1
|
Mehta V, Ajmera P, Kalra S, Miraj M, Gallani R, Shaik RA, Serhan HA, Sah R. Human resource shortage in India's health sector: a scoping review of the current landscape. BMC Public Health 2024; 24:1368. [PMID: 38773422 PMCID: PMC11110446 DOI: 10.1186/s12889-024-18850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND For healthcare delivery to be optimally effective, health systems must possess adequate levels and we must ensure a fair distribution of human resources aimed at healthcare facilities. We conducted a scoping review to map the current state of human resources for health (HRH) in India and the reasons behind its shortage. METHODS A systematic search was conducted in various electronic databases, from the earliest available date till February 2024. We applied a uniform analytical framework to all the primary research reports and adopted the "descriptive-analytical" method from the narrative paradigm. Inductive thematic analysis was conducted to arrange the retrieved data into categories based on related themes after creating a chart of HRH problems. RESULTS A total of 9675 articles were retrieved for this review. 88 full texts were included for the final data analysis. The shortage was addressed in 30.6% studies (n = 27) whereas 69.3% of studies (n = 61) addressed reasons for the shortage. The thematic analysis of data regarding reasons for the shortage yielded five kinds of HRH-related problems such as inadequate HRH production, job dissatisfaction, brain drain, regulatory issues, and lack of training, monitoring, and evaluation that were causing a scarcity of HRH in India. CONCLUSION There has been a persistent shortage and inequitable distribution of human resources in India with the rural expert cadres experiencing the most severe shortage. The health department needs to establish a productive recruitment system if long-term solutions are to be achieved. It is important to address the slow and sporadic nature of the recruitment system and the issue of job insecurity among medical officers, which in turn affects their other employment benefits, such as salary, pension, and recognition for the years of service.
Collapse
Affiliation(s)
- Vini Mehta
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India.
| | - Puneeta Ajmera
- Department of Public Health, School of Allied Health Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Sheetal Kalra
- School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Mohammad Miraj
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AlMajmaah, Saudi Arabia
| | | | - Riyaz Ahamed Shaik
- Department of Family and Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
| | - Ranjit Sah
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India.
- SR Sanjeevani Hospital, Kalyanpur, Siraha, Nepal.
| |
Collapse
|
2
|
Larrarte-González MA, Pineda-Posada M, Gaitán ÁA, Amaya-Amaya J, Ojeda K. Health professionals' preferences with the use of pegfilgrastim on-body injector at oncology centers in 8 cities in Colombia. BMC Health Serv Res 2023; 23:529. [PMID: 37221537 DOI: 10.1186/s12913-023-09454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Febrile neutropenia associated with some chemotherapy regimens can lead to potentially fatal complications and high health care costs. Administration of pegfilgrastim using an On-Body Injector (OBI) may be more convenient for cancer patients and physicians in countries with limited access to high-complexity healthcare. This study aims to describe physician and nurse preferences regarding different options for administration of pegfilgrastim at cancer centers, the chemotherapy schemes for which pegfilgrastim is most frequently prescribed and how healthcare providers prioritize certain administration schemes according to patients' access to healthcare services. METHODS Observational, descriptive, cross-sectional study and survey, conducted between 2019 and 2020, to describe physician and nurse preferences regarding options for administration of pegfilgrastim at cancer centers, the demographics of the study population and characteristics of participating cancer centers. It included 60 healthcare professionals practicing at oncology centers from 8 cities in Colombia who were contacted and surveyed via telephone. Quantitative continuous variables were summarized using central tendency and dispersion measures. RESULTS It was found that 35% of participants are haemato-oncologists, oncologists or hematologists, 30% are general practitioners, and 35% are other healthcare professionals (i.e., nurse, oncology nurse and head nurse). Our study shows that 48% of physicians prefer the use of OBI, particularly in the scheme of 24 h after myelosuppressive chemotherapy administrations. Regardless of patient frailty and travel time to the clinic, over 90% of healthcare providers (HCPs) prefer to prioritize preventing the patient from having to return to the clinic for pegfilgrastim administration as well as to increase healthcare staff availability through the use of OBI. CONCLUSIONS The present study is the first one in Colombia that sought the reasons behind HCPs' choice to use OBI pegfilgrastim. Our results indicate that most professionals prefer to avoid the patient having to re-enter the care center for pegfilgrastim administration to facilitate access to healthcare for patients; patient characteristics and ease of transport are determining factors for respondents when choosing an option for drug administration. We found OBI is the preferred alternative by most HCPs and a good resource optimization strategy in the context of cancer patients' health care in Colombia.
Collapse
Affiliation(s)
| | | | | | | | - Kelman Ojeda
- Centro Javeriano de Oncología of the Hospital Universitario San Ignacio, Carrera 7# 40-62, Bogotá, Colombia
| |
Collapse
|
3
|
Li Y, Yu W, Li L, Yao Q, Jiang K, Zhu T, Jiang E. Oncology nursing on the move: a contemporary issue on Chinese oncology nursing in cancer care. Front Public Health 2023; 11:1061572. [PMID: 37181711 PMCID: PMC10173744 DOI: 10.3389/fpubh.2023.1061572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Cancers have become the primary cause of death among Chinese residents, seriously affecting their health and life. Oncology nursing is a specialized nursing practice focusing on cancer education, prevention, screening, early detection, and palliative and hospice care. China has made tremendous progress in developing oncology nursing. However, to ensure more individuals can get cancer care, the country's healthcare system still confronts several problems in oncology nursing that need to be addressed to ensure that more individuals can receive cancer care. This article reviews the current development of oncology nursing in China, especially in pain symptom control, palliative care, end-of-life care, education and training. The challenges faced in oncology nursing in China and the suggestions for developing oncology nursing in China are also discussed and proposed in this review. The growth of research on oncology nursing by Chinese nursing scholars and concerned policymakers is anticipated to ultimately improve oncology nursing and the quality of life of patients with cancer in China.
Collapse
Affiliation(s)
- Yingyang Li
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Wenjing Yu
- Department of Orthopedics, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Lamei Li
- Department of Neonatal Intensive Care, Zhengzhou Central Hospital, Zhengzhou, China
| | - Qianqian Yao
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Kexin Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tao Zhu
- Department of Geriatrics, Kaifeng Traditional Chinese Medicine Hospital, Kaifeng, China
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, China
- Department of Scientific Research, Scope Research Institute of Electrophysiology, Kaifeng, China
- *Correspondence: Enshe Jiang,
| |
Collapse
|
4
|
PENS approach for breaking bad news in the oncology outpatient setting: a real-world report. Support Care Cancer 2023; 31:13. [PMID: 36513796 PMCID: PMC9747823 DOI: 10.1007/s00520-022-07458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. METHODS This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. RESULTS Fifty patients (mean age 53.7 years, range 28-76) were included in the study. The average duration of BBN was 6.1 (range 2-11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. CONCLUSIONS The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/07/034707).
