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Oral cancer screening can assist in the early detection of oral potentially malignant lesions (OPMLs) and prevention of oral cancers. It can be challenging for clinicians to differentiate OPMLs from benign conditions. Adjunct screening tools such as fluorescence visualisation (FV) and DNA image cytometry (DNA-ICM) have shown success in identifying OPMLs in high-risk clinics. For the first time we aimed to assess these technologies in Indian rural settings and evaluate if these tools helped clinicians identify high-risk lesions during screening.Dental students and residents screened participants in five screening camps held in villages outside of Hyderabad, India, using extraoral, intraoral, and FV examinations. Lesion and normal tissue brushings were collected for DNA-ICM analysis and cytology.Of the 1116 participants screened, 184 lesions were observed in 152 participants. Based on white light examination (WLE), 45 lesions were recommended for biopsy. Thirty-five were completed on site; 25 (71%) were diagnosed with low-grade dysplasias (17 mild, 8 moderate) and the remaining 10 showed no signs of dysplasia. FV loss was noted in all but one dysplastic lesion and showed a sensitivity of 96% and specificity of 17%. Cytology combined with DNA-ICM had a sensitivity of 64% and specificity of 86% in detecting dysplasia.DNA-ICM combined with cytology identified the majority of dysplastic lesions and identified additional lesions, which were not considered high-risk during WLE and biopsy on site. Efforts to follow-up with these participants are ongoing. FV identified most high-risk lesions but added limited value over WLE.

Background/Objective: With the increasing interest in natural products, a phase I openlabel study of OMN54 (Aneustat™) in patients with advanced malignancies was initiated to determine toxicity, maximum tolerated dose (MTD), dose limiting toxicities (DLT), and pharmacokinetics (PK). OMN54 is a multitargeted agent, combining three Chinese botanicals; Ganoderma lucidium, Salvia miltiorrhiza and Scutellaria barbata. Methods: Eligible patients (pts) were >18 years of age with advanced solid tumors, able to swallow oral capsules, ECOG performance status < 2, measurable disease as defined by RECIST 1.1 and adequate organ function. Results: Twenty-two patients were enrolled in 6 dose levels, 2 with daily dosing and 4 with twicedaily dosing ranging from 1 to 5 grams daily. All were evaluated for toxicity and 20 for response. No treatment-related dose-limiting toxicities (DLTs) were reported and the recommended phase II dose (RP2D) was determined to be 2.5 g twice daily. Seven adverse events in 5 patients were reported as possibly drug-related; 6 were GI toxicity and 1 was a skin disorder. All were grade 1 except one grade 2 vomiting. No RECIST responses were seen. Six pts were treated with > 2 cycles; one for 8 cycles. Four patients had reductions in TGF –β and EGF, exploratory biomarkers possibly suggestive of a drug effect. Plasma half-lives of 1 -2 hours were noted for all parent drug chemical markers with no accumulation over time. Conclusion: OMN54 was well tolerated, with no DLTs observed. Further studies at the RP2D will assess the biological activity.

Active surveillance (AS) has gained acceptance as a primary management approach for patients diagnosed with low-risk prostate cancer (PC). In this qualitative study, we compared perspectives between patients and health care professionals (HCP) to identify what may contribute to patient–provider discordance, influence patient decision-making, and interfere with the uptake of AS. We performed a systematic comparison of perspectives about AS reported from focus groups with men eligible for AS (7 groups, N = 52) and HCP (5 groups, N = 48) who engaged in conversations about AS with patient. We used conventional content analysis to scrutinize separately focus group transcripts and reached a consensus on similar or divergent viewpoints between them. Patients and clinicians agreed that AS was appropriate for low grade PC and understood the low-risk nature of the disease. They shared the perspective that disease status was a critical factor to pursue or discontinue AS. However, men expressed a greater emphasis on quality of life in their decisions related to AS. Patients and clinicians differed in their perspectives on the clarity, availability, and volume of information needed and offered; clinicians acknowledged variations between HCP when presenting AS, while patients were often compelled to seek additional information beyond what was provided by physicians and experienced difficulty in finding or interpreting information applicable to their situation. A greater understanding of discordant perspectives about AS between patients and HCP can help improve patient engagement and education, inform development of knowledge-based tools or aids for decision-making, and identify areas that require standardization across the clinical practice.

Background: In prostate cancer, men diagnosed with low risk disease may be monitored through an active surveillance. This research explored the perspectives of men with prostate cancer regarding their decision-making process for active surveillance to identify factors that influence their decision and assist health professionals in having conversations about this option. Methods: Focus group interviews (n = 7) were held in several Canadian cities with men (N = 52) diagnosed with prostate cancer and eligible for active surveillance. The men’s viewpoints were captured regarding their understanding of active surveillance, the factors that influenced their decision, and their experience with the approach. A content and theme analysis was performed on the verbatim transcripts from the sessions. Results: Patients described their concerns of living with their disease without intervention, but were reassured by the close monitoring under AS while avoiding harmful side effects associated with treatments. Conversations with their doctor and how AS was described were cited as key influences in their decision, in addition to availability of information on treatment options, distrust in the health system, personality, experiences and opinions of others, and personal perspectives on quality of life. Conclusions: Men require a thorough explanation on AS as a safe and valid option, as well as guidance towards supportive resources in their decision-making.

