvalidation. In the validation population, the AUC was 0.714 (95% CI: 0.695-0.734). When endoscopy was used for individuals with medium risk and high risk, 81.4% of total HGIN and EC cases could be detected, while the screening demand reduced by 51.0%. Conclusion: The developed and validated prediction model showed good performance on identifying individuals at a higher risk for HGIN and EC. This model might be used to guide population-based esophageal cancer screening in high-risk areas. Have you got a Conflict of Interest?: No
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1767 A Systematic Review of Patient Education Strategies for Oncology in Low- and Middle-income Countries K. Christiansen1, L. Buswell2, T. Fadelu2 1 Colorado School of Public Health, Aurora, United States, 2Dana-Farber Cancer Institute, Center for Global Cancer Medicine, Boston, United States Background: Knowledge about cancer screening and treatment can facilitate early diagnosis and improve treatment adherence, which contribute to better cancer outcomes. Patient education programs improve knowledge, satisfaction, and quality of life. While cancer incidence and mortality rates are rising in low- and middle-income countries (LMICs), there is limited literature in these settings to inform patient education to achieve meaningful outcomes. Aim: The purpose of this systematic review is to summarize the published research on oncology education and evaluation strategies in LMICs to identify best practices and areas needing further investigation. Methods: This review, following PRISMA guidelines, involved a search of four databases for all studies related to oncology patient education in LMICs through December 2021. Two researchers independently reviewed abstracts and full texts for inclusion. Studies available in English that included an educational intervention and an oncologic disease were included. Data about study location, characteristics of the educational intervention, and the intervention’s evaluation were collected. Results: Of the 2,047 articles generated in the search, only 77 met the inclusion eligibility criteria. Twenty-four countries were represented in the studies (Figure 1). Most studies, 57 (74%), were from upper-middle income countries, while only six (8%) and 14 (18%) occurred in low-income and lower-middle income countries, respectively. Breast and gynecologic cancers were the most targeted cancers at 25 (32%) and 13 (17%), respectively. Only two (2%) studies were for hematologic cancers. Education methods included 31 (40%) technology-based interventions, 26 (34%) lectures/audiotapes, and 25 (33%) written materials without mention of a visual component. Fifty-seven (74%) studies used more than one education method. The most frequent education provider were nurses in 25 (33%) of studies. Literacy level was considered in only 20 (26%) studies. An evaluation was included in 74 (96%) studies, though the rigor of the evaluations varied greatly. The most common outcomes evaluated were 35 counts (47%) of patient knowledge, 16 (22%) quality of life, and 16 (22%) mental health. However, only 41 (55%) of studies used a validated evaluation tool. Conclusion: Conclusion:There is a dearth of research on oncology patient education in low- and lower-middle income countries. The limited data show vast heterogeneity in education and evaluation approaches. Further research to determine successful patient education and evaluation strategies could improve treatment experiences and outcomes of patients with cancer in LMICs.
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Figure 1. Countries represented in the systematic review
Have you got a Conflict of Interest?: No
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1774 Application of WeChat platform combined with pain diary visual health education in cancer pain patients Y.x. Zhou1 1 Chongqing University Cancer Hospital, chongqing, China Background: To explore the application effect of WeChat platform combined with pain diary visual health education in cancer pain patients Aim: To explore the application effect of WeChat platform combined with pain diary visual health education in cancer pain patients Methods: From April 1, 2022 to August 30, 2022, 100 patients with cancer pain were selected as the research objects, and randomly divided into the observation group and the control group, 50 cases in each; the control group was given routine care, given a comfortable ward environment, and individual The health education platform promotes education and health guidance, and distributes health education manuals and psychological care for patients with pain. Use drug treatment as prescribed by the doctor, observe adverse reactions, etc.; teach patients pain assessment methods and routine pain assessment. On the basis of the control group, the experimental group used WeChat platform health education combined with pain diary to conduct follow-up comprehensive evaluation. The pain diary is a pain patient feedback on the daily pain situation of cancer pain patients at home by filling out an online pain questionnaire. Pain diaries can help patients record changes in pain, medication use, and adverse drug reactions during hospitalization and at home, so as to provide accurate information to medical staff during follow-up. Upload pain-related health education videos to the WeChat group of pain patients, inform patients and their families, and guide patients in need to watch them. And WeChat appointment follow-up, patient information feedback, etc. Nursing staff routinely make an appointment video follow-up for patients with pain once a week. If patients have any adverse reactions or burst pain, they can keep a cancer pain diary at any time and contact the nursing staff through WeChat. Results: Patients' pain score (NRS) in the control group: 4.3±0.5 points, the observation group: 2.1±0.2 points, the observation group was significantly better than the control group (P<0.05);The scores of physical function, role function, cognitive function, emotional function and social function in the EORTC QLQ-C30 observation group after intervention were higher than those in the control group (P<0.05), and the differences were statistically significant. Conclusion: WeChat platform combined with pain diary vis0ual health education management can effectively manage out-of-hospital patients and realize the effective connection between internal and external management of cancer pain patients. It can help patients manage their self-efficacy, improve their enthusiasm and effectiveness in participating in disease management, comprehensively improve the overall management of cancer pain, improve patients' quality of life and improve nursing satisfaction, which is worthy of clinical application. Have you got a Conflict of Interest?: No
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1780 Misinformation on YouTube about lung cancer: Is information accurate? E. Kang1, Y. Kim1, H. Park2 1 National Cancer Center, Department of cancer control, Goyang, Gyenggi-do, Korea, Republic of, 2Seoul National University Hospital, Department of family medicine, Seoul, Korea, Republic of Background: As the number of users who use short videos such as YouTube increases, gradually more people use YouTube to create, share, and search for health-related information[1]. With this trend of information-seeking behavior, medical experts utilize those channels to disseminate health information[2]. Therefore, handling misinformation on social media like YouTube has become an important public health goal, especially in cancers where unproven treatments or tests are associated with reduced survival and worsened quality of life; unfortunately, much of the content is of moderate or poor quality and risks exposure to misinformation[3]. Aim: This study aimed to investigate the quality of information and contents of misinformation about lung cancer on YouTube, depending on whether provided by a medical professional. Methods: We reviewed 224 YouTube videos about “lung cancer” that recorded more than 10,000 views. The experts were classified as doctors, Korean medical doctors, pharmacists, and nutritionists. Misinformation was defined as information that deviates from the current diagnosis and treatment guidelines, and that does not have an obvious reference in databases such as PubMed is provided. To analyze viewers' preference for each YouTube information, sentiment analysis was performed on comments. Results: Of the total 224 YouTube videos, 112 (50.0%) were provided by professionals, of which 101 were doctors, 7 Korean medical doctors, 2 pharmacists, and 2 nutritionists. YouTube videos containing misinformation accounted for 37.9% of all videos, and there was no significant difference in the number of views or comments depending on containing misinformation or harmful information. Both misinformation and harmful information provided by YouTube videos were presented by non-professionals in a significant number of cases. As for the type of misinformation, recommendation of unproved treatment and prevention methods accounted for 65.9%, and in both cases including misinformation and harmful information, the proportion of positive sentiment of comments was significantly higher. Conclusion: A large quantity of information about lung cancer is available on YouTube, and much of them are provided by experts. However, there is misinformation in the YouTube content, and viewers may receive this misinformation more positively. Table 1. Basic characteristics of YouTube videos (N=224), N(%)
Containing misinformation Total Yes 224 85 (37.9%) (100.0%)
No
pvalue
1
pvalue
Yes
No
77 (34.4%)
147 (65.6%)
0.267
215,743
164,917 0.193
0.726
136.5
153.5
139 (62.1%)
Average N of 182,389 204,556 168,833 views Average N of 145.8 130.8 160.6 comments Providing information by medical professionals
Containing harmful information
0.633
Yes No
112 < < 28 (33.0%) 84 (60.4%) 24 (31.2%) 88 (59.9%) (50.0%) 0.001 0.001 112 57 (67.0%) 55 (39.6%) 53 (68.8%) 59 (40.1%) (50.0%)
N; Number Table 2. Classification of misinformation content on YouTube (N=85)
Classification of misinformation (N (%))
Total
Recommendation of unnecessary medical examinations Recommendation of unproved treatment and prevention methods Advocacy for e-cigarettes Advise not to undergo necessary tests such as LDCT Numerical error Others
Providing information by medical professionals Yes No
14 (16.5%)
9 (32.1%)
5 (8.8%)
56 (65.9%)
13 (46.4%)
43 (75.4%)
5 (5.9%)
0 (0.0%)
5 (8.8%)
2 (2.4%)
2 (7.1%)
0 (0.0%)
5 (5.9%) 3 (3.5%)
1 (3.6%) 3 (10.7%)
4 (7.0%) 0 (0.0%)
N; Number References 1. Brachtenbach T et al. YouTube: Searching for answers about breast cancer. Breast Dis 39:85-90, 2020 2. Wang X et al. Online Health Information Seeking: A Review and Meta-Analysis. Health Commun 36:1163-1175, 2021 3. Loeb S et al. Quality of bladder cancer information on YouTube. European urology 79:56-59, 2021 Have you got a Conflict of Interest?: No
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1784 RBM10 inhibits the progression of EGFR mutant lung adenocarcinoma by m6A regulated alternative splicing X. Ren1, Y. Yu1 1 Harbin medical university cancer hospital, Harbin, China Background: Lung adenocarcinoma is the pathological type most prone to distant metastasis in non-small cell lung cancer, but the mechanism of metastasis has not been fully defined. RNA binding motif protein10(RBM10) has been found frequently mutated in various types of tumors, including lung adenocarcinoma (LUAD). Our previous study found that RBM 10 was frequently truncated in EGFR mutant LUAD metastasis specimens, resulting in its reduced expression, which may be involved in LUAD metastasis. As a hot shear factor studied in recent years, RBM10 can also regulate the alternative splicing of multiple proteins. Aim: This study is aiming to find the connection between RBM10 and lung adenocarcinoma metastasis, and provide a new idea for the prevention and treatment of lung adenocarcinoma metastasis.# Methods: TCGA database is used to analysis the relationship between RBM10 and WNT5a. The clip SEQ technique was used to determine that the selective shear of WNT5a was regulated by RBM 10. In order to find the regulatory mechanism of its metastasis, we intended to determine that RBM 10 is regulated by m6A methylation by MeRIP and m6A ELISA. To determine that RBM 10 directly targeted on WNT5a and affects the changes of its transcripts, cell lines that stably overexpress (binding site mutant and wild-type) or knock down RBM 10 are established and verified. Western Blotting is used to verify that RBM 10 inhibits EMT by regulating WNT5a in vitro.Kaplan-Meier survival curves and statistical analyses were all performed using SPSS software, version 26.0. Pvalue less than 0.05 was considered to denote statistical significance. Results: In TCGA database, the results showed that the expression level of RBM10 in metastasis group was significantly lower than that in non-metastasis group (P = 5.98e-05, t = 4.0797). Also, the Relapse-Free Survival and Overall Survival of patients with RBM10 high expression was significantly longer than RBM10 low expression patients. (P<0.05) The expression of RBM10 is relativity lower in EGFR mutated LUAD cell lines and EGFR mutated patients. Also, overexpression of RBM10 inhibited EMT, increased WNT5a-L expression and decreased WNT5a-S expression. After using siRNA to interfere with the expression of two transcripts of WNT5a. PCR results showed that WNT5a-L inhibited EMT, while WNT5a-S was involved in promoting EMT. m6A ELISA and MeRIP were used to verify that RBM10 function was regulated by m6A methylation in EGFR mutant LUAD. Rip experiments verify that RBM10 and METTL3 can function through combination. Conclusion: RBM10 can inhibit the metastasis of lung adenocarcinoma, and RBM10 can be regulated by m6A methylation. Have you got a Conflict of Interest?: No
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1786 m6A methyltransferase FTO regulates EZH2 stabilization and current inhibition of lung cancer progression z. Jing1,1 1
哈尔滨医科大学, 哈尔滨, China
Background: With the development of epigenetics, researchers found that Zeste homolog 2 (EZH2) is one of the important genes. Glycolysis is the most obvious energy metabolism feature of tumors. Studying this core scientific issue, applying FTO to reverse or alleviate the progression of lung adenocarcinoma, and promoting the application of this achievement will provide new ideas for the diagnosis and treatment of lung adenocarcinoma. EZH2 may have m6A, and the existence of m6A modification may affect the regulation of EZH2 on the progression of lung adenocarcinoma through some m6A-specific methyl recognition proteins. Aim: This study aims to explore the mechanism of EZH2 involved in the progression of lung adenocarcinoma, to verify the regulation of m6A methylation on the progression of lung adenocarcinoma, to further understand the molecular mechanism of lung adenocarcinoma progression. Methods: Public databases such as TCGA were used to verify that EZH2 plays a role in promoting cancer in lung adenocarcinoma, and clinical samples were used to verify that EZH2 was in lung adenocarcinoma, and the levels of EZH2 and related proteins were detected by RT-qPCR. Lentiviral transfection system was used to construct lung adenocarcinoma cells with stable overexpression or knockdown of EZH2. Through molecular biology experiments such as CCK-8, clone formation, EdU, scratch, and transwell, the effect of EZH2 overexpression or knockdown was analyzed in vitro. The effect of lung adenocarcinoma cell progression; Western blot and real-time PCR were used to detect the changes of the proliferation and metastasis-related markers of lung adenocarcinoma cells after overexpression or knockdown of EZH2; EZH2 knockout lung adenocarcinoma cells were inoculated into the tail vein. The effects of EZH2 and FTO on glycolysis in lung adenocarcinoma were verified by measuring intracellular 2-[3 H]deoxyglucose and phosphorylated deoxyglucose levels, lactate production, and ATP levels; m 6A-ELISA and MeRIP experiments were used to further verify that EZH2 is affected by m6A The regulation function was performed, and the regulation of FTO on EZH2 was verified by CHIP and RIP ubiquitination experiments. FTO knockdown lung adenocarcinoma cells were constructed, and the expression of EZH2 and downstream proteins was detected by western blotting and RT-qPCR. Results: EZH2 expression promotes the glycolysis of tumor cells and promotes the proliferation and migration of lung adenocarcinoma. FTO reversed this effect and inhibited the progression of lung adenocarcinoma by regulating EZH2 ubiquitination, reducing EZH2 expression. Conclusion: EZH2 in lung adenocarcinoma tissue promotes tumor metastasis, and m 6A demethylase is involved in inhibiting lung adenocarcinoma metastasis; the mechanism of EZH2 promoting lung adenocarcinoma metastasis is to inhibit the occurrence of EMT in lung adenocarcinoma by regulating m6A demethylase. Have you got a Conflict of Interest?: No
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1787 An analysis of key stakeholder policy perspectives in the proposed e-cigarette regulations in New Zealand L. Hardie1, J. McCool1, B. Freeman2 1 University of Auckland, School of Population Health, Auckland, New Zealand, 2The University of Sydney, School of Public Health, Sydney, Australia Background The use of e-cigarettes has been increasing and may play a role in smoking cessation. However, youth uptake is a growing public health concern. Policymakers tasked with implementing regulations must consider the impacts on both groups. Previous research has highlighted perceptions of debate on appropriate ecigarette regulation. However, there is a lack of research in the New Zealand context. Aim This study aims to determine key stakeholders' support for drafted legislation in New Zealand. Methods Using written submissions made during public consultation in 2020, we conducted a content analysis to determine support for e-cigarette regulations. Submissions made by the e-cigarette industry and the health sector were included for analysis. Results This research confirms that the industry (n= 21) continues to be more likely to oppose restrictions on ecigarettes than health organisations (n= 36). Few health organisations opposed regulations. Conclusion The industry continues to oppose regulation akin to the introduction of previous tobacco control measures. Despite perceptions of division within the health sector, this study demonstrates that New Zealand health organisations are generally unified in support of comprehensive e-cigarette restrictions. Policymakers should be cautious of industry opposition to regulation positioned as public health interest. Have you got a Conflict of Interest?: No
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1788 Innovative funding trends: case study learnings & recommendations to enable greater access to cancer treatment W. Brown1, F. Arnaiz2, P. Morales2 1 IQVIA, Consulting Services, Petaling Jaya, Malaysia, 2F. Hoffmann-La Roche Ltd, Global Funding and Financing, Basel, Switzerland Context The expanding variety of new and innovative funding schemes for the treatment for cancer and other NCDs are enabling more patients to access treatment and filling gaps in UHC provision - particularly in low-middle income countries (LMICs). However, there is a lack of evidence about what these schemes are, how they work, and the impact they are having. Aim This report “Innovative Funding Models for High-Cost Non-Communicable Diseases (NCDs)": A global study of new solutions disrupting healthcare financing” by IQVIA in collaboration with Roche, aims to shine a light on innovative funding and financing models across the world to strengthening our collective understanding of the different types of schemes that are possible and in doing so, enable new conversations about how to build sustainable and comprehensive funding for conditions like cancer. Strategy/tactics The report is the culmination of 4 years of research and interviews. It identifies a shortlist of 106 examples of innovative funding mechanisms from 15 countries and uses a framework to characterize the different types of innovation that the models represent. Through an analysis of 31 case studies, the policy report draws out what made these different schemes successful, to guide others working in this field to build and scale sustainable funding models that can extend UHC coverage and increase access to treatment for patients. Outcomes The report defines an innovative funding model as a non-traditional approach that unlocks new funding sources and/or deploys funds to address funding, access or coverage. The report identifies five archetypes of innovative funding and financing, based on the component of the model that makes it innovative:
• • • • •
Government funded schemes Blended finance Novel private insurance Multi-source crowdfunding Financial services
What was learnt: Key success factors that were common among the most effective, innovative models:
• • • •
Partnership between trusted local stakeholders for on-the-ground insight and effective implementation Robust risk governance plans, with data systems to monitor and evaluate programme outcomes are in place Funding programmes should address a recognized unmet need, where possible along with government NCD priorities Models are mutually beneficial and yield tangible outcomes for all partners involved. They are as simple as possible, minimizing complexity for patients and those implementing the schemes to reduce barriers to adoption
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Actions & Next steps
•
The findings of the report have been shared and presented with healthcare leaders all over the world. Our intent is to create and enable a network of people and organizations interested in the ideation, development, and scale-up of funding solutions for NCDs and beyond, including actions such as the UICC, C/CAN, Access Accelerated, ATMI, the NCD Alliance and APEC.
Have you got a Conflict of Interest?: Yes If yes please specify:: This report was commissioned by F. Hoffmann-La Roche AG (a pharmaceutical company) and prepared by IQVIA (a private life-sciences industry services provider).
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1791 Safe practices for legitimate medical use of opioids: A study of trends in opioids prescription over a decade A. Pandit1, S. Bhatnagar1, S. Mishra1 1 All India Institute of Medical Sciences, New Delhi, Onco-Anesthesia and Palliative Medicine, New Delhi, India Background and context:Despite being placed in the WHO Model list of essential medicines, opioids have been legally classified as controlled drugs. An unwavering availability of opioids is crucial for effective pain and palliative care and for managing opioid dependence. Difficulty with procurement and distribution due to restraining laws, costs, bureaucracy, and concerns of addiction, restrictions due to pandemic have constrained the legitimate medical use of opioids. Aim:To study the pattern of morphine consumption and the use of safety protocols for prescribing opioids in a tertiary cancer hospital in India. Strategy / Tactics: We studied the medical and pharmacy records retrospectively, to investigate the pattern of oral Morphine consumption and distribution from 2008 to 2020. Programme / Policy process: An 'automatic-referral' and 'integrated-care' model of palliative care is followed at our institute. Meticulous prescription practices are implemented to reinforce responsible and judicious use of oral morphine for cancer pain, to prevent drug abuse. (Figure 4) Safe prescription protocols followed at our institute include impeccable assessment of physical, social, emotional, spiritual aspects of pain, continuing education of caregivers and health care professionals, verbal and written communication of all stakeholders, screening for opioid abuse, inpatient palliative care, multidisciplinary collaboration for comprehensive care and monthly audits. Outcomes: The number of new cancer patients visiting the hospital, the number of re-visits of these patients, and registration and admission to palliative care service increased unswervingly from 2008 to 2019 with a sharp fall in 2020 owing to the COVID pandemic. Annual oral morphine consumption showed a steady increase from 4.89 kgs in 2008 to 11.53 kgs in 2019 with a fall to 5.68kgs in 2020. However, the trend for oral morphine dispensed per patient per visit showed a mild increase from 1.1 grams in 2008 to 2.06 grams in 2012, followed by a gradual decline to 0.89 grams of oral Morphine prescribed per patient visit in 2020. Opioid diversion incidence was found to be nil. What was learnt: (if relevant, please also detail here the potential of replicability): The number of patients requiring palliative care is constantly increasing with the increase in opioid consumption. Comprehensive interventions and immaculate patient assessment, alongside safety protocols, can help prevent opioid use disorders. Effective integration of palliative care and oncology, with good communication and education of all stakeholders, are effective tools for judicious use of opioids. Table 1: Patient registrations and Morphine consumption
Year
New Cancer patients (n)
2008 2009
8793 8504
New Revisits patients per year registered to the with cancer Palliative hospital care team (n) (n) 295 74280 404 74080
Revisits Admissions Oral Oral per year in Morphine Morphine to the Pain Palliative consumed consumed clinic (n) care ward per year per visit (n) (kgs) (gms)
4457 5174 1
-
4.89 7.17
1.1 1.39
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
8679 8633 9059 10084 11000 11099 12372 13260 13186 13008 7093
408 421 410 428 362 640 671 725 963 1120 723
82597 85070 91100 106261 138125 146688 157884 171778 181566 178700 82392
4906 4793 6030 7144 10539 11584 14443 15530 17240 17857 6398
603 383 494 608 619 729 908 1022 1227 1514 479
Figure 1: Annual Percent Change in morphine consumption from years 2008-2020.
2
8.1 7.41 12.44 10.28 10.15 14.05 13.84 9.37 9.6 11.53 5.68
1.65 1.55 2.06 1.44 0.96 1.21 0.95 0.6 0.56 0.65 0.89
Figure 2: Management protocol for patient presenting with Cancer pain
Have you got a Conflict of Interest?: No
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1793 Online retail promotion of e-cigarettes in New Zealand: A content analysis of e-cigarette retailers L. Hardie1, J. McCool1, B. Freeman2 1 University of Auckland, School of Population Health, Auckland, New Zealand, 2The University of Sydney, School of Public Health, Sydney, Australia Background From 2018 until the New Zealand government enacted legislation in 2020 to govern the sale and marketing of electronic cigarettes retailers could market their products with few restrictions. Aim This study explores online e-cigarette retailer marketing in the absence of regulations. Methods New Zealand-based online e-cigarette retailer websites were identified using a keyword search. Ten New Zealand-based retailer websites were selected based on top results from Google. We also included the four leading tobacco companies operating in New Zealand. A content analysis of the online marketplace was performed. Results Price was variable, with disposable devices sold from as little as $9.99 (NZD). Online e-cigarette retailers frequently presented health (79%) and smoking cessation (71%) messages. Nicotine addiction warnings were explicit in less than half of retailer sites (43%), and only 29% of retailers stated that the use of devices might pose health risks. Marketing techniques with potential youth appeal included sweet flavours (80%) and cartoon characters on e-liquid products (20%). Only one retailer had an age verification procedure to purchase a product. Conclusion The findings suggest that online marketing is likely to appeal to young people despite industry assurances that e-cigarettes are only promoted to adult smokers who want to quit. Study findings may help inform future decisions on the regulation of e-cigarette marketing. Have you got a Conflict of Interest?: No
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1794 BARRIERS TO WILMS TUMOR CARE AND EFFECT OF PATIENT NAVIGATION: CAREGIVERS PERCEPTIVES FROM RURAL RWANDA. P. Uwamahoro1, l. Ng'ang'a1, E. Benemaliya2, V. Mukandayisenga1, O. Nsanzimana1, L. Mujyuwisha1, L. Buswell3, L. Lehmann3, C. Shyirambere1 1 Partners In Health, Kigali, Rwanda, 2Ministry of Health, Butaro, Rwanda, 3Dana-Farber Cancer Institute, Boston, United States Background: Wilms tumor (WT) is a highly curable cancer. In Rwanda, each treatment modality is offered at a different health facility, contributing to care delays. We implemented a patient navigation (PN) program, a patient-centered approach to identify and address barriers to WT care Aim: We report on the perception of caregivers on barriers to WT care and effect of the PN at Butaro Hospital in Rwanda. Methods: From March 2020 to February 2021, a trained navigator coordinated care of newly diagnosed WT patients, educated caregivers and proactively identified and addressed barriers. Caregivers were interviewed at the end of their child’s treatment. We conducted thematic analysis and used MAXQDA for data analysis. Results: Fourteen caregivers were interviewed. The multi-institution care involving many referrals, long treatment process, complexity of health system and financial implications were reported as main barriers. Family conflicts and abandonment, emotional impact and social influences such as other caregiver’s discouragements, and beliefs around cancers and its management would lead to loss of treatment interest. Caregivers highlighted the benefit of PN in overcoming the mentioned barriers. Advocacy for patients and PN linkage to care providers, helped patients and caregivers easily navigate through the health system, relieved the financial burden and logistics incurred by the treatment journey. Regularly checking in and appointment reminders by the PN provided emotional support. Family education by PN using an illustrated booklet reduced negative beliefs associated with cancer treatment. The enhanced caregiver’s confidence and knowledge in WT management improved treatment adherence Conclusion: Although the WT treatment modalities is full of challenges, PN has demonstrated benefits in addressing barriers to care, improved caregiver’s knowledge and perception of cancer and importance of treatment adherence. Strategies to implement and continually improve PN to better serve the needs of WT and other cancers appears to have benefits and needs further study in low-income countries. Have you got a Conflict of Interest?: No
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1796 Effectiveness of Cloud-based Computer Aided Quality Control System in Korean National Lung Cancer Screening Y. Kim1, E. Kang1 1 National Cancer Center, Department of cancer control, Goyang, Gyenggi-do, Korea, Republic of Background:Korean national lung cancer screening program (KNLCS) targeting high-risk smoking population using low-dose CT (LDCT) was implemented in 2019. A cloud-based quality control system (CQCS) using computer aided detection program (CAD) was used to assist radiologists in detection, measurement and categorization of lung nodules in LDCT. From 2021, Artificial Intelligence (AI)-based CAD has been launched as a developed version of CQCS. Aim:This study aimed to evaluate the effectiveness of CQCS on positive rate and inter-observer variability in KNLCS on national level. Methods:Among 302 screening units in KNLCS, 48 screening units are using CQCS. 61 radiologists using CQCS interpreted 28,677 (18.7%) LDCTs obtained from KNLCS from 2019 to 2021. The other 516 radiologists not using CQCS evaluated 124,515 (81.3%) LDCT screenings. This study compared the quality index measured between groups of radiologists using and not using CQCS and before and after using CQCS from 2019 to 2021. Also, we compared the quality index measured before and after the implementation of AI-based CQCS on registered units in 2021. The main quality index was evaluated by positive rates (the proportion of nodules classified as LungRADS category 3 and 4) and their variabilities across radiologists in screening units. Coefficient of quartile variation (CQV) of positive rates was used to calculate variabilities (θCQV=(θ3-θ1)/(θ1+θ3)). Results: In CQCS, positive rates were higher by 2.19% (11.40% vs. 9.21%; p<.001) (Figure 1(A)) and variability of the positive rates was lower by 0.192 (CQV, 0.261 vs. 0.453) (Figure 1(B)). When positive rates were compared before and after using CQCS, the positive rates were increased by 4.90% (11.41% vs. 6.51%; p<.001) (Figure 1(C)) and the variability (CQV) was decreased from 0.448 to 0.330 (Figure 1(D)) after utilization of CQCS among 29 radiologists.After adopting AI-based CAD program in CQCS, the positive rates were increased by 1.75% (11.71% vs. 9.96%; p=.044) and the variability (CQV) was increased from 0.233 to 0.272 for 35 radiologists. Conclusion: The CQCS showed effectiveness in assisting in lung nodule detection and lowering variabilities of screening results across radiologists and screening units. Further studies on a quality control strategy in relation to newly implemented AI-based CAD are required.
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Figure 1. Comparison of LDCT lung cancer screening positive rates and variabilities of the positive rates between groups of radiologists using CQCS (N=61) and not using CQCS (N=516) and between groups of radiologists before and after using CQCS (N=29) (2019-2021)
Have you got a Conflict of Interest?: No
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1801 Cancer Control in 50 years of independence of Bangladesh M.H. Talukder1 1 National Institute of Cancer Research and Hospital, Cancer Epidemiology, Dhaka, Bangladesh Background: GLOBOCAN 2020 estimates a total of 1,56,775 new cases every year in Bangladesh, while the total number of cancer deaths accounts 108 990 per year. A well conceived and well managed national cancer control strategy, plan and program is essential to combat the huge burden.
Aim: To review the policy, implementation and evaluation of cancer control in 50 years of independence of Bangladesh
Methods: We used desk review as the primary method. National, international reports, published books, articles on the cancer scenario in Bangladesh have been reviewed.
Results: Significant achievement and advancement of treatment facilities in terms of modern equipment and human resources observed over the last five decades. The National Institute of Cancer Research and Hospital (NICRH), the only comprehensive multidisciplinary centre, has been established as a 50-bedded hospital and expanded in phases to 500 bed capacity. The major limitation is the insufficient facility to treat the massive burden of cancer patients. Moreover, these facilities are highly centralized, mostly in the capital and major cities. Private cancer centers are irrationally costly. Fifteen government medical college hospitals have departments of radiotherapy, but most of them lack functioning radiation machines. At present we are lacking any cancer control strategy, plan and program. The National Cancer Control Strategy and Plan of Action 2009-2015 has not been updated and implemented. The National Cancer Control Council headed by the minister for health is almost non-functioning. We have no national cancer screening program. An opportunistic facility based screening program is being implemented for breast and cervical cancer by a public medical university based on CBE and VIA. Coverage and effectiveness is not satisfactory. The country is still lacking a population-based cancer registry. The only hospital-based cancer registry started at the National Institute of Cancer Research and Hospital (NICRH) by the department of cancer epidemiology in 2004 with support from the World Health Organization. Reports published irregularly for 2005, 2005-2007, 20082010, 2011-2013 (draft), 2014 and 2015-2017. Several voluntary organizations are working for prevention, early detection and screening. Significant impact not marked for lack of concerted effort or effective collaboration with the government program. The government is now implementing a project to establish comprehensive cancer centres in all eight administrative divisions for both curative and preventive services.
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Conclusion: An effective cancer control strategy, plan and program is essential. Population based cancer registry and organized screening program for breast, cervical and oral cancers, and palliative care to be emphasized. Collaboration with the non-government organizations is necessary.
Have you got a Conflict of Interest?: No
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1804 Survivorship: The experience of breast cancer patients in Cyprus S. Christodoulidou1 1 Europa Donna Cyprus, Psychology, Nicosia, Cyprus Background and context: In 2020, there were 2.3 million women diagnosed with breast cancer, making it the world’s prevalent cancer (WHO). With the advance of medicine and improvements in early detection, breast cancer prognosis has significantly improved over time. As a result, there is a growing population of breast cancer survivors worldwide. Even though, breast cancer survivors continue to increase globally there is still limited knowledge about the experiences and needs that are of greatest significance in this population. Research regarding breast cancer survivorship issues and the views of patients in the Cypriot population remains limited. Aim: The aim of this study is to bridge this gap of knowledge and to qualitatively explore and generate a databank of the needs, experiences, priorities, and challenges of breast cancer survivors living in Cyprus. Strategy / Tactics: The present study aims to recruit breast cancer survivors from all over the island, between the ages of 30 and 60. Focus groups will be conducted to explore the participants’ perspectives regarding survivorship using a semistructured format. These discussions will be transcribed verbatim, cross-checked for accuracy, and analysed qualitatively using thematic analysis. Expected Outcomes / Programme / Policy process: The acquired knowledge obtained from this research project will be implemented in our patient advocacy and awareness campaigns, conferences and seminars, e-health, and printed information materials. It can also be used as strong leverage in advocating and lobbying to influence decision makers to take political actions and adjust national strategies and planning in relation to breast cancer survivorship care. We are hoping that this project will be an opportunity for participants to share their views & experiences. In return, this additional knowledge can contribute to the development of supportive and social services to meet the needs of the Cypriot community. Finally, we expect that this research project will motivate other researchers in Cyprus and around the globe to engage into further explorations of breast cancer survivorship in Cyprus and physicians to gain a better understanding of the needs of this population. Key words: breast cancer, survivorship, Cyprus, qualitative research, thematic analysis, patient empowerment, survivorship care Have you got a Conflict of Interest?: No
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1805 Self-collected HPV test can help in maintaining high compliance to cervical screening through pandemic S. Bose1, R. Mandal1, P. Basu2, M. Vernekar1, P. Chatterjee1 1 Chittaranjan National Cancer Institute, Gynecology Oncology, Kolkata, India, 2International Agency for Research on Cancer, Early Detection, Prevention and Infections Branch, Lyon, France Background: A national mitigation strategy for COVID-19 pandemic was adopted in India by phased lockdowns followed by conditional relaxations.The restrictions had a heavy toll upon continuity of health care. Chittaranjan National Cancer Institute, Kolkata,India initiated a community-based cervical cancer screening demonstration project in May 2017 with an objective to screen at least 6,000 women opportunistically in the region every year with the Human Papilloma Virus test. The project was at a risk of being severely impacted due to the pandemic induced restrictions and the hesitancy of the healthy women to visit health facilities. Aim: To evaluate the impact of switching from provider-collected cervical sample for HPV test to self-sample and compliance of the HPV positive women towards further treatment during the pandemic situation. Strategy / Tactics: The project had to innovate, adapt and incorporate measures for its sustenance.Data has been analysed from April 2019- March 2021. Policy process: The project targets to screen women aged 30-60 years from the rural and semi-urban communities around the city of Kolkata. The eligible women are identified through home visits by community health workers and counselled by them to undergo screening. From May 2017 till March 2020 the women attended nearby primary health facilities where trained health workers collected cervical samples . The samples were then taken to the hospital laboratory for testing by the hybrid capture technique. The HPV positive women were advised to attend the community clinics for colposcopy followed by immediate ablative or excision treatment, if lesions were detected. During a nationwide lockdown period extending from March 2020 to June 2020, no screening was possible. Following partial relaxation of lockdown, the community health workers distributed the self-sampling device to the women during home visits and counselled them to self-collect the samples. The HPV positive women were advised to attend the cancer institute for colposcopy and were managed as before. We compared the monthly participation of women to screening in 2019, 2020 and 2021 to understand the impact of pandemic induced restrictions. We also evaluated the compliance of the HPV positive women to further evaluation and treatment during this period. Outcomes: The number of women screened in 2019, 2020 and 2021 was 6,758, 5,875, and 6,124 respectively. The monthly break up of participation showed significant reduction during and immediately after lockdown that was compensated by increased participation to self-collection. The HPV positivity remained unchanged during this period even after shifting to self-collection (2019- 4.3%; 2020- 4.6%; 2021- 4.4%). The compliance to further treatment was 79% in 2019, 81.4% in 2020 and 78.2% in 2021. What was learnt: Self sampling is the preferred method for cervical cancer screening in the post pandemic era. Have you got a Conflict of Interest?: No
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1806 Egypt Experience and Vision in cancer control G. Amira1,2, H. Khaled3,4, G. Esmat5, A. Selim6,7, O. Sherif Omar8,9, I. Sallam10 1 NCI Cairo University, Surgical Oncology, Cairo, Egypt, 2Nasser Institute, Surgical Oncology, Cairo, Egypt, 3NCI Cairo University, Medical Oncology, Cairo, Egypt, 4Wadi El Nile Hospital, Medical Oncology, Ciro, Egypt, 5Cairo University, Hepatogastroenterology and Infectious Diseases, Cairo, Egypt, 6Cairo University, Interventional Radiology, Giza, Egypt, 7Seha Scan Center, Interventional Radiology, Giza, Egypt, 8Sherif Omar Cancer care Foundation, Breast Care, Giza, Egypt, 9Cairo University, Breast Surgical Oncology, Giza, Egypt, 10MISR Cancer Center, Breast Surgical Oncology, Giza, Egypt
Background and context: Egypt, is leading the African Continent which is a developing and a LMICs. The 3rd in Africa population of about 104 million population and the first in the Arab world and it is substantial to develop its guidelines to combat its health problems especially cancers and the successful experience of the National Egyptian Models give a unique opportunity for similar healthcare systems to develop their own policies and plans.
1
The Egyptian healthcare system is pluralistic, comprising a variety of healthcare providers from the public as well as the private sector and the NGOs. The government ensures basic universal health coverage, due to social and economic pressures. However, several recent efforts have been directed towards enhancing the system. Especially the presidential initiatives, generalization of insurance coverage for all citizens and vision of Egypt 2030. Aim: to emphasize on the role of health care systems and NGOs in combatting cancer, a successful model for the African countries to be implemented in similar healthcare systems, and the Vision of the Country and future plans. - To present a National practical model easily applicable. - To Motivate the policy makers to adopt the national initiatives. - To Encourage stakeholders to have an active role in achieving goals. - To Understand the role of registry, epidemiological data in planning. - To Implement the model in different healthcare systems. Programme / Policy process: - 100 Million Health promotion initiatives for the General Health and Chronic disease control. - presidential breast cancer initiatives for 28 million female targeted screening programme, the New National Screening Program. - National Surveillance Program for Hepatitis C: diagnosis, treatment and eradication. - Training of high volume of HCP, Nurses, Volunteers to work in different programs. - presidential efforts to extend the insurance to benefit every citizen. - Process of presidential initiatives involved available resources and work force capacities to screen, diagnose and treat women's cancers. - Joint programmes covered by Governmental, Insurance, NGOs. Outcomes: - maximal eradication of Hepatitis C virus and declaration of Egypt free Virus C Country by 2022. - Better detection rates and treatment quality outcome for breast cancer. - More than 6000 early Breast Cancer cases detected in the first two years of the presidential initiatives. - Reproducible model of care transferred to different health categories in the country and in Africa. What was learnt: - We succeeded to motivate LMICs to benefit from our experience. - We understood and analyze barriers of the Low resource setting (epidemiological- Cultural- Geographical). - We Studied the Epidemiology of the most common cancers and its impact on planning. - We emphasized on the importance of national registry its impact on planning. - We presented possible solutions and capabilities to develop national cancer control plans. Have you got a Conflict of Interest?: No
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1807 A cross-sectional survey of Quality of life of patients on palliative care during Covid-19 lockdowns A. Pandit1, S. Adhikari1, B. Pangaria1, S. Bhatnagar1 1 All India Institute of Medical Sciences, New Delhi, Onco-Anesthesia and Palliative Medicine, New Delhi, India Background:The Covid pandemic in its first wave in 2020 forced India to enact a strict complete lockdown. With such restrictions causing stress and anxiety and poor access to health care, quality of life (QoL) is lowered. Aim: This study assessed the QoL and pain control in cancer patients receiving palliative treatment during lockdown imposed by the first wave of Covid-19 outbreak. Methods: Study Design- Over the course of one month, this cross-sectional observational study was conducted at a tertiary cancer hospital in India. Convenience sampling was used. Institutional ethical clearance was obtained (CTRI/2020/06/025797). Participants- Those who were unable to visit the palliative outpatient department on their scheduled appointments due to the COVID-19 pandemic lockdown restrictions were contacted telephonically and included in the study. Interventions- Patients were interviewed for the Numerical Rating scale (NRS) for pain assessment, and the Functional Assessment of Chronic Illness Therapy system of QoL questionnaire–FACT G7 was filled out after they were communicated by phone. Analysis- The severity of the illness, patients' demographics, and pain levels, were evaluated. SPSS v 21 was used to examine the findings. Student t-test was applied to compare QoL between comparable groups. Results:85 patients were contacted. 51 people (out of 85) were interviewed on the phone. The average score for overall QoL was 14+/-3.8. The majority of those who were unable to visit did so because they lived on the other side of restricted state boundaries (56.9%, n=29). Access to healthcare:Mean QoL scores were 12.7+/-3.76 and 15.0+/-3.60 amongst patients who did not have access to medications and who did have access, respectively (p=0.03). Treatment was delayed for 51% (n=26) participants and 76.5% (n=39) participants feared their cancer shall progress during the lockdown phase. Pain:The mean NRS was 4.5+/-2.1. The variables NRS (pain) and QoL score were found to be negatively correlated (Pearson's Correlation Coefficient: r (49) = -.69, p < .00001) Conclusion: During the pandemic, cancer patients suffered due to delays in routine medical care, progressive disease, symptom burden, and heightened distress associated with the threat of COVID-19 itself. Therefore, decentralization of palliative care services to the primary care level and strengthening of telemedicine practices should be a step toward a more all-inclusive approach to the management of the vulnerable population suffering from cancer.
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Table no 1. Demographic characteristics of patients who were interviewed Age in years
• • • •
18-30 30-50 50-65 · >65
No. of patients (Total=51) 2 (3.9%) 15 (29.4%) 19 (37.3%) 15 (29.4%)
Sex (M:F) 30:21 Distance of hospital from home: No. of patients (Total=51) 1 2 19 • · < 5km 29 • · 5-10km • · >10km • · Another state
Table 2. Disease and symptom characteristics of the patients interviewed Stage of Disease No. of patients (Total=51) 0 2 4 • Stage 1 3 22 • Stage 2 20 • Stage 3
• • •
Stage 4 Cancer has spread Not aware
Disease status :
• • • •
· Under evaluation · Under active therapy · Under palliative care · Cancer survivor
Patient has complaints of pain?
• •
No. of patients (Total=51) 39 12
· Yes · No
Need morphine for pain relief?
• •
No. of patients (Total=51) 4 27 19 1
No. of patients (Total=51) 18 33
· Yes No
Have difficulty in accessing morphine?
No. of patients (Total=18) 6 12
2
• •
· Yes · No
Have difficulty in getting access to other medicines?
• •
· Yes · No
My Fear Is
• • • •
· Getting infected by COVID19 · Cancer will progress · Family will get infected · None
Treatment
• • • • • •
No. of patients (Total=51) 23 28
Undergoing treatment despite lockdown Therapy delayed due to lockdown Opted to stay at home Completed treatment and is on follow up Recently diagnosed and treatment not started Other
No. of patients (Total=51) 10 39 0 2
No. of patients (Total=51) 14 26 3 5 2 1
3
Figure 1: Scatter diagram showing distribution of NRS scores vs QoL scores
Have you got a Conflict of Interest?: No
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1814 Assessing cervical precancer treatment rate among women in Johannesburg - record linkage of laboratory data A. Juggernath1,2, M. Kawonga1,2, P. Michelow3,4, C. Kabudula5, L. Thomas1,6,7 1 University of the Witwatersrand, School of Public Health, Community Health, Johannesburg, South Africa, 2Gauteng Department of Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa, 3University of the Witwatersrand, School of Pathology, Anatomical Pathology, Johannesburg, South Africa, 4National Health Laboratory Services, Johannesburg, South Africa, 5University of the Witwatersrand, School of Public Health, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Acornhoek, South Africa, 6University of Pretoria, School of Health Systems and Public Health, Tshwane, South Africa, 7Gauteng Department of Health, Ekurhuleni Health District, Public Health Unit, Ekurhuleni, South Africa Background: Despite being preventable, cervical cancer is one of the most common cancers and the commonest cause of cancer deaths in women in South Africa. While a national screening programme exists, a reduction in incidence is only possible if women who screen positive undergo precancer treatment. Routine monitoring of the screening cascade does not take place, therefore presenting an opportunity to use sources outside of the routine health information system to assist in monitoring this programme. Aim: Analyse the follow-up over two years of women who had cervical smears done in public sector facilities of Johannesburg in 2017. Methods: A retrospective cohort of 67 208 women using probabilistic record linkage of laboratory records – cytology with high-grade squamous intraepithelial lesions (HSIL), and histology. The HSIL prevalence; follow-up, confirmation, and precancer treatment rates, and time intervals between these, were calculated. Variables were compared across age, HIV status, screening facility type and geographic region (subdistrict) through KruskalWallis and Wilcoxon rank-sum tests, and logistic regression to assess for factors associated with them. Results: The median age of women screened was 40 (IQR: 32–50); 48.8% of those with a known status had HIV; 65.8% screened at primary healthcare clinics (PHCs); and most screened in sub-district D (23.2%). HSIL prevalence was 6.2% with greatest odds in women with HIV (OR:3.02; 95% CI:2.75-3.31). Of the 4182 women who had a screening result of HSIL, 26.6% underwent follow-up procedures. Women with HSIL who screened at community health centres (CHCs) (OR:1.28; 95% CI:1.03-1.58) or hospitals (OR:1.61; 95% CI:1.26-1.90) or in subdistrict B (OR:2.68; 95% CI:2.02-3.45) had greatest odds of follow-up. Treatment on the first follow-up was received by 475 (62,0%) women, and the remaining 38,0% had confirmatory tests, of which 49,5% subsequently received treatment. The overall precancer treatment rate was 16,1%. Women who screened at CHCs (OR:1.34; IQR:1.041.72), hospitals (OR:1.63; IQR:1.28-2.09) and subdistrict B (OR:2.47; IQR:1.70-3.58) had the greatest odds of treatment. The median time from the screening test to any follow-up procedure was 131 days (IQR:80-189); to confirmatory test of 123 days (IQR:51-175); and overall time to precancer treatment of 151 days (IQR:101-246). Conclusion: Precancer treatment rates are far below WHO’s elimination target. A simpler screening cascade; benchmarking against high-performing subdistricts; and improved information systems may increase precancer treatment to reduce cervical cancer incidence. Have you got a Conflict of Interest?: No
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1815 Combinations of lifestyle behaviors trajectories and cancer risk among Korean men N.M. Luu1, T.T. Bui1, T.P.T. Tran1, J.-K. Oh1 1 National Cancer Center Korea, Graduate School of Cancer Science and Policy, Department of Cancer Control and Population Health, Goyang, Korea, Republic of Background: Specific lifestyle behaviors increase the risk of developing cancer (tobacco use, alcohol intake, physical inactivity, being overweight, or obesity). Few studies have explored the association between lifestyle combinations and cancer risk. Aim: This study aimed to identify the latent classes based on lifestyle behaviors trajectories and to investigate the association between these classes and the risk of cancer incidence. Methods: We used data from the National Health Insurance Service (NHIS) in Korea between 2002 and 2018.The smoking status, alcohol consumption, body mass index (BMI), and physical activity were repeatedly measured in four waves of the general health examination provided by the NHIS between 2002 and 2009. Cancer incident cases were identified by ICD-10 codes and were tracked from 2010 to 2018. Trajectory analysis was used to identify the patterns of alcohol consumption, smoking, BMI, and physical activity. Latent class analysis was used to identify latent classes based on trajectories of smoking, alcohol drinking, BMI, and physical activity. Trajectory analysis and latent class analysis are used to identify different subgroups within populations that share certain external characteristics. Trajectory analysis describes the course of a measured variable over time whereas latent class analysis identifies the subgroup at a time. Results: Cox proportional regression models were used to calculate the hazard ratio. Among 1,817,046 men (20 years or older); 111,991 cancers occurred. We clustered five trajectory groups of each smoking, alcohol consumption, physical activity, and BMI. Six lifestyle behavioral latent classes were identified. The highest risk group tends to be moderate drinkers, moderate-heavy smokers, and physically inactive. This group showed the risk of all cancer was 1.32 times higher (95%CI=1.19-1.47) compared to the healthy group (non-drinkers, nonsmokers, physically active, and normal weight). Among the five most common cancers in Korea, this group also showed an increased risk for cancer in the lung (HRs=3.79, 95%CI=2.53-5.66), stomach (HRs= 1.54, 95%CI=1.192.00), colorectal (HRs=1.50, 95%CI=1.10-2.03), and liver (HR=1.67, 95%CI=1.11-2.52). Conclusion: A combination of trajectory analysis and latent analysis can help to identify different risk groups in the population over time. Smoking, alcohol consumption, and physical inactivity have been shown to have an impact on cancer risk, and that is also reflected in the results of this study. Funding: This research was supported by the “International Cooperation & Education Program (NCCRI NCCI 52210-52211, 2021)” and a research grant (NCC2010303) from National Cancer Center, Korea. Have you got a Conflict of Interest?: No
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1818 MAKNA Research Grants: an example of the importance of supporting locally-led research on cancer A. Bt Ahmad1, C. Pei Feng1 1 MAKNA, Kuala Lumpur, Malaysia MAKNA (National Cancer Council) is a Malaysian nonprofit organization that dedicates its efforts and resources to reduce the burden of cancer via financial, physical, emotional and educational support. Apart from helping cancer patients in bettering their quality of lives, MAKNA has been funding cancer research since 2001 and is the only Malaysian nonprofit organization to provide such grants. We strategically provide two main types of funds: the MAKNA Cancer Research Award for young researchers and the MAKNA Cancer Research Collaboration Fund to promote collaboration between institutions.
Thanks to these grants, we help accelerate the pace of research across cancer fields. We promote cancer research to the country’s best scientists and physicians who contribute to gain a deeper understanding of the cause and pathology of cancer initiation and progression. We hope to apply the knowledge gained from research to detect cancer at the earliest stage, make successful treatment possible and get closer to finding cancer solutions. Research funding is limited in Malaysia and to bridge this gap, MAKNA laid out a strategy to fund high quality and impactful research, in line with the organization's vision and mission. We rely on a transparent approach to carefully select the best research projects. Each application goes through a peer-review process and is selected by experts from the Academy of Sciences Malaysia (ASM), our established partner that provides advisory input and expert opinion. The selection criteria used for the evaluation are: approach, originality and innovation, doability, significance and relevance of project to cancer or to the nation, potential project outcomes, financial feasibility and the track record of the investigator. The applications are ranked and shortlisted based on a scoring system. Additionally, a research impact assessment is required to identify the project that will benefit the academics and non-academics.
Since MAKNA began to support cancer research, RM9.5 million (approximately 2,2 millions USD) has been invested to fund 101 projects. MAKNA Cancer Research Collaboration Fund supports research on a large scale by collaborating with higher institutions and organizations. The types of research funded by MAKNA includes treatment, diagnostic, prevention and policy. MAKNA spent RM4.5 million for the treatment research (29%), RM989 000 for basic research (36%) and RM890 000 for diagnostic (9%). In 2001, the MAKNA Cancer Research Award was initiated to specifically promote cancer research among young scientists in Malaysia in collaboration with the ASM. Between 2001 and 2021, MAKNA funded 66 young scientists to kick start their research career. The route of research is continual. There should not be a stop towards supporting cancer research and that is what MAKNA aims to achieve for the past 21 years. As a well established NGO in Malaysia, it is within our capacity and responsibility to support and localize cancer research.
Have you got a Conflict of Interest?: No
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1821 Palliative Radiotherapy for Geriatric Patients at Cipto Mangunkusumo Hospital Indonesia M. Yudistira1, S. Gondhowiardjo1, R. Putranto2, H. Handoko1, M. Permata1 1 Universitas Indonesia - Cipto Mangunkusumo Hospital, Radiotherapy, Jakarta, Indonesia, 2Universitas Indonesia Cipto Mangunkusumo Hospital, Internal Medicine, Jakarta, Indonesia Background: Along with increasing age, geriatric patients experience a decrease in resistance to stressors that occur to them, including comorbidities, cancer, and their treatment. With limited time and energy for cancer patients and geriatric patients, it is very important to make the best decisions in cancer management. Various factors, need to be considered in the implementation of geriatric radiotherapy Aim: To investigate geriatric palliative radiotherapy management in order to understand the factors that can influence the outcome at radiotherapy department, Cipto Mangunkusumo Hospital. Methods: Forty-three subjects were collected using the total sampling method for the period January 1, 2019, to December 31, 2020. The characteristic data will be displayed in tabular form. The Kaplan-Meier curve analysis was used to construct the overall survival curve, and the differences between groups were tested using the Log-rank test. The hazard ratio will be assessed by Cox's proportional hazard test. The independent variable with a p-value < 0.05 in the bivariate test will be tested multivariately using cox regression Results: From this study, the benefits obtained were in the form of a partial response (53.5% in the 60–70 year age group and 30.2% in the >70 year age group) and complete response (7% or 3 patients in the group). In the Kaplan-Meier test, there were 3 variables that bivariate had significant differences in survival, including the location of the primary tumor, performance status, and visceral metastases, each with a significance value of p = 0.016, p = 0.004, and p = 0.021. It was found that the performance status have a significant effect on survival (p = 0.03) (multivariate cox regression). There was no significant relationship between the independent variables studied for symptomatic outcomes and patient acute toxicity (multinomial logistic regression test). Conclusion: 90.7% of geriatric patients who received palliative radiotherapy at Cipto Mangunkusumo Hospital benefited from treatment with various fractionation schemes with minimal side effects, and it was discovered that the patient's performance status had a significant effect on overall survival. Thus we can see that performance status is an important consideration in choosing fraction scheme in geriatric patients receiving palliative radiotherapy. Keywords: radiotherapy, palliative, geriatric, survival, symptomatic outcome, toxicity Have you got a Conflict of Interest?: No
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1822 Total unsaturated fatty acid intake and stomach cancer N. TA1, N. Le1 1 School of Medicine, International University of Health and Welfare, Japan, Narita, Japan Background: Stomach cancer incidence and mortality are currently among the first three leading cancers in Vietnam in 2018. Objective: The aim was to examine the association between dietary intake of total unsaturated fatty acid and stomach cancer admitted into hospitals in the city of Hanoi. Methods: A case-control study was carried out on 1,182 stomach cancer cases and 2,995 hospital controls. SerumH. pylori infection status was examined. The validated demographic, lifestyle and semi-quantitative food frequency and questionnaires were used to collect data by the trained interviewers. Nutrient intake was converted using the data of food frequency intake and the Nutritive Composition Table of Vietnamese Foods. The odds ratio and 95% confidence interval (OR, 95%CI) were estimated using unconditional logistic regression analysis. Results: Total unsaturated fatty acid intake was significantly inverse association with stomach cancer, tertile-5 versus tertile-1, adjusted OR (95%CI): 0.36 (0.28, 0.48) for both gender, and adjusted OR (95%CI): 0.38 (0.28, 0.52) in men, adjusted OR (95%CI): 0.30 (0.18, 0.51) for women. Conclusions: We observed a strong beneficial effect against stomach cancer in a large case-control study in North Vietnam. Natural organic foods rich in unsaturated fatty acid intake daily would be recommended to prevent this fatal cancer. Have you got a Conflict of Interest?: No
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1823 Immunohistochemical analysis and imaging features of intrahepatic biliary cystadenoma: Two cases report s. bao1, w. wang2 1 Jinzhou Medical University, Jinzhou, China, 2The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
A CK7 is highly stained only in the inner epithelium of the cyst
The expression of progesterone receptor in ovarioid stroma was positive Background: Biliary cystadenoma are rare benign cystic tumors of the liver or extrahepatic bile ducts, accounting for less than 5% of all cysts found in the liver. It mainly occurs in the intrahepatic biliary system, and its etiology is not clear, and malignant transformation into biliary cystadenocarcinoma is possible. The disease can occur at any age, mostly in women, especially middle-aged women, with an average age of 50. Intrahepatic biliary cystadenoma is an isolated multilocular cystic mass that grows slowly and has a long history. Complete resection is the best treatment with good prognosis. Aim: Preoperative diagnosis of biliary cystadenoma is difficult due to nonspecific radiological and hematological findings and is usually confirmed by postoperative pathology. Two pathologically confirmed cases of intrahepatic biliary cystadenoma are reported. The clinical, radiological, and pathological features are reviewed and compared with those previously reported. Improve understanding of the disease to help make a correct diagnosis and better manage it. Methods: Data were retrieved from our database for two patients diagnosed and treated with intrahepatic biliary
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cystadenoma at our hospital and investigated for age, sex, medical history, imaging, surgical, pathological and follow-up records. To discuss the imaging and pathological features of hepatic gallbladder adenoma and the prognosis after operation. The origin of the lesion was analyzed by immunohistochemistry. Results ：Both patients were female, both had abdominal pain, and one patient could feel an abdominal mass. Blood test results were generally normal except for CA19-9 elevation in one patient. Computed tomography (CT) scans of both patients revealed a cystic lesion with internal septa in the liver. Both patients underwent segmental hepatectomy with complete removal of the tumor. Histopathological examination revealed ovarioid mesenchymal stroma beneath the intraepithelial layer of the tumors, which we diagnosed as intrahepatic biliary cystadenoma. Immunohistochemical results showed that the inner epithelial layer of tumor was CK (+); CK7 (+); CK19 (+); CK20 (-); Tumor mesenchymal matrix: ER (+); PR (+); KI67 (-); P53 (-). Both patients were followed up for more than 20 months, and no recurrence occurred during the follow-up. Conclusion ：Two rare cases of intrahepatic biliary cystadenoma are reported. The possibility of intrahepatic biliary cystadenoma should be considered when imaging findings of hepatic cystic lesions with internal separations. According to the immunohistochemical results, the intrahepatic biliary cystadenoma we reported is a benign tumor, and we believe that the tissue expressing mesenchymal matrix is derived from ectopic primary cells of the gonads, and the bile duct epithelium of the tumor is characterized by mucous secretion. Have you got a Conflict of Interest?: No
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1835 The effect of Psychological Intervention and Treatment on the Improvement X. Zheng1 1 Affiliated Cancer Hospital of Chongqing University, Chongqing, China Background: There is no obvious disorder in the early stage of malignant tumors. Many patients have been in the late stage, which not only brings life impact, such as: anxiety, depression, fear, irritability, etc. To this end, the psychological care of patients is especially important in the treatment process, and through its exchange, interaction, introduction of successful cases, etc., improve the care and nursing effect. Aim: To evaluate the improvement effect of psychological intervention and treatment on mood disorders in patients with advanced malignant tumors. Methods: Ninety-two Patients with advanced malignancy in the Affiliated Cancer Hospital of Chongqing University from January 2019 to January 2020 were selected as research objects, and they were divided into the experimental group and the control group by random number table method, with 46cases in each group. Under conditions with the same treatment approach，the experimental group was given Psychological intervention， and the control group was was given Conventional intervention. The improving effect of mood disorders was evaluated by SDS, SAS scale . Results: After the intervention, the anxiety and depression scores of the study group were (30.27±2.00) and (31.66±2.04) lower than those of the control group (41.86±4.31) and (40.97±4.18), respectively, and the differences were statistically significant (P<0.05). Conclusion: Psychological intervention can help improve the bad mood of malignant tumor patients,which can guide patients to maintain a positive and optimistic attitude to bravely accept treatment, extend life and improve the quality of life. Have you got a Conflict of Interest?: No
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1836 Protein intake and stomach cancer T. NGUYEN1, N. Le1 1 School of Medicine, International University of Health and Welfare, Japan, Narita, Japan Background: Vietnamese food consumption in the last century was poor in protein, especially limited protein contributed from animal sources. A lack of protein intake may be associated with an increased risk of stomach cancer which has been ranked as the third most common cancer in the country. Objective: The aim was to investigate the role of protein intake in the development of stomach cancer through a case-control study. Methods: We recruited 1,182 stomach cancer cases and 2,995 hospital controls who were admitted into hospitals located in the city of Hanoi. Protein intake was estimated using the data of food frequency intake and the Nutritive Composition Table of Vietnamese Foods. Other covariates were collected using the validated demographic, lifestyle, and semi-quantitative food frequency and questionnaires by the trained interviewers. The odds ratio and 95% confidence interval (OR, 95%CI) were examined using unconditional logistic regression analysis. Results: A higherprotein intake was associated with a significantly decreased risk of stomach cancer in the present study. Men and women combined, tertile-5 versus tertile-1, OR (95%CI): 0.37 (0.26, 0.53) for total protein intake, OR (95%CI): 0.37 (0.27, 0.49) for protein contributing from animal sources, OR (95%CI): 0.32 (0.24, 0.42) for protein contributing from fish and poultry. The risk reduction was also seen in men OR (95%CI): 0.38 (0.25, 0.58) and women OR (95%CI): 0.35 (0.19, 0.64) for total protein intake. Conclusions: Intake of protein contributing from animals, fish, and poultry with a recommended amount daily in low- and medium-income countries including Vietnam is essential to prevent stomach cancer. Have you got a Conflict of Interest?: No
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1837 The role of the International Atomic Energy Agency & re-establishing radiotherapy services in Papua New Guinea A. Mel1 1 Papua New Guinea National Cancer Centre, ANGAU Memorial Provincial Hospital, Lae, Papua New Guinea Background and context: Papua New Guinea (PNG) officially became a member of the International Atomic Energy Agency (IAEA) in 2012 and in 2015 signed its first Country Programme Framework (CPF) for 2016-2021. The CPF focused on four main areas: 1) Health and Nutrition; 2) Food and Agriculture; 3) Water and Environment; and 4) Radiation Safety and Security. In 2016, radiotherapy services in PNG ceased due to the source for its sole Cobalt-60 treatment unit requiring replacement. This sole unit is located at the PNG National Cancer Centre (PNGNCC) in Lae (PNG). Compounding this was a lack of suitably qualified national personnel and the departure of the only foreign clinical oncologist in 2016. Aim: To discuss the role of the IAEA in PNG and its efforts to re-establish radiotherapy services in PNG focusing on the milestones and bringing to light the drawbacks which have hindered it. Strategy / Tactics: In 2013, at the request of PNG, the IAEA undertook an integrated mission on the Programme of Action for Cancer Therapy (imPACT) assessment in PNG. The published findings from this imPACT review report aided greatly in establishing the roadmap for PNG and its ambitions with regards to radiotherapy and the future of its service. Consequently, the IAEA, under its CPF with PNG for 2016-2021 focusing on radiation safety and security, utilised this imPACT review report to establish key agendas to be addressed during its cycle. These included the passing of fundamental legislation, the creation of a national regulatory body, the identification and training of the national human resource, and radioactive source replacement. Outcomes: In partnership with the IAEA, PNG has been able to create and pass its Radiation Safety and Control Act 2019, create the necessary regulatory body in the form of the National Institute of Standards and Technology (NISIT), identify and send national candidates away to foreign medical schools and institutes for training in clinical oncology, radiation therapy and medical physics, and we are currently scheduled to replace our Cobalt-60 radioactive source in 2022 provided they can meet all the of the IAEA’s radiation safety and security criteria. What was learnt: During the implementation of the IAEA’s CPF with PNG from 2016-2021, several key agendas were delivered. However, the lack of governmental will from GoPNG was also apparent in the long delay that had occurred in the delivery of these. Furthermore, the cohesiveness of PNG’s cancer prevention and control program, when aligned with IAEA’s imPACT review from 2013 suggests more work is required to build a program in PNG that will attempt to address its cancer burden in a more comprehensive manner addressing all key areas of the cancer control continuum. PNG’s experience is replicable, even more so in other PICTs, where there currently exist no radiotherapy services in the great majority of them except for New Caledonia, French Polynesia, and Guam. Have you got a Conflict of Interest?: No
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1838 Our Story During The Covid-19 Pandemic M. Muhamad1,2, N.A. Maskor1, A. Ismail1,2, N.H. Nik Mahmood1,3 1 KanWork Cancer Society, Seri Kembangan, Malaysia, 2Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia, 3Universiti Selangor (Unisel), Shah Alam, Malaysia Background KanWork Cancer Society (KanWork) is a registered non-government association that provides support to those affected by cancer (http://www.kanwork.org). Majority members are cancer survivors. They are participants of the society’s chat group where they engage and support each other. The COVID-19 is a stressful event that may lead to significant psychological symptoms like anxiety, depression, and insomnia (Massicotte et al., 2021). Since lockdown in March 2019, the anxiety among KanWork members was evidenced from their communication in the society’s chat group. The common dialogue was on the prevalent high Covid cases and mortality. The call during the lockdown was to stay home. The extended home stay further fueled the stress. Realizing this issue, the society initiated a project "KanWork Stay @Home: CERITA KAMI (Our Story)" that encourages members to share their experiences during the challenging time. Aim To improve the psychological well-being of those affected by cancer during the pandemic. Strategy Our Story utilized self-narrative for KanWork members to share experiences. It also communicates information, express emotions, and helps to convey thoughts and feelings from one to another (Trzebinski & Antczak, 2007). KanWork members conversationsat the chat group on their experiences during the pandemic was analyzed inductively for themes (Merriam S., 2009). A common theme is reported as a short story on KanWork’s Facebook, https://www.facebook.com/kanwork.official/. Some stories are from individual member or volunteer, both from Malaysia and abroad. Most stories are in Bahasa Malaysia with illustrations. A few in English. Outcomes A total of 118 Our Story series had been posted since 2020. We receive positive feedback from the many followers. For wider access, 50 of the earliest Our Story is documented in an e-book (www.ebook.kanwork.org). They are organized under 5 themes; Covid-19, Healthy lifestyle, Lockdown, Ramadan and Aidilfitri (cultural events), and Treatment and Patient Support. Our Story Project is on-going. What was learnt Those living with cancer and pandemic challenges can be inspired through Our Story. The self-narrative provides a mean to express one’s thoughts and feelings in constructive ways among peers. As a support strategy, Our Story can improve one’s psychological well-being. The self-narrative also creates lens for others to understand the life and challenge of cancer survivors during the pandemic. It can be replicated. References: Massicotte, V., Ivers, H., & Savard, J. (January 08, 2021). COVID-19 Pandemic Stressors and Psychological Symptoms in Breast Cancer Patients.Current Oncology, 28, 1, 294-300. Merriam, S. B., (2009). Qualitative research: A guide to design and implementation. San Francisco: Jossey-Bass. Trzebinski, J., & Antczak, E. (2007). Narrative mode in impression formation. Psychology of Language and Communication, 11, 21-35. Have you got a Conflict of Interest?: No
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1839 Clinical Efficacy of Si-Jun-Zi-Tang and Regulation of Gut Microbiota in Post-operative Lung Cancer Patients Y. He1, Y. Gu1, A. Qi1, C. Zhang1, Y. Wang1, W. Yang1, Y. Gong1, L. Jiao1, L. Xu1 1 Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China Background: The expanding global population of patients with lung cancer represents a public health challenge. Gut microbiota is closely related to cancer progressions, inflammatory responses, and immune dysregulations. SiJun-Zi-Tang(SJZT), a Traditional Chinese Medicine formula from Prescriptions of Peaceful Benevolent Dispensary, is widely utilized for cancer patients with deficiency of vital energy, performing well in nourishing vitality. SJZT exerts anti-tumor and immuno-regulation effects by regulating microbiome dysbiosis and modulating gut homeostasis. Accordingly, the regulation of gut microbiota by SJZT could be a new strategy for cancers. However, the therapeutic effect of SJZT in postoperative lung cancer and the mechanism related to gut microbiota remain unknown. Aim: To investigate the clinical efficacy of SJZT in postoperative lung cancer and the regulation of gut microbiota, thus providing a new perspective and clinical basis for postoperative lung cancer. Methods: 65postoperative lung cancer patients were recruited and randomly divided into the control group or the SJZT group. The quality of life was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Lung Cancer13 (QLQ-LC13). The outcomes endpoint was the mean change of each item from baseline to week 1and 4. The clinical parameters such as blood cell cluster differentiation antigen and circulating cytokines levels were evaluated before the intervention, at week 1 and 4. We assessed the fecal microbial abundance and diversity by performing the 16S rRNA sequencing and bioinformatics analysis. Results: SJZT significantly enhanced the physical and cognitive functioning in QLQ-C30. For blood parameters, CD3+, CD3+CD4+, CD3+CD8+, IL-10 level were greatly upregulated, and IL-8 level was downregulated by SJZT compared to the control group. 16S rRNA sequencing revealed that SJZT significantly increased the richness and composition diversity of the microbial community. Furthermore, we identified several microbiota biomarkers that showed a significant difference between the two groups. Notably, SJZT prominently enriched the abundance of beneficial gut microflora producing short-chain fatty acids, such asAcidaminococcaceae, Christensenellaceae, Subdoligranulum, Phascolarctobacterium, and Alistipes. Conclusion: Our study indicates that SJZT improves life qualities, ameliorates immune functions, and alleviates inflammatory cytokines in postoperative lung cancer patients. The mechanism could be concerned with increasing the richness and diversity of gut microbiota and optimizing microbial structure, thus keeping gut micro-environment equilibrium and immune homeostasis. Our findings uncover that SJZT demonstrates the therapeutic potential in postoperative lung cancer and shows clinical significance for gut microbiota-oriented strategies by SJZT.
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Have you got a Conflict of Interest?: No
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1840 Antiplatelet drugs and breast cancer risk in a large nationwide Danish case-control study M. Cairat1,2, A. Pottegård3, M. Olesen3, L. dossus4, A. Fournier1, B. Hicks5 1 Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, Villejuif, France, 2Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France, 3Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark, 4Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon CEDEX 08, France, 5Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom Background: Low-dose aspirin has been hypothesized to prevent cancer risk by inhibiting platelet aggregation. However, the anti-cancer effect of low-dose aspirin has recently been questioned and its effect on breast cancer development remains unclear. If low-dose aspirin impacts breast cancer through its antiplatelet properties, other antiplatelet drugs may elicit similar effects. Yet, the impact of other antiplatelet drugs on breast cancer risk has rarely been evaluated. Aim: Thus, this study aimed to investigate the associations between breast cancer risk and antiplatelet drugs in a nationwide case-control study. Methods: From the Danish healthcare registries, we identified as cases all women with invasive breast cancer diagnosis between 2001 and 2018 (n=68,851). We matched each case to 10 population controls on age and calendar time. We used the prescription registry to identify exposure to low-dose aspirin, clopidogrel and dipyridamole. We defined ever users of antiplatelet drugs as those who filled at least 2 prescriptions. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals for breast cancer associated with the use of antiplatelet drugs, overall, by breast cancer subtype and by cumulative defined daily doses (DDDs). Results: Twelve percent of women had ever been exposed to low-dose aspirin, 2% to clopidogrel and 2% to dypiridamole. In multivariable models, breast cancer risk was not associated with ever use of low-dose aspirin [OR= 0.99 (0.96 – 1.02)], clopidogrel [OR= 0.93 (0.87 – 1.00)], and dypiridamole [OR= 1.00 (0.93 – 1.08)], compared with never use, and there was no evidence of a dose response relation. However, we found an inverse association between dipyridamole and breast cancer risk among women aged less than 55 years old, with suggestion of a dose-response relationship [OR per 1000 DDDs=0.73 (0.55 – 0.97)]. Associations did not differ by breast cancer histological type, estrogen receptor status or clinical stage at diagnosis. Conclusion: Overall, findings from this large nationwide study do not support the use of low-dose aspirin as a suitable pharmacological candidate for breast cancer prevention. The effect of other antiplatelet drugs, in particular dipyridamole, may warrant further investigation. Have you got a Conflict of Interest?: No
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1843 Proton Pump Inhibitors Exposure and Risk of Cancers: A Meta Analysis of Cohort Studies T.H. Tran1,2, S.K. Myung3 1 National Cancer Center Graduate School of Cancer Science and Policy, Department of Cancer Control and Population Health, Goyang, Korea, Republic of, 2University Medical Center Ho Chi Minh City, Department of Pharmacy, Ho Chi Minh City, Vietnam, 3National Cancer Center Graduate School of Cancer Science and Policy, Department of Cancer Biomedical Science, Goyang, Korea, Republic of Background: Proton pump inhibitors (PPIs) are widely used to treat various gastrointestinal disorders. Observational studies have raised concern about an association between PPIs use and cancers, but findings have been inconsistent. Aim: This meta-analysis aimed to estimate from published studies the pooled cancers risk among subjects exposed and not exposed to PPIs. Methods: We searched PubMed and EMBASE from inception to March 2022 to identify relevant cohort studies on the association between PPIs exposure and cancers risk. Two reviewers independently screened search results for eligibility and extracted data from included studies. If data were reported in more than one study on the same cancer type, the study presenting the most comprehensive data was included. Studies that were not published in English, in peer-reviewed journals, or only presented at conferences were excluded. Our primary analysis quantified cancers risk among subjects exposed vs not exposed to PPIs, expressed as the pooled (adjusted) hazard ratio (HR) and 95% confidence interval (95% CI) as estimated in the random-effect model. The NewcastleOttawa Scale for cohort studies was used to evaluate the quality of included studies. Publication bias was assessed by Egger’s regression test. Results: Of the 1,916 reports yielded by the search 15 cohort studies with 5,232,885 subjects were retained. Our main analysis (exposed vs. non-exposed) revealed a significant overall association between PPIs exposure and cancers risk (HR = 1.22, 95% CI: 1.02-1.46, I2 = 85.4%). In the subgroup meta-analysis by type of cancer, the use of PPIs was significantly associated with gastric cancer (HR = 1.56, 95%CI: 1.08-2.26, I2 = 82.4%) and liver cancer (HR = 1.48, 95%CI: 1.15-1.90, I2= 50.6%) but not for colorectal cancer (HR = 1.15, 95%CI: 0.85-1.54, I2= 88.9%). Cancers risk was not associated with duration of PPIs use longer than one year (HR = 1.27, 95%CI: 0.76-2.12, I2= 80.8%). In addition to the overall PPIs class effect in the primary analysis, lansoprazole (HR = 1.65, 95%CI: 1.11-2.47, I2= 59.0%) and omeprazole (HR = 1.51, 95%CI: 1.06-2.14, I2= 41.7%) were significantly associated with cancers risk. Conclusion: Pooled risk estimates suggest that the exposure to PPIs is associated with a general 1.22-fold increase in cancers risk, independent of the duration of PPIs exposure. Have you got a Conflict of Interest?: No
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1845 Screening performance of ABUS in Chinese average-risk women: A multi-center population-based study W. Ren1, H. Yan1, Y. Qiao2, F. Zhao1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Cancer Epidemiology, Beijing, China, 2School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical Colleg, Beijing, China Background: Automated breast ultrasound (ABUS) is a newly designed breast screening technique to be proposed as a promising tool to overcome the limitations of conventional ultrasound, such as operator dependency and lack of standardization, especially in resource-limited areas. However, it is currently unknown the screening performance of ABUS in the population-based screening program. Aim: To evaluate the screening performance and cancer detection rate of ABUS for breast cancer by comparing it to handheld ultrasound (HHUS) and mammography (MAM). Methods: A multi-center population-based cross-sectional study was conducted between Feb 2018 and Dec 2020 in six county-level Maternal and Child Health Hospitals in China. A total of 29,749 asymptomatic women aged 35 to 64 years were recruited for the study. All eligible women received both HHUS and ABUS. The women aged 45 years and above also underwent MAM. Women in the BI-RADS categories 1 and 2 were considered negative screening results, whereas categories 4 and 5 were considered positive results and biopsied. The reference standard of cancer diagnosis was a combination of biopsy results and 1-year clinical follow-up after initial screening. The cancer detection rate, sensitivities, specificities, the positive predictive values (PPV), the negative predictive values (NPV), and receiver operator characteristics (ROC) of HHUS, ABUS, and MAM were calculated and compared stratified by age and breast density. The agreement of BI-RADS categories among three methods was evaluated using kappa statistics. Results: Of 29,284 women analyzed (mean [SD] age, 46.4 [6.9] years), 39 cases of breast cancer were detected. The cancer detection rate between HHUS and ABUS was comparable in the whole study population (p=0.63), and both were higher than that of MAM among women aged 45 to 64 years though not differ significantly (p=0.79; p=0.51). The BI-RADS assessment between ABUS and HHUS showed substantial agreement(κ=0.60). However, MAM showed moderate agreement with two ultrasound modalities (κ=0.25; κ=0.22). In the total participants, there were no significant differences between HHUS and ABUS in sensitivity and specificity (p=0.13; p=0.45). Additionally, the specificities of both ABUS and HHUS were lower than MAM among women with dense breasts (all p＜0.01). The difference in estimates was significant to the ROC curves whose areas under the curve (AUC) (95% CI) were 0.96 (0.92-0.99) and 0.91 (0.85-0.97) for ABUS and HHUS, respectively (p=0.04). Conclusions: To our knowledge, this is the first population-based study to evaluate the screening performance of ABUS in average-risk women. Screening performance and cancer yields of ABUS were not inferior to HHUS, suggesting that ABUS has the potential to be the alternative modality of HHUS in Chinese women. To demonstrate the longterm effect of ABUS and find the best screening strategies, further follow-up studies are urgently needed.
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Table 1 The cancer detection rate and screening performance between ABUS, HHUS, and MAM stratified by age Screeni The cancer The ng detection Sensitivities Specificities PPV NPV positive method rate %(95%CI) %(95%CI) %(95%CI) %(95%CI) rate n(%) s n(%) 35-44 years 0.04(0.01,0. 3.27(2.96,3. 62.50(24.49,97 96.76(96.44,97 1.22(0.40,2. 99.97(99.93,99. HHUS 09) 60) .76) .07) 83) 99) 0.05(0.02,0. 3.04(3.09,3. 75.00(34.91,96 96.64(96.31,96 1.41(0.52,3. 99.98(99.94,10 ABUS 10) 74) .81) .95) 04) 0.00) P 0.02 0.56 — 0.57 0.05 — 45-64 years 0.17(0.11,0. 3.09(2.83,3. 90.32(74.25,3. 97.07(96.81,97 5.41(3.62,7. 99.98(99.95,10 HHUS 24) 36) 60) .32) 72) 0.00) 0.18(0.13,0. 3.20(2.94,3. 96.98(96.71,97 5.77(3.96,8. ABUS 100.00 100.00 26) 48) .23) 09) 0.16(0.11,0. 2.73(2.48,3. 83.87(66.27,94 97.43(97.17,97 5.99(3.95,8. 99.97(99.92,99. MAM 24) 00) .55) .67) 65) 99) P 0.70 0.55 — 0.61 0.80 — P 0.79 0.01 — 0.05 0.70 — 0.51 0.05 0.89 P ＜0.01 — — Abbreviations:ABUS, automated breast ultrasound; CI, confidence interval; HHUS, handheld ultrasound; MAM, mammography; PPV, the positive predictive values; NPV, the negative predictive values （H-A）
（H-A）
（H-M）
（A-M）
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Table 2 The cancer detection rate and screening performance between ABUS, HHUS, and MAM stratified by density Screenin The cancer Sensitivitie Specificitie NPV The positive PPV g detection rate s s %(95%CI rate n(%) %(95%CI) methods n(%) %(95%CI) %(95%CI) ) Women with nondense breasts 98.19(97.85 6.06(2.65,11.59 0.12(0.05,0.23 1.92(0.05,0.23 HHUS 100.00 100.00 ) ) ，98.49) ) 98.35(98.02 6.61(2.90,12.61 0.12(0.05,0.23 1.76(1.47,2.10 ABUS 100.00 100.00 ) ) ，98.64) ) 0.10(0.04,0.21 1.94(1.63,2.29 87.5(21.27 98.16(97.81 5.26(2.14,10.54 99.98(99.9 MAM ) ) ，73.41) ，98.47) ) 2，100.00) P — 0.49 — 0.47 0.86 — P 0.80 0.95 — 0.90 0.78 — P 0.80 0.45 — 0.40 0.65 — Women with dense breasts 99.99(99.9 0.21(0.13,0.33 4.32(3.83,4.66 86.96(31.18 95.97(95.55 HHUS 5.08(3.13,7.73) ) ) ，62.35) ，96.36) 0，99.99) 98.81(95.38 0.25(0.16,0.37 4.43(4.02,4.86 ABUS 100.00 5.58(3.57,8.26) 100.00 ) ) ，96.21) 99.96(99.8 0.20(0.12,0.32 3.30(2.94,3.68 82.61(29.85 98.90(96.53 MAM 6.19(3.49,8.88) ) ) ，61.3) ，97.24) 9，99.99) P 0.65 0.52 — 0.58 0.75 — 0.87 0.52 P ＜0.01 — ＜0.01 — 0.54 0.73 P ＜0.01 — ＜0.01 — Abbreviations:ABUS, automated breast ultrasound; CI, confidence interval; HHUS, handheld ultrasound; MAM, mammography; PPV, the positive predictive values; NPV, the negative predictive values （H-A）
（H-M）
（A-M）
（H-A）
（H-M）
（A-M）
Have you got a Conflict of Interest?: No
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1846 Telementoring Breast Cancer Cases By National Multidiciplinary Expert in Indonesia D.T. SINULINGGA1, G. TEO2, I.D. PANGESTI3, R.I. PUTRI4, B. BRAHMA5, K. BROHET6, O.P. RAHAYUNINGTYAS7, R.S.W. NINDITO8 1 DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, MEDICAL SERVICES, West Jakarta, Indonesia, 2DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, PALLIATIVE DEPARTMENT, GENERAL PRACTITIONER, West Jakarta, Indonesia, 3DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, OUTPATIENT DEPARTMENT, GENERAL PRACTITIONER, West Jakarta, Indonesia, 4DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, PATHOLOGY ANATOMY SPECIALIST, West Jakarta, Indonesia, 5DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, ONCOLOGY SURGEON SPECIALIST CONSULTANT; Head of Indonesian Journal of Cancer, West Jakarta, Indonesia, 6DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, RADIOTHERAPHY DEPARTMENT, Specialist, West Jakarta, Indonesia, 7DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, DIRECTORATE PLANNING, ORGANIZATION AND GENERAL SERVICES, West Jakarta, Indonesia, 8DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, PRESIDENT DIRECTOR, West Jakarta, Indonesia Background and context: Indonesia is an archipelagic country. There are 6000 inhabited islands of the 17508 islands and only 5 large islands in existence, with uneven population density. In 2017, Dharmais Cancer Hospital was appointed as a National Cancer Center and according to the Road Map for Cancer Management Policies, especially during the pandemic, Dharmais NCC was assigned to conduct telementoring to foster other hospitals in Indonesia. One way of telementoring is to discuss breast cancer cases through the ECHO platform. In each session, there are 2 part activities: didactic session by an expert and case presentation by network hospitals located in areas with incomplete facilities or human resources, so that they can carry out standardized management. This activity has been held for 7 sessions out of 10 planned sessions
Aim: 1. To transfer knowledge about the latest management of breast cancer by experts. 2. To carry out case referrals more quickly and comprehensively because they are discussed by various fields of science and can be managed according to available conditions and facilities Strategy / Tactics: 1. Supported by the ministry of health: make invitation and present the policy in cancer control at launching session. 2. Involving national cancer network hospitals and supported by their top management 3. Involving expert from various disciplines related to breast cancer (radiodiagnostics, pathology, surgery, systemic therapy and immunotherapy, radiotherapy, medical rehabilitation, nutrition, palliatives) 4. Case presentation from a network hospital with limited facilities and human resources
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Programme / Policy process: 1. Propose the concept note to ECHO India 2. Advocacy to the ministry of health and outreach to network hospitals 3. Determine regular meetings, every 2 weeks, Mondays, at 13.00-14.30 Outcomes: Increased knowledge of participants and improved management of breast cancer cases What was learnt: (if relevant, please also detail here the potential of replicability) The limitations of radio diagnostic tools in peripheral hospitals can be helped by combining several examinations Some cases get input from the pathology and therapy side because they are not in accordance with the clinical/symptoms From the evaluation survey for each session: 1.On average 84% of respondents said that the Case Discussion in the ECHO session would AFFECT/CHANGE the practice/action plan on the patient 2.Average – 94% of respondents said LEARNING NEW THINGS in the Case Discussions that have been presented Have you got a Conflict of Interest?: No
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1848 Development of Combination Strategies for FAK Inhibitor in Diffuse Gastric Cancer K. Peng1, T. Liu1, A. Bass2 1 Zhongshan Hospital Fudan University, shanghai, China, 2Columbia University Irving Medical Center, New York, United States Background:Diffuse gastric cancer (DGC) is a subtype of gastric cancer (GC), which is characterized by a highly invasive growth pattern, usually with a dismal prognosis. Our previous study found thatCdh1(E-Cadherin) loss andRHOAY42C mutation work together to activate focal adhesion kinase (FAK), which transform normal gastric epithelial cells to DGC. Phospho-FAK (pFAK), the active form of FAK, is the prognostic factor in several tumors. The prognostic value of pFAK in GC remains to be explored. Besides, our prior work also showed that small molecule FAK inhibitors have efficacy in DGC, however drug resistance occurs quickly after the treatment, which inspire us to explore the combination strategy for FAK inhibitors in DGC. Aim: Our study aims to research the prognostic value of pFAK in GC and explore the targets for the combination with FAK inhibitors in DGC. Methods: To explore the prognostic value for pFAK, we retrospectively collected 178 formalin-fixed paraffinembedded tumor tissues from GC patients underwent D2 gastrectomy without neoadjuvant treatment. The immunohistochemistry staining of pFAK was assessed by H-score. Survival analysis was performed by KaplanMeier and risk factors were evaluated by COX regression analysis. For the exploration of targets for the combination with FAK inhibitors, we mainly used the DGC model ofCdh1-/-RHOAY42C/+murineorganoidsand NUGC4, SNU668 human cell lines. Genome-wide ORF screen was used to select the pathways contributing to the resistance of FAK inhibitors. Digiwest was used to analyze the pathway alterations after the treatment of FAK inhibitor as the compensatory signaling changes might lead to the resistance. Bothin vitroandin vivoexperiments were used to validate whether the inhibitors targeting the resistance-related pathways were the candidates for the combination with FAK inhibitors. Results:For the GC samples, 79 samples were divided to pFAK-positive group and 99 samples to pFAK-negative group. We found that the prognosis of pFAK-positive group was worse than that of the pFAK-negative group in GC (HR=1.755, 95% CI 1.124-2.740,P=0.011) and DGC subgroup (HR=1.753, 95% CI 0.985-3.121,P=0.047). We also found that positive pFAK was the independent risk factor for the worse prognosis of GC (HR=1.89, 95% CI 1.21-2.96,P=0.0054). Besides, we identified that CDK6 promoted FAK inhibitor resistance by ORF screen and CDK4/6 inhibition enhanced the efficacy of FAK inhibitor in DGC models. Furthermore, we demonstrated that FAK inhibitor treatment in DGC models led to compensatory MAPK pathway activation in DGC, and that small molecule MAPK inhibitors also effectively enhanced FAK inhibitor efficacy. Conclusion:Through analysis of a large collection of clinically annotated GC samples, we demonstrate that pFAK is a negative prognostic factor in GC. We also find that FAK inhibitors combined with MAPK inhibitor or CDK4/6 inhibitor warrant further testing in clinical trials in DGC. Have you got a Conflict of Interest?: No
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1849 Degree of food processing and breast cancer risk in the EPIC cohort. M. Cairat1,2, S. Yammine3, T. Fiolet1, C. Biessy2, V. Viallon2, F. Rauber4, R. Bertazzi Levy4, C. Augusto Monteiro4, C. Casagrande2, G. Nicolas2, M. Touvier3, M. Deschasaux3, B. Srour3, M.-C. Bouton1, N. Kliemann2, J. Blanco Lopez2, A. Al Nahas2, F. Morales Berstein5, M. J. Gunter2, K. Chang6, E. P. Vamos6, C. Millett6, I. Huybrechts2 1 Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, Villejuif, France, 2Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France, 3Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University Paris cité (CRESS), Bobigny, France, 4University of São Paulo, São Paulo, Brazil, 5University of Bristol, MRC Integrative Epidemiology Unit, Bristol, United Kingdom, 6Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom Background: Recent epidemiological evidence suggested a positive association between ultra-processed food consumption and breast cancer risk, although some studies also reported a null association. Further, the evidence regarding associations between dietary intakes of lower degrees of food processing and breast cancer risk is limited. Aim: Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) were used to investigate the associations between dietary intake by degree of food processing and breast cancer risk, overall and by breast cancer subtypes and by menopausal status, body mass index and use of menopausal hormone therapy. Methods: EPIC is a prospective cohort study initiated in 1992 in 10 European countries.Complex foods and recipes had been disaggregated into ingredients. More than 11,000 food ingredients were classified into four groups of food processing level using the NOVA classification system (minimally processed / culinary ingredients / processed / ultra-processed). Cox proportional hazards models were used to estimate hazard ratios (HR) of breast cancer per one standard deviation increase in consumption of NOVA groups. Absolute intake in grams per day was used to take into account foods that do not provide energy and non-nutritional factors related to food processing. Results: During a median follow-up time of 14.1 years (SD=3.9), 14,933 breast cancer cases were diagnosed (1603 in situ, 13,320 invasive, and 10 of unknown invasiveness status) among the 318,686 participants. No associations were found between breast cancer risk and minimally processed foods [HR=0.99 (0.97 – 1.01)], processed culinary ingredients [HR=1.01 (0.98 – 1.03)] and ultra-processed foods [HR=1.01 (0.99 – 1.03)]. However, a positive association was found between higher levels of processed foods and breast cancer risk [HR=1.05 (1.03 – 1.07)]. The associations did not differ by breast cancer subtypes and menopausal status. The associations between processed foods and breast cancer risk disappeared when we further adjusted our models for alcohol intake [HR=1.01 (0.98 – 1.05)] or when alcoholic drinks were excluded from processed foods intake [HR=1.02 (0.99 – 1.05)]. When absolute intake in kcal per day was used instead of grams per day, the results were similar. Conclusion: This study suggests that processed foods may be associated with a higher breast cancer risk, although the association seems mainly driven by alcoholic drinks. These analyses should be validated in cohorts with repeated dietary intake measurements in order to consider potential changes in the consumption of (ultra)processed foods over time.
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1853 The economic and social burden of cervical cancer in Asia-Pacific S. Akinola1, V. Veigas2 1 Roche Diagnostics International Ltd., Global Access and Policy, Rotkreuz, Switzerland, 2Roche Diagnostics Asia Pacific, Health Policy & Patient Access Value, Singapore, Singapore Background and context:Cervical cancer is not only a global health issue but also a regional health issue for the Asia Pacific region with a significant threat to population health. Women make up almost 50% of the population in the Asia Pacific region and contribute around 36% to the Gross Domestic Product (GDP). Due to the COVID-19 pandemic, vital resources were diverted away from cervical cancer prevention – vaccination, screening, and treatment that has affected the progress made. Screening and diagnostics play a critical role in patient care management and in addressing the public health issue of cervical cancer and achieving the elimination goal to screen 70% of women with a high-performance test by 2030. The focus will be on India, Pakistan, Indonesia, and the Philippines as countries where the incidence of cervical cancer is on the rise. Aim: To develop thought leadership in sustaining the political commitment to the growing disease burden of cervical cancer and the value of diagnostics by providing tangible recommendations to aid policy conversations in supporting increased funding to scale and sustain cervical cancer screening and diagnosis. Strategy / Tactics: White paper and virtual roundtable to disseminate insights and engagement with policy makers The white paper will: • Characterize cervical cancer burden by country and existing diagnostics infrastructure and screening programs in each country
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Identify gaps in diagnosis/screening efforts, the impact of COVID-19, and key considerations for expanding screening and diagnostics infrastructure to improve access to support the WHO’s Global Strategy to Accelerate the Elimination of Cervical Cancer Summarize the social and economic value delivered by diagnostic efforts and a corresponding need to increase diagnostics healthcare spending.
The virtual roundtable will:
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Engage the target audience (policymakers and influencers) in a conversation to activate a call-to-action. This event will provide an opportunity to discuss the insights and actions for regional policymakers to support the elimination strategy.
Social media:
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Social media amplification of findings from white paper
Programme / Policy process: To engage with policymakers in the region to raise awareness and commit to a national cervical cancer elimination strategy. Outcomes: To raise awareness and garner political support for eliminating cervical cancer in India, Pakistan, Indonesia, and the Philippines. In addition, financial commitment to scale and sustain existing programs.
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What was learnt: (if relevant, please also detail here the potential of replicability) References https://data.worldbank.org/indicator/SP.POP.TOTL.FE.ZS?locations=Z4 https://www.mckinsey.com/featured-insights/asia-pacific/the-future-of-women-in-asias-workforce Have you got a Conflict of Interest?: Yes If yes please specify:: Roche Sponsorship of the conference.
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1854 Total monounsaturated fatty acid-MUFA intake, and stomach cancer D. Nguyen1, N. Le1 1 School of Medicine, International University of Health and Welfare, Japan, Narita, Japan Background: Monounsaturated fatty acid intake may be associated with a lower risk of stomach cancer. Objective: We investigated the association between monounsaturated fatty acid intake and the development of stomach cancer in Northern Vietnam. Methods: We performed a case-control study on 1,182 stomach cancer incidences and 2,995 hospital controls who completed surgery in hospitals located in the city of Hanoi. We calculated monounsaturated fatty acid intake using the obtained data on food frequency intake and the Nutritive Composition Table of Vietnamese Foods. We used the validated demographic, lifestyle, and semi-quantitative food frequency and questionnaires to collect data from the study participants by the trained interviewers. The odds ratio and 95% confidence interval (OR, 95%CI) were examined. Results: The estimated amount of intake daily was from 4.7 g/day (tertile-1) to 21.1 g/day (tertile-5). A highermonounsaturated fatty acid intake was to reduce the significant risk of stomach cancer. The adjusted odds ratio and 95% confidence interval, tertile-5 versus tertile-1, OR (95%CI): 0.41 (0.31, 0.54), men and women combined, OR (95%CI): 0.48 (0.35, 0.67) for men, and OR (95%CI): 0.32 (0.24, 0.42) for protein contributing from fish and poultry. The risk reduction was also seen in men OR (95%CI): 0.27 (0.16, 0.46) for women. Conclusions: We observed a significant effect of total monounsaturated fatty acid intake in preventing stomach cancer in the study population. Have you got a Conflict of Interest?: No
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1855 Gene mutations in newly diagnosed multiple myeloma patients detected by NGS: data from one center of China Y.-t. Wang1, L. Bao1 1 Beijing Jishuitan Hospital, Hematology department, Beijing, China Background: Multiple myeloma (MM) accounts for approximately 10% of all hematological malignancies. Although the application of proteasome inhibitors (such as bortezomib) has greatly improved the survival of MM, it is still an incurable disease. Previous studies have found that the occurrence and development of MM are related to the abnormality of multiple oncogenes and proto-oncogenes, including Bcl-2, C-myc, RAS, P53, RB1, etc. A large number of studies have continuously explored and discovered many new pathogenic genes and abnormally activated/inhibited signaling pathways, revealing that the genetic background of MM is more complex, and a single gene cannot clarify the biological characteristics of MM. Large-scale studies abroad have carried out Next Generation Sequencing (NGS) detection on NDMM patients based on clinical trials, and the results have explained the gene mutations of MM patients in Western countries. The gene mutation data from China is rare. Aim: To investigate the genetic mutation of newly diagnosed multiple myeloma (NDMM) patients, and to explore its correlation with genetic abnormalities detected by FISH. Methods: A total of 133 patients with NDMM were enrolled. After enriching plasma cells with CD138 magnetic beads, 92 MM-related target gene mutations were detected by Illumina sequencing platform, and 6 common genetic abnormalities were detected by FISH. Results: 105 cases (78.9%) had at least one gene mutation detected by NDMM. The top 5 genes with gene mutation rate were KRAS, NRAS, TRAF3, BRAF and TP53. Cytogenetic abnormalities detected by FISH have a certain correlation with gene mutations, t(11;14) translocations are often accompanied by CYLD mutations, and BRAF, CDKN1B, RUNX3 and ZFHX4 in t(14;16) and t(14;20) translocations The mutation ratio was higher, TP53, CRBN, JAK2, SP140 and TNFRSF21 mutations were easy to be combined with 17p deletion, IRF4 mutation ratio was high and TET2 mutation ratio was low in 1q21 triple amplification, and HIST1H1E mutation was more likely to be seen in 1q21 quadruple amplification. Conclusion: There are various gene mutations in NDMM patients, mainly RAS/MAPK and NF-κB pathway gene pathways. Have you got a Conflict of Interest?: No
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1857 Screening in the IARC Handbooks of Cancer Prevention Programme – Past achievements and future perspectives B. Lauby-Secretan1 1 International Agency for Research on Cancer (IARC) / WHO, ESC, Lyon Cedex 08, France The IARC Handbooks of Cancer Prevention series provide comprehensive reviews and consensus evaluations of the effectiveness of interventions to reduce cancer incidence or mortality. TheIARC Handbooks are widely used by national and international health agencies to implement evidence-based interventions or develop policy recommendations to reduce cancer risk at the population level. The Programme evaluates interventions of primary prevention and of secondary prevention (screening and early diagnosis). In the recent volumes, we have reviewed and evaluated screening methods for cancers of the breast, colon, cervix and oral cavity. EachHandbook has brought forward cancer-specific characteristics of the screening strategies and level of implementation, and different challenges in the evaluation of the evidence. In this presentation I will offer an overview of the similarities and differences between these Handbooks, showing how the outcomes are specific to each cancer in terms of what was evaluated and the additional information provided. Have you got a Conflict of Interest?: No
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1863 Defining National Research Priorities for Prostate Cancer in Zambia - a model for Sub Saharan Africa D. Lombe1, S. Msadabwe2, M. Mwamba3, A. Aggarwal4 1 Regional Cancer Treatment Services, MidCentral District Health Board, Palmerston North, New Zealand, 2Cancer Diseases Hospital, Oncology, Lusaka, Zambia, 3ZAMBART, Lusaka, Zambia, 4London School of Hygiene and Tropical Medicine, London, United Kingdom Background: Cancer is a major public health problem globally contributing significantly to the burden on health and economic systems. The World Health Assembly Resolution 70.12 was a commitment to re-invigorate the investment into cancer prevention and control in the context of an integrated approach. Quality data is a prerequisite for the formulation of good policies that can be successfully implemented in local contexts, bearing in mind institutional, legal frameworks and national priorities. In line with the 2030 Sustainable Development that states 'Ensure healthy lives and promote well-being for all at all ages' this research sought to establish the most pertinent questions for the establishment of a robust prostate cancer control program in Zambia where it is the 3rd most cause of cancer mortality but highly neglected. Aim: To develop a research agenda focused on barriers to early detection, diagnosis and treatment of prostate cancer within the Zambian context and its national cancer control plan Methods: Themes were identified from a systematic review of literature of published work in Sub-Saharan Africa between 1995 and 2021 on delays to seeking, reaching and receiving quality care. Twenty-three themes were identified and formed the basis of a Delphi consensus process. Twenty-five stakeholders were identified nationally across Zambia and requested to score each theme based on feasibility for investigation; whether they perceived that this affected a significant proportion of prostate cancer patients (large scale), an unavoidable cause of death or disability (high impact); and if it would be readily changed to improve care (modifiable). There were 3 rounds (R) to the process: 2 by electronic survey and 1 in-person meeting. In R1 statements that scored above 15 from over 70% of participants were prioritised immediately for R3 discussion. Those scoring below 30 % were dropped and those in between were re-surveyed in R2. Results: Twenty-two and 17 of the identified stakeholders responded to R1 and R2 respectively. Ten experts were invited to round 3. Five statements were prioritised immediately from R1 to R3; 4 were dropped and 14 had no consensus. In round 2, 5 were prioritised for the consensus meeting making 10 research areas. Lack of awareness(1); cost and lack of availability of diagnostics (2,3); cost of specialist cancer treatments (4), lack of essential medicines for prostate cancer (5) inadequate coordination of the prostate cancer pathway and staff training (6,7) were identified as priority research areas. Conclusion: Recognising the inequalities in cancer care pathways (screening, self-appraisal, diagnosis, treatment) in resource challenged health systems, different cancer control strategies are required for specific micro- and macro- groups. A robust research agenda on the 7 priority areas identified is pertinent to produce data that will inform policy makers in the synthesis of prostate cancer control programs in Zambia. Have you got a Conflict of Interest?: No
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1864 Tertiary lymphoid structure genes mediated model predicts the prognosis and immunotherapy in melanoma B. Wang1, J. Liu1, Y. Jiang1 1 West China Hospital, Sichuan University, Department of Medical Oncology, Cancer Center, Chengdu, China Background: Emerging evidence has proven that tertiary lymphoid structures (TLSs) are predictive biomarkers of favorable clinical outcomes in melanoma, whereas the exact role of TLS-related genes remained unclear. In the present study, we aimed to establish a novel risk-scoring model based on TLS-related genes to predict the prognosis and immunotherapeutic efficacy in melanoma. Aim: Our study aimed to construct a robust prognosis prediction model based on TLS-related genes and provide an effective tool for immunotherapy of melanoma patients. Methods: Patients in the TCGA-SKCM cohort (n=468) were clustered into two subtypes based on the prognosisrelated genes associated with TLSs though consensus clustering analysis, and differentially expressed genes were screened between two clusters. By univariate and the least absolute shrinkage and selection operator (LASSO) Cox regression analysis, a 13-gene signature was selected to construct a prognostic risk-scoring model. The median risk score served as the unified cutoff to divide patients into high- and low-risk groups. GSE65904 (n = 220) and GSE544467 (n = 79) cohorts were used for external validation. Univariate and multivariate cox analysis were used to select significant variables for construction of nomogram. The nomogram model was evaluated by concordance index, time-dependent receiver operating characteristics (ROC) curve, calibration curve and decision curve analysis (DCA). GSEA, CIBERSORT, Tumor Immune Dysfunction and Exclusion (TIDE) and Immunophenoscore (IPS) were utilized to explore the potential mechanism of immune-related process and immunotherapy. Results: Thirteen signature genes (CCL8, DLX3, CNTFR, CNFN, BCAN, CD33, HAPLN3, ABCB1, CLIC2, GCNT1, FGF1, A2ML1, GBP2) were developed to construct a risk-scoring model. Melanoma patients could be grouped into high- and low-risk groups, and low-risk patients showed better survival than high-risk patients. Area under the curve values of 1, 3, and 5 years were 0.76, 0.72, and 0.73 in the training set, respectively, indicating a good predictive efficacy. In addition, based on independent prognostic factors including risk score, age, stage, T and N Staging after univariate and multivariate Cox regression analyses, a nomogram was constructed to better estimate individual survival. For the prediction of 1, 3, and 5-year overall survival probability according to the nomogram, the area under the receiver operating characteristic curve was 0.81, 0.80 and 0.76, respectively. Furthermore, we explored the correlation of the prognostic risk-scoring model with tumor microenvironment (TME) and immunotherapeutic efficacy. Patients in the low risk group featured immunoactive TME, higher IPS scores and lower TIDE scores, and was regarded as the potential beneficiaries of immunotherapy. Conclusion: he 13-gene risk score proposed in the research may provide new insights into the individualized evaluation of melanoma prognosis and Immunotherapeutic Efficacy Have you got a Conflict of Interest?: No
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1866 Death Acceptance Among Persons with Cancer and Its Impact S. Thanasilp1,2 1 Chulalongkorn University, Faculty of Nursing, Bangkok, Thailand, 2Chulalongkorn University, Asian Wisdom Care Research Unit, Bangkok, Thailand Background: Persons with cancer who perceived death acceptance (DA) mostly accept of the natural process of death and preparing for their death. The consequence of death acceptance such as spiritual well-being is very importance knowledge for nurses. Aim: The purposes of this study were to describe DA among persons with cancer and to test the predictor of death acceptance on spiritual well-being. Methods: The participants were 120 persons with cancer from three tertiary hospitals in Thailand. The research instruments consisted of 3 questionnaires: a personal information questionnaire, the Buddhist Death Acceptance Scale and the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale (FACIT-Sp-12). Cronbach's alpha coefficient of the last 2 instruments were .82, equally. Descriptive statistics, Pearson's correlation, and stepwise multiple regression were used to analyze the data. Results:The results revealed that persons with cancer mean aged of 49.96 years (SD = 12.41, range = 17-77 years) had perceive death acceptance at a high level (Mean= 3.37, SD= 0.54), and perceive spiritual well-being at a moderate level (Mean= 2.60,SD= 0.40). A total of 8% of variance of spiritual well-being among persons with cancer was explained by death acceptance. Conclusion: From this crucial knowledge, nurses can develop spiritual well-being interventions by helping persons with cancer to cope with their death. Therefore, a better quality of life and good death can be achieved. Table 1Mean, SD, and level of DA and SWB among persons with cancer (n=120)
M 3.37 2.60
Total Death Acceptance Total Spiritual Well-being
SD Level 0.54 High 0.40 Moderate
Table 2 Stepwise Multiple Regression of SWB (n = 120)
Variable Constant Death acceptance
b 22.35 2.63
SE 2.69 .79 b
Note:R=.30, R2=.09, R2adj=.08, SE=4.58, F=11.19, and the p-value =.001 Have you got a Conflict of Interest?: No
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Beta .30
t 8.32 3.35
p-value .00 .00
1870 High content screening to identify DNA damage response proteins in mitosis for cancer therapeutic synergies X. Yang1, B. Xu2,1 1 Tianjin Medical University Cancer Institute and Hospital, Department of Biochemistry and Molecular Biology, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Cancer Research Center, Tianjin, China, 2Chongqing University Cancer Hospital and Chongqing University School of Medicine, Chongqing Key Laboratory of Intelligent Oncology for Breast Cancer, Chongqing, China Background: The mitotic spindle assembly checkpoint (SAC) and the DNA damage response (DDR) are the two major self-monitory systems in mammalian cells to guard genome stability and chromosomal integrity. Growing evidence has shown that the interplay of these two systems is critical for the cancer response to therapeutics. However, a clear picture of how these pathways overlap has yet to be seen. Aim: To draw a comprehensive picture of the crosstalk between the DDR and SAC in order to find synergistic strategies for cancer therapy. Methods: We conducted a high-content screen using a customized siRNA library. The library included siRNAs against 122 genes essential for DDR. The mitotic timing was observed by time-lapse microscopy. In cells cotransfected with the individual siRNAs and the GFP-Histone H2B plasmid, we recorded mitotic timing and chromosome dynamics by time-lapse microscopy. Results: 64 of 122 knock-down genes resulted in a significant reduction of mitotic timing in at least one of the three siRNAs. 26 of them showed that at least two separate siRNA targets resulted in a shortened mitotic timing (p<0.05). 7 of the 26 genes were considered hits because treatment with each of the three individual siRNAs resulted in a marked decrease in mitotic timing. Poly [ADP-ribose] polymerase 1 (PARP1) is one of the seven genes. Knock-down of PARP1 resulted in the mitotic timing shortened to 45 minutes, similar to that of Mad1 knock-down. Lagging chromosomes were also observed in knock-down cells. In cells treated with nocodazole, a spindle damaging agent, PARP1 knock-down cells showed impaired activation of the SAC. Inhibition of PARP1 by an inhibitor 3-aminobenzamide (3A-B) resulted in a similar effect as that of knock-down. Therefore, either genetic ablation or pharmacological inhibition of PARP1 caused a defect in the SAC. A protein-protein interaction enrichment analysis showed the interconnection of PARP1 with many mitotic proteins. The pathway analysis predicts that PARP1 regulates SAC by interaction with ATM, BRCA1, BRCA2, NUPR1, and CDKN1A (p21). Coimmunoprecipitation of ATM identified that PARP1 was in the complex of ATM in mitosis. Conclusion: These results indicate that PARP-1 plays a critical role in the activation of the SAC. Our findings not only demonstrate the interplay between the DDR and SAC, but also provide novel synergistic approaches toward cancer therapeutics. Have you got a Conflict of Interest?: No
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1872 Nation-wide Gastric Cancer Prevention in China: Effect, Affordability, and Cost-Effectiveness Optimization J. Jiang1, Z. Wang1, Y. Zhao1, C. Yang1, W. Gu1 1 Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Epidemiology and biostatistics, Beijing, China Background: China accounts for nearly half of new cases and deaths owing to gastric cancer (GC) worldwide. Unlike neighboring countries such as Japan and South Korea, China’s vast aging population, limited resources, and considerable regional diversity have impeded nationwide GC prevention. Accumulating empirical data from ongoing programs on primary and secondary prevention of GC in selected areas of China could contribute to future decision-making on a large scale, and the Health China 2030 Planning Outline provides further opportunities to promote population cancer control. Aim: To project future trajectories of the GC burden in China under different scenarios of GC prevention and identify strategies to improve affordability and cost-effectiveness. Methods: Using a cohort of Chinese men and women born during 1951–1980, we assumed that different prevention strategies were conducted, including eradication of Helicobacter pylori and endoscopy screening (onetime, annual, biennial, triennial, or stratified according to personal risk). We performed a literature search to identify most up-to-date data and populate a Markov model to project the number of new GC cases and deaths during 2021–2035, as well as medical and financial resource requirements. We examined the impacts of general (among the whole population) and targeted (high-risk populations, e.g., family history, smoking) prevention. Results: During 2021–2035, 10.0 million new GC cases and 5.6 million GC deaths would occur, with 7.6%–35.5% and 6.9%–44.5%, respectively, being avoidable through various prevention strategies. Relative to routine care (the status quo), Helicobacter pylori eradication was a cost-saving strategy. Although barely within current capacity, nationwide endoscopy screening could become cost-effectively appealing through targeted rather than general prevention, that is, incremental cost-effectiveness ratios for one-time, annual, biennial, and triennial screening over routine care were reduced by 44.1%–49.4%, all down to below a willingness-to-pay level of 70,000 CNY/QALY (China’s capita gross domestic product level). Affordability could be further improved through stratified screening, which incorporated blood test results for individualizing screening frequency, and required 22% and 55% fewer endoscopic procedures than targeted biennial and annual screening, respectively. Conclusion: This study highlights the need for China and similar countries to accelerate actions and research and to tailor specific GC prevention strategies to local needs. The present findings provide important input in future decision-making. Have you got a Conflict of Interest?: No
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1872 Nation-wide Gastric Cancer Prevention in China: Effect, Affordability, and Cost-Effectiveness Optimization J. Jiang1, Z. Wang1, Y. Zhao1, C. Yang1, W. Gu1 1 Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Epidemiology and biostatistics, Beijing, China Background: China accounts for nearly half of new cases and deaths owing to gastric cancer (GC) worldwide. Unlike neighboring countries such as Japan and South Korea, China’s vast aging population, limited resources, and considerable regional diversity have impeded nationwide GC prevention. Accumulating empirical data from ongoing programs on primary and secondary prevention of GC in selected areas of China could contribute to future decision-making on a large scale, and the Health China 2030 Planning Outline provides further opportunities to promote population cancer control. Aim: To project future trajectories of the GC burden in China under different scenarios of GC prevention and identify strategies to improve affordability and cost-effectiveness. Methods: Using a cohort of Chinese men and women born during 1951–1980, we assumed that different prevention strategies were conducted, including eradication of Helicobacter pylori and endoscopy screening (onetime, annual, biennial, triennial, or stratified according to personal risk). We performed a literature search to identify most up-to-date data and populate a Markov model to project the number of new GC cases and deaths during 2021–2035, as well as medical and financial resource requirements. We examined the impacts of general (among the whole population) and targeted (high-risk populations, e.g., family history, smoking) prevention. Results: During 2021–2035, 10.0 million new GC cases and 5.6 million GC deaths would occur, with 7.6%–35.5% and 6.9%–44.5%, respectively, being avoidable through various prevention strategies. Relative to routine care (the status quo), Helicobacter pylori eradication was a cost-saving strategy. Although barely within current capacity, nationwide endoscopy screening could become cost-effectively appealing through targeted rather than general prevention, that is, incremental cost-effectiveness ratios for one-time, annual, biennial, and triennial screening over routine care were reduced by 44.1%–49.4%, all down to below a willingness-to-pay level of 70,000 CNY/QALY (China’s capita gross domestic product level). Affordability could be further improved through stratified screening, which incorporated blood test results for individualizing screening frequency, and required 22% and 55% fewer endoscopic procedures than targeted biennial and annual screening, respectively. Conclusion: This study highlights the need for China and similar countries to accelerate actions and research and to tailor specific GC prevention strategies to local needs. The present findings provide important input in future decision-making. Have you got a Conflict of Interest?: No
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1885 Advances in Diagnostic Stratification of Pediatric Acute Leukemia by ECHO in Indonesia H.I. Mahdi1, C. SAPARIYANTO2, R. WIGATI3, S. SOLINA4, Z. REVINA5, D.T. SINULINGGA5, O.P. RAHAYUNINGTYAS6, F. SAIDAH2, R.S.W. NINDITO7 1 DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, MEDICAL SERVICES; MEDICAL STAFF OF PEDIATRICIAN, West Jakarta, Indonesia, 2DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, MEDICAL STAFF OF PEDIATRICIAN, West Jakarta, Indonesia, 3DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, MEDICAL STAFF OF PEDIATRICIAN, INTENSIVE CONSULTANT, West Jakarta, Indonesia, 4DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, GENERAL PRACTITIONER; QUALITY MEDICAL SERVICES, West Jakarta, Indonesia, 5DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, MEDICAL SERVICES, West Jakarta, Indonesia, 6DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, DIRECTORATE PLANNING, ORGANIZATION AND GENERAL SERVICES, West Jakarta, Indonesia, 7DHARMAIS NATIONAL CANCER CENTER OF INDONESIA, PRESIDENT DIRECTOR, West Jakarta, Indonesia Background and context: Indonesia is a vast archipelagic country while hospitals do not yet have the same service standards. Acute Leukemia is the most malignancy in Childhood in Indonesia. Geographical, limited healthcare infrastructure and resources especially pediatric oncologists are key hurdles in improving pediatric acute leukemia outcomes. Resources are centered in main cities, where most of patients are referred to. This leads to late diagnosis, suboptimal management, high mortality and also poor survival rate. Standardizing hospital's services within the national network through telementoring will enable care provision thus reducing referral and improving outcomes. Telemonitoring activities with ECHO are one of the easiest and fastest ways to solve this problem. Hospitals as a cancer services network can consult their complicated patients to be discussed with a multidisciplinary team to decide on the required treatment recommendations quickly and more precisely.
Aim: 1.Improvement of knowledge on advances in diagnostic stratification of pediatric acute leukemia of the cancer network hospitals 2.Establishment of diagnostic stratification tools of paediatrics acute leukaemia at cancer network hospitals 3.Reduction of time gap from diagnosis to treatment Strategy / Tactics: 1. 2.
Supported by the ministry of health Involving national cancer network hospitals and supported by their top management. They are: 1. RSUP Sanglah, Bali
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3. 4.
2. RSUP Hasan Sadikin, Bandung 3. RSUP Prof Kandou, Manado 4. RSUP Adam Malik, Medan 5. RSUP M Djamil, Padang 6. RSUP M Hoesin, Palembang 7. RSUP dr Kariadi, Semarang 8. RSUP dr Sardjito, Yogyakarta 9. RSUD dr Soetomo, Surabaya 10. RSUP dr Wahidin Sudirohusodo, Makassar 11. RSUP Fatmawati, Jakarta 12. RSUPN dr Cipto Mangunkusumo, Jakarta 13. RSUP J Leimena Ambon 14. RSUD Abdul Wahab Syahranie KalTim 15. RSUD Arifin Achmad Pekanbaru 16. RSUD Tarakan Jakarta 17. RSUD Bogor 18. RSUD Sudono Madiun 19. RSUD Budhi Asih Jakarta 20. RSUD Cengkareng Jakarta 21. RSUD Abdul Moeloek Lampung 22. RSUD dr Soedarso Pontianak 23. RS Umum Bethesda Serukam Involving expert from multidisciplinary Involving the Paediatrics of Medical Association
Programme / Policy process:
1. 2. 3.
Propose the concept note to ECHO India Advocacy to the ministry of health and outreach to network hospitals Determine regular meetings, every month with 1,5 hours duration
Outcomes:
1. 2.
Increased knowledge of participants and improved management of paediatrics acute leukaemia Improvement of paediatrics acute leukaemia survival rate
What was learnt: (if relevant, please also detail here the potential of replicability)
1. 2. 3.
Very limitation of center of diagnostic, need to propose the referral system and its cost Very limitation of the available drug, need to propose the National Health Insurance to cover This activity is replicable.
