Trends in incidence and survival of childhood cancers in Khon Kaen, Thailand (2000-2019): a population-based Khon Kaen Cancer Registry study.

BACKGROUND: In Thailand, the national health care system and nationwide standard treatment protocols have evolved over time, potentially influencing the trends in the incidence and survival rates of childhood cancers. However, further investigations are required to comprehensively study these trends in Khon Kaen, Thailand. METHODS: Childhood cancer patients aged 0-14 years (n = 541) who were diagnosed with one of the five most common cancers between 2000 and 2019 from the population-based Khon Kaen Cancer Registry were enrolled. Descriptive statistics were used to analyse the demographic data, which are presented as numbers, percentages, means, and standard deviations. The trends in incidence between 2000 and 2019, including age-standardized incidence rates (ASRs) and annual percent changes (APCs), were analysed using the Joinpoint regression model. Survival analysis was performed for 5-year relative survival rates (RSRs) according to the Pohar Perme estimator and Kaplan-Meier survival curves. RESULTS: The ASRs of the overall top 5 childhood cancer groups were 67.96 and 106.12 per million person-years in 2000 and 2019, respectively. Overall, the APC significantly increased by 2.37% each year for both sexes. The overall 5-year RSRs were 60.5% for both sexes, 58.2% for males, and 63.9% for females. The highest 5-year RSR was for germ cell tumours (84.3%), whereas the lowest 5-year RSR was for neuroblastoma (29.1%). CONCLUSIONS: The incidence and survival rates of childhood cancers in Khon Kaen, Thailand, varied according to sex. The incidence trends increased over time, meanwhile, the relative survival rates rose to satisfactory levels and were comparable to those of other nations with similar financial status. The implementation of national health policies and adherence to national treatment guidelines have improved cancer diagnosis and treatment outcomes.

Health Literacy and COVID-19 Vaccination among Cancer Patients in Northeastern Thailand: A Cross-Sectional Study.

OBJECTIVE: This study aimed to explore factors associated with COVID-19 vaccine uptake among patients with cancer in northeastern Thailand. METHODS: A cross-sectional study was conducted in northeastern Thailand between December 29th, 2022 and January 31st, 2023. A community-based, multistage sampling method was used to select patients with any medically diagnosed cancer. An interview form was developed to assess patient sociodemographic factors, health literacy, and COVID-19 vaccination status. Multivariable logistic regression analysis was used to identify the factors associated with COVID-19 vaccination status. RESULTS: Of the 449 participants, 368 (81.96%) had received at least two doses of a COVID-19 vaccine. The multivariable analysis revealed that factors associated with COVID-19 vaccination among cancer patients included: 1) health literacy (excellent: adjusted odd ratio (ORAdj) = 7.23; 95% confidence interval (CI): 2.11-24.71, p = 0.002); sufficient: ORAdj = 6.03; 95% CI: 2.00-18.24, p = 0.001); problematic: ORAdj = 3.88; 95% CI:1.37-11.00, p = 0.011); 2) marital status (ORAdj = 2.90; 95% CI: 1.37-6.14, p = 0.005); 3) cancer treatment at a general hospital (ORAdj = 2.50; 95% CI: 1.25-5.00, p = 0.010); and 4) history of laboratory-confirmed COVID-19 infection (ORAdj = 2.37; 95% CI:1.19-4.71, p = 0.014). CONCLUSIONS: The strongest predictor of receiving COVID-19 vaccines was health literacy, which enhances healthcare provider awareness of communicable disease prevention and control for patients with cancer as well as counselling and educating to improve their health literacy. It could influent a higher rate of vaccine uptake among patients with cancer.

Associations between ultrasound screening findings and cholangiocarcinoma diagnosis in an at-risk population.

