BackgroundBreast cancer remains a significant global health challenge, characterized by high morbidity and mortality rates, particularly in resource-limited settings where access to advanced diagnostic imaging is scarce. In Somaliland, early detection is critical to improving survival outcomes. Breast self-examination (BSE) serves as a vital, cost-effective, and non-invasive screening tool that empowers women to identify early pathological changes. This study investigated the prevalence of BSE practice and its associated sociodemographic, knowledge-based, and attitudinal factors among female medical students in Borama, Somaliland.MethodsA university-based cross-sectional study was conducted among 202 female medical students in April–May 2024. Data were collected using a structured self-administered questionnaire through convenience sampling with proportional quotas across selected health science faculties. Data analysis included descriptive statistics and binary logistic regression to identify independent predictors of BSE practice, with statistical significance set at p < 0.05.ResultsThe findings revealed a high level of knowledge (77.7%) and overall positive attitudes (80.2%) toward BSE. However, the actual prevalence of BSE practice was moderate, only 46.5% (n = 94) of participants had ever performed BSE, and among these, only 51.1% practiced monthly as recommended. Multivariable logistic regression identified attitude as the strongest predictor of practice (OR = 3.251, 95% CI: 1.68–6.29, p < 0.001), followed by age (5.012, p < 0.001), indicating that older students and those with proactive health beliefs were significantly more likely to engage in BSE.ConclusionDespite high theoretical knowledge, a substantial “knowledge-practice gap” exists. Interventions should transition from purely factual education to attitude-focused behavioral training. Integrating practical BSE demonstrations into university curricula is essential to equip future healthcare professionals with the habits necessary to promote early detection in the wider community.
BackgroundProstate cancer is one of the most frequently diagnosed malignancies among men worldwide and represents a growing public health concern in low-and-middle-income countries. In sub-Saharan Africa, including South Africa, the disease is often diagnosed at advanced stages due to limited screening services, delayed referrals, and structural health barriers. Understanding the socio-demographic patterns, point prevalence, and geographic origins of patients presenting with prostate cancer is critical for informing targeted cancer control interventions.ObjectiveThis study aimed to describe the socio-demographic characteristics, population point prevalence, geographic distribution, and referral patterns of patients diagnosed with prostate cancer at Nelson Mandela Academic Hospital in South Africa.MethodsA quantitative cross-sectional study was conducted using secondary data from medical records of men diagnosed with prostate cancer between March 2020 and December 2021. A total of 224 patient records were reviewed. Variables collected included age, district, and sub-district residence, and referral facility. Patients were categorised into low, intermediate, and high-risk clinical groups. Descriptive statistics and chi-square tests were used to assess associations between geographic variables and disease risk. Geographic distribution was visualised using heat maps.ResultsThe mean age of participants was 72.6 years (SD ± 8.8). Most patients (61.2%; 95% CI: 54.4%–67.6%) presented with high-risk disease at diagnosis. High-risk disease was most prevalent among patients aged 80 years and older (87.8%; 95% CI: 75.2%–95.4%). The majority of patients originated from the OR Tambo District (75.4%;95% CI: 69.3%–80.9%), particularly the King Sabata Dalindyebo sub-district, followed by Peripheral sub-districts; Amathole District (9.4%; 95% CI: 5.9%–14.0%), Chris Hani District (6.7%; 95% CI: 3.8%–10.8%), Alfred Nzo District (4.9%; 95% CI: 2.5%–8.6%), and Joe Gqabi District (3.6%; 95% CI: 1.6%–6.9 There was no statistically significant association between geographic district and risk category (p = 0.932).ConclusionMost prostate cancer patients presenting to the teaching hospital were diagnosed with advanced disease, irrespective of geographic location. These findings highlight the need for strengthened early detection strategies, decentralised screening services, improved referral pathways, and targeted community awareness programmes in rural provinces of South Africa.
