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Velasco Yanez RJ, Carvalho Fernandes AF, de Freitas Corpes E, Moura Barbosa Castro RC, Sixsmith J, Lopes-Júnior LC. Palliative care in the treatment of women with breast cancer: A scoping review. Palliat Support Care 2024; 22:592-609. [PMID: 38058195 DOI: 10.1017/s1478951523001840] [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] [Indexed: 12/08/2023]
Abstract
OBJECTIVES Recent studies on the quality of life in women with breast cancer show a high prevalence of signs and symptoms that should be the focus of palliative care (PC), leading us to question the current role they play in addressing breast cancer. Therefore, the objective of this review is to map the scope of available literature on the role of PC in the treatment of women with breast cancer. METHODS This is a methodologically guided scoping review by the Joanna Briggs Institute and adapted to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist for report writing. Systematic searches were conducted in 8 databases, an electronic repository, and gray literature. The searches were conducted with the support of a librarian. The study selection was managed through the RAYYAN software in a blind and independent manner by 2 reviewers. The extracted data were analyzed using the qualitative thematic analysis technique and discussed through textual categories. RESULTS A total of 9,812 studies were identified, of which only 136 articles and 3 sources of gray literature are included in this review. In terms of general characteristics, the majority were published in the USA (35.7%), had a cross-sectional design (44.8%), and were abstracts presented at scientific events (19.6%). The majority of interventions focused on palliative radiotherapy (13.6%). Thematic analysis identified 14 themes and 12 subthemes. SIGNIFICANCE OF RESULTS Our findings offer a comprehensive view of the evidence on PC in the treatment of breast cancer. Although a methodological quality assessment was not conducted, these results could guide professionals interested in the topic to position themselves in the current context. Additionally, a quick synthesis of recommendations on different palliative therapies is provided, which should be critically observed. Finally, multiple knowledge gaps are highlighted, which could be used for the development of future studies in this field.
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Affiliation(s)
| | | | | | | | - Judith Sixsmith
- School of Health Sciences, University of Dundee, Dundee, Scotland
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2
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Anderson BO, Duggan C, Scheel JR. Resource-appropriate evidence-based strategies to improve breast cancer outcomes in low- and middle-income countries guided by the Breast Health Global Initiative and Global Breast Cancer Initiative. J Surg Oncol 2023; 128:952-958. [PMID: 37811558 DOI: 10.1002/jso.27480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organization, Geneva, Switzerland
- Department of Surgery and Global Health Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Program in Epidemiology, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Catherine Duggan
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Program in Epidemiology, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - John R Scheel
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Arnaud A, Grenier J, Boustany R, Kirscher S, Mege A, de Rauglaudre G, Vazquez L, Debourdeau P. Role of supportive care in improving the quality of life and reducing unscheduled hospital care in patients with metastatic breast cancer. Support Care Cancer 2021; 29:3735-3742. [PMID: 33205324 DOI: 10.1007/s00520-020-05877-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Metastatic breast cancer (MBC) patients experience long survival and report poorer quality of life than localized breast cancer patients. Comprehensive supportive care (CSC) has been shown to improve the quality of life (QoL) of MBC. The respective part of each support care has not been fully examined, and little is known about whether meeting patients' needs is accompanied by decreased unscheduled hospital care (UHC). METHODS This prospective monocentric study included women who started a new treatment line for MBC between January 2018 and December 2018. The endpoints were factors associated with UHC and QoL (SF36) at month 12. RESULTS 100 patients were offered CSC, 78 were included (21 refusals, 1 no MBC). CSC was provided to 60 patients: pain (43%), psychological (37%), kinesitherapy (30%), social assistance (22%), esthetic (18%), nutrition (18%), massage (13%), and none (10%). CSC rate was not statistically different among patients with (58%) and without UHD (49%). Factors associated with a decrease of UHC were age > 65 years (p = 0.01), no previous treatment for MBC (p = 0.0001) with a trend for the lack of CSC (p = 0.054). Among the 8 domains of the SF36 scale, only health change perception was improved (p = 0.01) and its predictive factors were treatment carried out as planned (p = 0.0004), pain care (p = 0.003), and lack of MBC progression (p = 0.0035). CONCLUSION CSC can improve QoL in MBC. Painful patients might benefit more from CSC. UHC did not decrease for patients receiving CSC as expected possibly because of their important needs for clinical care.
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Affiliation(s)
- Antoine Arnaud
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Julien Grenier
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Rania Boustany
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Sylvie Kirscher
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Alice Mege
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | | | - Léa Vazquez
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France.
| | - Philippe Debourdeau
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
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4
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Stoltenberg M, Spence D, Daubman BR, Greaves N, Edwards R, Bromfield B, Perez-Cruz PE, Krakauer EL, Argentieri MA, Shields AE. The central role of provider training in implementing resource-stratified guidelines for palliative care in low-income and middle-income countries: Lessons from the Jamaica Cancer Care and Research Institute in the Caribbean and Universidad Católica in Latin America. Cancer 2021; 126 Suppl 10:2448-2457. [PMID: 32348569 DOI: 10.1002/cncr.32857] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
Individuals in low-income and middle-income countries (LMICs) account for approximately two-thirds of cancer deaths worldwide, and the vast majority of these deaths occur without access to essential palliative care (PC). Although resource-stratified guidelines are being developed that take into account the actual resources available within a given country, and several components of PC are available within health care systems, PC will never improve without a trained workforce. The design and implementation of PC provider training programs is the lynchpin for ensuring that all seriously ill patients have access to quality PC services. Building on the Breast Health Global Initiative's resource-stratified recommendations for provider education in PC, the authors report on efforts by the Jamaica Cancer Care and Research Institute in the Caribbean and the Universidad Católica in successfully developing and implementing PC training programs in the Caribbean and Latin America, respectively. Key aspects of this approach include: 1) fostering strategic academic partnerships to bring additional expertise and support to the effort; 2) careful adaptation of the curriculum to the local context and culture; 3) early identification of feasible metrics to facilitate program evaluation and future outcomes research; and 4) designing PC training programs to meet local health system needs.