The rate of cholangiocarcinoma (CCA) is increasing every year, especially in northeastern Thailand. Screening for CCA using ultrasonography (US) is the fastest technique to identify patients in early stage of CCA development. Currently, few studies have examined patterns of hepatobiliary abnormalities identified using US, which can be indicative of CCA. We aim to evaluate the rate of CCA and its relations to history of US findings. Our study included participants who underwent US and pathological diagnosis of CCA from the Cholangiocarcinoma Screening and Care Program, Northeast Thailand between 2013 and 2020. Data on histological findings were based on the standard protocol of the tertiary hospital at Khon Kaen University. CCA data is categorized into two groups (yes/no) to find the relationship with history of US findings. The adjusted odds ratio (AOR) and their 95% confidence intervals (CI) were used to evaluate the relationship obtained by multiple logistic regression. Of 1880 subjects who underwent US and a pathological diagnosis of CCA, the overall rate of CCA was 35.74%. CCA rate among those with liver mass (LM) was 54.85% and with dilated bile duct (DBD) was 62.01%. The relationship between DBD and CCA was highly significant (AOR = 3.46; 95% CI 2.74-4.36) followed by LM (AOR = 2.28; 95% CI 1.81-2.86) P value < 0.001. Our study reveals that US findings history have a strong association with CCA, especially in people diagnosed with DBD and LM. Therefore, these abnormalities can be indicators for suspected CCA diagnosis through US.

Development of a School-Based Health Literacy Model for Liver Fluke Prevention and Control Using Participatory Action Research.

BACKGROUND: Liver fluke caused by Opisthorchis viverrini is a serious health problem in the northeastern region of Thailand. It is associated with endemic cholangiocarcinoma (CCA) in this region. This study was performed to develop a school-based health literacy model for liver fluke prevention and control using participatory action research.   Method: The participants of this study included 3 school administrators, 5 teachers, 45 senior high school students, 2 health officers, and 5 health volunteers. in Phanom Phrai District, Roi-et Province, Thailand. The study employed mixed methods for data collection, including qualitative methods namely policy analysis, interview, and problem-solving as well as quantitative methods namely pre and post-tests and implementation of health literacy. Six months later, researchers evaluated the outcome. The average scores of the participants' health literacy and their practical skills were measured. RESULT: The participants' health literacy and practical skill mean score increased after the intervention (mean difference=20.20, 95%CI 15.37-25.03, p-value <0.001) and (mean difference=21.10, 95%CI 19.10-23.10, p-value <0.001). School activities were concluded regarding public relations for one time a week, exhibitions, learning summary speech contests, and organizing a school food safety club. In addition, school rules were agreed and included: (1) cooked food consumption (2), stopping undercooked cyprinoid fish by the household cooker (3), correcting misunderstanding in each household in the community (4), hygienic defection, and (5) reminding friends to stop consumption of undercooked food. CONCLUSION: The results indicated that school-based model was effective. The stakeholder experiences and learning processes using teamwork will help the development of skills to cooperate and coordinate students choosing the best method for Liver fluke prevention and control. Moreover, they should continue to improve the suitable network for each school to ensure that the models are sustainable.

Attitudes and Beliefs of Cancer Patients Demanding Medical Cannabis Use in North Thailand.

OBJECTIVE: Cannabis is therapeutic for numerous medical conditions. The demand for medical cannabis (MC) use in cancer patients is increasing, even with many patients lacking proper knowledge about MC. Therefore, this study aimed to describe the attitudes and beliefs of cancer patients demanding MC use in northern Thailand. METHODS: This cross-sectional study administered multistage random sampling to recruit 565 cancer patients who indicated that they demand MC use in northern Thailand. These patients responded to a self-administered structured questionnaire about their feelings on MC. We used descriptive statistics, including frequency and percentage, to describe categorical data, whereas we used mean and standard deviation for continuous data. RESULTS: Out of a total of 565 participants, 59.7% were female, 40.3% were male, and 46.4% were middle-aged adults, with a mean age of 58.3 ± 13.0 years. Of these participants who demanded the use of MC, the top three most common types of cancers were breast cancer (27.8%), colorectal cancer (21.4%), and lung cancer (10.6%). Most of the participants (51.2%) had early-stage cancer, and 46.5% received chemotherapy. We found that patients who demanded MC use had a generally positive attitude (53.3%). Among the patients who required MC use, 55.4% believed that it would help relieve side effects caused by modern treatments, cure cancer (38.8%), relieve suffering from cancer symptoms (30.6%), and cause one to live longer and to improve their health (16.3%). Most patients' decisions regarding MC use (45.3%) demanded MC use after receiving modern treatments, and 95.6% demanded MC use with modern treatment. Overall, these patients (65.3%) needed MC from the MC clinic in the Government Hospital. CONCLUSIONS: This study highlights the attitudes and beliefs towards MC use among cancer patients, their positive expectations of the outcome, and the need for MC use.

