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Rubagumya F, Fundytus A, Keith-Brown S, Hopman WM, Gyawali B, Mukherji D, Hammad N, Pramesh CS, Aggarwal A, Eniu A, Sengar M, Riechelmann RSR, Sullivan R, Booth CM. Allocation of authorship and patient enrollment among global clinical trials in oncology. Cancer 2023; 129:2856-2863. [PMID: 37382190 DOI: 10.1002/cncr.34919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/11/2023] [Accepted: 03/29/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Oncology randomized controlled trials (RCTs) are increasingly global in scope. Whether authorship is equitably shared between investigators from high-income countries (HIC) and low-middle/upper-middle incomes countries (LMIC/UMIC) is not well described. The authors conducted this study to understand the allocation of authorship and patient enrollment across all oncology RCTs conducted globally. METHODS A cross-sectional retrospective cohort study of phase 3 RCTs (published 2014-2017) that were led by investigators in HIC and recruited patients in LMIC/UMIC. FINDINGS During 2014-2017, 694 oncology RCTs were published; 636 (92%) were led by investigators from HIC. Among these HIC-led trials, 186 (29%) enrolled patients in LMIC/UMIC. One-third (33%, 62 of 186) of RCTs had no authors from LMIC/UMIC. Forty percent (74 of 186) of RCTs reported patient enrollment by country; in 50% (37 of 74) of these trials, LMIC/UMIC contributed <15% of patients. The relationship between enrollment and authorship proportion is very strong and is comparable between LMIC/UMIC and HIC (Spearman's ρ LMIC/UMIC 0.824, p < .001; HIC 0.823, p < .001). Among the 74 trials that report country enrollment, 34% (25 of 74) have no authors from LMIC/UMIC. CONCLUSIONS Among trials that enroll patients in HIC and LMIC/UMIC, authorship appears to be proportional to patient enrollment. This finding is limited by the fact that more than half of RCTs do not report enrollment by country. Moreover, there are important outliers as a significant proportion of RCTs had no authors from LMIC/UMIC despite enrolling patients in these countries. The findings in this study reflect a complex global RCT ecosystem that still underserves cancer control outside high-income settings.
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Affiliation(s)
- Fidel Rubagumya
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | - Adam Fundytus
- British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Sophie Keith-Brown
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Wilma M Hopman
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Manju Sengar
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Jalali R, Nogueira-Rodrigues A, Das A, Sirohi B, Panda PK. Drug Development in Low- and Middle-Income Countries: Opportunity or Exploitation? Am Soc Clin Oncol Educ Book 2022; 42:1-8. [PMID: 35658520 DOI: 10.1200/edbk_10033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Low- and middle-income countries (LMICs) represent a diverse group of regions with varied cancer presentation. Drug development and accessibility across these regions have primarily been dependent on the trials initiated and conducted across high-income countries. Representation of LMIC regions in these trials in terms of study population has been minimal, leading to inequitable distribution of optimal and affordable cancer care. In spite of many challenges, LMICs have now increasingly been able to contribute to anticancer drug development. The opportunities present in LMICs must be explored and used in conjunction with due collaborative efforts from high-income countries, health care planners, and regulatory agencies. Global drug development trials should not only factor in suitable representation of LMICs but also design studies with pragmatic objectives and endpoints so that the trial results lead to equitable and affordable cancer care. Strengthening collaboration between cancer researchers from LMICs and high-income countries and empowering the local investigator with adequate resources will help remove current disparities.
