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The objectives of this study were to identify cancer-related health care services and to explore the presence of inter-organizational interactions among clinical and support oncology services in southern Puerto Rico.
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Background: Cancer care in low-middle income countries is very poor. About 85% of preventable cancers such as cervical cancers are contributing factors to mortality rate which is 18 times higher in low middle-income countries. Thi...
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Background: Cancer care in low-middle income countries is very poor. About 85% of preventable cancers such as cervical cancers are contributing factors to mortality rate which is 18 times higher in low middle-income countries. This is partly due to observed delays and underutilization of prevention, diagnosis, and treatment services in developing countries, and delays in seeking health care when symptoms start or inadequacy or lack of services. Similar trends in delays are observed in Eswatini, and this study was conducted to identify the causes of such delays in Eswatini. Methods: A qualitative phenomenological study was conducted among cancer survivors and health workers. Focused group discussions were conducted among the cancer survivors from all four regions in the country using a focus group discussion topic guide. The health workers were enrolled as key informants and face-to-face interviews were conducted using a key informant interview guide. The key informants were hospital managers such as Hospital Administrators, Hospital Matrons, and Hospital Senior Medical Officers from all major hospitals and health centres in the country. Results: The findings showed that causes of cancer delays were due to patient related delays which include fear of cancer diagnosis and denial that led to delay in seeking care; shock, disbelief, and fear at time of diagnosis which delayed use of treatment services. Part of the delays were due to health system related delays which include lack of knowledge by health care workers; inadequacy of infrastructure and skill for delivering cancer services in the health system; delays in being (properly) diagnosed and treated for cancer. Conclusion: Cancer care delays in Eswatini relate to both the patient and the health system. These findings should be using in developing strategies to improve cancer care in Eswatini and to replan cancer programs so that they meet the needs of cancer patients.
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There is debate as to whether patients requiring resection for oesophageal cancer should be referred to specialist centralised units rather than being managed by general surgeons in district general hospitals (DGH). The aim of thi...
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There is debate as to whether patients requiring resection for oesophageal cancer should be referred to specialist centralised units rather than being managed by general surgeons in district general hospitals (DGH). The aim of this study was to determine the effects of centralising oesophageal cancer surgery on outcome and quality of service for patients with oesophageal cancer in a peripheral region. Patients with biopsy proven oesophageal cancer diagnosed over a 4 year period were identified from pathology records.
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OBJECTIVE:To assess cervical cancer services and knowledge of health service providers in public health facilities.RESULT:Two of the three hospitals had cervical cancer screening services. One-third of the hospital had cervical ca...
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OBJECTIVE:To assess cervical cancer services and knowledge of health service providers in public health facilities.RESULT:Two of the three hospitals had cervical cancer screening services. One-third of the hospital had cervical cancer diagnosis service punch biopsy and cervical cancer treatment. Majority, 289 (93.5%) of study participants said cervical cancer was a preventable disease. Having multiple sexual partners 257 (83.2%) and post coital bleeding 251 (81.2%), were the most mentioned risk factor and clinical manifestation of cervical cancer respectively. Majority of the participants were aware of the correct time to start screening 291 (70.5%), and only 95 (25.9%) knew the screening intervals. Overall, 165 (53.4%) of health providers scored below the mean knowledge level score. Females had better knowledge about cervical cancer than males (X 2 ?=?8.4, P?=?0.003).
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Objective In 2009, the APOS commissioned a survey of its members and attendees of the annual meetings in 2008 and 2009. The goal of the survey was to assess the scope of psychosocial support services for cancer patients in the USA...
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Objective In 2009, the APOS commissioned a survey of its members and attendees of the annual meetings in 2008 and 2009. The goal of the survey was to assess the scope of psychosocial support services for cancer patients in the USA. Methods Two hundred thirty-three individuals (27% response rate) completed the survey, which included questions assessing the extent to which respondents' institutions provided informational and psychosocial support services and conducted screening for psychosocial distress. Results Respondents were primarily psychologists, although oncologists, nurses, social workers, and others were represented, as well. A broad array of informational and support services were endorsed as being provided to cancer patients, both at no charge or for a fee. Respondents identified social workers as the professionals most often providing psychosocial services to cancer patients. Respondents also indicated that most psychosocial services have not been tailored to fit a culturally diverse population. Furthermore, most of the organizations represented in the survey do not routinely screen cancer patients for psychosocial distress. Conclusions A broad range of psychosocial services are provided in cancer treatment settings; however, despite National Comprehensive Cancer Network and Institute of Medicine recommendations, routine screening for distress is not offered in a majority of cancer care organizations. Despite the racial, ethnic, cultural, and linguistic diversity of the US population, most organizations have not adapted their educational materials nor their psychosocial services to meet the needs of a diverse patient population.
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Objective: We aimed to estimate the proportion of patients visiting the emergency department (ED) who were not up to date with cancer screening guidelines to assess the scope of need and potential impact of ED-based cancer screeni...
