Adherence to cancer prevention guidelines in 18 African countries

Helping Patients Eat Better During and Beyond Cancer Treatment: Continued Nutrition Management Throughout Care to Address Diet, Malnutrition, and Obesity in Cancer

Cancer patients and survivors are at risk of poor clinical outcomes due to poor nutritional intake following cancer diagnosis. During cancer treatment, treatment toxicities can affect eating patterns and can lead to malnutrition resulting in loss of lean body mass and excessive weight loss. Following treatment and throughout survivorship, patients are at risk of not meeting national nutrition guidelines for cancer survivors, which can affect recurrence and survival. Obesity, which is highly prevalent in cancer patients and survivors, can affect clinical outcomes during treatment by masking malnutrition and is also a risk factor for cancer recurrence and poorer survival in some cancers. Appropriate and effective nutritional education and guidance by trained clinicians are needed throughout the cancer continuum. This article presents an overview of recommendations and guidelines for nutrition and weight management and provides recent examples of behavioral theory-based targeted lifestyle interventions designed to increase adherence to recommendation by cancer patients and survivors.

Cancer-related risk factors and incidence of major cancers by race, gender and region; analysis of the NIH-AARP diet and health study

Background

Racial disparities in the incidence of major cancers may be attributed to differences in the prevalence of established, modifiable risk factors such as obesity, smoking, physical activity and diet.

Methods

Data from a prospective cohort of 566,398 adults aged 50–71 years, 19,677 African-American and 450,623 Whites, was analyzed. Baseline data on cancer-related risk factors such as smoking, alcohol, physical activity and dietary patterns were used to create an individual adherence score. Differences in adherence by race, gender and geographic region were assessed using descriptive statistics, and Cox proportional hazards models were used to determine the association between adherence and cancer incidence.

Results

Only 1.5% of study participants were adherent to all five cancer-related risk factor guidelines, with marked race-, gender- and regional differences in adherence overall. Compared with participants who were fully adherent to all five cancer risk factor criteria, those adherent to one or less had a 76% increased risk of any cancer incidence (HR: 1.76, 95% CI: 1.70 – 1.82), 38% increased risk of breast cancer (HR: 1.38, 95% CI: 1.25 – 1.52), and doubled the risk of colorectal cancer (HR: 2.06, 95% CI: 1.84 – 2.29). However, risk of prostate cancer was lower among participants adherent to one or less compared with those who were fully adherent (HR: 0.79, 95% CI: 0.75 – 0.85). The proportion of cancer incident cases attributable to low adherence was higher among African-Americans compared with Whites for all cancers (21% vs. 19%), and highest for colorectal cancer (25%) regardless of race.

Conclusion

Racial differences in the proportion of cancer incidence attributable to low adherence suggests unique opportunities for targeted cancer prevention strategies that may help eliminate racial disparities in cancer burden among older US adults.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3557-1) contains supplementary material, which is available to authorized users.

Preoperative Assessment of Hepatocellular Carcinoma with Split-Bolus Combined Phase Contrast-Enhanced Computed Tomography

Background

The aim of this study was to investigate the feasibility of a split-bolus combined phase contrast-enhanced computed tomography protocol in evaluation of liver vasculature in hepatocellular carcinoma (HCC) patients for the purpose of surgery guidance.

Material/Methods

Two groups of patients were recruited for the study: 24 consecutive cases of HCC who underwent multiphasic CT examination, and 22 consecutive cases who afterwards underwent split-bolus combined phase CT examination. The multiphasic protocol included an unenhanced scan and 3 image acquisitions after contrast injection. The injection of contrast medium was 440 mgI/kg in a single bolus. The split-bolus combined phase protocol included unenhanced scan and combined phase. The injection of contrast medium was 440 mgI/kg for the first bolus and 220 mgI/kg for the second bolus. The vascular delineation was evaluated with Likert scales. The CT values were measured, and the contrast-to-noise ratio (CNR) was calculated. We also compared the effective radiation dose (ED) of the 2 protocols.

Results

All mean CT values were significantly higher in the split-bolus protocol than in the multiphasic protocol (all P<.05), except for the hepatic vein (P>.05). The ED was significantly lower in the split-bolus protocol, corresponding to a dose reduction of 66% compared to the multiphasic protocol (P<.05). The scores of the branches of the hepatic vein in the split-bolus protocol were not lower than those in the multiphasic protocol.

Conclusions

For the preoperative HCC patients, the split-bolus combined phase CT examination meets the diagnostic requirement of surgical planning, with approximately 60% reduction in the radiation dose.

Adherence to cancer prevention guidelines in South Africa is associated with health care access

BACKGROUND

Cancer prevention guidelines have been developed to improve knowledge and adherence to modifiable cancer risk factors. The implementation of these guidelines has largely been studied in North American and European populations. The aim of this study was to examine the association between health care access and adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention guidelines in South Africa, where the cancer incidence is rising.

METHODS

Data from the 2003 South Africa World Health Survey was used to assess adherence to WCRF/AICR cancer prevention guidelines on alcohol, body mass index, nutrition, physical activity and smoking. Health care affordability, availability, accessibility, accommodation and acceptability in the past 12 months were assessed via self-report.

RESULTS

Residing in a high socio-economic status household (affordability), visiting a non-governmental health care facility (availability), perception of health care provider skills as adequate (accommodation) and lack of perception of worse treatment based on social class (acceptability) were each associated with higher levels of adherence to the WCRF/AICR guidelines.

CONCLUSIONS

In South Africa, better access to health care is associated with better patient adherence to cancer prevention guidelines. Future studies and efforts can focus on improving access to quality health care in this population.