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Malapati SH, Hyland CJ, Liang G, Edelen MO, Fazzalari A, Kaur MN, Bain PA, Mody GN, Pusic AL. Use of patient-reported outcome measures after breast reconstruction in low- and middle-income countries: a scoping review. J Patient Rep Outcomes 2024; 8:25. [PMID: 38416222 PMCID: PMC10899941 DOI: 10.1186/s41687-024-00687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly administered in high-income countries to monitor health-related quality of life of breast cancer patients undergoing breast reconstruction. Although low- and middle-income countries (LMICs) face a disproportionate burden of breast cancer, little is known about the use of PROMs in LMICs. This scoping review aims to examine the use of PROMs after post-mastectomy breast reconstruction among patients with breast cancer in LMICs. METHODS MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched in August 2022 for English-language studies using PROMs after breast reconstruction among patients with breast cancer in LMICs. Study screening and data extraction were completed. Data were analyzed descriptively. RESULTS The search produced 1024 unique studies, 33 of which met inclusion criteria. Most were observational (48.5%) or retrospective (33.3%) studies. Studies were conducted in only 10 LMICs, with 60.5% in China and Brazil and none in low-income countries. Most were conducted in urban settings (84.8%) and outpatient clinics (57.6%), with 63.6% incorporating breast-specific PROMs and 33.3% including breast reconstruction-specific PROMs. Less than half (45.5%) used PROMs explicitly validated for their populations of interest. Only 21.2% reported PROM response rates, ranging from 43.1 to 96.9%. Barriers and facilitators of PROM use were infrequently noted. CONCLUSIONS Despite the importance of PROM collection and use in providing patient-centered care, it continues to be limited in middle-income countries and is not evident in low-income countries after breast reconstruction. Further research is necessary to determine effective methods to address the challenges of PROM use in LMICs.
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Affiliation(s)
- Sri Harshini Malapati
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.
| | - Colby J Hyland
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - George Liang
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Maria O Edelen
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Amanda Fazzalari
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Manraj N Kaur
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Gita N Mody
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea L Pusic
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
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2
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Schantz C, Coulibaly A, Traoré A, Traoré BA, Faye K, Robin J, Teixeira L, Ridde V. Access to oncology care in Mali: a qualitative study on breast cancer. BMC Cancer 2024; 24:81. [PMID: 38225594 PMCID: PMC10788985 DOI: 10.1186/s12885-024-11825-6] [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: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in terms of incidence and mortality among women worldwide, including in Africa, and a rapid increase in the number of new cases of breast cancer has recently been observed in sub-Saharan Africa. Oncology is a relatively new discipline in many West African countries, particularly Mali; thus, little is known about the current state of cancer care infrastructure and oncology practices in these countries. METHODS To describe the challenges related to access to oncology care in Mali, we used a qualitative approach, following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Thirty-eight semistructured interviews were conducted with health professionals treating cancer in Mali (n = 10), women with breast cancer (n = 25), and representatives of associations (n = 3), and 40 participant observations were conducted in an oncology unit in Bamako. We used the theoretical framework on access to health care developed by Levesque et al. a posteriori to organise and analyse the data collected. RESULTS Access to oncology care is partly limited by the current state of Mali's health infrastructure (technical platform failures, repeated strikes in university hospitals, incomplete free health care and the unavailability of medicines) and exacerbated by the security crisis that has been occurring the country since 2012. The lack of specialist doctors, combined with limited screening campaigns and a centralised and fragmented technical platform in Bamako, is particularly detrimental to breast cancer treatment. Women's lack of awareness, lack of information throughout the treatment process, stereotypes and opposition to amputations all play a significant role in their ability to seek and access quality care, leading some women to therapeutically wander and others to want to leave Mali. It also leaves them in debt and jeopardises the future of their children. However, the high level of trust in doctors, the involvement of international actors, the level of social support and the growing influence of civil society on the issue of cancer also represent great current opportunities to fight cancer in Mali. CONCLUSION Despite the efforts of successive Malian governments and the commitment of international actors, the provision of health care is still limited in the country, entrenching global inequalities in women's bodies.
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Affiliation(s)
- Clémence Schantz
- Université Paris Cité, IRD, Inserm, Ceped, F-75 006, Paris, France.
- Institution Convergences Et Migrations, Aubervilliers, France.
| | | | | | - Bakary Abou Traoré
- Centre de Santé de Référence de La Commune 2, Bamako, Mali
- Centre National de La Recherche Scientifique Et Technologie (CNRST), Bamako, Mali
| | - Kadiatou Faye
- Association Les Combattantes du Cancer, Bamako, Mali
| | - Julie Robin
- Université Paris Cité, IRD, Inserm, Ceped, F-75 006, Paris, France
| | - Luis Teixeira
- Pathophysiology of Breast Cancer Team, Department of Senology, Université Paris Cité INSERM U976, HIPIAP-HP, Hôpital Saint-Louis, Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75 006, Paris, France
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Habila MA, Sagay E, Obeng-Kusi M, Ali MJ, Magaji FA, Shambe IH, Daru PH, Jacobs ET, Madhivanan P, Sagay AS, Musa J. Utilization of opportunistic cervical cancer screening in Nigeria. Cancer Causes Control 2024; 35:9-20. [PMID: 37530986 DOI: 10.1007/s10552-023-01764-1] [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: 05/01/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND While various interventions have been conducted to decrease cervical cancer's burden in Nigeria, no study has examined the trends in cervical cancer screening uptake over time. The present study sought to fill this gap in knowledge using data collected at Jos University Teaching Hospital (JUTH) in Nigeria. METHODS Data collected continuously between 2006 and 2016 were analyzed to identify trends in screening uptake, changes in risk factors for cervical cancer, and to identify factors for women screened at Jos University Teaching Hospital (JUTH) in Jos, Nigeria. Categorical analyses and logistic regression models were used to describe patient characteristics by year, and to identify factors associated with repeated screening uptake. RESULTS A total of 14,088 women who were screened between 2006 and 2016 were included in the database; 2,800 women had more than one screening visit. Overall, screening uptake differed significantly by year. On average women were first screened at age 38. About 2% of women screened were women living with HIV. Most women (86%) had normal pap smear at first screening, with the greatest decreased risk of abnormalities observed between 2011 and 2014. Odds of a follow-up screening after a normal result decreased significantly between 2008 and 2016 compared to women screened in 2006 and 2007. Finally, women living with HIV had increased odds of follow-up screening after having a normal pap smear. CONCLUSIONS These findings contribute to our understanding of the potential social and health system barriers to cervical cancer control in Nigeria. The findings may assist policy makers to design interventions to increase access and compliance to recommended screening schedules in this vulnerable population.
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Affiliation(s)
- Magdiel A Habila
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Emmanuel Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Mavis Obeng-Kusi
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Maryam J Ali
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Iornum H Shambe
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Public Health Research Institute of India, Mysore, India
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Hu S, Wu Y, Luan J, Wang S, Fan G. Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in HER2-positive metastatic breast cancer in Chinese setting. J Cancer Res Clin Oncol 2023; 149:17933-17942. [PMID: 37964082 DOI: 10.1007/s00432-023-05496-2] [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: 07/25/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Trastuzumab deruxtecan (T-DXd) expressed substantial improvement in the progression-free survival and overall survival contrasted with trastuzumab emtansine (T-DM1) in patients with HER2-positive metastatic breast cancer (mBC), becoming the second-line standard of care, promisingly. We aim to estimate the cost-utility of T-DXd versus T-DM1 in HER2-positive mBC from the Chinese healthcare perspective. METHODS A partitioned survival model was applied to examine the cost-utility of T-DXd versus T-DM1. Clinical patients and outcome data were sourced from the DESTINY-Breast 03 trial. Costs and utilities were sourced in Chinese setting. Total costs, quality-adjusted life months (QALMs), and an incremental cost-utility ratios (ICUR) were calculated for cost-utility analysis. The willingness-to-pay threshold was set at $3188/QALM. Univariate, scenario, and probabilistic sensitivity analyses were performed. RESULTS T-DXd group gained ∆QALM of 7.09 months and ∆Cost of $304,503 compared with T-DM1 therapy, which caused an ICUR of $42,936/QALM. The results of sensitivity analyses confirmed the base-case findings. Furthermore, T-DXd must reduce the price to enter the Chinese mainland market. At least when the cycle cost of T-DXd is reduced to $2975, T-DXd has an 83.3% chance of becoming a better choice. CONCLUSIONS T-DXd appears to be not cost effective compared with T-DM1 for HER2-positive mBC patients previously treated with trastuzumab and a taxane.
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Affiliation(s)
- Shanshan Hu
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yilai Wu
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
- Department of Pharmacy, The First Affiliated Hospital of Wannan Medical College, Anhui, China
| | - Jiajie Luan
- Department of Pharmacy, The First Affiliated Hospital of Wannan Medical College, Anhui, China
| | - Shuowen Wang
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
| | - Guorong Fan
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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Dahut WL, Kamal AH, Lacasse LA, Sanders KM, Knudsen KE. A tripartite approach toward ending cancer as we know it, for everyone: An American Cancer Society perspective. J Surg Oncol 2023; 128:931-937. [PMID: 37818915 DOI: 10.1002/jso.27463] [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: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Gaps in the cancer care continuum are vast, both in the United States and globally. The American Cancer Society orchestrates an integrated, tripartite approach toward improving the lives of cancer patients and their families through research, advocacy, and patient support. With a focus on eradicating cancer disparities, the American Cancer Society aims to scale and deploy best practices worldwide through partnerships, to ensure everyone has an opportunity to prevent, detect, treat, and survive cancer.
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Affiliation(s)
| | | | - Lisa A Lacasse
- American Cancer Society, Atlanta, Georgia, USA
- American Cancer Society Cancer Action Network (ACS CAN), Atlanta, Georgia, USA
| | | | - Karen E Knudsen
- American Cancer Society, Atlanta, Georgia, USA
- American Cancer Society Cancer Action Network (ACS CAN), Atlanta, Georgia, USA
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Mwenda V, Bor JP, Nyangasi M, Temmerman M. Mobilizing stakeholders to drive the cervical cancer elimination agenda in Kenya: The national cervical cancer stakeholders' forum 2022. DIALOGUES IN HEALTH 2022; 1:100066. [PMID: 38515876 PMCID: PMC10953883 DOI: 10.1016/j.dialog.2022.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 03/23/2024]
Abstract
Background Kenya is among the nineteen countries in Sub-Saharan Africa with the highest burden of cervical cancer globally. The high burden of cervical cancer in developing countries reflects the absence of effective cervical cancer prevention programs with limited resources invested to provide comprehensive services. Objective We aimed to engage stakeholders in a structured consultative forum, to gain insights and forge effective partnerships to drive the cervical cancer elimination agenda in Kenya. Methods The National Cervical Cancer Stakeholders Consultative Forum was organized as a part of activities to commemorate the National Cervical Cancer Awareness Month on 19th January 2022 in Nairobi, Kenya. The overall goal of the meeting was to provide a forum to sensitize stakeholders on the National Cervical Cancer Prevention and Control Program (NCCP) with a view to strengthen partnerships, increase coordination for improved service delivery and to provide a forum for resource mobilisation and alignment of key stakeholders towards elimination of cervical cancer in Kenya. Nominal group technique was adopted for structured discussions, and the findings analysed to derive key themes. Findings Key challenges to primary and secondary prevention of cervical cancer were identified as low awareness, stigma and misinformation, high unmet need for treatment of early lesions, few health care providers with capacity to screen and treat, inadequate supplies, inefficient health information systems and poor referral pathways. Championing integration of cervical cancer screening and treatment services into routine health programs, strengthening policy implementation and robust monitoring and evaluation were identified as critical interventions. Conclusion The National Cervical Cancer Stakeholders Forum 2022 provided insights for enabling Kenya to progress on the 2030 elimination targets. Such forums can be useful in bringing all actors together to evaluate achievements and identify opportunities for more effective national cervical cancer prevention and control programs.