Collapse
|
5
|
Duffy C, Santana V, Inaba H, Jeha S, Pauley J, Sniderman L, Ghara N, Mushtaq N, Narula G, Bhakta N, Rodriguez-Galindo C, Brandt H. Evaluating blinatumomab implementation in low- and middle-income countries: a study protocol. Implement Sci Commun 2022; 3:62. [PMID: 35690878 PMCID: PMC9187890 DOI: 10.1186/s43058-022-00310-5] [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: 04/26/2022] [Accepted: 05/18/2022] [Indexed: 11/12/2022] Open
Abstract
Background The recent implementation of novel therapies has accelerated progress in pediatric cancer care. Despite the significantly poorer survival of patients in low- and middle-income countries (LMICs), administation complexities and other significant resource barriers have limited the translation of these novel therapies in these regions. This study aims to develop a model that can be used to support the implementation of novel therapies, such as blinatumomab (bispecific antibody therapy for B-cell acute lymphoblastic leukemia [B-ALL]) in LMIC centers, with the long-term goal of developing an implementation framework for similar future efforts. Methods In this study, mixed methods will be applied to understand the key contextual considerations that can be accounted for through a training program and prospectively designed implementation activities. The Consolidated Framework for Implementation Research will guide the activities related to implementation evaluation in parallel with a drug donation program. A multidisciplinary research team comprising high- and low-middle income healthcare professionals, industry, and implementation scientists has been assembled with the common goal of improving safe access to blinatumomab. To assess the factors affecting blinatumomab administration, semi-structured interviews with diverse collaborators and quantitative assessments of organizational characteristics will be conducted, together with quantitative and qualitative assessments of feasibility, acceptability, appropriateness, and cost of blinatumomab implementation. A quantitative assessment of stakeholder perceptions of different implementation strategies used as part of the multifaceted approach will also be performed. Finally, we will examine the key domains and processes used and construct the implementation roadmap for translation of novel therapies. Discussion This study will rigorously develop an implementation roadmap for translation of novel therapies in low-resource settings. The knowledge gained in the formative assessment will reveal the priority areas and key implementation strategies. Thereby, the resultant roadmap will facilitate future scale-out strategies for novel therapies in LMICs, thus increasing access, building capacity for management, and ultimately improving the care for children in LMICs.
Collapse
|
6
|
Garattini SK, Valent F, Minisini AM, Riosa C, Favaretti C, Regattin L, Fasola G. Analysis of workload generated in the two years following first consultation by each new cancer patient: studying the past to plan the future of cancer care. BMC Health Serv Res 2022; 22:1184. [PMID: 36131286 PMCID: PMC9494889 DOI: 10.1186/s12913-022-08573-3] [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: 01/06/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Prevalence of cancer patients is dramatically increasing. We aimed at quantifying the oncology workload generated by each new cancer patient in the two years following first consultation. Methods In this record-based retrospective study, we retrieved data of all newly diagnosed patients treated at the Oncology Department of Udine Academic Hospital between 01.01.2012 and 31.12.2017. We calculated mean number and standard deviation of the activity type generated by each new cancer patient during the following 2 years. Results Seven thousand four hundred fifty-two cancer patients generated a total of 85,338 clinical episodes. The two-years mean number of oncology episodes generated was 11.31 (i.e., for every 1,000 new cancer patients, 11,310 oncology activities are generated overall in the following two-year lapse). Patients with advanced disease generated the highest workload (24.3; SD 18.8) with a statistically significant difference compared to adjuvant and follow-up patients (p < 0.001). The workload generated in the period 0–6 and 0–12 months was significantly higher than in the following months (p < 0.001) and it was also higher for patients initially designated to treatment (p < 0.001). Conclusion This is the first study reporting on the mean oncology workload generated during the 2 years following first consultation. Workload is the highest for patient with advanced disease, especially in the first months and in patients in active treatment. A detailed analysis of workloads in oncology is feasible and could be crucial for planning a sustainable framework for cancer care in the next future.
Collapse
Affiliation(s)
- S K Garattini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy.
| | - F Valent
- Institute of Hygiene and Clinical Epidemiology, Academic Hospital of Udine ASUFC, 33100, Udine, UD, Italy
| | - A M Minisini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - C Riosa
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - C Favaretti
- Center for Leadership in Medicine, Catholic University of Sacred Heart, 000168, Rome, RO, Italy
| | - L Regattin
- Medical Director, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - G Fasola
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| |
Collapse
|
7
|
Seguin M, Morris M, McKee M, Nolte E. "There's Not Enough Bodies to Do the Demand": An Exploration of Key Stakeholder Views on the Role of Health Service Capacity in Shaping Cancer Outcomes in 7 International Cancer Benchmarking Partnership Countries. Int J Health Policy Manag 2022; 11:1024-1034. [PMID: 33589567 PMCID: PMC9808162 DOI: 10.34172/ijhpm.2020.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Differences in cancer survival are shaped by differences in health system capacity in workforce and infrastructure. Part of the International Cancer Benchmarking Partnership (ICBP), this study explored stakeholders' perceptions of the role of health system capacity necessary for cancer care in influencing cancer survival in 7 high-income countries. METHODS We conducted semi-structured interviews with 79 key informants from national, regional, and local tiers of health systems, professional bodies, patient associations, and academic experts in Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the United Kingdom. Data collection was guided by a conceptual model linking characteristics of health systems and cancer survival along the cancer patient journey, from recognition of symptoms at pre-diagnostic stages through to survivorship or death. Data were analysed using a thematic approach. RESULTS We identified 3 themes as important in shaping cancer outcomes: primary care and access to diagnostic evaluation, specialist care and access to treatment, and workforce pertaining to diagnostic and treatment phases. Improved infrastructure for diagnosis and treatment had improved cancer outcomes in all jurisdictions. However, this was seen as insufficient if staffing was inadequate. Consolidation of services and greater surgical specialisation was important in some jurisdictions if accompanied by a reconfiguration of services, in particular the creation of specialist multidisciplinary teams, along with supporting capacity in the wider health system. Staff shortages were commonly cited as reasons why some jurisdictions lagged behind others. CONCLUSION Continued improvement in cancer outcomes will require sustained investment in plans to deliver and maintain the workforce engaged in cancer care and in the infrastructure on which they depend. However, strategic plans must recognise that systems for cancer care do not work in isolation from the rest of the health system and a whole systems approach is essential if we are to improve outcomes for an ageing, increasingly multimorbid population.
Collapse
Affiliation(s)
| | | | | | - Ellen Nolte
- Department of Health Services Research & Policy, London School of Hygiene & Topical Medicine, London, UK
| |
Collapse
|
8
|
Aemaz Ur Rehman M, Farooq H, Ebaad Ur Rehman M, Ali MM, Zafar A, Khokhar MA. Perceptions of oncology as a career choice among the early career doctors in Pakistan. BMC MEDICAL EDUCATION 2022; 22:61. [PMID: 35081960 PMCID: PMC8790828 DOI: 10.1186/s12909-022-03123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lack of oncologists is a growing global concern. With the rise in cancer burden across the world, the supply-demand mismatch of the oncology workforce is projected to increase. Furthermore, oncology is a low-ranked field of choice among medical students, and without understanding the perceptions and concerns of early-career doctors regarding oncology, any investments made in cancer care will be futile. This study aims to determine the opinions of young doctors and the factors most affecting their preferences in order to devise focused strategies to attract more doctors into oncology. METHODS A cross-sectional study was conducted on 300 early-career doctors across various public and private hospitals in Pakistan, from March to November 2019. A close-ended, self-administered questionnaire was used to assess their opinions in terms of the workplace environment, scope, and the emotional and financial aspects of oncology. Data was analyzed using SPSS version 23 and the influence (positive or negative) of the perceptions on the choice of oncology as a career was determined by binary logistic regression analysis. RESULTS Almost three-quarters of the participants did not want a career in oncology. The top positive perceptions about oncology in descending order were: progressive field, gender-neutral, stable working hours, financially healthy, and work-family balance. Top negative perceptions were: lack of oncologic facilities in hospitals, radiation exposure, need for private practice, poor patient prognosis, high patient load, and depressing environment. Participants who attended private medical school (p < 0.10), planned to live abroad (p < 0.10), had an oncologist (p < 0.05), cancer survivor or death due to cancer in the family (p < 0.05), were more likely to adopt oncology as a career. Those who believed that poor patient prognosis can have an impact on career choice were less likely to prefer oncology (p < 0.05). CONCLUSION Despite the rising cancer burden, early career doctors are reluctant to join oncology. Curricular, infrastructural and policy changes are needed at the level of medical school, oncology training and practice to recruit more young doctors and minimize the existing paucity of the oncologic workforce.
