101
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Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries. Soc Sci Med 2017; 176:158-165. [DOI: 10.1016/j.socscimed.2017.01.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 07/18/2016] [Accepted: 01/22/2017] [Indexed: 12/17/2022]
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102
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Yap ML, Hanna TP, Shafiq J, Ferlay J, Bray F, Delaney GP, Barton M. The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries. Clin Oncol (R Coll Radiol) 2017; 29:72-83. [PMID: 27916340 DOI: 10.1016/j.clon.2016.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/07/2016] [Accepted: 11/07/2016] [Indexed: 01/04/2023]
Abstract
More than half of all cancer diagnoses worldwide occur in low- and middle-income countries (LMICs) and the incidence is projected to rise substantially within the next 20 years. Radiotherapy is a vital, cost-effective treatment for cancer; yet there is currently a huge deficit in radiotherapy services within these countries. The aim of this study was to estimate the potential outcome benefits if external beam radiotherapy was provided to all patients requiring such treatment in LMICs, according to the current evidence-based guidelines. Projected estimates of these benefits were calculated to 2035, obtained by applying the previously published Collaboration for Cancer Outcomes, Research and Evaluation (CCORE) demand and outcome benefit estimates to cancer incidence and projection data from the GLOBOCAN 2012 data. The estimated optimal radiotherapy utilisation rate for all LMICs was 50%. There were about 4.0 million cancer patients in LMICs who required radiotherapy in 2012. This number is projected to increase by 78% by 2035, a far steeper increase than the 38% increase expected in high-income countries. National radiotherapy benefits varied widely, and were influenced by case mix. The 5 year population local control and survival benefits for all LMICs, if radiotherapy was delivered according to guidelines, were estimated to be 9.6% and 4.4%, respectively, compared with no radiotherapy use. This equates to about 1.3 million patients who would derive a local control benefit in 2035, whereas over 615 000 patients would derive a survival benefit if the demand for radiotherapy in LMICs was met. The potential outcome benefits were found to be higher in LMICs. These results further highlight the urgent need to reduce the gap between the supply of, and demand for, radiotherapy in LMICs. We must attempt to address this 'silent crisis' as a matter of priority and the approach must consider the complex societal challenges unique to LMICs.
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Affiliation(s)
- M L Yap
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia; Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia.
| | - T P Hanna
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - J Shafiq
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia
| | - J Ferlay
- International Agency for Research on Cancer, Lyon, France
| | - F Bray
- International Agency for Research on Cancer, Lyon, France
| | - G P Delaney
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia; Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia
| | - M Barton
- Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia
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Vignier N, Spira RD, Lert F, Pannetier J, Ravalihasy A, Gosselin A, Lydié N, Bouchaud O, Desgrées du Loû A. Accès aux soins des personnes originaires d’Afrique subsaharienne vivant avec une hépatite B chronique. SANTE PUBLIQUE 2017. [DOI: 10.3917/spub.173.0361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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104
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Vignot S, André T, Gonçalves A, Guièze R, Magné N, Orbach D, Penel N, Thariat J, Wislez M, Bay JO. [Which recent results in Oncology and Hematology will have an impact on our practices? The point of vue of Bulletin du Cancer editorial board]. Bull Cancer 2016; 104:6-19. [PMID: 28007296 DOI: 10.1016/j.bulcan.2016.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 01/05/2023]
Abstract
Among the results presented at international congresses or published in scientific journals, which are those that have a real impact on daily practice? Every year, the editorial board of the Bulletin du Cancer proposes a selection of key data in oncology and hematology. The objective is to discuss results that change or reinforce the strategies in 2016 but also identify key information for our reflections in 2017.