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Affiliation(s)
- Valerian Mwenda
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Joan-Paula Bor
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Mary Nyangasi
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
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8
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Information needs during cancer care: qualitative research with advanced cervical cancer patients in Brazil, China, Germany, and the United States. Gynecol Oncol Rep 2022. [DOI: 10.1016/j.gore.2022.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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9
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Mutebi M, Lewison G, Aggarwal A, Alatise OI, Booth C, Cira M, Grover S, Ginsburg O, Gralow J, Gueye S, Kithaka B, Kingham TP, Kochbati L, Moodley J, Mohammed SI, Mutombo A, Ndlovu N, Ntizimira C, Parham GP, Walter F, Parkes J, Shamely D, Hammad N, Seeley J, Torode J, Sullivan R, Vanderpuye V. Cancer research across Africa: a comparative bibliometric analysis. BMJ Glob Health 2022; 7:bmjgh-2022-009849. [PMID: 36356985 PMCID: PMC9660667 DOI: 10.1136/bmjgh-2022-009849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/29/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Research is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals. METHODOLOGY Bibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009-2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed to understand multiple impact metrics and context relative outputs in comparison with the disease burden as well as the application of a funding thesaurus to determine funding resources. RESULTS African countries in total published 23 679 cancer research papers over the 12-year period (2009-2020) with the fractional African contribution totalling 16 201 papers and the remaining 7478 from authors from out with the continent. The total number of papers increased rapidly with time, with an annual growth rate of 15%. The 49 sub-Saharan African (SSA) countries together published just 5281 papers, of which South Africa's contribution was 2206 (42% of the SSA total, 14% of all Africa) and Nigeria's contribution was 997 (19% of the SSA total, 4% of all Africa). Cancer research accounted for 7.9% of all African biomedical research outputs (African research in infectious diseases was 5.1 times than that of cancer research). Research outputs that are proportionally low relative to their burden across Africa are paediatric, cervical, oesophageal and prostate cancer. African research mirrored that of Western countries in terms of its focus on discovery science and pharmaceutical research. The percentages of female researchers in Africa were comparable with those elsewhere, but only in North African and some Anglophone countries. CONCLUSIONS There is an imbalance in relevant local research generation on the continent and cancer control efforts. The recommendations articulated in our five-point plan arising from these data are broadly focused on structural changes, for example, overt inclusion of research into national cancer control planning and financial, for example, for countries to spend 10% of a notional 1% gross domestic expenditure on research and development on cancer.
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Affiliation(s)
- Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Grant Lewison
- King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Olusegun Isaac Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - Christopher Booth
- Departments of Oncology & Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Miska Cira
- National Cancer Institute Center for Global Health, Rockville, Maryland, USA
| | - Surbhi Grover
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, Virginia, USA
| | - Serine Gueye
- Service d'urologie de l'Hopital General Idrissa Pouye, Dakar, Senegal
| | | | - T Peter Kingham
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lofti Kochbati
- Abderrahmen Mami Teaching Hospital, Ariana El Manar University, Tunis, Tunisia
| | | | | | | | - Ntokozo Ndlovu
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Groesbeck Preer Parham
- World Health Organization, Geneve, Switzerland,Department of Obstetrics and Gynecology, UTH-Women and Newborn Hospital, University of Zambia, Lusaka, Zambia
| | - Fiona Walter
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jeannette Parkes
- Department of Radiation Oncology, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Delva Shamely
- Faculty of Health Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Nazik Hammad
- Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Torode
- Global Oncology Group, King's College London, London, UK
| | | | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine and Korle Bu Teaching Hospital, Korle-Bu, Ghana
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da Silva RGD, Araujo CAS. Initiatives to reduce the waiting time to initiate oncological treatment: a scoping literature review. Rev Panam Salud Publica 2022; 46:e170. [PMID: 36382252 PMCID: PMC9642818 DOI: 10.26633/rpsp.2022.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/06/2022] [Indexed: 11/09/2022] Open
Abstract
Objective. To identify the managerial actions proposed and employed to reduce the waiting time to initiate oncological treatments in the public health system and its application in Latin America. Method. We searched seven databases in December 2020. Search terms were conceptualized into three groups: waiting time, cancer, and terms related to public sector. The eligibility criteria included theoretical or empirical academic articles written in English, Spanish, or Portuguese, that focused on managerial solutions to face oncological healthcare queues' dilemma. Results. The search returned 1 255 articles, and 20 were selected and analysed in this review. Results show that most of the proposals are related to the process and people dimensions. The actions related to the process dimension were mainly associated with programming new treatment pathways and integrating cancer systems. People's dimension initiatives referred mostly to task forces and groups of specialists. Some initiatives were related to implementing technological solutions and the technology dimension, mainly concerning radiotherapy devices' acquisition. Conclusion. Few studies focus on analysing actions to minimize waiting time to initiate oncological treatments. The prevalence of conceptual and illustrative case studies indicates the lack of research maturity on this theme. Future studies should focus on setting the field's theoretical foundations, considering the existing paradigms, or developing new ones. There is a need for empirical studies applying a multidisciplinary approach to face the oncological treatment waiting time challenge and proposing new and innovative initiatives.
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11
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Zhu Y, Liu K, Wang M, Wang K, Zhu H. Trastuzumab deruxtecan versus trastuzumab emtansine for patients with human epidermal growth factor receptor 2-positive metastatic breast cancer: A cost-effectiveness analysis. Breast 2022; 66:191-198. [PMID: 36327624 PMCID: PMC9619174 DOI: 10.1016/j.breast.2022.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND DESTINY-Breast03 (NCT03529110) was the first global phase III study to assess the antitumor activity of trastuzumab deruxtecan (T-DXd) compared to trastuzumab emtansine (T-DM1) in 2022. However, the balance between efficacy and cost of T-DXd remains unclear. As a result, the present study's goal is to investigate the cost-effectiveness of T-DXd vs T-DM1 as a second-line treatment for patients with HER2-positive MBC from the US and Chinese payer's perspectives. METHODS A Markov model with a 20-year time horizon was developed to evaluate the overall cost of patient treatment, incremental cost-effectiveness ratio (ICER), quality-adjusted life-years (QALYs), and life-years (LYs) in the US and China at WTP levels of 150,000/QALY and 37,653/QALY, respectively (3 times GDP per capita in 2021). Key data were gathered from the US government's official website, the Xiangya Hospital of Central South University, and published literature. To determine the model's stability, a sensitivity analysis was performed. A subgroup analysis was also implemented. RESULTS Compared with T-DM1, treatment with T-DXd generated an additional 1.672 QALYs (2.796 LYs), resulting in an ICER of $13,342/QALY (US) and $186,017/QALY (China). The cost of drugs is the most influential factor in the American and Chinese models. Subgroup analysis revealed that the T-DXd and T-DM1 regimens were more cost-effective at reducing the risk of death in the US and Chinese HER2-positive MBC patients. CONCLUSION T-DXd as second-line treatment could gain more health benefits for HER2-positive MBC patients in comparison with T-DM1, which is considered to be cost-effective in the US but not in China.
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Affiliation(s)
- Youwen Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Kun Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Min Wang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Kailing Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China,Corresponding author. Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
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12
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Fan H, Yan T, Chen S, Du Z, Alimu G, Zhu L, Ma R, Tang X, Heng Y, Alifu N, Zhang X. Polydopamine encapsulated new indocyanine green theranostic nanoparticles for enhanced photothermal therapy in cervical cancer HeLa cells. Front Bioeng Biotechnol 2022; 10:984166. [PMID: 36213060 PMCID: PMC9534555 DOI: 10.3389/fbioe.2022.984166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Photothermal therapy (PTT) has attracted extensive attention in cancer treatment due to its non-invasiveness, high efficiency, and repeatability in recent years. Photothermal agents (PTAs) are the key factor for PTT. Recently, although an increasing number of PTAs have been developed, there is still a great demand for optimized photothermal nanoparticles (NPs) with low toxicity, bio-safety and stability. Herein, new indocyanine green (IR820) with near-infrared (NIR:700–1,700 nm) fluorescence emission was selected as a photothermal agent (PTA). To enhance the PTT property, IR820 was encapsulated with another kind of PTA, polydopamine (PDA) under alkaline conditions. Furthermore, to improve the biocompatibility of the NPs, methoxy polyethylene glycol amine (mPEG-NH2) was modified via a Michael addition to form a novel kind of IR820@PDA@PEG NPs. After detailed characterization and analysis, the obtained IR820@PDA@PEG NPs showed a spherical shape with an average diameter of ∼159.6 nm. Meanwhile, the formed IR820@PDA@PEG NPs exhibited better photostability and lower cytotoxicity than free IR820 molecules. The photothermal performance of IR820@PDA@PEG NPs was further analyzed in vitro, and the temperature of IR820@PDA@PEG NPs (100 μg/ml) reached 54.8°C under 793 nm laser irradiation. Afterwards, the cellular uptake of IR820@PDA@PEG NPs was evaluated via confocal laser scanning fluorescence microscopic imaging. Then, PTT experiments on HeLa cells demonstrated that IR820@PDA@PEG NPs can hyperthermal ablate cancer cells (∼49.1%) under 793 nm laser irradiation. Therefore, IR820@PDA@PEG NPs would be a promising PTA for the treatment of cervical cancer HeLa cells.
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Affiliation(s)
- Huimin Fan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, School of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China
| | - Ting Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Shuang Chen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhong Du
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Gulinigaer Alimu
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Lijun Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Rong Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaohui Tang
- Central Laboratory of Xinjiang Medical University, Urumqi, China
| | - Youqiang Heng
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Nuernisha Alifu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, School of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China
- *Correspondence: Nuernisha Alifu, ; Xueliang Zhang,
| | - Xueliang Zhang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, School of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China
- *Correspondence: Nuernisha Alifu, ; Xueliang Zhang,
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Wang Y, Liang X, Wang S, Wang Y, Qin L, Chen D, Jiang Y, Zhang H. Analysis of the Risk Factors for Elevated D-Dimer Level After Breast Cancer Surgery: A Multicenter Study Based on Nursing Follow-Up Data. Front Oncol 2022; 12:772726. [PMID: 35928882 PMCID: PMC9343692 DOI: 10.3389/fonc.2022.772726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
D-dimer level is often used to assess the severity of trauma as well as the risk of thrombosis. This study investigated the risk factors for high postoperative D-dimer level. This study included a total of 2706 patients undergoing breast cancer surgery to examine the associations between various clinicopathological factors and variation in D-dimer levels. After adjusting for other factors, T stage, neoadjuvant chemotherapy, blood loss, surgery type, diabetes, and elevated leukocyte and neutrophil counts were found to be significant risk factors for D-dimer variation. This study identified several factors associated with elevated D-dimer levels and consequent thrombosis after breast cancer surgery, which may aid in the development of more precise preventive measures and interventions as well as serve as a reference for future research.