IntroductionBreast and cervical cancers are leading causes of morbidity and mortality among women in sub-Saharan Africa, yet screening uptake remains low in Ghana. Sexual autonomy, defined as a woman's ability to negotiate sexual activity and refuse unwanted sex, may influence health-seeking behaviours, including cancer screening. However, evidence on the association between sexual autonomy and screening uptake across rural-urban contexts is limited. This study examined the association between sexual autonomy and uptake of breast cancer (BC) and cervical cancer (CC) screening services among Ghanaian women in rural and urban areas using recent national-level data.MethodsWe analysed data from a weighted sample of 8,044 women aged 15–49 years in the 2022 Ghana Demographic and Health Survey (GDHS), conducted across all sixteen regions of Ghana. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed using Stata/SE version 17 with complex survey design adjustments. The main outcome measures were self-reported uptake of BC and CC screening services. Sexual autonomy was the primary explanatory variable.ResultsOverall, women with sexual autonomy were more likely to screen for BC (AOR = 2.10, 95% CI: 1.68–2.63) and CC (AOR = 1.95, 95% CI: 1.32–2.88). For BC screening, sexually autonomous women in both urban (AOR = 2.16, 95% CI: 1.57–2.98) and rural (AOR = 1.92, 95% CI: 1.40–2.63) areas had higher odds of screening, with the association being stronger among urban women. For CC screening, sexual autonomy was a statistically significant predictor only in urban areas (AOR = 2.06, 95% CI: 1.22–3.48); no statistically significant association was observed in rural settings.ConclusionsThis study demonstrates rural-urban differences in the relationship between sexual autonomy and uptake of breast and cervical cancer screening services among Ghanaian women of reproductive age. The findings highlight structural inequalities in women's empowerment and access to cancer screening services. Interventions aimed at improving screening uptake should address sexual autonomy alongside location-specific barriers, particularly in rural areas where cervical cancer screening remains suboptimal. Self-reported screening data may be subject to recall bias; responses to sexual autonomy questions may also reflect social desirability. These limitations should be considered when interpreting findings.
Protracted armed conflict causes profound disruption to health systems both directly and indirectly; this has high impacts on complex, resource-intensive conditions such as oncology. In Syria, fourteen years of conflict after the violent suppression of uprisings in 2011 resulted in the fragmentation of its health system into at least four subnational systems; these emerged as parallel structures with uneven governance, service availability, and access to care. Despite the fall of the regime in December 2024, the impact of this fragmentation on access to oncology services remains. In this perspective, we explore its impact on the cancer care continuum from prevention through to detection, diagnosis, and management; we argue that early recovery efforts must prioritize institutional coherence over rapid service expansion. In the early recovery period, constraints include the absence of a national cancer registry, limited diagnostic capacity and centralized distribution, shortages in radiotherapy and systemic therapies, and the lack of integrated multimodal care within oncology centers. Patient journeys, particularly outside of major urban centers, require patients to traverse large geographies, adding to costs and burdens. Drawing on lessons from post-conflict health system reforms in other countries, we propose a sequenced approach to oncology recovery centered on three priorities: strengthening governance and national stewardship, formalizing referral pathways aligned with system capacity, and defining a phased essential cancer service package linked to financial protection. Restoring continuity across the cancer care continuum requires aligning governance, service delivery, and financing before expanding specialized services. Without this consolidation phase, expansion risks reinforcing existing inequities rather than addressing them.
IntroductionDisparities in access to cancer clinical trials persist among patients with limited socioeconomic resources. Clinical trial navigation programs are an emerging solution to improve clinical trial access, although their components are varied and not well-described.MethodsGuiding participation toward Understanding, Inclusion, Diversity, and Equity in Cancer Clinical Trials (GUIDE) is an evidence-based clinical trial navigation program that focuses on financial reimbursement for trial-related expenses and clinical trial navigation services, including local resource connections. We are conducting a pilot randomized controlled trial of 100 adults with cancer who are eligible for a clinical trial to evaluate GUIDE implementation outcomes and preliminary efficacy in increasing clinical trial enrollment and retention, reducing the financial burden and resolving health-related social needs, and increasing patient trust, health-related quality of life, and resilience. Staff time and effort, participant time, overheads, and reimbursement costs of GUIDE will also be evaluated. Participants are randomized 1:1 to GUIDE with usual care versus usual care alone for a 6-month period. Usual care includes institutional social work and patient and financial navigation support.DiscussionAlthough disparities in clinical trial participation may be addressed by clinical trial navigation programs, components of effective programs are not well-understood, in part due to a paucity of published protocols. To address these critical gaps in clinical trial representation and navigation program transparency, we present the GUIDE protocol.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT06484595.
