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Jackman JM, Yibrehu B, Doyle A, Alatise OI, Wuraola FO, Olasehinde O, Peter Kingham T. Updates in global oncology: Advancements and future directions. J Surg Oncol 2024; 129:1374-1383. [PMID: 38624014 DOI: 10.1002/jso.27633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
Globally, cancer is the second leading cause of death, and low- and middle-income countries bear most of the disease burden. While cancer is increasingly recognized as a major global health issue, more work remains. Understanding the status of global cancer care will shape the next steps in ensuring equitable global access to cancer care. This article highlights ongoing initiatives in global oncology and the next steps in advancing the field.
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Affiliation(s)
- Julia M Jackman
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Betel Yibrehu
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Alex Doyle
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Caribbean Colon Cancer Initiative, Bridgetown, Barbados
| | - Olusegun Isaac Alatise
- Surgery Department, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Olalekan Olasehinde
- Surgery Department, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - T Peter Kingham
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Sfeir S, Allen L, Algera MD, Morton R, Farrell R, Brennan D, Driel WJV, Rijken MJ, Eiken M, Sundar SS, Coleman RL. Exploring global barriers to optimal ovarian cancer care: thematic analysis. Int J Gynecol Cancer 2024:ijgc-2024-005449. [PMID: 38821547 DOI: 10.1136/ijgc-2024-005449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVE To explore the barriers to ovarian cancer care, as reported in the open ended responses of a global expert opinion survey, highlighting areas for improvement in global ovarian cancer care. Potential solutions to overcome these barriers are proposed. METHODS Data from the expert opinion survey, designed to assess the organization of ovarian cancer care worldwide, were analyzed. The survey was distributed across a global network of physicians. We examined free text, open ended responses concerning the barriers to ovarian cancer care. A qualitative thematic analysis was conducted to identify, analyze, and report meaningful patterns within the data. RESULTS A total of 1059 physicians from 115 countries completed the survey, with 438 physicians from 93 countries commenting on the barriers to ovarian cancer care. Thematic analysis gave five major themes, regardless of income category or location: societal factors, inadequate resources in hospital, economic barriers, organization of the specialty, and need for early detection. Suggested solutions include accessible resource stratified guidelines, multidisciplinary teamwork, public education, and development of gynecological oncology training pathways internationally. CONCLUSIONS This analysis provides an international perspective on the main barriers to optimal ovarian cancer care. The themes derived from our analysis highlight key target areas to focus efforts to reduce inequalities in global care. Future regional analysis involving local representatives will enable country specific recommendations to improve the quality of care and ultimately to work towards closing the care gap.
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Affiliation(s)
| | - Lucy Allen
- University of Birmingham, Birmingham, UK
| | - Marc Daniël Algera
- Gynaecological Oncology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
- Maastricht University GROW Research Institute for Oncology and Reproduction, Maastricht, Limburg, The Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | - Rhett Morton
- University of Queensland Queensland Centre for Gynaecological Cancer Research, Herston, Queensland, Australia
| | - Rhonda Farrell
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Donal Brennan
- Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Willemien J van Driel
- Center for Gynaecological Oncology Amsterdam, Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Marcus J Rijken
- Center for Gynaecological Oncology Amsterdam, Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Mary Eiken
- International Gynecologic Cancer Society, Austin, Texas, USA
| | - Sudha S Sundar
- Department of Gynaecology Oncology, University of Birmingham, Birmingham, UK
| | - Robert L Coleman
- Gynecologic Oncology, Texas Oncology Houston Memorial City, Shenandoah, Texas, USA
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Hill SK, Bempong-Ahun N, Okolo ID, Lalla AT, Worku D, Asres T, Philpotts L, Fallah PN, Varallo J, Corlew S, Kamfwa P, Parham GP, Hicks ML, Ibbotson G, Randall T. Improving access to safe, quality surgical care for gynecologic cancers through capacity-building interventions in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024; 165:552-561. [PMID: 37927080 DOI: 10.1002/ijgo.15156] [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: 04/21/2023] [Revised: 07/16/2023] [Accepted: 09/10/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Following the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low- and middle-income countries (LMICs). A well-integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task-sharing and training of gynecologic oncologists (GynOncs). OBJECTIVES This review aimed to explore existing literature on capacity-building for surgical management of early-stage gynecologic cancers. SEARCH STRATEGY The search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE. SELECTION CRITERIA Studies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task-sharing, or outcomes following operation by subspecialists compared to specialists were included. DATA COLLECTION AND ANALYSIS Results were synthesized using narrative synthesis approach with emergence of key themes by frequency. MAIN RESULTS The scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non-subspecialized care, and task-shifting/-sharing. CONCLUSIONS A multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity-building and task-sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost-effectiveness.
