- Fatima Cardoso
- Gouri Shankar Bhattacharyya
- Alexandru Eniu
391O - Setting up breast services improvements and learning bridges in Kyrgyzstan: The SILK project
- Olivia Pagani
- Olivia Pagani
- Maria Del Grande
- Fedro Peccatori
- Chris De Wolf
- Giancarlo Pruneri
- Lara Mattei
- Antonella Richetti
- Stefano Presilla
- Taalaigul Sabyrbekova
- Nargiza Bakirova
- Tatiana Soldak
- Damir Abdyldaev
- Turusbek Abdyldaev
- Ibragimbek Aliev
- Rahatbek Aralbaev
- Svetalana Naizabekova
- Bermet Shaimurzaeva
- Olga Shimkina
- Rolf Marti
- Franco Cavalli
Abstract
Background
In Kyrgyzstan, a low-middle income Central-Asia republic, breast cancer (BC) management does not meet minimal standards: ∼70% of women are diagnosed late and do not receive adequate treatments. Setting up BC services is a health priority.
Methods
In 2011, the Swiss Development Cooperation in Central Asia audited for a BC project in Kyrgyzstan. The audit found a dramatic situation in imaging, histologic diagnosis and treatment (local and systemic). A multi-step program was funded, supported by the European School of Oncology (ESO), the Swiss Cancer League and the Swiss Association against Cancer in close collaboration with the local ONG Ergene (Europa Donna member), the Swiss Embassy and the Kyrgyz Ministry of Health. The first priorities were mammographic and histologic diagnosis. From 2017, Swiss and Italian breast specialists periodically visited Kyrgyzstan to supply materials, teach health professionals and trace progress and problems; Kyrgyz doctors were trained in Switzerland and Italy, patients were provided educational support and devices (prostheses, wigs).
Results
Improvements were significant and fast. The mammography quality is now acceptable and the pathologists routinely assess hormonal receptors, HER-2 and Ki-67 expression and biomarkers for differentiating tumor subtypes. Diagnostic and therapeutic guidelines have been implemented with local physicians. Thanks to a Canadian government donation, two Linear Accelerators and one Computed Tomography for radiotherapy planning are being purchased, replacing old, unsafe equipment. A US ONG assisted in chemotherapy regimen implementation. Current steps involve training of radiation oncologists, medical physicists, technicians and surgeons in modern BC loco-regional approaches, discussing the availability of drugs of the WHO list of essential medicines, establishing tele pathology and mobile mammography.
Conclusions
The SILK project shows effective BC cooperative programs in low-middle income countries are feasible. Strict and continuous collaboration with local governments, organizations and health professionals is vital to ensure their success. SILK is a model adaptable and exportable to other critical situations across the world.
Legal entity responsible for the study
European School of Oncology.
Funding
European School of Oncology, Swiss Cancer League.
Disclosure
G. Pruneri: Honoraria (self): Roche Foundation Medicine. All other authors have declared no conflicts of interest.
392O - Treatment outcomes of colorectal cancer patients enrolled in a comprehensive benefits program of the National Health Insurance System in the Philippines: Data from the program pilot site
- Danielle Benedict L. Sacdalan
- Danielle Benedict L. Sacdalan
- Frederic Ivan L. Ting
- Mayou Martin Tampo
- Hermogenes III Monroy
- Dennis L. Sacdalan
Abstract
Background
Colorectal cancer is the third most common site of malignancy in the Philippines. This has led the Philippine Health Insurance Corporation (PhilHealth), an attached agency of the Philippine Department of Health, to create the Z-Package Colorectal Cancer Benefit Program to fund the treatment of Filipinos with stage I-III colorectal cancer. This program intends to provide quality care through a multidisciplinary team approach to optimize treatment outcomes for this disease without causing financial toxicity on the part of the patients. The University of the Philippines - Philippine General Hospital (UP-PGH) is the pilot site of this program. This is the first study to report data from the colorectal cancer Z-package program.
Methods
Three-year data from patients enrolled under the Z-Package Colorectal Cancer Benefit Program from 2016 to 2018 were reviewed by the UP-PGH colorectal cancer study group. Descriptive statistics and Cox proportional hazards regression were employed to summarize patient characteristics and analyze treatment outcomes.
Results
A total of 251 patients were enrolled in the Z-package Benefit Program from 2016 to 2018. The mean age at enrolment was 57 years old. 66% of patients were males. 78% of patients had rectal cancer and 82% were diagnosed with Stage 3 disease. Compliance to the prescribed surgery, chemotherapy, and/or radiation treatment were 90%, 77%, and 96% respectively. Recurrence, morbidity, and mortality rates of enrolled patients from 2016-2018 were 17%, 22%, and 19%, respectively. Morbidities were mostly due to chemotherapy. Patients in this program had a 2-year survival rate of 74% and 3-year survival rate of 70%.
