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Kalsi S, French H, Chhaya S, Madani H, Mir R, Anosova A, Dubash S. The Evolving Role of Artificial Intelligence in Radiotherapy Treatment Planning-A Literature Review. Clin Oncol (R Coll Radiol) 2024; 36:596-605. [PMID: 38981781 DOI: 10.1016/j.clon.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 05/30/2024] [Accepted: 06/11/2024] [Indexed: 07/11/2024]
Abstract
This paper examines the integration of artificial intelligence (AI) in radiotherapy for cancer treatment. The importance of radiotherapy in cancer management and its time-intensive planning process make AI adoption appealing especially with the escalating demand for radiotherapy. This review highlights the efficacy of AI across medical domains, where it surpasses human capabilities in areas such as cardiology and dermatology. Focusing on radiotherapy, the paper details AI's applications in target segmentation, dose optimization, and outcome prediction. It discusses adaptive radiotherapy's benefits and AI's potential to enhance patient outcomes with much improved treatment accuracy. The paper explores ethical concerns, including data privacy and bias, stressing the need for robust guidelines. Educating healthcare professionals and patients about AI's role is crucial as it acknowledges potential job-role changes and concerns about patients' trust in the use of AI. Overall, the integration of AI in radiotherapy holds transformative potential in streamlining processes, improving outcomes, and reducing costs. AI's potential to reduce healthcare costs underscores its significance with impactful change globally. However, successful implementation hinges on addressing ethical and logistical challenges and fostering collaboration among healthcare professionals and patient population data sets for its optimal utilization. Rigorous education, collaborative efforts, and global data sharing will be the compass guiding its' success in radiotherapy and healthcare.
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Affiliation(s)
- S Kalsi
- Lister Hospital, Stevenage, United Kingdom.
| | - H French
- University of Chester, United Kingdom
| | - S Chhaya
- New Cross Hospital, Wolverhampton, United Kingdom
| | - H Madani
- Lister Hospital, Stevenage, United Kingdom
| | - R Mir
- Mount Vernon Cancer Centre, Northwood, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - A Anosova
- Mount Vernon Cancer Centre, East & North Hertfordshire NHS Trust, United Kingdom
| | - S Dubash
- Mount Vernon Cancer Centre, Northwood, United Kingdom; Department of Surgery and Cancer, Imperial College, London, United Kingdom
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2
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Hammad N, Rubagumya F. Radiotherapy and conflict: from disruption to expansion and hope. Lancet Oncol 2024:S1470-2045(24)00493-5. [PMID: 39362230 DOI: 10.1016/s1470-2045(24)00493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 10/05/2024]
Affiliation(s)
- Nazik Hammad
- University of Toronto, St Michael's Hospital, Toronto, ON M5B 1C9, Canada.
| | - Fidel Rubagumya
- University of Rwanda, Rwanda Military Referral and Teaching Hospital, Kigali City, Rwanda
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3
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Shakir M, Irshad HA, Khowaja AH, Tahir I, Shariq SF, Rae AI, Hamzah R, Gupta S, Park KB, Enam SA. Adjuvant therapy for brain tumors in LMICs: A systematic review of barriers and possible solutions. Clin Neurol Neurosurg 2024; 244:108460. [PMID: 39059287 DOI: 10.1016/j.clineuro.2024.108460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Adjuvant therapy is an important tool in the arsenal of brain tumor management and can improve patients' outcomes significantly but low- and middle-income countries (LMICs) often face challenges in provision. Therefore, our study aims to highlight barriers and strategies to adjuvant therapy of brain tumors in low-resource settings. METHOD A comprehensive search of literature was conducted using PubMed, CINAHL, Google Scholar, and Scopus, from inception to October 20, 2022. The review included studies on adjuvant therapy for brain tumors in LMICs and identified themes using the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) domains. RESULTS 32 studies were included in the review. The most reported barriers to adjuvant care were limited access to healthcare (14 %), limited access to chemotherapy and radiation equipment (25 %), and traditional or alternative medications (11 %). Strategies for improvement include improving the availability of specialized radiation oncology training (8 %) and improving access to neuro-diagnostics and neurotherapeutics (12 %). In addition, efforts to subsidize treatment (4 %) and provide financial coverage through the Ministry of Health (4 %) can help to address the high cost of care and improve access to funding for chemotherapy. Finally, establishing documentation systems and registries (16 %), implementing standardized national treatment guidelines (8 %) can help to improve overall care for brain tumor patients in LMICs. CONCLUSION A multimodal approach of strategies targeting workforce, infrastructure, service delivery, financing, and information management is needed to improve adjuvant care for brain tumors. International collaboration and partnerships can also play a key role in addressing barriers and improving care in LMICs.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | | | | | - Izza Tahir
- Medical School, Aga Khan University, Karachi, Pakistan
| | | | - Ali I Rae
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Radzi Hamzah
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B Park
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Kong FMS. Precision radiation therapy in the modern era of multidisciplinary care in oncology: What matters to our patients and beyond? JOURNAL OF THE NATIONAL CANCER CENTER 2024; 4:260-262. [PMID: 39281719 PMCID: PMC11401493 DOI: 10.1016/j.jncc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Affiliation(s)
- Feng-Ming Spring Kong
- The University of Hong Kong- Shenzhen Hospital, Li Ka Shing Faculty of Medicine, Hong Kong, China
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Bamodu OA, Chung CC. Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries. JCO Glob Oncol 2024; 10:e2300439. [PMID: 39173080 DOI: 10.1200/go.23.00439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/25/2024] [Accepted: 07/18/2024] [Indexed: 08/24/2024] Open
Abstract
The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.
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Affiliation(s)
- Oluwaseun Adebayo Bamodu
- Directorate of Postgraduate Studies, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Ilala District, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Ilala District, Dar es Salaam, Tanzania
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington DC
| | - Chen-Chih Chung
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
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6
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Viani GA, Gouveia AG, Arcidiacono F, Marta GN, Hamamura AC, Anselmo P, Barbosa FS, Moraes FY. Efficacy and safety of hypofractionated radiotherapy versus conventional fractionated radiotherapy in diffuse intrinsic pontine glioma: A systematic review and meta-analysis. Rep Pract Oncol Radiother 2024; 29:309-317. [PMID: 39144263 PMCID: PMC11321787 DOI: 10.5603/rpor.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/16/2024] [Indexed: 08/16/2024] Open
Abstract
Background Diffuse intrinsic pontine glioma (DIPG) stands as the predominant type of brainstem glioma. It is characterized by a notably brief median survival period, with the majority of patients experiencing disease progression within six months following radiation therapy. This systematic review and meta-analysis aims to assess the efficacy and safety of hypofractionated radiotherapy (HFRT) compared to conventionally fractionated radiotherapy (CFRT) in DIPG treatment. Materials and methods A systematic literature search was conducted in four databases, and relevant studies comparing HFRT and CFRT in DIPG were included. Data were extracted and analyzed for overall survival (OS), progression-free survival (PFS), and treatment-related toxicities. Statistical analysis was performed using random-effects models with heterogeneity assessment. Results Five studies met the inclusion criteria, comprising 518 patients. No significant difference in one-year OS was observed between HFRT and CFRT (29% vs. 22%, p = 0.94). The median OS was similar in both treatment groups (9.7 vs. 9.3 months, p = 0.324). Similarly, no significant difference in one-year PFS was found between HFRT and CFRT (19.8% vs. 16.6%, p = 0.82), with comparable median PFS (9.3 vs. 9.4 months, p = 0.20). In meta-regression analysis, there was no association of chemotherapy (p > 0.05) or radiation biologically effective dose (BED) (p > 0.05) regarding OS or PFS outcomes. There were no significant differences in treatment-related toxicities. Conclusions HFRT yields one-year OS and PFS rates similar to CFRT in DIPG, with no significant differences in treatment-related toxicities. Chemotherapy and BED did not affect OS or PFS.
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Affiliation(s)
- Gustavo A Viani
- Department of Medical Imagings, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Andre G Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Division of Radiation Oncology, Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Gustavo N Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Radiation Oncology Department, Hospital Sirio Libanês, São Paulo, Brazil
- Post-Graduation Program, Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Carolina Hamamura
- Department of Medical Imagings, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Felipe S Barbosa
- Department of Medical Imagings, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Fabio Y Moraes
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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7
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Mikhail-Lette M, Cordero L, Lievens Y, Al-Ibraheem A, Urbain JL, Chera B, Muylle K, Vaandering A, Rosa AA, Cerci JJ, Sathekge M, Minjgee M, Nansalmaa E, Erdenechimeg S, Ruiz RL, Scott A, Paez D, Giammarile F, Veduta A, Minoshima E, Vichare S, Abdel-Wahab M. Six country vignettes: Strengthening radiotherapy and theranostics. J Cancer Policy 2024; 40:100471. [PMID: 38556128 DOI: 10.1016/j.jcpo.2024.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND For cancer patient populations worldwide, the synchronous scale-up of diagnostics and treatments yields meaningful gains in survival and quality of life. Among advanced cancer therapies, radiotherapy (RT) and theranostics are key to achieving practical, high-quality, and personalized precision medicine - targeting disease manifestations of individual patients and broad populations, alike. Aiming to learn from one another across different world regions, the six country vignettes presented here depict both challenges and victories in de novo establishment or improvement of RT and theranostics infrastructure. METHODS The International Atomic Energy Agency (IAEA) convened global RT and theranostics experts from diverse world regions and contexts to identify relevant challenges and report progress in their own six countries: Belgium, Brazil, Costa Rica, Jordan, Mongolia, and South Africa. These accounts are collated, compared, and contrasted herein. RESULTS Common challenges persist which could be more strategically assessed and addressed. A quantifiable discrepancy entails personnel. The estimated radiation oncologists (ROs), nuclear medicine physicians (NMPs), and medical physicists (MPs for RT and nuclear medicine) per million inhabitants in the six collective countries respectively range between 2.69-38.00 ROs, 1.00-26.00 NMPs, and 0.30-3.45 MPs (Table 1), reflecting country-to-country inequities which largely match World Bank country-income stratifications. CONCLUSION Established goals for RT and nuclear medicine advancement worldwide have proven elusive. The pace of progress could be hastened by enhanced approaches such as more sustainably phased implementation; better multinational networking to share lessons learned; routine quality and safety audits; as well as capacity building employing innovative, resource-sparing, cutting-edge technologic approaches. Bodies such as ministries of health, professional societies, and the IAEA shall serve critical roles in convening and coordinating more innovative RT and theranostics translational research, including expanding nuanced global database metrics to inform, reach, and potentiate milestones most meaningfully. POLICY SUMMARY Aligned with WHO 25×25 NCDs target; WHA70.12 and WHA76.5 resolutions.
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Affiliation(s)
- Miriam Mikhail-Lette
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria.
| | - Lisbeth Cordero
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Jean-Luc Urbain
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Bhishamjit Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Aude Vaandering
- Department of Radiation Oncology, Université Catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
| | - Arthur Accioly Rosa
- Department of Radiation Oncology, Oncoclínicas Salvador and Hospital Santa Izabel, Salvador, Bahia, Brazil
| | - Juliano Julio Cerci
- Department of Nuclear Medicine, Quanta Diagnóstico e Terapia, Curitiba, Brazil
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | | | | | | | - Rolando Loría Ruiz
- Radiation Therapy Center Siglo 21, Hospital México and Clínica Bíblica, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Andrew Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Diana Paez
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Francesco Giammarile
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Anna Veduta
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Erika Minoshima
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Shrikant Vichare
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - May Abdel-Wahab
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
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8
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Al-Mahnabi AD, Al-Wassia RK. A retrospective study on the delay in three different timescales of CT simulation among patients with pediatric cancer in a tertiary hospital. Oncol Lett 2024; 27:272. [PMID: 38686353 PMCID: PMC11056923 DOI: 10.3892/ol.2024.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/13/2023] [Indexed: 05/02/2024] Open
Abstract
Patients with pediatric cancer receive radiotherapy to cure several types of cancer, requiring computed tomography simulation (CT sim) for precise treatment. However, there is currently no suitable framework to reduce the inherent delays in CT sim. The present study aimed to identify the underlying causes of the delays in CT sim regarding three different time periods (duration of patient admission to CT sim, diagnosis to treatment and CT sim to treatment) among patients with pediatric cancer. A total of 58 patients with pediatric cancer who received radiation therapy under anesthesia at King Abdulaziz University Hospital (Jeddah, Saudi Arabia) between 2016 and 2021 (60 months) were included in the current study. The underlying cause of delays regarding three separate time periods was determined according to patient type, diagnosis, therapy type and year of diagnosis. The CT sim processing time averaged 73 days and was received by patients after 28.96±28.5 days. The major delays in terms of frequency and length of duration between different time points such as patient admission and CT sim, interval between diagnosis and treatment, and duration between CT sim and therapy were (mean±SD) 37.13±29.9, 58.08±24.9 and 28.15±7.9 days, respectively. Machine availability, instability of the patients' medical condition and intensity-modulated radiation therapy (IMRT) caused 66.6% of the delays. In conclusion, outpatients may experience CT sim delays. Machine availability, conditions of patients and IMRT treatment were the major reasons to cause the delay in CT sim. Strategies should be employed to prevent CT sim delays and improve patient experience.