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Affiliation(s)
- Sarah K Hill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Isioma Dianne Okolo
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amber Trujillo Lalla
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dawit Worku
- Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - Tadios Asres
- Department of Obstetrics and Gynecology, Rwanda Military Hospital (RMH), Kigali, Rwanda
| | - Lisa Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Parisa N Fallah
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John Varallo
- The Global Surgery Foundation, Geneva, Switzerland
| | - Scott Corlew
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Kamfwa
- Department of Gynecologic Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Groesbeck P Parham
- Women and Newborn Hospital-University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Michael L Hicks
- Women and Newborn Hospital-University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Gynecologic Oncology, Michigan Cancer Institute, St. Joseph Mercy Oakland, Pontiac, USA
| | - Geoffrey Ibbotson
- The Global Surgery Foundation, Geneva, Switzerland
- United Nations Institute for Training and Research, Geneva, Switzerland
| | - Thomas Randall
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Allanson E, Hari A, Ndaboine E, Cohen PA, Bristow R. Medicolegal, infrastructural, and financial aspects in gynecologic cancer surgery and their implications in decision making processes: Quo Vadis? Int J Gynecol Cancer 2024; 34:451-458. [PMID: 38438180 DOI: 10.1136/ijgc-2023-004585] [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] [Indexed: 03/06/2024] Open
Abstract
Surgical decision making is complex and involves a combination of analytic, intuitive, and cognitive processes. Medicolegal, infrastructural, and financial factors may influence these processes depending on the context and setting, but to what extent can they influence surgical decision making in gynecologic oncology? This scoping review evaluates existing literature related to medicolegal, infrastructural, and financial aspects of gynecologic cancer surgery and their implications in surgical decision making. Our objective was to summarize the findings and limitations of published research, identify gaps in the literature, and make recommendations for future research to inform policy.
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Affiliation(s)
- Emma Allanson
- Division of Obstetrics and Gynaecology, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Anjali Hari
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
| | - Edgard Ndaboine
- Department of Obstetrics & Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Mwanza, Tanzania
| | - Paul A Cohen
- Division of Obstetrics and Gynaecology, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Robert Bristow
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
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Anakwenze CP, Allanson E, Ewongwo A, Lumley C, Bazzett-Matabele L, Msadabwe SC, Kamfwa P, Shouman T, Lombe D, Rubagumya F, Polo A, Ntekim A, Vanderpuye V, Ghebre R, Kochbati L, Awol M, Gnangnon FHR, Snyman L, Fokom Domgue J, Incrocci L, Ndlovu N, Razakanaivo M, Abdel-Wahab M, Trimble E, Schmeler K, Simonds H, Grover S. Mapping of Radiation Oncology and Gynecologic Oncology Services Available to Treat the Growing Burden of Cervical Cancer in Africa. Int J Radiat Oncol Biol Phys 2024; 118:595-604. [PMID: 37979709 DOI: 10.1016/j.ijrobp.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/09/2023] [Accepted: 10/22/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To meet the demand for cervical cancer care in Africa, access to surgical and radiation therapy services needs to be understood. We thus mapped the availability of gynecologic and radiation therapy equipment and staffing for treating cervical cancer. METHODS AND MATERIALS We collected data on gynecologic and radiation oncology staffing, equipment, and infrastructure capacities across Africa. Data was obtained from February to July 2021 through collaboration with international partners using Research Electronic Data Capture. Cancer incidence was taken from the International Agency for Research on Cancer's GLOBOCAN 2020 database. Treatment capacity, including the numbers of radiation oncologists, radiation therapists, physicists, gynecologic oncologists, and hospitals performing gynecologic surgeries, was calculated per 1000 cervical cancer cases. Adequate capacity was defined as 2 radiation oncologists and 2 gynecologic oncologists per 1000 cervical cancer cases. RESULTS Forty-three of 54 African countries (79.6%) responded, and data were not reported for 11 countries (20.4%). Respondents from 31 countries (57.4%) reported access to specialist gynecologic oncology services, but staffing was adequate in only 11 countries (20.4%). Six countries (11%) reported that generalist obstetrician-gynecologists perform radical hysterectomies. Radiation oncologist access was available in 39 countries (72.2%), but staffing was adequate in only 16 countries (29.6%). Six countries (11%) had adequate staffing for both gynecologic and radiation oncology; 7 countries (13%) had no radiation or gynecologic oncologists. Access to external beam radiation therapy was available in 31 countries (57.4%), and access to brachytherapy was available in 25 countries (46.3%). The number of countries with training programs in gynecologic oncology, radiation oncology, medical physics, and radiation therapy were 14 (26%), 16 (30%), 11 (20%), and 17 (31%), respectively. CONCLUSIONS We identified areas needing comprehensive cervical cancer care infrastructure, human resources, and training programs. There are major gaps in access to radiation oncologists and trained gynecologic oncologists in Africa.