Conclusions
The results of this study show that a multidisciplinary-approach to patient care funded by a comprehenesive benefits program can positively impact patients’ overall survival in colorectal cancer. This study serves to promote the support for this program by PhilHealth in the future.
Legal entity responsible for the study
University of the Philippines - Philippine General Hospital.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
393O - Timeliness of lung cancer treatment utilizing the rapid access lung cancer clinic in a regional Australian Hospital
- Nguyen M. Chau
- Nguyen M. Chau
Abstract
Background
Patients in remote and rural areas of Australia are disadvantaged in receiving and accessing healthcare. Lung cancer incidence and mortality is increased in remote areas compared to metropolitan regions. The rapid access lung cancer (RALC) clinic was established in 2017 in order to optimize timeliness to treatment and improve patient outcomes.
Methods
Retrospective audit of all patients diagnosed with lung cancer in 2018 within the Ballarat Health service and was stratified according to stage of cancer. Mean timeframes were derived from the Australian optimal care pathway (OCP) for people with lung cancer and analysed using descriptive statistics.
Results
Total of 84 patients were diagnosed with lung cancer in 2018, with 72% being seen in the RALC clinic. Overall 77.3% met the OCP timeframe of referral to treatment in less than 42 days as compared to only 48.5% in 2015-2016. Stage I/II, III and stage IV patients had mean referral to treatment intervals of 53, 40 and 22 days respectively. Stage IV RALC patients compared to general clinic patients, proceeded to treatment faster after diagnosis (7 days vs 28 days, p = 0.04) and were presented at MDT more frequently (44.5% vs 13.5%). In Stage I/II and stage III patients who had delays from diagnosis to treatment, main reasons were waiting times for surgery, radiotherapy and further diagnostic test. Limitations of a regional centre include having to refer externally for both EBUS and complex surgery offered only in metropolitan hospitals.
Conclusions
RALC clinics have reduced time to definitive treatment. Early stage patients require more complex work up and multi-modality treatment, so have a longer time to first treatment over advanced stage patients. Despite the obstacles of a regional centre, the time to treatment were shorter that of metropolitan public hospitals. Longer follow-up will determine if improved timeliness will lead to better patient outcomes.
Legal entity responsible for the study
Ballarat Health Service.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
537O - Evaluating medical oncology outcomes: An Asian lung cancer study
- Rolf A. Stahel
- Les Mery
- Freddie Bray
- Patumrat Sripan
- Ross A. Soo
- Hans H. Storm
- Rolf A. Stahel
Abstract
Background
Cancer is a significant public health issue. The need to improve prevention and control programs is especially critical in Asia, where approximately half of all newly diagnosed cancers globally occur. To better understand factors related to aetiology and clinical prognosis, cancer registries have been increasingly integrated within medical oncology. Combining diagnosis, treatment, quality of life and mortality data helps to effectively guide clinical practices that ultimately improve patient care.
Methods
To examine and compare clinical outcomes in lung cancer patients across settings, a retrospective population-based study was launched in selected Asian countries. All incident cases diagnosed between 2017 – 2019 in Yogyakarta (Indonesia), Penang (Malaysia), Lampang (Thailand) and Singapore will be eligible for inclusion. Using the registry as the study base, details of tumour characteristics including data for survival analyses, molecular testing, stage, performance status and treatments within the first six month will be abstracted from chart reviews.
Results
For the study period, over 5 000 cases are expected from all four sites: 1 000 from Yogyakarta; 1 000 from Lampang; 650 from Penang; and 3 000 from Singapore. Following a literature review, an initial list of indicators was developed. These were further refined through expert review, to yield a final set of 40 clinical indicators, ranging from diagnosis to palliative care. This presentation will provide an overview of the study, expected outcomes and preliminary results from 50 – 100 cases per site.
Conclusions
This study will establish methods that allow for clinical information to be integrated with existing population-based cancer registries, permitting comparisons in clinical outcomes for helping to set public policy.
Legal entity responsible for the study
ESMO.
Funding
European Society for Medical Oncology.
Disclosure
All authors have declared no conflicts of interest.
Discussion led by moderators
- Fatima Cardoso
- Gouri Shankar Bhattacharyya
- Fatima Cardoso
- Gouri Shankar Bhattacharyya