Geographic Distribution of Cancer Care Providers in the Philippines

In the Philippines, a lower middle-income country in Southeast Asia, 6 of 10 Filipinos die without seeing a doctor. To ensure universal access to cancer care, providers must be equitably distributed. Therefore, we evaluated the distribution of oncologists across all 17 regions in the Philippines.

We gathered data from the official websites of national medical societies on their members’ regional area of practice: Philippine Society of Medical Oncology, Philippine Radiation Oncology Society, Surgical Oncology Society of the Philippines, Society of Gynecologic Oncologists of the Philippines, and Philippine Society of Hospice and Palliative Medicine. We compared this with the regional census to determine the number of board-certified oncologists per 100,000 Filipinos.

For a population of almost 110 million, the Philippines has a total of 348 medical oncologists, 164 surgical oncologists, 99 radiation oncologists, 142 gynecologic oncologists, and 35 hospice and palliative medicine (HPM) specialists. This translates to 0.32 medical oncologists, 0.15 surgical oncologists, 0.09 radiation oncologists, 0.13 gynecologic oncologists, and 0.03 HPM specialists for every 100,000 Filipinos. The number of oncologists is highest in the National Capital Region in Luzon and lowest in the Bangsamoro Autonomous Region in Muslim Mindanao. All regions have at least one medical and gynecologic oncologist. Two regions (12%) have no surgical oncologists, five regions (29%) have no radiation oncologists, and eight regions (47%) have no HPM specialists.

Efforts are needed to increase the number of oncologists and improve equity in their distribution to ensure universal access to cancer care in the Philippines.

A Novel Approach in Management of Placenta Accreta Spectrum Disorders: A Single-Center Surgical Experience From Vietnam

Background: Placenta accreta spectrum disorder (PASD) is the leading cause which results in highly maternal mortality during pregnancy. Although hysterectomy has been the gold standard for PASD, recent data, together with our experience, suggest that conservative management might be better; and thus, we here attempted to determine this.

Methods: A retrospective observational study enrolled 65 patients at the Tu Du Hospital in Vietnam between January 2017 and December 2018. This study included all pregnant women above 28 weeks of gestational age, who had undergone cesarean delivery due to PASD diagnosed preoperatively by ultrasound or upon laparotomy. Additionally, all patients who desired uterine preservation underwent uterine conservative surgery, avoiding hysterectomy.

Results: Overall, the rate of successful preservation was 93.8%. Other main parameters evaluated included average operative blood loss of 987 mL, mean blood transfusion of 831 ± 672 mL; mean operative time of 135 ± 31 min, and average postoperative time of 5.79 days. Postoperative complications happened in six out of 65 cases due to intraoperative bleeding and postoperative infection, requiring peripartum hysterectomy in four patients.

Conclusions: Uterine conservative surgery was associated with less operative blood loss and blood transfusion amount. Its success rate of preservative method was approximately 94% in our study. Thus, this method can be acceptable in PASD management. Further studies might be necessary to evaluate the long-term effects of this method in PASD management

The 4th Syiah Kuala International Conference Conjunction With The 5th Aceh Surgery Update International Conference

Assalamualaikum Wr. Wb

All Praise and gratitude we pray the presence of Allah SWT for all His grace and guidance so we can still work to help in the fields of education and humanity. With greetings and prayers we praise the prophet rahmatan lil alamin Rasulullah Muhammad SAW who has brought us from the realm of darkness to a realm full of knowledge.
This year 2022, we will organized a collaborative event between Faculty of Medicine Universitas Syiah Kuala and Department of Surgery Faculty of Medicine Universitas Syiah Kuala. The event called the The 4th Syiah Kuala International Conference (SKIC) In Conjunction with The 5th Aceh Surgery Update International Conference (ASUIC) 2022. This conference will be delivered a concept as Hybrid Conference will be held on October 6th – 9th 2022, with theme Reconnecting; Advances in Surgery and Clinical Collaboration. This Hybrid conference will be attended by international and national speakers who have expertise in the field of surgery, medical education, clinical medicine and the latest information regarding Medical Education and Health Transformation from Indonesian government. This scientific event felt very special with the presence of the Bali Medical Journal Indexed by SCOPUS (Q4) and Web of Science in scientific publications for all topics presented, both in symposium and free paper sessions.
I would like to welcome all experts who are willing to attend in this outstanding hybrid conference to be resource persons at this scientific event, I would like to thank all the committees and sponsors who have helped us to make this activity a success. Finally, I also welcome all the participants, I hope you all get valuable scientific experinces in wonderful city of Banda Aceh.

