World Cancer Congress, Aug. 18-21, 2010

International Union Against Cancer's 2010 World Cancer Congress

The International Union Against Cancer's (UICC's) 2010 World Cancer Congress took place Aug. 18 to 21 in Shenzhen, China, and attracted approximately 2,000 participants from around the world. The congress aimed to raise awareness of the global cancer epidemic, facilitate the sharing of ideas to address the epidemic, and target politicians and policy makers. The theme of the 2010 congress was "It's Everyone's Business," which aimed to reinforce the idea that cancer does not discriminate and that despite medical advances, nearly eight million individuals die of the disease per year.

The congress was structured around the World Cancer Declaration, which includes 11 goals that, if reached, will help to reverse and reduce the burden of the global cancer epidemic by 2020. The 11 goals of the declaration include significant drops in global tobacco consumption, obesity, and alcohol intake; universal vaccination programs for hepatitis B and human papilloma virus to prevent liver and cervical cancer; reductions in the emigration of clinical practitioners with specialist oncology training; universal availability of effective pain medication; and a reduction in misconceptions about cancer.

"One of the major focuses of the meeting, which is most unique, is that it was structured around a program that targets the World Cancer Declaration, which is a document developed by the UICC two years ago. The document was worked [on] up until this meeting and discussed a completely new effort to have cancer declared on the global political agenda. This conference was used as a platform to promote cancer [being] added to the international political agenda," said David Hill, Ph.D., UICC's immediate past president.

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More than one-third of cancers are attributable to lifestyle factors, infectious diseases, and environmental or occupation-related hazards, and are therefore potentially preventable; leading experts spoke during the congress on the need for additional actions to address these factors. While initiatives to address lifestyle factors such as tobacco use -- including bans on tobacco advertising, tax increases on tobacco products, and cessation programs -- have reduced cancer deaths, not all countries have implemented these programs. Initiatives for vaccination and other prevention methods have also proved effective in reducing cancer-related death, but experts say improvements are needed.

"Adopting global, national, and personal strategies to address these factors has been proven to reduce the number of cancer cases and deaths, but there is still more than can be done," Hill said in a statement.

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One of the key initiatives launched at the conference, the Global Access to Pain Relief Initiative (GAPRI), led by Hill, aims to make effective pain control measures available to all cancer patients globally. According to the World Health Organization, approximately five billion individuals live in countries with limited access to pain medications, including opioid analgesics. In addition, many countries have limited access to basic pain medication for moderate to severe pain.

"During the conference, we announced our plans for the Global Access to Pain Relief Initiative, where all patients will have access to adequate pain relief, including opioid analgesics," Hill said.

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Prior to the congress, the UICC endorsed the International Psycho-Oncology Society (IPOS) recommendation to include distress as the sixth vital sign assessed in routine clinical practice -- along with body temperature, pulse (or heart rate), blood pressure, respiratory rate, and pain.

"Importantly, the UICC's endorsement provides a mandate for member organizations to call on their home nations to rank distress as the sixth vital sign in cancer care," IPOS president, Maggie Watson, Ph.D., said in a statement. "This will inspire historic reform of standards and guidelines for clinical practice, with positive implications for international cancer control."

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A group of leading experts forming the Informal Working Group on Cancer Treatment in Developing Countries (CanTreat International) presented a comprehensive outline (CanTreat Issue Paper) to increase access to cancer treatment, including radiotherapy, surgery, and drugs in emerging economies and developing countries. The outline explains the need for new cancer treatment access strategies and provides evidence on current programs. In addition, the report provides an action plan to bridge the large gap between higher- and lower-income countries in access to cancer treatment by reducing the cost of and expanding access to cancer diagnosis, treatment, and palliative care.

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Other highlights from the congress included presentations as well as plenary and poster sessions focused on the primary prevention of cancer, tobacco control, treatment, and palliative care as well as initiatives to address the global cancer epidemic.

In one study, Amy Y. Zhang, Ph.D., of Case Western Reserve University in Cleveland, and Laura Siminoff, Ph.D., of Virginia Commonwealth University in Richmond, evaluated 235 patients with advanced stage non-small-cell lung cancer and their caregivers to assess differences in opinion between patients and caregivers in treatment and care decisions.

While more patients were willing to stop treatment when it was no longer providing benefit, the researchers found that more caregivers were willing to stop treatment when the adverse effects worsened. In addition, more caregivers were willing to discuss hospice compared to patients, with hospice care preferred at home versus other options. Compared to patients, more caregivers reported differences of opinions in the family and avoidance of family discussion of certain issues. Among both patients and caregivers, perceived family disagreement was significantly associated with depression.

"The findings suggest that patients and caregivers have different perspectives of treatment and care plans due to their respective interests and concerns for each others," the authors write. "Such a difference of opinion in the family can be a significant source of mental distress for both patients and caregivers."

In another study, researchers at the University of Hong Kong evaluated the implementation of a smoking cessation hotline (Youth Quitline) for youth smokers (aged between 12 and 25) who smoked at least one cigarette in the past month. The researchers recruited 618 youth smokers (74 percent males and 52 percent below 18 years of age) to the program, and the subjects received telephone counseling.

The researchers found that youth callers smoked for 4.5 years on average, with 73 percent smoking daily and 60 percent smoking a half pack or less during a smoking day. In addition, 56 percent intended to quit smoking within the following 30 days. The researchers followed up with 68 percent of youth smokers at six months and 45 percent at 24 months, with 19 percent reporting quitting for 30 days at six months and another 24 percent reporting attempting to quit or reducing daily cigarette consumption by half compared to baseline.

"This is the first Youth Quitline in Hong Kong and has provided a platform to publicize and promote youth quitting in the community," the authors write. "It is effective in assisting youth smokers to quit or change their smoking behaviors, and its existence would promote health, reduce smoking prevalence, and save lives in the society."

In a cross-sectional study, researchers in Morocco identified determinants of breast cancer diagnosis at a late stage between June and August 2008. The researchers administered a standardized questionnaire to 186 patients with breast cancer.

The researchers found that 39 percent of breast cancer cases were diagnosed at a late stage. Compared to patients from urban areas, logistic regression analysis revealed that patients from rural or suburban areas were more likely to be diagnosed at late stage (odds ratios, 3.7 for rural versus urban and 2.6 for suburban versus urban). In addition, patients without health care coverage were at a higher risk of being diagnosed at a late stage (odds ratio, 3.4).

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