BackgroundOverall survival for childhood cancer continues to improve, and with a large proportion of patients reaching reproductive age the question of fertility is becoming increasingly important. The long-term side effects of cancer treatment can include reduced reproductive function. The aim of this study is to present the baseline data from inclusion of a prospective follow-up study of fertility surveillance in children diagnosed with cancer. We are striving to evaluate whether anti-mullerian hormone (AMH) could be used as a surveillance modality in prospective monitoring of ovarian reserve in female childhood cancer survivors.MethodsParticipants aged 0–17 years were enrolled at the Pediatric Oncology Center at Sahlgrenska University Hospital in Gothenburg, Sweden, between May 2016 and March 2021. Inclusion criteria were new diagnosis of pediatric cancer and scheduled treatment with chemotherapy and/or radiotherapy. The cohort will be part of a longitudinal follow-up program until the patients are approximately 25 years old; at this age puberty has passed and ovarian reserve in adult age can be evaluated. AMH levels are measured at inclusion and then every 2 years. Fertility preservation treatment will be offered in appropriate cases.ResultsAfter initial assessment of data, 74 participants were included in the study. The mean age was 7.7 years (median 8). The most common type of cancer was solid tumors (n = 24), followed by leukemia (n = 21). The baseline data showed initial levels of AMH between 0.03 and 9.97 μg/L, with a mean value of 1.7 μg/L and a median value of 1.1 μg/L. Fifty-six participants had AMH measured before cancer treatment started, and 18 had AMH levels taken after initiation of cancer therapy. Age-adjusted AMH values were on average 79% lower in patients who had already been exposed to cancer treatment compared with the untreated group. Two patients were offered fertility preservation before initiation of cancer therapy.ConclusionThis is a presentation of the baseline data from a planned long-term follow-up study. The long-term study has a unique prospective design that will follow girls from cancer diagnosis through their adolescence and up to fertile age, including an assessment of AMH levels. This may enable identification of who would be likely to benefit from fertility preservation, and when.
IntroductionImplementing cancer survivorship guidelines in resource-limited settings poses unique challenges. While the National Comprehensive Cancer Network (NCCN) has developed harmonized survivorship guidelines for sub-Saharan Africa, little is known about the contextual factors that may affect their implementation in Nigeria, which bears the second-highest cancer burden in Africa. The objective of this study was to explore barriers and facilitators that may influence the implementation of NCCN harmonized survivorship guidelines based on perceptions, experiences, and attitudes of patients, caregivers, and healthcare providers at a major Nigerian cancer center using the Consolidated Framework for Implementation Research (CFIR).MethodsThe study used qualitative methods and interviewed 22 key informants to explore experiences and perceptions. Data collection and analysis were guided by CFIR domains: inner setting, outer setting, intervention characteristics, and individual characteristics.ResultsNine patients, nine healthcare providers, and four caregivers were interviewed via Zoom. The study highlighted several factors that may influence the implementation of guidelines. Healthcare workers perceived barriers to implementing the guidelines included human resource shortages, financial constraints, and limited awareness of the guidelines. However, strong communication practices and the existing infrastructure were seen as potential facilitators. Among patients and caregivers, social and religious influences emerged as factors that could either support or hinder implementation, while financial-related constraints remained the most prominent barrier.ConclusionThis study underscores the need for context specific guidelines. In this setting, such guidelines should more effectively address financial hardship, recognize and leverage the central role of caregivers, and consider the influence of faith and social networks in shaping patient experiences.