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Affiliation(s)
- Alshaimaa D. Al-Mahnabi
- Department of Radiology, Radiation Oncology Unit, King Abdulaziz University, Jeddah 21598, Saudi Arabia
| | - Rolina K. Al-Wassia
- Department of Radiology, Radiation Oncology Unit, King Abdulaziz University, Jeddah 21598, Saudi Arabia
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Cury FL, Viani GA, Gouveia AG, Moraes FY. In reply to Niu et al: Meta-analysis of 5-day preoperative radiotherapy for soft tissue sarcoma (5D-PREORTS). Radiother Oncol 2024; 195:110255. [PMID: 38522598 DOI: 10.1016/j.radonc.2024.110255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Fabio L Cury
- Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, Canada.
| | - Gustavo A Viani
- Ribeirao Preto Medical School, Department of Medical Imagings, Hematology and Oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Andre G Gouveia
- Department of Oncology - Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Fabio Y Moraes
- Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, Canada
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10
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Mahadevan J, Appudurai R, Sothipragasam S, Kumar R, Rajasooriyar C. "Current", "heated rods", and "hot vapour": why patients refuse radiotherapy as a treatment modality for cancer in northern Sri Lanka. Support Care Cancer 2024; 32:361. [PMID: 38753165 DOI: 10.1007/s00520-024-08561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/09/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Significant proportions of patients either refuse or discontinue radiotherapy, even in the curative setting, leading to poor clinical outcomes. This study explores patient perceptions that underlie decisions to refuse/discontinue radiotherapy at a cancer care facility in northern Sri Lanka. METHODS An exploratory descriptive qualitative study was carried out among 14 purposively selected patients with cancer who refused/discontinued radiotherapy. In-depth semi-structured interviews were transcribed in Tamil, translated into English, coded, and thematically analyzed. RESULTS All participants referred to radiotherapy as "current" with several understanding the procedure to involve electricity, heat, or hot vapour. Many pointed to gaps in information provided by healthcare providers, who were perceived to focus on side effects without explaining the procedure. In the absence of these crucial details, patients relied on family members and acquaintances for information, often based on second or third-hand accounts of experiences with radiotherapy. Many felt pressured by family to refuse radiation, feared radiation, or felt ashamed to ask questions, while for others COVID-19 was an impediment. All but three participants regretted their decision, claiming they would recommend radiation to patients with cancer, especially when it is offered with curative intent. CONCLUSION Patients with cancer who refused/discontinued radiation therapy have significant information needs. While human resource deficits need to be addressed in low-resource settings like northern Sri Lanka, providing better supportive cancer care could improve clinical outcomes and save healthcare resources that would otherwise be wasted on patient preparation for radiotherapy.
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Affiliation(s)
| | - Ramalingam Appudurai
- Department of Clinical Oncology, Hospital Road, Teaching Hospital Jaffna, Jaffna, 40 000, Sri Lanka
- Tellipalai Trail Cancer Hospital, Tellipalai, Sri Lanka
| | | | - Ramya Kumar
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Chrishanthi Rajasooriyar
- Department of Clinical Oncology, Hospital Road, Teaching Hospital Jaffna, Jaffna, 40 000, Sri Lanka.
- Tellipalai Trail Cancer Hospital, Tellipalai, Sri Lanka.
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11
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Silverwood S, Lichter K, Conway A, Drew T, McComas KN, Zhang S, Gopakumar GM, Abdulbaki H, Smolen KA, Mohamad O, Grover S. Distance Traveled by Patients Globally to Access Radiation Therapy: A Systematic Review. Int J Radiat Oncol Biol Phys 2024; 118:891-899. [PMID: 37949324 DOI: 10.1016/j.ijrobp.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/30/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE This study aimed to systematically review the literature on the travel patterns of patients seeking radiation therapy globally. It examined the distance patients travel for radiation therapy as well as secondary outcomes, including travel time. METHODS AND MATERIALS A comprehensive search of 4 databases was conducted from June 2022 to August 2022. Studies were included in the review if they were observational, retrospective, randomized/nonrandomized, published between June 2000 and June 2022, and if they reported on the global distance traveled for radiation therapy in the treatment of malignant or benign disease. Studies were excluded if they did not report travel distance or were not written in English. RESULTS Of the 168 studies, most were conducted in North America (76.3%), with 90.7% based in the United States. Radiation therapy studies for treating patients with breast cancer were the most common (26.6%), while external beam radiation therapy was the most prevalent treatment modality (16.6%). Forty-six studies reported the mean distance traveled for radiation therapy, with the shortest being 4.8 miles in the United States and the longest being 276.5 miles in Iran. It was observed that patients outside of the United States traveled greater distances than those living within the United States. Geographic location, urban versus rural residence, and patient population characteristics affected the distance patients traveled for radiation therapy. CONCLUSIONS This systematic review provides the most extensive summary to date of the travel patterns of patients seeking radiation therapy globally. The results suggest that various factors may contribute to the variability in travel distance patterns, including treatment center location, patient residence, and treatment modality. Overall, the study highlights the need for more research to explore these factors and to develop effective strategies for improving radiation therapy access and reducing travel burden.
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Affiliation(s)
- Sierra Silverwood
- Michigan State University College of Human Medicine, Grand Rapids, Michigan.
| | - Katie Lichter
- Department of Radiation Oncology, University of California, San Francisco, California
| | | | - Taylor Drew
- Stritch School of Medicine, Maywood, Illinois
| | - Kyra N McComas
- Department of Radiation Oncology Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siqi Zhang
- Biostatistics Analysis Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hasan Abdulbaki
- University of California, San Francisco, School of Medicine, San Francisco, California
| | | | - Osama Mohamad
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Botswana-UPenn Partnership, Philadelphia, Pennsylvania
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12
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Saeedian A, Tabatabaei FS, Azimi A, Babaei M, Lashkari M, Esmati E, Abiar Z, Moadabshoar L, Sandoughdaran S, Kamrava M, Amini A, Ghalehtaki R. PErspective and current status of Radiotherapy Service in IRan (PERSIR)-1 study: assessment of current external beam radiotherapy facilities, staff and techniques compared to the international guidelines. BMC Cancer 2024; 24:324. [PMID: 38459443 PMCID: PMC10921664 DOI: 10.1186/s12885-024-12078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND AND PURPOSE Radiotherapy (RT) is an essential treatment modality against cancer and becoming even more in demand due to the anticipated increase in cancer incidence. Due to the rapid development of RT technologies amid financial challenges, we aimed to assess the available RT facilities and the issues with achieving health equity based on current equipment compared to the previous reports from Iran. MATERIALS AND METHODS A survey arranged by the Iran Cancer Institute's Radiation Oncology Research Center (RORC) was sent to all of the country's radiotherapy centers in 2022. Four components were retrieved: the reimbursement type, equipment, human resources, and patient load. To calculate the radiotherapy utilization rate (RUR), the Lancet Commission was used. The findings were compared with the previous national data. RESULTS Seventy-six active radiotherapy centers with 123 Linear accelerators (LINACs) were identified. The centers have been directed in three ways. 10 (20 LINACs), 36 (50 LINACs), and 30 centers (53 LINACs) were charity-, private-, and public-based, respectively. Four provinces had no centers. There was no active intraoperative radiotherapy machine despite its availability in 4 centers. One orthovoltage X-ray machine was active and 14 brachytherapy devices were treating patients. There were 344, 252, and 419 active radiation oncologists, medical physicists, and radiation therapy technologists, respectively. The ratio of LINAC and radiation oncologists to one million populations was 1.68 and 4.10, respectively. Since 2017, 35±5 radiation oncology residents have been trained each year. CONCLUSION There has been a notable growth in RT facilities since the previous reports and Iran's situation is currently acceptable among LMICs. However, there is an urgent need to improve the distribution of the RT infrastructure and provide more facilities that can deliver advanced techniques.
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Affiliation(s)
- Arefeh Saeedian
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh-Sadat Tabatabaei
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirali Azimi
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Babaei
- Department of Radiation Oncology, Cancer Institute, IKHC, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Lashkari
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Cancer Institute, IKHC, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Esmati
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Cancer Institute, IKHC, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Abiar
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Moadabshoar
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mitchell Kamrava
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Reza Ghalehtaki
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Radiation Oncology Research Center, Radio-Oncology Ward, Cancer Institute, Keshavarz Blvd, Qarib Street, Tehran, Iran.
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Court LE, Aggarwal A, Jhingran A, Naidoo K, Netherton T, Olanrewaju A, Peterson C, Parkes J, Simonds H, Trauernicht C, Zhang L, Beadle BM. Artificial Intelligence-Based Radiotherapy Contouring and Planning to Improve Global Access to Cancer Care. JCO Glob Oncol 2024; 10:e2300376. [PMID: 38484191 PMCID: PMC10954080 DOI: 10.1200/go.23.00376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/22/2023] [Accepted: 01/22/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Increased automation has been identified as one approach to improving global cancer care. The Radiation Planning Assistant (RPA) is a web-based tool offering automated radiotherapy (RT) contouring and planning to low-resource clinics. In this study, the RPA workflow and clinical acceptability were assessed by physicians around the world. METHODS The RPA output for 75 cases was reviewed by at least three physicians; 31 radiation oncologists at 16 institutions in six countries on five continents reviewed RPA contours and plans for clinical acceptability using a 5-point Likert scale. RESULTS For cervical cancer, RPA plans using bony landmarks were scored as usable as-is in 81% (with minor edits 93%); using soft tissue contours, plans were scored as usable as-is in 79% (with minor edits 96%). For postmastectomy breast cancer, RPA plans were scored as usable as-is in 44% (with minor edits 91%). For whole-brain treatment, RPA plans were scored as usable as-is in 67% (with minor edits 99%). For head/neck cancer, the normal tissue autocontours were acceptable as-is in 89% (with minor edits 97%). The clinical target volumes (CTVs) were acceptable as-is in 40% (with minor edits 93%). The volumetric-modulated arc therapy (VMAT) plans were acceptable as-is in 87% (with minor edits 96%). For cervical cancer, the normal tissue autocontours were acceptable as-is in 92% (with minor edits 99%). The CTVs for cervical cancer were scored as acceptable as-is in 83% (with minor edits 92%). The VMAT plans for cervical cancer were acceptable as-is in 99% (with minor edits 100%). CONCLUSION The RPA, a web-based tool designed to improve access to high-quality RT in low-resource settings, has high rates of clinical acceptability by practicing clinicians around the world. It has significant potential for successful implementation in low-resource clinics.
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Affiliation(s)
| | - Ajay Aggarwal
- Guy's and St Thomas Hospitals, London, United Kingdom
| | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | - Lifei Zhang
- University of Texas MD Anderson Cancer Center, Houston, TX
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Ehret F, Kohlhase N, Eftimova D, Hofmann T, Fürweger C, Haidenberger A, Kufeld M, Muacevic A, Santacroce A. Self-Shielding Gyroscopic Radiosurgery: A Prospective Experience and Analysis of the First 100 Patients. Cureus 2024; 16:e56035. [PMID: 38606262 PMCID: PMC11008698 DOI: 10.7759/cureus.56035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/13/2024] Open
Abstract
Background Stereotactic radiosurgery is a well-established treatment option for the management of various benign and malignant brain tumors. It can be delivered with several treatment platforms, usually requiring shielded radiation vaults to meet regulatory safety requirements. Recent technical advances have led to the first self-shielding platform enabling the delivery of gyroscopic radiosurgery (GRS). Given the limited number of GRS treatment platforms, the novelty of its characteristics, and the lack of available data, we report our prospective experience with the first 100 patients treated with GRS. Materials and methods Patients undergoing GRS for the treatment of intracranial tumors were enrolled in this prospective study. Patient and treatment characteristics, including patient satisfaction, were collected and analyzed. Results A total of 100 patients with 155 tumors were treated. The most commonly treated tumors comprised brain metastases (BM) (49%), vestibular schwannomas (31%), and meningiomas (14%). The median prescription dose for malignant and benign tumors was 20 and 13 Gy, respectively. The median prescription isodose line was 56%. Gross tumor volumes were small, with a median of 0.37 cc for BM and 0.92 cc for the other entities. The median total treatment time was 40 minutes. Dosimetric performance indices showed median values of 1.20 (conformity index), 1.24 (new conformity index), 1.74 (homogeneity index), and 3.13 (gradient index). Volumetric assessment of the treated tumors showed an overall decrease in size at the first available follow-up. Most patients were satisfied with the treatment experience. Conclusion Our first prospective experience of the use of GRS is favorable. Analyses of the dosimetric performance, treatment times, volumetric assessment, and patient satisfaction demonstrate its suitability for stereotactic treatments of intracranial tumors. Further prospective clinical and dosimetric analyses for GRS are pending.