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Affiliation(s)
- Stéphane Vignot
- Institut Jean-Godinot, département d'oncologie, 1, rue du Général-Koenig, 51726 Reims cedex, France.
| | - Thierry André
- Hôpital Saint-Antoine, service d'oncologie, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Anthony Gonçalves
- Institut Paoli-Calmettes, département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Romain Guièze
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique adulte, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Daniel Orbach
- Institut Curie, département de pédiatrie, adolescents et jeunes adultes, rue d'Ulm, 75005 Paris, France
| | - Nicolas Penel
- Centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Juliette Thariat
- Centre Antoine-Lacassagne, département de radiothérapie, 33, avenue Valombrose, 06189 Nice, France
| | - Marie Wislez
- Hôpital Tenon, service de pneumologie, 4, rue de la Chine, 75020 Paris, France
| | - Jacques-Olivier Bay
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique adulte, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
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105
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Antunes JLF. The impact of unemployment on cancer mortality, and how to avoid it. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:404. [PMID: 27867956 DOI: 10.21037/atm.2016.08.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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106
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Pearce A, Bradley C, Hanly P, O'Neill C, Thomas AA, Molcho M, Sharp L. Projecting productivity losses for cancer-related mortality 2011 - 2030. BMC Cancer 2016; 16:804. [PMID: 27756270 PMCID: PMC5069877 DOI: 10.1186/s12885-016-2854-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/11/2016] [Indexed: 12/24/2022] Open
Abstract
Background When individuals stop working due to cancer this represents a loss to society – the loss of productivity. The aim of this analysis was to estimate productivity losses associated with premature mortality from all adult cancers and from the 20 highest mortality adult cancers in Ireland in 2011, and project these losses until 2030. Methods An incidence-based method was used to estimate the cost of cancer deaths between 2011 and 2030 using the Human Capital Approach. National data were used for cancer, population and economic inputs. Both paid work and unpaid household activities were included. Sensitivity analyses estimated the impact of assumptions around future cancer mortality rates, retirement ages, value of unpaid work, wage growth and discounting. Results The 233,000 projected deaths from all invasive cancers in Ireland between 2011 and 2030 will result in lost productivity valued at €73 billion; €13 billion in paid work and €60 billion in household activities. These losses represent approximately 1.4 % of Ireland’s GDP annually. The most costly cancers are lung (€14.4 billion), colorectal and breast cancer (€8.3 billion each). However, when viewed as productivity losses per cancer death, testis (€364,000 per death), cervix (€155,000 per death) and brain cancer (€136,000 per death) are most costly because they affect working age individuals. An annual 1 % reduction in mortality reduces productivity losses due to all invasive cancers by €8.5 billion over 20 years. Conclusions Society incurs substantial losses in productivity as a result of cancer-related mortality, particularly when household production is included. These estimates provide valuable evidence to inform resource allocation decisions in cancer prevention and control.
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Affiliation(s)
- Alison Pearce
- National Cancer Registry Ireland, Building 6800 Cork Airport Business Park, Kinsale Rd, Cork, Ireland. .,Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia.
| | - Cathy Bradley
- Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Paul Hanly
- National College of Ireland, Mayor Street, IFSC, Dublin 1, Ireland
| | - Ciaran O'Neill
- National University of Ireland, University Road, Galway, Ireland
| | | | - Michal Molcho
- National University of Ireland, University Road, Galway, Ireland
| | - Linda Sharp
- Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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107
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Melo ECP, de Oliveira EXG, Chor D, Carvalho MS, Pinheiro RS. Inequalities in socioeconomic status and race and the odds of undergoing a mammogram in Brazil. Int J Equity Health 2016; 15:144. [PMID: 27628786 PMCID: PMC5024478 DOI: 10.1186/s12939-016-0435-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/05/2016] [Indexed: 12/05/2022] Open
Abstract
Background Access to mammograms, in common with other diagnostic procedures, is strongly conditioned by socioeconomic disparities. Which aspects of inequality affect the odds of undergoing a mammogram, and whether they are the same in different localities, are relevant issues related to the success of health policies. Methods This study analyzed data from the 2008 PNAD - Brazilian National Household Sample Survey (11.607 million women 40 years of age or older), on having had at least one mammogram over life for women 40 years of age or older in each of Brazil’s nine Metropolitan Regions (MR), according to socioeconomic position. The effects of income, schooling, health insurance and race in the different regions were investigated using multivariate logistical regression for each region individually, and for all MRs combined. The age-adjusted odds of a woman having had a mammogram according to race and stratified by two income strata (and two schooling strata) were also analyzed. Results Having a higher income increases four to seven times a woman’s odds of having had at least one mammogram in all MRs except Curitiba. For schooling, the gradient, though less steep, is favorable to women with more years of study. Having health insurance increases two to three times the odds in all MRs. Multivariate analysis did not show differences due to race (except for the Fortaleza MR), but the stratified analysis by income and schooling shows effects of race in most MRs, with greater differences for women with higher socioeconomic status. Conclusions This study confirms that income and schooling, as well as having health insurance, are still important determinants of inequality in health service use in Brazil. Additionally, race also contributes to the odds of having had a mammogram. The point is not to isolate the effect of each factor, but to evaluate how their interrelations may exacerbate differences, generating patterns of cumulative adversity, a theme that is still little explored in Brazil. This is much more important when we consider that race has only recently started be included in analyses of health outcomes in Brazil.