IntroductionBreast cancer (BC) is the second most prevalent cancer in women and the second leading cause of cancer-related mortality in the United States. The risk of cardiovascular disease (CVD) is significant among women with BC across their survivorship trajectory. Chemotherapy and radiotherapy contribute to acute cardiac disease, but late-stage CVD increases with disease comorbidity, poor lifestyle behaviors, and inadequate healthcare access.MethodsThis observational study describes CVD risk in a national sample of 2,745 female BC survivors from the National Health Interview Survey (NHIS) from 2019–2022. Chi-square and logistic regression models examined CVD prevalence across BC survivorship cohorts from less than one year up to 10+ years, as well as sociodemographic characteristics, clinical comorbidities, lifestyle behaviors, social determinants of health, and self-reported general health status.ResultsCVD prevalence was highest among women surviving BC 10 years or more and least among one- to five-year BC survivors. Being unmarried, delayed medical care, hypertension, history of smoking, poor general health, and older age were significantly associated with CVD diagnoses.DiscussionPreventive behaviors and appropriate management of comorbidities continue to be key targets for reducing CVD. Clinical guidelines recommend enhanced CVD screening for up to five years after BC treatment. However, CVD risk continues to increase over time for BC survivors. CVD screening in BC survivors should be lifelong and risk-stratified based on BC treatment and other health profile indicators. Clinicians should prioritize a holistic approach to CVD prevention not just immediately after treatment, but for more than a decade afterward.
BackgroundThe ‘Call for a Kit (CFAK)' initiative offers consultations for colorectal cancer (CRC) screening non-responders through person-centered, community-delivered patient navigation strategies. This study investigated CFAK's impact on tackling inequalities in CRC screening participation since the new fecal immunochemical test (FIT) implementation.Methods2,360 bowel cancer screening non-responders were contacted via telephone and offered in-person or telephone consultations as part of the CFAK intervention between July 2022 and February 2023. Outcomes included uptake of the consultation offer and subsequent completion/return of a FIT kit. The intervention's effectiveness in reducing inequalities was assessed using multivariate logistic regression.ResultsOf 2.360 individuals calls, 333 attended a consultation, requested a test kit and completed a test, equating to a 14.1% completion rate across the sample. FIT kit return was higher among individuals with Indian (22.0 vs. 13.6%; adjusted odds ratio (aOR): 2.26, 95% confidence interval (CI): 1.52–3.34; 0.001), Black, mixed, or other ethnic backgrounds than white adults. Importantly, people with disabilities (33.7 vs. 12.7%; aOR: 3.58, 95% CI: 2.49–5.14; 0.001) were more likely to return a test kit compared to people without a disability.ConclusionThe findings show that CFAK is more effective among marginalized groups, such as ethnic minority groups and people with learning disabilities, who are less likely to participate in bowel cancer screening when routinely invited.
BackgroundCognitive bias is increasingly recognized as a significant factor contributing to diagnostic errors in the medical field. While interventions to reduce biases have mainly been studied in adult hospital or acute care settings, the impact of cognitive bias on diagnostic errors in pediatrics is also noteworthy.Case presentationWe discuss a 17-year-old who presented for treatment of a clinically and radiographically diagnosed macrocystic lymphatic malformation. Overcoming the challenges of diagnostic anchoring and medical mimicry, medical evaluation was abruptly adjusted, and surgical resection revealed a diagnosis of immature teratoma.ConclusionThe case helps highlight how cognitive biases can contribute to diagnostic delay and exemplifies methods employed to overcome bias. Understanding and addressing cognitive biases are essential for improving diagnostic accuracy and patient care in pediatric settings.