Summary Following the implementation of the National Cancer Prevention and Control Results-based Budget Programme (PpR Cancer–024) in 2011, the Peruvian Government approved the Plan Esperanza—a population-based national cancer control plan—in 2012. Legislation that ensured full government-supported funding for people who were otherwise unable to access or afford care and treatment accompanied the Plan. In 2013, the Ministry of Health requested an integrated mission of the Programme of Action for Cancer Therapy (imPACT) report to strengthen cancer control in Peru. The imPACT Review, which was executed in 2014, assessed Peru's achievements in cancer control, and areas for improvement, including cancer control planning, further development of population-based cancer registration, increased prevention, early diagnosis, treatment and palliative care, and the engagement and participation of civil society in the health-care system. This Series paper gives a brief history of the development of the Plan Esperanza, describes the innovative funding model that supports it, and summarises how funds are disseminated on the basis of disease, geography, and demographics. An overview of the imPACT Review, and the government's response in the context of the Plan Esperanza, is provided. The development and execution of the Plan Esperanza and the execution of and response to the imPACT Review demonstrates the Peruvian Government's commitment to fighting cancer across the country, including in remote and urban areas.

Aims: Oral cancer is ranked among the top three commonly occurring cancers in India with over 120,000 cases reported annually. Advanced stage diagnosis is common due to poor access to healthcare and low socioeconomic status, limiting the 5-year survival rate to a dismal 27%. In India, 60-80% of patients present with advanced disease as compared to 40% in developed countries. Oral cancer screening is a quick, painless, and non-invasive exam to detect suspicious lesions that can reduce mortality rates significantly. The aim of the project was to determine the feasibility of conducting oral cancer screening in rural areas around Hyderabad, India in collaboration with Two Worlds Cancer Collaboration, Canada; MNJ Cancer Hospital, India and two dental colleges in Hyderabad. Methods: Planning and communication between the Indian and Canadian partners were facilitated by Zoom videoconferencing. Ethics approval for the feasibility phase was obtained in both countries. A feasibility study was planned in a rural village. Prior to screening, the Urulla village community school required infrastructure changes such as furniture and electricity. Fluorescence Visualization (FV) units were shipped from Canada to India to assess if they improve the sensitivity and specificity of screening in this setting. The Canadian team trained the Indian clinicians on use of FV and study methodology. The feasibility study was conducted in March 2018 where participants received a detailed risk habit evaluation, intraoral and extraoral examination. Results: A total of 114 participants were screened, 62% males and 38% females with a median age of 55 years. Four percent had a family history of oral cancer, 33% had a smoking history of which the majority (65%) smoked beedis. Nineteen percent chewed pan, gutka or other chewing substances. Seventy-one percent drank alcohol, primarily beer/toddy (65%). Screening data was complete for 112 participants of which 16 (14.2%) had intraoral lesions. Lesion presence was not significantly associated with smoking, chewing habit or alcohol drinking (P=0.370, P=0.207, P=0.393). The majority of lesions were on the labial and buccal mucosa (79%). Forty-three percent of lesions showed a loss of fluorescence. Out of the 16 lesions, 7 lesions were clinically deemed as high-risk and recommended to undergo biopsy. Loss of fluorescence was noted in 6 out of 7 lesions, and was highly significant with high-risk lesion presence (p Conclusion: The high evidence of disease warrants the need for oral cancer screening in rural India. The feasibility study paved way for the pilot study which aims to screen over 1000 participantsin rural areas around Hyderabad using additional adjunct tools like FV and Quantitative Cytology to improve accuracy and semi-automate the screening process. Acknowledgements: This study was supported through fundraising efforts by Two Worlds Cancer Collaboration, an NPO based in Kelowna, Canada. Two Worlds aims to provide cancer palliative care in low resource countries. Citation Format: Madhurima Datta, Nallan CSK Chaitanya, Shyam Ndvn, Gayatri Palat, Jean Jacob, Priya Chandran, Vineela Rapelli, Jagannath Jn, Sandra Broughton, Simon Sutcliffe, Denise Marie Laronde. Indo-Canadian parternship for oral cancer screening in rural India [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5774.

Background: Over the last decade, active surveillance has proven to be a safe approach for patients with low-risk prostate cancer. Although active surveillance presents several advantages for both patients and the health care system, all eligible patients do not adopt this approach. Our goal was to evaluate the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach. Methods: Focus groups (n = 5) were held with physicians who provided care for men with low-risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of health care professionals (HCPs) was captured to understand their decisions in proposing active surveillance and to reveal the barriers and facilitators that affect the adherence to this approach. A content analysis was performed on the verbatim transcripts from the sessions. Results: Although physicians agreed that active surveillance is a suitable approach for low-risk prostate cancer patients, they were concerned about the rapidly evolving and non-standardized guidelines for patient follow-up. They pointed out the need for additional tools to appropriately identify proper patients for whom active surveillance is the best option. Urologists and radiation-oncologists were keen to collaborate with each other, but the role of general practitioner remained controversial once patients were referred to a specialist. Conclusions: Integration of more reliable tools and/or markers in addition to more specific guidelines for patient follow-up would increase the confidence of both patients and physicians in the choice of active surveillance.

