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Joseph A, Akinsete AM, Lasebikan NN, Adeneye S, Awofeso OM, Oladipo AT, Ajose AO, Ojo O, Merrell K, Ngwa W, Puthoff DS, Onitilo AA. The Landscape of Pediatric Radiation Oncology in Nigeria. JCO Glob Oncol 2024; 10:e2300219. [PMID: 38207247 DOI: 10.1200/go.23.00219] [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: 06/30/2023] [Revised: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 01/13/2024] Open
Abstract
Radiation therapy (RT) is an essential part of the multidisciplinary treatment of pediatric cancer. Over the past five decades, significant advances have been made in the delivery of RT, with better dose delivery to disease targets while minimizing exposure to nearby organs at risk. These advances have led to improved treatment outcomes, increased survival, and reduced treatment-related toxicities. Advanced treatment techniques, however, require significant investment in infrastructural and personnel resources. This review documents what is currently available regarding expertise and infrastructure for pediatric radiation oncology practice in Nigeria. It was performed to serve as a foundation for the creation and design of tailored solutions (initiatives and policies) to increase pediatric radiation availability, accessibility, and equity in Nigeria and ultimately improve pediatric cancer treatment outcomes in the region.
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Affiliation(s)
- Adedayo Joseph
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye M Akinsete
- Hematology & Oncology Unit, Department of Pediatrics, College of Medicine University of Lagos, Lagos, Nigeria
| | | | - Samuel Adeneye
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Opeyemi M Awofeso
- Psychosocial Oncology & Palliative Care, Dana Farber Cancer Institute, Boston, MA
| | - Aishat T Oladipo
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Azeezat O Ajose
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwatimileyin Ojo
- Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, NY
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - David S Puthoff
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
| | - Adedayo A Onitilo
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
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Zhou Y, Luo B, Sang J, Li C, Zhu M, Zhu Z, Dai J, Wang J, Chen H, Zhai S, Lu L, Liu H, Yu G, Ye J, Zhang Z, Huan J. A cloud-based consultation and collaboration system for radiotherapy: Remote decision support services for community radiotherapy centers. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107270. [PMID: 36516515 DOI: 10.1016/j.cmpb.2022.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE This study aimed to establish a cloud-based radiotherapy consultation and collaboration system, then investigated the practicability of remote decision support for community radiotherapy centers using the system. METHODS AND MATERIALS A cloud-based consultation and collaboration system for radiotherapy, OncoEvidance®, was developed to provide remote services of LINAC modeling, simulation CT data import/export, target volume and organ-at-risk delineation, prescription, and treatment planning. The system was deployed on a hybrid cloud. A federate of public nodes, each corresponding to a medical institution, are managed by a central node where a group of consultants have registered. Users can access the system through network using computing devices. The system has been tested at three community radiotherapy centers. One accelerator was modeled. 12 consultants participated the remote radiotherapy decision support and 77 radiation treatment plans had been evaluated remotely. RESULTS All the passing rates of per-beam dose verification are > 94% and all the passing rates of composite beam dose verification are > 99%. The average downloading time for one set of simulation CT data for one patient from Internet was within 1 min under the cloud download bandwidth of 8 Mbps and local network bandwidth of 100 Mbps. The average response time for one consultant to contour target volumes and make prescription was about 24 h. And that for one consultant to design and optimize a IMRT treatment plan was about 36 h. 100% of the remote plans passed the dosimetric criteria and could be imported into the local TPS for further verification. CONCLUSION The cloud-based consultation and collaboration system saved the travel time for consultants and provided high quality radiotherapy to patients in community centers. The under-staffed community radiotherapy centers could benefit from the remote system with lower cost and better treatment quality control.
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Affiliation(s)
- Yin Zhou
- Evidance Medical Technologies Inc, Suzhou, China.
| | - Binghui Luo
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Jiugao Sang
- Department of Radiation Oncology, Rudong County People's Hospital, Rudong, Nantong, China
| | - Cheng Li
- Homology Medical Technologies Inc. Ningbo, China
| | - Meng Zhu
- Evidance Medical Technologies Inc, Suzhou, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jianrong Dai
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhua Wang
- Ningbo Medical Center, Li Huili Hospital, Ningbo, China
| | - Haibo Chen
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Shuwei Zhai
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Lina Lu
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Hui Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Genhua Yu
- Department of Radiation Oncology, Zhebei Mingzhou Hospital, Huzhou, China
| | - Jin Ye
- Homology Medical Technologies Inc. Ningbo, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jian Huan
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China.