Collapse
Affiliation(s)
- Muhammad Aemaz Ur Rehman
- Department of Medicine, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
| | - Hareem Farooq
- Department of Medicine, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
| | | | - Muhammad Mohsin Ali
- Department of Medicine, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
| | - Amjad Zafar
- Department of Oncology, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
| | - Muhammad Abbas Khokhar
- Department of Oncology, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
| |
Collapse
|
9
|
Gunasekera S, Seneviratne S, Jalink M, Joseph N, Ariyarathna Y, Booth CM, Wijeratne DT. Clinical Oncology Workload in Sri Lanka: Infrastructure, Supports, and Delivery of Clinical Care. JCO Glob Oncol 2021; 7:1703-1710. [PMID: 34914534 PMCID: PMC8691498 DOI: 10.1200/go.21.00345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Sri Lanka is a lower middle-income country undergoing a demographic transition with an increasing aging population. This has given rise to a higher burden of noncommunicable diseases including cancer. A well-trained oncology workforce is essential to address this growing public health challenge. Understanding the baseline status of the clinical oncology workforce is an essential step to improving cancer care delivery in Sri Lanka. METHODS In this cross-sectional study, we distributed a web-based survey to all clinical oncologists in Sri Lanka. The survey captured data regarding clinical workload, demographic details, practice setting, and perceived barriers to quality patient care. RESULTS A total of 41 of 54 oncologists responded to the survey, and all participants had training in clinical oncology. Thirty-seven (90%) of 41 oncologists treated both solid and hematologic malignancies, and the median duration of independent practice was 5 years. Almost two thirds of the oncologists (26 of 41, 63%) work at an academic center, and two thirds of the oncologists (27 of 41, 66%) work in both public and private sectors. A majority of the oncologists (26 of 41, 63%) were on-call 7 days per week. More than half of the oncologists saw over 400 new patient consults per year. With regard to barriers to quality patient care, most of the concerns relate to the scarcity of resources. CONCLUSION This study sheds significant light about the clinical oncology workload landscape in Sri Lanka. Compared with other low- and middle-income countries, Sri Lankan clinical oncologists are faced with a very high workload, which may affect delivery or care.
Collapse
Affiliation(s)
- Sanjeeva Gunasekera
- National Cancer Institute, Maharagama, Sri Lanka.,Sri Lanka Cancer Research Group, Colombo, Sri Lanka
| | - Sanjeewa Seneviratne
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Matthew Jalink
- Department of Oncology, Queen's University, Kingston, Canada
| | - Nuradh Joseph
- Sri Lanka Cancer Research Group, Colombo, Sri Lanka.,General Hospital Chilaw, Chilaw, Sri Lanka
| | - Yasantha Ariyarathna
- National Cancer Institute, Maharagama, Sri Lanka.,Sri Lanka Cancer Research Group, Colombo, Sri Lanka
| | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, Canada.,General Hospital Chilaw, Chilaw, Sri Lanka
| | - Don Thiwanka Wijeratne
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.,Department of Medicine, Queen's University, Kingston, Canada
| |
Collapse
|
10
|
Karim S, Sunderji Z, Jalink M, Mohamed S, Mallick I, Msadabwe-Chikuni SC, Delgarno NJ, Hammad N, Berry S. Oncology training and education initiatives in low and middle income countries: a scoping review. Ecancermedicalscience 2021; 15:1296. [PMID: 34824619 PMCID: PMC8580602 DOI: 10.3332/ecancer.2021.1296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background The global cancer burden falls disproportionately on low and middle-income countries (LMICs). One significant barrier to adequate cancer control in these countries is the lack of an adequately trained oncology workforce. Oncology education and training initiatives are a critical component of building the workforce. We performed a scoping review of published training and education initiatives for health professionals in LMICs to understand the strategies used to train the global oncology workforce. Methods We searched Ovid MEDLINE and Embase from database inception (1947) to 4 March 2020. Articles were eligible if they described an oncology medical education initiative (with a clear intervention and outcome) within an LMIC. Articles were classified based on the target population, the level of medical education, degree of collaboration with another institution and if there was an e-learning component to the intervention. Findings Of the 806 articles screened, 25 met criteria and were eligible for analysis. The majority of initiatives were targeted towards physicians and focused on continuing medical education. Almost all the initiatives were done in partnership with a collaborating organisation from a high-income country. Only one article described the impact of the initiative on patient outcomes. Less than half of the initiatives involved e-learning. Conclusions There is a paucity of oncology training and education initiatives in LMICs published in English. Initiatives for non-physicians, efforts to foster collaboration within and between LMICs, knowledge sharing initiatives and studies that measure the impact of these initiatives on developing an effective workforce are highly recommended.