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Objective: We aimed to estimate the proportion of patients visiting the emergency department (ED) who were not up to date with cancer screening guidelines to assess the scope of need and potential impact of ED-based cancer screening interventions. Methods: Adult participants from the 2015 National Health Interview Survey were included. Among patients nonadherent to national breast, colorectal, or lung cancer screening guidelines, the proportion of patients reporting an ED visit within the last year was estimated, accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and screening adherence. Results: Of screening eligible respondents, 17.2% of women nonadherent to mammography screening, 16.9% of patients nonadherent to colorectal cancer screening, and 25.0% of patients nonadherent to lung cancer screening reported at least one ED visit in the preceding year. Patients visiting the ED with postsecondary school education were more likely to be up to date with mammography screening than those without advanced education (odds ratio [OR] 1.45; 95% confidence interval [CI]: 1.21-1.74; P = .01). Patients without insurance were less likely than those with insurance to report being up to date with both mammography screening (OR 0.31; 95% CI: 0.21-0.48; P = .01) and colorectal cancer screening (OR 0.56; 95% CI: 0.34-0.93; P = .03). Discussion: Opportunities to improve cancer screening adherence exist through ED-based preventative care interventions, which leverage multidisciplinary partnerships, including radiologists, to reach large volumes of patients who are not engaged in cancer screening.
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Objective: Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. This systematic review assesses the effectiveness of central...
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Objective: Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. This systematic review assesses the effectiveness of centralisation of care for patients with gynaecological cancer, in particular, survival advantage. Methods: A comprehensive search of the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010 was conducted. Registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies were also searched. Randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies were included and multivariable analysis to adjust for baseline case mix were used. Results: Five retrospective observational studies met the inclusion criteria. Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. Conclusions: The meta-analysis provides evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere.
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摘要 :Distress has been endorsed as the 6th Vital Sign by the International Psycho-Oncology Society (IPOS) in 2009 with Screening for Distress as a proposed IPOS strategy in 2010. The need for skilled psychological care is well-recogniz...
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Distress has been endorsed as the 6th Vital Sign by the International Psycho-Oncology Society (IPOS) in 2009 with Screening for Distress as a proposed IPOS strategy in 2010. The need for skilled psychological care is well-recognized as a necessary, integral part of oncology care. There has been significant development of this field over the last two decades in the area now commonly labelled “psycho-oncology”. Given the advances in psycho-oncology, it is helpful to overview the approaches to provision of psychological care, so we can better understand how to care for the emotional needs of cancer patients, their partners and families. The focus here is on patients with high and enduring levels of need in terms of emotional functioning and the formal therapies that are available to help patients and their families manage these needs.
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Although colorectal cancer (CRC) is the second leading cause of cancer death in the U.S., screening rates are low. Understanding the predictors of CRC screening is needed. In 2003, a random sample of patients aged 50 and over from...
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Although colorectal cancer (CRC) is the second leading cause of cancer death in the U.S., screening rates are low. Understanding the predictors of CRC screening is needed. In 2003, a random sample of patients aged 50 and over from three inner-city health centers was surveyed by computer-assisted telephone interview concerning CRC screening. The questionnaire was based on the Transtheoretical Model and the Theory of Reasoned Action. Factor analysis with Varimax rotation and logistic regression analyses were conducted. Of 319 surveys with data about endoscopy, 148 (46%) met guidelines (19 reported sigmoidoscopy within 5 years, 105 reported colonoscopy within 10 years, and 24 reported both within 5 years). Factor analysis identified three factors associated with increased likelihood of lower endoscopy within guidelines: Social Influence for CRC Screening (Eigenvalue 1.73), Barriers to Lower Endoscopy (Eigenvalue 2.00), and Lower Endoscopy Benefit/Ease (Eigenvalue 1.19). Variables in logistic regression associated with a lower rate of endoscopy include being African American (Odds Ratio (OR) = 0.35, 95% confidence interval = 0.13–0.96), being a current smoker (OR = 0.13, CI = 0.03–0.60), and having a higher score on the Barriers to Lower Endoscopy factor (i.e., viewed the inconvenience and unpleasant aspects as more troubling, OR = 0.33, CI = 0.18–0.60). The perceived inconvenience and unpleasant aspects of lower endoscopy are substantial barriers to screening. Advances in colon preparation procedures and better educational campaigns might lessen this perceived barrier and may be particularly important in disadvantaged and African American communities.
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Prevention is crucial to reducing cancer burden. Awareness of prevention information is critical to engaging the public in prevention activities. We examined 106,610 information requests from the general public to the Cancer Infor...
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Prevention is crucial to reducing cancer burden. Awareness of prevention information is critical to engaging the public in prevention activities. We examined 106,610 information requests from the general public to the Cancer Information Service from 2002 to 2006. The percent of requests related to primary prevention decreased in 2003, but otherwise remained stable around 19%. The percent of requests related to secondary prevention decreased over time, from 38% (2003) to 14% (2006). Demographic characteristics were associated with patterns of change across time. Results suggest that efforts are needed to increase public awareness of cancer prevention, particularly among certain populations.
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