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Affiliation(s)
- Chidinma P Anakwenze
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emma Allanson
- Division of Obstetrics & Gynecology, King Edward Memorial Hospital for Women, Subiaco, Australia, and Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | | | - Christian Lumley
- Office of Global Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisa Bazzett-Matabele
- Department of Obstetrics & Gynecology, University of Botswana, Gaborone, Botswana, and Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Paul Kamfwa
- Gynecologic Oncology Unit, Cancer Diseases Hospital, Lusaka, Zambia
| | | | - Dorothy Lombe
- Cancer Screening, Treatment and Support Cluster, Health New Zealand, Palmerston North, New Zealand
| | - Fidel Rubagumya
- Rwanda Military Hospital, Kigali, Rwanda, and Division of Cancer Care and Epidemiology and Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Alfredo Polo
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | - Atara Ntekim
- Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
| | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology, and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology, and Women's Health and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Lofti Kochbati
- Department of Radiotherapy, Abderrahmen Mami Hospital, Tunis, Tunisia
| | - Munir Awol
- Department of Oncology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Freddy Houéhanou Rodrigue Gnangnon
- Department of Visceral Surgery, National Teaching Hospital of Cotonou, Cotonou, Benin, Department of Epidemiology of Chronic Diseases in the Tropical Zone, Institute of Epidemiology and Tropical Neurology, Limoges, France, and Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
| | - Leon Snyman
- Department Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Joël Fokom Domgue
- Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, and Faculty of Medicine and Biomedical Sciences, Department of Obstetrics and Gynecology, University of Yaoundé, Yaoundé, Cameroon
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe, and Department of Radiotherapy and Oncology, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Malala Razakanaivo
- Department of Radiotherapy, Joseph Ravoahangy Andrianavalona University Hospital, Antananarivo, Madagascar
| | - May Abdel-Wahab
- Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Kathleen Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hannah Simonds
- Department of Radiation Oncology, Stellenbosch University, Cape Town, South Africa, and Department of Oncology, University Hospitals Plymouth Trust, Plymouth, United Kingdom
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Talia KL, van der Griend R. Supporting gynaecological pathology: volunteering at home and abroad. Pathology 2023; 55:591-595. [PMID: 37330339 DOI: 10.1016/j.pathol.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Karen L Talia
- Royal Children's Hospital, Royal Women's Hospital and Australian Centre for the Prevention of Cervical Cancer, Melbourne, Vic, Australia.
| | - Rachael van der Griend
- Canterbury Health Laboratories, Te Whatu Ora, Waitaha Canterbury, Christchurch, New Zealand
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Hoegl J, Fernandes A, Escalona S, López Basalo A, Pareja R. Gynecologic Oncology at Home: a new opportunity to teach and learn. Int J Gynecol Cancer 2022; 32:1615-1616. [PMID: 36288815 DOI: 10.1136/ijgc-2022-004067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Jorge Hoegl
- Departamento de Ginecología y Obstetricia, Hospital General del Este Dr. Domingo Luciani, Caracas, Venezuela, Bolivarian Republic of
| | - Andreina Fernandes
- Laboratorio de Genética Molecular, Instituto de Oncología y Hematología, Caracas, Venezuela, Bolivarian Republic of
| | - Sunangela Escalona
- Centro Médico de Oncología, Barquisimeto, Venezuela, Bolivarian Republic of
| | | | - Rene Pareja
- Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Bogotá, Colombia, Medellin, Colombia
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Van Christ Manirakiza A, Pfaendler KS. Breast, Ovarian, Uterine, Vaginal, and Vulvar Cancer Care in Low- and Middle-Income Countries. Obstet Gynecol Clin North Am 2022; 49:783-793. [DOI: 10.1016/j.ogc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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