IntroductionGenetic testing enables precision medicine by improving disease risk awareness, prevention, and treatment. Despite national guidelines, fewer than 20% of eligible US patients with a personal or family history of breast or ovarian cancer undergo testing, with notable disparities by race, age, and insurance. Population-scale programs and point-of-care strategies, such as risk assessments during mammography, aim to address these gaps. This study evaluates the effectiveness of three outreach methods and clinic workflow variations on genetic testing participation among high-risk patients.MethodsThe study was conducted at eight Providence Health and Services clinics in California. To evaluate the effectiveness of three outreach methods on genetic testing participation, high-risk patients were randomized to receive one of three methods: mailed brochure, email, and SMS text message. The effectiveness of two workflows was assessed retrospectively, comparing genetic testing among patients who were offered testing in the same building to those who were required to go to a different building. Descriptive and regression analyses were used to examine associations between outreach and workflow and test order rates. A stratified analysis by workflow was used to further examine associations between patient characteristics and genetic testing.ResultsA total of 7,112 patients received outreach methods, and 16,965 were included in the retrospective analysis by workflow. Overall, genetic testing following outreach was low, less than 3%, and did not differ by outreach method. The different building workflow was associated with a lower order rate than the same building workflow (IRR = 0.72, 95% CI = 0.65–0.80). The differences in order rates by patient characteristics were larger in the different building workflow.ConclusionThe findings suggest that while outreach yields low engagement, low-cost methods such as email are feasible, and point-of-care access is critical for improving participation and equity. Health systems should prioritize same-day testing and provider capacity to expand access and reduce barriers.
BackgroundBreast cancer risk assessment for women aged 30–39 years would facilitate the offer of early screening and prevention approaches in those at increased risk. The Breast CANcer Risk Assessment in Young women (BCAN-RAY) study (NCT05305963) is evaluating the feasibility of breast cancer risk assessment in women aged 30–39 years without a strong family history, aiming to recruit a diverse ethnic and socioeconomic sample. The present analysis compares uptake rates to the study by ethnicity and socioeconomic status.MethodsA total of 14,366 women aged 30–39 years, without a strong family history of breast cancer, were invited via general practices across Greater Manchester and Cheshire. Aggregated data on ethnicity and socioeconomic status of residence (via Index of Multiple Deprivation quintiles) at general practice level were used for invited women and self-reported ethnicity for those enrolled into the study. Chi-squared tests assessed differences in study uptake according to ethnicity and socioeconomic status.ResultsOverall uptake to BCAN-RAY was 5.2% (750/14,366 women). Highest uptake was seen in White women (654/5,005; 13.1%) compared to Black (10/511; 2%) and Asian women (50/2,089; 2.4%) [χ2 (4) = 219.86, p < 0.001]. Women residing in the most deprived areas were also underrepresented among enrolled participants [χ2 (4) = 75.31, p < 0.001].ConclusionAlternative delivery models need to be considered to improve accessibility and engagement in future research and in any implementation to routine practice.
BackgroundCancer is a significant public health issue in low-and-middle-income countries, especially in Africa, accounting for over half a million deaths every year. While lifestyle and/or behavioral interventions such as exercise and dietary modifications are known to improve patient outcomes and quality of life, critical evidence from resource-limited settings like Africa is scanty.ObjectiveThis review examined clinical trials on the current status and distribution of cancer-associated lifestyle and non-pharmacological clinical trials in Africa, highlighting trends, gaps, and opportunities for future research.MethodsThree trial registries (ClinicalTrials.gov, ICTRP and PACTR) were systematically searched for trials on lifestyle and non-pharmacological interventions for cancer in Africa from July 2005 to October 2024. A structured data extraction process was applied to collect information on sample characteristics and outcomes. Descriptive statistics were used to synthesize frequencies and proportions across included trials.ResultsOverall, 53 trials matching the criteria were identified. Most of the trials were in Egypt (38/53, 71.7%), Kenya (4/53, 7.5%), and Nigeria (5/53, 9.4%). Breast cancer had the highest number of conducted trials conducted (24/62, 45.3%), followed by colorectal (6/64, 11.3%), and acute lymphoblastic leukemia (4/64, 7.5%). Concerning sponsorship, most trials were sponsored by academic institutions (45/53, 84.9%), locally sponsored by institutions from within the host country (37/53, 69.8%), conducted among patients (88.7%), and cancer survivors (84.9%). Most trials involved physical activity interventions (25/53, 47.2%) and psychological interventions (10/53, 18.9%), with (32/53, 60.4%) trials completed and (13/53, 24.5%) trials ongoing.ConclusionNon-pharmacological interventions for the management of cancer appear to be nascent in Africa. Oncology trials are needed to ensure the effectiveness of non-pharmaceutical/lifestyle interventions in Africa, especially sub-Saharan Africa (SSA). In the current era of precision medicine, interventions proven successful in high income countries cannot be assumed to work equally well in low-and-middle-income countries, especially in Africa, given the genetic, socioeconomic, and environmental differences.