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Affiliation(s)
- Felix Ehret
- Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DEU
- Charité - Universitätsmedizin Berlin, German Cancer Consortium (DKTK) partner site Berlin, and German Cancer Research Center (DKFZ) Heidelberg, Berlin, DEU
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Nadja Kohlhase
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Dochka Eftimova
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Theresa Hofmann
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Christoph Fürweger
- Medical Physics, European Radiosurgery Center Munich, Munich, DEU
- Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, DEU
| | | | - Markus Kufeld
- Radiosurgery, European Radiosurgery Center Munich, Munich, DEU
| | | | - Antonio Santacroce
- Radiosurgery, European Radiosurgery Center Munich, Munich, DEU
- Medicine, Faculty of Health, Witten/Herdecke University, Witten, DEU
- Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, DEU
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15
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Yorke AA, Williams VM, Elmore S, Alleyne-Mike K, Addison E, Kyeremeh PO, Tagoe SNA, Trauernicht CJ, Lazarus GL, Ford EC. Radiation Therapy Physics Quality Assurance and Management Practices in Low- and Middle-Income Countries: An Initial Pilot Survey in Six Countries and Validation Through a Site Visit. Adv Radiat Oncol 2024; 9:101335. [PMID: 38405318 PMCID: PMC10885564 DOI: 10.1016/j.adro.2023.101335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/31/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Our purpose was to assess physics quality assurance (QA) practices in less resourced radiation therapy (RT) centers to improve quality of care. Methods and Materials A preliminary study was conducted in 2020 of 13 select RT centers in 6 countries, and in 2021, our team conducted onsite visits to all the RT centers in Ghana, one of the countries from the initial survey. The RT centers included 1 private and 2 public institutions (denoted as Public-1 and Public-2). Follow-up surveys were sent to 17 medical physicists from the site visit. Questions centered on the topics of equipment, institutional practice, physics quality assurance, management, and safety practices. Qualitative and descriptive methods were used for data analysis. Questions regarding operational challenges (machine downtime, patient-related issues, power outages, and staffing) were asked on a 5-point Likert scale. Results The preliminary survey from 2020 had a 92% response rate. One key result showed that for RT centers in lower gross national income per capita countries there was a direct correlation between QA needs and the gross national income per capita of the country. The needs identified included film/array detectors, independent dose calculation software, calibration of ion chambers, diodes, thermoluminiscence diodes (TLDs), phantoms for verification, Treatment Planning System (TPS) test phantoms, imaging test phantoms and film dosimeters, education, and training. For the post survey after the site visit in 2021, we received a 100% response rate. The private and the Public-1 institutions each have computed tomography simulators located in their RT center. The average daily patient external beam workload for each clinic on a linear accelerator was: private = 25, Public-1 = 55, Public-2 = 40. The Co-60 workload was: Public-1 = 45, Public-2 = 25 (there was no Co-60 at the private hospital). Public-1 and -2 lacked the equipment necessary to conform to best practices in Task Group reports (TG) 142 and 198. Public-2 reported significant operational challenges. Notably, Public-1 and -2 have peer review chart rounds, which are attended by clinical oncologists, medical physicists, physicians, and physics trainees. All 17 physicists who responded to the post site visit survey indicated they had a system of documenting, tracking, and trending patient-related safety incidents, but only 1 physicist reported using International Atomic Energy Agency Safety in Radiation Oncology. Conclusions The preliminary study showed a direct correlation between QA needs and the development index of a country, and the follow-up survey examines operational and physics QA practices in the RT clinics in Ghana, one of the initial countries surveyed. This will form the basis of a planned continent-wide survey in Africa intended to spotlight QA practices in low- and middle-income countries, the challenges faced, and lessons learned to help understand the gaps and needs to support local physics QA and management programs. Audits during the site visit show education and training remain the most important needs in operating successful QA programs.
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Affiliation(s)
- Afua A. Yorke
- Department of Radiation Oncology, UW Medicine, Seattle, Washington
| | | | - Shekinah Elmore
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kellie Alleyne-Mike
- Department of Radiation Oncology, Cancer Center of Trinidad and Tobago, St. James Medical Complex, St. James, Trinidad, and Tobago
| | - Eric Addison
- Komfo Anokye Teaching Hospital, Oncology Directorate, Kumasi, Ghana
| | | | - Samuel Nii Adu Tagoe
- University of Ghana and National Center for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | | | - Eric C. Ford
- Department of Radiation Oncology, UW Medicine, Seattle, Washington
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Starling MTM, Thibodeau S, de Sousa CFPM, Restini FCF, Viani GA, Gouveia AG, Mendez LC, Marta GN, Moraes FY. Optimizing Clinical Implementation of Hypofractionation: Comprehensive Evidence Synthesis and Practical Guidelines for Low- and Middle-Income Settings. Cancers (Basel) 2024; 16:539. [PMID: 38339290 PMCID: PMC10854666 DOI: 10.3390/cancers16030539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
The global cancer burden, especially in low- and middle-income countries (LMICs), worsens existing disparities, amplified by the rising costs of advanced treatments. The shortage of radiation therapy (RT) services is a significant issue in LMICs. Extended conventional treatment regimens pose significant challenges, especially in resource-limited settings. Hypofractionated radiotherapy (HRT) and ultra-hypofractionated/stereotactic body radiation therapy (SBRT) offer promising alternatives by shortening treatment durations. This approach optimizes the utilization of radiotherapy machines, making them more effective in meeting the growing demand for cancer care. Adopting HRT/SBRT holds significant potential, especially in LMICs. This review provides the latest clinical evidence and guideline recommendations for the application of HRT/SBRT in the treatment of breast, prostate, and lung cancers. It emphasizes the critical importance of rigorous training, technology, stringent quality assurance, and safety protocols to ensure precise and secure treatments. Additionally, it addresses practical considerations for implementing these treatments in LMICs, highlighting the need for comprehensive support and collaboration to enhance patient access to advanced cancer care.
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Affiliation(s)
| | - Stephane Thibodeau
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON K7L 3N6, Canada
| | | | | | - Gustavo A. Viani
- Department of Medical Imagings, Ribeirão Preto Medical School, Hematology and Oncology of University of São Paulo (FMRP-USP), Ribeirão Preto 14049-900, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
| | - Andre G. Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
- Division of Radiation Oncology, Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Lucas C. Mendez
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Gustavo Nader Marta
- Radiation Oncology Department, Hospital Sirio Libanês, Sao Paulo 01308-050, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
| | - Fabio Ynoe Moraes
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON K7L 3N6, Canada
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
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17
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Amjad R, Moldovan N, Raziee H, Leung E, D’Souza D, Mendez LC. Hypofractionated Radiotherapy in Gynecologic Malignancies-A Peek into the Upcoming Evidence. Cancers (Basel) 2024; 16:362. [PMID: 38254851 PMCID: PMC10814353 DOI: 10.3390/cancers16020362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Radiotherapy (RT) has a fundamental role in the treatment of gynecologic malignancies, including cervical and uterine cancers. Hypofractionated RT has gained popularity in many cancer sites, boosted by technological advances in treatment delivery and image verification. Hypofractionated RT uptake was intensified during the COVID-19 pandemic and has the potential to improve universal access to radiotherapy worldwide, especially in low-resource settings. This review summarizes the rationale, the current challenges and investigation efforts, together with the recent developments associated with hypofractionated RT in gynecologic malignancies. A comprehensive search was undertaken using multiple databases and ongoing trial registries. In the definitive radiotherapy setting for cervical cancers, there are several ongoing clinical trials from Canada, Mexico, Iran, the Philippines and Thailand investigating the role of a moderate hypofractionated external beam RT regimen in the low-risk locally advanced population. Likewise, there are ongoing ultra and moderate hypofractionated RT trials in the uterine cancer setting. One Canadian prospective trial of stereotactic hypofractionated adjuvant RT for uterine cancer patients suggested a good tolerance to this treatment strategy in the acute setting, with a follow-up trial currently randomizing patients between conventional fractionation and the hypofractionated dose regimen delivered in the former trial. Although not yet ready for prime-time use, hypofractionated RT could be a potential solution to several challenges that limit access to and the utilization of radiotherapy for gynecologic cancer patients worldwide.
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Affiliation(s)
- Razan Amjad
- Department of Radiation Oncology, King Abdulaziz University, Rabigh 25732, Saudi Arabia
- Department of Radiation Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Nataliya Moldovan
- Department of Radiation Oncology, BC Cancer, Kelowna, BC V1Y 5L3, Canada
| | - Hamid Raziee
- Department of Radiation Oncology, BC Cancer, Kelowna, BC V1Y 5L3, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - David D’Souza
- Department of Radiation Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Lucas C. Mendez
- Department of Radiation Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
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18
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Gan DEH, Bustam AZ. Cancer trend and radiotherapy utilization at a tertiary academic hospital in Malaysia. J Cancer Res Ther 2024; 20:358-362. [PMID: 38554346 DOI: 10.4103/jcrt.jcrt_1953_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 04/01/2024]
Abstract
AIMS To determine the trend of cancer cases referred to the Department of Clinical Oncology in UMMC in terms of patient volumes over a period of 10 years. To define the stage at presentation of the top five cancers in males and females, respectively. To determine the overall radiotherapy utilization rates. METHODS AND MATERIAL This is a retrospective analysis of all new cases seen at the Department of Clinical Oncology, University of Malaya Medical Centre (UMMC), from the year 2009 to 2018 inclusive. The top five cancers in males and females were defined in terms of patient volumes and stage at presentation. The overall actual radiotherapy utilization rates were determined. RESULTS A total of 12,672 patients were included for analysis. A total of 62.9% of the cases were females and 37.1% were males. The median age of presentation was 59 years old. Breast cancer was the most common cancer, followed by colorectal, lung, thyroid, and prostate cancer. The most common presenting stage was stage 4. The overall actual radiotherapy utilization rate (aRTU) was 40.1%. Curative intent makes up 74.3% of radiotherapy and 66.6% of chemotherapy utilization. CONCLUSIONS The cancer distribution and trends among our patients are comparable with national and regional data. The overall actual radiotherapy utilization rate in the UMMC was lower than the estimated optimal rate of 53% but higher than the actual rate of 28% for Malaysia. This study provides valuable insight into current cancer trends and treatment demands to facilitate service planning.
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Affiliation(s)
- Daniel E H Gan
- Department of Clinical Oncology, University of Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, Lembah Pantai, Kuala Lumpur, Malaysia
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Gay SS, Cardenas CE, Nguyen C, Netherton TJ, Yu C, Zhao Y, Skett S, Patel T, Adjogatse D, Guerrero Urbano T, Naidoo K, Beadle BM, Yang J, Aggarwal A, Court LE. Fully-automated, CT-only GTV contouring for palliative head and neck radiotherapy. Sci Rep 2023; 13:21797. [PMID: 38066074 PMCID: PMC10709623 DOI: 10.1038/s41598-023-48944-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
Planning for palliative radiotherapy is performed without the advantage of MR or PET imaging in many clinics. Here, we investigated CT-only GTV delineation for palliative treatment of head and neck cancer. Two multi-institutional datasets of palliative-intent treatment plans were retrospectively acquired: a set of 102 non-contrast-enhanced CTs and a set of 96 contrast-enhanced CTs. The nnU-Net auto-segmentation network was chosen for its strength in medical image segmentation, and five approaches separately trained: (1) heuristic-cropped, non-contrast images with a single GTV channel, (2) cropping around a manually-placed point in the tumor center for non-contrast images with a single GTV channel, (3) contrast-enhanced images with a single GTV channel, (4) contrast-enhanced images with separate primary and nodal GTV channels, and (5) contrast-enhanced images along with synthetic MR images with separate primary and nodal GTV channels. Median Dice similarity coefficient ranged from 0.6 to 0.7, surface Dice from 0.30 to 0.56, and 95th Hausdorff distance from 14.7 to 19.7 mm across the five approaches. Only surface Dice exhibited statistically-significant difference across these five approaches using a two-tailed Wilcoxon Rank-Sum test (p ≤ 0.05). Our CT-only results met or exceeded published values for head and neck GTV autocontouring using multi-modality images. However, significant edits would be necessary before clinical use in palliative radiotherapy.