Have you got a Conflict of Interest?: No
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1887 Squamous cell carcinoma and skin bleaching in Senegal: epidemio-clinical and histopathological aspects F. LY1, M. Diallo2, A. Deme3 1 University Cheikh Anta DIOP de DAKAR, Dermatology/Faculty of Medicine Pharmacy and Odontology, Dakar, Senegal, 2University Cheikh Anta DIOP de DAKAR, Dermatology / Faculty of Medicine Pharmacy and Odontology, Dakar, Senegal, 3University Cheikh Anta DIOP de DAKAR, Institut Curie/Faculty of Medicine Pharmacy and Odontology, Dakar, Senegal Background: Cosmetic skin bleaching is a common practice among women in sub saharan africa with prevalence from 25 to 71%. The main products used were high potent corticosteroids, hydroquinone and mercury. Squamous cell carcinoma (SCC) is rare in patients with phototype VI of Fitzpatrick. In 2000 the first case of SCC associated with cosmetic skin bleaching was reported by Addo in Accra, Ghana. Aims: Our aims were to describe epidemiological clinical and histopathological aspects of the SCC associated with cosmetic skin bleaching ocuring in black african women living in Senegal, sub saharan Africa. Patients and methods: We conducted a descriptive multicentric study from August 2005 to October 2021 in Senegal. We included all patients consulting for cutaneous squamous cell carcinoma associated with skin bleaching. Diagnosis was made by pathological examination. Sociodemographic, clinical, paraclinical and therapeutic data were recorded. Results: A total of 34 female patients were included from Senegal. The age varied from 37 to 77 years. Topical hydroquinone and highly potent corticosteroids were the main products used over the whole body, for an average duration of 20.3 years. No pre-neoplastic skindisease was found in our patients. The clinical aspects of tumours were as follows: cauliflower-like, ulcerated and nodular. The average development time before consultation was 6.75 months. The cutaneousSCC were localized most commonly on to lichenoid lesions or exogenous ochronotic lesions on photo-exposed areas: face, neck or upper back. One patient present two squamous cell carcinoma. Histopathological examination found a well differenciated carcinoma, associated with stigma of HPV infection (Koïlocytes) and yellow-brown "banana-shaped" ochronosis deposits in 50 % of cases. Solar elastosis was seen only in one case. The UV exposition, the immunosuppression (long term use of high potent corticosteroids), chronic inflammation, toxicity of products (hydroquinone and mercury) and HPV infection are certainly the main associated factors. The additional factor is the destruction of melanin. The outcome was favourable in the majority of patients after surgical resection. Four deaths occurred. Conclusions: To our knowledge, this is the largest series of squamous cell carcinomas associated with cosmetic use of bleaching products were reported in Senegal, West Africa. The mechanism was not fully elucidated and further studies are necessary. These observations provide an additional argument for the prevention of skin bleaching and including skin bleaching among known risk factors for squamous cell carcinoma. Have you got a Conflict of Interest?: No
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1889 Convening Cancer & Artistic Communities for Storytelling Results in Shared Vulnerability & Enhanced Empathy R. Richardson1, M. Hildebrandt2 1 Livestrong Cancer Institutes / Value Institute for Health and Care, Austin, United States, 2The University of Texas at Austin, College of Fine Arts, Art and Art History, Austin, United States Robin N. Richardson, Asst. Director, Care Delivery Transformation & Community Engagement, Livestrong Cancer Institutes (LCI)/Value Institute for Health & Care Megan Hildebrandt, MFA, Associate Chair, Art/Art History, University of Texas at Austin (UT) Background/Aim: The Aesthetics of Health (AOH) undergraduate visual art studies course at UT aims to enhance students’ awareness of cancer’s impact not only medically but also socially, emotionally, financially, & spiritually & to examine how this might impact students’ artwork, capacity for empathy, & connection to audience. Strategy/Tactics: During spring 2021 semester, instructors employed assorted pedagogical methods, including art, illness narrative, & community engagement, led by professors, community practice artists, & cancer experts, respectively, as well asoral storytelling by those with lived experience of cancer (ie, cancer patients, posttreatment survivors, & loved ones). The 15 student-artists created self-selected media works combining health & activism & displayed them in public spaces, including online. Student-artists took the Toronto Empathy Questionnaire (TEQ) during the first & last weeks of the course & provided feedback. Interviews were held with cancer storytellers following participation. Programme: Diverse participation included engaging: those who had cancer as a young adult (18-40), an age group historically not well served in traditional cancer care (for medical, psychosocial & practical needs); most participants identified as non-white (primarily Latinx & Asian) with 2 who identified as immigrants; diversity in diagnoses/care experiences; & those from LGBTQIA+, disability & Jewish communities. Outcomes: Student-artists’ average score on the TEQ increased from 52.46 at pretest to 55.38 at posttest. Student-artists & storytelling participants also reported having positive experiences. The class also demonstrated that healing requires more than traditional healthcare generally offers; technology can help to build empathy across communities; & access to care is a privilege. What was learnt: AOH’s social practice approach encouraged student-artists to realize new ideas & relationships & modestly increased their capacity for empathy. The AOH framework demonstrates promise for increasing empathy through the arts in other educational, clinical, & artistic institutions. This session would offer attendees: • Understanding a novel intervention to make art with/for those impacted by cancer, resulting in increased empathy & processing lived illness experience. • Exploring how to meaningfully & appropriately engage diverse communities to leverage lived experiences with healthcare. • Walking away with a framework that results in high quality creative work that deeply considers individuals. Examples of students’ works include:
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Have you got a Conflict of Interest?: No
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1891 ChemoSafe: the current safety practice and potential for improvement- the case of Ethiopia K. Abdella1, M. O'Brien2, J. Swindell2, Z. Gizachew3, Y. Tilahun4 1 Ministry of Health Ethiopia, Diseases Prevention and Control, Addis Ababa, Ethiopia, 2American Cancer Society, Cancer Treatment, Washington DC, United States, 3American Cancer Society, Cancer Treatment, Addis Ababa, Ethiopia, 4Clinton Health Access Initiative, Cancer Care, Addis Ababa, Ethiopia Kunuz Abdella1,Meg O’brien2 , Zelalem Gizachew2, Justine Swindell 2 Yared Tilahun3: 1Federal Ministry of Health, Ethiopia; 2The American Cancer Society; 3Clinton Health Access Initiative, Ethiopia. Background: Ethiopia is rapidly expanding cancer care services. Currently, around 17 hospitals are providing chemotherapy services. Safety of care is a concern. Service decentralization is the main strategic approach to narrow the cancer care gap. Aim: The study objective is to assess the current level of safe handling and administration, implementation of chemoSafe guidelines in 17 hospitals providing chemotherapy services. Strategy/Tactics: The chemotherapy handling practices of 17 hospitals providing chemotherapy services were assessed using a pre-designed ChemoSafe facility assessment tool. Outcomes: Local ChemoSafe working group established. The local team designed and developed training materials, SOPs, and safety guidelines to influence policy and strategy at national level. None of the assessed facilities has any safety standards or equipment in place. Personal protective supplies are not available. Staffs in cancer care did not receive systematic training on safe handling and administration of drugs. Against international standard, none of the hospitals involve pharmacists in drug preparation and administration. A team of nurses and pharmacists from participating hospitals got a comprehensive training on chemotherapy safety with practical skill stations. Lessons learnt: Local team with high level of expertise can be constituted to support and guide local efforts. The local team can influence policy and national safety strategy to impact change of practice. International collaboration would facilitate development of in-country capacity. Expansion of cancer care in the country need to be supported by availability and practice of safety procedures.Safety provisions is an urgent issue that needs immediate intervention. Have you got a Conflict of Interest?: No
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1897 Expression of extracellular matrix metalloproteinases and their tissue inhibitors in human cancer cell lines J. Markowski1, K. Siemianowicz2, W. Likus3 1 Medical University of Silesia, Department of Laryngology, Faculty of Medical Sciences in Katowice, Katowice, Poland, Katowice, Poland, 2Medical University of Silesia, Department of Biochemistry, Faculty of Medical Sciences in Katowice, Poland, Katowice, Poland, 3Medical University of Silesia, Department of Anatomy, Faculty of Health Sciences in Katowice, Katowice, Poland, Katowice, Poland Background: The main role of matrix metalloproteinases (MMPs) is a degradation of connective tissue extracellular matrix proteins. This matrix is not only an extracellular scaffold, but can also serve as a reservoir of biologically active substances, e.g. growth factors being releasedby the action of matrix metalloproteinases. These enzymes can influence on cells’ functions, phenotypic features and can be involved in cell proliferation and differentiation. Matrix metalloproteinases take part in various biologically important processes, like trophoblast implantation, embryogenesis, morphogenesis, wound healing, angiogenesis, cell migration, apoptosis, tissue remodelling, and physiological involution of tissues and organs. During neoplasm development matrix metalloproteinases are essential for a progressive growth of neoplasm, tissue infiltration and metastases. In each of these processes matrix metalloproteinases catalyse a degradation of proteins constituting the extracellular matrix of normal tissues. Matrix metalloproteinases activity depends on the balance between activity and inhibition by tissue inhibitors of metalloproteinases. Aim: The aim of the presented study was an evaluation of basic gene expression of 5 matrix metalloproteinases: MMP-1, MMP-2, MMP-9, MMP-13, MMP-14, and their 3 tissue inhibitors: TIMP-1, TIMP-2, and TIMP-3 in 3 cell lines of human cancers: colorectal cancer SW480, breast cancer MCF7, and hepatocellular cancer HUH7. Methods: Three commercial human cancer cell lines (bought from ATCC) were cultured. RNA was isolated. Realtime PCR was performed and basic expression of studied genes was evaluated. Results: All 5 MMPs genes presented the lowest expression in colorectal cancer cell line, whereas their highest expression was detected in breast cancer. TIMP-1 and TIMP-2 genes presented the same expression pattern. TIMP-3 gene had the lowest expression inhepatocarcinoma cell line and the highest in breast cancer cell line. Conclusions: The results of the presented study have shown that although the basic gene expressions of evaluated matrix metalloproteinases and their tissue inhibitors were different in each studied human cancer cell line, the pattern of their expression was almost identical (except TIMP-3). Have you got a Conflict of Interest?: No
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19 Precision Oncology and Breast Cancer: Considering Canada's Approach in an Evolving Landscape C. Ammendolea1, N. Chari1 1 Canadian Breast Cancer Netwrok, Ottawa, Canada The cancer treatment landscape is undergoing a seismic shift with the introduction and integration of precision oncology approaches. Such approaches help clinicians and patients identify key drivers of a patient’s tumour, potentially leading to more precise treatment decisions and reduced treatment toxicities, improving treatment outcomes and providing patients with better quality of life. While many centres in Canada have introduced some form of precision oncology, its use for breast cancer is not yet standard. Breast cancer, as the most common malignancy and cause of cancer-associated death amongst women worldwide (Sung et al., 2020), is primed to be significantly impacted by such approaches. National guidelines around precision oncology in the breast cancer space would ensure equitable access for all patients and could also offer significant cost savings. As decisions emerge around the regulation and implementation of precision oncology, it is critical that they are informed by patients and physicians. To understand the different perspectives and values on precision oncology in breast cancer, the Canadian Breast Cancer Network hosted two national roundtables – one with breast cancer patients and one with oncologists. Our work found that for patients, living a healthy life and playing an active role on their healthcare team is the top priority. For the oncologists, eligibility is a significant, if not principal rationale for testing. Both groups commented on the inconsistent communication, education, and testing related to precision oncology. They also identified the importance of having an evidence-based national framework to ensure equitable and consistent access for all patients. Building on the momentum of COVID-19 vaccine and testing approvals, we recommend that Health Canada and health technology agencies develop pathways for accelerated positive recommendations based on global real word evidence. Regarding the education and communication surrounding precision oncology, it will be incumbent upon patient groups, cancer care agencies, and healthcare professionals to ensure patients receive the appropriate educational materials. Addressing both the regulation and education surrounding precision oncology can lead to improved outcomes for those living with breast and other forms of cancer. Have you got a Conflict of Interest?: Yes If yes please specify:: Support was provided to us by the following partners: Amgen Canada, AstraZeneca, Bayer, Canexia Health, GSK Canada, Janssen Canada and Pfizer Canada.
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1900 An antibody-drug conjugate targeting a GSTA glycosite epitope of MUC1 expressed by non-small cell lung cancer D. Zhou1 1 Tongji University, Shanghai, China Background: Antibodies targeting aberrantly glycosylated proteins are ineffective in treating cancer. Antibodydrug conjugates have emerged as effective alternatives, facilitating tumor-specific drug delivery. Previous studies have assessed the aberrantly glycosylated tandem repeat region of MUC1 glycoprotein as three site-specific glycosylated neoantigen peptide motifs (PDTR, GSTA, and GVTS) for binding with a monoclonal antibody. Aim: This study aimed to develop an antibody-drug conjugate for cancer treatment based on monoclonal antibodies against the aforementioned three neoantigen peptide motifs. Methods: Internalization of monoclonal antibodies was assessed via immunofluorescence staining and colocalization with lysosomal markers in live cells. Antibody positivity in tumor and peritumoral tissue samples was assessed via immunohistochemistry. The efficacy of anti-MUC1 ADCs was evaluated using various cancer cell lines and a mouse tumor xenograft model. Results: An anti-MUC1 ADC was synthesized by conjugating GSTA neoantigen-specific 16A with monomethyl auristatin E (MMAE), which displayed potent antitumoral efficacy with an IC50ranging 0.2-49.4 nM toward various cancer cells. In vivo, 16A-MMAE inhibited tumor growth in a dose-dependent manner in a mouse xenograft model established using the NCI-H838 NSCLC cell line, at a minimum effective dose of 1 mg/kg. At 3 mg/kg, 16A-MMAE did not cause significant toxicity in a transgenic mouse expressing human MUC1. Conclusion: The high antitumoral efficacy of 16A-MMAE suggests that aberrant glycosylated MUC1 neoantigen is a potential target for the development of ADCs for treating various cancers. Personalized therapy may be achieved through such glycosite-specific ADCs. Have you got a Conflict of Interest?: No
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1903 Patient navigation: fighting for the rights of breast cancer patients in Brazil S. Gioia1, L. Brigagão1, M. Rocha2, M.P. Costa3 1 State Health Department, Mastology, Rio de Janeiro, Brazil, 2Municipal Health Department, Mastology, São João de Meriti, Brazil, 3City Hall of Rio de Janeiro, City Council Chambers, Rio de Janeiro, Brazil Background and context: Noncommunicable diseases, such as cancer, are surpassing infectious diseases as the most pressing health care threat in low- and middle-income countries (LMICs). By 2025, 59% of new cancer cases and 68% of all cancer deaths will occur in LMICs, and health care systems in these countries are struggling to respond to this changing landscape. Recognizing the need for cancer control strategies, the Brazilian government issued Ministry of Health Law No. 12.732/12, also called the Law of 60 Days, in 2012. This law states that treatment of any cancer for patients in the public health system must start within 60 days of definitive diagnosis. Aim: Due to the good results of the Patient Navigation (PN) program in Rio de Janeiro (RJ), to increase compliance with the Law of 60 Days, we present here, municipal law No. 7,197, of December 15, 2021, which provides for the PN in the public sector. Strategy: This law passed in RJ encourages the expansion of PN. The purpose of the PN is to guarantee the patient and the medical treatment in a time of adjustable diagnosis and to coordinate individualized assistance with a focus on ongoing cancer care, and should specifically offer: training for health professionals to coordinate care from diagnosis to the beginning of treatment in oncology referral centers; help the patient to understand his journey through the health system, addressing clinical and non-clinical issues; and planning the patient's needs, identifying barriers to diagnosis and treatment and offering solutions for their improvement. Policy process: The law was built from a broad discussion with society about the good results achieved with the implementation of the PN in RJ. After the start of the program in one of the breast cancer diagnostic centers of the State Health Department of RJ, there was an increase in compliance with the Law of 60 Days from 22% (2019) to 86% (2020). Outcomes: PN facilitates the initiation of treatment at the specialized center within a period shorter than that determined by this Law; collaborates with health teams to provide comprehensive and resolute actions; provides individual guidance, support, education, coordination of care, and assistance to patients; and reduce costs of the resources used. To comply with this Law, the Executive Power will adopt effective administrative measures, observing the dictates of the relevant legislation in force. What was learned: Implementing a breast cancer PN program in Brazil has great potential to alleviate the barriers faced by patients in the public sector. By promoting adherence to the Law of 60 Days, PN could shorten the time to the start of cancer treatment, reduce loss to follow-up, and improve the outcomes of women with breast cancer in Brazil. This experience was an incentive for the passage of the law in the Senate and soon we will have the federal law that provides for the creation of PN programs in health services in Brazil. Have you got a Conflict of Interest?: No
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1905 Defining Care: Oral Storytelling with Young Adult Women Cancer Survivors R. Richardson1, A. Gray Rendón2 1 Livestrong Cancer Institutes / Value Institute for Health and Care, Austin, United States, 2Smithsonian Institution, National Museum of American History, Div. of Medicine & Science, Washington, United States BACKGROUND/AIM: The study purpose is to examine oral storytelling of young adult (YA) cancer experiences to identify themes, compare to literature, & highlight the uniqueness & potential inequities of an adult cancer experience of those under 40 years old. STRATEGY/TACTICS: This mixed methods research included focus groups & one-on-one interviews with those impacted by YA cancer treatment (including post-treatment survivors, loved one caregivers & members of an oncology care team) who identify as women. Participants were asked to define care & provide examples of how they receive or provide care. Participants also reviewed themes from Audre Lorde’s “Cancer Journals” published in 1980 including: (1) women’s roles as caregivers, (2) women's lack of “psychic time or space” to process emotions during cancer treatment, & (3) women’s transformation of silence into language & action during cancer treatment. PROGRAMME: Diverse participation included: Cancer as YAs (18-40), an age group historically not well served in traditional cancer care (for medical, psychosocial & practical needs); more than half as non-white (primarily Latinx & Asian); diversity in diagnoses/care experiences; & those experiencing cancer disparities, members LGBTQIA+ communities, & not having health insurance during cancer. OUTCOMES: Themes included: There is no single cancer experience. Some define care in terms of clinical care while others consider care in terms of addressing practical needs. Many YA women who are in post-treatment cancer survivorship experienced solely women caregivers. There seems to be consensus that the medical system does not allow psychic time & space to process a diagnosis—but some YA women do not allow themselves this time & space to sit with their disease or effects from their disease, even years later. Many YA women who were raised to not challenge authority learned to find their voice & advocate for themselves during their cancer treatment. WHAT WAS LEARNT: This novel engagement framework developed for this project builds trust across participants & the research team, leading those impacted by cancer to often consider their care experiences in ways that they previously had not. Participants explained within this framework, they were able to remember parts of their cancer journey that they previously had not, & they were able to talk about difficult parts of their journey (eg mourning their fertility) when they could not with friends, family or even therapists. THIS SESSION WOULD OFFER ATTENDEES: • Understanding a novel intervention to utilize literature as a framework for those impacted by cancer to examine their care experience. • Exploring how to meaningfully & appropriately engage diverse communities to leverage lived experiences with healthcare. • Walking away with a framework that deeply considers lived cancer experience. Lorde quotes used as prompts:
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2
Examples of quotes from storytellers:
3
Demographics of participants:
Have you got a Conflict of Interest?: No
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1908 Regional differences in staffing levels in radiation oncology facilities in Portugal E. NETTO1,2, N. Sousa1,3, I. Fernandes1,4, C. Portugal1, J. Dinis1,3 1 Directorate-General of Health, National Program for Oncological Diseases, Lisboa, Portugal, 2Instituto Português de Oncologia de Lisboa Francisco Gentil, Radiation Oncology, Lisbon, Portugal, 3Instituto Português de Oncologia do Porto Francisco Gentil, Medical Oncology Department, Porto, Portugal, 4Centro Hospitalar de Lisboa Norte, Hospital Santa Maria, Medical Oncology Department, Lisbon, Portugal Background and context: increasingly complex radiotherapy requires critical decisions about robust investment in expensive technology as well as the need of highly specialized workforce in its human resources, including radiation oncologists (RO), medical physicists (MP), and radiotherapists (RTT). Aim: our goal was to evaluate the Portuguese national health system available infra-structure and human resources in radiation oncology and compare to the established international standards. Strategy / Tactics: create the body of evidence necessary to support policy-makers in strategic decisions regarding allocation of the necessary resources to provide the care patients need. Programme / Policy process: we retrieved the available data from the National Program for Oncological Diseases survey regarding human resources, infra-structure, and technical availability, among the Portuguese national health system radiation oncology facilities. The IAEA’s staffing calculator was used. Surveys results with missing data were not excluded. Responses were correlated to demographic data and to recommended international standards. Descriptive statistics was applied. Outcomes: The national survey retrieved data from three out of five national health regions: North Region (ARSN), Center Region (ARSC), and Lisbon & Tagus River Region (ARSLVT), representing 90% of continental Portugal population. Data of RO, MP and RTT per million habitants were, respectively: 11.4, 2.2, 25.3 for ARSN; 12.4, 4.7, 20.0 for ARSC; and 8.1, 1.4, and 19,4 for ARSLVT. Linear accelerators availability per million habitants was 3.9 for ARSN, 2.9 for ARSC, and 3.1 for ARSLVT. All data were below the average results from the ESTRO-HERO: 12.8, 7.6 and 26.6 for RO, MP and RTT, respectively. Mean workload as new patients per RO was 198 cases/year for the whole cohort (range 114-280). Regional asymmetries were found in workload with 208 cases/year for ARSN, 161 for ARSC and 208 ARSLVT. Despite the study’s limitations, IAEA’s staffing calculator estimation showed a consistent but variable shortage of human resources for the national health system in all regions from 10% (RO, ARSN) up to several hundred (MP, ARSLVT). What was learnt: we found significant differences in staffing between regions, and a consistent shortage in medical physicists. Workload pressure was also asymmetric among facilities delivering radiation oncology in Portugal. Central coordination in planning workforce allocation and accrual is warranted. Have you got a Conflict of Interest?: No
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1909 Clinical Characteristics of Endometrial cancer in Guatemalan women: A retrospective cohort study V. De Falla1, A. Velarde1, A. Salazar2, F. Figueroa1, C. García3, I. Orozco1, J. Figueroa3, A. Zamorano4 1 Liga Nacional Contra El Cancer e Incan, Research, Guatemala, Guatemala, 2Washington University School of Medicine, Research, Missouri, United States, 3Liga Nacional Contra El Cancer e Incan, Surgery, Guatemala, Guatemala, 4University of Texas Health Science Center at Houston, Department of Obstetrics, Gynecology and Reproductive Sciences, Houston Texas, United States Background: In Guatemala, data on endometrial cancer (EC) is not routinely reported in the older Mayan descendants’ women due to barriers that limit them to seek healthcare. EC may be sporadic or genetically associated, as in Lynch Syndrome (LS). Previous data suggested that Guatemala has a high incidence of colorectal cancer in young patients, which is also linked to LS. Aim: We therefore sought to describe the clinical characteristics of EC patients, comparing those <50 years with those ≥50 years to determine if there is a similar association. Methods: This IRB-approved single-institution retrospective cohort study included patients ≥18 years diagnosed with a primary EC at the Liga Nacional Contra El Cáncer (Liga-Incan), the largest specialized oncologic hospital in Guatemala City, data was collected from the years 2013 until 2019. Chi-squared, Fisher’s exact, and Kruskal-Wallis tests were used to evaluate differences by age. Results: Among 243 patients of Mayan descendants, 62 (25.5%) were aged <50 years, and 181 (74.5%) were ≥50 years. In the younger group most were diagnosed with stage I or II disease (59.01%) and with endometrioid histology (59.68%) as compared to those ≥50 years in whom stage I or II disease was 52% and with endometrioid histology (58%). Stage at diagnosis was found to be significantly different between the age groups, driven by a significant number of those ≥50 years. Younger women had a significantly higher median weight (71 vs 64 kg, p=0.04). Younger women from rural areas presented more often than did older women to our oncologic facility (OR 0.44 [95%CI 0.23 -0.83], p=0.01). Conclusion: EC data in Guatemala is severely limited by the lack of reporting in the older population due to barriers to seek healthcare. Upon review, the majority of older patients did not pursue complete treatment. This observation is strengthened by the finding that more younger patients presented from rural areas, perhaps because these patients may be more able to travel to the city to seek healthcare. Our study highlights the limitations in treating an elderly population in a low-resourced area. More research is necessary to investigate the prevalence of inherited cancer syndromes in women and to identify the ways to best care for the elderly women. Have you got a Conflict of Interest?: No
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1910 Improving the oral cancer screening among high-risk people: A nationwide screening program Y.-T.C. Lo1, M.-Y. Shih1, T.-H. Hsu1, L.-J. Lin1, P.-C. Hsieh1, S.-L. Chia1, C.-C. Wu1 1 Ministry of Health and Welfare, Health Promotion Administration, Taipei City 103205,, Taiwan Background: A nationwide, population-based biennial oral visual screening program for people aged ≥ 30 years with oral habits of betel quid chewing and/or cigarette smokers has been launched by the Health Promotion Administration of the Ministry of Health and Welfare (HPA, MOHW). The delaying treatment of oral cancer was associated with poorer survival of oral cancer. Evidence indicated that high dose betel quid (BQ, 10 yrs/1-10 pieces per day) or cigarette smoking (CS, 10 yrs/≥20 sticks per day) had dose-response increased the risk of oral potentially malignant disorders (OPMD). To improve the efficiency of oral cancer screening, the HPA has been dedicated to regulating the screening procedure since 2017 and provided the high-risk name lists (people with a high dose of BQ or CS) to the local health departments (LHDs) in 2021. The HPA has guided the LHDs to implement the organized oral cancer screening programs, and priority to invitations for participation and referrals if he/she has OPMDs. Aim: The study aims to assess whether targeting a high-dose-risk group strategy could benefit oral cancer screening. Methods: This study was a cross-sectional design and used national oral cancer screening data. The logistic regression models were used to estimate the adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI). Methods: This study was a cross-sectional design. We defined and selected high dose risk groups by using Taiwan's national oral cancer screening data. The logistic regression models were used to estimate the adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI). Results: There were about 370,000 high-risk subjects from 2010 to 2020 and the HPA provided a total of 50,000 name lists to the LHDs in 2021. The number of people screened decreased from 2016 to 2019, but the detection rate of OPMD rose from 3.85 to 5.78 (per 1000 people). The detection rate was higher among males and aged 45 to 69 yrs. Due to COVID-19, the oral cancer screening number was lower by 18% than last year, but the OPMD detection rate remained 7 (per 1000 people). Adjusted covariates, compared to year 2017, we found that year 2019, 2020, 2021 were significantly had higher OPMD detection rate (AOR=1.35; 95% CI: 1.29, 1.42 for year 2019; AOR=1.65; 95% CI: 1.58, 1.73 for year 2020; AOR=1.56; 95% CI: 1.48, 1.64 for year 2021). The 2021 oral cancer detection rate was higher than the year 2017 (AOR=1.60; 95%CI: 1.47, 1.74). Conclusion: This high dose of BQ/CS name list and organized oral cancer screening program were effective to lead the LHDs to optimize and prioritized the oral cancer services. The number of screenings for high-risk name list people should be gradually increased into the organized invitation oral cancer screening program to achieve the benefits of early detection and timely treatment. Have you got a Conflict of Interest?: No
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1918 Strategic Partnerships in Building Sustainable Fundraising for Cancer in Indonesia: Bracelet of Hope Movement T.B.M. Permata1, J. Soekasah-Joesoef2, A. Soekasah2, W. Guritno2, S. Gondhowiardjo1 1 Raditha Onkora Foundation/Radiation Oncology Department, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, 2Yayasan Dunia Kasih Harapan, Jakarta, Indonesia Amount raised: ~ USD 70,000 Background: The catastrophic impact of cancer significantly burdens patients and their families, extending beyond the cost of medical expenses, including loss of productivity, and high living costs needed during the treatment period. Even though the national health insurance has covered almost all the medical fees, patients still requires support to stay in proximity to the centre during their treatment and living costs. Aim: To support cancer patients during their cancer treatment to ensure continuity and completion of medical treatment. In addition, cancer awareness campaign was also pursued by providing accurate cancer information to the public. Strategy: Partnerships between public figures, radiation oncologists and the national cancer control committee at the period have built sustainable collaborations in raising cancer awareness campaigns through World Cancer Day events annually and public support in fundraising to support cancer patients. Programme process: The Bracelet of Hope movement was initially launched for a movie premier highlighting a cancer patient’s journey. However, a strong bond with the radiation oncology group has grown into more activities and events throughout the years. Main stakeholders involved:
• •
A civil society called Yayasan Dunia Kasih Harapan, which was pioneered and run by a group of public figures, also known as Warriors of Hope, prominent in movie and fashion industry. Radiation oncologists from Cipto Mangunkusumo National General Hospital (RSCM), collaborating either as a private foundation (Raditha Onkora) or for their official/organizational roles.
Costs and returns: Funds raised from the Bracelet of Hope movement were sufficient to provide a Room of Hope (a waiting room for cancer patients and their families) at the RSCM. Moreover, when the radiation oncologists established a complimentary accommodation for patients in need, the Warriors of Hope had raised funds to purchase a Car of Hope (to transport patients daily between the hospital and the house). Interestingly, the movement continues to grow and now the group is also able to support the monthly operational cost of theHouse of Hope. Innovative methods: Bracelets of Hope were made from “Jumputan” fabric, leftovers from a prominent fashion house. Families of cancer patients joined the movement by braiding the fabric in the Room of Hope while waiting for treatment, and were paid for it. The braids were then professionally polished and sold through the Hope’s various platforms. All profits were allocated back to support the cancer patients. Lessons learnt: Strategic partnerships with cancer medical society has proven effective in creating accurate contents to be distributed to the public using the influence of public figures. Have you got a Conflict of Interest?: No
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1920 Changes in the DALYs of colorectal cancer in China: Screening intervention perspective Y.-J. Li1, J.-F. Shi1 1 Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Background: As the third leading cause of cancer deaths worldwide, colorectal cancer (CRC) is preventable through controlling modifiable risk factors, screening and early detection. Aim: The past, current and future burden of CRC disability adjusted life years (DALYs) in China was analyzed from the screening intervention perspective to provide reference basis for the accurate prevention and control of CRC. Methods: Based on the data of Global Burden of Disease 2019, the DALYs, age-standardized DALY rate, and the composition of different subgroups were extracted and described to analyze the time trend in 2000-2019 and the current situation in 2019, and compare with the international status. The autoregressive integrated moving average model was established to predict the disease burden of CRC in China in the next 30 years. Results: In 2019, the DALYs due to CRC in China was 6.395 million person-years (standardized rate of 320.6/100,000), accounting for 26.3% of the global burden and 9.5% of all cancers burden in China; the DALYs in men accounted for 65.2%, 44.9% in ≥65 years old, 73.7% in the age group recommended by local screening guidelines (40-75 years), the years lived with disability accounted for 4.8%. Compared with 1990, the DALYs due to CRC in China increased by 181.5% in 2019, and with a greater increase in aged ≥65 years person compared with those aged <65 years (303.3% and 126.2%). Factors with the largest increase in the percentage of clearly attributable were high BMI (151.1% increase), diet high in red meat (86.4%) and diet high in processed meat (78.8%), etc. For DALY rate, it was 245.6/100,000 in 1990 and 320.6/100,000 in 2019, an increase of 30.5%; for reference, Australia (began in 2006), the UK (1988), and Japan (1992), where population-wide screening has been conducted, had a decrease in DALY rate of 36.0%, 28.6%, and 17.8%, respectively. The projections of DALY rate suggest that without continued expansion of population-based screening, the DALY rate in China will reach 326.2/100,000 and 513.1/100,000 in 2030 and 2050. Conclusion: The burden of DALYs due to CRC in China has been increasing over the past 30 years, and would become heavier because of population aging and the concomitant disability issue. The setting of age range recommended by the current local screening guideline could theoretically target 70% of the population from which the DALYs burden originates, however, the real-world population screening coverage is still limited. The observed decline in CRC-related DALY rate in selected countries was substantially due to the implementation of mass screening, indicating the importance of speedily expanding the population coverage of CRC screening in China. Have you got a Conflict of Interest?: No
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1930 Risk stratification value of methylation biomarkers among hrHPV positive women: a 3-year cohort study R. Rezhake1, Y. Wang1, G.-Q. Shen1, Y.-M. Zhang1, Y.-L. Qiao1,2 1 Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China, 2School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Background: Appropriate triage of high-risk human papillomavirus (hrHPV) positive women remains a critical issue in cervical cancer screening. Methylation-based biomarkers have shown promise, while lacking populationbased prospective evidence. Aim: In this population-based cohort study, we aimed to evaluate the triage performance of a panel of methylation markers targeting the host cell gene EPB41LE and viral late gene regions of HPV16,18 regions. Methods: A total 2000 women from rural China has been recruited to a cervical cancer screening cohort in 2018 and followed-up until 2021. A swab sample and two cytology samples were collected at the baseline. In this posthoc study, we performed the methylation test using a pyrosequencing-based methylation assay (careME Methylation Test®) for the hrHPV positive women at baseline using their swab samples. Results: The positive rate of methylation was 12.4% (29/234) among hrHPV positive women, and test positivity was significantly increased by the histology lesions (8.2% in normal, 9.1% in CIN1, 62.5% in CIN2, 75.0% in CIN3 and 100% in cancer cases, ptrend <0.05). Cross-sectional sensitivity of methylation to triage hrHPV positive women was 70.6%, which was similar to HPV16/18 triage (64.7%, p=0.56), while lower than cytology triage (94.1%) although not significant (p=0.10); while methylation showed the super specificity at 91.2%, significantly higher than HPV16/18 (78.9%) and cytology (79.4%) triage (p<0.001 for both). Women with positive methylation result at baseline had 2.5 times higher risk of hrHPV persistence (RR=2.5, 95%CI: 1.7-3.6) at 1-year follow-up and had more than 9 times higher risk of CIN2+ during 3-year follow-up (RR=9.1, 95%CI: 4.8-17.5). The 3-year longitudinal sensitivity and specificity of methylation for CIN2+ were 57.1% and 92.8%, the respective values were 71.4% and 77.7% for HPV16/18 triage, and 75.9% and 80.4% for cytology triage. Conclusion: Methylation showed super specificity to triage hrHPV positive women compared to HPV16/18 and cytology triage, and showed promising risk-stratification value to predict hrHPV persistence and CIN2+ occurrence, indicating that DNA methylation could be a useful triage tool for hrHPV positive women. Have you got a Conflict of Interest?: No
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1932 ADDRESSING GLOBAL SHORTAGES IN THE PEDIATRIC CANCER MEDICINES MARKET – ASSESSING POTENTIAL TO IMPROVE SUPPLY E. Kobayashi1, S. de Chazal1, K. Catlin1, D. Sun1, H. Xie1, T. Vuong1, V. Mulema1, T.M Hughes2, A.L. Frazier3,4, A. Denburg5,6 1 Clinton Health Access Initiative, Boston, United States, 2Icahn School of Medicine at Mount Sinai, New York, United States, 3Dana Farber/Boston Children’s Hospital, Cancer and Blood Disorders Center, Boston, United States, 4Harvard Medical School, Boston, United States, 5The Hospital for Sick Children, Toronto, Canada, 6University of Toronto, Toronto, Canada Background and aims There are chronic global shortages of medications that are essential in the treatment of childhood cancer. We set out to understand root causes and suggest market interventions that could sustainably improve availability of quality products with a stringent regulatory approval (SRA) at affordable prices. Methods A mixed methods approach was used, including literature review; review of data on procurement, SRA status, China’s National Medical Products Administrative data, and India’s import/ export data; and interviews with experts. A forecast of estimated potential demand was generated using ACCESS FORxECAST model; the potential demand under different scenarios was compared with current supply. Semi-structured interviews were then held with ten manufacturers from China and India. Results The analysis identified three essential pediatric cancer products that face chronic supply challenges -- 6mercaptopurine (6-MP), asparaginase, and dactinomycin, and compiled the current challenges faced. At present, the demand for SRA products in LMICs is limited. All of the buyers who shared procurement data were buying non-SRA products, even when they were concerned about quality.SRA products cost five to ten times as much as non-SRA products. The small market size in LMICs does not justify resource investment to pursue SRA approval for Indian and Chinese manufacturers who already sell without SRA approval. Only two manufacturers expressed interest in obtaining SRA approval. India and China exports only meet 20% of global demand, though this is likely an undercount.The remaining demand is either met with SRA-approved products, or unmet. SRA manufacturers appear to have capacity to serve the potential unmet demand, but are exiting due to low demand and low profit margins especially for products with expensive, cumbersome, or unattractive manufacturing routes. Pediatric demand could potentially double in size in the future, as roughly half of pediatric cancer cases are undiagnosed. Conclusions Multiple approaches are needed to boost procurement demand and reduce market entry barriers including pooled procurement, fast track regulatory pathways for SRA approved products in LMICs, and clear procurement plans. Have you got a Conflict of Interest?: No
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1937 Awareness & Knowledge regarding Genetic Breast Cancer in LMIC – A Questionnaire based Study of 300 Patients A. Mishra1, N. Kumar1, S. Deo1, A. Gogia2, DN Sharma3, S. Bhoriwal1, J. Sharma1 1 All India Institute of Medical Sciences, New Delhi, Surgical Oncology, New Delhi, India, 2All India Institute of Medical Sciences, New Delhi, Medical Oncology, New Delhi, India, 3All India Institute of Medical Sciences, New Delhi, Radiation Oncology, New Delhi, India Background: Understanding of Genetic factors and familial breast cancer introduced new treatment pathways for risk reduction among breast cancer patients. Genetic breast cancer is entirely a different subset and definately it needs a patient oriented planning. However educational background, awareness and knowledge of patients, availability of genetic testing and busy tertiary care hospital settings in LMIC are the challenges for the optimal management of Genetic and familial breast cancers. Aim: Current prospective questionnaire based study is aimed to evaluate knowledge and awareness of breast cancer patients pertaining to genetic aspect, attitude toward genetic testing, proposed intervention, and its acceptance to develop targeted educational and healthcare strategies. Methods: This prospective questionnaire-based study with an educational interventional component was carried out on 300 newly diagnosed female breast cancer patients at a high volume North Indian tertiary care cancer center. A clinically validated structured questionnaire containing 19-questions to test knowledge, awareness of breast cancer, its genetic aspect, attitude toward genetic testing and prophylactic interventions was executed. The study was conducted in three phases i.e., Questionnaire based Pre-intervention assessment, Educational Intervention (Brief 20 min descriptive educational session with 2 page educational material in layman's language) & Questionnaire based post-Intervention assessment (after 7 days). For assessment of impact of educational intervention, pre-intervention response scores were compared with post-intervention response scores using Stuart Maxwell test of marginal homogeneity and Positive percent changes were noticed. Results: In below mentioned table the highlight of results are documented. The impact of educational intervention has been noticed via positive percentage change in the level of knowledge and awareness pertaining to genetic aspect of breast cancer.
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Sporadic (n=250)
S.No Question
1 2 3 4 5 6 7 8 9
Pre & Post educational intervention Positive Percentage change
Awareness and knowledge regarding Breast Cancer 12.08 Awareness and Knowledge regarding Breast cancer screening 28.12 Awareness and Knowledge regarding treatment of breast 81.01 cancer. Awareness and Knowledge regarding Familial/ hereditary 65.2 breast cancer. Awareness and Knowledge regarding genetic risk factors 9 including BRCA. Willingness for genetic testing for self or family member 12.0 Awareness regarding Prophylactic Interventions 43.3 Willingness for different Prophylactic Interventions 58.22 (Surveillance) Willingness for Chemoprophylaxis 5
0.015 0.001
Familial (n=50) Pre & Post educational intervention P Positive Value Percentage change 16.67 0.2231 60.8 0.0009
0.001
90
0.0186
0.0001
100
0.0003
0.0027
27.27
0.0143
0.0001 0.0001
66.6 90.47
0.0564 0.0001
0.0001
100
0.0001
0.0253
22.7
0.1025
P Value
Conclusion: A single short educational interventions showed significant improvement in the awareness level, knowledge regarding breast cancer and its genetic aspect. Educational intervention has improved patient awareness and willingness for genetic testing and prophylactic intervention. In familial or hereditary cases, impact was more profound than sporadic cases. Hence, in LMIC educational tools can help in dealing with complex issues like genetic testing and risk reduction strategies. Have you got a Conflict of Interest?: No
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1939 Towards continuous and coordinated care for breast health in Odisha, India P. Bhamare1, N. Mohanty2, A. Padhi2, D. Swain2, V. Srivastava1, J.P. Mohapatra1, S. Kumar1 1 Jhpiego, New Delhi, India, 2Jhpiego, Bhubaneshwar, India Background: Breast cancer is the leading cancer among women in India. From 2008 to 2012, India has seen an increase of 11.54% in incidence and 13.82% increase in mortality due to breast cancer (1). In Odisha, breast cancer incidence rate is 15.38 per 100, 000 population and as per latest estimates only 0.2% of eligible females were screened for breast cancers in 2020 (2). Jhpiego in collaboration with Novartis demonstrated a model of strategic catalytic support for programmatic improvement in public facilities across one district of Odisha state. The project focused on three major gaps in the breast cancer continuum: low awareness, delay in detection and inadequate management capacity of public health systems. Aim: To demonstrate pathways for continuous and coordinated care for breast health in Odisha. Strategy: Incisive gap assessment, assured government ownership, aligned programmatic priorities and onboarded stakeholders were the key approaches used for implementation of this catalytic support Programme process: Jhpiego conducted a situational analysis in Khurda district of Odisha and identified key gaps and focused on prioritised and feasible areas in the initial phase. Operational framework with specific, measurable and timebound activities was prepared in consultation with state and district officials. Series of capacity building activities were conducted including ToT and training for 200+ nurses and doctors from the district on awareness generation, screening, early identification and referral of cancer suspected patients. To ensure conversion of knowledge into skills and skills into practice; Mentorship and Support visits (MSV) were conducted for 1000+ health systems staff. MSVs also included tracking and follow up of women with suspected breast cancer (Figure attached). Findings were periodically shared with officials for review, replication and scaleup. Advocacy efforts were continued for the budgetary provisions towards abovementioned strategies.
Outcomes:
• • • •
Contextually relevant learning resource package for the state Prototype of District level working group for Breast Health interventions Continuous and coordinated care attempted for 22389 screened women and 10 women were initiated on treatment State decided scale up and budgeted for next phase of implementation across 10 districts
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What was learnt: Strategic catalytic support can ensure continuous and coordinated care for breast health in the state of Odisha. Government ownership and capacity building of human resources are most important elements in ensuring the continuum. References 1. Malvia S,Bagadi SA,Dubey US,Saxena S. Epidemiology of breast cancer in Indian women.Asia Pac J Clin Oncol.2017;13(4):289-295. 2. International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS Have you got a Conflict of Interest?: No
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1942 Clinical profiling and gene analysis of breast cancer ER intratumour heterogeneity X. Wang1, y. Yin1 1 First affiliated hospital of Nanjing Medical University, Nanjing, China Background: Breast cancer has the highest incidence among the world's population, 1/3 of the patients diagnosed with early breast cancer still progressed into metastatic outcomes with poor prognosis. In fact, most treatment strategies for metastatic breast cancer depend on hormone receptor status and molecular subtypes of primary lesions. The main clinical manifestation is the discordance of receptor expression in metastases. Nevertheless, the correlation between ER transformation and the somatic mutation profiles in breast cancer metastatic lesions remains unclear. Aim: We aimed to evaluate the frequency, clinical characteristics and prognostic value of ER receptor conversion between primary and first metastatic lesions in 115 patients whose primary ER status are positive. We also compared the results of NGS of 42 patients and explored latent genes related to ER discordance in expression. Methods: We retrospectively identified 115 consecutive cases of BC patients who had biopsies or resections of recurrent lesions from a prospective database including all hospitalized BC patients from 2018.11-2020.11 at JiangSu Province Peoples' Hospital. Qualified metastatic tumor tissue sequencing information was available for 42 patients. Samples were accessed using theFoundationOneCDx assay (Foundation Medicine, Cambridge, MA, USA) panel including 733 tumor related genes.All data were analyzed using SPSS 25.0 software (Chicago, IL, USA). Results: All 115 patients (primary ER status is positive) were divided into two groups, 70(60.87%) patients ER status remained positive while 45(39.14%) patients ER status transformed into negative. The histological type (p=0.008) and DFS (p=0.004) were significantly different in two subgroups. There were no significant correlations between the age at the time of diagnosis, BMIclassification, menopausal status, surgery, histological grade, tumor size, lymph node status, metastasis, Ki67, adjuvant radiotherapy, neoadjuvant, metastasis site before second biopsy, first treatment after recurrent and first PFS after rebiopsy. Cox regression analysis of DFS proved metastasis to be distinct risk factor for poor survival (hazard ratio [HR] > 1,p = 0.001). By contrast, neoadjuvant proved to be protective factor for better survival (hazard ratio [HR] ＜ 1,p ＜ 0.001) （Table2）.
We then compared the differentially mutated genes in the ER differential expression BC patient groups and mutations in KMT2C (n=6) was exclusively detected in ER+ to – subgroup and accounted for 37.5%. The distribution of KMT2C mutations was different among the two cohorts. We identified the mutation in codon 321 was the hot spot of KMT2C in our patient cohort. KMT2C mutations harbored significantly more mutations in genes involved in the Ubiquitin mediated proteolysis and Lysine degradation signaling pathway
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Conclusion: KMT2C mutation may play a crucial role in the ER loss expression in metastatic BC, but further research is needed to unveil the underlying mechanism. Have you got a Conflict of Interest?: No
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1943 Combining ctDNA and CEA for recurrence risk stratification of CRC J. Gu1, F. LEI2, X. WANG2, W. Huang2, X. He2, Y. Hong2, Q. Zeng2, Y. Wang2, Q. Gao2, P. Niu2, D. Huang2, Z. Gao2, C. Ding2, Z. Zhai2, K. An2, H. Chen3, S. Chen3, Z. Yuan3, X. Zhao3, Y. Bai3 1 Peking University Cancer Hospital; Peking University Shougang Hospital, Beijing, China, 2Peking University Shougang Hospital, Beijing, China, 33D Medicines Inc. Shanghai, China., Shanghai, China Background: At present, the sensitivity of postoperative ctDNA to predict the risk of postoperative recurrence of stage I-III colorectal cancer (CRC) is not high. It is difficult to improve the sensitivity of NGS detection to predict recurrence risk. Aim: the purpose of this study is to improve the low sensitivity of postoperative ctDNA alone in predicting the risk of postoperative recurrence of stage I-III CRC by combining postoperative ctDNA with clinical serological tumor marker CEA. Methods: The tumor tissue and peripheral plasma (obtained 7-10 days after surgery) of 108 patients diagnosed with stage I-III CRC at Peking University Shougang Hospital were successfully analyzed with a 733-gene NGS panel and a 127-gene ultra-deep target panel in a CLIA-certified laboratory, respectively. The relationship between the postoperative ctDNA status, preoperative CEA and recurrence-free survival (RFS) was identified by log-rank test and Cox regression analysis. Results: In total, 17 patients were postoperatively positive for ctDNA (tumor-informed, ≥1 somatic mutation). Postoperative ctDNA positivity was independently associated with poorer RFS (HR=8.4, P<0.0001). The sensitivity and specificity were 46.4% and 95% for predicting recurrence, respectively. Preoperative CEA was significantly associated with poor RFS (HR=3.9, P=0.0002). The sensitivity and specificity of preoperative CEA level in predicting recurrence were 64.3% and 72.5%. Based on postoperative ctDNA status, there was no difference in recurrence risk between patients with abnormal preoperative CEA and patients with normal CEA among patients with positive postoperative ctDNA. Among patients with negative ctDNA after surgery, the recurrence risk of patients with abnormal preoperative CEA was 8.9 times higher than that of patients with normal preoperative CEA. Combining the postoperative ctDNA and preoperative CEA, patients with positive postoperative ctDNA had the highest risk of recurrence, followed by patients with negative postoperative ctDNA and abnormal preoperative CEA, compared with patients with both negative postoperative ctDNA and abnormal preoperative CEA (HR=29.2, HR=8.9, P<0.0001). Conclusion: The combination of postoperative ctDNA and preoperative CEA can more accurately subdivide the stage I-III CRC population and provide more comprehensive indicators for the next treatment and follow-up plan, which may become the research direction of follow-up clinical trials. Have you got a Conflict of Interest?: No
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1947 Strategies changes - more effectiveness and sustainability for INCAvoluntário during the COVID-19 pandemic A. Almeida1, B. Rodrigues 1 Brazilian National Cancer Institute, INCAvoluntário, Rio de Janeiro, Brazil Background – INCAvoluntário isaproject of theBrazilianNational Cancer Institute that coordinatesthevoluntary actions within the Institute. Among the objectives are the humanization of the hospital environment and improvement of thepatient’s lifequality andtheir caregivers. INCAvoluntário is maintained through donations of financial and material resources. In 2020, with the Covid-19 pandemic, there was a sudden decrease in resourcesthat highly impacted the course of the activities. Objectives– 1) Ensure the sustainability of the project, increasing the capture of human, financial and material resources, with the receipt of a more qualified donation. 2) Make work more efficient, to fully meet the demand of patients with fewer resources. Methods– A plan was carried out to map the scenario and situation of INCAvoluntário and outline strategies for contouring the impacted areas. The plan was implemented at the end of 2020 and in 2021, and divided into fouractionareasas follows: 1) Structure– for a safer environment, adjustments were made to the INCAvoluntário spaces and the acquisition ofPPE -Personal Protective Equipment for the team. 2) Activities– the program for granting benefits to patients (basicfoodbaskets, transportation assistance, disposable diapers) in social vulnerability was not interrupted. As for the continuity of activities forinpatients, partnerships were made with INCA professionals, who helped identify users' needs and distribute materials. Other actions also startedhappeningonline, such as arts and crafts courses for patients. 3) Human Resources– Alignment and integration of activities to serve more patients with fewer people. Online selections were also promoted for new volunteers. 4) Fundraising– This area was greatly impacted by the reduction or suspension of several donations; the closing ofcharitybazaars (representing 30% of financial income); and the abrupt decrease in material donations as people were not leaving their homes. To reverse this situation, new partnerships were implemented, strengthening the capture and dissemination on digital platforms. Credit card donations were also made available on the website and actions to improve the quality of material donations Results– In 2021, 38,464 patients were assisted and 5,339 patients benefited. There was also a 45% increase in financial collection compared to 2020. Conclusion– INCAvoluntário took advantage of the crisis moment generated by the COVID-19 pandemic to get stronger by changing the way it works, making it more focused and integrated. With less human resources, it was possible to get the financial and material collections increased and guarantee full support to the Institute's patients. Have you got a Conflict of Interest?: No
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1948 Sustainable Progress of Increasing Radiotherapy Access: Checkpoint Evaluation of Indonesia’s Roadmap Planning S. Gondhowiardjo1,2, F.R. Adlar1, T.B.M. Permata1,2 1 Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, 2Indonesian Radiation Oncology Society (IROS), Jakarta, Indonesia Background and context: Radiotherapy is a cornerstone in cancer treatment, with more than 50% of cancer cases requiring radiotherapy.1 As the incidence of cancer increases over time, it is paramount that the development of radiotherapy services keep up to its pace. The Indonesian Radiation Oncology Society has developed long-term radiotherapy access roadmap for Indonesia since 2010 to plan the required increase in radiotherapy access nationwide.2 Aim: To evaluate the achievements of targeted increase in radiotherapy machines and radiation oncologists numbers in Indonesia, in perspective of the planned roadmap. Strategy / Tactics: Forward planning conducted has enabled targeted increase of radiotherapy centres and radiation oncologists’ numbers, based on calculated need from 2010 until 2035. Calculation was based on the target to achieve the ideal target of 1 MV per million. Regional distribution of these centres and radiation oncologists is also a crucial factor, as Indonesia is a vast archipelago country. Monitoring and evaluation of efforts and advocacy were routinely performed annually. Programme / Policy process: Prior calculation has summed up to a total of 189 radiotherapy machines needed by 2035. Initial evaluation showed 47 and 31 additional machines were needed by 2015 and 2020 respectively. Upon evaluation, the target was met with currently 78 operating radiotherapy machines, albeit 2 provinces (Maluku and Papua) still having none. Further down the road, further addition needed will be 33, 36 and 40 machines by 2025, 2030 and 2035, respectively. Training of radiation oncologist has shown a steady increase in line with the calculated estimate. From a total of 49 radiation oncologist in 2012 to 138 radiation oncologist in 2022. Outcomes: Sustainable effort and advocacy made by the Indonesian Radiation Oncology Society have shown to provide improvement in radiotherapy access according to the planned roadmap. Lessons learnt: Looking into the future, more endeavours and cooperation with key stakeholders will be made to improve radiotherapy access, especially in specific regions of Maluku and Papua. Updated target parameters and further roadmap will be needed, more accurately also by taking into account the estimated projection of increasing cancer incidence. References: 1. Rosenblatt E, Fidarova E, Zubizarreta EH, Barton MB, Jones GW, Mackillop WJ, et al. Radiotherapy utilization in developing countries: An IAEA study. Radiother Oncol. 2018 Sep;128(3):400-405. 2. Gondhowiardjo S, Sekarutami SM, Giselvania A, Octavianus S, Assegab MI.Improving access to radiation therapy in Indonesia.Appl Rad Oncol.2019;8(2):17-21. Have you got a Conflict of Interest?: No
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1953 Evaluation of a Project ECHO to Support National Cancer Control Plan Implementation in LMICs L. Eldridge1, M. Kohli Cira1, K. Duncan1, K. Hohman2, L. Given2, P. Adsul3 1 National Cancer Institute, Rockville, United States, 2Strategic Health Conce[ts, Arvada, United States, 3University of New Mexico Comprehensive Cancer Center,, Albuquerque, United States Background: The International Cancer Control Partnership (ICCP) is a coalition of organizations that support country-led cancer control planning efforts. The ICCP ECHO Program uses the Project ECHO© technologyenabled collaborative learning model to foster knowledge exchange for low- and middle-income countries implementing National Cancer Control Plans (NCCPs), bringing together in-country teams and global cancer control experts through monthly hour-long ECHO sessions. Aim: To evaluate the utility of the ICCP ECHO as a virtual learning environment that fosters knowledge exchange. Methods: Twenty-eight participants (46%) from eight country teams responded to baseline and endpoint evaluation surveys, before the program began and at the end of 12 months respectively. Self-reported knowledge of and confidence using 12 evidence-based strategies for NCCP implementation were assessed using a Likert scale ranging from 1 (not at all knowledgeable/confident) to 3 (knowledgeable/confidence or very knowledgeable/confident). Implementation strategies ranged from building partnerships and political will to planning for costing and sustainability. Statistical analysis of the responses was conducted using a paired T-test. Results: Overall knowledge increase was statistically significant, with an average increase of 0.27 (95% CI 0.140.40, p=0.0002). Overall confidence increase was also statistically significant, with an average increase of 0.17 (95% CI 0.001-0.33, p=0.0487). Average overall knowledge and confidence was 2.42 and 2.44 at baseline and 2.75 and 2.69 at endpoint. The greatest statistically significant increase in knowledge was for integration with health programs/systems, with a mean increase of 0.46 (95% CI 0.46-0.78, p=0.0002). While the change in overall confidence was statistically significant, creating an implementation plan was the only strategy with a statistically significant change, with a mean increase of 0.21 (95% CI 0.02-0.41, p=0.0311). Respondents reported that hearing specific experiences shared during case presentations from participating countries was valuable. Major takeaways included the importance of collaboration, leveraging existing resources, and learning from county experiences. Conclusions: Survey responses indicate that participation in the ICCP ECHO program provided an opportunity for individual knowledge and confidence gain. This evaluation paves the path for future strategies that can promote NCCP implementation, in addition to Project ECHO. Have you got a Conflict of Interest?: No
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1959 Impact of Area-Level Deprivation on Interventions to Increase Adherence to Cancer Screening among Rural Women E. Paskett1, V. Champion2, T. Stump2, P. Monahan2, M. Katz1, S. Rawl2, R. Baltic1 1 Ohio State University, Columbus, United States, 2Indiana University, Indianapolis, United States Background: Compared to urban settings, rural areas have lower cancer screening rates and higher cancer mortality. Within rural areas, area-level socioeconomic conditions impact health care access and uptake. Aim: We conducted a randomized controlled trial among women aged 50-74 years old who lived in 99 rural counties in Ohio and Indiana, USA, to compare the effectiveness of 1) a mailed tailored DVD intervention (DVD); 2) a DVD intervention plus telephonic patient navigation (DVD/PN); and 3) usual care (UC) to simultaneously increase adherence to any breast, cervical and colorectal cancer screening that was not up to date (UTD) at baseline. We sought to examine the impact of area deprivation on screening and intervention effectiveness. Methods: Interventions focused on constructs associated with cancer screening including knowledge, perceived personal risk for cancer, and benefits and self-efficacy, as well as resolving barriers to obtaining needed tests.A total of 983 women were randomized: 19% needed all three tests, 29% needed two tests, and 52% needed only one test. Results: Women were on average 59 years old, the majority were married, insured, white, and 84% reported educational attainment past high school. The national percentile of adjusted area-level deprivation index (ADI) was 66 (range 1-100), with higher scores indicating higher economic deprivation. At 12 months, the percent of women receiving ALL needed screening was 10% in UC, 15% in those receiving the mailed DVD, and 30% for women receiving the combined DVD/PN intervention (ORs= 1.9 and 5.8, respectively vs UC, p<0.001). A total of 25% of women in UC, 29% in the DVD group, and 49% in the DVD/PN group received ANY needed screenings (OR= 3.8 for DVD/PN vs UC, p<0.001). The ADI was significantly related to receiving both ALL orANY needed screenings at 12 months, with those in higher deprivation areas having lower adherence (p=0.004 and p=0.031, respectively) in adjusted models. No interaction of ADI with the interventions was found. Conclusion: This is the first study to compare interventions to simultaneously increase adherence to three screening tests in rural women, a medically underserved population with higher cancer mortality. Results demonstrate the value of these remote interventions, especially PN, in rural areas, and point to the need to focus on areas with higher economic deprivation to increase cancer screening adherence.(Supported by grant R01CA196243 from the National Institutes of Health, National Cancer Institute) Have you got a Conflict of Interest?: Yes If yes please specify:: E. Paskett is the MPI of grants to the institution from Merck Foundation, Pfizer, and Genentech, not related to this study.
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1960 Eliminating global cancer survival disparities through a patient-centered access to treatment model A. Annamalay1, J.M. Wrigglesworth1, B. Murphy-Eustis1, P. Garcia-Gonzalez1 1 The Max Foundation, Seattle, United States Background and context: The Max Foundation (Max) aims to accelerate health equity by delivering medication, technology, and supportive services to patients facing cancer and other critical illnesses. Through our flagship program, Max Access Solutions (MAS), we channel life-saving cancer treatment to patients living in low- and middle-income countries (LMICs) in partnership with their treating physicians and institutions. Aim: Through MAS, Max aims to eliminate survival disparities in cancer by providing access to life-saving treatment to patients where that treatment is otherwise not available locally. Strategy / Tactics: MAS is an innovative global-to-local systems integration model that provides access to treatment in LMICs. The four pillars of the model are the treating physicians, a local team of Max advocates, treatment made available through collaboration with drug and diagnostics companies, and an international supply chain. Through a sophisticated virtual system, Patient Access Tracking System (PATS), that links implementing partners and tracks key data points in real time, MAS overcomes some of the most insidious barriers to access to treatment for cancer and other critical diseases in LMICs. Programme / Policy process: Partner hematologists and oncologists in LMICs submit requests on behalf of individual patients. Upon receiving the request, a team of local Max advocates contact the patient to provide services as needed and help navigate the process. In parallel, Max sources the needed treatment, leads the importation process, and ships it directly to the treating institution through a Good Distribution Practice (GDP) compliant international supply chain. Individual patient information, tracking, and supply chain data is input into PATS to allow for robust reporting, quality assurance, safety, and health system strengthening. Outcomes: In 2021, The Max Foundation partnered with 520 physicians from 380 treating institutions in 75 countries. Through 327 international shipments, the organization delivered 9,119,946 defined daily doses of medicine for 34,235 patients. The most commonly treated disease was chronic myeloid leukemia (CML), followed by gastrointestinal stromal tumors (GIST), accounting for 88.4% and 8.7% of patients, respectively. The median timeon-treatment for CML patients actively on imatinib, our longest-running program, was 8 years. What was learnt: Through evaluation of patient outcomes, including time-to-treatment discontinuation and overall survival, we’ve demonstrated that our innovative access to treatment program has allowed CML and GIST patients in low- and middle- income countries to have similar outcomes to patients diagnosed with these indications in high-income countries. We have begun to apply this access model to other oncological and rare diseases and believe it will achieve similar outcomes for patients around the world. Have you got a Conflict of Interest?: No
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1964 Are Hypnosis and Neuroscience efficient in quitting smoking? J. Bilachi1 1 CHC Psicólogos Madrid, Psychology and Hypnosis, Madrid, Spain Background: Smoking affects physical health and has a negative impact on the brain. Smoking may increase the risk of age-related macular degeneration, contribute to type 2 diabetes and cause narrowing of blood vessels all over the body, including those that supply blood to the penis. Smokers have a much more chance to develop colorectal cancer, gum disease, and rheumatoid arthritis. Nicotine works as a neurotransmitter in the brain because it is like the neurotransmitter acetylcholine, increasing signals in the brain moreover, nicotine also stimulates the pleasure centers of the brain, and activates dopamine signals, creating a pleasant sensation. This causes a nicotine tolerance, so continued and more nicotine is needed. The changes that occur in the brain because of this cycle creates a dependence on nicotine because your body is used to having the nicotine in your system, which then becomes an addiction that can be difficult to break. People who smoke may experience more rapid cognitive decline than non-smokers. The risk of dementia and loss of brain volume are some of these cognitive declines. Aims: To evaluate the effectiveness of applying hypnosis based on neuroscience and personality traits, helping patients to quit smoking, Methods: Historic questionnaire was applied, the Stanford Hypnotic Clinical Scale (SHCS) followed by the “Big Five Inventory” (BFI). This study case had six male patients and six female patients (ages between 40-and 60 years old). The hypnosis techniques were Progressive Relaxation, Age Regression, Stress Relief, Healing Images, MindBody Images, Anchoring, Reducing Anxiety, Age Progressive, Time distortion, Metaphors, and Rewrite the Scripts. The patients were attended once a week for three months (12 hypnosis clinical sessions) and at the same time, half of them did self-hypnosis three times a week and the other six times a week. The patients were seen once weekly sessions of clinical hypnosis during the first month followed by twice-monthly sessions of hypnosis over three months. Self – Hypnosis was practiced during the treatment (three men and three women practiced selfhypnosis twice more than the other six patients). All the patients had not taken any quitting-smoking medicines before beginning the treatment nor during it. Results: The most relevant data is, therefore, of those who stopped smoking addiction: of the 12 patients, 9 stopped smoking (75%), 5 men (83,33%), and 4 women (66,66%). Of the 9 who had quit smoking, no one had a relapse. Of the 3 patients who did not quit smoking, 1 man and 2 women, were in the group who did not do selfhypnosis twice more than the other group. Conclusion: When we combined techniques of hypnosis based on neuroscience and personality traits the results of the treatment showed evidence that hypnosis helped people to quit smoking. Furthermore, the practice of selfhypnosis fastens the success of the process of living without cigarettes. Have you got a Conflict of Interest?: No
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1962 The Impact of the COVID19 Pandemic on Radiotherapy Services in Indonesia - Melyda1, T.B.M. Permata1,2, S. Gondhowiardjo1,2 1 Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, 2Indonesian Radiation Oncology Society (IROS), Jakarta, Indonesia Background: The COVID-19 pandemic has had substantial impact on the treatment of cancer patients including radiation therapy (RT) and it has been dramatically modified during this time. Lessons learnt are important to be documented and made known by societies to better prepare for the future. Aim: We aim to evaluate and update the impact of first, second, and third wave of COVID-19 pandemic on RT services in Indonesia. Methods: We conducted surveys for all the RT centres in Indonesia in year of 2020 - 2022 about COVID-19 impact to services and adjustments/strategies needed. Results:There was more decreasing number of RT cases number in second wave compared to the first one. The use of hypofractionation technique was also increasing in second wave of COVID19, with the most common implementations were for breast, cervical cancer, palliative RT. Prioritization scheme to critical cases and postpone of the non-emergency/benign/slow growing tumor cases were also applied to help health care facilities to give prompt treatment to the most needed during that time, since ability to deliver care was very limited. There was also reduction in working hours of RT centres mostly caused by more infected medical staff, rotational working shift specifically for COVID19 patients, and significant reduction of total number of patients. The use of telemedicine was considerably increased, which was appropriate in minimizing the risk of COVID-19 transmission amongst patients and healthcare workers, while still maintaining to keep the treatment going as best as possible. Conclusion: Various important adjustments due to the first wave of COVID-19 were applied and improved during the COVID19 second and third wave. These has allowed RT centres to continue to operate effectively, while protecting patients and staffs from the risk of COVID19 transmission. Have you got a Conflict of Interest?: No
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1973 Design and implementation of breast cancer early detection program in two states of India S. Kumar1, V. Srivastava1, N. Akhtar2, D. Singh2, M. Kujur3, P. Bhamare1, G. Usmanova1, M. McCarthy4 1 Jhpiego, New Delhi, India, 2Jhpiego, Lucknow, India, 3Jhpiego, Ranchi, India, 4Jhpiego, Baltimore, United States Background: Breast cancer is the most common cancer among women in India. Since 2018, Jhpiego has co-designed and implemented a resource-appropriate strategy for early detection of breast cancer in consultation with local stakeholders from Uttar Pradesh and Jharkhand states of India. This was rolled out in a decentralized manner through primary health care system under national program for prevention and control of common cancers. Aim: To share insights from design and implementation of breast cancer early detection program in resource limited settings of Uttar Pradesh and Jharkhand states of India Strategy: Situational assessment was conducted using Breast Health Global Initiative (BHGI) “BCI2.5 toolkit”. The results were presented to Breast Health Technical Advisory Committee (BHTAC) formed to design breast cancer early detection program. BHTAC recommended set of strategies based on which a conceptual framework for the integration of breast health services into the existing health system was designed. Upon approval from State Technical Advisory Group (TAG) context specific strategic implementation plan was prepared and executed. (Figure 1)
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Programme process: The existing Government of India guidelines were followed for better integration and sustainability of the program within the exiting public health system. The intervention package covered breast care continuum: awareness generation at the community level, early detection and screening at the primary level, diagnostic facility level interventions. Outcomes: The intervention covered 225 facilities from two states of India.Over the period of 18 months more 1,800 health care workers were trained on awareness generation, early detection, referral and management of benign breast conditions. As a result of training the mean knowledge scores improved from 69% to 93%, whereas mean Clinical Breast Examination (CBE) skills improved from 21% to 95%. Overall, 108,112 women in the age group 30-65 years were reached for breast health awareness; out of these, 54,431 women came to the health facilities for CBE (50%) and 2,219 were found to be positive for CBE (4%); 887 women reached the diagnostic facility (40%) and 584 of them were found to be CBE positive on undergoing repeat CBE by medical officer or staff nurse (66%); 387 of these women underwent diagnostic evaluation (66%), out of which 25 were confirmed to have breast cancer (7%) and 21 initiated treatment (84%). What was learnt: The results demonstrate the feasibility and effectiveness of implementing a large-scale, decentralized breast cancer early detection program delivered through the existing primary health care system in India. Have you got a Conflict of Interest?: No
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1976 Creating a Global Community to Revolutionize Cancer Care R. Richardson1, R. Schear1 1 Livestrong Cancer Institutes / Value Institute for Health and Care, Austin, United States Background/aim: Globally, health care is at a critical juncture. Covid disrupted all healthcare, including cancer. Although challenges to care transformation are often regional—depending on financing, patient support infrastructure & disparities—a global response is needed. Strategy/Tactics: In April 2022, Dr. Elizabeth Teisberg’s Value Institute for Health & Care convened the inaugural Redefining Health Care Summit, gathering 100 leaders from 22 countries ready to accelerate care transformation. The 3 day in-person Summit in Barcelona included a 4-hour work session to advance meaningful cancer journeys with 32 participants. The goal was to elevate common barriers to advancing high-value cancer care & share patient-centric solutions cross-regionally. Participants held group interviews with two patient luminaries – a Latinx breast cancer survivor from the U.S. who faced delayed diagnosis as a young adult & a Moroccan leukemia survivor in active treatment last 20 years facing barriers to oral chemo, transportation & support. Programme: Participants drafted & shared cancer care innovations identifying operational challenges, successes & help needed, & then pitched their initiative for feedback/support. Before, during & following the summit, participants engaged an online platform, the Health Care Transformation Community (HCTC) to connect with others, pose questions, & share resources. During the four-hour workshop, participants were fully engaged, not checking phones or computers, & open vulnerable conversations commenced. Participants engaged in “Snowball Fight” activity where they wrote their contact information & a goal to achieve cancer care transformation, held up their papers, crumbled them, & tossed them. They then picked up another’s snowball to identify their accountability partner. Outcomes: Common cross-regional challenges identified included the results in Table one below. Feedback from participants in an online survey following the convening was overall positive & articulated that the majority of participants felt strongly or very strongly that the Summit helped them learn something new about how to transform healthcare to improve outcomes for patients; provided practical tools to use in their work, & the agenda, structure & themes elevated the patient perspective. What Was Learnt: Barriers to achieving care transformation in oncology vary across regions but mostly fall within common themes. Convening a global community to share solutions & lessons learned is critical to reaching local successes. Continuing to engage & support participants following an event is often challenging. Using the HCTC, webinars, & other tools to address participants’ specific needs shows promise in continuing to build off of the momentum initiated at the event. Next steps include coming to a consensus on how we define "value-based care" & expanding this reach to low & middle-income countries.
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Images of patient luminaries:
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Table of identified challenges:
Have you got a Conflict of Interest?: No
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1977 The Elusive Chase for Equity: A Collaborative Research Program to Address Disparities for BC First Nations K. Linn1, N. Caron2, W. Clarmont3, R. Woods3, G. Ogilvie2 1 Harvard University, Boston, United States, 2University of British Columbia, Vancouver, Canada, 3BC Cancer, Vancouver, Canada Background and context: The paucity of Indigenous-specific cancer information is a barrier to reconciliation and the transformation of British Columbia’s (BC) health system to better serve Indigenous people, as outlined in BC’s Indigenous Cancer Strategy and the Canadian Strategy for Cancer Control. This lack of data is a national and global challenge for Indigenous Peoples that is long overdue to be addressed. Aim /Strategy / Tactics: A comprehensive record-linkage methodology established a vast holding of First Nations-specific cancer data to support policy change. Without such capacity, clinical guidelines and treatment pathways are based on data that excludes Indigenous identifiers and perpetuates the persistent inability to study and understand cancer with an Indigenous lens. Programme / Policy Process: Our process leveraged the First Nations Client File (FNCF), a longitudinal registry of all registered First Nations residents in BC. The FNCF is a unique database created annually and is the product of a multi-step probabilistic linkage between an extract of the Indigenous and Northern Affairs Canada Indian registry, the BC Ministry of Health Client Roster and BC Vital Statistics birth and death records. The FNCF was then linked to a comprehensive set of Ministry of Health and BC Cancer Registry administrative databases. Outcomes: This extensive collaboration between Indigenous, provincial and federal government data sources permitted the development of this linked data platform; the most comprehensive linked data set of cancer system data and First Nations identity in Canada. Outputs of this work are manifesting in two forms: research manuscripts for peer-review journals and knowledge products to be used by First Nations communities and leadership to engage communities and health system partners to enable desired cancer care change. Lessons Learned: The development of this data platform was possible due to taking a partnership approach that included First Nations organizations and the health system. Several layers of formal governance structures ensured the development, analysis, and reporting of data according to First Nations' perspectives and priorities. Shared learning was a major outcome, including the health system better understanding First Nations perspectives on health and wellness and best practices in cancer control being shared by health system partners. As a result, First Nation-specific cancer data is now available and being used to assess health systems performance and impact policy and address disparities in experiences and outcomes. Have you got a Conflict of Interest?: No
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1984 Holistic Wellness Campaign N.A. Maskor1, M. Muhamad1,2, N.H. Zainordin1, N.H. Nik Mahmood1,3 1 KanWork Cancer Society, Seri Kembangan, Malaysia, 2Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia, 3Universiti Selangor (Unisel), Shah Alam, Malaysia Background: KanWork Cancer Society (KanWork) is a registered non-governmental organization that aims to provide support to those affected by cancer and promote healthy lifestyle. Majority members are cancer survivors. They aspire to be cancer free and live a good quality life. According to Clinton et al. (2020) sustaining a good quality life helps in preventing cancer recurrence. Towards that, KanWork has initiated a campaign “Be Healthy with KanWork” to promote holistic wellness (physical, mental, spiritual, and social) for members and the public in 2021. Aim: To enhance members and community well-being through holistic healthy lifestyle. Strategy: The campaign comprised of two programs; monthly and weekly. They include those related to the four holistic wellness domains. Due to the Covid-19 Pandemic, the program was implemented in hybrid mode (face to face and virtual). Public access to the program was synchronized through Facebook Page, YouTube Channel, and Facebook Group. Outcomes (2021): 1.Twelve educational monthly programs such as Cancer and Treatment, Mental Well-being, and Spiritual Wellbeing. 1555 KanWork members and the public participated. Majority (89%) reported the program was effective. 2.Ten videos of recorded educational program shared in YouTube channel (https://www.youtube.com/channel/UC4QYHhRzJ5YRD4pxxkwTCSQ). 3.Five weekly programs such as Walking and Exercise, Nutrition, Gardening and Quran Recitation. Members actively participate in WhatsApp Group, while public via Facebook Group (https://www.facebook.com/groups/2121131208042345). 4.Shared brief information with illustration about the activities (https://www.facebook.com/kanwork.official/). 5.KanWork collaborated with 14 related NGO’s who also benefit from the campaign. What was learnt: From our experience to be successful, a wellness campaign requires: -Wide publicity including via social media. -Good collaboration with other organizations. -Participants inspire, encourage, and support each other, consistent with Park et al. (2008) observation that a critical factor affecting health and well-being is desire and motivation. -Experienced and dedicated personnel and volunteers. With positive feedback and continuing participation by many, Be Healthy with KanWork is going on for the second year. There is a potential for the campaign to be replicated accordingly. References: Clinton, S. K., Giovannucci, E. L., Giovannucci, E. L., Giovannucci, E. L., & Hursting, S. D. (2020). The World Cancer Research Fund/American Institute for Cancer Research Third Expert Report on Diet, Nutrition, Physical Activity, and Cancer: Impact and Future Directions. Journal of Nutrition, 150, 4, 663-671. Park, C. L., Edmondson, D., Fenster, J. R., & Blank, T. O. (2008). Positive and negative health behavior changes in cancer survivors: A stress and coping perspective. Journal of HealthPsychology,13(8), 1198Y1206. Have you got a Conflict of Interest?: No
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1990 Patient navigation: the unprecedented viable S. GIOIA1, L. Brigagão1, M. Rocha2, P. Goss3 1 State Health Department, Mastology, Rio de Janeiro, Brazil, 2Municipal Health Department, Mastology, São João de Meriti, Brazil, 3Global Cancer Institute, Global Research, Boston, United States Background: The content of this presentation deals with the experience of the navigation program for patients in a breast cancer diagnosis center of the State Health Department of Rio de Janeiro (RJ). The objective was to show how the patient navigation program can allow the proper application of the 60-day Law, being a topic of interest for the planning and evaluation of actions to control this cancer in Brazil. Aim: The patient navigator accompanied women from the Unified Health System (Sistema Único de Saúde — SUS) with a diagnosis of breast cancer to start treatment at a specialized center within 60 days. Methods: Information on the clinical characteristics of the patients, clinical dates, and barriers encountered were collected. Univariate logistic regression was used to assess factors associated with starting treatment within 60 days. Results: From January to July 2020, 301 breast biopsies were performed, 126 (42%) of breast cancer. The mean age was 54 years (26–88). 75% of the lesions were diagnosed in advanced stages (IIB to IV). The mean time to start treatment was 39 days (11–108). The main barriers found were fear (93%), difficulty in communicating with the medical team (81%), and uncoordinated health care (37%). Being treated outside the city of RJ was the main factor associated with treatment within 60 days (79.5% vs. 20.5%, p < 0.001). Conclusion: The integration of the patient browser into work processes contributed to compliance with the 60day Law in 86% of cases. In the context of a complex and fragmented healthcare system for a population in a situation of socioeconomic vulnerability, the patient navigation program proves to be a tool to increase the rate of law enforcement in Brazil. Have you got a Conflict of Interest?: No
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1992 Systemwide focus on treating tobacco dependency as part of ambition for a Smokefree 2030 A. Rutter OBE1, R. McIlvenna1, R. Sharrock2, D. Gardiner3,3,3, B. Scott4, T. Ghee1, C. Mills5, C. Barry2, A. Lloyd1, G. Smith3, J. Feeney3, E. Milne6 1 Fresh and Balance, Salvus House, Durham, United Kingdom, 2Gateshead NHS Foundation Trust, Division of Medicine, Gateshead, United Kingdom, 3Department of Health and Social Care, Office for Health Improvement and Disparities, Newcastle Upon Tyne, United Kingdom, 4Northumbria NHS Foundation Trust, North East & North Cumbria Integrated Care System, North Shields, United Kingdom, 5North East Commissioning Support, Newcastle Upon Tyne, United Kingdom, 6Newcastle City Council, Public Health, Newcastle Upon Tyne, United Kingdom Background and context: Smoking rates have fallen significantly in the North East of England (nearly halved since 2005 from 29% to 15%), but smoking is still the single largest cause of preventable ill health and premature death. Tobacco dependency affects almost all patient pathways and treating tobacco dependency (TTD) is not just about preventing disease, but it is a clinically effective treatment for d illnesses including cancer. The North East and North Cumbria (NENC) Integrated Care System (ICS) prioritised a key focus around tobacco and a dedicated Taskforce for TTD has been in place since 2017. The National Health Service (NHS) Long Term Plan (LTP) published in 2019 set out the requirement for NHS funded services to treat tobacco dependence (TTD) to be made available to all inpatients (Acute & Mental Health), pregnant women and higher risk outpatients who smoke, by 31 March 2024.In 2019 the Government stated its ambition for a Smokefree 2030 and that the NHS can help to deliver this. In early 2020 the covid 19 pandemic arrived. Aim: The vision for the TTD landscape within the NENC is that every smoker will make at least one significant quit attempt per year, with tobacco dependency being discussed by every Health Care Professional they come into contact with.Smokers will have a choice as to how to quit and can access support anywhere in the region, This will be set within a broader tobacco control programme.
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Strategy: The multi-disciplinary/agency taskforce is jointly chaired by a Clinical Lead for Tobacco and a Director of Public Health (from local government) providing a unique partnership approach and the work is coordinated by a Smokefree NHS Strategic Manager with a small but expanding team. Excellent support is provided by key agencies including the Office for Health Improvement and Disparities. Core to progress has been highlighting impact of tobacco on health inequalities and working closely with the regional tobacco control programme (Fresh) has been key. Programme: A multistrand regional programme is in place including: media and communications with world first smoking and covid mass media campaign "Don't Wait" https://www.facebook.com/watch/?v=610075463006041, communications strategy, nicotine management policy, patient referral pathways, training packages, expert support and advice to all Trusts, region wide staff cessation programme. Outcomes: All 10 Trusts are well ahead of the national target with collection of patient metrics and TTD services in place by early summer 2022, the ICS is first in country to sign new national NHS Smokefree Pledge and endorsement of ground breaking report of recommendations to Govt or a Smokefree 2030, 4 bursts of “Don’t Wait” campaign run, over 1100 staff members in quit programme in first 3 months. (Full data will be available at conference) What was learnt: Progress to TTD can be made during a pandemic if there is a dedicated Taskforce in place to maintain focus and momentum. Have you got a Conflict of Interest?: No
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1995 Profiling Social Support System for Breast Cancer Patients and Survivors N.H. Nik Mahmood1,2, M. Muhamad1,3, N.A. Maskor1 1 KanWork Cancer Society, Seri Kembangan, Malaysia, 2Universiti Selangor (Unisel), Shah Alam, Malaysia, 3Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia Background: Breast cancer is one of the top types of cancer affecting women both in the developed and developing countries. Social support has been shown to offset or moderate the impact of stress caused by the illness and other related negative outcomes (Adam & Koranteng, 2020). A significant support system should help to reduce their pains and provide additional physical, emotional, informational and spiritual support to a breast cancer patient. Women diagnosed with breast cancer need social support from various sources such as spouses, family members, medical health professional and support group. The question lies whether or not the breast cancer patients and survivors are effectively getting the above mentioned support from various sources? Aim: This study aims to profile an effective social support system for breast cancer patients and survivors. Methods: Survey and interview methods were used in this study. A number of 100 breast cancer patients and survivors participated in the survey and 12 respondents were interviewed. The instrument to measure emotional, instrumental, informational and spiritual support was adapted from Krishnasamy (1996). Quantitative data were analyzed using descriptive statistics whereas qualitative data using thematic analysis method. Results: The findings of the study showed that 68% of the respondents reported having a family history of breast cancer, 44.6% of the married respondents reported that husband was the first person to be referred to when they detected irregularity to their breast whereas 46.7% of the not married women had named the doctors and 35% of widowed/divorced women named the children playing that role. 44.6% of the women still named the husband as the main source of support, 33.3% of the not married women indicated parents as the main source of the social support. Interview data reported that positive thinking and positive attitude, putting breast cancer diagnosis and treatment into perspective and avoid the “Why-Me” syndrome help them to cope with the disease. The study reveals the respondents lack of emotional, instrumental, informational, and spiritual support. Conclusion: The study indicated that women with breast cancer need more emotional, instrumental, informational and spiritual support from various support sources. Therefore, an effective social support system needs to be established in the country to ensure a quality social support for women with breast cancer. Reference Adam A, Koranteng F (2020) Availability, accessibility, and impact of social support on breast cancer treatment among breast cancer patients in Kumasi, Ghana: A qualitative study. PLoS ONE 15(4): e0231691. https://doi.org/10.1371/journal.pone.0231691 Krishnasamy, M. (1996). Social support and the patient with cancer: a consideration of a literature. Journal of Advanced Nursing, 23, 757-762 Have you got a Conflict of Interest?: No
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1996 Improving safe handling and administration of chemotherapy in Nigeria U.E. Nwokwu1, P. Ibeka2, J. Swindell3, M. OBrien3 1 Federal Ministry of Health, Abuja, Nigeria, 2Clinton Health Access Initiative, Abuja, Nigeria, 3American Cancer Society, Washington, DC, United States Background: The Nigerian Federal Ministry of Health (FMOH) is committed to making cancer treatment more accessible and affordable. As part of the effort, Nigeria recently launched a new national ChemoSafe policy and completed assessments of safe handling and administration of chemotherapy agents across 12 cancer treatment centers. Aim: To improve safe handling and administration of chemotherapy in cancer treatment centers in Nigeria. Strategy/tactics: Create a national policy framework and identify and address gaps in cancer treatment centers with a focus on infrastructure, personal protective equipment (PPE), operating procedures, and health worker training. Programme: A draft policy was developed by a team of experts from the National Cancer Control Programme and the Department of Food and Drug Services of the FMOH. It was reviewed by the National cancer control and prevention Technical Working Group and the next draft was presented to a forum of stakeholders to obtain their input and buy-in. The final draft policy was approved by the Honourable Minister of Health in June 2021 as a National Policy on Chemotherapy Safety with four objectives: 1) to standardise the safe handling of chemotherapeutic agents in cancer treatment centres; 2) to provide comprehensive instructions on the safety measures that would protect oncology practitioners, patients, and other hospital users from the hazards of chemotherapy agents; 3) to improve the knowledge base of health workers on the safe use of chemotherapy in cancer management; and 4) to define responsibilities of each player in the cancer space in the use of chemotherapy in cancer care. FMOH team conducted assessments across 12 cancer treatment centres using the ChemoSafe App developed by Allied Against Cancer to benchmark each centre against key performance indicators for safety. The assessment identified five priority areas for initial interventions: 1) create facility-level safety plan; 2) establish secure budgets to purchase personal protective equipment; 3) improve access to incineration for hazardous waste; 4) purchase and install biosafety cabinets; and 5) institute annual refresher training for all staff who handle hazardous drugs. The assessment showed that 42% of the institutions need essential PPE, 75% need refresher training, 58% need a facility safety plan, 50% need efficient waste management, and 67% need a biosafety cabinet. Outcome: The national policy and assessment findings provide an action plan for FMOH and cancer centre leaders to implement practical changes that will improve the safety of health workers and people receiving cancer treatment. Action plans across the cancer centres reveal many opportunities for no/low-cost improvements that can be met within the first year of the program intervention. In addition, the exercise of conducting the assessment created an opportunity for oncology pharmacists and nurses to take on leadership roles in improving the safety of their workspaces. Have you got a Conflict of Interest?: No
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2001 Cascade analysis for women presenting with breast concerns to a Zonal Hospital in Mwanza, Tanzania T. Friebel-Klingner1, E. Joo1, M. Kirahi2, N. Masalu2, L. Washington2, A. Rositch1 1 Johns Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore, United States, 2Bugando Medical Centre, Mwanza, Tanzania, United Republic of Background: In Tanzania, high breast cancer morbidity and mortality can be attributed, in part, to delays and incomplete care across the cancer continuum. Our current “Time to A.C.T.” study (Sood et.al. 2021) intends to reduce breast cancer morbidity and mortality through creating, implementing, and monitoring standardized care and treatment pathways at Bugando Medical Centre (‘Bugando’), a zonal hospital in Mwanza, Tanzania. We adapted the cascade analysis tool (Wagner et. al. 2019) to track the flow of patients with breast concerns through Bugando and depict the sequential steps and losses along the cancer care pathway. Aim: By adapting the cascade analysis, we aimed to identify specific step(s) along the breast cancer care pathway at Bugando where care is incomplete, and if corrected, would have a large impact on improving breast cancer patient care and outcomes. Methods: This prospective cohort included women presenting to Bugando between February 2020 and January 2022. Eligible adult women presenting with a breast concern were followed from their initial consult visit through cancer treatment. At first visit, based on clinical breast exam and personal history, if breast cancer was suspected, diagnostic tests (i.e., FNA-C, Breast Ultrasound, Biopsy, Chest X-ray, Abdominal Ultrasound, or CT scan) were ordered. Upon results of the diagnostic test, any patient found to have breast cancer was offered appropriate treatment (surgery and/or chemotherapy). Results: Overall 698 women presented with a breast concern. Of these, 79% (n=486) were noted as potentially having a breast malignancy (step 1). Of those, 89% (n=431) had at least one diagnostic test ordered (step 2) and 87% (n=371) of those patients completed at least one test (step 3). Of those, 41% (n=153) were diagnosed with breast cancer (step 4), of which 61% (n=96) initiated treatment with surgery and/or chemotherapy (step 5). In steps 2 and 3, there was a loss of 55 and 60 patients, respectively. For step 5, there was a loss of 57 women. If drop off was eliminated at step 2, an extra 10 women would have completed the pathway through step 5, if drop off was eliminated at step 3, an extra 13 women would have completed the pathway through treatment initiation, and if drop-off was eliminated at step 5, 57 additional women would have initiated treatment. Conclusion: Cascade step 5, initiating cancer treatment, was identified as the step that would have the biggest impact on improving the breast cancer care pathway at Bugando. Although non-linear modifications are needed to better adapt cascade analysis to breast cancer care in our system, this process can be used to monitor ongoing system changes. It will also be integrated into a new patient navigation program focused on reducing overall loss in the system and supporting patients diagnosed with breast cancer to initiate and complete treatment. Have you got a Conflict of Interest?: No
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2004 Youth Cancer Europe: Transforming individuals voices into a vibrant community for youth with cancer U. Kosir1, K. Rizvi1, on behalf of Youth Cancer Europe Steering Committee 1 Youth Cancer Europe, Cluj-Napoca, Romania Background: Even though cancer is rare among adolescents and young adults (AYAs; 15 – 39 years of age), it poses a significant burden on one’s person and their lived environment. Compared to younger children or older adults,AYAs have unique developmental needs and distinctive biology. With the ever-improving survival rates, there is an increasing need to address AYAs health, as well as long-term psycho-social needs – a substantial proportion of AYAs experience difficulties navigating healthcare system, report mental distress, experience discrimination, and face high risk for other health problems. Aims: To address the unmet AYA needs, the advocacy work by Youth Cancer Europe (YCE), the largest and most encompassing pan-European cancer charity for young patients, has been invaluable. Theoverarching aims are provision of age-appropriate care, long-term follow up and quality of life, along with political and regulatory representation of AYAs with cancer. Strategy: The comprehensive agenda set out by YCE integrates evidence from systematic literature reviews, syntheses of existing cancer care policies, and extensive consultations with expert panels of patients, academics, and medical professionals. Since 2018 we organized over 10 mission meetings, a Leadership summit with patient representatives from 31 countries, were awarded several EU grants, led educational webinars, and have 5 existing projects in line with the Europe Beating Cancer Plan. The multidisciplinary and rigorous method has allowed YCE to engage withrelevant stakeholders such as the European Parliament, European Commission, regional and local authorities, specialist networks and multidisciplinary global working groups. Outcomes: Adaptation to life with cancer is a complex process with many individual and socio-cultural factors at play. The growing recognition of AYAs and their needs is a direct result of the consistent advocacy work with an assertive agenda. In 2018, the process resulted in a detailed 5-step call to action described and published as a White Paper. The five topic areas are: financial discrimination, cross-border healthcare, fertility preservation, dental care and reconstructive surgery and mental health. All work is done by cancer patients for cancer patients, in a transparent fashion, increasing work’sreplicability and encouraging inclusion and diversity in the conduct of patient research and advocacy. Impact: A few voices grew into a vibrant international community of several thousand AYA patients, survivors, and caretakers. This community has been crucial during the pandemic, providing online support for patients, and can be seen from a quick mobilization of resources to help almost 200 young Ukrainian cancer patients to relocate and continue their treatments abroad. YCE community recognizes illness as only one part of young people’s identity and uses the common goal – giving voice to young people – to leverage the myriad other skills AYAs have. Have you got a Conflict of Interest?: Yes If yes please specify:: UK has received speaker fees from MSD. KR has received fees from Novartis and Roche. None are related to the work presented here.
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2006 Addressing women’s cancers: an economic evaluation of breast and cervical cancer interventions in Kenya B. Hutchinson1, M. Nyangasi2, C. Meyer3, R. Watts4, B. Anderson5, V. Mwenda2, K.M. Kabubei6, A.E. Gordillo-Tobar7, C. Levin8, R. Nugent1, T.L. Kuguru7 1 RTI International, Seattle, United States, 2Kenya Ministry of Health, National Cancer Control Program, Nairobi, Kenya, 3RTI International, Boston, United States, 4Forecast Health, Perth, Australia, 5World Health Organization, Geneva, Switzerland, 6The World Bank, Nairobi, Kenya, 7The World Bank, Washington DC, United States, 8University of Washington, Department of Global Health, Seattle, United States Background: Cancer is the fourth leading cause of death in Kenya, with breast and cervical cancers responsible for about one in four cancer deaths. The Ministry of Health is committed to reducing cancer incidence, downstaging diagnosed cancers, and improving survival rates through access to primary prevention interventions and quality early detection, treatment, and palliative care services. However, as it seeks to embed cancer care within its universal health coverage framework, it recognizes that strategic choices must be made to maximize health benefits from available resources. Aim: This benefit-cost analysis evaluated pathways to support addressing breast and cervical cancer. The analysis assists the Ministry’s decision-making around expansion of cancer services by investigating the impact of 1) focusing on early diagnosis of breast cancer in the short-term, followed by population-level scale up of screening using either a clinical breast exam or mammogram-led approach, and 2) scaling HPV-vaccination (using multiple delivery platforms) among adolescent girls, and population-level scale up of cervical cancer screening, diagnosis, and treatment services among women. Methods: In a unique national-level analysis, we used an epidemiological state-transition cohort simulation model—developed by WHO and IARC—calibrated with Kenya-specific incidence and mortality data from Globocan. We quantified the costs and health and economic outcomes of scaling breast and cervical cancer interventions over 40 years. Local per person screening, diagnosis, and treatment and supportive health-systemsstrengthening costs were obtained from published studies and Ministry of Health reports. Improvements in health (i.e. reductions in mortality) were monetized using a “value of a statistical life year” measure. We applied a five percent discount rate to future costs and monetized health benefits. Results: Over 40 years, the examined breast and cervical cancer interventions are estimated to respectively save 236,000 and 159,000 Kenyan lives. The interventions cost KES 749 billion (discounted) – representing a six percent increase over existing public health expenditures. Cervical cancer interventions comprised 61 percent of the costs and breast cancer interventions comprised 39 percent. In the long-term, under the most positive scenario modeled, every Kenyan shilling (KES) invested in breast and cervical cancer control generated 2.3 shillings in benefits in return—creating KES 350 billion in net benefits. Conclusion: Strengthening cancer care requires significant resources to enhance clinical services and to strengthen health systems. But the long-term the benefits of breast and cervical cancer programs outweigh their costs, providing an economic rationale for Kenya to continue to strengthen it’s framework for cancer control and to increase the services available to girls and women to reduce the preventable burden of breast and cervical cancers. Have you got a Conflict of Interest?: No
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2007 Bridging the Gap: Clinical Trials & Patient Education R. Richardson1, R. Schear1 1 Livestrong Cancer Institutes / Value Institute for Health and Care, Austin, United States Background/aim: To patients and loved ones “clinical trial” correlates with options, cutting edge, opportunities, progress, but also daunting, uncertainty, confusion, mysterious, guinea pig, and mistrust. Despite incredible progress in advancing treatment options for cancer patients, huge barriers and inequities within clinical research continue to prevent access to potentially lifesaving interventions. According to the Cancer Action Network’s 2018 report, "Barriers to Patient Enrollment in Therapeutic Clinical Trials for Cancer: A Landscape Report," enrollment in a cancer clinical trial involves a multi-step process and while participation is typically thought of in terms of a patient decision, the patient is not presented with the option until the last step, which is only reached if previous barriers have not been encountered.Furthermore, many eligible patients are not even approached to enroll. Strategy/Tactics: To bridge the gap between cancer patients and clinical trials, the Livestrong Cancer Institutes (LCI) held interviews with cancer survivors, caregivers, and researchers, conducted an extensive literature review, and held a half-day roundtable symposium in Dec 2018. The 60 participants included cancer survivors, caregivers, pharmaceutical companies, health plans, researchers, clinicians, clinical administrators, nonprofit and advocacy organizations, and community health, health equity, health communication, and patient education experts.
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Programme: This interactive roundtable included a panel of cancer patients, survivors and caregivers described why and how they decided to opt in or out of a clinical trial.A graphic illustrator captured key elements of the symposium, including state of the field, waypoints/opportunities, and developing interventions.
Outcomes: The symposium resulted in mapping patient barriers to clinical trials, challenging/confirming assumptions, stakeholder commitment to address barriers, and developing implementation strategy.Major barriers identified included confusing eligibility/enrollment processes, health literacy and cultural/language appropriateness concerns, timeliness issues, lack of trust for clinical research, and support needed for financial/practical/emotional costs. What was learnt: From the symposium data, LCI derived a comprehensive strategy to address gaps in clinical trial education, which includes: (1) community education to eliminate stigma around clinical trials, build/maintain trust, and improve public awareness; (2) patient and caregiver education to ensure that informed consent is informed, to gain better understanding of equipoise, and to help all involved understand what to expect throughout the process from finding a trial to receiving treatment, including out-of-pocket costs, and (3) provider education to ensure timely connection to clinical trials available inside and outside of our institution, and to eliminate as much implicit bias in accessing trials as possible.
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Have you got a Conflict of Interest?: No
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2009 Expanding Patient Navigation in LMICs: Early Lessons from a Global Toolkit and Community Platform Pilot H. Freedman1, K. McComb1, A. Chybisov1, E. Krisel1, S. Umar1, J. Kilonzo2, D. Gitonga2, M. Kaur3, Z. Bernacca3 1 American Cancer Society, Global Capacity Development and Patient Support, Kennesaw, United States, 2Steps Ahead Consulting Ltd, Nairobi, Kenya, 3Mabadiliko Changemakers Ltd, Kampala, Uganda Background and context: Patient navigation refers to individualized assistance offered to patients, families, and caregivers to help overcome health care system barriers and facilitate timely access to quality health and psychosocial care, from pre-diagnosis through all phases of the cancer experience. Despite the established benefits of patient navigation, it is under-utilized in in low- and middle-income countries (LMICs). Since 2015, the American Cancer Society (ACS) has leveraged its patient navigation expertise to support the development and implementation of two comprehensive programs in Kenya and Uganda. Building on these experiences, ACS has developed a new initiative to expand patient navigation implementation in other LMICs. Aim: The Building Expertise, Advocacy, and Capacity for Oncology Navigation (BEACON) Initiative is a virtual model of training, technical assistance, and networking that aims to increase patients’ access to care and reduce health disparities in LMICs through the uptake of patient navigation. Strategy / Tactics: ACS has developed a comprehensive toolkit that provides extensive tools, resources, and guidance adapted for global applicability to support users to lead key processes for program design, implementation, evaluation and refinement. ACS also created an online platform that:
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convenes a growing community of cancer professionals and administrators interested in patient navigation enables users to access the Toolkit and exchange information and ideas helps ACS facilitate a peer learning collaborative and deliver timely virtual learning events.
Finally, ACS offers individualized technical assistance and planning grants to participating organizations. Programme: ACS selected 10 health institutions (both public and private) and cancer organizations from 8 countries in Asia, Africa, and Latin America for a 15-month pilot. The pilot began in February 2022 with a launch, orientation, and individual goal-setting sessions. ACS is facilitating two virtual events monthly and up to 25 hours of technical assistance for each organization. ACS is using Google Analytics to collect anonymous data on Toolkit and platform use and commissioning an external evaluation. Since the launch, 79 participants have registered and joined the online community. Participants have engaged in 354 working sessions with Toolkit content, and ACS has conducted four virtual events averaging 45 community participant attendees. Outcomes: Preliminary observational and quantitative data suggest pilot participants have strong interest and motivation to offer patient navigation. However, they face different institutional opportunities, challenges, and expectations. Providing consistent, targeted technical assistance and facilitating exchanges of information and experience between participants from around the world can lead to well designed, impactful, and sustainable patient navigation programs. Have you got a Conflict of Interest?: No
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2013 A systematic review on selected maternal dietary factors and risk of childhood acute leukemia J. Blanco1, I. Iguacel2, S. Pisanu3, C. Choma Bettega Almeida4, E. Steliarova-Foucher5, C. Sierens6, M.J Gunter1, E. Ladas7, R.D Barr8, K. Van Herck6, I. Huybrechts1 1 International Agency for Research on Cancer, Nutrition and Metabolism Branch, Lyon, France, 2University of Zaragoza, Faculty of Health Sciences, Zaragoza, Spain, 3University of Cagliari, Department of Biomedical Sciences, Section of Microbiology and Virology,, Cagliari, Italy, 4Federal University of Paraná, Department of Nutrition, Curitiba, Brazil, 5International Agency for Research on Cancer, Cancer Surveillance Unit, Lyon, France, 6Ghent University, Department of Public Health and Primary Care, Ghent, Belgium, 7Columbia University Medical Center, Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, New York, United States, 8McMaster University, Departments of Pediatrics, Pathology and Medicine, Hamilton, Ontario, Canada Background: Childhood Acute Leukemia (CAL) is the most common type of cancer in children, almost 80% correspond lymphoblastic (ALL), and near 15% to myeloid type (AML). Despite many studies the etiology remains unknown. Aim: This review aims to summarize the current evidence on the role of selected maternal dietary factors in the development of CAL. Methods: Studies published until December 2021 that evaluated the maternal dietary risk factors for CAL were identified in a three-step search in PubMed and Web of Science, without limit of publication year or language. A total of 39 studies (2 prospective cohort studies, 3 pooled analysis and 34 case-control studies) were included. Results: Main findings suggest that a maternal diet rich in vegetables and proteins, fish and seafood may decrease the risk of ALL, while higher intakes of butter, sugar, syrup, meat, and meat products increased the risk of ALL. A meta-analysis reported decreased ALL risk with higher intakes of fruit (OR=0.81, 95%CI:0.67-0.99), vegetables (OR:0.51, 95%CI:0.28,0.94) and legumes (OR=0.76, 95%CI:0.62-0.94). Micronutrient intakes, such as pro vitamin A, beta-carotene, reduced glutathione, and folates were negatively associated with ALL. Increasing intake of coffee during pregnancy was positively associated with the risk of ALL and AML. A metaanalysis, reported an adjusted OR = 1.44, 95% CI:1.07–1.92 for ALL with coffee intake; other meta-analyses reported for ALL an OR=1.65, 95% CI:1.28-2.12 and for AML an OR=1.58, 95% CI: 1.20-2.08. For tea a metaanalysis, found an inverse association with low to moderate consumption (OR=0.85, 95% CI: 0.75–0.97), while for cola-beverages one study reported a positive association with AML. With respect to supplementation of vitamins and minerals, main findings reported protective effects for folic acid, iron, and multivitamins, however there were also contradictory results. A meta-analysis reported for maternal folic acid supplementation before pregnancy an OR=0.69, 95%CI:0.50–0.95, and for the use of vitamin supplements an OR=0.81, 95% CI: 0.74-0.88 for the risk of ALL. Conclusion: Overall, the main findings indicate that a maternal dietary intake rich in vegetables, fruits, and proteins (sources of glutathione, and antioxidants) and supplementation with folic acid and other vitamins could potentially reduce the risk of CAL. Although mechanisms remain unclear, bioactive components such as glutathione, carotenoids, vitamin A, C and E and, flavonoids, play a role in the DNA oxidation and repair, cell differentiation, proliferation, and apoptosis; while the effects of caffeine and chlorogenic acid in inhibiting Topoisomerase I and II may negatively affect DNA replication, transcription, recombination, and chromatin remodeling. Have you got a Conflict of Interest?: No
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2014 PILOTING THE FIRST CANCER SUPPORT TRUST FUND THROUGH ADVOCACY AND COLLABORATION IN NORTH WEST NIGERIA M. MUHAMMED BELLO1, H. KAKUDI2, S. UMAR JALO3, N. TIJJANI1 1 AMINU KANO TEACHING HOSPITAL, COMMUNITY MEDICINE, KANO, Nigeria, 2SAVE A LIFE CANCER AWARENESS AND SUPPORT NETWORK, KANO, Nigeria, 3COMMUNITY HEALTH AND RESEARCH INITIATIVE, PROGRAM MANAGER, KANO, Nigeria Amount raised:$6450 Background and context: Breast/cervical cancer is the most common type of malignant tumor in women worldwide. But cancer is not a death sentence as chances are that even the most malignant tumor can be cured successfully if it has been timely detected and properly diagnosed and treated. Most women especially in the rural areas are not able to afford treatment due to high out-of-pocket spending. As such traditional method of treatment is sort after rather than seeking medical help. On the 4th of February 2021, Save a life Cancer Awareness and Support Network ( SALCASUN) marked the WCD by collaborating withCommunity Health And Research Initiative (CHR) an NGO based in Kano to sign an MOU on establishing a Cancer Support Trust Fund in order to ease the cost of treatment for cancer patients. Aim:1-It is aimed at ensuring a sustainable financing mechanism for supporting less privileged cancer patients and survivors through the provision of yearly insurance coverage and payment for drugs. 2-To identify at least 50 less privileged cancer patients across the state for support and enrolled them in the Kano State Contributory Health Scheme by end of 2022 through payment of their premiums. 3-To improve the quality of life of less privileged cancer patients and survivors by reducing out-of-pocket spending for patients. Strategy / Tactics: TheTwo NGOs jointly established the first Cancer Support Trust Fund in February 2021 in other to support cancer patients in Kano. 2-An initial take-off grant of ₦500,000 ($1500)was donated by one of the founding NGOs (CHR) and a fundraising event was organized by SALCASUN where ₦500,00($1500) was raised and ₦700,000($1700) was donated again by CHR. 4- Aminu Garba Magashi (AGM) provided sponsorship for radio programs in other to increase awareness.5-Advocated for cancer patients to be included in the state health insurance scheme. Program process:The pilot study of the selection criteria was conducted in 3 tertiary health centers in the stateAminu Kano Teaching Hospital, Yusuf Maitama Sule University Teaching Hospital, and Murtala Muhammad Specialist Hospital. Vulnerable cancer patients were carefully selected by purposive sampling using standard criteria and ethical clearance was obtained from the health research ethics committees of the State Ministry of Health and Aminu Kano Teaching Hospital. Costs and returns:
Cost of funds raised Funds raised
$1678 $9450
What was learned: The major challenge is the availability of funds to enroll more patients. The National and State Health Insurance Schemes are not providing much range of services for cancer patients, thus the need to scale up. Replicability: Due to the high population in Nigeria, the replicability potential of establishing funds by other organizations or a consortium of organizations is feasible in other to raise funds to support out-of-pocket spending and help alleviate the economic situations for patients and their caregivers.
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Have you got a Conflict of Interest?: No
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2015 Alcohol causes cancer media campaign- raising public awareness amidst a global pandemic A. Rutter1, A. Lloyd1, S. Taylor1, T. Ghee1, L. Surtees1 1 Fresh and Balance, Salvus House, Durham, United Kingdom Background and context: Among those aged 15 -49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability. Drinking alcohol increases the risk of at least seven types of cancer. The UK Chief Medical Officers’ Low Risk Alcohol Guidelines states that “these risks start from any level of regular drinking and then rise with the amounts of alcohol being drunk.” We have also seen that awareness of the links between alcohol and cancer are not only low but falling. In 2020 we found only 33% of the North East (NE) population was aware that alcohol can cause cancer, down from 41% in 2019. To compound matters, alcohol use soared during the covid-19 pandemic in the NE and alcohol related deaths in England hit a record high during 2020 amid the pandemic. The solutions for tackling alcohol harm are complex, with price, promotion and availability all adding to the problem. However campaigns provide our public with a crucial “right to know”. Aim:The aim of the campaign from Balance (the UK’s only regional alcohol programme) is to provide the public with a compelling “stop and think” moment around alcohol following worryingly high levels of drinking during the pandemic and a record year for alcohol deaths. It is also to position alcohol much more closely to tobacco. Strategy: An integrated campaign ran for 5 weeks in November 2021 on TV, VOD, radio, online advertising on display and Facebook, partner toolkits and PR. Key target audiences were 40 plus men and women, targeting advertising towards lower income households with a view to tackling health inequalities. The campaign and materials were branded with NHS, Cancer Research UK and Balance logos. TV advert: https://fb.watch/cpxRzvy4b9/ Programme:Our primary message was to encourage people to reduce their alcohol drinking to reduce their risk, with resources to promote Balance’s ReducemyRisk.tv website and links to the Alcohol Change Try Dry app which is an all year round tool. Outcomes: An independent evaluation (701 people) found almost half of all people who saw the campaign took action as a result (including almost 3 in 5 increasing and higher risk drinkers) 61% recalled the campaign. Alcohol’s link with cancer was the strongest message take out, with 2 in 3 people identifying the key message that you can reduce your risk by cutting down alcohol consumption. 87% felt it was easy to understand the campaign message and 80% found the campaign messages believable. 57% agreed that the campaign made them more aware of the harms of drinking alcohol.What was learnt:It is vital that we increase the priority to addressing alcohol in relation to cancer and the public right to know of the clear links. The government has recently consulted on a new 10 year cancer plan for England and Balance has submitted to this with evidence provided of the urgent need for a comprehensive national alcohol strategy as we recognize that media campaigns are no magic solution on their own.
Have you got a Conflict of Interest?: No
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2016 Cancer Life reiMagined: The CaLM Model of Whole-Person Cancer Care R. Schear1, R. Richardson1, D.S.G. Eckhardt1, D.E. Kvale1, L. Cannon1, A. Luna1 1 University of Texas at Austin, Livestrong Cancer Institutes, Dell Medical School, Austin, United States Background: Cancer care traditionally focuses on treating disease, and deprioritizing emotional, financial, and practical support. Especially in countries with nascent infrastructure, it is commonly thought that delivery ofperson-centeredcancer care (measures/meets patient preferences/goals ), is too complex, costly, or simply infeasible. Aim: We developed and tested a new model of care which hardwired addressing the needs of the whole person while delivering treatment. It was built based on decades of research in chronic care across the US, Europe, Australia & Canada, building on the notion that high-quality care can be delivered if the system leverages appropriate human resources, supports patient experience, prioritizes empathy, and has a resilient environment for care teams. Strategy: The CaLM Modelhas 4 unique value propositions: Team-Based Care:oncologists & interdisciplinary experts working side by side on 1 care plan executed by NPs. PatientCo-Design. Measuring Outcomes that Matter: those prioritized by patients (capability, comfort, calm), inst. of measuring standard indicators. Flipped Approach: Patients receive a whole-person assessment at intake to triage support. At minimum, all receive pain and symptom management, mental healthcare, and navigation. Care is driven by RNs, MAs, and social workers.The Model delivered outpatient med onc. to 281 patients betw. Dec 2018 and Nov 2019. In addition to treatment for breast, head/neck/lung, GI, GYN, and heme malignancies, we offered symptom & med management, nutrition, emotional support, genetic counseling, oncofertility, survivorship, and integrative onc. We measured patient experience through 90 minute semi-structured interviews w/ 15 patients and deployment of online survey assessing access, communication, and care coordination. We assessed QOL through analysis of ePROs (anxiety, depression, symptom burden/interference, social, emotional functional well-being.) An 18 month chart abstraction evaluated utilization of supportive care services. Outcomes: Early data show that the Model reduces symptom burden, improves QOL, and radically improves patient experience. A comparison of baseline-endline scores shows a reduction in severe anxiety, depression, and physical symptoms and an increase in mild/moderate symptoms. Conclusion: The delivery of team-oriented care results in relational, empathic, and personalized care. CaLM shows promise to shift the care paradigm by demonstrating the feasibility and effectiveness of a meaningfully patient-centered model that builds a foundation for value-based payment. Person-centered care should not only be accessible in countries with developed cancer care infrastructure. There are basic tenets of person centered care from the model that we believe can be applied in middle income settings. Next steps include seeking input from a global audience and to assess feasibility of implementing the model outside the US in a phased approach.
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Have you got a Conflict of Interest?: No
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2018 Encourage a culture of online giving A. Mathew1 1 FOCP, marketing, Sharjah, United Arab Emirates Amount raised:450,000 AED (122,515.65 $) Background and context:Friends of Cancer Patients (FOCP) a UAE-based civil society organisation with a vision to see a world where cancer no longer has power over our lives. FOCP inspires hope in the lives of Patients, Families, Donors & Community. Since its inception in 1999, FOCP’s long-lasting and far-reaching impact on society has significantly transformed lives and provided support that people can rely on. Fundraising is essential for the survival and success of non-profit organizations. In fact, online fundraising campaigns are one of the primary focus of the organization to fulfill the fundraising targets. Before the advent of online fundraising, fundraising was primarily focused on obtaining as many donations as possible, but outreach efforts intoday’s competitive environment must now focus on other equally important objectives. Aim:Online fundraising campaigns capitalizing entirely on the digital media. Crowdfunding is one of the innovative method used to increase awareness and generate funding in a nonprofit organization via online. Also has become an effective way for organizations, schools & Individuals to raise funds for the charity. Online Fundraising campaigns also focus on:
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Raise Brand Awareness Acquire New Recurring Donors Welcoming Corporates & Individual donors
Strategy / Tactics: More than75% of donors prefer to give online. We have implemented 3 strategic pillars to increase online engagement with our donors to encourage a culture of online giving. 1.Attract:Fundraising strategy will help todefine the theme of crowd funding campaign pages and attract the donors. 2.Engage:Build creative campaigns that resonates with our community, and motivate and encourage our audience to give and participate in the campaigns. 3.Educate:Need to outline social causeand the charitable role of FOCP in providing access to treatment by helping cancer patients. Programme process: The process is simple. 1. To crowdfund, an organization, school or individual simply sets up a campaign pagein the approved crowd fundraising platform - www.yallagive.com 2. Start the campaign with thetarget amount. 3. Then, the crowd funderinvite and share the page with their larger network of contacts on social media to help raise the targeted fund.
