Cập nhật lúc : 15/06/2016 10:52




(Early cancer diagnosis allows successfull treatment.
Late diagnosis of cancer leads to difficult and insufficient treatment)
Abtract: Cancer has become the leading cause of death in many countries.It is also being a burden in Vietnam because of lack of the necessary personnel, hospitals and equipments to manage the cases which, for many different reasons. Presently cancer, which is a global epidemic and is not limited to any category of people.
A majority of cancers in Vietnam are diagnosed at an advanced stage of disease because of lack of screening and early detection services, as well as limited awareness of early signs and symptoms of cancer among the public and health care. Its frequency is even expected to rise rapidly within the next few years if adequate precautions, based on current knowledge in oncology, are not taken presently. This rise in our country which already has any problems making cancer management very difficult necessitates satisfactory measures in order to mitigate what some are already considering as an impending tragedy or catastrophe.
To improve survival for patients, early diagnosis should be the most important gold in cancer control program in Vietnam.
Cancer is an emerging public health problem in Vietnam.Accordingto the International Agency for Research on Cancer (IARC), about 150,000 new cancer cases and 75,000 cancer deaths occurred in 2008 in Vietnam. These numbers are projected to increase rapily (189.000 new cancer cases in 2020) within next few years simply due to the aging and growth of the population, with the potential to be even higher because of the adoption of behaviors and lifestyles associated with economic development, suchas smoking, unhealthy diet, and physical inactivity. Despite this growing burden, cancer continues to receive low public health priority in Vietnam, largely because of limited resources and other pressing public health problems, including communicable diseases such as acquired immune deficiency syndrome (AIDS)/human immunodeficiency virus (HIV) infection, malaria, and tuberculosis . It may also be in part due to a lack of awareness about the magnitude of the current and future cancer burden among policy makers, the general public, and international private or public health agencies.
In addition , most of cancer patients present at the hospital at an advanced stage. The data from many reports show that the proportion of stage 3-4 is about 80%(2 ) when the cancer can not be or only very ineffectively cured and treatment cost rise substantially.
Down-staging should be an important goal of cancer control in VietNam. It is also suitable to the one of targets of Vietnam National Strategy for Cancer Control up to 2010 and 2020.This paper intends some of this impending difficult prevision and some of the possible solutions of the problem.
Việt Nam là một trong những nước đang phát triển với mức thu nhập GNP trung bình là 640 USD năm 2005, dân số là 83.119 triệu người.Ung thư là một vấn đề y tế công cộng đang nổi lên ở Việt Nam. Theo điều tra của Cơ quan Quốc tế Nghiên cứu về Ung thư (IARC), mỗi năm tại Việt Nam có khoảng 150.000 trường hợp ung thư mới và 75.000 ca tử vong do ung thư ( số liệu năm 2008 ).Những con số này được dự báo sẽ tăng rất nhanh (khoảng 189.000 trường hợp ung thư mới trong năm 2020) trong vài năm tiếp theo , lý do đơn giản có thể nhìn thấy được là do sự lão hóa và tăng trưởng dân số, việc thay đổi các hành vi và lối sống gắn với phát triển kinh tế như hút thuốc, chế độ ăn uống không lành mạnh, và ít vận động. Mặc dù gánh nặng ngày càng tăng này nhưng ung thư vẫn đang đứng ở vị trí ưu tiên khiêm tốn trong hệ thống y tế công cộng Việt Nam, chủ yếu là do nguồn lực hạn chế và sự ưu tiên tập chung giải quyết các vấn đề y tế công cộng cấp bách khác, bao gồm các bệnh truyền nhiễm như hội chứng suy giảm miễn dịch mắc phải (AIDS) / virus suy giảm miễn dịch ở người (HIV) và các bệnh nhiễm trùng.