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Affiliation(s)
- Skylar S Gay
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA.
| | - Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Callistus Nguyen
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Tucker J Netherton
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Cenji Yu
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Yao Zhao
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
| | | | | | | | | | | | | | - Jinzhong Yang
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | | | - Laurence E Court
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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Aggarwal A, Court LE, Hoskin P, Jacques I, Kroiss M, Laskar S, Lievens Y, Mallick I, Abdul Malik R, Miles E, Mohamad I, Murphy C, Nankivell M, Parkes J, Parmar M, Roach C, Simonds H, Torode J, Vanderstraeten B, Langley R. ARCHERY: a prospective observational study of artificial intelligence-based radiotherapy treatment planning for cervical, head and neck and prostate cancer - study protocol. BMJ Open 2023; 13:e077253. [PMID: 38149419 PMCID: PMC10711912 DOI: 10.1136/bmjopen-2023-077253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/17/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Fifty per cent of patients with cancer require radiotherapy during their disease course, however, only 10%-40% of patients in low-income and middle-income countries (LMICs) have access to it. A shortfall in specialised workforce has been identified as the most significant barrier to expanding radiotherapy capacity. Artificial intelligence (AI)-based software has been developed to automate both the delineation of anatomical target structures and the definition of the position, size and shape of the radiation beams. Proposed advantages include improved treatment accuracy, as well as a reduction in the time (from weeks to minutes) and human resources needed to deliver radiotherapy. METHODS ARCHERY is a non-randomised prospective study to evaluate the quality and economic impact of AI-based automated radiotherapy treatment planning for cervical, head and neck, and prostate cancers, which are endemic in LMICs, and for which radiotherapy is the primary curative treatment modality. The sample size of 990 patients (330 for each cancer type) has been calculated based on an estimated 95% treatment plan acceptability rate. Time and cost savings will be analysed as secondary outcome measures using the time-driven activity-based costing model. The 48-month study will take place in six public sector cancer hospitals in India (n=2), Jordan (n=1), Malaysia (n=1) and South Africa (n=2) to support implementation of the software in LMICs. ETHICS AND DISSEMINATION The study has received ethical approval from University College London (UCL) and each of the six study sites. If the study objectives are met, the AI-based software will be offered as a not-for-profit web service to public sector state hospitals in LMICs to support expansion of high quality radiotherapy capacity, improving access to and affordability of this key modality of cancer cure and control. Public and policy engagement plans will involve patients as key partners.
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Affiliation(s)
- Ajay Aggarwal
- Institute of Clinical Trials and Methodology - MRC CTU at UCL, University College London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Peter Hoskin
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, UK
| | - Isabella Jacques
- Institute of Clinical Trials and Methodology - MRC CTU at UCL, University College London, London, UK
| | - Mariana Kroiss
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, UK
| | - Sarbani Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Indranil Mallick
- Department of Radiation Oncology, Tata Memorial Center, Kolkata, West Bengal, India
| | | | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, UK
| | | | - Claire Murphy
- Institute of Clinical Trials and Methodology - MRC CTU at UCL, University College London, London, UK
| | - Matthew Nankivell
- Institute of Clinical Trials and Methodology - MRC CTU at UCL, University College London, London, UK
| | | | - Mahesh Parmar
- Institute of Clinical Trials and Methodology - MRC CTU at UCL, University College London, London, UK
| | - Carol Roach
- Institute of Clinical Trials and Methodology - MRC CTU at UCL, University College London, London, UK
| | - Hannah Simonds
- Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | | | | | - Ruth Langley
- Institute of Clinical Trials and Methodology - MRC CTU at UCL, University College London, London, UK
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Hagos G, Hammad N, Stanway S, Yusuf A, Hailemariam T. Cancer care in Needle Hospital, Hargeisa, Somaliland. Ecancermedicalscience 2023; 17:1642. [PMID: 38414938 PMCID: PMC10898905 DOI: 10.3332/ecancer.2023.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Indexed: 02/29/2024] Open
Abstract
Somaliland is an autonomous region in the northern part of Somalia that declared its independence in 1991. It is a low-income country (LIC) with a population size of 5.7 million with a gross domestic product per capita of $775. Health services are delivered by public, private and non-governmental organisations. The public health care system in Somaliland is facing huge challenges. Seven percent of the population suffers from non-communicable diseases, but data on cancer incidence and mortality are not available. Much of the emphasis in public health has been placed on primary care and maternal and child health. There is still a large gap in cancer prevention, early detection and screening in the country. Additionally, there is no cancer registry or published data on cancer. Currently, there are a few private hospitals that provide chemotherapy services in Somaliland of which Needle Hospital is one. Services provided in this hospital include medical oncology for all solid tumours, palliative care, follow-up and cancer health education. The hospital provides services for patients from Somaliland and neighbouring countries including Djibouti, Somalia and Ethiopia. As a new oncology clinic in an LIC, the clinic is facing many challenges, like the absence of a multidisciplinary tumour board, presentation of patients at the advanced stage of tumours and poor cancer awareness in the general population.
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Affiliation(s)
| | - Nazik Hammad
- Saint Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Canada
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22
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Macbeth F, Fallowfield L, Treasure E, Ahmad I, Zheng Y, Treasure T. Removal or ablation of asymptomatic lung metastases should be reconsidered. BMJ 2023; 383:e073042. [PMID: 37945005 DOI: 10.1136/bmj-2022-073042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, University of Sussex, Sussex, UK
| | - Elizabeth Treasure
- Patient author, Oxford University Counselling Service, University of Oxford, Oxford, UK
| | - Irfan Ahmad
- Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Yan Zheng
- Department of Thoracic Surgery, Affiliated Cancer Hospital of ZhengZhou University/Henan Cancer Hospital, People's Republic of China
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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23
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Mereu L, Pecorino B, Ferrara M, Tomaselli V, Scibilia G, Scollo P. Neoadjuvant Chemotherapy plus Radical Surgery in Locally Advanced Cervical Cancer: Retrospective Single-Center Study. Cancers (Basel) 2023; 15:5207. [PMID: 37958381 PMCID: PMC10648104 DOI: 10.3390/cancers15215207] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Several pretreatment variables have been found to correlate with the clinical outcome of patients treated with NACT plus radical hysterectomy, such as FIGO stage, tumor size, and lymph node status. METHODS A single-center retrospective observational study to evaluate the use of NACT in LACC, particularly in the lymph-node-positive subpopulation. The study, conducted at the Maternal and Child Department of "Cannizzaro Hospital" in Catania, included patients treated between 2009 and 2019. Multivariate analysis was performed to analyze responses to NACT according to clinicopathologic parameters. Kaplan-Meyer disease-free survival (DFS) and overall survival (OS) curves were generated according to different lymph node status subgroups. RESULTS A total of 151 consecutive patients were enrolled in the study. Significant independent risk factors for response to NACT were preoperative tumor diameter, parametrium involvement, and lymphoma vascular space invasion (LVSI). T initial diameter at NMR was found to be the independent prognostic predictor for general (p = 0.024) and lymph node (LND) response (p = 0.028). Tumors between 2 and 6 cm have a better response to NACT than tumors > 6 cm, and LVSI absence was an independent prognostic factor for LND response to NACT. Survival DFS and OS curves were significant for positive vs. negative pathologic LND. CONCLUSIONS Neoadjuvant chemotherapy followed by surgery cannot be considered a standard of care in patients with locally advanced cervical cancer, particularly in the subgroup with pre-NACT imaging suspected for LND metastases.
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Affiliation(s)
- Liliana Mereu
- Obstetrics and Gynecology Unit, “G. Rodolico” University Hospital of Catania, CHIRMED Department, University of Catania, 95123 Catania, Italy
| | - Basilio Pecorino
- Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, 95100 Catania, Italy; (B.P.); (M.F.); (P.S.)
- Maternal and Child Department, University of Enna “Kore”, 94100 Enna, Italy
| | - Martina Ferrara
- Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, 95100 Catania, Italy; (B.P.); (M.F.); (P.S.)
- Maternal and Child Department, University of Enna “Kore”, 94100 Enna, Italy
| | - Venera Tomaselli
- Economics and Business Department, University of Catania, 95129 Catania, Italy;
| | - Giuseppe Scibilia
- Obstetrics and Gynecology, “Giovanni Paolo II” Hospital, 97100 Ragusa, Italy;
| | - Paolo Scollo
- Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, 95100 Catania, Italy; (B.P.); (M.F.); (P.S.)
- Maternal and Child Department, University of Enna “Kore”, 94100 Enna, Italy
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Belkacemi Y, Biston MC, Benchekroun N, Benider A, Chargari C, Debbi K, Doré M, El Kacimi H, Flandin I, Lalya I, Samlali H, Sellal N, Supiot S. Limited applicability and implementation of the international oncology treatments guidelines in low- and middle-income countries, an example from the Mediterranean area borders. Cancer Radiother 2023; 27:666-675. [PMID: 37550156 DOI: 10.1016/j.canrad.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
The quality of cancer care in the modern era is based on a precise diagnosis and personalized therapy according to patients and their disease based on validated guidelines with a high level of evidence. During cancer patients' management, the objective is first to make an accurate diagnosis and then offer the best treatment, validated beforehand in a multidisciplinary board meeting, with the best benefit/risk ratio. In the context of many low- and middle-income countries, the limited available means do not allow an adequate offer, resulting in non-optimal patients' care. In addition, in many low- and middle-income countries, priority can be given to other types of disease than cancer, which may considerably reduce allocation of specific resources to cancer care. Thus, the limited availability of systemic therapy, radiotherapy machines, brachytherapy and technological development may come up against another difficulty, that of geographical distribution of the means in the countries or a lack of expertise due to insufficient training programs. For all these reasons, the implementation of the guidelines established in Western countries could be impossible for many low- and middle-income countries which, moreover, have to face a completely different epidemiology of cancers compared to developed countries. In this work, we will discuss through a few examples of common cancers on both borders of the Mediterranean area, the applicability of the guidelines and the limits of their implementation for optimal cancer care.