Factors Influencing Demand for Medical Cannabis Use among Cancer Patients in the North of Thailand.

OBJECTIVE: Cancer treatments often cause side effects. Cannabis is a plant that has been studied and used to treat and relieve side effects from modern medicine. Medical cannabis (MC) was legalized in Thailand in 2019 with limited research on demand for its use. Therefore, this study aimed to identify factors associated with demand for MC use among cancer patients in the North of Thailand. METHODS: This analytical cross-sectional study administered a multistage random sampling to recruit 1,284 cancer patients in northern Thailand to response a self-administered structured questionnaire. Generalized Linear Mixed Model (GLMM) was used to identify the determinants of demand for MC use among the population, presented adjusted odds ratios (adj.OR), 95% confidence intervals (95% CI), and p-values. RESULT: Nearly half of the respondents reported demand to use MC (44.0%). The factors that were significantly associated with demand to use MC included had high levels of health literacy about MC (adj.OR = 5.70; 95% CI: 4.08 to 7.96), higher levels of social support (adj.OR =5.50; 95% CI: 3.60 to 8.39), positive attitudes toward MC use (adj.OR = 2.56; 95% CI: 1.83 to 3.56), aged less than 30 (adj.OR =1.89; 95% CI: 1.21 to 2.93), diagnosis with cancerfor more than 12 months ago (adj.OR =1.73; 95% CI: 1.19 to 2.52) when controlling effect of other covariates. CONCLUSION: We found substantial demand for MC use among cancer patients. Health literacy,social support, attitudes about MC, age, and duration of having cancer were significantly associated with demand for MC use. Therefore, improving health literacy and social support, especially among older cancer patients, could help increasing demand for MC as a complementary medicine to treat cancers.

Health Insurance and Colorectal Cancer Survival in Khon Kaen, Thailand.

Background: Evidence from healthcare studies demonstrates that patients' health insurance affects service accessibility and the outcome of treatment. However, assessment on how colorectal cancer survival relates to health insurance is limited. Objective: The study examined the association between health insurance and colorectal cancer survival in Khon Kaen, Thailand. Methods: The retrospective cohort study was conducted with 1,931 colorectal cancer patients from Khon Kaen cancer registry between January 1, 2003 and December 31, 2012, and was followed-up until December 31, 2015. Relative survival was used to estimate the survival rate. Cox proportional hazard regression was used to estimate the relationship between health insurance and colorectal cancer survival, represented with the hazard ratio. Result: Most of the participants were males, and the median age was 62 years. The median survival time was 2.25 years (95% CI: 2.00-2.51). The five-year observed survival rate and relative survival rate were 36.87 (95% CI: 34.66-39.08) and, 42.28 (95% CI: 39.75-44.81), respectively. The factors that showed significant associations with poorer survival after adjustment for gender and age were non-surgical treatments (HRadj=1.88;95%CI=1.45-2.45), advanced stage (III+IV) (HRadj=2.50; 95%CI=2.00-3.12), histological grading in poorly differentiated (HRadj=1.84; 95%CI=1.32-2.56), and Universal Coverage Scheme (HRadj=1.37;95%CI=1.09-1.72). Conclusion: The survival of colorectal cancer patients in the Universal Coverage Scheme was likely to be poorer than in the Civil Servant Medical Benefit Scheme. This indicates an urgent need for a national program for colorectal cancer screening in the general population and access to health insurance.