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Affiliation(s)
- Rakesh Jalali
- Neuro-Oncology Cancer Management Team, Apollo Proton Cancer Centre, Taramani, Chennai, India
| | - Angelica Nogueira-Rodrigues
- Federal University of Minas Gerais, DOM Oncologia, Grupo Oncoclínicas, EVA Brazilian Group of Gynecologic Cancer, LACOG, Porto Alegre, Brazil
| | - Arunangshu Das
- Department of Oncology, Square Hospitals Ltd, Dhaka, Bangladesh
| | - Bhawna Sirohi
- Department of Medical Oncology, Apollo Proton Cancer Centre, Taramani, Chennai, India
| | - Pankaj Kumar Panda
- Clinical Research Secretariat, Apollo Proton Cancer Centre, Taramani, Chennai, India
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3
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Alghamdi MA, Alghamdi SM, Bahadur YA, Asiri MA, AlHussain HA, Alhebshi AS, Alothman MO, Al-Omair AS, Alghamdi AA, Qanat AS, Aqeeli MO, Alsuhaibani AA, Alshehri SM, Alotain IM, Mail NK, Alhashemi HH, Alassaf HA. Scholarly Activity of Radiation Oncologists in High-Income Developing Countries: Saudi Arabia as an Example. JCO Glob Oncol 2021; 7:378-383. [PMID: 33720748 PMCID: PMC8081503 DOI: 10.1200/go.20.00449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To examine the trends and quality metrics of publications by radiation oncologists in Saudi Arabia. METHODS PubMed was searched using names of all Saudi radiation oncologists to retrieve published articles between January 2010 and December 2019. International collaboration, journal impact factor and country of origin, and number of citations were collected. Each article was assessed for epidemiologic type and independently assigned a level of evidence (LOE) by two authors. The trend in publications was examined and compared in the first and second 5-year periods (2010-2014 and 2015-2019) using relevant parameters. RESULTS A total of 186 publications were found and included. The most common type of research was cohort studies followed by case reports and case series in 24%, 14%, and 13% of all publications, respectively. Dosimetry, clinical, and preclinical studies formed 7%, 8.6%, and 7.5% of the total publications, respectively. The LOE was I, II, III, IV, and not applicable in 8.6%, 22%, 25.8%, 29%, and 14.5% of the included publications, respectively. Comparing the first and second 5-year periods, there was an increase in international collaboration (P < .001) in the second period. The number of citations (P < .001) and journal impact factor (P = .028) were lower in the second period. LOE and publications in international journals were not statistically different between the two periods. CONCLUSION Although radiation oncology research activity in Saudi Arabia has gained momentum in terms of volume and international collaboration over time, the LOE has not improved. This calls for a national effort to make the contribution to the literature a priority, allocate adequate resources, and apply appropriate measures to enhance research productivity and quality.
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Affiliation(s)
- Majed A Alghamdi
- Department of Medicine, College of Medicine, Al Baha University, Al Baha, Saudi Arabia.,Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - Suliman M Alghamdi
- Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Yasir A Bahadur
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mushabbab A Asiri
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hussain A AlHussain
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Adnan S Alhebshi
- Radiation Oncology, Oncology Institute, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Majid O Alothman
- Radiation Oncology, Oncology Institute, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Ameen S Al-Omair
- Radiation Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Ahmed S Qanat
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed O Aqeeli
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah A Alsuhaibani
- Radiation Oncology, University Oncology Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Salem M Alshehri
- Radaition Oncology, Department of Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ibrahim M Alotain
- Radaition Oncology, Department of Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Noor K Mail
- Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Hashem H Alhashemi
- Department of Internal Medicine, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hossam A Alassaf
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Spreafico A, Hansen AR, Abdul Razak AR, Bedard PL, Siu LL. The Future of Clinical Trial Design in Oncology. Cancer Discov 2021; 11:822-837. [PMID: 33811119 PMCID: PMC8099154 DOI: 10.1158/2159-8290.cd-20-1301] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/18/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022]
Abstract
Clinical trials represent a fulcrum for oncology drug discovery and development to bring safe and effective medicines to patients in a timely manner. Clinical trials have shifted from traditional studies evaluating cytotoxic chemotherapy in largely histology-based populations to become adaptively designed and biomarker-driven evaluations of molecularly targeted agents and immune therapies in selected patient subsets. This review will discuss the scientific, methodological, practical, and patient-focused considerations to transform clinical trials. A call to action is proposed to establish the framework for next-generation clinical trials that strikes an optimal balance of operational efficiency, scientific impact, and value to patients. SIGNIFICANCE: The future of cancer clinical trials requires a framework that can efficiently transform scientific discoveries to clinical utility through applications of innovative technologies and dynamic design methodologies. Next-generation clinical trials will offer individualized strategies which ultimately contribute to globalized knowledge and collective learning, through the joint efforts of all key stakeholders including investigators and patients.