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Hatcher JB, Oladeru O, Chang B, Malhotra S, Mcleod M, Shulman A, Dempsey C, Mula-Hussain L, Tassoto M, Sandwall P, Dieterich S, Sulieman L, Roa D, Li B. Impact of High-Dose-Rate Brachytherapy Training via Telehealth in Low- and Middle-Income Countries. JCO Glob Oncol 2021; 6:1803-1812. [PMID: 33216647 PMCID: PMC7713515 DOI: 10.1200/go.20.00302] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Our objective was to demonstrate the efficacy of a telehealth training course on high-dose-rate (HDR) brachytherapy for gynecologic cancer treatment for clinicians in low- and middle-income countries (LMICs). METHODS A 12-week course consisting of 16 live video sessions was offered to 10 cancer centers in the Middle East, Africa, and Nepal. A total of 46 participants joined the course, and 22 participants, on average, attended each session. Radiation oncologists and medical physicists from 11 US and international institutions prepared and provided lectures for each topic covered in the course. Confidence surveys of 15 practical competencies were administered to participants before and after the course. Competencies focused on HDR commissioning, shielding, treatment planning, radiobiology, and applicators. Pre- and post-program surveys of provider confidence, measured by 5-point Likert scale, were administered and compared. RESULTS Forty-six participants, including seven chief medical physicists, 16 senior medical physicists, five radiation oncologists, and three dosimetrists, representing nine countries attended education sessions. Reported confidence scores, both aggregate and paired, demonstrated increases in confidence in all 15 competencies. Post-curriculum score improvement was statistically significant (P < .05) for paired respondents in 11 of 15 domains. Absolute improvements were largest for confidence in applicator commissioning (2.3 to 3.8, P = .009), treatment planning system commissioning (2.2 to 3.9, P = .0055), and commissioning an HDR machine (2.2 to 4.0, P = .0031). Overall confidence in providing HDR brachytherapy services safely and teaching other providers increased from 3.1 to 3.8 and 3.0 to 3.5, respectively. CONCLUSION A 12-week, low-cost telehealth training program on HDR brachytherapy improved confidence in treatment delivery and teaching for clinicians in 10 participating LMICs.
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Affiliation(s)
- Jeremy B Hatcher
- Rayos Contra Cancer, Nashville, TN.,Vanderbilt University School of Medicine, Nashville, TN
| | - Oluwadamilola Oladeru
- Rayos Contra Cancer, Nashville, TN.,Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | | | | | - Megan Mcleod
- Rayos Contra Cancer, Nashville, TN.,Vanderbilt University School of Medicine, Nashville, TN
| | - Adam Shulman
- Rayos Contra Cancer, Nashville, TN.,Radiating Hope, Salt Lake City, UT
| | - Claire Dempsey
- Calvary Mater Newcastle Hospital, University of Newcastle, Newcastle, Australia.,Department of Radiation Oncology, University of Washington
| | - Layth Mula-Hussain
- Rayos Contra Cancer, Nashville, TN.,Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Sonja Dieterich
- Department of Radiation Oncology, University of California Davis, Davis, CA
| | - Lina Sulieman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Dante Roa
- Rayos Contra Cancer, Nashville, TN.,Department of Radiation Oncology, University of California Irvine, Irvine, CA
| | - Benjamin Li
- Rayos Contra Cancer, Nashville, TN.,Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
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Elmore SNC, Royce TJ, Oladeru OT, Freese CM, Wakefield DV, Vapiwala N, Zietman AL. Global Health Perspectives Among Radiation Oncology Residency Program Directors: A Knowledge, Attitudes, and Practices Survey. Int J Radiat Oncol Biol Phys 2020; 107:419-425. [PMID: 32126266 DOI: 10.1016/j.ijrobp.2020.02.467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Interest in global health has risen among medical students applying to and residents training in radiation oncology, often outpacing available educational offerings. The Association of Residents in Radiation Oncology Global Health Subcommittee sought to determine the perceptions of program directors (PDs) in radiation oncology and their current or planned global health curricular opportunities. METHODS AND MATERIALS A standardized, Knowledge-Attitudes-Practices survey composed of 32 binary items was sent to PDs for all Accreditation Council for Graduate Medical Education-accredited radiation oncology programs. RESULTS The program response rate was 60% (55 of 91). Responding programs were distributed evenly geographically and included a range of training program sizes. Most PDs (77%) knew that most nations did not meet standard minimum benchmarks for radiation therapy access. Although 89% would support residents in pursuing global health rotations, only 22% would support departmental funding of such rotations. Furthermore, 94% believed that global health was a field worthy of an academic career, but only 39% believed that it had appropriate rigor. Only 8% of programs had dedicated global health rotations. CONCLUSIONS Radiation oncology PDs largely expressed favorable views of global health as a pursuit and affirmed a high degree of resident and medical student interest. However, faculty commitment and program offerings currently lag behind the interest level. In particular, a substantial number of PDs do not perceive global health to be a rigorous academic endeavor. Future progress in academic global health in radiation oncology will require strategies to systematically support pathways for the development of experience and scholarship both within and beyond residency.