We investigated the mechanism of action, safety, and efficacy of the Site-Specific Immunomodulator (SSI) QBECO, a novel immunotherapy for Crohn’s disease (CD). Using human monocytic THP-1 cells, we demonstrate that SSI QBECO (derived from the common colon bacteriaE. coli) activates macrophages to an M1 phenotype (associated with enhanced capacity to eliminate bacteria and activate innate immune responses). We assessed SSI QBECO in a compassionate use protocol of ten adult patients with active CD. Patients with moderate to severe clinical symptoms receiving conventional CD treatments and/or complementary therapies were included, except patients receiving anti-TNF medications. SSI QBECO was self-administered subcutaneously every second day, for a minimum of 2.5 months and a maximum of 11 months. All 10 patients reported improvement of symptoms while on the SSI QBECO treatment. Seven patients reported full resolution of clinical symptoms during a course of SSI QBECO of at least three months. Three patients have experienced ongoing sustained clinical remission after discontinuing all medications, including SSI treatment. The longest case of clinical remission is still ongoing (>4 years). No serious severe adverse clinical events were reported. Collectively, we conclude that treatment with the immunoactive SSI QBECO was well tolerated and effective for treatment of Crohn’s disease in this case series.

Acute infection is known to induce strong anti-tumor immune responses, but clinical translation has been hindered by the lack of an effective strategy to safely and consistently provoke a therapeutic response. These limitations are overcome with a novel treatment approach involving repeated subcutaneous delivery of a Klebsiella-derived investigational immunotherapeutic, QBKPN. In preclinical models of lung cancer, QBKPN administration consistently showed anti-cancer efficacy, which was dependent on Klebsiella pre-exposure, but was independent of adaptive immunity. Rather, QBKPN induced anti-tumor innate immunity that required NK cells and NKG2D engagement. QBKPN increased NK cells and macrophages in the lungs, altered macrophage polarization, and augmented the production of cytotoxic molecules. An exploratory trial in patients with non-small cell lung cancer demonstrated QBKPN was well tolerated, safe, and induced peripheral immune changes suggestive of macrophage polarization and reduction of PD-1 and PD-L1 expression on leukocytes. These data demonstrate preclinical efficacy, and clinical safety and tolerability, for this cancer immunotherapy strategy that exploits innate anti-tumor immune mechanisms.

International meetings on various aspects of cancer- its etiology, its diagnosis, its treatment, its palliation, and its prevention and control are held frequently. Many have similar themes, and many seek and receive the same speakers and audiences. A fundamental question arises: what difference does any individual meeting/congress/ conference make or add to our understanding of the relevant issues? While many meetings conduct evaluations at the end of the Congress, few use evaluation as a tool to guide design, implementation, and evaluation of both short and long term impacts, and address the question of "what difference did the Congress make". The International Cancer Control Congresses, which are held biennially in different regions of the world, took the opportunity to use evaluation in this way, and ask the relevant questions. This paper describes that evaluation session of the ICCC4, held in Seoul, Korea in November 2011, which was part of the larger evaluation issue.

81 Background: Active surveillance has gained widespread acceptance as a safe approach for patients with low risk prostate cancer. Despite presenting several advantages for both patients and the health care system, active surveillance is not adopted by all eligible patients. In this study, we evaluated the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach. Methods: We conducted five focus groups with a total of 48 health care providers (HCP) including family physicians, urologists, surgeons, radiation oncologists, fellows, and residents/medical students. These participants were all providing care for men with low risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of these HCP from academic hospitals in four Canadian provinces was captured. A content and theme analysis was performed on the verbatim transcripts to understand HCP decisions in proposing active surveillance and reveal the facilitators that affect the adherence to this approach. Results: Participants agreed that active surveillance is a suitable approach for low risk prostate cancer patients, but expressed concerns on the rapidly evolving and non-standardized guidelines for patient follow-up. They raised the need for additional tools to appropriately identify the patients best suited for active surveillance. Collaborations between urologists, radiation-oncologists, and medical oncologists were favoured, however, the role of general practitioners remained controversial once patients were referred to a specialist. Conclusions: Integration of more reliable tools and/or markers, and more specific guidelines for patient follow-up would help both patients and physicians in the decision-making for active surveillance.