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Affiliation(s)
- Mark Stoltenberg
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Massachusetts.,Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard Medical School, Boston, Massachusetts
| | - Dingle Spence
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Hope Institute Hospital, Kingston, Jamaica.,Department of Medicine, University of the West Indies, Mona Campus, Mona, Jamaica
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Massachusetts.,Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard Medical School, Boston, Massachusetts
| | - Natalie Greaves
- Department of Medical Sciences, University of the West Indies, Cave Hill Campus, Cave Hill, Barbados
| | - Rebecca Edwards
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
| | - Brittany Bromfield
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica
| | - Pedro E Perez-Cruz
- Palliative Medicine and Continuing Care Program, Faculty of Medicine, Pontifical Universidad Católica of Chile, Santiago, Chile.,Departament of Internal Medicine, Faculty of Medicine, Pontifical Universidad Católica of Chile, Santiago, Chile
| | - Eric L Krakauer
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - M Austin Argentieri
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
| | - Alexandra E Shields
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard Medical School, Boston, Massachusetts.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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5
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Mutebi M, Anderson BO, Duggan C, Adebamowo C, Agarwal G, Ali Z, Bird P, Bourque JM, DeBoer R, Gebrim LH, Masetti R, Masood S, Menon M, Nakigudde G, Ng'ang'a A, Niyonzima N, Rositch AF, Unger-Saldaña K, Villarreal-Garza C, Dvaladze A, El Saghir NS, Gralow JR, Eniu A. Breast cancer treatment: A phased approach to implementation. Cancer 2021; 126 Suppl 10:2365-2378. [PMID: 32348571 DOI: 10.1002/cncr.32910] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
Optimal treatment outcomes for breast cancer are dependent on a timely diagnosis followed by an organized, multidisciplinary approach to care. However, in many low- and middle-income countries, effective care management pathways can be difficult to follow because of financial constraints, a lack of resources, an insufficiently trained workforce, and/or poor infrastructure. On the basis of prior work by the Breast Health Global Initiative, this article proposes a phased implementation strategy for developing sustainable approaches to enhancing patient care in limited-resource settings by creating roadmaps that are individualized and adapted to the baseline environment. This strategy proposes that, after a situational analysis, implementation phases begin with bolstering palliative care capacity, especially in settings where a late-stage diagnosis is common. This is followed by strengthening the patient pathway, with consideration given to a dynamic balance between centralization of services into centers of excellence to achieve better quality and decentralization of services to increase patient access. The use of resource checklists ensures that comprehensive therapy or palliative care can be delivered safely and effectively. Episodic or continuous monitoring with established process and quality metrics facilitates ongoing assessment, which should drive continual process improvements. A series of case studies provides a snapshot of country experiences with enhancing patient care, including the implementation of national cancer control plans in Kenya, palliative care in Romania, the introduction of a 1-stop clinic for diagnosis in Brazil, the surgical management of breast cancer in India, and the establishment of a women's cancer center in Ghana.
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Affiliation(s)
- Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University Hospital, Nairobi, Kenya
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Clement Adebamowo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.,Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.,Center for Bioethics and Research, Ibadan, Nigeria
| | - Gaurav Agarwal
- Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | | | - Jean-Marc Bourque
- Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rebecca DeBoer
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Luiz Henrique Gebrim
- Department of Mastology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Referência da Saúde da Mulher, São Paulo, Brazil
| | - Riccardo Masetti
- Department of Women and Child Health, Catholic University, Rome, Italy
| | - Shahla Masood
- University of Florida Health Jacksonville Breast Center, Jacksonville, Florida
| | - Manoj Menon
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Anne Ng'ang'a
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Nixon Niyonzima
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Uganda Cancer Institute, Kampala, Uganda
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karla Unger-Saldaña
- Epidemiology Unit, Instituto Nacional de Cancerología - México, Mexico City, Mexico
| | - Cynthia Villarreal-Garza
- Tecnologico de Monterrey, Centro de Cancer de Mama, Hospital Zambrano Hellion, Monterrey, Mexico
| | - Allison Dvaladze
- Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | | | - Julie R Gralow
- Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | - Alexandru Eniu
- Hopital Riviera Chablais, Vaud-Valais, Rennaz, Switzerland
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6
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Chen Y, Lin S, Zhu Y, Xu R, Lan X, Xiang F, Li X, Zhang Y, Chen S, Yu H, Wu D, Zang J, Tang J, Jin J, Han H, Tao Z, Zhou Y, Hu X. Prevalence, trend and disparities of palliative care utilization among hospitalized metastatic breast cancer patients who received critical care therapies. Breast 2020; 54:264-271. [PMID: 33212422 PMCID: PMC7679246 DOI: 10.1016/j.breast.2020.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/24/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early integration of palliative care (PC) for patients with advanced cancer has been recommended to improve quality of care. This study aims to describe prevalence, temporal trend and predictors of PC use in metastatic breast cancer (mBCa) patients receiving critical care therapies (CCT; included invasive mechanic ventilation, percutaneous endoscopic gastrostomy tube, total parenteral nutrition, tracheostomy and dialysis). METHODS The National Inpatient Sample was queried for mBCa patients receiving CCT between 2005 and 2014. Annual percent changes (APC) were calculated for PC prevalence in the overall cohort and subgroups. Multivariable logistic analysis was used to explore predictors of PC use. RESULTS Of 5833 mBCa patients receiving CCT, 880 (15.09%) received PC. Rate of PC use increased significantly from 2.53% in 2005 to 25.96% in 2014 (APC: 35.75%; p < 0.0001). Higher increase in PC use was observed in South (from 0.65% to 27.11%; APC: 59.42%; p < 0.0001), medium bedsize hospitals (from 3.75% to 26.05%; APC: 38.16%; p = 0.0006) and urban teaching hospitals (from 4.13% to 29.86%; APC: 37.33%; p = 0.0005). Multivariable analysis revealed that year interval, urban teaching hospitals, and invasive mechanical ventilation were associated with increased PC use, while primary diagnosis of gastrointestinal disorders, fractures, metastatic sites from lymph nodes and tracheostomy were associated with lower PC use. CONCLUSIONS PC use in mBCa patients receiving CCT increases significantly over the period. However, it still remains low. Efforts to illustrate disparities in PC use are needed to improve quality of care for mBCa patients receiving CCT, especially for those hospitalized in rural and nonteaching hospitals.
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Affiliation(s)
- Ying Chen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Shuchen Lin
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihui Zhu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rui Xu
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xiaohong Lan
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Fang Xiang
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xiang Li
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Ye Zhang
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Shudong Chen
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Hao Yu
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Dongni Wu
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Juxiang Zang
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jiali Tang
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jiewen Jin
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hedong Han
- Department of Health Statistics, Second Military Medical University, Shanghai, 200433, China
| | - Zhonghua Tao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yonggang Zhou
- Department of Pharmacy, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
| | - Xichun Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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7
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Osman H, Shrestha S, Temin S, Ali ZV, Corvera RA, Ddungu HD, De Lima L, Del Pilar Estevez-Diz M, Ferris FD, Gafer N, Gupta HK, Horton S, Jacob G, Jia R, Lu FL, Mosoiu D, Puchalski C, Seigel C, Soyannwo O, Cleary JF. Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline. J Glob Oncol 2019; 4:1-24. [PMID: 30085844 PMCID: PMC6223509 DOI: 10.1200/jgo.18.00026] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose The purpose of this new resource-stratified guideline is to provide expert guidance to clinicians and policymakers on implementing palliative care of patients with cancer and their caregivers in resource-constrained settings and is intended to complement the Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update of 2016. Methods ASCO convened a multidisciplinary, multinational panel of experts in medical oncology, family medicine, radiation oncology, hematology/oncology, palliative and/or hospice care, pain and/or symptom management, patient advocacy, public health, and health economics. Guideline development involved a systematic literature review, a modified ADAPTE process, and a formal consensus-based process with the Expert Panel and additional experts (consensus ratings group). Results The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including Expert Panel). Recommendations The recommendations help define the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings. Additional information is available at www.asco.org/resource-stratified-guidelines. It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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Affiliation(s)
- Hibah Osman
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Sudip Shrestha
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Sarah Temin
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Zipporah V Ali
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Rumalie A Corvera
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Henry D Ddungu
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Liliana De Lima
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Maria Del Pilar Estevez-Diz
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Frank D Ferris
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Nahla Gafer
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Harmala K Gupta
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Susan Horton
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Graciela Jacob
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Ruinuo Jia
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Frank L Lu
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Daniela Mosoiu
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Christina Puchalski
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Carole Seigel
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Olaitan Soyannwo
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - James F Cleary
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
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8
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Abstract
Historically, HER2-positive breast cancer had a poor prognosis. The development of molecul ar ther apies that target the HER2 receptor has TR ansformed outcomes. Here, the evidence on Anti-HER2 therapies is summarised.