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Costs and returns: Costs:Zero costs, because the campaign is drive by the fundraiser in their network contacts Returns: 450,000 AED (122,515.65 $) What was learnt: (if relevant, please also detail here the potential of replicability) Usefundraising toolsto compile reports that include data like how users engaged in the crowd funding campaign and their giving method and amount. This way, we can note which campaign were most successful and educate the fundraiser to create campaign accordingly in the future! You may also be able to identify areas for improvement. We learned from past campaigns to tweak and develop our crowd funding strategies. Have you got a Conflict of Interest?: No
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2023 Student-led Establishment of Multidisciplinary Tumor Boards In Pakistan: Our Experience U.J. Rao1, E. Tahir1, M. Abdul Rehman1, J. Khan2, K. Sohail2, A.M.H. Khan3, A.N. Abbasi3 1 Dow Medical College, Dow University Of Health Sciences, Karachi, Pakistan, 2Jinnah Sindh Medical University, Karachi, Pakistan, 3The Aga Khan University, Karachi, Pakistan Background and context: The idea of multidisciplinary tumor boards (MTBs) has been adopted by healthcare institutions worldwide and is an integral part of cancer-care (Specchia ML et al., 2020). Due to a paucity of resources, Pakistan has been slow to integrate MTBs (Abbasi AM et al., 2019). As a developing country, one way to overcome this hurdle is to make use of virtual MTBs (VMTBs) which are more feasible as compared to inperson MTBs (Abdul Rehman M et al., 2022). Aims: Formulate a plan for the amelioration of cancer-care disparity in Pakistan, by:
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Facilitating MTBs in low-resource settings Mass awareness and educational campaigns Mobilizing donation pools for non-affording patients
Strategy/tactics: Through the Tumor Board Establishment Facilitation Forum (TEFF), an independent student-led initiative, we developed a voluntary network of healthcare providers which supports TEFF in its operations and works to reduce cancer-care disparity in Pakistan. Programme/policy process:Since 2017, TEFF has employed a functional structure through which departments undertake responsibilities such as:
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Recruiting cancer-care providers for our network Communicating with hospital departments in order to assist VMTB formation Administrating VMTBs VMTB shadowing by students Awareness sessions Social media coverage Generating funds
Outcomes: Our first MTB was established in 2020 for the breast surgical unit of Dr. Ruth Pfau Civil Hospital, Karachi (CHK). We have since conducted 21 VMTBs for breast and gynecology units at CHK. 38 cases have been discussed in these VMTBs with adjustment of treatment plans. We are currently establishing an otolaryngology MTB at CHK and Jinnah Postgraduate Medical Center, Karachi. Our awareness campaigns have touched >3000 individuals. Data collection for future publications is under process. What was learnt:
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Students’ potential to pick up leadership roles and execute plans with persistence and collaboration Willingness and motivation of the targeted surgical departments were pivotal to success Trial-and-error helped form fool-proof strategies to advocate the importance of tumor boards in cancercare Altruism was instrumental in the accomplishment of our philanthropic goal
This is a novel student-led initiative to contribute to cancer care. Our success in establishing MTBs serves as a highly replicable model, and highlights the clinical impact undergraduates can make. Have you got a Conflict of Interest?: No
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2024 Investment cases for tobacco control in low- and middle-income countries G. Spencer1, B. Hutchinson1, R. Nugent1, N. Mann2, D. Tarlton3, R. Small4, D. Webb4 1 RTI International, Center for Global Noncommunicable Diseases, Research Triangle Park, United States, 2RTI International, Public Health Policy Science, Research Triangle Park, United States, 3UNDP, Health and Development, Istanbul, Turkey, 4UNDP, New York, United States Background: The FCTC 2030 project supports low- and middle-income countries in strengthening implementation of the WHO Framework Convention on Tobacco Control (FCTC). The project has partnered with 34 countries to further their work in tobacco control. One component of the support received is an investment case for tobacco control. An investment case analyzes the health and economic costs of tobacco use as well as the potential gains from scaled-up implementation of WHO FCTC measures. Aim: Given the heterogeneity in terms of tobacco use prevalence and current level of tobacco control implementation across countries, the investment cases aim to be adaptable and customized for the needs of each country to provide a strong policy tool to advocate for increased tobacco control measures. Methods: Each FCTC investment case includes two components, an economic analysis and an institutional context analysis (ICA). The economic analysis consists of two steps. The first step—assessing the current health and economic burden of tobacco use—involves estimating tobacco-attributable mortality and morbidity as well as the direct and indirect costs of tobacco use. The second step examines the impact that implementing new tobacco control policies or intensifying existing ones can have on reducing these costs. The ICA analyzes political and institutional factors, their incentives and constraints, and how they shape the likelihood of tobacco control success. Where data is available, we also undertake an equity analysis to understand how increases in tobacco taxes affect different socioeconomic groups. Results: The investment cases have found that tobacco use costs countries between 0.2 and 7.3% of GDP annually. Factors such as smoking prevalence, life expectancy, wage and employment rates, and health system capacity all impact the level of burden. By investing in tobacco control, countries can achieve a relative reduction in smoking prevalence of 10 to 39% and realize a returns on investment of over 1,000 per dollar invested. Due to relatively low implementation costs and high effectiveness, tobacco taxes often offer the highest return on investment. The FCTC investment cases have been used by policymakers, government officials, and Ministries of Health and Finance to promote stronger tobacco legislation in their countries. For example, in Georgia, the investment case presented in 2017 was used by Georgian policymakers to pass landmark tobacco legislation that includes prohibition of smoking in enclosed public spaces; bans advertising, sponsorship and promotion of tobacco products; and enforcement of plain packaging and health warnings. Conclusion: While the variation across countries and in the implementation of the investment cases makes comparing results difficult, the message is clear that customized investment cases show that tobacco use undermines economic growth and tobacco control efforts are worth the investment both in health and economic terms. Have you got a Conflict of Interest?: No
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2026 HPV DNA testing for Women Living with HIV visiting Women’s Health Program, CBCHS clinics M. Florence1, N. Calvin1, N. Kathleen1, M. Eveline1, S. Manga1 1 CBCHS, Women's Health, Bamenda, Cameroon Background and context: It is a well-established fact that HPV is about six times more prevalent in HIV patients than their HIV negative counterparts. Due to immunosuppression, high risk HPV infections persist in women living with HIV population and would often progress to cause cervical neoplasia. WHO recently instituted HPV DNA testing as primary test for cervical cancer across the globe based on adequate evidence from well-designed large randomized controlled trials and meta-analyses. Novel tests for oncogenic subtypes of HPV has improved on cervical cancer screening efficacy to about 95% hence making cervical cancer risk predictability higher.This write up summarizes the findings and lessons learnt from screening women living with HIV for cervical cancer using HPV DNA between January to December 2021 at the Women’s Health Program (WHP) of the CBCHS. Aim: The aim was for early diagnosis and treatment of precancers and cancers among people living with HIV in resource limited settings. Strategy / Tactics: Within CBCHS-WHP clinics a total of 3,468 were tested for HPV in 2021 among 620 (17.9%) were women living with HIV and receiving ART treatment in various care and treatment centers across the Country. Of these 620 women living with HIV, 320 (52.6%) were positive for oncogenic HPV types. A total 2690 were HIV negative with 792 (29.4%) testing positive for oncogenic HPV types. Women with unknown HIV status (158) were excluded from the analysis. This gave an estimated two times more positives found in HIV positive patients than their HIV negative counterparts Outcomes: These results indicate the need for HIV-cervical cancer screening integration so as to facilitate systematic screening of women living with HIV given the high positive rate recorded in them compared to their HIV negative counterparts. Efforts need to be made to ensure HPV DNA testing is made systematic in the HIV population. It will equally be necessary to evaluate barriers in uptake of HPV DNA testing in the HIV population. What was learnt: A systematic screening of people living with HIV will greatly reduce cervical cancer incidence and mortality in resource limited settings. Have you got a Conflict of Interest?: No
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2027 Food Biodiversity and Cancer risk in Nine European Countries: an Analysis of a Prospective Cohort Study I. Huybrechts1, G.T. Hanley-Cook2, C. Biessy1, B. Chimera1, M. Deschasaux3, M. Touvier3, E. Kesse-Guyot3, B. Srour3, C. Casagrande1, G. Nicolas1, J. Blanco Lopez1, C.J Millett4, K.A Murray5, P. Vineis6, C. Lachat2, M. Gunter1 1 International Agency for Research on Cancer, Nutrition and Metabolism Branch, Lyon, France, 2Ghent University, Department of Food Technology, Safety and Health, Ghent, Belgium, 3Sorbonne Paris Nord University, Nutritional Epidemiology Research Team (EREN), Bobigny, France, 4Imperial College London, Public Health Policy Evaluation Unit, School of Public Health, London, United Kingdom, 5Imperial College London, MRC Centre for Global Infectious Disease Analysis, School of Public Health, London, United Kingdom, 6Imperial College London, Department of Epidemiology and Biostatistics, School of Public Health, London, United Kingdom Background Promoting diversity in human diets has potential co-benefits for both public health and sustainable food systems. Recent analyses demonstrated a significant inverse association between food biodiversity and total mortality, as well as cause-specific mortality, including deaths due to cancer. However, current evidence on potential protective effects of food biodiversity on cancer risk is limited. Aim These analyses aim to assess how Dietary species richness (DSR) is associated with cancer risk in European populations. Methods We examined the associations between DSR and subsequent cancer risk among 450,111 adults enrolled in the European Prospective Investigation into Cancer and Nutrition Study (EPIC, initiated in 1992), free of cancer, diabetes, heart attack, or stroke at baseline. Usual dietary intakes were assessed at recruitment with countryspecific dietary questionnaires. DSR of an individual’s yearly diet was calculated based on the absolute number of unique biological species in each (composite) food and drink. Associations were assessed by fitting multivariableadjusted Cox proportional hazards regression models. Results During a median follow-up time of 14.1 years (SD=3.9), 53,187 cases were diagnosed with cancer. Hazard ratios (HRs) and 95% confidence intervals (CIs) comparing overall cancer risk in the 2nd, 3rd, 4th, and 5th (highest) quintiles of DSR to the 1st (lowest) quintile indicate significant inverse associations, after stratification by sex, age, and study centre and adjustment for smoking status, educational level, marital status, physical activity, alcohol intake, total energy intake, Mediterranean diet score, red and processed meat intake, and fibre intake [HR (95% CI): 1.02 (0.99-1.05), 0.98 (0.94-1.02), 0.95 (0.91-0.99), and 0.95 (0.90-1.00), respectively; PWald<0·001 for trend]. Significant inverse associations were also observed between DSR and the incidence of specific cancer types, namely, Oropharynx, Oesophageal, Proximal colon and lung cancer (p<0.005 for all cancer types). An important study limitation is that our findings were based on an observational cohort using self-reported dietary data obtained through single baseline food frequency questionnaires; thus, exposure misclassification and residual confounding cannot be ruled out. Conclusions In this large Pan-European cohort, higher DSR was inversely associated with overall cancer risk and the risk of specific cancer types, independent of socio-demographic, lifestyle, and other known dietary risk factors. These analyses should be validated in cohorts with repeated dietary intake measurements in order to consider potential changes in food consumption over time. Have you got a Conflict of Interest?: No
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2028 Cancer Registration in Nigeria: Challenges and Interventions J.A. Adediji1,2, D.E. Babatunde3, R. Huss2 1 University of Benin Teaching Hospital, Centre for Training Community Health Officers, Benin City, Nigeria, 2University of Leeds, Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, Leeds, United Kingdom, 3Bowen University, Department of Anatomy, Iwo, Nigeria BACKGROUND OF STUDY Over 100,000 Nigerians are diagnosed with cancer annually, and about 80,000 died from it. This is likely to be an underestimate because of paucity of reliable information due to poor functioning of cancer registry and registration system in Nigeria probably because Cancer registry/registration (CR/CRn) is not yet an integral part of cancer control in Nigeria. Nigeria is predicted to expect a 75% increase in cancer-induced death by 2030 (Morounke et al., 2017) and there is an urgent need to fight this rise in cancer burden. AIM AND OBJECTIVES The aim of this study is to analyse the challenges of cancer registration and identify feasible strategies of improving cancer registration in Nigeria. The objectives include reviewing the status of cancer registration; analysing the challenges and success stories of cancer registration; identifying and appraising possible intervention strategies to improve cancer registration. METHODOLOGY This in-depth study uses secondary data obtained from published and unpublished documents to analyse the challenges of CRn in Nigeria and propose possible intervention strategies to improve CRn in Nigeria through review of success stories in Guam, South Africa, Brazil, Turkey, Columbia, and China with similar context like Nigeria. The conceptual framework adopted for this study is called Cancer Registry Framework (CRF) which is a combination of social ecological model of McLeroy et al., (1988) and the key indicators of cancer registry described by Piñeros et al., (2017) including analytical criteria proposed by Walley, and Wright (2010). FINDINGS The major challenges of CRn are poor attitudes of stakeholders; poor education/training; lack of registry-specific funding; and non-availability of oncology care services. Several interventions were identified e.g., behaviour change communication, education/training, optimization of the use of IT for data collection, advocacy and mass media, organizational reformation of CR system, integration of cancer registration, and provision of registryspecific funds via tobacco tax and making cancer a registrable disease. RECOMMENDATIONS It is highly recommended that the Federal Ministry of Health in collaboration with concerned stakeholders should revitalize the organization of the cancer registry system by establishing a National Cancer Registry fully owned by the Federal Government of Nigeria which will in-turn establish new Population based Cancer Registries in states without CRs; formulate, enact, and implement laws and policies that will allocate tobacco tax for cancer registryspecific funding in Nigeria. KEYWORDS Cancer registry, Cancer registration, National System of Cancer Registries, National Cancer Registry, Population Based Cancer Registry, Hospital Based Cancer Registry. Have you got a Conflict of Interest?: No
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2030 : The role of ICAM1 in glioblastoma tumor associated macrophages under hypoxic conditions. K. Devaraja1, S. Mansouri2,3 1 University of Toronto, Institute of Medical Science, Scarborough, Canada, 22. MacFeeters-Hamilton Center for Neuro-Oncology Research, Toronto, Canada, 3University of Toronto, Toronto, Canada Background: Glioblastoma (GBM) is an aggressive and highly fatal brain cancer in adults. Existing treatment methods are ineffective and we are in need of new treatments that extend the overall survival and improve quality-of-life. Cell adhesion molecules (CAMs) are proteins that enable cells to communicate with one another and the surrounding environment. Intracellular adhesion molecule 1 (ICAM1) is a CAM expressed by TAMs in GBM. Tumour associated macrophages (TAMs) are thought to enhance tumour growth and proliferation, particularly within the characteristic hypoxic tumour microenvironment (TME) of GBM. I hypothesize that the expression of ICAM1 on the surface of TAMs contributes to GBM cell invasiveness, especially in the hypoxic TME, by enhancing the interaction between tumour cells and macrophages, thereby facilitating the migration and invasion of the tumour. cells. Aim: My project aims to determine if ICAM1 expression in TAMs contributes to GBM tumourigenicity, uncover the mechanism of this behaviour and if there are biological-sex related differences associated with its function in macrophages. I hypothesize that the expression of ICAM1 on the surface of TAMs contributes differently to male and female GBM cell invasiveness, especially in the hypoxic TME, by enhancing the interaction between tumour cells and macrophages, thereby facilitating the migration and invasion of the tumour cells. Methods: Assess the expression levels of ICAM1 in primary and immortalized human and mouse macrophages under hypoxic conditions (1% O2, 0.2% O2, and HIF stabilizing drug IOX4) using Western Blotting and RT-PCR. Analyze the effect of ICAM1 deficiency on macrophage behaviour including migration, proliferation, and adhesion to tumour cells using alamar blue and transwell migration assay. The results were analyzed using statistical analysis method descriptive statistics. Results: ICAM1 is highly expressed in different cell types within the GBM microenvironment, including TAMs. The expression is particularly enhanced when primary or immortalized macrophages are treated with tumour cellconditioned medium in vitro and is further exacerbated upon incubation of these cells in a hypoxic chamber at 1% and 0.2% oxygen levels and treatment of HIF-stabilizing drug IOX4. The migration levels of bone marrow derived macrophage mouse cell type is higher in wild type cells than in ICAM1 deficient cells. Migration levels are higher when wild type and ICAM1 deficient cells are co-cultured with tumour cell condition media then without. Conclusion: It is evident that the hypoxic tumour microenvironment increases the expression of ICAM1 in macrophages. ICAM1 increases macrophage migration levels when co-cultured with and without tumour cell condition media. The tumour microenvironment increases migration levels of macrophages. The expression of ICAM1 in TAMs in hypoxic TME promotes GBM cell invasiveness and migration. Have you got a Conflict of Interest?: No
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2032 Developing an Innovative Mechanism to Measure Patient Experience R. Schear1, R. Richardson1, R. Boaz1 1 University of Texas at Austin, Livestrong Cancer Institutes, Dell Medical School, Austin, United States Background: Patient experience is rapidly becoming a more cutting edge domain to assess to evaluate personcentered care, compared to patient satisfaction. There are several well-known validated tools in the literature that measure patient experience (PX) such as communication and access to care. However, no single tool encompasses a comprehensive set of domains. Further, with the onset of COVID-19 and turn towards digital communication and telehealth, many care systems are seeing rates of patient engagement drop drastically, resulting in the need for innovative engagement mechanisms to receive feedback on PX and care delivery. Aim: We aimed to develop and deploy a novel PX survey, and mitigate response barriers in order to achieve at least a 30% response rate. Methods: We conducted a systematic review of the literature to determine validated tools for measuring PX. Our review resulted in over 12 tools from US, Canada, Australia, and Europe including the AOPSS, CPEQ, CAHPS, P3CEQ, NCPES, PPPC-R, CER, and others, which we analyzed in depth tool by tool. Working with our patient advisory boards, we received IRB approval, and determined the domains questions we would build into the tool. Domains included: Whole Person Care, Communication, Care Coordination, Empowerment and Access to Care. These domains are previously defined core components of the CaLM clinic model (bit.ly/3Ab8z06). Questions were taken from different validated patient experience surveys such as the Patients’ Perceptions of PatientCenteredness Questionnaire (Ryan et al. 2019), Cancer Patient Experience Questionnaire (Iversen et al. 2012), Medical Care Questionnaire (MCG) for oncology outpatients (Harley et al. 2009), Trust in Oncologist Scale – short form (Hillen et al. 2017), and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Cancer Care Survey Version: Drug Therapy (Evensen et al. 2019) and other team-generated questions are specific to the CaLM Model. With the co-design of our patient boards, we worked through two drafts of the PX tool, and then sought patient advisor input at a third working session to fine tune the format, language, look and feel of the tool in the platform they selected (REDCAP). Patient advisors tested the tool before deployment, and the survey was sent via a Twilio integration in April of 2022 through SMS to over 400 patients’ cell phones for a 30 day completion window. Quantitative and qualitative analysis is underway. Results: Patients and loved ones spent an average of 12 hours per week managing their care. The majority of patients reported that providers considered their thoughts and feelings; respected their beliefs, values and customs, and encouraged patients to take the role they wanted in their own care. Conclusion: Though measuring PX is challenging in a post-COVID world, by collaborating with patient advisors in design and deployment of PX research, we can successfully implement patient-centered tools with a higher response rate. Have you got a Conflict of Interest?: No
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2035 Para-aortic surgical staging in locally advanced cervical cancer: A single institutional experience L. Li1, D. Zou1, Y. Tang1 1 Chongqing University Cancer Hospital, Department of Gynecologic Oncology, Chongqing, China Background: Para-aortic lymph nodes (PALNs)status isan important prognostic factor for survival in patients with cervical cancer anda key point for individualizing treatment in patients with locally advanced cervical cancer (LACC). Aim: The aim of the study is to assess the safety and efficacy of laparoscopic or robot-assisted para-aortic lymphadenectomy (with orwithout pelvic lymphadenectomy) in the setting of surgical staging of patients with LACC. Methods: Data from 251 patients with LACC who underwent para-aortic surgical staging and chemo-radiation therapy, treated at the Gynecologic Oncology Department of Chongqing University Cancer Hospital between January 2016 and December 2020, were retrospectively analyzed. Results: Surgical staging was performed via the laparoscopic approach in 74.1% (186 of 251) of patients and robotic in 25.9% (65 of251) of patients. Of these,196 patients underwent pelvic lymphadenectomy. Metastatic lymph nodes (LN) were identified in 95 patients (37.8%), 42 (16.7%) had positive PALNs and 29 (11.5%) had metastatic LN in the pelvic and para-aortic area. Up staging occurred in 25.9% of patients who underwent surgical staging, This approach allowed the modification of the initial treatment plan in the para-aortic area in 20.7% of patients and in the pelvic area in 22.3%. Mean operative time was 135 min (SD +/- 52.4). Mean blood loss was 73 ml (SD +/- 92.5). Mean time from surgery to initiation of radiotherapy was 12 days (SD +/- 7.9). The overall intraoperative morbidity rate was 4.4%, while the postoperative morbidity rate was3.98%, with only 6 patients presenting grade 3 morbidity. Conclusion: Laparoscopic or robotic-assisted para-aortic and (or) pelvic lymphadenectomy provides precise information about nodal state and allows personalized treatment planning in patients with LACC. It was not associated with higher rates of early toxicity during chemoradiation or a delay in treatment. Have you got a Conflict of Interest?: No
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2041 Pacific Island Cancer Control: The Pacific Cancer Initiative N. Palafox1, M. Reichhardt2, J. Taitano3, V. Tofaeono4, R. Leon-Guerrero5, H. Robinett6, L. Buenconsejo-Lum7, J. Baksa8 1 University Of Hawaii Cancer Center, Population Science in the Pacific, Honolulu, United States, 2Yap State, Comprehensive Cancer Program, Cancer Programs, Kolonia, Micronesia, Federated States of, 3Cancer Council of the Pacific Islands, Tamuning, Guam, 4American Samoa Community Cancer Coalition, Tafuna, United States, 5University of Guam, Guam Cancer Center, Tamuning, Guam, 6University of Hawaii Cancer Center, Population Sciences, Honolulu, United States, 7University of Hawaii, John A. Burns School of Medicine, Honolulu, United States, 8University of Hawaii, Department of Family Medicine and Community Health, Honolulu, United States INTRODUCTION: Six Pacific Island jurisdictions, including 3 sovereign nations (Republic of Palau, Federated States of Micronesia, Republic of the Marshall Islands (RMI)) and 3 United States Territories (Commonwealth of the Northern Marianas, Guam, American Samoa) suffer from heavy cancer burdens. The capacity of each respective jurisdiction to manage cancer across the screening, diagnostic, treatment and survivorship continuum is limited due to limited health finances, a limited health workforce to manage cancer burdens, and underdeveloped cancer screening programs. The cancers are in part attributable to several preventable cancer risk factors. The Pacific region has high rates of Hepatitis B infection, prevalent obesity, prevalent smoking and areca nut use, high rates of chronic Human Papilloma Virus (HPV) infection, and a 12-year history of nuclear testing in the RMI. The human and financial cost of cancer has adversely affected the development of the health care systems and economic development. Beginning in 1997, these Island jurisdictions began a regional effort to plan a strategic path to systematically address the rising cancer burden called the Pacific Cancer Initiative (PCI). AIM: Through systematic comprehensive cancer prevention and control planning, linked to community organization as well as regional partnership building and shared goals, cancer prevention and control can be systemically addressed in the isolated, rural and resource- limited Pacific island settings. STRATEGY: The core strategic elements of the PCI Initiative aimed to develop a Pacific regional organization with shared cancer elimination goals that could adequately represent the 6 Pacific jurisdictions. Facilitating cancer coalitions with multi-level stakeholders to develop community-based and data-informed comprehensive cancer control plans at the jurisdiction and regional levels, implementing a regional cancer data system for data-driven decision making, and developing a cancer research program for the region were essential activities of the PCI. Each part of development was dependent on the former stage. The theoretical framework for development of the organizational structure and work was based on the socio-ecological model of health. OUTCOMES: The PCI has founded multi-stakeholder cancer coalitions in all 6 jurisdictions; the Cancer Council of the Pacific Islands - a regional cancer coalition; a regional population-based cancer registry; the development of sequential 5-year Comprehensive Cancer Control Plans at the jurisdiction and regional levels; evidence-based public health practice programs ; resource appropriate cancer screening development; and priority-based cancer research for the Pacific. LESSONS LEARNED: A Pacific regional, community-based, multi-stakeholder, comprehensive cancer control strategy is effective to galvanize funding efforts, understand and manage cancer prevention and control, and sustain local cancer research efforts in the Pacific. Have you got a Conflict of Interest?: No
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2042 Working towards a Smokefree workforce in the NHS - a regional 'staff tobacco dependency project' R. Sharrock1, R. McIlvenna2, C. Barry1 1 NENC ICS - Tobacco Workstream, Queen Elizabeth Hospital, Gateshead, United Kingdom, 2Fresh - Balance, Salvus House, Durham, United Kingdom Background: The North East and North Cumbria Integrated Care System (NENC ICS) has the largest footprint of any ICS in England, and has oversight of ten Foundation Trust (FT) Acute Hospitals and the North East Ambulance Service. NENC ICS chose to support the implementation of the NHS Long Term Plan - Tobacco Dependency Treatment Services (TDTS), at scale, in all FTs, within the first year of implementation. This ambitious project has required additional consideration of interventions to facilitate culture change amongst front line colleagues to enable support and 'buy in' for this critical agenda. In particular, NHSE funded a pilot 'Staff Tobacco Dependency Offer' (STDO) to be delivered across the region, providing free stop smoking support/products to all who registered. Aims: 1 - To recruit NHS employees, who were dependent on tobacco, to a 'quit attempt', with an offer that covered a large geographical footprint and diverse staff groups, with the principle of 'barrier-free access' to stop smoking support/products. 2 - To ascertain the factors that determine the success of this type of intervention and any specific requirements of NHS staff as a sub group of smokers requesting support. 3 - To analyse the 'reach' of this intervention by employment group/ demographics - to ensure that it does not widen health inequalities, but delivers resource to those who otherwise would not engage in existing services. 3 - To consider the whole system benefits of pursuing a 'smokefree' workforce as a support to the implementation enhanced inpatient tobacco dependency services, and the applicability to other employing organisations. Methods: We mobilised the STDO in December 2021, with a simple screensaver/ poster that was circulated across all FTs. This encouraged staff who smoked to register to receive free products (NRT or e-cigarettes) and behavioural support via either a QR code, an email address or a mobile telephone number which could receive calls or SMS. They were then contacted to provide a consultation to advise product choice, offer behavioural support and arrange delivery at a time and location to suit them. Outcomes are recorded at 4 and 12 weeks. Service evaluation questions are asked at 4 weeks, and participants have also been invited to interview for qualitative analysis. Results: Over 1100 staff members signed up to the initiative within the first three months, and outcome measures are still being recorded. Provisional results of note are that >60% of registrants had not previously accessed stop smoking services, despite them being available in 9/10 localities. >750 registrants requested cigarettes to form all or part of their quit attempt. The predominant staff groups at the outset were admin/clerical, and nursing/midwifery. However as we moved to word of mouth referrals only, we are seeing 50% of registrants from Routine and Manual Groups. Conclusion: A proactive, flexible, 'barrier free' STDO is a critical tool for smokefree workplaces. Have you got a Conflict of Interest?: No
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2046 Cancer Epidemiology and Burden in Jordan,2014-2018. O. Nimri1,2 1 Jordan CancerRegistry, Cancer Prevention Dept., Amman, Jordan, 2Ministry of Health., Cancer Prevention Department., Amman, Jordan Background: Jordan lately celebrating its 100th anniversary as a state, a centenary of achievements and challenges. The cancer burden in theHashemite Kingdom of Jordan is a challenge, as well as a success. The influx of huge number of displaced refugees to Jordan in a short period was one of those challenges, specially to the health system and cancer care. As a new UICC member, we would like to share our data. Aim: Epidemiology provides information about the burden of cancer and its risk factors. Data can provide policymakers and health providers, as well the interested individuals, the guide for cancer prevention and ways to evaluate cancer prevention and control. Methods: Cancer data was obtained from the national population-based Jordan cancer registry, which collects cancer incidence data from all inhabitants in the country, both Jordanians and Non-Jordanians. Retrospective 2014-2018 period adult cancer data was analyzed. Results: Data figures showed a total of 42,236 (48.1% male and 51.9% female) incidences were recorded among all populations including the huge influx of refugees. 29,660 (70.2%) were Jordanians, Non-Jordanian 12,576 (29.8%). Refugees’ main nationalities are Iraqis (5.7%), Libyans (5.5%), Yemen (3.8%), Syrian (3.5%), and Palestinians (3.2%). The top three cancers among the non-Jordanian population of males were; Colorectal (799 cases,12.8%), Lungs (575 cases 9.2%) Leukemia (412 cases 6.6%) while in females; Breast (2,412 cases 37.8%), Colorectal (606 cases 9.6%), Thyroid (366 cases, 5.7%). Jordan population incidences of Colorectal top the list with (1,849 cases 13.1%), followed by Lung (1,705 cases 12 %) then Urinary Bladder (1,228 cases 8 %) while in females; Breast (6,185 cases 39.7%), Colorectal (1,456 cases 9.3%), Thyroid (995 cases, 6.4%). Conclusion: Results showed a very high similarity of occurring cancers among Jordanian and non-Jordan people, which could have indication of some common risk factors among regional individuals. On the other hand, Jordan does not have an endorsed national cancer control strategic plan (NCCP). Which is one of the top primacies in the national cancer control issue in the country, which can arrange and organize the whole cancer continuum, from prevention, early detection, diagnosis, treatment, and palliative care.
Have you got a Conflict of Interest?: No
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2047 Predictive Value of the lipoprotein(a) in Prognostic of Rectal Cancer Patients with Neoadjuvant Treated S. Li1, R. Wei1, G. Yu1, Z. Jiang1 1 National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China Background: Background: According to the National Comprehensive Cancer Network (NCCN) guidelines, local advanced rectal cancer (LARC) patients should be treated with neoadjuvant chemoradiotherapy (nCRT) combined with surgery plus adjuvant chemotherapy. The nCRT can reduce the tumor burden, and local recurrence rate, as well as improve the R0 resection rate and anus preservation rate of LARC. However, it cannot be ignored that approximately 20%-46% of LARC patients with available postoperative pathological data showed that the tumor cells did not regress significantly or even not at all. Aim: This study aimed to explore the predictive value of the lipoprotein(a) in overall survival (OS) and disease-free survival (DFS) of LARC patients treated with nCRT. Methods: A total of 296 LARC patients undergoing nCRT with total mesorectal excision (TME) were enrolled. Preoperative clinical features and postoperative pathological characteristics were collected. Cox regression analysis was performed, and a Cox-based nomogram was developed to predict OS and DFS. We also assessed the predictive performance of the nomogram with calibration plots and the receiver operating characteristic (ROC) curves. Results: Among 296 patients, the median lipoprotein(a) before nCRT (pre-LPa) was 25.2 nmol/L (interquartile range, IQR: 11.5 nmol/L-58.6 nmol/L). In the Cox multivariate regression analysis, we found that pre-LPa, nCRT with surgery interval, ypTNM stage, tumor regression grade (TRG), vascular invasion, and carbohydrate antigen 19-9 before nCRT (pre-CA19-9) were predictors of OS. Meanwhile, pre-LPa, nCRT with surgery interval, ypTNM stage, TRG, and vascular invasion were predictors of DFS. The predictive nomograms were developed to predict 3-years OS, 5-years OS, 3-years DFS, and 5-years DFS with an area under the ROC curve (AUC) of 0.8262, 0.8497, 0.7493, and 0.7406, respectively. Good statistical performance on internal validation was shown by calibration plots and ROC curves. Conclusion: In conclusion, this study demonstrated that pre-LPa was an independent prognostic factor for OS and DFS in LARC patients treated with nCRT followed TME. Nomograms incorporating pre-LPa, nCRT with surgery interval, ypTNM stage, TRG, vascular invasion, and pre-CA19-9 could be helpful to predict the OS and DFS. Have you got a Conflict of Interest?: No
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2048 Predictive Value of the Indirect Bilirubin in Prognostic of Rectal Cancer Patients with Neoadjuvant Treated S. Li1, R. Wei1, G. Yu1, Z. Jiang1 1 National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China Background: According to the National Comprehensive Cancer Network (NCCN) guidelines, local advanced rectal cancer (LARC) patients should be treated with neoadjuvant chemoradiotherapy (nCRT) combined with surgery plus adjuvant chemotherapy. The nCRT can reduce the tumor burden, and local recurrence rate, as well as improve the R0 resection rate and anus preservation rate of LARC. However, it cannot be ignored that approximately 20%-46% of LARC patients with available postoperative pathological data showed that the tumor cells did not regress significantly or even not at all. Aim: This study aimed to explore the predictive value of the indirect bilirubin (IBIL) in overall survival (OS) and disease-free survival (DFS) of LARC patients treated with nCRT. Methods: A total of 324 LARC patients undergoing nCRT with total mesorectal excision (TME) were enrolled. Preoperative clinical features and postoperative pathological characteristics were collected. Cox regression analysis was performed, and a Cox-based nomogram was developed to predict OS and DFS. We also assessed the predictive performance of the nomogram with calibration plots and receiver operating characteristic (ROC) curves. Results: Among 324 patients, the median IBIL before nCRT (pre-IBIL) was 6.2 umol/L (interquartile range, IQR: 4.6 umol/L -8.4 umol/L). In the Cox multivariate regression analysis, we found pre-IBIL, smoking history, tumor regression grade (TRG), vascular invasion, and carbohydrate antigen 19-9 before nCRT (pre-CA19-9) were predictors of OS. Meanwhile, pre- IBIL, BMI, nCRT with surgery interval, TRG, and vascular invasion were predictors of DFS. The predictive nomograms were developed to predict 5-year OS and 5-year DFS with an area under the ROC curve (AUC) of 0.7518 and 0.7355, respectively. Good statistical performance on internal validation was shown by calibration plots and ROC curves. Conclusion: In conclusion, this study demonstrated that pre-IBIL was an independent prognostic factor for OS and DFS in LARC patients treated with nCRT followed TME. Nomograms incorporating pre-IBIL, BMI, smoking history, nCRT with surgery interval, TRG, vascular invasion, and pre-CA19-9 could be helpful to predict the OS and DFS. Have you got a Conflict of Interest?: No
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2054 Accelerating declines in smoking prevalence among Aboriginal and Torres Strait Islander peoples S. Wells1, R. Maddox1 1 Australian National University, Canberra, Australia Background and context: Despite Australia being seen as a world leader in commercial tobacco control,smoking is the single biggest contributor to the burden of disease, with substantial racialised inequities. Over a third (37%) of Aboriginal and Torres Strait Islander deaths are attributable to tobacco use, increasing to 50% of deaths among those aged ≥45 years and a leading cause of cancers. We have recently witnessed declines in smoking among Aboriginal and Torres Strait Islander population. However, daily smoking prevalence remains at 40.2% among Aboriginal and Torres Strait Islander peoples overall,5,6 nearly four times as high as the general population (11.6%). Such racialised inequities reflect the use of commercial tobacco as a weapon of colonisation, embedded and exploited by colonisers in first encounters as a gesture of goodwill, and soon becoming a valued commodity; resulting in dangerous implications for Indigenous peoples. Aim: To prevent and eliminate tobacco related harms, including tobacco related cancers. Strategy / Tactics: Are embedding structural and social supports to eliminate tobacco related death and disease, including tobacco related cancers the next logical steps to preventing and eliminating tobacco related harms? Programme / Policy process: Tobacco control is defined as “a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke”. This presentation reports the attitudes and beliefs regarding tobacco control in Aboriginal and Torres Strait Islander contexts, aiming to accelerate declines in smoking prevalence in the Aboriginal and Torres Strait Islander population. Outcomes: There are immediate ongoing opportunities to accelerate reduction in smoking prevalence through a comprehensive approach to tobacco control, including by not limited to expanding: 1. Monitoring compliance of retail supply 2. Advertising and promotion at retail premises 3. Supply of smoking products 4. Sale of smoking products by minors 5. Smoking at liquor-licensed venues 6. Smokefree outdoor eating and drinking Incorporating perspectives of Aboriginal and Torres Strait Islander peoples and community-controlled organisations may help to shift attention away from individual blame and personal responsibility, to focus on commercial tobacco and the Tobacco Industry as the issue promoting, marketing and selling products to actively undermine peoples agency, self-determination and sovereignty, ultimately to be free from nicotine dependence. What was learnt: Further embedding structural and social supports to eliminate tobacco related death and disease are required to prevent tobacco related harms. Have you got a Conflict of Interest?: No
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2055 S100A7 as a driver of immunosuppressive tumor microenvironment shed light on immunotherapy in LUSC C. Liu1, J. He1 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Chile Background:The use of immune checkpoint inhibitors (ICIs) has drastically improved the prognosis of lung squamous cell carcinoma (LUSC) patients with limited treatment options, however only certain cases can fully benefit from ICIs. In our previous studies, S100A7 has been reported to accelerate tumor progression by activating the p-ERK pathway in LUSC. Aim: This study aimed to elucidate the role of S100A7 in the tumor immune microenvironment (TIME) and immunotherapy efficacy in LUSC. Methods: Immunohistochemical analysis of PD-L1 expression and CD8+ tumor infiltrating lymphocytes (TILs) was applied to investigate the correlation between S100A7 expression and TIME. The mechanism of S100A7 regulating PD-L1 expression and infiltration of CD8+TILs was then explored. Based on a mouse model and a clinical cohort, the association between S100A7 expression and the efficacy of ICIs was also analyzed. Results: Immunohistochemical results revealed that S100A7 expression correlates with an immunosuppressive TIME as characterized by low PD-L1 expression and low CD8+T cells infiltration. Notably, a negative relationship between S100A7 expression and both CXCL9 expression and CD68+macrophage count was also observed in LUSC samples, which may further lead to a decrease in CD8+T cells. Our in vitrostudies showed that S100A7 deregulates PD-L1 and CXCL9 expression in tumor cells by activating the p-AKT pathway. Upregulation of S100A7 in LUSC murine models dampened the anti-tumor response elicited by immunotherapy. In contrast, targeted inhibition of S100A7 may enhance the efficacy of immunotherapy by yielding an inflammatory phenotype. Furthermore, based on our cohort of LUSC patients treated with ICIs, we have identified that the baseline plasma level of S100A7 was higher in patients with progressive disease. The predictive value of S100A7 for immunotherapy response was then confirmed with an area under the curve of up to 0.869 and was found to be an independent predictive biomarker. Conclusion: This study deepened in the understanding of the role played by S100A7 in the TIME, offering a novel insight of its mechanism of action on immunotherapy resistance. Our results indicate that S100A7 may emerge as a powerful predictive tool for ICIs and S100A7 targeted therapy may help to expand the benefits of immunotherapy in a wider population of LUSC patients. Have you got a Conflict of Interest?: No
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2058 If cancer doesn't discriminate, why should we? A. de Cima1, E. Puente2 1 American University of Paris, Paris, France, 2Universidad Iberoamericana, Mexico City, Mexico If cancer does not discriminate, why should we? The effects of discrimination in people's lives end up isolating them, depriving them of their rights and subjecting them to inequality in exercising them. Social stigmas normalize a difference in treatment towards those who do not fit or comply with the parameters of historically accepted conceptions. In Mexican culture, as in many other Latin American countries there are multiple prejudices that are rooted in the private and public spheres against different minorities. Fundación CIMA, true to its founding vision of reaching the underserved communities in Mexico, has taken a step forward towards making thetransgendercommunity’s challenges visible, when they refer to breast cancer; creating customized messages and integrating them into the discourse, dissemination and narrative of our awareness campaigns; promoting public policy to improve their access to health care conditions, is a first step towards equality. For CIMA it is imperative to lead the change in reaching out to this minority in the same manner that over twenty years we have strived to ensure the awareness, timely detection and timely access to medical care in breast cancer. To cite one of the studies consulted, we refer to the one conducted in the Netherlands in 2018, (BMJ 2019;365:l1652), with which it is reported that given the use of hormonal therapies, there is a small increased risk for transgender women compared to people born male, and a lower risk in transgender men compared to people born female. This suggests that hormone treatments alter the risk of breast cancer regardless of sex at birth. We will join this minority by denouncing the rejection, delay and disregard they often suffer when seeking medical attention in public health services. Gender change in Mexico should be considered a health issue, currently it is not. It is a priority to push for improvements in our health system, considering all of us. There will be no real progress if public policies and the national health system continue to exclude care and access to the appropriate and quality hormone therapies required by the transgender community, as well as the medical care that derives from them. On June 28th, Gay Pride Day in Mexico, which also celebrates diversity and the transgender community, we will launch the first nationwide campaign that gives visibility to this community regarding the care and rights they have in relation to the problem of breast cancer. Messages: - We celebrate who and how you are. - We are all human beings, let's demand our health rights together. - We are talking to you too, you are also at risk. - Prolonged Hormonal therapies can increase the risk of breast cancer. Let's demand diagnostic studies. - We all deserve efficient and timely health services. - If cancer doesn't discriminate, why would we? - Either everyone has access to health services, or the system doesn't work Hashtags: #CimaTeVe (CIMA sees you) #TransCommunity Have you got a Conflict of Interest?: No
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2060 Reproductive, lifestyle, and familial risk factors associated with breast cancer in Nepal A. Rana1, M. Neupane2, P. Pyakurel3, R.B. Sah3, A. Ghimire3, N. Lamichhane4, D. Singh5 1 B. P. Koirala Memorial Cancer Hospital, Department of Cancer Prevention, Control and Research, Bharatpur, Nepal, 2B. P. Koirala Memorial Cancer Hospital, Department of Radiodiagnosis Imaging and Nuclear Medicine, Bharatpur, Nepal, 3B. P. Koirala Institute of Health Sciences, Dharan, Nepal, School of Public Health and Community Medicine, Dharan, Nepal, 4B. P. Koirala Memorial Cancer Hospital, Department of Surgical Oncology, Bharatpur, Nepal, 5International Agency for Research on Cancer, Cancer Surveillance Branch, Lyon, France Background: Breast cancer is the second most common cancer among females in Nepal and is expected to become the leading cancer site in terms of number of cases and deaths. Various risk factors related to changes in lifestyle and reproductive behavior that could possibly be linked to this disease are identified by several studies conducted in Western countries. In the past several years, Westernization of diet and changes in reproductive behavior among Nepalese women could possibly be linked to the increase in number of cases. A better understanding of risk factors in the local context could help design effective strategies for breast cancer prevention and early detection. Aim: The aim of this study is to assess the association of various risk factors with breast cancer in Nepal. Methods: A hospital-based case-control study was conducted at the largest cancer hospital (B. P. Koirala Memorial Cancer Hospital) in 2020 in Nepal. In total, 50 consecutive breast cancer cases were age-matched to 150 controls with no history of the disease using purposive sampling method. Semi-structured questionnaire was used to collect information on socio-demographic characters, reproductive history, dietary and personal habits, family history, and history of benign breast disease. In addition, anthropometric measurement was done on all subjects. Conditional logistic regression was used to analyze the association between exposure and outcome, and reported using odds ratios (OR) at 95% confidence intervals (CI). Results: The odds of disease was higher in cases who were Dalit/Madhesi (adjusted OR 8.22, 95% CI 2.37-28.4, pvalue 0.001), had 3 or more children (adjusted OR 5.61, 95% CI 1.14-27.6, p-value 0.034) and had history of benign breast disease (adjusted OR 13.6, 95% CI 3.23-57.4, p-value 0.001). Women who had undergone hysterectomy had lower odds of breast cancer (adjusted OR 0.12, 95% CI 0.012-0.83, p-value 0.031). Knowledge of mammography was significantly lower among cases than control (adjusted OR=0.13, 95% CI=0.03-0.65, pvalue=0.012). Conclusion: We found that the mean age at diagnosis was a decade earlier in Nepal than that reported by studies conducted in Western countries. Women who belonged to ethnic minority group and who had history of benign breast disease were at significant risk of breast cancer, whereas history of hysterectomy was found to be protective. Cases had low level of knowledge on risk factors and screening for breast cancer. This study highlights the need to increase awareness about breast cancer risk factors among general population. Have you got a Conflict of Interest?: No
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2065 Breast Cancer Knowledge, Attitudes and Practices amongst Women in Qatar E. Hamed1, B. Alemrayat1, M. Syed1, S. Nashif2, H.M. Abu Rasheed3, T. Kane2 1 Primary Health Care Corporation, Doha, Qatar, 2College of Medicine, Qatar University, Doha, Qatar, 3Qatar Cancer Society, Doha, Qatar Abstract: Background: Breast cancer is a life-threatening disease affecting women across the globe. It is the most prevalent type of cancer among women and is the primary cause of cancer-related mortality. In Qatar, breast cancer continues to be the most commonly diagnosed cancer among women. Aim: This cross-sectional study examines knowledge, attitudes, and practices surrounding breast cancer awareness and screening among women residents in Qatar. Methods: Females, >18 years old, registered with the Primary Health Care Corporation were invited to complete an Arabic or English online survey using a modified version of the Breast Cancer Awareness Module. Results: Of the 9008 participants, 69% report awareness of breast cancer warning signs, but the results did not substantiate these claims. There remains a disconnect between participants’ perceived awareness of their ability to detect breast cancer and their actual recognition of individual signs and symptoms. Nearly half (45.4%) report rarely or never checking their breasts for abnormalities (44.6%). Breast self-examination (BSE) and Breast Cancer Screening (BCS) uptake is low and many are unaware of the starting age for invitation to Qatar’s BCS program. While only 18% of women report receiving an invitation, 94% attended, indicating that the BCS invitation is a remarkably effective means of improving screening uptake. Conclusion: Policymakers should capitalize on early recognition, which is possible in the youthful population. Broadening awareness campaigns and interventions targeting a broader audience including males, community and religious leaders and healthcare professionals may prove more effective in Arab communities.
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Have you got a Conflict of Interest?: No
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2068 Baseline distress and analysis of the utility of breast cancer survivor video narratives in Botswana L.T. Mokokwe1, N. Ngwako2, G. Gabaatlhole1, B. Bontshwanetse3, K. Kebuang3, T. Segadimo3, T. Ralefala3,2, F.K. Barg4, B.E. Gaolebale3, Y.M. Martei4 1 Botswana - University of Pennsylvania Partnership, Gaborone, Botswana, 2University of Botswana, Gaborone, Botswana, 3Princess Marina Hospital, Gaborone, Botswana, 4University of Pennsylvania, Family Medicine and Community Health, Philadelphia, United States Background: Breast cancer patients in Botswana, including those with HIV, experience a disproportionate burden of mortality1. Breast cancer-associated distress may lead to inability to effectively cope with cancer diagnosis, symptoms and treatment2. Previous studies in culturally diverse communities in North America have shown narrative health communication media to be effective in promoting positive health behaviours 3. Aim: Our objectives were to characterize baseline levels of distress and sources of distress among breast cancer patients in Botswana and leveraging Botswana’s rich culture of storytelling, explore the usability and utility of culturally adapted survivor video narrative interventions among breast cancer patients. Methods: We prospectively enrolled patients presenting for routine breast cancer care at Princess Marina Hospital in Botswana. Distress scores (DS) and sources of distress were assessed using the National Comprehensive Cancer Network Distress Thermometer (NCCN DT) translated to Setswana. Severe distress was defined as DS ≥42. Predictors of distress will be analysed using regression analysis once we have enrolled our target of 100 patients for the pilot study. Usability and utility of the survivor narrative videos were assessed on a Likert scale. Results: 84 patients with median age of 50 years have been enrolled to date. 38% are patients living with HIV. 76% of patients experienced severe distress. The common sources of distress were worry (66%), sadness & fears (53%), finances (50%) and nervousness & pain (48%). 92% of patients strongly agreed videos were presented in a way that was easy to understand. 86% wished there were more stories to watch, and 81% would recommend the program to other patients. Complete results will be available for WCC. Conclusion: Majority of breast cancer patients have clinically significant levels of distress related to multiple stressors. There is opportunity to use the NCCN DT for standard screening and referral for supportive interventions and resources. The culturally and language-matched video narratives have high utility and usability in this patient population and may be leveraged in routine breast cancer care. Future studies will test the implementation and effectiveness of survivor narrative videos in a clinical trial. References: 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018;68(6):394424. doi:10.3322/caac.21492 2. NCCN.NCCN Practice Guidelines.; 2013. 3. Hinyard LJ, Kreuter MW. Using Narrative Communication as a Tool for Health Behavior Change: A Conceptual, Theoretical, and Empirical Overview.Heal Educ Behav. 2007;34(5):777-792. Accessed April 11, 2022. http://www.jstor.org/stable/45055957. Have you got a Conflict of Interest?: No
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2071 Association of different treatment with the expression of subsets of T Lymphocytes in breast cancer patients. K. Kataria1, G. Puri2, A. Srivastava2, A. Dhar2, P. Ranjan2, S. Chumber2, S. Hussain3, S. Deo4 1 All India Institue of Medical Sciences, Surgical Disciplines, Delhi, India, 2All India Institute of Medical Sciences, New Delhi, Surgical Disciplines, NEW DELHI, India, 3National Institute of cancer prevention and research, Division of Molecular Oncology, Noida, India, 4All India Institute of Medical Sciences, New Delhi, Surgical Oncology, NEW DELHI, India Background: Breast Cancer is the leading malignancy in females, worldwide. It is established that an effective antitumor immune response requires the involvement of both CD4+ and CD8+ T cells. However, little is known about the dynamic and functional alterations of these T cell subsets in the immunoediting processes during breast cancer progression. Aim:
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To determine the expression of different subtypes of T cells : T- Regulatory cells (FOXP3CD25) , T helper cells (CD4) , Cytotoxic T cell (CD8) before therapy in blood, and tumor tissue.
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Impact of Surgery and Chemotherapy on immunological status of the tumour in breast cancer patients.
Methods: This prospective cohort study was conducted with objective to determine the expression of different subtypes of T cells: T- Regulatory cells(FOXP3CD25) , T helper cells (CD4) , Cytotoxic T cell (CD8) in peripheral blood before and after chemotherapy and surgery, and in the tumor tissue. Results: A total of 90 subjects were recruited with 60 cases (30 underwent NACT and 30 upfront surgery) and 30 controls comprising of 22 patients operated for fibroadenoma and remaining 8 underwent radical duct excision for various reasons. There was fall of CD4 T lymphocytes as the stage of the disease progressed, axillary metastasis, increased tumor size which was coupled with the rise of CD 8 T lymphocytes and regulatory T lymphocytes. This was reversed with therapy either chemotherapy or upfront surgery. Rise of CD8 T lymphocytes in the control group after surgical intervention. FOXP3 expression was significantly higher in the tumor tissue when compared to the normal adjacent tissue. Conclusion: In conclusion, the T-cell subgroups in breast cancer patients undergo dynamic, significant changes during surgery and chemotherapy. Monitoring T lymphocytes may provide useful information for the evaluation of the immune system and prognosis of patients. Have you got a Conflict of Interest?: No
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2072 Disruptions and mitigation strategies in cancer screening, diagnosis and treatment during COVID-19 pandemic I. Soerjomataram1, R. Shah, A. Mafra1, P. Coxeter2, J. Steinberg2, S. Hughes2, H. Hui2, M. Caruana2, M.D. David2, K. Canfell2 1 International Agency for Research on Cancer, Lyon, France, 2The Daffodil Centre, The University of Sydney and Cancer Council NSW, Sydney, Australia Background: Previous reviews have reported reduction in cancer services including diagnosis and treatment during the early phase of the COVID-19 pandemic. Aim: To carry out a systematic review consolidating and critically assessing evidence on the magnitude and impact of cancer services delays and disruptions during the COVID-19 pandemic, including screening, diagnosis, treatment, and palliative care. Additionally, collect information on the impact of mitigation strategies to reduce such delays and disruptions. Methods: The WHO COVID-19 Global research database was searched using terms related to COVID-19, cancer, and delays and disruptions on 5 January 2022, yielding 8,739 unique records. Given the large volume of records, we employ a highly collaborative approach to the screening of abstracts and titles as well as review of full texts and data extraction, leveraging the capabilities of an international team currently including 13 members from nine countries. At each step (title and abstract screening, full-text screening, data abstraction and risk of bias assessment), each record is randomly assigned to two reviewers who assess it independently. Disagreements are resolved by a third reviewer. To pool the estimates, we will use the generic inverse-variance random-effects method. Results: From 8,739 unique title/abstract records, 656 (7.5%) were shortlisted for full-text review, and results from 212 studies based on data from 43 countries were included in the final assessment. Preliminary results from a quarter of studies show continued disruptions throughout 2020. For example, one study found a reduction of up to 62% in breast cancer screening using mammograms during the first year of the COVID-19 pandemic period compared to a similar period pre-pandemic. Similarly, the number of colonoscopies decreased by 25%. For cancer treatment in 2020, another study showed reductions in number of surgeries (25%), chemotherapy (15%), and radiotherapy (6%). On the other hand, an increase in the number of immunotherapy treatments (34%) and a minor increase in systemic anticancer therapies (2.5%) was reported. Mitigation strategies included wide-ranging approaches such as strict infection control measures, rescheduling of appointments, and additional chemotherapy provision on weekends. The systematic review will be completed by June 2022, with the full results including separate analysis of disruptions during the post-COVID-19 vaccination period to be presented at the Congress. Conclusion: We developed a robust collaborative systematic review approach, enabling timely identification and synthesis of high-quality evidence. International high-quality evidence, with large studies presenting in-depth analyses for disruptions, delays, and mitigation strategies of cancer care services during COVID-19 pandemic. The results of this review can inform the ongoing public health response to the COVID-19 pandemic. Have you got a Conflict of Interest?: No
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2073 The unmet needs among multiethnic colorectal cancer survivors in Malaysia. N.-N.-A. Bujang1,2, Y.-C. Kong1, S. Subramaniam3, A.-B. Awang-Mahmud1, N. Bhoo-Pathy1 1 University Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, Kuala Lumpur, Malaysia, 2Ministry of Health, Putrajaya, Malaysia, 3National Institute of Health, Institute for Clinical Research, Shah Alam, Malaysia Background: Colorectal cancer is one of the leading cancers globally. Detailed knowledge of the issues faced by survivors, their needs, and the extent to which these needs are met by current services is critical to guide where to focus the limited healthcare resources in response to the growing population of colorectal cancer survivors. Aim: This study aimed to describe the prevalence of unmet needs among multi-ethnic colorectal cancer survivors in Malaysia and the associated factors. Methods: A cross-sectional study was conducted in several oncology centres in the Klang Valley, in Northern and Southern Malaysia via an interviewer-administered questionnaire using REDCap.um (online survey tool). The questionnaire was developed locally and specifically for colorectal cancer survivors (Neat-CC) with good validity and reliability. Cronbach’s alpha of all the domains was above 0.7. The dual-language questionnaire (English-Bahasa Melayu) has 51-items covering five domains and one subdomain of needs (diagnosis needs, practical, health, financial, employment, psychosocial and information needs). A cancer survivor is considered an individual who has been diagnosed with cancer from the point of diagnosis through the remaining years of life. Thus, a universal sampling of 616 respondents who 1) had been diagnosed with colorectal cancer for at least a month, 2) aged above 18 years old and 3) were clinically fit with no other cancer were recruited. Results: High levels of unmet needs were most commonly reported in the domains of health needs (97.4% [95% CI,0.96,0.98]), psychosocial needs (92.0% [95%CI,0.90,0.94]), information needs (96.9% [95%CI,0.96,0.98]) and financial needs (90.9% [95%CI,0.89,0.93]). The most frequently endorsed as high needs in the health domain were waiting time in the hospital/institution to be shortened (81.3%), the location of hospital facilities (71.7%) and cancer treatment side effects management (81.5%). More than half (54.7%) of the survivors expressed a high need to have easy access to counselling services. High employment needs were also reported among 45.2% of the respondents with higher needs in terms of workplace flexibility. The factors that were identified to be associated with higher needs were ethnicity, lower level of education, presence of stoma and not receiving financial assistance (including insurance and private/public fund). Conclusion: The high unmet needs in various domains highlight the importance to revamp survivorship management and embarking on appropriate interventions which cater to the needs of multi-ethnic colorectal cancer survivors in Malaysia.
Have you got a Conflict of Interest?: No
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2076 Image-Guided Theranostic Nanomedicine for Precise Combination Therapy of Lung Cancer X. Yin1, Y. Cui2, R.S. Kim2, W.R. Stiles2, S.H. Park2, H. Wang2, L. Ma3, L. Chen4, Y. Baek2, S. Kashiwagi2, K. Bao2, A. Ulumben2, T. Fukuda2, H. Kang2, H.S. Choi2 1 The Second Affiliate Hospital of Xi’an Jiaotong University, Department of Oncology, Xi'an, China, 2Massachusetts General Hospital, Department of Radiology, Boston, United States, 3The Second Affiliate Hospital of Xi’an Jiaotong University, Department of Pathology, Xi'an, China, 4Shaanxi Provincial People’s Hospital, Department of Pathology, Xi'an, China Background: Lung cancer remains the leading cause of cancer-related deaths worldwide. The prognosis of lung cancer patients is still low. The development of more effective theranostic strategies with fewer side effects is an urgent need. Image-guided drug delivery provides specific targeting and image navigation for diagnosis and therapy. Recently, enormous efforts have been made to integrate various interventions into one nanoplatform, resulting in the advance nanomedicine. Aim: To make an innovative, noninvasive multifunctional theranostic drug delivery nanoplatform, a.k.a. H-dots. To perform real-time dual-channel NIR image-guided diagnosis, surgical intervention, and pathological assistance, as well as targeted delivery of gefitinib (Gef) and genistein (Gen) by H-dots for combination treatment with fewer adverse effects. To explore the mechanism of Gef/H-dot800 and Gen/H-dot700 complexes for targeted theranosis. Methods: The H-dot nanoplatform was designed and synthesized independently. The pH-responsive drug release tests of Gef/H-dot and Gen/H-dot complexes were done by rapid equilibrium dialysis devices. The therapeutic efficacy of the complexes was evaluated by the CCK-8 assay. Real-time fluorescence imaging was performed by 700 nm and 800 nm channels of the NIR system. The tissue sections were stained by H&E for pathology observation. Apoptosis was determined by TUNEL. Proliferation factor Ki-67, inflammatory factor COX2, angiogenesis factors VEGF and CD31 were detected by immuno- histochemistry test. The biochemical parameters were tested by ELISA kits. Results: The study demonstrated that the H-dots drug delivery nanocarrier is a promising targeted theranostic tool with specific biodistribution, better water solubility, bioavailability, and biosafety. The Gef and Gen release in the acidic tumor microenvironment and the synergistic effects of Gef/H-dot and Gen/H-dot complexes were confirmed. Those complexes not only provided real-time dual-channel intraoperative NIR fluorescence image guidance and pathological assistance, but also delivered both Gef and Gen simultaneously to the tumors for synergistic treatment with low nonspecific uptake to reduce adverse effects. This combination therapy significantly downregulated Ki-67, COX-2, CD31, and VEGF, accompanied by remarkable tumor regression. Conclusion: The Gef/H-dot and Gen/H-dot combination theranostics dramatically increase systematic therapeutic effects and decrease side effects of free drugs, which may reach successful clinical translation as the next generation targeted theranostics.
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Tab 1.Pharmacokinetic parameters of Gef/H-dot and Gen/H-dot(n = 4) Pharmacokinetic parameter Molecular weight (g·mol−1) Injected dose (nmol·kg−1) t½α (min) t½β (min) Area under the curve (AUC, min·nmol·mL−1) Plasma clearance (CL, mL·min−1) Volume of distribution (Vd, mL·kg−1)
Gef/H-dot800 ~16,370 2,500 9.08 ± 10.37 23.87 ± 4.09 475.0 ± 128.86 0.124 ± 0.02 186.84 ± 29.35
Fig 1.a) Physicochemical properties of theranostic H-dot complexes. b) In vitro therapeutic efficacy test.
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Fig 2.a) NIR fluorescence imaging. b) Real-time image-guided surgical intervention and image-guidance pathology test.
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Fig 3.a) Combination theranostic effects of Gef/H-dot with Gen/H-dot. b) Organ toxicity test. Have you got a Conflict of Interest?: No
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2078 DEVELOPING A NCCP IN THE CONTEXT OF COVID 19 J. Mudavanhu1 1 Ministry of Health and Child Care, NCDs, Harare, Zimbabwe
Author: Dr Justice Mudavanhu, Deputy Director NCDs and Cancer Coordinator, Ministry of Health and Child Care (MOHCC), Zimbabwe. dr.mudavanhu@gmail.com, +263774401919 Background Cancer on the African continent has become an overt public health crisis due to an aging population and changes in lifestyle. The WHO states that a national cancer control program should aim to reduce the incidence of cancer and its mortality, improve the quality of life of cancer patients through an NCCP that is systematic, equitable and evidence based1. Despite this, only 11 countries have a current NCCP in the African region2. Zimbabwe’s current NCCP expired in 2018, efforts are ongoing to establish the 2021 to 2025 amidst the challenges posed COVID- 19. Before the pandemic the country had challenges developing a new cancer strategy (the previous strategy ran from 2013 -2018). COVID-19 meant initial doing everything virtually and this was beset by many challenges and that in-country missions by international experts were restricted by lockdowns. This edition of NCCP (2021-2025) is a response by the MOHCC, its stakeholders (WHO, IAEA) to provide a strategic framework on how to prioritize interventions that will lead to cancer control and prevention in the country. Aim To guide Zimbabwe and put forward specific interventions towards cancer control and prevention based on the existing cancer burden, risk factor prevalence and available resources. Processes
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2. 3. 4. 5. 6.
This NCCP (2021-2022) development has input from diverse array of stakeholders done through several consultative meetings. Due to the COVID-19 restrictions most of the planning and writing were done virtually. Establishment of baseline cancer data done by IAES experts using the old cancer strategy etc. Identifying priority areas Defining key interventions Costing of the NCCP (previous one not costed) Dissemination and implementation of the NCCP
Strategies One of the barriers to the development of the Zimbabwe NCCP is organization of national cancer program within the MoHCC, the structure was inconsistent creating an obstacle to mobilize resources and partners for NCCP implementation. In 2021 the country requested the IAEA to provide advisory support on the development of a NCCP through PACT and its partners. A costed NCCP is being developed and the country has made great strides in increasing the budget on public health. The previous strategy had implementation challenges due to sub-optimal budget. The NCCP is being aligned to local, regional and international policies, (National Health Strategy 2021-2025, NCD Strategy 2021-2025, SDGs, etc.,) Outcomes
1. 2. 3.
A costed NCCP Cancer control TWG Investment case for cancer in Zimbabwe
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Lessons learnt
1. 2. 3.
NCCP costing is necessary to achieve the goals laid out in a country’s strategy, mobilization of resources. Cooperation of the government with IAEA and WHO is important to strengthen the country cancer control Adapting of ways of doing business is crucial during the pandemic
Have you got a Conflict of Interest?: No
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2081 Reduced lactate-dependent breast cancer cell motility through lactate dehydrogenase -A or –B knockdown M. Khajah1, S. Khushaish2, Y. Luqmani2,1 1 Kuwait University, Faculty of Pharmacy, Kuwait, Kuwait, 2Kuwait University, Faculty of Pharmacy, Pharmacology & Therapeutics, Kuwait, Kuwait Background: There is increasing body of evidence suggesting enhanced expression and activity of lactate dehydrogenase (LDH) enzyme in various forms of cancers which is correlated with poor clinical prognosis. We established several endocrine resistant breast cancer cell lines through shRNA-mediated knockdown of the parental estrogen receptor (ER) positive cell line MCF7. The generated ER negative cell lines demonstrated significantly enhanced degree of cell proliferation, motility, and invasion. Aim: In this study, we determined the expression profile of LDH-A and B in normal as well as in endocrineresistant and -responsive breast cancer cells and the effect of their knockdown on LDH activity, lactate production, proliferation and cell motility. Methods: LDH-A or –B knockdown was performed using siRNA and shRNA techniques. The expression profile of LDH and signaling molecules was determined using PCR and western blotting. LDH activity and lactate levels were measured by a biochemical assay. Cell motility was determined using wound healing, while proliferation was determined using MTT assay. Results: LDH-B was specifically expressed only in normal and endocrine-resistant breast cancer cells, while LDH-A was expressed in all of the tested cell lines. Enhanced LDH activity and lactate production was observed in endocrine resistant breast cancer cells when compared to normal or endocrine responsive cancer cells. LDHA or B knockdown significantly reduced LDH activity and lactate production, which led to reduced cell motility. Exogenous lactate supplementation enhanced cell motility coincident with enhanced phosphorylation of ERK1/2 and reduced E-cadherin expression. Conclusion: Enhanced extracellular lactate levels in endocrine resistant breast cancer cells is an important factor in enhancing their motile behavior, and LDH inhibition might be a promising therapeutic target to inhibit cancer cell motility. Have you got a Conflict of Interest?: No
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2084 Study of SSTR2A and SSTR5 immunohistochemical expression in pancreatic neuroendocrine neoplasms R. Yadav1, S. F U Khan1, S. A Shamim2, S. Rastogi3, P. Das1, S. Agarwal1, S. Pal4, N. R Dash4, A. N Singh4, V. P Jyotsna5, M. C Sharma1 1 AIIMS, Pathology, Delhi, India, 2AIIMS, Nuclear Medicine, Delhi, India, 3AIIMS, Medical Oncology, Delhi, India, 4AIIMS, GI Surgery, Delhi, India, 5AIIMS, Endocrinology, Delhi, India Background: Pancreatic neuroendocrine neoplasms are mostly low-grade malignancies; however, their biological behavior is quite variable and they may metastasize early, thus, requiring medical therapy instead of surgery. Somatostatin receptors (SSTR )are G-protein coupled receptors expressed by many normal tissues and tumors. Somatostatin analogues are available nowadays that act on these receptors in tumors and impact the survival of the patients. Aim: To evaluate the immunohistochemical expression of SSTR2A and SSTR5 in pancreatic neuroendocrine neoplasms and correlate it with clinicopathological features Methods: An ambispective cross-sectional study was conducted at AIIMS, New Delhi. 73 cases of pancreatic neuroendocrine neoplasms diagnosed over a period of seven years (2014-2021) were included in this study. Clinicopathological features were reviewed in detail. Immunohistochemistry for SSTR2A and SSTR5 was performed and interpretation was done based on the percentage of tumor cells showing expression and pattern of expression (location and intensity) to subdivide the expression into low and high subgroups. Results: The mean age of the patients at the time of diagnosis was 41 years with a range of 8 years to 70 years. Male to female ratio was 1.433. As per the WHO grading system, G1 group consisted of 31 cases (42.5%), G2 group consisted of 35 cases (47.9%) and G3 group consisted of 7 cases (9.6%). Majority of the tumors belonged to pT2, followed by pT3, pT1 and pT4. Overall, high SSTR expression was seen in 56.2% (41/73) cases. High SSTR2A expression was more frequent, noted in 53.42% (39/73) cases whereas high SSTR5 expression was identified in 15.07% (11/73) cases. High expression of SSTR2A and SSTR5 was more frequently seen in grade 1 and 2 tumors than grade 3 tumors or carcinomas. Most of the cases which expressed SSTR5 also showed concomitant SSTR2 expression and a statistically significant correlation was obtained between expression of SSTR2A and SSTR5. Conclusion: SSTR2A and SSTR5 expression, though, more commonly seen in lower grade tumors, is present across all grades so somatostatin analogues may be used as an adjuvant therapy in SSTR expressing pancreatic neuroendocrine neoplasms especially in unresectable and metastatic cases. Have you got a Conflict of Interest?: No
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2086 The new non-invasive methods for endometrial cancer detection in women over 50 years old B. Cai1, H. Luan1, Y. Li1, T. Zhu1, Y. Wang1, X. Tuo1, H. DUAN2, L. An3, X. Ma4, X. He5 1 Gansu Provincial Maternity Child-care Hosptal, Department of Obstetrics and Gynecology, lanzhou, China, 2Gansu University of Traditional Chinese Medicine, College of Pharmacy, lanzhou, China, 3Tianshui City Maternity Childcare Hosptal, Department of Gynecology, tianshui, China, 4Linxia Hui Autonomous Prefecture Maternity Child-care Hosptal, Department of Gynecology, linxia, China, 5Beijin Cispoly Co., Department of medical statistics and analysis, beijing, China Background: With the increasing burden of endometrial cancer all over the world, the evaluation of early detection strategies for high-risk women has also attracted attention. In the clinical practice, when a woman has postmenopausal bleeding (PMB) and her endometrial thickness is ≥ 5mm, she should then undergo clinical examination and hysteroscopy. Pain and repeated hysteroscopy often cause fear in women. Cytological high-risk DNA methylation test has a promising application prospect in EC test before invasive hysteroscopy procedure. Aim: The aim is to analyze and verify whether cytological methylation gene detection has better performance than the current clinical diagnostic indicators. Methods: 88 women over 50 years old who underwent endometrial biopsy in the hysteroscopic room were prospectively selected. If the biopsy result is positive, follow-up treatment shall be carried out. The biopsy or surgical pathology were as the final pathology. Cervical exfoliated cells were collected and stored in ThinPrep solution for methylation test, and office endometrial biopsy was performed in the study. The data of clinical syndrome and tests including bleeding, endometrial thickness (ET) ≥ 5mm, CA125 test, BMI measure were collected. The analysis of methylation level of CDO1 and CELF4 were determined by using CisEndo methylation real-time system (CISPOLY Co., China). Positive results were defined in ΔCt-CDO1≤8.4 or ΔCt-CELF4≤8.8. Results:54 of non-EC group (mean 59 years) and 34 of EC group (mean 58 years) were in the study. The positive rate of all tests in EC/non-EC were menopause (100%)/ (77.8%), bleeding (88.2%)/ (42.6%), ET ≥ 5mm (76.5%)/ (44.4%), CA125 (38.2%)/ (20.4%), BMI ≥ 25 (52.9%)/ (40.7%), methylated genes (85.3%)/ (14.8%), respectively. The PMB was the highest rate in EC group but still with higher rate in non-EC group (42.6%). The combined CDO1 and CELF4 tests were the 2nd highest positive rate in the EC group and with lowest positive rate in the non-EC group. 4 of women with the postmenopausal non-bleeding syndrome were 100% positive results in the methylated gene tests. The data show that methylated gene tests are the non-invasive detection with higher positive rate of EC and lowest rate in non-EC groups. Three EC women with PMB and ET ≤ 5mm were missed following the practice, but 3 of them were positive in the methylation results. Conclusion: The methylation test of cytological samples may be a new non-invasive method for women over 50 years old and this new discovery need more data for future validation. Have you got a Conflict of Interest?: No
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2087 Breast screening in Remote and rural areas in Algeria : how mammobile operation changed the real world h. kettab1 1 el amel association, algiers, Algeria
Background and context: Abstract text: Breast cancer was the first cause of death among Algerian women. In the 2000s. Noticing thegeneral incapacity to face this issue, despite the evidence, El Amel CPMC decided to face it but surely not alone. She put a strategy to mobilizepublic authorities, health professional and media. She managed to make them change the national policy, to put in place a national cancer plan, to put a consequent budget and to collaborate with the patient group. All stakeholders were involved and the challenge, right now, is to continue the fight against inequalities among women in accessing mammography, early detection and screening, anf then care. The fact is that this situation is a source of inequity and inequal access to screening and care for women in remote and rural areas. This operation was the arrow which targetted this issue and helped to put it in light in order to adress it and support the right of these full citizens to access to breast screening and TTT, like all other women in Algeria. At the same time, this led to the general improvement of cancer care for every one, all over the country, and even for other cancers. It is clear that the cancer care in general was not at top of what was expected to fight cancer, so the work to be done was huge. El Amel CPMC is proud to have been the locomotive for equal access to screening for all women, but also to a general improvement of cancer care.
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Aim: no more inequal access to screening and care for women living in remote and rural areas Strategy / Tactics: awareness caravans, (during 4 years), acquisition of the first mammobile in Algeria, mobilisation of all stakeholders and maintening the momentum Programme / Policy process: step by step, in partnership or challenging and adressing the issues with public officers, and media, with the concourse of health professionals Outcomes: many anti-cancer centers are open the last years, mainly in southern region (remote) and rural. screening in private sector more available but also public. The national cancer plan 2015-2019 was set also in the frame of the general mobilization launched by El Amel. What was learnt: (if relevant, please also detail here the potential of replicability) : this experience helped to screen thousands of women. the fact is that we can repete it with other mommobile unities as the country is vast. there is still one vehicle, but the building of centers avery where is a big lesson : a pilot operation became a symbol of cancer fight with determination. Have you got a Conflict of Interest?: No
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2088 A Geospatial Approach to Identify Geographic Disparities in Lung Cancer Screening in the US L. Sahar1, R.A. Smith2 1 American Cancer Society, Digital Solution, Atlanta, United States, 2American Cancer Society, Early Cancer Detection Science, Atlanta, United States Background: A leading cause for cancer deaths in the US, lung cancer also has one of the lowest survival rates, mostly attributed to the high proportion of late-stage diagnosis. Almost 10 years after the first USPSTF recommendation for annual lung cancer screening (LCS), uptake of LCS in the US remains low. A recently updated USPSTF recommendation nearly doubled the target population by expanding eligibility to ages 50-80 (from 5580) with 20 pack-year smoking history (from 30). Aim: We present two complimentary research analyses that evaluate access to LCS before and after the change in the screening recommendations and provide insight about disparities in access to LCS in the US. Methods: We developed a geospatial approach to measure accessibility to screening based on proximity of American College of Radiology (ACR) screening facilities to population centers. The methodology was implemented at different geographic levels (county and sub-county) and estimated initially the number of adults aged 55-80 with access within 40 miles (~ 64 km). Following the release of the updated recommendation, we incorporated estimates of eligible adults (aged 50-80 with 20 pack year history) to better measure accessibility based on distance to a screening facility. We also incorporated graduating distance thresholds (10/20/40/50/100 miles) and evaluated access across regions as well as rural and urban environments. Results were also integrated with additional datasets to identify potential focus areas for interventions and inform decision making. Results: The initial investigation revealed that the majority of adults aged 55-80 have access within 40 miles to an ACR screening facility (less than 6% do not have access). Geographic variations were noted across the country, region, and within states. Aligned with those results, the second study, utilizing the new USPSTF eligibility criteria, revealed about 5% of the eligible population do not have access to lung cancer screening facilities within 40miles. This study also revealed different patterns of accessibility at the different distances, across regions, and rural-urban areas. A consistent disparity, indicating a larger percentage of the population (~ 25%) with no access in rural areas was identified, across all distances and geographies.This percentage is translated to a larger number of adults with no access in rural areas compared to urban areas in longer distances (>=40 miles). Conclusion: A geographic approach to measuring access to services should evaluate accessibility at a subgeographic levels, and examine variations across geographic regions where interventions are targeted. Access layers can then be integrated with other data sources such as risk factors, mortality, and incidence rates to better focus varying geographies for interventions. This approach is essential for tailoring programs to communities and ensuring efficient allocation of resources. Have you got a Conflict of Interest?: No
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2090 Exosome-mediated transmissible endoplasmic reticulum stress in oral cancer cells effects pancreatic βcells R. Li1, N. Liao1, Y. Huang1, C. Wu1, Y. Li1 1 State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China Background: Cachexia is one of the important clinical manifestations of end-stage oral cancer, which significantly affects the prognosis of oral cancer patients. Current studies suggest that the development of cachexia in oral cancer patients includes many metabolic disorders including decreased islet function. Exosomes are extremely small in size, and recent studies have shown that they are one of the main modes of cellular substance delivery in malignant tumors. Exosomes are found in plasma, lymphatic fluid, saliva and other body fluids, and can not only play a role in the tumor microenvironment, but also deliver the vast majority of malignant cell messages to areas far enough away to perform the function of regulating distant organs. Our previous study found that the degree of endoplasmic reticulum stress in the tumor gradually increased during the progression of oral cancer, and cancer cells could transmit the endoplasmic reticulum stress to other cells. Aim: To investigatewhether oral cancer cells inhibit pancreatic β-cell function through exosome-mediated transmissible endoplasmic reticulum stress. Methods: Tunicamycin (TM) was selected as an endoplasmic reticulum stress (ERS) inducer. GW4869 was selected as an inhibitor of exosome secretion. Human oral squamous carcinoma cell lines CAl-27 and SCC-25 were selected as the donor cells and mouse insulinoma 6(MIN6)cell line was selected as the recipient cells. The expression of ERS markers was detected by qPCR.Insulin expression was detected by qPCR and Western Blot(WB). The pancreatic β-cells secretion function was measured by ELISAand BCA kit. Results: ERS was induced in oral cancer cells with TM.Supernatants of oral cancer cells underERS pretreated with and without GW4869 were added to MIN6 cells.The ERS markers BiP, CHOP, and XBP1s were found to be significantly upregulated in MIN6 cells by qPCR, and the expression of ERS markers in the GW4869 pretreatment group were lower than those in the GW4869-free group. This implies that exosomes from oral cancer cells mediate endoplasmic reticulum stress transmission to pancreatic β-cells. qPCR and WB analysis revealed that insulin was upregulated at the transcriptional level, downregulated at the translational level, and overall downregulated in insulin synthesis. Insulin in the GW4869 pretreatment group was lower than the GW4869-free group at the transcriptional level. This implies that exosome-mediated transmissible endoplasmic reticulum stress inhibits insulin synthesis. Insulin secreted by MIN6 cells was found to be downregulated by ELISAand BCA kit. Insulin in the GW4869 pretreatment group was higher at the secretory level than that in the GW4869-free group. This implies thatexosome-mediated transmissible endoplasmic reticulum stress inhibits insulin secretion. Conclusion: Oral cancer cells inhibit insulin synthesis and secretion through exosome-mediated transmissible endoplasmic reticulum stress, thereby inhibitingpancreatic β-cell function. Have you got a Conflict of Interest?: No
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2091 Multicancer Early Detection Tests: Report from an Internationl Summit to Clarify the Path Forward R.A. Smith1 1 American Cancer Society, Early Cancer Detection Science, Atlanta, United States Background and context: Cancer is a pervasive and growing global health challenge, with nearly 20 million new cases in 2020, and 1 in 6 deaths world-wide. Although there has been progress in early cancer detection, the benefits of existing technology are not equally applied within and across nations and regions, resulting in an enduring “cancer divide.” Recent advances in cancer biology, biomarker discovery, and laboratory methodology have generated the possibility for a paradigm shift in cancer prevention and control, from single cancer early detection tests to a blood-based multi-cancer early detection (MCED) approach. In parallel with the technological, evaluation, and implementation challenges of MCED tests, we should anticipate what is required for populationwide benefit. Aim: To address challenges in evidence generation, performance evaluation, regulatory review, equitable access to testing, follow-up and treatment, patient/provider/health system acceptance, economic impact, and industry engagement to provide a directional framework for international/interdisciplinary stakeholders to inform key priorities, common goals, and accelerate progress. Strategy / Tactics: An international and interdisciplinary universal cancer screening summit was hosted by the Mayo Clinic Cancer Center, the American Cancer Society, and the Union for International Cancer Control in Rochester, Minnesota on February 3-4, 2020, to coincide with World Cancer Day. Approximately 50 participants contributed to interactive discussions in 10 sequential sessions: 1) Defining the vision, 2) Pre-clinical research, 3) Clinical/Translational research, 4) Adopting an international perspective, 5) Regulatory approval and access, 6) Practice guidelines, 7) Modeling analyses, 8) Advocacy, 9) Industry Engagement, and 10) Clarifying the Roadmap. Outcomes: Conference attendees acknowledged the foremost need to determine the efficacy and effectiveness of MCED tests, especially for cancers without evidence of the efficacy of early detection. Implementation challenges include integration with existing screening paradigms, defining the target population, and target cancers. There also is the need to recognize that MCED tests have the potential to change cancer care systems around the world; thus, the challenge of achieving equity in access to MCED testing in different health care settings (low-, middle-, and high-income countries) must not be neglected. The challenges of achieving global equity in access to care are immense, and there is no simple blueprint. If MCED tests prove to be beneficial, there must be a global resolve to bring the benefits to diverse health settings, and globally transform the prevention and early detection of cancer. Free access to the report from the summit can be found at https://acsjournals.onlinelibrary.wiley.com/toc/10970142/2022/128/S4 Have you got a Conflict of Interest?: No
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2092 Impact of COVID-19 Pandemic on the Early-Stage Breast Cancer Management: A Single-Center Analysis H. Kamaruzaman1, M. Jafri2 1 MSc Clinical Oncology, University of Birmingham, Birmingham, United Kingdom, 2University Hospitals Birmingham NHS Foundation Trust, Cancer Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom Background: The initial phase of the COVID pandemic was unprecedented. In order to protect patients and enable continuity of care, modifications in breast cancer treatment were advised by national bodies with limited evidence. The idea is to establish a balance between the risk of contracting the virus and providing optimum oncology care to improve patients' outcomes. Aim: This study aims to determine the incidence and type of strategies of chemotherapy modifications in the first phase of the COVID-19 pandemic. Methods: A retrospective electronic records-based review of all newly diagnosed individuals with early breast cancer receiving chemotherapy in a UK teaching hospital were retrieved from the Breast Cancer Registry between January 2020 and February 2021. Statistical descriptive analysis was done using PivotTables of Microsoft Excel 365 and GraphPad Prism version 9.2.0. Results: A total of 131 female patients’ health records were included in the analysis. The mean age of the study population is 54.5 years. The incidence of pre-specified chemotherapy modifications was observed in the majority of the study population (84%); approximately half (52.7%) present with co-morbidities. Epirubicin, cyclophosphamide and taxane-based (EC-T) regime was the most modified chemotherapy regime (30%) out of nine frequently used chemotherapy regimens in the hospital. The most common modification strategy was a substitution of docetaxel or paclitaxel with nab-paclitaxel (Abraxane) in taxane-based chemotherapy (77.3%), followed by a reduction in treatment cycles from standard six cycles to four cycles (16.4%). The prognostic disease factor, which is a triple-negative subtype, is the highest among those receiving treatment modifications(28.2%). The highest frequency of referral to a medical oncologist was seen in the second quartile (May 2020until August 2020), reflecting the ease of lockdown restriction in the UK. Conclusion: The study highlighted an increase in treatment personalisation due to standard breast cancer management alteration during the pandemic wave. An in-depth exploration of the safety and cost-effectiveness of the modified intervention is warranted to guide future management. Have you got a Conflict of Interest?: No
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2093 Study of the burden of cancer among the Maldivian population M. Shifan1 1 Indhira Gandi Memorial Hospital, Department of Oncology, Male', Maldives Background: The disease burden in the Maldives shows a double burden of disease with communicable and noncommunicable diseases (NCDs) contributing to the morbidity and mortality disease burden with NCDs is accounting for 80% of the mortality (MoH, 2020); WHO, 2018). The international cancer controls partnership (ICCP) estimated that in Maldives cancers account for 40% of premature death from NCDs (ICCP, 2020). Global cancer observatory estimates that 13% of the people in the Maldives will develop cancer before the age of 75 years (WHO, 2021). While these estimates are available, it is important to further explore the common cancers observed in the Maldives to inform prevention, care and rehabilitation strategies to address the burden of cancer. Aim: To determine the annual incidence and relance of cancers among the patient cohort presenting to selected health facilities in the country. To determine the types of cancers diagnosed among the patient cohort presenting to selected health facilities in the country. Methods: The research was a descriptive study and adopted deductive approach to the inquiry. The sampling adopted a non-probability method focusing on patients seeking health care. As such all patients seeking health care at any of the hospitals in the country was used as the target population. The sample for the study cases were all patients diagnosed as a case of cancer upon referral to the department of oncology at IGMH. A data collection instrument was prepared for data collection in Dhivehi and English to endure consistency in interviewing to collect the data. Data was collected from the patients diagnosed with cancer with their consent, through interviews and responses with regard to details of diagnosis was verified against their prescription and/or discharge summaries that are obtained from the patient. The data collection was conducted in either English or Dhivehi, based on the preference of the participant. Results: The study showed that breast cancer was the most prevalent malignancy in the Maldives followed by thyroid cancer. The study also showed that there was a slight female predominance among cancers diagnosed in the country. Conclusion: This may be useful to establish national guidelines on cancer screening and to plan to establish new facilities such as functional scans, radiotherapy and radioactive iodine ablation. Have you got a Conflict of Interest?: No
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2094 Risk Factors for Common Malignancies in the Maldives M.A. Ahmed1 1 Indhira Gandi Memorial Hospital, Department of Oncology, Male', Maldives Background: The disease burden in the Maldives shows a double burden of disease with communicable and noncommunicable diseases (NCDs) contributing to the morbidity and mortality disease burden with NCDs is accounting for 80% of the mortality (MoH, 2020); WHO, 2018). The international cancer controls partnership (ICCP) estimated that in Maldives cancers account for 40% of premature death from NCDs (ICCP, 2020). Global cancer observatory estimates that 13% of the people in the Maldives will develop cancer before the age of 75 years (WHO, 2021). While these estimates are available, it is important to further explore the common cancers observed in the Maldives to inform prevention, care and rehabilitation strategies to address the burden of cancer. Aim: The common risk factors for cancer among the patients diagnosed with cancer who presented to selected health facilities in the country The clinical outcomes of the diagnosed patients over one year period from date of diagnosis. Methods: The research was a descriptive study and adopted deductive approach to the inquiry. The sampling adopted a non-probability method focusing on patients seeking health care. As such all patients seeking health care at any of the hospitals in the country was used as the target population. The sample for the study cases were all patients diagnosed as a case of cancer upon referral to the department of oncology at IGMH. A data collection instrument was prepared for data collection in Dhivehi and English to endure consistency in interviewing to collect the data. Data was collected from the patients diagnosed with cancer with their consent, through interviews and responses with regard to details of diagnosis was verified against their prescription and/or discharge summaries that are obtained from the patient. The data collection was conducted in either English or Dhivehi, based on the preference of the participant. Results: The study showed that smoking tobacco and betel nut chewing was common among the Maldivian population. It also showed a high rate of polycystic ovary disease among women presenting with breast cancer. Conclusion: These findings may be useful to design public awareness campaigns, screening guidelines, and to improve cancer diagnostic facilities as well introducing treatments such as radiotherapy. Have you got a Conflict of Interest?: No
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2098 Banning flavours including menthol in tobacco products: The Canadian experience R. Cunningham1, M. Chaiton2, L. Hagen3 1 Canadian Cancer Society, Ottawa, Canada, 2Ontario Tobacco Research Institute, Toronto, Canada, 3ASH Canada, Edmonton, Canada Background and context: Research has established that menthol cigarettes encourage smoking initiation and discourage cessation, and that flavoured tobacco products generally are especially appealing to youth. Measures to ban or restrict menthol and other flavours in tobacco products are supported by FCTC guidelines and have been implemented or are under consideration in an increasing number of countries worldwide. Canada banned flavoured cigarettes and little cigars (menthol excepted) in 2010. In 2015, two provinces banned characterizing flavours including menthol in tobacco products, followed by other provinces/territories in subsequent years. At the national level, Canada banned menthol in cigarettes and most cigars at the ingredient level in 2017 followed by all tobacco products in 2018. Aim: This presentation will outline Canada’s experience – including opportunities and challenges – banning flavoured tobacco including menthol and relay this experience and recommendations to other jurisdictions. Strategy / Tactics: A series of advocacy strategies were used regarding flavoured tobacco. A crucial factor was health organizations publicizing surveillance data revealing that 52% of high school tobacco users consumed flavoured tobacco, and 32% of high school smokers smoked menthol. Further, data showed that the earlier 2010 legislation banning flavours (other than menthol) in little cigars of 1.4 grams would be easily undermined by marketing of little cigars of just more than 1.4 g. Also, one effective approach was to show elected representatives, and media, colourful packages of flavoured tobacco, which greatly increased awareness of the problem. Advocacy by health organizations, work by public servants, and political support were all essential. Programme / Policy process: Banning flavours by provinces and nationally was done through legislation and/or regulations. Outcomes: A number of lessons can be drawn from the Canadian experience. In Canada, provincial legislation made up for policy shortcomings in the initial national legislation in effect in 2010. Successful action by several provinces made it easier for other provinces to act, and in turn the national government. Bans on flavoured tobacco, including menthol cigarettes, were implemented with no credible indication of an increase in contraband sales volumes, despite the pre-existing substantial availability of contraband products in the two largest population provinces. What was learnt: (if relevant, please also detail here the potential of replicability) The Canadian experience shows that bans on flavours including menthol in tobacco products are feasible and resulted in reduced tobacco use, especially for youth, in Canada. The Canadian experience provides an example that can be adopted in other countries. Have you got a Conflict of Interest?: No
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2099 Application of Radiomics for differential diagnosis of lung adenocarcinoma and lung squamous carcinoma Y. Dingli1 1 JiLin Cancer Hospital, Changchun, China Background: The two main pathological subtypes of NSCLC are lung squamous cell carcinoma and lung adenocarcinoma, which have similar clinical manifestations, but are significantly different in pathogenesis, treatment plan and patient prognosis. For example, bevacizumab can be used to treat ADC, but it may cause massive bleeding in PATIENTS with SCC. Therefore, accurate differentiation between ADC and SCC before treatment is important for clinical intervention and patient prognosis. Aim: To investigate the value of feature extraction combined machine learningfor predicting pathologic types oflung adenocarcinoma(ADC)and lung squamous carcinoma(SCC). Methods: We collected data of1013 patients with postoperative pathological confirmed lung cancerwereretrospective analyzed,who underwent preoperative CT scan of the chest was performed.Among them, 515wereADCpatients (ADCgroup) and498 wereSCCpatients (SCCgroup).The feature extraction software MaZda (Version 4.6) was used to extract the texture feature parameters at the largest level of the lesionon CT images, and the data was standardized by Standardization, followed by dimensionality reduction by Univariate_Logistic, LASSO and MultiVariate_Logistic algorithm, retaining the two features with obvious differences between groups to construct and screen the bestmachine learningmodels.The dataset was divided into training and validation groupsat theratio of 7:3. Six machine learning algorithms were used to process the best classifier was selected according to the accuracy size, and obtained the ROC curve predicting the pathological classification ofADCandSCC,and the corresponding AUC, specificity, sensitivity and accuracy. Results: The resultsshow that there were515patients in group 1and498in group 2, and no significant differences in sex（χ2=3.323、P=0.068）and age（t=0.601，P=0.548）.A total of 306 texture feature parameters were extracted from the lesions,more of radiomicsfeatures with significant differences between2groups,16optimalradiomicsfeatures were retained to construct the prediction model.Classifierlogistic is the best classifierin training set.The specific parameters of the model are AUC 0.826, whose accuracy, specificity and sensitivity are 0.757,0.727 and 0.787; those in the validation group are AUC 0.817, whose accuracy, specificity and sensitivity are 0.749,0.741 and 0.756, respectively. Conclusion: Feature extraction combined machine learningcaneffectively predictthepathological typesof ADCandSCC, and thelogisticmodel has the optimal performance. Have you got a Conflict of Interest?: No
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2100 Modeling the implications of a single dose HPV vaccine regimen in a high and low/middle income country setting V. Daniels1, K. Saxena1, Y.-T. Chen1 1 Merck & Co., Inc., Kenilworth, NJ, USA, Merck Research Laboratories, North Wales, United States Background: Although no human papillomavirus (HPV) vaccine is indicated for single-dose administration, some observational and short term clinical trial evidence suggests that a 1-dose regimen might reduce the risk of HPV infection. This study estimated the potential impact of implementing an off-label 1-dose HPV vaccination program, relative to the standard of care 2-dose program, with 9-valent vaccine (9vHPV) for adolescents, on HPVrelated cancers and costs in a high and low/middle income country setting. The analyses accounted for the uncertainty of the effectiveness and durability of a single dose. Method: A dynamic HPV transmission infection and disease model was adapted to population level data from the United Kingdom and Indonesia, and included a probabilistic sensitivity analysis using estimated distributions for duration of protection of 1-dose and degree of protection of 1 relative to 2 doses. One-way sensitivity analyses of key inputs were performed. Outcomes included additional HPV related cancer and disease cases and the difference in net monetary benefit (NMB). Results: In the UK, the 1-dose program was predicted to result in 81,738 additional HPV-related cancer cases in males and females over 100years compared to the 2-dose program, ranging from 33 to 113 (median 67) additional cases per 100,000 person-years (2.5% and 97.5% quantiles, respectively). For Indonesia, the model projected that an additional 110 to 497 (median 367) cancer cases per 100,000 person-years would not be prevented with a 9vHPV 1-dose (vs 2-dose) girls only program over 100 years in Indonesia. The results of the model were found to be sensitive to the median of the duration of protection distribution, coverage and discount rate. Conclusion: Adoption of a 1-dose 9vHPV vaccination program resulted in more vaccine-preventable HPV-related cancer and disease cases in males and females, introduced substantial uncertainty in health outcomes in both high and low/middle income country settings. The health impact on a low/middle income country is substantially larger and more uncertain due to differences in attributes related to disease burden, vaccine coverage (including historical HPV immunization program), screening practices and parameters related to socio-economic conditions. Have you got a Conflict of Interest?: Yes If yes please specify:: The authors are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
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2101 Requiring health warnings directly on cigarettes: Rationale and progress in Canada R. Cunningham1 1 Canadian Cancer Society, Ottawa, Canada Background and context: With on-cigarette warnings, smokers would be exposed to health messages all year, every day, and every time they smoke. The measure would decrease smoking at no cost to government. On-cigarette warnings would denormalize the product, make cigarettes less attractive, prompt discussion, and help combat contraband by providing a distinct marking for a particular country. Many youth experiment with smoking by “borrowing” a cigarette from a friend/sibling. Social smokers may borrow a cigarette. Children see cigarette butts in ashtrays at home. Smokers may bring a single cigarette without packaging when going outside to smoke. A warning on a cigarette is unavoidable, including when smokers have a cigarette in hand when smoking for 5 minutes. In many countries, especially in low- and middle-income countries, cigarettes are often available for sale individually, without packaging. These are all excellent communication opportunities. The content of an on-cigarette warning could include a rotated health messages, pictograms, a quitline number, “Quit smoking save money”, or a message about litter. On-cigarette warnings complement package warnings. Extensive research from many countries provides compelling evidence of the measure’s effectiveness. Tobacco companies have long used branding/designs on the cigarette for promotional purposes – if tobacco companies can use the cigarette to promote smoking, health departments should be able to use the cigarette to discourage smoking. On-cigarette warnings are included in FCTC Article 11 guidelines on packaging and labelling Aim: This presentation will outline rationale for on-cigarette warnings, and outline progress in Canada. Strategy / Tactics: A series of advocacy strategies have been used for on-cigarette warnings in Canada. Programme / Policy process: In Canada, health organization support for on-cigarette warnings goes back many years. In 2018, with a government tobacco control bill going through Parliament, Bill S-5, health organizations successfully advocated for an amendment for regulatory authority for the measure. The amendment had all-party support. In October 2018, Health Canada launched a public consultation for a new round of tobacco warnings, including for oncigarette warnings. On-cigarette warnings were supported by health organizations and opposed by the tobacco industry. Health Canada conducted research for on-cigarette warnings, building on other research. Outcomes: Health Canada’s Regulatory Plan states that it will publish draft new tobacco warning regulations in April-June, 2022. The presentation will provide the latest update. In the UK, a bill has been introduced in Parliament. Singapore requires a tax marking directly on cigarettes. What was learnt: (if relevant, please also detail here the potential of replicability) On-cigarette warnings are feasible, impactful, and inevitable and should be adopted worldwide. Have you got a Conflict of Interest?: No
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2102 Palestinian cancer patients- quality of life survey C. Jabari1, I. Nawajah2, H. Jabareen3 1 Patient's Friends Society-Jerusalem, East Jerusalem, Palestine, 2Hebron University, Mathematics, Hebron, Palestine, 3Hebron University, Nursing, Hebron, Palestine Background: Cancer is a leading cause of mortality in Palestine. Late diagnosis of cancer is a problem with at least 60% of cases being diagnosed at stage 3 or 4 which often results in more aggressive treatments, poorer outcomes and misunderstandings and confusion by patients and their caregivers alike. Cancer patients are usually treated by physicians and other health professionals employing the ‘medical model’ without considering other factors that might positively impact their treatment. While modern diagnostics and medicine are contributing to better outcomes for patients when diagnosed early, the holistic approach to patient care, patient satisfaction, quality of life and survivorship however are often overlooked or not sufficiently addressed. Aim: To measure satisfaction of cancer patients in Palestine undergoing outpatient treatments and to assess their quality of life (QOL). Methods: The Functional Assessment of Chronic Illness Therapy-General questionnaire, Arabic Version 2013 (FACT-G), 27 questions, was used to conduct a convenience sample survey of 203 cancer patients(98.5% response rate) undergoing chemotherapy, radiotherapy and hormonal therapies. Their physical, emotional, social and functional well-being were measured based on the patient’s self assessment during the week before the survey. Trained data collectors surveyed adults in the summer of 2016, within one year of diagnosis when they were attending outpatient treatment at a major ‘cancer centre’ in one Palestinian hospital, in the occupied Palestinian territories. An institutional review board (IRB) approval was obtained as well as verbal consent from each patient. Four primary QOL domains were measured: physical, social/family and functional well-being ( 7 items each, score range 0-28) and emotional well-being ( 6-items, score range 0-24). The FACT-G total score is computed as the sum of the four subscale scores, provided the overall item response is at least 80% (i.e. at least 22 of the 27 items were answered) and has a possible range of 0-108 points. A higher FACT-G score indicates a better quality of life. Means and standard deviations (SD) were used to describe all four domains. Data was tabulated using SPSS version 22.0 and possible associations between QOL and the following variables were analyzed: gender, age, education level, marital status, type of cancer, time since diagnosis, etc. Results: In comparing QOL among men and women, there was no significant difference, p-value=0.16 but social/family well being scores were the highest which is expected in this society where family support is strong. Emotional well being was the lowest scored for both groups.. The Cronbach alpha 0.91 indicated high internal consistency. Conclusion: This was a relatively small sample so further research is needed to assess QOL of cancer patients, especially emotional support, while considering their co-morbidities and other challenges such as access to care, equity and support systems. Have you got a Conflict of Interest?: No
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2103 Content analysis for dissemination and implementation in cervical cancer policies in Sub-Saharan Africa R. Konate1, C. Moucheraud2, M.K Cira3, P.E Gravitt3, A.F Rositch4 1 Johns Hopkins University, International Health, Baltimore, United States, 2University of California Los Angeles, Health Policy and Management, Los Angeles, United States, 3National Cancer Institute, Center for Global Health, Rockville, United States, 4Johns Hopkins University, Epidemiology, Baltimore, United States Background: Cervical cancer is the fourth most common type of cancer in women in the world and the leading cause of cancer death among women in Sub-Saharan Africa (SSA). Development of national cervical cancer control plans is an important step towards effective cervical cancer elimination, and these must be effectively disseminated and implemented to have measurable impact. Aim: Recognizing the importance of implementing cancer control plans to reduce the global burden of cancer, we aim to analyze the content related to dissemination and implementation in cancer control plans for cervical cancer in SSA. Methods: We searched the International Cancer Control Partnership (ICCP) portal and the WHO NonCommunicable Disease (NCD) document repository for all cervical cancer control plans. To explore content and gaps in the plans with regards to dissemination and implementation, we assessed 23 National Cancer Control Plans (NCCP) and Cervical Cancer Control Plans (CCCP) using a 30-point scoring system based on the Implementability Framework. This framework includes 8 main domains to assess implementability: adaptability, usability, validity, applicability, communicability, accommodation, implementation, and evaluation, and was adapted to WHO’s cervical cancer elimination strategy 90/70/90 targets. Results: We identified a cancer control plan in 42/48 countries in SSA, of which we included the most recent CCCPs and NCCPs in English or French from 23 countries and excluded 17 countries with only NCD plans. Overall, CCCPs had higher implementability scores on average (score=21.7) than NCCPs (score= 18.3) and were more likely to address the items in the Implementability Framework. Most plans addressed stakeholder involvement (74%, N=17), responsibility allocation (87%, N=20), definition of technical resources required (83%, N=19), and inclusion of a monitoring and evaluation plan (78%, N=18). Only 5 countries (22%) include all the strategic actions defined by the WHO to reach the 90-70-90 targets. The major gaps identified were the lack of specific strategies accompanying the plans recommendations for cervical cancer control, particularly in terms of HPV vaccination roll out and cervical cancer management. Dissemination strategies were seldom included in the plans (17%, N=4), nor were budgetary details and financing strategies. Conclusion: Only a small portion of the national plans in SSA currently include comprehensive details on dissemination and implementation of the WHO strategic actions to eradicate cervical cancer within the next century. This study highlights focus areas specific to dissemination and implementation of CCCPs and NCCPs that will facilitate global realization of WHO cervical cancer elimination targets. Have you got a Conflict of Interest?: No
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2104 TOBACCO INDUSTRY VERSUS PUBLIC HEALTH IN ZAMBIA. B.I. Chitindi1 1 Tobacco Free Association of Zambia, Advocacy, Lusaka, Zambia Background and context: Each year, tobacco costs the Zambian economy ZMW 2.8 billion, equivalent to 1.2 percent of its GDP. These costs includeZMW 154 million in healthcare expenditures, and ZMW 2.7 billion in lost productive capacities due to premature mortality, disability, and workplace smoking. The productivity losses from current tobacco use in Zambia – 94.5 percent of all tobacco-related costs – indicate that tobacco use causes problems in Zambia far beyond the health sector. Each year tobacco consumption kills over 7, 000 Zambians and COVID-19 pandemic has brought many social and economic burdens in communities and the nation at large. The pandemic has opened door to tobacco industry’s charity paving way to a relationship to exploit further its business. Zambia signed World Health Organization Framework Convention on Tobacco Control (WHO-FCTC) on 23rd May, 2008 and ratified the treaty. Zambian government’s efforts to domesticate tobacco control law, has faced challenge with tobacco industry interference. The industry is blocking life serving policies, when health should be number one priority, measures preventing industry influence is non existence. Aim: Monitoring and Exposing Tobacco Industry Interference activities in Tobacco Control Policies. Strategy / Tactics: Held high – level Engagement Meetings with Government Officials exposing tobacco industry interference in tobacco control policies. Formed an informal alliance of civil society organizations, investigative journalists, health professionals, media personalities, youth lead organizations, religious representatives, civic leaders and representatives, exposed tobacco industry interference. Programme / Policy process: Produced and published multimedia messages exposing tobacco industry interference in print and electronic media including social media platforms (Radio, Print Press, and Television), social media (Facebook, twitter, WhatsApp) and press briefings.
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Conducted live phone-in Radio programs on leading radio stations engaged Medical Consultants, economists, Civic Leaders, churches and public celebrities. Boosted social media activation through the use of banners and scripted short video creations
Outcome: Engagement of media platforms is very effective, tobacco industry interference exposure reached out to over 8 million Zambians. Government officials and the public have now the knowledge of tobacco harms and tobacco industry interference. What was learnt: The communication strategy in engaging media platforms is very effective, the tobacco industry interference exposure reached out to over 8 million Zambians. Conclusion: Government Officials should not heed tobacco industry’s misleading arguments and threats, but adopt a code of conduct for all public officials when interacting with tobacco industry and limited only when strictly necessary. Zambia should domesticate the World health Organization Framework Convention on Tobacco Control to save the lives of its citizens. Have you got a Conflict of Interest?: No
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2105 Jejak Kanser: Combined Community Cancer Screening and Covid-19 Vaccination in Malaysia M. Munisamy1, M. Thoo Xiu Wen1, T. Jia Hwong1, N. Wai Hou1, J. Pereira1, J. Canute1, N. Alysa Azryn1, M. Ma'som1, S. Rajendran1, T. Umakanthan1, S. Kanagasundaram1 1 National Cancer Society Malaysia, Kuala Lumpur, Malaysia Background and context: There has been many disastrous effects of Covid-19 on the Malaysian cancer landscape. Two among these are: i) the higher-risk of Covid-19 transmissibility to cancer patients and the poorer outcomes they face if infected; and ii) the decrease of cancer screening efforts, especially in rural and small communities. Restarting community cancer screening programmes in combination with delivery of Covid-19 vaccination may be a successful strategy to mitigate both these effects, with a particular focus on health access and health equity to these communities. Aim: The Jejak Kanser (translation: Tracking Cancer) programme is a mobile community cancer screening and Covid-19 vaccination programme carried out in rural and small communities in Malaysia, aimed at providing equitable access to cancer screening and Covid-19 vaccination at the community level. Strategy / Tactics: Mobile teams from the National Cancer Society of Malaysia deploy together with local government and civil society partners to small communities for a one or two day screening programme on-site at the community level which screens for i) screen able cancers such as breast cancer, cervical cancer, colorectal cancer and prostate cancer; and ii) cancer risk factors such as obesity, hepatitis B and C, carbon monoxide levels for smokers, and blood glucose levels, among others. Along with the screening programme, educational talks and awareness activities are carried out. Covid-19 vaccination in terms of primary or booster vaccination is also provided on-site. Programme / Policy process: Local government and civil society partners act to publicize the screening event to local communities and handle on-the ground arrangements including venue and F & B arrangements. National Cancer Society of Malaysia mobile teams provide the human resources including clinical personnel and manage all clinical processes and costs. Outcomes: The Jejak Kanser programme is ongoing, and within the past 4 months has been carried out in 8 different localities in 4 different states with about 5000 participants having attended thus far. 33.2% of attendees who attended primarily for cancer screening also availed themselves of Covid-19 vaccination services; while 92.6% of attendees who attended primarily for Covid-19 vaccination availed themselves of cancer screening. 67.8% of all attendees had never attended or undergone any form of cancer screening previously. What was learnt: Efforts to carry out community cancer screening in rural communities is an important step inrestarting cancer screening services by cancer organisations. Providing cancer screening with Covid-19 vaccination improves equitable access for both these services and may be beneficial in improving uptake for both of these services for the community at large. Have you got a Conflict of Interest?: Yes If yes please specify:: 1. Honoraria from Novartis, MSD, Astra-Zeneca, Roche and Merck 2. Grants from Pfizer, MSD, Roche, Astellas and Astra-Zeneca 3. Advisory Board from MSD, Roche, Novartis
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2106 Crisis Task Shifting: Involvement of a Cancer Organisation in Covid-19 Vaccination. M. Munisamy1, M. Thoo Xiu Wen1, T. Jia Hwong1, M. Ma'som1, S. Rajendran1, J. Pereira1, N. Alysa Azryn1, J. Canute1, N. Wai Hou1, T. Umakanthan1, S. Kanagasundaram1 1 National Cancer Society Malaysia, Kuala Lumpur, Malaysia Background and context: Vaccination has been touted as one of the key strategies to contain the Covid-19 pandemic, whose devastating social, economic and health effects were far-reaching on many different community segments, including on people living with cancer. As vaccination began to be rolled out in Malaysia, people living with cancer, especially those with mobility issues, those who were bedbound, and those who lived in rural areas, faced access issues to being vaccinated. Aim: The National Cancer Society of Malaysia, working together with the Ministry of Health, Malaysia aimed at providing equitable access to Covid-19 vaccination to people living with cancer and their caregivers all over the country by acting as a vaccination provider via mobile outreach vaccination teams provided free of cost. Strategy / Tactics: Working together with the Ministry of Health and the Department of Social Welfare, bedbound, disabled and chronically ill patients (including people living with cancer) were identified and contacted to assess their illness status and willingness to receive Covid-19 vaccination. A call centre manned by trained volunteers acted to answer queries from identified individuals or caregivers and tackle vaccine hesitancy issues. Upon agreement, mobile teams from the National Cancer Society of Malaysia went to their homes to vaccinate these individuals and their households. Post-vaccination, vaccinees were followed-up after 1 and 3 days respectively to monitor adverse effects post immunisation and provide assistance on how to proceed. Programme / Policy process: The mobile outreach vaccination programme was advertised in mainstream media and plugged in into the National Covid-19 Immunisation Programme. On-the ground logistics and navigation to homes was handled by local civil society partners and Ministry of Health or Department of Social Welfare officers. National Cancer Society of Malaysia mobile teams provided the human resources including clinical personnel and managed all clinical processes and costs. Outcomes: Via this programme, a total of more than 10,000 , bedbound, disabled and chronically ill patients (including people living with cancer) were vaccinated across 6 states in the most rural areas. In total, via community outreach programmes, National Cancer Society of Malaysia provided more than 200,000 (and this continues to be an ongoing programme). What was learnt: Active support of a national Covid-19 vaccination programme enabled the society to provide protection to its most important stakeholders: people living with cancer. In addition to providing them with an invaluable service, joining the programme enabled the society to build better links in integrating clinical service provision better with the public health services across different geographic regions in Malaysia. Have you got a Conflict of Interest?: Yes If yes please specify:: 1. Honoraria from Novartis, MSD, Astra-Zeneca, Roche and Merck 2. Grants from Pfizer, MSD, Roche, Astellas and Astra-Zeneca 3. Advisory Board from MSD, Roche, Novartis
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2108 Incorporating Performance Improvement Projects in a Pediatric Cancer Care Integrated Practice Unit (IPU) V. Mohammed1, A. Alkofide1, M. AlSaleh1, I. Ghemlas1, A. AlAnazi1, S. Ramiz1, A. Podda1, S. Khan1, N. Barcelon2, D. Bushnak2, N. Farhan2, A. AlHmouz2, H. Mahmoud2, K. AlShorman2, D. Qattan2, A. Alayesh3 1 King Faisal Specialist Hospital & Research Centre, Pediatric Hematology Oncology Department, Riyadh, Saudi Arabia, 2King Faisal Specialist Hospital & Research Centre, Pediatric Nursing Department, Riyadh, Saudi Arabia, 3King Faisal Specialist Hospital & Research Centre, Quality Management Department, Riyadh, Saudi Arabia Background and context: Cancer patient experience series of events influencing overall well-being of the patient and families. Pediatric Hematology Oncology department at King Faisal Specialist Hospital & Research Centre, Riyadh serve as tertiary care referral center for cancer care and stem cell transplant Aim: Our aim is to provide access to tertiary cancer care and deliver world-class patient experience, quality and safety of care to our patients across the continuum of care by focusing on our core-specialties and to transform into a financially sustainable and efficient program Strategy / Tactics: The Integrated Pediatric Oncology Practice program designed to ensure healthcare systems (outpatient & inpatient) functions seamlessly and efficiently Programme / Policy process: Incorporating Performance Improvement (PI) projects into the Integrated Practice Unit (IPU) covering all domains of healthcare delivery system through value-stream mapping Outcomes: A total of ten PI projects initiated in January 2021, identifying strategic healthcare delivery domains critical to the functionality of pediatric oncology patient access and services, baseline targets were set for each PIproject based on performance of each indicator during the year 2020 and incorporated into the IPU with timelymonitoring of hospital-metrics data and compared at the end of fiscal year 2021. Number of Procedural Sedation improved by 144% (180 procedures in 2020 to 439 procedures in 2021); Emergency room consultation turnaround-time reduced by 100% (2 hrs. in 2020 to 1 hr in 2021); Medication errors reduced by 33% (54 in 2020 vs. 36 in 2021), while the Medication reconciliation improved by 12% (84% in 2020 vs.96% in 2021) ; Efficiency of newly established Quaternary-care programs: CAR-T cell therapy delivery to high-risk patients improved by 500% ( one-patient in 2020 to 6 patients in 2021) and MIBG- therapy delivery improved by 50% (one patient in 2020 to two patients in 2021); Help-desk compliance improved by 20% (80% in 2020 vs. 100% in 2021) that had led to improvement in Patient Satisfaction by 5% (87% in 2020 vs. 92% in 2021); Financial indicators: Average Length of Stay improved by 12% (15.5 days in 2020 vs.13.6 days in 2021) and overall Revenue improved by 43%. Through our patient-centered IPU we were able to address all touch-points in the pediatric oncology patient journey and with identification of PI-performance projects we were able to achieve all-set targets, respectively. Results from this initiative earned us an official nomination in the prestigious Value Based Health Care Prize 2022- Europe What was learnt: In our experience an existing oncology IPU, supported our ability to adapt and mitigate through PI projects addressing full cycle of cancer care through comprehensive range of services, IPU demonstrated unexpected prospect in the face of adversity during the pandemic and has the potential to be adapted by any medical service for measurable outcomes Have you got a Conflict of Interest?: No
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2110 Uncovered: A Breast Recognition Project for Black, Indigenous and People of Colour with Breast Cancer M.J. DeCoteau1, J. Sikand1 1 Rethink Breast Cancer, Toronto, Canada BACKGROUND: In response to the significant underrepresentation of Black women in the breast cancer community and healthcare system, Rethink Breast Cancer created an unprecedented resource called Uncovered: A Breast Recognition Project in 2020 to amplify the experiences of Black, Indigenous and People of Colour (BI&POC) with breast cancer. It was created in collaboration with Michelle Audoin, a young, Black mom living with metastatic breast cancer. AIM: Uncovered’s goals are to help BI&POC with breast cancer feel seen in their unique experiences and to help educate healthcare providers on the realities and needs of BI&POC, so they are better equipped to support those they care for. STRATEGY & TACTICS: Uncovered shines a light on the impacts of breast cancer, cultural barriers and health inequities through the eyes of 16 women. Using powerful imagery that showcases examples of scars on melanated skin and genuine storytelling, the 2020 resource reached 7.9 million people via social and mainstream media, with many praises and messages of appreciation. A year later, Uncovered was filling a huge gap in the cancer community, but there was a need for more. Rethink’s Equity, Diversity and Inclusion Working Group created a second edition of Uncovered, with eight new patients identifying as Black, Indigneous or People of Colour. A wish list was developed — a call to action and list of tangible items healthcare professionals can implement into their practices to help patients feel more supported. This includes calls to integrate ethnically and culturally diverse patient navigators, Canadian race-based research and data collection and more. In rethinking the outreach approach for 2021, Rethink targeted culturally diverse and ethnic-centered media to reach the communities who may benefit from the resource. PROGRAMME & POLICY PROCESS: The principles of Uncovered are to amplify BI&POC breast cancer experiences through storytelling, build community and collaborate to make real change. OUTCOMES: The 2021 edition had an enormous impact in mainstream media with 101 articles across Canada reaching 12.7 million people and a social media reach of over 73,000, with a 2-year reach of ~20.5 million. Rethink is continuing Uncovered by meeting with hospitals, healthcare professionals, community organizations, policy makers and more to present this project and collaborate on events for the BI&POC community. WHAT WAS LEARNT: There is a continued need to address health inequities in Canada’s healthcare system, showing a promising future for Uncovered. Exploring this project and those like it will help prioritize diverse patient experiences in navigating breast cancer and create a safe space for listening, learning, healing and advocacy. Have you got a Conflict of Interest?: No
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2111 Facilitators Enabling Sustainable Cervical Cancer Control Programs: A Case Study from Zambia K. Duncan1, S. Kapambwe2, S.C. Msadabwe3, J. Herrington4, S. Green4, A.M. Stover4 1 US National Cancer Institute, Center for Global Health, Bethesda, United States, 2World Health Organization Africa Regional Office, Harare, Zimbabwe, 3Cancer Diseases Hospital, Ministry of Health, Lusaka, Zambia, 4Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States Background: In 2020, the World Health Organization (WHO) launched the 2020-2030 Global Strategy Towards the Elimination of Cervical Cancer. Facilitators to sustainability for cervical cancer programs, and links to the WHO building blocks for health systems, are unknown. We conducted a case study in Zambia to understand how facilitators of sustainability map to the six WHO building blocks for health systems strengthening. Aim: We identified facilitators of sustainable cervical cancer screening and treatment programs that strengthen healthcare systems in Zambia. We described how the cervical cancer program strengthens the health system, and developed a conceptual framework that links the facilitators to the WHO health systems framework. Methods: Key informant interviews were conducted with leadership in Zambia’s Cervical Cancer Program, including Ministry of Health (n=7), civil society (n=4), technical and implementing partners (n=5), academia (n=2), and donors/funders (n=4). Content analysis guided coding and analyses to reveal thematic content areas. Document review was conducted on National Strategies related to cervical cancer control, and triangulation of data sources informed the final framework creation. Results: The program strengthened 5 of the 6 WHO health system pillars, including, service delivery, health workforce, access to essential medicines and treatments, financing, and governance. The program strengthened the health system through: government coordination and infrastructure for program support, strategic partnership, and coverage of some screening services through the National Health Insurance Scheme. Recommendations from this research include: 1) implementation, integration, and coordination of cervical cancer programs through government structures, 2) make cancer screening and treatment a part of a National Health Insurance Scheme, 3) emphasize local leadership and decision making in partnerships and research, 4) support implementation science to understand how countries can transition from VIA to HPV-DNA screening, and 5) prioritize health information system strengthening. Conclusion: Our findings, using Zambia’s cervical cancer care program as an exemplar, suggest that health systems in LMICs can be enhanced through ensuring cervical cancer programs have key facilitators of sustainability in their design and implementation. Have you got a Conflict of Interest?: No
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2113 CYTOFastUrine: An Innovative Integrated Solution For Automated Urine Cytology Diagnostics M. Botteghi1, F. Trisolini2, A. Paradiso3, S. Martinotti4, A. Procopio5 1 Università Politecnica delle Marche, Department of Clinical and Molecular Sciences, Dogana, San Marino, 2Hospitex International, Sesto Fiorentino, Italy, 3WorldConnex, Serravalle, San Marino, 4Università degli studi di Chieti-Pescara, Chieti, Italy, 5Università Politecnica delle Marche, Ancona, Italy Background: In EU new cases of bladder, kidney and prostate cancer were more than 715,000 in 2020. A proper diagnosis and follow-up could save lives up to 12% of this population. The urine cytology diagnostics performed by pathologists is an expensive and time-consuming process. Aim: We are developing an innovative computerized diagnostics AI-assisted platform for urine cytology, based on The Paris System standard. The overall saving of early diagnosis through CYTOFastUrine approach in EU can be estimated at around 37 billion €/year, considering that about 18.7% of urinary tract tumors can be cured if early diagnosed. Methods: We developed the complete prototype of CYTOFastUrine made of sample processing with CYTOfast+ system, digitization of samples slides, computerized analysis capable of identifying suspected morphology and aggregates, remote diagnostics reporting through WaidX telemedicine platform. The digitization is managed with automatic slide scanners. Computerized diagnostic algorithms are integrated into the digitization platform. A team of remote pathologists takes care of the validation and quality control of the diagnostic platform. A webbased platform allows the patient to book a cytology test, self-collecting the samples directly at home and receiving the report within 48 hours. Results: Algorithm validation is ongoing. An overall of about 300 samples, 100 positive and 200 negative, will be used as initial validation set. Conclusion: Nowadays, vertical integrated digital pathology solutions for computerized cancer diagnosis with standardized liquid-based cytology aren’t available for urine cytology. CYTOFastUrine enables the possibility of installing laboratories everywhere, giving a valid answer to the increasing shortage of pathologists dedicated to urinary cytology. Have you got a Conflict of Interest?: No
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2116 Looking ahead for NCDs: Development Process of A 3-year strategy for NCD Malaysia M. Munisamy1, M. Thoo Xiu Wen1, M. Ma'som1, S. Rajendran1, J. Pereira1, J. Canute1, T. Jia Hwong1, S. Somasundaram1 1 National Cancer Society Malaysia, Kuala Lumpur, Malaysia Background and context: Globally, the NCD care landscape has been impacted negatively by the Covid-19 pandemic. Things are no different in an middle income country such as Malaysia. Resources, which have already been scarce for NCD management and care before the pandemic, have become even more limited with poorer outcomes predicted for people living with NCDs. At this time, it is important for alliances and coalitions of people living with NCDs to re-strategize and develop synergistic plans on how to move forward to advocate, and bring about meaningful change for the entire NCD care landscape in Malaysia. Aim: NCD Malaysia, a coalition of organisations working within the NCD landscape, aimed to develop a 3 year post-Covid strategy encompassing its goals, objectives and processes to be undertaken to achieve these objectives. Strategy / Tactics: The development of the three-year strategic plan was carried out using a multi-step process, based on a ‘bottom-up’ approach. First, insights in terms of ‘asks’ were compiled from 609 people living with NCDs all across Malaysia through the NCD Malaysian Advocacy Agenda of People Living with NCDs’ project. Member organisations of NCD Malaysia were presented with this list of ‘asks’ and required to prioritise them into focus areas according to the four global action pillars of the NCD Alliance namely Human rights and social justice; prevention; treatment, care and support’ and meaningful involvement. NCD Malaysia member organisations also built a list of activities to be carried out for each of the focus areas as well as the timeline in which they were to be carried out. Programme / Policy process: The entire process was carried out via a consultative and consensus-building approach; with individual NCD Malaysia member organisations reaching a consensus within themselves before coming together in a series of roundtables to get a larger common consensus with the rest of the NCD Malaysia community as a whole. Outcomes: As a result of the strategy development process, a national 3 year strategic plan document has been produced- incorporating both insights from people living with NCDs on the ground as well as input (and tacit commitment) from NCD member organisations on the way forward. What was learnt: The development process for a strategic plan for a coalition of civil society organisations is by itself an important process to engage in coalition building and strengthening of alliances. Through the development process, different member organisations are able to contribute meaningfully to the overall plan, marshal their own resources to support activities of the alliance; and leverage on the strategy as a whole to the benefit of their own individual organisations. The production process of this strategic plan can provide interesting input for other civil society alliances in their own coalition strengthening and building efforts Have you got a Conflict of Interest?: Yes If yes please specify:: 1. Honoraria from Novartis, MSD, Astra-Zeneca, Roche and Merck 2. Grants from Pfizer, MSD, Roche, Astellas and Astra-Zeneca 3. Advisory Board from MSD, Roche, Novartis
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2117 Improving Survivorship Programs: Recognizing psycho-social unmet needs R. deSouza1,2, D.S. Nag2 1 Nag Foundation, Pune, India, 2Nag foundation, Pune, India Background and context: The Indian Breast Cancer Survivors conference was firs held in 2010.The concept of this conference was to address the needs of breast cancer survivors and give them a platform where their doubts, fears, problems both physical and psychological could be addressed, as also an opportunity to connect with other survivors. It would be a much appreciated learning experience for patients, survivors and medical professionals. It addressed the lacunae in Survivorship, which is unavailable in most centres. The conference also is an opportunity to collect information based on the various issues faced by patients and survivors. This information helps to design programs to include in our survivorship program 2021 was the 9th IBCSC and taking into consideration Covid 19 pandemic, there was a restriction in the number of participants. Only patients who were diagnosed or relapsed during the pandemic were invited with a few survivors. Aim: Developing Survivorship programs based on the psycho social experiences Strategy / Tactics: Survey method and administration of FACT B and focus group discussions Programme / Policy process: The survey questionnaire was administered by volunteers in case the patient was not able to read or write. The survey questionnaire was in two languages English and Hindi Outcomes: About 55% of the patients fall in the age group of 31 – 50 50% of the attendees were in the 1 to 3 years post completion of treatment 34% of the attendees had a family history of cancer 52% of the attendees had some form of comorbid disease ( thyroid, diabetes, hypertension etc) 70% of the attendees have included exercise in their lifestyle. 30% of the patients had various issues related to a poor quality of life. One of the most common problems that was affecting their quality of life was Fatigue During the focus group discussion , many of the patients spoke of the impact of the disease and the treatment on their sexuality and sexual desire. The issue is often ignored by the treating doctors *Data is still being analysed What was learnt: (if relevant, please also detail here the potential of replicability) In a city like Pune which is cosmopolitan in nature and progressive in both academics and economical development , with access to self funded internationally comparable cancer treatment we fall short in addressing the overall health of the patient. Spirituality, Emotional and psychological wellness, sexuality are some of the areas which needs more focus and commitment. A Survivorship program that encompasses all dimensions of health needs to be included from the day of diagnosis. Have you got a Conflict of Interest?: No
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2118 Pattern of radiotherapy services for cancer patients at the largest cancer hospital in Nepal A. Rana1, D. Singh2 1 B. P. Koirala Memorial Cancer Hospital, Department of Cancer Prevention, Control and Research, Bharatpur, Nepal, 2International Agency for Research on Cancer, Cancer Surveillance Branch, Lyon, France Background: The burden of cancer is increasing in Nepal with 9% of total deaths reported due to cancer. Most of the cancers are diagnosed at an advanced stage, where different modalities of treatment are required. Radiotherapy is an essential component of cancer treatment for both the curative and palliative intent. In Nepal, there are only seven centers providing radiotherapy services (4 Tele-Cobalt machines, 6 Linear Accelerators and 5 High Dose Rate (HDR) Brachytherapy). Nepal is far below the World Health Organization (WHO) recommendation of one megavoltage machine per million populations. Provision of easily accessible high-quality radiation treatment is crucial to improve survival of cancer patients. Aim: Our study aims to assess the patterns of radiotherapy care services in patients for six common adult cancers (breast, cervix, lung, stomach, colorectal, and oral) and childhood cancers in Nepal. Methods: We planned to conduct a prospective cohort study that includes patients with targeted primary cancer types registered at the B. P. Koirala Memorial Cancer Hospital, Nepal. We intend to recruit at least 1200 cancer cases registered at the hospital from May 2022 to October 2022. Information regarding the treatment will be collected through face-to-face interview using a semi-structured questionnaire, and cross-verified from the patient’s medical records. The patients will be followed up until the completion of treatment. Performance and utilization of currently existing services, patients’ waiting time will be assessed for all cancer types. Expected outcome: We expect significant delays to access radiotherapy services, poor organization of radiation services, and poor survival of cancer patients. Have you got a Conflict of Interest?: No
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2120 Making the path easier for prostate cancer patients in Latin America L. Aguiar Green1 1 Movimiento Latinoamericano contra el Cáncer de Próstata, Project Manager, Ciudad de México, Mexico Background and context: The prevalence and mortality of prostate cancer is growing rapidly in Latin America. By 2040, the deaths of men from prostate cancer in the region will double, according to data from Globocan. Today 70% of diagnoses are made in advanced stages. As a result of this situation, in 2013 the Latin American Movement against Prostate Cancer (MOLACAP) was formed with the main goal to make prostate cancer care a priority in the region. In 2020, organizations from Argentina, Costa Rica, Colombia and Mexico launched the initiative “Making the path easier for prostate cancer patients” in spanish #FacilitarLaRuta. Aim: The aim is to generate evidence on the main barriers that prevent adequate care and treatment of patients with Prostate Cancer in Latin America and issue recommendations for decision makers, opinion leaders and general public. Strategy / Tactics: Strategy 1. Research: Learn from the patient's voice the information they had about the disease prior to diagnosis, lifestyle, diagnostic process, access to treatment, and options to improve their quality of life. Tactics:a) Focus Group B) Patients Interviews C) Document with recommendations. Strategy 2.Communication campaign to make barriers visible and trigger dialogue with decision makers. Tactics: a) Development of messages for each audience b) Social Media Campaign c) Virtual events. d) Advocacy guidelines for each country. Programme / Policy process: The research was conducted with 2 focus groups one in Costa Rica and one in Colombia, also more than 50 interviews with patients from Mexico and Argentina. The campaign was shared by 12 organizations in 6 countries, and 3 virtual events were held with the participation of patients, caregivers and experts. Outcomes: The digital campaign had a reach of 2,865,671 people and more than 400,000 interactions. New organizations joined the Latin American Movement against Prostate Cancer (MOLACAP) in Colombia and Dominican Republic. Alliances were consolidated with key actors. What was learnt: It was possible to combine resources and define general lines of action for the entire region, and at the same time identify the particularities of each country to focus strategies on the priorities of each organization. For example, in Argentina the messages focused on the need for a policy for early detection, in Costa Rica the importance of training medical personnel, in Mexico access to treatment and in Colombia doctorpatient communication. We believe that this project can be replicated with any type of cancer and is a success story of projects that can be developed regionally with patient group organizations in Latin America. Participants: ACIAPO, LALCEC (Argentina), Anasovi, APRECAP (Costa Rica), Instituto Oncoguía, (Brasil), Fundación Simmón (Colombia), Esperantra (Perú), Asociación Mexicana de Lucha contra el Cáncer y Salvati (México).
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Patient Testimony From Argentina
Social Media Post Example
Focus Group in Costa Rica Have you got a Conflict of Interest?: Yes If yes please specify:: Grants from Astellas, Bayer and Janssen.
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2121 International Registry for Men with Advanced Prostate Cancer (IRONMAN) Study: The Nigerian Experience A. Popoola1, C. Ogo2, O. Fatiregun3, H. Dogo4, S. Rotimi5, F. odedina6, C.I. Prostate Cancer Transatlantic Consortium7 1 Department of Surgery , University of Ilorin Teaching Hospital, Surgery, Ilorin, Nigeria, 2Federal Medical Center, Abeokuta, Surgery, Abeokuta, Nigeria, 3Lagos State University Teaching Hospital, Radiotherapy clinical oncology, Ikeja, Nigeria, 4University of Maiduguri Teaching Hospital, Surgery, 600104, Nigeria, 5Covenant University, Biochemistry, Ota, Nigeria, 6Mayo Clinic, Director, Center for Health Equity and Community Engagement Research (CHCR), Jacksonville, United States, 7CaPTC Investigators Prostate Cancer Transatlantic Consortium, Mayo Clinic, Jacksonville, United States Background: Prostate cancer (CaP) is a global disease with the greatest burden among Black men, including subSaharan African men. The International Registry to Improve Outcomes in Men with Advanced Prostate Cancer (IRONMAN) was established by the Prostate Cancer Clinical Trials Consortium (PCCTC) as a prospective, international cohort of men with advanced cancer. The goal of the study is to establish a population-based CaP registry and recruit patients across academic and community practices globally. The Prostate Cancer Transatlantic Consortium (CaPTC) joined the IRONMAN project in 2020 with active sites in Nigeria. Aim: The overall aims of the IRONMAN cohort are to develop a global picture of advanced CaP and facilitate a better understanding of the disease relative to clinical and molecular disease subtypes, treatment patterns, therapeutic regimens with associated adverse events, patient experiences and predictors of responses and unmet needs in treatment. This report presents the experiences of a low-resourced country, Nigeria, in launching the IRONMAN study Methods: CaPTC officially launched the IRONMAN study in Nigeria in 2021. Set up included obtaining national ethics approval, training of the multidisciplinary teams from 4 sites and 7 sub-sites, and activation of all sites. Data collection includes baseline and follow-up data from patients. Patients will be followed prospectively for overall survival, clinically significant adverse events, comorbidities, changes in cancer treatments, and patient-reported outcome measures (PROMs). Physician Questionnaires are also collected from all participating sites. PCCTC maintains close monitoring of the study Results: By the 9th month of the study, the Nigerian sites had recruited 42 patients who have been followed up for 3 to 9 months. There were initial challenges with infrastructures and skills. The training programs have developed a multi-disciplinary team of clinical researchers across multiple institutions, now primed to conduct clinical trials. Facilitated by CaPTC, the study has also helped strengthened multi-center national and international collaborations. Additionally, there are now several clinical trials ready sites in Nigeria, facilitated by audit of the research infrastructures across Nigeria. An added benefit is that there is an opportunity to have molecular typing of CaP in Nigeria Conclusion: The inclusion of low-resourced sites in international studies can significantly help to improve research workforce and research capacity. The Nigerian sites are top recruiting sites for the study, underscoring the benefits of biomedical research investments in LMIC Countries. The data from Nigeria would help to better understand CaP in Black men globally. Have you got a Conflict of Interest?: No
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2122 Early Detection of Recurrence in NSCLC by detecting cell free DNA: Can it answer the costs of ctDNA in LMICs J. SAIKIA1, P. Malik2, S. Kumar2, D. Jain3, K. Madan4, S.J. Bharati5, S. Deo1, S. Kumar1 1 All India Institute of Medical Sciences, New Delhi, India, Surgical Oncology, New Delhi, India, 2All India Institute of Medical Sciences, New Delhi, India, Medical Oncology, New Delhi, India, 3All India Institute of Medical Sciences, New Delhi, India, Pathology, New Delhi, India, 4All India Institute of Medical Sciences, New Delhi, India, Pulmonary Medicine, New Delhi, India, 5All India Institute of Medical Sciences, New Delhi, India, Oncoanaesthesia, New Delhi, India Background: Recurrence is frequently observed in early-stage non-small cell lung cancer (NSCLC), and the overall long-term survival remains poor. Although circulating tumor DNA (ctDNA) has emerged as a highly researched tool to detect/monitor minimal/molecular residual disease (MRD), it is costly (600 USD) and not easily accessible to the majority in low-resourced economies globally. Aim: This study aims to evaluate the feasibility of identification of cfDNA in pleural lavage fluid (PLV) and its estimation in PLV and plasma thereby correlating with early detection of recurrence among completely resected NSCLCs.