Cancer is a growing global health issue, and many countries are ill-prepared to deal with their current cancer burden let alone the increased burden looming on the horizon. Growing and aging populations are projected to result in dramatic increases in cancer cases and cancer deaths particularly in low- and middle-income countries. It is imperative that planning begin now to deal not only with those cancers already occurring but also with the larger numbers expected in the future. Unfortunately, such planning is hampered, because the magnitude of the burden of cancer in many countries is poorly understood owing to lack of surveillance and monitoring systems for cancer risk factors and for the documentation of cancer incidence, survival and mortality. Moreover, the human resources needed to fight cancer effectively are often limited or lacking. Cancer diagnosis and cancer care services are also inadequate in low-and middle-income countries. Late-stage presentation of cancers is very common in these settings resulting in less potential for cure and more need for symptom management. Palliative care services are grossly inadequate in low- and middle-income countries, and many cancer patients die unnecessarily painful deaths. Many of the challenges faced by low- and middle-income countries have been at least partially addressed by higher income countries. Experiences from around the world are reviewed to highlight the issues and showcase some possible solutions.

PURPOSE: To evaluate clinical outcome of patients with limited-stage diffuse large-cell lymphoma (DLCL) treated with three cycles of chemotherapy followed by involved-region irradiation (IRRT). PATIENTS AND METHODS: Adults with limited-stage DLCL were treated with brief doxorubicin-containing chemotherapy regimens between 1980 and 1998. IRRT was administered 3 to 4 weeks after the third chemotherapy treatment in a dose equivalent to 30 Gy in 10 fractions. RESULTS: Three hundred and eight patients (median age, 64 years) were included, and 299 experienced complete remission. After a median follow-up of 86 months, 64 patients developed progressive disease, and 104 patients died (43 from lymphoma, three from toxicity, and 58 from other causes). Actuarial overall and progression-free survival (PFS) rates were, respectively, 80% and 81% at 5 years and 63% and 74% at 10 years. For subgroups identified using the Miller modification of the International Prognostic Index (IPI), the overall survival rates at 5 and 10 years were, respectively, 97% and 89% (no factors), 77% and 56% (one or two factors), and 58% and 48% (three or four factors), and the 5-year and 10-year PFS rates were, respectively, 94% and 89% (no factors), 79% and 73% (one or two factors), and 60% and 50% (three or four factors). Men with testicular presentation, had a definitely inferior outcome. CONCLUSION: Long-term outcome with three cycles of doxorubicin-based chemotherapy and IRRT confirms that this is a successful approach for the majority of patients with limited-stage DLCL. Subgroups with worse prognoses can be identified, and these patients should be offered alternative treatment approaches.

In 2002, there were 10.9 million new cancer cases in the world; 6.7 million deaths were due to cancer 1 . Cancer incidence (new cases) rises each year due to population growth and aging. Overall, five year survival rates vary from less than 15% to greater than 60% across nations 2 . Although improvements in mortality from cancer are tak ing place, they do not offset the increase in incidence. Hence, each year, more people will develop cancer, more will die of cancer, and more will be survivors of cancer ‐ the burden (personnel, community and socio-economic) will continue, inexorably, to in crease. If the cancer issue is to be addressed, the interventions must be directed at the process of cancer, not solely to the disease. Thus, cancer control must address inci dence through primordial and primary prevention, detection of curable, asympto matic, early stage disease, effective treatment programs for established disease, and palliative, supportive and end-of-life care to meet the needs of those cured and those whose death requires dignity, symptom control and compassion. To be effective, can cer control plans must be directed to the entire population (the healthy, high-risk, ill, cured and dying), recognizing that disparities of access, circumstances, gender, eth nicity and social well-being exist in all populations. Population-based cancer control plans require a vision of what is to be achieved, principles that will characterize the intents and expectations, and a process for adapt ing plans to align with the contextual realities of the nation/country from cultural, political and resource perspectives. Consideration must be given to the extent that cancer control plans are specific to cancer, or whether they are integrated into strate gies that address many non-communicable diseases [NCDs], given the common risk factors across NCDs and the overlap of principles underlying disease control plans. Finally, all plans must consider the content, the implementation process, the ‘stake holders’ (government, non-government organizations [NGOs], foundations, profes sionals, patients, public and the private sector) and their roles and relationships, and the timeframe over which plans will be enacted. To control the process of NCDs, in cluding cancer, requires collaboration, relationships and ‘partnerships’ ‐ it cannot be achieved solely by discrete organizations, institutions, or disciplines. Given the diver sity and disparity across populations and the rising cancer/NCD burden that will face all, common purpose, collaboration, knowledge transfer and rational action must characterize the way forward. The purpose of the 3 rd International Cancer Control Congress (ICCC-3) was to promote and foster a global community of practice through enabling extensive participation and dialogue between countries and societies with wide and varying experiences in cancer control; building on and synergizing ongoing work by governments, NGOs, international organizations and patient and public groups to make sustainable cancer control an important global priority. The ICCC-3 was held in Cernobbio, Italy in November 2009, and was built upon the achievements of the ICCC-1 (Vancouver, 2005) and ICCC-2 (Rio de Janeiro, 2007) by ensuring an agenda that focused on: international collaboration; establishment of sustainable na tional/large population cancer control strategies; promoting broad cross-sectoral participation (e.g., governments, cancer organizations, foundations, non-govern