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Affiliation(s)
- Russell Burcombe
- Consultant Clinical Oncologist, Kent Oncology Centre, Maidstone & Tunbridge Wells NHS Trust
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9
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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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10
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Okoli C, Anyanwu SNC, Ochomma AO, Emegoakor CD, Chianakwana GU, Nzeako H, Ihekwoaba E. Assessing the Quality of Life of Patients with Breast Cancer Treated in a Tertiary Hospital in a Resource-Poor Country. World J Surg 2019; 43:44-51. [PMID: 30151677 DOI: 10.1007/s00268-018-4772-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Very few studies have assessed the quality of life (QoL) of patients living with breast cancer in a resource-poor setting like Nigeria. The aim of our study was to comprehensively examine the measures of QoL in breast cancer patients using the Functional Assessment of Cancer Therapy-Breast (FACT-B) version 4 in order to deepen the literature on QoL among breast cancer patients to include non-Western/northern patient populations. PATIENTS AND METHODS Purposive sampling of stable patients who attended general surgery clinics with histopathologically diagnosed breast cancer was done. Eligible patients were assessed using five domains of the FACT-B questionnaire including: the breast cancer-specific symptoms (BCS), emotional well-being (EWB), functional well-being (FWB), physical well-being (PWB), and social & family well-being (SWB). The questionnaire was administered in a face-to-face interview by trained research assistants. In addition, the five domains were compared among three different age categories, pre-menopausal and post-menopausal, and patients who have had surgery and chemotherapy alone. The SPSS (IBM Corp. Released in 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) and the Microsoft Excel (11. Corporation Microsoft, Redmond, WA, USA) were used for statistical analysis. Statistical significance was inferred when p <0.05. RESULTS Among the 60 enrolled participants, total score of the five domains (n = 144) was 74.59 ± 17.72, FACT-G score (n = 108) was 53.49 ± 12.56, Trial outcome index (n = 112) was 49.20 ± 13.13, PWB (n = 28) was 10.95 ± 6.37, SWB (n = 28) was 18.41 ± 6.48, EWB (n = 24) was 6.98 ± 4.15, FWB (n = 28) was 17.15 ± 7.12, and the BCS (n = 36) was 21.10 ± 8.93. EWB was significantly less in post-mastectomy patients on adjuvant chemotherapy (p = 0.031) and pre-menopausal women (p = 0.041) as well as in patients less than 40 years when compared with patients more 50 years (p = 0.049). CONCLUSIONS Breast cancer patients in resource-poor countries have a profoundly impaired quality of life. This study showed significantly lower emotional well-being domain scores in post-mastectomy patients on adjuvant chemotherapy, pre-menopausal women having breast cancer and in younger female patients. There is need to address this anomaly.
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Affiliation(s)
- Chinedu Okoli
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
| | - S N C Anyanwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Amobi O Ochomma
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Chiemelu D Emegoakor
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | | | - Henry Nzeako
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Eric Ihekwoaba
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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Smith SR, Zheng JY, Silver J, Haig AJ, Cheville A. Cancer rehabilitation as an essential component of quality care and survivorship from an international perspective. Disabil Rehabil 2018; 42:8-13. [PMID: 30574818 DOI: 10.1080/09638288.2018.1514662] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: There has recently been an emphasis on improving cancer care globally, including access to lifesaving treatment and earlier identification of disease. This will lead to more survivors stricken by impairments related to the early and late effects of cancer treatment. An unintended consequence of the noble plan to improve oncology care worldwide is demand on health care systems that may be unable to accommodate increased patient care needs for myriad reasons. As a result, those with disabilities may suffer.Methods: Literature search and input from experts in the field were used to evaluate the growing need for cancer rehabilitation and survivorship care to reduce morbidity associated with cancer treatment.Results: Many governmental and non-governmental organizations have started initiatives to improve cancer care across the continuum, and reduce the symptom burden of those living with cancer. While the start is promising, many barriers must be overcome to ensure high-quality care that would reduce cost and improve patient access, including a lack of trained rehabilitation specialists, poor coordination of efforts, and funding restrictions. Furthermore, global efforts to improve rehabilitation care often do not emphasize cancer rehabilitation, potentially leaving a gap and increasing physical and economic costs of disability. Finally, low-resource countries face unique challenges in improving cancer rehabilitation care.Conclusion: Cancer rehabilitation and survivorship care are needed to improve health care quality, as there is an expected influx of cancer patients with new global efforts to improve oncology care. To accomplish this, rehabilitation initiatives must emphasize cancer rehabilitation as a component of any program, and oncology endeavors should include a plan for the rehabilitation of cancer survivors to reduce morbidity and health care cost.Implications for RehabilitationCancer rehabilitation has the potential to reduce morbidity and health care costs associated with cancer and disability worldwideAdvocacy from international organizations regarding cancer rehabilitation is increasing, but has been disjointed and incompleteLow-resource countries in particular face several barriers to providing cancer rehabilitation and survivorship care.
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Affiliation(s)
- Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, MI, USA
| | - Jasmine Y Zheng
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania, PA, USA
| | - Julie Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, MA, USA
| | - Andrew J Haig
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, MI, USA
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, The Mayo Clinic, Rochester, Minnesota, MN, USA
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12
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Reid EA, Kovalerchik O, Jubanyik K, Brown S, Hersey D, Grant L. Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review. BMJ Support Palliat Care 2018; 9:120-129. [DOI: 10.1136/bmjspcare-2018-001499] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 08/22/2018] [Accepted: 09/05/2018] [Indexed: 01/01/2023]
Abstract
IntroductionOf the 40 million people globally in need of palliative care (PC), just 14% receive it, predominantly in high-income countries. Within fragile health systems that lack PC, incurable illness is often marked by pain and suffering, as well as burdensome costs. In high-income settings, PC decreases healthcare utilisation, thus enhancing value. Similar cost-effectiveness models are lacking in low-income and middle-income countries and with them, the impetus and funding to expand PC delivery.MethodsWe conducted a systematic search of seven databases to gather evidence of the cost-effectiveness of PC in low-income and middle-income countries. We extracted and synthesised palliative outcomes and economic data from original research studies occurring in low-income and middle-income countries. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and includes a quality appraisal.ResultsOur search identified 10 eligible papers that included palliative and economic outcomes in low-income and middle-income countries. Four provided true cost-effectiveness analyses in comparing the costs of PC versus alternative care, with PC offering cost savings, favourable palliative outcomes and positive patient-reported and family-reported outcomes.ConclusionsDespite the small number of included studies, wide variety of study types and lack of high-quality studies, several patterns emerged: (1) low-cost PC delivery in low-income and middle-income countries is possible, (2) patient-reported outcomes are favourable and (3) PC is less costly than the alternative. This review highlights the extraordinary need for robust cost-effectiveness analysis of PC in low-income and middle-income countries in order to develop health economic models for the delivery of PC, direct resource allocation and guide healthcare policy for PC delivery in low-income and middle-income countries.