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Affiliation(s)
- Shekinah N C Elmore
- Harvard Radiation Oncology Program, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Trevor J Royce
- Harvard Radiation Oncology Program, Boston, Massachusetts; Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Oluwadamilola T Oladeru
- Harvard Radiation Oncology Program, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Chris M Freese
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Daniel V Wakefield
- University of Tennessee Health Science Center, Memphis, Tennessee; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony L Zietman
- Harvard Radiation Oncology Program, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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Donkor A, Luckett T, Aranda S, Vanderpuye V, Phillips J. Experiences of barriers and facilitators to establishing and sustaining radiotherapy services in low- and middle-income countries: A qualitative study. Asia Pac J Clin Oncol 2020; 16:e74-e85. [PMID: 32030881 DOI: 10.1111/ajco.13310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/07/2020] [Indexed: 01/08/2023]
Abstract
AIMS The factors contributing to the establishment of high-quality radiotherapy services in low- and middle-income countries (LMICs) are poorly understood. The aim was to identify and describe barriers and facilitators to establishing and sustaining high-quality and accessible radiotherapy services in LMICs based on the experience of successful and unsuccessful attempts. METHODS An exploratory-descriptive qualitative study using semistructured telephone interviews was undertaken. Purposive and snowball sampling techniques were used to recruit participants. The World Health Organization Innovative Care for Chronic Conditions Framework informed the interview guide. A constant comparative data analysis approach was adopted. FINDINGS Seventeen participants were interviewed. Ten were working permanently in nine LMICs and seven were permanently employed in four high-income countries. Three themes were developed: committing to a vision of improving cancer care; making it happen and sustaining a safe service; and leveraging off radiotherapy to strengthen integrated cancer care. Identified barriers included lack of political leadership continuity, lack of a coordinated advocacy effort, non-Member State of the IAEA, lack of reliable epidemiological data, lack of a comprehensive budget and lack of local expertise. Facilitators identified included strong political support, vision champion, availability of a regulator, costed cancer control plan, diversified sources of funding, responsible project manager, adoption of evidence-based practice, strategic partnerships, motivation to provide patient-centered care, and availability of supportive technology. CONCLUSIONS Assessing the level of readiness to establish and sustain a radiotherapy service is highly recommended. Future research is recommended to develop a readiness assessment tool for radiotherapy services implementation at LMICs.
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Affiliation(s)
- Andrew Donkor
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, New South Wales, Australia.,National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Korlebu, Ghana
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Sanchia Aranda
- Faculty of Health, University of Technology Sydney, New South Wales, Australia.,Union for International Cancer Control, Geneva, Switzerland.,Cancer Council Australia, New South Wales, Australia
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Korlebu, Ghana
| | - Jane Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, New South Wales, Australia
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Datta NR, Rogers S, Bodis S. Challenges and Opportunities to Realize “The 2030 Agenda for Sustainable Development” by the United Nations: Implications for Radiation Therapy Infrastructure in Low- and Middle-Income Countries. Int J Radiat Oncol Biol Phys 2019; 105:918-933. [DOI: 10.1016/j.ijrobp.2019.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/03/2019] [Accepted: 04/27/2019] [Indexed: 12/27/2022]
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Elmore SNC, Grover S, Bourque JM, Chopra S, Nyakabau AM, Ntizimira C, Krakauer EL, Balboni TA, Gospodarowicz MK, Rodin D. Global palliative radiotherapy: a framework to improve access in resource-constrained settings. ANNALS OF PALLIATIVE MEDICINE 2019; 8:274-284. [PMID: 30823841 DOI: 10.21037/apm.2019.02.02] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
Radiotherapy is an essential component of cancer therapy. Lack of access to radiotherapy in less-developed countries prevents its use for both cure and symptom relief, resulting in a significant disparity in patient suffering. Several recent initiatives have highlighted the need for expanded access to both palliative medicine and radiotherapy globally. Yet, these efforts have remained largely independent, without attention to overlap and integration. This review provides an update on the progress toward global palliative radiotherapy access and proposes a strategic framework to address further scale-up. Synergies between radiotherapy, palliative medicine, and other global health initiatives will be essential in bringing palliative radiotherapy to patients around the globe.