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Affiliation(s)
- Anna Spreafico
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Albiruni R Abdul Razak
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada
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Olasehinde O, Alatise O, Omisore A, Wuraola F, Odujoko O, Romanoff A, Akinkuolie A, Arowolo O, Adisa A, Knapp G, Famurewa O, Omisile I, Onabanjo E, Constable J, Omoniyi-Esan G, Adesunkanmi AR, Lawal O, Kingham TP. Contemporary management of breast cancer in Nigeria: Insights from an institutional database. Int J Cancer 2021; 148:2906-2914. [PMID: 33506499 DOI: 10.1002/ijc.33484] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 01/07/2023]
Abstract
High-quality data are needed to guide interventions aimed at improving breast cancer outcomes in sub-Saharan Africa. We present data from an institutional breast cancer database to create a framework for cancer policy and development in Nigeria. An institutional database was queried for consecutive patients diagnosed with breast cancer between January 2010 and December 2018. Sociodemographic, diagnostic, histopathologic, treatment and outcome variables were analyzed. Of 607 patients, there were 597 females with a mean age of 49.8 ± 12.2 years. Most patients presented with a palpable mass (97%) and advanced disease (80.2% ≥ Stage III). Immunohistochemistry was performed on 21.6% (131/607) of specimens. Forty percent were estrogen receptor positive, 32.8% were positive for HER-2 and 43.5% were triple negative. Surgery was performed on 49.9% (303/607) of patients, while 72% received chemotherapy and 7.9% had radiotherapy. At a median follow-up period of 20.5 months, the overall survival was 43.6% (95% CI -37.7 to 49.5). Among patients with resectable disease, 18.8% (57/303) experienced a recurrence. Survival was significantly better for early-stage disease (I and II) compared to late-stage disease (III or IV) (78.6% vs 33.3%, P < .001). Receipt of adjuvant radiotherapy after systemic chemotherapy was associated with improved survival in patients with locally advanced disease (68.5%, CI -46.3 to 86 vs 51%, CI 38.6 to 61.9, P < .001). This large cohort highlights the dual burden of advanced disease and inadequate access to comprehensive breast cancer care in Nigeria. There is a significant potential for improving outcomes by promoting early diagnosis and facilitating access to multimodality treatment.
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Affiliation(s)
- Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Olusegun Alatise
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adeleye Omisore
- Department of Radiology, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Funmilola Wuraola
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Oluwole Odujoko
- Department of Morbid Anatomy and Forensic pathology, Obafemi Awolowo University / Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Anya Romanoff
- Breast Surgery, Dubin Breast Center, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA.,Department of Health System Design and Global Health, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
| | - Akinbolaji Akinkuolie
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Olukayode Arowolo
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adewale Adisa
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Gregory Knapp
- Department of Oncology, Division of Surgical Oncology, University of Calgary, Alberta, Canada
| | - Olusola Famurewa
- Department of Radiology, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Idowu Omisile
- Department of Psychology, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Jeremy Constable
- Department of Surgery, Memorial Sloan-Kettering Cancer center, New York
| | - Ganiyat Omoniyi-Esan
- Department of Morbid Anatomy and Forensic pathology, Obafemi Awolowo University / Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Abdul-Rasheed Adesunkanmi
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Oladejo Lawal
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Thomas P Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer center, New York
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Seo SW, Ombengi D, Sultan DH, Kahaleh AA, Nonyel N, Karwa R, Abrons J, Lukas S, Singhal M, Miller M, Truong HA. An ethics-based approach to global health research part 1: Building partnerships in global health. Res Social Adm Pharm 2020; 16:1574-1579. [PMID: 32952088 DOI: 10.1016/j.sapharm.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 01/23/2023]
Abstract
Global health partnerships (GHPs) can be the cornerstone for advancing research and public health. The steps to build a global research partnership focus on sharing a common research agenda, identifying key partners in the community, and establishing goals and expectations for partnerships. Moreover, upholding important values, such as communication, trust, and transparency is essential for building successful partnerships. Ethical dilemmas can propose challenges to researchers in global health. These challenges can be overcome by creating a shared vision for a research agenda, maintaining communication, and providing bidirectional training.