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13
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Galassi A, Morgan C, Muha C. Making the invisible visible: Oncology nursing efforts of NCI-designated cancer centers in LMICs. J Cancer Policy 2018; 17:34-37. [PMID: 37990688 PMCID: PMC10662967 DOI: 10.1016/j.jcpo.2017.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An increasing majority of new cancer cases and mortality occur in low- and middle-income countries (LMICs). Nurses provide most cancer care in LMICs, yet receive limited, if any, oncology education and training. To better understand the efforts taking place to address this need, the Center for Global Health (CGH) at the US National Cancer Institute (NCI) undertook a study of global oncology nursing projects at NCI-designated cancer centers. The 62 comprehensive and clinical NCI-designated cancer centers were surveyed about the nature and scope of their efforts in strengthening oncology nursing internationally. We received responses from 43 of the 62 cancer centers, with 21centers reporting a total of 29 projects. Twenty-three of 29 projects had involvement in an LMIC. The most common types of projects were research studies and short-term intensive trainings, most of which were for discrete tasks. Unsurprisingly, of the projects that had specific foci, most focused on breast or cervical cancer, and palliative care. Of the 22 projects that reported project costs, almost 90% were under $200,000 USD, suggesting that strengthening the global cancer workforce can be done with limited expense. While this study is limited to efforts of NCI-designated cancer centers, the findings reveal limited engagements in education and training of oncology nurses, who provide most of the cancer care in LMICs, but also provide tangible areas for strengthening this workforce and improving oncology care delivery.
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Affiliation(s)
- Annette Galassi
- Center for Global Health, U.S. National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - Camille Morgan
- Center for Global Health, U.S. National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - Catherine Muha
- Center for Global Health, U.S. National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States
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Spence D, Austin Argentieri M, Greaves N, Cox K, Chin SN, Munroe M, Watson G, Harewood H, Shields AE. Palliative Care in the Caribbean Through the Lens of Women with Breast Cancer: Challenges and Opportunities. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0280-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Global analysis of advanced/metastatic breast cancer: Decade report (2005-2015). Breast 2018; 39:131-138. [PMID: 29679849 DOI: 10.1016/j.breast.2018.03.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 02/05/2023] Open
Abstract
Approximately 0.5 million people worldwide die from metastatic breast cancer (mBC) every year. This manuscript provides an overview on the status of mBC in several regions of the world, highlighting the gaps in care, resources, and support available for patients with mBC. Primary research was conducted in 2015 and 2016, comprising four global qualitative and quantitative surveys of approximately 15,000 individuals in 34 countries. Secondary research was conducted using literature reviews of peer-reviewed publications, patient survey reports, and media or online articles. There have been modest improvements in mBC outcomes over the past decade. Patients are not provided with adequate information about mBC. There is a need for open discussion with patients and caregivers about realistic goals; however, physicians are not trained in communicating with patients about their disease. Maintaining patients' quality of life is a crucial goal; however, this has not improved, and in some cases, may have declined in the past decade. Public awareness and understanding of mBC is limited, with damaging consequences for patients and caregivers. Issues affecting employment remain relevant to patients with mBC and their caregivers. Globally, mBC is associated with a substantial economic burden. Relationships with caregivers are crucial to patients with mBC, and caregiver support needs are often overlooked. A strong and united global effort among healthcare professionals, including clinicians, oncologists, pharmaceutical manufacturers, payers, and policy makers, and with advocates, families, and patients, is necessary to improve the outcome and quality of life for patients with mBC.
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Reid EA, Gudina EK, Ayers N, Tigineh W, Azmera YM. Caring for Life-Limiting Illness in Ethiopia: A Mixed-Methods Assessment of Outpatient Palliative Care Needs. J Palliat Med 2018; 21:622-630. [PMID: 29425055 DOI: 10.1089/jpm.2017.0419] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Palliative care aims to reduce physical suffering and the emotional, spiritual, and psychosocial distress of life-limiting illness. Palliative care is a human right, yet there are vast disparities in its provision: of the 40 million people globally in need of palliative care, less than 10% receive it, largely in high-income countries. There is a particular paucity of data on palliative care needs across the spectrum of incurable disease in Ethiopia. OBJECTIVES The aims of this research were to assess the overall burden of life-limiting illness, the costs associated with life-limiting illness, and barriers to accessing palliative care in Ethiopia. DESIGN Mixed-methods case-series. SETTING/SUBJECTS One hundred adults (mean age: 43.7 ± 14 years, 64% female) were recruited at three outpatient clinics (oncology, HIV, noncommunicable disease) and hospice patient homes in Ethiopia. MEASUREMENTS Four internationally validated questionnaires were used to assess physical symptoms, psychosocial distress, and disability. In-depth interviews gauged poverty level, costs of care, and end-of-life preferences. Qualitative data were analyzed by thematic content, quantitative data by standard descriptive, frequency and regression analyses. RESULTS In oncology, 95.5% of the population endorsed moderate or severe pain, while 24% were not prescribed analgesia. Importantly, 80% of the noncommunicable disease population reported moderate or severe pain. The mean psychosocial distress score was 6.4/10. Severe disability was reported in 26% of the population, with mobility most affected. Statistically significant relationships were found between pain and costs, and pain and lack of well-being. Very high costs were reported by oncology patients. Oncology withstanding, the majority of subjects wished to die at home. Oncology patients cited pain control as the top reason they preferred a hospital death. CONCLUSION There are extensive unmet palliative care needs in Ethiopia. Untreated pain and high costs of illness are the major contributors to psychosocial distress and financial crisis in this Ethiopian population.