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Affiliation(s)
- Shekinah N C Elmore
- Harvard Radiation Oncology Program, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA; Botswana-UPENN Partnership, University of Botswana, Gaborone, Botswana
| | - Jean-Marc Bourque
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ontario, Canada; Institute of Cancer Policy, Kings College London, Guy's Hospital, London, UK
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Anna Mary Nyakabau
- Ministry of Health and Child Welfare, Parirenyatwa Group of Hospitals, Harare, Zimbabwe; CancerServe Trust, Harare, Zimbabwe
| | - Christian Ntizimira
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric L Krakauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Global Palliative Care Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tracy A Balboni
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA; 13Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mary K Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario,Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario,Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada
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Hayes NS, Hohman K, Vinson C, Pratt-Chapman M. Comprehensive cancer control in the U.S.: summarizing twenty years of progress and looking ahead. Cancer Causes Control 2018; 29:1305-1309. [PMID: 30569331 PMCID: PMC6322840 DOI: 10.1007/s10552-018-1124-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
In order to celebrate the accomplishments of the Centers for Disease Control and Prevention's (CDC) National Comprehensive Cancer Control Program (NCCCP), the Comprehensive Cancer Control National Partners (CCCNP) developed this Special Issue on Cancer Causes and Control. This, the third Special Issue on Comprehensive Cancer Control (CCC), is a reflection of 20 years of building successful partnerships to prevent and control cancer; planning and implementing strategic cancer control; collaborating to address national cancer prevention and control priorities; evaluating efforts; sharing successes; and, in later years, serving as a model for global cancer control planning and implementation. The CDC currently supports cancer control planning and implementation in all 50 states, the District of Columbia, eight tribes or tribal organizations, and seven Pacific Island Jurisdictions and U.S. territories through the NCCCP. CCC is an approach that brings together multi-sector partners to address the cancer burden in a community collectively by leveraging existing resources and identifying and addressing cancer related issues and needs. The Comprehensive Cancer Control National Partnership (CCCNP), a partnership of national organizations, has been committed to supporting comprehensive cancer control efforts since 1999. We summarize the efforts described in this Special Issue. We also describe opportunities and critical elements to continue the momentum for comprehensive cancer control well into the future.
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Affiliation(s)
- Nikki S Hayes
- Centers for Disease Prevention and Control, Atlanta, Georgia, USA.
| | - Karin Hohman
- Strategic Health Concepts, Arvada, Colorado, USA
| | - Cynthia Vinson
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Roberts PR, Jani AB, Packianathan S, Albert A, Bhandari R, Vijayakumar S. Upcoming imaging concepts and their impact on treatment planning and treatment response in radiation oncology. Radiat Oncol 2018; 13:146. [PMID: 30103786 PMCID: PMC6088418 DOI: 10.1186/s13014-018-1091-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/31/2018] [Indexed: 12/14/2022] Open
Abstract
For 2018, the American Cancer Society estimated that there would be approximately 1.7 million new diagnoses of cancer and about 609,640 cancer-related deaths in the United States. By 2030 these numbers are anticipated to exceed a staggering 21 million annual diagnoses and 13 million cancer-related deaths. The three primary therapeutic modalities for cancer treatments are surgery, chemotherapy, and radiation therapy. Individually or in combination, these treatment modalities have provided and continue to provide curative and palliative care to the myriad victims of cancer. Today, CT-based treatment planning is the primary means through which conventional photon radiation therapy is planned. Although CT remains the primary treatment planning modality, the field of radiation oncology is moving beyond the sole use of CT scans to define treatment targets and organs at risk. Complementary tissue scans, such as magnetic resonance imaging (MRI) and positron electron emission (PET) scans, have all improved a physician’s ability to more specifically identify target tissues, and in some cases, international guidelines have even been issued. Moreover, efforts to combine PET and MR to define solid tumors for radiotherapy planning and treatment evaluation are also gaining traction. Keeping these advances in mind, we present brief overviews of other up-and-coming key imaging concepts that appear promising for initial treatment target definition or treatment response from radiation therapy.
