2
|
Welten VM, Dabekaussen KFAA, Melnitchouk N. Global Health 101. Clin Colon Rectal Surg 2022; 35:355-361. [PMID: 36111085 PMCID: PMC9470279 DOI: 10.1055/s-0042-1746184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Global health is an evolving field that has been broadly defined as the promotion of health for all through transnational collaboration and research. It centers on the concepts of equity and collaboration. The focus of global health has recently undergone a major shift toward emphasizing the importance of a systems-based approach to healthcare delivery, which considers not only the target disease but also the many contextual factors, influencing the ability to deliver care equitably to a population to reduce the burden of any particular disease. Thus, an important global health delivery framework has been established to outline this inter- and multi-disciplinary systems-based to address major global health issues and improve health for all globally. The practice of global health, whether in research or in active intervention, necessitates guiding principles to ensure ethical conduct in the transnational partnerships and efforts to advance the field. With the introduction of the United Nations' Sustainable Development Goals in 2015, there has been a major shift in response to epidemiologic transition to focus on reducing the burden of noncommunicable diseases, including cancer, which disproportionately impact low-to-middle income countries. This is true for colorectal cancer, with care challenged by significant gaps in screening, early detection, and referral systems.
Collapse
Affiliation(s)
- Vanessa M. Welten
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Nelya Melnitchouk
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
3
|
Welten VM, Wanis KN, Semeniv S, Shabat G, Dabekaussen KFAA, Davids JS, Beznosenko A, Suprun U, Soeteman DI, Melnitchouk N. Colonoscopy Needs for Implementation of a Colorectal Cancer Screening Program in Ukraine. World J Surg 2022; 46:2476-2486. [PMID: 35835863 DOI: 10.1007/s00268-022-06656-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Ukraine, there is no established colorectal cancer screening program. We aimed to project the number of screening colonoscopies needed for implementation of various CRC screening strategies in Ukraine. METHODS We modified a previously developed Markov microsimulation model to reflect the natural history of adenoma and CRC progression among average-risk 50-74-year-olds. We simulated colonoscopies needed for the following screening strategies: no screening, fecal occult blood test yearly, FOBT yearly with flexible sigmoidoscopy every 5 years, FS every 5 years, fecal immunohistochemistry test (FIT) yearly, or colonoscopy every 10 years. Assuming 80% screening adherence, we estimated colonoscopies required at 1 and 5 years depending on the implementation rate. In one-way sensitivity analyses, we varied implementation rate, screening adherence, sensitivity, and specificity. RESULTS Assuming an 80% screening adherence and complete implementation (100%), besides a no screening strategy, the fewest screening colonoscopies are needed with an FOBT program, requiring on average 6,600 and 26,800 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. The most screening colonoscopies are required with a colonoscopy program, requiring on average 76,600 and 101,000 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. In sensitivity analyses, the biggest driver of number of colonoscopies needed was screening adherence. CONCLUSIONS The number of colonoscopies needed and therefore the potential strain on the healthcare system vary substantially by screening test. These findings can provide valuable information for stakeholders on equipment needs when implementing a national screening program in Ukraine.
Collapse
Affiliation(s)
- Vanessa M Welten
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Kerollos Nashat Wanis
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Galyna Shabat
- Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Kirsten F A A Dabekaussen
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jennifer S Davids
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | | | | | - Djøra I Soeteman
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nelya Melnitchouk
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| |
Collapse
|
5
|
Melnitchouk N, Shabat G, Lu P, Lyu H, Scully R, Leung K, Jarman M, Lukashenko A, Kolesnik OO, Goldberg J, Davids JS, Bleday R. Colorectal Cancer in Ukraine: Regional Disparities and National Trends in Incidence, Management, and Mortality. J Glob Oncol 2018; 4:JGO.18.00145. [PMID: 30354936 PMCID: PMC6657623 DOI: 10.1200/jgo.18.00145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose The incidence of colorectal cancer (CRC) is increasing worldwide, and the greatest increase is in low- to middle-income countries, such as Ukraine. Better knowledge of epidemiology of CRC in Ukraine is needed to understand how best to decrease the burden of disease. Methods The National Cancer Registry of Ukraine (NCRU) was queried for CRC incidence, mortality, stage, and treatment in Ukraine and assessed for regional variation from 1999 to 2015. Joinpoint analysis was used to analyze the trends. Results The incidence of colon cancer increased from 10.6 to 13.3 occurrences per 100,000, which provided an average annual percent change (AAPC) of 1.48 (95% CI, 1.3 to 1.7; P < .05). The incidence of rectal and anal cancers also increased from 9.9 to 11.5 occurrences per 100,000, which provided an AAPC of 1.0 (95% CI, 0.8 to 1.3; P < .05). Mortality remained the same (AAPC, 0.1; 95% CI, -0.3 to 0.2; P = .4). The proportion of patients who received cancer-specific treatment increased from 54.6% to 68.5% for colon cancer and from 61% to 74.4% for rectal and anal cancers. Overall, 34.5% of patients with colon cancer and 27.5% of patients with rectal cancer died within a year of diagnosis in 2015. Great regional variations in 1-year mortality and treatment received were identified. Conclusion The incidence of CRC in Ukraine is increasing. Despite stable mortality rates, many do not receive cancer-specific treatment, and a large proportion of patients die within a year of diagnosis. These findings illustrate the need to promote establishment of a screening program and to improve access to cancer-specific therapy in Ukraine.
Collapse
Affiliation(s)
- Nelya Melnitchouk
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Galyna Shabat
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Pamela Lu
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Heather Lyu
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Rebecca Scully
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Krystle Leung
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Molly Jarman
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Andrey Lukashenko
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Olena O. Kolesnik
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Joel Goldberg
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Jennifer S. Davids
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Ronald Bleday
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| |
Collapse
|