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Affiliation(s)
- Eleanor Anderson Reid
- 1 Section of Global Health and International Emergency Medicine, Department of Emergency Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Esayas Kebede Gudina
- 2 Department of Internal Medicine, Jimma University College of Health Sciences , Jimma, Ethiopia
| | - Nicola Ayers
- 3 Federal Ministry of Health , Addis Ababa, Ethiopia .,4 Hospice Ethiopia , Addis Ababa, Ethiopia
| | - Wondimagegnu Tigineh
- 5 Department of Oncology, Tikur Anbessa Hospital, Addis Ababa University College of Health Sciences , Addis Ababa, Ethiopia
| | - Yoseph Mamo Azmera
- 3 Federal Ministry of Health , Addis Ababa, Ethiopia .,4 Hospice Ethiopia , Addis Ababa, Ethiopia
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Ryan C, Burcombe R, Coleby T. Foreword. ACTA ACUST UNITED AC 2017; 26:S3. [PMID: 28981332 DOI: 10.12968/bjon.2017.26.sup16a.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Delivering multifaceted, quality care to women living with metastatic breast cancer (MBC) demands professional competence and an advanced level of practice. The breast cancer nursing community is evolving to meet this need as more nurses are appointed specifically for the advanced disease setting, while nurses who previously worked only in early stage disease are now delivering care across the disease trajectory, fulfilling a 'diagnosis to death' nursing model. The MBC nursing community, linked by UK charity Breast Cancer Care and the Roche Nursing Matters programme, offers forums for learning, and provides ongoing support to this group of nurses. This supplement has been commissioned by Roche Products Ltd to continue supporting nurses who treat patients with MBC by sharing learning and best practice, with a view to encouraging innovation in service delivery.
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Affiliation(s)
- Claire Ryan
- Macmillan Nurse Clinician Metastatic Breast Cancer, Kent Oncology Centre, Maidstone & Tunbridge Wells NHS Trust
| | - Russell Burcombe
- Consultant Clinical Oncologist, Kent Oncology Centre, Maidstone & Tunbridge Wells NHS Trust
| | - Tracey Coleby
- Macmillan Breast Palliative Care Lead, The Christie NHS Foundation Trust
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18
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Ryan C. Improving patient care: expert nursing and service development. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S21-S25. [PMID: 28981329 DOI: 10.12968/bjon.2017.26.sup16a.s21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Early access to a clinical nurse specialist will ensure that patients receive the interventions and support they need. Optimum outcomes will be achieved if specialists work in collaboration with a wider team.
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Affiliation(s)
- Claire Ryan
- Macmillan Nurse Clinician Metastatic Breast Cancer, Kent Oncology Centre, Maidstone & Tunbridge Wells NHS Trust
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Ryan C. Introduction. ACTA ACUST UNITED AC 2017; 26:S4-S6. [PMID: 28981331 DOI: 10.12968/bjon.2017.26.sup16a.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Metastatic breast cancer (MBC), also known as secondary breast cancer (SBC), occurs when cells from the primary breast tumour metastasise from the breast to other parts of the body via the blood or lymphatic systems. The disease may range from limited bone metastases to widespread and life-threatening metastases in visceral organs such as the liver, lung and brain (National Institute for Health and Care Excellence (NICE), 2009; 2014). MBC is incurable, and the primary goal of treatment is to extend life and palliate symptoms, while preserving quality of life (NICE, 2009; 2014).
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Affiliation(s)
- Claire Ryan
- Mamillan Nurse Clinician Metastatic Breast Cancer, Kent Oncology Centre, Maidstone & Tunbridge Wells NHS Trust
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20
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Coleby T. Defining what matters most to patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S15-S20. [PMID: 28981330 DOI: 10.12968/bjon.2017.26.sup16a.s15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Advanced communication skills are needed to identify patients' needs and provide the psychological and social support they require. Meanwhile, early access to palliative care will improve symptom control.
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Affiliation(s)
- Tracey Coleby
- Macmillan Breast Palliative Care Lead, The Christie NHS Foundation Trust
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21
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Fadhil I, Lyons G, Payne S. Barriers to, and opportunities for, palliative care development in the Eastern Mediterranean Region. Lancet Oncol 2017; 18:e176-e184. [PMID: 28271872 DOI: 10.1016/s1470-2045(17)30101-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 12/31/2022]
Abstract
The 22 countries of WHO's Eastern Mediterranean Region are experiencing an increase in the burden of non-communicable diseases (NCDs), including cancer. Of the six WHO regions, the Eastern Mediterranean Region is projected to have the greatest increase in cancer incidence in the next 15 years. Furthermore, most cancers are diagnosed at a late stage, resulting in a lower cancer survival rate than in the European Region and the Region of the Americas. With increasing numbers of deaths from cancer, palliative care should be available to relieve suffering in patients with advanced disease and at the end of life. However, in the Eastern Mediterranean Region, the palliative care available is variable and inconsistent. Several barriers exist to the development and expansion of palliative care delivery in this region, including the absence of palliative care in national policies, little partnership working, insufficient palliative care education for health-care professionals and volunteers, poor public awareness, and gaps in access to essential pain-relief medicines. In this Review, we explore data and evidence from published literature, WHO meeting reports, cancer control mission reports, and the WHO global NCD country capacity survey to identify the status of palliative care in the Eastern Mediterranean Region, including the challenges and opportunities for development.
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Affiliation(s)
- Ibtihal Fadhil
- WHO, Eastern Mediterranean Regional Office, Cairo, Egypt.
| | - Gemma Lyons
- WHO, Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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22
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Tucker CA, Martin MP, Jones RB. Health information needs, source preferences and engagement behaviours of women with metastatic breast cancer across the care continuum: protocol for a scoping review. BMJ Open 2017; 7:e013619. [PMID: 28213599 PMCID: PMC5318560 DOI: 10.1136/bmjopen-2016-013619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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
INTRODUCTION The health information needs, information source preferences and engagement behaviours of women with metastatic breast cancer (mBC) depend on personal characteristics such as education level, prior knowledge, clinical complications, comorbidities and where they are in the cancer journey. A thorough understanding of the information behaviours of women living with mBC is essential to the provision of optimal care. A preliminary literature review suggests that there is little research on this topic, but that there may be lessons from a slightly broader literature. This review will identify what is known and what is not known about the health information needs, acquisition and influences of women with mBC across the care continuum. Findings will help to identify research needs and specific areas where in-depth systematic reviews may be feasible, as well as inform evidence-based interventions to address the health information needs of female patients with mBC with different demographics and characteristics and across the mBC journey. METHODS AND ANALYSIS A scoping review will be performed using the guidelines of Arksey and O'Malley as updated by subsequent authors to systematically search scientific and grey literature for articles in English that discuss the health information needs, source preferences, engagement styles, and associated personal and medical attributes of women ≥18 years living with mBC at different stages of the disease course. A variety of databases (including Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Excerpta Medica Database (EMBASE), Academic Search Premier, Cochrane Database of Systematic Reviews, PsycINFO, Health Source: Nursing/Academic Edition, and PQDT Open), oncology, patient advocacy and governmental websites will be searched from inception to present day. Research and non-research literature will be included; no study designs will be excluded. The six-stage Arksey and O'Malley scoping review methodological framework involves: (1) identifying the research question; (2) searching for relevant studies; (3) selecting studies; (4) charting the data; (5) collating, summarising and reporting the results; and (6) consulting with stakeholders to inform or validate study findings (optional). Data will be extracted and analysed using a thematic chart and descriptive content analysis. ETHICS AND DISSEMINATION Being a secondary analysis, this research will not require ethics approval. Results will be disseminated through patient support organisations and websites and publications targeting healthcare professionals, advocates and patients.