Sự báo động không chỉ dừng ở tỉ lệ mắc bệnh, trong một công bố gần đây về tỉ lệ tử vong do ung thư của tổ chức y tế thế giới WHO ( tháng 4 năm 2014), nhiều người đã giật mình khi biết tỉ lệ tử vong ở việt nam thuộc tốp thứ 2 trong số những quốc gia dẫn đầu về tỉ lệ mắc căn bệnh này( xấp xỉ 50%) . Nguyên nhân dẫn đến tình trạng này là do phần lớn bệnh nhân ung thư ở Việt Nam có mặt tại bệnh viện ở giai đoạn muộn. Các dữ liệu từ nhiều báo cáo cho thấy tỷ lệ bệnh nhân đến viện ở của giai đoạn 3-4 là khoảng 80% khi việc điều trị chỉ mang tính chất giảm nhẹ triệu chứng và chi phí điều trị tăng đáng kể. 
Nhiều điều tra, nghiên cứu đã chứng minh rằng 30% ung thư có thể chữa khỏi nếu được phát phát hiện sớm . Như vậy việc phát hiện sớm cần thiết phải trở thành 1 mục tiêu quan trọng trong trương trình phòng chống ung thư ở Việt Nam. Nó cũng phù hợp với mục tiêu giảm tỉ lệ ung thư bị phát hiện ở giai đoạn muộn từ 80% xuống 50% theo Chiến lược quốc gia về kiểm soát ung thư giai đoạn 2010- 2020 . Bài viết này sẽ đề cập đến các nguyên nhân dẫn tới việc chẩn đoán muộn đồng thời đưa ra 1 vài giải pháp khả thi cho trình trạng trên.
There are many reasons lead to late cancer presentation among population and health care systoms at many different levels:
• Ignorance of the seriousness of the disease.
• Urban location of most of the hospitals making them distant and difficult to access by most of the population,
• Insufficient infrastructure and equipment of thehospitals
• Financial constraint.
• Lack of cancer awareness manifests itself at different levels: 
At the population level, it is one of the major reasons for late presentation of cancer patients to medical centers. 
Lack of awareness of signs and symptoms of cancer : According to the resource of Prof-Dr Bui Dieu-National Cancer Hospitals shows that the rate of people who have an awareness of at least 4 symptoms that can lead cancer is 22.3%, compared to 19.7 % who do not have any awareness of signs and symptoms at all
In addition , lack of education of cancer process in most of population. This includes the general tendency for patients to go first to the fetish doctors, traditional healers and sometimes prayer houses before turning to the hospital with late stage cancer, when palliation is the only treatment option . It also comprises the situation of some traditional healers claiming to treat every condition including cancer and refusing to refer cancer patients to the hospitals.
At the level health care providers, lack of cancer awareness can sometime lead to delays in management : insituational and physician related delays were present in over 40% of the cancer in breast cancer . it was even noted that patients who were reffered from or recieved initial treatment at, peripheral hospitals had longer delays than those who came for first consultation at the teaching hospital. 
At general lack of cancer awareness among policy makers and international private or public health egencies concerning the manitude of the current and future cancer burden , it economic impact may also partly explain the relatively low public health priority cancer in Vietnam
80% of Vietnamese cancer patients therefore reportedly present at late advanced stages .The result is that, most often, cancer is fatal due to this late stage at clinical presentation. paradoxically reinforcing the notion that allopathic medical care is ineffective in treating cancer and other diseases. Other consequences of this situation are the inadequate exposure to sufficient case-mix and case-load during training as well as the absence of the early disease profile manageable by radical resection or minimal invasive techniques . This places our Medical Schools and Teaching Hospitals in the unfortunate tendency of creating a group of professionals. 
This lack of awareness is probably the only single possible common denominator to all the other reasons for this late presentation to hospital
Improvement of cancer awareness will greatly help in the down staging of cancer cases seen in medical centres in Vietnam. This in turn will improve the prognosis and reduce the mortality. It will also reduce the cost of cancer management which is always very high and often beyond the reach of the average Vietnamese patient who generally foots the bill for the management in a setting where the majority have no social security system. As we know that if cancer patients is diagnosesd at early stage, its only requires surgery and endocrine supporting treatment , so, treatment costing around VND 10 milion (USD 441) for each session. However , if the illness is detected in second or third stage, apart from surgerys and endocrine supporting treatment, the treatment process will also include chemotherapy and radiotherapy which all augment costs to VNd 60-70 milion( USD 2.649- 3.090) .According to an investigation by 3 cancer centers in Vietnam, research found that after 1 year of treatment, 67% of patients must borrow money, 22% of patients must sell all of their property and a further 8% of patients stop receiving medical treatment altogether.