BackgroundThis study aimed to retrospectively analyze secular trends in respiratory failure-associated mortality (AAMR) and its demographic and geographic variations among US adult cancer patients from 1999 to 2023.MethodsThis study conducted a comprehensive retrospective analysis of respiratory failure-associated mortality data from 1999 to 2023 among US adult cancer patients and assessed secular trends (AAPC/APC) as well as variations across geographic, urban/rural, and racial/ethnic subgroups.ResultsDuring the study period, the overall age-adjusted mortality rate (AAMR) demonstrated a statistically significant long-term decline (AAPC: −0.60, 95% CI: −0.87 to −0.33, P < 0.05). However, this trend was punctuated by a synchronized and significant surge in AAMR across all subgroups between 2018 and 2021, with Annual Percentage Changes (APCs) of 5.02 (95% CI: 3.52–6.55) for males and 5.56 (95% CI: 3.29–7.89) for females (P < 0.05). Persistent health inequities were identified: non-Hispanic Black individuals (AAMR: 2023: 34.56, 95% CI: 33.86–35.26) and residents in non-metropolitan areas (AAMR: 2023: 30.52, 95% CI: 29.99–31.05) exhibited markedly higher mortality risks compared to other racial and geographic cohorts (P < 0.05).ConclusionThe collective reversal in respiratory failure-associated mortality after 2018, likely driven by cumulative treatment toxicities and pandemic-related disruptions, highlights a critical shift in cancer survivorship risks. Persistent racial and urban-rural inequities underscore systemic barriers to specialized care. To mitigate this rising burden, it is essential to institutionalize interdisciplinary oncology-pulmonary collaboration and implement targeted screening for high-risk populations.
IntroductionCancer is a real public health problem, the extent of which remains poorly understood due to the lack of reliable and up-to-date statistical data. Establishing a registry providing accurate data on prevalence and mortality is essential to improve the fight against cancer. Therefore, we felt it was appropriate to evaluate the implementation of the national cancer registry in Senegal and shed light on the next steps.MethodsA mixed-method study was conducted among Senegalese citizens aged 18–65, including ministry of health Officials, hospital managers, administrators, and clinicians. Quantitative data, collected through individual surveys (REDCap, face-to-face, or telephone) were analyzed using descriptive statistics. Qualitative data, from 18 semi-structured interviews, were transcribed, coded and analyzed using a hybrid thematic approach, supplemented by REA and Dedoose and QDA Miner software.ResultsThis evaluation revealed that four (4/7; 57.14%) of the Ministry of Health Social Action (MoHSA) cancer registry team and eleven (11/20; 55.00%) hospital directors/clinical department heads endorsed the existence of clearly established standards for implementing the cancer registry in Senegal. Regarding the assertion that key stakeholders have collectively developed a workable plan to facilitate the implementation of a cancer registry in Senegal, all members of the MoHSA team and seven of them endorsed this assertion, compared to only seven (7/20; 35%) of the hospital directors/clinical department heads. Finally, all members (7/7; 100%) of the MoHSA registry team and 40% (8/20) 20) of hospital directors/heads of clinical departments agreed that the designated focal person is fully informed about the cancer registry.Indeed, the sustainability of the registry will also depend on the establishment of solid mechanisms for monitoring and controlling activities related to its management.DiscussionAll Ministry of Health officials agreed on the need for key stakeholders to collectively develop a feasible plan to facilitate the implementation of a cancer registry in Senegal. They recognize the registry's importance, but its partial implementation leads to data fragmentation, requiring resources and capacity building to ensure its sustainability.