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Affiliation(s)
- Carol A Tucker
- Faculty of Health & Human Sciences, Plymouth University, Plymouth, UK
| | - M Pilar Martin
- Adelphi University College of Nursing and Public Health, Garden City, New York, USA
| | - Ray B Jones
- Faculty of Health & Human Sciences, School of Nursing and Midwifery, Plymouth University, Plymouth, UK
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Health-related quality of life and psychological distress among cancer survivors in Southeast Asia: results from a longitudinal study in eight low- and middle-income countries. BMC Med 2017; 15:10. [PMID: 28081724 PMCID: PMC5234136 DOI: 10.1186/s12916-016-0768-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/08/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A better understanding of health-related quality of life (HRQoL) and psychological distress in cancer survivors can raise awareness, promote the development of policies in cancer survivorship care, and facilitate better targeted use of limited resources in low- and middle-income countries (LMICs). The main objectives of this paper were therefore to assess HRQoL and the prevalence of psychological distress amongst cancer survivors in Southeast Asia and identify risk factors of these outcomes. METHODS The ACTION study was a longitudinal study in eight LMICs in Southeast Asia with 5249 first time cancer survivors followed up at 1 year after diagnosis. HRQoL was assessed using the EORTC QLQ-C30 and EQ-5D. Psychological distress (anxiety and depression) was assessed using the Hospital Anxiety and Depression Scale. General linear models and multiple logistic regression were used to identify independent predictors of HRQoL and psychological distress. RESULTS One year after diagnosis, the mean EORTC QLQ-C30 global health score for survivors was 66.2 out of 100 (SD 22.0), the mean index score on the EQ-5D was 0.74 (SD 0.23), 37% of survivors had at least mild levels of anxiety, and 46% showed at least mild levels of depression. Poorest HRQoL and highest prevalence of anxiety and depression were seen in patients with lung cancer and lymphomas, while highest scores and least psychological distress were seen in female patients with breast and cervical cancer. The most significant predictor of poor HRQoL and psychological distress outcomes was cancer stage at diagnosis. Age, co-morbidities, treatment, and several socioeconomic factors were associated with HRQoL and psychological distress. CONCLUSIONS Cancer survivors in LMICs in Southeast Asia have impaired HRQoL and substantial proportions have psychological distress. Patients with advanced cancer stages at diagnosis and those in a poor socioeconomic position were most at risk of such poor outcomes. Supportive interventions for cancer patients that address wider aspects of patient wellbeing are needed, as well as policies that address financial and other barriers to timely treatment.
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Enhancement of oncology nursing education in low- and middle-income countries: Challenges and strategies. J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2016.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Challinor JM, Galassi AL, Al-Ruzzieh MA, Bigirimana JB, Buswell L, So WK, Steinberg AB, Williams M. Nursing's Potential to Address the Growing Cancer Burden in Low- and Middle-Income Countries. J Glob Oncol 2016; 2:154-163. [PMID: 28717695 PMCID: PMC5495453 DOI: 10.1200/jgo.2015.001974] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Julia M. Challinor
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Annette L. Galassi
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Majeda A. Al-Ruzzieh
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Jean Bosco Bigirimana
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Lori Buswell
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Winnie K.W. So
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Allison Burg Steinberg
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Makeda Williams
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
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Abstract
Cancer is now recognized as one of the four leading causes of morbidity and mortality worldwide, and incidence is expected to rise significantly in the next two decades. Unfortunately, low- and middle-income countries (LMIC) suffer disproportionately from the world's cancer cases. The growing burden of cancer and maldistribution of cancer care resources in LMIC warrant a massive re-evaluation of the structural inequalities that produce global oncological disparities and a worldwide commitment to improve both prevention and treatment strategies. Efforts to improve cancer care capacity should focus on horizontal strengthening of healthcare systems that provide safe, affordable, effective and sustainable care. In response to current deficiencies, many international organizations have started to partner with LMIC to create solutions. Telemedicine and international collaboration are also promising ways to effect change and improve global oncological care.
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Affiliation(s)
- Madeline Pesec
- Brown University 6683, 69 Brown Street, Providence, RI 02912, USA
| | - Tracy Sherertz
- Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA 94115, USA
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Hannon B, Zimmermann C, Knaul FM, Powell RA, Mwangi-Powell FN, Rodin G. Provision of Palliative Care in Low- and Middle-Income Countries: Overcoming Obstacles for Effective Treatment Delivery. J Clin Oncol 2016; 34:62-8. [DOI: 10.1200/jco.2015.62.1615] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Despite being declared a basic human right, access to adult and pediatric palliative care for millions of individuals in need in low- and middle-income countries (LMICs) continues to be limited or absent. The requirement to make palliative care available to patients with cancer is increasingly urgent because global cancer case prevalence is anticipated to double over the next two decades. Fifty percent of these cancers are expected to occur in LMICs, where mortality figures are disproportionately greater as a result of late detection of disease and insufficient access to appropriate treatment options. Notable initiatives in many LMICs have greatly improved access to palliative care. These can serve as development models for service scale-up in these regions, based on rigorous evaluation in the context of specific health systems. However, a multipronged public health approach is needed to fulfill the humane and ethical obligation to make palliative care universally available. This includes health policy that supports the integration of palliative care and investment in systems of health care delivery; changes in legislation and regulation that inappropriately restrict access to opioid medications for individuals with life-limiting illnesses; education and training of health professionals; development of a methodologically rigorous data and research base specific to LMICs that encompasses health systems and clinical care; and shifts in societal and health professional attitudes to palliative and end-of-life care. International partnerships are valuable to achieve these goals, particularly in education and research, but leadership and health systems stewardship within LMICs are critical factors that will drive and implement change.