This lack of awareness is probably the only single possible common denominator to all the other reasons for this late presentation to hospital
Improvement of cancer awareness will greatly help in the down staging of cancer cases seen in medical centres in Vietnam. This in turn will improve the prognosis and reduce the mortality. It will also reduce the cost of cancer management which is always very high and always very high and often beyond the reach of the average Vietnamese patient who generally foots the bill for the management in a setting where the majority have no social security system.
The experience gained in the process of transforming the HIV-AIDS pandemic from a new and unknown disease to virtually a house hold word, in such a relatively short time, can form a reproducible basis, with some adaptations and modifications, to enable plan better the fight against cancer which is a much ‘older’ killer. The HIV-AIDS pandemic has effectively highlighted certain facts: The fight against diseases such as HIV–AIDS is global and solutions can emerge from anywhere. Conducting research only in high-income countries neglects the possibilities of elucidating variability in the causes of and risk for noncommunicable diseases among populations worldwide, of enabling high- and low-income Other ways that could be effective in a continent like Vietnamese with weak cancer infrastructure is the organization of information sessions in other structures outside the health centres like churches, mosques, schools, universities and markets to create cancer awareness 
The value of societal engagement: successful programs have actively involved the affected communities, harnessed the goodwill and support of high-profile celebrities, and energized advocacy and political support and will.
To raise awareness about cancer amongst local communities and health professionals alike, more solutions and initiatives could be implemented. 
Establishing Be clear on cancer campaign and National cancer awareness campaign

These include:
1. Raising awareness through marketing campaigns and educating children and young adults in learning environments on the ways to recognise the early signs and symptoms for some cancers, as well as to communicate that the timely diagnosis and evaluation of symptoms will increase the opportunities for treatment and provide an improved quality of life for people living with cancer
2. Fostering greater awareness in community settings such as the workplace, highschool, university...which offers access to a captive audience, making it an effective channel for communication and educational messages
3. The use of mobile phones to send SMS for education and awareness and in support of public health and behavioural change campaigns. SMS is also used to deliver information to health workers
4. Educate community members about of the benefits of cancer screening. Successful community education encourages residents to learn about cancer and to talk to their doctors about being screened at the appropriate time. 
5. Engage and educate county residents within the priority populations for cancer screening at sites where you already interact with them.
6. Identify and work to empower local elected officials, hospitals, health systems, federally qualified health centers and large employers who could act as organizational champions to promote cancer screening to residents, patients, and employees

It is generally well known that cancer patients present themselves to medical centres in Vietnam at advanced stages for many reasons among which is lack of cancer awareness. This lack of awareness is probably the only single possible common denominator to all the other reasons for this late presentation to hospital. are projected to increase rapidly in Africa within the next few years. It is therefore necessary for African countries to strive to put in more effort towards cancer control and awareness than is presently the case in order to downgrade cancer cases and also prevent the projected increase in cancer incidence in Africa. This they can do with the help of the International Community and the knowledge gained from the fight against HIV-AIDS pandemic. The observation that only 5-10% of all cancer cases are a result of genetic defects, the remaining 90–95% being due to the environment and lifestyle and therefore potentially preventable opens a gateway for a serious and concerted effort to eliminate cancer. With a well packaged plan and the help of international partners, Africa can offer a very good setting for a programme in this fight against cancer to the benefit of all humanity.
To save more lives, we need to ensure everyone has access to information and services to help them make possible changed for your healthy
“I don’t want anyone to die when God has provided an opportunity for us to live longer”
------Dawn, 32 year old, kenya-----------
Source: Alliance for cervical cancer prevention 2004. Women’s stories, women’s lives: Experiences with cervical cancer screening and treatment.

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