Methods: This study included patients diagnosed with stage I-IIIA NSCLC at the All India Institute of Medical Sciences, New Delhi between March 2017 and February 2020. All patients received standard of care management involving surgical resection followed by adjuvant chemotherapy whenever applicable, followed by surveillance. Pleural lavage and Plasma samples were collected intraoperatively serial plasma samples at one-month postsurgery in all patients.
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Cell-free DNA (cfDNA) was isolated using QIAamp-DNA Blood Mini-Kit (QIAGEN) and measured quantitatively by qPCR in a TaqMan probe-detection approach using the human β-actin gene as the amplifying target. The relationship between cfDNA status and recurrence, detected by radiographic imaging or histologically was evaluatedResults: The cohort consisted of 40 patients with a median age of 55.2 (36-74) years, of which 56% were males, 53% were non-smokers, 65% had adenocarcinoma, and 37% were EGFR mutated NSCLC. Stage distribution was 47% for Stage I and 29% for Stage II and 23% for Stage IIIA. At a median follow-up of 30.2 (10.160.0) months, 13 (32%) patients had relapsed. The cost of cfDNA estimation per sample was 65 USD. Figure 1 shows the cfDNA levels among various samples. A significant disease-free survival (DFS) was recorded for patients with cfDNA level cut-offs at 175ng/ml, 125ng/ml and 100ng/ml for intraoperative pleural lavage, pre and post-op plasma respectively. Patients with raised cfDNA in pleural lavage (>175ng/ml) and preoperative plasma (>125ng/ml) had a significantly poorer 2-year OS, p=0.005 and p=0.012 respectively
(Figure 2). High cfDNA in pleural lavage had increased pleural recurrences (p=0.021) and correlated significantly with poorer DFS at 2-years (p=0.001) with increased hazards (HR=9.767,95% CI=2.098-45.451, p=0.004).Conclusion: CfDNA estimation in pleural lavage and plasma perioperatively identified patients with a high risk of relapse in early-stage NSCLC. This can be achieved at one-tenth the cost of ctDNA estimation which if could be evaluated in larger samples can help to guide disease surveillance and management on a large scale among low and middle-income countries (LMICs). Have you got a Conflict of Interest?: No
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2124 Impact of covid-19 on presentation, staging and treatment of lung malignancies in Northern India J. SAIKIA1, P. Malik2, D. Jain3, K. Madan4, S. Pathy5, S.J. Bharti6, S. Deo1, S. Kumar1 1 All India Institute of Medical Sciences, New Delhi, India, Surgical Oncology, New Delhi, India, 2All India Institute of Medical Sciences, New Delhi, India, Medical Oncology, New Delhi, India, 3All India Institute of Medical Sciences, New Delhi, India, Pathology, New Delhi, India, 4All India Institute of Medical Sciences, New Delhi, India, Pulmonary Medicine, New Delhi, India, 5All India Institute of Medical Sciences, New Delhi, India, Radiation Oncology, New Delhi, India, 6All India Institute of Medical Sciences, New Delhi, India, Oncoanaesthesia, New Delhi, India
Background: COVID 19 has affected oncology services to a great extent. Early referral has been vital to improving outcomes in cancer. We retrospectively compared the newly diagnosed cases of lung malignancies attending our thoracic surgery clinic during two time periods (before and during the first wave of covid pandemic). Aim: The aim of this study was to identify the factors affected during management of NSCLCs during a global crisis and its impact on a developing nation. Methods:This study includedall patients with a diagnosis of primary malignancy of the lung operated between 2019 and 2020 at the Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi. Prospective database was queried for demographics, pathology, performance status, clinical presentation and patient pathway Results: A total of 61 and 21 cases of lung neoplasms have been operated during 2019 and 2020 (covid-era) respectively which also includes carcinoids (n=12 in 2019, n=4 in 2020). The number of cases has reduced considerably during covid-era. There was a significant upstaging of cases between pre-covid and covid-era during 2020 (p=0.012), table 1. Additionally the time interval between date of diagnosis at a primary centre and patient’s first visit to referral tertiary centre has also multiplied three times which was statistically significant, p=0.028. Although the median time for registration and surgery at the tertiary centre was higher during covidera, but it was not significant (p=0.081).
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Conclusion: COVID-19 has affected catastrophically in patients with lung cancer. This includes nearly 75% reduction in number of overall operable cases. Moreover, time intervals for patient referral and attending to a tertiary care centre has increased significantly during covid. This has translated to the increased upstaging during covid, a two-fold decrease in Stage I lung cancers and nearly tripling of Stage IIIA cases. Despite increase in this referral time, patients' time spent for treatment at tertiary centre remained reasonable like pre-covid periods, reflecting increased steps taken to fast forward investigations, multidisciplinary planning, operating priorities and discharging procedures during the pandemic. Have you got a Conflict of Interest?: No
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2125 Exposure Disparities and Cancer Risk from the Environment and Workplace M. McDiarmid1 1 University of Maryland School of Medicine, Division of Occupational Medicine, Dept of Medicine, Baltimore, United States Background: Exposure to environmental and occupational hazards are estimated to cause up to 10% of cancers world-wide, but this burden disproportionately targets low and middle- income countries. Most of this disparity reflects resource constraints that limit controls on environmental pollution, hazardous waste handling, workplace safety and toxics management. Context: The Collegium Ramazzini, an independent, international academy of experts in the fields of occupational and environmental health works toincrease scientific knowledge of the environmental and occupational causes of disease, and shares this knowledge toprotect health, prevent disease and save lives. A major work of the Collegium is Cancer Prevention and Control. It is named in honor of Dr. Bernardino Ramazzini (1633-1714), Professor of Medicine in the Universities of Modena and Padova, the Father of Occupational Medicine. Aligned with theRamazzini Institute, and other cancer research institutions globally, Collegium members document the environmental and occupational links to cancer risk through both laboratory- based and epidemiology studies of suspect cancer-causing agents. We also study primary and secondary prevention strategies to minimize that risk. To communicate findings to the public, the Collegium also prepares evidencebased policy statements of global relevance regarding key public health threats, including many cancer-related topics as exposures to asbestos, benzene, butadiene, pesticides, tobacco and e-cigarettes. The Collegium Ramazzini also acts as a convening authority on scientific topics of global public health importance by organizing major meetings on the health impact of environmental hazards, engaging stakeholders across scientific disciplines and geographic locations. Aims: Given that environmental and occupational cancer excesses are preventable, this presentation will discuss policy initiatives that reduce risk at the source and describe other low- cost prevention approaches. Strategies:Prevention strategies discussed will include hazard mapping, expanding existing cancer registries to record occupation and industry and prioritizing secondary prevention and screening efforts for high- risk populations, as those exposed to lung cancer-causing agents. Outcomes: Such efforts will lead to attainable reductions in risk and future cancer rates. Have you got a Conflict of Interest?: No
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2126 Ewing Sarcoma in Children: A Tertiary Care Center Experience A. Ali1, V. Mohammed1, D. Bushnak2, A. Alanazi1, I. Alfawaz1, A. Alkofide1, R. Pant3, Z. Habib4, S. Alshanafey4, L. Alotaibi5, A. Ahmad2, H. Khoja6, Y. Khafaga7 1 King Faisal Specialist Hospital & Research Centre, Pediatric Hematology Oncology Department, Riyadh, Saudi Arabia, 2King Faisal Specialist Hospital & Research Centre, Pediatric Nursing Department, Riyadh, Saudi Arabia, 3King Faisal Specialist Hospital & Research Centre, Orthopedic Surgery Department, Riyadh, Saudi Arabia, 4King Faisal Specialist Hospital & Research Centre, Pediatric Surgery, Riyadh, Saudi Arabia, 5King Faisal Specialist Hospital & Research Centre, Pediatric Radiology Department, Riyadh, Saudi Arabia, 6King Faisal Specialist Hospital & Research Centre, Pathology And Laboratory Medicine Department, Riyadh, Saudi Arabia, 7King Faisal Specialist Hospital & Research Centre, Oncology Department, Riyadh, Saudi Arabia Background: Ewing Sarcoma (ES) affects bones or soft tissue and continues to be a challenge to treat particularly in patients with metastatic disease. King Faisal Specialist Hospital & Research Centre, Riyadh is a regional tertiary referral center for children with malignancies Aim: Outcomes analysis was undertaken to assess the effect of standardization of treatment protocols based on Children’s Oncology Group (COG) Methods: Retrospective chart-review of children aged ≤ 14 years, diagnosed and treated for ES during 2005 – 2020.Clinical data collected using IRB-approved case report form, while cases with limited data or previouslytreated were excluded Results: There were a total of 148 cases, of which 134 were eligible for analysis. Of these, 64 (48%) were male and 70 (52%) female. Median age at diagnosis was 9.5 years (0.4 – 14.1 yrs). Localized disease was seen in 82 (61%) and 52 (39%) metastatic. Primary bone tumors were seen in 79 patients (59%) and 55(41%) patients had soft tissue lesions. Combination therapy was administered in 68% of the which included local control (radiation or surgery or both). Five-year overall survival (OS) for all stages was 70% with an event-free survival (EF) of 62.2%. Disease progression was documented in 51 pts (30%) of which 29 pts (57%) had metastatic disease at diagnosis. Secondary malignancy was seen in 2 patients (Acute lymphoblastic leukemia and osteosarcoma). 5-year OS in patients with localized and metastatic disease was 81.3% and 49.1% respectively (statistically significant; p-value <0.05). In 2013, treatment protocols were all moved to COG-based regimens. Comparative Subgroup analysis was done on patients treated from 2005-2013 and 2014-2020. 5-year OS for all stages was 65.7% and 77.7%, respectively (p-value =NS). However, 5-year EFS survival was 51.4% and 85.9%, (p-value <0.05). A statistical significance was also observed in the 5-year OS between patients receiving chemotherapy plus local control vs. chemotherapy alone, 78% vs. 50.2%, respectively (p-value <0.05). Additionally, subgroup analysis for 5-year OS and EFS for localized disease was 64.8% (2005-2013) and 96.2% (2014-2020). For metastatic disease, 5-year OS was 49.6% (2005-2013) and 49.6% (2014-2020) however the EFS for the subgroups was 29.4% (2005-2013) and 68.8% (2014-2020), (p-value <0.05) Conclusion: We conclude that there was a significant improvement in outcomes for patients with Ewing Sarcoma both localized and metastatic with the transition to COG based therapy using compressed cycle Vincristine/Doxorubicin/Cyclophosphamide alternating with Ifosfamide/Etoposide. Additionally, metastatic patients were treated with continuation/maintenance therapy with Irinotecan/Temozolomide. Recently established chemotherapy regimens with continuation therapy and second- and third-line regimens may increase the EFS as observed in our cohort. Multivariate analysis and longer follow up in the second group is warranted Have you got a Conflict of Interest?: No
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2127 Evaluating Opioid Consumption as an Indicator of the COVID-19 Pandemic’s Effect on Global Palliative Care B. Hastie1, J. Cleary1 1 Walther Global Palliative Care & Supportive Oncology, Indiana University Simon Comprehensive Cancer Center, IU School of Medicine, Dept of Medicine, Indianapolis, United States Background: The COVID-19 Pandemic heightened attention and exacerbated the global need for Palliative Care (PC) and cancer patients have been disproportionately affected. Low and middle-income countries (LMICs) remain at greatest risk with little to no access to essential controlled medicines for those who need PC. Propelled by the Pandemic’s impact on global disparities in access and availability, the 2022 Joint Call to Action of the UN Commission on Narcotic Drugs, WHO and International Narcotics Control Board (INCB) aims for measurable progress with significant attention at national, regional, and international levels. Key post-pandemic factors include morphine-equivalence consumption trends of essential controlled medicines as indicators to gauge COVID’s impact and progress toward bridging the access abyss. Aim: This study evaluated global and regional opioid consumption data and trends with special examination of the impact on reporting and consumption of essential controlled medicines and palliative care for pre-, peri- and into post-pandemic years. Methods: Utilizing data provided annually to the INCB by every country (back to 1964), morphine-equivalence (ME) metrics were calculated and trends analyzed Globally and for WHO regions (AFRO, AMRO, EMRO, EURO, SEARO, WPRO) for the WHO List of Essential Controlled Medicines for PC (morphine, hydromorphone, fentanyl, oxycodone, pethidine, codeine, excluding methadone). Secondary analyses examined the impact of COVID on reported opioid consumption and palliative care globally and regionally. Results: A consistent rise in global consumption of all study opioids was shown in1998 to circa 2012. Specific for Morphine in 1989-2014, slow and steady increase globally and regionally was revealed. Since 2014-15, apart from select regional increases in fentanyl and oxycodone, global levels decreased with more reduction in amounts reported during COVID (2018-20). Morphine increased globally in 2019-20 (AFRO, AMRO, WPRO increases vs decreases in EMRO, EURO, SEARO). Current global morphine consumption has returned to 2006 levels. These vagaries reflect INCB-reported challenges with tracking and/or supply chains secondary to COVID, non-reports ranging 0.5% (morphine) to 58.5% (hydromorphone) but significantly more countries reporting “0” than previous years. Conclusion: COVID-19 worsened global inequities by massively disrupting supply chains and governments’ ability to report and obtain the appropriate quantity of opioids and cancer medications to thwart disease and mitigate suffering. This study shows COVID’s initial influence on opioid consumption data. Some LMICs and many high-income countries with robust systems, PC services and cancer plans fared slightly better but lasting effects continue. This study informs the Joint Call to Action in addressing staggering disparities and resounding effects of the Pandemic on access to essential controlled medicines, PC and global efforts to rectify gaping inequities. Have you got a Conflict of Interest?: No
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2128 Expression and cytotoxic function of the TRPA1 and TRPV1 receptors on mouse osteosarcoma K7M2 cells L. Hudhud1, A. Stieb1, V. Kormos1, A. Kecskés1, É. Szőke1, Z. Helyes1 1 University of Pécs, Pharmacology and Pharmacotherapy Department and János Szentágothai Research Centre, Pécs, Hungary Osteosarcoma is the most common primary malignant bone tumor in children and adolescence 1. Transient receptor potential (TRP) vanilloid 1 (TRPV1) and ankyrin1 (TRPA1) receptors are non-selective cation channels expressed in primary sensory neurons, vascular smooth muscle, endothelial and inflammatory cells, as well as certain cancer cells like prostate carcinoma, and breast cancer 2. They were previously shown to affect the proliferation of different tumors such oral squamous cell carcinoma 3. These channels can be activated by endogenous stimuli such as anandamide, protons, formaldehyde besides the exogenous activators like capsaicin and allyl-isothiocyanate (AITC), respectively4.This study investigates the expression of these receptors in mouse osteosarcoma K7M2 cells and the effect of the TRPV1 agonist capsaicin, and the TRPA1 agonist AITC on cell viability.The highly sensitive in situhybridization RNAscope showedTrpa1 mRNA expression in these cells. Tested at 5, 10, 20, 50, and 100 μM concentrations by the ATP-based viability assay, both capsaicin and AITC induced cytotoxicity in a concentration-dependent manner in K7M2 cells with 69% and 21% cell viability at 100 μM, respectively. These results suggest that capsaicin and AITC can cause osteosarcoma cell death which might open future therapeutic opportunities. But, further studies are needed to determine the channelsdependent or independent pathways. Referecnces (1) Taran, S. J.; Taran, R.; Malipatil, N. B. Pediatric Osteosarcoma: An Updated Review. Indian J. Med. Paediatr. Oncol. Off. J. Indian Soc. Med. Paediatr. Oncol. 2017,38 (1), 33–43. https://doi.org/10.4103/0971-5851.203513. (2) Fernandes, E.; Fernandes, M.; Keeble, J. The Functions of TRPA1 and TRPV1: Moving Away from Sensory Nerves. Br. J. Pharmacol. 2012,166 (2), 510–521. https://doi.org/10.1111/j.1476-5381.2012.01851.x. (3) Kiss, F.; Kormos, V.; Szőke, É.; Kecskés, A.; Tóth, N.; Steib, A.; Szállási, Á.; Scheich, B.; Gaszner, B.; Kun, J.; Fülöp, G.; Pohóczky, K.; Helyes, Z. Functional Transient Receptor Potential Ankyrin 1 and Vanilloid 1 Ion Channels Are Overexpressed in Human Oral Squamous Cell Carcinoma. Int. J. Mol. Sci. 2022,23 (3), 1921. https://doi.org/10.3390/ijms23031921. (4) Pohóczky, K.; Kun, J.; Szalontai, B.; Szőke, É.; Sághy, É.; Payrits, M.; Kajtár, B.; Kovács, K.; Környei, J. L.; Garai, J.; Garami, A.; Perkecz, A.; Czeglédi, L.; Helyes, Z. Estrogen-Dependent up-Regulation of TRPA1 and TRPV1 Receptor Proteins in the Rat Endometrium. J. Mol. Endocrinol. 2016, 56 (2), 135–149. https://doi.org/10.1530/JME-15-0184. Have you got a Conflict of Interest?: No
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2129 The Power of a Metastatic Breast Cancer Advocacy Program with Engaged Allies M.J. DeCoteau1, J. Sikand1 1 Rethink Breast Cancer, Toronto, Canada BACKGROUND & CONTEXT: In 2015, Rethink Breast Cancer developed a Metastatic Breast Cancer (MBC) program after listening to issues affecting MBC patients that included isolation from the breast cancer community, a lack of public understanding of MBC, and barriers to treatment access. AIM: Rethink aimed to do more for MBC patients to help improve outcomes in both quality and quantify of life. This included breaking down the barriers between the early and metastatic breast cancer communities and making the general public aware of the unmet needs of the MBC community in order to unite and engage many voices in advocacy campaigns. STRATEGY & TACTICS: We enhanced our resources to support and empower the MBC community by amplifying the voices of the MBC community and co-creating tools and resources specific to MBC needs. These initial efforts gave us a better understanding of the issues and opportunities of how Rethink could help more. It became clear Rethink needed to focus efforts on improving access to treatments as there were major delays in getting cancer medications to Canadian patients due to administrative processes. To build a strategically sound approach that would make impactful change,we met with stakeholders in 2017, including medical oncologists, manufacturers and bureaucratic bodies. This work led to our #MBCintheDark campaign, advocating for transparency and accountable deadlines from decision-makers and manufacturers. We developed educational explainer content to prime the community on these issues and leveraged our existing platforms to engage the broad community and underscore that advocating for change cannot be left to people with MBC alone. PROGRAMME & POLICY PROCESS: The integrated advocacy model included developing robust educational content, executing targeted government relations and launching a public-facing advocacy campaign that rallied almost 10,000 people to sign and share our #MBCintheDark petition. OUTCOMES: A successful win was announced in spring 2018, when the pCPA announced their benchmarks for shorter timelines to negotiate drug prices and sign a letter of intent. To build on the success of this model, in 2019 we introduced the 10,000 MBC Allies Pledge to rally the breast cancer community, regardless of stage, and unite around MBC advocacy and policy change. The MBC Allies regularly learn about MBC issues and then are called upon to take action as needed. At over 6,000 MBC Ally pledges, Rethink continuously engages this group and leverages their strength to advocate for systems change: holding decision-makers accountable; the #BitterestPill campaign; #MakeMBCCount campaign for better MBC data collection; earlier access to second doses of COVID vaccines for cancer patients; and more. WHAT WAS LEARNT: Through transparency, engagement and relevant content, a strong community foundation can be leveraged to generate a united community, actionable allyship and advocacy programs for real change. Have you got a Conflict of Interest?: No
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2131 Transporting Hope by Bridging the Gaps During the Covid19 Pandemic in Paraguay A. Pomata1, N. Gimenez2, M. Ortega1, H. Caniza3 1 Instituto Nacional del Cancer, Central, Capiata, Paraguay, 2Fundacion Unidos Contra el Cancer, Capital, Asuncion, Paraguay, 3Conacyt, Central, Asuncion, Paraguay Transporting Hope by Bridging the Gaps During the Covid19 Pandemic in Paraguay 1-Pomata, Alicia- 2-Caniza, Horacio-3-Ortega, Marina A.- 4-Gimenez, Norah 1,3-Programa Nacional de Control del Cáncer, PRONAC 2-National Council of Science and Technology, CONACYT. 4-Fundacion Unidos contra el Cáncer, FUNCA. Background and Context Due to the COVID-19 pandemic, in Paraguay almost 100% of the efforts and resources of the budget were focused on containing it. Similarly, cancer screening and diagnosis were affected by the mandatory isolation. In response to the situation and the need to reactivate the activities, the National Council of Science and Technology (CONACYT) launched a call for projects that promotes creative tools that were immediately applicable and allowed the resumption of daily activities with security schemes, the proposal of safe transportation for cancer screening won the prizes. Purpose Reduce the gaps generated during the Covid 19 pandemic in access to early detection, diagnosis and treatment of cancer and achieve the greatest efficiency of available resources with the greatest effectiveness in the care of the population at risk for non-communicable chronic pathologies, supporting in an articulated manner the plan for the elimination of cervical cancer in line with the strategy proposed by the WHO, as well as the early detection of breast cancer, both pathologies are the most prevalent in women in the country. Strategy The localities within the Department were primarily identified in order to call for eligible patients. A communication campaign was carried out through community radio stations and loudspeakers, as well as personal contacts were made through nurses in Family Health Units (USF) in order to prepare the agenda, the dates and times available for the transfer and that the doubts of the interested women were evacuated. Later on, journeys were organized in which the scheduled women received free and safe transportation from specific points in the communities to the screening centers. Upon arrival, the women were attended to without excessive delays due to prior scheduling. Program Process The project called "United for Health and Life" benefit 128 women from five different districts with PAP smears, HPV tests and mammograms.Between February and April 2021, six journeys were carried out with follow-up of the benefited women. The project received from CONACYT, 4700 usd for its implementation. Innovative methods Innovation in management, articulating the private and public sector and optimizing resources for the benefit of vulnerable population.
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Conclusions The project proposed a simple solution involving several stakeholders for an important problem in the country, which is access to health. Finally, thanks to the implementation of the pilot project, today the program is a reality with a sustainable vision that has been successfully replicated in other cities. Source: Direct from the MoH Have you got a Conflict of Interest?: No
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2132 Antitumor potential of rPllans-II, a recombinant snake venom phospholipase A2 against Cervical Cancer cells E. Jimenez-Charris1, L. Montealegre-Sanchez1, A. Montoya-Gomez1, M.J. Sevilla-Sánchez1, D. Osorno-Valencia1, M. Mosquera Escudero1 1 Universidad del Valle, Department of Physiological Sciences, Cali, Colombia Background:Despite advances in understanding the pathophysiological mechanisms of cervical cancer, available chemotherapy treatments display adverse effects on the patients' life quality. For this reason, new molecules with antitumor potential and few side effects are required. Aim: To evaluate the cytotoxic activity of rPllans-II on two cervical cancer lines and the recombinant protein's safety on healthy mice's cervical tissue. Methods:rPllans-II was produced in E. coli BL21 (DE3) cells, and the cytotoxicity was determined by the MTT assay on Ca Ski and HeLa cells. The rPllans-II harmlessness was evaluated by measuring pro-inflammatory markers in blood samples from healthy mice inoculated intra-cervically. Results:rPllans-II generated 42% and 20% cytotoxicity in HeLa and Ca Ski cells, respectively. At the same time, no significant differences were found in the concentration of the pro-inflammatory markers IL-6 and TNF-α between control and inoculated mice. Conclusion: This is the first report on the selective antitumor effects of rPllans-II against cervical carcinoma cells, and these results suggest that it could be considered a promising prototype for therapy against cervical cancer. Have you got a Conflict of Interest?: No
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2133 Sharing data for comparing colorectal cancer screening performance. Proposal for a consortium N. Segnan1, C. Senore2, E. Dekker3, L. Rabeneck4, V. Coupé5, B. Jahn6, S. McCarthy7, M.I. Portillo Villares8, D. Puricelli Perin9, P. Doria-Rose7, I. Lansdorp-Vogelaar10 1 CPO Piemonte, Epidemiology and screening unit, Turin, Italy, 2University Hospital Città della Salute e della Scienza, Epidemiology and screening unit - CPO, Turin, Italy, 3Amsterdam University Medical Centre, Dept of Gastroenterology &Hepatology, Amsterdam, Netherlands, 4Cancer Care Ontario, Toronto, Canada, 5VUmc Amsterdam, Department of Epidemiology and Data Science, Amsterdam, Netherlands, 6University for Health Sciences, Medical Informatics and Technology, Hall, Austria, 7US National Cancer Institute, Bethesda, United States, 8Basque Country Colorectal Cancer Screening Program, Bilbao, Spain, 9Frederick National Laboratory for Cancer Research, Frederick, United States, 10Erasmus MC, Rotterdam, Netherlands Colorectal cancer (CRC) screening is now delivered globally, within organized programs, or in opportunistic settings. This wide experience would offer an opportunity to exchange approaches and results to facilitate optimization of CRC screening practices and to improve their health impact. However, diverse approaches adopted in different settings pose specific challenges when comparing results or building predictive models to anticipate their outcomes. The expected impact of a screening strategy is dependent not only on the characteristics of the test adopted, but also on the starting and stopping age, on the recommended frequency of its use, as well as on multiple factors acting at the patient (i.e. socio-demographic characteristics), provider (i.e. specialty and patient volume) and system level (i.e. organizational setting). Monitoring efforts using quantitative data have been implemented in several countries, but program performance indicators are usually presented for a single year and screening episode, while screening is a complex multi-step process of care, involving also repeated testing at the stipulated intervals and appropriate follow-up of those with abnormal screening results. Using aggregated data might lead to misclassification of exposures and outcomes and to biased estimates of performance indicators, while the interpretation of the comparison across different programs might be difficult given the potential for ecological fallacy. To avoid these potential sources of biases and to improve the accuracy and the validity of the comparisons across programs, detailed individual-level longitudinal data about the screening history of the eligible individuals are needed. We propose to establish an international multidisciplinary collaborative network of CRC screening programs, aiming to implement a common accessible database, in order to generate comparable estimates of indicators and outcomes of CRC screening across different programs and countries and to maintain a data-sharing platform to be prepared for future innovations. Federated data systems where individual-level data remain at their original source, but are transformed into a common format to facilitate distributed analysis and aggregation of results could represent feasible approaches to the implementation of a shared screening data warehouse collecting at regular intervals anonymized individual records. Such a working model might be applicable under strict international regulatory frameworks, such as the General Data Protection Regulation of the European Union, provided that the validation of the local databases will be successful. Establishing such collaborative network would support the implementation of actions aimed to promote capacity for implementation research and for monitoring and evaluating progress in cancer control, advancing progress toward the world cancer declaration targets. Have you got a Conflict of Interest?: No
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2135 Fakous Cancer Center 30 years NGO experience G. Amira1, O. Sherif Omar2, H. Khaled3, A. Selim4, I. Sallam5 1 NCI Cairo University, Surgical Oncology, Cairo, Egypt, 2Sherif Omar Cancer Care Foundation, Breast Surgical Oncology, Giza, Egypt, 3NCI Cairo University, Medical Oncology, Cairo, Egypt, 4Cairo University, Interventional Radiology, Giza, Egypt, 5MISR Cancer Center, Breast Surgical Oncology, Giza, Egypt
Fakkous Cancer Center which is a UICC center was established in 1992 by Prof. Sherif Omar as one of the earliest not for profit rural cancer centers in Egypt. This center is located in the eastern side of the delta region and serving not only its governorate but extends its services to the nearby governorates that lacked cancer services at the time of initiation as well as for some reaming cities till now. Throughout the last three decades, it has managed to provide and maintain high level of comprehensive cancer service including the full spectrum from early detection to diagnosis and treatment including surgery, chemotherapy as well as radiation therapy.The challenges faced at the time of establishment from funding to turning the idea into a real working model were not the main struggles faced. The real challenge, for this center that is 200 km away from Cairo, was in creating a sustainable program from all its aspects. The main challenge was in building a crew of consultants and specialists as well as a huge paramedical supporting team. In addition to that, creating a sustainable financial model that covers and maintains the centers expenditures was the main concern, bearing in mind that the population served in this area is from a low socioeconomic status. The first concern was solved by creating effective collaboration with the national cancer institute to build a visiting consultants program as well as creating a local nursing school in order to maintain a high level of training to the nursing and para medical team. The second concern was solved by creating an effective partnership with the Egyptian national insurance system so that to ensure that the patients receive a free of charge service, yet maintaining a reasonable financial income to the center to maintain its services.Over the past three decades, this center has provided outpatient services to more than 40000 patients, performed more than 28000 cancer surgeries, gave more than 300000 radiotherapy sessions as well as more than 100000 chemo sessions.
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The sustainability of the project and the development of new leadership led Prof Sherif Omar to handover the leadership in 2017 to Prof Omar Sherif Omar . Prof Omar Jr is currently the director of the breast surgery unit at Cairo University Hospital as well as the chairman and managing director of Fakous Cancer Center. In 2017, Prof Omar Jr established Sherif Omar Cancer Care Foundation and managed in 2021 to create a new expansion hospital in the heart of Cairo that will be mainly focused on the diagnosis and treatment of breast cancer. Have you got a Conflict of Interest?: No
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2137 A national surveillance program for hepatocellular carcinoma for patients with liver cirrhosis G. Amira1, G. Esmat2, H. Khaled3, A. Selim4, O. Sherif Omar5, I. Sallam6 1 NCI Cairo University, Surgical Oncology, Cairo, Egypt, 2Cairo University, Hepatogastroenterology and Infectious Diseases, Cairo, Egypt, 3NCI Cairo University, Medical Oncology, Cairo, Egypt, 4Cairo University, Interventional Radiology, Giza, Egypt, 5Sherif Omar Cancer Care Foundation, Breast Surgical Oncology, Giza, Egypt, 6MISR Cancer Center, Breast Surgical Oncology, Giza, Egypt
Background and context Hepatocellular Carcinoma still poses a serious problem in Egypt and worldwide. Liver cirrhosis (LC), viral hepatitis, male sex and older age are the main risk factors. In September 2019, following the universal national screening program for hepatitis C, the National Committee for Control of Viral Hepatitis (NCCVH) launched a national surveillance program for patients with HCV related LC. Aim HCC surveillance for early detection and reduction of HCC-related mortalities strategy/tactics A national practice recommendation for HCC surveillance and management was drafted. Phone calling campaigns HCV treated patients were arranged. Training programs were offered to the hepatologists and radiologists at the dedicated centres. Programme/policy process Targeted patients are offered a free visit every 4 months where abdominal ultrasonography and alpha-fetoprotein test are used to screen for HCC. Suspected cases are referred to specialized centres for dynamic imaging studies and treatment if needed.HCC multi-disciplinary Treatment Centers are the key to the management decisions
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Outcomes Out of 81 214screened patients in the period between September 2019 and December 2021, 821 were diagnosed with HCC at the 1st follow up visit . BCLC class B and C tumours were more frequently diagnosed at the 1st visit compared to the follow-up visits. First visit presenters had statistically significant mortality rates. The duration between the end of the HCV treatment visit and the 1st screening visit was an independent predictor of havingadvanced tumour. what was learnt Earlier linkage of patients with HCV related LC to surveillance programs reduces the occurrence of advanced hepatocellular carcinoma, HCV-related mortality, and the economic burden of the disease. Have you got a Conflict of Interest?: No
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2139 Towards developing cancer control guidelines in a developing nation G. Amira1, H. Khaled2, G. Esmat3, A. Selim4, O. Sherif Omar5, I. Sallam6 1 NCI Cairo University, Surgical Oncology, Cairo, Egypt, 2NCI Cairo University, Medical Oncology, Cairo, Egypt, 3Cairo University, Hepatogastroenterology and Infectious Diseases, Cairo, Egypt, 4Cairo University, Interventional Radiology, Giza, Egypt, 5Sherif Omar Cancer Care Foundation, Breast Surgical Oncology, Giza, Egypt, 6MISR Cancer Center, Breast Surgical Oncology, Giza, Egypt Background and Aim. The practice of medicine evolved from expertise-based medicine into evidence-based medicine, integrating clinician experience with the best available evidence. The step forward was the introduction of guidelines. This concept applies as well to cancer control guidelines. It takes into consideration many aspects including the quality of evidence, magnitude of benefit and harms, values, and differences of the patients, in addition to the consideration of resources available. International guidelines are probably impractical or not feasible to be adopted in countries with limited resources for numerous reasons including shortage of the healthcare work staff, limited infrastructure, number of hospitals, hospital beds, diagnostic facilities, clinics, and shortage of medications, especially expensive medications. So, it is important for policymakers to prioritize resource utilization and plan infrastructure development. Strategy and Policy process. There are 4 resource certification levels that can be applied to any cancer care delivery system. Basic level resources refer to fundamental resources that are necessary for any healthcare system to function. Limited level resources are services that can reduce major improvement but at minimal financial resources. Enhanced level resources are services that are optional. They improve the quality and several options available for our patients but come at extra cost. Maximum level resources are what can be offered independent of course and their maximum level resources. The international cancer guidelines are not meant to replace national guidelines, but to complement them. Simply because national guidelines can take into consideration more accurate assessment of the local available resources. Lack of local data is a challenge to develop national guidelines. That is why the committees for their development rely heavily on local experts’ opinion. Each community must decide what value, kind of investment, for what kind of benefit. For example, WHO defines a reasonable upper threshold to be invested for each quality-adjusted life years gained to be three times the country's GDP. Once developed, they need to be disseminated, and encouraged to be published in international journals. Lastly, guideline development is a dynamic process and relies on integration of new data available. To have data, research is needed, and to have research funding must be available, which is a challenge, even in communities with maximum resources. Conclusion. Research stratified guidelines are important. They are the best way to ensure benefit and access for patients, because they assure affordability and sustainability of the healthcare service. Have you got a Conflict of Interest?: No
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2142 Bridging the gap for better care and quality for cancer patients through international cooperation A. Pomata Gunsett1, N. Mitsui1, J. Rolon1 1 Instituto Nacional del Cancer, Central, Capiata, Paraguay Background and context: On the way to reorganize and optimize health services in order to prioritize cancer as one of the pathologies with the highest incidence and mortality, Paraguay has undergone a Integrated Mission of Programme of Action for Cancer Therapy" (imPACT Review), concibed to evaluate national capacity and health system readiness to plan and implement adequate cancer control strategies according to their specific cancer burden. The report left a series of recommendations in order to strengthen the few actions carried out up to that time. Aim: To demonstrate the usefulness of international cooperation in the development of a local situation diagnosis, with the objective of identifying the most relevant issues to be addressed in all cancer-related areas, including legislative, regulatory and care-related areas. Strategy On the occasion of the analysis of the imPACT review by different local decision-makers, fundamental actions were taken to position cancer as one of the main public health problems in the country. More weaknesses than strengths were found at the time of the diagnosis, which represented many years of local neglect, however, qualified human resources with great potential for the development of improvements were also reported as strengths. This served as a basis for identifying local leaders who could carry out short- and medium-term projects that would respond to the observations made in the report. Policy process: One of the main ones was to incorporate the National Cancer Control Program within the functional and organizational structure of the National Cancer Institute in order to join efforts and build together the necessary public policies to contain the problem, after this merger and through the participation of various stakeholders the country would have its first law onComprehensive Care for Cancer Patientsto ensure timely and quality access to a dignified and comprehensive health care to cancer. The first guidelines, protocols and best practice manuals in the areas of early detection, diagnosis and treatment of cancer were also developed. New stakeholders and international technical cooperation initiatives were identified where the country has benefited from training and exchange, as well as project financing. Cancer care services have been decentralized after it was shown that access was one of the main problems of the population affected by this pathology. Outcomes: The results have been positive in the final balance, the country has been able to use the situation report to identify areas to be prioritized and has initiated efforts to improve areas where more attention is needed.
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What was learnt: Due to the excellent experience with this type of collaborative work, and in order to further support established public policies on cancer, the country has requested and is working on its first National Cancer Control Plan again under the sponsorship of international cooperation provided by IAEA, IARC and WHO Have you got a Conflict of Interest?: No
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2144 Childhood cancer, age group 0-15 years of all nationalities_2014-2018. O. Nimri1,2 1 Jordan Cancer Registry., Amman, Jordan, 2Ministry of Health., Cancer Prevention Department., Amman, Jordan Background: The cancer burden in the Hashemite Kingdom of Jordan is a challenge, as well as a success. The influx of the huge number of displaced refugees to Jordan in a short period was one of such challenges, particularly to the health system and cancer care. Aim: The epidemiology information about the burden cancer data can provide, policymakers and health care providers, as well those interested parties and societies, the lead for cancer prevention and the evaluation of cancer prevention and control. Tactics: Childhood cancer data for the age group 0-15 years of all nationalities obtained from the population-based Jordan cancer registry, that collects cancer incidence data from all residents in the country, both Jordanians and Non-Jordanians. Backdated data for the period 2014-2018 cancer data was analyzed. Outcomes: Data showed a total of 2,035 (57.5% male and 42.5% female) incidences among all childhood populations containing the influx of the refugee's children. 1,297 (63.7%) were Jordanians, Non-Jordanian 738 (36.3%). children's main nationalities were Iraqis (5.4%), Libyans (7.9%), Yemen (5.7%), Syrian (6.9%), and Palestinians (3.4%) others (7%). The five cancers among the non-Jordanian children were; Leukemia (20.8%), Brain CNS (7.6%) Eye (11.1%) Lymphoma (9.5%), and CT (5.8%). Jordan population incidences of children of the same age group Leukemia (26.9%) Brain& CNS (16.8%) Lymphoma (11.7%) Eye (4.2%). Conclusion, What could be learned: A high similarity of the cancers among Jordanian and non-Jordan children, that could have the indication of common risks or genetics among the different populations in the region which may need further studies and follow-ups. These results could be the basic initiation for a further knowledge transfer to action steps in the course of the cancer care with a focus on the global childhood cancer control initiative in controlling childhood cancers. Have you got a Conflict of Interest?: No
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2145 Precision oncology – How can we pay for it? A. Matus Perez1, S. Petcharapiruch2, J. Ng2, H. Le1, T. Ee Min2 1 Roche, Singapore, Singapore, 2IQVIA, Singapore, Singapore Ariosto Matus1, Hang Le1, Junice Ng2, Sirinthip Petcharapiruch2, Tan Ee Min2
1. 2.
Roche, Asia-Pacific IQVIA, Asia-Pacific
Background Precision oncology drives better clinical, economic, and societal outcomes, and yet many people in Asia-Pacific (APAC) still do not have access to it. Aim This work aimed to explore the challenges in access to precision oncology in APAC and how we can catalyse access to an affordable precision oncology care that can be scaled up by countries and relevant stakeholders. Methods A landscape assessment framework was developed based on literature review and was validated by an advisory panel that comprised medical oncologists, HTA experts and health economists. To validate market evaluation and recommendations, domains of the framework – HTA agency and payers, HTA process and approach, pricing and reimbursement, public-private engagement and public policy data and infrastructure – formed the basis of our interviews with 18 clinicians, HTA experts and health economists across Australia, Mainland China, Malaysia, South Korea, Taiwan, and Thailand. Results We found varied levels of access and adoption of precision oncology and characterized the six markets into three archetypes - Initializing, Defining, and Innovating. The initializing archetype is characterized by markets such as China that are embarking on and formalizing their access approach for precision oncology. Markets in the defining archetype, such as Malaysia, Thailand and Taiwan, are establishing and refining the precision oncology strategy most appropriate to the market priorities. In the innovating archetype, markets such as Australia and South Korea have well-established HTA agencies and systems that are refining their frameworks for access to precision oncology. Across all archetypes, a comprehensive approach and system to manage access challenges is needed. Strategic initiatives to incorporate precision oncology into the healthcare system are proposed for each archetype. In general, these include: 1) acclimatizing HTA pathways to new methods of evidence generation, demonstrating the values of precision oncology, 2) developing, testing and fine-tuning alternative flexible payment systems to accommodate a changing reimbursement landscape, 3) building nationwide testing and data infrastructure to collect clinical and genomic information as the precursor to understanding population and individual health, 4) establishing a robust data governance framework as an essential safeguard for public interest, and 5) building collaborations among relevant stakeholders to co-create and co-invest new strategies and solutions. Conclusion Countries in all archetypes have choices regarding how they position themselves while pursuing initiatives to advance the use of precision oncology. All stakeholders have a role to play in realizing patient access to precision oncology and a concerted effort is needed to design effective solutions. Have you got a Conflict of Interest?: No
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2147 Cancer Incidence and mortality among Young Adults in Greater Mumbai, a population based cancer registry data s. koyande1, B. shweta1, M. NEVREKAR1, V. DESHMANE2 1 INDIAN CANCER SOCIETY, MUMBAI CANCER REGISTRY, MUMBAI, India, 2INDIAN CANCER SOCITY, MUMBAI CANCER REGISTRY, MUMBAI, India Background: Young adult age group is the important lifecycle of the human being as it is bridging between pediatric and adult age groups. The burden of cancer incidence in young adults (15-34 years) is rarely being addressed in India. Aim: This study aimed to investigate the burden of cancer in young adults. Methods: Cancer Incidence and mortality in young adults for 2017 in Mumbai Cancer Registry (MCR) is analysed and the trends data from 1964 to 2017 were utilised. In MCR each case is medically recoded by following WHO coding manuals. Percentage distributions, median age, age-specific incidence rates, age-adjusted incidence rate (AAR) per hundred thousand, and annual percent changes (APCs) were calculated for young adults of both sexes. For comparison, the other registries data have been utilised at the national and international levels. Results: 746 new cancer cases and 276 cancer-associated deaths occurred among young adults in Mumbai in 2012, which equated to an AAR of 14.1 per 100,000 population in males and 14.9 in females. 29 years is the median age of the cancer diagnosis in 2017 in young adults from Mumbai. The burden was slightly higher among women. The most common cancer types overall in terms of new cases were leukemia, female breast cancer, lymphoma, brain, mouth, and bone. Breast cancer in females and leukemia in males were the major contributors to cancer incidence. In Mumbai, from 1964-to 2017, 33,437 young adults were reported with 50.4% males and 49.6% females. The APC value for males over the period (1964-2017) is 0.09 and for females -0.1 Conclusion: The burden of cancer in young adults is growing but comparatively lower than that was observed in adults and older ages. Though the cancer burden is low, the social and monetary effects remain vital mainly affecting early morbidity and mortality. The baseline study will help policymakers to develop a plan to deal with the future demand of these groups and it may enhance future research to identify factors affecting cancer incidence in this age group. The need of the hour is focussing on awareness, prevention, early detection, and treatment for this age group to reduce the cancer burden. Have you got a Conflict of Interest?: No
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2154 Treatment success in a RCT in Cervical cancer screen and treat setting in Zambia stratified by HIV status N. Nyambe1, R. Muwonge2, L. Pinder3, M. Mwanahamuntu4, E. Lucas2, R. Sankaranarayanan5, W. Prendiville2, G. Parham4, P. Basu2 1 University of North Carolina at Chapel Hill- UNC- Zambia Limited, Lusaka, Zambia, 2International Agency for Research on Cancer, World Health Organization, Early Detection, Prevention & Infection Branch, Lyon, France, 3University of Washington, Department of Obstetrics and Gynecology, Seattle, WA, United States, 4University Teaching Hospital, Women and New Born, Lusaka, Zambia, 5Research Triangle Institute, New Delhi, India
Background: Low-cost ablative treatment is being evaluated and recommended for treatment of cervical precancerous lesions among women with a type 1 transformation zone. A randomized control trial comparing three modalities for treatment of precancerous cervical lesions is ongoing in Zambia including a battery-operated thermal ablator, cryotherapy and large loop excision of the transformation zone (LLETZ). We describe preliminary results of treatment efficacy stratified by HIV status. Aim: To determine the treatment success in a randomized control trial in Cervical cancer screen and treat setting in Zambia stratified by HIV status Methods: VIA screen-positive women eligible for ablative treatment are randomized to receive thermal ablation (TA), cryotherapy or LLETZ. Treatment efficacy at 6- and/or 12-month follow-up was based on HPV status among those HPV positive at baseline and on VIA status among those HPV negative at baseline. Results: A total of 2858 women with baseline HIV status information have been randomized to treatment, 1681 (59%) of whom were HIV-positive. Almost all HIV-positive women (99%) were on anti-retroviral therapy (ART). Among 937 (80%) HIV-negative and 1287 (77%) HIV-positive women eligible for follow-up, follow-up data to assess treatment success (TS) were available for 625 (67%) and 730 (57%), respectively. Overall, TS was significantly lower among HIV-infected women compared to HIV-negatives (51% [375/730] versus 84% [525/625]; p-value<0.001). Similar TS rates and rate differences were observed regardless of treatment received. TS among WLHIV was further reduced by coinfection with HPV. While success rates were ≥90% among HPV-negative women regardless of HIV-infection status, that for HIV-negative but HPV positive women was 64% and 33% for those infected with both HIV and HPV. Conclusion: With the current WHO initiative for Cervical Cancer Elimination, these findings highlight the challenges in eliminating the disease in women living with HIV. Investigations are underway to determine the underlying causes of these findings. Have you got a Conflict of Interest?: No
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219 China Lung Cancer Screening Study (CLUS) version 2.0 : study design and baseline screening results Y. Zhang1, B. Han1 1 Chest Hospital affiliated to Shanghai Jiaotong University School of Medicine, Department of Pulmonary Medicine, shanghai, China Background: Lung cancer screening with low-dose computed tomography (LDCT) have demonstrated to have mortality benefits for high-risk individuals. In 2013, our team performed China Lung Cancer Screening (CLUS) study version 1.0 which was published inLung Cancer. The key finding showed that LDCT led to a 74.1% increase in detecting early-stage lung cancer compared to usual care. Aim: The present study was conducted from 2018 to validate the efficacy of LDCT in detecting early stage lung cancer and explore new techniques for lung cancer screening (NCT03975504). Methods: From 2018–2019, eligible participants with high-risk factors of lung cancer were enrolled to take LDCT detection. Any non-calcified nodules or masses with longest diameters of ≥5mm identified on LDCT images were considered as positive. Artificial intelligence was used in screening high-risk populations and imaging diagnostics. Liquid Biopsy biomarkers were explored in distinguishing positive lung nodules between malignant and benign. Participants who were heavy smokers (over 30 pack/y) were recommended to take the AutofluorescenceBronchoscopy (AFB) detection even their LDCT images were negative. Results: A total of 5265 eligible high-risk participants were enrolled into the study after questionnaire inquiries, and 4491 participants (85.3%) underwent LDCT detection. A positive screening result was observed in 498 participants (11.1%), and 82 participants (1.83%) were highly suspected as lung cancer after multidisciplinary discussion. Up to October 2020, 62 patients were diagnosed by operation or biopsy, including 57 lung cancer (stage 0: 5, stage I: 47, stage II to IV: 5), 2 mediastinal tumor, 3 benign nodules. Early-stage lung cancer was found in 91.2%. 19 subjects received AFB detection, and one participant was diagnosed as squamous metaplasia. Conclusion: LDCT screening could detect more early-stage lung cancer patients. New techniques will improve the implementation of LDCT Screening.
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Have you got a Conflict of Interest?: No
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22 Evolution of Androgenic Deprivation in Treatment of Prostate Cancer in Kinshasa. D. MONINGO MOLAMBA1 1 Clinique de Pointe à Pitre, Urologie, Kinshasa, Congo, Democratic Republic of the Lecancer de la prostate (PCa) est un cancer hormono-dépendant. Dans notre région, la plupart des patients arrivent souvent au stade localement avancé ou au stade métastatique. Cela justifie le choix de la privation d’androgènes comme mode de traitement. Objectif: L’objectif de cette étude était de décrire les caractéristiques sociodémographiques des patients atteints de PCa. Identifier la période pendant laquelle la maladie reste sensible à la privation d’androgènes. Évaluer le pronostic du patient en termes de survie. Méthodes:Il s’agit d’une étude observationnelle rétrospective de l’évolution des patients pris en charge pour la PCa. Elle a porté sur 51 cas et a été menée à la clinique pointe-à-Pitre (CPAP) dans le canton de Matete pendant une période de 4 ans (de mars 2014 à juin 2018). Résultats :L’âge moyen des patients était de 69,4 ± 9,7 ans (40 à 92 ans) ; 39,2 % des patients atteints de PCa étaient âgés de 70 à 79 ans (tableau 1) ; 45,1 % avaient consulté pour une dysurie et 25,5 % étaient hypertendus. Tous avaient effectué la biopsie de la prostate, 47,1% ont été diagnostiqués au stade métastatique, avec un PSA ≥ 100 ng / ml, des scores Gleason de 8 à 10 et un TNM au stade clinique de 3 à 4. Environ 51 % ont été soumis à l’androcure, 23,5 % avaient été tubés chirurgicalement et 3,9 % avaient subi une prostatectomie radicale. 41,1 % avaient résisté à la castration dans un délai médian de 1,4 an après la réponse au traitement. La survie médiane était de 30 mois, avec une survie moyenne de 26,6 mois. Conclusion: Lecancer de la prostate a impliqué la plupart des patients âgés de 70 à 79 ans. Le diagnostic a été effectué récemment avec un taux de castration élevé et une survie médiane de 30 mois. Mots-clés :Privation, Cancer de la prostate (PCa), Clinique Pointe à Pitre (CPAP). Open Journal of Urology, 2021, 11, 137-157 https://www.scirp.org/journal/oju ISSN Online: 2160-5629 ISSN Print: 2160-5440. Email: dmoningo@yahoo.fr. Have you got a Conflict of Interest?: No
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247 The prognostic significance of intra-tumoral tertiary lymphoid structures in perihilar cholangiocarcinoma F.-P. Zhang1, K. Zhu1, T.-F. Zhu1, C.-Q. Liu1, L.-b. Xu1, G. Xiao1, C. Liu1 1 Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Department of Biliary-Pancreatic Surgery, Guangzhou, China Background: Ectopic lymphoid structures termed tertiary lymphoid structures (TLSs) have immunomodulatory function and positively affect prognosis in certain cancers. However, their clinical relevance and prognostic utility in perihilar cholangiocarcinoma (pCCA) are unknown. Aim: We aimed to investigate the prognostic value and functional involvement of TLSs in pCCA. Methods: Ninety-three patients with surgically resected pCCA were included retrospectively. Hematoxylin & eosin and immunohistochemical staining identified and classified the TLSs, and multiple immunohistochemistry determined the TLS composition in the pCCA samples. Correlations between clinical features and TLSs were analyzed using Fisher’s exact test or a Chi-squared test. Recurrence-free survival (RFS) and overall survival (OS) correlations with TLSs were analyzed using Cox regression and Kaplan-Meier analyses. Results: We identified TLSs in 86% of patients with pCCA, including lymphoid aggregates (6.45%), primary (13.98%), and secondary follicles (65.59%). Patients with intra-tumoral secondary follicle-like TLSs (S-TLSs) had a better OS (P= 0.003) and RFS (P= 0.0313). Multivariate analysis identified the presence of S-TLSs as a good independent prognostic indicator for OS, but not RFS. Interestingly, the presence of S-TLS only indicated better 5year OS in patients without lymph node metastasis (LNM–, P = 0.016), but not in the patients with lymph node metastasis (LNM+,P = 0.1503). Conclusion: Therefore, intra-tumoral S-TLSs predicted longer OS in patients with surgically resected pCCA, suggesting a contribution of intra-tumoral S-TLSs to effective antitumor immunity. And S-TLSs have promise for diagnosis and therapy development in pCCA.
Table 1. Correlation analyses between intra-tumoral TLSs and the patients’ clinicopathological characteristics. TLS pCCA TLS pCCA Clinicopathological Available Percentage n = 13 n = 80 P-value Variables data (n) (n%) (14.0%) (86.0%) Age, years ≤ 60 54 58.06 10 44 0.137 > 60 39 41.94 3 36 Sex male 53 56.99 5 48 0.146 female 40 43.01 8 32 Tumor size, cm ≤ 2.5 27 29.03 2 25 0.333* > 2.5 66 70.97 11 55 Differentiation moderate + 73 78.49 9 64 0.467* good -
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Table 1. Correlation analyses between intra-tumoral TLSs and the patients’ clinicopathological characteristics. poor 20 21.51 4 16 T stage T1 + T2 62 66.67 4 58 0.008* T3 + T4 31 33.33 9 22 Lymph node metastasis absence 54 58.06 5 49 0.123 presence 39 41.94 8 31 M stage M0 88 94.62 13 75 1* M1 5 5.38 0 5 TNM stage I + II 39 41.94 2 37 0.036 III + IV 54 58.06 11 43 CEA, ng/ml ≤4 53 56.99 6 47 0.395 >4 40 43.01 7 33 CA19-9, U/ml ≤ 135 31 33.33 3 28 0.533* > 135 62 66.67 10 52 HBsAg absence 75 80.65 9 66 0.270* presence 18 19.35 4 14 Microscopic residual tumor R0 69 74.19 9 60 0.735* R1 24 25.81 4 20 TLS, tertiary lymphoid structure; CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9. *Fisher’s exact test and a Chi-squared test were used. Table 2. Correlation analyses between intra-tumoral S-TLSs and the patients’ clinicopathological characteristics. Clinicopathological S-TLS pCCA S-TLS pCCA P-value Variables n = 32 (34.4%) n = 61 (65.6%) Age, years ≤ 60 24 30 0.017 > 60 8 31 Sex male 14 39 0.062 female 18 22 -
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Table 2. Correlation analyses between intra-tumoral S-TLSs and the patients’ clinicopathological characteristics. Tumor size, cm ≤ 2.5 6 21 0.114 > 2.5 26 40 Differentiation moderate + 24 49 0.552 good poor 8 12 T stage T1 + T2 17 45 0.045 T3 + T4 15 16 Lymph node metastasis absence 12 42 0.004 presence 20 19 M stage M0 31 57 0.657* M1 1 4 TNM stage I + II 8 31 0.017 III + IV 24 30 CEA, ng/ml ≤4 17 36 0.586 >4 15 25 CA19-9, U/ml ≤ 135 8 23 0.217 > 135 24 38 HBsAg absence 25 50 0.656 presence 7 11 Microscopic residual tumor R0 24 45 0.898 R1 8 16 *Fisher’s exact test and a Chi-squared test were used. Table 3. Univariate and multivariate analyses of overall survival. OS Univariate Multivariate Variables HR 95% CI P-value HR 95% CI P-value Age, y (> 60/≤ 60) 1.535 0.943–2.498 0.085 Sex (male/female) 0.645 0.397–1.049 0.077 3
Table 3. Univariate and multivariate analyses of overall survival. Tumor size, cm (> 2.5/≤ 2.5) 1.396 0.810–2.404 0.229 Differentiation 1.628 0.918–2.888 0.095 (poor/moderate + good) T stage (T3 + T4/T1 + T2) 1.381 0.836–2.281 0.207 Lymph node metastasis 0.745– 1.870 1.151–3.038 0.012 1.291 (presence/absence) 2.237 M stage (M1/M0) 1.529 0.553–4.231 0.413 TNM stage (III + IV/I + II) 1.585 0.956–2.626 0.074 0.821– CEA, ng/ml (> 4/≤ 4) 1.755 1.092–2.833 0.021 1.388 2.349 0.975– CA19-9, U/ml (> 135/≤ 135) 1.850 1.112–3.049 0.016 1.768 3.205 HBsAg (presence/absence) 1.184 0.655–2.140 0.577 Microscopic residual tumor 1.141 0.674–1.932 0.623 (R1/R0) 0.330– S-TLS (presence/absence) 0.472 0.284–0.784 0.004 0.570 0.985
0.363
0.221 0.061
0.044
Statistical analysis was performed using univariate and multivariate Cox proportional hazards regression models. TLS, tertiary lymphoid structure; S-TLS, secondary follicle-like TLS; CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9; HR, hazard ratio; OS, overall survival
Figure 1. Classification of TLS and TLS-positive patients with pCCA.
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Figure 1. Classification of TLS and TLS-positive patients with pCCA.
Figure 2. Representative images of multiplex immunofluorescence staining showing the cellular composition of primary and secondary TLSs in pCCA.
Figure 3. Impact of TLSs on OS in patients of pCCA with or without lymph node metastasis. Have you got a Conflict of Interest?: No
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248 The prevalence of mental health disorders among cancer patients during the COVID-19 pandemic: a metaanalysis l. zhang1, x. liu1, f. tong1, f. liu1 1 hunan cancer hospital, changsha, China Background and Aim: The coronavirus disease 2019 (COVID-19) pandemic has an important influence on public mental health, especially cancer patients. We aimed to assess the prevalence rate (PR) of depression, anxiety, post-traumatic stress disorder (PTSD), insomnia, distress, and fear among cancer patients during the pandemic via meta-analysis. Methods: Studies that reported the PR of six mental health problems among cancer patients during the COVID19 pandemic were searched in PubMed, Embase, PsycINFO, and Web of Science databases, until Jan 10, 2022. Meta-analysis result was merged using PR and 95% confidence interval (CI), and heterogeneity among studies was evaluated by I2and Cochran’s Q test. Moreover, publication bias was examined using funnel plot and Egger test. All data analyses were performed using Stata14.0 software. Results: Forty studies with 27,590 subjects were included. Pooled results showed that the PR of depression, anxiety, PTSD, distress, insomnia, and fear among cancer patients were 32.5%, 31.3%, 28.2%, 53.9%, 23.2%, and 67.4%, respectively. Subgroup analysis revealed the PR of depression and anxiety estimated by different measuring scales was inconsistent; patients with head and neck cancer had the highest PR of depression (74.6%) and anxiety (92.3%). Further, stratified analysis revealed that patients with higher education level had higher level of depression (37.2%). Higher level of PTSD was observed in employed patients (47.4%) or women with cancer (27.9%). What was learnt: This meta-analysis evaluated the adverse mental health status among patients with cancer during COVID-19 outbreak. Therefore, it is necessary to develop psychological interventions to improve the mental health of cancer patents during the pandemic. Have you got a Conflict of Interest?: No
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25 The quality of life of caregivers of women receiving cancer treatment in Turkey M.N. Keles1, T.N.M. Salameh2, M. Seven3 1 Halic University, Nursing, İSTANBUL, Turkey, 2Koc University, School of Nursing, İSTANBUL, Turkey, 3University of Massachusetts, Amherst College of Nursing, Amherst, United States Background:Cancer is a life-threatening disease chronic disease that negatively affects the lives of patients and family caregivers in different life domains, including social, work, family, and marriage life. Nevertheless, little is known about the quality of life of caregivers of women receiving cancer treatment. Aim:This study factors related to the quality of life of caregivers of women receiving cancer treatment in Turkey. Methods:This descriptive study included 128 family caregivers of women receiving cancer treatment in a medical oncology inpatient clinic at a university hospital in Istanbul, Turkey. The measurement tools included: the Caregiver Identification Form, the Patient Identification Form, and the Quality of Life Scale-Family Version. Results:The mean score of the quality of life of participants was 4.41±0.63 (Max= 6.03, Min=2.77). Caregivers’ gender, the average time of care per day, and cancer metastasis were significant factors related to caregivers’ quality of life and explained 38.3% of the variance in the quality of life. More specifically, female caregivers, caregivers of patients with metastasis, and those who gave care for 19-24 hours per day had lower quality of life scores. Conclusion: While female caregivers need further support to improve their quality of life, the metastasis of cancer and average time of care per day are particularly important factors to consider in supporting caregivers of female cancer patients. Have you got a Conflict of Interest?: No
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253 The prevalence and risk factors of psychological problems of healthcare workers during the COVID-19 pandemic l. zhang1, x. liu1, f. tong1, f. liu1 1 hunan cancer hospital, changsha, China Background and objective:The COVID-19 pandemic is an unprecedented and long-lasting crisisthat hasexerted devastating impactson the psychological statusof healthcare workers (HCWs). This cross-sectionalstudy investigatedthe prevalence and potential risk factors contributing topsychological disordersamong HCWs. Methods: A total of 439 HCWs wereenrolled in this study. Anxiety and depression levels were measured using the Chinese 14-item Hospital Anxiety and Depression Scale (HADS). An 18-item scale was used to measurefear related to COVID-19.The Post Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) was used to assess the presence and severity of post-traumatic stress disorder (PTSD).Fear was measured by modified scale of SARS epidemic. Differences in fear, anxiety, depression, PTSD, and hope levels among HCWs with different clinical characteristics were analyzed. Results:The prevalence of anxiety, depression, and PTSD in HCWs was 15.71%, 9.57%, and 12.76%, respectively. Females andnurses had higher fear and higher PTSDlevels. Further analysis of female HCWsrevealed that PTSD levelsin the 31-59 age group werehigher than that in 18-30 age group; married HCWswere more fearful than single HCWs. Conclusion:There is a high prevalence of anxiety, depression, and PTSD in HCWs during the COVID-19 pandemic. Female and nurse HCWs are prone to developing psychological disorders. Clinical supportive care could be implemented for the unpredictable, long-lasting pandemic. Have you got a Conflict of Interest?: No
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258 Plasma lipids associated with gastric lesion progression to gastric cancer: a prospective lipidomics study Z.-C. Liu1, S. Huang1, W.-C. You1, K.-F. Pan1, W.-Q. Li1 1 Peking University Cancer Hospital & Institute, Department of cancer epidemiology, Beijing, China Background:Gastric cancer (GC) is preceded by stepwise progression of precancerous gastric lesions. Distinguishing individuals of precancerous gastric lesions that have progression potential to GC is a critical need. Perturbated lipid metabolism, particularlyde novo lipogenesis, is involved in gastric carcinogenesis. We conducted the first prospective lipidomics study exploring lipidomic signatures for the risk of gastric lesion progression and early GC. Aim:To draw a lipidomic landscape and define lipidomic signatures associated with the progression of gastric lesions and risk of early GC. Methods:Our two-stage study of targeted lipidomics enrolled 400 subjects from the National Upper Gastrointestinal Cancer Early Detection Program in China, including 200 subjects of GC and different gastric lesions in the discovery and validation stages. Of validation stage subjects, 152 cases with gastric lesions were prospectively followed for the progression of gastric lesions by up to 1204 days. We examined the lipidomic signatures associated with the risk of advanced gastric lesions and their progression to GC. Tissue proteomic data were integrated to match highlighted lipids with biologically related protein expression in gastric mucosa. Results:We identified 11 plasma lipids significantly inversely associated with the risk of gastric lesion progression and GC occurrence. These lipids were integrated as latent profiles to derive 5 subject clusters that had distinct risk of gastric lesion progression. Integrating the latent profiles significantly improved predictions on the progression potential of gastric lesions (AUC:0.82 vs 0.68, Delong’s P=4.6×10-4) and risk of early GC (AUC:0.93 vs 0.48, P=6.3×10-5). Integration with the proteomic analyses yielded associations between highlighted lipids, their biologically correlated proteins and the risk of GC, supporting the role of the pathways involving monocarboxylic acid metabolism and lipid transport and catabolic process in GC. Conclusion:Our study revealed the lipidomic signatures associated with the risk of gastric lesion progression and GC occurrence. Decreased plasma lipids show promise as noninvasive biomarkers for early detection of GC, exhibiting translational implications for GC prevention. Have you got a Conflict of Interest?: No
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259 Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials – Is Africa the Answer? D. Kizub1, C. Manner2, K. Graef2, B. Abubakar3,4, J. Orem5, F. Odedina6,4, M.C. Adeyeye7, G. Nakigudde8, K. Ayalew9, C. Kalidas10, T. Norman11, H.K. Lyerly12, L. Fashoyin-Aje9, J. Freedman13, J. Dent2, B. Cance14, J. Gralow15 1 UT MD Anderson Cancer Center, Cancer Med - Fellowship Prog, Houston, United States, 2BIO Ventures for Global Health, Seattle, United States, 3National Hospital Abuja, Abuja, Nigeria, 4African Organization for Research and Training in Cancer, New York, United States, 5Uganda Cancer Institute, Kampala, Uganda, 6Mayo Clinic, Rochester, United States, 7National Agency for Food and Drug Administration and Control, Abuja, Nigeria, 8Uganda Women’s Cancer Support Organization, Kampala, Uganda, 9United States Food and Drug Administration, Silver Spring, United States, 10Bayer, Pittsburg, United States, 11Bill & Melinda Gates Foundation, Seattle, United States, 12Duke University, Durham, United States, 13Genentech, South San Francisco, United States, 14American Cancer Society, Atlanta, United States, 15American Society for Clinical Oncology, Alexandria, United States Background and context:Patients of African ancestry are not well-represented in cancer clinical trials despite bearing a disproportionate share of mortality. Aim:We describe key stakeholder values and priorities related to bringing early-stage cancer clinical trials to Africa and outline essential action steps. Strategy / Tactics:“Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials – Is Africa the Answer?” satellite session was organized at 2021 Accelerating Anti-Cancer Agent Development and Validation Workshop. Panelists included representatives of African Organization for Research and Training in Cancer, Uganda Cancer Institute, Uganda Women’s Cancer Support Organization, BIO Ventures for Global Health, Bill and Melinda Gates Foundation, U.S. Food and Drug Administration, Nigeria’s National Agency for Food and Drug Administration and Control, Bayer, Genentech, and moderated by oncologists leading American Society for Clinical Oncology and American Cancer Society. Programme / Policy process:Participants shared their own perspectives and experience in improving access to cancer clinical trials in Africa and reviewed existing efforts (Table 1). Key panel discussion themes and resulting action steps for each stakeholder group were agreed upon by all participants. Outcomes:Panelists agreed that increasing diversity in cancer clinical trials by including African patients is key to ensuring novel drugs are effective across populations. They underscored the importance of equity in clinical trial access for patients in Africa. Panelists discussed perceived barriers to opening registration cancer clinical trials in Africa and described specific innovative solutions from their work that addressed these obstacles (Table 2). Multisectoral collaboration efforts based on stakeholder values which allow for leveraging of limited resources and result in sustainable capacity-building and mutually beneficial long-term partnerships were discussed as key to outlined action steps (Table 3). What was learnt:The panel discussion resulted in valuable insights about key stakeholder values and priorities related to bringing early-stage clinical trials to Africa, as well as specific action items for each stakeholder group.
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Table 1: Initiatives and research to improve cancer care and clinical trial access in Sub-Saharan Africa
Area of collaboration Partner organizations and projects Bridging disparities in AORTIC, advocacy for clinical trial capacity building cancer care and clinical BVGH African Access Initiative (AAI) and African Consortium for trial access Cancer Clinical Trials (AC T) improving affordability of standard of care cancer drugs and showcasing interests and experience of African clinical trial Prostate Cancer Trans-Atlantic Consortium (CaPTC) European and Developing Countries Clinical Trials Partnership (EDCTP) Clinical trial regulatory Mapping African Research Ethics Capacity (MARC) project frameworks and A call for multidisciplinary regional collaboration to develop guideline accreditation standards and technical support for the development of harmonization clinical trial units (CTUs) National Medicines Regulatory Authorities initiatives to harmonize regulatory frameworks and guidelines Evaluating acceptability and implementation of GCP guidelines for clinical trials Development of GCP-compliant data management guidelines for multi-national clinical trials Academic cancer center Partners in Health – Rwanda Military Hospital partnerships to build University of California, San Francisco – Ocean Road Cancer cancer clinical care and Institute in Tanzania research capacity, University of Washington/Fred Hutch – Uganda Cancer Institute including clinical trials University of Pennsylvania – Botswana Partnership University of North Carolina Chapel Hill – Malawi University of Chicago – University of Ibadan, Nigeria 3
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Table 2: Barriers to cancer clinical trials in Africa and key stakeholder initiatives to address these
Barrier Stakeholder Low priority Cancer research placed on research, organizations including by governments, resulting in limited funding and insufficient human resource capacity
Initiative(s) Uganda Cancer Institute (UCI) collaboration with Fred Hutchinson Cancer Institute to show impact of clinical trials which resulted in investment into clinical trial infrastructure and subsequent sustained government funding; African Organization for Research and Training in Cancer (AORTIC) efforts to build clinical trial capacity by working with global pharmaceutical companies Concerns about Regulatory Collaboration between the Bill and Melinda Gates regulatory agencies, global Foundation and the National Agency for Food and infrastructure, data health non-profits, Drug Administration and Control (NAFDAC) in quality and global Nigeria to create an online platform for expedited integrity, and pharmaceutical paperless clinical trial protocol review patient safety companies BIO Ventures for Global Health evaluating and showcasing clinical trial capacity and interests and experience of individual investigators to improve access to cancer clinical trials in Africa 5-year plan to help optimize regulatory and human resource infrastructure, data quality, and patient safety at global sites participating in Genentech’s clinical trials resulting in addition of sites in Algeria, Kenya, Nigeria, Morocco, Uganda Bayer conducting needs assessments in Ghana and engaging local experts for prostate cancer capacity building and healthcare systems strengthening Patient concerns Patient advocacy Patient education about and recruitment into UCI about clinical trial organizations, clinical trials by Uganda Women’s Cancer Support procedures, drug cancer research Organization, patient support to resolve logistics and safety, logistics organizations decrease loss to follow-up
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Table 3: Stakeholder values/priorities and action items to improve equity and diversity in cancer clinical trials through by building capacity for registration cancer clinical trials in Africa
Stakeholder Action items group, values, and experience African Cancer • Prioritize building clinical trial capacity, including seeking Research technical assistance and funding for staff training and proper Institutions facilities from pharmaceutical companies, ministries of health, Values:including academic institutions, global health non-profit organizations, and African patients in cancer-focused clinical societies. clinical trials to • Improve the global visibility of sites qualified to conduct clinical ensure results are trials by, for example, submitting profiles to the online platform applicable; managed by BVGH (AC T). improved patient • Demonstrate the impact of research on local populations to ensure outcomes; clinical government buy-in, prioritization, and allocation of resources. trial capacity • Work together with regulatory agencies to optimize processes of building; local clinical trial initiation and drug approval. investigator-led • Incentivize clinical trial training and design by local investigators, trials; stronger including through provision of protected time and career regulatory advancement opportunities. capacity and • Ensure that clinical trials do not interfere with the quality of government routine patient care. support • Involve/empower patient advocates to participate in clinical trial procedure approval and ask for their help with patient education and recruitment. 3
Patient Advocacy Groups Values:high quality cancer care, including novel treatments; partnering for clinical trial design and implementation
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•
• •
Advocate for patient access to cancer clinical trials through discussions with policymakers, ministries of health, and regulatory agencies. Work together with clinical investigators, pharmaceutical companies, and regulatory agencies to make sure trials are relevant and not burdensome for patients. Support cancer research organizations and pharmaceutical companies in patient education and recruitment. Use the availability of clinical trials to encourage African patients to seek care in-country (vs. abroad)
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Regulatory Agencies (in Africa, unless noted otherwise) Values:patient safety, clinical trial data applicability to patients
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• • •
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•
Global Pharmaceutical Companies Values:equitable access to novel treatments, sustainable partnerships with local experts for trial capacity building, regulatory compliance, data quality, market access
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• •
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•
Collaborate with in-country cancer-focused research organizations and other key stakeholders to provide relevant training in bioethics and GCP to regulatory agency employees. Collaborate with in-country cancer-focused research organizations and other key stakeholders (such as pharmaceutical companies and global health non-profit organizations) and leverage technology to achieve a transparent, relatively uncomplicated, and relatively quick process for launching new clinical trials and drug approvals that aligns with international standards. Advocate for inclusion of patient advocates in clinical trial protocol review and implementation. Allocate funding to build clinical trial capacity at cancer-focused medical centers. Establish partnerships with foreign regulators, akin to the international GCP collaboration among regulatory agencies in Canada, Europe, Japan, United Kingdom, and the US to share data and experiences and conduct collaborative inspections for marketing applications. Encourage investigators to include racially and ethnically diverse patient populations in their trials, including through education/training about the value of diversity in clinical trials and incentives such as funding for trials aimed at specific racial or ethnic minority populations based on strong scientific justification. (For regulatory agencies in high-income countries) Offer technical assistance to help African regulatory agencies refine processes for clinical trial implementation. Partner with institutions that are developing clinical trial infrastructure in Africa. Allocate funding to build sustainable clinical trial infrastructure (e.g., personnel training, equipment upgrades) within larger Africa program budgets. Prioritize Africa, for clinical trials as well as market entry and sustained access, early in the lifecycle planning for new products. Incorporatediversity at the planning stages of cancer clinical trials, including biomarkers that are enriched in local populations and therapies that are more relevant to sub-groups of patients in specific regions, instead of assessing retrospectively following trial completion. Align with African regulatory agencies and governments to ensure market access and continued drug accessibility for patients prior to clinical trial implementation. Connect cancer experts who have experience with clinical trial design and implementation to investigators in African countries, for both mentorship and collaboration.
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Global Health Non-Profit Organizations Values:bringing high-quality clinical trials to African patients through collaboration with regulatory agencies and local investigators
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Connect African regulatory agencies, ministries of health, and cancer-focused medical and research centers to experts and funding opportunities necessary to build regulatory and clinical trial capacity, including fostering mentorship/apprenticeship relationships with experts who are experienced in running clinical trials. Prioritize investments in African-led clinical trials (vs. trials led by entities based in high-income countries) that have the greatest potential to improve patient care . Advocate for inclusion of patient advocates as equal partners at the table. Provide technical expertise related to price negotiations and ensuring access to cancer drugs after clinical trials are completed. Provide opportunities for clinical trials workforce development, especially through training. Foster networking among African clinical trialists. 10, 11, 20,37
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American Society of Clinical Oncology (ASCO) Values:improving diversity and equity in clinical trials
Share experiences related to clinical trial capacity building in Africa with other pharmaceutical companies. Document and disseminate challenges and solutions related to clinical trial implementation in Africa. Leverage resources such as BVGH’s AC T online platform to identify and connect with qualified clinical trial sites in Africa. Advocate for inclusion of in-country patient advocates to ensure clinical trial fit to patient needs and the local context. Advise regulatory agencies about clinical trial timelines to ensure timely approval of protocols.
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Provide opportunities for continued dialogue between stakeholders through future meetings Provide professional development opportunities for young oncology professionals Partner in increasing capacity of the oncology workforce in the region Provide opportunities for training in quality monitoring and reporting Collaborate in trainings in clinical trials design and conduct Create opportunities for funding global oncology research focused on low- and middle-income regions Partner in education on advancements in cancer care and research, including that done in Africa
Have you got a Conflict of Interest?: No
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260 CT-radiomics Approach for Preoperative Estimating Portal Vein System Involvement in Pancreatic Adenocarcinoma F.-M. Chen1, Y. Zhou2 1 the Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Radiology, Wuxi, China, 2the Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Hepatobiliary Surgery, Wuxi, China
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Risk factors SMPV deformity Radiomic signature
Odd ratio (95% CI)
Regression coefficient Final scoring
7.56 (2.73–20.93) 21.89 (7.28-69.8)
2.02 3.63
1 1.8
Background: Intraoperative finding of superior mesenteric-portal vein (SMPV) involvement in pancreatic ductal adenocarcinoma (PDAC) is an indicator for synchronous vein resection during pancreatectomy. The degree of tumor contacted with the SMPV and presence of venous deformity on preoperative CT images are the currently used indications for PDAC involving SMPV. However, they are highly specific but relatively low sensitive. Therefore, it is necessary to develop improved markers to compensate for this drawback. Aim: To develop a risk score model to estimate intraoperative SMPV involvement in PDAC using radiomic analysis on CT images.Methods:Data from2 institution-based cohorts of PDAC patients undergoing preoperative CT scans were used to develop (n=173) and validate (n=156) a radiomic-based SMPV involvement risk score using clinical and imaging variables. A radiomic signature was developed based on 2,436 radiomic features extracted from the semi-automatic three-dimensional segmentation on CT images. The SMPV involvement risk score was built by using multivariate logistic regression and compared with the standard radiological criteria. Results: Fifty-nine (34.1%) and 57 (36.5%) PDACs with SMPV involvement were surgically identified in the development and validation cohorts, respectively. A 12-feature-based radiomic signature achieved areas under receiver operating characteristics curves (AUCs) ≥ 0.89 for estimating SMPV involvement. Multivariate regression identified radiomic signature and SMPV deformity were associated with SMPV involvement. The risk score model had significant improvement over the radiologic evaluation in terms of AUC (0.928 vs 0.768, [P < 0.001]) and sensitivity (84.2% vs 66.7% [P = 0.025]). Conclusion: This novel risk score, combining radiomic signature and venous deformity, demonstrated good performance for estimating SMPV involvement preoperatively for patients with PDAC. Have you got a Conflict of Interest?: No
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261 Development of Clinical and Radiomics Model for Predicting the Brain Metastasis of LS-SCLC Q. Hou1, J. Cao1, N. Yao1, L. Wei1, B. Sun1, Y. Liang1, X. Cao1 1 Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Department of Radiotherapy, TaiYuan, China Background: Prophylactic cranial irradiation (PCI), significantly reducing the risk of brain metastasis (BM) in Limited-stage SCLC (LS-SCLC), inevitably leads to neurotoxicity. Differentiating the risk of BM in patients and individualized PCI treatment decisions may play an important role in improving the benefit of LS-SCLC patients. Aim: This study aimed to construct two models based on clinical and radiomics to predict BM in LS-SCLC and to optimize PCI treatment decisions. Methods: 246 and 97 patients with LS-SCLC were retrospectively analyzed and divided into PCI group (78 and 33 cases) and non-PCI group (168 and 64 cases) from January 2013 to December 2018. Univariate and multivariate Cox proportional hazards regression models were used to identify clinical factors associated with the incidence of BM in the training cohort. The LASSO Cox and Spearman correlation test was used to select the radiomics features significantly associated with the incidence of BM and calculated the radiomics score (Radscore). Then, the calibration curve, the area under the curve (AUC) was used to verify the predictive power of the model. The maximally selected rank statistics were used to select the optimal nomogram score for divided risk patients into the high- and low-risk groups. The Log-rank was used to assess differences between groups. Results: The clinical model showed that tumor stage, chemotherapy cycles, time to radiotherapy, LDH, ProGRP, and lymphocytes monocytes ratio (LMR) were significantly associated with the BM in LS-SCLC patients (Table1). The AUC in the training cohort and validation cohort was 0.782, 0.731 in 1-year, and 0.725, 0.705 in 2-year, respectively (Fig 1). 8 features were selected by LASSO Cox and Spearman correlation test and used to build the radiomics score. The AUC in the clinical model, Radscore and Radiomics model were 0.754, 0.845, and 0.886 in 1year, and 0.808,0.878 and 0.940 in 2-year, respectively (Fig 1). Based on the nomogram score of 177 and 155, patients were divided into high- and low-risk cohorts in the clinical and radiomics model. In the high-risk cohort, the BM incidence of the non-PCI group was significantly higher than that of the PCI group, OS of the non-PCI group was significantly lower than that of the PCI group. Contrastingly, there was no difference between the PCI group and the non-PCI group for both the BM incidence and OS in the low-risk group (Fig 2, Fig 3). Conclusion: Compared to the clinical model, the Radioimics model can predict the incidence of BM in LS-SCLC patients wither higher accuracy. Based risk stratification, can better stratify the risk of BM and further guide individualized PCI treatment.
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Fig 1
Fig 2
2
Fig 3 Table1
Factors Tumor stage (III vs I-II) Chemotherapy cycles (≥4 vs <4) Time to Radiotherapy <1.8 vs ≥1.8 No RT vs ≥1.8 LDH (High vs Low) ProGRP (High vs Low) LMR (High vs Low)
HR (95%CI) 3.91 (1.20-12.76)
P 0.024
0.39(0.20-0.75)
0.005
0.24 (0.08-0.69) 0.66 (0.39-1.11) 2.09 (1.24-3.35) 2.29 (1.12-4.68) 0.46 (0.26-0.79)
0.008 0.118 0.006 0.023 0.005
Have you got a Conflict of Interest?: No
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273 Epidemiological profile and clinico-pathological features of pediatric gynecological cancers in Kenya A. Mburu1, P. Itsura2, E. Omenge2, P. Tonui2, E. Odongo2, A. Shaffi2, A. Covens3, B. Rosen4 1 Aga Khan Hospital, Reproductive Health, Mombasa, Kenya, 2Moi University, Eldoret, Kenya, 3Sunnybrook, Toronto, Canada, 4Beaumont, Michigan, United States Background: The main pediatric (0–18 years) gynecologic cancers include stromal carcinomas (juvenile granulosa cell tumors and Sertoli-Leydig cell tumors), genital rhabdomyosarcomas and ovarian germ cell. Outcomes depend on time of diagnosis, stage, tumor type and treatment which can have long-term effects on the reproductive career of these patients. Aim: This study seeks to analyze the trends in clinical-pathologic presentation, treatment and outcomes in the cases seen at our facility. This is the first paper identifying these cancers published from sub-Saharan Africa. Methods: Retrospective review of clinico-pathologic profiles and treatment outcomes of pediatric gynecologic oncology patients managed at MTRH between 2010 and 2020. Data was abstracted from gynecologic oncology database and medical charts. Results: Records of 40 patients were analyzed. Most, (92.5%, 37/40) of the patients were between 10 and 18 years. Ovarian germ cell tumors were the leading histological diagnosis in 72.5% (29/40) of the patients; with dysgerminomas being the commonest subtype seen in 12 of the 37 patients (32.4%). The patients received platinum-based chemotherapy in 70% of cases (28/40). There were 14 deaths among the 40 patients (35%) Conclusion: Surgery remains the main stay of treatment and fertility-sparing surgery with or without adjuvant platinum-based chemotherapy are the standard of care with excellent prognosis following early detection and treatment initiation. LMICs face several challenges in access to quality care and that affects survival of these patients. Due to its commonality, ovarian germ cell cancers warrant a high index of suspicion amongst primary care providers attending to adnexal masses in this age group. Have you got a Conflict of Interest?: No
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274 Association between MRI features, BRCA mutation and prognosis of early breast cancer patients L. Lin1, T. Jiang1, Z. Wang2,3, J. Zhou1, S. Sun1, Q. Xiao1, Z. Hu4,3, C. You1,3, Y. Gu1,3 1 Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai, China, 2Fudan University Shanghai Cancer Center, Department of Cancer Prevention, Shanghai, China, 3Shanghai Medical College, Fudan University, Department of Oncology, Shanghai, China, 4Fudan University Shanghai Cancer Cente, Department of Breast Surgery, Shanghai, China Background: BRCA gene mutations, as germline predisposition factors of breast cancer, influence the selection of personalized diagnosis and treatment strategies for tumor patients. However, the relationship between BRCA mutation, MRI characteristics and prognosis are not clear. Aim: The study aimed to demonstrate the different MRI features between BRCA-positive and -negative tumor lesions and to identify features to predict the prognosis of breast cancer patients with BRCA mutations. Methods: A total of 94 BRCA-positive and 183 BRCA-negative breast cancer patients were included in this study. All of their clinical, pathological and MR images were collected, and the correlations of the features were analyzed. Results: The molecular subtype, Ki67 index, and breast parenchymal enhancement (BPE) were significantly different between the BRCA-positive and BRCA-negative groups. Further stratified analysis showed that in earlystage breast cancer patients with a small tumor size and with or without lymphovascular invasion, BRCA-positive patients had a significantly higher rate of adverse outcomes and significantly shorter progress free survival (PFS) (recurrence/metastasis 113.88±6.98 vs. 131.76±1.70, all events 102.36±8.05 vs. 119.22±4.85). In addition, MRI feature analysis showed that the type of MR enhancement was correlated with the prognosis of patients with early-stage breast cancer, and ring shape enhancement was associated with lower PFS. Conclusions: In conclusion, a correlation between BRCA mutation and breast cancer prognosis was found. Moreover, MRI contrast type was related to the recurrence or metastasis of early-stage breast cancer with a small tumor volume. Have you got a Conflict of Interest?: No
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275 The value of imaging combined with clinicopathological features in the diagnosis of high-risk breast lesions J. Zhou1, S. Sun1, L. Lin1, T. Jiang1, X. Hu1, C. You1, Y. Gu1 1 Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai, China Background: High-risk breast lesions(HRLs) are a group of morphologically and biologically heterogeneous diseases with an increased risk of breast cancer during follow-up after diagnosis. The HRLs mainly include atypical ductal hyperplasia, atypical lobular hyperplasia, flat epithelial atypia, papillary lesions, sclerosing adenosis, and mucocele-like lesions. Currently, HRLs are found mainly through image-guided biopsies, but because of sampling volume limitations or suboptimal targeting, there is a risk of upgrading to ductal carcinoma in situ or invasive malignancy at the time of surgical excision. As a result, surgical excision is often recommended. To some extent, this results in excessive treatment and unnecessary surgery. Aim: Comparing the diagnostic and predictive value of imaging features of different modes for HRLs to improve image recognition and assist in clinical decisions. Methods: We retrospectively reviewed 230 HRLs detected by mammography, ultrasound, and MRI before biopsy at the Fudan University Cancer Hospital from January 2017 to March 2018. The clinical features, imaging data according to the BI-RADS lexicon, and tumor upgrade rates were received. Based on the different risks of upgrade reported, the lesions were classified into high-risk I (HR-I, with atypical hyperplasia(AH)) and high-risk II (HR-II, without AH). We analyzed the association between clinicopathological and imaging factors and upgrade. We used the receiver operating characteristic (ROC) curve to compare the efficacy of three imaging modes for predicting upgrade. Results: All 230 lesions were single, and the overall upgrade rate was 20.4%（47/230). The upgrade rate (38.5% vs 4.1%) was higher in HR-I compared to HR-II (P < 0.01). In patients with AH, estrogen receptor-positive (ER+) patients accounted for 81.0% (64/79). For all HRLs and HR-I, in clinical characteristics, age, maximum size of lesion, and menopausal status were significantly associated with upgrade (P < 0.05). In imaging factors, MRI background parenchymal enhancement (BPE), signs of MRI and ultrasound were significantly correlated with upgrade (P < 0.05). Patients with negative MRI or ultrasound manifestations had lower upgrade rates (P < 0.01). For HR-II, only BPE showed a significant difference between groups (P = 0.001). Multifactorial analysis of all HRLs showed that age and BPE were independent predictors of upgrade (P < 0.01). The AUCs for HRLs upgrading to malignancy in mammography, ultrasound, and MRI were 0.606, 0.590, and 0.913, respectively, indicating that MRI diagnosis was significantly better than mammography and ultrasound (P < 0.001). Conclusion: HRLs with AH had a higher rate of upgrade and increased ER expression. Among three imaging modes, MRI was more effective than ultrasound and mammography in diagnosing the upgrade of HRLs. Older age and moderate to marked BPE can indicate malignant upgrade. MRI can provide a certain value for the diagnosis and follow-up of HRLs. Have you got a Conflict of Interest?: No
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322 Reassessing the causal role of obesity in breast cancer susceptibility Y. Hao1, J. Xiao1, Y. Liang1, X. Wu1, H. Zhang2,3, C. Xiao4, L. Zhang1, S. Burgess5, N. Wang4, X. Zhao1, P. Kraft6, J. Li1, X. Jiang7 1 Sichuan University, Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Chengdu, China, 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, United States, 3Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States, 4Sichuan University, Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Chengdu, China, 5University of Cambridge, MRC Biostatistics Unit, Cambridge, United Kingdom, 6Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, United States, 7Sichuan University, Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Chengdu, China Background: Previous Mendelian randomization (MR) studies on obesity and breast cancer (BC) risk adopted a small number of instrumental variables and mainly focused on crude total causal effects. Aim: We aim to investigate the independent causal effect of obesity-related exposures on breast cancer susceptibility, considering the distribution of fat, covering both early and late life. Methods: Using an enlarged set of female-specific genetic variants associated with adult general (body mass index, BMI) and abdominal obesity (waist-to-hip ratio with and without adjusted for BMI, WHR and WHRadjBMI) as well as using sex-combined genetic variants of childhood obesity (childhood BMI), we performed a two-sample univariable MR (UVMR) to re-evaluate the total effect of each obesity exposure on BC overall (Ncase= 133,384, Ncontrol= 113,789). We further looked into its estrogen receptor (ER)-defined subtypes (NER+= 69,501, NER–= 21,468, Ncontrol= 105,974). Multivariable MR (MVMR) was applied to estimate the independent causal effect of each obesity-related trait on BC taking into account confounders as well as to investigate the independent effect of adult and childhood obesity considering their inter-correlation. Results: In UVMR, significant protective effects of both adult BMI (OR = 0.89, 95%CI = 0.83-0.96) and childhood BMI (OR = 0.78, 95%CI = 0.70-0.87) were observed for BC overall. Comparable effects were found in ER+ and ER− subtypes. Similarly, genetically predicted adult WHR was also associated with a significantly decreased risk of BC overall (OR = 0.87, 95%CI = 0.80-0.96), restricting to ER+ subtype (OR = 0.88, 95%CI = 0.80-0.98) (Figure 1). Conditional on childhood BMI, the effect of adult general obesity on BC overall attenuated to null (BMI: OR = 1.00, 95%CI = 0.90-1.10), while the effect of adult abdominal obesity attenuated to some extent (WHR: OR = 0.90, 95%CI = 0.82-0.98; WHRadjBMI: OR = 0.92, 95%CI = 0.86-0.99). On the contrary, an independent significant protective effect of childhood BMI was observed in BC overall, irrespective of adult measures (adjusted for adultBMI: OR = 0.84, 95%CI = 0.77-0.93; adjusted for adultWHR: OR = 0.84, 95%CI = 0.76-0.91; adjusted for adultWHRadjBMI: OR = 0.80, 95%CI = 0.74-0.87). Conclusion: While successfully replicating the inverse causal relationship between obesity-related exposures and risk of BC, our study demonstrated the protective effect of adult obesity to be largely (adult BMI) or partly (adult WHR or WHRadjBMI) attributed to childhood obesity. Our findings highlight an independent role of childhood obesity in affecting the risk of BC as well as the importance of taking into account the complex interplay underlying correlated exposures.
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Have you got a Conflict of Interest?: No
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334 A real-world study on ovarian cancer patients receiving olaparib in a Chinese tertiary cancer hospital Y. Wang1, J. Yang1, D. Du2, A. Lau3, Y. Dai1, W. Qin4, N. Li5, G. Li1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Pharmacy, Beijing, China, 2Hubei Cancer Hospital, Department of Pharmacy, Wuhan, China, 3University of Illinois at Chicago, Department of Pharmacy Practice, Chicago, United States, 4China-Japan Friendship Hospital, Department of Pharmacy, Beijing, China, 5National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Gynecologic Oncology, Beijing, China Background: In recent years, olaparib, a poly ADP-ribose polymerase (PARP) inhibitor, provides a new modality for the treatment of ovarian cancer. However, patients treated with oral antitumor agents are likely to have less frequent contact with healthcare professionals. As a result, patient safety, drug adherence, lab parameter monitoring, and timely follow-up might be compromised. Oncology pharmacists are positioned to play important roles in patient education and pharmacotherapy optimization. So far, little has been reported about the services provided by oncology pharmacists during olaparib treatment. Aim: To establish a pharmacist-driven follow-up program for ovarian cancer patients receiving Olaparib, provide patient education, get information on adverse drug reactions (ADRs), identify and manage drug-related problems and improve drug adherence and patient satisfaction. Methods: Ambulatory adult patients with ovarian cancer receiving olaparib were enrolled. At least one telephone follow-up session was conducted by oncology pharmacists. Pharmacists collected data on the type and grade of ADRs, drug adherence, olaparib dosing, concomitant medications, pharmacists' suggestions as well as patient satisfaction. The demographic data were analyzed using descriptive statistics. Continuous variables were reported as means and dichotomous variables were reported as percentages. Results: 83 patients were enrolled with the median age of 58. The average number of the follow-up sessions provided to each patient was 1.31, and the average duration of each follow-up was 17.78 minutes. The olaparib starting dose for most patients (97.59%) was 600mg/d. 36.14% of the patients had missed olaparib doses and 27.71% of the patients had dose adjustments due to ADRs. The most common ADRs were: fatigue (40.96%), anemia (36.14%), leukopenia (36.14%), nausea (28.92%), decreased appetite (16.87%) and thrombocytopenia (16.87%). Pharmacists made 196 suggestions mainly related to rational use of the medications and management of ADRs. Common concomitant medications were antihypertensive, anti-hyperglycemic, and anti-hyperlipidemic medications. The pharmacists identified 4 clinically significant DDIs in two patients. Most patients (97.53%) were satisfied with the follow-up, and most (95.12%) were willing to receive further follow-up from pharmacists. Conclusion: The study provides the real-world evidence that the types of ADRs were similar to those previously observed in clinical trials, and the ADRs could be well managed with the assistance of oncology pharmacists through follow-up phone calls. Drug adherence of olaparib was not very good, indicating patient education is very necessary. DDIs were not common in these patients. Overall, the patients were satisfied with this service and willing to receive further follow-up from pharmacists. Similar services could therefore be expanded to patients with other disease states. Have you got a Conflict of Interest?: No
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336 C1QTNF6 regulated by miR‐29a-3p promotes proliferation and migration in stage I lung adenocarcinoma Y. Xu1, L. Lin1, G. Lin1, Y. Zeng1 1 The Second Affiliated Hospital of Fujian Medical University, Department of Pulmonary and Critical Care Medicine, Quan, China Background: C1QTNF6 has been implicated as an essential component in multiple cellular and molecular preliminary event, including inflammation, glucose metabolism, endothelial cell modulation and carcinogenesis. However, the biological process and potential mechanism of C1QTNF6 in lung adenocarcinoma (LUAD) is indefinite and remains to be elucidated. Aim: Therefore, we investigated the interaction among the traits of C1QTNF6 and LUAD pathologic process. Methods: RT-qPCR and western blot were conducted to determine the expression levels of C1QTNF6. RNA interference and overexpression of C1QTNF6 was constructed to identify the biological function of C1QTNF6 in cellular proliferative, migratory and invasive potentialsin vitro. Dual-luciferase reporter assay was applied to identify the possible interaction between C1QTNF6 and miR‐29a-3p. Moreover, RNA sequencing analysis of C1QTNF6 knockdown was performed to identify the potential regulatory pathways. Results: C1QTNF6 was upregulated in stage I LUAD tissues compared with adjacent non-cancerous tissues. Concurrently, C1QTNF6 knockdown could remarkably inhibit cell proliferation, migratory and invasive abilities, while overexpression of C1QTNF6 presented opposite results. Additionally, miR‐29a-3p may serve as an upstream regulator of C1QTNF6 and reduce the expression of C1QTNF6. Subsequent experiments showed that miR‐29a-3p could decrease the cell mobility and proliferation positive cell rates, as well as reduce the migratory and invasive possibilities in LUAD cells via downregulating C1QTNF6. Moreover, RNA sequencing analysis demonstrated that the cytokine-cytokine receptor interaction pathway may participate in the process of C1QTNF6 regulating tumor progression. Conclusion: Our study first demonstrated that downregulation of C1QTNF6 could inhibit tumorigenesis and progression in LUAD cells negatively regulated by miR‐29a-3p. These consequences could reinforce our awareness and understanding of the underlying mechanisms and provide a promising therapeutic target for LUAD. Have you got a Conflict of Interest?: No
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342 Combined Lifestyle Score and Risk of Upper Gastrointestinal Cancer Mortality in the Linxian General Population h. Yang1, X.-k. Wang1, J.-b. Wang2, F.-h. Zhao1, J.-H. Fan1, Y.-L. Qiao1, P. Taylor3, C. Abnet3 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Cancer Epidemiology, Beijing, China, 2the Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Department of Epidemiology and Biostatistics, Hangzhou, China, 3National Cancer Institute, Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Rockville, United States Background: Several studies have indicated that combinations of lifestyle and dietary factors are associated with the risk of upper gastrointestinal (UGI) cancer mortality, but limited data are available from long-term follow-up studies in China. Aim: The objective of this study is to explore the association of combined lifestyle risk factors with the risk of UGI cancer mortality, including esophageal squamous cell carcinoma (ESCC) mortality, gastric cardia carcinoma (GCC) mortality, and gastric non-cardia carcinoma (GNCC) mortality in the Linxian General Population Nutrition Intervention Trial (NIT) cohort. Methods: This study was an observational cohort study. We examined the relationship of combined lifestyles at baseline, including alcohol drinking, smoking, fresh fruit and vegetables consumption/year, drinking tap water, eating food cooked in oil, and meat and egg consumption, with UGI cancer mortality. A combined lifestyle score (CRS) was calculated using a point system method. Cox proportional hazards models were used to estimate hazard ratios(HRs) and 95% confidence intervals (95%CIs). Results: During the 30-year follow-up, we identified 4,557 UGI cancer deaths, including 2,594 from ESCC, 1,403 from GCC, and 560 from GNCC. Multivariate analysis shows that compared with subjects who had a CRS equal to or less than 5 points, the HR for individuals with 6 to 10 points, 11 to 15 points, and more than 15 points were 1.22(95% CI: 1.03-1.44), 1.39(95% CI: 1.17-1.64), and 1.83(95% CI: 1.49-2.24) for UGI cancer mortality, respectively. Comparableassociations were observed for ESCC mortality. Only CRS with over 15 points could significantly increase the risk of GCC mortality (HR=1.04, 95%CI: 1.02-1.05). The correlations between CRS and risk of total UGI cancer and ESCC mortality were significant among younger (<55 years) participants and males. No association was observed between CRS and the risk of GNCC mortality. Conclusion: Higher CRS values, based on eight lifestyle factors, were associated with an increased risk of UGI cancer mortality, especially for ESCC. Even small differences in lifestyle may make a large difference to health. Have you got a Conflict of Interest?: No
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347 QUALITY OF END-OF-LIFE CARE, QUALITY OF DYING AND DEATH, AND GRIEF IN BEREAVED FAMILY CAREGIVERS P. Pokpalagon1, S. Chaiviboontham1, A. Siripitayakunkit1, T. Junda1, P. Jaiboon2, K. Khunpinit2 1 Mahidol University, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand, 2Mahidol University, Student in Master of Nursing Science Program in Adult Nursing, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Background: The bereaved family should continue to have care even after the patient's death. The palliative care team should assess the grief of family members after the loss and follow up. Aim: To examine factors associated with grief in bereaved family caregivers. Methods: In this descriptive study a total of 318 participants, the primary family caregivers of patients who died 312 months, were recruited for this study by the purposive sampling method. The instruments were used for collecting data including; 1) the participant demographic data form; 2) the quality of dying and death questionnaire (QODD); 3) the family APGAR questionnaire, and 4) the inventory of complicated grief. The data were analyzed by using descriptive statistics, Kruskal Wallis Test, Mann Whitney U test, and Spearman rank-order correlation coefficient. Results: The results showed that family caregivers had satisfaction with the quality of end-of-life care with a mean score of 69.31 and family perception of the quality of dying and death at a moderate level with a mean score of 61.88. Family caregivers had 74.8 percent of normal grief and 25.2 percent had complicated grief.The grief in bereaved family caregivers was a significant negative correlation with age of the deceased (r = -.239, p < .01), the quality of care (r = -.218, p < .01), and the quality of dying and death (r = -.185, p < .01). Grief was significantly positively correlated with the time after death (r=.152; p < .01). Family caregivers who cared for gradual death patients, with well prepared for the loss, non-attachment with patient, and received palliative care had significantly lower levels of grief than caregivers of sudden death patients (Z=-3.178; p < .01), unprepared (χ2=33.825; p < .001), strong attachment (χ2=19.063; p < .001) and no palliative care (χ2=13.708; p < .01). Conclusion: The quality of end-of-life care, preparation for loss, palliative care received, and the quality of dying and death help bereaved family caregivers cope with grief after their loss. The results of this study could be applied to the care of bereaved family caregivers to help them more effectively adapt to the grief after the loss. Have you got a Conflict of Interest?: No
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360 Refined Staging System Integrating FIGO classification and Corpus Uterine Invasion for M0 Cervical Cancer X.D. Huang1, Y. Ou Yang1, K. Chen1, L. Shi1, F.P. Chen1, X.P. Cao1 1 Sun Yat-sen University Cancer Center, Guangzhou, China Background:The International Federation of Gynecology and Obstetrics (FIGO) staging system are widely accepted as the lingua franca to depict tumor extent in cervical cancer (CC). However, the current FIGO classification disregards extension to the uterine corpus, which is considered to be related to more aggressive biological behaviour of CC. Nonetheless, despite its potential prognostic significance, novel prognostic tools integrating corpus uteri invasion for CC are still not yet developed. Aim: To investigate the prognostic value of corpus uterine invasion and construct refined staging system combining corpus uterine invasion with conventional FIGO classificationfor better prognostication in CC. Methods: A total of 809 cases of biopsy-proven,non-metastatic CC were identified from an academic cancer center. Recursive partitioning analysis (RPA) method was used to develop the staging system with respect to overall survival (OS). Internal validation was performed by using calibration curve with 1000 bootstrap resampling to compare RPA-predicted survival with the observed survival after bias correction. Performances of the RPArefined schemas were compared against the conventional FIGO 2018 classification by the receiver operating characteristic curve (ROC) and decision curve analysis (DCA). Results: We identified that corpus uterine invasion was independently prognostic for OS, DFS and DMFS in ourcohort. RPA modelling using a two-tiered stratification by corpus uterine (positiveand negative) and FIGO classification divided CC into three risk groupings with significantly disparate survival: RPA-FIGO I', FIGO stage I and corpus uteri negative; RPA-FIGO II' ,FIGO stage II and corpus uteri negative; and RPA-FIGO III', FIGO stage III or corpus uteri positive; with 5-year OS of 90.8%, 82.1% and 68.5% for proposed FIGO stage I'-III' respectively (P≤0.003 for all pairwise comparisons).Our proposed RPA-refined staging system was well validated with RPApredicted OS rates and showed optimal agreement with actual observed survivals in calibration plots. Additionally, the proposed RPA models outperformed the conventional FIGO stage with higher accuracy of survival prediction (AUC: RPA-FIGO vsFIGO,0.663 [95% CI 0.629-0.695] vs0.638 [0.604-0.671],P=0.067). Conclusion: Herein, we generated a refined staging system that integrates the conventional FIGO 2018 classification with corpus uterine status in non-metastatic CC. Our new staging schemas exhibit improved survival prediction over the current staging system.
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Figure 1 Pelvic MRI images showing corpus uterine invasionof the cervical cancer patients.
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Figure 2 Proposed RPA-FIGOstaging systemincorporating the corpus uteri statusfor M0 cervcal cancer.
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Figure 3 Receiver operating characteristic curve (A-C) and decision curve analysis (D-F) comparing the efficacy of survival prediction between the proposedRPA-FIGO staging systemand the 2018 FIGOclassification. Have you got a Conflict of Interest?: No
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366 Radiotherapy contouring training & feedback - developing a cloud based tool for global use P. Lewis1, D. Lombe2, B.C. M'ule3, E. Addison4, T. Patel5, A. Cameron6, S. Hughes5, T. Dembrey6, A. Aggarwal5 1 Royal United Hospitals, Clinical Oncology, Bath, United Kingdom, 2MidCentral District Health Board, Regional Cancer Treatment Services, Wellington, New Zealand, 3Cancer Diseases Hospital, Medical Physics Department, Lusaka, Zambia, 4Komfo Anokye Teaching Hospital, Oncology Directorate/ Medical Physics Department, Kumasi, Ghana, 5Guy's Cancer Centre, London, United Kingdom, 6University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom Background: Radiotherapy contouring is a complex task, and it is recognised that expert peer review in the planning stages can improve the quality of treatment delivered [1]. Previous work has highlighted the potential for information and communication technology (ICT) platforms to facilitate radiotherapy peer review [2]. In this era of increased remote working, such platforms provide a significant opportunity to bring together radiotherapy professionals from diverse settings for education, training and quality improvement through cloud-based peer review. At present, existing platforms have not demonstrated suitability for use in resource-limited settings [3], despite the clear benefits such technology could provide. Aim: To develop a cloud-based platform for remote radiotherapy peer review and education, suitable for global use among radiotherapy professionals with varying resources. Methods: A working group of clinical oncologists, medical physicists and software engineers from the UK, Zambia and Ghana was formed. Utilising an existing web-based radiotherapy training programme, user perspectives from clinical teams in all three countries were used to create a bespoke platform for anonymous upload and transfer of radiotherapy contours for remote expert review. Functionality of the upload, file transfer, case review and feedback tools was trialled between countries. The platform was updated and further developed in an iterative process, incorporating feedback from working group members. Results: The platform demonstrated good functionality at all stages of the peer review process, in all three countries. Cases were uploaded from local treatment planning systems, and CT images and contours/structure sets were successfully viewed by designated remote reviewers. Reviewers were able to provide qualitative, case-specific feedback on contouring, which was instantly available to the submitting user. Conclusion: This cloud-based platform for radiotherapy peer review and education has demonstrated good functionality in the preliminary stages of its development, in both well-resourced and resource-limited settings. Ongoing work is required to maximise functionality, and a formal pilot study is planned to assess its use as a qualitative, formative educational tool for radiotherapy professionals globally. [1] Marks LB, Adams RD, Pawlicki T, et al: Enhancing the role of case-oriented peer review to improve quality and safety in radiation oncology: Executive summary. Pract Radiat Oncol 3:149-156, 2013 [2] Ngwa, W, Sajo E, Ngoma T, et al: Potential for information and communication technologies to catalyze global collaborations in radiation oncology. Int J Radiat Oncol Biol Phys 91:444-447, 2015 [3] Lewis PJ, Amankwaa-Frempong E, Makwani H, et al. Radiotherapy Planning and Peer Review in Sub-Saharan Africa: A Needs Assessment and Feasibility Study of Cloud-Based Technology to Enable Remote Peer Review and Training. JCO Glob Oncol. Jan;7:10-16, 2021 Have you got a Conflict of Interest?: No
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370 Evaluation of a new breast ultrasound on lesion detection and characterization in asymptomatic women B. Xu1, W. Luo1, Y. Jia1, M. Wang1, L. Tian1, Y. Liu1, D. Yang1, J. Li1 1 Sichuan University, Chengdu, China Background: The use of new automatic ultrasound devices for auxiliary diagnosis is booming, such as Artificial Intelligent Breast Ultrasound (AIBUS), however, the evaluation of such products is usually based on the data from clinical diagnostic trials instead of evidence for the application in the asymptomatic population. Aim: This study aimed to assess the reliability of Artificial Intelligent Breast Ultrasound (AIBUS) in comparison to hand-held breast ultrasound (HHUS) in the primary screening setting. Methods: A total of 852 participants who underwent both HHUS and AIBUS were included. AIBUS data on a separate workstation were reviewed and scored for image quality by two radiologists, who were unaware of the results of HHUS. Breast imaging reporting and data system (BI-RADS) final assessment, breast density category, quantified lesion features, and examination time were evaluated for the two devices. The statistical analysis was measures of central tendency and dispersion, McNemar’s test, pairedt-test, and Wilcoxon test. The kappa coefficient and consistency rate were calculated in different subgroups. Results: Regarding image quality, the subjective satisfaction with AIBUS reached 70%. Moderate agreement was found for BI-RADS final recall assessment (κ = 0.47, consistency rate = 73.9%) and breast density category (κ = 0.50, consistency rate = 74.8%) between AIBUS with good quality images and HHUS. The lesions were measured statistically smaller and deeper by AIBUS than those by HHUS (P< 0.001), though neither more than 3 millimeters. The amount of time required for the AIBUS examination and image interpretation was 1.03 (95%CI (0.57, 1.50)) minutes shorter than that of HHUS per case. Conclusion: Moderate agreement was obtained for the description of the final recall assessment and breast density category. Further prospective studies in larger collectives are necessary to follow up on pathological outcomes. Have you got a Conflict of Interest?: No
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383 LncRNA MIR99AHG promotes invadopodia formation in colorectal cancer metastasis via interacting with PTBP1 D. Li1, X. Wang2, Y. Lu3, X. Zhao3, X. Wang1 1 Fourth Military Medical University, Department of Gastroenterology, Tangdu Hospital, Xi’an, Shaanxi, China, 2General Hospital of Shenyang, Department of Gastroenterology, Shenyang, Liaoning, China, 3Fourth Military Medical University, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, 710032, China Background: Metastasis accounts for the majority of recurrence and death in colorectal cancer (CRC) patients; however, the regulation mechanisms for CRC metastasis, especially in its initial stages, remain largely unknown. Aim: In this study, we aim to identify long noncoding RNAs (lncRNAs) functionally involved in CRC metastasis initiation as well as elucidate their regulatory mechanisms. Methods: We performed whole transcriptome sequencing using CRC cell lines with divergent spontaneous metastatic properties. The biological roles and mechanisms of lncRNA MIR99AHG were characterized with a series of in vitro andin vivomodels and molecular analyses. The invadopodia in CRC cells were observed by electron microscopy and Western blot analysis. Tumor tissues from patients with CRC were isolated for phenotypical analysis. Results: MIR99AHG was upregulated in metastatic CRC tissues and associated with tumor stage and poor prognosis (Figure 1). MIR99AHG potently drove migration, invasion and metastasis in CRC cells, and these effects were dependent on its role in promoting invadopodia formation. MIR99AHG was identified to bind the RNA splicing factor PTBP1. Mechanistically, MIR99AHG synergized with PTBP1 to direct and strengthen its binding to the 5’ splice site of SMARCA1 intron 12 (Figure 2), thereby promoting inclusion of the alternative exon 13 to generate a long isoform (SMARCA1-L), which is functionally inert in chromatin remodeling. The canonical SMARCA1 isoform without exon 13, rather than SMARCA1-L, inhibited CRC cell migration and invasion and suppressed a core set of genes involved in invadopodia formation. Clinically, SMARCA1-L levels are positively correlated with MIR99AHG and PTBP1 in patients with metastatic CRC (Figure 3) .
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Figure 1 MIR99AHG was upregulated in metastatic CRC tissues and associated with tumor stage and poor prognosis
Figure 2 MIR99AHG synergized with PTBP1 to direct and strengthen its binding to the 5’ splice site of SMARCA1 intron 12
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Figure 3 SMARCA1-L levels are positively correlated with MIR99AHG and PTBP1 in patients with metastatic CRC Conclusion: This study identified MIR99AHG as a metastasis-driving lncRNA that functions by triggering an alternative splicing switch of SMARCA1 pre-mRNA, highlighting the notion of lncRNA-mediated splicing regulation of chromatin remodelers during CRC metastasis.
Have you got a Conflict of Interest?: No
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387 PDE3A facilitates hypoxia-induced cancer stemness in triple negative breast cancer. s. pu1, N. Hao2, Y. Ren2, J. He2 1 Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, Xi'an, China, 2Department of Breast Surgery, First Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, xi'an, China Background: Triple negative breast cancer (TNBC) is a type of aggressive breast cancer with a poorer survival. Tumor hypoxic microenvironment, induced by exposed to intrinsic (e.g.oncogenes) and external factors (e.g.chemocherapy), is an important factor in both tumour progression and responses to chemotherapies. Recent studies have demonstrated that the progression of tumor hypoxic condition may result in the emergence of cancer stem cells (CSC), which also arise as a consequence of metastasis. However, the mechanism of targeting tumor hypoxic signaling in cancer stem cells remains to be investigated. Aim: (i) To investigate the mechanistic role of phosphodiesterase 3A (PDE3A) in TNBC and its links with breast cancer mortality, particularly caused by stemness and resistance to chemotherapy; and (ii) to investigated the effect and mechanism of PDE3A in hypoxic microenvironment on triple negative breast cancer stemness. Methods: The expression level of PDE3A was determined by immunohistochemical staining and analysed the mRNA expression profiles from The Cancer Genome Atlas of triple negative breast tumors. Roles of PDE3A in cancer cell growth, metastasis, stemness and activation of tumor hypoxic were determined by molecular and cell biology methods. Immunoprecipitation was used to examine the binding of proteins and chromatin immunoprecipitation (ChIP), promoter luciferase reporter assay were included for detecting the transcription of PDE3A in TNBC. TNBC xenograft nude mice were used to study the inhibition of tumor development. Results: PDE3A is a novel triple negative breast cancer target, which is overexpressed in TNBC tissues and significantly associated with clinical pathology of advanced TNM stage and poor prognosis of tumour patients. Increased PDE3A expression was pivotal for tumour cells to survive in the oxygen deprivation conditions. Mechanistically, PDE3A facilitates cancer stemness by suppressing cAMP/PKA/GSK3β signaling pathway, transporting accumulated SOX9 to the nucleus to promote the expression of stemness-related transcriptional factors in the oxygen deprivation conditions. In addition, hypoxic microenvironment induced by chemotherapy (epirubicin) treatment results in the translocation of HIF-1α, an hypoxia sensor, into the nucleus to promote PDE3A expression through direct binding to the PDE3A promoter. Furthermore, PDE3A-specific siRNAs encapsulated by jetPEI nanocarriers prominently inhibit tumor growth and metastasisin vivo. Conclusion: We identified an important role of PDE3A in the tumor hypoxic microenvironment and stemness, representing a future biomarker and therapeutic target of TNBC. Have you got a Conflict of Interest?: No
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391 CircRACGAP1 promotes stemness and metastasis of NSCLC via recruitment of PTBP1 to promote RIF1 deacetylation X. Liu1, P. Liu1 1 The Second Xiangya Hospital of Central South University, Department of Oncology, Chang Sha, China Background: Circular RNAs (circRNAs) are diagnostic and therapeutic targets in various malignancies. CircRACGAP1 was documented to exhibit an oncogenic role in non-small cell lung cancer (NSCLC). This work further explored the working mechanisms behind circRACGAP1-mediated NSCLC development. Aim: CircRNAs is related to a variety of biological processes such as carcinogenesis, inflammation and neural development. In a previous study, circracgap1 is highly expressed in NSCLC and promotes the tumorigenesis and progression of NSCLC through mir-144-5p / cdkl1 axis 11. However, the regulatory function and detailed mechanism of circracgap1 in the development of NSCLC are still unclear, which is worthy of further discussion. Methods: The level of CircRACGAP1 was detected by qRT-PCR. Stemness were evaluated by sphere formation, CD133 positive cell percentage, and expression of OCT4, Sox2, Nanog, and CD44. Migration and invasion were determined by wound healing and transwell assays. The protein expression was determined by Western blot. RNA-pull down, RIP, and Co-IP assays were used to confirm the targeting relationship between molecules or proteins. The effect of circRACGAP1was verified byin vivotumor growth and metastasis assays. Results: CircRACGAP1 is highly expressed in NSCLC and is closely related to Sox2 expression. The stem cells, metastasis and epithelial-mesenchymal transformation of NSCLC cells with CircRACGAP1 deletion were inhibited. Mechanistically, CircRACGAP1 promotes NSCLC progression by recruiting RNA binding protein PTBP1, thus enhancing the expression and stability of SIRT3 and subsequently leading to RIF1 deacetylation and Wnt/ βActivation of the catenin pathway. Knockout of SIRT3 or RIF1 gene inhibited stem cells and metastasis of NSCLC cells, while overexpression of CircRACGAP1 reversed this inhibition. CircRACGAP1 deletion inhibited the growth and metastasis of NSCLC in vivo. Lower overall survival was observed in NSCLC patients with higher serum exosomal CircRACGAP1 levels. Conclusion: CircRACGAP1 endows NSCLC cell stemness and metastasis via recruitment of PTBP1 to facilitate SIRT3-mediated RIF1 deacetylation. Our resultsuncover a novel mechanism and provide a therapeutic target for NSCLC. Have you got a Conflict of Interest?: No
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393 Geographic Accessibility of Radiotherapy Facilities in Sub-Saharan Africa P. Nadella1, H. Iyer2, A. Manirakiza3, V. Vanderpuye4, S. Triedman5,6, L. Shulman7, T. Fadelu2,5 1 University of Pennsylvania, Center for Global Health, Philadelphia, United States, 2Dana-Farber Cancer Institute, Division of Population Sciences, Boston, United States, 3King Faisal Hospital, Kigali, Rwanda, 4Korlebu Teaching Hospital, National Center for Radiotherapy, Oncology and Nuclear Medicine, Accra, Ghana, 5Dana-Farber Cancer Institute, Center for Global Cancer Medicine, Boston, United States, 6Warren Alpert Medical School of Brown University, Providence, United States, 7University of Pennsylvania, Abramson Cancer Center, Philadelphia, United States Pranay Nadella, MPhil1, Hari S. Iyer, ScD2, Achille Manirakiza, MD3, Verna Vanderpuye, MBChB4, Scott A. Triedman, MD5,6, Lawrence N. Shulman MD7, Temidayo Fadelu, MD, MPH2,5
1. 2. 3. 4. 5. 6. 7.
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA King Faisal Hospital, Kigali, Rwanda National Center for Radiotherapy, Oncology and Nuclear Medicine, Korlebu Teaching Hospital, Accra, Ghana. Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, MA, USA Warren Alpert Medical School of Brown University, Providence, RI, USA Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
Background: Access to radiotherapy in Sub-Saharan Africa (SSA) remains unacceptably low. Prior studies have focused how many radiotherapy machines a country has but have not accounted for geographic accessibility, a known barrier to radiotherapy compliance. Aim: This study describes geographic accessibility –measured as travel time by road –to radiotherapy in SSA. Methods: This study utilized geographic information systems modeling techniques. A list of radiotherapy facilities was obtained from the Directory of Radiotherapy Centres. We used a least-cost-path algorithm implemented in Google Earth Engine to estimate travel times. AccessMod5 was used to compute the percentage of each country’s population with access to a radiotherapy facility within prespecified time intervals. We then ranked countries using three measures of access: two-hour geographic access, units per capita, and units per cancer case. Results: Only 24.4% of the population of SSA can access a radiotherapy facility within two hours of travel; access was 14.6% and 42.5% within one and four hours respectively (Figure 1). Over 80% of Rwandans and South Africans were within two-hours of radiotherapy (Figure 2). On the other hand, twenty-one countries had no access to radiotherapy at two hours. While countries with more radiotherapy units per capita tended to have higher two-hour access, there was notable discordance between the two measures. Mauritania, Zambia, Sudan, and Namibia were among the top ten countries ranked by machines per capita, but none ranked in the top ten by two-hour geographic access. There was similar discordance between two-hour access and radiotherapy units per cancer case; Rwanda, Nigeria, Senegal and Cote d’Ivoire ranked in the top ten for the former but ranked worse for the latter (Figure 3). Conclusion: Prior measures of radiotherapy access, in terms of availability metrics like machines per country and units per capita, provide an incomplete picture. Less than 25% of the population of SSA is within two-hours of radiotherapy, which is an immense barrier to care considering radiotherapy often requires daily treatment for weeks. Geographic location of radiotherapy centers is a crucial component of access that should be considered for future planning in SSA.