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Affiliation(s)
- Yanqiu Wang
- Department of Breast Surgery, Second Hospital of Dalian Medical University, Dalian, China
| | - Xi Liang
- Department of Breast Surgery, Second Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
| | - Shujun Wang
- Department of Obstetrics and Gynecology, Second Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
| | - Yuying Wang
- Department of Breast Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
| | - Ling Qin
- Department of Operation Room, Second Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
| | - Danni Chen
- Department of Neurology, Boao Yiling Life Care Center, Boao, China
| | - Yanlin Jiang
- Department of Breast Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Hao Zhang
- Department of Breast Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
- *Correspondence: Xi Liang, ; Shujun Wang, ; Yuying Wang, ; Ling Qin, ; Hao Zhang,
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Deep learning in image-based breast and cervical cancer detection: a systematic review and meta-analysis. NPJ Digit Med 2022; 5:19. [PMID: 35169217 PMCID: PMC8847584 DOI: 10.1038/s41746-022-00559-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022] Open
Abstract
Accurate early detection of breast and cervical cancer is vital for treatment success. Here, we conduct a meta-analysis to assess the diagnostic performance of deep learning (DL) algorithms for early breast and cervical cancer identification. Four subgroups are also investigated: cancer type (breast or cervical), validation type (internal or external), imaging modalities (mammography, ultrasound, cytology, or colposcopy), and DL algorithms versus clinicians. Thirty-five studies are deemed eligible for systematic review, 20 of which are meta-analyzed, with a pooled sensitivity of 88% (95% CI 85–90%), specificity of 84% (79–87%), and AUC of 0.92 (0.90–0.94). Acceptable diagnostic performance with analogous DL algorithms was highlighted across all subgroups. Therefore, DL algorithms could be useful for detecting breast and cervical cancer using medical imaging, having equivalent performance to human clinicians. However, this tentative assertion is based on studies with relatively poor designs and reporting, which likely caused bias and overestimated algorithm performance. Evidence-based, standardized guidelines around study methods and reporting are required to improve the quality of DL research.
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15
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Getachew S, Addissie A, Seife E, Wakuma T, Unverzagt S, Jemal A, Taylor L, Wienke A, Kantelhardt EJ. OUP accepted manuscript. Oncologist 2022; 27:e650-e660. [PMID: 35524760 PMCID: PMC9355816 DOI: 10.1093/oncolo/oyac081] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Many women in rural Ethiopia do not receive adjuvant therapy following breast cancer surgery despite the majority being diagnosed with estrogen-receptor-positive breast cancer and tamoxifen being available in the country. We aimed to compare a breast nurse intervention to improve adherence to tamoxifen therapy for breast cancer patients. Methods and Materials The 8 hospitals were randomized to intervention and control sites. Between February 2018 and December 2019, patients with breast cancer were recruited after their initial surgery. The primary outcome of the study was adherence to tamoxifen therapy by evaluating 12-month medication-refill data with medication possession ratio (MPR) and using a simplified medication adherence scale (SMAQ) in a subjective assessment. Results A total of 162 patients were recruited (87 intervention and 75 control). Trained nurses delivered education and provided literacy material, gave additional empathetic counselling, phone call reminders, and monitoring of medication refill at the intervention hospitals. Adherence according to MPR at 12 months was high in both the intervention (90%) and control sites (79.3%) (P = .302). The SMAQ revealed that adherence at intervention sites was 70% compared with 44.8% in the control sites (P = .036) at 12 months. Persistence to therapy was found to be 91.2% in the intervention and 77.8% in the control sites during the one-year period (P = .010). Conclusion Breast nurses can improve cost-effective endocrine therapy adherence at peripheral hospitals in low-resource settings. We recommend such task sharing to overcome the shortage of oncologists and distances to central cancer centers.
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Affiliation(s)
- Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University (Saale), Halle, Germany
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University (Saale), Halle, Germany
| | - Edom Seife
- Radiotherapy Center, Tikur Anbessa Hospital, Addis Ababa University, Ethiopia
| | - Tariku Wakuma
- Department of Surgery, Aira General Hospital, Ethiopia
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-UniversityHalle (Saale), Germany
| | | | - Lesley Taylor
- City of Hope National Medical Center, Duarte, CaliforniaUSA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University (Saale), Halle, Germany
| | - Eva J Kantelhardt
- Corresponding author: Eva J. Kantelhardt, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Magdeburgerstrasse 8; 06097 Halle, Germany. Tel: +493455571847
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Akanda R, Kawale P, Moucheraud C. Cervical cancer prevention in Africa: A policy analysis. J Cancer Policy 2022; 32:100321. [PMID: 35560260 PMCID: PMC10091860 DOI: 10.1016/j.jcpo.2021.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cervical cancer is a major public health challenge in Africa. We analyzed the presence and content of policies for the primary, secondary and tertiary prevention of cervical cancer in Africa, to identify areas of opportunity for policy strengthening in the region most affected by cervical cancer globally. METHODS We searched for publicly-available policy documents among countries in Africa. Using a data extraction form, we gathered data from these policies about key elements of primary, secondary and tertiary prevention approaches and activities based on World Health Organization (WHO) guidelines. We also contacted key stakeholders in each country to confirm these details. We summarized each country's policy details (summed score for each prevention stage and overall), and compared these scores across individual countries and groups of countries based on economic, policy and public health characteristics. RESULTS Most countries had at least one policy addressing some aspect of cervical cancer prevention. Primary and secondary prevention were more commonly addressed, and certain details like age of vaccination, screening age/interval and method, were frequently mentioned in these policies. CONCLUSION Countries with high HIV burden and relatively more donor financing for health had more comprehensive cervical cancer policies; there was no apparent association with cervical cancer mortality, female representation in government, or economic indicators (poverty prevalence or income inequality). POLICY SUMMARY There is room to improve cervical cancer policy comprehensiveness in Africa, and to bring these policies in line with evidence and expert recommendations. This analysis is timely given upcoming monitoring of the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. These findings suggest some improvements in African cervical cancer policy, including increased inclusion of vaccination, but many topics remain under-specified. The influence of internal and external factors on policymaking should also be considered.
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Puspitaningtyas H, Espressivo A, Hutajulu SH, Fuad A, Allsop MJ. Mapping and Visualization of Cancer Research in Indonesia: A Scientometric Analysis. Cancer Control 2021; 28:10732748211053464. [PMID: 34702111 PMCID: PMC8554557 DOI: 10.1177/10732748211053464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The incidence of cancer and its prevalence are increasing in Indonesia. It is crucial to ensure national cancer policies are evidence-based and promote research. While cancer research is being conducted across Indonesia, the extent and focus of research activities are not known, with no existing synthesis of the cancer research landscape. We seek to address this gap by characterising trends in the extent and types of cancer research conducted in Indonesia. Methods Scientometric study using descriptive analyses to determine annual growth patterns in publications across all cancer research literature from Indonesia. We developed a classification system for both research type and study design which was applied to all included publications. A visualisation software tool (VOSviewer) was used to explore the geographical distribution of research activity. The Wilcoxon rank-sum test was used to determine the influence of international collaboration on the impact factor of journals in which articles were published. Results We retrieved 1773 cancer-related articles published by Indonesia-affiliated authors from 1961 to 2020, with notable year-on-year increases in the annual total number of published articles since 2015. Most articles (84.0%) were published by authors affiliated with institutions on Java Island. The most commonly published article type was basic research and discovery science (28.8%), using a one-group analytical study design (28.8%). International collaboration was significantly correlated with a higher h-index of the journal in which research was published (P < .0001, r = .317). Conclusion An increase in the number and range of topics explored in cancer-related publications over time was identified. The summary of the current corpus of cancer-related research for Indonesia can be used to direct the development of the national cancer control plan alongside informing the national cancer research strategy. Our novel and feasible scientometric approach can be used to direct future national and regional mapping of cancer research.
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Affiliation(s)
| | | | | | - Anis Fuad
- 59166Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, 4468University of Leeds, Leeds, UK
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Addressing breast cancer mortality in low-income and middle-income countries: if you can't measure it, it doesn't exist. Lancet Oncol 2021; 22:1493-1494. [PMID: 34653371 DOI: 10.1016/s1470-2045(21)00519-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 12/29/2022]
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Reibold CF, Tariku W, Eber-Schulz P, Getachew S, Addisie A, Unverzagt S, Wienke A, Hauptmann S, Wickenhauser C, Vetter M, Jemal A, Thomssen C, Kantelhardt EJ. Adherence to Newly Implemented Tamoxifen Therapy for Breast Cancer Patients in Rural Western Ethiopia. Breast Care (Basel) 2021; 16:484-490. [PMID: 34720808 PMCID: PMC8543345 DOI: 10.1159/000512840] [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: 06/24/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Endocrine therapy for breast cancer (BC) patients is highly underutilized in rural Ethiopia and other African countries. OBJECTIVE This study aims to assess the feasibility of and adherence to tamoxifen therapy in rural Ethiopia. METHODS We ascertained the hormone receptor (HR) status in 101 women diagnosed with BC from January 2010 to December 2015 and who had surgery in Aira Hospital, in rural Ethiopia. From 2013, tamoxifen was offered to patients with HR-positive (HR+) tumors. Prescription refill records and a structured questionnaire were used to assess receipt of and adherence to tamoxifen. RESULTS Of the 101 BC patients tested for HR status during the study period, 66 (65%) patients were HR+ and were eligible for tamoxifen treatment. However, 15 of the HR+ patients died before tamoxifen became available in 2013. Of the remaining 51 HR+ patients, 26 (51%) initiated tamoxifen but only 9 of them (35%) adhered to therapy (medication possession rate ≥80%, median observation 16.2 months). After 1 year, 52% of the patients were still adherent, and 9 patients had discontinued therapy. The reasons for non-initiation of tamoxifen included patient factors (n = 5), including financial hardship or lack of transportation, and health care provider factors (n = 12). CONCLUSIONS Endocrine therapy for BC patients seems feasible in rural Western Ethiopia, although non-adherence due to financial hardship and a less developed health care infrastructure remains a major challenge. We postulate that the implementation of breast nurses could reduce patient and health system barriers and improve initiation of and adherence to endocrine treatment.