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Affiliation(s)
- Enirtes Caetano Prates Melo
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation -DEMQS/ENSP, Rua Leopoldo Bulhões, 1480, room 806. Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil. .,Health Information and Networks Research Group, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | | | - Dóra Chor
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation -DEMQS/ENSP, Rua Leopoldo Bulhões, 1480, room 806. Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil
| | - Marilia Sá Carvalho
- Health Information and Networks Research Group, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.,Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Rejane Sobrino Pinheiro
- Health Information and Networks Research Group, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.,Institute for Studies in Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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108
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Wulaningsih W, Serrano FEC, Utarini A, Matsuguchi T, Watkins J. Smoking, second-hand smoke exposure and smoking cessation in relation to leukocyte telomere length and mortality. Oncotarget 2016; 7:60419-60431. [PMID: 27509177 PMCID: PMC5312393 DOI: 10.18632/oncotarget.11051] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/19/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the link between smoking exposure, telomere length and mortality, with emphasis on second-hand smoke (SHS) exposure and the duration of smoking cessation. RESULTS A total of 1,018 participants died during follow-up (mean: 10.3 years). A 50 base-pair decrease in LTL was shown among cotinine-confirmed current versus never smokers. The 90th quantile of LTL decreased with increasing cotinine among never smokers, indicating a role of SHS. Longer telomeres with smoking cessation were indicated but limited to a 3-16 year period of abstaining smoking. When assessing mortality, we observed a lower risk of all-cause death for the second quintile compared to the first among never smokers (HR: 0.67, 95% CI: 0.52-0.87), and a higher risk was found among current smokers (HR: 1.89, 1.19-2.92). MATERIALS AND METHODS We studied 6,456 nationally representative U.S. respondents with mortality follow-up through to 31 December 2011. Smoking status was assessed by interviews and cotinine levels. Relative leukocyte telomere length (LTL) was quantified by polymerase chain reaction (PCR). Multivariable linear regression was performed to examine LTL by smoking exposure, adjusted for age, sex, race/ethnicity, socioeconomic status, education, body mass index, alcohol consumption, and physical activity. We further estimated the association of LTL with cotinine levels using quantile regression, and with smoking cessation dynamics. Cox regression was used to estimate mortality by smoking status and LTL. CONCLUSION Our findings indicated a complex association between smoking, telomere length, and mortality. LTL alterations with SHS and smoking cessation warrant further investigation for translation to public health measures.
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Affiliation(s)
- Wahyu Wulaningsih
- Division of Cancer Studies, King's College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Division of Haematology/Oncology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- PILAR Research and Education, Cambridge, UK
| | - Fidel Emmanuel C. Serrano
- National Institute of Molecular Biology and Biotechnology, University of The Philippines Diliman, Diliman, Quezon City, Metro Manila, The Philippines
| | - Adi Utarini
- Department of Health Policy and Management, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tetsuya Matsuguchi
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
- Driver Group, L.L.C., San Francisco, CA, USA
| | - Johnathan Watkins
- PILAR Research and Education, Cambridge, UK
- Institute for Mathematical and Molecular Biomedicine, King's College London, London, UK
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109
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Affiliation(s)
- Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO 63110, USA.
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