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Affiliation(s)
- Y Belkacemi
- Department of Radiation Oncology and Henri-Mondor Breast Center, centre hospitalier universitaire Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Inserm U955, i-Biot Team, IMRB, university of Paris-Est Crétil, Créteil, France.
| | - M-C Biston
- Centre Léon-Bérard and Creatis, CNRS UMR 5225, Inserm U1044, Insa-Lyon, université Lyon 1, Villeurbanne, France
| | - N Benchekroun
- Department of Radiation Oncology, centre Mohamed-VI, université de Casablanca, Casablanca, Morocco
| | - A Benider
- Department of Radiation Oncology, centre Mohamed-VI, université de Casablanca, Casablanca, Morocco
| | - C Chargari
- Department of Radiation Oncology, groupe hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université Paris VI, Paris, France
| | - K Debbi
- Department of Radiation Oncology and Henri-Mondor Breast Center, centre hospitalier universitaire Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Inserm U955, i-Biot Team, IMRB, university of Paris-Est Crétil, Créteil, France
| | - M Doré
- Department of Radiation Oncology, Institute de cancérologie de l'Ouest (ICO) centre René-Gauducheau, Saint-Herblain, France
| | - H El Kacimi
- Department of Radiation Oncology, Institut d'oncologie de Rabat, Rabat, Morocco
| | - I Flandin
- Department of Radiation Oncology, centre hospitalier universitaire de Grenoble, Grenoble, France
| | - I Lalya
- Department of Radiation Oncology, hôpital militaire Mohamed-V, Rabat, Morocco
| | - H Samlali
- Department of Radiation Oncology, clinique d'oncologie le Littoral, Casablanca, Morocco
| | - N Sellal
- Department of Radiation Oncology, hôpital universitaire Mohmed-VI, université Abdelmalek-Essadi, Tanger, Morocco
| | - S Supiot
- Department of Radiation Oncology, Institute de cancérologie de l'Ouest (ICO) centre René-Gauducheau, Saint-Herblain, France; Université de Nantes, Nantes, France
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25
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Rosa AA, de Sousa CFPM, Pimentel LCF, Martins HL, Moraes FY, Marta GN, Castilho MS. Radiotherapy resources in Brazil (RT2030): a comprehensive analysis and projections for 2030. Lancet Oncol 2023; 24:903-912. [PMID: 37541272 DOI: 10.1016/s1470-2045(23)00284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The demand for radiotherapy in Brazil is unfulfilled, and the scarcity of data on the national network hampers the development of effective policies. We aimed to evaluate the current situation, estimate demands and requirements, and provide an action plan to ensure access to radiotherapy for those in need by 2030. METHODS The Brazilian Society for Radiation Oncology created a task force (RT2030) including physicians, medical physicists, policy makers, patient advocates, and suppliers, all of whom were major stakeholders involved in Brazilian radiotherapy care. The group was further divided into seven working groups to address themes associated with radiotherapy care in Brazil. From March 1, 2019, to Aug 3, 2020, there were monthly meetings between the group's leaders and the Central Committee and six general meetings. First, a comprehensive search of all different national databases was done to identify all radiotherapy centres. Questionnaires evaluating radiotherapy infrastructure and human resources and assing the availability, distribution, capacity, and workload of resources were created and sent to the radioprotection supervisor of each centre. Results were analysed nationally and across the country's regions and health-care systems. A pre-planned review of available databases was done to gather data on active radiation oncology centres and the distribution of radiotherapy machines (linear accelerators [LINACs]) across Brazil. We used national population and cancer incidence projections, recommended radiotherapy usage from the medical literature, and national working patterns to project radiotherapy demands in 2030. An action plan was established with suggestions to address the gaps and meet the demands. FINDINGS The database search yielded 279 centres with an active radiotherapy registry. After applying predefined exclusion criteria, 263 centres were identified that provided external beam radiotherapy machines with or without brachytherapy. All 263 operational centres answered the questionnaires sent on Dec 9, 2019, which were then returned between Jan 1 and June 30, 2020. There were 409 therapy machines, 646 radiation oncologists, 533 physicists, and 230 989 patients undergoing radiotherapy (150 628 [65·2%] in the public health-care system and 80 937 [35·0%] in private). The mean annual occupation rate was 566 patients per treatment machine (SD 250). The number of residents per treatment machine ranged from 258 333 to 1 800 000. Technology availability varied considerably among regions and systems. In 2030, 639 994 new cancer cases are expected, which will require 332 797 radiotherapy courses. Therefore, 530 LINACs, 1079 radiation oncologists, and 1060 medical physicists will be needed. INTERPRETATION The expected increase in cancer incidence in the coming years will probably increase the disparities in cancer care and the burden for Brazilian patients. We provide a roadmap of the current situation and the particularities of the Brazilian radiotherapy network, which can serve as a starting point for cancer policy planning to improve this scenario. FUNDING Accuray, BRAINLAB, Elekta, IBA, ONE medical solution, SUN NUCLEAR corporation, VARIAN, and ZIGMA.
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Affiliation(s)
- Arthur Accioly Rosa
- Grupo Oncoclínicas, Salvador, Bahia, Brazil; Latin America Cooperative Oncology Group, Porto Alegre, Brazil
| | | | | | | | - Fabio Ynoe Moraes
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
| | - Gustavo Nader Marta
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Aruah SC, Chidebe RC, Orjiakor TC, Uba F, Shagaya UN, Ugwanyi C, Umar AA, Ige T, Asogwa OC, Ahmadu OT, Ali-Gombe M, Adewumi A, Okwor VC, Mutiu JA, Bello B, Eriba LO, Ahmed YA, Bisalla A, Itanyi U, Balogun RA, Alabi S, Pistenmaa D, Coleman CN, Manjit D. Status of Government-Funded Radiotherapy Services in Nigeria. JCO Glob Oncol 2023; 9:e2200406. [PMID: 37348033 PMCID: PMC10497276 DOI: 10.1200/go.22.00406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/20/2023] [Accepted: 04/18/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE Access to radiotherapy (RT) is now one of the stark examples of global cancer inequities. More than 800,000 new cancer cases require potentially curative or palliative RT services in Africa, arguably <15% of these patients currently have access to this important service. For a population of more than 206 million, Nigeria requires a minimum of 280 RT machines for the increasing number of cancer cases. Painfully, the country has only eight Government-funded RT machines. This study aimed to evaluate the status of the eight Government-funded RT services in Nigeria and their ability to deliver effective RT to their patients. METHODS A survey addressing 10 critical areas was used to assess the eight Government-funded RT services in Nigeria. RESULTS Unfortunately, six of the eight centers (75%) surveyed have not treated patients with RT because they do not have functioning teletherapy machines in 2021. Only two RT centers have the capability of treating patients using advanced RT techniques. There is no positron emission tomography-computed tomography scan in any of the Government-funded RT centers. The workforce capacity and infrastructure across the eight centers are limited. All of the centers lack residency training programs for medical physicists and radiation therapy technologists resulting in very few well-trained staff. CONCLUSION As the Nigerian Government plans for the new National Cancer Control Plan, there is an urgent need to scale up access to RT by upgrading the RT equipment, workforce, and infrastructure to meet the current needs of Nigerian patients with cancer. Although the shortfall is apparent from a variety of RT-capacity databases, this detailed analysis provides essential information for an implementation plan involving solutions from within Nigeria and with global partners.
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Affiliation(s)
- Simeon C. Aruah
- Radiation Oncology Department, National Hospital Abuja, Abuja, Nigeria
- College of Medicine, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Runcie C.W. Chidebe
- Project PINK BLUE—Health & Psychological Trust Centre, Abuja, Nigeria
- Department of Sociology & Gerontology, Miami University, Oxford, OH
- Scripps Gerontology Center, Miami University, Oxford, OH
| | - Tochukwu C. Orjiakor
- Project PINK BLUE—Health & Psychological Trust Centre, Abuja, Nigeria
- Department of Psychology, University of Nigeria Nsukka, Enugu, Nigeria
| | - Fatima Uba
- Radiation and Clinical Oncology Department, National Hospital Abuja, Abuja, Nigeria
| | | | - Charles Ugwanyi
- Neurosurgery Department, National Hospital Abuja, Abuja, Nigeria
| | - Aisha A. Umar
- Department of Radiology, National Hospital Abuja, Abuja, Nigeria
| | - Taofeeq Ige
- Medical Physics Department, National Hospital Abuja, Abuja, Nigeria
| | - Obinna C. Asogwa
- Medical Physics Department, National Hospital Abuja, Abuja, Nigeria
- Radiotherapy Department, Asi Ukpo Comprehensive Cancer Center, Calabar, Nigeria
| | - Oiza T. Ahmadu
- Radiation Oncology Department, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria
| | - Musa Ali-Gombe
- Radiology Department, Gombe State University, Gombe, Nigeria
- Department of Radiotherapy and Oncology, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Alabi Adewumi
- Radiation Oncology Department, Nigeria Sovereign Investment Authority-Lagos University Teaching Hospital (NSIA-LUTH), Lagos, Nigeria
| | - Vitalis C. Okwor
- Radiation Oncology Department, University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu, Nigeria
| | - Jimoh A. Mutiu
- University of Ibadan/University College Hospital Ibadan, Ibadan, Nigeria
| | - Basheer Bello
- Radiation Oncology Department, Usman Danfodio University Teaching Hospital (UDUTH), Sokoto, Nigeria
| | - Lucy O. Eriba
- Radiation Oncology Department, University of Benin Teaching Hospital (UBTH), Edo State, Nigeria
| | - Yusuf A. Ahmed
- Centre for Energy Research and Training, Ahmadu Bello University, Zaria, Nigeria
- Nigeria Atomic Energy Commission (NAEC), Abuja, Nigeria
| | - Awwal Bisalla
- Nigeria Atomic Energy Commission (NAEC), Abuja, Nigeria
| | - Ukamaka Itanyi
- Radiology Department, University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja, Nigeria
| | | | - Suleiman Alabi
- Radiation and Clinical Oncology Department, National Hospital Abuja, Abuja, Nigeria
| | - David Pistenmaa
- International Cancer Expert Corps (ICEC) Inc, Washington, DC
| | | | - Dosanjh Manjit
- University of Oxford, Oxford, United Kingdom
- European Centre for Nuclear Research (CERN), Geneva, Switzerland
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Sabbagh A, Weiss J, Tawk B, Mohammed MA, Abdulbaki H, Moraes FY, Grover S, Yap ML, Zubizarreta E, Lievens Y, Rodin D, Mohamad O. Hypofractionation Adoption in Prostate Cancer Radiotherapy: Results of an International Survey. JCO Glob Oncol 2023; 9:e2300046. [PMID: 37319396 PMCID: PMC10497301 DOI: 10.1200/go.23.00046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Hypofractionation is noninferior to conventional fractionation in the treatment of localized prostate cancer. Using results from the European Society of Radiation Oncology's (ESTRO) Global Impact of Radiotherapy in Oncology (GIRO) initiative survey on hypofractionation, this study identifies rates of adoption, facilitating factors, and barriers to adoption of hypofractionation in prostate cancer across World Bank income groups. MATERIALS AND METHODS The ESTRO-GIRO initiative administered an international, anonymous, electronic survey to radiation oncologists from 2018 to 2019. Physician demographics, clinical practice characteristics, and hypofractionation regimen use (if any) for several prostate cancer scenarios were collected. Responders were asked about specific justifications and barriers to adopting hypofractionation, and responses were stratified by World Bank income group. Multivariate logistic regression models were used to analyze variables associated with hypofractionation preference. RESULTS A total of 1,157 physician responses were included. Most respondents (60%) were from high-income countries (HICs). In the curative setting, hypofractionation was most often preferred in low- and intermediate-risk prostate cancers, with 52% and 47% of respondents reporting hypofractionation use in ≥50% of patients, respectively. These rates drop to 35% and 20% in high-risk prostate cancer and where pelvic irradiation is indicated. Most respondents (89%) preferred hypofractionation in the palliative setting. Overall, respondents from upper-middle-income countries and lower-middle- and low-income countries were significantly less likely to prefer hypofractionation than those from HICs (P < .001). The most frequently cited justification and barrier were availability of published evidence and fear of worse late toxicity, respectively. CONCLUSION Hypofractionation preference varies by indication and World Bank income group, with greater acceptance among providers in HICs for all indications. These results provide a basis for targeted interventions to increase provider acceptance of this treatment modality.
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Affiliation(s)
- Ali Sabbagh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Jessica Weiss
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Bouchra Tawk
- Clinical Cooperation Unit—Translational Radiation Oncology, National Center for Tumoral Diseases NCT Heidelberg, German Cancer Research Center (DKFZ), Heidelberg University Hospital, Heidelberg, Germany
| | - Mohammed A. Mohammed
- American University of Beirut Medical Center, Beirut, Lebanon
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Hasan Abdulbaki
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Fabio Y. Moraes
- Department of Oncology, Division of Radiation Oncology, Queen's University, Kingston, ON, Canada
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mei Ling Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, UNSW Sydney, Liverpool, NSW, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, NSW, Australia
- The George Institute for Global Health, UNSW Sydney, Newtown, NSW, Australia
| | | | - Yolande Lievens
- Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, ON, Canada
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
- Department of Urology, University of California San Francisco, San Francisco, CA
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Yorke AA, Carlson C, Koufigar S, Zhu H, Li B. Reimagining Education in Global Radiotherapy: The Experiences and Contribution of Rayos Contra Cancer. JCO Glob Oncol 2023; 9:e2200320. [PMID: 37043712 DOI: 10.1200/go.22.00320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
PURPOSE Technology advancements ushered in a new era of how we reimagine our human interaction, with videoconferencing becoming commonplace in educational, professional, and social settings. These tools became the new paradigm in online/virtual education for all institutions around the world. Particularly in global health, where the traditional norm for support relied on traveling and onsite visits, we face a ripe opportunity for innovation. METHODS From 2019 to present, Rayos Contra Cancer has conducted remote operations by organizing the efforts of volunteer educators and moderators who are radiotherapy professionals or trainees from across the United States and other parts of the world. On average, each program consists of 17 virtual sessions. The hour-long sessions are conducted over Zoom and include didactics, question-and-answer dialogue with participants, and sample cases. The educators are seasoned and accomplished radiation oncologists, physicists, dosimetrists, and radiation therapists who teach single or multiple topics in a program. Participants are radiotherapy professionals or trainees affiliated with a radiotherapy clinic in a low- and middle-income country. RESULTS The number of participant clinics ranged from 2 to 120 per program. Our combined programs have resulted in over 2,000 unique participants spanning approximately 500 unique centers in 54 countries with the support of over 200 unique educators and moderators from centers in 18 countries. CONCLUSION When the world shut down, we were forced to reimagine how we approached global health education. Our data show tremendous growth year to year and from one curriculum to another. The feedback from our participants demonstrates that our approach is an effective way to engage practitioners in radiotherapy centers with fewer resources.