Collapse
Affiliation(s)
- Safiya Karim
- Department of Medical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, AB T2N 4N2, Canada
| | - Zahra Sunderji
- Department of Family Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada
| | - Matthew Jalink
- Department of Oncology, Queen's University, Kingston, ON K7L 5P9, Canada
| | - Sahar Mohamed
- Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata 700 160, India
| | | | - Nancy J Delgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON K7L 0E9, Canada
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, ON K7L 5P9, Canada
| | - Scott Berry
- Department of Oncology, Queen's University, Kingston, ON K7L 5P9, Canada
| |
Collapse
|
11
|
Gadgil D, Sengar M, Pramesh CS, Badwe R, Ranganathan P. Building research capacity in India: The Masters in Clinical Research program at the Tata Memorial Centre. Perspect Clin Res 2021; 12:189-192. [PMID: 34760645 PMCID: PMC8525792 DOI: 10.4103/picr.picr_48_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 11/26/2022] Open
Abstract
Clinical research is an essential part of evidence-based medicine. The conduct of high-quality clinical research requires the backing of strong infrastructure, especially well-trained clinical research professionals. Tata Memorial Centre is the largest public cancer center in India and has been offering a Masters degree in Clinical Research since 2014. In this article, we look at the need for clinical research training, the evolution of this course and the impact it has had on clinical research capacity in India
Collapse
Affiliation(s)
- Durga Gadgil
- Research Consultant, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Department of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra Badwe
- Department of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Priya Ranganathan
- Department of Anaesthesiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
12
|
Fundytus A, Sengar M, Lombe D, Hopman W, Jalink M, Gyawali B, Trapani D, Roitberg F, De Vries EGE, Moja L, Ilbawi A, Sullivan R, Booth CM. Access to cancer medicines deemed essential by oncologists in 82 countries: an international, cross-sectional survey. Lancet Oncol 2021; 22:1367-1377. [PMID: 34560006 PMCID: PMC8476341 DOI: 10.1016/s1470-2045(21)00463-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The WHO Essential Medicines List (EML) identifies priority medicines that are most important to public health. Over time, the EML has included an increasing number of cancer medicines. We aimed to investigate whether the cancer medicines in the EML are aligned with the priority medicines of frontline oncologists worldwide, and the extent to which these medicines are accessible in routine clinical practice. METHODS This international, cross-sectional survey was developed by investigators from a range of clinical practice settings across low-income to high-income countries, including members of the WHO Essential Medicines Cancer Working Group. A 28-question electronic survey was developed and disseminated to a global network of oncologists in 89 countries and regions by use of a hierarchical snowball method; each primary contact distributed the survey through their national and regional oncology associations or personal networks. The survey was open from Oct 15 to Dec 7, 2020. Fully qualified physicians who prescribe systemic anticancer therapy to adults were eligible to participate in the survey. The primary question asked respondents to select the ten cancer medicines that would provide the greatest public health benefit to their country; subsequent questions explored availability and cost of cancer medicines. Descriptive statistics were used to compare access to medicines between low-income and lower-middle-income countries, upper-middle-income countries, and high-income countries. FINDINGS 87 country-level contacts and two regional networks were invited to participate in the survey; 46 (52%) accepted the invitation and distributed the survey. 1697 respondents opened the survey link; 423 were excluded as they did not answer the primary study question and 326 were excluded because of ineligibility. 948 eligible oncologists from 82 countries completed the survey (165 [17%] in low-income and lower-middle-income countries, 165 [17%] in upper-middle-income countries, and 618 [65%] in high-income countries). The most commonly selected medicines were doxorubicin (by 499 [53%] of 948 respondents), cisplatin (by 470 [50%]), paclitaxel (by 423 [45%]), pembrolizumab (by 414 [44%]), trastuzumab (by 402 [42%]), carboplatin (by 390 [41%]), and 5-fluorouracil (by 386 [41%]). Of the 20 most frequently selected high-priority cancer medicines, 19 (95%) are currently on the WHO EML; 12 (60%) were cytotoxic agents and 13 (65%) were granted US Food and Drug Administration regulatory approval before 2000. The proportion of respondents indicating universal availability of each top 20 medication was 9-54% in low-income and lower-middle-income countries, 13-90% in upper-middle-income countries, and 68-94% in high-income countries. The risk of catastrophic expenditure (spending >40% of total consumption net of spending on food) was more common in low-income and lower-middle-income countries, with 13-68% of respondents indicating a substantial risk of catastrophic expenditures for each of the top 20 medications in lower-middle-income countries versus 2-41% of respondents in upper-middle-income countries and 0-9% in high-income countries. INTERPRETATION These data demonstrate major barriers in access to core cancer medicines worldwide. These findings challenge the feasibility of adding additional expensive cancer medicines to the EML. There is an urgent need for global and country-level policy action to ensure patients with cancer globally have access to high priority medicines. FUNDING None.
Collapse
Affiliation(s)
- Adam Fundytus
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada; Departments of Oncology, Queen's University, Kingston, ON, Canada
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | | | - Wilma Hopman
- Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Matthew Jalink
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada; Departments of Oncology, Queen's University, Kingston, ON, Canada; Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
| | - Felipe Roitberg
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Elisabeth G E De Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lorenzo Moja
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - André Ilbawi
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | | | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada; Departments of Oncology, Queen's University, Kingston, ON, Canada; Public Health Sciences, Queen's University, Kingston, ON, Canada.
| |
Collapse
|
13
|
Ranganathan P, Chinnaswamy G, Sengar M, Gadgil D, Thiagarajan S, Bhargava B, Booth CM, Buyse M, Chopra S, Frampton C, Gopal S, Grant N, Krailo M, Langley R, Mathur P, Paoletti X, Parmar M, Purushotham A, Pyle D, Rajaraman P, Stockler MR, Sullivan R, Swaminathan S, Tannock I, Trimble E, Badwe RA, Pramesh CS. The International Collaboration for Research methods Development in Oncology (CReDO) workshops: shaping the future of global oncology research. Lancet Oncol 2021; 22:e369-e376. [PMID: 34216541 PMCID: PMC8328959 DOI: 10.1016/s1470-2045(21)00077-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
Low-income and middle-income countries (LMICs) have a disproportionately high burden of cancer and cancer mortality. The unique barriers to optimum cancer care in these regions necessitate context-specific research. The conduct of research in LMICs has several challenges, not least of which is a paucity of formal training in research methods. Building capacity by training early career researchers is essential to improve research output and cancer outcomes in LMICs. The International Collaboration for Research methods Development in Oncology (CReDO) workshop is an initiative by the Tata Memorial Centre and the National Cancer Grid of India to address gaps in research training and increase capacity in oncology research. Since 2015, there have been five CReDO workshops, which have trained more than 250 oncologists from India and other countries in clinical research methods and protocol development. Participants from all oncology and allied fields were represented at these workshops. Protocols developed included clinical trials, comparative effectiveness studies, health services research, and observational studies, and many of these protocols were particularly relevant to cancer management in LMICs. A follow-up of these participants in 2020 elicited an 88% response rate and showed that 42% of participants had made progress with their CReDO protocols, and 73% had initiated other research protocols and published papers. In this Policy Review, we describe the challenges to research in LMICs, as well as the evolution, structure, and impact of CReDO and other similar workshops on global oncology research.
Collapse
Affiliation(s)
- Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Durga Gadgil
- Research Administration Council, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Marc Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium; Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Chris Frampton
- Departments of Medicine and Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA
| | | | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ruth Langley
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Prashant Mathur
- National Centre for Disease Informatics and Research, Bengaluru, India
| | - Xavier Paoletti
- University of Versailles Saint-Quentin-en-Yvelines, Versailles, France; Department of Biostatistics, Institut Curie, Saint-Cloud, France; Department of Statistics for Precision Medicine, INSERM U900, Paris, France
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Douglas Pyle
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - Preetha Rajaraman
- US Department of Health and Human Services, Washington, DC, USA; US Embassy, New Delhi, India
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Ian Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Edward Trimble
- Office of the Director, National Cancer Institute, NIH, US Department of Health and Human Services, Washington, DC, USA
| | - Rajendra A Badwe
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - C S Pramesh
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| |
Collapse
|
14
|
Gyawali B, Jalink M, Effing SMA, Dalgarno N, Kolomitro K, Thapa N, Poudyal BS, Berry S. Oncology training programmes for general practitioners: a scoping review. Ecancermedicalscience 2021; 15:1241. [PMID: 34267797 PMCID: PMC8241444 DOI: 10.3332/ecancer.2021.1241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Due to the increasing global burden of cancer and the shortage of trained medical oncologists, training General Practitioners (GPs) in Oncology (known as GPOs) has been proposed as a means to potentially ease some burden on medical oncologists with heavy workloads, especially in low-and-middle-income countries (LMICs), by task-sharing and task-shifting. We undertook a scoping review to identify and characterise the existing training programmes and curricula for GPOs globally. DESIGN We searched three major electronic databases: EMBASE, Medline/PubMed and Education Source for articles that described a medical oncology training programme for GPs. All study types were eligible in this review. We followed a two-stage standardised screening process using two independent reviewers to evaluate the eligibility of the articles. RESULTS Five peer-reviewed articles were included in our review and grey literature scans identified an additional seven GPO training programmes for a total of 12 programmes and their curricula. All of the included studies were from high-income countries. The duration of programmes varied from comprehensive programmes structured over 2 years (n = 2) to shorter duration medical oncology training activities (n = 2), a short, 1.5-day workshop and a 10-hour course. In the grey literature, GPO training programme durations ranged from 2 weeks to 13 months. A mixture of delivery methods was employed including didactic lectures and clinical rotations. CONCLUSION This scoping review identified a small number of heterogeneous studies and grey literature sources that described and/or evaluated medical oncology training programmes for GPs. The information synthesised here can be used to foster the collaboration needed for the continued development of GPO programmes that could help address the problem of lack of workforce to meet the rising burden of cancer, especially in LMICs.