Thank You
Sincerely yours,

Implementation of a colorectal cancer screening intervention in Malaysia (CRC-SIM) in the context of a pandemic: study protocol

Introduction Colorectal cancer (CRC) is the second most common cancer in Malaysia and cases are often detected late. Improving screening uptake is key in down-staging cancer and improving patient outcomes. The aim of this study is to develop, implement and evaluate an intervention to improve CRC screening uptake in Malaysia in the context of the COVID-19 pandemic. The evaluation will include ascertaining the budgetary impact of implementing and delivering the intervention.

Methods and analysis The implementation research logic model guided the development of the study and implementation outcome measures were informed by the ‘Reach, Effectiveness, Adoption, Implementation and Maintenance’ (RE-AIM) framework. This CRC screening intervention for Malaysia uses home-testing and digital, small media, communication to improve CRC screening uptake. A sample of 780 people aged 50–75 years living in Segamat district, Malaysia, will be selected randomly from the South East Asia Community Observatory (SEACO) database. Participants will receive a screening pack as well as a WhatsApp video of a local doctor to undertake a stool test safely and to send a photo of the test result to a confidential mobile number. SEACO staff will inform participants of their result. Quantitative data about follow-up clinic attendance, subsequent hospital tests and outcomes will be collected. Logistic regression will be used to investigate variables that influence screening completion and we will conduct a budget impact-analysis of the intervention and its implementation. Qualitative data about intervention implementation from the perspective of participants and stakeholders will be analysed thematically.

Ethics and dissemination Ethics approval has been granted by Monash University Human Research Ethics Committee (MUHREC ID: 29107) and the Medical Review and Ethics Committee (Reference: 21-02045-O7G(2)). Results will be disseminated through publications, conferences and community engagement activities.

Trial registration number National Medical Research Register Malaysia: 21-02045-O7G(2).

Economic Evaluation of a Global Reconstructive Surgery Visiting Educator Program

The objective of this study was to quantify the cost-effectiveness and economic value of a reconstructive surgery visiting educator trip program in a resource-constrained setting.

Reconstructive surgical capacity remains inadequate in low- and middle-income countries, resulting in chronic disability and a significant economic toll. Education and training of the local surgical workforce to sustainably expand capacity have been increasingly encouraged, but economic analyses of these interventions are lacking.

Data were analyzed from 12 visiting educator trips and independently-performed surgical procedures at 3 Vietnamese hospitals between 2014 and 2019. A cost-effectiveness analysis was performed using standardized methodology and thresholds to determine cost-effectiveness. Sensitivity analyses were performed with disability weights, discounting, and costs from different perspectives. Economic benefit was estimated using both the human capital method and the value of a statistical life method, and a benefit-cost ratio was computed.

In the base case analysis, the visiting educator program was very cost-effective at $581 per disability-adjusted life year (DALY) averted. Economic benefit was between $21·6 million and $29·3 million, corresponding to a 12- to 16-fold return on investment. Furthermore, when considering only costs to the organization, the cost decreased to $61 per DALY averted, with a 113- to 153-fold return on investment for the organization.

Visiting educator programs, which build local reconstructive surgical capacity in limited-resource environments, can be very cost-effective with significant economic benefit and return on investment. These findings may help guide organizations, donors, and policymakers in resource allocation in global surgery.

Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programmes, and Risk-based Screening Initiatives

Close to half (45.4%) of 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined on the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.

Contextualizing policy implementation, challenges, and plans for improving breast cancer early detection programs in Indonesia

Late-stage breast cancer (BC) is commonly diagnosed in limited-resource countries such as Indonesia. The lack of information for decision-making emphasizes the need for efforts to support evidence-informed practice for improving BC early detection in Indonesia. This study attempts to understand the local context evidence on policy implementation, challenges, and plans for enhancing BC early detection programs in Indonesia. The evidence gained from this study will help harness the power of scientific reasoning that shapes theories of how BC early detection intervention works and its operationalization in practice.

This study engaged three interrelated phases of qualitative methods. Phase I involved a document analysis in determining the predominant strategy and approach to the landscape of BC early detection programs. Phase II was an in-depth interview to clarify the operationalization of the technical aspect, eliciting stakeholder experiences and their perceptions about the factors supporting or hindering goal achievement. In phase III, two consecutive collaborative expert workshops and a collaborative learning process nested with the Indonesia Project ECHO team for Knowledge Summaries for Comprehensive Breast Cancer Control.

Current BC early detection strategies to downstage women’s symptomatic breast abnormalities are considered an essential preparatory step before starting a screening program at the enhanced or maximal level of resources. However, the absence of an integrated cancer registry system renders it impossible to measure the full effect of the program implementation as a public health policy. Emphasis on improving structural barriers during the follow-up of abnormalities, patient navigation for referrals, and a surveillance system to track the times from presentation to diagnosis and diagnosis to treatment is needed for Indonesia’s early detection services continuum.