IntroductionThe social determinants of health (SDOH), such as socioeconomic status, rurality, and healthcare access, are increasingly recognized as key factors in the care of head and neck cancer (HNC). In central Missouri, where rurality and socioeconomic disparities are prevalent, understanding these factors is essential for improving early diagnosis and outcomes.MethodsRetrospective analysis of 880 patients diagnosed with primary HNC at the Ellis Fischel Cancer Center from 2006 to 2022. Demographic and tumor staging data were collected from electronic medical records. Socioeconomic status was assessed using Area Deprivation Index (ADI) scores, rurality was determined by Rural-Urban Commuting Area (RUCA) codes, and travel distance to care was estimated from patients' addresses. Associations between SDOH factors and stage at diagnosis were evaluated using chi-square tests, ANOVA, and multivariate logistic regression.ResultsPatients residing more than 100 miles from the cancer center had higher rates of stage IV presentation compared to local Boone County residents (53 vs. 28%; p = 0.005). Higher state ADI scores were significantly associated with advanced-stage disease (p = 0.017). In multivariate analysis, travel distance (OR = 1.24, 95% CI: 1.09–1.41, p = 0.001) and ADI (OR = 1.06, 95% CI: 1.01–1.11, p = 0.02) remained independently associated with a higher stage at diagnosis. RUCA classification (p = 0.769) and sex (p = 0.312) were not significantly associated with stage.DiscussionGreater travel distance and higher socioeconomic deprivation were independently associated with advanced-stage HNC at diagnosis. These findings underscore the importance of addressing SDOH HNC care, particularly in rural and disadvantaged populations.
IntroductionSocial determinants of health influence outcomes in cervical cancer. This study aimed to characterize the socioeconomic factors affecting survival in patients with cervical cancer receiving palliative care.Material and methodsWe conducted a retrospective cohort study of 368 women who attended social work services at an oncology hospital in Quito, Ecuador, between 2017 and 2021. Descriptive statistics, bivariate analysis, Kaplan-Meier survival curves, and Cox regression models were applied.ResultsThe median age was 52.5 years (IQR 45–65), with 46.5% identifying as mestizo and 46.5% as indigenous. Most patients (80.4%) had incomes below the basic salary, and the proportion of married individuals declined from 53.3% to 38.9% upon transition to palliative care. The average stay in palliative care was 46 days. Tertiary education was associated with a higher mortality risk (adjusted HR: 3.16; 95% CI: 1.51–6.60; p = 0.002). In contrast, having children was linked to lower mortality risk (one child: HR 0.56; 95% CI: 0.31–0.99; p = 0.046; two or more children: HR 0.47; 95% CI: 0.27–0.82). Patients with middle income had reduced mortality risk (HR: 0.71; 95% CI: 0.53–0.97; p = 0.032). No significant differences in survival were observed based on ethnicity or province of residence.ConclusionSurvival among cervical cancer patients in palliative care is short. Socioeconomic factors—particularly education, income, and family structure—significantly influence mortality. Integrating social support into cancer care is essential to improve health outcomes and equity in this population.
BackgroundLong-term survival of children and adolescents (CA) diagnosed with cancer has hardly been researched in Slovenia. Our aim was to present the survival trend at the population level over a period of 60 years with an additional comparison between observed and net survival.MethodsFrom the Slovenian Cancer Registry, we obtained data on malignant cancer cases (excluding cases of non-melanoma skin cancer) in CA aged 0–19 years diagnosed in Slovenia in 1964–2023. Survival estimates were calculated using the Kaplan-Meier estimator for observed survival and the non-parametric Pohar-Perme estimator for net survival by age, period and ICCC groups.ResultsOf the total 4,067 cancer cases, 3,935 first primary cancers were included in the survival analysis. A steady increase in the crude incidence rate was observed over the 60-year period, from 10.9 per 100,000 in the period 1964–1973 to 17.7 per 100,000 in the period 2014–2023, largely on account of increases in ICCC groups I, II, IV, X and XI. For ICCC cancer groups I, II, IV, V, VI and X, the change in the 10-year net survival was more than 50 percentage points, while at the same time for groups V and VI the 10-year net survival for patients diagnosed in the period 2004–2013 was 100%. The observed 5-year survival 30.8% (27.3–34.8%) in the period 1964–1973 steadily increased to 87.8% (85.3–90.3%) in the period 2014–2023. The 5-year observed survival in the period 2014–2023 was worst for children diagnosed at the age of 1–4 years (83.6%, 77.8–89.9%) and best for adolescents diagnosed at the age of 15–19 years (90.2%, 86.3–94.2%). The differences between the observed and net survival were very small, with a difference exceeding 1 percentage point for survival of 30 years or more.ConclusionsIncreasing survival among Slovenian children and adolescents indicates significant progress in cancer diagnosis and treatment. The need for systematic surveillance of the late effects of cancer treatment is increasing with the growing number of survivors (resulted from decreasing mortality and increasing survival) in order to maintain their health and quality of life as they age.