Collapse
Affiliation(s)
- Bishal Gyawali
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, 10 Stuart Street, 2nd Level, Kingston, ON K7L 3N6, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
- Department of Oncology, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V6, Canada
- contributed equally
| | - Matthew Jalink
- Department of Oncology, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V6, Canada
- contributed equally
| | | | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen’s University, 18 Barrie Street, Kingston, ON K7L 3N6, Canada
| | - Klodiana Kolomitro
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen’s University, 18 Barrie Street, Kingston, ON K7L 3N6, Canada
| | - Niresh Thapa
- Karnali Academy of Health Sciences, Jumla, Military Sadak, Chandannath 21200, Nepal
| | - Bishesh Sharma Poudyal
- Clinical Hematology and Bone Marrow Transplant Unit, Department of Medicine, Civil Service Hospital, Kathmandu 44600, Nepal
| | - Scott Berry
- Department of Oncology, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V6, Canada
| |
Collapse
|
15
|
DeBoer RJ, Mutoniwase E, Nguyen C, Ho A, Umutesi G, Nkusi E, Sebahungu F, Van Loon K, Shulman LN, Shyirambere C. Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource-Limited Context. Oncologist 2021; 26:e1189-e1196. [PMID: 33969927 PMCID: PMC8265342 DOI: 10.1002/onco.13818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background Moral distress and burnout are highly prevalent among oncology clinicians. Research is needed to better understand how resource constraints and systemic inequalities contribute to moral distress in order to develop effective mitigation strategies. Oncology providers in low‐ and middle‐income countries are well positioned to provide insight into the moral experience of cancer care priority setting and expertise to guide solutions. Methods Semistructured interviews were conducted with a purposive sample of 22 oncology physicians, nurses, program leaders, and clinical advisors at a cancer center in Rwanda. Interviews were recorded, transcribed verbatim, and analyzed using the framework method. Results Participants identified sources of moral distress at three levels of engagement with resource prioritization: witnessing program‐level resource constraints drive cancer disparities, implementing priority setting decisions into care of individual patients, and communicating with patients directly about resource prioritization implications. They recommended individual and organizational‐level interventions to foster resilience, such as communication skills training and mental health support for clinicians, interdisciplinary team building, fair procedures for priority setting, and collective advocacy for resource expansion and equity. Conclusion This study adds to the current literature an in‐depth examination of the impact of resource constraints and inequities on clinicians in a low‐resource setting. Effective interventions are urgently needed to address moral distress, reduce clinician burnout, and promote well‐being among a critical but strained oncology workforce. Collective advocacy is concomitantly needed to address the structural forces that constrain resources unevenly and perpetuate disparities in cancer care and outcomes. Implications for Practice For many oncology clinicians worldwide, resource limitations constrain routine clinical practice and necessitate decisions about prioritizing cancer care. To the authors’ knowledge, this study is the first in‐depth analysis of how resource constraints and priority setting lead to moral distress among oncology clinicians in a low‐resource setting. Effective individual and organizational interventions and collective advocacy for equity in cancer care are urgently needed to address moral distress and reduce clinician burnout among a strained global oncology workforce. Lessons from low‐resource settings can be gleaned as high‐income countries face growing needs to prioritize oncology resources. Oncology providers in low‐ and middle‐income countries face resource priority setting decisions on a routine basis. This article describes the moral experience and recommendations of oncology clinicians, advisors, and program leaders engaged in clinical priority setting at a cancer center in Rwanda.
Collapse
Affiliation(s)
- Rebecca J DeBoer
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | | | - Cam Nguyen
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Anita Ho
- Program in Bioethics, University of California, San Francisco, California, USA.,University of British Columbia, Vancouver, Canada
| | - Grace Umutesi
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Eugene Nkusi
- Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
16
|
Martei YM, Rick TJ, Fadelu T, Ezzi MS, Hammad N, Quadri NS, Rodrigues B, Simonds H, Grover S, Incrocci L, Vanderpuye V. Impact of COVID-19 on Cancer Care Delivery in Africa: A Cross-Sectional Survey of Oncology Providers in Africa. JCO Glob Oncol 2021; 7:368-377. [PMID: 33689484 PMCID: PMC8081536 DOI: 10.1200/go.20.00569] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/21/2020] [Accepted: 02/09/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has disrupted cancer care globally. There are limited data of its impact in Africa. This study aims to characterize COVID-19 response strategies and impact of COVID-19 on cancer care and explore misconceptions in Africa. METHODS We conducted a web-based cross-sectional survey of oncology providers in Africa between June and August 2020. Descriptive statistics and comparative analysis by income groups were performed. RESULTS One hundred twenty-two participants initiated the survey, of which 79 respondents from 18 African countries contributed data. Ninety-four percent (66 of 70) reported country mitigation and suppression strategies, similar across income groups. Unique strategies included courier service and drones for delivery of cancer medications (9 of 70 and 6 of 70, respectively). Most cancer centers remained open, but > 75% providers reported a decrease in patient volume. Not previously reported is the fear of infectivity leading to staff shortages and decrease in patient volumes. Approximately one third reported modifications of all cancer treatment modalities, resulting in treatment delays. A majority of participants reported ≤ 25 confirmed cases (44 of 68, 64%) and ≤ 5 deaths because of COVID-19 (26 of 45, 58%) among patients with cancer. Common misconceptions were that Africans were less susceptible to the virus (53 of 70, 75.7%) and decreased transmission of the virus in the African heat (44 of 70, 62.9%). CONCLUSION Few COVID-19 cases and deaths were reported among patients with cancer. However, disruptions and delays in cancer care because of the pandemic were noted. The pandemic has inspired tailored innovative solutions in clinical care delivery for patients with cancer, which may serve as a blueprint for expanding care and preparing for future pandemics. Ongoing public education should address COVID-19 misconceptions. The results may not be generalizable to the entire African continent because of the small sample size.