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Affiliation(s)
| | - Wakuma Tariku
- Ethiopian Evangelical Church of Mekane Yesus EECMY Aira Hospital, Aira, Ethiopia
| | - Pia Eber-Schulz
- Department of Gynecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Sefonias Getachew
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addisie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Susanne Unverzagt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Steffen Hauptmann
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Claudia Wickenhauser
- Department of Pathology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Martina Vetter
- Department of Gynecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Christoph Thomssen
- Department of Gynecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Appleford G, RamaRao S, Bellows B. The inclusion of sexual and reproductive health services within universal health care through intentional design. Sex Reprod Health Matters 2021; 28:1799589. [PMID: 32787538 PMCID: PMC7887933 DOI: 10.1080/26410397.2020.1799589] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In this paper, we argue that how sexual and reproductive health (SRH) services are included in UHC and health financing matters, and that this has implications for universality and equity. This is a matter of rights, given the differential health risks that women face, including unwanted pregnancy. How traditional vertical SRH services are compensated under UHC also matters and should balance incentives for efficiency with incentives for appropriate provision using the rights-based approach to user-centred care so that risks of sub-optimal outcomes are mitigated. This suggests that as UHC benefits packages are designed, there is need for the SRH community to advocate for more than simple “SRH inclusion”. This paper describes a practical approach to integrate quality of SRH care within the UHC agenda using a framework called the “5Ps”. The framework emphasises a “systems” and “design” lens as important steps to quality. The framework can be applied at different scales, from the health system to the individual user level. It also pays attention to how financing and resource policies intended to promote UHC may support or undermine the respect, protection and fulfilment of SRH and rights. The framework was originally developed with a specific emphasis on quality provision of family planning. In this paper, we have extended it to cover other SRH services.
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Affiliation(s)
| | | | - Ben Bellows
- Associate, Population Council, Washington, DC, USA
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22
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Stanway S, Lodge M, Sullivan R, Diprose K, Young AM, Crisp N, Lewis P, Eden T, Aggarwal A, Nadin A, Chinegwundoh F, Sirohi B, Byrne G, Cowan R. The UK's contribution to cancer control in low-income and middle-income countries. Lancet Oncol 2021; 22:e410-e418. [PMID: 34478677 DOI: 10.1016/s1470-2045(21)00380-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
Cancer mortality rates in low-income and middle-income countries (LMICs) are unacceptably high, requiring both collaborative global effort and in-country solutions. Experience has shown that working together in policy, clinical practice, education, training, and research leads to bidirectional benefit for LMICs and high-income countries. For over 60 years, the UK National Health Service has benefited from recruitment from LMICs, providing the UK with a rich diaspora of trained health-care professionals with links to LMICs. A grassroots drive to engage with partners in LMICs within the UK has grown from the National Health Service, UK academia, and other organisations. This drive has generated a model that rests on two structures: London Global Cancer Week and the UK Global Cancer Network, providing a high-value foundation for international discussion and collaboration. Starting with a historical perspective, this Series paper describes the UK landscape and offers a potential plan for the future UK's contribution to global cancer control. We also discuss the opportunities and challenges facing UK partnerships with LMICs in cancer control. The UK should harness the skills, insights, and political will from all partners to make real progress.
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Affiliation(s)
| | - Mark Lodge
- UK Global Cancer Network, Manchester, UK; International Network for Cancer Treatment and Research, Oxford, UK
| | | | | | - Annie M Young
- UK Global Cancer Network, Manchester, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Nigel Crisp
- House of Lords, Houses of Parliament, London, UK
| | - Philippa Lewis
- Department of Clinical Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tim Eden
- World Child Cancer, London, UK; School of Medical Sciences, University of Manchester, Manchester, UK
| | - Ajay Aggarwal
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Ged Byrne
- Health Education England Global Engagement, London, UK; Department of Surgery, Manchester NHS Foundation Trust, Manchester, UK
| | - Richard Cowan
- UK Global Cancer Network, Manchester, UK; School of Medical Sciences, University of Manchester, Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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23
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A multicenter, hospital-based and non-inferiority study for diagnostic efficacy of automated whole breast ultrasound for breast cancer in China. Sci Rep 2021; 11:13902. [PMID: 34230562 PMCID: PMC8260602 DOI: 10.1038/s41598-021-93350-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/17/2021] [Indexed: 12/30/2022] Open
Abstract
This study is the first multi-center non-inferiority study that aims to critically evaluate the effectiveness of HHUS/ABUS in China breast cancer detection. This was a multicenter hospital-based study. Five hospitals participated in this study. Women (30–69 years old) with defined criteria were invited for breast examination by HHUS, ABUS or/and mammography. For BI-RADS category 3, an additional magnetic resonance imaging (MRI) test was provided to distinguish the true negative results from false negative results. For women classified as BI-RADS category 4 or 5, either core aspiration biopsy or surgical biopsy was done to confirm the diagnosis. Between February 2016 and March 2017, 2844 women signed the informed consent form, and 1947 of them involved in final analysis (680 were 30 to 39 years old, 1267 were 40 to 69 years old).For all participants, ABUS sensitivity (91.81%) compared with HHUS sensitivity (94.70%) with non-inferior Z tests, P = 0.015. In the 40–69 age group, non-inferior Z tests showed that ABUS sensitivity (93.01%) was non-inferior to MG sensitivity (86.02%) with P < 0.001 and HHUS sensitivity (95.44%) was non-inferior to MG sensitivity (86.02%) with P < 0.001. Sensitivity of ABUS and HHUS are all superior to that of MG with P < 0.001 by superior test.For all participants, ABUS specificity (92.89%) was non-inferior to HHUS specificity (89.36%) with P < 0.001. Superiority test show that specificity of ABUS was superior to that of HHUS with P < 0.001. In the 40–69 age group, ABUS specificity (92.86%) was non-inferior to MG specificity (91.68%) with P < 0.001 and HHUS specificity (89.55%) was non-inferior to MG specificity (91.68%) with P < 0.001. ABUS is not superior to MG with P = 0.114 by superior test. The sensitivity of ABUS/HHUS is superior to that of MG. The specificity of ABUS/HHUS is non-inferior to that of MG. In China, for an experienced US radiologist, both HHUS and ABUS have better diagnostic efficacy than MG in symptomatic individuals.
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24
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O'Donovan J, Newcomb A, MacRae MC, Vieira D, Onyilofor C, Ginsburg O. Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Glob Health 2021; 5:bmjgh-2020-002466. [PMID: 32409331 PMCID: PMC7228495 DOI: 10.1136/bmjgh-2020-002466] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer is the leading cause of female mortality in low-income and middle-income countries (LMICs). Early detection of breast cancer, either through screening or early diagnosis initiatives, led by community health workers (CHWs) has been proposed as a potential way to address the unjustly high mortality rates. We therefore document: (1) where and how CHWs are currently deployed in this role; (2) how CHWs are trained, including the content, duration and outcomes of training; and (3) the evidence on costs associated with deploying CHWs in breast cancer early detection. Methods We conducted a systematic scoping review and searched eight major databases, as well as the grey literature. We included original studies focusing on the role of CHWs to assist in breast cancer early detection in a country defined as a LMIC according to the World Bank. Findings 16 eligible studies were identified. Several roles were identified for CHWs including awareness raising and community education (n=13); history taking (n=7); performing clinical breast examination (n=9); making onward referrals (n=7); and assisting in patient navigation and follow-up (n=4). Details surrounding training programmes were poorly reported and no studies provided a formal cost analysis. Conclusions Despite the relative paucity of studies addressing the role of CHWs in breast cancer early detection, as well as the heterogeneity of existing studies, evidence suggests that CHWs can play a number of important roles in breast cancer early detection initiatives in LMICs. However, if they are to realise their full potential, they must be appropriately supported within the wider health system.
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Affiliation(s)
- James O'Donovan
- Department of Education, Oxford University, Oxford, Oxfordshire, UK .,Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | - Ashley Newcomb
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York, USA
| | - MacKenzie Clark MacRae
- Division of Research and Health Equity, Omni Med, Mukono, Uganda.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Dorice Vieira
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York, USA
| | - Chinelo Onyilofor
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ophira Ginsburg
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York, USA
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25
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Duggan C, Dvaladze A, Scheel JR, Stevens LM, Anderson BO. Situational analysis of breast health care systems: Why context matters. Cancer 2021; 126 Suppl 10:2405-2415. [PMID: 32348576 DOI: 10.1002/cncr.32899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Implementation of evidence-based, resource-appropriate guidelines for breast cancer control should be preceded by a baseline assessment or situational analysis to assess breast health infrastructure, workforce capacity, patient pathways, existing practices, accessibility, and costs. METHODS To support the assessment of breast health care systems within the broader context in which they exist, the Breast Health Global Initiative (BHGI) developed, tested, and refined a set of situational analysis tools with which to guide the assessment of breast health care capacity, identify the relative strengths and weaknesses of the health system, and support stakeholders in prioritizing actionable items to advance breast cancer care using evidence-based strategies tailored to their setting. The tools address 6 domains of breast health care delivery: 1) breast cancer early detection practices; 2) breast cancer awareness programs; 3) the availability of breast cancer surgery; 4) the availability of pathology; 5) the availability of radiotherapy, and 6) the availability of systemic therapy services. The current study also describes the more comprehensive International Atomic Energy Agency Programme of Action for Cancer Therapy (PACT) integrated missions for PACT (imPACT) review. RESULTS As of 2020, 5 formal BHGI situational analyses have been performed in India, Brazil, Panama, Tanzania, and Uganda. As of August 2019, a total of 100 imPACT reviews have been conducted in 91 countries. These assessments can contribute to more informed policymaking. CONCLUSIONS Situational analyses are a prerequisite for the development of resource-appropriate strategies with which to advance breast cancer control in any setting and should assess services across the entire breast health care continuum as well as the broader structural, sociocultural, personal, and financial contexts within which they operate.
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Affiliation(s)
- Catherine Duggan
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Allison Dvaladze
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,University of Washington, Seattle, Washington, USA
| | - John R Scheel
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Radiology, Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Lisa M Stevens
- Division of Programme of Action for Cancer Therapy (PACT), International Atomic Energy Agency, Vienna, Austria
| | - Benjamin O Anderson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Surgery, Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA
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26
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Palacios A, Rojas-Roque C, González L, Bardach A, Ciapponi A, Peckaitis C, Pichon-Riviere A, Augustovski F. Direct Medical Costs, Productivity Loss Costs and Out-Of-Pocket Expenditures in Women with Breast Cancer in Latin America and the Caribbean: A Systematic Review. PHARMACOECONOMICS 2021; 39:485-502. [PMID: 33782865 DOI: 10.1007/s40273-021-01014-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Our objective was to conduct a systematic review of the literature to identify, categorise, assess, and synthesise the healthcare costs of patients with breast cancer (BC) and their relatives in Latin America and the Caribbean (LAC). METHODS In December 2020, we searched for published data in PubMed, LILACS, EMBASE, and other sources, including the grey literature. Studies were eligible if they were conducted in LAC and reported the direct medical costs, productivity loss costs, out-of-pocket expenditure, and other costs to patients with BC and their relatives. No restrictions were imposed on the type of BC population (metastatic BC or human epidermal growth factor receptor 2-positive/negative BC, among others). We summarised the characteristics and methodological approach of each study and the healthcare costs by cancer stage. We also developed and applied an original ad hoc instrument to assess the quality of the cost estimation studies. RESULTS We identified 2725 references and 63 included studies. In total, 79.3% of the studies solely reported direct medical costs and five solely reported costs to patients and their relatives. Only 14.3% of the studies were classified as of high quality. The pooled weighted average direct medical cost per patient-year (year 2020 international dollars [I$]) by BC stage was I$13,179 for stage I, I$15,556 for stage II, I$23,444 for stage III, and I$28,910 for stage IV. CONCLUSION This review provides the first synthesis of BC costs in LAC. Our findings show few high-quality costing studies in BC and a gap in the literature measuring costs to patients and their relatives. The high costs associated with the advanced stages of BC call into question the affordability of treatments and their accessibility for patients. Registered in PROSPERO (CRD42018106835).