IntroductionIn Kenya prostate cancer (Ca) is the leading cause of cancer related mortality among men. There is lack of data on the social determinants of health and their impact on the stage at diagnosis.PurposeThe purpose of this study was to determine prostate cancer stage at diagnosis, and social determinants associated with advanced disease in a Kenyan population.MethodsWe analyzed data from 170 prostate cancer patients recruited from Kenyatta National Hospital (KNH) and MP Shah Hospital, Nairobi (2022–2024) on patients prospectively recruited in the International Registry for Men with Advanced Prostate Cancer (IRONMAN) and African Cancer Genome Registry (ACGR) registries. Patients included in the study had a histological diagnosis of prostate cancer. All participants completed standardized questionnaires assessing sociodemographic factors, health knowledge, and healthcare access. Clinical and pathological staging data was also collected and multivariable logistic regression used to determine factors associated with metastatic disease at diagnosis.ResultsThe mean age for the participants was 70 years. Most of the participants presented with advanced disease 84.7% (n = 144). Half of the participants (50%, n = 84) had a Gleason score of 9 and 10 or an ISUP (International Society of Urological Pathology) Grade 5, 36% (n = 60) had grades 3 and 4 the remaining 14% (n = 24) had grade 1 and 2. The median PSA was 81 ng/ml (IQR: 26.5–262) and the mean was 402.22 ng/ml (SD:1128.17) with most of the patients 60.5% (n = 92) having a PSA over 50 ng/ml. The odds of advanced disease were significantly lower among patients with tertiary education compared to primary or no formal education (OR = 0.0.13 95% CI: 0.03–0.56). Patients who were very spiritual had higher odds of advanced disease (OR = 4.51 95% CI: 1.33–15.22).ConclusionKenyan men in this cohort present predominantly with advanced prostate cancer, influenced by educational status, spirituality and region of residence. There is need for community-based awareness and screening programs for men with low education.
The development of effective treatment for many childhood cancers has led to dramatic increases in survival rates at the population level, at least in affluent industrialized countries. Studies of survival in numerous populations have been published, but population-based survival estimates that are essential for monitoring and planning are still lacking in many countries. There is no comprehensive account of the type and extent of available information on this topic. A scoping review of population-based studies of childhood cancer in the 21st century was carried out with the aim of repairing this omission. The electronic databases PubMed and Web of Science were searched, supplemented by the author's bibliographic files. The searches produced 5,490 references, of which 303 reported population-based studies containing at least one estimate of 5-year survival for children with cancer diagnosed during a period whose central year was 2001 or later. Overall, 75% of high-income countries with a child population ≥50,000 were represented in these studies, compared with 47% of upper middle income countries, 16% of lower middle income countries and 8% of low income countries. Among countries that were represented in population-based studies, 29% of high income countries were only represented in studies involving multiple countries compared with 75% of those in lower income categories. Similar contrasts were found between countries with very high Human Development Index and those in lower categories of Human Development Index. Wider availability of robust information on survival at population level will be essential for monitoring progress toward the goal set by the World Health Organization's Global Initiative for Childhood Cancer of 60% survival globally for children and adolescents with cancer by the year 2030. Increasing the coverage and quality of cancer registration and death notification in as many lower-resource countries as possible would in turn increase the volume and geographic spread of the data from which survival rates can be estimated for those countries. International collaborations whose results are underpinned by uniform procedures for data validation and analysis will continue to play a vital part in enabling comparison of childhood cancer survival between populations.
