511 JOURNAL OF SCIENCE, Hue University, N 0 61, 2010 CANCER CONTROL PROGRAM IN THUA THIEN HUE, VIETNAM, 2008 - 2009 Nguyen Dinh Tung Oncology Department of Hue Central Hospital Lecturer of Hue College of Medicine & Pharmacy SUMMARY Thua thien Hue is one of three biggest networks for Cancer Control Program in Vietnam. The first phase of program implementation was conducted in 2008, providing the cancer burden and assessement the abilities of the cancer screening in breast and cervix, improvement the facilities in diagnosis and cancer treatment. Methods: Cancer patients was registered in 14 hospital in Thua thien Hue from 2008 January to 2009 December.Women of 4 districts was attended the screening program of breast and cervix cancer was taken by study forms and analysed in SPSS 16.0. The other informations for cancer patients almost was collected from Hue Central Hospital and Thua thien Hue Health Office. Results: There is 2,641 cancer cases was registered in this province periode 2008, 2009; males 56.94%, females 43.06%. Order Prohibiting Smoking in public places for tobacco control, improving the cancer treatment net, mass media education in television, publishing the discs and brochures for cancer prevention and vaccination against HBV for 10,000 pupil. There was 14,017 women attended the screening program for breast and cervix cancer. The facilities for cancer diagnosis and treatment would be upgrading for meeting the needs of population. The collaboration to UICC, IARC and others would be sharring experience in cancer control program. Conclusion: Although the Cancer Control Program is just begining in preparation , some efforts by the government have already been made with cancer control. However,the cancer control in Thua thien Hue still has to deal with challenges such as poor quality of cancer morbidity and mortality data, shortage of resources and limited knowledge of general practitioners as well as the public about this disease. 1. Introduction Vietnam Cancer Control Program was approved by Primer Minister in 2007. The goal is to establish and maintain a system that integrates scientific progress and its practical applications into a comprehensive program that will reduce cancer morbidity and mortality in Vietnam.The first phase of program implementation was conducted in 2008 in six main cities of Vietnam, providing the guidelines for specifying program policy, components, implementing guidelines and timetable. 512 Viet Nam has proposed a National Strategy for Cancer Control up to 2010 and 2020 with the following objectives: 1. Reduce the incidence of tobacco related cancers by 30%, compared to the year 2000. 2. Ensure HBV vaccination coverage for all newborns. 3. Reduce breast, cervix, mouth and rectum cancers mortality rates. 4. Decrease the proportion of advanced stage cancers from 80 to 50%. 5. Establish a community-based terminal care system for cancer patients and ensure enough supplies of essential drugs. Thua Thien Hue is one of province was chosen in performing this program. The Cancer Control Programme begun in 2008, is an integrated approach utilizing primary, secondary and tertiary prevention in different regions of province at both hospital and community levels. 2. Methodology The cancer patients was registered in 14 hospitals in Thua Thien Hue from 2008 January to 2009 December. Data was analysed in CANREG softvare version 4. The screening of breast cancer and cervix cancer was carried out in 4 districs in over 14,000 women from 35 to 60 year old. Data was stored and analysed in SPSS 16.0 3. Results and discussion 3.1. Cancer problem in ThuaThien Hue 2008-2009 The population-based cancer registries have been introduced in Hanoi since 1987 and HochiMinh city in 1990. The data produced by these two registries are the first on cancer incidence in Vietnam. Although the registries still have many difficulties such as a non-homogeneous quality of primary health information and a shortage of human and financial resources, the quality of the data were compatible with those of other countries. The percentage of microscopic verification of registered cases is about 60% in Hanoi and about 70% in HochiMinh City. In 2000, Cancer registry was founded in Hue to assess the cancer burden in the Middle of Vietnam, to monitor trends in cancer incidence and to provide the public, health professionals and scientists with statistical information for education and research. Table 1 and figures 1& 2 shows the age-standardized rate of leading cancers of this registry in recent years and comparison with the data from some other registries . 