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Affiliation(s)
- Afua A Yorke
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA
| | | | - Sharareh Koufigar
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA
| | - Hong Zhu
- Rayos Contra Cancer, San Francisco, CA
| | - Benjamin Li
- Rayos Contra Cancer, San Francisco, CA
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
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Ige T, Lewis P, Shelley C, Pistenmaa D, Coleman CN, Aggarwal A, Dosanjh M, Zergoug I, Eduardo HM, Bvochora-Nsingo M, Fulu K, Ralefala T, Grover S, Maison-Mayeh AM, Ndi SR, Attalla E, Deiab N, Belay EY, Acquah GF, Amankwaa-Frempong E, Foy H, Ngigi E, Badi F, Elburi I, Harivony T, Kone A, Maiga S, Tolba A, Mootoosamy S, El-Boutayeb S, Momade A, Midzi W, Grobler M, Aruah SC, Kra J, Diagne M, Trauernicht C, Elbashir F, Ali NAE, Makwani H, Yusufu S, Farhat L, Mounir B, Awusi K, Azangwe G. Understanding the challenges of delivering radiotherapy in low- and middle-income countries in Africa. J Cancer Policy 2023; 35:100372. [PMID: 36512899 DOI: 10.1016/j.jcpo.2022.100372] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Access to high quality radiotherapy (RT) continues to be a major issue across Africa with Africa having just 34% of its optimal capacity. METHODS We co-developed a survey with clinical, academic and policy stakeholders designed to provide a structured assessment of the barriers and enablers to RT capacity building in Africa. The survey covered nine key themes including funding, procurement, education and training. The survey was sent to RT professionals in 28 countries and the responses underwent qualitative and quantitative assessment. RESULTS We received completed questionnaires from 26 African countries. Funding was considered a major issue, specifically the lack of a ring fenced funds from the Ministry of Health for radiotherapy and the consistency of revenue streams which relates to a lack of prioritisation for RT. In addition to a significant shortfall in RT workforce disciplines, there is a general lack of formal education and training programmes. 13/26 countries reported having some IAEA support for RT for education and training. Solutions identified to improve access to RT include a) increasing public awareness of its essential role in cancer treatment; b) encouraging governments to simplify procurement and provide adequate funding for equipment; c) increasing training opportunities for all radiotherapy disciplines and d) incentivizing staff retention. CONCLUSION This survey provides unique information on challenges to delivering and expanding radiotherapy services in Africa. The reasons are heterogonous across countries but one key recommendation would be for national Cancer Control plans to directly consider radiotherapy and specifically issues of funding, equipment procurement, servicing and training. POLICY SUMMARY The study demonstrates the importance of mixed methods research to inform policy and overcome barriers to radiotherapy capacity and capability in LMICs.
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Affiliation(s)
- Taofeeq Ige
- National Hospital Abuja, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | | | - Charlotte Shelley
- The Royal Surrey County Hospital NHS Foundation trust, Guildford, UK
| | - David Pistenmaa
- ICEC, International Cancer Expert Corps, Washington, DC, USA
| | | | | | - Manjit Dosanjh
- ICEC, International Cancer Expert Corps, Washington, DC, USA; CERN, ATS-DO, Geneva, Switzerland; Department of Physics, University of Oxford, UK.
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Christ SM, Willmann J. Measuring Global Inequity in Radiation Therapy: Resource Deficits in Low- and Middle-Income Countries Without Radiation Therapy Facilities. Adv Radiat Oncol 2023; 8:101175. [PMID: 37008253 PMCID: PMC10050474 DOI: 10.1016/j.adro.2023.101175] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/05/2023] [Indexed: 03/05/2023] Open
Abstract
Purpose Although radiation therapy (RT) is an effective and inexpensive pillar of multidisciplinary cancer care, access to RT facilities remains highly inequitable globally. Numerous studies have documented this resource gap, yet many countries continue facing their raging cancer epidemics ill-equipped. In this study, we present an estimation of resource deficits in low- and middle-income countries (LMICs) without any RT facilities at all. Methods and Materials This study builds on publicly available data on country classification, population, cancer incidence, and RT requirements provided by the World Bank Group, the World Health Organization, and the International Atomic Energy Agency. Leveraging these data, we developed a capacity-planning model to estimate the current deficit of fundamental RT resources for LMICs with more than 1 million inhabitants and no active RT facilities. Results There were 23 LMICs with a population of more than 1 million inhabitants and without any active RT facilities, 78% of which were located in sub-Saharan Africa. The aggregate population of these countries was 197.3 million people. The largest countries without RT facilities were Afghanistan and Malawi, with a population of 38.0 million and 18.6 million inhabitants, respectively. Estimated cancer incidence for all countries under study totaled at 134,783 new cases per year, 84,239 (62.5%) of which would have required RT. There was an aggregate deficit of 188 megavoltage machines and 85 brachytherapy afterloaders, along with simulation equipment and human capital in the magnitude of approximately 3363 trained radiation oncology staff. Conclusions Hundreds of thousands of patients with cancer in LMICs continue to live in countries without access to RT in their own country. This extreme form of global health inequity requires urgent and decisive action, the success of which depends on the integration of international and local efforts.
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Affiliation(s)
- Sebastian M. Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Corresponding author: Sebastian M. Christ, MD, PhD
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
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Vieira CM, Diniz PHC, Dizon DS, Nogueira-Rodrigues A. Patient navigation (PN) support to timely access to radiotherapy in the Brazilian public health system. Support Care Cancer 2023; 31:182. [PMID: 36820917 DOI: 10.1007/s00520-023-07615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/19/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Patient navigation (PN) is a community-based service delivery intervention designed to promote access to timely diagnosis and treatment of cancer and other chronic diseases by eliminating barriers to integral care. Considering the complex difficulties in accessing treatment and the positive results of PN in high-income countries, our group decided to evaluate this tool to improve radiotherapy (RT) access in the public system in Brazil. PATIENTS AND METHODS This pilot study took place in a public school hospital, with a historical cohort as the control arm. The primary endpoint was the time from histologic diagnosis and RT initiation among cancer patients receiving RT with curative intent in a PN program. The secondary objectives were the following time frames: referral to the first consultation by the RT team; first consultation up to RT beginning; RT beginning to RT end; referral to the end of RT and identifying/describing obstacles to the treatment; and assessing patient satisfaction with PN program. RESULTS A total of 124 patients were included in the retrospective arm and 73 in the navigation arm. Most had the loco-regionally advanced disease from the esophagus, head/neck, and rectum. PN decreased the median time from the biopsy result to the beginning of RT from 108 to 74 days (p < 0.001). PN reduced the time between biopsy results and referral to RT (53 to 40.5 days, p = 0.011), between the referral and the first consultation in the RT (25 to 13 days, p < 0.001), and between the referral to the end of the RT (98 to 78 days, p < 0.003). CONCLUSIONS Proper identification of barriers, especially in a low-resource setting, is mandatory to guide PN programs in LMICs. In an oncological context of socioeconomic vulnerability, PN is a financially viable and efficient tool to optimize access to timely RT.
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Affiliation(s)
- Carolina M Vieira
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 30130100, Brazil.
| | - Paulo H C Diniz
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 30130100, Brazil
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Franco P, De Felice F, Kaidar-Person O, Gabrys D, Marta GN, Banini M, Livi L, Jagsi R, Coles CE, Poortmans P, Meattini I. Equity, Diversity, and Inclusion in Radiation Oncology: A Bibliometric Analysis and Critical Review. Int J Radiat Oncol Biol Phys 2023; 116:232-245. [PMID: 36841344 DOI: 10.1016/j.ijrobp.2023.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
The promotion of equity, diversity, and inclusion (EDI) is being increasingly pursued in health care, both in general and within radiation oncology. Because bibliometrics is a powerful tool to reveal the scientific literature on a specific topic during a certain timespan, a systematic bibliometric analysis of the documents published on EDI in radiation oncology was performed, aiming at exploring common patterns in research and emerging trends, tracking collaborations and networks, and anticipating future directions in clinical research. Standard descriptive statistics and bibliometric techniques were used in the analysis. A collaboration network and thematic map were generated from the data. Four domains were represented: (1) motor themes, including themes well developed and important for the structuring of the research field; (2) niche themes, representing the isolated topics that do not share important external links with other themes; (3) emerging themes, referring to still weakly developed topics; and (4) basic themes, including the essential topics. EDI in the profession of radiation oncology is essential to ensure that the workforce delivering radiation oncology care both draws from the full talent pool of human capital and delivers the highest quality science and clinical care to all patients. The burgeoning literature on EDI in radiation oncology suggests that a large and growing cohort of scholars within radiation oncology are dedicated to addressing these important challenges.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, Maggiore della Carità University Hospital, Novara, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Dorota Gabrys
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo/Brasília, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Marco Banini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
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Hendrik H, Kamalrudin M, Razali M, Purnamawati S, Widikusumo A. COMPUTED RADIOGRAPHY UTILIZATION FOR TELECOBALT60 TO ACHIEVE THE RADIATION CERTAINTY. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 75:3080-3086. [PMID: 36723331 DOI: 10.36740/wlek202212132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim: This research aimed to show the achievement of Telecobalt60 radiation certainty using computed radiography, in comparation with non-verified computed radiography. PATIENTS AND METHODS Materials and methods: This research is a quantitative study, randomized double-blind, and consecutive sampling design. The study was conducted by observing and com¬paring the data of verified computed radiography (VerC) computed radiograph for Telecobalt60 compared to the non-verified computed radiography (nVerC) Telecobalt60 data. RESULTS Results: The results showed that there are significant statistical differences in several measurement characteristics between the verified computed radiography arm and the non-verified computed radiography arm. All of the value divergences of the verified computed radiography arm are less than 7 mm while the non-verified computed radiography arm are 7 mm or more (P<0.050). Furthermore, all of the edge aspect of measurement in the verified computed radiography arms are less than the non-verified computed radiography, all without manual block utilization (P<0.050). CONCLUSION Conclusions: We conclude that Telecobalt60 radiation certainty is significantly better achieved by using computed radiography, when compared to non-verified computed radiography Telecobalt60 use. This research contributes to provide evidence based for better Telecobalt60 radiation accuracy and quality of radiotherapy outcome by using computed radiography.
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Affiliation(s)
- Hendrik Hendrik
- DR. MOEWARDI GENERAL HOSPITAL, SURAKARTA, INDONESIA, UNIVERSITAS SEBELAS MARET, SURAKARTA, CENTRAL OF JAVA, INDONESIA
| | | | | | | | - Arundito Widikusumo
- UNIVERSITAS JENDERAL SOEDIRMAN, PURWOKERTO, CENTRAL OF JAVA, INDONESIA, PROF. DR. MARGONO SOEKARJO GENERAL HOSPITAL, PURWOKERTO, INDONESIA
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Martin MG, Chidebe RCW, Nwaneri MO, Miller E, Okoye I, Esiaka DK, Olasinde TA, Durosinmi-Etti FA, Igbinoba F, Adegboyega BC, Adenjii A, Aruah CS, Orjiakor TC, Abubakar BM, Atuwo D, O'Connor T. Impact of 10-Day Fulbright Specialist Program and Project Pink Blue Education Sessions on Medical Oncology Knowledge Among Physicians Who Treat Cancer in Nigeria. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:378-382. [PMID: 35838882 DOI: 10.1007/s13187-021-02130-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 06/15/2023]
Abstract
Despite an estimated population of over 201 million and over 115,950 yearly diagnosed new cases of cancer, Nigeria does not have dedicated medical oncologists. Most oncology care is delivered through surgical and clinical oncologists, who are trained in both radiation and medical oncology and they number fewer than 50 in the country. With a limited number of oncology professionals, cancer patients in Nigeria experience poor health outcomes, with an estimated cancer mortality rate of 75,000 deaths per year. Participants from 15 Nigerian states were selected to attend the medical oncology training. Through the support of Fulbright Specialist Program and Project PINK BLUE, two of the authors delivered 10 days of lectures based on ASCO, ESMO, and NCCN guidelines. Mean scores of both the pre- and post-course tests as well as a 1-year follow-up test were compared using GraphPad Prism 7.0a by paired t-tests. Forty-four clinical oncologists were selected for participation. Twenty-five (57%) completed the pre- and post-course tests. Of the 25 that completed both tests, percentage of correct answers increased from 45 to 59% (2-sided p-value < 0.0001). Improvements were seen in attending doctors 45 to 59% (p = 0.0046) and resident doctors 45 to 59% (0.0007). Eleven doctors responded to the 1-year follow-up test. Although not statistically significant, a numerical pattern for the benefits was maintained 1 year after the program (45% pre-course versus 52% post-course correct answers, Fisher's exact, p = 0.4185). In the short term, the training improved medical oncology knowledge in Nigeria, regardless of the participant's carrier stage. Long-term benefits were not sustained in a small sample of participants, and continuing education strategies are necessary. Similar models may be employed across Africa.