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Have you got a Conflict of Interest?: No
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398 The intrinsic role and mechanism of tumor expressed-CD38 on lung adenocarcinoma progression L. Gao1, X. Du2, F. Meng3, FX.-F. Qin4 1 The First Affilated Hospital of Anhui Medical University, Department of Infectious Disease,, Hefei, China, 2the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Science and Technology Town Hospital, Institute of Clinical Medicine Research,, Suzhou, China, 3Chinese Academy of Medical Sciences and Peking Union Medical College, Suzhou, China, 4Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Background:It has been recently reported that CD38 expressed on tumor cells of multiple murine and human origins could be up-regulated in response to PD-L1 antibody therapy, which led to dysfunction of tumorinfiltrating CD8+T immune cells due to increasing the production of adenosine. However, the role of tumor expressed-CD38 on neoplastic formation and progression remains elusive. Aim: In the present study, we aimed to delineate the molecular and biochemical function of the tumor-associated CD38 in lung adenocarcinoma progression. Methods: CD38 and TRPM2 sgRNA were colonized into Lenti-V2, pX458 plasmid and then transfect into cells according to the manufacturer's protocol for constructing CD38-KO cell lines . The Lentiviral-FG-EF/HTLV vector was used for constructing CD38-overexpression after packaged in 293T cells using FuGENE transfection. CD38cysteine205 and cysteine123 mutation were performed with QuickMutation™gene mutagenesis kit. Tissue microarrays of lung adenocarcinoma specimens were employed to analyze CD38 expression by immunohistochemically staining. HPLC was used to detect the changes of NAD+ and adenosine (ADO) affected by CD38 enzymatic activity. The detection of cADPR from cell lines, cancerous and non-cancerous pleural effusion was carried out according to the instructions of the Amplite™ Fluorimetric cADP-Ribose Assay Kit. C57BL/6 mouse, CD38 deficiency mouse and BALB/c-nude mice were used to performin vivo exprements. Results: Our clinical data showed that the upregulation of tumor-originated CD38 was correlated with poor survival of lung cancer patients. Using multiple in vitro assays we found that the enzymatic activity of tumor expressed-CD38 facilitated lung cancer cell migration, proliferation, colony formation, and tumor development. Consistently, our in vivo results showed that inhibition of the enzymatic activity or antagonizing the enzymatic product of CD38 resulted in the similar inhibition of tumor proliferation and metastasis as CD38 gene knock-out or mutation. At biochemical level, we further identified that cADPR, the mainly hydrolytic product of CD38, was responsible for inducing the opening of TRPM2 iron channel leading to the influx of intracellular Ca 2+and then led to increasing levels of NRF2 while decreasing expression of KEAP1 in lung cancer cells. Conclusion: we demonstrated a significant mechanism that the enzymatic of tumor-expressed CD38 could induce the open of TRPM2 by generating cADPR, then resulted in an elevated concentration of cytoplasm calcium and facilitated primary tumor progression and metastasis. We also found targeting enzymatic activity of CD38 and its enzymatic product cADPR might be a promising strategy for the lung cancer therapy. Have you got a Conflict of Interest?: No
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40 Assisted Dying the Perspective from Health Services Staff T. Moselen1, A. Hyatt2, G. McDonald1 1 Peter MacCallum Cancer Centre, Prevention & Wellbeing, Melbourne, Australia, 2Peter MacCallum Cancer Centre, Department of Health Services Research, Melbourne, Australia Background: The Voluntary Assisted Dying (VAD) act came into effect in Victoria Australia on 19 June 2019. The legislation underpinning this act is complex and unique, it provides those who meet strict eligibility at end-of-life with access to choose voluntary assisted dying. Given the role of health services staff in supporting patients in palliative care and at end-of-life, understanding their unique experiences since the implementation of voluntary assisted dying may have implications for supporting staff and for other states where similar laws are being newly implemented or considered. Aim: This study aimed to understand the experiences and perspectives of staff involved with the operation and implementation of the VAD clinical intervention at a specialist oncology tertiary health service in Melbourne Australia. Methods: An exploratory mixed-methods study design was employed, comprising a cross-sectional survey and qualitative interviews to investigate staff experiences of VAD, specifically: processes and procedures, emotions and values, interactions with colleagues, supporting patients and families, and support and training needs. Quantitative data were analysed descriptively; qualitative open-text responses and interview data were analysed thematically. Results: A total 135 surveys and 18 semi-structured interviews were completed. Overall, staff described the complexity of navigating VAD in practice, encompassing both positive and confronting experiences. Key areas of support comprised ongoing training and education, developing staff communication skills, assistance with workload management, and improved debriefing and peer support. In terms of values, participants discussed employing iterative consideration throughout the implementation of VAD to reaffirm their moral decisions related to VAD. Conclusion: Assessment of staff perspectives regarding the implementation and clinical practice of VAD identified a range of multifaceted experiences, processes, and support and education needs. Understanding and addressing key issues identified will be important for the long-term sustainability of VAD, and to support future implementation in other jurisdictions and countries. Have you got a Conflict of Interest?: No
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401 Prediction model of malignant probability of pulmonary nodules: a multicenter prospective cohort study Z. Wu1, F. Wang1, W. Cao1, W. Tang2, Y. Xie3, N. Wu1, F. Tan2, W. Chen2, N. Li2, J. He2 1 National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, Beijing, China, 2Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, Beijing, China, 3The Second People’s Hospital of Liaocheng, Shandong, Shandong, China Background: Lung cancer screening was compromised in its ability to manage pulmonary nodules due to high false-positive rate in the current mainstream screening methods, low-dose computed tomography (LDCT). Aim: We constructed prediction models aimed to reduce the over-diagnosis. Methods: Data from a large multicenter prospective cancer screening cohort in China were included for model constructing. The study outcome was defined as the detection of lung cancer within half a year after screening. Multivariable logistic regression models were used to estimate the probability of lung cancer incidence in the whole population, or smokers and non-smokers. Models were validated using clinical data from multiple hospitals in China. Results: In our cohort, 1,016,740 participants were assessed between 2013 and 2018. 5165 participants received LDCT screening with suspected pulmonary nodules were divided into training set, and 149 participants were diagnosed as lung cancer; in the validation set, these two numbers were 1,815 and 800. Age and 5 radiologic factors of nodules (calcification, density, mean diameter, edge, and pleural involvement) were included in our model for general population. Area under curve (AUC) value of the model was 0.868 (95%CI: 0.839-0.894) in our training set, and 0.751 (95%CI: 0.727-0.774) in the validation set. With 70.5% sensitivity and 70.9% specificity, 68.8% false-positive rate in the LDCT screening would be reduced. Models based on smokers (AUC = 0.732, 95%CI: 0.686-0.778) and non-smokers (AUC = 0.740, 95%CI: 0.712-0.767) also received excellent discrimination in the validation set with good calibration. Conclusion: Our models could provide help for the diagnosis of suspected pulmonary nodules, effectively reduce the false positive rate of LDCT screening in lung cancer screening in China.
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Table 1Baseline characters of the participants Characters
Training set Overall (N= 5165) 58.26±7.66
Age(mean±SD) Sex Male 2988 (57.9) Female 2177 (42.1) Missing 0 Education Low 1206 (23.3) Medium 3296 (63.8) High 663 (12.8) Body mass index <18·5 142 (2.7) 18·5-24 2616 (50.6) 24-28 1965 (38.0) ≥28 442 (8.6) Frequent exercise No 3742 (72.4) Yes 1423 (27.6) Passive smoking year No 938 (18.2) 0-19 years 593 (11.5) 20-39 years 2615 (50.6) ≥40 years 1019 (19.7) Smoking status Never-smoker 1780 (34.5) Ever-smoker 3385 (65.5) Missing 0 Family history of lung cancer No 2574 (49.8) Yes 2591 (50.2) Chronic respiratory diseases No 1515 (29.3) Yes 3650 (70.7) Emphysema No 4600 (89.1) Yes 565 (10.9) Maxmium 9.35±7.06 diameter(mm) Missing 0 Minmium 7.19±5.23 diameter(mm) Missing 0 Location Not upper lobe 3215 (62.2) Upper lobe 1950 (37.8) Density Solid 3878 (75.1) Part-solid 785 (15.2) Non solid 502 (9.7) Missing 0 Calcification No 4550 (88.1) Yes 615 (11.9) Missing 0 Pleural involvement No 4244 (82.2) Yes 921 (17.8) Missing 0 Edge Smooth 1732 (33.5) Spiculated 3433 (66.5) Missing 0 Shape Round 4772 (92.4) Ellipse 393 (7.6)
Benign (N= 5016) 58.29±7.66
Malignant (N= 149) 58.21±7.66
2904 (57.9) 2112 (42.1) 0
84 (56.4) 65 (43.6) 0
1170 (23.3) 3205 (63.9) 641 (12.8)
36 (24.2) 91 (61.1) 22 (14.8)
132 (2.6) 2540 (50.6) 1907 (38.0) 437 (8.7)
10 (6.7) 76 (51.0) 58 (38.9) 5 (3.4)
3628 (72.3) 1388 (27.7)
114 (76.5) 35 (23.5)
910 (18.1) 577 (11.5) 2542 (50.7) 987 (19.7)
28 (18.8) 16 (10.7) 73 (49.0) 32 (21.5)
1728 (34.4) 3288 (65.6) 0
52 (34.9) 97 (65.1) 0
2510 (50.0) 2506 (50.0)
64 (43.0) 85 (57.0)
1477 (29.4) 3539 (70.6)
38 (25.5) 111 (74.5)
4468 (89.1) 548 (10.9)
132 (88.6) 17 (11.4)
9.03±6.45
20.26±14.29
0
0
6.94±4.80
15.45±10.07
0
0
3142 (62.6) 1874 (37.4)
73 (49.0) 76 (51.0)
3797 (75.7) 740 (14.8) 479 (9.5) 0
81 (54.4) 45 (30.2) 23 (15.4) 0
4406 (87.8) 610 (12.2) 0
144 (96.6) 5 (3.4) 0
4160 (82.9) 856 (17.1) 0
84 (56.4) 65 (43.6) 0
1660 (33.1) 3356 (66.9) 0
72 (48.3) 77 (51.7) 0
4632 (92.3) 384 (7.7)
140 (94.0) 9 (6.0)
Pvalue
SMD
0.001 0.775
0.288 0.031
0.716
0.067
0.003
0.292
0.302
0.096
0.935
0.054
0.979
0.009
0.105
0.142
0.342
0.088
0.957
0.015
<0.001
1.013
<0.001
1.079
0.001
0.277
<0.001
0.464
0.002
Validation set Overall Benign (N= 1815) (N= 1015) 52.21 ±11.09 50.81 ±11.50
Malignant (N= 800) 53.98±10.30
774 (51.5) 730 (48.5) 311
457 (50.5) 448 (49.5) 110
317 (45.4) 282 (54.6) 201
1282 (70.6) 521 (28.7) 12
709 (69.9) 298 (29.4) 8
573 (71.6) 223 (27.9) 4
12.95±9.92
11.73±9.91
14.52±9.71
39
16
23
10.12±7.80
9.22±7.78
11.27±7.67
33
20
13
907 (52.3) 392 (22.6) 434 (25.0) 82
642 (65.9) 112 (11.5) 220 (22.6) 41
265 (34.9) 280 (36.9) 214 (28.2) 41
1732 (96.8) 57 (3.2) 26
959 (95.5) 45 (4.5) 11
773 (98.5) 12 (1.5) 15
1323 (72.9) 465 (25.6) 27
826 (81.4) 177 (17.4) 12
497 (62.1) 288 (36.0) 15
1315 (73.5) 473 (26.5) 27
714 (71.1) 290 (28.9) 11
601 (76.7) 183 (23.3) 16
0.334
<0.001
<0.001
0.565
0.603
0.314
0.064
Data were presented as mean±SD(standard derivation) or n (%) unless otherwise specified.
2
Pvalue
SMD
<0.001
0.290
0.385
0.049
0.576
0.050
<0.001
0.285
<0.001
0.265
<0.001
0.729
0.001
0.174
<0.001
0.438
0.010
0.126
Figure 1 Study profile * Invalid data included those: i) who did not meet the high-risk criteria but were classified as high-risk individuals; ii) who were actually high risks but were misclassified as low risks; iii) who were low risks but undertook the free LDCT scan.
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Figure 2 Effectiveness of covariates in the final model in general population
Figure 3 Comparison between models in the validation set Have you got a Conflict of Interest?: No
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402 A Recurrence Predictive Model for Node-negative Esophageal Squamous Cell Carcinoma After Upfront Esophagectomy H.-j. Gao1, S.-y. Hu2, Y.-c. Wei2 1 The Affiliated Hospital of Qingdao University, Department of Thoracic Surgery, Qingdao, China, 2The Affiliated Hospital of Qingdao University, Qingdao, China
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Background and context: The prognosis for pathologically node-negative (pN0) esophageal squamous cell carcinoma (ESCC) with surgery alone remains poor.Aim: We aimed to develop a model for more precise prediction of recurrences which will allow personalized managememnt for pN0 ESCC after upfront complete resection. Strategy / Tactics: Clinical and pathological records of patients with completely resected T1-3N0M0 ESCC were retrospectively analyzed between January 2014 and December 2019.Programme / Policy process:A nomogram for recurrence was established based on the Cox regression analysis and evaluated by C-indexes, AUC, and calibration curves. The model was further validated using bootstrap resampling and k-fold cross-validation and compared with the AJCC 8th TNM staging system using Td-ROC, NRI, IDI, and DCA. Outcomes: Two-hundred-and seventy cases were included in this study. The median follow-up was 45 months. Distant and/or loco-regional recurrences were noted in 89 (33.0%) patients. The predictive model revealed Tstaging, differentiation, perineural invasion, TLN, and PNI as independent risk factors for recurrence, with a cindex 0.725 in the bootstrapping cohort. Td-ROC, NRI, and IDI showed a better predictive ability than the AJCC 8th TNM staging system. Based on this model, the low-risk group had significantly lower incidence of recurrence than that of the high-risk patients (P < 0.001). What was learnt: The prognostic model developed in this study may facilitate precise prediction of recurrences for pN0 ESCC after upfront surgery. Stratifying management of those patients might bring a significant better survival benefits. Have you got a Conflict of Interest?: No
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408 Follicular thyroid cancer in a teenager: report of one case P.-Y. Ku1, W.-H. Chen1, Y.-J. Chen1, S.-B. Cheng1 1 Taichung Veterans General Hospital, General Surgeon, Situn Dist., Taichung City 407219, Taiwan (R.O.C.), Taiwan Background and context: Thyroid carcinomas, especially thyroid follicular carcinoma, are rare in pediatric or adolescent patients. The most common subtype is papillary thyroid cancer (PTC), followed by follicular thyroid cancer (FTC), which is extremely rare in children and adolescents. Aim: We introduce a case of teenager thyroid follicular carcinoma showing the rapid growth of a goiter. Strategy / Tactics: Left thyroidectomy follow by completion right thyroidectomy due to pathology reported thyroid follicular cancer pT3aN0M0 with extensive angioinvasion, post operation I-131 ablation therapy with 150mCi was also arranged Outcomes: There were no recurrence nor metastasis found in the latest follow up 6 months after operations. What was learnt: (if relevant, please also detail here the potential of replicability) Considering this rare case, cervical lesions in teenager should be carefully followed up due to similar microscopic features between follicular carcinoma and follicular adenoma. Nonetheless, when growing potential is detected in young cases (size bigger than 4cm according to ATA guidelines 2015), surgical intervention should be considered for possible malignant result. Have you got a Conflict of Interest?: No
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416 Identifying Effective Tax Policies to Reduce Cigarette Consumption: Cross Country Empirical Evidence E. Dauchy1, C. Shang2, V. Adrison3 1 Campaign for Tobacco Free Kids, International Research, Washington DC, United States, 2The Ohio State University, Wexner Medical Center., Columbus, United States, 3University of Indonesia, Department of Economics, Jakarta, Indonesia Background:Increasing cigarette prices with tax and price policies is the most effective way to reduce consumption. We evaluate the effectiveness of several aspect of tax systems, simultaneously and independently, to reduce cigarette demand over time and between 160 countries. Aim: We demonstrate that though tax policy is effective at reducing tobacco use, its impact is more significant when accompanied and supported by a strong tax system design and administration. Methods: : We construct tax system scores using the methodology developed by Tobacconomics, University of Chicago, with additional error corrections. The scoring system is based on 5 criteria (ranging from 0 to 5) including cigarette prices, affordability changes, tax burden, and tax system design. Higher scores represent stronger systems. The overall score is the average of the sub-scores. We use alternatively the levels and the resulting tax scores to estimate their impacts on cigarette demand. To do this we collect a biennial database of aspects of tobacco tax systems and rates from 2008 to 2020 across 160 countries, obtained from the WHO. We then use a two-way fixed effect model to estimate the impact of scores and tax and price measures on two margins of demand, cigarette prevalence among adults 15+ and sales volumes. Results: Most tax systems sub-scores significantly reduce independently the prevalence of adult cigarette smoking. A higher tax score by 1 unit reduces prevalence of smoking by about 0.55 percentage points (pp).The overall score is the most effective at reducing prevalence. Price and tax burden sub-scores significantly reduce cigarette sales volumes. A higher tax burden score by 1 unit reduces cigarette sales by -0.6 percent. Tax share scores are also the most effective at reducing cigarette sales. Prices scores or tax share scores are more effective at reducing prevalence if combined with strong tax systems. An improvement in price (tax) score increases the effectiveness of the overall tax system score to reduces prevalence and sales. Conclusion: All tax systems scores are very effective at reducing cigarette demand. A one point increase in scores leads to a -0.3 to -0.8 pp reduction in smoking prevalence and a -2% to -7% reduction in sales volume. Price increases are much more effective at reducing sales when combined with increases in tax shares than price increases alone. Have you got a Conflict of Interest?: No
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419 Breast cancer screening in a limited resource country N. Mohamed1 1 ZANZIBAR OUTREACH PROGRAM, MOBILE OUTREACH, ZANZIBAR, Tanzania, United Republic of Background: Breast cancer is the leading cause of death among women in both developed and developing countries. Given the increasing burden of breast cancer in the low and limited resource countries, cost-effective approaches are needed to improve the early detection of breast cancer. Global policies and guidelines are now placing much emphasis on promoting early detection of breast cancer through integrated breast cancer education and breast self-examination (BSE). In Zanzibar, for more than three years efforts have taken place under the partnership of Zanzibar Outreach Program (ZOP) with Zanzibar Cancer Association (ZCA) through Oman Cancer Association (OCA) to raise awareness that will help in early breast cancer detection through outreach programs, yet more efforts are needed to ensure everyone can perform BSE. Aim: Awareness of Beast CANCER and Self Breast examination Methods: Data were collected in all ZOP outreach camps Results: During the two years of screening 2020-2021, the total number of screened women was 1588. However, corona pandemic situation in 2020 limited expected number, hence only 610 women were screened, suspected were 35 (5.74%) and 3 (0.5%) were diagnosed with breast cancer of different stages, 2 undergone mastectomy and 1deceased due to metastasis. In 2021, total number screened were 978; 108 (11%)underwent further investigations due to the following findings (lump, breast discharge, mass,lymphadenopathy, discolorations, nipple dimpling, peau d’orange), and the diagnosed that had breastcancer of different stages were 8 (0.8%), 7 undergone mastectomy, and 1 joined oncology chemotherapy. Accordingly, breast cancer seems to be sustainable problem according to the data mentioned above. Conclusion: Our data show that breast cancer presentation is at a very late stage due to lack of awareness and specialized diagnostic equipment. Therefore, we conclude that relevant studies for gathering evidence is required in order to promote BSE and awareness in Zanzibar. The evidence obtained from the studies will assist to guide future research, determine the exact scale of breast cancer in Zanzibar, this will allow early detection and enable timely and proper breast cancer management. The study results will be recorded, disseminated and used to impart breast cancer self-diagnostic skills for women in Zanzibar. It is postulated that only women above 40 years were mainly at high risk of breast cancer but currently younger women around the age of 20 have been diagnosed with breast cancer, to the distress of many. Low-income countries specifically Zanzibar, has a limited number of qualified personnel to manage this overwhelming situation and hence early detection should be the key. Have you got a Conflict of Interest?: No
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422 Higher risk of cardiovascular death than cancer death after cancer diagnosis among long-term survivors Z. Wang1, L. Yang2, S. Wang3, L. Liu4, C. Sheng1, Y. Huang1 1 Tianjin Medical University Cancer Institute and Hospital, Tianjin, China, 2Peking University Cancer Hospital & Institute, Beijing, China, 3Peking University Health Science Center, Beijing, China, 4European Organization for Research and Treatment of Cancer, Brussels, Belgium Background: Most previous studies have focused more on the short-term risk of cardiovascular death related to traumatic psychological stress after cancer diagnosis, but less on the long-term risk of cardiovascular death. Aim: To investigate long-term risk of cardiovascular death among cancer patients and investigate whether and when cardiovascular death outweighs cancer death for cancers in different sites. Methods: Temporal trends in the proportions of cardiovascular death (PCV), cancer death (PCA), and other causes in all-cause deaths were used to show preliminary relationships between three causes of death in 4,806,064 cancer patients from the Surveillance, Epidemiology, and End Results (SEER) Program. Competing mortality risk curves were used to investigate when cumulative cardiovascular mortality rate (CMRCV) began to outweigh cumulative cancer mortality rate (CMRCA) for cancer patients survived more than 10 years. Competing risk models were used to investigate independent factors associated with cardiovascular death in long-term cancer survivors. Results: For all cancer patients, the PCV increased from 22.8% in the 5th year after cancer diagnosis, to 31.0% in 10th year, and 35.7% in the 20th year, while the PCA decreased from 57.7%, to 41.2% and 29.9%, respectively (Figure 1). The PCV outweighed the PCA (34.6% vs. 34.1%) since the 15th year for all cancer patients, as early as the ninth year for colorectal cancer patients (37.5% vs. 33.2%), and as late as the 22nd year for breast cancer patients (33.5% vs. 30.6%). The CMRCV outweighed CMRCA since the 15th year for cancer patients survived more than 10 years, the 5th year for those survived more than 15 years, and the 1st for those survived more than 20 years (Figure 2). Among cancer patients survived more than 20 years, elder age at diagnosis, male, local metastasis, and radiotherapy were associated with increased risk of cardiovascular death, while surgery and chemotherapy were associated with decreased risk of cardiovascular death. Sensitivity analysis by cancer sites showed similar results. Conclusions: Cardiovascular death will gradually outweigh cancer death as survival time increases for most cancer patients. Cardio-oncologist should be involved as early as possible in the anti-cancer treatments to reduce cardiovascular death in long-term cancer survivors.
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Figure 1. Temporal trends in the proportions of cardiovascular death (PCV), cancer death (PCA), and other causes in all-cause deaths in cancer patients
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Figure 2. Competing mortality risk curves for cancer patients survived more than 20 years by cancer sites. Abbreviations: CVD, cardiovascular disease; RESPIR, respiratory; BREAST, breast; COLRECT, colon and rectum; URINARY, urinary; LYMYLEUK, lymphoma of all sites and leukemia; FEMGEN, female genital; MALEGEN, male genital; DIGOTHR, other digestive; OTHER, all other sites. Have you got a Conflict of Interest?: No
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424 Role of IFI6 in modulating the proliferation, apoptosis and senescence of esophageal squamous cell carcinoma Y. Gao1, P. Liu1, Y. Zhu1, X. Xu1, W. He1, J. Dai1 1 The Affiliated Jiangyin Hospital of Xuzhou Medical University, Department of Gastroenterology, Jiangyin, China Background: Esophageal cancer is one of the most malignant tumors worldwide. Dysfunction of Interferon alphainducible protein 6 (IFI6) has been implicated in numerous human diseases, including cancer. Aim: This study investigated the function and potential molecular pathways of IFI6 in esophageal squamous cell carcinoma (ESCC) cells. Methods: Real-time PCR analysis was employed to evaluate the mRNA levels of IFI6. CCK-8-based analysis, EdU staining, colony formation assays, β-galactosidase staining and Annexin V/PI double-staining assay were used to determine the influence of IFI6 on cell growth, senescence and apoptosis. Besides, we used a cell cycle analysis by flow cytometry. The association of IFI6 and tumor growth was investigated in vivo. RNA-sequencing was performed to identify the transcripts and pathways affected by IFI6. Results: IFI6 was overexpressed and silenced in TE-1 and TE-10 cells using lentiviruses. Upregulated IFI6 resulted in the promotion of cell growth both in vitro and in vivo, whereas downregulation of IFI6 induced the opposite effect. IFI6-overexpressing inhibited cell senescence and apoptosis, while IFI6-downregulation increased cell senescence and apoptosis. Both IFI6 overexpression and silencing did not influence cell cycle progression. RNAseq and Kyoto Encyclopedia of Genes and Genomes-base pathways analysis were performed in IFI6 overexpression and silencing TE-1 cells. A total of 9 mRNAs revealed consistent associations with both IFI6 overexpression and silencing. IFI6 appeared to have modulated the TE-1 cells via complex mechanism. KEGG pathway analysis revealed that IFI6 affected multiple pathways, including peroxisome, spliceosome, histidine metabolism, proteasome, MAPK signaling pathway, protein processing in endoplasmic reticulum and p53 signaling pathway, among others. Conclusion: IFI6 played a positive role in the proliferation of ESCC cells both in vitro and in vivo experiments. IFI6 attenuated cell senescence and apoptosis in ESCC cells and modulated downstream mRNAs implicated in various pathways, suggesting that IFI6 could be a novel therapeutic target in the treatment of ESCC. Have you got a Conflict of Interest?: No
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429 Molecular subtypes of Gastric Cancer and clinico-pathological implication. K. Vaiphei1, G. Gude2 1 Post Graduate Institue of Medical Educaiton and Research, Histopathology, Chandigarh, India, 2Post Graduate Institute of Medical Education and Research, Histopathology, Chandigarh, India Background: Classification systems for gastric cancer (GC) were based oncomprehensive molecular analysis to provide insights into developing personalized therapy. Aim: to study was to establish a less cumbersome and clinically relevant assay for different histological gastric cancer histological tumor types. Methods: 100 gastric cancer patients who were treated either with resection or who underwent endoscopic biopsy for histological diagnosis were included in the study. The clinicopathological parameters were analyzed. The tumor tissue with adjoining gastric mucosa was assessed for mismatch repair protein deficiency (MMRd), P53 aberrancy, and E-cadherin aberrancy by immunohistochemistry (IHC). Her2/neu amplification by IHC and fluorescencein-situ hybridization. Results: Fifty-seven cases were of Laurén intestinal subtype and 43 cases had diffuse morphology. The age range is 25-90yrs (Mean - 53.3yrs), the male-female ratio is 3.3:1. Diffuse GC is more common in younger female patients (P - 0.041). Eight cases showed MMRd, is of intestinal subtype and more commonly seen in Gastric cancer with lymphoid stroma. MMRd is associated with older age, distal location, and better outcome and survival (P 0.042). P53 aberrancy is identified in 51% of cases. MMRd and P53 showed an inverse relation. P53 positive gastric cancer shows a higher pT and lymph node involvement (P- 0.028). Her2neuoverexpression is identified in 15% of the cases of GC. Conclusion: All Her2 positive cases were of intestinal morphology which also includes 2 cases of cribriform carcinoma and 1 hepatoid adenocarcinoma. Thirty cases were microsatellite stable, P53, and E-cadherin wild type. We have demonstrated that GC can be classified into clinically relevant subgroups by using a convenient screening tool. Have you got a Conflict of Interest?: No
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434 Spatial and temporal epidemiological analysis of female breast cancer mortality in Suzhou, China:20062020 L. Wang1, Y. Lu1, C. Huang1 1 Suzhou Center for Disease Control and Prevention, Suzhou, China Background: Breast cancer is the cancer with the highest incidence of women in the world. And the direct medical cost of breast cancer continues to rise in China and breast cancer is an important disease that affects women's health and increases the burden of disease. At present, most domestic tumor epidemiological studies use general characterization, but the space-time characteristic analysis is rare. Geographic information system technology can provide a powerful auxiliary role for disease prevention and control research.Therefore, this article used geographic information system to study the temporal and spatial changes of female breast cancer deaths in Suzhou, and found areas with high and low incidences, which provided a localized scientific basis for the prevention and treatment of breast cancer in our city. Aim: The epidemiological trend and spatial distribution of female breast cancer mortality in Suzhou were analyzed, so as to provide a scientific basis for prevention and treatment of breast cancer. Methods: The annual trend of female breast cancer mortality data from 2006 to 2020 years was analyzed. The spatial auto-correlation analysis was carried out by Moran's I method of GeoDa software to explore its regional aggregation. Results: The average annual crude mortality rate (CR) of breast cancer in Suzhou was 8.54 per 100,000 from 2006 to 2020, while the age-standardized mortality rate (ASMR) was 7.38 per100,000. The annual change percentage (APC) of CR in recent 15 years was 1.98% (1.30%- 2.66%), which was statistically significant (P<0.001). The annual change trend of ASMR was decreased slightly (APC=-0.95%, P=0.04). Spatial analysis indicated that there was a certain clustering of breast cancer in Suzhou. Conclusion: The CR of female breast cancer in Suzhou showed an upward trend, but ASMR decreased slightly. Health promotion and education should be strengthened in the areas with high incidence of female breast cancer death in Suzhou, and the participation rate of breast cancer screening should be further improved. Table I.Annual change of female breast cancer mortality rate (1per 100,000) in Suzhou from 2006 to 2020
Year 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 APC（％） 95%CI P-value
Age-standardized Crude mortality rate mortality rate (CR) (ASMR) 7.32 9.03 7.31 7.95 8.23 8.28 8.23 8.01 7.36 7.02 7.52 7.04 8.25 7.27 8.56 7.32 8.91 7.48 9.05 7.49 8.49 6.79 10.08 8.02 9.89 7.88 9.00 7.04 9.26 7.03 1.98 -0.95 1.30~2.66 -1.75~-0.15 0.0001 0.04
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Figure I.Age distribution of female breast cancer mortality rate (1per 100,000) in Suzhou from 2006 to 2020
Figure II.Local spatial auto-correlation clustering map of age-standardized mortality rate (1/100,000) of breast cancer in Suzhoufrom 2006 to 2020 Have you got a Conflict of Interest?: No
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445 A Mediation Model through Caregiver Depression of Childhood Cancer Patients undergoing inpatient treatment J. Wang1,2, P.C Coyte2, D. Shao1, X. Zhen1, N. Zhao1, X. Sun1 1 Shandong University, Jinan, China, 2University of Toronto, Toronto, Canada Title:The Relationship between Unmet Needs of Chinese Family Caregivers and the Quality of Life of Childhood Cancer Patients undergoing inpatient treatment: A Mediation Model through Caregiver Depression Background: A large proportion of the global burden of childhood cancer is borne by China. These patients have a poor quality of life (QoL) and the unmet needs of their family caregivers are high. However, the association between the unmet needs of family caregivers and a care-recipient’s QoL are poorly understood. Aim: First, to measure the QoL of children with cancer and the unmet needs of their family caregivers; second, to assess the relationship between the unmet needs of family caregivers and the QoL of care-recipients; and third, to explore the potential mediating role played by depression among caregivers on the relationship between the unmet needs of caregivers and the QoL of care-recipients. Methods: A total of 286 childhood cancer caregivers were included in the study. The caregiver’s unmet needs were assessed using the Comprehensive Needs Assessment Tool for Cancer Caregivers (CNAT-C) and the caregiver’s depression was assessed through the Patient Health Questionnaire (PHQ-9). The patient’s QoL was proxy-reported by the Pediatric Quality of Life Inventory Measurement Models (PedsQL 3.0 scale Cancer Module). Descriptive analyses, Independent Student’s t-tests, one-way ANOVA, and mediation analyses were performed. Results: The mean scores (and associated standard deviation, SD) for unmet needs, depression, and QoL were 65.47((26.24)), 9.87(7.26), and 60.13((22.12) respectively. A caregiver’s unmet needs (r = -0.272, P<0.001) and depression (r = -0.279, P<0.001) were negatively related to a care recipient’s QoL. Depression played a partial mediator role in the relationship between unmet needs and QoL, and the mediation effect ratio was 38.15%. Conclusion: This study demonstrated the mediating role played by a caregiver’s depression in the relationship between a caregiver’s unmet needs and a care-recipient’s QoL. Given the important role played by nursing interventions in addressing depression, it is important to standardize the programs that focus on psychological well-being of childhood cancer caregivers. Have you got a Conflict of Interest?: No
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448 A Mediation Model through Caregiver Depression of Childhood Cancer Patients Undergoing Inpatient Treatment J. Wang1,2, P.C Coyte2, D. Shao1, X. Zhen1, N. Zhao1, x. Sun1 1 Shandong University, Jinan, China, 2University of Toronto, Toronto, Canada Title: The Relationship between Unmet Needs of Chinese Family Caregivers and the Quality of Life of Childhood Cancer Patients Undergoing Inpatient Treatment: A Mediation Model through Caregiver Depression Background: A large proportion of the global burden of childhood cancer is borne by China. These patients have a poor quality of life (QoL) and the unmet needs of their family caregivers are high. However, the association between the unmet needs of family caregivers and a care-recipient’s QoL are poorly understood. Aim: First, to measure the QoL of children with cancer and the unmet needs of their family caregivers; second, to assess the relationship between the unmet needs of family caregivers and the QoL of care-recipients; and third, to explore potential mediating role played by depression among caregivers on the relationship between the unmet needs of caregivers and the QoL of care-recipients. Methods: A total of 286 childhood cancer caregivers were included in the study. The caregiver’s unmet needs were assessed using the Comprehensive Needs Assessment Tool for Cancer Caregivers (CNAT-C) and the caregiver’s depression was assessed through the Patient Health Questionnaire (PHQ-9). The patient’s QoL was proxy-reported by the Pediatric Quality of Life Inventory Measurement Models (PedsQL 3.0 scale Cancer Module). Descriptive analyses, Independent Student’s t-tests, one-way ANOVA, and mediation analyses were performed. Results: The mean scores (and associated standard deviation, SD) for unmet needs, depression, and QoL were 65.47((26.24)), 9.87(7.26), and 60.13((22.12) respectively. A caregiver’s unmet needs (r = -0.272, P<0.001) and depression (r = -0.279, P<0.001) were negatively related to a care recipient’s QoL. Depression played a partial mediator role in the relationship between unmet needs and QoL, and the mediation effect ratio was 38.15%. Conclusion: This study demonstrated the mediating role played by a caregiver’s depression in the relationship between a caregiver’s unmet needs and a care-recipient’s QoL. Given the important role played by nursing interventions in addressing depression, it is important to standardize the programs that focus on psychological well-being of childhood cancer caregivers. Keywords: Childhood Cancer; Family Caregiver; Unmet Needs; Quality of Life; Depression.
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Figure . A mediation model of the association between a caregiver’s unmet needs and a care-recipient’s quality of life (QoL) through depression exhibited by the caregivers. Standard error in the parentheses and path coefficients estimated by bootstrap procedure are shown. ** P-value <0.01; ***P-value <0.001.
Have you got a Conflict of Interest?: No
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461 First Vietnamese cohort study on Copenhagen Index versus ROMA in preoperative ovarian tumors stratification T. Tran Doan1, H. Nguyen Vu Quoc1, T. Le Minh1, K. Vo Van1, L. Chuang2 1 Hue University of Medicine and Pharmacy, Department of Obstetrics and Gynecology, Hue city, Vietnam, 2University of Vermont Larner College of Medicine, Department of Obstetrics and Gynecology, Burlington, United States Background: Ovarian cancer (OC) is one of the ten most commonly diagnosed cancers in women and has the highest mortality rate and the worst prognosis of all gynecological cancers. In 2009, Moore et al. developed the Risk of Ovarian Malignancy Algorithm (ROMA) by integrating serum carbohydrate antigen (CA-125) and human epididymis protein (HE4) values and menopausal status, which has been introduced in clinical practice by the US Food and Drug Administration to differentiate between low- and high-risk patients with OC. In 2015, Karlsen et al. developed the Copenhagen Index (CPH-I) based on these two biomarkers and patient age. Aim: This study aimed to evaluate the diagnostic performances of the CPH-I and ROMA in the preoperative prediction of OC. Methods: In a prospective cohort study, data were collected from 475 patients with ovarian masses diagnosed by gynecologic examination/ ultrasound who were hospitalized at the Departments of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy Hospital, and Hue Central Hospital, Vietnam, between January 2018 and June 2020. ROMA and CPH-I were calculated based on measurements of serum CA-125 and HE4. The final diagnosis was based on clinical features, radiologic and histopathologic findings, and the International Federation of Gynecology and Obstetrics (FIGO) 2014 stages of OC were recorded. Matching the values of ROMA and CPH-I to postoperative histopathology reports resulted in the preoperative prediction values. Results: Among the 475 women, 408 had benign tumors, 5 had borderline tumors and 62 had malignant tumors. The two indices showed similar discriminatory performances with no significant differences (p> 0.05). At the optimal cut-off, the sensitivities/specificities of ROMA and CPH-I for OC diagnosis were 74.2%/ 91.8% and 87.1%/ 78.5%, respectively. The optimal cut-off for CPH-I was 1.89%. The areas under the ROC curves (AUCs) of ROMA and CPH-I were 0.882 (95% CI: 0.849-0.909) and 0.898 (95% CI: 0.867-0.924), respectively. Conclusion: The introduction of the Copenhagen Index to help stratify the malignancy risk of ovarian tumors, irrespective of menopausal status, might be applied as a simple alternative with similar efficacy to ROMA in clinical practice. Have you got a Conflict of Interest?: No
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463 Participatory approach in improving access and coverage of cervical cancer prevention and control in Vietnam V.Q.H. NGUYEN1, T.H. DUONG2, T.X.H. NGHIEM3, V.D. DUONG4 1 Hue University of Medicine and Pharmacy, Hue, Vietnam, 2National Institute of Hygiene and Epidemiology, Hanoi, Vietnam, 3Ministry of Health, Mother and Child Health, Hanoi, Vietnam, 4UNFPA Vietnam, Hanoi, Vietnam Background and context: From 1990 until 2010, there were opportunistic and small-scale cervical cancer screening projects in Vietnam, using conventional Pap’s smear, whilst visual inspection with acetic acid (VIA) being implemented at limited extend. On-demand HPV vaccines were introduced in 2009. A key objective of the National Cervical Cancer Action Plan (2016–2025) is to screen 60% of women aged 30–54 years for cervical cancer by 2025. Aim: To improve the access and the coverage of cervical cancer prevention and control in Vietnam. Strategy / Tactics: Mobilizing various stakeholders and resources through the participatory approach by promulgating of policy and professional papers for multilevel implementation of HPV vaccination and cervical cancer screening. Programme / Policy process: In 2011 the first National Guidelines on screening and treatment of precancerous lesions for cervical cancer secondary prevention was deployed, based on Pap’s smear and VIA. The updated National Guidelines for cervical cancer control & prevention (2019) showed significant role of HPV DNA testing, increasing role of liquid-based cytology, while VIA still be used in remote/limited resource areas. There was a concerted participatory approach, in which the Ministry of Health issued the legal and professional framework; the Provincial Authorities approved and issued detailed activities plan, and the implementing agencies were the Provincial Departments of Health and the Centers for Diseases Control & Prevention. Target groups for screening were women aged 21 – 65 years, and for vaccination were children aged 12 years (6th grade), implemented by Expanded Programme on Immunization at schools. Screening being co-paid by women at a subsidized cost, depending on province’s policy; whilst vaccination cost was covered privately and is to be fully covered by Provinces in the future. Outcomes: Data from the Vietnam Sustainable Development Goal on Children and Women 2020-2021 Survey (SDGCW)[i] indicated that 73.5% of women aged 30–49 years have ever heard or read about cervical cancer (85.0% in urban and 66.7% in rural areas); 62% of women and adolescent age 15-29 years have ever heard or read about HPV vaccination (73.1% in urban and 56% in rural areas). The rate of cervical cancer screening was 28%, as compared to those of less than 5% in 2010, among them 13.6% have one screening test and 14.6% have two or more; whilst the HPV vaccination rate increased from less than 2% in 2010 up to 12% in 2021 (15.6% in urban and 9.2% in rural areas). [i] Vietnam General Statistics Office & UNICEF. 2021. Vietnam Sustainable Development Goal on Children and Women (SDGCW) Survey 2020-2021. Hanoi, Vietnam. What was learnt: (if relevant, please also detail here the potential of replicability) The participatory approach is a feasible strategy and could be scaled-up across Vietnam and other similar infrastructures and settings. Have you got a Conflict of Interest?: No
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481 Functional heterogeneity of epidermal resident and monocyte-derived langerhans cells on melanoma progression J. Li1, J. Tao2 1 Department of Dermatology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China, 2Depertment of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China Background: As the only antigen-presenting cells that reside in normal epidermis, langerhans cells (LCs) have diverse functions in skin homeostasis, including either immunogenic or tolerogenic responses. In the context of inflammation or cancer, circulating monocytes are recruited into the epidermis to form monocyte-derived langerhans cells (moLCs) and replace resident LCs (rLCs) that have migrated to the draining lymph nodes. However, the role of different subsets of LCs in the progression of cutanous malignant melanoma remains unclear. Aim: To explore the functional heterogeneity of epidermal rLCs and moLCs on the development of melanoma. Methods: We used Langerin-DTR transgenic and moLC conditional knockout mouse models to investigate the different effects of LC subsets on the progression of melanoma. In addition, we induced human monocytederived moLCs from PBMC in vitro to explore its immunosuppressive phenotype and function and interaction with T cells. We also analyzed the composition and proportion of LC subsets in patients with different stage of melanoma and its correlation with anti-PD-1 therapy. Results: We demonstrated that melanoma growth accelerated after rLC elimination, while moLC depletion could suppress tumor progression. The number of rLCs decreased while moLCs increased in both melanoma mouse model as well as patients with different stage of melanoma during tumor progression. In addition, the frequency of moLCs in anti-PD-1 therapy-naive patients was higher than that of previously anti-PD-1 treated patients with melanoma. Furthermore, moLC could induce the development and activation of Toxp3+Treg cells while inhibit the proliferation of CD8+CTLs. Mechanistically, TGF-β and PGE2 could induce the tolerogenic phenotype and function of moLCs, notably PGE2-AhR-COX2 axis could promote the secretion of IL-10, TGF-β and PGE2 and upregulate the expression of PD-L1. Conclusion: Collectively, we revealed the functional heterogeneity of LCs subsets on the progression of melanoma, thus furthering our understanding of LC biology. Have you got a Conflict of Interest?: No
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488 Esophageal cancer in China: Practice and research in the last decades H. Zhu1, K. Zhao1 1 Fudan University Shanghai Cancer Center, Shanghai, China Background and context: China represents more than 50% of global burden of esophageal cancer. Esophageal cancer in China has been recognized by the international community by the early studies, especially epidemiological studies form North Central Taihang Mountain region (Linxian). China has benefited from international cooperation and support, including US-NCI and IARC since 1970s, which graced patients and families from generation to generation. China is now the second largest world economy, and has changed a lot including esophageal cancer prevention, treatment, and research. Aim: To share the recent knowledge of esophageal cancer in China, with comparison of early results, as well as key studies of the globe. Strategy / Tactics: The subtitles include incidence and mortality, risk factors, screening, clinical diagnosis, treatment, research, and future directions. We will collect the pearls of publication and present the international readers the most recent, objective, and valuable information of the 8th most common and 6th most deadly cancer in China. Programme / Policy process: Scientific publications from China related to esophageal cancer have steadily increased. The total number exceeded that of that of USA in 2012 and have been the leading country in quantities ever since. In 2021, China accounts for 40% of world esophageal cancer publication in PubMed, which is 2.5- fold of Japan and 3.2- fold of USA. At present, 469 Chinese clinical trials of esophageal cancer are registered on ClinicalTrials.gov, which is only second to USA. Outcomes: Stage I, II, III, IIV esophageal cancer has account for 17.00%, 32.42%, 30.27% and 20.31%, respectively, according to a multicenter study from 18 hospitals across 6 regions in China. The 3- and 5-year OS rates of the 5283 investigated EC patients were 49.98% and 39.07%, respectively. Their median survival was 36.00 months. What was learnt: (if relevant, please also detail here the potential of replicability) With the huge geographic and socioeconomic difference of the nation, there is a lot of gaps between high-incidence and low incidence regions within China, as well as compared with esophageal cancer in other countries. At the same time, we find that our diseases and treatments are very different from those in other parts of the world. Have you got a Conflict of Interest?: No
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492 Access to and affordability of World Health Organization essential cancer medicines in Kenya, Rwanda, & Uganda D. Kizub1, S. Naik2, A.A. Abogan3, D. Pain4, S. Sammut5, L.N. Shulman4, Y.M. Martei4 1 UT MD Anderson Cancer Center, Cancer Med - Fellowship Prog, Houston, United States, 2Harvard Medical School, Boston, United States, 3Clinton Health Access Initiative, Boston, United States, 4University of Pennsylvania, Philadelphia, United States, 5University of Pennsylvania, Wharton School, Philadelphia, United States Background: Cancer mortality is high in sub-Saharan Africa (SSA), partly due to inadequate treatment access. Aim: We explored access to and affordability of cancer treatment regimens based on the World Health Organization (WHO) Essential Medicines List (EML) and specific health metrics. We draw examples from Kenya, Uganda, and Rwanda, focusing on regimens for the top ten cancers. Methods: Population, healthcare financing, minimum wage, and cancer incidence data were obtained from the WHO, World Bank, public sources, and GLOBOCAN, respectively. National EML (NEML) alignment with 2019 WHO EML with respect to cancer treatment was calculated as a proportion. Cancer treatment regimen pricing was calculated using price data public and proprietary sources and methods from our prior study, including the use of WHO EML indications. Affordability through universal healthcare coverage (UHC) was assessed as total cost < 3x gross national income (GNI) per capita; and to patients out-of-pocket (OOP) was assessed as 30-day treatment course cost < 1 day of minimum wage work. Results: Cervical, breast, prostate, colorectal, ovarian cancer, non-Hodgkin’s lymphoma, and leukemia were seven of the top ten cancers in all three countries. Fifty-seven (93.4%) of WHO EML cancer medicines were part of 2019 Kenya NEML compared to 70.5% and 41.1% on 2016 Uganda and 2015 Rwanda NEML, respectively (Table 1). The Kenya NEML did not include all medicines recommended for treatment of one of its ten most common cancers (leukemia), compared to four for Uganda (leukemia, lymphoma, breast cancer, prostate cancer) and five in Rwanda (leukemia, lymphoma, breast, prostate, lung cancer). Generic chemotherapies were available and affordable to governments through UHC to treat non-Hodgkin’s lymphoma, cervical, breast, prostate, colorectal, ovarian cancers, and select leukemias. All currently recommended treatments for prostate cancer, including leuprolide, bicalutamide, and abiraterone were not affordable through government UHC purchasing. Additionally, treatment regimens that included bendamustine, trastuzumab, rituximab, imatinib, dasatinib, and EGFR tyrosine kinase inhibitors, were not affordable through government purchasing in all three countries, while capecitabinebased regimens were not affordable through government purchasing in Uganda and Rwanda. (Table 1) All therapies were not affordable OOP. Conclusion: All cancer treatment regimens were not affordable paying OOP, and were not covered by government insurance, making even generic drugs out of reach for most in these countries. Newer targeted drugs were not affordable to all three governments. Both UHC of cancer drugs and improving affordability of targeted therapies to LMIC governments in SSA are key to improving treatment access and health outcomes.
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Table 1: 2019 WHO EML, cancer treatment indications, and alignment with NEMLs. (*added in 2015) Medicine
2019 WHO EML Indication
Arsenic trioxide* Asparaginase* Bendamustine* Bleomycin
Acute promyelocytic leukemia (APL) Acute lymphoblastic leukemia (ALL) Follicular lymphoma (FL), chronic lymphocytic leukemia (CLL) Testicular germ cell tumor, ovarian germ cell tumor, Hodgkin lymphoma, Kaposi’s sarcoma Early-stage colon cancer, early-stage rectal cancer, metastatic colorectal cancer, + metastatic breast cancer, ovarian germ cell tumors, osteosarcoma, retinoblastoma Osteosarcoma, retinoblastoma; local and metastatic breast cancer, cervical cancer, + ovarian cancer, local head and neck cancer CLL + Epithelial ovarian cancer, early-stage cervical cancer, head and neck cancer, + testicular germ cell tumor, ovarian germ cell tumor, non–small-cell lung cancer, osteosarcoma CLL, diffuse large B-cell lymphoma (DLBCL), early-stage and metastatic breast + cancer, gestational trophoblastic neoplasia, Hodgkin lymphoma, FL, Burkitt’s lymphoma, rhabdomyosarcoma, Ewing sarcoma, ALL, multiple myeloma Acute myelogenous leukemia (AML), APL, ALL, Burkitt’s lymphoma + Hodgkin lymphoma + Gestational trophoblastic neoplasia, rhabdomyosarcoma, Ewing sarcoma, Wilms + tumor AML, APL, ALL + Early-stage breast cancer, metastatic breast cancer, metastatic prostate cancer + Epithelial ovarian cancer, DLBCL, early-stage and metastatic breast cancer, + Hodgkin lymphoma, Kaposi’s sarcoma, FL, osteosarcoma, Ewing sarcoma, acute lymphoblastic leukemia, Wilms tumor, Burkitt’s lymphoma Epithelial ovarian cancer, testicular germ cell tumor, gestational trophoblastic + neoplasia, Hodgkin lymphoma, non–small-cell lung cancer, ovarian germ cell tumor, retinoblastoma, Ewing sarcoma, ALL, Burkitt’s lymphoma CLL, AML 0 Early-stage breast cancer, early-stage and metastatic colon cancer, early-stage + rectal cancer Epithelial ovarian cancer,non–small-cell lung cancer, metastatic breast cancer + Chronic myeloid leukemia (CML) + Testicular germ cell tumor, ovarian germ cell tumor, osteosarcoma, + Rhabdomyosarcoma, Ewing sarcoma, AML Metastatic colorectal cancer + ALL, APL + Early-stage and metastatic breast cancer, gestational trophoblastic neoplasia, + osteosarcoma, ALL, APL ALL + Local and metastatic colon cancer, metastatic rectal cancer + Local and metastatic breast cancer, local and metastatic epithelial ovarian cancer, + ovarian germ cell tumours, Kaposi sarcoma, nasopharyngeal/head and neck cancer, non-small cell lung cancer, cervical cancer Hodgkin lymphoma + Testicular germ cell tumours, ovarian germ cell tumors, Hodgkin lymphoma + Retinoblastoma, Rhabdomyosarcoma, Ewing sarcoma, ALL, Nephroblastoma + (Wilms tumour), Burkitt lymphoma, Hodgkin lymphoma, DLBCL, Kaposi sarcoma Non-small cell lung cancer, metastatic breast cancer + Tumor lysis syndrome + Osteosarcoma, Burkitt’s lymphoma, early-stage colon cancer, early-stage rectal + cancer, gestational trophoblastic neoplasia Primary and secondary prophylaxis + Testicular germ cell tumor, ovarian germ cell tumor, osteosarcoma, soft tissue + sarcoma, rhabdomyosarcoma, Ewing sarcoma Early-stage breast cancer, metastatic breast cancer + Metastatic prostate cancer + Ovarian germ cell tumor, ALL, Burkitt’s lymphoma, multiple myeloma; + metastatic prostate cancer
Capecitabine* Carboplatin Chlorambucil Cisplatin*
Cyclophosphamide
Cytarabine Dacarbazine Dactinomycin Daunorubicin Docetaxel Doxorubicin
Etoposide
Fludarabine* Fluorouracil Gemcitabine* Hydroxycarbamide Ifosfamide Irinotecan* Mercaptopurine Methotrexate Thioguanine Oxaliplatin Paclitaxel
Procarbazine Vinblastine Vincristine
Vinorelbine Allopurinol Calcium folinate (Leucovorin) Filgrastim (G-CSF)* Mesna Anastrozole (class) Bicalutamide Dexamethasone
Kenya EML 2019 + + + +
2
Uganda EML 2016 0 + 0 +
Rwanda EML 2015
+
0
+
+
+ +
0 +
+
+
+ + +
0 0 0
+ + +
0 + +
+
0
0 +
0 +
+ + +
0 + +
+ + +
+ + +
+ + +
0 + +
+ + +
0 0 +
0 + +
0 + +
+ +
0 0
+ + +
+ 0 +
0 0 0 +
Diethylstilbesterol Metastatic prostate cancer Hydrocortisone ALL Methylprednisolone ALL Leuprolide (class, includes Metastatic prostate cancer; early-stage and metastatic breast cancer goserelin) Tamoxifen Local and metastatic breast cancer Prednisolone ALL, Burkitt lymphoma, Hodgkin lymphoma, DLBCL Imatinib CML, GI stromal tumor Trastuzumab Early-stage and metastatic HER2+ breast cancer Rituximab Imatinib-resistant CML Cancer Medicines Added in 2017 Bortezomib Multiple myeloma Zoledronic acid Multiple myeloma Nilotinib CML Dasatinib Imatinib-resistant CML Cancer Medicines Added in 2019 Melphalan Multiple myeloma Lenalidomide Multiple myeloma Thalidomide Multiple myeloma Pegasparaginase ALL Realgar-Indigo naturalis APL Abiraterone/prednisone Metastatic prostate cancer Erlotinib or gefitinib Non–small-cell lung cancer Nivolumab or pembrolizumab Metastatic melanoma TOTAL
3
+ + + +
+ + + +
0 + 0 0
+ + + + +
+ + 0 0 +
+ + + + +
+ + + 0
0 0 0 0
0 + 0 0
+ + + 0 0 + + + 57/61
0 0 + 0 0 0 0 0 43/61
+ 0 0 0 0 0 0 0 25/61
Table 2: Estimated treatment regimen costs and affordability.
Have you got a Conflict of Interest?: No
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493 B3GNT3 glycosylates multiple selectin-binding glycans and promotes lymphatic metastasis in thyroid cancer X. Liu1,2, Z. Zhao1,2, C. Cui1,2, X. Wang3,2, B. Zhu3,2, R. Liu3,2, T. Shi3,2, R. Dong3,2, H. Sun1,2 1 Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China, 2Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China, 3China-Japan Union Hospital of Jilin University, Changchun, China Background: Lymphatic metastasis is the leading cause responsible for recurrence and progression in thyroid cancer. The role of glycosylation-associated gene seizes more momentum in lymphatic metastasis of thyroid cancer. Therefore, it is of great necessity to explore the clinical significance and biological role of specific glycosylation-associated gene in lymphatic metastasis of thyroid cancer. Aim: This study aims to investigate the clinical significance and functional role of glycoprotein, β-1,3-Nacetylglucosaminyltransferase 3 (B3GNT3), in lymphatic metastasis of thyroid cancer. Methods:B3GNT3 expression was analyzed in RNA sequencing dataset of thyroid cancer from TCGA, and further verified in our clinical samples through a series of techniques, including immunohistochemical staining, Western blot and enzyme-linked immunosorbent assay (ELISA) . The biological roles of B3GNT3 in lymphatic metastasis of thyroid cancer were investigated by functional assays in vitro, including invasion and migration assays, cell Counting Kit-8 analysis, colony formation assay, Tube formation of human umbilical vein endothelial cells and adherence assay, and animal experimentsin vivo. Mass spectrum, immunoprecipitation and Western blot were performed to identify the potential binding glycans. Results:B3GNT3 was specifically upregulated in thyroid cancer tissues with lymphatic metastasis. Functional experiments in vitro showed that B3GNT3 promoted mesh formation and migration of HUVECs and invasion and migration of thyroid cancer cells, but did not influence proliferation or growth of tumor cells. Importantly and consistently, B3GNT3 promoted lymphatic metastasis of thyroid cancer cellsin vivo by inducing the lymphangiogenic formation and enhancing invasive capability of thyroid cancer cells, and the tumorigenesis of thyroid cancer cells were not affected by B3GNT3 either. Mechanistic dissection further revealed that B3GNT3 increased the glycosylation levels of multiple types of Lewis X (sLeX) glycans, including CD15s, CD44v6 and PSGL1 to enhance the adhenrence of thyroid cancer cells to HUVECs and promote lymphangiogenesis and lymphatic metastasis of thyroid cancer. Finally, the positive clinical correlations of B3GNT3 expression with CD15s, CD44v6 and PSGL-1 expression levels were demonstrated in clinical thyroid cancer sample tissues. Conclusion: Our results for the first time, to the best of our knowledge, unravel a novel dual mechanisms by which B3GNT3 promoted lymphatic metastasis of thyroid cancer, which will facilitate early detection and diagnosis, as well as the development of anti-lymph node metastatic therapeutic strategy in thyroid cancer. Have you got a Conflict of Interest?: No
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501 Using technology to Spread the word J. GOVIL1 1 CHAIRMAN, DELHI BRANCH, INDIAN CANCER SOCIETY, NEW DELHI, India Background and context: Indian Cancer Society, Delhi has made Cancer Awareness a cornerstone of policy. We progressed from physical activity to use of technology. An e-curriculum for a Course on Cancer Fundamentals was created. Seeking the widest coverage, the Course is offered free of cost on the Government of India’s self-learning platform SWAYAM. Its release coincided with the COVID lockdown, and over 8000 applied from across the country. Eminent Oncologists contributed time to film video messages explaining cancer minutiae. Responding to the demand, a Hindi version e-Chaitanyawas created, followed by another in Punjabi. We hope to upload others in more regional languages, in replicable models. Our partnership with Delhi University Digital Learning Centre has been a motivating factor in our strategy. This year, we are working with them on a Faculty Development Program under the New Education Policy. Faculty of all Indian Universities can apply for a concentrated 5-day Course on Cancer Control. Our message: Cancer is the only NCD that holds promise of Cure when Detected early. Since the NEP demands student enrollment under guidance, this has the potential of being a game changer. A mobile app upgrade, also available free to users which will serve as an interactive Knowledge Hub. This will cover 3 major cancers – Breast, Uterine Cervix & oral Cavity in an interactive app, which is an upgrade on Version 1. We rely on the Medical fraternity to deliver reliable information in 5 regional languages. Aim: Using technology to bring cancer awareness and encourage advocates within the community. Strategy / Tactics: Webinars & on-line Workshops as well as Community education Opportunities are offered once a month. We are delighted to have eminent Oncologists readily participate to speak on many aspects of Cancer as a Lifestyle Disease.Social Media sites act as voice multipliers, and carry snippets of thought-provoking messages far & wide. Radio Talks, Mobile Apps and e-Learning are one stop resource for cancer information. Programme / Policy process: Cancer awareness as a policy process – Jagriti. So that the conquest of cancer by choice; not by chance. Outcomes: Bringing about Health Literacy to the general public. What was learnt: (if relevant, please also detail here the potential of replicability) Radio talks and Mobile Apps have generated interest and our helpline is inundated with calls for screening. The SWAYAM Course has been taken by college students, young Doctors, particularly in small towns. Since it access in Hindi, Health workers in the heartland are referring to it. Inputs of well-known Doctors make this a trusted source.The simple language used is an asset. Doctors have told us of their delight in additional information in the Course material. To conclude the Pandemic taught us new ways of spreading the word that is effective in expanding reach & cutting cost. It has taught us that technology used wisely can be a valuable tool. Have you got a Conflict of Interest?: No
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504 The prognostic value of IPI in patients with primary breast lymphoma, a multicenter retrospective study K. Feng1, S. Zhao2, Q. Shang1, G. Qiao3, J. Liu1, C. Yang1, Y. Wei4, Y. Li3, F. Ren1, L. Xuan1, X. Wang1, X. Wang1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2Beijing Tuberculosis and Thoracic Tumor Research Institute/Beijing Chest Hospital,, Beijing, China, 3Yantai Yuhuangding Hospital, Yan Tai, China, 4An Yang tumor hospital, Anyang, China
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Background: The prognostic value of International Prognostic Index (IPI) of primary breast lymphoma (PBL) remain controversial. Aim: The present study aimed to evaluate the prognostic value of IPI in patients with PBL in a Chinese population.Methods:We searched the published cohort studies regarding PBL and summarized 25 studies on the prognostic value of IPI in PBL. Then a multicenter retrospective study of 71 patients with PBL was performed. The Kaplan–Meier method and log-rank tests were used for the survival analysis. Cox regression analysis was performed to evaluate the prognostic factors. Subgroup analysis was performed to assess the prognostic significance of IPI scores. Results: The median follow-up was 4.7 years (range, 0.7–21.8 years). The 5-year progression-free-survival (PFS) and overall survival (OS) rates were 90.2% and 96.3%. In the multivariate analysis, only IPI scores and radiotherapy were significantly associated with OS and PFS (P < 0.05). Subgroup analyses showed survival analysis of IPI scores for the PFS and OS of patients using rituximab were not significantly different (P > 0.05). Conclusion: Our study confirms the prognostic value of IPI in patients with PBL, but the prognostic value of IPI proved to be relatively low with the addition of the rituximab. Have you got a Conflict of Interest?: No
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513 Legal Framework for Equitable Cancer Care in South Africa S. Meyer1 1 Cancer Alliance, Access to Medicine, Cape Town, South Africa The South African healthcare system arguably is one of the most inequitable health systems in the world with 84% of the population wholly dependent on public health services. Recent research confirms this position for cancer health care. Dedicated cervical and breast cancer policies have been approved. However, only the cervical cancer policy largely focused on secondary screening, has been integrated in Primary Health Care. There is no National Cancer Control Plan. The Strategic Framework and policies will not alleviate the current cancer care gaps as Provincial Health Departments are not instructed to prioritise implementation of cancer policies in health budgets. In accordance with the Constitution, Health Services is a delegated function. This implies that the implementation of policies is dependent on the financial capacity of the specific province to implement a specific policy. Section 27 recognise health as a human right. Under the proposed National Health Insurance (NHI), the health system has committed to address issues of equity, quality, efficiency, and affordability, which provides an anchor for the proposed Cancer ACT. There is however no clarity how cancer will be managed within the NHI. There is a need for a legal framework that delegates clear responsibilities, accountability against milestoned goals and reporting, providing a mechanism that will enforce equitable access to cancer care between levels of care, between the public and private sectors across the cancer continuum of care, with suitable patient protections. If we want to achieve equitable cancer care that is focused on population-based care, South Africa should examine what it would take to establish a legal framework that can focus on integrated cancer care – in line with the WHA 70/12 Resolution – recognising that there will always be budgetary constraints. Six countries have enacted dedicated Cancer Acts: United Kingdom, United States, Japan and most recently three LMIC countries followed, namely Kenya, Philippines and Chile. Against these international benchmarks, the existing South African legal health system will be analysed to determine whether a dedicated national Cancer Act in South Africa will provide the necessary long term national goal setting and accountability framework to link with other legal and human rights mechanisms, to ensure equitable population-based cancer care services and appropriate patient protection. A desktop review using a human rights lens will inform recommendations for a policy development process towards enhanced cancer care legislation. In-depth individual interviews will further explore the possible added value of dedicated cancer legislation in South Africa from legal/judicial, health service delivery and health care user perspectives. Sharing our in depth research of how legal frameworks can impact cancer care in LMIC countries can be used as a baseline for other countries that face similar problems for replication. Have you got a Conflict of Interest?: No
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515 South Africa's Cost of Cancer: Estimated burden and projected costs of cancer by 2030 S. Meyer1 1 Cancer Alliance, Access to Medicine, Cape Town, South Africa The South African healthcare system arguably is one of the most inequitable health systems in the world with 84% of the population wholly dependent on public health services. Cancer Alliance an Alliance of 30 non-profit cancer organisation commissioned the Technical report “Estimating and Projecting the Burden of Cancer” in 2019. This was before COVID. In 2021 a focussed advocacy report “Cost of Cancer” was released. The Technical Report analyse the associated cost of cancer for which cancer policies are in place or in process (cervical, breast, prostate, lung cancers. Haematological cancers were included with associated HIV link. With this in mind the Advocacy report focussed on cancer care across the continuum of care to highlight the current and ongoing inequities in access to quality cancer care. The inequitable distribution of resources between public and private health sectors extends to other categories of health workers and within the private sector, patients receive different standards of care depending on the specific medical insurance package they can afford and many are subjected to crippling co-payments to complete their treatment. Within the public sector, urban-rural and interprovincial disparities continue to disadvantage marginalised communities particularly in accessing specialised cancer care. The report focus on specific actions required to achieve equitable cancer care. A compelling call is made for the integration of cancer symptom recognition, survivorship and palliative care into the training of community health workers. It frames the need for standardised, quality cancer care within the constitutional right to health, highlighting that inequitable access means a violation of that right. The report does not provide recommendations, however call for a coming together of government and civil society partners, and health workers in public and private sectors, all centred on the patient voice, to create a road map for achieving quality, standardised and equitable access to cancer care for all. A road map that goes beyond a policy framework and includes a detailed plan for funding, human resources, health system strengthening, and education across the continuum of cancer care is required. Cancer Alliance embarked on a series Solution Labs focussed discussions with small groups of key informants and stakeholders on various topics to garner specific solutions. The central theme associated with these discussions isReThinkReDesign-ReEngineer.These solutions are presented to the National Department of Health to consider for implementation. Nine Themes have been selected as specific focus areas. The outcomes of all the solutions labs associated with the nine themes will be summarised and presented. In line with the UICC #CloserTheCareGap and the WHO call for #leavenoonebehind this research and the models used for projection and estimates offers LMIC countries with a model that is potentially replicable. Have you got a Conflict of Interest?: No
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517 Development of an immune-related prognostic biomarker for Triple-negative breast cancer y. zhang1, Q. Wang2, W.-K. Yang3, Y.-S. Wang4, X.-X. Wei1, T. Liang1, W.-T. Fan4, L. Liang5, Y.-N. XU6 1 The First Affiliated Hospital of Guangdong University of Pharmacy, Department of Pathology, guangzhou, China, 2Shenzhen University, College of Life Sciences and Oceanography, Shenzhen, China, 3Maternity & Child Healthcare Hospital ofLonghua District, Department of Prevention and Health Care, shenzhen, China, 4Guangzhou Huayin Medical Laboratory Center.Ltd, guangzhou, China, 5Nanfang Hospital and Basic Medical College, Southern Medical University, Department of Pathology, guangzhou, China, 6Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Department of Anesthesiology, wuhan, China Background:Triple-negative breast cancer (TNBC) is characterized by a shorter survival time and higher mortality rates compared to other breast cancer sub-types. Increasing evidence indicates that tumor micro environment (TME) is tightly associated with the immunological surveillance and defense during the development of breast cancer. Although oncology studies employing digital dissection methodologies have provided some insight on the biological features of TME, results of these technologies rarely have therapeutic impact. Aim:The aim of this study was to investigate immune characteristics in TNBC to identify novel prognostic biomarkers. Methods:In this study, we extracted whole transcriptome from 30 TNBC patients and then used bioinformatics approaches to characterize cell type content in tumor tissue compared with para-cancerous tissue. We identified 4 types of up regulated immune cells and 4 types of down regulated immune cells in the tumor tissue samples. After comprehensive bioinformatics analyses, we developed an‘immune infiltration score’ (IIS) to quantitatively model immune cell infiltration in TNBC. Then we used 132 TNBC patients from the Cancer Genome Atlas program (TCGA) to validate the IIS in evaluating the micro environment of TNBC. Results showed that IIS score can clearly separate cancer and para-cancerous tissue in the TNBC-TCGA cohort with the same cutoff value 0, and those patients with a higher IIS had significantly higher PD-L1 expression and shorter progression-free survival time than those with a lower IIS value, indicating IIS score can be generalized to other TNBC datasets. Conclusion:In sum, we explored the immune infiltration landscape in 30 TNBC patients and provided a novel and reliable biomarker to evaluate the progression-free survival and prognosis of the TNBC patients. IIS can also be used to guide the treatment of TNBC patients and even throw light on the mechanism of the immunotherapy effect differences among different TNBC patients, which need expand sample size and further clinical validation in the future.
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Table 1 Details of the clinic pathological information of TNBC patient population Age, years Mean(SD) Median[IQR] Tuomr size, cm Mean(SD) Median[IQR] Metastasis 0 1 Pathological type Invasive ductal carcinoma
All patients (n=30) Grade II (n=13)
Grade III (n=17)
p
49.20 (9.96) 48.00 [40.50, 57.00]
53.23 (9.18) 56.00 [47.00, 57.00]
46.12 (9.66) 45.00 [40.00, 52.00]
0.051
2.79 (1.46) 2.50 [1.75, 3.10]
2.74 (1.99) 1.70 [1.70, 3.10]
2.84 (0.96) 2.60 [2.20, 3.10]
0.861
21 (70.0) 9 (30.0)
8 (61.5) 5 (38.5)
13 (76.5) 4 (23.5)
0.630
30(100)
13(100)
17(100)
1
Table 2 clinicopathological baseline data Case
Age
Tumor size(cm)
No. of lymph nodes with metastatic cancer 9 1 1 0 0 17 0 0 14 0 1 0 0 3 0 2 0 4 8 1 0 0 17 10 0 0 1 0
Regional lymph nodes metastasis
T N operataion ways stage stage
2.0*1.0*1.0 2.2*1.0*1.5 1.0*3.0*1.2 2.5*2.5*2.0 1.3*1.7*1.0 3.7*2.7*2.3 2.0*1.3*1.0 4.8*2.1*1.0 3.6*1.3*1.5 2.9*1.5*1.8 3.1*1.2*1.0 3.0*2.5*1.5 2.5*1.8*2.0 2.8*1.9*1.0 2.0*1.9*1.0 2.2*1.8*1.0 2.0*1.2*1.1 2.6*2.4*1.0 1.7*1.2*1.3 2.3*1.7*1.2 1.7*1.0*1.0 1.9*1.1*1.0 5.5*5.0*1.2 8.0*6.0*2.0 2.5*2.5*2.0 1.5*1.2*1.3 2.0*2.0*1.1 2.0*1.2*1.3
Histology No. of Grading collected limph nodes II 10 II 12 Ⅲ 12 III 2 Ⅱ 16 Ⅱ 24 Ⅲ 15 III 17 Ⅲ 37 Ⅲ 15 Ⅱ 16 III 28 Ⅲ 24 Ⅲ 10 Ⅲ 11 Ⅲ 9 Ⅲ 27 Ⅲ 13 Ⅱ 24 Ⅲ 15 Ⅱ 24 Ⅲ 15 Ⅱ 20 Ⅱ-Ⅲ 31 Ⅲ 4 Ⅲ 21 II 9 II 6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
67 70 53 42 49 65 46 37 36 40 66 64 46 60 59 37 47 49 57 42 40 40 37 56 43 30 66 52
yes yes yes no no yes no no yes no yes no no yes no yes no yes yes yes no no yes yes no no yes no
T2 T2 T2 T2 T1 T2 T2 T2 T2 T2 T2 T2 T2 T2 T1 T2 T1 T2 T1 T2 T1 T1 T3 T3 T2 T1 T2 T2
N2 N1 N1 N0 N0 N3 N0 N0 N3 N0 N1 N0 N0 N1 N0 N1 N0 N2 N2 N1 N0 N0 N3 N3 N0 N0 N1 N0
29 30
72 57
7.5*2.0*2.0 0.7*0.9*0.8
Ⅲ II
0 9
no yes
T3 T1
N0 N2
4 21
NA stands for not applicable.
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radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy radical mastectomy Breast-conserving tumor resection radicalmastectomy radicalmastectomy
Table 3. Quantitating Immune cell component in xCell and Cibersort Cell Type CD8+ Tcm Th1 cells aDC Macrophages cDC Neutrophils CD4+ Tcm Mast cells
xCell Cibersort up-regulation up-regulation up-regulation unavailable up-regulation Not Significant up-regulation up-regulation down-regulation Same trend down-regulation Same trend down-regulation unavailable down-regulation down-regulation
3
Have you got a Conflict of Interest?: No
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520 Africa Cancer Research and Control ECHO Content Analysis N. Lasebikan1, M.K. Cira2, E. Elibe2, R. Erickson2, T. Estes2, T. Fadelu3, A. Frank2, P. Ibeka4, C. Mugo-Sitati5, A. Zakieh2, A. Nakaganda6 1 University of Nigeria Teaching Hospital, Enugu, Nigeria, 2US National Cancer Institute, Rockville, United States, 3Dana-Farber Cancer Institute, Boston, United States, 4Clinton Health Access Initiative, Abuja, Nigeria, 5Kenya Network of Cancer Organizations, Nairobi, Kenya, 6Uganda Cancer Institute, Kampala, Uganda Background: The Africa Cancer Research and Control ECHO® (Africa Cancer ECHO) is a virtual platform for multidirectional learning about evidence-based strategies for implementation of National Cancer Control Plans in the Africa region. The Africa Cancer ECHO convenes bi-weekly sessions under the leadership of a volunteer-led Steering Committee of regional cancer control experts. Aim: This study aims to provide a baseline content analysis of the 2020-2021 Africa Cancer ECHO sessions by documenting the challenges and solutions to implementing locally relevant cancer control strategies as shared by presenters and participants, and the ways by which participants communicate experiences. Methods: The 2020-2021 Africa Cancer ECHO series was recorded and each of the 19 sessions was transcribed. The team of five coders will conduct a qualitative analysis of the transcribed text using Dedoose ® qualitative analysis software. The ECHO session content was initially coded using two guiding frameworks: 1) Text wascoded based on communicated strengths, weakness, opportunities, and threats (SWOT) associated with implementing cancer control strategies across the cancer continuum. 2) Text was coded by domains of the Core Elements of National Cancer Control Plans Checklist: Prevention; Diagnosis, staging, and screening; Treatment; Palliative care and survivorship; Service delivery; Governance; Health workforce; Health information systems; Research; and, Finance. An additional level layer of descriptive coding was done to classify the characteristics of participant presenters (i.e., occupation), and settings in which observations are made (i.e., geographical context, institutional context). The next phase of sub-coding will highlight cross-cutting themes that emerge across the Core Elements. Results: A total of 1,546 excerpts were coded across the 19 sessions. The top coded core element was Service Delivery (802) followed by Diagnosis, Staging and Screening (346). The highest code co-occurrence was Opportunity in Service Delivery (96 excerpts). The coded text will be analyzed with the 2020-2021 Africa Cancer ECHO Steering Committee to identify context specific and cross-cutting themes in barriers and facilitators to cancer control implementation. The analysis will also highlight ways in which knowledge is exchanged and utilized via the virtual ECHO platform. Conclusion: The study aims to demonstrate that qualitative content analysis can be used to further understand the value of a virtual knowledge exchange network for cancer control implementation. Have you got a Conflict of Interest?: No
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521 Cancer Patient Barriers to Accessing Radiotherapy Services through the Brazilian Unified Health System L. Tramujas Vasconcellos Neumann1, A.C. Arena Siqueira1, M.H. Kruse1, A. Marques dos Santos1, L. Holtz de Camargo Barros1 1 Instituto Oncoguia, São Paulo, Brazil Background: In 2020, there were an estimated 592,212 new cases of cancer in Brazil (GLOBOCAN, 2020). Radiotherapy is an important treatment for many of these cancers. About 80% of the Brazilian population access health services through the publicly funded Unified Health System (SUS) and 80% of cancer patients receive radiotherapy through SUS (Viani et al., 2022). The Law of Sixty Days (12.732/12) was enacted in 2013 and establishes that cancer patients treated through SUS must initiate treatment within 60 days of confirmed diagnosis. Aim: The objective of the study was to investigate the extent of cancer patients’ knowledge about radiotherapy and identify the main challenges in access to treatment. Methods: From April to June 2021, a cross-sectional study using an online survey was distributed to the institutional and social networks of Oncoguia, a cancer patient advocacy organization in Brazil. Analysis was conducted to assess barriers to access faced by patients based on the health system used (public, private, or direct-payment). Results: Analysis included only respondents who exclusively used SUS for their cancer treatment (N=327). A majority (70%) of respondents were female, active (37%) or former (57%) cancer patients, and lived in the southeast (47%) or south (13%) of Brazil. Most respondents self-identified as white (51%) or black (25%). The average age was 46. A majority (58%) had breast cancer, followed by cervical cancer (15%). About half (48%) had finished treatment and 39% were undergoing treatment at the time of the survey. Almost one in three (29%) had metastatic cancer. More than one in four (28%) of all respondents began their radiotherapy more than 60 days after the treatment was prescribed by their doctor. According to those delayed more than 60 days, the three main reasons for delay were system-related: 51% reported waiting lists where they lived; 23% stated the radiation machine was broken; and 8% noted radiotherapy services were not available. Experienced delays over 60 days were more likely when radiotherapy (29%) was the first treatment or a combination of chemotherapy and radiotherapy (44%) was the first treatment. Conclusion: Our results demonstrate an inadequate application of and adherence to the Brazilian Law of Sixty Days, which was created to guarantee patients who rely on SUS to receive timely access to cancer treatment. The experienced delays were largely due to systemic barriers within SUS related to insufficient resources. These barriers can directly impact the morbidity and mortality of cancer patients and must be addressed. Have you got a Conflict of Interest?: No
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522 Law of Sixty Days for Timely Cancer Treatment Initiation: A Brazilian Case Study M. Kruse1, L. Holtz de Camargo Barros1, T. Farina Matos1, T. Turbay2, M. Caleffi2 1 Instituto Oncoguia, São Paulo, Brazil, 2Federação Brasileira de Instituições Filantrópicas de Apoio à Saúde da Mama, Porto Alegre, Brazil Background: Over 75% of Brazilians rely exclusively on free, universal healthcare provided by the Unified Health System (SUS).1 However, the need for services often exceeds the resources available, resulting in delayed care and poorer outcomes. Brazil’s Law of Sixty Days was developed to help SUS patients receive timely cancer treatment. Aim: From 2009-2011, nearly half of all new cancer cases in SUS began treatment 61+ days after diagnosis.2 Patients were unaware of their increased morbidity and mortality risks from delayed care. New policies were needed to facilitate faster treatment initiation. Strategy: In 2012, over 75 patient organizations participated in public congressional hearings and advocated Members of Congress to address the delays occurring within SUS. Policy Progress: The Law of Sixty Days (12.732/12) states that SUS patients must begin treatment within a maximum of 60 days from the signature date in the pathology report diagnosing the cancer. The Law's regulatory document (MS.GM Ordinance No. 876/13) initially determined the 60-day timeline began on the date of diagnosis in the patient record, not the pathology report. This created delays due to scheduling patient appointments. Through additional advocacy, the document was amended to its current intended form. To collect real-time implementation data, the Cancer Information System (SISCAN) was created. Today, the National Cancer Institute uses SISCAN to monitor the 60-day timeline as a health system performance indicator. Outcomes: The Law of Sixty Days was enacted in 2013. In 2019, 37.6% of all new cancer cases in SUS began treatment 61+ days after diagnosis.3 Additional laws were passed, including the Law of Compulsory Notification (13.685/18) that requires registration of all cancers diagnosed in SUS and private facilities and the Law of Thirty Days (13.896/19) that obligates SUS patients’ diagnostic tests for suspicious malignancy must be completed within a maximum of 30 days. Lessons: Monitoring by patient organizations was critical to ensuring the Law of Sixty Days was executed as intended. The Law by itself was not sufficient; subsequent laws were needed for a more comprehensive policy that considered the myriad of factors contributing to delays in SUS. Systemic challenges within SUS still exist, but with the Law of Sixty Days, the Ministry of Health and patient organizations can monitor adherence and raise concern when needed. In addition, patients now have a legal right to timely treatment, which if not met, can lead to judicial action. The lessons from Brazil can inform similar advocacy and policies to improve cancer patient health outcomes around the world. 1. WHO. Brazil's march towards universal coverage. Vol 88: Bulletin of the World Health Organization; 2010:641716. 2. FEMAMA. Implementation of the Law of 60 Days. Available: https://bit.ly/36rY1AH. Accessed 24 March 2022. 3. DATASUS. Painel-Oncologia. Available: https://bit.ly/3qb99Jd. Accessed: 8 March 2022. Have you got a Conflict of Interest?: No
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53 Hepatoblastoma in an adolescence with biliary atresia post portoenterostomy C.-Y. Lai1, S.-B. Cheng1,2, F.-L. Huang3, C.-C. Lin3 1 Taichung Veterans General Hospital, Surgery, Taichung, Taiwan, 2Chung Shan Medical University, Nutrition, Taichung, Taiwan, 3Taichung Veterans General Hospital, Pediatrics, Taichung, Taiwan Background and context:Both biliary atresia(BA) and hepatoblastoma(HB) are of low incidence and the combination is even rare. Reviewing the literature, there were only two toddler cases. We reported an adolescence with BA and hepatoblastoma and her treatment course.A 15 year-old girl, born at 37 weeks of gestation as twin A with a birth weight of 2100gm had underwent portoenterostomy(Kasai procedure) for biliary atresia at the age of 7 weeks. She had been relatively well until RUQ abdominal dull pain persisted for about 3 months before she sought for medical attention. Sonography initially showed an heterogenous mass in right liver while an elevated α-fetoprotein level(AFP) was found(319477 ng/ml, Normal ≦12 ng/ml). Further CT scan revealed a 9.5 cm heterogenous enhanced tumor, occupying between segment IV-V-VIII of the liver. Staging image with chest CT and whole body bone scan showed no evidence of distant metastasis. Diagnostic true cut biopsy reported hepatoblastoma of fetal type. The patient was treated with 5 courses of cisplatin and epirubicin chemotherapy and 3 sessions of trans-arterial chemo-embolization(TACE). After 6-moth therapy, the tumor size reduced to about 5cm while AFP level decreased to 970.3 ng/ml. She underwent partial hepatectomy of segment IV-V-VII and 4 weeks after postoperative recovery, she continued on the chemotherapy with the same regimen. The patient’s AFP level kept decreasing into normal limit(4.85ng/ml) while CT scan disclosed stable condition. Strategy / Tactics: Combined systemic chemotherapy and loco-regional TACE, then surgery Outcomes: Remain disease-free What was learnt: (if relevant, please also detail here the potential of replicability) Hepatoblastoma would still occur in adolescence, yet rare. The combination of systemic and loco-regional chemotherapy seemed feasible for tumor control.
Figure 1. Well-capsulated tumor with yellow-tan nodule pattern and focal post-treatment necrosis in the center
Figure 2 Microscopic examination show high nuclear/cytoplasmic ratio, pleomorphic clear cell pattern Have you got a Conflict of Interest?: No
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538 PREVENTIVE HEALTH PRACTICES RELATING TO BREAST CANCER AMONG CHRISTIAN RELIGIOUS LEADERS IN AKURE, ONDO STATE B. Anyanwu-Akeredolu1, I. Awoyelu1 1 Breast Cancer Association of Nigeria, Ibadan, Nigeria Background: Breast cancer is the leading cause of cancer deaths in Nigerian women. Although there is increasing awareness of the disease and campaign to access treatment and care from the hospitals. However, public perception remains strong that Christian religious leaders have spiritual powers to cure diseases including breast cancer. Christian religious leaders are more often than not the first port of call when breast cancer occurs and invariably become potential resources for breast cancer prevention and control. Aim: To assess the knowledge, perception of breast cancer and preventive health practices relating to breast cancer among Christian religious leaders in Akure, Ondo State, Nigeria. Methods: This is a descriptive, cross-sectional study where data on knowledge, perception and preventive practices relating to breast cancer were collected from 418 Christian religious leaders in Akure using semistructured interviewer administered questionnaire. A stratified sampling technique was used where Christian religious leaders in Akure were stratified by blocks in accordance with Christian Association of Nigeria (CAN) categorisation. A scoring system was developed to provide a grade score to assess the knowledge (16 points), perception (11 points) and preventive practices (6 points). Knowledge score was categorised into; good (>74%), satisfactory (50% - 74%) and poor (<50%), while perception score was categorised as either poor (0 – 6) or good (>6). Preventive health practices was categorised as poor (≤3) or good (>3). Data were analysed using descriptive statistic and bivariate logistic regression at 5% level of significance. Results: The majority of the respondents were married (87.4%), Yoruba (87.9%), male (66.6%) and between the ages of 41 – 60 years (55.8%). Many (51.2%) of Christian religious leaders in Akure had good knowledge of breast cancer, most (93%) had positive perception of breast cancer. The result further showed that one in every three (33.0%) Christian religious leaders had poor pastoral preventive health practices relating to breast cancer. 76.2% of churches had organised general health awareness programmes for members prior to the study. However, only 35.7% of the churches had organised breast cancer awareness programme for members. Knowledge and perception of breast cancer were both associated with breast cancer preventive health practices among Christian religious leaders. Good and moderate knowledge were found to increase the likelihood of good breast cancer preventive health practices among Christian religious leaders by 1500% and 200% respectively. Conclusion: Christian religious leaders in Akure had a considerable good knowledge of breast cancer and showed some good preventive health practices. There was, however, poor knowledge of breast cancer risk factors. Most of the Christian religious leaders had never carried out proactive measures to support breast cancer patient. Nevertheless, they were willing to learn more about breast cancer and promote breast cancer awareness among church members. Have you got a Conflict of Interest?: No
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541 Barriers and Challenges in providing standard breast cancer care in low resource settings S.K. Yadav1, D. Sharma1, D.B. Sharma1, C.K Jha2, S. Shekhar3 1 NSCB Medical College, Surgery, Jabalpur, India, 2AIIMS, Surgery, Patna, India, 3AIIMS, Biostatistics, Patna, India Background: Breast cancer survival represents the triumph of scientific advancement; however, this improved survival is not seen uniformly across the globe as many centers still struggle to provide standard basic care to breast cancer patients. Aim: We investigated the barriers to the delivery of standard breast cancer care in low resource settings (LRS) as compared to standard resource settings (SRS). Methods: An online survey via Google forms was distributed to surgeons who manage breast cancer. Their practice setting was defined as SRS if they had all six essential investigative and therapeutic modalities currently recommended by the international guidelines for the management of breast cancer; and LRS if they lacked any of the six modalities. These included X Ray Mammography (MMG), Core needle biopsy (CNB) facility, Immunohistochemistry (IHC) facility, Sentinel lymph node biopsy (SLNB) facility using radiocolloid, facility of Frozen section biopsy (FSB) and Facility of radiotherapy (RT). Results: One hundred ninety-nine surgeons from eleven countries completed the survey- 51 practiced in SRS and 148 in LRS based on our definition. Two most common facilities lacking in LRS were SLNB and IHC (67% and 60%). SRS surgeons offered SLNB to all eligible patients; but only 25% from LRS could offer it; its barriers included non-availability of radio-colloid (40%), FSB (38%) and training (22%). Similarly, SRS surgeons offered Breast Conservation Surgery (BCS) to all eligible patients; but only 42% from LRS offered it; its barriers included unreliable follow up (64%), lack of FSB (51%), lack of radiotherapy facility (48%) and lack of training (25%). Only 22% respondents from LRS said all of their eligible patients received hormonal therapy and only 8% said all eligible patients received radiotherapy as compared to 98% and 75% from SRS. Conclusion: There are widespread limitations in LRS, making it difficult to follow standard breast cancer guidelines resulting in suboptimal cancer care. Improving resources at these centers will go a long way in improving breast cancer survival. Have you got a Conflict of Interest?: No
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542 The prognostic role of γδ T cells in colorectal cancer R. Ma1, K. Li1, M. Gong1 1 The First Affiliated Hospital of Xi’an Jiaotong University, Department of Surgical Oncology, Xi'an, China
Background: The relationship of γδ T cell infiltration with the prognosis and clinicopathological features of patients with CRC remains to be further verified. Aim: The objective of this study was to explore the prognostic role of γδ T cells in colorectal cancer. Methods: Immunohistochemistry was used to analyze the infiltration degree of γδ T cells in tumor and normal tissues of CRC. Survival analysis was used to determine the relationship between γδ T cells infiltration in tumor tissues and the prognosis of CRC patients. Results: The degree of γδ T cell infiltration between tumor tissues and normal tissues of CRC was not significantly different (t=0.35, P=0.73). However, the Chi-square test showed that γδ T cell infiltration was significantly correlated with the survival status of the patients (x2=4.88, P=0.03). Besides, the degree of γδ T cell infiltration in tumor tissue was significantly correlated with the prognostic improvement of the patients with CRC (LogrankP=0.02), and could predict the benefit from adjuvant chemotherapy. Conclusion: γδ T cell infiltration degree in tumor tissue was an important factor to improve the prognosis of patients with CRC, and could predict the benefit from adjuvant chemotherapy. Have you got a Conflict of Interest?: No
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546 Role and mechanism of NCAPD3 in promoting gastric cancer malignant phenotype S. Zhang1, Q. Luo1, L. Xiao1, F. Yang2, J. Zhu3, X. Chen2, S. Yang1 1 Fujian Medical University Union Hospital, Oncology Medicine, Fuzhou, China, 2Fujian Medical University Union Hospital, Respiratory Medicine, Fuzhou, China, 3the Second Hospital, Cheeloo College of Medicine, Shandong University, general surgery, Jinan, China Background:Gastric cancer (GC) is one of the major malignancies threatening human lives and health. Non-SMC condensin II complex subunit D3 (NCAPD3) plays a crucial role in the occurrence of many diseases. However, its role in GC remains unexplored. Methods:The Cancer Genome Atlas (TCGA)database, clinical samples, and cell lines were used to analyze NCAPD3expression in GC. NCAPD3wasoverexpressed andinhibited by lentiviral vectorsandtheCRISPR/Cas9 system, respectively. The biological functions ofNCAPD3were investigated in vitro and in vivo. Gene microarray, Gene set enrichment analysis (GSEA)andingenuity pathway analysis (IPA) were performed to establish the potential mechanisms. Results:NCAPD3washighly expressed in GC and was associated with a poor prognosis. NCAPD3upregulation significantly promoted the malignant biological behaviors of gastric cancer cell, while NCAPD3inhibition exerted aopposite effect. NCAPD3loss can directly inhibit CCND1 and ESR1 expression to downregulate the expression of downstream targets CDK6 and IRS1 and inhibit the proliferation of gastric cancer cells. Moreover,NCAPD3loss activates IRF7 and DDIT3 to regulate apoptosis in gastric cancer cells. Conclusion:Overall, our study revealed that NCAPD3silencing attenuates malignant phenotypes of GC and that it is a potential target for GCtreatment. Have you got a Conflict of Interest?: No
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549 Mass media influence on the risk perception of tobacco induced diseases among Indian Adults P. Ravi1, D. Dhawan2, M.A. Bekalu3, S. Donaldson4, K. Viswanath2 1 Mel & Enid Zuckerman College of Public Health, University of Arizona, Department of Health Promotion Sciences, Tucson, United States, 2Dana-Farber Cancer Institute, Boston, United States, 3Harvard T.H Chan School of Public Health, Boston, Massachusetts, USA, Social and Behavioral Sciences, Boston, United States, 4Union for International Cancer Control (UICC), Geneva, Switzerland, Switzerland Background: Exposure to mass media can bring about behavior change among adults. Mass media may influence tobacco initiation or quitting intentions based on the type of exposure, and other environmental factors. Perceived risk plays a significant role in predicting quitting tobacco. Aim: To examine the influence of mass media on risk perception of smoking and smokeless tobacco (SLT) use, and to explore the social disparities in risk perception of smoking and SLT health effects. Methods: This cross-sectional study analyzed data from India’s Global Adult Tobacco Survey India-2 (GATS), 2016–2017.The objective of our study was to determine the association between mass media exposure and risk perception of tobacco use among Indian adults. Risk perception of smoking, SLT, and secondhand smoking were the outcome variables of interest. Independent variables of interest included mass media exposure. Logistic regression analysis was conducted to determine the association of risk perception of smoking and SLT use with pro-and anti-tobacco mass media exposure with controlling for age, gender, residence, occupation, education, and wealth variables. Results: The analyses showed that exposure to anti-smoking messaging was significantly associated with risk perception of smoking (OR, 2.49; 95% CI, 2.21 – 2.80) and risk perception of secondhand smoke exposure (OR, 2.66; 95% CI, 2.40 – 2.96). Exposure to anti-SLT messaging was also significantly associated with risk perception of serious illness due to SLT use (OR, 3.37; 95% CI, 2.94 – 3.85) and risk perception of oral cancer (OR, 3.18; 95% CI, 2.79 – 3.61). Pro-smoking and pro-SLT messages were associated with lower risk perception of smoking, secondhand smoking, and SLT health effects. The risk perceptions of smoking and SLT were lower among rural communities, individuals with no formal education, those who were unemployed, and those in the highest wealth category. Conclusion: There is a significant association between anti-smoking and anti-SLT mass media messaging with risk perception of smoking and SLT use.Exposure to pro-smoking and SLT messages was associated with decreased risk perception of smoking, secondhand smoking, and SLT health effects. Our findings emphasize the need for increased awareness about the risk perception of smoking and SLT use among rural communities, those with no formal education, the unemployed, and also those with high incomes.
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Table 1. Logistic Regression for the outcome variables – Risk perception of serious illness due to smoking and secondhand smoke exposure to non-smokers Predictors
OR (95% CI) Risk perception of smoking Tobacco causes serious illness
Risk perception of secondhand smoke exposure causes serious illness in non-smokers
Residence
Urban Rural (reference)
1.201* (1.00, 1.43) 1.00
0.94 (0.816 1.09) 1.00
Age
15 and above
0.99 (0.99, 1.00)
0.99 (0.99, 0.99)
Gender
Male Female (reference)
0.93 (0.81, 1.06) 1.00
1.20* (1.04, 1.39) 1.00
Education
No Formal Schooling 0.41* (0.32, 0.51) Primary 0.59* (0.48, 0.74)
0.34* (0.26, 0.45) 0.50* (0.39, 0.64)
Secondary
0.73* (0.56, 0.95)
Occupation
Wealth Category
0.74* (0.59, 0.93)
University and above 1.00 (reference)
1.00
Unemployed
0.71* (0.58, 0.86)
0.64* (0.53, 0.79)
Retired
0.81 (0.59, 1.11)
0.91 (0.68, 1.22)
Homemaker
1.19* (1.03, 1.37)
1.07 (0.93, 1.23)
Student
1.24 (0.98, 1.56)
1.30* (1.00, 1.69)
Self-employed
1.05 (0.88, 1.26)
0.99 (0.85, 1.16)
Employed (reference) 1.00
1.00
Lowest Low
1.28* (1.06, 1.54) 1.29* (1.06, 1.56)
1.00 (0.82, 1.23) 0.94 (0.78, 1.14)
Medium
1.18 (0.96, 1.45)
0.94 (0.77, 1.14)
High
1.21* (1.00, 1.47)
0.97 (0.79, 1.19)
Highest (reference)
1.00
1.00
Exposure to Pro-smoking Messages 0.83* (0.71, 0.96)
0.88 (0.76, 1.03)
Exposure to Anti-smoking Messages 2.49* (2.21, 2.80)
2.66* (2.40, 2.96)
* p<0.05
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Table 2. Logistic Regression for the outcome variables – Risk perception of serious illness, oral cancer, and dental disease due to smokeless tobacco (SLT) use Predictors
Residence Urban Rural Age 15 and above Gender Male Female Education No Formal Schooling Primary Secondary University and above Occupation Unemployed Retired Homemaker Student Self-employed Employed Wealth Lowest Category Low Medium High Highest Exposure to Pro-tobacco Messages Exposure to Anti-tobacco Messages
OR (95% CI) Risk perception of SLT causes serious illness 1.03 (0.88, 1.21) 1.00 0.99* (0.98, 0.99) 1.15 (0.98, 1.35) 1.00 0.17* (0.12, 0.25)
Risk perception of SLT causes oral Risk perception of SLT causes dental disease cancer 0.88 (0.74, 1.50) 1.00 0.99* (0.98, 0.99) 1.36* (1.17, 1.59) 1.00 0.20* (0.13, 0.29)
1.08 (0.94, 1.24) 1.00 0.99* (0.99, 0.99) 1.55* (1.36, 1.76) 1.00 0.37* (0.29, 0.48)
0.28* (0.19, 0.40) 0.43* (0.29, 0.63) 1.00
0.31* (0.21, 0.46) 0.56* (0.39, 0.81) 1.00
0.44* (0.34, 0.56) 0.61* (0.47, 0.79) 1.00
0.67* (0.53, 0.86) 0.80 (0.52, 1.23) 1.24* (1.06, 1.46) 1.36 (0.97, 1.90) 1.02 (0.84, 1.23) 1.00 0.94 (0.73, 1.22) 1.02 (0.77, 1.34) 0.87 (0.67, 1.11) 0.97 (0.75, 1.26) 1.00 0.83 (0.66, 1.03)
0.67* (0.54, 0.83) 0.77 (0.53, 1.13) 0.98 (0.84, 1.14) 1.07 (0.76, 1.50) 0.93 (0.78, 1.11) 1.00 1.00 (0.78, 1.29) 0.95 (0.73, 1.23) 0.81 (0.64, 1.04) 0.86 (0.67, 1.11) 1.00 0.93 (0.76, 1.14)
0.70* (0.58, 0.85) 1.11 (0.83, 1.49) 1.10* (0.97, 1.26) 1.06 (0.85, 1.32) 1.02 (0.89, 1.17) 1.00 0.91 (0.76, 1.09) 0.87 (0.72, 1.05) 0.77 (0.64, 0.92) 0.87 (0.73, 1.04) 1.00 0.68 (0.57, 0.80)
3.37* (2.94, 3.85)
3.18* (2.79, 3.61)
2.47* (2.22, 2.75)
* p<0.05 Have you got a Conflict of Interest?: No
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55 Industry responses to the work of those involved in exposing the harmful practices of corporations M. Mialon1, K. Evans-Reeves2, B. Matthes3, P. Chamberlain3, A. Gilmore3, N. Paichadze4, G. Fooks5 1 Trinity Colleg Dublin, Dublin 2, Ireland, 2Bath Spa University, Bath, United Kingdom, 3The University of Bath, Bath, United Kingdom, 4The George Washington University, Washington D.C., United States, 5Aston University, Birmingham, United Kingdom Understanding and addressing harmful corporate practices is a key building block in protecting and promoting public health internationally. Corporations are however aggressive and inventive in their responses to health professionals, civil society organizations, scholars, journalists, and government officials, whose work focuses on highlighting these corporate practices. The tobacco industry, for example, monitored and spied on the activities of public health professionals, used misleading criticism of their work, and attacked their reputation and motivation. With the present project, our aims were i) to map industry responses to the work of health professionals, civil society organisations, and scholars involved in identifying, monitoring and raising awareness about the harmful practices of corporations, across the globe, ii) to identify solutions to address these responses and better protect public health professionals, and, ultimately, public health policy. Our project comprised three interrelated work packages. The first (WP1) involved a scoping review of: a) industry responses to the work of those exposing their harmful practices; b) public health community’s responses to these industry activities. The second (WP2) comprised an online survey sent to approximately 75-100 individuals who, through their profession, expose the harmful practices of corporations to generate new and up-to-date data on the form and trends in industry responses to health activities. We will focus on the perceptions and experiences of the survey participants. Thirdly, we organized an online focus group (WP3) aimed at identifying solutions to face these responses from the industry. Ethics approval was granted from the ethics committee of Trinity Business School, Trinity College Dublin, Ireland. Have you got a Conflict of Interest?: No
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550 Effects of Fasting Plasma Glucose Levels on Survival in Advanced Colorectal Cancer Patients with T2DM Q. Meng1, Y. Yu1, K. Wang1, Z. Zhang2, D. Hao3, G. Wang1 1 Harbin Medical University Cancer Hospital, Department of Gastrointestinal Medical Oncology, Harbin, China, 2Wenzhou Medical University, School of Biomedical Engineering, Wenzhou, China, 3Harbin Medical University, Department of Pathology, Harbin, China Background: Studies have shown that diabetes mellitus type 2 (T2DM) has a significant impact on the occurrence and development of colorectal cancer (CRC). However, the cut-off value of blood glucose that most affects patient survival has not been determined. Purpose: This study aims to evaluate the prognosis of patients with advanced CRC with T2DM, and trying to find the cut-off value of blood glucose that affects the survival of patients with advanced CRC. Methods: We retrospectively collected advanced CRC patients with T2DM at Harbin Medical University Cancer Hospital from January 2010 to December 2018. The median fasting plasma glucose (FPG) value of patients before each admission to the hospital was taken as their fasting blood glucose control level. Continuous relationship between FPG levels and overall survival (OS) analyzed by restricted cubic spline (RCS) function. Using X-tile software to determine the relationship between OS and FPG levels, and to determine the cut-off value of blood glucose affecting survival in patients with advanced CRC. OS was analyzed with the Kaplan-Meier's Log-rank method and compared among groups stratified by FPG. Univariate and multivariate Cox proportional hazards regression was used to analyze confounding factors such as gender and age that may affect patient OS. Results: A total of 190 patients met the inclusion criteria, with a median age of 67 years, including 134 males and 56 females. There was no association between FPG levels and overall mortality risk (P=0.714). X-tile analysis revealed that the optimal FPG cut-off value was 8.6. The median OS was 33.03 months in the FPG≤8.6 mmol/L group and 22.57 months in the FPG>8.6 mmol/L group. Compared with the FPG>8.6mmol/L group, the patients in the FPG≤8.6mmol/L group had no significant prolongation of OS (P=0.077). In univariate analysis, tumor location (right colon vs rectum, P=0.008; hazard ratio [HR]: 1.709; 95% confidence interval [CI]: 1.148-2.545) was significantly associated with OS. All factors were included in multivariate analysis, the results showed that age (<65 years old vs ≥ 65 years old, P=0.032; HR: 0.658; 95%CI: 0.449-0.965), tumor location (right colon vs rectum, P=0.003; HR: 1.892; 95%CI: 1.239-2.890), mismatch repair gene status (mismatch repair-deficient vs mismatch repair-proficient, P=0.047; HR: 3.740; 95%CI: 1.019-13.727) can be used as independent prognostic makers for advanced colorectal cancer. Conclusions: Our study shows that fasting blood glucose levels do not affect survival in advanced CRC patients with T2DM. And no cut-off values were generated that could affect patient survival.
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2
Have you got a Conflict of Interest?: No
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554 Plasma lipids and the Prognosis of Lung squamous cell carcinoma C. Hu1, Y. Fan1, L. Chen2, G. Lin2, L. Lin2, Y. Xu2, H. Lin2, J. Lan2, Z. Hu1, Y. Xu2, Y. Zeng2 1 Fujian Medical University, Epidemiology and Health Statistics, Fuzhou, China, 2The Second Affiliated Hospital of Fujian Medical University, Fuzhou, China Background: Lung squamous cell carcinoma (LSCC) is one subtypes of Non-small cell lung carcinoma (NSCLC) with a poor prognosis. The standard therapy of LSCC remains platinum-containing chemotherapy. However, platinum resistance severely affects the efficacy of chemotherapy in advanced LSCC. Lipidomics has now emerged as a new hotspot for the discovery of new biomarkers and the in-depth study of the lipid profile and pathophysiological mechanisms of LSCC. Aim: The purpose of this study was to identify biomarkers associated with LSCC prognosis using targeted lipidomic analysis, and to provide new treatment strategy for advanced LSCC. Methods: Plasma lipids were measured in 68 plasma samples (29 in the platinum-containing chemotherapy regimen group and 39 in the untreated group) by LC/MS. Univariate statistical analysis and multivariate statistical analysis were used to explore the differential lipids within two groups. Kaplan–Meier (KM) curve, multivariate Cox model, and the log-rank test were used to evaluate the effect of lipid molecules on the prognosis of LSCC. Results: Plasma lipids were measured in 68 plasma samples and a total of 242 lipids were detected: 129 glycerol esters, 80 glycerophospholipids, 19 fatty acids, 10 sphingolipids and 4 sterolipids. Our results revealed that 32 lipid characteristics displayed different between the two groups. The relationship between lipid molecules and clinical outcome was examined using the KM curve. Higher expression of TAG(48:2-FA14:0) ,TAG(50:4-FA14:0) , TAG(53:3-FA18:2) was associated with a worse overall survival of LSCC patients (P<0.05). A total of 68 patients with clinical information were included for the multivariate Cox regression analysis, including gender, age, tumor stage, smoking status, chemotherapy status, PS score, the use of antiangiogenic drugs and transition states. Based on the Cox regression models, we identified that elevated levels of TAG (48:2-FA14:0) [HR = 2.952 (1.218– 7.155),P= 0.017] was associated with a worse overall survival of LSCC patients . Conclusions: In this study, we identified that a total of 32 lipids could be affected by the platinum-based chemotherapy in the plasma of LSCC patients. In addition, TAG (48:2-FA14:0) was significantly associated with the prognosis of LSCC patients and may be regarded as a potential biomarker for LSCC.
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2
Have you got a Conflict of Interest?: No
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570 Clinical Features and Prognosis of Advanced Intra- and Extra-pulmonary Neuroendocrine Carcinomas X. Chen1, N. Guo1, P. Guo1, F. Yang1, Q. Luo1, S. Yang1, X. Chen1 1 China, Fuzhou, China Aim: We analyzed the clinical features and prognosis of advanced intra- and extra-pulmonary neuroendocrine carcinomas (NECs)in order to provide further guidance for the clinical treatment of small-cell lung cancer(SCLC), which is a type ofadvanced intrapulmonary NECs(IPNECs). Methods: The clinical data and survival of 123 patients with advanced IPNECs and extra-pulmonary NECs(EPNECs) in the Fujian Medical University Union Hospital, Fujian Province, China, between January 2013 to November 2019 were collected. We retrospectively analyzed the corresponding clinical diagnosis and treatment, and explored the relevant factors affecting the survival prognosis of patients with IPNECs and EPNECs. Results: The data of 123 patients were collected. There were 90 cases of IPNECs(including 81 cases of SCLC), 25 cases of EPNECs involving in the gastrointestinal tract, and 8 cases of EPNECs in other regions.The median overall survival (OS) of IPNECs was 13.53 months, of which the median OS of SCLC was 12.97 months, and the median OS of other IPNECs was 27.07 months. The median OS of EPNECs in the gastrointestinal tract was 9.42 months, and the OS of EPNECs in the other regions was 8.69 months. The median OS of IPNECs was significantly longer than that of the EPNECs in the gastrointestinal tract and in the other regions (P < 0.05). Multivariate analysis showed that age, liver metastasis, number of cycles of first-line chemotherapy, and chest radiotherapy were risk factors affecting OS in patients with NECs (P < 0.05). Conclusion: The survival of IPNECs was significantly longer than that of EPNECs of the gastrointestinal tract and in other regions. However, patients with advanced NECs who were older and had liver metastases had a poorer prognosis. Multi-disciplinary treatments such as multi-cycle chemotherapy and combination of chemotherapy and radiotherapy should play an important role in prolonging the survival of NECs. Have you got a Conflict of Interest?: No
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571 Coalition role in shaping policies and overcoming crisis I. Elhajje1 1 Children's Cancer Center of Lebanon, Public Relations and External Affairs, Beirut, Lebanon with the pandemic consequences and crisis the world continues to witness, the purpose of this presentation is to highlight the importance of partnerships and the role of Coalition in leveraging and developing them to ease cancer patients journey, to assist in creating and implementing policies. best practices on partnerships will be shared from the Children's Cancer Center of Lebanon (CCCL) based in a country who has in addition to C-19 suffered many crisis. Emphasizing its leading position in Lebanon, CCCL initiated the Lebanese Cancer Cooperation (LCC), between cancer and blood NGOs in Lebanon, on July 4, 2019 at a gathering organized and attended by international and national officials and 25 NGOs. the CCCL is a regional reference center pioneering in the treatment of children with cancer at no cost to their parents and without any discrimination. for 20 years the CCCL treated over 2800 and offered 6000 medical consultation free of charge with a cure rate of 80%. the LCC is to Advocate for cancer patients and cancer control in Lebanon, toEmpower NGOs & civil society through capacity building,Create better awareness,to support members and cancer patients, togrow the network of cancer ngos and patients groups support. Today, 20 NGOs joined the LCC, administered bythe CCCL: The members will create and establish an agreement committing to the cause and mission and vision of the cooperation. officially announce the cooperation, through an nationwide ceremony with media coverage, and commenced the process of formalizing the network. Programme / Policy process: the future and most urgent strategic approach to officially and effectively impact outcomes and reshaping policies is to establish an entity with clear goals and set of Outcomes: clear subcommittees with functional procedures and policies identify its role which will help and influence decisions, the cooperation work and the strategic future plans. All of which serve the aims and objectives stated above of the LCC and most importantly to ease the lives of patients living with cancer and the survivors. despite the shortages of medication, postponement of some of health awareness and other program, health services and systems distracted, prevention measures and routine tests that can early detect pre-cancer and the struggles because of wide currency fluctuations since 2019, the presentation will demonstrate the continuum of care beyond crisis by members. in addition to example of multi-stakeholders and sectorial Awareness campaigns , and the coordination efforts during the pandemic for example exchange of PPEs and C-19 vaccinations. learned toNavigate crisis, Building a culture of partnership within cancer organizations, Leveraging & developing partnerships in times of crisis. the presentation will present an Inspiring success stories, Crisis management toolkit, Framework for partnerships within organization, Proposals and partnership building and review best practices Have you got a Conflict of Interest?: No
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572 Golden Ribbon Chain by CCCL S. Kurdi1 1 Children's Cancer Center of Lebanon, Fundraising, Beirut, Lebanon Amount raised: 352,868 USD Background and context: During the COVID-19 pandemic and lockdowns a major shift in strategy was done focusing on digital campaigns. The Golden Ribbon Chain was designed and launched as an online platform where every donation of 50,000 LBP ($33.17) adds a golden ribbon to the map of Lebanon to complete a chain of 10,452 ribbon. The goal was to cover the Lebanese map with 10,452 golden ribbons (representing the area of Lebanon in sqm), hence a total of 574,860,000 LBP, covering the treatment cost of 7 patients at CCCL in 2020. We have worked on this unique online platform to give donors an interactive experience and social media engagement and show them that their support could have an impact on their nation’s children. Through the platform, anyone can see how many ribbons have been added to the map, the total amount of donations received, and thus participate by donating online through an easy and secure portal and add more ribbons to the map. Over a period of 9 months, 1,463 donors added 10,690 ribbons to the map, helping CCCL exceed the target initially set. Aim:
• • • • •
Strengthendigital campaigns that can unite Lebanese for a Common goal Spread awareness Raise funds, Engaging the mass through an easy and affordable donation campaign
Strategy / Tactics:
• • • • • • • • • • •
Launching the campaign when everyone was at home and spending a lot of time online Engaging Lebanese & the diaspora in a common goal at a time when their nation was suffering and passing through hardships Targeted broadcast emails and social media campaigns Sought the support of influencers Full-fledged media campaign Digital interactive map Using the Golden Ribbon to spread awareness about childhood cancer Easy participation online through a quick donation processing portal Providing each donor with a unique number for the ribbon(s) which they have added to the map Enabling the option of sharing the ribbon(s) and unique number(s) to social media to engage friends and family Maintaining a very low cost ratio through creating the whole platform and campaign in-house without relying on any partner
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Programme process:
• • • • •
Website design Campaign’s promotional plan, visuals and TVC Campaign launching and promotion Processing online payments Providing feedback and recognition
Costs and returns:
Cost Return 1,124 USD 352,868 USD What was learnt: (if relevant, please also detail here the potential of replicability)
• • • •
Trending digital campaigns and social media Showing donors their impact in real time motivates them to donate again Having a simple and quick donation process helps us avoid frustrated donors The campaign’s is suitable to be launched several times with the same or new common goal set
Have you got a Conflict of Interest?: No
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574 Incidence and Relative Risk of Liver Dysfunction in Patients Treated With PD-1/PD-L1 Inhibitors for NSCLC X. Chen1, S. Yang1, X. Chen1 1 China, Fuzhou, China Background: Programmed cell death protein-1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitor treatments have exhibited promising effects on advanced non-small cell lung cancer (NSCLC). However, the treatments are accompanied by unique immune-related side effects. Namely, immune-related liver dysfunction is increasingly common, and serious cases require proper management. Aim: The purpose of our research was to assess the incidence and risk of liver dysfunction in NSCLC cases treated with PD-1 or PD-L1 inhibitor treatments through a large meta-analysis of existing clinical trials. Methods: Relevant studies between January 2015 and January 2020 were retrieved from sources including PubMed, EMBASE, The Cochrane Library, and abstracts presented at ASCO meetings and ClinicalTrials.gov, and were then reviewed. The characteristics and incidence of all-grade and high-grade elevated ALT/AST were collected. Results: In reviewing the literature systematically, we identified 8 randomized controlled trials (RCTs), including 4294 patients in total. In patients who received PD-1/PD-L1 inhibitors, the incidence rates of all-grade and highgrade ALT elevations and all-grade and high-grade AST elevations were 1.40%, 0.89%, 11.62%, and 1.36%, respectively. These patients displayed a greater risk of all-grade elevated ALT and AST, which was more significant than that of the chemotherapy group (ALT: RR, 1.93; p = 0.001; AST: RR, 1.49; p = 0.007). A similar result was observed in the relative risk (RR)of high-grade elevated ALT/AST (ALT: RR, 1.97; p = 0.05; AST: RR, 2.77; p = 0.02). There was a higher RR of all-grade and high-grade AST elevations with PD-1 inhibitors compared with that of chemotherapy. (RR: 1.43, p = 0.02 vs RR:2.47, p = 0.05). Moreover, the risk of all-grade ALT and AST elevation in patients receiving second-line treatment was higher compared with those receiving first-line treatment (ALT: RR, 2.70; p = 0.001; AST: RR, 3.14; p = 0.001). Conclusion: Our meta-analysis indicated that PD-1/PD-L1 inhibitors may cause a greater risk of immune-related liver dysfunction compared with chemotherapy as a result of PD-1 rather than PD-L1 inhibitors. A comprehensive understanding of this phenomenon may aid in the early detection of NSCLC and guidelines for the interruption of treatment. Have you got a Conflict of Interest?: No
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576 Estimation of the need for radiation therapy at a Haitian cancer clinic. J.J. Bernard1, V.J. DeGennaro1 1 Innovating Health International, Oncology, Port-au-Prince, Haiti Background: According to GLOBOCAN estimations, more than 12000 cases of cancer were diagnosed in Haiti in 2020. Radiation therapy is not available in Haiti, and therefore most of the patients with cancer receive suboptimal treatment. The absence of national data due to a non-functional cancer registry makes any evaluation on cancer care in Haiti a challenging task. Aim: The aim of this study was to estimate the number of patients with cancer in need for radiation therapy at a Haitian cancer clinic. Methods: This estimation is based on the 5-year cohort of Innovating Health International’s (IHI) cancer program from 2016 to 2020. Were included all new cancer cases with documented staging of their cancer. Patients with indication of upfront radical, neoadjuvant or adjuvant radiation therapy were identified in the database according to the international guidelines (European Society for Medical Oncology (ESMO), National Cancer Care Network (NCCN). All cases with recurrence or needing palliative radiation therapy were excluded. The proportion of cases in need per year and per cancer type was then calculated. Results: Of the 3060 patients managed by IHI for cancer during the study period, 2739 patients were selected for this estimation. Overall, 57.7% [95% CI: 55.9% - 59.6%] of these patients needed radiation therapy, the proportion increasing from 52.1% in 2016 to 60.3% in 2020. The proportions per cancer type were 80% for head and neck [95% CI: 71.5% - 86.9%] and central nervous system cancers [95% CI: 28.4% - 99.5%], 77.1% [95% CI: 74.6% 79.4%] for breast cancer, 55.8% [95% CI: 41.3% - 69.5%] for skin cancers (non-melanoma), 55.2% [95% CI: 51.3% 59.1%] for gynecological cancers (cervical, endometrial, vulvar and vaginal), 40.4%[95% CI: 30.9% - 50.5%] for sarcomas, 31.3% [95% CI: 11.0% - 58.7%] for lung cancer, 29.3% [95% CI: 18.1% - 42.7%] for urological cancers (prostate and penis), 17.8% [95% CI: 13.1% - 23.3%] for gastrointestinal cancers (rectal, esophageal, anal and gastric) and 15.4% [95% CI: 9.4% - 23.2%] for blood cancers (lymphomas). Conclusion: Overall, 57.7% of patients with cancer at IHI’s clinic for the study period should have benefited from radiation therapy, with an increase of the proportion from 2016 to 2020. Advocacy toward the Haitian government is highly needed to implement radiation therapy centers in Haiti in order to ensure an optimal treatment of cancers. Have you got a Conflict of Interest?: No
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580 A study of clinical efficiency and prognosis of APL-2016 regimen in 53 APL children K. Zhang1, J. Yu1, X. Wen1, X. Guan1, Y. Guo1, Y. Dou1, J. Xiao1, Y. Shen1 1 Children's Hospital of Chongqing Medical University, chongqing, China Background: Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia(AML), accounted for 5%-10% of pediatric AML. The cytogenetic feature is PML-RARα fusion gene. The treatment regimen included alltrans retinoic acid(ATRA)and arsenic trioxide(ATO)regimens made APL become the most curable type in AML. But specific treatment regimens, especially for children, are still worth exploring. Whether reducing the use of chemotherapy could achieve desirable remission in pediatric APL remains to study. Aim: To evaluate the clinical efficacy, treatment-related adverse reactions and prognostic factors of children with newly-diagnosed APL and treated with APL-2016 regimen in Children's Hospital of Chongqing Medical University. Methods:APL-2016 regimen was designed with risk-adaptive method. Low-risk(LR) and intermediaterisk(IR)patients received ATRA plus ATO in induction,while high-risk(HR) patients also received doxorubicin(DNR) or idarubicin(IDA). Consolidation included ATRA plus DNR or IDA, with 1 cycle for LR and IR patients, and 2 cycles for HR patients. During maintenance period, ATRA and ATO were used for 6 cycles in LR and IR patients, and 8 cycles in HR patients. 53 newly diagnosed APL children from May 2016 to May 2021 were enrolled and clinical data were analyzed. Results: All patients were diagnosed by bone marrow cytology and biopsy, together with positive t (15,17) and(or) positive PML/RARα fusion gene. The median age was 8.5 years, contained 28 boys and 25 girls. The median follow-up time was 22 months. The common features of immunophenotype were high expression of CD33, CD117 and MPO. All patients had PML/RARα fusion gene. t(15;17)classical karyotype accounted for 90.4%. Hematologic complete remission (HCR) rate after induction was 96.1%. The 5-year event-free survival(EFS)rate and overall survival(OS)rate were 75.3% and 100% respectively. 4 patients relapsed, with no dead patient. DIC and LDH＞500IU were the factors influenced prognosis(p=0.02,p=0.048), which analyzed by chi-square test. The adverse reactions occurred more in HR patients than that in LR and IR patients on the whole. Differentiation syndrome(DS) rate was 60.8% and bone marrow suppression rate was 64.7% during induction. chemotherapyassociated myocardial damage and hepatic damage occurred throughout therapeutic period in HR patients. Conclusion: Our study indicated ATRA plus ATO therapy received a good therapeutic response in APL children, and lower dose of chemotherapy brought about a fine remission in HR patients, with less adverse reactions, proved APL-2016 regimen is relatively effective and safe for APL children. However, DS, bone marrow suppression ，cardiac and hepatic toxicity were frequent in our study. Current effort should focus on the prevention of DS and the reduction of chemotherapy. Patients with DIC and (or) LDH>500IU at first diagnosis need to be closely monitored for bleeding tendency and applied supportive therapy timely. Have you got a Conflict of Interest?: No
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583 New technologies for smoking cessation C. St-Louis1 1 Canadian Cancer Society, Prevention Department, Montréal, Canada Canadian Cancer Society is Canada’s leading non-profit organization having helped over 55 million people since its creation (1). We offer more than ten cancer prevention and health promotion programs in Québec, that reach people of all ages, with an increasing focus on diverse populations. Lung cancer is the leading cause of death from cancer for men and women in Canada (2) and about 72% of cases are due to smoking tobacco (3). For the past twenty years, Canadian Cancer Society has offered smoking cessation programs that are constantly evolving to meet the changing needs of users, the increasing diversity of target audiences and the growing technologies for inhaling nicotine. Canadian Cancer Society is on the lookout for the best strategies and evidence-based practices to develop smoking and vaping prevention and cessation programs, with a commitment to refining its expertise in technological solutions. During the conference, we will present an overview of our cessation programs in Québec. Since 2002, we have been offering cessation services with La Ligne J’Arrête, a telephone follow-up service for tobacco cessation. SMAT, a text messaging service for cessation was later introduced (starting 2010), with 90% of satisfied users (4), allowing us to anchor our technological expertise. This program reduced traffic on helplines by providing 24/7 support through text messages and Facebook Messenger that redirects users to other complementary services. To meet the smoking cessation needs for young adults, we implemented Nicobar in 2017. Now transformed in a virtual experience, the website pairs smokers to quit buddies through a gamified approach, by inviting them to join a user-mediated Facebook support. Vaping was later integrated in our programs and led to the creation of CESVAP, an 8-week-program targeting young adults by adding an application to all SMAT and Nicobar features. In addition to the above, an innovative smoking cessation program for people with mental health conditions is under development. Challenges arise in these virtual environments as users demonstrate a significant need for closer follow-up. Therefore, the introduction of a conversation AI application capable of managing emotions is vital for the success of our programs. By attending this conference, you will gain understanding on how we use the most current technology to reach diverse populations and innovate in the smoking cessation domain. Our learnings over the last years allow us to consider the creation of a “robot” that is constantly evolving to offer smoking cessation support. Integrating this robot in all our cessation programs will enable us to offer support with a connected vision on all programs, i.e. to develop a logbook and personalized follow-ups according to individual needs. Thus, technological advancement and a development protocol could be shared for easy replication of the programs in other cultures and contexts while protecting user data and privacy.