513 Table 3.1. Cancer incidence of Thua Thien Hue 2008, 2009 Years 2008 2009 Total % Males 745 759 1,504 56.94 Females 573 564 1,137 43.06 Both 1,318 1,323 2,641 100.00 34.8 31.3 24.6 11.5 7.5 6.4 5 4.2 3.9 3.8 0 5 10 15 20 25 30 35 40 Figure 3.1. 10 leading cancer in males ( Age Standardised Rate) 21.7 9.9 8.9 6.7 6 5.8 4.3 4 3.3 2.5 0 5 10 15 20 25 Figure 3.2. 10 leading cancer in females ( Age Standadised Rate) In Thua thien Hue, cancer of the liver, stomach, lung, oral cavity, non Hodgkin lymphoma are the most frequent in males and cancer of the breast, stomach, lung , liver, oral cavity are the most frequent in females. The difference between the Midle and the North is in lung cancer (in the North is highest in lung cancer while the Middle is liver cancer) and the South is in cancer of the cervix: the incidence of this cancer in the South 514 is almost several times higher than that in the Middle ( ASR 26 : 5.8). In periode 2008, 2009, the cancer incidence in Thua thien Hue is ASR 173.5 for males and 103.9 for females. Based on the estimation of the International Agency for Research on Cancer 2008 for Vietnam, the cancer incidence is ASR 154.4 for males and 127.7 for females. 3 2. Cancer Control Activities 3.2.1. Tobacco Control Program Vietnam is a country with a very high level of tobacco production and consumption. The cultivated surface for tobacco plants was about 24 000 ha and tobacco production represented about 2 billion packs of cigarettes.In a disigned survey, 70% smokers began before 25 years old and "water pipe"smoking was strongly related to lung and superior aero-digestive tract cancer. Thua thien Hue province has a campain for the fight against tobacco was legitimized in the Order Prohibiting Smoking in Public Places: Schools, Hospitals, Meeting Rooms, Theaters, Public Transportation Vehicles, prohibition of advertisement of tobacco in the mass media, increasing consumption tax and prohibition of smoking in medical institutions. Thua thien Hue and the whole country has actively participated in the International Non-smoking Day with an anti-tobacco campaign in the mass media. Thua thien Hue is also destroy a factory for production of cigarettes.This would be explained the cause of decreasing for lung cancer in this area. 3.2.2 Vaccination for Liver Cancer Liver cancer is one of the leading cancers in Vietnam and the highest incidence in Thua thien Hue. Since 1995, Vietnam has successfully produced a vaccine against HBV, which makes the goal of primary prevention of liver cancer more realistic and sustainable. Since 2000, this vaccine was included in the extended program of immunization for newborns and pupil Hue City. In a report, 75% liver cancer was living in the rural location of Thua thien Hue, coast and moutain areas.There is over 10,000 pupil was injected for prevention Hepatitis in Thua thien Hue. 3.2.3. Breast Cancer Screening Implementation of breast cancer screening program has a nationwide anti-breast cancer scheme: public information and health education, case finding and treatment integrated into the community health structure and equipped to control breast cancer in a systematic sustained manner. There is over 14,000 women in 35 to 60 years old was attended this program by Breast Selft Examination . The suspected cases was refered to Hue Central hosptal to confirm diagnosis. There is 5 cases breast cancers among 68 suspected cases in 2008, 2009. In the observation of 6617 women from 35 to 60 years old for knowledge in breast cancer and understanding about breast cancer screening, the result as table 2: 515 Table 3.2. Observation the understanding on breast cancer Question Answer % 1 Understansding on breast cancer Do not know 50.76 2 Cause of breast cancer Do not know 45.34 3 Breast cancer is serious disease Do not know 29.97 4 Breast selft examination Never 52.09 5 Talking about breast selft examination Nobody 37.04 6 Description symptom of anormal breast tumor 22.88 7 To see doctor when they have tumor No 31.71 8 Understanding about methods of breast screening Do not know 41.57 9 Worried about breast cancer Die, loss of breast, loss of finance 