BACKGROUND The aim of this study was to determine the prognostic factors for local failure and cause specific survival in differentiated thyroid carcinoma and the impact of surgery, radioiodine, and external beam radiation therapy (RT) when used as part of the initial management. METHODS The authors reviewed the records of 382 patients with differentiated thyroid carcinoma (papillary, 262; follicular, 120) managed at the Princess Margaret Hospital (PMH) between 1958 and 1985. There were 220 patients with Stage I or II, 102 with Stage III, and 33 with Stage IV disease (according to 1987 staging criteria of the International Union Against Cancer). The median duration of follow-up was 10.8 years. Potentially important prognostic factors for cause specific survival (CSS) and local relapse free rate (LRFR) were tested by multivariate regression analysis with emphasis on treatment factors. RESULTS For patients with papillary tumors, the 10-year CSS and overall survival were 93% and 85%, respectively; for those with follicular tumors, they were 69% and 56%. The LRFR for both histologic types were 86% at 10 and 15 years. Age >60 years, tumor size >4 cm, poor differentiation, postoperative presence of macroscopic residual disease, and presence of distant metastasis at presentation were identified in multivariate analysis as statistically significant factors for cause specific death. Age >60, tumor size >4 cm, multifocality, postoperative residuum, lymph node involvement, less extensive surgery (less than near-total thyroidectomy), and the lack of use of radioiodine were significant with regard to locoregional failure. The use of external RT was associated with more advanced local disease. There were no statistically significant differences in CSS or LRFR between patients who received RT and those who did not, even after adjustment for identified prognostic factors. In the subgroup of 155 patients with papillary histology and microscopic residuum, both 10-year CSS (100% vs. 95%, P = 0.038) and LRFR (93% vs. 78%, P = 0.01) were higher for patients given RT than for those not given RT. The 33 patients with macroscopic residual disease who received postoperative RT had a 5-year LRFR of 62% and CSS of 65%. CONCLUSIONS The prognostic factors for differentiated thyroid carcinoma have been clearly identified. Initial total thyroid ablation with total thyroidectomy and radioiodine was associated with a lower rate of local relapse, although CSS was unaffected. Many patients at risk for local recurrence received postoperative RT, which did not significantly affect the risk of local relapse or CSS in the entire group. A beneficial effect of RT was demonstrated in the subgroup of patients with papillary tumors and microscopic residuum. Patients with postoperative macroscopic residual disease appeared to benefit from RT (with or without radioiodine). A Phase III trial involving patients at high risk for local recurrence is required to assess the potential benefit of RT. Cancer 1998;82:375-88. © 1998 American Cancer Society.

Chapter 16 discusses how cancer control – with its greater emphasis on prevention and information prior to a cancer diagnosis – benefits from employing a public engagement/social mobilization model in many ways.

Chapter 23 defends the principles of population-based cancer control for all, but recognize that opportunities, priorities, and the real-life context will determine which policies and practices are pursued with what vigour, when, and how, to fulfil these principles.

Chapter 15 discusses the need for a strategy directed to the elements of the cancer process, from primary prevention to end-of-life care, and that the strategy be directed to the entire population. A comprehensive, population-based strategy is based upon certain foundational premises.

Chapter 1 discusses that treatment is essentially a facility-based intervention according to defined or accepted protocols; care describes the coordination and integration of activities to enhance well-being, including treatment episodes, across the various locations and circumstances in which care is provided; and control refers to the system response to meet the needs of the population served, encompassing issues of awareness, communication, education, access, support, costs, etc. associated with interventions to control cancer.

Cancer is a leading cause of death worldwide, accounting for approximately 7.6 million deaths (13% of all deaths) in 2008. Cancer mortality is projected to increase to 11 million deaths in 2030, with the majority occurring in regions of the world with the least capacity to respond. However, cancer is not only a personal, societal and economic burden but also a potential societal opportunity in the context of functional life - the years gained through effective prevention and treatment, and strategies to enhance survivorship. The United Nations General Assembly Special Session in 2011 has served to focus attention on key aspects of cancer prevention and control. Firstly, cancer is largely preventable, by feasible means. Secondly, cancer is one of a number of chronic, non- communicable diseases that share common risk factors whose prevention and control would benefit a majority of the world's population. Thirdly, a proportion of cancers can be attributed to infectious, communicable causal factors (e.g., HPV, HBV, H.pylori, parasites, flukes) and that strategies to control the burden of infectious diseases have relevance to the control of cancer. Fourthly, that the natural history of non-communicable diseases, including cancer, from primary prevention through diagnosis, treatment and care, is underwritten by the impact of social, economic and environmental determinants of health (e.g., poverty, illiteracy, gender inequality, social isolation, stigma, socio-economic status). Session 1 of the 4th International Cancer Control Congress (ICCC-4) focused on the social, economic and environmental, as well as biological and behavioural, modifiers of the risk of cancer through one plenary presentation and four interactive workshop discussions. The workshop sessions concerned 1) the Global Adult Tobacco Survey and social determinants of tobacco use in high burden low- and middle-income countries; 2) the role of diet, including alcohol, and physical activity in modifying the risk of cancer and other non-communicable diseases; 3) the role of infections in modifying the risk of cancer; and 4) the public policies and actions that can be implemented to effectively reduce the risk of cancer at population levels. Workshop discussions highlighted the need for high quality data on the prevalence of modifiable factors in different settings, as well as the social, economic and environmental drivers of these factors, in order to inform prevention and control programs. For some factors, further work needs to be done to develop simple and valid measurement tools. Given that many of these factors are common to both cancer and other non-communicable diseases, cancer prevention should be viewed within the broader perspective of the prevention of non-communicable diseases and should engage all relevant actors, including the general public, health and other professionals, workplaces and institutions, the media, civil society, schools, governments, industry, and multinational bodies. Many policies and plans have been implemented in various settings to control the drivers of modifiable factors and promote health and well-being. Mapping, analysis, and contextualization of those policies that are relevant would be helpful to promote action around cancer prevention in different settings.