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Affiliation(s)
- See-Won Seo
- Albany College of Pharmacy and Health Sciences, 106 New Scotland Ave, Albany, NY, 12208, USA.
| | - David Ombengi
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Dawood H Sultan
- Mercer University College of Health Professions, 3001 Mercer University Drive, Atlanta, GA, 30341, USA.
| | - Abby A Kahaleh
- Roosevelt University College of Pharmacy, 1400 N Roosevelt Blvd, Schaumburg, IL, 13 60173, USA.
| | - Nkem Nonyel
- University of Maryland, Eastern Shore School of Pharmacy and Health Professions, Hazel Hall, Room 1041, Princess Anne, MD, 21853, USA.
| | - Rakhi Karwa
- Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN, 47907, USA.
| | - Jeanine Abrons
- University of Iowa College of Pharmacy, 180 S Grand Avenue, CP 354, Iowa City, IA, 52241, USA.
| | - Stephanie Lukas
- St. Louis College of Pharmacy, St. Louis, Missouri, 4588 Parkview Place, St. Louis, MO, 63110-1088, USA.
| | - Mudit Singhal
- D'Youville School of Pharmacy, 320 Porter Avenue, Buffalo, NY, 14201, USA.
| | - Monica Miller
- Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN, 47906, USA.
| | - Hoai-An Truong
- University of Maryland Eastern Shore, School of Pharmacy and Health Professions, 1 College Backbone Road, Princess Anne, MD, 21853, USA.
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Chilukuri S, Panda PK, Jalali R. PITChing (professional organisations, innovative trial designs and collaborative approach) for evidence generation for proton therapy. Radiat Oncol 2020; 15:138. [PMID: 32487113 PMCID: PMC7268635 DOI: 10.1186/s13014-020-01538-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/14/2020] [Indexed: 12/25/2022] Open
Abstract
Developments in the field of proton beam therapy (PBT) have recently crossed the tipping point wherein the modality is now more versatile than ever before, with possibilities and likely indications expanding rapidly. However the pace of evidence generation lags behind the developments in the field. Generating quality evidence has its own set of challenges owing to complexities of conducting randomized controlled trials, which are the hallmark of level 1 evidence generation. Here we discuss various challenges to clinical evidence generation in PBT and have suggested certain solutions including collaborative approaches and alternative study designs to mitigate these challenges.
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Gupta T, Achari R, Chatterjee A, Chen ZP, Mehta M, Bouffet E, Jalali R. Comparison of Epidemiology and Outcomes in Neuro-Oncology Between the East and the West: Challenges and Opportunities. Clin Oncol (R Coll Radiol) 2019; 31:539-548. [PMID: 31182288 DOI: 10.1016/j.clon.2019.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022]
Abstract
Although neoplasms of the brain and central nervous system (CNS) are relatively uncommon, comprising only 1-2% of the overall cancer burden, they represent a substantial source of morbidity and mortality worldwide. The age-adjusted annual incidence of CNS tumours is reportedly low; however, there is substantial global variability in its incidence, with nearly a five-fold difference between regions with the highest rates in developed countries in the West and those with the lowest rates in developing countries in South-East Asia, including India, possibly attributable to key differences in environmental factors, genetic susceptibilities and cultural practices, as well as resource constraints in low-middle income countries precluding precise ascertainment and accurate diagnosis. The burden of CNS tumours is further compounded by the fact that they require highly specialised and skilled multidisciplinary care, including access to modern neuroimaging, neurosurgery, neuropathology and molecular biology, radiotherapy, chemotherapy and rehabilitation services, which may not be widely available in an integrated manner in large parts of the world with a large variation in clinical pathways, non-uniformity of care and resultant heterogeneity in clinical outcomes. CNS tumours encompass a heterogeneous spectrum of histopathological entities with differences in presentation, distinct molecular/genetic alterations, diverse biological behaviour and varying clinical outcomes. Survival is highly dependent on histology, grade and molecular biology, but varies widely across continents, even for the same tumour type and grade. In general, survival is higher in children with primary brain tumours than in adults, largely due to the differences in histological distribution across age groups. However, there is widespread variability, with 5-year survival for paediatric brain tumours being <40% in some low-middle income countries compared with 70-80% in the developed world. This review compares the descriptive epidemiology and clinical outcomes of primary brain tumours between the East and the West that pose unique challenges but also provide new opportunities in contemporary neuro-oncological practice.
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Affiliation(s)
- T Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.
| | - R Achari
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, India
| | - A Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Z-P Chen
- Department of Neurosurgery, SunYat-sen University Cancer Centre, Guangzhou, China
| | - M Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - E Bouffet
- Neuro-Oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - R Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, India
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