Collapse
Affiliation(s)
- Yehoda M. Martei
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA
| | - Tara J. Rick
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Nazik Hammad
- Queen's University Cancer Center of Southeastern Ontario, Kingston Health Science Center, Kingston, ON, Canada
| | | | - Belmira Rodrigues
- African Organization for Research and Training in Cancer, Cape Town, South Africa
| | - Hannah Simonds
- Division of Radiation Oncology, Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Verna Vanderpuye
- National Center for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Jalan D, Rubagumya F, Hopman WM, Vanderpuye V, Lopes G, Seruga B, Booth CM, Berry S, Hammad N. Training of oncologists: results of a global survey. Ecancermedicalscience 2020; 14:1074. [PMID: 32863868 PMCID: PMC7434506 DOI: 10.3332/ecancer.2020.1074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Indexed: 01/20/2023] Open
Abstract
While several studies have highlighted the global shortages of oncologists and their workload, few have studied the characteristics of current oncology training. In this study, an online survey was distributed through a snowball method for cancer care providing physicians in 57 countries. Countries were classified into low- or lower-middle-income countries (LMICs), upper-middle-income countries (UMICs) and high-income countries (HICs) based on World Bank criteria. A total of 273 physicians who were trained in 57 different countries responded to the survey: 33% (90/273), 32% (87/273) and 35% (96/273) in LMICs, UMICs and HICs, respectively. About 60% of respondents were practising physicians and 40% were in training. The proportion of responding trainees was higher in LMICs (51%; 45/89) and UMICs (42%; 37/84), than HICs (19%; 28/96; p = 0.013). A higher proportion of respondents from LMICs (37%; 27/73) self-fund their core oncology training compared to UMICs (13%; 10/77) and HICs (11%; 10/89; p < 0.001). Respondents from HICs were more likely to complete an accepted abstract, poster and publication from their research activities compared to respondents from UMICs and LMICs. Respondents identified several barriers to effective training, including skewed service to education ratio and burnout. With regard to preparedness for practice, mean scores on a 5-point Likert scale were low for professional tasks like supervision and mentoring of trainees, leadership and effective management of an oncology practice and understanding of healthcare systems irrespective of country grouping. In conclusion, the investment in training by the public sector is vital to decreasing the prevalence of self-funding in LMICs. Gaps in research training and enhancement of competencies in research dissemination in LMICs require attention. The instruction on cancer care systems and leadership needs to be incorporated in training curricula in all countries.
Collapse
Affiliation(s)
| | | | - Wilma M Hopman
- Kingston General Hospital Research Institute, Kingston, Ontario K7L 2V7, Canada
| | | | - Gilberto Lopes
- University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Bostjan Seruga
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia 1000
| | | | - Scott Berry
- Department of Oncology, University of Toronto, Toronto ON M4N 3M5, Canada
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston ON K7L 5P9, Canada
| |
Collapse
|
19
|
Grover S, Shah S, Bhatia R, Urusaro S, Monare B, Ralefala T, Seiphetlheng A, Singh SP, Dhaliwal G. Development and Usability of a Smartphone Application for Tracking Oncology Patients in Gaborone, Botswana. Methods Inf Med 2020; 59:31-40. [PMID: 32838443 DOI: 10.1055/s-0040-1713129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The majority of new cancer cases are expected to be diagnosed in low- and middle-income countries (LMICs) by 2025, and 65% of cancer deaths currently occur in LMICs. Treatment adherence, patient monitoring, and follow-up are essential to cancer care but are often not possible in these settings. Out Patient (OP) Care, a smartphone application (app) developed to fill this gap, texts appointment reminders to patients and electronically stores medical records confidentially. OBJECTIVES This study aims to present the development of this app and evaluate its usability and feasibility as defined by provider and patient experiences in the context of a multidisciplinary cancer clinic in Gaborone, Botswana. METHODS OP Care was piloted at a multidisciplinary team gynecologic oncology clinic in Gaborone, Botswana. The app was developed through an iterative process with feedback from clinic staff and physicians. The usability was evaluated using a cross-sectional survey. All staff members in the gynecologic oncology clinic, which typically consists of one doctor and four nurses, as well as a portion of the staff in the (Princess Marina Hospital general) oncology ward used the app. All providers using the app were surveyed, along with all patients who attended the gynecologic oncology clinic during the 3-week survey period. Staff demographics, reactions, and opinions on usability, as well as patients' reactions to the appointment reminders were collected. Agreement to the ease-of-usability statements was recorded on a 1 (not at all) to 7 (extremely so) scale. Primary outcomes were the app's usability and the feasibility of text reminders from the patient's perspective. RESULTS Nine staff and 15 patients were surveyed. Staff included three doctors and six nurses and encompassed all of the staff in the gynecologic oncology clinic as well as a portion of the general oncology ward. All surveyed staff owned a smartphone and used a computer at home. Most (78%) staff did not feel that OP Care would increase their work burden and were willing to use the app if implemented permanently (median: 6; interquartile range [IQR]: 1). Seventeen out of the nineteen usability questions, such as "I feel comfortable using this system," scored a median of 6, corresponding to "very much so." Patients reported that the reminder text messages were helpful (median: 6; IQR: 1) and preferred the text reminders to be in Setswana (median: 7; IQR: 1). CONCLUSION High usability scores indicate that the app can be scaled up to usage in this clinic and others. Although patients appreciate OP Care, the option for call and text reminders in Setswana is indicated.
Collapse
Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Sidrah Shah
- Medical School, University of Texas Southwestern Medical School, Dallas, Texas, United States
| | - Rohini Bhatia
- School of Medicine, University of Rochester, Rochester, New York, United States
| | - Sandra Urusaro
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Barati Monare
- Botswana-UPenn Partnership, Gaborone, Botswana.,Department of Oncology, Princess Marina Hospital, Gaborone, Gaborone, Botswana
| | - Tlotlo Ralefala
- Department of Oncology, Princess Marina Hospital, Gaborone, Gaborone, Botswana
| | | | | | | |
Collapse
|
20
|
Gouveia AG, Zalay OC, Chua KL, Moraes FY. Response evaluation after stereotactic ablative radiotherapy for localised non-small-cell lung cancer: an equipoise of available resource and accuracy. Br J Radiol 2020; 93:20190647. [PMID: 31778312 DOI: 10.1259/bjr.20190647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is growing evidence supporting the use of stereotactic ablative radiotherapy (SABR) on the treatment of localised stage non-small-cell lung cancer (NSCLC). Distinctive imaging challenges are posed post-SABR treatment. Thus, it is imperative to provide guidance on assessing treatment response, especially for new adopters. This commentary is about filling a gap in response evaluation after SABR for localised NSCLC.
Collapse
Affiliation(s)
| | - Osbert C Zalay
- Department of Oncology - Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Kevin Lm Chua
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore.,Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Fabio Ynoe Moraes
- Department of Oncology - Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| |
Collapse
|
21
|
Kirby E, Broom A, Karikios D, Harrup R, Lwin Z. Exploring the impact and experience of fractional work in medicine: a qualitative study of medical oncologists in Australia. BMJ Open 2019; 9:e032585. [PMID: 31826894 PMCID: PMC6924865 DOI: 10.1136/bmjopen-2019-032585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Fractional (part-time) appointments are becoming more commonplace in many professions, including medicine. With respect to the contemporary oncological landscape, this highlights a critical moment in the optimisation of employment conditions to enable high-quality service provision given growing patient numbers and treatment volume intensification. Data are drawn from a broader study which aimed to better understand the workforce experiences of medical oncologists in Australia. This paper specifically aims to examine a group of clinicians' views on the consequences of fractional work in oncology. DESIGN Qualitative, one-on-one semistructured interviews. Interview transcripts were digitally audio recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory. SETTING New South Wales, Australia. PARTICIPANTS Medical oncologists (n=22), including 9 female and 13 male participants, at a range of career stages. RESULTS Four key themes were derived from the analysis: (1) increasing fractional employment relative to opportunities for full-time positions and uncertainty about future opportunities; (2) tightening in role diversity, including reducing time available for research, mentoring, professional development and administration; (3) emerging flexibility of medical oncology as a specialty and (4) impact of fractional-as-norm on workforce sustainability and quality of care. CONCLUSION Fractional appointments are viewed as increasing in oncology and the broader consequences of this major shift in medical labour remain unexamined. Such appointments offer potential for flexible work to better suit the needs of contemporary oncologists; however, fractional work also presents challenges for personal and professional identity and vocational engagement. Fractional appointments are viewed as having a range of consequences related to job satisfaction, burnout and service delivery. Further research is needed to provide a critical examination of the multiple impacts of workforce trends within and beyond oncology.