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Affiliation(s)
- Paul Russell Roberts
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, 30322, USA
| | - Satyaseelan Packianathan
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA
| | - Ashley Albert
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA
| | - Rahul Bhandari
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA.
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Anakwenze CP, Ntekim A, Trock B, Uwadiae IB, Page BR. Barriers to radiotherapy access at the University College Hospital in Ibadan, Nigeria. Clin Transl Radiat Oncol 2017; 5:1-5. [PMID: 29594210 PMCID: PMC5833915 DOI: 10.1016/j.ctro.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/20/2017] [Accepted: 05/28/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Nigeria has the biggest gap between radiotherapy availability and need, with one machine per 19.4 million people, compared to one machine per 250,000 people in high-income countries. This study aims to identify its patient-level barriers to radiotherapy access. Material and methods This was a cross sectional study consisting of patient questionnaires (n = 50) conducted in January 2016 to assess patient demographics, types of cancers seen, barriers to receiving radiotherapy, health beliefs and practices, and factors leading to treatment delay. Results Eighty percent of patients could not afford radiotherapy without financial assistance and only 6% of the patients had federal insurance, which did not cover radiotherapy services. Of the patients who had completed radiotherapy treatment, 91.3% had experienced treatment delay or often cancellation due to healthcare worker strike, power failure, machine breakdown, or prolonged wait time. The timeliness of a patient’s radiotherapy care correlated with their employment status and distance from radiotherapy center (p < 0.05). Conclusions Barriers to care at a radiotherapy center in a low- and middle-income country (LMIC) have previously not been well characterized. These findings can be used to inform efforts to expand the availability of radiotherapy and improve current treatment capacity in Nigeria and in other LMICs.
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Affiliation(s)
- Chidinma P Anakwenze
- University of Alabama Birmingham School of Medicine, Birmingham, AL, United States.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Atara Ntekim
- College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria
| | - Bruce Trock
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, United States
| | | | - Brandi R Page
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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11
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Radiation Oncology Quality and Safety Considerations in Low-Resource Settings: A Medical Physics Perspective. Semin Radiat Oncol 2017; 27:124-135. [DOI: 10.1016/j.semradonc.2016.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Guadagnolo BA, Petereit DG, Coleman CN. Cancer Care Access and Outcomes for American Indian Populations in the United States: Challenges and Models for Progress. Semin Radiat Oncol 2017; 27:143-149. [PMID: 28325240 PMCID: PMC5363281 DOI: 10.1016/j.semradonc.2016.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Low socioeconomic and health care access realities of being American Indian/Alaskan Native (AI/AN) in the United States combined with decades of data documenting poor cancer outcomes for this population provide a population nested within the United States that is analogous to the cancer care landscape of low- and middle-income countries internationally. We reviewed the medical literature with respect to cancer prevention, access to cancer treatment, and access to effective supportive and palliative care for AI/AN populations in the United States. Research confirms poorer cancer outcomes, suboptimal cancer screening, and high-risk cancer behaviors among AI/AN communities. AI/AN cancer patients are less likely to undergo recommended cancer surgeries, adjuvant chemotherapy, and radiation therapy than their White counterparts. Studies including both rural and urban survivors with AI cancer revealed barriers to receipt of optimal cancer symptom management and proportionally lower hospice use among AI/AN populations. Culturally tailored programs in targeted communities have been shown to mitigate the observed cancer-related health disparities among AI/AN communities. There is still much work to be done to improve cancer-related health outcomes in AI/AN communities, and the goals of the providers serving them corresponds with those propelling the growing interest in global oncology equity. Policy work and more funding are needed to continue to build upon the work that the Indian Health Service and established cancer-related health programs have begun in AI/AN communities.
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Affiliation(s)
- B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
| | | | - C Norman Coleman
- International Cancer Expert Corps, New York, NY; Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
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13
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Rodin D, Yap ML, Grover S, Longo JM, Balogun O, Turner S, Eriksen JG, Coleman CN, Giuliani M. Global Health in Radiation Oncology: The Emergence of a New Career Pathway. Semin Radiat Oncol 2017; 27:118-123. [DOI: 10.1016/j.semradonc.2016.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Eriksen J. Postgraduate Education in Radiation Oncology in Low- and Middle-income Countries. Clin Oncol (R Coll Radiol) 2017; 29:129-134. [DOI: 10.1016/j.clon.2016.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/28/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022]
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Abstract
The radiation stress response can have broad impact. In this Failla Award presentation it is discussed in three components using terms relevant to the current political season as to how the radiation stress response can be applied to the benefit for cancer care and as service to society. Of the people refers to the impact of radiation on cells, tissues and patients. The paradigm our laboratory uses is radiation as a drug, called "focused biology", and physics as "nano-IMRT" because at the nanometer level physics and biology merge. By the people refers to how the general population often reacts to the word "radiation" and how the Radiation Research Society can better enable society to deal with the current realities of radiation in our lives. For the people refers to the potential for radiation oncology and radiation sciences to improve the lives of millions of people globally who are now beyond benefits of cancer treatment and research.