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Have you got a Conflict of Interest?: No
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589 Global dissemination of evidence-based cancer information: U.S. NCI’s PDQ and NCC of China collaboration. L. Hansen1, J. Ren2, M. Beckwith1, N. Li2, P. Hu1, B. Kramer3, M. Taylor1, R. Juthe1, J. He2 1 U.S. National Cancer Institute, Rockville, United States, 2National Cancer Center of China, Beijing, China, 3Lisa Schwartz Foundation, Hanover, United States Strategies for international dissemination of evidence-based cancer information through translation: The U.S. National Cancer Institute’s PDQ Cancer Information and the National Cancer Center of China Collaboration. Leshia Hansen1, Jiansong Ren2, Margaret Beckwith1, Ni Li2, Ping Hu1, Barnett Kramer3, Martina Taylor1, Robin Juthe1, Jie He2 1-U.S. National Cancer Institute (NCI); 2-National Cancer Center of China (NCC); 3- Lisa Schwartz Foundation, formerly NCI Background PDQ® is a collection of evidence-based cancer information created by the U.S. National Cancer Act of 1971. It covers cancer treatment, screening, prevention, genetics, supportive care, and complementary/alternative medicine and is available for health professionals and patients on the National Cancer Institute’s (NCI) website and through syndication partners. The National Cancer Center (NCC) of China was established by Ministry of Health of China in 2011 with the main missions including policy development, research, training, and education for cancer prevention and control. Aim The primary aim is to support the global dissemination of high-quality cancer information. Another aim is to demonstrate a successful collaboration between NCI PDQ and NCC, resulting in the translation and dissemination of cancer information to Chinese speakers. Strategy PDQ Editorial Boards review published literature, assess the strength of the evidence, and update the PDQ health professional summaries. These are translated into lay language for patients. NCC chose the 6 most common cancer types in China and translated relevant PDQ content, including screening, prevention, treatment, genetics, and supportive care and the NCI Dictionary of Cancer Terms. Program Process NCC and NCI PDQ established processes for downloading, translating, and updating content. Translators were recruited from medical universities; expert reviewers ensured accurate translations. A translation memory was created to allow for efficient and consistent translations. Routine comparison of the content will be conducted to update the translations with the latest NCI PDQ information. A marketing effort is planned for the launch of the website.
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Outcomes NCI routinely assesses usage of PDQ content on NCI’s website, and data show that users find the content useful to its broad global audience. NCC plans to collect analytics to evaluate content dissemination and uptake. Collaboration NCI encourages collaborations with U.S. and international partners to increase access to PDQ cancer information and to share best practices with programs whose goal is to provide high-quality health information to the public. Lessons Learned Challenges overcome included working with XML content, establishing a translation process, and building a mechanism to keep content up to date. Lessons learned will inform future collaborations, including efforts to translate PDQ content into other languages.
Have you got a Conflict of Interest?: No
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599 Improving the inclusion of Culturally and Linguistically Diverse (CALD) populations in clinical trials C. Allan1, T. Desai1,2 1 Cancer Council Victoria, Melbourne, Australia, 2McCabe Centre for Law & Cancer, Melbourne, Australia Background and context: Clinical trials are critical to improving patient outcomes. Australia has one of the most culturally and linguistically diverse (‘CALD’) populations in the world. Yet cancer patients from CALD backgrounds are underrepresented in cancer clinical trials due to interrelated opportunity, cultural and communication barriers. This limits the generalisability of trial results and increases health disparities in cancer outcomes. Identifying and implementing ways to improve the inclusion of CALD patients in cancer clinical trials could improve health equity. Aim: To improve participation rates of CALD patients in cancer clinical trials to reduce health inequities and improve health outcomes. Strategy / Tactics: Adopting a multidisciplinary and collaborative approach: (1) reviewing relevant domestic and international laws and policies to identify useful regulatory levers; (2) identifying and consulting with relevant experts and community members; (3) developing a survey of Australian health professionals involved in cancer clinical trial recruitment to gather evidence and appraise strategies to improve access. Programme / Policy process: Desktop literature review and analyses of relevant laws and policies; identification of and consultations with relevant experts and stakeholders within and external to Cancer Council Victoria; online survey of health professionals. Outcomes: Existing local, national, and international laws offer limited support to increase inclusion of CALD patients in clinical trials in Australia. Though there is scope to change normative standards and policies to drive inclusivity, this alone is not enough. Consultations conducted found that addressing poor representation of CALD patients in clinical trials requires improvements to research design; recruitment and consent processes; ethics and governance; health literacy; and clinical research culture. New collaborations developed through the consultation process include a survey to understand the opportunities and barriers for recruiting CALD patients into cancer clinical trials in Australian health services. What was learnt: Improving inclusivity of CALD patients in clinical trials relates to broader health equity issues and is important for all multicultural societies seeking to improve health outcomes. It requires a multipronged, multidisciplinary and collaborative approach with many complementary solutions or actions. Better data and codesign with people of CALD backgrounds must underpin this. Priority action areas identified are: data collection; improving consent processes; incentives for sponsors to include underrepresented populations; and ways to embed the values of equity and justice into health service organisations, including a review of Cancer Council Victoria's own programs and services related to clinical trials. Have you got a Conflict of Interest?: No
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60 Cross-Cultural Validation of Stool Based Colorectal Cancer Screening Methods in the North West of Iran R. Dolatkhah1, M.H. Somi2, S. Dastgiri3, M. Asghari Jafarabadi4, H. Mashhadi Abdolahi3, D. Shanehbandi5, M. Asadi6, M. Nezamdoust2, N. Dolatkhah7, F. Farassati8 1 Tabriz University of Medical Sciences, Hematology and Oncology Research Center, Tabriz, Iran, Islamic Republic of, 2Tabriz University of Medical Sciences, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran, Islamic Republic of, 3Tabriz University of Medical Sciences, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran, Islamic Republic of, 4School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran, Zanjan, Iran, Islamic Republic of, 5Tabriz University of Medical Sciences, Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran, Islamic Republic of, 6IBG Izmir Biotip ve Genome Merkezi, IBG Izmir Biotip ve Genome Merkezi, Izmir, Turkey, 7Tabriz University of Medical Sciences, Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran, Islamic Republic of, 8Midwest Biomedical Research Foundation, Kansas City, MO, USA, Kansas city, United States Background: Although the incidence of colorectal cancer varied in different parts of the world, according to the latest report of the International Agency for Research on Cancer in 2020, globally, colorectal cancer (CRC) is the third most common cancer and the second leading cause of death from cancer. Incidence and mortality from CRC both can be reduced and prevented using screening and early detection programs. Aim: The current research study aimed to assess the sensitivity and specificity of stool- based tests compared with colonoscopy, in the Northwest population of Iran. The primary outcome was the sensitivity and specificity of mtsDNA for colorectal cancer compared with colonoscopy, the secondary outcome was the sensitivity of all tests for advanced adenoma. Specificity was calculated using normal colonoscopy results (without cancer and AA). Methods: The study designed as a cross-cultural analytic study, to evaluate the diagnostic accuracy of stool-based tests compared with colonoscopy. All individuals first were assessed with our CRC risk assessment tool, then eligible volunteers entered the study. Colonoscopy was performed on all participants, also stool- based tests including traditional guaiac, high-sensitivity guaiac-based, fecal immunochemical test (FIT), and multitarget stool DNA (MtsDNA) panel tests were performed. The multitarget stool DNA test consisted of molecular assays for mutant KRAS and BRAF , aberrantly methylated BMP3 (Bone Morphogenetic Protein 3 gene) , NDRG4 promoter regions (N-Myc Downstream-Regulated Gene 4) , and β-actin. Results: Mt-sDNA test had the highest diagnostic accuracy ratios, with a sensitivity of 77.8 %( 95% CI: 40-97.2) for the detection of CRC, and 33.3% (95% CI: 7.49-70.1) for the detection of AA, with a combined specificity of 92.8 % (95% CI: 87.1-96.5) for the detection of CRC and AA. The FIT test alone had a sensitivity of 66.7 %( 95% CI: 29.992.5), and 22.2% (95% CI: 2.81-60) for the detection of CRC and AA respectively, with a combined specificity of 94.9% (95% CI: 89.8-97.9). The likelihood ratio of Mt-sDNA test had a moderate probability for detection of CRC (LR+= 8.79; 95% CI: 4.716.4), with a LR negative = 0.24 (95% CI: 0.07-0.83). Positive predictive value (PPV) of Mt-sDNA test was lower than that of the FIT test alone for the detection of CRC (35% vs 40%), but the combined negative predictive value of Mt-sDNA test was higher than that of other tests negative predictive value (NPV)= 94.1%; 95% CI: 88.7-97.4) Conclusion: Our results showed that both Mt-sDNA panel and the FIT test had acceptable cut-off points for cancer detection, however, Mt-sDNA test had better diagnostic accuracy, and is a more useful screening test. Among four stool based tests, Mt-sDNA test had the highest sensitivity for detection of cancer and advanced adenoma. Our results of the diagnostic accuracy of stool- based tests for CRC screening was comparable with the recently provided guidelines.
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Table 2. Comparing Diagnostic Accuracy Results with the last published NCCN guideline for colorectal cancer screening Sensitivity Specificity Colorectal Cancer Advanced Adenoma NCCN Our Results NCCN Our Results NCCN Our Guideline Guideline Guideline Results high-sensitivity 62-79% 66.7% 7% 22.2% 87-96% 96.4% guaiac-based test FIT 76-95% 66.7% 27-47% 22.2% 89-96% 94.9% Mt-sDNA panel 92% 91.2% 42% 33.3% 87% 92.8% Table 1. Diagnostic Accuracy Analysis Results of Mt-sDNA, FIT, high sensitivity FOB Hb, and traditional FOB Guaiac test compared with Colonoscopy (as golden standard method) TP Sensitivity Specificity ROC area LR + LR PPV % NPV % % % (95% CI) (95% (95% CI) (95% (95% (95% CI) (95% CI) CI) CI) CI) MtCRC (n=9) 7 77.8 91.2 0.85 8.79 0.24 35 98.5 sDNA (40-97.2) (85.4(0.69(4.7- (0.07(15.4- (94.8test 95.2) 0.99) 16.4) 0.83) 59.2) 99.8) AA (n=9) 3 33.3 88.4 0.61 2.88 0.75 15 95.6 (7.49(82.1(0.44(1.03- (0.47(3.21- (90.670.1) 93.1) 0.77) 8.04) 1.2) 37.9) 98.4) Both 10 55.6 92.8(87.1- 0.74 7.67 0.48 50 94.1 (n=18) (30.896.5) (0.62(3.71- (0.29(27.2- (88.778.5) 0.86) 15.8) 0.81) 72.8) 97.4) FIT CRC (n=9) 6 66.7 93.9 0.80 10.9 0.36 40 97.9 (29.9(88.7(0.64(4.97- (0.14(16.3- (93.992.5) 97.2) 0.97) 23.8) 0.89) 67.7) 99.6) AA (n=9) 2 22.2 91.2 0.57 2.51 0.85 13.3 95 (2.81-60) (85.4(0.42(0.67- (0.6(1.66- (90-98) 95.2) 0.71) 9.48) 1.21) 40.5) Both 8 44.4 94.9 0.69 8.76 0.59 53.3 92.9 (n=18) (21.5(89.8(0.58(3.61- (0.39(26.6- (87.369.2) 97.9) 0.82) 21.3) 0.89) 78.7) 96.5) FOB CRC (n=9) 6 66.7 95.2 0.81 14 0.35 46.2 97.9 Hb¶ (29.9(90.4(0.65(5.94- (0.14(19.2- (9492.5) 98.1) 0.97) 33) 0.88) 74.9) 99.6) AA (n=9) 2 22.2 92.5 0.57 2.97 0.84 15.4 95.1 (2.81-60) (87-96.2) (0.43(0.77- (0.59(1.92- (90.20.72) 11.4) 1.2) 45.4) 98) Both 8 44.4 96.4 0.70 12.3 0.58 61.5 93 (n=18) (21.5(91.7(0.59(4.5- (0.38(31.6- (87.569.2) 98.8) 0.82) 33.5) 0.87) 86.1) 96.6) †
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FOB CRC (n=9) 5 55.6 91.2 0.73 6.28 0.49 27.8 97.1 Guaiac¶¶ (21.2(85.4(0.56(2.88- (0.23(9.69- (92.786.3) 95.2) 0.91) 13.7) 1.01) 53.5) 99.2) AA (n=9) 3 33.3 89.8 0.62 3.27 0.74 16.7 95.7 (7.49(83.7(0.45(1.15- (0.47(3.58- (90.870.1) 94.2) 0.78) 9.25) 1.18) 41.4) 98.4) Both 8 44.4 92.8 0.69 6.13 0.59 44.4 92.8 (n=18) (21.5(87.1(0.57(2.79- (0.39(21.5- (87.169.2) 96.5) 0.81) 13.5) 0.91) 69.2) 96.5) †True Positive, ††Positive Likelihood Ratio, †††Negative Likelihood Ratio, ‡Positive Predictive Value, ‡‡Negative Predictive Value, * Colorectal Cancer, ** Advanced Adenoma, ¥ ROC, receiver operating characteristic, ¶traditional guaiac-based fecal occult blood tests, ¶¶ High sensitivity guaiac-based fecal occult blood tests Have you got a Conflict of Interest?: No
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601 E2F-1 and Akt1 interaction is involved in CDDP-induced apoptosis in Triple Negative Breast Cancer Cells S. Al-Bahlani1, S. Al-Jaaidi2, B. Al-Dhahli1, A. Al Sibani3, T. Al Harthi1, H. Al Ghafri4 1 Sultan Qaboos University, Allied Health Sciences, Muscat, Oman, 2Sultan Qaboos University, Biology, Muscat, Oman, 3Sultan Qaboos University, Sultan Qaboos Comprehensive Cancer Center, Muscat, Oman, 4Sultan Qaboos University, Microbiology, Muscat, Oman Background: Chemoresistance of CDDP remains an obstacle to an effective treatment for triple negative breast cancer (TNBC) patients. CDDP resistance can be due to inhibition of apoptosis by the survival protein, Akt1 that negatively affects the function of the pro-apoptotic E2F-1 protein. Aim: We aimed to investigate the expression levels and interaction between E2F-1 and Akt1 which have not been studied in TNBC cells and whether CDDP could influence such an interaction. Methods: MDA-MB-321 cells were treated with increasing concentrations of CDDP (2.5-40 μM; 24 h). CDDPinduced apoptosis was confirmed biochemically using cleaved PARP and flow cytometry analysis and morphologically using Haematoxylin and Eosin staining, Hoechst stain, Scanning Electron Microscope. Caspase-3 cleavage; indicator of apoptosis induction was measured by immunofluorescence. Western blot was used to investigate the effect of CDDP on E2F-1 and Akt1 expression while their co-localization and interaction were detected using immunofluorescence and immunoprecipitation respectively. Results: Western blot analysis revealed an increase in E2F-1 and a decrease in Akt1 expression as the concentration of CDDP increased compared to untreated cells. The merge of E2F-1 and Akt1 immunosignals observed by immunofluorescence demonstrated that CDDP-treated cells resulted in the co-localization of immunosignals in clusters and with increased intensity in the cytoplasm. Immunoprecipitation and western blot further supported the interaction between E2F-1 and Akt1 indicating a potential interaction of both proteins at the endogenous level of MDA-MB-231 cells. Conclusion: Our findings suggest an interaction between E2F-1 and Akt1 and that this interaction could be the precursor for the CDDP-induced apoptosis in TNBC cells. Have you got a Conflict of Interest?: No
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603 The National Partnership “Better Knowledge on Late Adverse Effects after Cancer” M.L. Kloster1 1 Danish Cancer Society, Patient Support and Volunteering, Copenhagen Ø, Denmark Background Due to improvements in treatment of cancer, the total population of cancer survivors is increasing. Approx. 360.000 people live with/after a cancer diagnosis in Denmark(1). More cancer survivors therefore experience late adverse effects after cancer treatment (LAEs), which may affect quality of life. However, evidence on how to treat and prevent LAEs is lacking(2;3;4) Aim The overall aim of the national partnership Better Knowledge on Late Adverse Effects(BKLAE) is to improve the quality of life of cancer patients with LAEs. Thus, there is a need for research, development and implementation of new evidence-based treatment concepts for LAEs in the Danish health care system. By establishing a national partnership between three national research centers for LAEs and patient organizations,BKLAEwill work to disseminate and implement the results of this new research in the health care system and advocate for an increased political focus on LAEs. Strategy With funds from the annual fundraising drive 'Break Cancer’, three national research centers were established, focusing on LAEs after breast cancer, cancer in the pelvic organs and across cancer sites, respectively. Besides the research centers the partnership consists of Danish Comprehensive Cancer Centre, The Patient Organization for LAEs and the Danish Cancer Society. A steering group and advisory board with representatives from the Danish health care system and political stakeholders was established. Programme/Policy process The research centers carry out research and work to disseminate knowledge nationally through generic models, clinical guidelines and through counselling others within the field. They present their work at network meetings to the advisory board and at national conferences. To ensure mutual inspiration, learning, coordination and collaboration, the partnership have ongoing meetings. The partnership monitors the development regarding treatment of LAEs in Denmark and communicate news from the field. The partnership works to create political awareness to LAEs through the media and by disseminating the patients’ stories about life with LAEs. Outcomes BKLAEhas resulted in new knowledge and interventions in regards to the treatment of LAEs. Increased awareness has led to establishment of new clinics for treating LAEs and to hospitals prioritizing funding towards the field. National clinical guidelines on the treatment of LAEs have been developed as well as a generic model for a clinical setup that is applicable to other hospitals. Finally, PRO-tools for screening for LAEs while generating research data has been developed. What was learnt The partnership has shown that a committed national collaborative setup with ongoing meetings, networking and continuous focus can create strong collaboration in this field of research with results for patients and increased political focus. The setup is replicable to other areas within the patient trajectory of cancer treatment. Have you got a Conflict of Interest?: No
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604 Epidemiological trend and disease burden of female breast cancer in Jiangsu Province, China: 1990-2019 L. Wang1, J. Zhou2, H. Yu2, R. Han2, Y. Lu1 1 Suzhou Center for Disease Control and Prevention, Suzhou, China, 2Jiangsu Center for Disease Control and Prevention, Nanjing, China Background: Breast cancer is the most common female cancer. In 2020, the global cancer registry data showed that breast cancer has surpassed lung cancer to become the world's largest cancer. Although the incidence rate of breast cancer in China is not the highest in the world, it has increased considerably in recent years, and the burden of disease has increased year by year. The research on cancer disease burden, especially the attribution analysis of risk factors, is helpful to grasp the burden of cancer on people's health from a macro perspective and formulate health strategies. Aim: To analyze the trend of the incidence, mortality and disease burdenof breast cancer in femalein Jiangsuduring 1990-2019. Methods: Based on the estimation of data inJiangsufrom the Global Burden of Disease 2019(GBD2019), the incidence, mortality, disability-adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD) on breastcancer for femalein Jiangsuduring 1990-2019were standardized by the world standard populationused for GBD2019. The GBD study applied the attributable burden formula to estimate theattributable mortality by sevenrisk factors of breast cancer, including alcohol use, high body mass index(BMI), low physical activity, high fasting plasma glucose(FPG), and smokingand so on. The incidence,mortality, attributable deaths and the disease burden due to breast cancer in femalein Jiangsuwereanalyzed. Results: In 2019,the age-standardized incidence rate of 34.58/100 000, which increased by 124.98% respectively compared with 1990.The annual percentage change (APC) is 2.93% (2.85- 3.01%).The change trend of standardized mortality presents a "wave" type, first rising and then falling, and has increased slightly in the last decade.The peak incidence rate in 2019 was 65- 69 years old, which was 10 years later than in 1990. From 1990 to 2019, the change trend of DALYstandardized rate and YLL standardized rate was the same as that of standardized mortality, while YLD standardized rate increased year by year. Compared with 1990, the proportion of breast cancer deaths attributable to high BMI in Jiangsu increased by 165.12% in 2019. The proportion of breast cancer deaths attributable to high red meat diet, high FPG, alcohol use, and smoking increased, attributable to a slight decrease in the proportion of breast cancer deaths from second hand smoke and low physical activity. Conclusion: The disease burden of female breast cancer in Jiangsu province has been increasing during1990and 2019. It is necessary to strengthen the prevention and treatment of breast cancer.
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Table 1The incidence and mortality of breast cancer in Jiangsu Province, 1990-2019 Years 1990 1995 2000 2005 2010 2015 2019 APC(%) pvalue
Number of patients (person) Standardized incidence rate (1/100,000)
Death toll (person)
4877 (3795-6085) 6265 (5077-7488) 8321 (6758-10259) 10948 (9001-13356) 15041 (11900-18962) 18987 (14330-25025) 23073 (15742-34270) 5.63 (5.57-5.69) <0.001
2620 (2064-3228) 3047 (2543-3594) 3596 (2946-4330) 4019 (3359-4811) 4418 (3553-5607) 5203 (3993-6991) 6144 (4461-8983) 2.73 (2.61-2.85) <0.001
15.37 (11.98-19.09) 17.05 (13.97-20.33) 19.42 (15.9-23.74) 22.64 (18.61-27.69) 27.26 (21.61-34.28) 30.76 (23.13-40.26) 34.58 (23.61-50.57) 2.93 (2.85-3.01) <0.001
Standardized mortality rate (1/100,000) 8.58 (6.8-10.52) 8.68 (7.27-10.31) 8.77 (7.23-10.53) 8.58 (7.18-10.27) 8.15 (6.56-10.34) 8.32 (6.39-11.18) 8.75 (6.34-12.79) -0.18 (-0.29--0.07) <0.001
Note: the data in brackets are 95% CI values
Table 2 The burden and composition of breast cancer in Jiangsu Province, 1990-2019 Disability adjusted life years（ DALY)
Premature death loss of life years（YLL）
Person year (10,000)
Standardization rate (1/ 100,000)
Standardization Proportion of Person year rate (1/ YLL in the (10,000) 100,000) DALY (%)
1990 1995 2000 2005 2010 2015 2019
8.46 10.02 11.94 12.92 14.14 15.84 18.04
263.58 270.51 276.25 265.75 256.58 257.35 269.17
APC(%)
2.40(2.28-2.52) -0.17(-0.27--0.07)
pvalue
<0.001
Years
0.003
8.13 9.60 11.38 12.18 13.11 14.52 16.45 2.19(2.062.32) <0.001
253.17 259.15 263.24 250.42 237.85 236.06 245.37 -0.37(-0.48-0.26) <0.001
2
96.08 95.81 95.31 94.25 92.70 91.71 91.22 -
Disability lost life years（YLD） Proportion Person Standardization of YLDin year rate (1/ the DALY (10,000) 100,000) (%) 0.33 10.41 3.92 0.42 11.36 4.19 0.56 13.00 4.69 0.74 15.33 5.75 1.03 18.73 7.30 1.31 21.29 8.29 1.58 23.80 8.78 5.78(5.703.12(3.02-3.22) 5.86) <0.001 <0.001 -
Figure1 The attributable value of female breast cancer attributable to different risk factors in 1990 and 2019, Jiangsu province (%) Have you got a Conflict of Interest?: No
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605 A questionnaire-based risk assessment tool for personalized screening of gastric cancer in Chinese populations X. Zhu1,2, J. Lv3,4, M. Zhu1,2, C. Yan1,2, B. Deng5, C. Yu3,4, Y. Guo6, J. Ni1, Q. She5, T. Wang1,7, J. Wang1,2, Y. Jiang1,2, J. Chen1,2, D. Hang1,2, C. Song1,2, X. Gao5, J. Wu5, J. Dai1,2, H. Ma1,2, L. Yang8, Y. Chen8, M. Song9, Q. Wei10,11, Z. Chen8, Z. Hu1,2,7, G. Jin1,2,7, Y. Ding5, L. Li3,4, H. Shen1,2 1 Nanjing Medical University, Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing, China, 2Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China, 3Peking University Health Science Center, Department of Epidemiology and Biostatistics, School of Public Health, Beijing, China, 4Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China, 5Affiliated Hospital of Yangzhou University, Department of Gastroenterology, Yangzhou, China, 6Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China, 7The Affiliated Suzhou Hospital of Nanjing Medical University, Public Health Institute of Gusu School, Suzhou, China, 8University of Oxford, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, United Kingdom, 9Harvard T.H. Chan School of Public Health, Departments of Epidemiology and Nutrition, Boston, United States, 10Duke Cancer Institute, Duke University Medical Center, Durham, United States, 11Duke University School of Medicine, Department of Population Health Sciences, Durham, United States Background: Effective risk prediction models are lacking for personalized endoscopic screening of gastric cancer (GC), a leading cause of cancer death in China and worldwide. Aim: To develop, validate, and evaluate a questionnaire-based GC risk assessment tool for risk prediction and stratification in the Chinese population. Methods: In this three-stage multi-center study, we first selected eligible variables by Cox regression models and constructed a GC risk score (GCRS) based on regression coefficients in 416,343 subjects (aged 40-75 years) from the China Kadoorie Biobank (CKB) cohort (development cohort). In the same age range, we validated the GCRS effectiveness in 13,982 subjects from another independent Changzhou cohort (validation cohort) as well as in 3,007 subjects from an endoscopy screening program in Yangzhou. Incident GC cases were identified by prospective follow–up in the two cohorts, and the detected GC cases were diagnosed by biopsy in the screening program. Finally, we categorized participants into low (bottom 20%), intermediate (20%-80%), and high risk (top 20%) groups by the GCRS distribution in the development cohort. Results: During median follow-ups of 10.1 years and 13.6 years, 3,089 and 329 GC cases were ascertained in the development and validation cohorts. The GCRS using 11 questionnaire-based variables demonstrated a C-statistic of 0.75 (95% CI, 0.74-0.75) and 0.75 (95% CI, 0.72-0.78) in the two cohorts, respectively (Table 1 and Figure 1). In the validation cohort, the 10-year risk was 0.34%, 1.05%, and 4.32% for individuals with a low (≤13.6), intermediate (13.7~30.6), and high GCRS (≥30.7) (Figure 2). The GCRS performed well in risk stratification in the endoscopic screening program, with the detection rate of GC varying from 0.00% in individuals with a low GCRS, 0.47% with intermediate GCRS, to 3.44% with high GCRS. A proportion of 74.3% (26 of 35) of all GC cases were identified from the high-GCRS group, which represented 25.1% of all the screened participants (Figure 3). Conclusion: The GCRS can be an effective risk assessment tool for tailored endoscopic screening of GC in China. We have developed an online tool (RESCUE) to aid the use of GCRS by the general public (http://ccra.njmu.edu.cn/rescue/web).
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Table 1. Prediction of the predictors for the risk of GC in the CKB cohort in a multivariate Cox regression model and corresponding risk points Variables Regression coefficient HR (95% CI) Age at baseline, years 40-44 Reference 45-49 0.47 1.59 (1.31 to 1.94) 50-54 0.87 2.39 (2.00 to 2.86) 55-59 1.33 3.79 (3.18 to 4.52) 60-64 1.67 5.29 (4.43 to 6.30) 65-69 1.90 6.71 (5.62 to 8.01) 70-75 2.13 8.42 (7.02 to 10.11) Sex Women Reference Men 0.87 2.39 (2.15 to 2.66) Education College or above Reference High school 0.40 1.49 (1.19 to 1.87) Middle school 0.54 1.72 (1.39 to 2.12) Illiterate or primary school 0.67 1.95 (1.58 to 2.39) BMI ≥18.5 kg/m2 Reference <18.5 kg/m2 0.25 1.28 (1.11 to 1.48) Pack-years of smoking 0 Reference (0, 20) 0.12 1.13 (1.00 to 1.27) ≥20 0.22 1.25 (1.12 to 1.39) Alcohol drinking per day Never or light (<25 g/d in men; <15 g/d Reference in women) Moderate or heavy 0.17 1.19 (1.07 to 1.32) Intake of fresh vegetables and fruits Frequent Reference Occasional 0.10 1.11 (1.01 to 1.21) Intake of preserved foods Occasional Reference Frequent 0.40 1.50 (1.39 to 1.62) Previous cancer diagnosis No Reference Yes 1.09 2.96 (2.22 to 3.95) Family history of cancer in first-degree relatives No Reference Yes 0.40 1.50 (1.38 to 1.63) History of peptic ulcer No Reference Yes 0.47 1.59 (1.40 to 1.82)
2
P-value
Points assigned
<0.001 <0.001 <0.001 <0.001 <0.001 <0.001
0.0 4.6 8.6 13.2 16.5 18.8 21.1
<0.001
0.0 8.6
<0.001 <0.001 <0.001
0.0 4.0 5.3 6.6
<0.001
0.0 2.5
0.049 <0.001
0.0 1.2 2.2 0.0
0.001
1.7
0.027
0.0 1.0
<0.001
0.0 4.0
<0.001
0.0 10.7
<0.001
0.0 4.0
<0.001
0.0 4.6
Figure 1. Distribution, calibration and discrimination of the GCRS in the CKB and Changzhou cohorts
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Figure 2. Inverted Kaplan-Meier plot of incident GC in the CKB and Changzhou cohorts by GCRS
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Figure 3. Comparison of pathological biopsy reports by GCRS in the Yangzhou screening program. Ten risk categories (D1~D10) were based on the same cut-offs of the GCRS deciles from the CKB. DYS indicates dysplasia; IM, intestinal metaplasia; AG, atrophic gastritis. "Normal" biopsy report includes the diagnosis of chronic superficial gastritis or no lesions.
Have you got a Conflict of Interest?: No
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611 Role of FANCE c.G1028A:p.R343Q mutation in the tumorigenesis C. Luo1, L. Zhang1, W. Dai1, J. Liang1, R. Ni1, Q. Wang1, Y. Gao1 1 The Affiliated Huaian No.1 People’s Hospital, Nanjing Medical University, HUAI'AN, China Background: Genetic factors play a vital role in tumorigenesis, as they can significantly escalate tumor susceptibility by introducing chromosomal and genetic abnormalities. Here, we reported an extremely rare familial cancer involving 25 of 47 members across four generations of a family who developed a total of 12 different cancer types. Aim: To study the underlying pathogenesis and therefore provide appropriate genetic counseling to this family or such individuals. Methods: Germline whole-genome sequencing was performed using DNA extracted from peripheral blood of the family members to detect single-nucleotide variants, small insertions and deletions. Chromosomal breakage was investigated in lymphocytes exposed to mitomycin C. FANCE mutant cells was established by CRISPR/Cas9. Formation of g-H2AX and RAD51 foci was observed after exposing cells to neocarzinostatin. Proliferation, and migration of mutant cells were examined and the potential molecular mechanisms were investigated by RNAsequencing. Results: 25 individuals of 47 family members (53.2%) were developed cancer, including 5 cases of breast cancer, 3 cases each of osteosarcoma and fibroadenoma of the breast, 2 cases each of esophageal squamous cell carcinoma, gastric cancer, pancreatic cancer, endometrial carcinoma, and glioma, and 1 case each of colon cancer, lung cancer, lymphoma, and colon tubular adenoma. The median age at time of diagnosis was 40 (range, 23–53) years. Four of five members in the 2nd generation and 12 of 18 members in the 3rd generation developed cancer. Sequencing revealed that 100% of the family members with cancer and 80% of the relatives who had not been diagnosed with cancer carried FANCE mutations (c.G1028A:p.R343Q) in the fifth exon. Chromosomal breaks in the lymphocytes from the affected cases were notably increased compared to those in the unaffected relatives and unrelated controls after exposure to mitomycin C. FANCE c.G1028A:p.R343Q mutant BEAS-2B cells were established by CRISPR/Cas9. Fewer RAD51-positive foci at the sites of DNA damage were observed in FANCE mutant BEAS-2B cells. The number of FANCE mutant cells in the S and G2/M phases was increased, cell proliferation was enhanced compared with the wild-type cells. RNA-sequencing data showed that the cell cycle, DNA repair and disease of DNA repair related genes were significantly enriched. Conclusion: FANCE c.G1028A:p.R343Q mutation was correlated with the onset of tumors in this family. Genetic sequencing and necessary genetic counseling are of great significance for this family. Have you got a Conflict of Interest?: No
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612 Molecular characterization of esophageal basaloid squamous cell carcinoma and immunotherapy outcomes Y. Li1, Y. Pan1, N. Cheng1, C. Guo1, X. Xue1, L. Xue1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Pathology, Beijing, China Background: Esophageal squamous cell carcinoma (SCC) is one of the most common cancers and the leading cause of cancer-related death in China, and esophageal basaloid squamous cell carcinoma (BSC) is a rare variant (2.2%-11.3%) of SCC with highly aggressive behavior due to vessel invasion and distant metastasis. However, the treatment for esophageal BSC is akin to typical SCC, and little was known for the effect of different treatment therapies on BSC. Aim: To investigate the genetic characteristics and treatment outcomes of esophageal BSC. Methods: We analyze the difference of genetic alterations between different tumor components using Whole Exome Sequencing (WES) from 12 patients (Cohort1) diagnosed with esophageal BSC (Ba) coexisting with conventional SCC (Co), who underwent esophagectomy at our Hospital (Cancer Hospital, Chinese Academy of Medical Sciences, China). We analyzed the PD-L1 expression and different benefits of chemotherapy with or without immunotherapy (I+C or C) on 14 BSC and 68 conventional SCC patients (Cohort2) underwent neoadjuvant treatment before esophagectomy. Results: In Cohort1, the most common somatic nonsynonymous variations in Ba included mutations of TP53 (83%) and TTN (25%), consisting with Co and esophageal SCC samples from The Cancer Genome Atlas (TCGA). All 12 patients enrolled had shared variations between Ba and Co, which most likely to be driver genetic events such as TP53. No significant differences were observed in mutated genes . And mutation spectra was similar between these two tumor components, with a predominance of the C>T/G>A transition. These findings suggested the common genetically clonal origin of Ba and Co. Compared with Co, Ba had significant CNV gains in chr2. The overall mutation signatures were similar between Ba and Co with very strong enrichment of signature 1 (associated with age) . Most importantly, we found that signature 15 (associated with defective DNA damage repair) was less prominent in Ba , and TMB was lower. In Cohort2, no significant difference of PD-L1 expression was observed between BSC and SCC. However, according to the Mandard TRG score of surgical specimens, we found that chemotherapy with immunotherapy seemed to have less benefit on BSC than SCC (33.3% vs 65.6%); while only chemotherapy worked about the same on BSCs and SCCs (42.9% vs 42.9%). Besides, both two BSC patients with good response to the addition of immunotherapy in Cohort2 were PD-L1 negative. Conclusion: Our results revealed the characteristics in SNV, mutation signature, TMB and CNV, as well as the common genetically clonal origin of BSC and SCC. Our results indicated the distinct immune characteristics of BSC, and proved that immunotherapy was not an effective treatment options for BSC by comparing the Mandard TRG score after neoadjuvant treatments. Have you got a Conflict of Interest?: No
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613 Holding hands through rare cancer journey S. Samineni1, A. Tandon1 1 The Max Foundation, Seattle, United States Background and context: CML and GIST are the two rare cancers we work with amongst others in South Asia . Both are life threatening diseases and require lifelong therapy. Our group of survivors come from diverse backgrounds ranging from different age-groups to socio-economic strata. People living with cancer and their families face major obstacles in terms of support systems and resources available to lead the rest of their lives with hope and dignity. The impact of the burden it has on them is undeniable Aim: The Max Foundation aims to provide access to cancer treatment, care and support to individuals impacted by cancer Strategy / Tactics: A)Providing medicines as donation through Patient Assistance Programs and helping thousands of patients live beyond their cancer in regions where access to medicine is not locally available B)Bringing people together and providing a safe platform in the form of Patient Support Groups for exchanging perspectives, sharing concerns, and gaining confidence to face the future Programme / Policy process: To provide medication and wrap around services to patients in South Asia. Patients enrolled in Assistance Programs through which they are provided medication and monitored closely by maintaining regular contact, thus improving compliance. In addition to receiving medication there are unmet needs of these patients · Cost for monitoring and diagnostic tests· . Travel and Lodging · Disease Awareness · Peer to peer support The Patient Support Groups associated with and supported by The Max Foundation includes Friends of Max, India, Max Ko Saathi, Nepal, CML Collectives Sri Lanka, Bangladesh CML Supporting Group and KIRAN in Pakistan are working extensively in bringing together patients and caregivers and providing them with treatment-related information and emotional support through its Support Group Meetings. Outcomes: Approximately 16,000 patients benefit from the Assistance Programs in South Asia. It has been observed that access to medication is not sufficient for lifelong treatment of life-threatening diseases. Patients need a platform to share and learn from each other’s experiences and most importantly it gives healthcare professionals a chance to understand the gaps in their care. In 2021, The Max Foundation touched the lives of 1022 patients across South Asia through its Support Group Meetings bringing patients and caregivers together by providing them a platform to share and learn from one another and most importantly it gave them an opportunity to learn about latest treatment protocols from their treating physicians What was learnt:(if relevant, please also detail here the potential of replicability) Cancer diagnosis can be difficult for a patient and knowing that they are not alone in this journey gives them the strength to navigate the complex process of managing a life-altering illness such as cancer. These support programs are `of utmost importance in improving the quality of life of our patients.
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2
Have you got a Conflict of Interest?: No
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616 A Novel Forewarning Model of Catastrophic Health Expenditure for Breast Cancer Patients based on "SHA 2011" A. Zheng1, X. Shao2, Q. Fang2, B. Chen1, X. Wang2, F. Jin1 1 the First Hospital of China Medical University, Department of Breast Surgery, Shenyang, China, 2China Medical University, College of health management, Shenyang, China Background: Breast cancer has become the most common cancer globally, which imposed a heavy social and economic burden on individuals, families and countries. The incidence of catastrophic health expenditure (CHE) is an important indicator of a country's equity in financing. According to World Health Organization, when personal cash health expenditures account for 40% of household consumption expenditures, CHE occurs. Although the factors that influence CHE for breast cancer patients are well defined, the extent to which each factor affects CHE is still unclear. Aim: In this study, a forewarning model of CHE for families with breast cancer patients was constructed, which could help clinicians and hospital administrators predict the risk of CHE according to each patient's situation and take corresponding preventive measures to reduce CHE. Methods: This retrospective multi-center cross-sectional study was conducted in China. Based on "The System of Health Accounts 2011" (SHA 2011), a multi-stage stratified probability-proportion random sampling method was used to select patients. A database of 86,432 breast cancer patients was created including 58257 out-patients and 28175 hospitalized patients in 435 medical institutions at every level between 2015 and 2020. The data of medical expenses was collected from statistical office and accounting system of sampling medical institutions. The information about basic condition of individual and family was obtained from questionnaire surveys. The MannWhitney U test or Chi-square test were used to determine the differences between families with and without CHE. The influencing factors which led to CHE were ranked by Back-Propagation (BP) neural network. The algorithm process included forward propagation of information mediated by hidden layer (input layer to output layer) and back propagation of error (output layer to input layer). Results: In China, 45.22% of families with breast cancer patients suffered from CHE. Higher incidence of CHE was correlated with older patients (P<0.001), longer duration of disease(P<0.001), higher hospitalization frequencies(P<0.001), more family members over 60-year-old(P<0.001), lower total household income (THI， P<0.001), lower reimbursement ratio (P<0.001), lower level of education (P=0.002) and more comorbidities (P=0.047) (Table 1). The neurons in input layer correspond to X1 to X11 (Table 2). Two neural network models were constructed according to the single-factor results, and there were 8 input layer variables in Model I (X1-X3, X6, X8-X11). The input layer variables of Model II were X1 to X11. The optimal number of hidden layers was obtained according to the empirical formula and the mean square error (MSE) minimization principle (Figure1). The BP neural network indicated that THI was the most critical factor that determined CHE, as well as reimbursement ratio was ranked 4th behind hospitalization frequency and level of education (Table 3). Risk of CHE can be predicted in this model more precisely by considering the importance of each factor. Conclusions: In China, the CHE for families with breast cancer patients was characteristic of high incidence, which caused large social and economic burden. THI, level of education, hospitalization frequency and reimbursement ratio were the main factors influencing CHE. This model was expected to provide a reference for clinical practice and hospital management.
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Table 1 Single-factor Analysis of CHE in Breast Cancer Patients Characteristics Age Duration of breast cancer (year) <1 1-3 4-5 6-9 >9 Hospitalization frequency (time) 1-4 5-8 9-12 >12 Hospitalization time (day) 1-3 4-6 7-9 10-12 >12 Tumor stage I II III IV Level of education primary school junior high school high school Bachelor degree or above Number of family members 1-2 3-4 5-6 Number of family members over 60 0 1 >1 Number of comorbidities 0 1 >1 Total household income (CNY) 0-60000 60001-120000 120001-180000 180001-240000 240001-300000 >300000 Reimbursement ratio 0%-20% 21%-40% 41%-60% 61%-80% 81%-100%
The percentage offamilies without The percentage of families with CHE（%） CHE（%） 46 (37, 56) a 68 (51, 75) a 15.0% 18.1% 13.4% 21.8% 31.8%
6% 13.6% 14.7% 34.7% 30.9%
34.6% 30.5% 19.6% 15.3%
9.4% 24.9% 32.8% 32.8%
17.4% 19.3% 19.9% 18.1% 25.2%
18.1% 18.1% 20.0% 26.0% 17.7%
21.8% 28.7% 24.0% 25.5%
21.5% 25.3% 24.2% 29.1%
9.0% 30.5% 44.6% 15.9%
18.1% 35.8% 34.7% 11.3%
32.7% 62.0% 5.3%
36.6% 57.7% 5.7%
55.8% 40.5% 3.7%
14.0% 56.2% 29.8%
40.5% 34.3% 25.2%
48.7% 25.3% 26.0%
3.1% 7.8% 14.3% 23.1% 8.7% 43.0%
54.3% 19.6% 11.7% 9.1% 1.5% 3.8%
3.4% 29.9% 42.7% 23.1% 0.9%
11.3% 40.4% 34.7% 12.5% 1.1%
P <0.001 <0.001
<0.001
0.087
0.734
0.002
0.574
<0.001
0.047
<0.001
<0.001
P-value for non-parametric test
a
2
Table 2 Study variable and its assignment table Code X1
Variable Age
X2
Duration of breast cancer
X3
Hospitalization frequency
X4
Hospitalization time
X5
Tumor stage
X6
Level of education
X7 X8 X9
Number of family members Number of members over 60 Number of comorbidities
X10
Total household income (CNY)
X11
Reimbursement ratio
Y1
Family health expenditure/ Total household income
Value year <1 years:1; 1-3 years:2; 4-5 years:3; 6-9 years:4; >9 years:5 1-4 times:1; 5-8 times:2; 9-12 times:3; >12times:4 1-3 days:1; 4-6 days:2; 7-9 days:3; 10-12 days:4; >12 days:5 I:1; II:2; III:3; IV:4 primary school:1; junior high school:2; high school:3; Bachelor degree or above:4 1-2:1; 3-4:2; 5-6:3 0:1; 1:2; >1:3 0:1; 1:2; >1:3 0-6000:1; 60001-120000:2; 120001-180000:3; 180001-240000:4; 240001-300000:5; >300000:6 0%-20%:1; 21%-40%:2; 41%-60%:3; 61%-80%:4; 81%-100%:5 0%-20%:1; 21%-40%:2; 41%-60%:3; 61%-80%:4; >80%:5
Table 3 Rank of importance of influencing factors in patients with breast cancer Variable X10 X6 X3 X11 X1 X8 X2 X9
Model 1 MIV 0.3193 0.2161 -0.1592 0.0872 0.0366 0.0342 -0.0191 8.07E-04
Rank 1 2 3 4 5 6 7 8
Variable X10 X3 X6 X11 X8 X4 X9 X1 X7 X2 X5
3
Model 2 MIV 0.3369 -0.1682 0.1526 0.1286 0.1069 -0.0945 -0.0803 0.0306 0.0194 0.0186 0.0056
Rank 1 2 3 4 5 6 7 8 9 10 11
Figure 1. Fitting graph of factors influencing the output value and target value of BP neural network. (A) Model 1; (B) Model 2 Have you got a Conflict of Interest?: No
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62 Creating an Oncology Center of Excellence in Vietnam – Needs Assessment and Plan Implementation K. Smith1,2 1 University of Pennsylvania, Department of Medicine, Division of Hematology and Oncology, Philadelphia, United States, 2Vinmec Times City International Hospital, Hematology and Oncology, Hanoi, Vietnam Background and context: Vietnam is a rapidly developing middle-income country but its healthcare system lags behind its economic growth. Challenges include shortage of medical staff, overcrowded facilities, lack of training, limited access to medications and testing, and fragmentation of care. University of Pennsylvania has partnered with Vinmec Times City International Hospital to elevate the quality of cancer available to patients in Vietnam by creating an Oncology Center of Excellence (COE). This abstract reveals our program’s progress over the past 21 months. Aim: To create an Oncology COE. Strategy: We identified our program’s strengths and weaknesses and listed improvements that would be necessary for us to provide high-quality, patient-centered, multidisciplinary care that leads to excellent patient outcomes. Developing an Oncology COE will be a lengthy process which will take many years. We are initially focusing on breast cancer. We prioritized physician and nursing training, development of clinical pathways, establishment of a cancer registry, tracking of quality measures, creation of a nurse navigator role, and development of more patient supportive services. Program process:
• • • • • •
Training: Three physicians have completed 3 months of training in the US. We started monthly case conferences and weekly educational meetings for medical oncologists. We are currently creating an oncology nursing curriculum with online coursework and hands-on learning that will lead to certification. Pathways: We implemented pathways for the diagnosis, treatment, and follow-up of breast cancer. Cancer registry: We are collecting data on all newly diagnosed breast and colon cancer patients. We will expand to other cancer types when we get additional human resources. Quality measures: We are tracking 6 breast cancer quality measures and 6 general oncology quality measures. Nurse navigation: We created a nurse navigator role whose responsibilities include triage, assisting all new breast cancer patients, and providing patients with treatment summaries. Patient supportive services: We now offer home nursing services and psychological counseling.
Outcomes: Our program is still in its beginning stages and outcome data is mostly immature. We have demonstrated improvement in breast cancer outcomes with implementation of our breast cancer pathways. Sentinel lymph node rates have increased from 21% to 100% and genetic testing for high-risk patients has increased from 11% to 57%. What was learnt: Changing practice habits and introducing new concepts such as nurse navigation and social work are difficult and take time. We have already noticed some improvement in our outcomes so we are hopeful we will continue to advance cancer care quality and progress towards our goal of becoming an Oncology COE. Have you got a Conflict of Interest?: No
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622 Synergistic interactions of chromatin regulators across tumors reveals their epigenetic regulation mechanisms K. Li1, M. Cao1, D. Xu1, L. Wang2, J. Lu2, Z. Xu1, D. Zheng1, P. Li1, X. Bi1, L. Chen1 1 Hainan Medical University, Haikou, China, 2Haerbin Medical University, Haerbin, China Background: Chromatin regulators (CRs) play a key role in the development of cancer by regulating the gene transcription process by combinatorial pattern. Analysis of the epigenetic regulation mechanism of CRs is of great significance in cancer research. Here, we identified the interaction of CRs and constructed CR-CR interaction networks across five tumor cell lines. The global interaction analysis revealed that CRs tend to function in synergistic. Aim: Unravel the interaction between CRs and how they regulate gene transcription. Exploring how CRs are involved in cancer progression and its impact on cancer. Methods: 644 alignment BAM files in five human tumor cell lines were obtained from the Encyclopedia of DNA Elements (ENCODE) and ChIP-Atlas, involving a total of 166 CRs. Reads from CRs ChIP-seq data were aligned to hg38/GRCh38 assembly of the human genome.The MACS2 peak calling was used to compare the ChIP-seq signal with a corresponding whole cell extract sequenced control.Enriched intervals with the threshold of q value less than 0.05 were considered as binding profiles (peaks) for a CR or HM. The peaks found in at least two replicate ChIP-seq experiments except located in ENCODE blacklist regions were taken into account. Results: This research demonstrated that there were large-scale synergistic CRs in tumors.There were five common CRs (SIN3A, EP300, RCOR1, TAF1 and ZBTB33) play a consistent regulatory role in all cancer cell lines, and five specific CRs (ATF2, CTCF, EZH2, PRDM10 and NFYB) play a distinct regulatory role in only one cell line.The common CR SIN3A tended to bind to promoter regions and regulated H3K4me3, H3K4me2 and H3K9ac in multiple cell lines, revealing that SIN3A plays a part in activating transcription factors. However, the common CR EP300 tended to bind to the distal regulatory region and regulated H3K4me2 and H3K27ac, consistent with the previous study that EP300 may act as a potential super-enhancer. Specific CRs regulated the diversity of the transcription process, not only mediating histone modifications but also affecting DNA methylation, and different types of CRs can jointly influence biological processes, such as the occurrence and development of cancer through their synergistic effect. Conclusion: Overall, the research comprehensively analyzed the interactions among CRs and how they regulate gene transcription. CRs perform their regulatory function in multiple ways, the research provides a reference to predict binding partners and cellular functions. At the same time, the synergistic regulation of a certain CR-CR pair has multiple signal patterns in their binding sites. These patterns can affect histone modifications, the binding motif, the regulation of downstream target genes and biological functions. In addition, CR can distinguish cancer patients with different survival times, this highlights the critical role of CR in cancer diagnosis. Have you got a Conflict of Interest?: No
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627 An overview of holistic breast cancer care from the perspective of high school girls in LMICs. A. Addai1,2,3 1 Breast Care International, Kumasi, Ghana, 2Female's Health Counsel, Kumasi, Ghana, 3Peace and Love Hospitals, Kumasi, Ghana Background and context: According to Globocan, in 2020 breast and cervical cancers accounted for 48% of all new female cancer cases in Africa. Cancer survival is disproportionately low in LMICs due to low rates of early stage diagnosis. Myths and misconceptions, lack of education, stigma, misinformation, lack of accessibility and affordability of care are some of the reasons for late stage presentation in Ghana. Globocan estimates that cancer incidence will double in 2035 with over 70% occurring in LMICs. This means a 14 year old high school girl child today will be 27 years in 2035 and can have a cancer diagnosis. Aim: This project by Female's Health Counsel aims to actively engage the youth with cancer education; using the 'nothing about us without us' idea to involve the next generation in idealising what holistic breast cancer care should look like, for a woman in a LMIC. Some African countries have limited or no cancer education and treatment options available, which means women diagnosed with cancer have to travel to countries like Ghana for treatment. This Ghanaian project will serve as a blueprint to replicate in other LMIC countries. Strategy / Tactics: 5 high school girls selected from Lincoln Community School in Accra and International Community School in Kumasi were educated about breast and cervical cancers as well as menstrual health. This knowledge was then used as the foundation to study the current breast cancer care pathway for women in Ghana.The girls with the guidance of a medical doctor studied the story of Joyce, a breast cancer survivor who presented in October 2012 with locally advanced disease. A breast and cervical cancer pathway is developed to improve the care Joyce received and find reasons for her delay and how to bridge that gap to increase early stage presentation and cancer survival. Programme / Policy process: All girls take a pre-programme questionnaire before the first session. They then go through 4 sessions of breast, menstrual and cervical health education with QnA sessions. A detailed story of Joyce's breast cancer journey is studied and discussed as a case study. The students also spoke to 2 other breast cancer survivors during the program. Outcomes: High school students are educated about breast, menstrual and cervical health. A breast and cervical cancer pathway is developed from a high school student's perspective with ideas on how to keep Ghanaian women educated and screened for the two most common female cancers, help decrease late stage presentation and improve holistic cancer care of women in Ghana. What was learnt: High school students are willing to learn about their health and their teachers are willing to let them learn about their health. The first 4 sessions of this project should be adapted to each country eg. Schools in Malawi and Zambia requested HIV and pregnancy education be included in the health sessions. Funding is needed to fully execute this project across the continent. Have you got a Conflict of Interest?: No
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629 Dedicated specialist rehabilitation team improve functional outcomes for patients on Cancer Wards J. Wade1, S. Aldrich2, G. Jones1, R. Marshall2, S. Penfold2, N. Peat1 1 Guy's and St Thomas' NHS Trust, Physiotherapy Department, London, United Kingdom, 2Guy's and St Thomas' NHS Trust, Occupational Therapy Department, London, United Kingdom Background: The deleterious effects of cancer and its treatment frequently have a damaging impact on physical function, quality of life, and increased dependency on formal care. What’s more, an acute hospital admission only exacerbates these risks. Given this, it is worrisome that cancer patients under acute hospital care often have restricted access to the specialist rehabilitation clinicians who could deploy suitable rehabilitative countermeasures such as early, specified inpatient specialist rehabilitation delivered at a meaningful dose and frequency. Aim: We aimed to determine whether such an approach could be provided realistically and whether such countermeasures maximise functional outcome during acute admission. Methods: Patients with complex rehabilitation needs requiring dual professional input (Physiotherapy and Occupational therapy) on 2 acute inpatient cancer wards (max bed occupancy = 52) were eligible. They received ≥2 specialist rehabilitation sessions daily over a 5-day week by a dedicated Cancer Rehabilitation Transition Service during their inpatient admission. Patient demographics and clinical characteristics described the patients’ presentation. Measures of Dependency (Northwick Park Disability Scale (NPDS, max score=100), Functional Independence (Barthel Index (BI), max score=20), Self-Confidence in achieving primary rehab goal (Likert Scale 010) and Quality of Life (QoL) (EQ5D-5L, max score=1) were undertaken at admission and discharge from therapy. The effect of specialist rehabilitation on the change in NPDS and BI constructs, and on QoL were assessed using paired -tests. Other outcomes were evaluated using descriptive statistics. Results: Between 13 January 2020 to 16 July 2021, 55 patients (55% F, mean (±SD) 65 (±11) years) were treated. There was a statistically significant mean (95%CI) change in the NPDS [-12(-14.6 to -9.4), <0.001], and on discharge 77% of patients moved from higher dependency level to a lower dependency, meaning they were less dependent on formal care support. Statistically significant changes in functional independence were also observed in the BI [5.1 (4.0 to 6.2), <0.001]. In 93% of patients self-confidence increased [3.9 (1-8)], and overall health related QoL (EQ5D-5L) improved in 73% [0.23 (0.14 to 0.31), <0.001]. Conclusion: Early and intense inpatient specialist rehabilitation provides statistically significant and favourable outcomes in function and improvements in quality of life in cancer patients with complex rehabilitation needs. The data provides evidence supporting the need for further experimental work to 1) test the efficacy of individual rehabilitation specification and overall dosing and frequency parameters, and 2) identify the spectrum of cancer patients for whom this model of rehabilitation delivery would benefit most, to inform future service models. Have you got a Conflict of Interest?: No
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63 #Raise1K crowdfunding platform S.O. Dawodu1 1 Raise Foundation, Minna, Nigeria Amount raised:N21,947,226:50($52,884.88) Background & context:Raise Foundation is an NGO in Niger State,Nigeria.We work to improve Maternal, Neonatal and Child Health our activities include breast and cervical cancer awareness and prevention.In 2016, the Foundation set up a walk-in Cancer Screening Centre, where women access screening and preventive therapy.Our Cervical cancer screening is done with Visual inspection with Acetic acid (VIA) and a “See and Treat” method with Cryotherapy.Recently our treatment of cervical lesions is done with thermal ablation.Patients treatment are paid for by the Foundation via #Raise1K crowdfunding platform which include any of the following;Immunohistochemistry, Histology,X-ray,Surgery (Lumpectomy,Mastectomy,Hysterectomy)Chemotherapy and Radiotherapy. Aim:To help raise funds for breast and cervical cancer patient’s treatment Strategy/Tactics:#Raise1K campaign is a platform where a minimum of N1000($2.40) monthly is directly debited from donors accounts.The campaign started in November 2018 with a fundraising dinner, the proceeds from the dinner and the funds raised through the campaign is used for breast and cervical cancer patients’ management.Most of our donors have a standing order with their banks.The Foundation has so far screened a total of 7,927 women(fig 1),85% of whom are indigent women with an average household income of less than $2 per day
2016 2017 NUMBER OF WOMEN 2018 SCREENED FOR 2019 OCTOBER BREAST AND 2020 2016 TO CERVICAL CANCER 2021 DECEMBER Total 2021 Lumpectomy and biopsies SUMMARY OF Cryotherapy treatment INVESTIGATIONS Hysterectomy Malignant cases (Breast cancer)
650 1,756 2,007 1,989 998 527 7,927 127 9 2 38
Selection of audience–This was a qualification stage with thorough comprehensive research and analysis to determine donor capacity and disposition.We were able to forecast judging from the evidence of donor’s principle and prospects. Our message–We developed documentaries using insights on the patients’ journey by putting a human face on our facts and statistics.Our theme was “Keeping up with the Survivors” which allowed donors to understand what is was to be in the survivor’s shoes.Our patients and their families shared their story without bias of being judged or questioned. The donation–Our strategy was to get as many people as possible to donate an affordable amount, which would give a huge multiplier effect.The foundation set-up an online payment platform and a different sub-account for this purpose. Communication–Our donors are regularly informed on the progress of patients,with what has been attained from their donations.We let them know their impact by sharing patients’ outcomes,this gives donors assurance that their donation has directly improved a situation. Programme process:We have a referral system in place where patients are screened and positive cases are taken to secondary and tertiary health facilities for treatment.Payment are directly made to health facilities for diagnosis and treatment. Costs:N4,140,000:00($11,468.14)
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S/No 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Activity Cost (Naira) Dinner 1,200,000:00 Awareness campaign (radio jingles, T.V 300,000:00 Adverts) Documentaries 300,000:00 Souvenirs 180,000:00 Entertainment 560,000:00 Hall rental 500,000:00 Hall decor, tables and chairs 350,000:00 Sound and lights 280,000:00 LED Screen 220,000:00 Setting up of paystack – payment platform 250,000:00 Grand Total 4,140,000:00
Cost (USD) 3,324.09 831.02 831.02 498.61 1,551.24 1,385.04 969.52 775.62 609.41 692.52 11,468.14
Returns:N21,947,226:50($52,884.88) What was learnt:This program has high potential for replicability and sustainability because it is a seamless and efficient means of raising funds for indigent breast and cervical cancer patients Have you got a Conflict of Interest?: No
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630 Accelerating the Pan-Canadian Interdisciplinary Palliative Care Competency Framework into Action K. DeCaria1, D. Dudgeon1, R. Shaw Moxam1, J. Moat2 1 Canadian Partnership Against Cancer, Toronto, Canada, 2Pallium Canada, Ottawa, Canada Background and context: Canadians want highly skilled providers who can address their palliative care needs, whenever and wherever those skills are required. However, many Canadians don't receive high-quality palliative care. In response to calls for better access to palliative services, Health Canada developed a Framework and an Action Plan on Palliative Care in Canada which called for the development of a pan-Canadian palliative care competency framework. Strategy / Tactics: The Canadian Partnership Against Cancer in collaboration with Health Canada, Canadian Society of Palliative Care Physicians, BC Centre for Palliative Care and Pallium Canada recently adapted competency documents developed by Nova Scotia, Quebec, Ontario, Alberta and British Columbia to produce the Canadian Interdisciplinary Palliative Care Competency Framework.This Framework sets out competencies for nurses, physicians, social workers, personal support workers, and volunteers who care for people with life-limiting conditions. Outcomes: The Framework serves as a guiding document for jurisdictions that lack an explicit set of palliative care competencies, and as high-level guidance for provinces that have built their own competency frameworks. The Framework includes skills’ self-assessments that individuals can complete to identify gaps in their own competencies and address with supplemental educational and training resources. Pallium Canada is building a Learner Journey Application that will aid healthcare workers to identify, plan, and achieve their palliative care learning goals. What was learnt: (if relevant, please also detail here the potential of replicability) As the practice of palliative care changes across Canada, the Framework will evolve to meet future needs and reflect other members of the interdisciplinary team, such as spiritual care, physio- and occupational therapy, volunteer coordinators, and others. Have you got a Conflict of Interest?: No
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631 Implementation of Advance technology in New Cancer Center for creating sustainable Health Service. S. SEWSURN1 1 NEW CANCER CENTRE, VICTORIA HOSPITAL, MINISTRY OF HEALTH AND WELLNESS, ONCOLOGY, PORT LOUIS, Mauritius Title: Implementation of Advance technology in New Cancer Center for creating sustainable Health Service. Sub: Abstract on Practice, Advocacy Reports of Cancer Care, Detection and Identification in Mauritius Island for World Cancer Congress 2022 EVT 2201584 INT 6064 IAEA SUPPORT. About the Author: Dr. Shashi Sewsurn, served as REGIONAL HEALTH DIRECTOR at prestigious DR.A.G. JEETOO HOSPITAL & currently, serving as Head of Radiation and Clinical Oncology, Consultant In-charge at New Cancer Centre and Victoria Hospital. Education: Fellowship at University of Pennsylvania School of Medicine, USA, IAEA Fellowship at Tata Memorial Hospital, India, Post Graduation in Clinical Radiation Oncology, and Bachelor of Medicine and Bachelor of Surgery from Bangalore Medical College, India. Presented Scientific Papers at ASCO, IAEA, Vienna, Shangai Chamber of Commerce, ARA Conference at Houston, Texas. 6 Publications in International Journals. Blessed with Awards in both National and International level, and Gold Medalist academically. I am honored to be Nominated to participate in the WORLD CANCER CONGRESS 2022 and submitting Abstract on the Summaries of practice, policy and advocacy reports with Advances in integrating Radiation Medicine for the diagnostic and Treatment of cancer as part of national efforts in Mauritius. Radiology & Oncology Centre in Victoria Hospital, Mauritius dates back to 1969. We have One LINEAR ACCELERATOR, two Cobalt units (Equinox and Elite 80). 2D Simulator, 2D-treatment Planning System, LDR Brachytherapy is also facilitating our treatment. The human resources have been built to cater our cancer services at Victoria Hospital, New Cancer Centre and all over the Island. Our dream project of NEW CANCER CENTER in Mauritius is near Completion and partially Operational. 2 Linear Accelerators, HDR Brachytherapy, PET CT Scan CYBER KNIFE are in pipeline. IAEA Expert Dr FRANCESCO GIAMMARILE is currently,visiting our NEW CANCER CENTER for Nuclear medicine PET CT, Spec, Dexa. It, Mauritius, is a welfare state offering free treatment and services to all the citizens of the country with basic healthcare facilities. However, we all need is Training to manage the New Technologies such as 3D Conformal Radiotherapy IMRT, CYBERKNIFE, HDR Brachytherapy, Bone marrow Transplant etc. We need training from Experts from IAEA and other countries, to improve our services, to realize our dream ONE WORLD ONE HEALTH. I wish to attend WCC in-person Geneva, it would benefit our country immensely as there will be opportunities for personal interaction. Thanks, Dr. (Mrs.) Shashi Sewsurn. Have you got a Conflict of Interest?: No
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632 Integrated prevention of cervical cancer and HIV: Findings from a randomized implementation science trial S. Subramanian1, M. Mbizvo2, J. Beizer3, N. Chelwa2 1 RTI International, Waltham, United States, 2Population Council, Lusaka, Zambia, 3RTI International, North Carolina, United States Background: Women in Zambia, like in many sub-Saharan African countries, face a dual burden from cervical cancer and the human immunodeficiency viruses (HIV). HIV incidence among adolescent girls and young women (AGYW) is disproportionately higher than among males of the same age. HIV prevalence is about 11% in young women 20 to 24 years of age and about 7% in young men of the same age. It is estimated that only 42% of youth aged 15 to 24 years know their HIV status because of low testing uptake in this age group. Zambia also has the third highest incidence of cervical cancer in the world, with about 66 new cases per 100,000 women.It has initiated human papillomavirus (HPV) vaccination for girls who are 14 years old, but vaccination among all eligible AGYW is extremely low and this presents a missed opportunity for preventing cervical cancer. Aim: To conduct a randomized study to assess the role of HPV vaccination as an entry point for engaging in HIV prevention and testing to reduce the high burden that results from both cervical cancer and HIV. Methods: We conducted a three-arm cluster randomized study; one arm offered education sessions with adolescent-friendly clinics, a second arm offered education sessions alone and the third arm was usual care. The education sessions were held every month in a youth club format and consisted of tailored content by age group delivered via role plays and interactive discussions. The focus of the education was on HIV prevention, importance of HIV testing, knowledge of rights, self-efficacy to seek health care services and knowledge of practices to maintain good health. Trained peer navigators conducted the education sessions and facilitated health facility visits in the adolescent-friendly clinic arm. The AGYW received brochures on HPV vaccination, contraception selection and clinic services. The clinic offered HIV testing, HPV vaccination, contraceptives, and referral services for cervical cancer screening and sexually transmitted infection treatments. We enrolled 200 AGYW aged 10 to 20 years in each trial arm for a total of 600 participants. Results: Our 6-month interim analysis indicates that 87% of the AGYW had received at least one dose of the HPV vaccine in the arm with the education sessions and adolescent-friendly clinic while it was lower than 20% in the other two arms. In the same timeframe, 92%of the AGYW in the arm with the education sessions and adolescentfriendly clinic had received counseling and undergone HIV testing which again is substantially higher than the other comparisons arms. Conclusion: An integrated approach that includes HIV education and testing along with HPV vaccination is an effective approach to engage adolescents and young women to reduce the burden of both HIV and cervical cancer. Additionally, this model could also prove cost-effective as it avoids a siloed approach to health care delivery and could be ideal for implementation in resource constrained settings. Have you got a Conflict of Interest?: No
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635 Parent Summit A.S. Fernandez1 1 Kythe Foundation Inc, Quezon City, Philippines Background and context: When a child is diagnosed with cancer, his parents face the uncertainty and devastating effects this news brings. From coping with the diagnosis, doctors’ appointments, going through the treatment process to financial and emotional difficulties, parents can be overwhelmed by the demands of the situation. Access to information relevant to their child’s illness, treatment and continued development is vital and can be an important source of support. Kythe Foundation Inc, the only organization in the Philippines providing hospitalbased child life services to children with cancer and chronic illnesses, crafted a program, the online Parent Summit, to provide a virtual space where parents and caregivers of children with cancer could gather and access learning opportunities from respected resource persons, relevant to the understanding and better care of their children. Aim: The key aim of the Parent Summit is to increase parents' knowledge of their children’s illness and treatment journey, as well as, to empower them to develop the needed skills to ensure that they are able to care for and support their children adequately and appropriately, physically, emotionally and socially. Strategy / Tactics: On the third quarter of 2020, the Parent Summit was launched as a virtual learning session, gathering together parents of children with cancer from different islands in the Philippines. This was designed to be held once every quarter, involving an hour long lecture and a thirty minute segment for question and answer. On the onset, a survey was carried out with the parents to determine specific topics that they would need and find most helpful. Based on the results of the survey, topics for the Parent Summits were chosen. Programme / Policy process: The Parent Summit has been conducted every quarter since the second half of 2020. The topics have included, among others, supporting chronically ill children through the pandemic, developmental and hospital-related characteristics of children and teens, proper nutrition and the power of play. A developmental psychologist, a certified child life specialist and a nutritionist were invited to do the talks. Outcomes: There has been a growing number of parents attending the summit. Many have expressed appreciation at having the opportunity to learn despite the distance and lack of resources. Feedback from the parents have also shown an increase in the knowledge and skills that they use in supporting their children through the pandemic and through their treatment journey, in understanding the value of play and presence, as well as, in communicating more effectively with them. What was learnt: Parents may find it difficult to access learning opportunities due to the expense and lack of information. The Parent Summit has allowed this to be possible for them. Moreover, consultations with parents is essential to ensure the topics undertaken address their needs. Have you got a Conflict of Interest?: No
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637 The natural course of hepatocellular carcinoma based on the multistate Markov model M. Cao1, W. Chen1 1 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Office of Cancer Screening, Beijing, China Background: Hepatocellular carcinoma (HCC) remains the leading cause of cancer-related death worldwide. Chronic infection with Hepatitis B virus (HBV) has been recognized extensively to be one of the most dominant causes of HCC. Before the occurrence of HCC, multiple disease stages in the liver have appeared, and chronic hepatitis and cirrhosis are the most common generally. Thus, a better understanding of the multi-step natural history of HCC in HBV carriers is of great significance for determining risk at certain disease profiles. Aim: We aimed to develop a multi-state Markov model to model the process of HCC from HBV chronic infection in a prospective population-based cohort. Methods: A longitudinal prospectively population-based cohort study was conducted in seven rural sites between October 2017 and October 2021. Chronic HBV carriers aged 35 to 70 years in the target regions had to take immunochromatographic strip-tests for the detection of HBsAg again, and only the HBsAg-positive patients were eligible for the study. Patients were excluded if they were diagnosed with liver cancer or other malignancies, and had a serious illness before the beginning of the study. Eligible participants in each center were invited to undergo each consecutive round, except for those who died or who had been diagnosed with liver cancer in the previous screening round. We model the natural progression of HCC as transitioning through five different states: (1) chronic infection with the HBV; (2) chronic hepatitis; (3) compensating liver cirrhosis; (4) decompensating liver cirrhosis; (5) liver cancer. Annual transition probabilities were estimated for each state using the multi-state Markov model. Results: Between 2017 and 2021, a total of 9409 individuals participated in four rounds of screening. The probabilities of developing HCC per year for patients diagnosed with chronic HBV infection, hepatitis, compensated cirrhosis, and decompensated cirrhosis were 0.001% (95% CI: 0.001-0.013), 0.004% (95% CI: 0.0030.014), 0.087% (95% CI: 0.067-0.115), and 0.110% (95% CI: 0.058-0.200), respectively. After three years, the corresponding data have been predicted to be 0.009% (95% CI: 0.008-0.053), 0.018% (95% CI: 0.016-0.056), 0.243% (95% CI: 0.197-0.309), and 0.295% (95% CI: 0.174-0.491). Males had a higher probability to progress to liver cancer compared to females. The estimated mean sojourn times were 3.378 years (95% CI: 3.229-3.535), 1.205 years (95% CI: 1.150-1.263), 6.255 years (95% CI: 5.080-7.700), and 8.583 years (95% CI: 4.506-16.351) for patients diagnosed with chronic infection of HBV, hepatitis, compensated cirrhosis, and decompensated cirrhosis. Conclusion: The Markov model is well suited to analyze the health service databases since it is able to capture the complex progression information of chronic diseases over a continuous time. The probability of evolution to HCC depends on the state of the disease. Have you got a Conflict of Interest?: No
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640 Effect of piezo2 on the invasion and metastasis ability of colon cancer cells through the RhoA pathway H. Zhang1 1 Ningxia Medical University, Yinchuan, China Background: The malignant potential of cancer is characterized by cell movement and invasion, as well as tumorigenesis and metastasis. The main cause of death in patients with colorectal cancers is tumor invasion and metastasis. Piezo2 is a key component of the Piezo protein family, according to research. It is highly expressed in numerous illnesses, including laryngeal squamous cell carcinoma and stomach cancer, as a mechanically triggered ion channel. Its induced Ca2+influx and activation of downstream signal pathways are involved in tumor development, such as Ca2+/Wnt11/β-catenin signal regulation after Piezo2 activation, recruitment of Fyn kinase to the leading edge of cells and calpain activation, Ca2+influx activating RhoA to control the formation and orientation of SF and FAs, which leads to cell proliferation, increased vascular permeability, and tumor angiogenesis. RhoA signaling pathway is related to many important cellular activities, such as cell contraction, proliferation and migration, adhesion, cell cycle progression and gene expression. Aim: To explore the significance of mechanical stress activated by piezo2 and its effect on downstream RhoA signal pathway in the invasion and metastasis of colorectal cancer cells. Methods: immunohistochemistry， real-time fluorescence quantitative PCR (qPCR) and Western Blot, lentiviral vector, CCK-8 detection， transwell cell invasion test and scratch repair test.co-immunoprecipitation (CO-IP). Flow cytometry ，BALB/c nude mouse tumorigenesis test. Results: The positive expression rate of Piezo2 and RhoA in cancer tissue was higher than that in paracancerous tissue, . CCK-8 results showed that knocking down Piezo2 inhibited the proliferation of HCT116 and SW620 cells. Knockdown of Piezo2 significantly inhibited the invasionand migration of HCT116 and SW620. The binding of Piezo2 to RhoA protein was shown by immunoprecipitation. Flow cytometry showed that the continuous increase of Ca2+induced by high Ca2+in Piezo2 knockdown group was significantly decreased, proportion of apoptosis in LV-shPiezo2 group was significantly lower. the results of tumor formation in nude mice showed that LV-shPiezo2 inhibited tumor growth, immunohistochemical detection showed that the proliferation ability of Ki67 cells in tumor tissue of LV-shPiezo2 group was weaker than that of control group LV-NC group. Westernblot detection showed that the expression of Piezo2 was down-regulated by lentiviral vector, the expression of RhoA, ROCK, LIMK and cofilin decreased. Conclusion: Piezo2-induced Ca2+influx activates downstream signal pathways involved in tumor development, Ca2+influx can activate RhoA signal, and RhoA activation can promote the proliferation and metastasis of colorectal cancer cells. Therefore, we speculate that piezo2 may be a promising target for the treatment of colorectal cancer, and the inhibition of RhoA signal pathway is a feasible way to inhibit the invasion and metastasis of colorectal cancer. Have you got a Conflict of Interest?: No
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657 Women’s attitude towards a personalized breast cancer screening program – a qualitative study in Denmark J.V. Bigaard1, C.H. Rasmussen2, A.-B. Kvernrød2 1 Danish Cancer Society, Copenhagen, Denmark, 2Danish Cancer Society, Prevention & Information, Copenhagen, Denmark Background In Denmark, a national breast cancer screening program was introduced in 2008. Women aged 50-69 are offered mammography every second year. More than 84 pct. of the women participate after invitation[1]. The program is a one-size-fits-all, but today knowledge exists to plan screening individually based on: a blood test screening for common genes; a score for breast tissue density; lifestyle risk factors; and the woman's family history of breast cancer[2]. A feasibility study has received funding to test a personalized program considering individual cancer risks. The study will recruit 1000 women of whom half will receive an individual screening program and the other half will continue in the existing program. We present findings from a qualitative study about women’s perception of personalized risk-based breast cancer screening. Personalized screening is possible but do the women want it and are they willing to partake in a feasibility study? Aim To provide insights into women's attitudes, incentives and barriers toward participating in a feasibility study offering a personalized breast cancer screening. Methods Four focus groups with women aged 50-69 were planned in 2020, using a semi-structured interview guide. We conducted one focus group with eight women, before lock-down due to COVID-19, and the following interviews were conducted individually by telephone with 15 women. All educational levels were represented. Two further focus groups will be held in May 2022. Results The study identified four themes. Health perception and behavior:The women perceived health as a sort of balance between health concepts as exercise, weight, a healthy diet, state of mind and “hygge”/enjoying life. Perceptions of their breast cancer risk and the existing screening program. They knew the most important risk factors and were not too worried about breast cancer. They assessed the benefits of screening in relation to disadvantages such as pain and radiation exposure. Possible participation in an individual riskbased screening program?They found it relevant to spend health care resources on women in the “high risk group” who would be offered annual mammography. At the same time, they worried about ending up in the “low risk group” who will only be offered mammography every fourth year. They were not ready to give up mammograms themselves. Conclusion Not surprisingly, the findings suggest a positive perception about personalized breast cancer screening. The major barrier seems to be the wish for a more intensive program despite low risk. A planned feasibility study in Denmark must prioritize the risk communication thoroughly to recruit women for the study. 1. Biannual Quality Report in Danish 2021: https://www.sundhed.dk/content/cms/78/4678_dkms_rapport2021_offentlig_version.pdf. 2. Yanes, T., et al., Clinical applications of polygenic breast cancer risk: a critical review and perspectives of an emerging field. Breast Cancer Res, 2020.22(1): p. 21. Have you got a Conflict of Interest?: No
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658 Active case-finding improves completeness and accuracy of a rural cancer registry in South Africa N.I. Somdyala1, L. Mbuthini2, B. Müller3, N. Sithole1, A. Ncinitwa1, D. Bradshaw1,4 1 South African Medical Research Council, Burden of Disease Research Unit, Cape Town, South Africa, 2University of Cape Town, Centre for Lung Infection and Immunity, Department of Medicine, UCT Lung Institute, Cape Town, South Africa, 3F. Hoffmann-La Roche Ltd, Global Access, Basel, Switzerland, 4University of Cape Town, Department of Family Medicine and Public Health, Cape Town, South Africa Background: The quality and accuracy of the data provided by cancer registries has a significant impact on decision making. Over decades, high-income countries have been successful in monitoring their cancer burden because of well-established data abstraction techniques such as digital systems. Conversely, in low- and middleincome countries, sparsely distributed cancer registries, using alternative less costly, but imprecise methods are struggling to capture all cancer cases. A population-based cancer registry in South Africa covering a resourcelimited rural population is faced with challenges in case finding yet the quality and accuracy of the data provided has a significant impact on decision making. Aim: To assess the quality of data submitted to the rural Easter Cape Cancer Registry in South Africa using the two data quality attributes completeness and accuracy and to determine the benefits of using active and passive case-finding methods for cancer registration in this population. Methods: Data used were collected between January 2014 and December 2015 from four hospitals, two peripheral and two referral hospitals, to compare the completeness and accuracy of active and passive casefinding methods. From all four hospitals during the same period, a first set of data obtained through passive reporting was compared with a second set of data obtained through active case finding. Results: Combined for the two peripheral hospitals surveyed, active case-finding identified 95% of all cases diagnosed. In contrast, passive case finding covered significantly fewer cases among all cases identified (71% for both peripheral hospitals combined; p < 0.05). The significantly higher performance of active over passive case finding for the peripheral hospitals was not observed for the two referral hospitals. For these hospitals combined, the proportion of cases captured by active or passive case finding alone was 88% for both methods. We also provide an assessment of the accuracy of information abstracted from the medical records by each method with regard to data on tumour topography and morphology. Conclusion: Covering multiple facilities during active case finding can significantly improve quality of data, while passive case finding is challenged by data collection being confined to one specific health facility, only. Better investment in active case finding is recommended in settings with resource-distribution disparities. Have you got a Conflict of Interest?: Yes If yes please specify:: Co-author Dr Borna Müller is employed by F. Hoffmann-La Roche Ltd, a pharmaceutical producer of cancer drugs and diagnostics. No other co-author nor the project received financial support from Roche.
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660 Building Coalitions through the Sarawak Patients’ Organisation Knowledge Exchange (SPOKE) Program Y.K. Cheng1 1 Society For Cancer Advocacy and Awareness Kuching (SCAN), Kuching, Malaysia Background and context: The Society for Cancer Advocacy and Awareness Kuching (SCAN) was established in Sarawak, Malaysia in 2017 with the mission to be the voice for cancer patients. As a young NGO, SCAN is small and don’t have much influence over any decision makers. Furthermore, there exists other patient groups in Sarawak with overlapping roles with different services and different target groups. These groups have differing level of interest and commitment to cancer advocacy. Due to this, SCAN began a networking session for other cancer organizations in Sarawak in 2018. This was a precursor to SPOKE and was more for networking. After this initial session, SCAN decided to organize a similar event but with an additional aim. This successor event was names Sarawak Patients’ Organisation Knowledge Exchange (SPOKE). SPOKE was organized in 2019 and in 2021. Aim: The aim of SPOKE is to amplify patient groups’ voice by building a coalition of patient groups while increasing knowledge and sharing amongst the group. The groups can then work together to find issues that is affecting cancer patients and bring them to the right stakeholders. Strategy / Tactics: Hold SPOKE as a one or half day long workshop, inviting participants from various cancer patient’s organizations to exchange knowledge and discuss on various advocacy issues and building coalitions. Programme / Policy process: To facilitate the exchange of knowledge, talks are organized on topics that are of interest to the participants. These includes Patient Navigation, Financial Aid schemes and cancer research. Part of the agenda would also be to introduce the participants. This is done through live or online presentations. The aim is to inform what services each NGO is able to provide and hopefully increase the chances of joint projects between NGOs. Discussion on advocacy issues are planned with actionable outcomes the goal. Outcomes: During the first SPOKE, no advocacy goal was planned, consequently only a press release was made.
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The second year, an advocacy target was planned. This was to urge the state government to enforce a more stringent smoking ban at eateries. A statement to the press was issued and this was noticed by the Federal Health Minister and tweeted by him.
Tweet From Malaysian Minister of Health
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The third year, a panel discussion on “Patient Doctor Communication” was added with a breakout session to discuss on possible recommendations. These were then compiled and submitted to the oncological unit at the state hospital.
What was learnt: For smaller organizations, building a coalition of other cancer organizations is a good way to amplify advocacy power especially if other organizations are less focused towards advocacy. Starting with easier advocacy objectives might also be considered especially if the other organizations are less eager to voice out to the government. Have you got a Conflict of Interest?: No
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661 Correlation analysis of intraoperative opioid dosage with prognosis of patients with pancreatic cancer W. Zhang1, H. Zou1 1 Harbin Medical University Cancer Hospital, Pain Medicine, Harbin, China Background: Pancreatic cancer is a malignant tumor with high mortality, which mainly occurs in men and elderly patients (40-85 years old).In recent years, some studies have focused on whether factors related to surgery (such as intraoperative radiotherapy and chemotherapy, anesthesia and medication) can affect postoperative recurrence and metastasis of pancreatic cancer patients and the survival of patients. Studies have shown that intraoperative use of volatile anesthetics and opioids can inhibit the defense function of host cells, especially NK cells, NKT cells and cytotoxic lymphocytes, thus affecting tumor progression Aim: To investigate the correlation between intraoperative opioid dosage and survival and prognosis of pancreatic cancer Methods: The clinical data of 102 patients with pancreatic cancer who received surgical treatment in The Affiliated Cancer Hospital of Harbin Medical University from September 2013 to August 2018 were retrospectively analyzed. The clinical data, intraoperative anesthesia, opioid dosage,overall survivaland relapse-free survival of all patients were collected.SPSS 26.0 statistical software was used for data analysis, Cox regression analysis was used to analyze the factors affecting RFS and OS, kaplan-Meier method was used to construct the survival curve of fentanyl dosage and RFS and OS in pancreatic cancer patients, and log-rank test was performed Results: After conversion, the intraoperative opioid dosage of 102 patients was uniformly expressed as the total amount of fentanyl, and they were divided into twogroupsaccording to the median fentanyl dosage (≥2.21 mg was defined as the high-dose group, < 2.21 mg was defined as the low-dose group).The 1 -, 3 -, and 5-year overall survival rates were 65.0%, 39.4%, and 3.4% in low-dose group, and 81.9%, 50.7%, and 14.8% in high-dose group, respectively.Multivariate Cox analysis showed that patient age, BMI, tumor length, TNM stage and duration of surgery were predictors of low RFS in pancreatic cancer patients (P<0.05), and intraoperative fentanyl dosage did not affect RFS in pancreatic cancer patients.Patients' age, BMI, tumor length, TNM stage, and duration of surgery were associated with low OS in pancreatic cancer patients (P<0.05), and intraoperative fentanyl dose did not affect OS in pancreatic cancer patients. Conclusion: K-M curve showed that the survival rate of pancreatic cancer patients in the high-dose group was higher, but there was no statistical significance. Have you got a Conflict of Interest?: No
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662 Induced expression of AMOT reverses adriamycin resistance in breast cancer cells H. Zhang1, X. Wang2, J. Liu3, X. Wang4 1 Cancer hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Radiation Oncology, Luoyang, China, 2Cancer hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China, 3Cancer hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Department of General Surgery, Luoyang, China, 4Cancer hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China Background: Adriamycin (ADR) is widely used against breast cancer, but subsequent resistance always occurs. Aim: YAP, a downstream protein of AMOT, importantly contributes to ADR resistance, whereas the mechanism is largely unknown. Methods: MCF-7 cells and MDA-MB-231 cells were used to establish ADR-resistant cell. Then, mRNA and protein expressions of AMOT and YAP expressions were determined. After AMOT transfection alone or in combination with YAP, the sensitivity of the cells to ADR were evaluated in vitroby examining cell proliferation, apoptosis and cell cycle, as well asin vivoby examining tumor growth. Additionally, the expressions of proteins in YAP pathway were determined in AMOT-overexpressing cells. Results: In the ADR-resistant cells, the expression of AMOTwas decreasedwhileYAP wasincreased, respectively, and the nucleus localization of YAPwas increased at the same time. After AMOT overexpression, these were inhibited, whereas the cell sensitivity to ADR was enhanced. However, the AMOT-induced changes were significantly suppressed by YAPknockdown. The consistent resultsin vivoshowed that AMOT enhanced the inhibition of ADR on tumor growth, and inhibited YAP signaling, evidenced by decreased levels of YAP, CycD1 and p-ERK. Conclusion: Our data revealed that decreased AMOT contributed to ADR resistance in breast cancer cells, which was importantly negatively mediated YAP. These observations provide a potential therapy against breast cancer with ADR resistance. Have you got a Conflict of Interest?: No
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663 Unlocking the potential of hospital based cancer registries by the Children’s Cancer Center of Lebanon M. Yassin1 1 Lebanese American University, Information Technology, Beirut, Lebanon Background and context: The incidence of cancer is increasing with a projection of 10 to 11 million cases to be diagnosed in LMICs by 2030 according to the WHO. In view of the current Lebanese financial crisis and the ongoing paralysis of our unemployed youth, the public health sector is facing a low-resource setting for the development and maintenance of its NCR. The scarcity of information provided by the cancer registry at the ministry of public health jeopardize the epidemiological research of physicians that solely depend on cancer data for cancer control. Aim: After analyzing the cancer reports by our national cancer registry, the latest graphs date back to 2016 for counts of cases and 2015 for pediatric cases. We at the Children’s Cancer Center of Lebanon aim at achieving excellent data quality for building a HBCR. As part of our mission to support cancer patients across Lebanon, an effective HBCR serves as a tool for all hospitals in creating effective cancer programmes and serving cancer patient purposes. Strategy / Tactics: The CCCL’s mission is to cater to all children with cancer around Lebanon with a goal set to provide them with high-quality cancer care. As such, our strategy is to expand our scope of interest in dealing with cancer on a systematic approach by creating a qualified staff for the cancer registry, improving the quality and use of the HBCR, enhancing cancer data reports and assisting the MOPH in developing a cancer control plan. Process: From the 130 hospitals around Lebanon that admit cancer patients, these hospitals collect information encountered according to their coding rules. The CCCL’s information systems department with close coordination with the head of the epidemiological surveillance program at the MOPH will manage the collection of data using the active and passive methods, highly experienced registry personnel shall convert the data collected to ICD-O3, formatted data to be stored to CanReg5 and a team to develop analytical reports and graphs. Outcomes: Since the start of the project, the CCCL has signed a trust relationship with the MOPH to work closely on developing a national cancer control program. Given its leading position, CCCL has been identified as a key stakeholder by the WHO and were interviewed by experts from the IARC discussing the technical mission in developing a national cancer control and prevention strategy. What was learnt: An effective HBCR is a key component in improving quality of cancer care and health care planning by improving cancer patient care, survival rate and prevention strategies. Dictionary CCCL: Children’s Cancer Center of Lebanon HBCR: Hospital-based Cancer Registry IARC: International Agency for Research on Cancer ICD-O-3: International Classification of Diseases for Oncology, 3rd Edition LMIC: Low and Middle-Income Countries MOPH: Ministry of public health NCR: National Cancer Registry WHO: World Health Organization Have you got a Conflict of Interest?: No
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666 Increasing HPV vaccination coverage in Denmark with a campaign J.H. Mortensen1, J. Bigaard1 1 The Danish Cancer Society, Department of Prevention and Information, Copenhagen, Denmark Background In 2009, vaccination against human papillomavirus (HPV) was successfully introduced in the Danish childhood vaccination programme for girls aged 12 years. Coverage was immediately high [1]. However, a public debate questioning the safety of the vaccine led to a rapid decline in vaccination coverage from 80% to 30%. In May 2017, the Danish Health Authority, the Danish Cancer Society and the Danish Medical Association launched the national campaign‘Stop HPV – stop cervical cancer’aiming to increase vaccination coverage. In 2019 boys were included in the vaccination programme and the name of the campaign was changed to‘Stop HPV – get vaccinated’. Aim The aim of the campaign was to rebuild parents’ trust in HPV vaccination through refocusing attention on the scientific evidence of the vaccine's effectiveness and safety and the diseases HPV causes. Strategy The main strategy was to bring back focus on preventing cancer caused by HPV and to humanise the cancer diseases by putting faces on the statistics. Through the professional partnership and supporting stakeholders the campaign had a strong trustworthy foundation in terms of providing parents relevant knowledge about HPV vaccination. The campaign’s Facebook page and local activities were essential for reaching parents and answering their many questions. Outcomes The campaign succeeded in achieving a balanced communication about HPV vaccination’s safety and ability to prevent cancer caused by HPV. The high proportion of parents that were unsure about HPV vaccinating their daughters decreased from 38% in 2016 to 10% in 2022. The parents' trust led to increased vaccination coverage – from 15.237 vaccinations among girls in 2016 to 32.786 in 2021. In 2018, 2019 and 2020 more girls than a birth cohort got vaccinated indicating a catch-up among girls whose parents had postponed vaccination [2]. Today 90% of both girls and boys are HPV vaccinated [1]. What was learnt? Cooperation between authorities, health professionals and non-governmental organizations were essential to regain trust. Dialogue with parents on both social media and through local activities driven by volunteers supported that. A comprehensive social media strategy using a mix of personal stories from cancer patients and facts (heart-brain communication) proved useful as well as providing information directly to parents in their local communities. On Facebook, the campaign created a space for parents in a forum where they usually seek information. They could easily get in touch with the Health Authority, ask questions and get answers before deciding about the vaccine. The parents’ concerns was taken seriously and they were met with understanding, curiosity and personal answers.
1.The Danish vaccination register. 2022 [cited 7 April 2022] Available from: https://statistik.ssi.dk/. 2. Hansen, P.R., M. Schmidtblaicher, and N.T. Brewer,Resilience of HPV vaccine uptake in Denmark: Decline and recovery.Vaccine, 2020. Have you got a Conflict of Interest?: No
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668 Dose of intra-operative opioids has no impact on recurrence or survival in primary liver cancer L. Zhao1, H. Zou1 1 Harbin Medical University Cancer Hospital, Pain Medicine, Harbin, China Background: Intra-operative use of opioid analgesics might have impact on cancer recurrence and survival after surgery. Aim: The objective of this study was to investigate the association between the intra-operative fentanyl equivalents and survival outcome in patients with primary liver cancer after receiving hepatectomy. Methods: This was a retrospective single-center cohort study, and clinical data of 700 patients with primary liver cancer who underwent hepatectomy in Harbin Medical University Cancer Hospital from September 2013 to August 2018 were reviewed. After propensity matching, 376 patients were included. Patients were divided into high-dose and low-dose group according to the median intra-operative fentanyl equivalents (1.500mg). Kaplan Meier curve and Cox proportional hazards regression model were used. Results: Results of univariable analysis showed there were no significant differences in recurrence-free survival (P=0.136) and overall survival (P=0.444) between high-dose fentanyl equivalents and low-dose fentanyl equivalents group. The multivariable Cox regression analysis found that dose of intra-operative fentanyl equivalents was not associated with recurrence-free survival (HR: 1.119, 95%CI: 0.851 to 1.472, P=0.422) or overall survival (HR: 0.939, 95%CI: 0.668 to 1.319, P=0.715). Conclusion: The amounts of intra-operative fentanyl equivalents had no impact on recurrence-free or overall survival in patients with primary liver cancer after curative hepatectomy. Have you got a Conflict of Interest?: No
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67 Stakeholder-relevant interventions and outcomes for cancer survivorship: toward a future research agenda R. Urquhart1, S. Murnaghan1, C. Kendell2 1 Dalhousie University, Department of Community Health & Epidemiology, Halifax, Canada, 2Nova Scotia Health, Halifax, Canada Background: The Pan-Canadian Framework for Cancer Survivorship Research identifies intervention research as apriority for future cancer survivorship research. The Framework also emphasizes that survivor-relevant outcomes should be incorporated by researchers in future studies. Both are critical to conducting research that makes a real impact on cancer survivors’ care, experiences, and outcomes. Aim: This study sought to identify stakeholder-relevant interventions and outcomes pertinent to post-treatment follow-up care to inform future research and ensure it aligns with what stakeholders deem most important in the follow-up period. Methods: We conducted a descriptive qualitative study using semi-structured interviews with stakeholders from across Canada. Stakeholders included survivors, family/friend caregivers, oncology providers, primary care providers, and cancer system decision-/policy-makers. Data analysis used techniques commonly employed in descriptive qualitative research, including coding, grouping, detailing, and comparing the data. Results: Forty-four participants took part in this study: 11 survivors, seven family/friend caregivers, 18 health care providers, and eight decision-/policy-makers. Stakeholder-relevant interventions were categorized into five groups: information provision, peer support, navigation, knowledge translation interventions, and caregiverspecific supports. Thirteen stakeholder-relevant outcomes were categorized into five outcome domains: psychosocial, physical, economic, informational, and patterns and quality of care. In the psychosocial domain, one's reintegration after cancer treatment was described by all stakeholder groups as one of the most important challenges faced by survivors and identified as a priority outcome to address in future research. Conclusion: This study provides a roadmap for future research and practice in cancer survivorship care.The succinct suite of stakeholder-relevant interventions and outcomes, common across cancer types and populations, identified in this study should be used in future research and quality improvement initiatives. Have you got a Conflict of Interest?: No
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671 Variation in cancer patients’ survival in relation to their reported care experiences S. Alessy1,2, E. Davies2, J. Rawlinson3, M. Baker3, M. Lüchtenborg2 1 Saudi Electronic University, Public Health Department, College of Health Sciences, Riyadh, Saudi Arabia, 2King's College London, Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, Faculty of Life Sciences & Medicine, London, United Kingdom, 3National Cancer Research Institute, Patient representative Group, London, United Kingdom Background: Patient experience is evolving as a measure of care quality in many care settings. Aim: To examine whether having a better care experience with a Clinical Nurse Specialist (CNS) is associated with better cancer patients’ survival in England. Methods: We identified 99,371 colorectal, lung, breast and prostate cancer patients who reported their care experience with a CNS from the National Cancer Patient Experience Survey (2010-14) and English cancer registration linked dataset. We categorized patients’ experiences into three groups (excellent, non-excellent, and no CNS name was given), across three aspects of CNS care: the ease of contacting their CNS, feeling that a CNS had listened to them, and the degree to which explanations given by a CNS were understandable. We used univariable and multivariable Cox proportional hazards regression analyses to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) by patient experience for each cancer adjusting for age, sex, socioeconomic deprivation, ethnicity, residence area, route to diagnosis, and disease stage at diagnosis. Results: Among the three compared groups (excellent experience, non-excellent experience, and no CNS name given), patients who reported not being given a CNS’ name had the lowest survival. In the adjusted Cox regression analysis, the results show that among those who reported not being given a CNS’ name, the highest risk of death was in those with colorectal, breast and prostate cancers only (colorectal HR: 1.40; 95% CI: 1.32–1.84; breast HR: 1.34; 95% CI: 1.25-1.44; prostate HR: 1.09; 95% CI: 0.99–1.13). However, this association seemed reversed among lung cancer patients, although attenuated when accounting for potential confounders. The possibility that reverse causation may explain these findings was considered where possible. Conclusion: A limited association was found between a better care experience with CNS and better cancer patients’ survival in England. These findings provide new evidence of the vital contribution CNS may make to cancer survival and suggest CNS’ input and support should be available to all patients after the diagnosis. Have you got a Conflict of Interest?: No
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679 Intraoperative opioids have adverse effects on the survival and relapse-free survival of patients with glioma L. Xuejiao1, Z. Huichao1 1 Harbin Medical University Cancer Hospital, Pain Medicine, Harbin, China Background: In recent years, a large number of studies have explored the relationship between opioids and the survival time of cancer patients, but no unified conclusion has been reached. Glioma is a malignant tumor with high risk of recurrence. In glioma patients undergoing surgical resection under general anesthesia, using opioids for intraoperative analgesia, some studies have found that opioids shorten the overall survival(0S) and recurrence-free survival(RFS) of patients. We explored the relationship between opioids and OS, as well as its effect on RFS. Aim: To compare the difference in OS and RFS in glioma patients with different doses of opioids. Methods: We retrospectively analyzed 247 glioma patients with brain resection treated with intravenous opioid infusion for analgesia under general anesthesia. All opioids were converted into fentanyl equivalent, patients were divided into the high and low dose groups. A statistically significant difference between each variable and the fentanyl equivalent was determined by the X2 test. Ineligible samples were excluded after propensity score matching for the full data.The remaining samples underwent X2 test、univariate and multivariate cox analyze the relationship of each variable with OS and RFS. The relationship between high and low dose group was studied by Kaplan-Meier survival analysis. SPSS25.0 statistical software was used for date analysis. Results: Univariate cox test of the OS and RFS of the glioma patients included in the study was associated with fentanyl equivalent. After Kaplan-Meier survival analysis, OS and RFS in the high-dose group were lower than those in the low-dose group, P=0.040. Conclusion: The results show that OS and RFS were shorten by high-dose opioids in glioma patients. Have you got a Conflict of Interest?: No
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68 Returning to work after cancer treatment: a longitudinal qualitative study R. Urquhart1, S. Scruton1, C. Kendell2 1 Dalhousie University, Department of Community Health & Epidemiology, Halifax, Canada, 2Nova Scotia Health, Halifax, Canada Background: Return to work (RTW) is an important part of cancer recovery, with research showing that it is a means of returning to normality, providing daily structure, and offering a distraction from one’s diagnosis. Despite these benefits, unemployment is higher, and productivity, earnings, and work retention are worse for cancer survivors who RTW compared to persons without a cancer history. Many survivors endure physical and/or psychological side effects during their recovery, which can hinder an optimal RTW process. Few studies have investigated the RTW process and how survivors’ needs and experiences change over time. Such information, however, is critical to supporting cancer survivors’ recovery and optimizing their RTW outcomes. Aim: This study sought to explore 1) cancer survivors’ needs related to RTW and how these changed over time and 2) their experiences reintegrating back to work and what helps and hinders this process. Methods: A prospective qualitative longitudinal design was employed using the principles of phenomenological inquiry. Cancer survivors took part in three in-depth interviews: at the end of treatment, and 3 and 9 months after the first interview. Survivors were 18 years and older, employed at the time of their diagnosis, had completed or were nearing completion of primary treatment (e.g., surgery, radiotherapy, and/or chemotherapy), and had an intention to RTW. Transcripts were analyzed using constant comparative analysis, guided by the Cancer and Work model. Results: 38 in-depth interviews were conducted with 13 participants. Participants resided in four Canadian provinces: Nova Scotia, Ontario, Quebec, and Alberta. Most (76.9%) identified as a woman and most (61.5%) were 40 years of age or older. The resultant themes were: 1) supports received or desired to enable RTW; 2) limited understanding of the long-term impacts of a cancer diagnosis and its treatment; 3) worries and self-doubts about returning to work; and 4) changing perspectives on life and work after cancer. Conclusion: Cancer patients returning to work after treatment often experience challenges throughout the process, including varying levels of support from others and a range of ongoing effects and decreased motivation to RTW. There is a clear gap in terms of the professional supports available to these individuals. Future research should focus on investigating how to improve both quality and accessibility of supports in a way that is personalized to the individual. Have you got a Conflict of Interest?: No
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680 Assessment of cervical and breast cancer screening in Latin America and Caribbean: CanScreen5/CELAC project I. Mosquera1, S. Luciani2, C. Barajas2, M. Maza2, S. Benítez Majano2, E. Lucas1, L. Zhang1, P. Basu1, A. Carvalho1 1 International Agency for Research on Cancer, Lyon, France, 2Pan American Health Organization, Washington, United States Background: In the Community of Latin American and Caribbean States (CELAC), breast cancer (BC) and cervical cancer (CC) are the first and third causes of cancer death among females (13.5 and 7.6/100,000). Mortality for both cancers can be decreased through a population-based screening of eligible women. Aim: To describe characteristics of national programmes for CC and BC screening in CELAC. Methods: Representatives of the Ministries of Health of 33 countries were invited to participate in the CanScreen5/CELAC project. Twenty-seven countries took part in a cancer screening training programme during 2020-2021, and 24 submitted data using standardized questionnaires. Data from 19 countries were reviewed, cross-checked against policies, protocols and guidelines, discussed, and validated. Results: Screening programmes were reported by 17 countries for CC and by 12 for BC. There was a great variability in the screening methods, interval, and target age. For CC, screening with cytology every 3 years was the most frequently reported (n=10; 58.8%). Only 6 countries (35.3%) used a single primary test. Most countries had a dedicated budget for screening (n=12, 70.6%), a programme coordinator (n=15; 88.2%) and a responsible for quality assurance (QA; n=10; 58.8%). Only 4 countries had a system to invite women individually (23.5%). Out of pocket expenditure was needed in 1 country for screening (5.9%), 6 for diagnosis (35.3%) and 5 for treatment (29.4%). Mexico and Central America countries (n=6) showed a high level of organization of the screening programme with an active contact of screen-positive women and cancer cases, and documented performance indicators, though only one country had published evaluation reports in the last 5 years. BC screening was mainly conducted with mammography every 2 years (n=6; 50.0%). Compared with CC screening, there was a lower proportion of countries with dedicated budget (n=7; 58.3%) and a programme coordinator (n=10; 83.3%), but higher regarding having a responsible for QA (n=9; 75.0%). Women had to pay for screening in 2 countries (16.7%), for diagnosis in 5 (41.7%) and for treatment in 4 (33.3%). Seven countries actively contacted screen-positive women and cancer cases (58.3%). Only 5 countries had documented performance indicators (41.7%; none from the Caribbean), with 4 having published reports in the last 5 years (33.3%). Conclusion: While CC and BC screening activities are being conducted in CELAC, large gaps were noted in the organization of services, active invitation to screening, and active follow-up of screen-positive women. CELAC governments should guarantee sustainable funding, implementation of QA, and universal access to cancer diagnosis and treatment to improve their programmes. Moreover, data are scarce, preventing proper monitoring and evaluation of the programmes. This stresses the need for countries to strengthen their health information system and improve their screening programme organization. Have you got a Conflict of Interest?: No
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681 Facilitating Access to high-cost drugs (Trastuzumab) at reduced rates for advanced breast cancer in Nigeria H. A-Arome1,2, D.Z. Shinkafi-Bagudu, S. Alabi2, D.R. Hassan2,3 1 Medicaid Cancer Foundation, Patient Access to Cancer Care- PACE, Abuja, Nigeria, 2Medicaid Cancer Foundation, Abuja, Nigeria, 3Medicaid Cancer Foundation, Board of Scientific Advisors, Abuja, Nigeria Background and context:Access to appropriate therapy for breast cancer patients is challenging in low- and medium-income countries (LMICs) and dire in those with advanced disease. The rising burden of metastatic breast cancer is linked to a wide disparity in access to effective and affordable targeted therapies. Delayed diagnosis, high cost of treatment therapies, refusal or abandonment of therapy, inadequate access to trained providers contribute amongst other parameters to the poor outcomes seen. Aim: The Patient Access to Care Program (PACE) is a unique program established by the Medicaid Cancer Foundation (MCF-a non-profit, non-governmental organization) based on the need to have a structured, affordable access to therapies that can treat, extend life and palliate symptoms for individuals with breast cancer. PACE represents an innovative cancer care model that has set the standard for access programs for other targeted or innovative therapies. The purpose of this article is to describe the structure of PACE as well as important lessons that have contributed to the success of the program. Strategy / Tactics: Efficient organization and Strong advocacy leading to innovative partnerships with pharmaceutical companies to make targeted therapies such as trastuzumab (Herceptin), accessible and affordable to all medically and financially eligible patients in Nigeria. Programme / Policy process: A sensitisation on the availability of targeted therapy was carried out, data was stratified based on sex, diagnosis (advanced stage), referring hospital/physician, consent, and proof of ability to co-pay. The discounted cost of drugs was further subsidized by Medicaid Cancer Foundation and made available to the patients who have also been taken through the process. Outcomes: To date, based on the outcome of their immunohistochemistry (IHC) results, 46 patients have received a total of 305 vials of drugs between 2019 and 2021. The introduction of PACE has resulted in a 54% reduction in cost price of the two leading breast cancer chemotherapies on the program. We have also recorded a 80% upturn in enquiries translating to commencement of treatment. What was learnt: This article may assist other organizations with the development of successful and far reaching patient access programs in the nearest future. Have you got a Conflict of Interest?: No
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682 Cost of treatment for neoplasms in underdeveloped regions of China based on SHA2011 and Random Forest Model h. xiaobin1, c. xinyao1, W. cong1, H. yuansheng2, M. Yumei2, Q. Lei3, W. Huaiqi4 1 Lanzhou university, Lanzhou city, China, 2Health Commission of Gansu province, Lanzhou city, China, 3Lanzhou University, Lanzhou city, China, 4Health Propaganda&Education Center of Gansu, Lanzhou city, China Background: China is facing a heavy burden of cancer.Almost 22% of global new cancer cases and close to 27% of global cancer deaths occurred in China.Researches on the cost of cancer in developing countries are rare. Many patients with cancer in northwest of China are typically either receiving therapy, thereby sending their families into poverty, or abandoning treatment. Aim: This study applied the System of Health Accounts recommended by WHO in 2011 (SHA 2011) to examined the economic burden of neoplasm in Gansu, China, and designed to identify problems in the entire financial flow of neoplasm treatment service delivery in undeveloped region of northwest China, including financing scheme, services provider, disease and patients distribution. Methods: Macro data was obtained from official year book and sampling data were collected through multistage stratified sampling method from medical health and care institutions with different levels in Gansu province. 1105 institutions were investigated, and a total of 10,640,000 cases information were collected, from which a total of 305,850 cases about neoplasm patients were extracted in the present study. Top-down approach was performed to decompose the Current Curative Expenditure (CCE) of neoplasm and the formula to calculate CCE was introduced step-by-step. Results: The CCE of neoplasm amounted to 4442.269 million CNY in Gansu 2017,more than half of which were directly burdened by patients and their family, and patients were over-reliant on inpatient service provided by hospitals while the service delivered by primary health care establishment were not fully utilized. The middle-aged adults (40-64) and elderly (over 65 years old) consumed majority of expenditure, and the age of female (45-54 years old) with peak of CCE of neoplasm was almost 15 years younger than male (60-64 years old). Additionally, for male, the top three neoplasms in terms of consuming CCE of neoplasm were stomach cancer, colorectal cancer and lung cancer, whereas that were uterine leiomyoma, breast cancer as well as cervix uteri cancer for female. For neoplasms inpatients, Multiple linear regression analysis showed that the influencing factors of hospitalization expenditures included the length of stay, institutional level, operation, proportion of drug, gender, serious condition, age, insurance, institutional type and neoplasms(P<0.05）.The random forest regression model showed that the top 5 influential factors in the ranking of importance were the length of stay, operation, proportion of drug,neoplasms and institution level. Conclusion: SHA 2011 is a powerful tool to describe financial flow and to link expenditure to treatment of disease, and in aspect of treatment of neoplasm in Gansu province, the unreasonable financing scheme, unbalanced allocation of medical resource to heath provider, as well as the distinct distribution characteristics of beneficiaries’expenditure should attract wide attention to policy maker.
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Table 1 – The CCE of neoplasms classified by ICD-10 and service function(top 5) Inpatient Outpatient Totals Rank Neoplasms Million Million Million % % % CNY CNY CNY stomach 1 583.011 91.0 57.320 9.0 640.331 14.4 cancer colorectal 2 403.292 93.5 28.136 6.5 431.428 9.7 cancer 3 lung cancer 358.628 92.0 31.278 8.0 389.906 8.8 uterine 4 250.375 84.2 47.059 15.8 297.435 6.7 leiomyoma breast 5 210.346 74.8 70.747 25.2 281.093 6.3 cancer total 3927.079 88.4 515.190 11.6 4442.269 100.0 #
#
#
*
The malignant neoplasms in central nervous system The first and second column percentages refer to proportion of outpatient and inpatient expenditurein the totalCCE of a certain neoplasm, and the last column percentage refers to proportion of a certain neoplasm’s expenditure in the total CCE of all neoplasms. #
Table 2 – The CCE of neoplasms classified by ICD-10 and gender(top 5) Males Females Rank Million Million Neoplasms % Neoplasms CNY CNY Stomach Uterine 1 472.723 22.3 272.218 cancer leiomyoma 2 Lung cancer 272.918 12.9 Breast cancer 259.562 Colorectal Cervix uteri 3 249.765 11.8 247.029 cancer cancer Esophagus Colorectal 4 165.271 7.8 181.663 cancer cancer Stomach 5 Liver cancer 100.557 4.7 167.608 cancer total 2123.629 100.0 total 2318.640
2
% 11.7 11.2 10.7 7.8 7.2 100.0
3
Have you got a Conflict of Interest?: No
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685 The Value of 18F-PSMA-PET/CT for Initial Diagnosing and Staging Prostate Cancer with PSA in the Gray Area S. Bian1, F. Yao1, D. Zhu1, Y. Yang2, K. Tang2, X. Ji2 1 The First Affiliated Hospital of Wenzhou Medical University, Department of Radiology, Wenzhou, China, 2The First Affiliated Hospital of Wenzhou Medical University, Department of PET/CT, Wenzhou, China Background: The prostate cancer (PCa) is a common malignant tumor of the male urinary system, the incidence and mortality of which are increasing rapidly.The early symptoms of PCa are not obvious. Therefore, early diagnosis and stage have a significant impact on the management of PCa. According to European Association of Urology(3), serum prostate-specific antigen (PSA), which includes free PSA (fPSA), PSA density (PSAD), and free/total PSA (f/t PSA), is a common biomarker for detecting PCa, guiding pathological biopsy and clinical treatment. PSA level is associated with an increased diagnosis of PCa, but it has a somewhat high false positive rate because of prostatitis or benign prostatic hyperplasia (BPH). In order to diagnose and stage PCa, PSA screening must combine with other clinical parameters or imaging examinations. Nonetheless, tPSA levels between 4.0 ng/ml and 10.0 ng/ml are often called the “gray area”, within which it is controversial to diagnose and stage PCa. Aim:To investigate the value of 18F-PSMA-PET/CT for initial diagnosing and staging prostate cancer in patients with prostate-specific antigen (PSA) in the gray area. Methods: 115 patients with PSA gray area (serum tPSA 4ng/ml-10ng/ml) from March 2019 to September 2021 were analyzed retrospectively. All patients were confirmed as prostate cancer by prostate biopsy or radical prostatectomy (RP) pathology. A total of 115 patients underwent 18F-PSMA-1007 PET/CT to evaluate their TNM stage and guide treatment. The correlation between maximum standardized uptake value (SUVmax), PSA level, prostate-specific antigen density (PSAD), International Society of Urologic Pathology (ISUP) grade and pathological T stage were analyzed by non-parametric spearman. Calculated the sensitivity, specificity, positive predictive value and negative predictive value of 18F-PSMA-PET/CT in the diagnosis of metastasis. Results:There were 115 patients with PSA gray area prostate cancer (mean PSA 6.79 ± 1.51 ng / ml). 18F-PSMA1007 PET/CT showed nodular or diffuse abnormal accumulation of radioactivity in the prostate in all patients. Pathological T staging was positively correlated with SUVmax of prostate lesions (r=0.36, P < 0.001, respectively), but not with tPSA level and PSAD (P > 0.05). The sensitivity, specificity and accuracy of 18F-PSMA-1007 PET/CT in detecting lymph node metastasis were 85.71%, 98.66% and 98.42%. It is also effective in the diagnosis of bone metastasis, which should change treatments of patients with bone metastasis. Conclusion: 18F-PSMA-1007 PET/CT has more high detection ability in detecting the stage of primary tumor in patients with PSA gray area, compared with tPSA level and PSAD. Within this PSA range, it also has high accuracy for regional lymph node metastasis and bone metastasis. In conclusion, 18F-PSMA-1007 PET/CT can provide important clinical value for initial diagnosing and staging of patients with PSA gray area.
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Table 1A: Correlation between SUVmaxof primary tumors and other parameters pathological tPSA PV T stage P 0.020 0.859 ＜0.001
PSAD
ISUP grade
0.394
0.004
r 0.363 0.271 0.021 Table 1B: Correlation between pathological T stage and other parameters SUVmax tPSA PV P 0.903 0.990 ＜0.001
0.101
0.332
PSAD 0.549
ISUP grade 0.002
r
-0.071
0.348
0.363
0.271
0.001
Table 2:Accuracy of 18F-PSMA-PET/CT forN stage For RP patients analysis n=74 HP+(n=4) HP-(n=70) PET+(n=7) 4 3 PPV 57.14% PET-(n=67) 0 67 NPV100% SE100% SP 95.71% ACC 95.95% For PLND nodes analysis n=380 HP+(n=7) HP-(n=373) PET+(n=11) 6 5 PPV54.55% PET-(n=369) 1 368 NPV 99.73% SE85.71% SP98.66% ACC98.42% Table 3: Characteristics of the patients with bonemetastasis (LNMs)on18F-PSMA-PET/CT Patients No. Age tPSA Bone metastasis Bone metastasis site on Regular follow-up (yr) (ng/ml) SUVmax PET/CT (cm) 1 85 5.78 8.6 T10 vertebral body Back painand then increase of cancer focus on ECT 2 72 6.12 7.0 T9vertebral body ECT: neg no changes on other images 3 80 5.55 19.2 bilateral iliac bones and left Lumbar pain and then increase ischium of cancer focuson ECT 4 81 5.18 13.5 right pubis ECT: pos regularendocrine therapy 5 66 7.72 8.3 L1vertebral body ECT: pos regularendocrine therapy 6 75 8.52 11.2 T5vertebral body Bone pain and no bone concentration in ECT after treatment 7 72 4.99 24.3 whole body bones Bone pain and decreased metabolism in PET/CT after treatment 8 73 7.80 8.8 whole body bones Bone pain relieved after treatment neg: negative; pos: positive
Have you got a Conflict of Interest?: No
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Follow up time (month) 34 8 14 34 30 8
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689 Proportion and Number of Cancer Cases and Deaths Attributable to Lifestyle Risk Factors in Vietnam L. Ha1, A. Tran1, L. Bui2,3, T. Pham1,3,4 1 Hanoi Medical University, Hanoi, Vietnam, 2Harvard T.H. Chan School of Public Health, Nutrition, Boston, United States, 3Research Advancement Consortium in Health, Hanoi, Vietnam, 4Harvard T.H. Chan School of Public Health, Epidemiology, Boston, United States Background: The burden of cancer in Vietnam has been growing rapidly in recent decades. Many types of cancer are attributable to lifestyle risk factors; however, the extent of how these factors contribute to the cancer burden in Vietnam is not well-documented. Aim: To estimate the number and proportion of cancer cases and deaths attributable to five lifestyle risk factors (including tobacco smoking, second-hand smoking, alcohol consumption, high body mass index compared to a reference population, and inadequate physical activity) in Vietnam in 2020. Methods: Population attributable fractions (PAFs) were calculated for relationships of risk factors and cancer types with sufficient evidence according to International Agency for Research on Cancer (IARC) or convincing strong evidence according to the World Cancer Research Fund/ American Institute for Cancer Research (WCRF/AICR). Relative risks (RRs) were retrieved from meta-analyses, pooled analyses of cohort studies, or cohort studies where possible through a systematic PubMed/MEDLINE search. Prevalence of exposure to risk factors was obtained from the most current available nationally representative population surveys in Vietnam. Cancer cases and deaths were obtained from the GLOBOCAN 2020. Results: An estimated 40.3% of all cancer cases in men (39,911 of 98,916 cases) and 7.1% of all cancer cases in women (5952 of 83,647 cases) were attributable to these lifestyle risk factors (Fig. 1). The proportions of cancer deaths attributable to these lifestyle risk factors were 44.0% in men (32,766 of 74,481 deaths) and 8.4% in women (4041 of 48,209 deaths) (Fig. 2). Tobacco smoking was the leading cause of cancer cases and deaths in men, with PAFs of 33.9% and 37.2%, respectively, followed by alcohol consumption (5.5% and 5.4%, respectively) and high BMI (3.1% and 3.5%, respectively). While in women, high BMI accounted for the highest proportion of cancer cases (3.2%) and second-hand smoking accounted for the highest proportion of cancer deaths (3.2%). Overall, among all cancer types, lung and upper aerodigestive tract cancer cases and deaths could have been reduced at least by half if these lifestyle risk factors had been eliminated.
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Figure 1: Proportion and number of all cancer cases attributable to lifestyle risk factors in Vietnam in 2020, by sex and exposure.
Figure 2: Proportion and number of all cancer deaths attributable to lifestyle risk factors in Vietnam in 2020, by sex and exposure. Note for figures: All risk factors: all studied risk factors; BMI: body mass index; PAF: population attributable fraction.