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Affiliation(s)
- Breffni Hannon
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Camilla Zimmermann
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Felicia M. Knaul
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Richard A. Powell
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Faith N. Mwangi-Powell
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
| | - Gary Rodin
- Breffni Hannon, Camilla Zimmermann, and Gary Rodin, Princess Margaret Cancer Centre, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Felicia M. Knaul, Harvard Global Equity Initiative and Harvard Medical School, Boston, MA; Richard A. Powell, Independent Global Health Researcher; Faith N. Mwangi-Powell, University Research Company, Nairobi, Kenya
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Piderman KM, Radecki Breitkopf C, Jenkins SM, Lapid MI, Kwete GM, Sytsma TT, Lovejoy LA, Yoder TJ, Jatoi A. The impact of a spiritual legacy intervention in patients with brain cancers and other neurologic illnesses and their support persons. Psychooncology 2015; 26:346-353. [DOI: 10.1002/pon.4031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 09/01/2015] [Accepted: 10/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Katherine M. Piderman
- Chaplain Services; Mayo Clinic Rochester; 200 First Street SW EI 2-130 Rochester MN USA
| | - Carmen Radecki Breitkopf
- Division of Health Care Policy and Research, Health Sciences Research; Mayo Clinic Rochester; 200 First St. SW Charlton 6-235 Rochester MN USA 55905
| | - Sarah M. Jenkins
- Biostatistics and Informatics; Mayo Clinic Rochester; Rochester MN USA
| | - Maria I. Lapid
- Psychiatry and Psychology; Mayo Clinic Rochester; Rochester MN USA
| | - Gracia M. Kwete
- Mayo Medical School; Mayo Clinic Rochester; Rochester MN USA
| | | | - Laura A. Lovejoy
- Chaplain Services; Mayo Clinic Rochester; 200 First Street SW EI 2-130 Rochester MN USA
| | - Timothy J. Yoder
- Chaplain Services; Mayo Clinic Rochester; 200 First Street SW EI 2-130 Rochester MN USA
| | - Aminah Jatoi
- Medical Oncology; Mayo Clinic Rochester; Rochester MN USA
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Ganz PA, Stanton AL. Living with Metastatic Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:243-54. [PMID: 26059940 DOI: 10.1007/978-3-319-16366-6_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Although prevalence estimates are imprecise, growing numbers of women in the United States are living longer with metastatic breast cancer, attributable at least in part to the availability of effective targeted therapies. Women living with metastatic disease are understudied, however, and substantial heterogeneity exists in both the clinical characteristics of metastatic tumors and the physical and psychological experience of patients living with the disease. Survivorship issues are complex for patients who are living with metastatic disease over extended periods of time, from years to decades. Newly diagnosed patients with stage IV disease are confronting cancer for the first time, while others have metastatic disease as a result of breast cancer recurrence. Many patients are able to live for years on stable medical regimens, and yet others live with a moving target of aggressive disease with arduous treatments and uneven response. The psychological common denominator is the experience of profound life threat and the accompanying uncertainty, for both the affected woman and her loved ones. Maintaining life balance in the face of metastatic disease, as well as managing pain, fatigue, and other physical and psychological symptoms are major challenges. Increasingly, the clinical approach to metastatic disease reflects the consensus that palliative and supportive care are essential from the point of diagnosis. To remedy the paucity of systematic research on women living with metastatic breast cancer for extended periods, we offer directions for research to understand the experience of metastatic breast cancer and to provide evidence-based inter-professional care.
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Affiliation(s)
- Patricia A Ganz
- UCLA Schools of Medicine and Public Health, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA,
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30
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Islami F, Lortet-Tieulent J, Okello C, Adoubi I, Mbalawa CG, Ward EM, Parkin DM, Jemal A. Tumor size and stage of breast cancer in Côte d'Ivoire and Republic of Congo - Results from population-based cancer registries. Breast 2015; 24:713-7. [PMID: 26371692 DOI: 10.1016/j.breast.2015.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/07/2015] [Accepted: 08/26/2015] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Breast cancer is now the leading female cancer in sub-Saharan Africa, but there is relatively little information on breast cancer characteristics from this region. We studied, on a population basis, the size and stage of female breast cancer at diagnosis in Côte d'Ivoire and Republic of Congo. METHODS Data on tumor size and stage of breast cancer at diagnosis were collected by population-based cancer registries in Abidjan (the capital of Côte d'Ivoire; 141 cases) and Brazzaville (the capital of Republic of Congo; 139 cases) from a random group of female breast cancer cases that were diagnosed in 2008-2009 using the same protocol. RESULTS The majority of breast cancers in both countries were advanced cancers. In Côte d'Ivoire, 68% of tumors were ≥5 cm in diameter and 74% of cancers were stage III or IV at diagnosis; the corresponding proportions in Republic of Congo were 63% and 81%. CONCLUSION These results underscore the importance of increased awareness about early detection of breast cancer, as well as expansion of the capacity to provide appropriate diagnosis, treatment, and palliative care in sub-Saharan Africa.
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Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - Joannie Lortet-Tieulent
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - Catherine Okello
- African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom
| | - Innocent Adoubi
- Service de Cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Cote d'Ivoire
| | - Charles Gombé Mbalawa
- Service de Carcinologie et Radiothérapie, Centre Hospitalier Universitaire de Brazzaville, Brazzaville, Congo
| | - Elizabeth M Ward
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - D Maxwell Parkin
- African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom; Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Public Health, University of Oxford, Oxford, United Kingdom.
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
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31
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Demment MM, Peters K, Dykens JA, Dozier A, Nawaz H, McIntosh S, Smith JS, Sy A, Irwin T, Fogg TT, Khaliq M, Blumenfeld R, Massoudi M, De Ver Dye T. Developing the Evidence Base to Inform Best Practice: A Scoping Study of Breast and Cervical Cancer Reviews in Low- and Middle-Income Countries. PLoS One 2015; 10:e0134618. [PMID: 26325181 PMCID: PMC4556679 DOI: 10.1371/journal.pone.0134618] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/12/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast and cervical cancers have emerged as major global health challenges and disproportionately lead to excess morbidity and mortality in low- and middle-income countries (LMICs) when compared to high-income countries. The objective of this paper was to highlight key findings, recommendations, and gaps in research and practice identified through a scoping study of recent reviews in breast and cervical cancer in LMICs. METHODS We conducted a scoping study based on the six-stage framework of Arskey and O'Malley. We searched PubMed, Cochrane Reviews, and CINAHL with the following inclusion criteria: 1) published between 2005-February 2015, 2) focused on breast or cervical cancer 3) focused on LMIC, 4) review article, and 5) published in English. RESULTS Through our systematic search, 63 out of the 94 identified cervical cancer reviews met our selection criteria and 36 of the 54 in breast cancer. Cervical cancer reviews were more likely to focus upon prevention and screening, while breast cancer reviews were more likely to focus upon treatment and survivorship. Few of the breast cancer reviews referenced research and data from LMICs themselves; cervical cancer reviews were more likely to do so. Most reviews did not include elements of the PRISMA checklist. CONCLUSION Overall, a limited evidence base supports breast and cervical cancer control in LMICs. Further breast and cervical cancer prevention and control studies are necessary in LMICs.