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Affiliation(s)
- Alfredo Palacios
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina.
- Facultad de Ciencias Económicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Carlos Rojas-Roque
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Lucas González
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Ariel Bardach
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Claudia Peckaitis
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Andres Pichon-Riviere
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Federico Augustovski
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
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27
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Bing EG, Brown ML, Cuevas A, Sullivan R, Parham GP. User Experience With Low-Cost Virtual Reality Cancer Surgery Simulation in an African Setting. JCO Glob Oncol 2021; 7:435-442. [PMID: 33788595 PMCID: PMC8081482 DOI: 10.1200/go.20.00510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/14/2020] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Limited access to adequate cancer surgery training is one of the driving forces behind global inequities in surgical cancer care. Affordable virtual reality (VR) surgical training could enhance surgical skills in low- and middle-income settings, but most VR and augmented reality systems are too expensive and do not teach open surgical techniques commonly practiced in these contexts. New low-cost VR can offer skill development simulations relevant to these settings, but little is known about how knowledge is gained and applied by surgeons training and working in specific resource-constrained settings. This study addresses this gap, exploring gynecologic oncology trainee learning and user experience using a low-cost VR simulator to learn to perform an open radical abdominal hysterectomy in Lusaka, Zambia. METHODS Eleven surgical trainees rotating through the gynecologic oncology service were sequentially recruited from the University Teaching Hospital in Lusaka to participate in a study evaluating a VR radical abdominal hysterectomy training designed to replicate the experience in a Zambian hospital. Six participated in semi-structured interviews following the training. Interviews were analyzed using open and axial coding, informed by grounded theory. RESULTS Simulator participation increased participants' perception of their surgical knowledge, confidence, and skills. Participants believed their skills transferred to other related surgical procedures. Having clear goals and motivation to improve were described as factors that influenced success. CONCLUSION For cancer surgery trainees in lower-resourced settings learning medical and surgical skills, even for those with limited VR experience, low-cost VR simulators may enhance anatomical knowledge and confidence. The VR simulator reinforced anatomical and clinical knowledge acquired through other modalities. VR-enhanced learning may be particularly valuable when mentored learning opportunities are limited.
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Affiliation(s)
- Eric G. Bing
- Department of Applied Physiology and Wellness, Center for Global Health Impact, Simmons School of Education and Human Development, Southern Methodist University, Dallas, TX
- Department of Anthropology, Dedman College of Humanities and Sciences, Southern Methodist University, Dallas, TX
| | - Megan L. Brown
- Department of Anthropology, Dedman College of Humanities and Sciences, Southern Methodist University, Dallas, TX
| | - Anthony Cuevas
- Simulation Laboratory, Department of Teaching and Learning, Simmons School of Education and Human Development, Southern Methodist University, Dallas, TX
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, Kings Health Partners Comprehensive Cancer Centre, School of Cancer Sciences, London, United Kingdom
| | - Groesbeck P. Parham
- Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel, Chapel Hill, NC
- Department of Obstetrics and Gynecology, University of Zambia, UTH-Women and Newborn Hospital, Lusaka, Zambia
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28
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Piña-Sánchez P, Chávez-González A, Ruiz-Tachiquín M, Vadillo E, Monroy-García A, Montesinos JJ, Grajales R, Gutiérrez de la Barrera M, Mayani H. Cancer Biology, Epidemiology, and Treatment in the 21st Century: Current Status and Future Challenges From a Biomedical Perspective. Cancer Control 2021; 28:10732748211038735. [PMID: 34565215 PMCID: PMC8481752 DOI: 10.1177/10732748211038735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Since the second half of the 20th century, our knowledge about the biology of cancer has made extraordinary progress. Today, we understand cancer at the genomic and epigenomic levels, and we have identified the cell that starts neoplastic transformation and characterized the mechanisms for the invasion of other tissues. This knowledge has allowed novel drugs to be designed that act on specific molecular targets, the immune system to be trained and manipulated to increase its efficiency, and ever more effective therapeutic strategies to be developed. Nevertheless, we are still far from winning the war against cancer, and thus biomedical research in oncology must continue to be a global priority. Likewise, there is a need to reduce unequal access to medical services and improve prevention programs, especially in countries with a low human development index.
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Affiliation(s)
- Patricia Piña-Sánchez
- Oncology Research Unit, Oncology Hospital, Mexican Institute of Social Security, Mexico
| | | | - Martha Ruiz-Tachiquín
- Oncology Research Unit, Oncology Hospital, Mexican Institute of Social Security, Mexico
| | - Eduardo Vadillo
- Oncology Research Unit, Oncology Hospital, Mexican Institute of Social Security, Mexico
| | - Alberto Monroy-García
- Oncology Research Unit, Oncology Hospital, Mexican Institute of Social Security, Mexico
| | - Juan José Montesinos
- Oncology Research Unit, Oncology Hospital, Mexican Institute of Social Security, Mexico
| | - Rocío Grajales
- Department of Medical Oncology, Oncology Hospital, Mexican Institute of Social Security, Mexico
| | - Marcos Gutiérrez de la Barrera
- Oncology Research Unit, Oncology Hospital, Mexican Institute of Social Security, Mexico
- Clinical Research Division, Oncology Hospital, Mexican Institute of Social Security, Mexico
| | - Hector Mayani
- Oncology Research Unit, Oncology Hospital, Mexican Institute of Social Security, Mexico
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29
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Borras AM. Toward an Intersectional Approach to Health Justice. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:206-225. [PMID: 33356774 DOI: 10.1177/0020731420981857] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite unprecedented global wealth creation, health inequity-the unjust health inequality between classes and groups among and within countries-persists, reviving the relevance of social justice as a lens to understand and as an instrument to intervene in these issues. However, the theoretical aspects and polysemous character of social justice as applied in the field of public health are often assumed rather than explicitly explained. An intersectional justice approach to understanding health inequality, inequity, and injustice might be useful. It argues that preexisting class-, race/ethnicity-, and gender-based health injustice and the socially differentiated impacts of the COVID-19 pandemic are shaped, interconnectedly, by economic maldistribution, cultural misrecognition, and political misrepresentation. Pursuing health justice requires analyses, strategies, and interventions that integrate the economic, cultural, and political spheres of redistribution, recognition, and representation, respectively. Such an intersectional approach to health justice is even more relevant and compelling in light of the COVID-19 pandemic. This article is broadly about class, race/ethnicity, and gender political economy of public health-but with a narrower focus on maldistribution, misrecognition, and misrepresentation, shaping social and health injustices.
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Affiliation(s)
- Arnel M Borras
- School of Health Policy and Management, 56014York University, Toronto, Ontario, Canada
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30
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Breast Reconstruction Practices and Barriers in West Africa: A Survey of Surgeons. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3259. [PMID: 33299721 PMCID: PMC7722587 DOI: 10.1097/gox.0000000000003259] [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] [Received: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Access to breast reconstruction is limited in low-income countries. Identifying current barriers that plague both providers and patients can inform future interventions focused on improving access to care. The goal of this study was to delineate perceptions of breast reconstruction among providers in West Africa and define current barriers to care. Methods: Surveys were administered to surgeons attending the annual meeting of the West African College of Surgeons in 2018. Surgeons were surveyed regarding their practices and perceptions of breast reconstruction. Information on barriers to breast reconstruction focused on patient- and surgeon-related factors was also obtained. A univariate analysis was performed to assess association of demographic and practice information with perceptions of reconstruction barriers. Results: Thirty-eight surgeons completed the questionnaires; 10 of the respondents were plastic surgeons (27%). The survey response rate was 40%. Factors that a majority of surgeons believed to limit access to reconstruction included limited experience (72.9%), resources (76.3%), and a lack of referrals for reconstruction (75%). In total, 76.5% of surgeons had performed <10 breast reconstruction cases in the past year. Two patient factors highlighted by most surgeons (>80%) were a lack of knowledge and concerns about cost. Conclusions: Perspectives from surgeons in the West African College of Surgeons suggest that barriers in access, patient awareness, surgeon technical expertise, and cost limit the delivery of breast reconstructive services to women in the region. Implementation of interventions focused on these specific metrics may serve as valuable first steps in the movement to increase access to breast reconstruction.
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31
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Taghavi K, Moono M, Asangbeh S, Gillett G, Pascoe M, Manasyan A. Strengthening global commitment to eliminating cervical cancer: What lessons from the past can we apply to the future? J Glob Health 2020; 10:020385. [PMID: 33214893 PMCID: PMC7648905 DOI: 10.7189/jogh.10.020385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Katayoun Taghavi
- Institute of Social and Preventive Medicine, University of Bern, Switzerland.,The Graduate School for Cellular and Biomedical Sciences of the University of Bern, Bern Switzerland
| | - Misinzo Moono
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Serra Asangbeh
- Institute of Social and Preventive Medicine, University of Bern, Switzerland.,The Graduate School for Cellular and Biomedical Sciences of the University of Bern, Bern Switzerland
| | - Grant Gillett
- Department of Bioethics, University of Otago, Dunedin, New Zealand.,Newlands Clinic, Harare, Zimbabwe
| | | | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,University of Alabama at Birmingham, Alabama, USA
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32
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Ueda SM, Temkin SM. A global care package for women: Gender-neutral human papillomavirus eradication. Cancer 2020; 126:4660-4663. [PMID: 32780470 DOI: 10.1002/cncr.33115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Stefanie M Ueda
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California
| | - Sarah M Temkin
- Division of Gynecologic Specialty Surgery, Anne Arundel Medical Center, Annapolis, Maryland
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33
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Hemida RA, van Doorn HC, Massuger LF. Collaboration Benefits All. JCO Glob Oncol 2020; 6:56-58. [PMID: 32031439 PMCID: PMC6998033 DOI: 10.1200/jgo.19.00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Reda A. Hemida
- Department of Obstetrics and Gynaecology, Mansoura University, Mansoura, Egypt
| | - Helena C. van Doorn
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Leon F.A.G. Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands
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34
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Qin L, Fu Y, Li C, Chen S, Lv Y, Hao M, Zhang H, Wang Y. Analysis of risk factors for high postoperative D-dimer levels: A single-center nurse-observational study. Int J Biol Markers 2020; 35:23-28. [PMID: 32567475 DOI: 10.1177/1724600820931861] [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: 11/15/2022]
Abstract
BACKGROUND As an elevated D-dimer level is directly proportional to the degrees of trauma and coagulation, it is often used to assess the severity of the trauma as well as the risk of thrombosis. This study aimed to investigate the risk factors for a high postoperative D-dimer level. METHODS A total of 623 patients undergoing radical mastectomy were included. The association between various clinicopathological factors and D-dimer variation was examined. RESULTS Age, neoadjuvant chemotherapy, diabetes, and elevated neutrophil count were significant risk factors for D-dimer variation, after adjusting for other factors. CONCLUSIONS This study has identified the characteristics of patients who are likely to experience considerable postoperative increases in the D-dimer level. The development of effective nursing interventions for these patients is the focus of future studies.