30.31 10 Prognostic of breast cancer disease Curability 61.67 3.2.4. Cervix cancer screening Until recently minimum prevention strategies against cervical cancer in Vietnam are safe sex and screening with a Pap smear examination every 3 years. The Cancer Control Program of Thuathien Hue recommends regular Pap tests for 14,074 women who are or have been sexually active and who have a cervix. The interval of Pap smear testing for each patient should be recommended by the physician based on risk factors (e.g. early onset of sexual intercourse, history of multiple partners, low socioeconomic status). Patients at increased risk due to unprotected sexual activity or multiple partners should receive appropriate counseling about sexual practices. There are 196 has been high risk for cercical cances including 6 cases was confirmed as cancer . Lessons learned from successful Papanicolaou cytology cervical cancer prevention in Thua thien Hue are: IF our ideological commitment is to improve health outcomes as quicky as possible among many women as possible THEN Papanicolaous screening services ( with or without HPV/VIA testing services) should be provided without further delay in any setting where cervical screening is appropriate but unavailable, with consideration given to HPV vaccination after, rather than before, the possibility has been excluded that HPV vaccination may be ineffective for cervical cancer prevention and/or full coverage of target demographic groups by screening services has been achieved, whichever comes first. 516 3.2.5. Improvement for facilities of cancer diagnosis and treatment Thua Thien Hue is the biggest cancer centers in the Middle of Vietnam, it is become one of three cancer centers network for diagnosis and treatment following the indication from Ministry of Health .The number of cancer beds has increased significantly, over 200 beds in Thua thien Hue. In the whole country, the facilities for treatment and diagnosis of cancer have increased in quantity and quality.There was a gamma knife and brachytherapy, cobalt radiation and will be set up a new linear accelerator in Thua thien Hue. The number of staff has also been increased to meet the needs of the population. Despite all these effort, the gap to be filled in cancer care needs is still very large. To solve this problem, Thua thien Hue are in process to receive the ODA project from foreign countries. Table 3.3. Requirement of palliative care in Hue Central Hospital in 2008 No Sites Cases 1 Bronchus, Lung Cancer 108 2 Head & Neck Cancer 40 3 Kidney Cancer 03 4 Cervix & Ovary cancer 24 5 Breast cancer 21 6 Digestive Organ 26 7 Lymphoma 07 8 Others 44 Total 273 The National conference on cancer control ,National conference on breast cancer , Pathology symposium, Radiation symposium, was organized in Thua thien Hue in the last 2008, 2009. However, the knowledge of general practitioners on new concepts in pain relief is still very limited while requirement of palliative care has just centralised in hospital ( see Table 3). Still no facility for hospice care exists in Thua thien Hue as well as Vietnam. Terminal care for cancer patients still relies on their family. The cancer control program in Thua thien Hue is also received support from Ministry of Health, UICC, IARC in sharring experience, medical staff training and others. Hue College of Medicine and Pharmacy is training for medical staffs in the Middle and Highlands with specialized oncology in general level and level I. 517 Another Activities : Mass media in cancer prevention on television in Hanoi and Hue( 102 times), vaccination for cervical cancer, publishing document for cancer prevention ( 152 discs , 40.000 brochures ) 4. Conclusions Thua thien Hue was chosen one of three biggest networks in the cancer control program in Vietnam.There is 2,641 cancer cases was registered in Thua thien Hue periode 2008, 2009; males 56.94%, females 43.06%. Thua thien Hue has a campain for the fight against tobacco was legitimized in the Order Prohibiting Smoking in public places. The vaccination for hepatitis was injected for 10.000 pupil. The screening of breast cancer and cervical cancer was performed in 14,074 women .There is no hospice care and home care for cancer patients .Increasing the beds and medical staffs to meet the needs of population. 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