Collapse
Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, UNSW, Sydney, New South Wales, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Deme Karikios
- Medical Oncology, Nepean Cancer Care Centre, Nepean Hospital, Penrith, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rosemary Harrup
- Department of Medical Oncology/Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
22
|
Abudu RM, Cira MK, Pyle DH, Duncan K. Landscape of Global Oncology Research and Training at National Cancer Institute-Designated Cancer Centers: Results of the 2018 to 2019 Global Oncology Survey. J Glob Oncol 2019; 5:1-8. [PMID: 31756139 PMCID: PMC6882505 DOI: 10.1200/jgo.19.00308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The National Cancer Institute (NCI)-Designated Cancer Centers (NDCCs) are active in global oncology research and training, leading collaborations to support global cancer control. To better understand global oncology activities led by NDCCs, the NCI Center for Global Health collaborated with ASCO to conduct the 2018/2019 NCI/ASCO Global Oncology Survey of NDCCs. METHODS Seventy NDCCs received a two-part survey that focused on global oncology programs at NDCCs and non-National Institutes of Health (NIH)-funded global oncology projects with an international collaborator led by the NDCCs. Sixty-seven NDCCs responded to the survey. Data were coded and analyzed by NCI-Center for Global Health staff. RESULTS Thirty-three NDCCs (47%) reported having a global oncology program, and 61 (87%) reported a collective total of 613 non-NIH-funded global oncology projects. Of the NDCCs with global oncology programs, 17 reported that trainees completed rotations outside the United States and the same number enrolled trainees from low- and middle-income countries (LMIC). Primary focus areas of non-NIH-funded projects were research (469 [76.5%]) and capacity building or training (197 [32.1%]). Projects included collaborators from 110 countries; 68 of these were LMIC. CONCLUSION This survey shows that there is a substantial amount of global oncology research and training conducted by NDCCs and that much of this is happening in LMIC. Trends in these data reflect those in recent literature: The field of global oncology is growing, advancing scientific knowledge, contributing to building research and training capacity in LMIC, and becoming a recognized career path. Results of the 2018 Global Oncology Survey can be used to foster opportunities for NDCCs to work collaboratively on activities and to share their findings with relevant stakeholders in their LMIC collaborator countries.
Collapse
Affiliation(s)
- Rachel M. Abudu
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Mishka K. Cira
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Kalina Duncan
- National Cancer Institute Center for Global Health, Rockville, MD
| |
Collapse
|
23
|
Chopra S, Mittal P, Viswanathan A, Tharavichitkul E, Zubizarreta E, Nout RA, Yap ML, Grover S, Rodin D, Rai B, Gondhowiardjo S, Shrivastava SK. Global Collaborations for Cervical Cancer: Can the East-West Alliance Facilitate Treatment for all? Clin Oncol (R Coll Radiol) 2019; 31:529-538. [PMID: 31229379 DOI: 10.1016/j.clon.2019.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/11/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022]
Abstract
Despite the advances in the primary prevention of cervical cancer, there is an absolute increase in the incidence of cervical cancer as a result of an increase in world population. A vast majority of patients in low and low-middle income countries continue to present at a locally advanced stage, necessitating treatment with chemoradiation and brachytherapy. There is a dearth of equipment and trained professionals for the treatment of cervical cancer, especially in low and low-middle income countries. There is an urgent need to improve treatment availability and develop better treatments. Worldwide trends, however, reveal a low number of therapeutic and innovative research trials in cervical cancer. The present article elucidates the existing challenges and provides solutions to improve outcomes. The proposed strategies hinge on strengthening collaborations for global advocacy.
Collapse
Affiliation(s)
- S Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
| | - P Mittal
- Homi Bhabha National Institute, Mumbai, India; Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - A Viswanathan
- Department of Radiation Oncology, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - E Tharavichitkul
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - E Zubizarreta
- Division of Human Health, International Atomic of Energy Agency - Vienna International Centre, Vienna, Austria
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Center LUM, Leiden, the Netherlands
| | - M L Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, UNSW Sydney, Liverpool, New South Wales, Australia; Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia; School of Public Health, The University of Sydney, Camperdown, Australia
| | - S Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA; Botswana-UPENN Partnership, University of Botswana, Gaborone, Botswana
| | - D Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - B Rai
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gondhowiardjo
- Department of Radiotherapy, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - S K Shrivastava
- Department of Radiation Oncology, Apollo Hospital, Belapur, Navi Mumbai, India
| |
Collapse
|
24
|
Vanderpuye V, Hammad N, Martei Y, Hopman WM, Fundytus A, Sullivan R, Seruga B, Lopes G, Sengar M, Brundage MD, Booth CM. Cancer care workforce in Africa: perspectives from a global survey. Infect Agent Cancer 2019; 14:11. [PMID: 31139248 PMCID: PMC6528232 DOI: 10.1186/s13027-019-0227-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/10/2019] [Indexed: 12/26/2022] Open
Abstract
Background While the burden of cancer in Africa is rapidly rising, there is a lack of investment in healthcare professionals to deliver care. Here we report the results of a survey of systemic therapy workload of oncologists in Africa in comparison to oncologists in other countries. Methods An online survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 65 countries. The survey was distributed within Africa through a network of physicians associated with the African Organisation for Research and Training in Cancer (AORTIC). Workload was measured as the annual number of new cancer patient consults seen per oncologist. Job satisfaction was ranked on a 10-point Likert scale; scores of 9–10 were considered to represent high job satisfaction. Results Thirty-six oncologists from 18 countries in Africa and 1079 oncologists from 47 other countries completed the survey. Compared to oncologists from other countries, African oncologists were older (median age 51 vs 44 years, p = 0.007), more likely to prescribe chemotherapy and radiation [61% (22/36) vs 10% (108/1079), p < 0.001], less likely to have completed training in their home country [50% (18/36) vs 91% (979/1079), p < 0.001], and more likely to work in the private sector [47% (17/36) vs 34% (364/1079), p = 0.037]. The median number of annual consults per oncologist was 325 in Africa compared to175 in other countries. The proportion of oncologists seeing > 500 consults/year was 31% (11/36) in Africa compared to 12% (129/1079) in other countries (p = 0.001). African oncologists were more likely than global colleagues to see all cancer sites [72% (26/26) vs 24% (261/1079), p < 0.001]. Oncologists in Africa were less likely than other oncologists to have high job satisfaction [17% (6/36) vs 30% (314/1079), p = 0.013]. Conclusion African oncologists within the AORTIC network have a substantially higher clinical workload and lower job satisfaction than oncologists elsewhere in the world. There is an urgent need for governments and health systems to improve the oncologist-to-patient ratio and develop new models of capacity building, retention and skills enhancement to strengthen the wide variety of cancer care systems across continental Africa.