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Affiliation(s)
- C. Norman Coleman
- Associate Director, Radiation Research Program, Division of Cancer Treatment and Diagnosis; Senior Investigator, Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and Senior Medical Advisor, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington DC
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16
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Rodin D, Longo J, Sherertz T, Shah MM, Balagun O, Wendling N, Van Dyk J, Coleman CN, Xu MJ, Grover S. Mobilising Expertise and Resources to Close the Radiotherapy Gap in Cancer Care. Clin Oncol (R Coll Radiol) 2016; 29:135-140. [PMID: 27955997 DOI: 10.1016/j.clon.2016.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Closing the gap in cancer care within low- and middle-income countries and in indigenous and geographically isolated populations in high-income countries requires investment and innovation. This is particularly true for radiotherapy, for which the global disparity is one of the largest in healthcare today. New models and paradigms and non-traditional collaborations have been proposed to improve global equity in cancer control. We describe recent initiatives from within the radiation oncology community to increase access to treatment, build the low- and middle-income countries' radiation oncology workforce, mobilise more professionals from within high-income countries and raise awareness of the global need for equitable cancer care.
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Affiliation(s)
- D Rodin
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - J Longo
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - T Sherertz
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - M M Shah
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - O Balagun
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Cornell University Medical School, New York, New York, USA
| | - N Wendling
- International Cancer Expert Corps (ICEC), New York, New York, USA
| | - J Van Dyk
- International Cancer Expert Corps (ICEC), New York, New York, USA; Departments of Oncology and Medical Biophysics, Western University, London, Ontario, Canada; Medical Physics for World Benefit (MPWB), Canada
| | - C N Coleman
- International Cancer Expert Corps (ICEC), New York, New York, USA
| | - M J Xu
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - S Grover
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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A Roadmap and Cost Implications of Establishing Comprehensive Cancer Care Using a Teleradiotherapy Network in a Group of Sub-Saharan African Countries With No Access to Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 95:1334-1343. [PMID: 27315665 DOI: 10.1016/j.ijrobp.2016.03.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/15/2016] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To propose a roadmap and explore the cost implications of establishing a teleradiotherapy network to provide comprehensive cancer care and capacity building in countries without access to radiation therapy. METHODS AND MATERIALS Ten low-income sub-Saharan countries with no current radiation therapy facilities were evaluated. A basic/secondary radiation therapy center (SRTC) with 2 teletherapy, 1 brachytherapy, 1 simulator, and a treatment planning facility was envisaged at a cost of 5 million US dollars (USD 5M). This could be networked with 1 to 4 primary radiation therapy centers (PRTC) with 1 teletherapy unit, each costing USD 2M. The numbers of PRTCs and SRTCs for each country were computed on the basis of cancer incidence, assuming that a PRTC and SRTC could respectively treat 450 and 900 patients annually. RESULTS An estimated 71,215 patients in these countries will need radiation therapy in 2020. Stepwise establishment of a network with 99 PRTCs and 28 SRTCs would result in 155 teletherapy units and 96% access to radiation therapy. A total of 310 radiation oncologists, 155 medical physicists, and 465 radiation therapy technologists would be needed. Capacity building could be undertaken through telementoring by networking to various international institutions and professional societies. Total infrastructure costs would be approximately USD 860.88M, only 0.94% of the average annual gross domestic product of these 10 countries. A total of 1.04 million patients could receive radiation therapy during the 15-year lifespan of a teletherapy unit for an investment of USD 826.69 per patient. For the entire population of 218.32 million, this equates to USD 4.11 per inhabitant. CONCLUSION A teleradiotherapy network could be a cost-contained innovative health care strategy to provide effective comprehensive cancer care through resource sharing and capacity building. The network could also be expanded to include other allied specialties. The proposal calls for active coordination between all national and international organizations backed up by strong geopolitical commitment and action from all stakeholders.