The goals of cancer control strategies are generally uniform across all constituencies and are to reduce cancer incidence, reduce cancer mortality, and improve quality of life for those affected by cancer. A well-constructed strategy will ensure that all of its elements can ultimately be connected to one of these goals. When a cancer control strategy is being implemented, it is essential to map progress towards these goals; without mapping progress, it is impossible to assess which components of the strategy require more attention or resources and which are not having the desired effect and need to be re-evaluated. In order to monitor and evaluate these strategies, systems need to be put in place to collect data and the appropriate indicators of performance need to be identified. Session 2 of the 4th International Cancer Control Congress (ICCC-4) focused on how to manage population health to prevent and detect cancers and non-communicable diseases through two plenary presentations and four interactive workshop discussions: 1) registries, measurement, and management in cancer control; 2) use of information for planning and evaluating screening and early detection programs; 3) alternative models for promoting community health, integrated care and illness management; and 4) control of non-communicable diseases. Workshop discussions highlighted that population based cancer registries are fundamental to understanding the cancer burden within a country. However, many countries in Africa, Asia, and South/ Central America do not have them in place. A new global initiative is underway, which brings together several international agencies, and aims to establish six IARC regional registration resource centres over the next five years. These will provide training, support, infrastructure and advocacy to local networks of cancer registries, and, it is hoped, improve the host countries' ability to assess and act on cancer issues within their jurisdictions. Multiple methods of programme evaluation were presented across workshops, but all were attuned to both the resource base and the specific questions to be addressed. Where innovative strategies were being tested, customized evaluation strategies should be undertaken. Where programmes are well-developed and data is being collected for evaluation, there is the opportunity for sophisticated analytical methods to be used to pinpoint specific areas or delivery sites for future quality improvement. Finally, unique opportunities now exist to integrate the strategies developed in cancer control and evaluation with those under development for other non-communicable diseases. This area will likely be one for future development.

Substantial differences in population-based cancer control outcomes exist within and between nations. Optimal outcomes derive from 'what we know', 'what we apply in practice', and 'how complete and compliant is the population uptake of public health and clinical practice change'. This continuum of research (scientific discovery) to practice (application and uptake) to policy impacts the speed and completeness of practice change and is greatly influenced by the ability, opportunity and readiness of countries to implement evidence informed practices and policies through innovative change. Session 4 of the 4th International Cancer Control Congress focused on knowledge exchange through three plenary presentations and five interactive workshop discussions: 1) the role of epidemiological data as a basis for policy formulation; 2) existing global frameworks for cancer control; 3) knowledge exchange as it relates to public health practice and policy; 4) knowledge exchange in relation to primary, community, and specialist cancer care; and 5) the role of public engagement and advocacy in influencing cancer control policy. Common themes emerging from workshop discussions included the recognition of the importance of knowledge exchange processes, constituents and forums as key aspects of preparedness, awareness and readiness to implement public health and clinical practice change. The importance of cultural and contextual differences between nations was identified as a challenge requiring development of tools for generating relevant population/societal data (e.g., projection methodologies applied to population demographics, outcomes and resources, both societal, human and fiscal) and capacity building for facilitating knowledge transfer and exchange between the constituencies engaged in population-based public health practice and clinically based primary care and disease specialty practice exchange (researchers, health practitioners, health administrators, politicians, patients and families, and the private and public sectors). Understanding patient and public engagement advocacy and its role in influencing health and public policy investment priorities emerged as a critical and fundamental aspect of successful implementation of evidence-informed cancer control change.