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Affiliation(s)
- M G Martin
- West Cancer Center and Research Institute, Memphis, TN, USA.
- Fulbright Specialist Program, Washington, D.C., USA.
- West Cancer Center, 1588 Union Ave, Memphis, TN, 38104, USA.
- Birmingham City University, Birmingham, UK.
| | - R C W Chidebe
- Birmingham City University, Birmingham, UK
- Project PINK BLUE - Health & Psychological Trust Centre, Abuja, Nigeria
- National Cancer Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - M O Nwaneri
- Birmingham City University, Birmingham, UK
- Project PINK BLUE - Health & Psychological Trust Centre, Abuja, Nigeria
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - E Miller
- West Cancer Center and Research Institute, Memphis, TN, USA
- Birmingham City University, Birmingham, UK
| | - I Okoye
- Birmingham City University, Birmingham, UK
- Project PINK BLUE - Health & Psychological Trust Centre, Abuja, Nigeria
- University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - D K Esiaka
- Birmingham City University, Birmingham, UK
- Union College, Schenectady, NY, USA
| | - T A Olasinde
- Birmingham City University, Birmingham, UK
- Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - F A Durosinmi-Etti
- Birmingham City University, Birmingham, UK
- Lagos University Teaching Hospital, Lagos, Nigeria
| | - F Igbinoba
- Birmingham City University, Birmingham, UK
- National Hospital, Abuja, Nigeria
| | - B C Adegboyega
- Birmingham City University, Birmingham, UK
- Lagos University Teaching Hospital, Lagos, Nigeria
| | - A Adenjii
- Birmingham City University, Birmingham, UK
- Lagos University Teaching Hospital, Lagos, Nigeria
| | - C S Aruah
- Birmingham City University, Birmingham, UK
- National Hospital, Abuja, Nigeria
- University of Abuja College of Medicine, Abuja, Nigeria
| | - T C Orjiakor
- Birmingham City University, Birmingham, UK
- University of Nigeria, Nsukka, Nigeria
| | - B M Abubakar
- Birmingham City University, Birmingham, UK
- National Hospital, Abuja, Nigeria
| | - D Atuwo
- Birmingham City University, Birmingham, UK
- National Cancer Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - T O'Connor
- Fulbright Specialist Program, Washington, D.C., USA
- Birmingham City University, Birmingham, UK
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Zhou Y, Luo B, Sang J, Li C, Zhu M, Zhu Z, Dai J, Wang J, Chen H, Zhai S, Lu L, Liu H, Yu G, Ye J, Zhang Z, Huan J. A cloud-based consultation and collaboration system for radiotherapy: Remote decision support services for community radiotherapy centers. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107270. [PMID: 36516515 DOI: 10.1016/j.cmpb.2022.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE This study aimed to establish a cloud-based radiotherapy consultation and collaboration system, then investigated the practicability of remote decision support for community radiotherapy centers using the system. METHODS AND MATERIALS A cloud-based consultation and collaboration system for radiotherapy, OncoEvidance®, was developed to provide remote services of LINAC modeling, simulation CT data import/export, target volume and organ-at-risk delineation, prescription, and treatment planning. The system was deployed on a hybrid cloud. A federate of public nodes, each corresponding to a medical institution, are managed by a central node where a group of consultants have registered. Users can access the system through network using computing devices. The system has been tested at three community radiotherapy centers. One accelerator was modeled. 12 consultants participated the remote radiotherapy decision support and 77 radiation treatment plans had been evaluated remotely. RESULTS All the passing rates of per-beam dose verification are > 94% and all the passing rates of composite beam dose verification are > 99%. The average downloading time for one set of simulation CT data for one patient from Internet was within 1 min under the cloud download bandwidth of 8 Mbps and local network bandwidth of 100 Mbps. The average response time for one consultant to contour target volumes and make prescription was about 24 h. And that for one consultant to design and optimize a IMRT treatment plan was about 36 h. 100% of the remote plans passed the dosimetric criteria and could be imported into the local TPS for further verification. CONCLUSION The cloud-based consultation and collaboration system saved the travel time for consultants and provided high quality radiotherapy to patients in community centers. The under-staffed community radiotherapy centers could benefit from the remote system with lower cost and better treatment quality control.
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Affiliation(s)
- Yin Zhou
- Evidance Medical Technologies Inc, Suzhou, China.
| | - Binghui Luo
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Jiugao Sang
- Department of Radiation Oncology, Rudong County People's Hospital, Rudong, Nantong, China
| | - Cheng Li
- Homology Medical Technologies Inc. Ningbo, China
| | - Meng Zhu
- Evidance Medical Technologies Inc, Suzhou, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jianrong Dai
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhua Wang
- Ningbo Medical Center, Li Huili Hospital, Ningbo, China
| | - Haibo Chen
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Shuwei Zhai
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Lina Lu
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Hui Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Genhua Yu
- Department of Radiation Oncology, Zhebei Mingzhou Hospital, Huzhou, China
| | - Jin Ye
- Homology Medical Technologies Inc. Ningbo, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jian Huan
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China.
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He J, Wang Q, Hu Q, Li C. Cost-effectiveness analysis of ultra-hypofractionated radiotherapy and conventionally fractionated radiotherapy for intermediate- to high-risk localized prostate cancer. Front Oncol 2023; 12:841356. [PMID: 36713549 PMCID: PMC9883113 DOI: 10.3389/fonc.2022.841356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Background Radiotherapy is an effective curative treatment option for intermediate- to high-risk localized prostate cancer. According to the HYPO-RT-PC trial (ISRCTN45905321), there was no significant difference in 5 years of follow-up in terms of failure-free survival, overall survival, urinary toxicity, and bowel toxicity, while erectile function decreased between ultra-hypofractionated radiotherapy with conventionally fractionated radiotherapy, except that the incidence of urinary toxicity in ultra-hypofractionated radiotherapy was higher at 1 year of follow-up. We evaluated the cost-effectiveness of ultra-hypofractionated radiotherapy and conventionally fractionated radiotherapy for intermediate- to high-risk localized prostate cancer from the Chinese payer's perspective. Methods We developed a Markov model with a 15-year time horizon to compare the cost and effectiveness of ultra-hypofractionated radiotherapy with those of conventionally fractionated radiotherapy for localized intermediate- to high-risk prostate cancer. The outcomes were measured in quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), and willingness-to-pay (WTP). Univariable and probability sensitivity analyses were performed to evaluate the robustness of the Markov model. Results Based on the Markov model, conventionally fractionated radiotherapy yielded 2.32 QALYs compared with 2.14 QALYs in ultra-hypofractionated radiotherapy in China. The cost of ultra-hypofractionated radiotherapy was found to be decreased by about 14% folds ($4,251.04) in comparison with that of conventionally fractionated radiotherapy. The ICER of conventionally fractionated radiotherapy versus that of ultra-hypofractionated radiotherapy was $23,616.89 per QALY in China. The failure-free survival with grade 2 or worse urinary toxicity and the discount rate per annum were the most sensitive parameters utilized in ultra-hypofractionated radiotherapy. The cost-effectiveness acceptability curve showed that conventionally fractionated radiotherapy had 57.7% probability of being cost-effective under the Chinese WTP threshold. Conclusion From the perspective of Chinese payers, ultra-hypofractionated radiotherapy was not a cost-effective strategy compared with conventionally fractionated radiotherapy for patients with localized intermediate- to high-risk prostate cancer. Nevertheless, reduction of the grade 2 or worse urinary toxicity of ultra-hypofractionated radiotherapy could alter the results.
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Affiliation(s)
- Jiaoxue He
- Department of Clinical Medicine, Southwest Medical University, Luzhou Sichuan, China,Department of Oncology, Wenjiang District People’s Hospital, Wenjiang, Chengdu, China
| | - Qingfeng Wang
- Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiancheng Hu
- Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Changlin Li
- Department of Clinical Medicine, Southwest Medical University, Luzhou Sichuan, China,Department of Oncology, the Seventh People’s Hospital, Chengdu, China,*Correspondence: Changlin Li,
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Chen R, Xu Q, Dong B, Hou Z, Zhang Q, Zhang Y, Liu X, Chen Y, Chen M. Characteristics of Global Radiation Therapy Trials Between 2017 and 2022: A Cross-Sectional Study. Int J Radiat Oncol Biol Phys 2023:S0360-3016(22)03698-7. [PMID: 36623606 DOI: 10.1016/j.ijrobp.2022.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Runzhe Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Qingqing Xu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Baiqiang Dong
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China.
| | - Zan Hou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Qun Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Xu Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China.
| | - Yuanyuan Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China.
| | - Ming Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China.
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Deribe L, Addissie A, Girma E, Abraha A, Adam H, Berbyuk Lindström N. Stress and coping strategies among parents of children with cancer at Tikur Anbessa Specialized Hospital paediatric oncology unit, Ethiopia: a phenomenological study. BMJ Open 2023; 13:e065090. [PMID: 36609328 PMCID: PMC9827240 DOI: 10.1136/bmjopen-2022-065090] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study explores sources of stress, conditions that help reduce stress levels and coping strategies among parents of children with cancer receiving chemotherapy at Tikur Anbessa Specialized Hospital (TASH) in Ethiopia. DESIGN A qualitative phenomenological approach was used. SETTING Parents of children receiving chemotherapy at the TASH paediatric oncology unit. PARTICIPANTS Fifteen semistructured in-depth interviews were conducted with nine mothers and six fathers of children with cancer from November 2020 to January 2021. RESULTS Sources of stress related to child's health condition as the severity of the child's illness, fear of treatment side effects and loss of body parts were identified. Parents mentioned experiencing stress arising from limited access to health facilities, long waiting times, prolonged hospital stays, lack of chemotherapy drugs, and limited or inadequate information about their child's disease condition and treatment. Other sources of stress were insufficient social support, stigmatisation of cancer and financial problems. Conditions decreasing parents' stress included positive changes in the child's health, receiving cancer treatment and access to drugs. Receiving counselling from healthcare providers, getting social support and knowing someone who had a positive treatment outcome also helped reduce stress. Coping strategies used by parents were religious practices including prayer, crying, accepting the child's condition, denial and communication with health providers. CONCLUSION The main causes of stress identified by parents of children with cancer in Ethiopia were the severity of their child's illness, expectations of poor treatment outcomes, unavailability of cancer treatment services and lack of social/financial support. Measures that should be considered to reduce parents' stress include providing psycho-oncological care for parents and improving the counselling available to parents concerning the nature of the child's illness, its treatment, diagnostic procedures and treatment side effects. It may also be helpful to establish and strengthen family support groups and parent-to-parent communication, improve the availability of chemotherapy drugs and offer more education on coping strategies.
