No abstract

ImportanceLip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.ObjectiveTo analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence ReviewThe incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.FindingsIn 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and RelevanceIn this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.

Objectives To systematically evaluate the cost-effectiveness of telehealth-delivered nutrition interventions for improving health outcomes in adults living with chronic disease. Methods PubMed, CENTRAL, CINAHL and Embase were systematically searched from database inception to November 2021. Included studies were randomized controlled trials implementing a telehealth-delivered diet intervention in adults with chronic disease compared to non-telehealth (either alone or in combination with an exercise prescription), which reported on cost-effectiveness or cost-utility analysis. All studies were independently screened, and data extraction and quality appraisal adhered to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist by two review authors. Data analysis was conducted by grouping studies according to their telehealth modality and payer perspective. Results Twelve randomized controlled trials; five phone-only interventions, three mobile health (mHealth), two online, and one each using a combination of phone-online or phone-mHealth interventions) were included in the review. mHealth interventions were found to be the most cost-effective intervention (in 100% (n = 3) of studies. Across all telehealth interventions analyzed from health system perspectives (n = 10), 60% studies were found to be cost-effective. One of the three (33%) studies analysed from societal perspectives reported that the intervention was cost-effective. Cost-utility analyses (n = 10) found 30% of studies were cost-saving and more effective, making the interventions dominant over usual care. One study reported no difference in costs or effectiveness and the remaining six studies reported increased cost and effectiveness, requiring payers to determine whether the incremental cost per additional quality-adjusted life year (QALY) gained falls within an acceptable willingness-to-pay threshold. Quality of study reporting varied with between 63% to 92%. Conclusions Telehealth-delivered nutrition care programs appear to be cost-effective from a health system perspective, particularly mHealth modalities for managing chronic disease nutrition care. These findings support telehealth-delivered nutrition care as an effective intervention to deliver high-quality care in a cost-effective way. Funding Sources None.

This study aimed to assess socio-demographic correlates of unhealthy lifestyles among adolescents and adults in Ethiopia. A population-based national cross-sectional survey using the WHO NCD STEPS instruments was conducted. Data were collected in 2015, from a total of 9,800 participants aged between 15 and 69 years. Unhealthy lifestyle scores (0 [most healthy] to 5 [most unhealthy]) were determined based on diet (daily fruit and vegetable consumption), smoking status, overweight/obesity, alcohol intake, and physical activity. A co-occurrence of 3 or more unhealthy lifestyles was considered as an unhealthy lifestyle. The study found that 98.2% of participants had low consumptions of fruit and vegetables, 5.4% smoked tobacco, 15.0% consumed excessive alcohol, 66.0% had inadequate physical activity and 2.3% were obese. One in eight (13%) participants were having three or more unhealthy lifestyles. We found that male sex, urban residence, older age, being married or living in common-law, and higher income were associated with unhealthy lifestyles. Participants with higher educational status had lower odds of unhealthy lifestyles. Socio-demographic characteristics such as sex, age, marital status, residence, income, and educational status were correlated with individuals’ lifestyles. Tailored interventions that target specific socio-demographic groups are required to address the increasing burden of unhealthy lifestyles in Ethiopia.

32 Purpose Adverse drug reactions (ADRs) are a global problem and constitute a major clinical problem in terms of human suffering. The high toxicity and narrow therapeutic index of chemotherapeutic agents makes oncology pharmacovigilance essential. The objective of the current study was to assess the pattern of ADRs that occur in patients with cancer who were treated with chemotherapy in a tertiary care teaching hospital in Ethiopia. Methods A cross-sectional study over a 2-year period from September 2013 to August 2015 was conducted in patients with cancer who underwent chemotherapy at Gondar University Referral Hospital Oncology Center. Data were collected directly from patients and their medical case files. Reported ADRs were assessed for causality using the WHO causality assessment scale and Naranjo’s algorithm. Severities of the reported reactions were also assessed using National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0). Pearson’s χ2 test was used to examine the association between two categorical variables. Results A total of 815 ADRs were identified from 203 patients who were included in the study. The most commonly occurring ADRs were nausea and vomiting (18.9%), infections (16.7%), neutropenia (14.7%), fever and/or chills (11.3%), and anemia (9.3%). Platinum compounds (31.4%) were the most common group of drugs that caused ADRs. Of reported ADRs, 65.8% were grades 3 to 4 (severe level), 29.9% were grades 1 to 2 (mild level), and 4.3% were grade 5 (toxic level). Significant association was found between age, number of chemotherapeutic agents, and dose of chemotherapy with the occurrence of grades 3 to 5 toxicity. Conclusion The high incidence of chemotherapy-related ADRs among patients with cancer is of concern. Establishing an effective ADR monitoring and reporting system—oncopharmacovigilance—and creating awareness among health care professionals of the importance of ADR reporting may help prevent the problem. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.