Oral Cancer Disparities in the Outer US-affiliated Pacific Islands

OBJECTIVE/HYPOTHESIS

Oral cancers in the US-affiliated Pacific Islands are poorly described despite disproportionately higher incidences in certain jurisdictions. This study attempts to better characterize the incidence, staging, and management of oral cancers in this region.

STUDY DESIGN

Retrospective Epidemiological Study.

METHODS

A retrospective review was conducted across the US-affiliated Pacific Islands between 2007 and 2019. Patient data were obtained for individuals with primary head and neck cancers from the Pacific Regional Central Cancer Registry database. All cohorts were age-adjusted to the 2000 US Standard Population. Further analysis was performed on oral cavity cancers due to their clear predominance within the sample.

RESULTS

A total of 585 patients with primary head and neck cancers were included. The average age was 54.5 ± 12.9 years, and most patients were male (76.8%). Oral cancer subsite analysis revealed the proportional incidence of buccal mucosa was higher in 5 of 9 jurisdictions when compared with the United States (p < 0.001). Tongue and lip cancers were not found to have significantly higher incidence proportions. Patients in the Pacific Islander group were less likely to be detected at earlier stages for cancers of the cheek and other mouth (p < 0.001), tongue (p < 0.001), and lips (p < 0.001) compared with the United States.

CONCLUSIONS

Many Pacific Island populations are burdened with higher incidences of oral cancer with later staging. Further investigation is recommended to evaluate oral cancer-related outcomes and mortality in this region.

LEVEL OF EVIDENCE

3 Laryngoscope, 2022.

Costs and Resources Used by Population-based Cancer Registries in the US-Affiliated Pacific Islands

Background: The costs of cancer registration have previously been estimated for registries in the continental United States and many international registries; however, to date, there has been no economic assessment of population-based registries in the US-Affiliated Pacific Islands. This study estimates the costs and factors affecting the operations of US-Affiliated Pacific Island population-based cancer registries. Methods: The web-based International Registry Costing Tool1 was used to collect costs, resources used, cancer cases processed, and other registry characteristics from the Pacific Regional Central Cancer Registry (PRCCR), Federated States of Micronesia National Cancer Registry, and nine satellite jurisdictional registries within the US Pacific Islands. The registries provided data on costs for June 30, 2016-June 29, 2017, and cases processed during 2014. Results: Local host institutions provided a vital source of support for US-Affiliated Pacific Islands registries, covering substantial fixed costs, such as management and overhead. The cost per cancer case processed had an almost tenfold variation across registries, with the average total cost per case of about $1,413. The average cost per inhabitant in the US-Affiliated Pacific Islands was about $1.77 per person. Discussion: The challenges of collecting data from dispersed populations spread across multiple islands of the US-Affiliated Pacific Islands are likely leading factors driving the magnitude of the registries' cost per case. The economic information from this study provides a valuable source of activity-based cost data that can both help guide cancer control initiatives and help registries improve operations and efficiency.

Comprehensive cancer control planning in the Pacific: the Cancer Council of the Pacific Islands a multi-national regional coalition

INTRODUCTION

In the early 1990s, a comprehensive cancer control (CCC) approach was developed in the United States (US). In 2003, the US-Affiliated Pacific Islands (USAPI) adopted the CCC approach through a regional coalition, the Cancer Council of the Pacific Islands (CCPI). Using the CCC approach, the CCPI developed jurisdiction-specific cancer coalitions and initiated their respective cancer plans.

METHODS

The evolution of the CCC approach and the history of the CCPI regional coalition are reviewed. The outcomes of the regional approach for cancer control in the USAPI are described to illustrate the possibilities, value-added and innovation of using a CCC strategy in a multi-national coalition based in a resource-limited environment.

RESULTS

The CCC approach enabled the CCPI to (1) harmonize cancer control efforts between the six USAPI jurisdictions, (2) represent the USAPI cancer needs as a single voice, and (3) develop a regional cancer control strategy. Outcomes include (1) a regional cancer registry, (2) three sequential regional CCC plans, (3) leveraged resources for the USAPI, (4) enhanced on-site technical assistance and training, (5) improved standards for cancer screening, (6) evidence-based cancer control interventions adapted for the USAPI.

CONCLUSION

The regional CCPI coupled with the CCC approach is an effective engine of change. The CCC strategies enabled navigation of the political, geographic, cultural, and epidemiologic Pacific environment. The regional partners have been able to harmonize cancer control efforts in resource-limited settings. Regional cancer coalitions may be effective in the global arena for cancer control between communities, states, or countries.

[Radiosurgery in pediatrics]

The aim of this study was to introduce a new surgical instrument and to discuss early experience using radio-surgery method in different pediatric operations.

METHOD

Radio-surgery (RS) machine (Ellman, Surgitron) generates ultra-high frequency waves that cause heat in the tissue water, producing steam, resulting in cutting or coagulation of the tissue, causing minimal "collateral" tissue damage (vaporisation). It has several electrode-types (7 electrodes are in a standard set).

PATIENTS

Using the Surgitron unit with good results in 45 general and specialised pediatric patients.

CONCLUSIONS

RS is easily to use for incising skin, to prepare subcutaneous tissue and to coagulate. Surgitron can preferable used for fine incision. RS works well in clinical praxis because it creates minimal "collateral" heat. So damage to tissue is small which produces faster wound healing and--possibly--aesthetic scars. RS technique is atraumatic which can be used in almost every operative intervention.

[Selection of wound dressings]

The successful wound treatment depends on the adequate local agents and the well selected dressing. There is not single universal dressing that suitable for the management of all types of wounds and a few are suitable for single wound in the all stages of wound healing. The base and the main goal of dressing selection to produce rapid and optimal wound healing, cosmetically acceptable too, to reduce pain, to prevent and control the bacterial state of wound, to decrease the quantity of wound secretion, to cause minimal distress to the patient, and to improve the quality of patient's life. Author gives a summerizing of the wound healing, a discussion about the wound related factors: e.g. wound type, wound surface, wound characteristics and the bacterial profile of wounds. He gives informations about the wound dressing collecting into groups and the classification of the different dressings.

[Malignant fibrous hystiocytomas of unusual localizations]

25 cases of malignant fibrous histiocytomas of different localisation were diagnosed in the St. John's Hospital (Budapest, Hungary) in a 10-year period from 1982 to 1992. In the present study ten patients are reported with rare localisation of this tumor caused abdominal complications. Special attention is payed to diagnostic difficulties. The importance of morphological diagnosis is emphasized because modern therapeutic methods favourably influence the prognosis of this tumor.

[Successful operation of bleeding perforated Curling's ulcer]

The Curling's ulcer is a special form of the stress ulcers which occurs in the stomach and duodenum in 2.0-25%. It's pathogenesis is unknown even though it is clearly related to larger burns poor early treatment and septic complications. Since the institution of routine prophylaxis of H2 receptor antagonists and antacids have decreased the incidence of Curling's ulcers and have reduced the occurrence of clinical complications of ulcers too: the perforation and bleeding. In the large patient-number of the author (2300 pro 22 yrs.) the occurrence of the Curling's ulcer is 0.82%! In the burn-disease (30-40% of the all burn injuries) that is 2.0--2.7%. The author discusses 3 successfully operated Curling's ulcer bleeded and perforated.