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Affiliation(s)
- Margaret M. Demment
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
| | - Karen Peters
- Division of Community Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - J. Andrew Dykens
- Department of Family Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
| | - Haq Nawaz
- Department of Medicine, Griffin Hospital & Yale University-Griffin Prevention Research Center, New Haven, Connecticut, United States of America
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
| | - Jennifer S. Smith
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Angela Sy
- School of Nursing and Dental Hygiene, University of Hawai’i at Mānoa, Honolulu, Hawaii, United States of America
| | - Tracy Irwin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Thomas T. Fogg
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
| | - Mahmooda Khaliq
- Department of Community and Family Health, University of South Florida, Tampa, Florida, United States of America
| | - Rachel Blumenfeld
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mehran Massoudi
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Timothy De Ver Dye
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- * E-mail:
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32
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El Saghir NS, Farhat RA, Charara RN, Khoury KE. Enhancing cancer care in areas of limited resources: our next steps. Future Oncol 2015; 10:1953-65. [PMID: 25386812 DOI: 10.2217/fon.14.124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
In-depth knowledge of local conditions is necessary in order to enhance care in low- and middle-income countries. In this review we discuss: improving cancer diagnosis, optimizing patient management, increasing health awareness, prevention, early detection, eradication of causative infectious diseases and agents, tobacco control, healthy diets and lifestyles, availability of diagnostic methods, easy access to care, affordable costs, improving infrastructures, quality care measures, implementing and adapting guidelines, multidisciplinary management, supportive and survivorship care, research and optimization of medical school curriculum and training in oncology. Establishment of national cancer control plans by policy makers, physician societies, medical schools, and patient advocates is recommended. We will review evidence and controversies, and outline the next steps needed to prevent cancer and enhance care of cancer patients in LMICs.
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Affiliation(s)
- Nagi S El Saghir
- Breast Center of Excellence, Naef K. Basile Cancer Institute, Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon
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Optimisation of the continuum of supportive and palliative care for patients with breast cancer in low-income and middle-income countries: executive summary of the Breast Health Global Initiative, 2014. Lancet Oncol 2015; 16:e137-47. [PMID: 25752564 DOI: 10.1016/s1470-2045(14)70457-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Supportive care and palliative care are now recognised as critical components of global cancer control programmes. Many aspects of supportive and palliative care services are already available in some low-income and middle-income countries. Full integration of supportive and palliative care into breast cancer programmes requires a systematic, resource-stratified approach. The Breast Health Global Initiative convened three expert panels to develop resource allocation recommendations for supportive and palliative care programmes in low-income and middle-income countries. Each panel focused on a specific phase of breast cancer care: during treatment, after treatment with curative intent (survivorship), and after diagnosis with metastatic disease. The panel consensus statements were published in October, 2013. This Executive Summary combines the three panels' recommendations into a single comprehensive document covering breast cancer care from diagnosis through curative treatment into survivorship, and metastatic disease and end-of-life care. The recommendations cover physical symptom management, pain management, monitoring and documentation, psychosocial and spiritual aspects of care, health professional education, and patient, family, and caregiver education.
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35
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Anderson BO, Ilbawi AM, El Saghir NS. Breast cancer in low and middle income countries (LMICs): a shifting tide in global health. Breast J 2014; 21:111-8. [PMID: 25444441 DOI: 10.1111/tbj.12357] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cancer control planning has become a core aspect of global health, as rising rates of noncommunicable diseases in low-resource settings have fittingly propelled it into the spotlight. Comprehensive strategies for cancer control are needed to effectively manage the disease burden. As the most common cancer among women and the most likely reason a woman will die from cancer globally, breast cancer management is a necessary aspect of any comprehensive cancer control plan. Major improvements in breast cancer outcomes in high-income countries have not yet been mirrored in low-resource settings, making it a targeted priority for global health planning. Resource-stratified guidelines provide a framework and vehicle for designing programs to promote early detection, diagnosis, and treatment using existing infrastructure and renewable resources. Strategies for evaluating the current state and projecting future burden is a central aspect of developing national strategies for improving breast cancer outcomes at the national and international levels.
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Affiliation(s)
- Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Departments of Surgery and Global Health-Medicine, University of Washington, Seattle, Washington
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36
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The relationship between economic characteristics and health-related quality of life in newly diagnosed cancer patients in Southeast Asia: results from an observational study. Qual Life Res 2014; 24:937-49. [DOI: 10.1007/s11136-014-0828-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/01/2022]
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Abstract
Healing fractures resulting from osteoporosis or cancer remains a significant clinical challenge. In these populations, healing is often impaired not only due to age and disease, but also by other therapeutic interventions such as radiation, steroids, and chemotherapy. Despite substantial improvements in the treatment of osteoporosis over the last few decades, osteoporotic fractures are still a major clinical challenge in the elderly population due to impaired healing. Similar fractures with impaired healing are also prevalent in cancer patients, especially those with tumor growing in bone. Treatment options for cancer patients are further complicated by the fact that bone anabolic therapies are contraindicated in patients with tumors. Therefore, many patients undergo surgery to repair the fracture, and bone grafts are often used to stabilize orthopedic implants and provide a scaffold for ingrowth of new bone. Both synthetic and naturally occurring biomaterials have been investigated as bone grafts for repair of osteoporotic fractures, including calcium phosphate bone cements, resorbable polymers, and allograft or autograft bone. In order to re-establish normal bone repair, bone grafts have been augmented with anabolic agents, such as mesenchymal stem cells or recombinant human bone morphogenetic protein-2. These developing approaches to bone grafting are anticipated to improve the clinical management of osteoporotic and cancer-induced fractures.
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Affiliation(s)
- Julie A Sterling
- Department of Veterans Affairs: Tennessee Valley Healthcare System (VISN 9), Nashville, USA,
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38
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Cardoso F, Bese N, Distelhorst SR, Bevilacqua JLB, Ginsburg O, Grunberg SM, Gralla RJ, Steyn A, Pagani O, Partridge AH, Knaul FM, Aapro MS, Andersen BL, Thompson B, Gralow JR, Anderson BO. Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. Breast 2013; 22:593-605. [PMID: 24001709 PMCID: PMC7442957 DOI: 10.1016/j.breast.2013.07.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/23/2013] [Indexed: 12/20/2022] Open
Abstract
Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment. Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments.
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Affiliation(s)
| | - Nuran Bese
- Acibadem Maslak Hospital Breast Health, Istanbul, Turkey
| | | | | | - Ophira Ginsburg
- Women’s College Research Institute, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Steven M. Grunberg
- Multinational Association of Supportive Care in Cancer, Shelburne, Vermont, USA
| | | | - Ann Steyn
- Reach to Recovery International; Reach to Recovery South Africa, Cape Town. South Africa
| | - Olivia Pagani
- European School of Oncology and Institute of Oncology of Southern Switzerland, Viganello, Switzerland
| | | | - Felicia Marie Knaul
- Harvard Global Equity Initiative, Boston, Massachusetts, USA; Tómatelo a Pecho A.C., Mexico City, Mexico
| | | | | | - Beti Thompson
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Julie R. Gralow
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA
| | - Benjamin O. Anderson
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA
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Ganz PA, Yip CH, Gralow JR, Distelhorst SR, Albain KS, Andersen BL, Bevilacqua JLB, de Azambuja E, El Saghir NS, Kaur R, McTiernan A, Partridge AH, Rowland JH, Singh-Carlson S, Vargo MM, Thompson B, Anderson BO. Supportive care after curative treatment for breast cancer (survivorship care): Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. Breast 2013; 22:606-15. [DOI: 10.1016/j.breast.2013.07.049] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/23/2013] [Indexed: 12/31/2022] Open
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