Using cancer risk algorithms to improve risk estimates and referral decisions

Background Cancer risk algorithms were introduced to clinical practice in the last decade, but they remain underused. We investigated whether General Practitioners (GPs) change their referral decisions in response to an unnamed algorithm, if decisions improve, and if changing decisions depends on having information about the algorithm and on whether GPs overestimated or underestimated risk. Methods 157 UK GPs were presented with 20 vignettes describing patients with possible colorectal cancer symptoms. GPs gave their risk estimates and inclination to refer. They then saw the risk score of an unnamed algorithm and could update their responses. Half of the sample was given information about the algorithm’s derivation, validation, and accuracy. At the end, we measured their algorithm disposition. We analysed the data using multilevel regressions with random intercepts by GP and vignette. Results We find that, after receiving the algorithm’s estimate, GPs’ inclination to refer changes 26% of the time and their decisions switch entirely 3% of the time. Decisions become more consistent with the NICE 3% referral threshold (OR 1.45 [1.27, 1.65], p < .001). The algorithm’s impact is greatest when GPs have underestimated risk. Information about the algorithm does not have a discernible effect on decisions but it results in a more positive GP disposition towards the algorithm. GPs’ risk estimates become better calibrated over time, i.e., move closer to the algorithm. Conclusions Cancer risk algorithms have the potential to improve cancer referral decisions. Their use as learning tools to improve risk estimates is promising and should be further investigated.

Perceptions of cervical cancer care among Ethiopian women and their providers: a qualitative study

Background Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. As the government rolls out the country’s first national cancer control strategy, information on patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment is critical. Methods This qualitative study aimed to assess the availability of cervical cancer care; explore care barriers and sources of delay; and describe women’s and providers’ perceptions and experiences of care. We analyzed data from 45 informants collected at 16 health centers, district hospitals and referral hospitals in East Gojjam Zone and a support center in Addis Ababa. Thirty providers and ten women receiving care were interviewed, and five women in treatment or post-treatment participated in a focus group discussion. Deductive and inductive codes were used to thematically analyze data. Results Providers lacked equipment and space to screen and treat patients and only 16% had received in-service cervical cancer training. Consequently, few facilities provided screening or preventative treatment. Patients reported low perceptions of risk, high stigma, a lack of knowledge about cervical cancer, and delayed care initiation. All but one patient sought care only when she became symptomatic, and, pre-diagnosis, only half of the patients knew about cervical cancer. Even among those aware of cervical cancer, many assumed they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay experienced by half of the patients. Once diagnosed, women faced multiple-month waits for referrals, and, once in treatment, broken equipment and shortages of hospital beds resulted in additional delays. Barriers to therapeutic treatment included a lack of housing and travel funds. Patient-provider communication of cancer diagnosis was often lacking. Conclusions In-service provider training should be intensified and should include discussions of cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities are also a priority. Expanded cervical cancer health education should focus on stigma reduction and emphasize a broad, wide-spread risk of cervical cancer.

Awareness regarding breast cancer among urban women in South India

Introduction and Aim: Breast cancer is associated with increased morbidity and mortality and recent trends have shown increased incidence among younger women. There is, therefore, an imminent need to raise the level of awareness among the women in the entire population. The present study was carried out to evaluate the level of awareness among urban women in South India. Methodology: This hospital based cross sectional study was carried out among 1000 adult women who visited the outpatient clinics of our tertiary care hospital for various illness. The level of awareness regarding breast cancer was elicited based on the risk factors of breast cancer, symptoms, and role of family history. Awareness regarding the tools for early detection, management and preventive measures was also elicited. Results: The study observed that 78.9% of the participants who were illiterates had no awareness of the symptoms, while 57.9% of the participants with high school level education were unaware of the symptoms. Regarding the role of genetics in breast cancer occurrence, 47% of the illiterate participants reported that breast cancer is not hereditary. It was observed that lack of awareness regarding the early detection was prevalent among 81%, 87% and 93% of the participants who were illiterate, primary, and middle school level educated respectively. Conclusion: The present study has also elucidated the lack of adequate knowledge on important facts regarding the breast cancer is alarming and this needs to be addressed with due focus on providing health education by health care providers at various levels of health system.

