KMS may be treated in a stepwise approach. High-dose steroid does not result in a high response rate and is not tolerated well. The response to IFNalpha2b is more favorable, but life-threatening adverse events may occur. Chemotherapy with vincristine or vinblastine may be useful as adjunctive therapy in KMS, but experience is still limited.

Amount raised: Bht 3 million (∼USD 90,000) Background and context: Thai Cancer Society (TCS), a new cancer patient support group (PSG) in Thailand, was established in 2016, under the auspices of Heart to Heart Foundation. TCS aims to raise awareness of cancer, promote access to universal cancer care, and coordinated existing cancer-specific PSGs. To promote the Thai Cancer Society, a campaign “Stronger than Cancer: 1,000,000 km for Cancer Patients” was launched in 1 October 2017 and ended on World Cancer Day (WCD), 4 February 2018. Aim: To engage general public to exercise and raise awareness of cancer prevention, TCS, and WCD. Strategy/Tactics: People like to share and this is the era of online content. Thai people likes to donate money as for merit-making and good luck. This campaign created a conditional donation scheme whereby people can only donate if they run or walk. Program process: The campaign created a Facebook page and provide piggy bank to multiple business groups and engage participant to donate, on condition that they have run or walk first then they can donate 1 baht (USD 0.03) per km. They may use Endomondo application to track their running distance, share it on Facebook page, and automatically accumulated at aim to collect 1,000,000 km by WCD. An running event was conducted on WCD to collect piggy bank and donation were concluded. Costs and returns: Around 4400 people signed up for the campaign, >30,000 piggy bank was distributed, and 2185 used Endomondo app and some used other methods to collect their record. The app recorded 1,090,000 km by WCD deadline. Over 3,000,000 Baht was raised within 4 month, and donation continued after the WCD since many people continue to exercise and collect money. The cost of whole program was 1,500,000 Bht, inclusive of the running event. What was learned: This campaign has successfully engage many people to start exercise, using donation as motivation. New mindset on cancer intervention has been cultivated that we can overcome the cancer in 1 way or another.

Background: Thailand is a resource-limited country with universal health care. Cancer services are available for everyone for free, but the system has been overloaded due to limited number of qualified specialist physicians, nurses, radiology technicians, and growing demand from ageing population. Patients with advanced cancer are often not referred to a palliative care (PC) service until multiple treatment failure. Aim: To provide a better access to PC, we initiated an independent palliative care counseling and home service, focusing on families of patients with advanced cancer. Methods: The families of patients with advanced cancer were referred to our home palliative care service through cancer patient support groups, self-referral or from other physicians. Eligibility for PC was guided through a Thai national guideline of cancer treatment as well as by NCCN guideline. Early stage cancer were excluded from the service and referred to oncology service of patient's choice. For each family, we arranged a family meeting/counseling session at patient's home or a designated place and introduce palliative care as well as cancer therapy options. If the patient choose palliative care, then we provide home PC. Patients are followed at home by home visits, and continually communicated online and by phone. Family members visits palliative clinic for morphine and other medications. Results: In the first 3 years of operation, 53 adult patients with advanced or recurrent cancer and their families were counseled. Fifty chose home palliative care service, exclusively (30) or along with a hospital oncology service (20), while 3 patients preferred life-prolonging cancer therapy. The average age (±SD) of patients were 60 (±16) years. The most common cancers were stage IV or metastatic breast (7), lung (6), colorectal (6), and leukemia/lymphoma (6). The median survival time of this PC cohort was 3.1 months, with 16 (32%) living > 6 months, and 10 (20%) > 1 year. Of 36 patients who had died, 22 (61%) died at home, 13 (36%) at a local hospital, and 1 (3%) at a cancer center. Conclusion: For advanced cancer patients, palliative care can be introduced early and efficiently by PC team and most people would prefer PC. PC counseling may serve as an entry point to cancer care system. For patients who choose early palliative care, it can reduce burden on the existing busy oncology service, while providing satisfaction on patients and family.