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Conclusion: To reduce cancer incidence and mortality, preventive actions focusing on tobacco control are likely to have the most significant impact, especially in men. More research is needed to identify modifiable risk factors among women in Vietnam. Have you got a Conflict of Interest?: No
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69 Respirando Esperanza A. Ortiz1, R. Alvarado1 1 Unidos Contra el Cáncer, Curridabat, Costa Rica Background: In 2012, it was estimated that 1.6 million people died from lung cancer worldwide; rates are higher in less developed regions, both in men and women (1). Lung cancer mortality rates in men are declining in most Western countries while trends in women tend to exceed or stabilize according to the epidemiological situation in men (2). In the region of the Americas, both the crude rate and the age-adjusted rate show higher mortality in men (1). Aim:To analyze the epidemiological behavior and socio-institutional response of lung cancer in Costa Rica Methods: the analysis of the epidemiological behavior of lung cancer was defined, through a descriptive and analytical study with a cross-sectional quantitative approach; the study periods were from 2000 to 2016 for incidence and from 2000 to 2019 for mortality. In a second phase, the public and private institutional response in Costa Rica was identified, given the epidemiological situation of lung cancer in Costa Rica. For this, a documentary review was developed and different actors were consulted through semi-structured interviews. Finally, in a third phase, a qualitative group interview was conducted in which patients diagnosed with lung cancer participated. The project was endorsed by the Scientific Ethics Committee of the Santa Paula University and registered with the National Council for Health Research (CONIS). Results: Lung Cancer Incidence, Costa Rica: According to the National Registry of Tumors of the Ministry of Health, the incidence of lung cancer in both sexes, between the period of 2000 and 2016 in Costa Rica, registered a relative decrease of 9.00% comparing both periods. Lung Cancer Mortality, Costa Rica: In both sexes, Costa Rica showed a constant linear growth in the crude lung cancer mortality rate between 1994 and 2019, with a relative increase of 11.11% comparing both periods. Conclusion: • Regarding mortality from lung cancer, from 1994 to 2019 it shows a constant growth in rates. • Costa Rica has positioned the cancer issue as part of the public health agenda, a process in which the Costa Rican Social Security Fund has played a central role. • The Ministry of Health developed the National Plan for the Prevention and Control of Cancer in Costa Rica, is currently coordinating the new proposal at the national level. • Among the main challenges at the country level in the field of lung cancer, the following stand out: promoting early diagnosis for lung cancer by strengthening the first level of care, as well as addressing the stigmatization of smokers with lung cancer and providing of resources to the health services network to improve the institutional response. Bibliographic references 1. Didkowska J, Wojciechowska U, Mańczuk M, Lobaszewski J. Lung cancer epidemiology: Contemporary and future challenges worldwide. Ann Transl Med. 2016;4(8):1–11. 2. Jemal A, Bray F, Ferlay J. Global Cancer Statistics: 2011. CA Cancer J Clin [Internet]. 1999;49(2):1,33-64. Have you got a Conflict of Interest?: No
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692 Reducing cancer care disparities in Nova Scotia, Canada: the power of community advocacy and engagement. K.J. Kaal1,2, R. Urquhart1, H. Hollenhorst3, J. Kirby4, C. Smith3, L. Hill3, J. Tarsuk3, K. Rigby3, M.A. Morrison3, D. Bethune3 1 Dalhousie University, Community Health & Epidemiology, Halifax, Canada, 2Nova Scotia Health, Halifax, Canada, 3Nova Scotia Health, Cancer Care Program, Halifax, Canada, 4Dalhousie University, Department of Bioethics, Halifax, Canada Background/contextYarmouth, NS and surrounding counties have the highest proportion of cancer patients in the province who travel more than 2.5 hours to access cancer care. Over the years, there were repeated calls from the community for more equitable access to cancer care services, specifically for radiation treatment closer to home. In 2017, the Cancer Care Program of Nova Scotia initiated a comprehensive, government and health authority-supported review of cancer services for the area to facilitate high-quality decision making about the allocation of limited healthcare resources. AimTo assess cancer services needs in a rural area of Nova Scotia informed by rigorous information gathering and community engagement. Strategy A multidisciplinary steering committee including experts and representatives of all stakeholder groups, guided by a healthcare ethicist, was formed to review feasibility and sustainability of adding radiotherapy services at the local hospital. Community engagement through focus groups and survey and communication was integral to the review. Transparency and equipoise were critical to ensure the trust of all stakeholders. Regular electronic, virtual, and in-person updates to all stakeholders and media were provided. Program process The review culminated in a one-day carefully planned deliberative engagement session facilitated by the healthcare ethicist, with community interest group leaders, patients, cancer program and provincial administrative leaders, experts in radiation oncology and cancer population analytics, and nursing. Three initial recommendations were discussed and voted on via written ballot. Instead of radiotherapy, a high majority voted in favor of service enhancements extending beyond the potential benefit of building a radiotherapy unit in Yarmouth. Outcomes Considerable learnings on all sides, understanding of the actual needs, complexities, and requirements of providing equitable, high-quality cancer care for the population occurred. A business case detailing an equityenhancing package of services was developed and submitted to the Nova Scotia government. Publicly-funded components include the adoption of evidence-based techniques of radiotherapy delivery using fewer treatments (hypofractionation), travel support, provision of lodging, improved appointment coordination to minimize trips to the major cancer center, enhanced use of distance technology for follow-up visits, and enhanced psychosocial support. This innovative model of community-based oncology enhances equitable access to cancer care in Yarmouth and serves as a model for other community oncology centers in Canada. What was learned A structured, stakeholder-driven process including the participation of community members is crucial in the context of complex decision making about the allocation of limited healthcare resource. It serves an important role in capturing community needs and allocation of resources to equitably address those needs. Have you got a Conflict of Interest?: No
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694 Diagnostic accuracy of multitarget stool DNA testing for colorectal cancer screening: meta-analysis R. Dolatkhah1, S. Dastgiri2, M. Asghari Jafarabadi3, H. Mashhadi Abdolahi2, M.H. Somi4 1 Tabriz University of Medical Sciences, Hematology and Oncology Research Center, Tabriz, Iran, Islamic Republic of, 2Tabriz University of Medical Sciences, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran, Islamic Republic of, 3School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran, Zanjan, Iran, Islamic Republic of, 4Tabriz University of Medical Sciences, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran, Islamic Republic of Background: Colorectal cancer (CRC) is the third most common cancer, but is the second leading cause of cancer-related death, worldwide. CRC screening programs reduce approximately 60% of cancer related deaths; however, the population clinical trials did on an intention to screen basis and provide a secure evidences for fecal tests’ diagnostic accuracy. Aim: Despite reliable and comprehensive studies in the last two decades, additional evidence-based analysis is needed to prove the diagnostic accuracy and specificity of the multi-target stool DNA (Mt-sDNA) test. Therefore, this study aimed to collect and summarize test data and conduct as a systematic review and meta-analysis, with respect to the Mt-sDNA test sensitivity and specificity, compared to colonoscopy. Methods: All manuscripts were screened for eligibility according to PICO criteria, date of publication, and type of study. Studies with reliable and available end points (SE, SP, true positives (tp), false positives (fp), false negatives (fn), true negatives (tn), number of diseased patients (CRC and advanced adenoma), and number of healthy controls were included. Participants were a normal population at an average risk of developing CRC. Study appraisal was performed by two independent investigators. We designed and performed this study and meta-analysis following the PRISMA guidelines. The systematic review question was the efficacy of Mt-sDNA tests for detecting CRC and any pre-cancerous lesions (advanced adenoma) compared with colonoscopy, as a gold standard method, in a normal population (asymptomatic persons with an average risk of developing CRC). We did not consider any geographic considerations in the search strategy. Inter-study variation in sensitivity and specificity, ROC area with 95% CI, heterogeneity (using the Chi-squared test), and inconsistency (using the I-squared test) were assessed. Publication bias across the studies was assessed with Deek’s asymmetry test.
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Results: Meta-analyses of the Mt-sDNA test showed a combined sensitivity of 89%, 51%, and 76% for the detection of CRC, advanced adenoma (AA), and combined CRC and AA, respectively. The overall specificity was 91%, 89%, and 90% for the detection of CRC, AA, and combined CRC and AA, respectively. Meta-analyses of the FIT test showed a combined sensitivity of 76%, 25%, and 55% for detection of CRC, AA, and combined CRC and AA, respectively. The combined specificity was 96%, 93%, and 95% for the detection of CRC, AA, and combined CRC and AA, respectively. Heterogeneity analysis showed that there was substantial heterogeneity between the 11 studies with the multi-target stool DNA test (I2= 100-99), and between the 6 studies with the FIT test (I2= 94-99) compared with colonoscopy. Conclusion: Mt-sDNA had significantly acceptable diagnostic accuracy for CRC and AA diagnosis, rather than FIT alone, but still has lower sensitivity and specificity than colonoscopy. Comparing Multitarget Stool DNA and FIT tests, Advantages and Disadvantages Recommended Sensitivity6 Specificity6 Procedure Harms Cost Testing Colorectal Advanced Adenoma Interval Cancer MT- Every 3 Years 92% 24%-42% sDNA Test FIT Annually 76%-95% 27%-47%
87%
Simple
89%-96% Simple
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Availability Diet and/or Patient SideMedication Compliance affecting Restriction Rate Detection Biases Non- Costly Less No nearly 70% Unaffected invasive Available Non- More More No invasive costAvailable effective
nearly 14% Affected
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Have you got a Conflict of Interest?: No
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698 Productivity loss related to premature cancer mortality in Brazil between 2001-2030 M. De Camargo Cancela1, J.E. Monteiro dos Santos1, L. Borges Lopes de Souza1, L.F. Leite Martins1, D.L. Bezerra de Souza2, A. Barchuk3, P. Hanly4, L. Sharp5, A. Pearce6, I. Soerjomataram7 1 Instituto Nacional de Câncer, Division of Cancer Surveillance and Data Analysis, Rio de Janeiro, Brazil, 2Universidade Federal do Rio Grande do Norte, Postgraduate Programme in Collective Health, Natal, Brazil, 3Petrov Research Institute of Oncology, ST Petersburg, Russian Federation, 4National College of Ireland, School of Business, Dublin, Ireland, 5Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom, 6The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, 7International Agency for Research on Cancer, Cancer Surveillance Branch, Lyon, France Background: Studies assessing productivity loss related to premature cancer mortality in Brazil are limited. This study reported Years of Potential Productive Life Lost (YPPLL) and productivity costs due to premature cancer mortality in Brazil between 2001-2015 and projected these up to 2030. Aim: To estimate productivity costs between 2001-2030 due to cancer premature mortality Methods: We defined premature mortality as deaths occurring before retirement age: 65 and 60 years for men and women respectively. Mortality data from all types of cancer were obtained from the Brazilian Ministry of Health. Economic and population data were obtained from the Brazilian Institute of Geography and Statistics databases. The Human Capital Approach method was applied to estimate productivity costs. Results: Between 2001-2015, there were 1.0 million premature cancer-related deaths (591,641 among men and 437,917 among women). Between 2016-2030, we predict 1.3 million premature deaths (737,917 among men and 617,181 among women). This equated to 14.9 million YPPLL, corresponding to USD 48.6 billion in total productivity costs between 2001 and 2015, and to 17.3 million YPPLL and USD 92,9 billion for the period 20162030. Among men, the highest productivity costs were for lung and trachea (USD 5.0 billion in 2001-2005 to 7,6 in 2026-2030), stomach (USD 4.0 billion in 2001-2005 to 6.6 in 2026-2030) and lips, oral cavity and pharynx (USD 3.7 billion in 2001-2005 to 6.4 in 2026-2030). Among women, the highest costs were observed for breast (USD 2.9 billion in 2001-2005 to 7.1 in 2026-2030), cervical (USD 2.0 billion in 2001-2005 to 4.4 in 2026-2030) and lungs and trachea (USD 958 million from 2001-2005) being replaced in the third place by colorectal cancer in 20262030 with a productivity cost of USD 2.3 billion. The total costs were USD 141.5 billion between 2001 and 2030. Conclusion: The substantial economic and social impacts of premature mortality from cancer in Brazil highlights the need to strengthen public health policies focused on promoting population-based healthy lifestyles to reduce cancer mortality. Several cancer sites associated with a high productivity cost identified in our study are preventable, or their burden could be reduced with national population-based screening and early diagnosis. Continuous efforts are required to strengthen the public health system to cope with the projected future increased burden, including treatment access. Have you got a Conflict of Interest?: Yes If yes please specify:: This study was funded by MSD Independent Oncology Policy Grant Program. The sponsor had no involvement in the study design, in data collection, analysis and interpretation; in the writing of the abstract and in the decision to submit the abstract for this conference.
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700 Acceptability and compliance with a breast cancer prevention campaign in the Northwest Region, Iran R. Dolatkhah1, S. Dastgiri2, G.H. de Bock3, Z. Sanaat1, M. Ranjkesh4, Z. Abbasi5, P. Jabbaripour5, S. Pashaei5, S. Poorsaberi5 1 Tabriz University of Medical Sciences, Hematology and Oncology Research Center, Tabriz, Iran, Islamic Republic of, 2Tabriz University of Medical Sciences, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran, Islamic Republic of, 3University Medical Center Groningen, Department of Epidemiology, Groningen, Netherlands, 4Tabriz University of Medical Sciences, Radiology, Tabriz, Iran, Islamic Republic of, 5Tabriz University of Medical Sciences, Faculty of Medicine, Tabriz, Iran, Islamic Republic of Background: Based on recent reports from Iran, breast cancer is the most common cancer when both sexes and all ages are combined, comprising 12.5% of all cancer cases. In the female population of the northwest of the country, the Age-Standardized Incidence Rate (ASIR) of breast cancer is estimated to be 31.1 per 100,000 women, with an increasing trend by Annual Percentage Change (APC) of 5.5%, over the past decade. Aim: In Iran, there is no national screening program for breast cancer, and limited data available on the acceptability and compliance of breast prevention programs in women. In addition, there are no guidelines for breast cancer screening. For that we are planning to set up a comprehensive breast cancer preventive campaign in the region. This study was performed as a first step to explore the options for the implementation of a comprehensive breast cancer preventive program in the northwestern region, Iran. For that, we aimed to document the acceptability and compliance of the campaign among the participating healthy women. Methods: This study was a feasibility study in which mixed methods were applied. Screening was implemented in a group of healthy women from different regions of East Azerbaijan (Northwest of Iran) during one year. Women eligible to participate (n = 321) in the study were voluntarily recruited. and women were invited by general invoices, telephone calls, posters and advertisements on social media in the study area. All women were invited to participate in an individual and/or group training for breast self-examination. Data for breast self-examination were collected from women self-reported results. Also clinical breast examination was performed every three months at the regional Oncology Clinic, Finally women were screened with two-view mammography, including bilateral craniocaudal (CC) and mediolateral oblique (MLO) views. The mammographic screening was performed and reported by an expert radiologist in mammography (MR). Results: A total of 321 Healthy women eligible to participate in the study were voluntarily recruited, and all underwent at least one breast self-examinations, and 145 (45%) at least two. The first and second clinical examinations were conducted in all women. Finally, 272 women (84.7 %) underwent mammography. Nine women (3.3%) underwent additional diagnostics with fine needle aspiration. All of them turned out to be benign, and no cancer was found. Forty-nine women (15.2%) were not referred for mammography. The main reasons were fear of positive findings during mammography, fear of cancer (12.7%), lack of knowledge about the aims and benefits of screening programs (11.5%), fear of mammography procedure and pain (9.0%), travel distance and costs (7.4% ) and family/personal problems (4.9%). Conclusion: The most important challenges for the implementation of a breast cancer prevention program in most low- and middle-income countries was lack of knowledge and attitude.
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Distribution of BIRADS scores for the mammograms performed as found during mammography † † For 63 women there were differences between the left and the right breast in the BIRADS score. Those women were classified based on their highest BIRADS score. ‡ Percentages are within 272 cases that underwent mammography Mammographic BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 reports† N (%) ‡ 60 (22.0) 99 (36.3) 104 (38.2) 8 (2.9) 1 (0.3) 95%CI 17.1-26.9 30.6-42.1 32.4-44.0 0.9-4.9 0-1
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Have you got a Conflict of Interest?: No
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701 Facilitating evaluation of the International Cancer Control Partnership: A Logic Model J. Fonseka1, A. Moore1, L. Zimmerman1, J.M. Bourque2, L. Foxhall3, L. Given4, K. Hohmann4 1 US Centers for Disease Control & Prevention, Atlanta, United States, 2Univ. of Ottawa, McGill University, Ottawa,, Canada, 3MD Anderson Cancer Center, Houston, United States, 4Strategic Health Concepts, Arvada, United States Background and context: The International Cancer Control Partnership (ICCP) formed in 2012 is a network of 22 organizations committed to building the capacity of low- and middle-income countries to develop effective national cancer control plans (NCCPs) to address the global cancer burden. This collaborative network provides leadership, expertise, coordination and technical assistance to in-country stakeholders to develop, implement, evaluate and sustain NCCPs. The ICCP’s vision is that all countries have a quality cancer control plan that links to its noncommunicable disease (NCD) efforts to achieve a 25% reduction in premature mortality from NCDs by 2025. Aim: The ICCCP recently engaged its stakeholders to plan a utilization-focused evaluation to assess partnership operations, strategic plan implementation, and ICCP global cancer control initiatives. Strategy / Tactics: The Centers for Disease Control and Prevention (CDC) Framework for Program Evaluation facilitates comprehensive program evaluation and its integration to public health practice. This framework was adapted for the ICCP evaluation needs. Evaluation subject matter experts conducted facilitated discussions with the ICCP Evaluation Workgroup to develop a logic model, identify evaluation questions and an evaluation planning matrix. Programme / Policy process: Development of the logic model considered 1) inputs or resources that would be invested in the program; 2) strategies or activities from the ICCP strategic plan that the partnership would undertake to produce intended outcomes; 3) outputs or tangible results of implementing program activities; 4) and expected initial, intermediate and long term outcomes. Evaluation questions related to assessing priority objectives in the Strategic Plan were identified by the ICCP Evaluation Workgroup. Outcomes: This approach facilitated stakeholder buy-in for developing planning documents essential for program evaluation. Such documents included a logic model and evaluation planning matrix that articulated evaluation questions, indicators, data collection sources, methods, data analysis and interpretation. What was learnt: (if relevant, please also detail here the potential of replicability) The logic model 1) informed linkages between resources, activities and desired results which helps overall program management, resource allocation and strategic planning; 2) clarified the expectations of the partnership; and 3) will facilitate program improvement. Have you got a Conflict of Interest?: No
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703 Identifying the main barriers for participation in a population-based colorectal cancer screening program R. Dolatkhah1, M.H. somi2, S. Dastgiri3, M. Asghari Jafarabadi4, H. Mashhadi Abdolahi3 1 Tabriz University of Medical Sciences, Hematology and Oncology Research Center, Tabriz, Iran, Islamic Republic of, 2Tabriz University of Medical Sciences, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran, Islamic Republic of, 3Tabriz University of Medical Sciences, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, Tabriz, Iran, Islamic Republic of, 4School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran, Zanjan, Iran, Islamic Republic of Background: Colorectal cancer (CRC) was the third most common cancer and the second leading cause of death from cancer in the world. In addition, CRC ranked the third most common cancer in Iran, but second in East Azerbaijan, with an increasing trend of annual percentage changes, 7.6% per year during the last 12 years. CRC is considered to be one of the most preventable cancers and population-based screening programs can reduce mortality by up to 60%. Despite the recommendations and guidelines provided by organizations and committees, mass screening has not yet taken place at the population level in many countries. Aim: The results of the present study are in line with those in the previous study regarding the development and validation of CRC risk assessment tool by using translated and validated NCCN guideline , in order to introduce and implement a CRC screening program in East Azerbaijan province. In this program, colonoscopy and three stool-based tests including FOBT, FIT and stool DNA test were performed for all eligible people. However, due to many problems and barriers during the study, mainly in the case of colonoscopy for eligible candidates, this section of the study was separately discussed. In other words, to the present study aimed to assess and report the main barriers of colonoscopy in implementing the population-based CRC screening in East Azerbaijan. Methods: Healthy individuals from all regions of the state were invited to participate in different healthcare centers. They were assessed by a provided online risk assessment tool, which was completed for all recruited subjects, and has been developed to assess the CRC risk based on personal and family history of adenoma, CRC, and other highrisk diseases. Research team staff assessed all individuals by this tool and then eligible people according to their lifetime risk of CRC were included in the study. There was not any age restriction in this study. Colonoscopy and three stool-based tests including fecal occult blood test, fecal immunochemical test and stool DNA tests were performed. Results: Overall, 725 cases including 425 (58.6%) males and 300 (41.4%) females participated in the study. Lack of knowledge and attitude about screening program was the most common barrier, especially among women (68% for women versus 58% for men) and those from rural areas (88% in rural versus 55% in urban areas). Fear of colonoscopy and procedure complications and pain (48%), discomfort and anxiety from inserting a tube into the bowel (65% among females versus 43% among males) were reported commonly. Embarrassment and dignity were other complaints, especially in women (62% in females versus 35% in males). Conclusion: Increasing knowledge and attitude about the aims and benefits of screening program, acceptable and convenient communication of health systems with the general population are considered to be the key elements in the success and implementation of any screening program.
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Table 1: Demographic Characteristics of the Study Participants (N=725) Variables Frequency and Percentages Variable Frequency Gender Age Residency Education
Risk Assessment
Male Female <50 ≥ 50 Urban Rural High Educated Moderate Educated Low Educated Average Risk Moderate Risk High Risk
425 300 283 442 288 437 374 215 136 180 351 194
Percentage (%) 58.6% 41.4% 39% 61% 39.7% 60.3% 51.6% 29.7% 18.7% 24.8% 48.4% 26.8%
Table 2. Patient-Related and Practical and Health System- Related Barriers and Problems among all 725 participants in Colorectal Cancer Screening, in East Azerbaijan, Iran Barriers and/orProblems Patient-Related Factors Practical and Health SystemRelated Factors Number Number (Percentage (Percentage within within group) group) Lack of Knowledge about Screening Male (n=425) 247 (58%) Lack of Male 149 (35%) Screening (n=425) Female (n=300) 204 (68%) Advices Female 141 (47%) (n=300) Lack of Knowledge about Male (n=425) 204 (48%) Prefer Male(n=425) 111 (26%) Significance and Advantages of Female (n=300) 186 (62%) Private Female 105 (35%) Screening Clinic (n=300) No need for Screening Because of Male (n=425) 285 (67%) Lack of Male 64 (15%) Having no Symptom Knowledge (n=425) Female (n=300) 162 (54%) of staff and Female 66 (22%) health(n=300) workers Lack of Knowledge about Male (n=425) 149 (35%) Traveling Male 98 (23%) Preventability and Treatability of Problems (n=425) CRC Female (n=300) 162 (54%) Female 141 (47%) (n=300) Fear of Colonoscopy Male (n=425) 149 (35%) Traveling Male 43 (10%) Costs (n=425) Female (n=300) 144 (48%) Female 42 (14%) (n=300) Anxiety about Going to Health Male (n=425) 102 (24%) TimeMale 204 (48%) Centers Consuming (n=425) Female (n=300) 111 (37%) and Female 69 (23%) Lengthy (n=300) Procedure Fear and Discomfort of Colonoscopy Male (n=425) 183 (43%) Female (n=300) 195 (65%) Embarrassment and Dignity Male (n=425) 149 (35%) Female (n=300) 186 (62%) Failed to Bowel Preparation Male (n=425) 153 (36%) Female (n=300) 84 (28%)
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Have you got a Conflict of Interest?: No
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705 Tobacco control policy implementation in Georgia G. Bakhturidze1 1 FCTC Implementation and Monitoring Center in Georgia, Tbilisi, Georgia Background and context: In 2017 as a result of continuous and substantial efforts of the Tobacco Control Alliance in Georgia, NCDC of the MoH and great political support from the Parliament of Georgia, were adopted the most effective changes in the tobacco control legislation. The role of the Public Defender of Georgia should be emphasized, who took the lead in conducting monitoring of the legislative and implementation process of tobacco control related measures and contributed to publication of a special report in 2016.In the process were involved representatives of the Health and Human Rights community and mass media, who played significant role in achieving the goal of implementation of effective and comprehensive tobacco control measures in order to protect Georgian population from the exposure to such a deadly product as tobacco. Aim: The aim of the paper is to do show process of monitoring and enforcement of new tobacco control regulations adopted in May 2017 and it is effective since May 2018. Strategy / Tactics: State program on Health promotion includes funding on capacity building of enforcement bodies of Georgian Government and active monitoring of smoke free policy, sale restrictions of tobacco products, prohibition of advertisements, etc. It’s strategically important synergy between Governmental and Non-Governmental actors to defense rights on healthy environment. Programme / Policy process: The state program of Health promotion is Governmental funded program and management is under National Center for Diseases Control and Prevention (NCDC) of the Ministry of Health (MoH) of Georgia. The volume of tobacco control regulations monitoring part of the state program is around 100 000 USD per year. The FCTC Implementation and Monitoring Center in Georgia (FCTC IMCG) implements the monitoring and capacity building work for promotion enforcement of tobacco control legislation after strict procedures of bidding. During 20182021 years the FCTC IMCG through their 40 monitors in whole country who monitors around 10 000 facilities regarding smoke-free policy implementation, 8 000 points of sale, and 4 000 public transport&advertisements. Outcomes: The level of enforcement from permanent monitoring on the tobacco control new regulations is around 95%. High compliance level of the law saves lives and keeps people healthier. The civil activism in Georgia is very low and around 97% of calls to the 112 service belongs to monitors of the FCTC IMCG. What was learnt: (if relevant, please also detail here the potential of replicability) The partnership between Governmental and Non-Governmental actors for implementation of tobacco control legislation and the FCTC requirements is crucial. There is need of sustainable funding of above-mentioned programs mostly in low and mid developed countries. Georgia’s example is important and we hope that most countries will share such good case of investment that saves lives. Have you got a Conflict of Interest?: No
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72 Cancer and Non-Communicable Diseases (NCDs) - awareness and screening of Police personnel in Mumbai G. A Mishra1, S. A Pimple1, CS Pramesh2, V. Y Kulkarni1, A. S Patil1, K. Oswal3, S. M Patil4, H.K. A Shaikh1, P. V Majmudar1, N. Kharodia3, D. Chaukar5, TS Shylasree6, P. Thakkar7, J. Bajpai1, S. Tandon8, P. Ravindra Biraris8, M. A Bhaskar8, A. Lila9, T. Bandgar9, S. Gaikwad10, S. Gupta1, T. Jamale11, D. Fernandes1, R. A Badwe12 1 Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 2Director, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 3Tata Trusts, Mumbai, India, 4Police Hospital, Mumbai, India, 5Division of Head & Neck Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 6Department of Gynecology Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 7Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 8Department of Pulmonary Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 9Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India, 10Department of Medicine, TN Medical College, Mumbai, India, 11Department of Nephrology, Seth G S Medical College and KEM Hospital, Mumbai, India, 12Director, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
Background:Police personnel are at increased risk of several Non Communicable Diseases (NCDs) including cancers because of their erratic lifestyle and work-related behavior. An awareness and screening program for NCDs and common cancers was initiated among Mumbai Police and their family members in December 2019. Aims: The ultimate goal of the program was to formulate demonstrable, sustainable and replicable model on prevention, control and early detection of NCDs including common cancers among Police personnel and their family members. Methods:This cross-sectional interventional study was initiated among Mumbai Police after obtaining Institutional Ethics Committee approval. Support of Senior Police Administration was gathered by holding meetings and explaining the concept. Temporarily clinics were set up at each police station in Mumbai and eligible participants were enrolled after obtaining informed consent. This was followed by risk factor assessment, health education program, screening for common cancers (breast, uterine cervix and oral cavity) and NCDs (obesity, hypertension and diabetes). Screen positives were referred for further investigations and management. Results:26,110 police personnel have been covered till end of February 2022. Risk factor assessment showed prevalence of tobacco consumption of 30% with 78% consuming smokeless tobacco. Alcohol use was noted among 34% police personnel. Compliance for participation in health education program was 99.9%. Compliance to screening of oral, breast and cervical cancers was 99.8%, 92.1% and 73.8%, screen positivity rate was 9.3%, 15.2% and 15.4% and compliance to referral was 70, 77 and 75% respectively. 1294 clinical oral pre-cancers, 45 cervical pre-cancers, 1 breast and 9 oral cavity cancers have been diagnosed. Diabetes and hypertension was newly detected in 2545 and 3844 police personnel during screening. Totally, (old and new cases inclusive) the prevalence of diabetes, hypertension and obesity was 5092 (19.5%), 5284 (20.25%) and 11,913 (45.66%) respectively. Police personnel diagnosed with NCDs, pre-cancers and cancers are being treated at the nodal hospitals. Conclusions:High prevalence of NCDs among police warrants urgent and periodic implementation of health education on life style modification and screening and institution of treatment in order to reduce morbidity and mortality among this special occupational health group. Have you got a Conflict of Interest?: No
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724 IMPACT OF HIV ON ACCESS TO CERVICAL CANCER CARE AND SURVIVAL IN COTE D’IVOIRE B. Simon1,2, H. Apollinaire3,4, D.-K.-C. Judith5,6, T. Boris7, T. Aristophane8,9, E. Didier K10,11, D. François10, A. Innocent1,12,5, J. Antoine10 1 Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote D'Ivoire, 2Programme PAC-CI, Research, Abidjan, Cote D'Ivoire, 3Université Félix Houphouët Boigny, Département Mère-enfant, Abidjan, Cote D'Ivoire, 4Centre Hospitalier Universitaire de Yopougon, Service de Gynéco-obstétrique, Abidjan, Cote D'Ivoire, 5Université Félix Houphouët Boigny, Immuno-hématologie et oncologie, Abidjan, Cote D'Ivoire, 6Centre National d’Oncologie médicale et de Radiothérapie Alassane Ouattara (CNRAO), Abidjan, Cote D'Ivoire, 7Elizabeth Glazer Paediatric AIDS Foundation, Research, Yaoundé, Cameroon, 8Centre Hospitalier Universitaire de Treichville, Service des Maladies infectieuses et tropicales (SMIT), Abidjan, Cote D'Ivoire, 9Université Félix Houphouët Boigny, Dermatologie et maladies infectieuses et tropicales, Abidjan, Cote D'Ivoire, 10INSERM/IRD « Global Health in Global South (GHiGS) » (Centre INSERM U1219, ISPED, Université de Bordeaux), Bordeaux, France, 11Université de Lomé, Faculté des Sciences de la santé, Santé Publique, Lomé, Togo, 12Centre Hospitalier Universitaire de Treichville, Service de Cancérologie, Abidjan, Cote D'Ivoire Background: An inverse relation between HIV infection and overall survival (OS) was originally documented in women diagnosed with invasive cervical cancer (ICC). It is still unclear whether this still holds true in a time of universal access to antiretroviral (ART) in sub-Saharan Africa. Aim:We evaluated the association between HIV status, access to cancer care (ACC) and OS among women diagnosed with ICC in Cote d’Ivoire. Methods: A cohort of women diagnosed with ICC was consecutively recruited from 2018 to 2020 in public/private referral centres of Abidjan, the unique urban area providing ACC in Côte d’Ivoire. Demographics, clinical data, HIV status and clinical stage (FIGO classification) were collected at enrolment while follow-up data including ACC (surgery or chemo-radiation) and death were prospectively collected. The OS was estimated by considering the time from ICC diagnosis to the last known contact alive. Logistic regression and hazard proportional Cox regression models allowed analysis of factors associated with ACC and OS, respectively. Results: A total of 294 women with ICC were recruited including 21.4% of women living with HIV (WLHIV), 87% on ART. The median age was 50 [IQR: 43-60] years. ICC diagnosis through regular screening was uncommon (4.8%) although more frequent among WLHIV (15.9%) compared to those HIV-negative (1.7%); p<0.001). An advanced ICC clinical stage (III-IV) was less frequent in WLHIV (63.5%) versus HIV-negative women (77.1%; p=0.03). ACC was initiated in 124 (42.2%) women with ICC (54.0% in WLHIV (n=34) versus 39.0% in HIV-negatives (n=90), p=0.03). In adjusted analyses, factors independently associated with ACC were FIGO I-II (aOR: 3.6; 95% CI [2.0-6.4]) and no use of traditional healers before ICC diagnosis (aOR: 3.7; 95% CI [2.0-7.0]). In women with ACC, the two-year OS was 56.8% (95% CI: [48.5 – 66.4]). In adjusted analysis, OS was independent of HIV status (aHR=0.83; 95% CI: [0.48 – 1.45]. FIGO advanced stages were independently associated with a higher risk of death (aHR= 2.04; 95%CI: [1.26 - 3.29]). Conclusion: In a period of increased access to ART, OS does not appear to be significantly impacted by HIV infection among women diagnosed with ICC in Côte d’Ivoire. Higher ACC in WLHIV might be mediated by enhanced access to ICC screening services through HIV clinics, supporting the need to expand access to these screening services across all healthcare facilities. Have you got a Conflict of Interest?: No
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73 Patients Presenting with Conjunctival Melanoma: Lessons Learned from a Multicenter International Study P. Jain1, P.T. Finger1, The American Joint Committee on Cancer's - Ophthalmic Oncology Task Force (AJCC-OOTF) 1 THE NEW YORK EYE CANCER CENTER, New York, United States Background: Conjunctival melanoma, a rare ocular cancer, comprises just 5% of all ocular melanomas. The local tumor recurrence rate and tumor-related mortality remain high, despite local management. Aim: An international multicenter data-pooled, registry study on conjunctival melanoma was analyzed. Methods: The American Joint Committee on Cancer's - Ophthalmic Oncology Task Force (AJCC-OOTF) used an internet-based registry to gather conjunctival melanoma patient data from 10 ophthalmic oncology centers between January 1, 2001 and December 31, 2013. The data collection was retrospective. Results: Of 288 patients recorded at presentation, clinical tumor staging was cT1 for >75% (n=218/288) with no cT4. Five patients presented with metastasis (Stage-IV) and all were cT3-staged tumors, multicentric (>1 tumor) and 4 had regional lymph node involvement. Over a median follow-up of 4.3 years, 24 patients developed metastasis. Of these, 12.5% were staged cTx (n=3/24, previously biopsied elsewhere), 54.1% cT1(n=13/24), 25% cT2 (n=6/24) and 8.3% cT3 (n=2/24). Most, 87.5% received more than 1 treatment (n=21/24), 50% received adjuvant episcleral plaque brachytherapy (n=12/24) and 12.5% had secondary exenteration (n=3/24). Multiorgan metastasis was seen in 41.7% patients (n=10/24); 45.8% had liver metastasis (n=11/24),37.5% lung metastasis(n=9/24), 12.5 % brain metastasis (n=3/24), 8.3% bone metastasis (n=2/24), 8.3% abdomen metastasis (n=2/24),and (1 case of each) had metastasis to bladder, peritoneum, parotid gland and skin. Tumor ulceration predicted mortality (p=0.04) but had no bearing on local recurrence. AJCC tumor staging predicted both local recurrence and mortality. Conclusion: Recurrent early bulbar conjunctival melanomas (cT1) can metastasize. Local tumor recurrence strongly correlated with metastasis. Whole body based systemic surveillance should be performed in all conjunctival melanoma cases. Have you got a Conflict of Interest?: No
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733 Comparison of potential of shear wave elastography for diagnosis between breast mass and non-mass like lesions L. Junnan1, L. Hong1 1 Tianjin Medical University Cancer Institute & Hospital, Tianjin, China Background: Non-mass like (NML) lesions of breast cancer are not only difficult to detect, but also difficult to diagnose. Shear wave elastography (SWE) features can improve the specificity of B-mode ultrasound. Up to now, most of the researches on SWE have been the overall research of mass and NML lesions or single NML researches, but there has been no research comparing mass and NML lesions in the same trial. Aim: To compare the diagnostic performance of shear wave elastography (SWE) in mass and non-mass like (NML) lesions, and found different individualized threshold of SWE parameters according to the type of lesions. Methods: A total of 623 breast lesions in 562 consecutive women who have been scheduled for ultrasound (US)guided automated gun biopsy, vacuum-assisted biopsy or surgical excision between January 2021 and December 2021 were included in this study. Diagnostic performances of conventional US and each quantitative SWE parameter (maximum elastic modulus (Emax), mean elasticmodulus (Emean), and elastic modulus standard deviation (Esd)) were calculated. Histological diagnosis and follow-up results were used as the reference standard. Results: The final status of the all lesions was benign in 281 and malignant in 342. The results showed that the diagnostic performance of conventional-US or SWE in mass lesions was better than that in NML lesions. Every parameter of SWE had different threshold between mass and NML lesions, and the threshold of mass were all higher than those of NML lesions. In mass group, the combination of conventional US with Esd got significantly higher diagnostic specificity (p＜0.05), without significantly higher Az value or lower diagnosticsensitivity. In NML lesion group, the combination of conventional US with Emax got significantly higher Az value and diagnostic specificity (p＜0.05，for both), without significant lower diagnosticsensitivity. Conclusion: SWE could increase diagnostic confidence for breast lesions, especially for NML lesions. NML lesions had lower threshold in SWE parameter than mass lesions. Have you got a Conflict of Interest?: No
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737 Polycyclic Aromatic Hydrocarbon associated lung cancer, an occupational hazard : a meta-analysis M. Wagh1 1 Regional Cancer Centre, Surgical Oncology, Thiruvananthapuram, India Background: Polycyclic aromatic hydrocarbons (PAH'S) are produced as a result of incomplete combustion of organic matter. Occupational exposure to these is usually by inhalation and skin contact. These are metabolized by cytochrome P 450 and the resultant diol epoxide-- DNA adduct can cause pulmonary inflammation, cytotoxicity, genotoxicity and carcinogenicity1. Occupational exposure to polycyclic aromatic hydrocarbons has been shown to be associated with lung cancer in various epidemiological studies in industries such as aluminum reduction/smelting, coal gasification, coke production, iron/steel foundries, coal/coke and related products and carbon/graphite electrodes production2,3. Robust data on the impact of occupational exposure to PAH and lung cancer, will help policy makers and administrators to take appropriate measures. Aim: To study the association between PAH exposure and lung cancer among workers in different occupations. Methods: A comprehensive literature search was conducted to retrieve relevant papers for meta-analysis. Cohort studies with standardized mortality ratios or standardized incidence ratios and calculated overall risk ratio with their corresponding 95% confidence intervals (CIs) were included in the analysis. Chi-square test for heterogeneity was used to evaluate the consistency of findings between the studies. Results: Using the predefined search criteria, 24 cohort studies were identified and included in the analysis. Altogether there were 296 810 lung cancer subjects. A significant risk of lung cancer was observed among the coal/coke and related product industry [Relative risk of 1.55 (95% CI 1.01–2.3)] and the iron/steel foundry industry [relative risk 1.52 (95% CI 1.05–2.20)]. Though there was an increased risk of lung cancer in other industries as ell, the risk ratios were not statistically significant. There was a wide variation in smoking habits amongst workers in different industries. Most studies did not adjust for smoking as a confounding factor Conclusion: Coal/coke industry and iron/steel industry workers showed a higher risk of lung cancer compared with other occupations exposed to PAHs. Larger such studies which also take into account the effect of smoking as a confounding factor and individual level exposures to PAH's are desirable. References: 1. Shimada T, Fujii-Kuriyama Y. Metabolic activation of polycyclic aromatic hydrocarbons to carcinogens by cytochromes P450 1A1 and 1B1. Cancer Sci 2004;95:1–6. 2. Rota M, Bosetti C, Boccia S, Boffetta P, La Vecchia C. Occupational exposures to polycyclic aromatic hydrocarbons and respiratory and urinary tract cancers: an updated systematic review and a meta-analysis to 2014. Arch Toxicol 2014;88:1479–1490 3.Boffetta P, Jourenkova N, Gustavsson P. Cancer risk from occupational and environmental exposure to polycyclic aromatic hydrocarbons. Cancer Causes Control 1997;8:444–472 Have you got a Conflict of Interest?: No
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74 Closing the Gap in Access to Chemotherapy for the Breast Cancer Patients amidst COVID-19 Pandemic in Myanmar Y.Y. HTUN1, T. WYNN1, Y.S.Y. SOE2, Z.T. KHINE2, M. KYI1, M.A.K. NAING1, T. AUNG2, P.T. HTOON1 1 Shwe Yaung Hnin Si Cancer Foundation, Medical Oncology, Yangon, Myanmar, 2Pun Hlaing Hospital, Medical Oncology, Yangon, Myanmar Background and context: Breast cancer is curable if detected and treated early. However, one-third of cancer patients in South-East Asia, especially women are vulnerable to financial catastrophe during treatment.1,2 Covid19 pandemic further limited the access to treatment and care services3. Shwe Yaung Hnin Si Cancer Foundation (SYHSCF), a non-profit organization dedicated to improving awareness and early detection of cancer, has provided chemotherapy service to needy breast cancer patients in its own unit since 2015, but had to close due to safety needs of the covid-19 situation. Collaboration with Pun Hlaing Hospital (PHH), a JCI-accredited and COVID-19 hybrid hospital was commenced in June 2020, to continue the chemotherapy services.
Aim:To close the gap in access to chemotherapy for needy breast cancer patients amidst COVID-19 pandemic. Strategy / Tactics: Following strategies were harnessed: 1) safety of patients 2) safety of healthcare providers 3) continuity of access to treatment. Programme / Policy process: The treatment services were provided in two sites: a daycare clinic unit of Pun Hlaing Hospital which provides four chemotherapy-chairs, four beds and one Bio-safety cabinet and at the Pun Hlaing outpatients clinic. A senior medical oncologist led the volunteer team: two medical oncologists, four doctors and four trained nurses. The initial screening for free chemotherapy and follow-ups were done via online consultations, based on current resource-enhanced NCCN guideline. Every patient was screened for COVID-19 and if positive, referred to public hospital. The team donned level II PPE and strictly followed local guidelines. Patients who needed radiation therapy were referred to Yangon General Hospital. Outcomes: The collaborative approach helped 163 needy breast cancer patients with free chemotherapy over twenty months. It ensured one-stop services for the patients which reduced their time and effort, facilitating quicker access to treatment. From the patients’ perspective, it provided enormous psychological and physical relief as they were able to access free treatment. From the staff perspective being able to work in a well-equipped private hospital with full protective gear reduced the risk of covid-19 infection and boosted staff confidence and morale. What was learnt: This collaborative approach provided a safe continuity of healthcare without unnecessary delay for needy breast cancer patients amidst pandemic, also helping to avoid potential financial catastrophe. Have you got a Conflict of Interest?: No
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75 THE SEXUALITY OF CERVICAL CANCER PATIENTS UNDERGOING RADIOTHERAPY R. BRONI1 1 UNIVERSITY OF GHANA, DEPARTMENT OF RADIOGRAPHY, Accra, Ghana Background: Cervical cancer kills approximately 300,000 people per year and affects nearly 600,000 more. Patients with cancer face a variety of sexual health issues: According to reports, 40％to 100％of cancer patients have such problems. The standard curative treatment for locally advanced cervical cancer is concurrent chemo-radiotherapy followed by brachytherapy which may lead to vaginal toxicity and associated sexual dysfunctions which negatively impacts the quality of life of the patient. Aim: The purpose of this study was to assess the sexuality of cervical cancer patients (CCPs) undergoing radiotherapy (RT) at a radiotherapy and oncology centre (ROC) in Ghana. Methods: A longitudinal study was used to assess the impact of RT on the sexuality of 44 premenopausal and menopausal CCPs presenting for RT at the ROC. The Female Sexual Function Index (FSFI) and Body Image Scale (BIS) questionnaires were used. Quantitative data was entered into a database, summarised and analyzed using MATLAB. Chi-square test was used as a test of significance for differences observed. Results: Cervical cancer (CC) was most prevalent (56.8%)among the menopausal CCPs. About 79.0% premenopausal and 96% menopausal CCPs were sexually inactive during the RT treatment, while 47.4% premenopausal and 24% menopausal CCPs patients were very much dissatisfied with their bodies at the onset of treatment. The frequency of orgasm in CCPs declined after treatment causing a deterioration in their sexual function. The patients’ sexuality was influenced by age and menopausal status. The decreased sexual desire of the CCPs resulted in an emotional distancing from partners, which invariably induced changes in their partners’ level of sexual interest. This study established significant differences between premenopausal and menopausal CCPs very dissatisfied about their sexual relationships with their partners on Day 1 (p=0.02) and on Day 15 (p= 0.00) of treatment. Conclusion: Higher prevalence of cervical cancer was identified in menopausal CCPs, and interest in sexual activity was more influenced by their menopausal status. This study concludes that surviving CCPs are more likely to develop sexual health problems which could substantially worsen. Have you got a Conflict of Interest?: No
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752 PAX1 and ZNF582 methylation for cervical cancer screening in both Chinese and Dutch cohorts N. Li1, Y. Hu1, A.G.J. van der Zee2, E. Schuuring2, G.B.A. Wisman2 1 Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China, 2Cancer Research Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands Background: Cohorts of women with high-risk human papillomavirus (hrHPV) infection harbor a spectrum of cervical diseases, ranging from women with just transient hrHPV infections to patients with cervical cancer. In Asian populations previous studies showed that analysis of PAX1 and ZNF582 methylation status may help to better discriminate between the different cervical conditions. Aim: The current prospective study was designed to assess and compare the potential diagnostic role of PAX1 and ZNF582 methylation analysis in a Dutch and a Chinese cohort. Methods: Methylation of PAX1 andZNF582 was evaluated in cervical scrapings from 2 independent patient groups. For the Dutch cohort, 190 scrapings with abnormal cytology (atypical squamous cells of undetermined significance (ASCUS) or worse), selected from the population-based screening program were included, of which 138 patients were hrHPV positive. For the hospital-based Chinese cohort, 246 liquid-based cytology samples were included of which 205 women with abnormal cytology (ASCUS or worse) and 227 women with hrHPV infection. PAX1 and ZNF582 methylation was detected using quantitative methylation-specific PCR (QMSP). Results: PAX1 and ZNF582 methylation showed high and similar specificity of 91-97% for CIN2+ in both abnormal cytology as well as hrHPV-positive samples with moderate and similar sensitivity of 43-61% for CIN2+ in both cohorts. Sensitivity for CIN3+ improved to 55-86%, but with a lower specificity (85-93%). Sensitivity could be improved further with ~20% by combinations of PAX1 or ZNF582 with different previously identified CIN2+specific methylation markers (ANKRD18P, C13ORF18, EPB41L3, JAM3, SOX1 and ZSCAN1). Conclusion: The diagnostic performance of PAX1and ZNF582 methylation markers shows high specificity to detect CIN2+/CIN3+ lesions in scrapings with abnormal cytology or hrHPV-positivity irrespective ofgeography and race. These markers as triage test might significantly decrease the number of unnecessary colposcopies. Randomized controlled trials and further large prospective studies are needed to confirm our findings. Have you got a Conflict of Interest?: No
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755 Sentinel lymph node detection in radical trachelectomy-- Could SLN replace lymphadenectomy? N. Li1, Y. Shen1, Y. Hu1 1 Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China Background: As many as 40% women of reproductive age are diagnosed with early-stage cervical cancer which has a better prognosis. Fertility-sparing surgery has become a preferred approach described in the literature. In order to reduce the surgical-related morbidity, sentinel lymph node biopsy (SLNB) has recently been proposed as an alternative offer to obtain prognostic implications of lymph node status. Aim: The aim of this study is to evaluate the potential feasibility of laparoscopic indocyanine green (ICG) sentinel lymph node (SLN) mapping in patients with early cervical cancer treated with fertility-sparing surgery. Methods: From January 2019 to August 2021, 5 women diagnosed with early stage cervical cancer underwent laparoscopic fertility-sparing surgery at Tianjin Central Hospital of Gynecology Obstetrics. After obtaining an adequate pneumoperitoneum and having inspected the abdominal cavity, 1 milliliter of ICG was injected at 3 and 9 o’clock of the cervix. Bilateral pelvic lymphadenectomy and radical trachelectomy were performed after laparoscopic SLN biopsy. Results: Five patients were aged between 28-31 years at diagnosis. Three out of the 5 cases were diagnosed with cervical squamous cell carcinoma and 2 patient was proved to be cervical adenocarcinoma. All of the 5 cases were classified as Federation International of Gynecology and Obstetrics (FIGO) stage IB1 preoperatively based the pelvic examination and magnetic resonance imaging. All of the 5 cases accepted ICG SLN mapping followed by laparoscopic SLN biopsy, bilateral pelvic lymphadenectomy and radical trachelectomy. No adverse events were recorded from ICG injection. Frozen sections of all of the SLNs were negative. In the final pathologic analysis, both SLNs and non-SLNs were proven to be negative in 4 patients. However, in the patient who was diagnosed as squamous carcinoma by cervical conization preoperatively, 2 out of 5 SLNs were positive while the non-SLNs were negative. In this case, the left SLN was diagnosed as lymph node micro-metastasis and the right SLN presented isolated solitary cell metastasis by postoperative ultra-staging pathology analysis. This patient refused further surgery and received 4 cycles of adjuvant chemotherapy. There was no evidence of recurrence during 26month follow-up. Conclusion: Laparoscopic ICG SLN mapping seems to be feasible in selected cervical cancer patients with tumors smaller than 2cm who accept radical trachelectomy. This procedure may be safely performed with primary vaginal closure and without the use of any uterine manipulator. Further studies and long-term follow-up are needed to clarify the role of SLN biopsy in fertility-sparing surgery in cervical cancer. Have you got a Conflict of Interest?: No
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76 Clinical Features in Advanced Retinoblastoma: High Risk Pathology and Metastatic Death A.S. Tomar1, P.T. Finger1, B. Gallie2, T. Kivelä3, A. Mallipatna4, AJCC-OOTF study group 1 The New York Eye Cancer Center, Ocular Oncology, New York, United States, 2The Eye Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Canada, 3University of Helsinki and Helsinki University Hospital, Ocular Oncology Service, Department of Ophthalmology, Helsinki, Finland, 4Hospital for Sick Children, Toronto, Canada Background: Advanced retinoblastoma is the most common presenting stage in developing countries and is responsible for metastasis-related death. Clinical features of retinoblastoma are widely used to decide between globe-salvage versus primary enucleation. Existing classification systems fail to predict the risk of metastatic disease at presentation or guide choice for treatment. Aim: This study investigates whether clinical features and tumor size in advanced intraocular retinoblastoma defined by 8th edition AJCC-UICC retinoblastoma staging can provide statistically significant medical evidence for high-risk pathology and thus risk of metastatic death. Methods: It is an international, multicenter, internet-enabled, registry-based retrospective data analysis of 2190 patients from 18 ophthalmic oncology centers across 13 countries on 6 continents (enrolled between 2001 and 2013). Clinical features associated with advanced retinoblastoma were defined by the 8th edition AJCC-UICC categories cT2 and cT3. In addition, new AJCC-Ophthalmic Oncology Task Force(OOTF) Tumor Size Groups were defined as Group 1:<50% of globe volume involved, Group 2:>50% but<2/3, Group 3:>2/3, and Group 4: diffuse infiltrating retinoblastoma. Treatments were primary enucleation, systemic chemotherapy with secondary enucleation, and systemic chemotherapy with eye salvage Results: Kaplan-Meier cumulative survival estimates showed that the risk of metastatic mortality increased with increasing cT subcategory and AJCC-OOTF Size Group (P < 0.001 for both). Cox-proportional hazards regression analysis confirmed a higher risk of metastatic mortality in categories cT3c (glaucoma), cT3d (intraocular hemorrhage), and cT3e (orbital cellulitis) compared with category cT2a, and patients with AJCC-OOTF Group 3 (tumor >2/3 globe volume) and Group 4 (diffuse infiltrating retinoblastoma) compared to Group 1. Of 942 advanced retinoblastoma eyes treated by primary enucleation, 282 (30%) had high-risk pathology. Both cT subcategories and AJCC-OOTF Size Groups (p<0.001 for both) were associated with high-risk pathology. Conclusion: Both AJCC-UICC RB staging clinical cT3 subcategories and AJCC-OOTF Size Groups provided a robust stratification of clinical risk for the presence of high-risk pathology and therefore the risk of metastatic death. Primary enucleation offered the highest survival rates for patients with advanced intraocular retinoblastoma. Have you got a Conflict of Interest?: No
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768 Met and Sil co-loaded PLGA-PEG nanoparticles for effective combination therapy against breast cancer A. Jabbari1, d. jafari-gharabaghlou2, N. Zarghami3 1 urmia medical science university, urmia, Iran, Islamic Republic of, 2tabriz medical science university, Tabriz, Iran, Islamic Republic of, 3istanbul aydin university, istanbul, Turkey Polymeric nanoparticle (NP) mediated combination chemotherapy has been proposed to be an efficient strategy for cancer treatment via exerting synergism among the different drugs, suppressing drug resistance, and enhancing pharmacokinetics of the drugs which leads to a decrease in the side effects of the drug payloads. The present study examines the synergistic anticancer efficiency of two natural-based anticancer agents, Metformin (MET) and Silibinin (SIL) co-loaded PLGA-PEG NPs against T47D breast cancer cells. The resultant drug-loaded PLGA-PEG NPs displayed a spherical morphology with the uniform nanosize distribution. For both drugs, burst discharge occurred in the first 8 h, followed by sustained release over 7 days. According to MTT assay and median-effect analysis, MET/SIL-loaded PLGA-PEG NPs exhibited the most synergistic cytotoxic effect against the breast cancer cells. Besides, it was revealed that the dual drug-loaded NPs could significantly alter the expression levels of Bax, Bcl-2, caspase 3 and 9, and hTERT compared to the free combination of the drugs as well as the single drug-loaded NPs. Taken together, this work revealed that MET/SIL-loaded PLGA-PEG NP based combination therapy might have a significant potential to improve the efficiency of breast cancer therapy. Have you got a Conflict of Interest?: No
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771 "Virtually together" – an Arab world video conferencing initiative for breast cancer patients & survivors C. El Jabari1, S. Hijazi1 1 Patient's Friends Society-Jerusalem, East Jerusalem, Palestine Background and context: A collective of patient groups were invited to join a mentoring programme in the Middle Easter North Africa region (EMRO), initiated by the UICC in 2021 Patient Group Mentoring Programme ( PGMP). These groups are dedicated to breast cancer care, patient support and mentoring and awareness raising. Since 2020 and the Covid pandemic, movement and face to face meetings were stopped. Patient’s Friends Society-Jerusalem (PFS) developed an initiative, a pilot, for interested groups to participate over a 3 month period, Dec 2021-Feb 2022 to meet other like-minded organizations at least virtually. Due to the vastness of the region, costs and difficulties in having face to face meetings, this seemed the best way to connect, sharing experiences and learning from each other, with men and women dedicated to cancer control and care. Palestine, Morocco and Egypt participated employing video and audio on Zoom Aim: To bring together ‘virtually’ cancer patients, survivors and their group facilitators. To address issues pertinent to them as individual groups and as a collective, to learn from each other, share concerns, values and network. Strategy / Tactics: PGMP members were invited by email and whatsapp to attend a series of virtual meetings. Three groups joined and were given a questionnaire ( 6 questions) in Arabic asking them about their group, what they expected/wanted from the meetings, their vision, who would attend and facilitate from each group. Each meeting was conducted in Arabic and lasted 2 hours, facilitated by PFS who were the lead in this pilot. All participants were engaged in conversations about cancer awareness work and achieving equity for their cancer patients. Programme / Policy process: Patients and facilitators from each country group prepared talking points of interest to them and which they felt was relevant to the attendees, sometimes with PowerPoint presentations. Outcomes: There were 3 virtual meetings. This became an empowerment project, giving everyone a voice! What was learnt: We learned we were similar in our wants and goals. We learned about strategies each other uses to promote their work in helping patients, raising awareness, etc. This initiative was much appreciated by all participants who said the meetings were' enriching' and they hoped the project will continue and grow and to include more groups. A modest investment in human resources, finances, time and commitment to engaging with others make this an easily sustainable project for other groups in different regions to emulate. This project is replicable and useful for those with access to the internet. It is an easy way to keep the ‘cancer’ conversations going and to learn from the other despite distance, time differences, location. It provides opportunities for cancer patients, survivors, their families and professionals to join the cancer care effort and reduce stigma, improve access to information and care, network and more. Have you got a Conflict of Interest?: No
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772 PD-L2 confers to anti-EGFR therapy resistance in HNSCC Y. Wang1, Y. Ren2, X. Wang1, X. Zhou1 1 Tianjin Medical University Cancer Institute and Hospital, Department of Maxillofacial and Otorhinolaryngological Oncology, Tianjin, China, 2Tianjin Medical University, Department of Genetics, Tianjin, China Background: Combination therapy has been explored for advanced head and neck squamous cell carcinoma (HNSCC) owing to the limited efficacy of anti-epidermal growth factor receptor (EGFR) therapy. Increased expression and glycosylation of immune checkpoint molecules (ICMs) in tumors are responsible for cetuximab therapy refractoriness. The role of programmed death ligand 2 (PD-L2), a ligand of PD-1, in the immune function of PD-L2 is unclear. Aim: Here, we examined the regulatory mechanism of PD-L2 glycosylation and its role in antitumor immunity and cetuximab therapy. Methods: Single-cell RNA sequencing and IHC staining were used to investigate PD-L2 expression in cetuximabresistant/sensitive HNSCC tissues. The mechanism of PD-L2 glycosylation regulation was explored in vitro. The effects of PD-L2 glycosylation on immune evasion and cetuximab efficacy were verified in vitro and using mice bearing orthotopic SCC7 tumors. Results: The PD-L2 levels were elevated and N-glycosylated in patients with cetuximab-resistant HNSCC. Glycosylated PD-L2 formed a complex with EGFR, which resulted in the activation of EGFR/STAT3 signaling and decreased the cetuximab binding affinity to EGFR. The N-glycosyltransferase FUT8, a transcriptional target of STAT3, was required for PD-L2 glycosylation. Moreover, glycosylation modification stabilized PD-L2 by blocking ubiquitin-dependent lysosomal degradation, which consequently promoted its binding to PD-1 and immune evasion. Inhibition of PD-L2 glycosylation using Stattic, a specific STAT3 inhibitor, or PD-L2 mutation blocking its binding to FUT8 increased cytotoxic T lymphocyte activity and augmented response to cetuximab. Conclusion: Increased expression and glycosylation of PD-L2 in tumors are an important mechanism for cetuximab therapy refractoriness. Thus, the combination of PD-L2 glycosylation inhibition and cetuximab is a potential therapeutic strategy for cancer. Keywords: head and neck neoplasms, immune evasion, biomarkers; tumor
Blockade of PD-L2 enhances the response to Cetux in HNSCC Have you got a Conflict of Interest?: No
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783 Success Story in Implementation of Human Papilloma Virus (HPV) Vaccination in Low resource Settings Y. VERMA1 1 Sikkim Manipal Institute of Medical Sciences ,Sikkim Manipal University, Pathology, Gangtok, India Background and context: Cervical cancer is a major cause of morbidity, mortality and premature deaths among middle-aged women in developing countries. India alone accounts for one fifth of the global burden of the disease. Sikkim is a small Himalayan state of India with a population of 0.65 million and having an Age Adjusted rate of Cervical cancer of 12.5. Aim: Introduction of free HPV vaccination in the State of Sikkim as a state program and make it the first state to do so in the Union of India . Strategy / Tactics: HPV vaccination was proposed for introduction in the state of Sikkim in 2014. Resistance from the anti vaccine groups, price of vaccine and change in political priorities led to the launch day to be cancelled .Political advocacy was not focused upon. The HPV vaccination introduction issue was kept alive for the next4 years targeting the politicians who are the final decision makers. Series of advocacy meeting was undertaken with evidence to the Politicians and executive. Finally the state announced the first round of HPV vaccination from 30th July to 14th August2018. It was introduced as the first state in the Union of India as a school based program for the Girl child between the age of 9-14. It was planned as a two dose vaccination of a quadrivalent Vaccine. UNICEF facilitated the vaccine procurement at concessional rates and WHO supported with technical knowledge . Outcomes: The first dose and second dose was to be provided to 25284 estimated girls between the age group of 9-14 years which included the catch up population from 10-14 years . A total of 24446 ( 96.69 % )of girls took the first dose of the estimated population and 23922 (97.86%) took the second dose of the first dose beneficiaries . This showed a high rate of compliance thanks to strong advocacy ,political will and safety of the vaccine . Adverse events following the two dose of immunization was limited to only minor events which lead to acceptance of the subsequent dose . What was learnt: (if relevant, please also detail here the potential of replicability)HPV vaccine has now been embedded in the Immunization program of the state with budgetary provision on a yearly basis and with a strong advocacy program has been moved into a facility based program in the second year of its introduction . The State Government is funding the program since its inception to implementation ensuring sustainability . Replicability Potential: Seeing the success of the introduction of HPV vaccination has lead to other states of the Indian Union to plan for introduction of vaccination making Sikkim as the model. This model is replicable in low resource settings were the need for HPV vaccination is most needed . Have you got a Conflict of Interest?: No
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785 Efficacy and safety of iodine-125 seed implantation as palliative treatment for inoperable pancreatic cancer K. Zhang1, B. Wang1, B. Qiu2, L. Wu1, Y. Liu3, J. Zhang3, R. Wang4, J. Wang2 1 Department of Oncology, tengzhou, China, 2Department of Radiation Oncology, Beijing, China, 3Department of Intervention Therapy, Shanxi, China, 4Department of Radiation Oncology, Dalian, China Background: Radioactive iodine-125 (125I) seed implantation demonstrated favorable efficacy for local tumor control, survival, and pain palliation in pancreatic cancer. Computed tomography (CT) guidance was commonly used to improve the outcome of radioactive 125I seed implantation, which is not a real-time image, and 125I seeds implanted into the tumors by free-hand. Therefore, a 3D printing template is used to assist radioactive 125I seed implantation for advanced pancreatic cancer, which appears to be a safe and effective method for highquality seed implantation. Since clinical outcomes involving tumor response in patients’ survival has not yet been reported, the present study aimed to investigate dosimetric outcomes, clinical efficacy involving tumor response, patients’ survival, pain palliation, and safety of 3D printing coplanar template-assisted 125I seed implantation as palliative treatment for inoperable pancreatic cancer. Aim: To investigate clinical efficacy and safety of 3D printing coplanar template-assisted iodine-125 (125I) seed implantation as a palliative treatment for inoperable pancreatic cancer. Methods: Consecutive 28 patients (16 males and 12 females, median age of 64 years) with histologically diagnosed pancreatic cancer who underwent 3D printing coplanar template-assisted125I seed implantation between June 2016 and May 2019 were analyzed. Among these 28 patients, 9 (32.1%) and 19 (67.9%) patients were presenting with tumor node metastasis (TNM) stage IIB and stage III cancer, respectively. Seed implantation was conducted for pain palliation intent in 25 patients and recurrent cancer after radiotherapy in 3 patients. Results: No significant differences were found between pre-planned and post-operative dosimetric parameters, involving D90, D100, V90, V100, V150, conformity index, external index, and homogeneity index (all p > 0.05). Two months after implantation, pain relief rate was 76% (19/25) for pain patients. Overall tumor response rate (complete response + partial response) was 60.7% (complete response 0 patients, partial response 17 patients, stable disease 8 patients, and progressive disease 3 patients). Median survival was 10.5 months and estimated 1year survival rate was 26.7%. Only one patient presented with a slightly upper gastro-intestinal hemorrhage, and another patient suffered from incomplete intestinal obstruction soon after implantation, both recovered after conservative medical treatment without a prolonged hospital stay. No major complication was observed. Conclusion: 3D printing coplanar template-assisted 125I seed implantation appears to be safe and effective palliative treatment for inoperable pancreatic cancer with favorable clinical outcome Have you got a Conflict of Interest?: No
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787 Cost-effectiveness of breast cancer screening programme using clinical breast examination in Vietnam T.T. Ngan1,2, S. Browne3, M. Goodwin3, H.V. Minh2, M. Donnelly1, C. O'Neill1 1 Queen's University Belfast, Centre for Public Health, Belfast, United Kingdom, 2Hanoi University of Public Health, Centre for Population Health Sciences, Hanoi, Vietnam, 3Roche Products Ireland Limited, Dublin, Ireland Background: For many low- and middle-income countries (LMICs) breast cancer (BC) screening based on mammography is not a feasible option. Clinical breast examination (CBE) may represent a pragmatic and costeffective alternative. Aim: This study examines the cost-effectiveness of CBE screening programme versus no screening among a patient group for whom its cost-effectiveness is likely to be least evident (HER2-positive patients) and discusses the wider implications for BC screening in LMICs. Methods: BC progression from the point it is diagnosed to when treatment is performed and afterwards until the end of an individual’s life was modelled by using a multi-state Markov model, constructed in Microsoft Excel. The model was used to examine clinical and economic outcomes over a life-time horizon from the patient, public payer, and healthcare sector perspective. Monthly cycle length with half-cycle correction was used. Costs and outcomes were discounted at 1.5% annually. HER2-positive patients entered the model at either ‘disease-free survival’ or ‘metastatic BC’ health state. The distribution was 83.3%:16.7% and 92.4%:7.6% in the no-screening and screening scenarios, respectively. The differences reflected the downstaging effect of CBE. Model outcome was expected quality-adjusted life years (QALYs). Base-case reported the incremental cost-effectiveness ratio (ICER) per QALY gained. Deterministic and probabilistic sensitively analyses were performed (DSA and PSA, respectively). Results: Compared with no-screening, ICER per QALY gained for the CBE screening programme was $1,801, $2,381, and $4,179 from three mentioned perspectives, respectively. These were less than the cost-effective threshold equalled to three times Vietnam’s gross domestic product (GDP) per capita of $8,145 indicating that CBE screening was cost-effective from all perspectives. All observations from 2000 iterations of Monte Carlo simulation in PSA were in the northeast quadrant of the cost-effectiveness plane and within the threshold indicating robustness of the finding. In DSA, the parameters to which ICERs are most sensitive are average age of cohorts, reduction in proportion of metastatic patients at diagnosis, cost of CBE, and BC detection rate of the programme. Conclusion: For HER2-positive patients and compared with no-screening, the implementation of CBE screening programme in Vietnam is cost-effective from all investigated perspectives. CBE is a ‘good value’ intervention and should be considered for implementation throughout Vietnam. Have you got a Conflict of Interest?: No
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79 Present and Future Economic Impact of Premature Colorectal Cancer Mortality in Brazil M. de Camargo Cancela1, J.E. Monteiro dos Santos1, L.B. Lopes de Souza1, A. Migowski2, L.F. Leite Martins1, D.L. Bezerra de Souza3, P. Hanly4, L. Sharp5, A. Pearce6, I. Soerjomataram7 1 Instituto Nacional de Câncer, Division of Cancer Surveillance and Data Analysis, Rio de Janeiro, Brazil, 2Instituto Nacional de Câncer, Cancer Early Detection Division, Rio de Janeiro, Brazil, 3Universidade Federal do Rio Grande do Norte, Postgraduate Programme in Collective Health, Natal, Brazil, 4National College of Ireland, School of Business, Dublin, Ireland, 5Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom, 6The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, 7International Agency for Research on Cancer, Cancer Surveillance Branch, Lyon, France Background: Colorectal cancer (CRC) ranks third in causes of cancer death in Brazil; half of these deaths occur in economically active individuals. The current and future economic impact of these deaths is still unknown in Brazil. Aim: Colorectal cancer (CRC) ranks third in causes of cancer death in Brazil; half of these deaths occur in economically active individuals. The current and future economic impact of these deaths is still unknown in Brazil. Methods: We calculated the age-standardised mortality rates between 2001 and 2015 and predicted theagestandardised mortality rates (ASR) between 2016-2030,Years of Potential Productivity Life Lost (YPPLL) and productivity loss due to premature colorectal (ICD10: C18-21) cancer mortality in Brazil between 2016-2030. The Human Capital Approach was applied to estimate productivity loss among those economically active (men 15-65 years and women 15-60 years). Mortality data were obtained from the Ministry of Health and economic and population data from Brazilian Institute of Geography and Statistics databases. Results: Overall, we estimated 202,099 CRC deaths of productive ages from 2001 to 2030. The ASR among men is estimated to increase from 5.0/100,000 in 2001-2005 to 6.3/100,000 in 2026-2030. Among women ASR will slightly increase from 3.5 in 2001-2005 to 4.2 in 2026-2030). The highest relative increases of ASR and productivity loss, comparing the first to the last quinquennium, were observed among men in the North region, 112.1% and 733% respectively and among women in the Northeast 111.6% and 567%, respectively. From 2001 to 2030, total of 2.6 million of YPPLL are predicted, corresponding to a total productivity loss of US$ 12.6 billion. Together, the South and Southeast regions will contribute 70% of these figures. Conclusion: The economic impact of colorectal cancer premature mortality is predicted to increase in all regions, and particularly among men. Consequently, YPPLL and productivity losses will be significant. To reduce colorectal cancer morbidity, mortality and economic impact, primary prevention, screening and early diagnosis are essential. The Ministry of Health recognizes the efficacy of screening, but issues related to human resources, equipment and logistics for diagnostic confirmation urge to be solved to offer CRC screening on a regular basis. Our findings highlight the need to implement strategies for primary and secondary prevention of colorectal cancer in Brazil.
Have you got a Conflict of Interest?: Yes If yes please specify:: This study was funded by MSD Independent Oncology Policy Grant Program. The sponsor had no involvement in the study design, in data collection, analysis and interpretation; in the writing of the abstract and in the decision to submit the abstract for this conference.
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799 Research Challenges Faced by African Investigators in Francophone countries. B. NKEGOUM1, n. COULIBALY2, E. KANINjING3 1 University Hospital Center, PATHOLOGY AND ONCOLOGY, YAOUNDE, Cameroon, 2Institut Pasteur, ABIDJAN, Cote D'Ivoire, 3georgia college, public health, MILLEDGEVILLE, United States BACKGROUND Many countries in Africa are faced with the double burden of infectious diseases and increasing prevalence of non-communicable diseases (NCDSs). While progress has been made on many health indicators, life expectancy and most population health indicators in sub-Saharan Africa lag behind most low-income and middle-income countries in different regions of the globe.To address this double burden of infectious and rapidly growing NCDs requires research that translate into Africa-based solution. Yet for researchers in French-speaking countries in Africa, linguistic and other barriers limit opportunities for participation in robust research that could lead to improvements in health outcomes and quality of life. AIM To present Research Challenges Faced by African Investigators in Francophone countries RESULTS Exposure to research conducted by other investigators facing similar challenges occur at scientific conferences and workshops where English is the dominant language of expression. For investigators with low English language proficiency, it’s a daunting task to grasp specifics of innovative research approaches and to ascertain potential areas of collaboration or participation with other researchers. French-speaking investigators also have to deal with the fact that information about extra-mural grant funding and scientific awards are often made in English with limited French translation. Moreover, in applying for grant funding, French-speaking investigators from sub-Sahara Africa are at a competitive disadvantage as their prior publication history have been in French journals with an impact factor generally lower that English language scientific journals.
The structure for promotion and career advancement at some universities in French-speaking countries does not emphasize or reward continuous research and publication beyond full professor level. Furthermore, attaining full professorship often comes with some administrative responsibilities at the university level which takes away time that could be devoted to research activities. Collaboration is not often emphasized leading to hesitancy in research participation.some clinicians are reluctant to collaborate with basic science researchers and share samples that could lead to advancement of scientific knowledge in the etiology of certain diseases. Underinvestment in research facilities and equipment, particularly in laboratories is a major disadvantage for researchers in sub-Saharan Africa. Investigators trained at institutions in Europe and America return home lacking basic equipment which makes it difficult for them to transfer the knowledge gained abroad. This limits opportunity to groom a pipeline of junior investigators with the xpertise to conduct cutting-edge research for health challenges. Conclusion by offering more opportunities for collaborations between anglophone and francophone researchers will contribute to reducing the challenges faced by these researchers. Have you got a Conflict of Interest?: No
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80 Lobe-specific analysis of sublobar lung resection for NSCLC patients with size ≤ 2 cm X. Lei1, S. Xu1 1 Tianjin Medical University General Hospital, Tianjin, China Background: Sublobar resection could be utilized as an alternative surgical strategy for early-stage NSCLC patients intolerable to lobectomy. But the choice between wedge resection and segmentectomy still remains debatable. Aim: Our study aims to explore the optimal surgical procedure for patients with NSCLC ≤ 2 cm according to lobespecific analysis. Methods: Clinical and survival data of patients with stage IA tumors with a diameter ≤ 2 cm receiving segmentectomy and wedge resection were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. After performing propensity score matching (PSM) to reduce the inherent bias of retrospective studies, we used the Kaplan-Meier method and log-rank tests to assess the differences in overall survival (OS). Results: A total of 1882 patients were identified from the SEER database after PSM analysis, including 941 patients receiving segmentectomy and 941 patients receiving wedge resection. Segmentectomy showed a better survival than wedge resection for patients with NSCLC ≤ 2 cm. However, for NSCLC ≤1 cm, there was no significant OS difference between segmentectomy and wedge resection. For NSCLC >1 to 2 cm, it demonstrated that there was an OS advantage of segmentectomy over wedge resection (p=0.024). However, the survival benefit was only observed in right upper NSCLC with size >1 to 2 cm but not all of other four lobes. Furthermore, multivariate cox regression analysis showed elder age, male, LUSC, no-LN dissection and wedge resection were associated with poor OS. Conclusion: In conclusion, compared to wedge resection, segmentectomy showed a better survival benefit only in size >1 to 2 cm NSCLC of primary tumor from right upper lobe. Therefore, for the early-stage NSCLC patients (size ≤2 cm) intolerable to lobectomy, we propose a lobe-specific sublobar resection strategy. And this need to be further validated in larger cohorts.
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Have you got a Conflict of Interest?: No
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805 Match- pair analysis of free flaps with local flaps in reconstruction of oral cavity defects. J. Sebastian1, B.T Varghese2, A. Vishwani3, D. G.M4, C. K George2 1 Regional Cancer Center Trivandrum, Surgical Oncology, Trivandrum, India, 2Regional Cancer Center, Head and Neck Oncolgy, Trivandrum, India, 3Regional Cancer Center, Head and Neck Oncology, Trivandrum, India, 4Regional Cancer Trivandrum, Head and Neck Oncology, Trivandrum, India Background: Advantages of free flaps (F.F) are lack of bulk, ease of dissection, and malleability. More conservative measures like local flaps (L.F) must be used for patients with advanced age, multiple preoperative morbidities, or advanced disease which results in shorter hospital stays, less risk of postoperative complications and less cost of treatment. Reconstructive technique selection is complex and must be based on patients pre-operative conditions, the nature of the disease, and the available resources. Aim: To determine whether the L.F are a good alternative to F.F in the reconstruction of oral cavity defects. Methods: 157 patients were identified retrospectively, (69 F.F and 88 L.F) operated between 2003 and 2019. 25 matched pairs were made on the basis of age, stage, primary site, flap size, type of surgery, neoadjuvant and adjuvant treatment. They were compared with respect to intraoperative time, total intensive care unit (ICU) and hospital stay, complications, speech, swallowing, aesthetics and donor site morbidity. Speech and swallowing were rated on a scale of 1-7 (validated from Tata memorial hospital, Mumbai) and aesthetics with Visual analogue scale (VAS) (1 to 10) prospectively while follow-up. (Jaescke R etal) (Table: 1).
Dysphagia assessment Grade 1 No complaints in swallowing Grade 2 Minimal complaints, able to swallow without difficulty with bolus Grade 3 Minimal complaints, able to swallow without difficulty without bolus Grade 4 Moderate complaints and difficulty swallowing with bolus Grade 5 Moderate complaints and difficulty swallowing without bolus Grade 6 Severe complaints with difficulty in swallowing with or without bolus Grade 7 Severe complaints, unable to swallow Speech assessment Grade 1 Speech is unintelligible Grade 2 Speech is usually unintelligible Grade 3 Speech intelligibility is difficult Grade 4 Speech is intelligible with careful listening Grade 5 Speech is intelligible, although noticeably in error Grade 6 Sound errors are occasionally noticed in continuous speech Grade 7 No sound errors were noticed in continuous speech V.A.S 0-2 Poor 3-5 Fair 6-8 Good 9-10 Excellent Table 1: Swallowing score, speech score and VAS.
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Results: The average age was 51.5 years in the L.F group and 44.7 years in the F.F group (difference not statistically significant). Among the 25 F.F, 18 were RAFF, 4 were FFF and 3 were ALT flaps, and in L.F, 17 were NLF, 4 were SMF, 3 were FAMM flaps and 1 was sternocleidomastoid flap (SCM)(Table 2). Both groups were comparable in terms of risk factors and comorbidities. Mean F.F size was 6x5 cm and 6x4 in L.F. Mean Operating time, ICU stay and total hospital stay were significantly different among two groups. Re-explorations were not significantly different. Speech and swallowing functions and aesthesis score were also not significant (Table 3).
Sex Primary site
F.F Male: 20 Female : 5 Tongue : 12 BM:10 LA: 3
L.F Male: 20 Female : 5 Tongue : 12 BM:10 LA: 2 FOM:1 T4A:16 T3:7 T2:2 9 RT:21 CRT:2 2 Complete: 0 Partial : 5 0
Stage
T4A:13 T3:10 T2:2 NACT 9 Adjuvant treatment RT:21 CRT:2 Tracheostomy 18 Flap failure Complete: 3 Partial : 1 Donor site complication Infection: 2 Hematoma: 2
Table 2: LA:Lower alveolus, BM:Buccal Mucosa, FOM:Floor of mouth, NACT: Neoadjuvant chemotherapy, RT:Radiotherapy, CRT :Chemoradiotherpay
Parameter Pair 1 Pair 2 Pair 3 Pair 4 Pair 5 Pair 6 Pair 7
Operating Time FF OperatigTime LF Icu stay FF Icu stay LF Hospital stay FF Hospital stay LF Re-exploration FF Re-exploration LF Speech score FF Speech score LF Swallow score FF Swallow score LF Aesthesis score FF Aesthesis score LF
Mean 7.5780 3.660 3.20 1.52 8.04 5.28 .20 .08 5.08 5.60 2.80 1.96 6.64 6.72
Table 3: Results.
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PStd. Deviation value 1.39120 0.001 .7599 1.041 0.001 .714 1.513 0.001 1.242 .408 0.265 .277 1.077 0.097 1.041 1.258 0.012 .790 1.411 0.845 1.595
Figure 1: Folded ALT flap ( A1 and A2) and folded SMF flap (B1 and B2).
Figure 2: RFFF (A) and SMF (B).
Figure 3: FFF (A) and NLF (B) Conclusion: Local flaps are an alternative to free flaps in the reconstruction of oral cavity defects, as it is less technically demanding, has good aesthetic and functional outcomes, and is having acceptable post-operative morbidity. Have you got a Conflict of Interest?: No
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81 Lobe-specific Adjuvant Chemotherapy For Stage IB- III NSCLC Patients：A SEER Population-Based Study X. Lei1, S. Xu1 1 Tianjin Medical University General Hospital, Tianjin, China Background: Adjuvant chemotherapy is considered necessary for stage II and stage III NSCLC patients according to the guidelines of different international lung cancer organizations, and adjuvant chemotherapy for stage IB NSCLC patients is still controversy which may be valuable for patients with high risk factors. Aim: In this study, we attempted to explore the best adjuvant chemotherapy strategy for NSCLC patients with stage IB to III according to lobe-specific analysis. Methods: We identified resectable NSCLC patients with stage IB、stage II and stage III who were received adjuvant chemotherapy and without radiotherapy after lobectomy or sublobar resection. Propensity score matching (PSM) analysis were performed to reduce the inherent bias of retrospective studies. We used Kaplan– Meier method and log-rank tests to assess the differences in overall survival (OS).Results: OS favored chemotherapy group compared with non-chemotherapy group in patients with stage IB、stage II and stage III NSCLC patients before PSM analysis. However, after performing PSM analysis, survival benefits were not found in stage IB group. For patients with stage II and stage III, OS benefit was remarkable after PSM analysis. However, subsequent lobar subgroup analysis indicated no survival advantages were observed not only for right middle lobe group with stage II and stage III but also for right lower lobe group with stage III.Conclusion: In conclusion, we propose a lobe-specific adjuvant chemotherapy for NSCLC patients. For stage IB NSCLC, right middle lobe NSCLC from stage IB- III and right lower lobe NSCLC from stage III adjuvant chemotherapy might not bring survival benefits. However, this needs to be further validated in larger cohorts.
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Have you got a Conflict of Interest?: No
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813 Sunscreens safety - Perceptions, Opportunties and Risks C. Sinclair1,2 1 Cancer Council Victoria, Prevention, Melbourne, Australia, 2The University of Queensland, St Lucia, Australia Background and context: Sunscreens are an important part of our sun protection advice yet at a time when the evidence of the effectiveness of sunscreen to reduce melanoma is stronger than it has ever been, public confidence in its safety appears to be declining. This presentation presents data on perceptions about sunscreen safety and efficacy and describes challenges facing promoting sunscreen as an important skin cancer preventive measure. Aim: To give an overview of the limitations of sunscreen, particularly sunscreen aerosols, and provide what our key messages should be in a public health context to restore public confidence in the product as a method to reduce the risk of skin cancer. Strategy / Tactics: A critical analysis was undertaken that includes recent reviews on sunscreen effectiveness and efficacy. In addition to this, data will be drawn from two recent research projects that have investigated the effectiveness of aerosol sunscreens. A 2021 analysis of the effectiveness of sunscreen aerosols in light and moderate wind conditions found that the proportion of sunscreen lost due to the impact of wind varied between products and ranged from 32%-79% for 10 kph and 28-93% for 20 kph wind conditions. The cost of adult whole body sunscreen application for aerosol sunscreen products ranged from $9.20AUD to $90AUD in the 20 kph wind conditions. This demonstrates that aerosol sunscreen are highly ineffective and costly method of skin cancer prevention. Programme / Policy process: Data showing how ineffective aerosols sunscreen are highlight that their use should be actively discouraged as compared to other forms of sun protection. Outcomes: We need to improve the public’s confidence in sunscreen if we are to realise the benefits. The use of aerosol sunscreens in particular should be actively discouraged as they are very ineffective as a UV filter in everyday conditions. We should encourage people to choose sunscreen (>SPF30) primarily based on how well it feels cosmetically to encourage more liberal application rather than focus on other intrinsic or technical benefits as well as to use it with other forms of sun protection. Unless we promote the benefits to make it easier for consumer to choose based on cosmetic appeal, the impact of social media concerns will continue to undermine the general public’s confidence in the product. Our public health communication (proactive and reactive) may be over complicating our sunscreen advice to the general public. What was learnt: (if relevant, please also detail here the potential of replicability) Aerosol sunscreen products are highly ineffective as a way to reduce sun burn and risk of skin cancer, however lotion based sunscreens must remain as an important measure along with other sun protection methods to reduce the risk of skin cancer. Have you got a Conflict of Interest?: No
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82 Increasing effectiveness of cancer primary & secondary prevention. Potential role of Military Medical Forces M. Akroush1, P. Natali2 1 MTCC, Fuhais, Jordan, 2"Regina Elena" National Cancer Inst., Rome, Italy Increasing the effectiveness of cancer primary and secondary prevention. The Potential role of Military Medical Forces. Maisam Akroush MD, Pier Giorgio Natali MD. The Mediterranean Taskforce for Cancer Control, Rome.Italy (MTCC, www.mtcc-prevention.net) Prevention and Early Diagnosis are established priority strategies in cancer control. Therefore, implementation and dissemination of policies aimed at translating these anticipatory care strategies into practice is critical in contrasting the foreseen increasing global cancer burden, changing epidemiology, the diminished role of primary care, costs, and disparities.The appreciation that military medicine can support global health is increasingly recognized. However, attempts to increase the engagement of military medicine in civil public health are limited. In consideration that in peacetime Military Medicine •is caring for active and retired personnel and their family members in significant number with «no disparities» •has a closer logistic and referral (Military Hospitals) between General Medicine and Specialists which is advantageous in limiting the occurrence of «advanced disease» •can resort to Opportunistic screenings during the mandatory routine check-up’s •features robust command/control hierarchies which can enforce «adherence to guidelines» •dealing with risk management can manage Environmental /Occupational relevant risks more efficiently •is relatively shielded by changes in health care “economic restrictions” Military General/Internal medicine and Specialists represent valuable supportive partners of their civilian counterparts in cancer control, primarily in diminishing the incidence of advanced disease, “The key challenge in cancer medicine”. The history of public health has clearly documented that only integrated programs resort in durable outcomes, thus MTCC strongly advocates that Military Medicine merges its defense and security missions with those of civil society at the national and global levels by enforcing the above activities which in peacetimes minimally conflict with the issue of “dual loyalty”. Have you got a Conflict of Interest?: No
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821 XRCC3 Thr241Met polymorphism and gastric cancer susceptibility: a meta-analysis Z. Chen1, K. Yang2 1 Zehua Chen, Chengdu, China, 2Kun Yang, Chengdu, China Background: The gene encoding X-ray repair cross-complementing group 3 (XRCC3) participates in the occurrence and development of a variety of cancers. Investigations of molecular epidemiology have revealed that in XRCC3, polymorphisms are related to an enhanced risk of cancer, but the outcomes have been inconsistent. Aim: The meta-analysis was conducted to evaluate the association between susceptibility to gastric cancer (GC) and XRCC3 polymorphism. Methods: The search for the Embase, PubMed, Cochrane and Web of Science databases was implemented. Odds ratios (ORs) containing 95% confidence intervals (95% CIs) were employed to evaluate the relationship between susceptibility to gastric cancer and XRCC3 polymorphism. Results: Twelve associated studies were analysed with a total of 4019 control samples and 2781 patients. In general, the comprehensive data indicated that the polymorphism XRCC3 Thr241Met was remarkably related to susceptibility to gastric cancer. When stratified by race, it can be observed that carriers of the Met/Met genotype are probably at higher gastric cancer risk in Asians, and this condition was not observed among non-Asians. When stratifying by the control source, the comprehensive outcomes suggested that the carriers of the Met/Met genotype may possess an enhanced gastric cancer risk in the population of case–control research based on hospital, but not in the population of case–control exploration based on population. Conclusion:The present meta-analyses show that XRCC3 polymorphisms are probably linked to the risk of gastric cancer, especially in Asian people. However, this finding needs further research and a larger population to confirm our results. Have you got a Conflict of Interest?: No
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822 Sequential development of embryoblast-like memory entities in human cancer tissues . L. Sanchez1 1 UIVERSIDAD COOPERATIVA DE COLOMBIA, MICROBIO0LOGIA, villavicencio, Colombia Background: Sequential development of embryoblast like memory entities in human cancer tissues :Anevolutionary self – repair structure with pluripotentiality Hidden collective organization of cancer cells can partially or completely return to embryoidgenotype‐ phenotype with the plasticity to transform their morphology on cell embryoblast-like memory entities by expression of dormant genes that arise from embryogenesis. After hundreds of driver mutations, cancer cells gain new abilities or attributes and recapitulate early stages of embryogenesis. Our findings document how malignant tissues reactivated ancestral storage memory and elaborate inside tumor glandsspiral-pyramidal-fractal chiral crystals (Tc) as geometric attractors proteins and biomimicry the primitive cellular blastocyst embryoblast fluid-filled cavity. fluid-filledcavity , with sensitive and specific expression of Neuron-specific enolase – immunopositivity . The resultant evolutionary embryoblast-like entity has higher survivability and spatial cephalic-caudal growth organization with pluripotentiality that carry the correct DNA instructions to repair ,and regenerate .The isolation and manipulation of these structures can guide and control the regenerative pathway mechanism in human tumors as follows: modify and reprogram the phenotype of the tumor where these entities are generated, establish a reverse primordial microscopic mold to use the swirlonic collective behavior of cellular building blocks to regenerate injured tissues, convert cancer cells to a normal phenotype through regeneration using the organizational level and scale properties of reverse genetic guidance, global control of mitotic activity and morphogenetic movements avoiding their spread and metastasis, determining a better life prognosis for patients who incubate these entities in their tumors compared to those who do not express them. An emergent self-repair structure, biological template to develop targeted therapeutic alternatives not only in cancer but also in treatment of autoimmune, viral diseases, and in regenerative medicine and rejuvenation Aim:
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Methods: Self-repair structures with pluripotentiality. Cell embryoblast-like entities identified in different types of cancer. Cancer generates self-assembly repair order structures via rotating vortices. Swirlonic state with spatial cephalic-caudal growth organization . Panelh, Iillustrates perfect embryoblast-like entities with high specific immunopositivity expression for neuron specific enolase,
Results:Conclusion: Figure illustrates perfect cell embryoblaststructure with defined visible pluripotentiality Observe optic vesicle petromastoid bone primitive aorta and common iliac.Material was captured in ascitic fluid carcinomatosis. A self-repair structure with spatial cephalic-caudal growth organization Have you got a Conflict of Interest?: No
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824 Serum electrolyte levels predict taxane-induced peripheral neuropathy in patients with breast cancer J. Zhai1, H. Mo1, F. Ma1 1 National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Medical Oncology, Beijing, China Background: Taxane-induced peripheral neuropathy(TIPN) is a debilitating adverse effect of neurotoxic cancer treatments with taxane. Limited knowledge exists of potential prechemotherapyblood-based biochemical factors associated with TIPN development. Aim: To identify the association of pretreatment blood-based and clinical factors with TIPN persistence in patients who received 3 kinds of taxanes including paclitaxel , docetaxel and nanoparticle albumin-bound (nab)-paclitaxel. Methods: This cohort study assessed pretreatment blood-based clinical factors and demographic characteristics of 873 patients treated with taxane at urban multicenter cancer clinics and academic institutions in China between December 2016 and October 2021.Participants aged 18 years or older with stage I to IV breast cancer who underwent primaryneoadjuvant and adjuvantchemotherapy with taxane were eligibleto do patient-reported neuropathy assessments using EORTC-CIPN20 questionnaire. Patients did the questionnaire after every cycle and we selected the highest TIPN toxicity score to analyze. The Posttreatment TIPN severity was compared with blood-based factors within 30 days before commencing treatment. Data were analyzed between November 2021 and March 2022. Results: The study included 873 breast cancer participants (women; median [interquartile range] age, 50 [16] years) who were consecutively recruited and referred(489 [56.0%])received paclitaxel, 282 [32.3%] received docetaxel, 102 [11.7%]]received nab-paclitaxel ).A total of 779(89.2%) patients reported neuropathy symptoms. The mean(SD) total score is 24.8(4.8) in the whole cohort, 24.4(4.4) in the paclitaxel group, 24.8(4.9) in the docetaxel group and 27.0(5.9) in the nab- paclitaxel group. In the whole cohort, patients with high pretreatment Cl demonstrated higher TIPN toxicity scores (mean [SD], 25.6 [6.0] vs 24.6[4.6]; P = .015) and higher motor toxicity scores (mean [SD], 9.2 [2.2] vs 8.9 [1.9]; P = .016). Patients with low pretreatment Na demonstrated higher TIPN toxicity scores (mean [SD], 25.3 [5.8] vs 24.7 [4.6]; P = .013) and higher motor toxicity scores (mean [SD], 9.0 [2.3] vs 8.9 [1.9]; P = .006). A multivariable model found a significant association of baseline blood-based and clinical factors with TIPN (F4,868= 19.7; P < .001; r2= 0.08). Factors associated with higher TIPN toxicity score were higher chemotherapy dose (β=0.005; 95% CI,0.004 to 0.006; P<.001), higher BMI (β=0.03; 95% CI,0.004 to 0.09; P=0.025), lower Na (β=−0.24; 95% CI,−0.39 to−0.09; P = .002) and higher Cl (β=0.30; 95% CI,0.16 to 0.44; P < .001). Conclusion: We found that the baseline electrolyte level is related to the severity of TIPN. Patients withhigh chemotherapy dose, high BMI, low Na and higher Cl were more likely to develop TIPN posttreatment. Closer monitoring of those at higher risk in order to allow dose modification may mitigate the development of longterm TIPN among patients receiving taxanes. Have you got a Conflict of Interest?: No
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834 The relationship between mammographic features and clinicopathological parameters in Chinese data base Y. Liu1, Y. Ji1, H. Lu1 1 Tianjin Medical University Cancer Institute and Hospital, Department of Breast Imaging, Tianjin, China Background: In China, breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women. Breast cancer encompasses a group of very heterogeneous diseases, which can be demonstrated at the molecular, histopathologic and clinical levels, so that mammographic patterns of breast cancer have a wide range of variation. Aim: To assess the relationship between mammographic features and clinicopathological parameters in Chinese data base. Methods: A retrospective review of mammographic images from a total of 198breast cancer patients imaged between January2016and March2017were conducted. The clinical information, including age, tumorsize, grade, and axillary lymph node status, were collected from our database. Estrogen receptor (ER), progesteronereceptor (PR), human epidermal growth factor receptor 2(Her2) and Ki-67 were analyzed on the surgically removed tumor samples by immunohistochemical staining analysis. Statistical analysis was performed to assess the correlation between mammographic features and clinicopathologic characteristics. Results: 54.0%(n=107) of the patients had a mammographic mass, 38.4%(n=76) had calcifications, 14.1% (n=28) had both a mass and calcifications on the mammogram, and 1.5% (n=3)had architectural distortion. Twelve masses had a regular shape, and ninety-five masses were irregular. Thirty-five masses had a spiculated margin, and seventy-two masses were non-spiculated. Irregular masses had a significantly higher PR-positive than regular masses (73/94, 77.7% vs. 5/11, 45.5%, p<0.05). The IDC grade of Ⅲ in mass was 16.7% (n=25), which were obviously higher than those in non mass as 6.0% (n=9) (p<0.05), whereas 4.7% (n=7) in architectural distortion/asymmetries, which were obviously lower than those in non-architectural distortion/asymmetries as 18.0% (n=27) (p<0.05). Conclusion: There is a relationship between mammographic features and clinicopathological parameters in Chinese data base. The mammography imaging recognition of breast cancer can assist in pretreatment planning and prognosis . Have you got a Conflict of Interest?: No
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841 Reevaluation of frozen pathological results of suspicious peritoneal nodules in gastric cancer patients C. Wang1, C. Tian1, J. Zhao1, J. Liu1, C. Ji1, D. Liu1, J. Sun1, H. Li1, X. Wang1 1 Zhongshan Hospital, Fudan University, Department of General Surgery, Shanghai, China Background: When frozen pathological results of suspicious peritoneal nodules found in gastric cancer (GC) patients present negative or dubious, the surgeons will sometimes be in a difficult situation to decide whether gastrectomy is still needed. However, there is little literature on frozen pathological results of peritoneal nodules and intraoperative surgical decision making accordingly in GC patients. Aim: To reevaluate pathological results of peritoneal nodules in GC patients and their overall survival (OS), making recommendations on intraoperative surgical decision making according to frozen pathological results. Methods: A total of 321 GC patients with pathological results of peritoneal biopsy specimens were enrolled retrospectively from January 2015 to July 2021 in Zhongshan Hospital, Shanghai. We analyzed pathological results and concordance of peritoneal nodules. We also performed survival analysis for frozen section (FS) and final pathology results and surgery according to frozen pathological results. Results: Of 70 patients whose FS results presented negative, 59(84.3%) had concordant negative final pathology results, while final pathology results of 11(15.7%) turned out to be positive. 44 (89.8%), 3(6.1%) and 2(4.1%) of 49 patients with dubious FS results had positive, negative or still dubious final pathology results respectively. Final pathology results of 95 FS positive patients were all positive. Negative pathological results indicated better prognosis than positive/dubious in both frozen section (median OS 33 vs. 17 months; hazard ratio (HR) 0.43, 95% confidence interval (CI) 0.27-0.68; P=0.0002) and final pathology (median OS >36 vs. 14 months; HR 0.32, 95%CI 0.21-0.49; P<0.0001). Gastrectomy for FS negative patients improved survival compared to without gastrectomy (median OS >36 vs. 14 months; HR 0.34, 95%CI 0.15-0.76; P=0.0062). Of patients with positive and dubious FS results, survival benefit was not demonstrated for gastrectomy vs. without gastrectomy (median OS 22 vs. 14 months; HR 0.73, 95%CI 0.42-1.26; P=0.24). Conclusion: Gastrectomy can be justified for treatment of gastric cancer patients with negative frozen pathological results of peritoneal nodules. For patients with positive and dubious frozen pathological results, gastrectomy is not recommended unless it is performed as palliative surgery.
Figure3. Kaplan-Meier plots of overall survival for gastrectomy in patients with negative(A) and positive/dubious(B) frozen pathological results. HR, hazard ratio; CI, confidence interval.
Figure2. Kaplan-Meier plots of overall survival according to frozen section(A) and final pathology(B) results. Neg, negative; Pos, positive; Dub, dubious; HR, hazard ratio; CI, confidence interval.
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Figure1. Pathological results and concordance of peritoneal(A), omentum(B) and peritoneum(C) nodules.
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843 HPV self-sampling for cervical cancer screening in India - acceptability, feasibility and validity G. A Mishra1, S. A Pimple1, K. V Anand1, V. Y Kulkarni1, S. K Biswas2, A. S Patil1 1 Department of Preventive Oncology, Centre for Cancer Epidemiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 2Department of Microbiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India Background: Cervical cancer is the second most common cancer among Indian women. Screening with cytology or VIA necessitates women to visit screening clinic, which may not always be accessible. It also involves vaginal speculum examination which may cause discomfort and make screening unattractive even among women who have access to health care. HPV self-sampling appears to overcome these challenges. The current study was designed to investigate the attitudes, acceptability, barriers, predictors and validity of HPV self-sampling among Indian women. Aim: To study the attitudes, acceptability, feasibility and validityof self-collection of specimens for HPV DNA testing among Indian population. Methods: This is community based interventional study among women in urban slum (500), urban non-slum (500) and rural (600) settings, each sub-divided into two groups, one to receive information about its use with pamphlets and the other with health education programme. The study involves, door to door visit to enlist the eligibles, obtain informed consents and conduct personal interviews to collect baseline data about Knowledge, Attitude and Practices (KAP) regarding cervical cancer, screening and HPV. HPV self-samplers were then distributed to the women with instructions regarding storage and return. The willingness to use self-samplers, refusals, reasons for the same, various other queries were captured. Post-intervention KAP was recorded. The HPV reports were distributed after 2 weeks. Women with positive result on either tests, were offered further work up at the Nodal Hospital. Results: The acceptance rate of self-sampling was 99.2%, 97% and 98.8% and HPV positivity was 7%, 7.8% and 7.8% among the urban slum, urban non-slum and rural women. Overall, the agreement rate between health personnel collected samples and self-collected samples was 95%. The major barriers of self-sampling were lack of confidence about performing the self-test correctly, fear that test would be painful, illiteracy and anxiety about test results. Conclusion: HPV self-sampling has good acceptability among Indian women and the results show good agreement with the health personnel collected samples. Disclosures: NIL Have you got a Conflict of Interest?: No
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846 The effect of intraoperative opioids on survival of patients with primary extrahepatic cholangiocarcinoma S. Lin1, H. Zou1 1 Harbin Medical University Cancer Hospital, Pain Medicine, Harbin, China Background and context: In recent years, studies have explored the correlation between opioids and the survival of cancer patients, but there is no study on the effect of intraoperative opioids on the recurrence and survival of patients with extrahepatic cholangiocarcinoma. Therefore, the data of 113 patients with extrahepatic cholangiocarcinoma were collected in this study. To investigate whether intraoperative opioid doses affect patients' relapse-free survival (RFS) and overall survival (OS). Strategy / Tactics: Clinical data of 113 ECC patients who underwent surgery in Harbin Medical University Cancer Hospital from September 2013 to August 2019 and were followed up in December 2021 were retrospectively collected. Patients were divided into high-dose group and low-dose group according to intraoperative opioid dosage. Univariate and multivariate Cox regression analysis were used to evaluate the effects of intraoperative opioids on RFS and OS of ECC patients. Results：Propensity to match (PSM) were recorded before the 113 patients, high and low dose group of patients with baseline indicators have differences, according to gender, age, height, body weight, body mass index (BMI), medical history, date of surgery, anesthesia, the operation time, whether intraoperative blood transfusion, TNM stage, tumor diameter 1-1 propensity score matching, A total of 66 patients were matched, and the two groups showed balance and comparability. Before PSM, multivariate Cox regression showed that the independent influencing factors of RFS were fentanyl equivalent (P=0.011), blood transfusion (P=0.036), TNM stage (I: 0.002, II: P=0.009, III: 0.001).The independent influencing factors of OS were fentanyl equivalent (P=0.004), blood transfusion (P=0.004), TNM stage (I: P=0.008, III: P=0.005).After PSM, the independent influencing factors of RFS were blood transfusion (P=0.036), TNM stage (I: P<0.001, III: P<0.001);The independent influencing factors of OS were blood transfusion (P=0.009) and TNM stage (I: 0.005, III: P=0.001).Kaplan-mieier and Log Rank methods showed that the RATE of RFS and OS in the low-dose group before PSM was higher than that in the low-dose group (P<0.001). Outcomes: Intraoperative high-dose opioid use increased mortality from extrahepatic cholangiocarcinoma, although it was not statistically significant.), TNM staging (I: 0.005, III: P=0.001).Kaplan-mieier and Log Rank methods showed that the RATE of RFS and OS in the low-dose group before PSM was higher than that in the low-dose group (P<0.001).
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847 Ten-year trends of clinical characteristics, treatment methods and survival outcomes of operable lung cancer D. Zhao1, L. Zhang2 1 Sun Yet-sen University Cancer Center, guangzhou, China, 2Sun Yat-sen University Cancer Center, guangzhou, China Background: Lung cancer is one of the cancers with the highest morbidity and mortality in the world. Since the 21st century, the clinical characteristics and treatment methods of lung cancer patients in China have changed greatly. Aim: The purpose is to understand the real trend of clinical characteristics, treatment methods and survival of lung cancer in China during the past 10 years, and provide scientific basis for accurate diagnosis and treatment of lung cancer. Methods: Based on the medical big data intelligent platform of Sun Yat-sen University Cancer Center, the patients hospitalized in the Department of Thoracic Surgery from 2011 to 2020 were included. The clinical characteristics, diagnosis, treatment methods, and survival outcomes were collected, and the clinical data were compared, analyzed, evaluated and summarized. Results: A total of 7800 patients were included in this study. The annual number of cases increased from 144 to 1350 from 2011 to 2020. During this period, the age distribution of patients showed a gradual average trend. The proportion of patients without clinical symptoms due to health examination abnormalities increased from 40.3% to 77.0% (χ2=392.361, P<0.001), the proportion of female patients increased from 36.8% to 47.7% ( χ2=61.802, P<0.001 ), the proportion of patients without smoking history increased from 47.2% to 66.0% (χ2=109.364, P < 0.001), and the average tumor diameter of patients decreased from 3.766cm to 2.300cm (P<0.001). In addition, the proportion of patients in stage I increased from 57.6% to 85.7% (χ2=248.331, P<0.001), while the proportion of patients in stage II and stage III decreased. The proportion of adenocarcinoma increased from 57.6% to 85.7% (χ2=248.331, P<0.001), while that of squamous cell carcinoma decreased from 27.8% to 9.4% (χ2=141.239, P<0.001). Among the patients who underwent surgical treatment, the proportion of minimally invasive thoracoscopic surgery increased from 41.0% to 62.7% (χ2=196.745, P<0.001), and the proportion of traditional thoracotomy decreased from 59.0% to 31.9% (χ2=299.020, P<0.001). Additionally, the gene mutation detection rate gradually increased, and the positive rate of EGFR mutation increased from 25.0% to 56.2% (χ2=113.843, P<0.001). The average total hospitalization time of patients decreased from 16.104 days to 9.689 days (P<0.001), and the average postoperative hospitalization time decreased from 8.924 days to 5.862 days (P<0.001). The 1year, 3-year and 5-year survival rates of patients increased from 89.8%, 73.9% and 63.8% to 99.6%, 90.7% and 80.8%, respectively (all P<0.001). The 5-year survival rates of patients with stage I, II and III lung cancer were 87.6%, 79.9% and 59.9% respectively, which were higher than those in other regions. Conclusion: There were significant changes in clinical features, treatment methods and survival outcomes of patients with operable lung cancer from 2011 to 2020. Have you got a Conflict of Interest?: No
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848 Risk and Prognosis of Secondary Bladder Cancer After Radiation Therapy for Pelvic Cancer S. Li1, R. Wei1, G. Yu1, Z. Jiang1 1 National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China Background: Radiation therapy (RT) is a crucial modality for the local control of pelvic cancer (PC), but the effect of pelvic RT on the development of secondary malignancy is still unclear. Aim: This study aimed to identify the relationship between radiation therapy received for the treatment of primary PC and subsequent secondary bladder cancer (SBC). Methods: The Surveillance, Epidemiology, and End Results (SEER) database (from 1975 to 2015) was queried for PC. Fine-gray competing risk regression and Cox regression analyses were employed to assess the cumulative incidence of SBC. Poisson regression and multiple primary standardized incidence ratios (SIR) were used to evaluate the radiotherapy-associated risk for patients receiving RT. Subgroup analyses of patients stratified by latency time since PC diagnosis, calendar year of PC diagnosis stage, and age at PC diagnosis were also performed. Overall survival (OS) was compared among different treatment groups with SBC by Kaplan–Meier analysis. Results: A total of 318,165 observations showed that the primary cancers were located in the rectum and rectosigmoid (22.54%), cervix uteri (6.35%), corpus uteri (25.53%), ovary (4.48%), prostate (39.86%), anus, anal canal, and anorectum (1.23%), 256,313 patients did not receive radiation therapy (NRT), 61,852 of whom had been treated with RT, 51,347 patients who underwent external beam radiation therapy (EBRT), and 10,505 patients receiving a combination of EBRT and brachytherapy (EBRT–BRT) who developed SBC. Receiving two types of radiotherapy was strongly consistent with a higher risk of developing SBC for PC patients in Fine-Gray competing risk regression (NRT vs. EBRT, adjusted HR= 1.71, 95% CI: 1.54-1.90, P<0.001; NRT vs. EBRT–BRT, adjusted HR= 2.16, 95% CI: 1.78-2.63, P<0.001) and Cox regression analysis (NRT vs. EBRT, adjusted HR= 1.75, 95% CI: 1.59-1.94, P<0.001; NRT vs. EBRT–BRT, adjusted HR= 2.33, 95% CI: 1.91-2.84, P<0.001). The results of the dynamic SIR and Poisson regression analysis for SBC revealed that a slightly increased risk of SBC was observed after RT in the early latency and was significantly related to the variations of age at PC diagnosis and decreased with time progress. For overall survival, the SBC after NRT, SBC after EBRT, and SBC after EBRT-BRT of 10-year survival rates were 37.9%, 29.2%, and 22.2%, respectively. Conclusion: Radiotherapy for primary pelvic cancers was associated with higher risks of developing secondary bladder cancer than patients unexposed to radiotherapy. Different pelvic RT treatment modalities had different effects on the risk of SBC. We suggest that patients with pelvic RT, especially young patients, require long-term monitoring of the risk of SBC. Have you got a Conflict of Interest?: No
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85 FOLLOW-UP OF BREAST CANCER PATIENTS IN A SIGNGLE CENTER IN CAMEROON SINCE THE COVID19 PANDEMIC B. NKEGOUM1 1 UNIVERSITY HOSPITAL CENTER AND CLINIQUE CAMASSISTANCE, PATHOLOGY AND ONCOLOGY, CAMEROON, Cameroon
1. BACKGROUND May 4, 2020
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The InternationalMonetary Fund (IMF) approved a disbursement under the Rapid Credit Facility (RCF) of US$ 226 million to support the authorities’ efforts in addressing Cameroon’s urgent balance of payment needs stemming from the COVID-19 pandemic and the terms of trade shocks from the sharp fall in oil prices. The IMF also approved the authorities’ request for an extension of the ECF arrangement, due to expire on June 25, 2020, to September 30, 2020 with a rephasing of access. To mitigate the impact of the pandemic, the government has taken several actions to contain the spread of the pandemic, increase health spending, strengthen existing social safety nets and provide support to affected businesses and households.
But not even a face mask or essential tool for hygiene have reached our Center and no financial support is given to Cancer Patient up to now for the whole country while patient are dying on daily basis, as most of them also refuse vaccine. Since our center was granted a Seedind Progress and Ressources for Cancer Community Metastatic Breast Cancer (SPARC/MBC) challenge A UICC support, we now have a sustainable palliative care center. 2. AIM the aim of the present study is to present the recent data on 20 months follow-up of breast cancer patients in a single SPARC center in Cameroon since the covid19 pandemic and project the global impact of the pandemic on the Cameroon national plan for cancer control. 3.RESULTS Before the COVID 19 Pandemic the first case of which was reported in Cameroon on the 6th March 2020, our palliative program was already available. This first COVID 19 case was observed just a Miles away from our Center and only one month after this first case, hundreds of cases spread in Yaounde, our Capital. One SPARC Patient of our cohort died of Covid19 END of March 2020. 15 MBC patients of our cohort also died during the last 20 months and 20 patients are not reachable since then, even via telephone call. 16 other Cancer patients subtypes died, 8 with COVID19 and 8 without. The COVID vaccine and test are not longer mandatory for cancer patients since three months. Advocacy visits to communities, hospitals and Universities is now introduced in our Center.Training of community health professionals, social workers and traditional healers Mobilization of breast cancers patients is now effective. We have started home visit in some parts of Cameroon.
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4. CONCLUSIONS 90 per cent of Cancer Patients in Cameroon live in Rural areas where facilities to screen, diagnose and treat this disease are missing and our Organization establishedtwenty years ago is committed to increase awareness to strength National Cancer Control Plan globally. Covid 19 and other factors may change this picture in the future and our organization is committed to implement and disseminate our skills and experience in rural Cameroon using strategies like the RE-AIM Framework. Have you got a Conflict of Interest?: No
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852 Access and affordability for high-quality oncology medicines: case study from the National Cancer Grid M. Sengar1, S. Patankar1, G. Chinnaswamy1, M VijayaKumar2, R. A. Badwe1, C S. Pramesh1 1 Tata Memorial Centre, Mumbai, India, 2Yenepoya (deemed to be University), Mangalore, India Background and context: Access to anti-cancer medicines is limited in health systems where public healthcare expenditure is low. Several initiatives such as essential medicines list, drug pricing control, and biosimilar/ generic development have attempted to address this issue, but implementation is challenging due to limited quality monitoring, frequent stock-outs, and differential procurement prices based on volume and disparate processes. The National Cancer Grid (NCG), a large network of cancer centres in India, is working towards ensuring access to affordable care. This case study describes the benefits of pooled procurement in ensuring access and affordability of high-quality anticancer medicines. Aim: The NCG evaluated the impact of a strategy of pooled procurement and group negotiation involving member centres in lowering the costs of high-value oncology medicines. Strategy / Tactics: A price-discovery cell with a defined, multi-disciplinary governance structure was established to facilitate the multi-stage procurement process till the award of the contract. Subsequently, the purchase was done at the individual centre’s level to avoid logistic issues and financial implications of inventory management and transport. Programme / Policy process: Candidate high-value medicines (function of cost and volume) were identified through a survey of centres. Relevant stock-keeping units(SKUs) for these medicines were listed to avoid wastage/ dosing challenges. The demand collation included the anticipated requirements and last procurement price for these SKUs with a minimum purchase commitment. Bids were submitted through an online portal. Each medicine and vendor were evaluated using predefined criteria in three stages- pre-qualification, technical and financial.To ensure effective price discovery, a reserve price was identified based on the earlier data on the lowest priced brand which met the quality criteria. Outcomes:45 drugs (85 SKUs) were identified with a pooled demand equivalent to 1.6 billion INR from 23 centres. The main reasons for non-participation were existing rate contracts and concerns about the acceptance of chosen brands by their oncologists. Out of 46 vendors who bid,24were awarded the rate contract. The process led to a saving of 14.2 billion INR from the MRP and 337 million INR less than the reserve price. The savings ranged from 20-80% of MRP and were more for generics than the innovator molecules. What was learnt: Pooled procurement with group negotiation based on defined quality parameters can leverage the economies of scale and allows substantially low prices for high-quality medicines irrespective of a centre’s purchasing power. Have you got a Conflict of Interest?: No
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861 Palliative Paramedicine Clinical Practice Appraisal and Content Analysis M. Juhrmann1, N. Anderson2, M. Boughey3, D. McConnell4, P. Bailey5, L. Parker6, A. Noble7, A. Hultink8, P. Butow9, J. Clayton1 1 University of Sydney, Northern Clinical School, Sydney, Australia, 2University of Auckland, School of Nursing, Auckland, New Zealand, 3University of Melbourne, Melbourne Medical School, Melbourne, Australia, 4St John Ambulance Northern Territory Incorporated, Darwin, Australia, 5St John Western Australia, Perth, Australia, 6Queensland Ambulance Service, Brisbane, Australia, 7South Australian Ambulance Service, Adelaide, Australia, 8County of Renfrew Paramedic Service, Ontario, Canada, 9University of Sydney, School of Psychology, Sydney, Australia Background: Palliative care is an emerging scope of practice for paramedicine. The COVID-19 pandemic has highlighted the opportunity for emergency settings to deliver palliative and end-of-life care to cancer patients wishing to avoid intensive life-sustaining treatment. However, a gap remains in understanding the scope and limitations of current paramedic services’ approach to palliative and end-of-life care. Aim: To examine the quality and content of existing Australian palliative paramedicine guidelines with a sample of guidelines from comparable Anglo-American ambulance services. Methods: We appraised guideline quality using the AGREE II instrument and employed a collaborative qualitative approach to analyse the content of the guidelines. Results: None of the guidelines were recommended by both appraisers for use based on the outcomes of all AGREE II evaluations. Scaled individual domain percentage scores varied across the guidelines: scope and purpose (8% to 92%), stakeholder involvement (14% to 53%), rigour of development (0% to 20%), clarity of presentation (39% to 92%), applicability (2% to 38%), and editorial independence (0% to 38%). Six themes were developed from the content analysis: (1) audience and approach; (2) communication is key; (3) assessing and managing symptoms; (4) looking beyond pharmaceuticals; (5) seeking support; and (6) care after death. Conclusion: It is important that ambulance services’ palliative and end-of-life care guidelines are evidence-based and fit for purpose. Future research should explore the experiences and perspectives of key palliative paramedicine stakeholders. Future guidelines should consider emerging evidence and be methodologically guided by AGREE II criteria.
Have you got a Conflict of Interest?: No
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863 Genetic characteristics involving the PD-1/PD-L1/L2 and CD73/A2aR axes and the immunosuppressive TME in DLBCL H. Liu1, T. Zhang1, X. Wang1, H. Lai1 1 Tianjin Medical University Cancer Institute and Hospital, Department of Lymphoma, Tianjin, China Background: Targeting the PD-1/PD-L1/L2 pathway combined with other immunosuppressive signaling, such as CD73/A2aR adenosine signaling, has emerged as a promising strategy for cancer treatment. Aim: To further investigate the genetic characteristics of these immune checkpoints in diffuse large B-cell lymphoma (DLBCL). Methods: We performed whole-exome sequencing/targeted deep sequencing to investigate the genetic characteristics of PD-1/PD-L1/L2 and CD73/A2aR. The immunosuppressive effect of these two pathways on the tumor microenvironment was evaluated via RNA sequencing. Single-cell RNA sequencing was further applied to investigate the dysfunctional CD8+T cells. In addition, multiplex immunofluorescence staining was used to quantitatively assess the expression of dysfunctional CD8+T cells in DLBCL. Results: SP140 was identified as a novel translocation partner for PD-L1, and a new inversion was detected between PD-L1 and PD-L2, both leading to the upregulation of PD-L1 expression. CD73 genetic mutations did not increase mRNA and protein expression. Patients with genetically altered CD73 tended to have a better overall survival than patients with wild-type CD73. Both PD-1/PD-L1 and CD73/A2aR signaling mediated the immunosuppressive microenvironment in DLBCL. The numbers of CD8+T cells with PD-1 and A2aR expression were positively correlated with the number of dysfunctional CD8+T cells ( R2=0.974, p=0.013). According to the grades of dysfunctional CD8+T cells we defined,grade1 dysfunctional CD8+T cells, with either PD-1+or A2aR+, were significantly associated with poorer survival than grade0 dysfunctional CD8+T cells, with both PD-1-and A2aR-; and patients with grade2 dysfunctional CD8+T cells showed the worst clinical outcomes. Conclusion: This study describes the additional genetic basis of PD-L1 overexpression and characterizes certain genetic alterations of CD73/A2aR in DLBCL. The degree of T cell dysfunction is correlated with clinical outcomes. Strategies that reverse T cell dysfunction by inhibiting PD-1/PD-L1/L2, particularly in combination with CD73/A2aR, may show potential as effective therapeutic options for DLBCL.