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Rodin D, Grover S, Xu MJ, Hanna TP, Olson R, Schreiner LJ, Munshi A, Mornex F, Palma D, Gaspar LE. Radiotherapeutic Management of Non–Small Cell Lung Cancer in the Minimal Resource Setting. J Thorac Oncol 2016; 11:21-9. [DOI: 10.1016/j.jtho.2015.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/22/2015] [Accepted: 09/30/2015] [Indexed: 01/22/2023]
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Abstract
eHealth is an umbrella term incorporating any area that combines healthcare and technology to improve efficiencies and reduce costs. The ultimate goal of eHealth is to rationalize treatment selection to improve patient safety and outcomes. Telemedicine, first used in the 1920s, is the oldest form of eHealth. The introduction of broadband Internet, followed by wireless technologies, has allowed an explosion of mHealth applications within this field. Wearable technologies, such as smartwatches, are now being used for diagnostics and patient monitoring. Challenges remain to develop reusable Clinical Decision Support systems that will streamline the flow of data from clinical laboratories to point of care. This review explores the history of eHealth, and describes some of the remaining integration and implementation challenges.
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Affiliation(s)
- Tibor van Rooij
- Department of Computer Science, University of Victoria, Victoria, British Columbia, Canada
| | - Sharon Marsh
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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Poverty, Health and Livelihoods. INFECTIOUS DISEASES AND RURAL LIVELIHOOD IN DEVELOPING COUNTRIES 2016. [PMCID: PMC7121515 DOI: 10.1007/978-981-10-0428-5_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Developing countries, especially those in the tropical regions of the world, are known for poverty and infectious diseases (ID). People in developing countries carry on their day-to-day living amongst these two challenges. Between the years 1940–2004, over 300 emerging human ID have been reported worldwide. Infectious diseases have resulted in high mortality and morbidity in developing countries. Affecting more than 1 billion of the world’s population, neglected tropical diseases (NTD) are a group of infectious diseases that are endemic in the poorest regions of the world. Most of the affected populations live in rural areas with very minimal resources but at high risk of disease due to their livelihood. Non-communicable diseases are also on the increase in developing countries, further exacerbating public health challenges in these regions. With nearly 15 million people dying each year as a result of ID, most of them living in developing countries, there is need to find solutions to prevent and tackle infectious diseases in these communities. This book is devoted to infectious diseases and livelihoods in developing countries.
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Global Radiation Oncology From the Trainee Perspective: A View From Beyond the Bunker. Int J Radiat Oncol Biol Phys 2015; 94:438-9. [PMID: 26867872 DOI: 10.1016/j.ijrobp.2015.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/20/2015] [Indexed: 11/21/2022]
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22
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Olson AC, Coleman CN, Hahn SM, DeWeese TL, Shulman LN, Chabner BA, Chao N, Martei YM, Mundt AJ, Grover S. A Roadmap for a New Academic Pathway for Global Radiation Oncology. Int J Radiat Oncol Biol Phys 2015; 93:493-6. [DOI: 10.1016/j.ijrobp.2015.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 11/30/2022]
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23
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Atun R, Jaffray DA, Barton MB, Bray F, Baumann M, Vikram B, Hanna TP, Knaul FM, Lievens Y, Lui TYM, Milosevic M, O'Sullivan B, Rodin DL, Rosenblatt E, Van Dyk J, Yap ML, Zubizarreta E, Gospodarowicz M. Expanding global access to radiotherapy. Lancet Oncol 2015; 16:1153-86. [PMID: 26419354 DOI: 10.1016/s1470-2045(15)00222-3] [Citation(s) in RCA: 626] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 12/31/2022]
Abstract
Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015-35 is US$26·6 billion in low-income countries, $62·6 billion in lower-middle-income countries, and $94·8 billion in upper-middle-income countries, which amounts to $184·0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14·1 billion in low-income, $33·3 billion in lower-middle-income, and $49·4 billion in upper-middle-income countries-a total of $96·8 billion. Scale-up of radiotherapy capacity in 2015-35 from current levels could lead to saving of 26·9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278·1 billion in 2015-35 ($265·2 million in low-income countries, $38·5 billion in lower-middle-income countries, and $239·3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even greater total benefit of $365·4 billion ($12·8 billion in low-income countries, $67·7 billion in lower-middle-income countries, and $284·7 billion in upper-middle-income countries). The returns, by the human-capital approach, are projected to be less with the nominal cost model, amounting to $16·9 billion in 2015-35 (-$14·9 billion in low-income countries; -$18·7 billion in lower-middle-income countries, and $50·5 billion in upper-middle-income countries). The returns with the efficiency model were projected to be greater, however, amounting to $104·2 billion (-$2·4 billion in low-income countries, $10·7 billion in lower-middle-income countries, and $95·9 billion in upper-middle-income countries). Our results provide compelling evidence that investment in radiotherapy not only enables treatment of large numbers of cancer cases to save lives, but also brings positive economic benefits.