The local context presented in this research increased the usability and usefulness of relevant evidence for decision-makers, thus bridging the gap in translating research findings into healthcare practice for BC early detection in Indonesia. Importantly, attention to providing a clear national guideline, developing a highly interoperable screening registry system, and ensuring the sustainability of pilot sites on mammography screening is critical to the success of expected outcomes.

Basic and clinical research publications of Indonesian neurosurgeons: Where are we?

With changes in European and the US academia and education systems, research has become a measurement to define academic productivity, as it is a crucial component in the process of becoming a well-trained neurosurgeon. In this recent study, we aimed to reveal the current status and challenges facing neurosurgical research in Indonesia.

An open-access PubMed MEDLINE database search was performed to reveal all articles published by Indonesian Neurosurgeons from 1980 to July 2021. The detail was extracted to the following parameters: academia center or city of the study, year of publication, study type, topic, journal, institution and Q status, first author, article citation, international collaboration, and the working field. These data were processed and examined.

During 1980 and July 2021, a total of 242 PubMed-indexed papers were published from Indonesia. The number of publications started increasing significantly from 2010 to 2021, with an average of 19 papers per year since 2010. Most of the studies came from Bandung (22.7%), with Universitas Padjadjaran as the center of the study. According to the paper type, the majority of the articles were basic and clinical research (45.5%). The most common study type was case reports (33.5%). Neurotrauma (21.9%) was the most frequent topic followed by neuro-oncology (21.07%) and spine trauma (11.98%).

Published articles in the neurosurgery field in Indonesia has shown a higher, promising trend. Despite many challenges faced in the process, there was significant progress in the past few decades compared to the previous ones. A comprehensive deliberate plan and multidisciplinary effort that focuses on overcoming the problems regarding defining academic productivity is needed for further improvement of neurosurgical care in Indonesia

Challenges and opportunities for breast cancer early detection among rural dwelling women in Segamat District, Malaysia: A qualitative study

Breast cancer patients in low- and middle-income countries often present at an advanced stage. This qualitative study elicited views regarding the challenges and opportunities for breast cancer screening and early detection among women in a low-income semi-rural community in Segamat district, Malaysia.

Individual semi-structured interviews with 22 people (health professionals, cancer survivors, community volunteers and member from a non-governmental organization) and four focus group discussions (n = 22 participants) with women from a local community were conducted. All participants were purposively sampled and female residents registered with the South East Asia Community Observatory aged ≥40 years were eligible to participate in the focus group discussions. Data were transcribed verbatim and analyzed using thematic analysis.

The thematic analysis illuminated barriers, challenges and opportunities across six domains: (i) personal experiences and barriers to help-seeking as well as financial and travel access barriers; (ii) primary care challenges (related to delivering clinical breast examination and teaching breast-self-examination); (iii) secondary care challenges (related to mammogram services); (iv) disconnection between secondary and primary care breast cancer screening pathways; and (v) opportunities to improve breast cancer early detection relating to community civil service society activities (i.e. awareness raising, support groups, addressing stigma/embarrassment and encouraging husbands to support women) and vi) links between public healthcare personnel and community (i.e. improving breast self-examination education, clinical breast examination provision and subsidised mammograms).

The results point to a variety of reasons for low uptake and, therefore, to the complex nature of improving breast cancer screening and early detection. There is a need to adopt a systems approach to address this complexity and to take account of the socio-cultural context of communities in order, in turn, to strengthen cancer control policy and practices in Malaysia.

Cost of postoperative sepsis in Vietnam

Despite improvements in medical care, the burden of sepsis remains high. In this study, we evaluated the incremental cost associated with postoperative sepsis and the impact of postoperative sepsis on clinical outcomes among surgical patients in Vietnam. We used the national database that contained 1,241,893 surgical patients undergoing seven types of surgery. We controlled the balance between the groups of patients using propensity score matching method. Generalized gamma regression and logistic regression were utilized to estimate incremental cost, readmission, and reexamination associated with postoperative sepsis. The average incremental cost associated with postoperative sepsis was 724.1 USD (95% CI 553.7–891.7) for the 30 days after surgery, which is equivalent to 28.2% of the per capita GDP in Vietnam in 2018. The highest incremental cost was found in patients undergoing cardiothoracic surgery, at 2,897 USD (95% CI 530.7–5263.2). Postoperative sepsis increased patient odds of readmission (OR = 6.40; 95% CI 6.06–6.76), reexamination (OR = 1.67; 95% CI 1.58–1.76), and also associated with 4.9 days longer of hospital length of stay among surgical patients. Creating appropriate prevention strategies for postoperative sepsis is extremely important, not only to improve the quality of health care but also to save health financial resources each year.