Collapse
Affiliation(s)
- Verna Vanderpuye
- 1National Centre for Radiotherapy Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O Box KB369, Accra, Ghana
| | - Nazik Hammad
- 2Department of Oncology, Queen's University, Kingston, Canada
| | - Yehoda Martei
- 3Botswana University of Pennsylvania Partnership, Gaborone, Botswana
| | - Wilma M Hopman
- Kingston General Health Research Institute, Kingston, Canada.,5Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Adam Fundytus
- 6Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| | - Richard Sullivan
- 7Institute of Cancer Policy, King's College London, & King's Health Partners Comprehensive Cancer Centre, London, UK
| | - Bostjan Seruga
- 8Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Gilberto Lopes
- 9University of Miami and Sylvester Comprehensive Cancer Center, Miami, USA
| | - Manju Sengar
- 10Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Michael D Brundage
- 2Department of Oncology, Queen's University, Kingston, Canada.,5Department of Public Health Sciences, Queen's University, Kingston, Canada.,6Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| | - Christopher M Booth
- 2Department of Oncology, Queen's University, Kingston, Canada.,5Department of Public Health Sciences, Queen's University, Kingston, Canada.,6Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| |
Collapse
|
25
|
Das BK, Swamy AV, Koti BC, Gadad PC. Experimental evidence for use of Acorus calamus (asarone) for cancer chemoprevention. Heliyon 2019; 5:e01585. [PMID: 31193009 PMCID: PMC6513775 DOI: 10.1016/j.heliyon.2019.e01585] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/20/2019] [Accepted: 04/24/2019] [Indexed: 11/25/2022] Open
Abstract
Cancer is one of the major non-communicable diseases posing substantial challenges in both developing and developed countries. The options available for treatment of different cancer are associated with various limitations, including severe toxicity, drug resistance, poor outcomes and a high risk of relapse. Hence, an increased attention and necessity for screening of various phytochemicals from natural sources for superior and safer alternative has been ongoing for several decades. In recent years, phytochemicals like galantamine, erwinaze, rivastigmine, resveratrol from natural sources have been found to be important therapeutic targets for the treatment of various diseases including cancer, neurodegeneration, diabetes, and cardiovascular effects. Acorus calamus (Sweet flag), and/or its bioactive phytochemical alpha (α)-and beta (β)-asarone, is a well-known drug in the traditional system of medicine which possesses anti-tumor and chemo-preventive activities as evident from numerous pre-clinical studies both in-vitro and in-vivo. In this article, we critically review the current available scientific evidences of A. calamus and/or asarone for cancer chemoprevention based on preclinical in-vitro and in-vivo models. In addition, we also have compiled and discussed the molecular targets of mechanism(s) involved in the anti-cancer activity of A. calamus/asarone. Still, extensive in-vivo studies are necessary using various animal models to understand the molecular mechanism behind the pharmacological activity of the bioactive phytochemicals derived from A. calamus. It is strongly believed that the comprehensive evidence presented in this article could deliver a possible source for researchers to conduct future studies pertaining to A. calamus and/or its bioactive phytochemicals asarone for cancer chemoprevention.
Collapse
Affiliation(s)
- Bhrigu Kumar Das
- KLE College of Pharmacy (A Constituent Unit of KLE Academy of Higher Education and Research, Belagavi), Vidyanagar, Hubballi, 580 031, Karnataka, India.,Off-campus Basic and Applied Sciences Research Centre of KLE Academy of Higher Education and Research at KLE College of Pharmacy, Vidyanagar, Hubballi, 580 031, Karnataka, India
| | - Ahm Viswanatha Swamy
- KLE College of Pharmacy (A Constituent Unit of KLE Academy of Higher Education and Research, Belagavi), Vidyanagar, Hubballi, 580 031, Karnataka, India
| | - Basavaraj C Koti
- KLE College of Pharmacy (A Constituent Unit of KLE Academy of Higher Education and Research, Belagavi), Vidyanagar, Hubballi, 580 031, Karnataka, India
| | - Pramod C Gadad
- KLE College of Pharmacy (A Constituent Unit of KLE Academy of Higher Education and Research, Belagavi), Vidyanagar, Hubballi, 580 031, Karnataka, India.,Off-campus Basic and Applied Sciences Research Centre of KLE Academy of Higher Education and Research at KLE College of Pharmacy, Vidyanagar, Hubballi, 580 031, Karnataka, India
| |
Collapse
|
26
|
Fundytus A, Hopman WM, Hammad N, Biagi JJ, Sullivan R, Vanderpuye V, Seruga B, Lopes G, Sengar M, Brundage MD, Booth CM. Medical oncology workload in Canada: infrastructure, supports, and delivery of clinical care. ACTA ACUST UNITED AC 2018; 25:206-212. [PMID: 29962838 DOI: 10.3747/co.25.3999] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In 2000, a Canadian task force recommended that medical oncologists (mos) meet a target of 160-175 new patient consultations per year. Here, we report the Canadian results of a global survey of mo workload compared with mo workload in other high-income countries (hics). Methods Using a snowball method, an online survey was distributed by national oncology societies to chemotherapy-prescribing physicians in 22 hics (World Bank criteria). The survey was distributed within Canada to all members of the Canadian Association of Medical Oncologists. Workload was measured as the annual number of new cancer patient consults per oncologist. Results The survey was completed by 782 oncologists from hics, including 58 from Canada. Median annual consults per mo were 175 in Canada compared with 125 in other hics. The proportions of mos having 100 or fewer consults or more than 300 consults per year were 3% (2/58) and 5% (3/58) in Canada compared with 31% (222/724) and 16% (116/724) in other hics (p < 0.001 and p = 0.023 respectively). The median number of patients seen in a full-day clinic was 15 in Canada and 25 in other hics (p = 0.220). Canadian mos reported spending a median of 55 minutes per new consultation; new consultations of 35 minutes were reported in other hics (p < 0.001). Median hours worked per week was 55 in Canada and 45 in other hics (p = 0.200). Conclusions Although the median annual clinical volume for Canadian mos aligns with recommended targets, half the respondents exceeded that level of activity. Health policymakers and educators have to consider mo workforce supply and alternative models of care in preparation for the anticipated surge in cancer incidence in the coming decade.
Collapse
Affiliation(s)
- A Fundytus
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute
| | - W M Hopman
- Kingston General Hospital Research Institute.,Department of Public Health Sciences, Queen's University, and
| | - N Hammad
- Department of Oncology, Queen's University, Kingston, ON
| | - J J Biagi
- Department of Oncology, Queen's University, Kingston, ON
| | - R Sullivan
- Institute of Cancer Policy, King's College London, and King's Health Partners Comprehensive Cancer Centre, London, U.K
| | | | - B Seruga
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - G Lopes
- University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, U.S.A
| | - M Sengar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - M D Brundage
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute.,Department of Oncology, Queen's University, Kingston, ON
| | - C M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute.,Department of Public Health Sciences, Queen's University, and.,University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, U.S.A
| |
Collapse
|
27
|
Fadelu T, Shulman LN. Health policy: Towards greater equity in the global oncology workforce. Nat Rev Clin Oncol 2018; 15:270-272. [PMID: 29485133 DOI: 10.1038/nrclinonc.2018.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Temidayo Fadelu
- Department of Medical Oncology of Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lawrence N Shulman
- Department of Medicine of Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|