Survival following a diagnosis of cancer is contingent upon an interplay of factors, some non-modifiable (e.g., age, sex, genetics) and some modifiable (e.g., volitional choices) but the majority determined by circumstance (personal, social, health system context and capacity, and health policy). Accordingly, mortality and survival rates vary considerably as a function of geography, opportunity, wealth and development. Quality of life is impacted similarly, such that aspects of care related to coordination and integration of care across primary, community and specialist environments; symptom control, palliative and end-of-life care for those who will die of cancer; and survivorship challenges for those who will survive cancer, differs greatly across low, middle and high-income resource settings. Session 3 of the 4th International Cancer Control Congress (ICCC-4) focused on cancer care and treatment through three plenary presentations and five interactive workshop discussions: 1) establishing, implementing, operating and sustaining the capacity for quality cancer care; 2) the role of primary, community, and specialist care in cancer care and treatment; 3) the economics of affordable and sustainable cancer care; 4) issues around symptom control, support, and palliative/end-of-life care; and 5) issues around survivorship. A number of recommendations were proposed relating to capacity-building (standards and guidelines, protocols, new technologies and training and deployment) for safe, appropriate evidence-informed care; mapping and analysis of variations in primary, community and specialist care across countries with identification of models for effective, integrated clinical practice; the importance of considering the introduction, or expansion, of evidence-supported clinical practices from the perspectives of health economic impact, the value for health resources expended, and sustainability; capacity-building for palliative, end-of-life care and symptom control and integration of these services into national cancer control plans; the need for public education to reduce the fear and stigma associated with cancer so that patients are better able to make informed decisions regarding follow-up care and treatment; and the need to recognize the challenges and needs of survivors, their increasing number, the necessity to integrate survivorship into cancer control plans and the economic and societal value of functional survival after cancer. Discussions highlighted that coordinated care and treatment for cancer patients is both a ' systems'challenge and solution, requiring the consideration of patient and family circumstances, societal values and priorities, the functioning of the health system (access, capacity, resources, etc.) and the importance assigned to health and illness management within public policy.

Purpose: With the increasing interest in natural products as therapeutics, we performed a Phase I open label study of OMN54 in patients with advanced malignancies to determine toxicity, maximum tolerated dose (MTD), dose limiting toxicities (DLT), and pharmacokinetics (PK). OMN54 is a multitargeted agent prepared from three Chinese botanical sources: Ganoderma lucidum, Salvia miltiorrhiza, and Scutellaria barbata, each with long histories of use as single agents. Methods: Eligible patients (pts) were ≥ 18 years with advanced solid tumor malignancies, able to swallow oral capsules, ECOG performance status ≤ 2, measurable disease as defined by RECIST 1.0, and adequate organ function. Results: 22 pts were enrolled in 6 dose levels, 2 at daily and 4 with twice daily dosing ranging from 1 to 5 gm orally per day; all evaluable for toxicity and 20 for response. Most common cancers included colorectal (13 pts), non small cell lung (3 pts), and ovarian (2 pts). 5 pts patients completed Cycle 1, 9 pts Cycle 2, 3 pts Cycle 3 and 1 pt each completed Cycles 4, 5, and 8. 2 pt had < 1 cycle. Only 7 AEs in 5 pts were reported as possibly related to study drug; 6 were gastrointestinal disorders, 1 a skin disorder. One GR 2 AE of vomiting was probably related to study drug. All other AEs were Grade 1. There were no treatment-related SAEs or DLTs. A recommended phase II dose (RP2D) is 2.5 g orally twice daily. PK data revealed evidence of detectable plasma total OMN54 in cohorts 1 to 6 with all 4 parent drug chemical markers with plasma half-lives of 1- 2 hours and no evidence of accumulation. Preliminary evidence of biological activity was seen with stable disease for 8 months in 1 pt and 4 pts with dose responsive reductions in TGF-β, EGF & Rantes, biomarkers of immune suppression. Significant TGF-β decreases were seen for 4 pts at doses of 2gm daily to 2.5 gm bid including an ovarian, colorectal, fallopian tube and esophageal cancer. Conclusion: OMN54 was well tolerated with no DLTs observed. Further studies at RP2D of 2.5 g bid orally should be done to assess activity. Citation Format: Daniel Renouf, Christian Kollmannsberger, Kim Chi, Stephen Chia, Anna Tinker, Teresa Mitchell, Stephen Lam, Teresa Joshi, David Kwok, John Ostrem, Simon Sutcliffe, Karen A. Gelmon. A phase 1 study of OMN54 in patients with advanced malignancies. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr C41.

Increasing the awareness of the clinical and psychosocial needs that are particular to adolescents and young adults (AYA) was a top priority, as was strengthening advocacy efforts to empower and support this group. To date, AYA advocates had some success in generating public awareness and building a solid clinical justification for increased focus on this population. It had been established that the economic burden of their mortality was significant, their cancers were unusual, their medical care was often inadequate, and their outcomes for many cancers had not improved in the past 3 decades. As the awareness and advocacy campaign continued to grow and evolve across the globe, it was an important goal to integrate the efforts of all stakeholders to ensure that it progressed with a single, consensual, focused message identifying a common priority for action. By coordinating the efforts of the scientific, medical, and advocacy communities, it was possible to amplify their separate efforts and activities and more efficiently achieve large-scale change in the world of AYA oncology.