Oral Cancer Knowledge and Awareness among Patients Referred to a University Dental Hospital in North Cyprus

Public knowledge about oral cancer may help to prevent and detect the disease at an early stage. This study aimed to evaluate the awareness and knowledge levels on oral cancer symptoms and risk factors among patients attending a faculty of dentistry in North Cyprus. A total of 250 adult dental patients participated voluntarily in a self-administered questionnaire. The questionnaire included questions on sociodemographic profile, oral cancer awareness, and knowledge. A total of 54.8% of the participants were male and 91.2% of the participants had a high school diploma and above education. Most participants were knowledgeable about oral cancer symptoms and a majority of them identified oral ulceration (64%). Tobacco cessation was the most selected option for protecting from oral cancer (79.6%). Significant differences were found between genders in current smokers, past tobacco users, alcohol users, and HPV awareness questions (p < 0.05). Furthermore, awareness and knowledge questions were compared between smoker and non-smoker participants and significant differences were found in the answers of ‘alcohol may cause mouth cancer’ and ‘quit tobacco use to prevent oral cancer’ (p < 0.05). This study showed that most of the participants were aware that tobacco cessation reduces the risk of oral cancer. The survey results showed that patients in North Cyprus are generally aware of the risk of tobacco-related oral cancer, but they demonstrate lower knowledge about other risk factors.

Exopolysaccharide Produced by Lactiplantibacillus plantarum-12 Alleviates Intestinal Inflammation and Colon Cancer Symptoms by Modulating the Gut Microbiome and Metabolites of C57BL/6 Mice Treated by Azoxymethane/Dextran Sulfate Sodium Salt

Exopolysaccharide produced by Lactiplantibacillus plantarum-12 (LPEPS) exhibited the anti-proliferating effect on human colon cancer cell line HT-29 in vitro. The purpose of the study was to determine the alleviating effects of LPEPS on colon cancer development of the C57BL/6 mice treated by azoxymethane/dextran sulfate sodium salt (AOM/DSS). The C57BL/6 mice treated by AOM/DSS were orally administered LPEPS daily for 85 days. The results showed that LPEPS oral administration enhanced colon tight-junction protein expression and ameliorated colon shortening and tumor burden of the AOM/DSS treated mice. Furthermore, LPEPS oral administration significantly reduced pro-inflammatory factors TNF-α, IL-8, and IL-1β levels and increased anti-inflammatory factor IL-10 level in the serum of the AOM/DSS-treated mice. LPEPS oral administration reversed the alterations of gut flora in AOM/DSS-treated mice, as evidenced by the increasing of the abundance of Bacteroidetes, Bacteroidetes/Firmicutes ratio, Muribaculaceae, Burkholderiaceae, and norank_o__Rhodospirillales and the decreasing of the abundance of Firmicutes, Desulfovibrionaceae, Erysipelotrichaceae, and Helicobacteraceae. The fecal metabolites of the AOM/DSS-treated mice were altered by LPEPS oral administration, involving lipid metabolism and amino acid metabolism. Together, these results suggested that LPEPS oral administration alleviated AOM/DSS-induced colon cancer symptoms of the C57BL/6 mice by modulating gut microbiota and metabolites, enhancing intestine barrier, inhibiting NF-κB pathway, and activating caspase cascade.

Evidence-Based Integrative Health Care to Promote Quality of Life in Older Adults With Cancer

Cancer disproportionately affects older adults and presents significant challenges to patients’ quality of life. Use of complementary medicine is increasing among older adults with cancer and these modalities have the potential for both benefit and harm. Thus, it is important that health care professionals are knowledgeable about the evidence-supported benefits and risks of complementary and integrative health approaches in the care of older adults with cancer. Integrative cancer care provides a comprehensive approach to reducing symptom burden in patients suffering with cancer symptoms and side effects of cancer treatment. Symptoms such as pain, fatigue, nausea, sleep disturbance, mood disorder, perceived stress, and reduced quality of life are common in this population.This session will discuss an evidence-based integrative approach to cancer care which incorporates both pharmacologic and non-pharmacologic modalities to decrease symptom burden, enhance patient well-being, and improve quality of life. Non-pharmacologic modalities used in the integrative approach to care will be described and relevant evidence for risks, benefits and indications will be presented. Case studies will be discussed to demonstrate the integration of these techniques into conventional western medical treatment plans for older adults with cancer. Diversity and inclusion issues relevant to integrative medicine for underserved cancer patients will be addressed, as well as recommendations for future research to expand access of underserved populations to evidence-supported integrative cancer care. A resource list will be provided to participants.

Predictors of Racial Differences in Depression and Affect among Older adult, Long-term Cancer Survivors

Research has long documented the psycho-social sequelae experienced by those who have been treated for and survived cancer. Depression, affect and other indicators of mood state have been an important focus of that research However, there is little research on racial differences in depression and affect outcomes or the specific cancer and age-related factors that predict them. The research to be presented is based on a 10 year, six wave NCI funded study of 471 older adult (age 60+), long-term cancer survivors randomly selected from the tumor registry of a comprehensive cancer treatment center. Key outcome measures were depression (CES-D) scale) and both positive and negative affect (PANAS). Covariance analyses and nested OLS Regression were used to identify Black-white differences these outcomes and the relative importance of both cancer and non-cancer predictors. Blacks reported lower levels of depression and negative affect when compared to whites. In a separate regression analysis of the black sub-sample, continuing cancer-related symptoms were by far the strongest predictors (beta =.16) of negative affect. In the white sub-sample, while cancer-related symptoms continued to be a significant predictor (beta=.16), non-cancer symptoms were substantially more important (beta=. 22). These results will hopefully help practitioners to have a better understanding of the nuanced racialized experiences and mental health among cancer survivors, and how these may impact after-care for older adult cancer survivors.