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Affiliation(s)
- Ling Qin
- Department of Operation Room, Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Yan Fu
- Department of Breast Surgery, Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Cong Li
- Department of Digestive Oncology, Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Shuang Chen
- Department of Breast Surgery, Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Ying Lv
- Department of Respiratory, Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Meijuan Hao
- Department of Breast Surgery, Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Hao Zhang
- Department of Breast Surgery, Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Yanqiu Wang
- Department of Breast Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
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35
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Jenkins C, Ha DT, Lan VT, Van Minh H, Lohfeld L, Murphy P, Ha LTH. Breast Cancer messaging in Vietnam: an online media content analysis. BMC Public Health 2020; 20:966. [PMID: 32560712 PMCID: PMC7304170 DOI: 10.1186/s12889-020-09092-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background Breast cancer incidence is increasing in Vietnam with studies indicating low levels of knowledge and awareness and late presentation. While there is a growing body of literature on challenges faced by women in accessing breast cancer services, and for delivering care, no studies have sought to analyse breast cancer messaging in the Vietnamese popular media. The aim of this study was to investigate and understand the content of messages concerning breast cancer in online Vietnamese newspapers in order to inform future health promotional content. Methods This study describes a mixed-methods media content analysis that counted and ranked frequencies for media content (article text, themes and images) related to breast cancer in six Vietnamese online news publications over a twelve month period. Results Media content (n = 129 articles & n = 237 images) sampled showed that although information is largely accurate, there is a marked lack of stories about Vietnamese women’s personal experiences. Such stories could help bridge the gap between what information about breast cancer is presented in the Vietnamese media, and what women in Vietnam understand about breast cancer risk factors, symptoms, screening and treatment. Conclusions Given findings from other studies indicating low levels of knowledge and women with breast cancer experiencing stigma and prejudice, more nuanced and in-depth narrative-focused messaging may be required.
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Affiliation(s)
- Chris Jenkins
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | - Dinh Thu Ha
- Hanoi University of Public Health, Hanoi, Vietnam
| | | | | | - Lynne Lohfeld
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Paul Murphy
- School of Arts, English and Languages, Queen's University Belfast, Belfast, UK
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Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Y. J, Gyawali B, McCormack V, de Anderson MM, Mehrotra R, Mohar A, Murillo R, Pace LE, Paskett ED, Romanoff A, Rositch AF, Scheel J, Schneidman M, Unger-Saldana K, Vanderpuye V, Wu TY, Yuma S, Dvaladze A, Duggan C, Anderson BO. Breast cancer early detection: A phased approach to implementation. Cancer 2020; 126 Suppl 10:2379-2393. [PMID: 32348566 PMCID: PMC7237065 DOI: 10.1002/cncr.32887] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.
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Affiliation(s)
- Ophira Ginsburg
- Perlmutter Cancer Center, Section for Global Health, Division of Health and Behavior, Department of Population Health, New York University Langone Health, NY, USA
| | - Cheng-Har Yip
- University of Malaya, Kuala Lumpur, Malaysia
- Ramsay Sime Darby Health Care Kuala Lumpur, Malaysia
| | - Ari Brooks
- Dept. of Surgery, University of Pennsylvania, PA, USA
| | | | - Maira Caleffi
- Breast Center Hospital Moinhos de Vento Porto Alegre, Brazil
| | - Jorge Dunstan Y.
- Department of Breast, Skin and Soft Tissue Sarcomas Surgery Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Bishal Gyawali
- Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada
| | | | | | | | - Alejandro Mohar
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Raul Murillo
- Centro Javeriano de Oncología – Hospital Universitario San Ignacio. Colombia
- Facultad de Medicina – Pontificia Universidad Javeriana, Colombia
| | - Lydia E. Pace
- Division of Women’s Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Anya Romanoff
- Department of Surgery, Division of Surgical Oncology, Breast Surgery, The Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Scheel
- Dept. of Radiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington Seattle, WA, USA
| | - Miriam Schneidman
- Health, Nutrition and Population Global Practice, The World Bank Group
| | - Karla Unger-Saldana
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Verna Vanderpuye
- National Center for Oncology, Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - Tsu-Yin Wu
- Center for Health Disparities Innovation and Studies, Eastern Michigan University, MI, USA
| | - Safina Yuma
- Dept. of Reproductive and Child Health, Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
| | - Allison Dvaladze
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Catherine Duggan
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Benjamin O. Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, Washington, USA
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Abstract
OBJECTIVE In this study, we quantified the global macroeconomic burden of breast cancer to underscore the critical importance of improving access to oncologic surgical care internationally. SUMMARY BACKGROUND DATA Breast cancer mortality in many low and middle-income countries (LMICs) is dramatically higher than in high-income countries. Prior to identifying solutions, however, it is important to first define the burden of disease. METHODS Data from the Institute of Health Metrics and Evaluation (2005-2015) were used to assess epidemiologic trends for 194, middle, and low-income countries. Economic burden defined by Welfare Loss (WL) was calculated by measuring disability-adjusted-life-years lost to breast cancer alongside the dollar equivalent of a value of statistical life year and as a function of each country's gross domestic product (GDP). RESULTS Annual mortality rates among breast cancer patients were significantly greater in LMICs in South Asia (3.06 per 100 women) and Sub-Saharan Africa (2.76 per 100 women), compared with high-income countries like the United States (1.69 per 100 women). From 2005-2015, mortality in South Asia increased by 8.20% and decreased by 6.45% in Sub-Saharan Africa; mortality rates in 2015 were observed as 27.9 per 100,000 in South Asia and 18.61 per 100,000 in Sub-Saharan Africa. Countries in South Asia demonstrated the greatest rise in WL due to breast cancer, from 0.05% to 0.08% of GDP. CONCLUSIONS The burden of disease and economic impact of breast cancer is intensifying in LMICs. Global efforts to improve access to surgical care for women with breast cancer could reduce mortality and mitigate the social and financial impact of this disease in LMICs.
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Lombardo MS, Popim RC. Access of the patient to the cancer network under the “Sixty-Day Law”: Integrative Review. Rev Bras Enferm 2020; 73:e20190406. [DOI: 10.1590/0034-7167-2019-0406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022] Open
Abstract
ABSTRACT Objectives: to analyze Brazilian scientific production on patient access to the oncology network under the “Sixty-Day Law”. Methods: integrative review of the literature in the databases Lilacs, PubMed and Scielo. The descriptors used were: neoplasms, health services accessibility, early detection of cancer. Articles published from 2015 to March 2019 were included. Results: 17 articles were analyzed and four themes emerged: inequality in access; qualification of Primary Care professionals; time as a determinant factor; information system as limiting factor. Conclusions: the access to the oncology network is unequal and there are several barriers faced by the users. A continuing education of health professionals is necessary to implement preventive strategies. Treatment initiation is late, showing non-compliance with the law. The health care network is highly fragmented, there is lack of coordination between the services and, consequently, there is a lack of patient follow-up.
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Murchland AR, Gottschlich A, Bevilacqua K, Pineda A, Sandoval-Ramírez BA, Alvarez CS, Ogilvie GS, Carey TE, Prince M, Dean M, Mendoza Montano C, Rivera-Andrade A, Meza R. HPV self-sampling acceptability in rural and indigenous communities in Guatemala: a cross-sectional study. BMJ Open 2019; 9:e029158. [PMID: 31662358 PMCID: PMC6830827 DOI: 10.1136/bmjopen-2019-029158] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Cervical cancer disproportionately burdens low-income and middle-income countries (LMICs) such as Guatemala. Self-collection testing for human papillomavirus (HPV) has been suggested as a form of cervical cancer screening to facilitate access in LMICs. This study assessed and compared the acceptability of self-collection HPV testing in two rural, indigenous and ethnically distinct communities in Guatemala: Santiago Atitlán, Sololá and Livingston, Izabal. METHODS All participants, women between the ages of 18 and 60, completed a questionnaire. Eligible participants were also asked to self-collect a vaginal sample and complete a questionnaire regarding comfort and acceptability. Self-collected samples were tested for high-risk HPV using the real-time PCR Hybribio kit. RESULTS In the indigenous community of Santiago Atitlán, of 438 age-eligible participants, 94% completed self-collection. Of those, 81% found it comfortable and 98% were willing to use it as a form of screening. In the multiethnic (Afro-Caribbean, indigenous) community of Livingston, of 322 age-eligible participants, 53% chose to self-collect. Among those who took the test, 83% found it comfortable and 95% were willing to use it as a form of screening. In Livingston, literacy (can read and/or write vs cannot read or write) was higher in women who chose to self-collect (prevalence ratio 2.25; 95% CI 1.38 to 3.68). Ethnicity, history of screening and reproductive history were not associated with willingness to self-collect in Livingston. Women in Santiago reported less prior use of healthcare than women in Livingston. Overall, 19% (106/549) of samples tested positive for high-risk HPV. CONCLUSION Among women willing to self-collect in rural and indigenous communities in Guatemala, self-collection for HPV testing is highly acceptable. However, willingness to try self-collection might vary across communities and settings. Women from a community that used less healthcare were more likely to choose self-collection. Further research is necessary to determine what factors influence a woman's choice to self-collect.
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Affiliation(s)
- Audrey R Murchland
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Anna Gottschlich
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kristin Bevilacqua
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Andres Pineda
- Center for the Prevention of Chronic Diseases, Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Berner Andrée Sandoval-Ramírez
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Universitat Rovira i Virgili, Hospital Universitari Sant Joan, Reus, Spain
| | - Christian S Alvarez
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Gina S Ogilvie
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Thomas E Carey
- Department of Otolaryngology-Head and Neck Surgery and Department of Pharmacology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark Prince
- Department of Otolaryngology Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Dean
- Laboratory of Translational Genomics, Division of Cancer, Epidemiology and Genetics, National Cancer Institute, Gaithersburg, Maryland, USA
| | - Carlos Mendoza Montano
- Center for the Prevention of Chronic Diseases, Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Alvaro Rivera-Andrade
- Center for the Prevention of Chronic Diseases, Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Rafael Meza
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Cancer Epidemiology and Prevention Program, University of Michigan Rogel Cancer Center, Ann Arbor, United States
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Luckett R, Mogowa N, Li HJ, Erlinger A, Hacker MR, Esselen K, Feldman S, Shapiro R, Morroni C, Ramogola-Masire D. Performance of Two-Stage Cervical Cancer Screening With Primary High-Risk Human Papillomavirus Testing in Women Living With Human Immunodeficiency Virus. Obstet Gynecol 2019; 134:840-849. [PMID: 31503167 PMCID: PMC6768725 DOI: 10.1097/aog.0000000000003496] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the performance of cervical cancer screening algorithms for women living with human immunodeficiency virus (HIV), using primary high-risk human papillomavirus (HPV) testing followed by cytology, visual inspection with acetic acid, or colposcopy. METHODS We conducted a prospective cohort study of women living with HIV in Botswana. All participants underwent high-risk HPV testing. Participants with positive high-risk HPV test results underwent cytology, visual inspection with acetic acid, colposcopy, and biopsy. Participants with negative high-risk HPV test results also underwent cytology. Histopathology was the reference standard for determination of preinvasive cervical disease and cervical cancer. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and likelihood ratios (LR) of high-risk HPV-based two-stage screening algorithms were calculated. RESULTS Among 300 women screened, 88 (29%) had a positive high-risk HPV test result, and 29 of the 88 (35%) women who tested positive for high-risk HPV had CIN 2 or higher on histopathology. High-risk HPV followed by colposcopy resulted in a sensitivity of 83%, specificity of 49%, PPV of 47%, LR+ of +1.6, and LR- of -0.4. High-risk HPV followed by visual inspection with acetic acid resulted in a reduced sensitivity of 59%, specificity of 49%, PPV of 39%, LR+ of +1.2, and LR- of -0.8. High-risk HPV testing followed by cytology also resulted in a reduced sensitivity of 62%, specificity of 77%, PPV of 60%, LR+ of +2.7, and LR- of -0.5. Stratification by HPV 16/18/45 did not improve performance of the algorithms. CONCLUSION In a high-risk population with HIV, high-risk HPV testing followed by colposcopy demonstrated the highest sensitivity and PPV in detecting high-grade cervical dysplasia. Allocating resources to colposcopy in resource-limited settings may be more effective than other screening strategies.