Canada is a westernized, market-economy nation with a publicly funded health care and cancer control system and has health indices reflective of a high-resource economy. Provision of health services is in accord with the Canada Health Act and is implemented through federal, provincial, and territorial relations wherein federal funding partly provides support for the provincial/territorial delivery of health services. Cancer services are provided within the acute health care system with dedicated entities existing in parallel in most provinces to provide services specific to the diagnosis, treatment, and support of cancer patients. Interprovincial and territorial collaboration to enhance and facilitate optimal cancer system performance is enabled through the Canadian Partnership Against Cancer (the Canadian national cancer control initiative). Adolescent and young adult (AYA) cancer patients use both the pediatric and adult cancer systems. There is recognition, however, that although AYA patients are numerically a small portion of all cancer patients, the negative personal, societal, and socioeconomic impacts of potential years of life lost are substantial and can be lessened through attention to awareness, education, redesign of care and care pathways, quality of life, developmental aspects related to adolescent-teen-adult transitions, continuity of care, and surveillance across pediatric and adult settings. Appropriate solutions need to be established within the framework of the Canadian Health Service by innovative rethinking and realignment of system capacity and performance to the special needs of AYA cancer patients.

Comprehensive cancer control is defined as an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality across the cancer control continuum from primary prevention to end-of-life care. This approach assumes that when the public sector, non-governmental organizations, academia, and the private sector share with each other their skills, knowledge, and resources, a country can take advantage of all its talents and resources to more quickly reduce the burden of cancer for all its population. One critical issue for comprehensive cancer control is the extent to which the private sector can contribute to cancer prevention and control programs and policies that have historically been lead by the public health sector, and similarly how can the public sector increase its investment and involvement in clinical research and practice issues that are largely driven by the private sector worldwide? In addition, building capacity to integrate research that is appropriate to the culture and context of the population will be important in different settings, in particular research related to cancer control interventions that have the capacity to influence outcomes. To whatever extent cancer control research is ultimately funded through the private and public sectors, if investments in research discoveries are ultimately to benefit the populations that bear the greatest burden of disease, then new approaches to integrating the lessons learned from science with the lessons learned from service (public health, clinical, and public policy) must be found to close the gap between what we know and what we do. Communities of practice for international cancer control, like the ones fostered by the first three International Cancer Control Congresses, represent an important forum for knowledge exchange opportunities to accelerate the translation of new knowledge into action to reduce the burden of cancer worldwide.

The burden of cancer continues to increase globally, with substantial personal, societal, and economic consequences. Population growth and aging underlie this increase&mdash, a reflection of the effect of population health interventions in the last two centuries. Much of this gain has come through observation, derivation of evidence, and rigorous application of valid science to the public, both healthy and affected by diseases such as cancer. Increasingly, molecular medicine will affect the knowledge of cause and the personalization of therapy. However, science informs the decision-making process and places evidence within the beliefs of individuals and society as they relate to innovation, judgment, and values&mdash, the &ldquo, logic&rdquo, underlying alignment of conventional and complementary (holistic) care as a basis for compelling, consistent, and confident decisions.

A key challenge in cancer control is the need for translational research to link discovery research with improved health outcomes. In British Columbia, we have built upon the idea of communities of practice to develop networks that will meet our cancer-control mandate.

Over the past few decades, there has been growing support for the idea that cancer needs an interdiscipli- nary approach. Therefore, the international cancer community has developed several strategies as outlined in the WHO non-communicable diseases Action Plan (which includes cancer control) as the World Health As- sembly and the UICC World Cancer Declaration, which both include primary prevention, early diagnosis, treat- ment, and palliative care. This paper highlights experi- ences/ideas in cancer control for international collabo- rations between low, middle, and high income coun- tries, including collaborations between the European Union (EU) and African Union (AU) Member States, the Latin-American and Caribbean countries, and the East- ern Mediterranean countries. These proposals are pre- sented within the context of the global vision on cancer control set forth by WHO in partnership with the Inter- national Union Against Cancer (UICC), in addition to is- sues that should be considered for collaborations at theglobal level: cancer survival (similar to the project CON- CORD), cancer control for youth and adaptation of Clinical Practice Guidelines. Since cancer control is giv- en lower priority on the health agenda of low and mid- dle income countries and is less represented in global health efforts in those countries, EU and AU cancer stakeholders are working to put cancer control on the agenda of the EU-AU treaty for collaborations, and are proposing to consider palliative care, population-based cancer registration, and training and education focus- ing on primary prevention as core tools. A Community of Practice, such as the Third International Cancer Con- trol Congress (ICCC-3), is an ideal place to share new proposals, learn from other experiences, and formulate new ideas. The aim of the ICCC-3 is to foster new inter- national collaborations to promote cancer control ac- tions in low and middle income countries. The develop- ment of supranational collaborations has been hin- dered by the fact that cancer control is not part of the objectives of the Millennium Development Goals (MG- Gs). As a consequence, less resources of development aids are allocated to control NCDs including cancer.