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Have you got a Conflict of Interest?: No
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864 ESTABLISHMENT OF PCR LAB FOR COVID-19 AT ATOMIC ENERGY MEDICAL CENTRE, KARACHI, PAEC BY IAEA SUPPORT-INT0098 H. Hashmi1, A. Jabeen1, R. Hashmatullah1, S. Farrukh1, A. Mehmood1 1 Atomic Energy Medical Center, Pakistan Atomic Energy Comission, karachi, Pakistan Background and context: Atomic Energy Medical Centre (AEMC) is the pioneer cancer hospital of Pakistan Atomic Energy Commission (PAEC) located in the premises of Jinnah Post Graduate Medical Centre, Karachi. Since its inception, it is providing quality care diagnostic and therapeutic services to cancer patients. AEMC, PAEC is honoured to establish a PCR laboratory for covid-19 testing under 2020-21 interregional technical cooperation project (INT0098) of IAEA. The project was designed to respond to member state need in event of disease outbreak, emergency and disasters. COVID 19 global pandemic since its spread in 2020 triggered severe health crisis all over the world. World health organization (WHO) and European Center for Disease Control (ECDC) issued guidelines for hospitals and PCR testing was set as gold standard. Based on a nuclear derived method known as Real Time Reverse TranscriptionPolymerase chain reaction (RT-PCR) is one of the most widely and authentic used laboratory method for detecting COVID-19 virus. Aim: In the COVID pandemic, which had hit our country leading to 486K cases and 10,000 deaths by December, 2020, AEMC being in a tertiary care hospital set its goal to provide rapid, accurate detection of COVID-19 virus continuing to global efforts to manage and reduce the spread of disease in Pakistan. Strategy / Tactics: In the process of this project under IAEA assistance, AEMC received real time RT-PCR machine, kits with reagents, laboratory consumables, biosafety cabinets. personal protection equipments. We trained our lab technicians and scientists trough webinars conducted by IAEA to ensure safe working of the equipment and analysis of sample. Programme / Policy process : PCR lab services at AEMC were started in February 2021. Our first target population was cancer patients admitted in our hospital for iodine ablation for thyroid cancer patients and prior to Radiotherapy treatment in cancer patients. Being a part of Pakistan Atomic Energy Commission (PAEC), second target was Nuclear power plant employees who were periodically in and out of quarantine period. Later on we offered services to other PAEC setup and local population. Outcomes: All together collaboration, support & efficiency provided by IAEA led to provision of efficient molecular diagnosis which is effectively helping in diagnostic screening for covid-19, helping in prevention & cure leading to a healthy society. Thus as a state member of IAEA, we are honored to claim the achievement of IAEA goal and extend our gratitude for supporting Pakistan for technology transfer and capacity building to fight against the challenges of corona virus pandemic. Have you got a Conflict of Interest?: No
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869 Macmillan Cancer Support and Boots UK - Improving Access to Support. L. Foreman1, S. Orridge2 1 Macmillan Cancer Support, Corporate Partnerships, London, United Kingdom, 2Boots UK, Corporate Social Responsibility, Nottingham, United Kingdom Background: Since 2009, together Boots UK and Macmillan have provided easily accessible, inclusive specialist cancer support and advice to thousands of people on the high street and online. The partnership aims to give everyone, everywhere, the best cancer information and support they need in a place that’s every day, reliable, familiar and trusted. At the heart of our partnership is our Boots Macmillan Information Pharmacist (BMIP) programme. Macmillan has helped train more than 4500 Boots pharmacists, to be specialists in cancer support, enabling them to understand more about the impact of a diagnosis, treatment and how to support people living with and affected by cancer in store and through virtual services. BMIPs offer a wide range of support, including answering medication queries, support with spotting early symptoms and signposting people to their GP. Context: The effects of the pandemic will be felt for many years, especially in cancer care. There has been a sustained reduction in the number of referrals, diagnoses, and treatments for many types of cancer unfortunately detrimentally impacting prognoses. Our 12-year strong partnership allows an opportunity to provide better, more widespread access to a BMIP across Boots pharmacy stores. In October 2021, Boots introduced a Palliative Care service to all Boots NHS contract pharmacies in the UK to support with the supply of end-of-life medicines to patients in a co-ordinated, consistent way. Aim:To ensure customers have access to a BMIP in every Boots pharmacy and timely access to supplies of palliative care medicines in pharmacies with an NHS contract. Strategy / Tactics:In October Boots more than doubled their BMIP population from 2,000 to 4,500, ensuring accessibility in all Boots pharmacy stores. An End of Life Care module was also developed to further enhance BMIP’s knowledge and understanding, enabling them to provide person-centred support for patients and their families at this challenging time. Programme / Policy process: New BMIPs undertook learning helping them truly understand the needs of people affected by cancer, enabling them to provide a ‘listening ear’ and respond with empathy, to find the information and support they need. Existing BMIPs were recommended to complete refresher training helping them to reflect on the invaluable role they play, and to consider how they can further develop their person-centred approach to these conversations. Outcomes: BMIP’s had 92,605 conversations with customers affected by cancer in 2021 and with the expansion, we expect this number to grow considerably in 2022. Voted Most Admired Corporate-NGO partnership in the C&E Barometer for third year running. Learnings: Due to the ongoing pressure on pharmacy services, we may look to develop training with additional pharmacy colleagues such as Boots Pharmacy Technicians as they may be more likely to be customer facing. This would further increase conversations with people living with cancer Have you got a Conflict of Interest?: No
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871 Percutaneous CT-Guided Microwave Ablation Combined with Vertebral Augmentation for Painful Spinal Metastases K. Zhang1, L. Chen1 1 Tengzhou Central People's Hospital, Oncology Department, Tengzhou, China Background: Vertebrae are the most common bone metastatic sites. Radiation therapy (RT) is the mainstay of treatment for vertebral metastases. However, it has several limitations. Percutaneous thermal ablation followed by vertebral augmentation is an emerging minimally invasive therapeutic alternative for the management of spinal metastases. Aim: This study aimed to retrospectively evaluate the effectiveness and safety of microwave ablation combined with vertebral augmentation for the treatment of painful vertebral metastases. Methods: Overall,91 patients(50 men, 41 women; mean age, 62[SD, 11] years; range, 36–78 years) with 140 metastatic vertebrae who experienced refractory moderate-to-severe pain were treated with CT-guided microwave ablation and vertebral augmentation. Procedural effectiveness was determined using the visual analog scale, daily morphine consumption, and the Oswestry Disability Index preprocedurally and during follow-up. Local tumor control was assessed at follow-up imaging. Results: The procedure was technically successful in all patients. The median visual analog scale score and mean morphine dose were 6 (range, 4–10) and 77.8 (SD, 31.5) mg (range, 15–143 mg), preprocedurally; 5 (range 3–8) and 34.5 (SD, 23.8) mg (range, 0–88 mg) at 3 days; 4 (range, 2–7) and 28.7 (SD, 16.4) mg (range, 0–73 mg) at 1 week; 3 (range, 1– 6) and 24.6 (SD, 13.2) mg (range, 0–70 mg) at 1 month; 3 (range, 1–6) and 21.70 (SD, 10.0) mg (range, 0–42 mg) at 3 months; and 3 (range, 1–8) and 21.0 (SD, 9.9) mg (range, 0–46 mg) at 6 months postprocedurally (allP < .05). A decrease in the Oswestry Disability Index score was also observed (P < .01). Follow-up with CT or MR imaging at 1 and 3months after the procedure was available in all patients, and none of the patients experienced local tumor progression during this period. Imaging at 6months after the procedure was available in all the surviving patients(88/91), and radiographic local control was achieved in 94.8% (128/135) of the treated metastatic vertebrae. Asymptomatic cement leakage occurred in 42 (30%) treated vertebrae. A grade 3 neural injury was observed in 1 patient (1.1%). The patient’s neurologic function returned to normal following treatment with mannitol, glucocorticoids, and radiation therapy. Conclusion: This study demonstrates that percutaneous CT-guided microwave ablation combined with vertebral augmentation is a safe and effective minimally invasive intervention for the treatment of painful spinal metastases. Have you got a Conflict of Interest?: No
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877 Identifying the challenges for women with ovarian cancer in LMIC; The Every Woman Study Collaboration F. Reid1, C. MacKay1, M. Eiken2, T. Adams3, Y.L. Woo4 1 World Ovarian Cancer Coalition, Toronto, Canada, 2International Gynecologic Cancer Society, Atlanta, United States, 3Groote Schur Hospital, Department of Obstetrics and Gynaecology, Cape Town, South Africa, 4University of Malaya Medical Centre, Kuala Lumpur, Malaysia Context GLOBOCAN projects that ovarian cancer incidence will rise almost 40% by 2040 with developing countries bearing the greatest burden[i](Fig. 1). 70% of those diagnosed each year live in low- or middle-income countries[ii](LMIC), where overall data about the disease’s burden is too poor to guide public-health.
The World Ovarian Cancer Coalition’s 2018 online Every Woman StudyTMcaptured data from 1531 women with ovarian cancer in 44 countries. Results published in 2020[iii] showed wide variations globally on key patient experience metrics, revealing opportunities for improvement. However, there was a lack of sufficient LMIC data. Aim This new collaboration addresses this gap and will provide novel evidence on women’s experience informing cancer planning, advocacy, and care in LMIC at national and international levels. Strategy With the International Gynecologic Cancer Society, the World Ovarian Cancer Coalition set up a global Oversight Committee with advocates and clinicians. The original survey was distilled to core questions on knowledge, symptoms, diagnosis, treatment, support, and priorities. To maximise uptake, the survey will be undertaken in hospital clinics, with known clinical contacts as country leads. Multilingual data will be collected on REDCap until December 2022. Women can complete the survey on paper, online via a secure link, or aided by a survey administrator. Minimum sample sizes were calculated to yield statistically significant results for each country. Outcomes This low-risk, observational study already has active interest from 24 LMIC, each with up to 10 participating centres. Well over 1,500 responses are expected. Other early results include the creation of novel patient literature in many centres; early engagement by one Ministry of Health, the formation of Ovarian Cancer Malaysia; and the opportunity for a number of groups to conduct their first in-country collaborations. Lessons learnt There is a strong desire in LMIC to develop quality ovarian cancer data to drive policy and improvements. Project leaders have had to explore how to maximise women’s ability to participate, address challenges faced by clinical teams, and find solutions that address local needs and circumstances.
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Figure 1 Globocan: Est. number of new cases of ovarian cancer: 2020 to 2040[i]
Africa Asia Europe Latin America and Caribbean Northern America Oceania Totals
2020
2040
24263 170759 66693 23513 26630 2101 313959
45332 238748 73124 35183 33531 3048 428966
% Change20202040 +86.8% +39.8% +9.6% +49.6% +25.9% +45.1% +36.6%
[i]Data extracted from https://gco.iarc.fr/tomorrow June 2021 https://gco.iarc.fr/tomorrow/en/dataviz/tables?sexes=2&single_unit=10000&cancers=25&populations=903_904_ 905_909_935_908&group_populations=0&multiple_populations=1&mode=population&multiple_cancers=0&typ es=0 [ii]Data extracted from https://gco.iarc.fr/today August 2021 https://gco.iarc.fr/today/online-analysis-multibars?v=2020&mode=population&mode_population=income&population=900&populations=900&key=total&se x=2&cancer=25&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_grou p%5B%5D=17&nb_items=10&group_cancer=1&include_nmsc=0&include_nmsc_other=1&type_multiple=%257B %2522inc%2522%253Atrue%252C%2522mort%2522%253Afalse%252C%2522prev%2522%253Afalse%257D&orie ntation=horizontal&type_sort=0&type_nb_items=%257B%2522top%2522%253Atrue%252C%2522bottom%2522 %253Afalse%257D [iii] Reid F, Bhatla N, et al: The World Ovarian Cancer Coalition Every Woman Study: identifying challenges and opportunities to improve survival and quality of life International Journal of Gynecologic Cancer Published Online First: 14 June 2020. doi:10.1136/ijgc-2019-000983 Have you got a Conflict of Interest?: No
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881 Comparison of Colonoscopy, Fecal Immunochemical Test, and Risk-adapted Approach in Colorectal Cancer Screening H. Chen1, J. Shi2, M. Lu1, Y. Li2, L. Du3, X. Liao4, D. Wei5, D. Dong6, Y. Gao7, R. Ying8, W. Zheng9, X. Miao10, H. Brenner11, M. Dai1 1 Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China, 2National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 3Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences /Cancer Hospital of University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China, 4Hunan Cancer Hospital, Changsha, China, 5Anhui Provincial Cancer Hospit, Hefei, China, 6Xuzhou Cancer Hospital, Xuzhou, China, 7Tumor Hospital of Yunnan Province/ Third Affiliated Hospital of Kunming Medical University, Kunming, China, 8Taizhou Cancer Hospital, Taizhou, China, 9Lanxi Red Cross Hospital, Lanxi, China, 10Wuhan University, Wuhan, China, 11German Cancer Research Center (DKFZ), Heidelberg, Germany Background: Developing personalized risk-stratified colorectal cancer (CRC) screening strategies is essential to tackle suboptimal participation, low screening yield, and stretched healthcare resources.Aim: To compare the effectiveness and cost-effectiveness of a risk-adapted screening approach with one-time colonoscopy and annual fecal immunochemical test (FIT) strategies for CRC screening. Methods: A randomized controlled trial conducted between May 2018 and May 2021 in six centers in China. Of 19,582 eligible participants aged 50–74 years, 19,373 (mean [Standard Deviation] age, 60.5 [6.5] years; men [n, %], 8,082 [41.7%]) were included in the primary analysis after excluding 209 individuals who did not meet the inclusion criteria. Participants were randomly allocated into one of the three screening arms in a 1:2:2 ratio: (1) one-time colonoscopy (n=3,883); (2) annual FIT (n=7,793); (3) annual risk-adapted screening (n=7,697), in which, based on the risk-stratification score, high-risk participants were referred for colonoscopy, and low-risk ones were referred for FIT. A total of three screening rounds were conducted. The detection rate of advanced colorectal neoplasia (CRC and advanced precancerous lesions) was the main outcome. Results: In the one-time colonoscopy, annual FIT, and risk-adapted screening arms over three screening rounds, the participation rates were 42.4%, 99.3%, and 89.2%, respectively; the detection rates for advanced neoplasm (intention-to-treat analysis) were 2.76%, 2.17%, and 2.35%, respectively, with odds ratio (OR)colonoscopyvs.FITof 1.27 (95% confidence interval [CI]: 0.99–1.63;P=0.056), ORcolonoscopyvs.risk-adapted screeningof 1.17 (95% CI: 0.91–1.49;P=0.218), and ORriskadapted screeningvs.FITof1.09 (95% CI: 0.88–1.35;P=0.438); the numbers of colonoscopies needed to detect one advanced neoplasm were 15.4, 7.8, and 10.2, respectively; the costs for detecting one advanced neoplasm from a government perspective using package payment format were CNY6,928, CNY5,821 CNY, and CNY6,694, respectively. Conclusion: The risk-adapted approach is a feasible and cost-favorable strategy for population-based CRC screening, and could complement the well-established one-time colonoscopy and annual repeated FIT screening
strategies. Figure 1.CONSORT flow diagram of the study participants Have you got a Conflict of Interest?: No
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883 Socio-economic consequences of cancer care, a patient perspective (SEC trial) J. Vancoppenolle1,2,3, N. Franzen1,2,3, S. Koole1, V. Retèl1,2, W. van Harten2,1,4,3, M. Schlander5,6 1 Netherlands Cancer Institute, Psychosocial Research and Epidemiology, Amsterdam, Netherlands, 2University of Twente, Enschede, Health Technology and Services Research Department, Enschede, Netherlands, 3European Fair Pricing Network, Amsterdam, Netherlands, 4Organization of European Cancer Institutes, Brussels, Belgium, 5German Cancer Research Center (DKFZ), Division of Health Economics, Heidelberg, Germany, 6University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany Background: The high cost of cancer care are not only a burden for healthcare systems but can also cause serious financial hardship for patients . A cancer diagnosis can result in direct and indirect cost that affect patients on multiple levels: increased insurance fees, co-payments, traveling costs but also income loss due to reduced ability to work . While there has been a substantial amount of research on financial distress and ‘toxicity’ in North America, the socio-economic impact of cancer in European health care systems is poorly understood3. Previous research has focused on individual countries. Cross-country studies and a tailored instrument to measure financial distress in Europe are missing. 1
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Aim: The aim is to explore patients' socio-economic consequences resulting from cancer diagnosis and treatment in European countries. Methods: A 41-item survey was developed, including questions regarding sociodemographic characteristics, coping behavior, and two validated questionnaires (Financial Index of Toxicity (FIT) & EQ-5D-5L). European patients are eligible for inclusion if they are, or were treated with systemic therapy, surgery and/or radiotherapy in the past 2 years. The survey is translated in 16 languages and distributed by 15 hospitals of Organization of European Cancer Institutes (OECI) and more than 20+ patient organizations across Europe (figure 1). Descriptive analysis will provide global insights in the socio-economic consequences of cancer care. Moreover, differences in financial hardship will be tested between and within countries, cancer types and sociodemographic characteristics using a regression model. Results: The SEC-trial started in September 2021 and will close in Q2-2022. Currently, we reached more than 2450+ patients. The primary outcome is the level of financial distress among cancer patients, measured by the validated Financial Index score, assessed per country. We will also present per country information on key financial indicators such as income loss, productivity loss, financial strain, and added treatment expenses. Final results will presented at the World Cancer Congress. Conclusions: Due to different healthcare and reimbursement systems across Europe, variation regarding the severity of the socio-economic consequences of cancer care is expected within and between countries.
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1. Carrera, P. M., Kantarjian, H. M. & Blinder, V. S. The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment. CA: A Cancer Journal for Clinicians 68, 153–165 (2018). 2.Zafar, S. et al. The Financial Toxicity of Cancer Treatment: A Pilot Study Assessing Out-of-Pocket Expenses and the Insured Cancer Patient's Experience. (2012). 3. Witte, J. et al. Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications. Annals of Oncology 30, 1061 (2019). Have you got a Conflict of Interest?: No
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887 Patient and caregiver perception of value dimensions for care in lung cancer B. Müller1, P. Varriale2, G. Katz3,4, L. Dallas5, A. Aguaron6, M. Azoulai2, N. Girard7 1 F. Hoffmann-La Roche Ltd, Global Access, Basel, Switzerland, 2Carenity (ELSE CARE), Paris, France, 3University of Paris School of Medicine, Chair of Innovation & Value in Health, Paris, France, 4PromTime, Paris, France, 5Roy Castle Lung Cancer Foundation, Liverpool, United Kingdom, 6Lung Cancer Europe, Madrid, Spain, 7Institut Curie, Institut du Thorax, Paris, France Background & Aim: The aim of this study was to assess the relative importance of dimensions of lung cancer (LC) care to patients and caregivers, and to explore the disease burden including economic aspects not commonly covered in patient reported outcomes. While the LC treatment landscape has rapidly evolved in recent years, easing symptom burden and treatment side effects remains a central consideration in disease control. Methods: A questionnaire was sent to LC patients and caregivers to assess how they value quality of life dimensions in care, assess communication between health care professionals and patients/caregivers, and evaluate economic impact on respondents. The questionnaire was based on commonly used patient reported outcomes instruments for Quality of life evaluation (FACT-L, EQ5D, QLQ-C30 and QLQ-LC13), as well as the ICHOM standard set of patient-centred outcomes for lung cancer. The survey’s respondents were participants on Carenity’s platform living in either France, UK, Germany, Italy, or Spain. Results: The survey included 150 respondents (77% patients, 33% caregivers). “Physical well-being” and “End-oflife care” (median score of 9.6 [7.7-10] and 9.7 [8.0-10]) were the most important dimension for the patients. “Physical well-being and functioning” was the dimension most frequently discussed with health care professionals (55%), while only 17% reported discussing “End-of-life care”. Among patients younger than 65 years, 43% stopped working after diagnosis. Among respondents that indicated their monthly household income before and after diagnosis, 55% reported a loss of income. Conclusion: This study underscores the importance of Quality-of-life priorities for LC patients care. It confirms LC care must consider patients’ psychological distress, desire to maintain independence, and ability to remain physically functional. It highlights the need for enhanced communication between patients and health care providers around healthcare priority and End-of-life care. It also highlights the disease’s considerable socioeconomic impact on patients and caregivers, despite insurance coverage of direct costs. Have you got a Conflict of Interest?: Yes If yes please specify:: This study was funded by F. Hoffmann–La Roche Ltd. The author BM is employed by F. Hoffmann–La Roche Ltd. Beyond the contributions of collaborators to this work, the funder did not play a role in the study design, data collection, analysis, decision to publish or preparation of the manuscript.
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892 Development of a prognostic model for small cell lung cancer based on clinical features and CT signs L. Wei1, J. Cao1, S. Xu2, Q. Hou1, N. Yao1, B. Sun1, B. Wang3, S. Zhang3 1 Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Department of Radiotherapy center, Taiyuan, China, 2Shanxi Children's Hospital, Department of Radiology, Taiyuan, China, 3Shanxi Medical University, Department of Medical Imaging, Taiyuan, China Background: Small-cell lung cancer (SCLC) has poor prognosis. Early accurate prognosis prediction is significant for making treatment decisions. Objective: We aimed to explore the clinical variables and CT imaging features related to the prognosis of SCLC and to construct a to construct a Nomogram-revised risk index + CT imaging features model (NRI-CT). Methods: The data of 722 patients pathologically diagnosed as SCLC were retrospectively analyzed. Univariate and multivariate COX regression models were used to analyze the clinical prognostic factors. Construct a Nomogramrevised risk index (NRI) on the basis of variables which P<0.05 and make risk stratification for SCLC. 313 patients with complete chest CT imaging data before treatment were retrospectively screened. Analyze the correlation between CT signs and SCLC prognosis. Univariate COX regression and least absolute shrinkage and selection operator (LASSO)-Cox regression model were used to construct CT-RISK. Incorporate CT-RISK into the original NRI model to construct NRI-CT. The prediction ability of NRI, CT-Risk and NRI-CT models were evaluated and compared by the area under ROC curve （AUC）, time-dependent AUC (tAUC), integrated Brier score (IBS) and clinical net benefit by decision curve analysis (DCA) . The improvement degree of NRI by NRI-CT was evaluated by net reclassification index (NRI*) and comprehensive discriminant improvement index (IDI). Results: Gender, monocyte (MON), neuron specific enolase (NSE), cytokeratin 19 fragment (Cyfra211), M stage, radiotherapy (RT), chemotherapy cycles and prophylactic cranial irradiation (PCI) were independent prognostic factorsC. The NRI was constructed based on the above eight variables. Kaplan-Meier curve and log-rank test showed statistically significant differences among different risk groups of NRI.Spiculation sign, liquefactive necrosis and lymph node fusion were associated with prognosis of SCLC. CT-RISK was constructed based on these three variables and divided SCLC patients into high-risk group and low-risk group using the cutoff value of 0.203. The median OS in the high-risk group was significantly lower than that in low-risk group (13.3 months vs 18.4 months, P<0.001). The AUC of NRI-CT (0.773，95%CI:0.716-0.829）was significantly higher than NRI（0.738 ，95%CI:0.679-0.797）and CT-RISK（0.587，95%CI:0.524-0.650）. TAUC, IBS, and DCA all showed that NRI-CT had better discrimination, calibration, and clinical net benefit than NRI and CT-RISK. In addition, the NRI* of NRICT was 14.8% (95%Cl: 3.64%-29.65%, P =0.028) and the IDI was 4.00% (95%Cl: 0.4%-7.24%,P =0.012) compared to NRI. Conclusion: Gender, MON, NSE, Cyfra211, M stage, RT, chemotherapy cycles and PCI were independent prognostic factors for SCLC. Spiculation sign, liquefactive necrosis and lymph node fusion also have prognosis predictive value. The NRICT model, which combined CT imaging features and clinical factors, could effectively improve the predictive accuracy of SCLC patients.
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Have you got a Conflict of Interest?: No
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893 ICO-tool kit 2: guide for multidimensional assessment in onco-hematological patients for palliative care teams D. Moreno-Alonso1, A. Durán-Adán1, J. Julià-Torras2, J. Majó-Llopart3, G. Serrano-Bermúdez1, J. Trelis-Navarro1 1 Institute Catalan of Oncology, Palliative Care Service, L'Hospitalet de Llobregat, Spain, 2Institute Catalan of Oncology, Palliative Care Service, Badalona, Spain, 3Institute Catalan of Oncology, Palliative Care Service, Girona, Spain Background: In the care of patients and relatives who live with an onco-hematological neoplasia, needs emerge that require a multidimensional and interdisciplinary approach. The systematic assessment of these, using validated tools, can allow the evaluation and monitoring of therapeutic objectives, interventions, and their results, as well as the transmission of objective information. Aim: To review and update the evaluation tools of the Institute Catalan of Oncology (ICO)-tool Kit 1 project (Garzón-Rodríguez C et al, 2010) using Delphi methodology to reach an agreement on their use in the multidimensional evaluation of the palliative needs of the onco-hematological patients and their families. Methods: After reviewing the original ICO-tool Kit 1 (Garzón-Rodríguez C et al, 2010), a bibliographic update of the scales and the most used tools in the palliative care (PC) multidimensional assessment of onco-hematological patients was made, including new instruments in decision-making and spirituality. Subsequently, a first level agreement was obtained through consensus techniques with a discussion group of experts. Consensus was achieved through interobserver agreement based on the daily practical experience of the members as well as the published evidence in this regard. Consequently, a survey was conducted using Delphi methodology to a representative sample of expert professionals from the three palliative care services of the three branches of a monographic cancer center, which included ten doctors, six nurses, three psycho-oncologists, and three social workers. Finally, by analyzing the responses, a degree of agreement was achieved for the choice of instruments for the new updated version of the kit. Results: The instruments selected were those that achieved a percentage of agreement between 90-100%. They included: CAGE test; Edmonton Symptom Assessment Scale; Bristol test; Emotional Distress Detection Questionnaire; Endicott criteria; Desire to anticipate death; Confusion Assessment Method; Pfeiffer test; GES spiritual assessment; Barthel index; ECOG Performance Status; Palliative Performance Status; Ramsay scale; Braden scale; PapScore Prognostic Survival Index; ECS-CP pain prognostic index; advanced care planning assessment and levels of therapeutic intervention. Conclusion: These tools allow a multidimensional evaluation in a systematic, objective, and measurable way of the needs that emerge during the process of an onco-hematological neoplasia; being able to report an improvement in the care of patients and their families, both in clinical and research terms. References: Garzón-Rodríguez, C. Et al. Multidimensional assessment tools for the use of doctors in palliative care: The ICOTool Kit Project. Medicina Paliativa. 2010;17:348-359.
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Have you got a Conflict of Interest?: No
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898 Hypofractionated EBRT and HDR-Brachytherapy in the treatment of Locally Advanced Cervical Cancer. N. Aliyeva1, K. Akbarov2, I. Isayev1, E. Guliyev1 1 National Center of Oncology, Radiotherapy, Baku, Azerbaijan, 2International Atomic Energy Agency, Vienna, Austria Background: The World Health Organization (WHO) declared a Public Health Emergency of International Concern on 30 January 2020 and a pandemic on 11 March 2020. Taking into account the requirements that have appeared for the reducing length of stay (RLoS) of patients in the radiotherapy department, we started hypofractionated external beam radiotherapy (EBRT) and high dose rate brachytherapy (HDRBt) for all cancer patients including cervical cancer cases. In the Radiotherapy Department of the National Center of Oncology (NCO) EBRT dose per fraction is usually 1.8 Gy, once a day, 5 times a week, with total doses of 45 Gy. In the case of metastases of the regional lymph nodes, we assign simultaneously integrated boost (SIB) of 2.3 Gy per fraction to the metastatic lymph nodes with a total dose of 57.5 Gy, which corresponds to 60 Gy by iso-effect. HDRBt dose per fraction is 7 Gy, twice a week, 4 fractions with a total dose of 28 Gy (EQD2 40 Gy). Aim: We evaluated early treatment outcomes and toxicity in patients with locally advanced cervical cancer treated with chemoradiation by hypofractionated EBRT and HDRBt. Methods: The treatment results of 32 patients who were treated in the Radiotherapy Department of NCO from April 2020 to February 2021 were analyzed. Fourteen of them had IIB stage, twelve - IIIC, four – IIIB, and two IVA cervical carcinoma. A histological examination revealed squamous cell carcinoma in 27 (84.4%), adenocarcinoma in 3 (9,4%), and adenosquamous carcinoma in 2 (6.25%) patients. All patients received concurrent chemoradiotherapy: EBRT (volumetric arc therapy - VMAT) dose per fraction 2.2 Gy, once a day, 5 times a week, 20 fractions, with total doses of 44 Gy (EQD2 44.73 Gy), with SIB 2.8 Gy per fraction to 56 Gy (EQD2 59.73) for N+ cases. All patients received intravenous infusions of Cisplatin weekly at a standard dose of 40 mg/m2. In the last week of EBRT, HDRBt was started. High-risk clinical target volume (HRCTV) was defined based on pretreatment and pre-brachytherapy MRI according to GEC-ESTRO recommendations. Patients received intracavitary/interstitial HDRBt dose per fraction of 11 Gy, once a week, 2 fractions with a total dose of 22 Gy (EQD2 38.5 Gy). Results: We analyzed close results of the treatment which were assessed two months after the course was completed. Complete regression and partial regression of the tumor developed in 84,4% (n27) and 15,6% (n5) cases respectively. Three out of five partial regressions were observed among the histological type of adenocarcinoma. Early toxicity such as enteritis, rectitis, and cystitis of II - III stages was observed in 12,4%, 10,2%, and 4,3% of cases accordingly. Toxicity stage IV was not observed among the patients. Conclusion: Based on analysis of close results moderately hypofractionated EBRT and HDRBt seems to be effective and safe treatment modality for locally advanced cervical cancer patients. Longer follow-up of patients is needed to make the final conclusions. Have you got a Conflict of Interest?: No
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904 Champions Circle, heros beyond chemo B. Koush1, I. El Hajje2 1 Childrens Cancer Center of lebanon (CCCL), Marketing and Communications, Beirut, Lebanon, 2childrens Cancer Center of Lebanon, PR& External affairs, london, United Kingdom Background and context: As the number of our childhood cancer survivors is fortunately increasing, while the progress of diagnosis and treatment is progressing rapidly, The CCCL’s Champions' Circle saw the light during a special event held on April 3, 2018 grouping inspirational cancer-fighters from all over Lebanon and the region. Aim: The aims are to build a strong relationship amongst survivors, enhance and help those survivors’ lives through continuous fellowship care, socialization, education and activism support, grow the club to reach all childhood cancer survivors in the region and to safeguard their wellbeing. We are currently over 250 cancer survivors. Strategy / Tactics: CCCL discovered that our survivors were distinguished with a spirit of trust, hope and strength among themselves, and provided moral support to each others. The overall strategy of this club, since its initiation to allow survivors to gather together for several activities for self-development, sharing of experiences as well as, fun activities and group sessions, in order to provide them with the needed support to cope with the post-treatment effects, in addition to emotionally supporting current patients at the center. Programme / Policy process: The Champions’ Circle program is to equip our heroes with educational and learning skills sessions, moral support to cope with post-treatment effects, also to engage them with outreach community conferences, and provide them with group support sessions and fun activities. And most recently, to ensure a healthy future lifestyle with less anxiety and fear, we provided our survivors and their parents with the COVID-19 vaccine to protect them from the global pandemic spread. We organized several awareness campaigns targeting eligible caregivers and survivors based on multiple published research and physician inputs. Sessions included oncologist interventions to educate families and survivors about healthylife tips and daily practice, importance of receiving the needed vaccines following cancer treatment. Outcomes: in 2021, the champions circle conducted several online sessions competitions to train them with business skills and plan about their fundraising ideas, also, several paragliding session activities were done for around 15 survivors to commemorate the Acknowledging the importance of protecting our survivors from covid and HPV, we launched both vaccination programs. As a result, 3 comprehensive virtual presentations and Q/A sessions by expert doctors were done, digital registration platforms were created to obtain registered data, all eligibles had their appointment schedule, with a result of 130 vaccinated survivors. What was learnt: (if relevant, please also detail here the potential of replicability) Because CCCL cares about the health of our heroes, we commit to using all available resources, including vaccinations, to help keep young cancer survivors safe. Have you got a Conflict of Interest?: No
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907 TTD Model Analysis for the Association of Physical Activity and HRQOL in Lung adenocarcinoma patients J. Zhuang1, Y. Liu1, X. Xu1, Y. Cai2, M. Liu1, Z. Chen1, S. Yang1, J. Lin3, M. Kang4, Z. Hu1,5,6, M. Lin7, F. He1,5,6 1 Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China, 2Department of Health Toxicology, School of Public Health, Xiamen University, Xiamen, China, 3Department of Thoracic Surgery, The first affiliated hospital of Fujian Medical University, Fuzhou, China, 4Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China, 5Fujian Provincial Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China, 6Fujian Digital Tumor Data Research Center, Fuzhou, China, 7Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China Background: Health-related quality of life (HRQoL) plays an important part in cancer survivors and may be improved by physical activity. Aim: Our aim is to explore the relationship between physical activity and time to deterioration (TTD) of HRQoL in lung adenocarcinoma patients. Methods: A hospital-based prospective study was conducted in our study. IPAQ-L was used to investigated the physical activity pre-therapy and EORTC QLQ-C30 and EORTC QLQ-LC13 were applied to explore the baseline and during follow-up HRQoL of the patients. The QoLR package was performed to calculate the HRQoL scores and determine the TTD events (MCID = 5 points). We used Cox regression analysis to explore how physical activity level effect the HRQoL. Results: For EORTC QLQ-C30, TTD events of physical functioning (PF) and dyspnoea (DY) in functioning scales and symptom scales was the most found in LUAD patients in the follow-up, physical activity was found significantly delay TTD of insomnia (SL) (HR= 0.759, 95%CI: 0.586-0.982, P=0.036) and diarrhoea (DI) (HR= 0.677, 95%CI: 0.489-0.938, P=0.019). For EORTC QLQ-LC13 scales, TTD of dyspnoea (LC-DY) events were found most, physical activity can delay the TTD of dyspnoea (LC-DY) (HR= 0.798, 95%CI: 0.647-0.985, P=0.036), sore mouth (LC-SM) (HR= 0.632, 95%CI: 0.425-0.940, P=0.029) and dysphagia (LC-DS) (HR= 0.658, 95%CI: 0.443-0.978, P=0.038). Conclusion: In summary, there were some evidences to prove that LUAD patients with pre-treatment physical activity can delay the TTD of multiple HRQoL indicators in EORTC QLQ-C30 and EORTC QLQ-LC13. Have you got a Conflict of Interest?: No
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91 Tracking disparities spanning the first phases of the cancer continuum among hard-to-reach communities N. Luxardo1, F. Sassetti2, L. Alva3, L. Passerino4, M. Kolvenbach5, E. Wright6, J. Billordo7, C. Scotta8, I. Spessotti9 1 CONICET/ University of Buenos Aires, Social Sciences, Buenos Aires, Argentina, 2National University of Entre Rios, Faculty of Engineer, Parana, Argentina, 3Health Center Gob. Uranga, Diamante, Argentina, 4University of Rafaela, Rafaela, Argentina, 5Academy of Media Arts (KHM), Cologne, Germany, 6University of Buenos Aires, Buenos Aires, Argentina, 7CAAC José D. Rodríguez/ National University of Entre Ríos, Paraná, Argentina, 8National University of Entre Rios/ Health Center Humberto D´Angelo, Parana, Argentina, 9National University of Entre Rios/ CIC D. Liotta, Diamante, Argentina Background: Cancer disparities have long been documented, ranging from variation in cancer risk distribution to weak surveillance systems that lack information for many underserved communities. These communities usually experience hazardous living and working conditions, have less access to early detection and timely/quality treatments, and have many other systematic differences that affect their risk of developing cancer. Primary and secondary prevention are core components for reducing disparities, but require a clear understanding of the multiple and intersecting mechanisms by which social inequalities affect each stage of the cancer continuum Aim: To analyze common patterns and context-specific pathways shaping conditions for cancer disparities in hard-to-reach communities of Entre Ríos (Argentina) during 2016-2022 Methods: A community-based participatory study combined with an implementation cycle based on medical anthropology and social epidemiology. Health centers and their census radii units were mapped using Geographic Information Systems. This information was cross-referenced with ecological variables, national census and sociodemographic district level statistics. Our own data layers generated from the combination of these variables led to the identification of segregated areas and populations. Ethnographic inquirirs allowed the identification of three communities with cultural identities. Complementary methods include life-course approach, institutional ethnography at local healthcenters, audiovisual methdos, etc. Primary data were validated and merged into the eco-social theory of disease distribution for analysis Results: The findings reveal singly and combined indirect/mediated pathways that operate at multiple levels. At neighborhood level, socioeconomic and ecological pathways are tracked in the next figures.
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Fig. 1 Households with unsatisfied basic needs (UBN) data according to census tract.
Fig. 2, 3.Areas affected by periodic flooding (1982-2018) compared to households with UBN according to census tract
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The pathways that connect the community contexts and daily lived experiences to conditions associated to cancer disparities have multiple dimensions, as shown in next Table Domains of social inequalities
Rural community
Fishermen community 1. Geological rifts
1.Forest fires Ecological contexts & environmental exposures
2. Water with arsenic 2. Natural resource degradation (e.g. deforestation). 3. Air pollution by open mining exploitation practices
Living conditions and infrastructure
1. Isolation 1. Inadequate housing 2. Lack of public transportation and lack of internet 1. Handling pesticides unprotected
1. Sun exposure without sunscreen protection
Exposures associated with occupations
1. Alcohol, drugs: hopelessness, despair related to unemployment and precarity. 1. Foods based on pork fat, fried meals with excess of salt, etc. associated with cultural traditions.
2, Wild animals hunted to eat. 3. Infectious parasitic diseases untreated.
2. High calorie-dense daily meals: overweight and obesity. Life-style modifiable risk factors
1.Data systems built on perverse incentives
1. Fragmentated and hand-made registries
2. Staff competing demands to priioritize and allocate resources: 2. Healthcare priorities move according to directors vector control strategies (e.g. dengue and chagas) versus chronic diisease strategies (e.g.highblood pressure and cancer). COVID-19 3. Early symptoms of cancer dismissed, not follow up. priority for the last 2 years. Local level healthcare system. Internal & external barriers and deterrents
4. COVID-19 as the only important disease in peripherical heathcenters.
3. Staff removed or sent to peripherical healthcenters as “punishments”.
5. Men avoid healthcare except for emergencies.
4. Men not managing major chronic conditions (e.g. diabetes) 5. Stigma surrounding colon screening 6. Older women want female staff only. 7. Cancer perceived as a death sentence.
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6. Men with untreated pulmonary problems and others pre-existing co-morbidities . 7. Perception of systematic governmental mistreatment of second-class citizens and use of communities for political ends
Conclusion: This study provides a rationale for understanding why underserved communities are more likely to be exposed to cancer risk factors/scenarios, but less likely to benefit from advances in cancer research, exacerbating disparities among groups. Research into the epidemiological baseline aiming to monitor/reduce disparities is challenging, dealing with multiple pathways, levels and poor-registered outcomes. Community engagement in healthcare is vital, but cumulative patterns of problematic interventions affect participation. A first step for a structural approach to address equity in the cancer care and control continuum is to restore trust in the community through the careful development of long-term relationships
Audiovisual based on the research process: Link: https://vimeo.com/691724839/5858aeeac1 Have you got a Conflict of Interest?: No
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912 Understanding cervical cancer risk factors and HPV vaccination behaviours among schoolgirls in Ghana. A. Ampofo1,2, A. Boyes1,2, L. Mackenzie1,2 1 The University of Newcastle, Health Behavior Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Newcastle, Australia, 2Hunter Medical Research Institute, Newcastle, Australia Background: In Ghana, the age-standardized incidence of cervical cancer is estimated to increase to 55.3 per 100,000 women by 2025. While a significant proportion of cervical cancer cases are attributable to HPV infections, a national HPV vaccination programme is yet to be initiated. Alongside assessing HPV vaccination intention and uptake, applied behavioural science can be used to build understanding of Ghanaian girls’ knowledge about and engagement in health risk behaviours associated with cervical cancer and HPV infection. Aim: To i) determine the prevalence and clustering of cervical cancer and HPV infection risk factors; ii) describe HPV vaccination uptake and intentions; and iii) explore factors associated with a clustering of a. risk factors, b. vaccination uptake and c. vaccination intentions among female senior high school students. Methods: Female students were recruited from 17 senior high schools in the Ashanti Region of Ghana. Based on a modified Integrated Behavior Model, an anonymous cross-sectional paper-and-pen survey was used to assess behavioural risk factors for cervical cancer and HPV infection (e.g., early sexual debut, multiple sexual partners), HPV vaccination intentions and uptake, perceptions and knowledge about cervical cancer and HPV infection, attitudes toward HPV vaccination, self-efficacy of vaccination, social factors and demographic characteristics. Latent class analysis explored the clustering of risk factors. Descriptive statistics and a partial least squares structural equation model were used to examine the proportion and correlates of vaccination uptake and intentions respectively. Results: Of the 2400 participants, about one-third had been exposed to at least one risk factor and belonged to high-risk cervical cancer and HPV infection clusters. Only 4.5% reported HPV vaccination uptake. The median intention score was 10 out of a possible 15, where higher scores represent stronger intentions toward vaccination. Participants with more knowledge of risk factors had significantly higher odds of belonging to cervical cancer and HPV infection high-risk classes. While greater social influence (β=0.23) and beliefs about vaccine effectiveness (β=0.21) were strongly associated with higher vaccination intention scores, there was a significant negative effect of vaccination intentions (β=-0.02) on uptake. Conclusion: Despite the high prevalence of cervical cancer and HPV infection risk factors, both a knowledgebehavior gap and HPV vaccination intention-behavior gap were observed. There is a need to develop interventions to equip students with risk-reduction skills and strategies to act on their intentions to improve vaccination uptake. Interventions could be tailored to social networks including parents and religious leaders who may potentially approve their decisions to vaccinate. This study highlights the benefits and an urgent call to implement a national vaccination programme toward cervical cancer elimination. Have you got a Conflict of Interest?: No
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914 Engaging young women to participate in cervical cancer screening in Ghana A. Ampofo1,2, A. Boyes1,2, L. Mackenzie1,2 1 The University of Newcastle, Health Behavior Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, Newcastle, Australia, 2Hunter Medical Research Institute, Newcastle, Australia Background: Cervical cancer is the second most common cancer and the leading cause of cancer death among women in Ghana. Cervical cancer screening, which is a cost-effective prevention and early detection strategy is not well patronized among eligible Ghanaian women (those aged at least 25 years). Understanding the determinants of cervical screening intentions and health information preferences is vital to engaging and informing the development of interventions that aim to increase screening participation. Aim: To i) describe cervical screening intentions and associated factors, and ii) determine the preferred sources, mediums and settings of cervical cancer information, among female senior high school students who are approaching being age-eligible for cervical screening. Methods: A cross-sectional paper-based survey was designed to assess students’ intentions to attend cervical cancer screening when they become age-eligible and associated factors; and their preferred sources, settings and mediums of cervical cancer information. Female students were recruited from 17 randomly selected senior high schools in the Ashanti Region, Ghana. Linear mixed regression was used to explore the association between intentions and correlates (including individual factors, family and partner influence, service provision and systemic factors). Descriptive statistics were used to examine the most preferred source, medium and setting of cervical cancer information. Results: A total of 2400 female students completed the survey, and the median intention score was 10 indicating higher intentions. Cervical screening intentions significantly increased with higher perceived benefits of screening; (β=0.14); more knowledge about cervical cancer and HPV (β=0.01); greater perceived seriousness of cervical cancer and HPV infection (β=0.07); provider recommendation (β=0.10); and family and partner approval (β=0.12). Providing free screening was associated with stronger intentions (β=0.11). More than 70% of students’ most preferred source, medium and setting of cervical cancer information is health professionals, as in-person one-onone education and in the hospital respectively. About two-thirds of students preferred online modalities (i.e. health department websites and online consultation with health professionals). Conclusion: Health interventions for improving students’ risk perceptions and knowledge about cervical cancer and HPV infection, and their attitudes may enhance screening intentions. Interventions that promote counselling skills and appropriate referrals could be tailored to health providers, family members and partners to improve screening participation. Engaging female students through credible sources (i.e. health professionals), in a resource-intensive one-on-one face to face education in a hospital setting could improve cervical cancer information dissemination. However, due to limited resources, online modalities of information provision have potential. Have you got a Conflict of Interest?: No
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921 The psychosocial impact of breast cancer in Portuguese women S. Silva1, F. Pacheco1, C. Bento2, J. Sousa2, N. Amaral1, V. Rodrigues1 1 Liga Portuguesa Contra o Cancro, Coimbra, Portugal, 2Moai Consulting, Lisboa, Portugal Background and aim: Breast cancer (BC) is the most prevalent type of cancer in Portuguese women, with more than 7000 new cases being diagnosed every year and around 1800 patients dying from the disease. Both patients and survivors – as well as their families – experience significant changes in different areas of their lives due to BC. Moreover, the disease carries a great psychological impact and can affect fertility. As a result, individuals are forced to postpone or completely abandon life projects. Although there are several studies on the economic impact of BC, its psychosocial impact has not been widely addressed in the literature. It is therefore relevant to gather real-world data on this subject. The aim of this study was to generate evidence on the psychosocial impact of BC on patients and survivors in Portugal. Methods: This cross-sectional and descriptive study was based on real-world evidence, collected through an online questionnaire. The sample consisted of 1000 BC patients and survivors living in Portugal. A descriptive analysis of aggregate responses was performed and correlation tests that measure the association between variables were carried out. Results: More than half of the sample (63%) is 41-55 years old and 75% were diagnosed between age 30 and 49. 82% of respondents were diagnosed with early disease. About 72% is in remission. Most women of reproductive age at the time of diagnosis did not perform fertility preservation; only 15% chose this option. No significant correlations were found between the variables of interest; hence, results correspond to the aggregated analysis of all responses. Regarding the psychosocial impact of the disease, 56% of patients were forced to postpone or abandon life projects; for instance, 21% put aside being a mother or having more children. Patients' family life is greatly affected by cancer, with 87% reporting a moderate or high impact on the level of stress and anxiety of family and friends; moreover, nearly half reported a moderate or high impact on family unity and cohesion. It is common for patients to seek psychological support (41% of respondents) to deal with the consequences of the disease. Conclusions: Breast cancer is responsible for a significant psychosocial burden not only on patients and survivors, but also on their families. By analyzing real-world data on the consequences of the disease, it was possible to identify several areas which are negatively impacted and to quantify this impact. The effects are long-term, since the sample was composed mainly by women in remission. Understanding both the immediate or long-term effect of the disease is key to improve policy and implement effective measures to foster patients and survivors' quality of life. Have you got a Conflict of Interest?: No
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923 Factors associated with the melanoma diagnostic interval in Ontario, Canada: A population-based study M. Mavor1, T. Hanna2, P. Groome1 1 Queen's University, Public Health Sciences, Kingston, Canada, 2Queen's University, Division of Cancer Care and Epidemiology, Kingston, Canada Background: The diagnostic period is a time of great anxiety for patients, and a timely diagnosis of cancer is important to improving outcomes. The incidence of melanoma continues to rise, yet its diagnosis and management remain understudied at the population level. Aim: To assess the length of the diagnostic interval, and variations according to patient-, disease-, and systemlevel factors, in a population-based sample of melanoma patients. Methods: A cross-sectional study of melanoma patients in Ontario, Canada, diagnosed from 2007-2019. We used administrative health data to measure (1) the diagnostic interval (DI), defined as time between a patient’s first cancer-related encounter with the health system and diagnosis, (2) the primary care subinterval (PCI), defined as time between first cancer-related encounter with a general practitioner or non-melanoma specialist and first melanoma-related specialist visit, or diagnosis, and (3) the specialist care subinterval (SCI), defined as time between first cancer-related encounter with a melanoma-related specialist and diagnosis. Multivariable quantile regression was used to estimate the association between various patient-, disease-, and system-level variables and the DI, PCI, and SCI at the median and 90th percentiles. Results: The cohort consisted of 33371 melanoma patients.Median DI was 36 days (interquartile range [IQR] 8–85 days), median PCI 22 days (IQR 6–54 days), and median SCI 6 days (IQR 1–42 days). Older age was associated with shorter DIs and PCIs at the 90th percentile, and high comorbidity was associated with longer intervals. Patients in the most deprived neighbourhoods experienced shorter DIs and PCIs. Those living in rural areas experienced longer DIs than those in major urban areas. All intervals varied significantly by histology and anatomic location of the melanoma, with larger differences in the SCI compared to the PCI. Finally, patients with a history of nonmelanoma skin cancer, and those previously established with a dermatologist experienced significantly longer intervals. Conclusion: This study found variability in the melanoma diagnostic interval, with half of the patients waiting longer than 36 days, and 10% of patients waiting longer than 142 days for diagnosis. We found various patient-, disease-, and system-level factors unrelated to patient healthcare need that are associated with longer diagnostic intervals, and these associations are different in the primary care and specialist care sub-intervals. The finding of different associations in the primary and specialist care intervals highlight the importance of separately examining the sub-intervals, as they relate to different aspects of the healthcare system. Future research should examine the differential importance of the diagnostic interval, primary care interval, and specialist care interval on outcomes. Have you got a Conflict of Interest?: No
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924 Effect of the age-adjusted Charlson comorbidity index on survival of esophageal cancer patients after surgry J. Song1, Q. Zeng1, J. Zhou1, Z. Hu1 1 Fujian Medical University, Department of Epidemiology and Health Statistics, Fuzhou, China Background: Although the prognosis of esophageal cancer has gradually improved in many countries due to the tremendous development has been achieved in the clinical application of minimally invasive esophagectomy preexisting concomitant diseases are still link to a poor prognosis. Aim: To investigate whether age-adjusted Charlson Comorbidity Index (ACCI) can predict postoperative overall survival (OS) and cancer-specific survival (CSS) in esophageal squamous cell carcinoma (ESCC) patients and evaluate the interaction between ACCI and other prognostic factors. Methods: A retrospective study was conducted on the data of patients with primary ESCC who underwent radical esophagectomy in the First affiliated Hospital of Fujian Medical University from July 2015 to November 2020. Cox regression models were used to analyze the effect of prognostic factors on overall survival and cancer-specific survival. The 1-year and 3-year survival and ability to predict the prognosis were evaluated in terms of prognostic factors. Results: A total of 352 patients were included in this study. Patients were divided into two ACCI groups according to the optimal cut-off value of 5 points. The median age of high ACCI group is significantly higher than that of low ACCI group (P <0.001). There were no significant differences between two ACCI group with gender, tumor size, TNM stage, degree of differentiation, application of antibiotics, application of postoperative chemotherapy and postoperative complications. Both in univariate and multivariate cox regression model, ACCI was the independent risk factor for OS and CSS (all P value<0.05). There were interactions between ACCI and other prognostic factors (application of postoperative chemotherapy, TNM stage, degree of differentiation, tumor size) (all P value<0.05). The Harrell’s C-statistics (C-index) of model was 0.719. Conclusions: ACCI was the independent risk factor for OS and CSS in esophageal cancer patients underwent radical resection of esophageal cancer, and there were interactions between ACCI and other prognostic factors (application of postoperative chemotherapy, TNM stage, degree of differentiation, tumor size). Have you got a Conflict of Interest?: No
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925 α-Hederin with cisplatin increases the apoptosis of gastric cancer via mitochondrial related apoptosis pathway H. Deng1 1 Chongqing University Cancer Hospital, Chongqing, China OBJECT: Cisplatin is a type of broad-spectrum anti-carcinogen that has been widely used in anti-gastric cancer therapy. Drug resistance prevails in gastric cancer therapy. α-Hederin has been reported to exert anti-tumour ability by inducing apoptosis in many cancers in vitro and in vivo. A combination chemotherapy regimen can improve the outcome of patients. METHODS: In the present study, we used a CCK-8 assay, Hoechst 33258 staining, Annexin V-PE/7-AAD, intracellular reactive oxygen species (ROS) measurement, mitochondrial membrane potential (MMP) assay kit and western blotting to detect apoptosis and mitochondrial function in gastric cancer (GC) cells. A xenograft tumour model in nude mice was used to evaluate the anti-tumour effects of cisplatin and α-Hederin in vivo. RESULTS: Combination treatment of cisplatin and α-Hederin increased the apoptotic effects in cisplatin-induced GC cell lines. In the xenograft mouse model, the combination of cisplatin and α-Hederin remarkably increased the tumour inhibition effect compared to either drug alone. Interestingly, combination of cisplatin and α-Hederin increased the expression of apoptosis-related proteins. Using in vitro experiments, we verified that the combination of cisplatin and α-Hederin increased the accumulation of ROS in GC cell lines and also reduced the MMP, thus inhibiting proliferation and promoting apoptosis in GC cells. CONCLUSION: α-Hederin enhances cisplatin-induced anti-tumour effects in GC both in vitro and in vivo by promoting the accumulation of ROS and decreasing MMP. Our data strongly suggested that α-Hederin is a promising candidate for intervention in gastric cancer. Have you got a Conflict of Interest?: No
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927 Characterizing melanoma diagnostic pathways in routine practice in Ontario, Canada: A population-based study M. Mavor1,2, T. Hanna2, P. Groome1,2 1 Queen's University, Public Health Sciences, Kingston, Canada, 2Queen's University, Division of Cancer Care and Epidemiology, Kingston, Canada Background: Diagnostic pathway guidelines have been introduced to optimize diagnostic processes. However, actual diagnostic pathways experienced by patients with melanoma have not been characterized. Aim: To identify the different diagnostic pathways experienced by melanoma patients in routine practice and compared patient, disease, and diagnostic interval characteristics across pathway groups. Methods: A population-based cross-sectional study of all cutaneous melanoma patients diagnosed in Ontario, Canada between January 1, 2007 and October 31, 2019 using linked administrative health data to collect all melanoma-related healthcare encounters during a patient’s diagnostic interval. We used latent class cluster analysis (LCCA) to identify patients with similar diagnostic pathways in routine practice. Input variables for LCCA included non-melanoma skin cancer and dermatologist history, first physician specialty seen in primary and specialist care, initial procedures, number of visits and procedures, and healthcare activity on the diagnosis date. We assessed associations between demographic and disease factors and pathway membership using chi-square tests and Pearson residuals, and characterized clusters by their diagnostic interval, primary care subinterval, and specialist care subinterval lengths. Results: We identified four diagnostic pathways: ‘primary care only’ (N=6107), ‘referred to specialist for immediate action’ (N=8987), ‘multiple visits and procedures’ (N=11893), and ‘specialist care only’ (N=6384). 75% first saw a GP, and 80% first saw a melanoma-related specialist. A higher proportion of patients in the ‘primary care only’ pathway lived in rural areas and in counties with zero dermatologists, while a higher proportion of patients in the ‘referred to specialist for immediate action’ and the ‘specialist care only’ pathways lived in urban areas and counties with high dermatologist density. Pathway membership also varied across health regions. Median intervals across pathways were 1-67 days for diagnostic interval, 1-30 days for primary care interval, and 1-25 days for specialist care interval. Patients in the ‘primary care only’ pathway had the shortest diagnostic interval, and patients in the ‘multiple visits and procedures’ pathway had the longest diagnostic interval. Conclusion: Melanoma patients in Ontario experience varying pathways to a diagnosis that are associated with the characteristics of the patient and where they live. Most patients saw both a GP and a specialist in their diagnostic interval, highlighting the importance of both GPs and specialists in the diagnosis of melanoma. Shorter diagnostic intervals in the ‘primary care only’ pathway demonstrate the important role of primary care in the diagnosis of melanoma. Future research should address reasons for the associations we observed, and whether they are indicating problems with access to high quality care. Have you got a Conflict of Interest?: No
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928 Computed tomography-guided microwave ablation combined with osteoplasty for the treatment of bone metastases K. Zhang1, X. Zhang1 1 Tengzhou Central People's Hospital, Oncology Department, Tengzhou, China Background: Bone metastases occur in approximately 50–70% of patients with malignant tumors often resulting in severe pain and reduced mobility. Currently, there are several treatment options for patients with bone metastases, including radiation therapy, bisphosphonate treatment, and surgical intervention , as well as minimally invasive treatments, such as thermal ablation, cryoablation, and osteoplasty. As patients progress to the advanced stage of their disease, the treatment for painful bone metastases is limited to palliative radiotherapy , which is slow to reduce pain and is only 60% effective . This delayed analgesia does not meet the clinical needs of patients who suffer from severe pain. Thermal ablation and osteoplasty are two common treatments for painful bone metastases. There have been some reports of promising clinical outcomes when combining the two treatment modalities; however, most of these studies had small sample sizes and may have been statistically underpowered. Compared to the effects of RFA, MWA offers the advantages of faster heating, shorter procedural times, and larger ablation areas, without requiring neutral electrodes. The present multicenter retrospective study of patients with extraspinal and spinal metastases aimed to investigate the efficacy and safety of combined MWA and osteoplasty in the treatment of bone metastases. Aim: To evaluate the efficacy and safety of combined MWA and osteoplasty as a palliative therapy for painful bone metastases. Methods: This was an extension study of our previous single-center study on extraspinal bone metastases. A retrospective review was conducted for 147 patients with painful bone metastases who underwent MWA combined with osteoplasty. In total, 102 (69.4%) patients had spinal metastases, 41 (27.9%) had extraspinal metastases, and four (2.7%) had both. Treatment efficacy was determined by comparing VAS scores, daily morphine equivalent opioid consumption, and ODI scores before treatment and during the follow-up period (mean follow-up, 9.8 months; range, 3–16 months). Results: The mean VAS score declined significantly from 6.4 ± 2.3 before treatment to 3.2 ± 2.1 at 24 hours, 1.9 ± 1.58 at 1 week, 1.78 ± 1.60 at 4 weeks, 1.82 ± 1.58 at 12 weeks, and 1.86 ± 1.57 at 24 weeks post-treatment, respectively (P < 0.01). The mean daily morphine equivalent consumption of opioids was also significantly reduced from 81.5 ± 32.8 mg before treatment to 40.01 ± 20.57 mg at 24 hours, 32.36 ± 10.22 mg at 1 week, 26.35 ± 10.01 mg at 4 weeks, 21.54 ± 8.32 mg at 12 weeks, and 19.33 ± 7.38 mg at 24 weeks post-treatment. The mean ODI score was lower post-treatment than that before treatment (P < 0.0001). Major complications occurred in 4/147 patients, with one pathological fracture, one nerve injury, and one mild skin infections. Minor cement leakages were observed at 69 sites (32.8%). Conclusion: MWA combined with osteoplasty is an effective and safe treatment for painful bone metastases. Have you got a Conflict of Interest?: No
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929 Cervical cancer trends in Brazil and regions in two decades (1998 to 2016): incidence and mortality R. Reis1, Y. Portella1, A. Scaff1, L.A. Maltoni Junior1 1 Fundação do Câncer, Rio de Janeiro, Brazil Background: Considered as a public health problem, cervical cancer has the attention of the World Health Organization (WHO). Cervical cancer is one of the few types of cancer that can be prevented and, if diagnosed at an early stage of the disease, can cause a woman to be cured. It is devastating that in the world there are still more than 600 thousand new cases of the disease per year, making it the fourth most frequent type of cancer. Cervical cancer incidence rates have fallen in most developed countries, something that is not observed in developing countries, like Brazil. Aim: To analyze the trend of incidence and mortality from cervical cancer (malignant neoplasm and in situ) from 1998 to 2016 in Brazil and geographic regions, in the population of women undergoing screening (range 25 to 64 years). Methods: For incidence, information on cervical cancer (malignant neoplasm - C53 and in situ neoplasm - D06) from 25 Population-Based Cancer Registries (RCBP), covering the period from 1998 to 2016, was used. The median of the rates was chosen as a measure of central tendency to obtain an overall assessment of the incidence rates. For mortality, we used the official information on Brazil, for the same period and locations. The study population was women over 15 years of age. Was used by Joinpoint for trends analysis. Results: Decreases were observed in the incidence rates of cervical cancer (C53) in Brazil (AAPC: -4.7) and in the regions, except for the southern region, where there was an increase in incidence in the period from 2008 to 2016 (APC: 2.12, but not significant p=0.237). For in situ cervical neoplasm (D06), an increase in incidence was observed for Brazil (AAPC: 1.73). For mortality, there is a decrease in rates, although small, but significant (AAC: -0.80). Conclusion: It can be observed that, despite the small, cervical cancer mortality rates in the country, it may be a reflection of the investment of supplementary health systems (public network and supplementary health) in the prevention, early diagnosis and treatment of the disease. Have you got a Conflict of Interest?: No
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93 ImPaCCT Foundation, Tata Memorial Centre, India S. Jatia1, M. Prasad1,2, G. Chinnaswamy1,2, S. Banavali1,2 1 Tata Memorial Hospital, ImPaCCT Foundation, Pediatric Oncology, Mumbai, India, 2Homi Bhabha National Institute, Mumbai, India Amount raised: The amount raised has consistently increased from USD 79,300 in 2010/11 to USD 5,281,189 in 2021/2022; USD 30,993,289 raised over 12 years. Background and context: The “Improving Paediatric Cancer Care and Treatment” or ImPaCCT Foundation (https://www.impacctfoundation.com) is the Foundation of Tata Memorial Centre (TMC), Mumbai, India, set up in 2010. Over the years, the foundation has considerably expanded in scope and services, and now supports not only Tata Memorial Hospital, Mumbai, but also the 9 peripheral centres of TMC spread across India, which together treat nearly 5000 children with cancer up to the age of 18 years. Aim: To provide holistic care and logistic support to all children with cancer, irrespective of family background, gender, socio-economic status, with a focus on obviating financial toxicity and consequently treatment abandonment. Strategy / Tactics: Financial needs were broken down by essential components of care and a strategic fundraising model was made. Additionally, all existing non-governmental organizations (NGOs) working with childhood cancer in our centre were brought together, so as to leverage their individual and collective strengths. Stakeholders involved:Active Fundraising is done through all segments of society: Government, NGOs, Corporates (through Corporate Social Responsibility) and Individual donors. Programme process: The foundation supports the costs of all individual components of care –initial diagnostics, complete treatment, patient and family travel and accommodation, nutrition support, formal and non-formal education, infection prevention/control and survivorship care. The foundation also facilitates voluntary donors for blood component and platelet transfusions, offers bereavement support, and psychosocial counselling, and supports several non-medical activities for the entertainment of children and families on treatment. Since 2016, we have also received funding for high-end medical equipment, clinical and translational research and education/ training of staff. The foundation is overseen by two physicians, an officer-in-charge and 4 administrative staff. Account-keeping, auditing and reporting is meticulous- all donors receive complete audited accounts of every donation. Costs and returns: Over 19,525 new patients (35% female) and thousands of old patients have been supported by the ImPaCCT foundation from 2010 to 2022. Treatment abandonment has consistently dropped fromover 20% in 2009 to <5% since 2015, and was 1.86% in 2021 (Jatia S, et al. Pediatric Blood Cancer. 2019;66: e2).The Foundation spends under 1% on administrative expenses; over 99% of all donations received are used towards patient care and support. What was learnt: Component-focused fundraising,dedicated personnel to manage and oversee the foundation have been key. Replicability potential:This model has already been replicated in other non-Mumbai TMC centres and other non-TMC centres across India. Have you got a Conflict of Interest?: No
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930 The diagnosis and treatment's impact of cervical cancer in Brazil according to the origin of the care network. A. Scaff1, R. Reis1, Y. Portella1, L.A. Maltoni1 1 Fundação do Câncer, Rio de Janeiro, Brazil Background: Considered a public health problem, cervical cancer has the attention of the World Health Organization (WHO). Cervical cancer is one of the few types of cancer that can be prevented and, if diagnosed at an early stage of the disease, can cause a woman to be cured. In Brazil, a total of 16,590 new cases of cervical cancer are estimated for the year 2022, with an estimated risk of 15.43 new cases per 100,000 women in the country. Despite being available, the structural limitation of the public health system in Brazil makes it difficult to access diagnosis and, consequently, treatment, negatively affecting prognosis. Aim: To evaluate the differences regarding the origin of the referral of women diagnosed with invasive or in situ cervical cancer to the hospital for treatment. Methods: Secondary data from the Hospital Cancer Registries (HCR) in Brazil from 2006 to 2018 were analyzed. Sociodemographic and diagnosis and treatment characteristics were analyzed and the relative frequencies of the variables were calculated, excluding ignored information. The chi-square test was calculated, with a confidence level of 95%, to assess the differences between the relative distributions of the variables according to the criterion of the origin of referral. R software, version 4.1.0 was used. Results: A total of 160,632 women with malignant or in situ cervical cancer were identified. The cases analyzed came from more than 300 hospitals in the country. Of these, about 28% were excluded from the analyzes because they did not have information about the origin of the referral to the hospital. A total of 78,714 women with cervical cancer were analyzed, corresponding to 68% of the database, and a total of 37,066 women diagnosed with in situ cervical cancer, corresponding to 32%. Most women come to treatment at an advanced stage of the disease. Conclusion: Despite the country's public health efforts, the difference in access to timely diagnosis and treatment is still clearly observed, which reflects social inequity. Have you got a Conflict of Interest?: No
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932 Inequalities in access to breast cancer treatment in Brazil Y. Portella1, A. Scaff1, R. Reis1, L.A. Maltoni1 1 Fundação do Câncer, Rio de Janeiro, Brazil Background: It is estimated that there will be an approximate 50% increase in breast cancer cases in Latin America and the Caribbean over the next 20 years. The occurrence of 2 million new cases of female breast cancer in the world was estimated for the year 2020, of which more than 210 thousand in Latin America and the Caribbean. In Brazil, it is estimated that 66,000 new cases of breast cancer are diagnosed in women in the country, corresponding to a risk of 61 new cases per 100,000 women (Incidence Estimate 2020, INCA). This neoplasm is considered the most frequent in the female population, without considering non-melanoma skin cancer. Therefore, it is necessary to better understand the magnitude and distribution of the disease in Brazil. Aim: To analyze possible inequalities found by Brazilian women in accessing breast cancer treatment, according to the origin of the medical referral: whether by public health - Unified Health System (SUS) or by private health (non-SUS). Methods: The database of Hospital-based Cancer Registries in Brazil, from 2006 to 2018, was used. Analysis of absolute and relative frequencies of variables was performed: race/skin color, education, staging, and time between diagnosis and treatment regarding the origin of the referral, whether SUS or non-SUS. The Chi-square test was used to assess the independence between the variable of origin of the referral and the others, with a significance level of 5%. Results: Of the women referred by the SUS, 51% are brown or black, while this percentage reaches 40% of those referred by the non-SUS health system. There is also a difference in relation to women's education (p-value < 0.001). Of those referred by the SUS, 61% have only completed elementary school (42% incomplete elementary school). Regarding staging, 20% of women referred by the SUS arrive in the early stages of the disease (staging 0 and I), a lower value when compared to those referred by the non-SUS system (32%). Conclusion: The portrait of unequal health, with differentiated access, which reinforces the need for massive social investment in education and health and actions linked to these two areas. Have you got a Conflict of Interest?: No
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937 Available in theory or in practice? An investigation into recurrent shortages of chemotherapies in Indonesia L.D. Rahmartani1, A. Hasnida2, A.K. Wagner3,4, A. Ferrario3 1 Universitas Indonesia, Cipto Mangunkusumo National Hospital, Department of Child Health, Faculty of Medicine, Jakarta Pusat, Indonesia, 2Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Health Care Governance, Rotterdam, Netherlands, 3Harvard Medical School, Department of Population Medicine, Boston, United States, 4Dana Farber/Harvard Cancer Center, Boston, United States Background: Shortages of essential chemotherapies for childhood cancer is a global problem. While shortages affect countries across the income spectrum, low- and middle-income countries have less resources available to proactively manage such shortages thus bearing a disproportionate burden of their negative impact. In this presentation, we will use the experience of Indonesia to discuss this global challenge and share lessons learned. Aim: To a) identify the reasons for recurrent pediatric chemotherapy shortages in Indonesia, their consequences, and coping approaches used and b) to discuss preventive/remedial strategies to tackle this global problem. Methods: Focus group discussions with clinicians and pharmacists (ongoing). Desk review. Results: In the past 5 years, shortages of essential chemotherapies listed in the National Formulary (6mercaptopurine, methotrexate, daunorubicin and asparaginase) have impacted care of children with cancer in Indonesia. Based on preliminary results, we identified supply chain vulnerabilities as one of the reasons for shortages. These include having only one licensed supplier on the local market (asparaginase) and having no licensed supplier on the local market (6-mercaptopurine). The existing supply chain issues are exacerbated by the lack of a nationally consolidated demand for pediatric oncology medicines and the absence of reliable data on the true incidence of pediatric acute lymphoblastic leukemia given there is no national registry. Except for daunorubicin, these medicines are not easily substitutable. The consequences of shortages include delays in treatment start, suboptimal treatment and increased costs for families to source these medicines and for the health system too. Special procurement for medicines without a local license has replaced regular procurement (6-mercaptopurine), sourcing products via informal brokers or through patients’ relatives from neighboring countries and purchasing medicines online are some of the coping approaches used to deal with shortages. Clinicians mentioned local production as an option to address shortages. Conclusion: Existing coping mechanisms to deal with shortages of chemotherapies in Indonesia expose patients to risks and are not sustainable. To avoid future shortages, including the possible announced withdrawal of asparaginase from the Indonesian market in 2023, demand and supply factors need to be addressed. This could be done through a proactive strategy involving horizon scanning, an analysis of the market and supply chain mapping to identify potential suppliers, consolidating demand across all provinces and using different contracting modalities to secure a reliable supply of essential medicines. In the longer term, opportunities to manufacture essential chemotherapies locally should be pursed. Have you got a Conflict of Interest?: No
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939 How data driven decisions improves patient experience and patient care in a public cancer center F. Orlandi1, M.P. Saavedra1, A. Garcia2, B. Caballero3 1 Instituto Nacional del Torax, Oncology, Santiago, Chile, 2CENS, Innovation, Santiago, Chile, 3Roche, Personalised Healthcare, Santiago, Chile Chile like many developing countries exhibits important waiting lists for public hospital healthcare. COVID-19 increased waiting lists by 365% decreasing patient’s quality of care, adding more pressure to the system. Lack of unified and standardized prioritization criteria and fragmentation in the decision-making process across levels of care has increased the occupancy of third level of care. Moreover, absenteeism and lack of operational efficiency within institutions leads to longer waiting times and ineffective care. It is even more relevant in cancer care, especially lung cancer (LC) patients, who are diagnosed in advanced stages. Access to prompt diagnosis and treatment is suboptimal and care compliant with local regulations is not always achieved. Aim: To transform patient care by increasing contact between the healthcare provider and patients using data across their journeys to improve their healthcare experience. Reduce absenteeism, optimize healthcare resource use and improve the resolution of cases. Strategy: We established a public-private partnership among Centro Nacional en Sistemas de Información en Salud, INT (Instituto Nacional del Tórax) and Roche. We invited startups to create a solution that would cover the patient's experience and transform the INT internal processes. An open innovation approach allowed us to develop a solution that can be scalable to similar sites. As a result, all parties participated in creating and integrating solutions to impact the overall patient experience, clinicians, and administrative personnel. The solution is a platform that integrates patients’ data from diagnosis to recovery, creating a constant communication flow that keeps them connected and contributes to the clinical decision making while reducing administrative tasks, through: Patient communication: Digital platform to keep up-to-date communication between patients and INT, track patients, and prioritize care according to LC stage to potentially increase life expectancy. Expenditure efficiency: Effective activation of Health Guarantees, reduction in operational inefficiencies, increased efficiency in care leveraging remote triage, navigation, and monitoring, effective decision making of healthcare professionals due to availability of patient diagnosis information. Digital transformation: new digital interfaces that contribute to dynamic management of demand and offer of healthcare services and use of technology to improve patient care Program / Policy process: Digital transformation and data usage for patient care. Outcomes: % reduction in time to treatment for patients with public health coverage measured at each stage of the process, # patients with expected response to treatment vs total of patients, increased life expectancy in months. Time to activation of GES, reduction in absenteeism, in treatment discontinuity. Readiness of patients for consultation, improvements in operational efficiency due to new digital processes Have you got a Conflict of Interest?: Yes If yes please specify:: I am at employee at Roche Chile
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941 Breast cancer screening and socio-demographic factors in Kuwait: A national study among Kuwaiti women N. Alsheridah1,2, S. Benitez Majano1, C. Maringe1, H. AlKhawari3, B. Rachet1 1 London School of Hygiene and Tropical Medicine, Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, London, United Kingdom, 2Ministry of Health, Public Health Administration, Kuwait City, Kuwait, 3Ministry of Health, Department of Medical Imaging, Al-Amiri Hospital, Kuwait City, Kuwait Background: Breast cancer incidence is increasing worldwide, including in the Arab world. Kuwait established a national breast cancer screening (BCS) programme in 2014. Aim: This study aims to examine how BCS uptake among women of Kuwaiti nationality varies sociodemographically at population-level. Methods: A national cross-sectional study was conducted in Kuwait using 2014-2019 data from the Kuwait National Mammography Screening programme (N=15,304) and census information from the target female Kuwaiti population (age 40-69) for BCS (N=863,036). BCS and population counts were defined by calendar year, age category (40-49, 50-59, 60-60), marital status (ever-married, single), education (none, primary/secondary, high school/diploma, bachelor/postgraduate) and region. The six regions were grouped in two categories according to their population density (indirectly reflecting accessibility to BCS centres) and used to stratify the analysis. Counts were modelled using a generalised linear model with a negative binomial distribution. Results: Overall, BCS remained very low, around 1.4% over the entire 2014-2019 period. BCS uptake was higher in densely populated regions, in younger, ever-married and educated women. The highest BCS uptake (high-density population, age 40-49, ever-married and highest education) was still as low as 4.5% in 2019, in contrast to 0.3% in the low-density population, age 60-69, single and lowest education level. Higher education level was linearly associated with larger BCS uptake in highly dense regions. In low-density populations, the contrast was only between the two lowest education levels (lower BCS uptake) and two highest levels (higher uptake). Conclusion: Although socio-demographic and geographic factors were clearly associated with differential BCS uptake, the proportion of screened women remained much too low to have any impact at population level. Novel strategies need to be implemented to increase BCS uptake among all women in Kuwait, particularly in older, single and less educated women. Have you got a Conflict of Interest?: No
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942 Paramedics and Palliative Care: Bringing Vital Services to Canadians Living With Cancer A. Coronado1, S. Crick2, D. Dudgeon1, R. Shaw Moxam1 1 Canadian Partnership Against Cancer, Toronto, Canada, 2Healthcare Excellence Canada, Ottawa, Canada Background and context: For people receiving end-of-life palliative care, most would prefer to remain at home with appropriate support.[1] However, families often have to call the emergency number when problems arise. Paramedics are uniquely positioned to support people to remain at home at end of life, but the protocols, tools and approaches they can utilize to support people to do so can be limited.[2] Aim: In 2018, the Canadian Partnership Against Cancer (CPAC) and Healthcare Excellence Canada (HEC) supported the implementation of Paramedics and Palliative Care: Bringing Vital Services to Canadians,to provide appropriate, inhome palliative care approaches for people living with cancer and other life-limiting conditions. Strategy / Programme: CPAC and HEC partnered with paramedic teams from 6 provinces across Canada over 4 years to implement this initiative. The main components of the innovative approach were:
• • • •
A clinical practice guideline specific to palliative care that allows paramedics to provide care in the home without transporting patients to the emergency department Paramedic-specific education on palliative care A tool to share patients’ goals of care between paramedics and the rest of the multi-disciplinary team and enable care consistent with those care wishes. Building relationships for interprofessional collaboration.
Outcomes: Through this four-year collaboration, more than 5,000 paramedics across 6 provinces were trained to provide patients with in-home support when they have a palliative emergency, require symptom management, and/or have an unexpected health event. The program shows a benefit to patients, providers, and the system: - 86.7% of patients/family were satisfied with the care they received - 90.2% of paramedics reported increased knowledge in palliative care - 66.5% of palliative care emergency calls enabled patients to receive care at home - 17 to 61 minutes were saved on average by providing paramedic palliative care at home What was learnt: Paramedics are uniquely placed to make a valuable impact on inter-disciplinary approaches as well as contributing to positive patient and system outcomes. This model has the potential to be replicated across other populations and geographies. To this end, a toolkit has been developed which synthesizes the experiences and learnings from this collaborative that are required to successfully develop a palliative approach to care for paramedics.
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[1] Canadian Partnership Against Cancer. Canadians’ Views of Palliative Care: National Online Survey. 2016.https://static1.squarespace.com/static/5755e91b044262d8f43cf6fa/t/58209f5ef7e0abaa8f492eb7/14785329 6149 2/Roulston-Ipsos.pdf Accessed March 1, 2022. [2] Carter AJE, Earle R, Gregoire MC, et al Breaking down silos: consensus-based recommendations for improved content, structure, and accessibility of advance directives in emergency and out of hospital settings. J Palliat Med 2020 Mar;23(3):379–88 Have you got a Conflict of Interest?: No
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946 Histopathologic Pattern of Benign Tumour of Female Genital tract in Birnin-Kebbi, Nigeria. O. OLUWOLE1 1 UNIVERSITY OF ABUJA, DEPARTMENT OF PATHOLOGY/FORENSIC MEDICINE, ABUJA, Nigeria Background: Gynaecological specimens form the major proportion of tissue biopsies in most pathology departments. Sexually active women are more prone to both benign and malignant diseases of the female genital tract Aim: This study aims to find out the histopathological distribution of benign tumours occurring in the female genital tract (FGT). Methods: This is a 4-year retrospective histopathological analysis of benign tumours of the female genital tract diagnosed between 2009-2012 in the Department of Histopathology, Federal Medical Centre, Birnin-Kebbi, Kebbi State, North-West, Nigeria. All the Haematoxylin &Eosin stained slides and paraffin embedded blocks were retrieved and studied.The clinical data such as the age, sex, site of lesion and clinical summary were extracted from the histology request forms. Results: A total of One hundred and thirty-six (136) women had benign tumours of the female genital tract. The age range is between 10-70 years, the mean age was 40 years, while 11 patients did not specify their ages. The peak age incidence was in the fourth decade (30-39) years. The most common benign tumour is leiomyoma 100 (73.5%), this is followed by mature cystic teratoma 12 (8.8%), serous cystadenoma 9 (6.6%), granulosa cell tumour 7 (5.2%), mucinous cystadenoma 3 (2.3%), fibroma 2 (1.5%), granular cell tumour 1 (0.7%), adenofibroma 1 (0.7%), and Brenner tumour 1 (0.7%). Conclusion: Benign tumours of the female genital tract are common in our environment. A very high-index of suspicion, good clinical acumen, adequate histopathologic sampling and reporting can go a long way at making diagnosis and giving appropriate treatment. Have you got a Conflict of Interest?: No
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957 The preliminary evaluation of pre-treatment plan QA and patient-specific QA in cervical cancer radiotherapy S. Li1, H. Luo1, F. Jin1 1 Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Department of Radiation Oncology, Chongqing, China Background: Patient-specific quality assurance (PSQA) is an important component of the implementation process of clinical radiotherapy, which ismainly affected by two factors: linear accelerator(linac) delivery errors and plan calculation errors in the treatment planning system(TPS). Linac delivery errors have been reported by many studies and can be limited by linac QA according to TG-142 report. However, there are fewer studies about plan QA. Aim: This study was to preliminary evaluation of pre-treatment plan QA and PSQA in cervical cancer radiotherapy using gamma pass rates(GPRs). Methods: A total of 40 cervical cancer patients(21 IMRT, 19 VMAT) were enrolled. The PSQAs were performed on the linac by ArcCHECK under 3%/3mm, 3%/2mm, 2%/2mm, and 1%/1mm GPR criterias, on the basis that completes the mechanical and dosimetrical QA, ensuring the stability and in-position accuracy of the linac in accordance with the TG-142 report. These pre-treatment plans QA were performed by SciMoca-A Monte Carlo method, firstly calculated by AAA dose algorithm in TPS and then recalculated by SciMoca. The GPRs of ArcCHECK and SciMoca with different radiotherapy techniques under different criterias were comprehensively compared and analyzed. Results: The mean GPRs of ArcCHECK vs.SciMocain 40 patients under 3%/3mm, 3%/2mm, 2%/2mm and 1%/1mm criteria were: 96.7±1.0% vs. 99.8±0.4%, 95.4±1.7%vs. 99.6±0.6%, 90.6±3.5%vs. 97.9±3.7%, 60.7±8.7% vs.70.6±18.3%. For all 40 plans, a maximum spearman correlation coefficient of 0.535 (P < 0.01) was found at 3%/3mm criteria for SciMoca GPR and 2%/2mm for ArcCHECK, and the strongest correlation was always found under 2%/2mm ArcCHECK criteria regardless of changes in the SciMoca criteria. Across the 21 IMRT plans, the maximum spearman correlation coefficient was found to be 0.755 (P<0.01) at 3%/3mm criteria for SciMoca and 1%/1mm for ArcCHECK. Furthermore, it was found that the correlation coefficients grew higher as the ArcCHERCH criteria got stricter. In the 19 VMAT cases, no statistically significant correlation was found. Conclusion: In the context of ensuring accurate delivery of linac, there is a strong correlation between the plan QAand PSQA, especially for IMRT plans. This correlation was more pronounced when the stricter 2%/2mm and 1%/1mm gamma criteria were used in the ArcCHECK procedure. Have you got a Conflict of Interest?: No
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96 Utilizing data visibility to address cancer policy challenges - experience with the Kenya Oncology Dashboard K. Mugambi1, P. Njiri1, V. Mulema2, K. Mlati3, V. Mwenda4, M. Nyangasi4 1 Clinton Health Access Initiative, Nairobi, Kenya, 2Clinton Health Access Initiative, Kampala, Uganda, 3Clinton Health Access Initiative, Johannesburg, South Africa, 4Ministry of Health, National Cancer Control Programme, Nairobi, Kenya Background: Cancer is the third leading cause of death in Kenya1. An estimated two thirds of cancer patients will die from the condition2. The National Cancer Control Programme (NCCP) aspires to utilize routine surveillance information to support efficient policymaking, cancer control planning, resource mobilisation and allocation, and continuous quality improvement. Currently, hospitals submit paper-based monthly reports to NCCP; these are often late or missing, leaving NCCP without the necessary information to monitor cancer treatment services and plan timely interventions. Aim: The NCCP in partnership with Clinton Health Access Initiative (CHAI) developed a digital platform to aggregate hospital level data in real time to address information gaps. Strategy: Starting with data capture, the NCCP ensured that paper-based daily activity registers were available at hospitals. The platform was developed and integrated within existing data systems thus eliminating adoption hesitancy. To enhance data use, the platform was made open access, permitting all stakeholders to have visibility. The data is summarised in simple graphics to guide prompt decision-making. For sustainability, NCCP integrated data use into routine oncology technical working group (TWG) meetings. NCCP worked with the AIDS Control Program to allocate server space, eliminating recurring data storage costs. Programme: Data from the dashboard was routinely shared at the monthly oncology TWG meetings. Once gaps were identified, NCCP followed up with facilities. Outcomes: For the first time, the NCCP had access to program performance in real time. Gaps such as low facility reporting rates and medicine stock-outs were identified. Following facility engagement, reporting rates increased from 57% to 86%. The stock out period for fifty-five medicines was reduced by half across the fourteen cancer centers. Information on medicines that were close to expiry facilitated redistribution, saving the government US$127,000 in 2021. Data from the tool was also used to conduct a national demand forecast which informed funding requests to the government. Consequently, an additional US$1 million was made available for medicines procurement for 2021/22. What was learnt: Health system visibility aided by a digital platform enhanced responsiveness to program gaps and enabled rectification. Data visibility that addressed an information gap unlocked additional funding from the government. The system can be replicated in Kenya and externally as it sits within DHIS2 – the health reporting system adopted by many countries in Africa.
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1.Ministry of Health. National Cancer Control Strategy 2017-2022. https://www.iccpportal.org/system/files/plans/KENYA%20NATIONAL%20CANCER%20CONTROL%20STRATEGY%202017-2022_1.pdf 2.World Health Organization. International Agency for Research on Cancer. Global Cancer Observatory. https://gco.iarc.fr/today/data/factsheets/populations/404-kenya-fact-sheets.pdf Accessed 23 March 2022 Have you got a Conflict of Interest?: No
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960 FLNA and its fragments promotes metastasis and Infigratinib sensitivity of intrahepatic cholangiocarcinoma F. MU1, Z. Zhao1, K. Xu1, L. Hu1, Y. Lv1, B. Wang1 1 Xi’an Jiaotong University, Xi’an, China, Xi’an, China Background: Filamin A (FLNA) is an important cytoskeleton protein, which participates in cell migration and is related to intracellular signal transduction. Studies have shown that FLNA plays an important role in melanoma, prostate cancer, colon cancer and other cancers. However, the correlation between FLNA and the occurrence and development of intrahepatic cholangiocarcinoma remains unclear. Aim: Detect The expression level of FLNA、FGFR and their correlation in intrahepatic cholangiocarcinoma,which induce the phenotype and drug resistance. Further explore the potential molecular mechanism of FLNA's role in intrahepatic carcinoma. Methods: The expression levels of FLNA and FGFR1 in tumors and adjacent normal tissues of patients with intrahepatic cholangiocarcinoma were detected by online database and immunohistochemistry of pathological specimens, and the relationship between the expression levels and the overall survival of patients with intrahepatic cholangiocarcinoma was evaluated. After regulating the expression level and cleavage level of FLNA in intrahepatic cholangiocarcinoma cell lines, the cell phenotype, FGFR1 and FGFR2 expression levels, and changes of subcutaneous tumor-forming specimens in nude mice were observed, and the effect of FLNA on the sensitivity of intrahepatic cholangiocarcinoma cell lines to FGFR-targeting drug was preliminarily explored. Results: Database and immunohistochemical results indicated that the expression of FLNA and FGFR in intrahepatic cholangiocarcinoma was higher than that in adjacent normal tissues, and there was a correlation between the expression of FLNA and FGFR, which was significantly correlated with poor prognosis of patients. In vitro cytological experiments showed that the intervention of FLNA expression and FLNA lysis level changed the proliferation, migration and invasion ability of intrahepatic bile duct cancer cells, and affected the cell cycle and autophagy level. Meanwhile, the low expression of FLNA and the increase of FLNA lysis reduced the transcription level and protein expression of FGFR1 and FGFR2. The tumorigenesis of intrahepatic cholangiocarcinoma cell lines with low expression of FLNA was significantly less than that of the control cell lines. IC50 showed that FLNA expression level and cleavage degree affected the sensitivity of intrahepatic cholangiocarcinoma to FGFRtargeted drugs. Conclusion: This study confirmed that FLNA is highly expressed in intrahepatic cholangiocarcinoma tissues and cells, and its expression significantly affects the proliferation, migration, invasion and other abilities of intrahepatic cholangiocarcinoma. Its expression level and cleavage degree are significantly correlated with FGFR transcription level and protein, and FLNA may affect the effect of FGFR-targeted therapy by regulating FGFR. Therefore, the expression of full length and fragment of FLNA may be a potential diagnostic and therapeutic target for intrahepatic cholangiocarcinoma. Have you got a Conflict of Interest?: No
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968 Sellar Region Lesions and Intracranial Aneurysms in the Era of Endoscopic Endonasal Approach S. Yan1, L. Zhou1, R. Tian1, L. Ma1, C. You1 1 West China Hospital of Sichuan University, Neurosurgery department, Chengdu, China Background: Sellar region lesions are a group of rare diseases in the clinical practice of neurosurgery. The endoscopic endonasal approach (EEA) has become an established treatment for sellar region lesions because of its minimal invasiveness and improved surgical field. Due to the pulling and dragging movements during the EEA, however, massive hemorrhage is thought to be the most severe intraoperative complication, and preoperatively complicated intracranial aneurysms (IAs) may play a role. Under the high comorbidity rate, preoperative evaluation and individualized formulation of treatment strategy should be discussed carefully. Aim: The study is aimed to sketch the clinical and radiological characteristics of patients diagnosed with sellar region lesions co-existed with IAs so as to strengthen the importance of preoperative radiological screening to such a group of patients. Methods: The study retrospectively collected 45 patients diagnosed with sellar mass and coexisting intracranial aneurysms from Dec 2016 to Nov 2020. Cases' history and imaging tests were reviewed for baseline characteristics, pathology subtypes, tumor and IA features, and therapeutic strategies. The prognosis of each patient was conducted with a telephone follow-up after surgery. Results: 45 of 405 (11.1%) screened patients had co-exsistence situations. The median age of included patients was 56.38 ± 11.21. 38 of 45 patients had histologically proven or presumed pituitary adenoma, the 4 remaining were classified as chordoma, and 3 as craniopharyngioma. 34 of 45 patients were classified as noninvasive tumors while the rest of those were considered invasive ones. 58 IAs were documented among the patients, 19 out of 58 (32.8%) IAs located on ICA C6 segment, 30 out of 58 (51.7%) IAs were micro-aneurysms with diameter less than 3 mm, 39 out of 58 (67.2%) IAs were narrow-neck (dome to neck ratio < 2), and 23 out of 58 IAs (39.7%) pointed to the cavernous sinus. 40 of 45 patients chose to deal with tumor firstly, 2 put IAs as a top priority, and the rest 3 chose conservative treatment. A total of 27 out of 45 (60%) patients were on follow-up, and 21 out of 27 (77.8%) patients reached complete improvement. Conclusion: The overall prevalence of sellar region lesions co-existed with the IAs is 11.1%. In the era of EEA for the sellar region lesions complicated with IAs, specific and individualized treatment strategies should be carried out during the clinical management. And we strongly recommend that CTA be considered a routine cerebrovascular screening before EEA to guarantee the safety of the procedure. Have you got a Conflict of Interest?: No
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974 circWDR37 resists chemotherapy-induced senescence and promotes metastasis of nasopharyngeal carcinoma J. Ma1, Q. Li1, Y.-Q. li1, N. Liu1, Y.-H. Zhao1, Q.-M. He1 1 Sun Yat-sen University Cancer Center, guangzhou, China Background: Circular RNAs (circRNAs) are a class of noncoding RNAs with covalently closed loop structures, produced in the back-splicing of precursor mRNA (pre-mRNA). Recent studies have shown that circRNAs play significant roles in multiple biological processes, including tumorigenesis. CircRNAs have been widely studied in tumor progression and metastasis. Furthermore, several studies have revealed that circRNAs participated in the regulation of Nasopharyngeal carcinoma (NPC) metastasis through the mechanism of miRNA sponges. However, it have not been studied the functions and mechanisms of circRNAs in regulating protein post-transcriptional modification and cellular senescence in NPC. Methods: To investigate the circRNAs that promote the metastasis of NPC, our group previously analyzed the expression profiles of circRNAs in a pair of NPC cell lines with diffirent metastasis potential. And circWDR37 was one of the significant upregulated circRNAs. Quantitative reverse transcription PCR and actinomycin D assays were used to confirm the circular structure of circWDR37. Then, transwell migration and invasion assays in vitro and in vivo nude mouse lymph node and lung metastasis models were performed to evluate the effects of circWDR37 on NPC metastasis. Mechanistically, RNA immunoprecipitation, pull-down assay and immunofluorescence microscopy were performed to confirm the interaction between circWDR37 and PKR in NPC. The clinical value of circWDR37 was evaluated in NPC patients. Results: We identify circular RNA circWDR37 as an unfavorable prognostic factor and key regulator to reprogram the senescent nasopharyngeal carcinoma (NPC) cells from cell cycle arrest to detrimental senescence-associated secretory phenotype (SASP). CircWDR37 releases NPC cells from cisplatin or gemcitabine-induced senescence to re-entered the cell cycle with reinforced growth, migration, invasion, and metastasis via activating the NF-κB pathway to stimulateCCND1 and SASP components transcription. Mechanistically, circWDR37 binds to doublestranded RNA (dsRNA)-activated protein kinase(PKR) to augment its homodimerization and autophosphorylatedactivation, which promotes PKR-mediated IKKβ, IκBα and p65 phosphorylation. Moreover, PKR competitively binds to IκBα and release p65 to be phosphorylated and translocated into the nucleus in a circWDR37-dependent manner. Conclusion: These findings provide new insights into the role of circWDR37-PKR-NF-κB axis in chemotherapyinduced senescence reprogramming and metastasis, and highlight potentially therapeutic targets in NPC. Have you got a Conflict of Interest?: No
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975 QUALITY IMPLEMENTATION OF STEREOTACTIC RADIOTHERAPY SERVICES ACROSS AN INTERNATIONAL NETWORK T. Aland1, N. Bailey1, L. Anderson1, K. Hiscoke1, R. Fitzgerald2, M. Knesl2, A. Fong2, M. Foote2 1 Icon Group, Strategic Investment & Clinical Care, South Brisbane, Australia, 2Icon Group, Icon Cancer Centres, South Brisbane, Australia Background: Icon Group operates a network of 30 radiotherapy centres across Australia and New Zealand.A project was launched in 2018 to implement a safe, high quality, and replicable stereotactic radiotherapy programme, building on existing network expertise, for a variety of stereotactic radiotherapy (SRT and SRS) and stereotactic body radiotherapy (SBRT) treatment techniques. Aim: The aim of this initiative was to provide these advanced treatments for patients in the community setting, resulting in reduced travel time and associated financial and personal burden, whilst ensuring the treatment received is equivalent to that offered by a high volume tertiary centre. Methods: Within the 30 centres, a mix of software and hardware existed from multiple vendors.Staff from the multi-disciplinary teams across the network had varied levels of clinical and technical experience.Project teams developed commissioning templates, clinical guidelines, and equipment/technique specific work instructions. A clinical governance model was implemented, which included the formation of physician led ‘clinical streams’, an endorsement programme, and specific requirements for commissioning, staff training, and staff competency assessments. The clinical streams contain a mix of physicians and key technical staff.Once all mandatory technical readiness requirements were met, experienced staff were available to provide remote and onsite training and support. To assist commencing physicians and to provide opportunities for learning and skill development, a mentorship program and virtual stereotactic chart round was established and held weekly. The virtual stereotactic chart round also served as a quality control measure. Additional Dosimetry checks of treatment plans were performed by experienced treatment planning staff within the virtual model. Results: Clinical guidelines and work instructions have been written for cranial SRT and SRS including multimetastases approach, as well as SBRT for spine, lung, liver, prostate, and oligometastases. The guidelines and work instructions include technique specific variations and cater to the various technology options available at Icon centres. To date, over 500 cases have been presented within the virtual chart round. Communication with the local teams regarding the need to adhere to approved clinical guidelines and work instructions, and clearly outlining the roles and responsibilities of each staff group during implementation, was essential. Conclusion: A highly replicable and safe model for implementing stereotactic services has been developed, and applied across 26 Icon centres, and could be extended to centres external to the Icon Group. Have you got a Conflict of Interest?: No
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976 Joy Cart initiative: Digital Moral Support Program to Support Children with Cancer in the UAE M. Mohammed1,1 1 Friends of Cancer Patients, Sharjah, United Arab Emirates Background and context: Over the past 22 years, Friends of Cancer Patients (FOCP) non-profit organization has achieved multiple milestones since its inception in 1999 under the directives and patronage of Her Highness Sheikha Jawaher bint Mohammed Al Qasimi. The key achievements for the organization are focused on advocacy, community awareness, and providing cancer patients with both financial and moral support throughout their journey with cancer and survivorship as well. FOCP has launched the Joy cart initiative which brings not only smiles to the faces of children suffering from cancer but also contributes to igniting hope in the hearts of young cancer patients. Aim: The main aim for this program is to minimize the impact of cancer through providing the moral and psychological support to needy cancer patients and their families. Especially since the start of COVID-19 pandemic, were all events and activities has been shifted from actual events into virtual events. Strategy / Tactics: The program conducts multiple activations & events at least once a month & throughout the year. Programme / Policy process: The Joy Cart Program events and activities has transitioned into virtual platforms in accordance with the country’s health safety guidelines to ensure the safety of the UAE community and specially to cancer patients due to their compromised immune system and to protect them from possible exposure to the virus. The program conducts virtual events on monthly basis which comprises of different educational workshops, health awareness lectures, entertainment sessions (e.g. puppet shows, magic shows, storytelling sessions) and many more in order to support children affected by cancer across the country during the difficult times. Outcomes: The Joy Cart program has encouraged children and youth affected by cancer to use their time in connecting with other cancer patients, carry out self-development activities, and pursue their favorite activities and hobbies. The program has assisted needy cancer patients and their families to combat the many challenges throughout the journey of diagnosis, treatment, and recovery during the pandemic with joy and hope. In 2021, a total of 16 events were conducted with a total of 368 children and youth has benefited from Joy Cart program’s activations. What was learnt: The virtual events under Joy Cart initiative has enabled FOCP to forge ahead with its commitment to delivering moral support to cancer patients and their families despite the prevailing challenging circumstances worldwide. We have proven that we can adapt to any challenges and advance the workflow using the latest technologies to increase productivity and offer qualitative services. These innovative measures are part of FOCP’s social responsibility and efforts to continue in its mission in the service of cancer patients and their families, despite the ongoing global health crisis. Have you got a Conflict of Interest?: No
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977 Financial support affects the survival of HER2-positive breast cancer from 2002 to 2020 in a Chinese cohort D. Zheng1, L. Song1, X. Liu1, X. Zhong1, Y. Xie1, C. Wang1, P. He1, X. Yan1, T. Tian1, H. Zheng1, T. Luo1 1 Sichuan University/West China Hospital, Chengdu, China Background: Trastuzumab has significantly improved the outcomes of human epidermal growth factor receptor 2 (HER2)-positive breast cancer over 20 years, and remains a cornerstone of treatment for this subtype today. Higher mortality was reported in underinsured breast cancer, but the mechanism remains unclear. Financial support for trastuzumab has transitioned from no support, to the Breast Cancer Assistant Program (BCAP), and finally, health insurance. Aim: Exploring the association between survival outcomes and different financial supports is necessary to further improve the outcomes of HER2-positive breast cancer in resource-limited regions. Methods: A prospective cohort of primary early unilateral HER2-positive breast cancer patients registered between January 2002 and December 2020 was used. Patients were divided into the following 3 groups, based on when they were diagnosed with breast cancer: (I) before 2011 (no financial support); (II) 2011–2017 (BCAP support); and (III) 2018 onwards (health insurance support). Overall survival and invasive disease-free survival (iDFS) were the primary outcomes. The follow-up was performed according to the standard procedure. Cox proportional hazards regression was used to explore the association between financial support and prognosis with adjustment of demographic and clinicopathological characteristics, and treatments. Results: A total of 2972 patients were finally identified. During the median follow-up period of 3.9 years, there were 153 breast cancer-related deaths. When fully adjusted potential covariates, patients supported by the BCAP had a 37% [hazard ratio (HR): 0.63, 95% CI: 0.41–0.96] decreased risk of overall mortality and that of patients covered by health insurance had a 64% decreased of overall mortality (HR: 0.36, 95% CI: 0.17–0.74) when compared with those who did not receive any financial support. Lower overall mortality was observed in patients covered by a higher reimbursement rate (HR: 0.68, 95% CI: 0.49–0.94) or the urban scheme (HR: 0.61, 95% CI: 0.43–0.86) than those covered by a lower reimbursement rate or the rural scheme. The same trends were also observed for iDFS and breast cancer-specific survival. Logistic regression analysis found that patients diagnosed with breast cancer during 2011–2017 [odds ratio (OR): 3.19, 95% CI: 2.20–4.71, P<0.001] and from 2018 (OR: 22.09, 95% CI: 14.76–33.73, P<0.001) showed stronger propensity for trastuzumab treatment. Mediation analysis showed that the financial support (including BCAP and health insurance) improved overall survival (direct effect [DE]: 9.33; indirect effect [IE]: 1.84) and iDFS (DE: 9.22; IE: 1.80), as they encouraged trastuzumab treatment by providing financial assistance (P<0.01). Conclusion: Our findings revealed the independent role of financial support in improving the survival outcomes of the HER2-positive breast cancer in resource-limited regions and the underneath mechanism. Have you got a Conflict of Interest?: No
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978 Efficacy of maintenance immune checkpoint inhibitors with or without pemetrexed in non-small cell lung cancer X. Gu1,2, W. Wang1, G. Lou1 1 Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Department of Thoracic Medical Oncology, Hangzhou, China, 2The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China Background: Advanced non-squamous non-small cell lung cancer (NS-NSCLC) patients withoutdriver gene mutations are usually treated with immune checkpoint inhibitors (ICIs) plus pemetrexed as maintenance therapy after first-line ICIs plus 4–6 cycles ofpemetrexed/platinum. Some patients in the real world receiveICIs monotherapy asmaintenance therapy. No clinical study has compared the efficacy and safety of ICIs with or without pemetrexed as maintenance therapy. Aim: We aimed to investigate whether the addition of pemetrexed to ICIs as maintenance therapy had clinical benefit in patients with advanced NS-NSCLC. We also stratified patients for PD-L1 expression to achieve precise benefit. Methods: We performed a retrospective study analyzing clinical dataofpatients with NS-NSCLC who were diagnosed in Zhejiang Cancer Hospital from September 2018 to May 2021 and receivedmaintenance therapy after 4–6 cycles ofICIs plus pemetrexed/platinum. Patients were divided into ICIs plus pemetrexed group and ICIs monotherapy group. We analyzed first-line progression-free survival, 2-year survival rate, and adverse events in the two groups of patients. Results: A total of 120 patients received ICIs with or without pemetrexed as maintenance therapy. Eightytwopatients received ICIs plus pemetrexed as maintenance therapy, and 38 patients received ICIs monotherapy.There were no statistically significant difference in median PFS betweentheICIsmonotherapygroupand ICIs plus pemetrexed group(12.00 months vs.12.07months, P=0.979). Amongpatients withPD-L1 TPS <1%, the median PFS wasworse withICIs monotherapy (9.50 months vs.14.20 months, P=0.039). Amongpatients withPD-L1 TPS ≥50% or1-49%, the median PFS in both groups was not statistically significant (P=0.866, P=0.589, respectively). The 2-year survival rates of the two groups were similar (66.7% vs.69.5%, P=0.812). The incidence of fatigue was significantly higher in the ICIs plus pemetrexed group (P=0.023). Conclusion: In NS-NSCLC patients with PD-L1 TPS ≥1%, no statistically significant difference in efficacy was observed between ICIs monotherapy and ICIs plus pemetrexed as maintenance therapy; however, the efficacy of ICIs monotherapy maintenance was worse in patients with TPS <1%. Have you got a Conflict of Interest?: No
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980 The Caregiver Initiative - a national alliance for improvement of conditions for caregivers L. Lund1 1 The Danish Cancer Society, Copenhagen, Denmark Background and context Informal caregivers are often central to the support and care of cancer patients (van Ryn et al, 2011). The caregiving role can be extremely demanding and have considerable costs to the caregivers’ own physical and mental health (Girgis et al, 2013). However, often, the caregivers’ needs for support are not met by the health care system (Wang et al, 2018). This is emphasized by the fact that one out of three contacts to the hotline of the Danish Cancer Society is from a caregiver (The Danish Cancer Society, 2022). If caregivers should be able to be a solid resource for the patients as well as take care of themselves, binding structured efforts to support caregivers in Denmark are needed. As this issue applies among caregivers of patients with other diagnoses than cancer as well, 30 Danish patient/caregiver interest groups and associations have joined forces in a national alliance: the Caregiver Initiative. Aim The aim of the Caregiver Initiative is to improve the conditions for informal caregivers. Strategy / Tactics Caregiver conditions should be improved through the five principles (launched November 2019): 1) the legal position of caregivers must be strengthened, 2) caregivers must be acknowledged, involved and informed, 3) knowledge of caregivers' conditions and relevant support strategies must be strengthened, 4) health problems and social isolation of caregivers must be prevented, and 5) caregivers must be ensured an appropriate balance between care tasks and working life. Programme / Policy process On basis of the five principles, political working groups (focusing on e.g. political initiatives and proposals) and professional interest groups (focusing on e.g. specific elements from the principles based on knowledge, experience and interest) are continuously established when relevant. The groups work independently, but is in contact with the Caregiver Initiative steering committee (the coordinating body of the Caregiver Initiative), especially regarding the political process. Outcomes Examples of themes which the Caregiver Initiative has been working with are: a) education about caregivers in the health care system, b) caregivers in the labor market (e.g. compassionate leave – a process around the European Union (EU) directive), c) collecting and sharing knowledge about caregivers across diagnoses, and d) caregiver counselors on the political agenda. What was learnt So far, the Caregiver Initiative has been a great success. The alliance makes sense as many challenges for caregivers are the same regardless of the patient’s diagnosis, and with its many participating organizations supporting and learning from each other, the Caregiver Initiative indeed speaks ‘the voice of the caregiver’ and has the potential of being a strong political voice which can improve not only the conditions for caregivers of cancer patients, but caregivers in general.
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Have you got a Conflict of Interest?: No
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982 Financial support affects the prognosis of HER2-positive breast cancer from 2002 to 2020 in a Chinese cohort D. Zheng1, L. Song1, X. Liu1, X. Zhong1, Y. Xie1, C. Wang1, P. He1, X. Yan1, T. Tian1, H. Zheng1, T. Luo1 1 Sichuan University/West China Hospital, Chengdu, China
Background: Trastuzumab has significantly improved the outcomes of human epidermal growth factor receptor 2 (HER2)-positive breast cancer over 20 years, and remains a cornerstone of treatment for this subtype today. Higher mortality was reported in underinsured breast cancer, but the mechanism remains unclear. Financial support for trastuzumab has transitioned from no support, to the Breast Cancer Assistant Program (BCAP), and finally, health insurance. Aim: Exploring the association between survival outcomes and different financial supports is necessary to further improve the outcomes of HER2-positive breast cancer in resource-limited regions. Methods: A prospective cohort of primary early unilateral HER2-positive breast cancer patients registered between January 2002 and December 2020 was used. Patients were divided into the following 3 groups, based on when they were diagnosed with breast cancer: (I) before 2011 (no financial support); (II) 2011–2017 (BCAP support); and (III) 2018 onwards (health insurance support). Overall survival and invasive disease-free survival (iDFS) were the primary outcomes. The follow-up was performed according to the standard procedure. Cox proportional hazards regression was used to explore the association between financial support and prognosis with adjustment of demographic and clinicopathological characteristics, and treatments. Results: A total of 2972 patients were finally identified. During the median follow-up period of 3.9 years, there were 153 breast cancer-related deaths. When fully adjusted potential covariates, patients supported by the BCAP had a 37% [hazard ratio (HR): 0.63, 95% CI: 0.41–0.96] decreased risk of overall mortality and that of patients covered by health insurance had a 64% decreased of overall mortality (HR: 0.36, 95% CI: 0.17–0.74) when compared with those who did not receive any financial support. Lower overall mortality was observed in patients covered by a higher reimbursement rate (HR: 0.68, 95% CI: 0.49–0.94) or the urban scheme (HR: 0.61, 95% CI: 0.43–0.86) than those covered by a lower reimbursement rate or the rural scheme. The same trends were also observed for iDFS and breast cancer-specific survival. Logistic regression analysis found that patients diagnosed with breast cancer during 2011–2017 [odds ratio (OR): 3.19, 95% CI: 2.20–4.71, P<0.001] and from 2018 (OR: 22.09, 95% CI: 14.76–33.73, P<0.001) showed stronger propensity for trastuzumab treatment. Mediation analysis showed that the financial support (including BCAP and health insurance) improved overall survival (direct effect [DE]: 9.33; indirect effect [IE]: 1.84) and iDFS (DE: 9.22; IE: 1.80), as they encouraged trastuzumab treatment by providing financial assistance (P<0.01). Conclusion: Our findings revealed the independent role of financial support in improving the survival outcomes of the HER2-positive breast cancer in resource-limited regions and the underneath mechanism. Have you got a Conflict of Interest?: No
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988 External validation of a survival prediction model in brain metastatic NSCLC with or without WBRT K. TRIKHIRHISTHIT1, J. Setakornnukul2, K. Thephamongkhol2 1 Sawanpracharak Hospital, Division of Radiation Oncology, Department of Radiology, Mueng Nakhonsawan, Thailand, 2Faculty of Medicine, Siriraj Hospital, Mahidol University, Division of Radiation Oncology, Department of Radiology, Bangkok noi, Thailand Background: Our web-based individual survival prediction model (https://siriraj-brainmetscore.netlify.app ) was developed to demonstrate the added survival benefit of whole brain radiotherapy(WBRT) in brain metastatic non-small cell lung cancer(NSCLC) unfit for surgery or stereotactic radiotherapy technique. Following TRIPOD statements, we used data from Siriraj hospital, a teaching medical center in Bangkok, Thailand for model development and internal validation. The model showed good calibration and discrimination in the derivation cohort. However a prediction model should not enter clinical practice without proven and value-adding performance. Aim: To external validate this model before entering clinical practice. Methods: We retrospectively collected one-hundred NSCLC with brain metastases from Sawanpracharak hospital, a tertiary center between January 2017 and June 2018. The predictive performance of our model was evaluated in terms of discrimination and calibration. Discrimination refers to the ability of a model to differentiate between patients who experience or do not experience the outcome event, estimated by the concordance index (c-index). A cindex close to 1.0 indicates excellent discrimination, whereas 0.5 indicates no discrimination beyond chance. Regarding calibration, it reflects the accuracy of the prediction. In our study, calibration is first reported graphically using a calibration plot, in which the predicted risk is plotted against the observed incidence of the outcome in 10 risk groups. These groups were generated by linear predictors, and the outcomes were split into 10 equal deciles. Perfect calibration shows prediction on the 45-degree line of the calibration plot. Calibration is also reported through plots of the predicted and observed survival curves for 3 risk groups (low, intermediate, and high), based on the linear predictor distribution using the 25th and 75th centile cutoffs to assess longitudinal calibration. Results: Compared to the development cohort, the patients in this validation set had worse neurological symptoms and were less likely to receive further systemic treatment than the patients in the development cohort. Less than 20% of EGFR/ALK mutations were tested in the validation cohort. The c-index of the validation data set dropped to 0.66 (95% CI, 0.59–0.73). The calibration plots for overall survival at 3 and 6 months showed negligible miscalibration. The model slightly overestimated the survival probabilities of the low- and high-risk groups. However, minimal underestimation was observed for the intermediate-risk group. Conclusion: Our model demonstrated successful predictive performance for discrimination and calibration in the original cohort, with slightly poorer but still acceptable performance in the separate data set. These results certify its value in aiding treatment decision-making when the administration of WBRT is unclear.
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Characteristics
Patient profile Age (mean ± SD)
DEVELOPMENT WBRT OSC Whole n= n= cohort 389(81.2%) 90(18.8%) n= 479
61.1 ± 11.4 63.2 ± 1.0 209 31 (43.5%) (41%) 285 48 (60.3%) (63%)
61.8 ± 62.8 ± 10.3 9.2 12 43 (50%) (43.0%) 6 (25%) 54 (54.0%)
380 58 (79.3%) (76%) 99 (20.7%) 18 (24%) 62 (13.0%) 7(9%) 55 (11.4%) 6(8%) 364 63 (75.7%) (83%)
18 76 (75%) (76.0%) 6 (25%) 24 (24.0%) 3 (13%) 10 1 (4%) (10.0%) 20 7 (7.0%) (83%) 83 (83.0%)
48 (12.3%) 8 (8.8%) 107 15 (27.5%) (16.5%) 234 68 (60.2%) (74.7%)
56 (11.7%) 3 (4%) 122 13 (25.4%) (17%) 302 59 (62.9%) (79%)
0 (0%) 1 (4%) 23 (96%)
Extra-cranial disease 28 (8.4%) 5 (6.4%) - Controlled lung and 43 (12.8%) 6 (7.7%) no ECM 58 (17.3%) 15 - Controlled lung & 206 (19.2%) ECM (61.5%) 52 - Uncontrolled lung (66.7%) or ECM - First diagnosis lung with any ECM
33 (8.0%) 5 (7%) 49 (11.9%) 17 73 (17.7%) (23%) 258 7 (9%) (62.5%) 45 (61%)
0 (0%) 5 (5.0%) 6 (29%) 23 2 (10%) (24.0%) 13 9 (9.0%) (62%) 58 (61.0%)
Female KPS ≥ 70%
60.6 ± 11.2 63.1 ± 12.3 162 47 (41.7%) (51.1%) 250 35 (65.5%) (38.5%)
VALIDATION WBRT OSC Whole n= n= cohort 76(76%) 24(24%) n= 100
Disease profile Histology 304 76 Adenocarcinoma (78.2%) (84.4%) Non-adenocarcinoma 85 (21.8%) 14 (15.6%) EGFR/ALK mutation 44 (11.3%) 15 47 (12.1%) (16.3%) 298 11 (76.6%) (12.0%) • Positive 66 • Negative (71.7%) • Unknown Neurological symptoms • • •
None Mild Major
DEVELOPMENT 2
VALIDATION
3 (3.0%) 14 (14.0%) 82 (83.0%)
Characteristics
Previous systemic treatment Further systemic treatment RPA • • •
- Class I - Class II - Class III
WBRT OSC Whole n= n= cohort 389(81.2%) 90(18.8%) n= 479 159 35 194 (41.6%) (38.0%) (40.9%) 139 14 153 (35.7%) (15.2%) (31.8%) 33 (9.5%) 2 (2.4%) 35 (8.1%) 197 31 228 (56.5%) (37.4%) (52.8%) 119 50 169 (34.1%) (60.2%) (39.1%)
LungMol GPA • • • • • • • • •
WBRT OSC Whole n= n= cohort 76(76%) 24(24%) n= 100 28 12 40 (37%) (50%) (40.0%) 15 0 (0%) 15 (21%) (15.0%) 3 (4.0%) 1 (4.4%) 4 46 6 (4.08%) (61.3%) (26.1%) 52 42 16 (53.1%) (42.7%) (69.6%) 42 (42.9%)
105 29 134 20 11 31 (39.0%) (56.9%) (41.9%) (46.5%) (78.6%) (54.4%) 115 15 130 16 2 18 (29.4%) (40.6%) (37.2%) (14.3%) (31.6%) Adenocarcinoma (42.8%) 45 (16.7%) 7 (13.7%) 52 (16.3%) 7 1 (7.1%) 8 (14%) - GPA 0–1 4 (1.5%) – 4 (1.3%) (16.2%) – – - GPA 1.5–2 25 (33.8%) 6 (50%) 31 (36.1%) – 4 6 (30%) - GPA 2.5–3 36 (48.7%) 5 (41.7%) 41 (47.7%) 2 (100%) 10 - GPA 3.5–4 13 (17.6%) 1 (8.3%) 14 (16.3%) (12.5%) – (50%) Non10 – 4 (20%) adenocarcinoma (62.5%) - GPA 0–1 4 (25%) - GPA 1.5–2 - GPA 2.5–3
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Have you got a Conflict of Interest?: No
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989 “Dubai Star-Studded Red Carpet Gala Dinner” by the Children’s Cancer Center of Lebanon (CCCL) C. Helou1 1 Children's Cancer Center of Lebanon, Fundraising, Beirut, Lebanon Amount raised: 1,713,141 $ Background and context: After successfully executing 5 gala dinners in Dubai from 2015 - 2019, and since the gala dinner was put on hold in 2020 due to the COVID-19 pandemic, an impactful comeback was sought in 2021. We considered for the first time to upgrade the scale of the CCCL’s usual Gala Dinners in Dubai to become a Star-Studded Red Carpet in close coordination with Mrs. Rima Fakih Slaiby, former Mrs. USA, and CCCL’s Ambassador who showed her willingness to support in reaching out to celebrities and entertainers for the sake of raising awareness about the Center’s mission and needs. The gala was held on Thursday November 4, 2021 at the Coca-Cola Arena, City Walk – Dubai. It was attended by more than 900 supporters, including established businessmen, public figures, celebrities, media and socialites from the UAE and the region, who enjoyed a special entertainment line-up of 8 international performers. This event was the Center’s biggest event in 2021, and was one of the most successful events the Center had ever made in terms of raising funds and awareness and media exposure. Aim:
• • • • •
Raise awareness in UAE about the Center. Establish strong relations with the local and international media Establish good relations with celebrities and influential figures Retain our donors and supporters Reaching out to new supporters and sponsors
Strategy / Tactics:
• • • •
Having big names attending the gala helped the Center to attract the media which is crucial to spread the word about the Center and the event. Raising the level of the event and the entertainment program helped us to include higher sponsorship packages and increase the table prices which lead to raising more funds. Choosing the venue that is new, central location, a land mark, large capacity, and well equipped will obviously encourage supporters to attend the event and invite their associates. Maintaining a balance between the positive ambiance and the critical mission
Programme process:
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Choosing venue and date Preparing sponsorship packages and prices Finalizing the Entertainment and program Acquiring needed licenses Recruiting event organizer Recognitions & thank you letters
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Innovative Methods:
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Having a special website for the event which includes all the details that people might need to know. (Program, auction items, location, donation link…) Doing the event in a huge concert arena was a new experience for most of the attendees. Having the performances integrated in the gala program helped keep the attendees entertained all through the night.
Costs and returns: Proceeds: 1,713,141 $ Expenses: 435,675 $ What was learnt:
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People enjoyed a show that includes variety of performances. Seating plan is always a challenge in such events that need a lot of attention. Importance of the media presence to make the event the talk of the town Presence of celebrities attract media Keep donors satisfied & recognized
Event's video: https://www.youtube.com/watch?v=hvJ2jZ_MPME Have you got a Conflict of Interest?: No
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990 Effects on radiosensitivity of glioma stem cells by interfering autophagy-related gene beclin1 Y. Li1, S. Xiong2, Y. Tang2, X. Chen3, C. Wang4, Z. Wu4, Y. Li4 1 Chongqing University Cancer Hospital, oncology department, Chongqing, China, 2Chongqing University Cancer Hospital, Department of Oncology, Chongqing, China, 3Chongqing University Cancer Hospital, Chongqing, Chongqing, China, 4Chongqing University Cancer Hospital, Chongqing, China Background: Glioma is a common malignant brain tumor characterized by poor prognosis. Unfortunately, gliomas are resistant to irradiation and chemotherapy. Thus, more effective treatment strategies need to be explored to manage this malignancy and improve the survival rate of patients. The radiosensitivity of tumors is affected by several factors, including cell cycle regulation, DNA damage repair, tumor stem cells, tumor microenvironment, and so forth. Certain studies revealed that autophagy might be associated with radioresistance in glioma. However, different degrees of autophagy had different roles in different studies. Hence, the mechanism involved in the autophagy-related signaling pathway was still not clear. whether the radioresistance in glioma stem cells (GSCs) correlates with autophagy needs further exploration. Based on the reported experimental results of other studies, some interfering strategies were employed in this study to increase the therapeutic sensitivity of glioma and improve the survival of patients. Aim: This study aimed to investigate whether radiation could induce autophagy in the glioma stem cells (GSCs) by detecting the expression of genes and proteins related to autophagy, and whether radiosensitivity could be enhanced by siRNA-beclin1. Methods: The U251 and T98G glioma cells were induced into GSCs and identified with CD133 and Nestin doublelabeling immunofluorescence. The GSCs were irradiated using different doses and harvested in different times. Reverse transcription–quantitative polymerase chain reaction and Western blot analyses to detect the gene and protein expression of microtubule-associated protein 1 light chain 3 (LC3) and Beclin1. The formation of autophagosomes were observed in the GSCs using double-labeling immunofluorescence. Cell counting kit-8, colony formation assay, and flow cytometry were performed to detect the change of radiosensitivity. A mouse model was constructed using GSC transfected with the siRNA-beclin1 lentivirus, followed by irradiation. Results: The U251 and T98G glioma cells were induced into GSCs and identified with CD133 and Nestin doublelabeling immunofluorescence. The GSCs were irradiated using different doses and harvested in different times. Reverse transcription–quantitative polymerase chain reaction and Western blot analyses to detect the gene and protein expression of microtubule-associated protein 1 light chain 3 (LC3) and Beclin1. The formation of autophagosomes were observed in the GSCs using double-labeling immunofluorescence. Cell counting kit-8, colony formation assay, and flow cytometry were performed to detect the change of radiosensitivity. A mouse model was constructed using GSC transfected with the siRNA-beclin1 lentivirus, followed by irradiation. Conclusion: The gene expression interfered by siRNA-beclin1 could enhance the radiosensitivity of GSCs. Have you got a Conflict of Interest?: No
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998 New Norm Same Cancer: A Multi-Stakeholder Partnership to Restart Cancer Screening Amidst Covid-19 in Malaysia M. Munisamy1, C. Fong2, W.W. Chuah2, J. Wong2, S. Kanagasundaram1, W.C. Pung2 1 National Cancer Society Malaysia, Kuala Lumpur, Malaysia, 2AstraZeneca. Sdn. Bhd, Petaling Jaya, Malaysia Background and context: Due to the Covid-19 pandemic, cancer screening has decreased significantly on a global level. This has led to significantly lowered rates of early detection, and contributing not only to poorer outcomes on a macro scale, but catastrophic impacts on individual patients. With conditions surrounding Covid19 continuing to wax and wane, it is difficult to ascertain the availability of the public health sector to return to actively carry out cancer screening, as had been done previously. Innovative transformational approaches are required to re-energise the landscape surrounding early cancer screening efforts at a country level. Aim: The New Norm Same Cancer programme is an ongoing local, multi-stakeholder, multi-faceted campaign which involved private sector hospitals, industry and civil-society partners aimed at reengaging the public on cancer screening and early detection; and drive them to restart cancer screening activities in Malaysia. Strategy / Tactics: The programme comprises of: i) a health awareness and communication media campaign on mainstream and social media; ii) offering of targeted early cancer screening tests at designated partner private hospitals across the country; and iii) subsidised downloadable vouchers of the cancer screening tests at regular and appropriate intervals throughout the campaign. Programme / Policy process: Civil society and industry partners worked together to create and sustain the health awareness and communication campaign; while a network of private sector institutions were roped in as partners to deliver the clinical services and carry out local promotional efforts. Outcomes: This programme, which has been ongoing from July 2021, had the buy-in and was supported by 12 hospitals across 5 states in Malaysia. At the 6 month mark, a total of 9.7 million campaign impressions (views, likes and shares) has been recorded with more than 14,000 vouchers downloaded. Of these, more than 1700 vouchers have been utilised by individuals to perform their cancer screening. What was learnt: While public sector resources continue to be tied up with Covid-19, leveraging on the available private sector health resources for restarting early screening efforts for cancer may be promising, especially in LMICs with thriving private health sector services. Replicating this win-win collaborative strategy for private sector health providers and industry and careful stewardship by civil society can prove to be successful in restarting stalled early cancer screening in different settings. Have you got a Conflict of Interest?: Yes If yes please specify:: 1. Honoraria from Novartis, MSD, Astra-Zeneca, Roche and Merck 2. Grants from Pfizer, MSD, Astellas, Roche and Astra-Zeneca 3. Advisory Board from MSD, Roche, Novartis 4. Authors 2,3,4, and 6 are employees of Astra-Zeneca Sdn Bhd
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