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Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, USA.
| | - David A Jaffray
- Princess Margaret Cancer Centre, Toronto, ON, Canada; TECHNA Institute, University Health Network, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Michael B Barton
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Michael Baumann
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bhadrasain Vikram
- National Cancer Institute, US National Institutes of Health, Bethesda, MD, USA
| | - Timothy P Hanna
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard University, Cambridge, MA, USA; Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Yolande Lievens
- Ghent University Hospital, Ghent, Belgium; Ghent University, Ghent, Belgium
| | - Tracey Y M Lui
- TECHNA Institute, University Health Network, Toronto, ON, Canada
| | | | - Brian O'Sullivan
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Danielle L Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Jacob Van Dyk
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Mei Ling Yap
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | | | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Coleman CN, Minsky BD. The verdict is in: the time for effective solutions to the global cancer burden is now. Lancet Oncol 2015; 16:1146-7. [DOI: 10.1016/s1470-2045(15)00276-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 11/25/2022]
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25
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Petereit DG, Coleman CN. Editorial: "global challenges in radiation oncology". Front Oncol 2015; 5:103. [PMID: 26029661 PMCID: PMC4432796 DOI: 10.3389/fonc.2015.00103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 12/27/2022] Open
Affiliation(s)
- Daniel Grant Petereit
- Walking Forward Program, Rapid City Regional Cancer Center, Rapid City, SD, USA
- International Cancer Expert Corps, New York, NY, USA
| | - C. Norman Coleman
- International Cancer Expert Corps, New York, NY, USA
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA
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26
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Grech G, Zhan X, Yoo BC, Bubnov R, Hagan S, Danesi R, Vittadini G, Desiderio DM. EPMA position paper in cancer: current overview and future perspectives. EPMA J 2015; 6:9. [PMID: 25908947 PMCID: PMC4407842 DOI: 10.1186/s13167-015-0030-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 02/26/2015] [Indexed: 12/31/2022]
Abstract
At present, a radical shift in cancer treatment is occurring in terms of predictive, preventive, and personalized medicine (PPPM). Individual patients will participate in more aspects of their healthcare. During the development of PPPM, many rapid, specific, and sensitive new methods for earlier detection of cancer will result in more efficient management of the patient and hence a better quality of life. Coordination of the various activities among different healthcare professionals in primary, secondary, and tertiary care requires well-defined competencies, implementation of training and educational programs, sharing of data, and harmonized guidelines. In this position paper, the current knowledge to understand cancer predisposition and risk factors, the cellular biology of cancer, predictive markers and treatment outcome, the improvement in technologies in screening and diagnosis, and provision of better drug development solutions are discussed in the context of a better implementation of personalized medicine. Recognition of the major risk factors for cancer initiation is the key for preventive strategies (EPMA J. 4(1):6, 2013). Of interest, cancer predisposing syndromes in particular the monogenic subtypes that lead to cancer progression are well defined and one should focus on implementation strategies to identify individuals at risk to allow preventive measures and early screening/diagnosis. Implementation of such measures is disturbed by improper use of the data, with breach of data protection as one of the risks to be heavily controlled. Population screening requires in depth cost-benefit analysis to justify healthcare costs, and the parameters screened should provide information that allow an actionable and deliverable solution, for better healthcare provision.
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Affiliation(s)
- Godfrey Grech
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Xianquan Zhan
- Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, Changsha, China
| | - Byong Chul Yoo
- Colorectal Cancer Branch, Division of Translational and Clinical Research I, Research Institute, National Cancer Center, Gyeonggi, 410-769 Republic of Korea
| | - Rostyslav Bubnov
- Clinical Hospital 'Pheophania' of State Management of Affairs Department, Kyiv, Ukraine ; Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Suzanne Hagan
- Dept of Life Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Dominic M Desiderio
- Department of Neurology, University of Tennessee Center for Health Science, Memphis, USA
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