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Affiliation(s)
- Rebecca Luckett
- Botswana Harvard AIDS Initiative Partnership
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- Harvard Medical School, Boston, MA
| | - Neo Mogowa
- Botswana Harvard AIDS Initiative Partnership
| | | | - Adrienne Erlinger
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Katharine Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sarah Feldman
- Harvard Medical School, Boston, MA
- Brigham and Women’s Hospital, Boston, MA
| | - Roger Shapiro
- Botswana Harvard AIDS Initiative Partnership
- Harvard Medical School, Boston, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Chelsea Morroni
- Botswana Harvard AIDS Initiative Partnership
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Botswana UPenn Partnership, Gaborone, Botswana
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Sarfati D, Dyer R, Vivili P, Herman J, Spence D, Sullivan R, Weller D, Bray F, Hill S, Bates C, Foliaki S, Palafox N, Luciani S, Ekeroma A, Hospedales J. Cancer control in small island nations: from local challenges to global action. Lancet Oncol 2019; 20:e535-e548. [PMID: 31395475 PMCID: PMC7746435 DOI: 10.1016/s1470-2045(19)30511-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
Cancer is a leading cause of death in small island nations and is forecast to increase substantially over the coming years. Governments, regional agencies, and health services of these nations face daunting challenges, including small and fragile economies, unequal distribution of resources, weak or fragmented health services, small population sizes that make sustainable workforce and service development problematic, and the unavailability of specialised cancer services to large parts of the population. Action is required to prevent large human and economic costs relating to cancer. This final Series paper highlights the challenges and opportunities for small island nations, and identifies ways in which the international community can support efforts to improve cancer control in these settings. Our recommendations focus on funding and investment opportunities to strengthen cancer-related health systems to improve sharing of technical assistance for research, surveillance, workforce, and service development, and to support small island nations with policy changes to reduce the consumption of commodities (eg, tobacco and unhealthy food products) that increase cancer risk.
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Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Paula Vivili
- Public Health Division, Pacific Community, Noumea, New Caledonia
| | | | | | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - David Weller
- James Mackenzie Professor of General Practice, Usher Institute of Population Health, Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Sarah Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Christopher Bates
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, Melbourne, VIC, Australia
| | - Sunia Foliaki
- Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
| | - Neal Palafox
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Alec Ekeroma
- Obstetrics and Gynaecology, University of Otago, Wellington, Wellington, New Zealand; National University of Samoa, Le Papaigalagala Campus, To'omatagi, Samoa
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Mukhopadhyay K, Paul P. Pharmaceutical growth versus health equity in India: when markets fail. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-018-0969-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Allanson ER, Powell A, Bulsara M, Lee HL, Denny L, Leung Y, Cohen P. Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis. PLoS One 2019; 14:e0217775. [PMID: 31269024 PMCID: PMC6608935 DOI: 10.1371/journal.pone.0217775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 05/19/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate morbidity for patients after the primary surgical management of cervical cancer in low and middle-income countries (LMIC). METHODS The Pubmed, Cochrane, the Cochrane Central Register of Controlled Trials, Embase, LILACS and CINAHL were searched for published studies from 1st Jan 2000 to 30th June 2017 reporting outcomes of surgical management of cervical cancer in LMIC. Random-effects meta-analytical models were used to calculate pooled estimates of surgical complications including blood transfusions, ureteric, bladder, bowel, vascular and nerve injury, fistulae and thromboembolic events. Secondary outcomes included five-year progression free (PFS) and overall survival (OS). FINDINGS Data were available for 46 studies, including 10,847 patients from 11 middle income countries. Pooled estimates were: blood transfusion 29% (95%CI 0.19-0.41, P = 0.00, I2 = 97.81), nerve injury 1% (95%CI 0.00-0.03, I2 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01-0.01, I2 = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01-0.02, P = 0.10, I2 = 32.2), ureteric injury 1% (95%CI 0.01-0.01, I2 0.00, P = 0.64), vascular injury 2% (95% CI 0.01-0.03, I2 60.22, P = 0.00), fistula 2% (95%CI 0.01-0.03, I2 = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00-0.01, I2 26.69, P = 0.25), and infection 8% (95%CI 0.04-0.12, I2 95.72, P = 0.00). 5-year PFS was 83% for laparotomy, 84% for laparoscopy and OS was 85% for laparotomy cases and 80% for laparoscopy. CONCLUSION This is the first systematic review and meta-analysis of surgical morbidity in cervical cancer in LMIC, which highlights the limitations of the current data and provides a benchmark for future health services research and policy implementation.
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Affiliation(s)
- Emma R. Allanson
- Division of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Western Australia, Crawley, WA, Australia
- * E-mail:
| | - Aime Powell
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Hong Lim Lee
- Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, WA, Australia
| | - Lynette Denny
- Department Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecological Cancer Research Centre, Cape Town, South Africa
| | - Yee Leung
- Division of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Western Australia, Crawley, WA, Australia
| | - Paul Cohen
- Division of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Western Australia, Crawley, WA, Australia
- Department of Gynaecological Oncology, Bendat Family Comprehensive Cancer Centre, St John of God, Subiaco, WA, Australia
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Zhao Y, Luo H, Zhang X, Bianba T, Li L, Wang Q, Guo L, Wang D, Ze Y, Zheng S. Clinicopathological characteristics and health care for Tibetan women with breast cancer: a cross-sectional survey. BMC Cancer 2019; 19:380. [PMID: 31023263 PMCID: PMC6482490 DOI: 10.1186/s12885-019-5580-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/04/2019] [Indexed: 12/04/2022] Open
Abstract
Background The healthcare system (HCS) improved in Tibet Autonomous Region (TAR), China. The present study aimed to investigate whether these improvements might alter the clinicopathological characteristics of a Tibetan female with breast cancer (BC) in TAR. Methods This was a single-center cross-sectional study conducted at TAR People’s Hospital. All Tibetan adult women were treated for BC in this hospital between January 1, 1973 and December 31, 2015. The inclusion criteria were as follows: (1) Tibetan adult woman living in Tibet; (2) Histopathology or cytopathology or both confirming primary BC; (3) All the treatments were finished in this hospital. χ2 test and logistic regression were applied, using age group and census register as the two covariates. Results A total of 273 patients with BC were included in the final analysis. Of these, 14 patients were in the free HCS, 183 patients had medical insurance combined with a new rural cooperative HCS, and 76 were in a rural and urban integration HCS. Currently, a rural and urban integration HCS is an improved system. Consequently, an increase in the proportion patients in the T1–3 stage was observed (0.198; 0.046 to 0.852) between the rural and urban integration HCS and free HCS. The proportion of patients in early (I + II) stage cancer (0.110; 0.019–0.633) also increased between these two HCSs. Conclusion This was the first report about Tibetan women with BC in Tibet. Some clinicopathological characteristics at the presentation of Tibetan women with BC may improve during different HCSs. The cancer awareness, early detection, and the overall management in patients with advanced stage BC might improve the prognosis of BC in the rural and urban integration HCS.
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Affiliation(s)
- Yulan Zhao
- Department of Oncology, Tibet autonomous region people's hospital, autonomous region, Lhasa, 850000, Tibet, China
| | - Hanhuan Luo
- Department of Pathology, Tibet autonomous region people's hospital, autonomous region, Lhasa, 850000, Tibet, China
| | - Xintian Zhang
- Department of Second Clinical Medicine, Sun Yat-sen University Zhongshan School of Medicine, Yuexiu District, Guangzhou, 510080, Guangdong, China
| | - Tashi Bianba
- Department of Oncology, Tibet autonomous region people's hospital, autonomous region, Lhasa, 850000, Tibet, China
| | - Lin Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and PeKing Union Medical College, Beijing, 100021, China
| | - Qian Wang
- Department of Pathology, Tibet autonomous region people's hospital, autonomous region, Lhasa, 850000, Tibet, China
| | - Lei Guo
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and PeKing Union Medical College, Beijing, 100021, China
| | - Dian Wang
- Department of Imaging, Tibet autonomous region people's hospital, autonomous region, 850000, Tibet, China
| | - Yongge Ze
- Department of Oncology, Tibet autonomous region people's hospital, autonomous region, Lhasa, 850000, Tibet, China.
| | - Shan Zheng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and PeKing Union Medical College, Beijing, 100021, China.
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Sundar S, Khetrapal-Singh P, Frampton J, Trimble E, Rajaraman P, Mehrotra R, Hariprasad R, Maitra A, Gill P, Suri V, Srinivasan R, Singh G, Thakur JS, Dhillon P, Cazier JB. Harnessing genomics to improve outcomes for women with cancer in India: key priorities for research. Lancet Oncol 2019; 19:e102-e112. [PMID: 29413464 DOI: 10.1016/s1470-2045(17)30726-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 08/03/2017] [Accepted: 09/11/2017] [Indexed: 02/08/2023]
Abstract
Cumulatively, breast, cervical, ovarian, and uterine cancer account for more than 70% of cancers in women in India. Distinct differences in the clinical presentation of women with cancer suggest underlying differences in cancer biology and genetics. The peak age of onset of breast and ovarian cancer appears to be a decade earlier in India (age 45-50 years) than in high-income countries (age >60 years). Understanding these differences through research to develop diagnosis, screening, prevention, and treatment frameworks that ar e specific to the Indian population are critical and essential to improving women's health in India. Since the sequencing of the human genome in 2001, applications of advanced technologies, such as massively parallel sequencing, have transformed the understanding of the genetic and environmental drivers of cancer. How can advanced technologies be harnessed to provide health-care solutions at a scale and to a budget suitable for a country of 1·2 billion people? What research programmes are necessary to answer questions specific to India, and to build capacity for innovative solutions using these technologies? In order to answer these questions, we convened a workshop with key stakeholders to address these issues. In this Series paper, we highlight challenges in tackling the growing cancer burden in India, discuss ongoing genomics research and developments in infrastructure, and suggest key priorities for future research in cancer in India.
