Báo cáo nghiên cứu khoa học: "Chương trình kiểm soát ung thư ở Thừa Thiên Huế, Việt Nam, 2008-2009" docx

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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.



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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 .


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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


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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:


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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.

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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.


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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. However, it is very necessary for training in specialized
oncology for medical staff, cancer research and scientific collaboration .
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3. Anh Hoang Pham, Situation with cancer control in Vietnam , Japanese Journal of
Clinical Oncology 32:S92-S97, (2002).
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Article of HCM city, Vol 12, No 4, 2008: 1-8.
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9. Vietnam Cancer Control :
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