Pilot Study: Evaluation of the efficacy of homeopathic anti-tumor protocols in Ehrlich tumor

Cancer is the second leading cause of death worldwide, with breast cancer one of the tumors with the highest incidence in Brazil, with an estimated 57,120 new cases in 2014. Several forms of treatment and control of cancer symptoms has been studied, among them homeopathy. In the Banerji clinic in India, doctors have used a protocol consisting of 4 homeopathic medicines with relevant results that motivated this study. In our research the Ehrlich tumor was used, a transplantable tumor cell, whose features are similar a breast carcinoma, as discovered in 1905 by Paul Ehrlich. Objective: To analyze the clinical and immunomodulatory Ehrlich tumor in mice treated with the homeopathic medications found in the Banerji Protocol and with thymulin 5CH. Methodology: The project was approved under protocol 158/13 of the Paulista University Ethics Committee. BALB / c mice between 6 and 9 weeks old were used. Each mouse was inoculated with 1x10 7 tumor cells into the peritoneum cavity, to obtain the ascitic form of tumor. Mice were divided in 5 groups (N=6 animals per group), being the following treatments: control treated with sterile water, Conium maculatum 200CH, Thuja occidentalis 200CH, Phytolacca decandra 200CH, Carcinosinum 200CH, every day being 0.1mL/10g body weight. The animals were weighed and the consumption of water and feed was measured daily. Clinical signals and body temperature were also registered daily. The survival of each group was also analyzed. Results: All groups presented reduction of body temperature one day before death. The peak of clinical symptoms in the majority of groups was in the D18, while Carcinosinum treated group had its peak in D29. The observed clinical symptoms were apathy, prostration, cyanosis, priapism, tachydyspnea, genital edema and secretion, decreased general activity, hair bristling and trembling. The control group had loose stools as unique symptom, seen in 20% of mice; the Carcinosinum treated group showed trembling as the sole symptom, that affected 20% of mice. The group treated with Conium maculatum showed higher incidence of clinical symptoms, involving up to 80% of mice, while the group treated with Carcinosinum showed lower incidence of clinical symptoms, affecting no more than 40% of mice, with weight reduction (reduction of ascites) and longer survival, when compared to the other groups. Conclusion: The results of the pilot study directed us to the second stage of the research, in which the histopathological and immunohistochemical observation will be assessed, being Carcinosinum the treatment chosen to this next step.

Physiological Effects of Green-Colored Food-Derived Bioactive Compounds on Cancer

Green-colored foods, such as broccoli, sprouts, soybean, and green leafy vegetables are considered one of the representative healthy foods for containing various functional ingredients that can combat chronic diseases, including diabetes, obesity, and cancer. Herein, we reviewed the anti-cancer activities and the underlying mechanisms of some important bioactive compounds, such as sulforaphane, catechins, chlorophyll, isoflavone, indole dervatives, and lutein, present in green-colored foods. In vivo and clinical studies suggest that sulforaphane, a sulfur-containing compound found in cruciferous vegetables, can ameliorate prostate and breast cancer symptoms by arresting cell-cycle progression and modulating Ki67 and HDAC expression. A green tea compound, known as epigallocatechin-3-gallate (EGCG), has shown remarkable anti-cancer effects against prostate cancer and lung adenocarcinoma in human trials through its antioxidative defense and immunomodulatory functions. Chlorophyll, a natural pigment found in all green plants, can regulate multiple cancer-related genes, including cyclin D1, CYP1A, CYP1B1, and p53. Epidemiological studies indicate that chlorophyll can substantially reduce aflatoxin level and can mitigate colon cancer in human subjects. Remarkably, the consumption of soy isoflavone has been found to be associated with the lower incidence and mortality of breast and prostate cancers in East Asia and in Canada. In vivo and in vitro data point out that isoflavone has modulatory effects on estrogen and androgen signaling pathways and the expression of MAPK, NfκB, Bcl-2, and PI3K/AKT in different cancer models. Other green food bioactive compounds, such as indole derivatives and lutein, also exhibited suppressing effects in rodent models of lung, liver, stomach, cervical, and prostate cancers. In addition, some micronutrients, such as folate, riboflavin, retinoic acid, and vitamin D3 present in green foods, also showed potential cancer suppressing effects. Taken together, these data suggest potential chemopreventive functions of the bioactive compounds from green-colored foods. This paper could be beneficial for further research on the anti-carcinogenic effects of green-colored food-derived compounds, in order to develop green chemotherapeutics for cancers.