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Affiliation(s)
- Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | | | - Jon Frampton
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Roopa Hariprasad
- National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Arindam Maitra
- National Institute of Biomedical Genomics, Kolkata, West Bengal, India
| | - Paramjit Gill
- Institute of Applied Health, University of Birmingham, Birmingham, UK
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Pathology and Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gurpreet Singh
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J S Thakur
- Department of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jean-Baptiste Cazier
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
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Zhu B, Pan Y, Zheng X, Zhang Q, Wu Y, Luo J, Li Q, Lu E, Xu L, Jin G, Ren B. A clinical, biologic and mechanistic analysis of the role of ZNF692 in cervical cancer. Gynecol Oncol 2018; 152:396-407. [PMID: 30466806 DOI: 10.1016/j.ygyno.2018.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cervical cancer (CC) is the most common malignancy in women. The zinc finger protein 692 (ZNF692) has been identified as a transcription factor and its aberrant expression participates in tumorigenesis of various cancers. However, its biological function and molecular mechanisms in cervical cancer remain unclear. METHODS Microarrays were analysed by immunohistochemistry (IHC) to investigate the expression of ZNF692 in cervical cancer and its relationship with clinicopathologic characteristics. siRNAs and expression plasmids were used to reveal the biological function of ZNF692 in CC and subcutaneous xenograft model to examine the role of ZNF692 in vivo. Chromatin Immunoprecipitation and luciferase reporter assay were performed to ascertain whether ZNF692 binds to the promoter region of p27kip1. RESULTS By analyzing The Cancer Genome Atlas (TCGA) dataset, we confirmed ZNF692 as a potential oncogene in CC. ZNF692 expression was up-regulated in CC tissues compared with that in adjacent normal tissues, and its overexpression was correlated with poor clinicopathologic characteristics. Moreover, ZNF692 promoted the proliferation, migration and invasion of CC cells both in vitro and in vivo. Regarding molecular mechanisms, up-regulation of ZNF692 was found to enhance the G1/S transition via regulating the p27kip1/PThr160-CDK2 signal pathway in CC cells. CONCLUSION ZNF692 promotes CC cells proliferation and invasion through suppressing p27kip1 transcription by directly binding its promoter region, which suggests that ZNF692 may serve as an underlying therapeutic target and prognostic marker in CC.
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Affiliation(s)
- Biqing Zhu
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, China; Jiangsu Key Laboratory of Molecular and Translational Cancer Research, China
| | - Yinpeng Pan
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, China; Jiangsu Key Laboratory of Molecular and Translational Cancer Research, China; Department of Thoracic Surgery, the First People's Hospital of Lianyungang City Affiliated with Lianyungang Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiufen Zheng
- Jiangsu Key Laboratory of Molecular and Translational Cancer Research, China; Department of Clinical Pharmacy, China Pharmaceutical University, China
| | - Quanli Zhang
- Jiangsu Key Laboratory of Molecular and Translational Cancer Research, China
| | - Yaqin Wu
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, China; Jiangsu Key Laboratory of Molecular and Translational Cancer Research, China
| | - Jing Luo
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, China
| | - Qian Li
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, China
| | - Emei Lu
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, China; Jiangsu Key Laboratory of Molecular and Translational Cancer Research, China.
| | - Guangfu Jin
- Department of Epidemiology, School of Public Health, Nanjing Medical University, China; Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, China.
| | - Binhui Ren
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, the Affiliated Cancer Hospital of Nanjing Medical University, China; Jiangsu Key Laboratory of Molecular and Translational Cancer Research, China.
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Rayne S, Schnippel K, Grover S, Fearnhead K, Kruger D, Benn C, Firnhaber C. Unraveling the South African Breast Cancer Story: The Relationship of Patients, Delay to Diagnosis, and Tumor Biology With Stage at Presentation in an Urban Setting. J Surg Res 2018; 235:181-189. [PMID: 30691793 DOI: 10.1016/j.jss.2018.09.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/13/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adverse outcomes from breast cancer disproportionately affect women in sub-Saharan Africa, with delay the most studied contribution to advanced stage at presentation. However, tumor molecular biology and its contribution to advanced stage are yet to be explored. MATERIALS AND METHODS Patients newly diagnosed with breast cancer in a South African tertiary breast center completed a questionnaire and file review concerning socioeconomics, delay to care, stage at presentation, and molecular characteristics. Logistic regression was done to determine the relative risk of advanced stage presentation. RESULTS Advanced stage was present in 70.1% (n = 162) of the 231 participants, with 55.8% stage III (n = 129) and 32% (n = 72) having a T4 tumor. The median age was 56 y with 21.6% (n = 47) aged <45 y. Most common subtype was luminal B (57.7%, n = 128) followed by luminal A (21.6%, n = 48), triple negative (13.9%, n = 31), and HER2 positive (6.7%, n = 15). Lobular cancer (incidence risk ratio [IRR], 1.29; 95% confidence interval [CI], 1.03-1.62), high grade and intermediate grade tumors (IRR, 1.90; 95% CI, 1.15-3.13 and IRR, 1.95; 95% CI, 1.18-3.22, respectively), high Ki67 proliferation index (IRR, 1.30; 95% CI, 1.02-1.66), and HER2 overexpression (IRR, 1.32; 95% CI, 1.12-1.55) were more likely to present with advanced disease, as were luminal B (HER2+) cancers (adjusted IRR [aIRR], 1.46; 95% CI, 1.10-1.95). Although on univariate analysis Black and young participants were both more likely to have advanced stage (IRR, 1.23; 95% CI, 1.01-1.49 and IRR, 1.25; 95% CI, 1.04-1.51, respectively), in multivariate analysis controlling for tumor biology and delay, these were no longer significant (aIRR, 1.12; 95% CI, 0.91-1.37 and aIRR, 1.17; 95% CI, 0.94-1.48, respectively). CONCLUSIONS Tumor biology has a compelling role in the etiology of advanced-stage disease irrespective of socioeconomic factors. Accurate pathologic assessment is important in planning breast cancer care in Africa.
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Affiliation(s)
- Sarah Rayne
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Kathryn Schnippel
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Princess Marina Hospital, Gaborone, Botswana, Botswana-UPENN Partnership, Gaborone, Botswana
| | - Kirstin Fearnhead
- Department of Anatomical Pathology, National Health Laboratory Services, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Deirdre Kruger
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Benn
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Darwinkel MC, Nduru JM, Nabie RW, Aswani JA. Evaluating the role of clinical officers in providing reproductive health services in Kenya. HUMAN RESOURCES FOR HEALTH 2018; 16:31. [PMID: 29996852 PMCID: PMC6042229 DOI: 10.1186/s12960-018-0296-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Most sub-Saharan African countries have too few reproductive health (RH) specialists, resulting in high RH-related mortality and morbidity. In Kenya, task sharing in RH began in 2002, with the training of clinical officer(s)-reproductive health (CORH). Little is known about them and the extent of their role in the health system. METHODS In 2016, we conducted a retrospective, quantitative two-stage study in Kenya to evaluate the use of CORH and 28 of their curriculum-derived RH competencies, to determine their contribution to expanded access to RH care. CORH were surveyed, using structured questionnaires and telephone interviews. Data on the frequency with which CORH used specified competencies were collected from health records in selected facilities. RESULTS Forty-nine of all 104 CORH participated in the survey (47%). Forty-eight (98%) had worked in the clinical area, and 79% were still engaging in clinical work. All 48 worked in emergency obstetrics, emergency gynaecology, and nonemergency RH, and 38 (79%) filled clinical leadership positions. Vasectomy was least performed, by only 9 (18%) CORH. All other competencies were applied by at least half of the CORH, and 22 competencies by more than three quarters. Forty-one (84%) CORH performed caesarean section (CS). Teaching and management were other common responsibilities. Data were collected from 12 facilities and analysed for 11. They generally confirmed the initial survey findings: CORH worked as obstetrics and gynaecology consultants and used most of their competencies. Analysis was based on 118 months of theatre records. CORH made significant contributions to their facility's capacity to perform RH surgery: most respondents performed at least 25% of these surgeries. They performed an average of six CS per month and more than 25% of perineal tear repairs (33%), uterus repairs (33%), manual placenta removals (26%), bilateral tubal ligations (39%), and cervical cancer staging (27%). Some experienced CORH conducted procedures beyond their training. CONCLUSIONS CORH expand access to emergency RH care. Their contributions span all areas of obstetric and gynaecological care, mentoring new health workers and expanding their scope of practice. However, the generally poor status of records documenting healthcare provision limits their usability in evaluation and research.
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Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, Coll-Seck AM, Grover A, Laski L, Roa M, Sathar ZA, Say L, Serour GI, Singh S, Stenberg K, Temmerman M, Biddlecom A, Popinchalk A, Summers C, Ashford LS. Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. Lancet 2018; 391:2642-2692. [PMID: 29753597 DOI: 10.1016/s0140-6736(18)30293-9] [Citation(s) in RCA: 427] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 01/10/2023]
Affiliation(s)
| | - Alex C Ezeh
- African Population and Health Research Center, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Center for Global Development, Washington, DC, USA
| | | | - Alaka Basu
- Department of Development Sociology, Cornell University, Ithaca, NY, USA
| | - Jane T Bertrand
- Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Robert Blum
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Monica Roa
- Independent Consultant, Islamabad, Pakistan
| | | | - Lale Say
- World Health Organization, Geneva, Switzerland
| | - Gamal I Serour
- International Islamic Center For Population Studies And Research, Al Azhar University, Cairo, Egypt
| | | | | | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
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Swanson M, Ueda S, Chen LM, Huchko MJ, Nakisige C, Namugga J. Evidence-based improvisation: Facing the challenges of cervical cancer care in Uganda. Gynecol Oncol Rep 2018; 24:30-35. [PMID: 29892691 PMCID: PMC5993527 DOI: 10.1016/j.gore.2017.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/04/2017] [Accepted: 12/28/2017] [Indexed: 12/15/2022] Open
Abstract
There is significant disparity in the prevalence of cervical cancer globally, with low- and middle-income countries (LMICs) shouldering a disproportionate share of disease incidence and an even greater proportion of morbidity and mortality. Available resources for diagnosis, treatment and palliation of cervical cancer are inversely related to per capita income. While prevention and screening remain public health priorities, given the large number of women affected by cervical cancer, expanding treatment capacity should be included in any evidence-based intervention plan. Uganda, a country with a high incidence of cervical cancer, serves as a representative case study in terms of the challenges of diagnosis and access to treatment in sub-Saharan Africa. Providers and patients in Uganda are challenged by late presentation to care, limited training opportunities, cost-prohibitive diagnostic studies, insufficient access to gold-standard treatment, and under-utilized palliative care services. This review highlights the ways in which Uganda's experience is typical of the continent at large, as well as areas where Uganda is unique. We describe the ways in which a small but dedicated group of gynecologists carefully use limited evidence and available resources creatively to provide the best possible care for their patients. We show that improvisation, albeit evidence-based, is central to the nature and success of oncology care in Africa (Livingston, 2012). We argue that a "recalibrated global response" (Farmer et al., 2010), particularly stressing the expansion of radiotherapy capabilities, could dramatically improve cancer care and outcomes for women in Uganda as well as in LMICs globally.
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Affiliation(s)
- Megan Swanson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States
| | - Stefanie Ueda
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States
| | - Lee-may Chen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States
| | - Megan J. Huchko
- Department of Obstetrics and Gynecology, Duke Global Health Institute, United States
| | - Carol Nakisige
- Division of Gynaecologic Oncology, Uganda Cancer Institute, Makerere University College for Health Sciences School of Medicine, United States
| | - Jane Namugga
- Division of Gynaecologic Oncology, Mulago National Referral Hospital, Makerere University College for Health Sciences School of Medicine, Uganda
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