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Affiliation(s)
- Leul Deribe
- Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aynalem Abraha
- Department of Oncology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Haileyesus Adam
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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In Reply to Chang et al. Int J Radiat Oncol Biol Phys 2023; 115:248-249. [DOI: 10.1016/j.ijrobp.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
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AI-assisted clinical decision making (CDM) for dose prescription in radiosurgery of brain metastases using three-path three-dimensional CNN. Clin Transl Radiat Oncol 2022; 39:100565. [PMID: 36594076 PMCID: PMC9804100 DOI: 10.1016/j.ctro.2022.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/04/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose AI modeling physicians' clinical decision-making (CDM) can improve the efficiency and accuracy of clinical practice or serve as a surrogate to provide initial consultations to patients seeking secondary opinions. In this study, we developed an AI network to model radiotherapy CDM and used dose prescription as an example to demonstrate its feasibility. Materials/Methods 152 patients with brain metastases treated by radiosurgery from 2017 to 2021 were included. CT images and tumor and organ-at-risk (OAR) contours were exported. Eight relevant clinical parameters were extracted and digitized, including age, numbers of lesions, performance status (ECOG), presence of symptoms, arrangement with surgery (pre- or post-surgery radiation therapy), re-treatment, primary cancer type, and metastasis to other sites. A 3D convolutional neural network (CNN) architecture was built using three encoding paths with the same kernel and filters to capture the different image and contour features. Specifically, one path was built to capture the tumor feature, including the size and location of the tumor, another path was built to capture the relative spatial relationship between the tumor and OARs, and the third path was built to capture the clinical parameters. The model combines information from three paths to predict dose prescription. The actual prescription in the patient record was used as ground truth for model training. The model performance was assessed by 19-fold-cross-validation, with each fold consisting of randomly selected 128 training, 16 validation, and 8 testing subjects. Result The dose prescriptions of 152 patient cases included 48 cases with 1 × 24 Gy, 48 cases with 1 × 20-22 Gy, 32 cases with 3 × 9 Gy, and 24 cases with 5 × 6 Gy prescribed by 8 physicians. The AI model prescribed correctly for 124 (82 %) cases, including 44 (92 %) cases with 1 × 24 Gy, 36 (75 %) cases with 1 × 20-22 Gy, 25 (78 %) cases with 3 × 9 Gy, and 19 (79 %) cases with 5 × 6 Gy. Analysis of the failed cases showed the potential cause of practice variations across individual physicians, which were not accounted for in the model trained by the group data. Including clinical parameters improved the overall prediction accuracy by 20 %. Conclusion To our best knowledge, this is the first study to demonstrate the feasibility of AI in predicting dose prescription in CDM in radiation therapy. Such CDM models can serve as vital tools to address healthcare disparities by providing preliminary consultations to patients in underdeveloped areas or as a valuable quality assurance (QA) tool for physicians to cross-check intra- and inter-institution practices.
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Van Christ Manirakiza A, Pfaendler KS. Breast, Ovarian, Uterine, Vaginal, and Vulvar Cancer Care in Low- and Middle-Income Countries. Obstet Gynecol Clin North Am 2022; 49:783-793. [DOI: 10.1016/j.ogc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Burger H, Wyrley-Birch B, Joubert N, Trauernicht CJ, Valentim JM, Groll J, Berz S, Vowles N, Parkes J. Bridging the Radiotherapy Education Gap in Africa: Lessons Learnt from the Cape Town Access to Care Training Programme Over the Past 5 Years (2015-2019). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1662-1668. [PMID: 33928527 PMCID: PMC8084586 DOI: 10.1007/s13187-021-02010-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
The role of radiotherapy (RT) in cancer care is well described, with a clear correlation between access to radiotherapy and overall survival. Cancer mortality rates in Africa are substantially higher than those of the rest of the world, which may be partly attributed to lack of RT access and insufficient human resources. The Access to Care (A2C) Cape Town RT training programme was created in 2014 with the aim of supplementing practical RT training in the region, focusing on clinics moving from 2 to 3D conformal radiotherapy (3DCRT). The programme makes use of hybrid teaching methods, including pre-course e-learning followed by 17 on-site days of free-thinking design exercises, didactic learning, hands-on treatment planning computer sessions (39% of total teaching time), virtual simulation training and departmental demonstration sessions. Email support is offered to all teams for 3 months after each course to develop clinical protocols. Thirteen teams (radiation oncologist, medical physicist and radiation therapy technologist) from Africa attended the course between 2015 and 2019, with additional participants from seven South African and four international centres. E-learning done on the LäraNära training platform was only successful once formal progress tracking was introduced in 2019 (34% vs. 76% test completion rate). Delays between course attendance and initial clinical use of equipment proved to be detrimental to knowledge retention, with some centres having to send a second team for training. The course will be modified for remote teaching in 2021, to make provision for the global changes in travel due to Covid-19.
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Affiliation(s)
- Hester Burger
- Division of Medical Physics, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
| | - Bridget Wyrley-Birch
- Department of Radiation Technology, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Nanette Joubert
- Division of Medical Physics, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Christoph Jan Trauernicht
- Division of Medical Physics, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
- Division of Medical Physics, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
| | | | - Jens Groll
- Varian Medical Systems, Steinhausen, Switzerland
| | - Stefan Berz
- Varian Medical Systems, Steinhausen, Switzerland
| | - Natalia Vowles
- Department of Radiation Technology, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Jeannette Parkes
- Department Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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Faroni L, Ferreira CG, Moraes F, Baldotto C, Zukin M, Aran V, Araujo LH. Real-World Evidence of Health Outcomes Related to Lung Stereotactic Body Radiation Therapy in Brazil. JCO Glob Oncol 2022; 8:e2200061. [PMID: 36351211 PMCID: PMC10166467 DOI: 10.1200/go.22.00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is an effective option for patients with both early-stage and oligometastatic non-small-cell lung cancer (NSCLC). However, data from Latin America are limited. Therefore, the aim of this study was to investigate the real-world outcomes of applying SBRT for lung lesions in a Brazilian institution. METHODS This study investigated a consecutive cohort of patients treated with SBRT for lung lesions (primary and metastasis). The study primary outcome was local control rates per lesion. Secondary outcomes included progression-free survival (PFS), overall survival (OS), and toxicity. RESULTS Between 2015 and 2019, a total of 216 patients received SBRT and were included in the study. The median follow-up was 24.5 months (5-70), primary NSCLC corresponded to 70% (n = 151) and nonprimary lung lesions to 30% (n = 65), respectively. Stage I NSCLC represented 56% (85 of 151) of the NSCLC cohort. The average number of fractions and total dose prescribed was 5 (3-10)/59 Gy (50-62 Gy). For stage I NSCLC (all lesions treated with a biologically effective dose [10] > 100 Gy), 2-year local control, OS, and PFS were 93.4%, 81.6%, and 80.7%, respectively. For stage IV lesions, if biologically effective dose (10) > 100 Gy or < 100 Gy, 2-year local control was 95.8/86.4% (P = .03), 2-year-OS was 81.6/60.5% (P = .006), and 2-year PFS was 38.9/17.9% (P = .10). Late toxicity was observed in 16.2% (n = 35) of the total cases. CONCLUSION Our results indicate that SBRT is effective (high local control and acceptable toxicity) for treating malignant lung lesions in a real-world scenario in Latin America.
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Affiliation(s)
- Lilian Faroni
- Instituto COI de Pesquisa e Ensino, Rio de Janeiro, Brazil.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | | | - Fabio Moraes
- Department of Oncology, Kingston General Hospital Queens University, Ontario, Canada
| | - Clarissa Baldotto
- Instituto COI de Pesquisa e Ensino, Rio de Janeiro, Brazil.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Mauro Zukin
- Instituto COI de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | - Veronica Aran
- Instituto Estadual do Cérebro Paulo Niemeyer (IECPN), Rio de Janeiro, Brazil
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Krishnamurthy R, Mummudi N, Goda JS, Chopra S, Heijmen B, Swamidas J. Using Artificial Intelligence for Optimization of the Processes and Resource Utilization in Radiotherapy. JCO Glob Oncol 2022; 8:e2100393. [PMID: 36395438 PMCID: PMC10166445 DOI: 10.1200/go.21.00393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The radiotherapy (RT) process from planning to treatment delivery is a multistep, complex operation involving numerous levels of human-machine interaction and requiring high precision. These steps are labor-intensive and time-consuming and require meticulous coordination between professionals with diverse expertise. We reviewed and summarized the current status and prospects of artificial intelligence and machine learning relevant to the various steps in RT treatment planning and delivery workflow specifically in low- and middle-income countries (LMICs). We also searched the PubMed database using the search terms (Artificial Intelligence OR Machine Learning OR Deep Learning OR Automation OR knowledge-based planning AND Radiotherapy) AND (list of Low- and Middle-Income Countries as defined by the World Bank at the time of writing this review). The search yielded a total of 90 results, of which results with first authors from the LMICs were chosen. The reference lists of retrieved articles were also reviewed to search for more studies. No language restrictions were imposed. A total of 20 research items with unique study objectives conducted with the aim of enhancing RT processes were examined in detail. Artificial intelligence and machine learning can improve the overall efficiency of RT processes by reducing human intervention, aiding decision making, and efficiently executing lengthy, repetitive tasks. This improvement could permit the radiation oncologist to redistribute resources and focus on responsibilities such as patient counseling, education, and research, especially in resource-constrained LMICs.
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Affiliation(s)
- Revathy Krishnamurthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jayant Sastri Goda
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ben Heijmen
- Division of Medical Physics, Department of Radiation Oncology, Erasmus MC Cancer Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jamema Swamidas
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Turner S, Benstead K, Millar BA, Morris L, Seel M, Leech M, Eriksen JG, Giuliani M. A new wave of leaders: Early evaluation of the interdisciplinary Foundations of Leadership in Radiation Oncology (FLiRO) program. Tech Innov Patient Support Radiat Oncol 2022; 24:94-100. [PMID: 36338012 PMCID: PMC9633739 DOI: 10.1016/j.tipsro.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Effective leadership across all areas of radiation oncology (RO) is vital to fully realise the benefits of radiation therapy in cancer care. We report outcomes of a novel interdisciplinary leadership program designed for RO professionals under a global joint society initiative. METHODS The Foundations of Leadership in RO (FLiRO) program was designed for aspiring RO leaders. Initially delivered in a blended learning format, it was adapted to fully virtual in 2021. It comprised a webinar tutorial, on-line modules and homework followed by 'live' in-person/virtual workshops over an approximately 6-week period. Topics included personal awareness, effective teamwork, quality improvement skills, leading change and conflict management. An immediate post-program online survey was performed using Likert scales to measure self-reported educational value, interaction with others and the likely application of learning to practice. Open comments were invited. RESULTS 170 participants from 36 countries and 6 continents took part from 2018 to 2021 (99 doctors, 36 physicists, 32 radiation therapists/RTTs and 3 others). 141 (83%) participants responded to the post-program survey. Average weightings for responders' views on whether pre-determined learning objectives were met ranged from 4.30 to 4.61 on a 5-point scale (1 = 'not met at all' and 5 = completely met). For the question addressing potential value of learning for application to their workplace, 124 of 130 (95%) of responders indicated that FLIRO would be 'very useful' or 'extremely useful'. CONCLUSION Initial evaluation of the FLiRO program supports its continuation and expansion with ongoing evolution based on emerging evidence around leadership education and participant feedback.
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Affiliation(s)
- Sandra Turner
- Sydney West Radiation Oncology Network, Westmead, NSW, Australia,University of Sydney, Faculty of Health Sciences and Medicine, NSW, Australia,Corresponding author at: Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Hawksbury and Darcy Rds, Westmead NSW 2145, Australia.
| | - Kim Benstead
- Gloucestershire Hospitals NHS Foundation Trust, United Kingdom
| | - Barbara-Ann Millar
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | | | | | - Michelle Leech
- Applied Radiation Therapy Trinity, Trinity St. James’s Cancer Institute, Discipline of Radiation Therapy, Trinity College, Dublin, Ireland
| | - Jesper G Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
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Maluf FC, Zibetti GDM, Paulino E, de Melo AC, Racy D, Ferrigno R, Uson Junior PLS, Ribeiro R, Moretti R, Sadalla JC, Nogueira Rodrigues A, Carvalho FM, Baiocchi G, Callegaro-Filho D, Angioli R. Recommendations for the treatment of vulvar cancer in settings with limited resources: Report from the International Gynecological Cancer Society consensus meeting. Front Oncol 2022; 12:928568. [PMID: 36203438 PMCID: PMC9530794 DOI: 10.3389/fonc.2022.928568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Due to scant literature and the absence of high-level evidence, the treatment of vulvar cancer is even more challenging in countries facing limited resources, where direct application of international guidelines is difficult. Recommendations from a panel of experts convened to address some of these challenges were developed. Methods The panel met in Rio de Janeiro in September 2019 during the International Gynecological Cancer Society congress and was composed of specialists from countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East. The panel addressed 62 questions and provided recommendations for the management of early, locally advanced, recurrent, and/or metastatic vulvar cancer. Consensus was defined as at least 75% of the voting members selecting a particular recommendation, whereas a majority vote was considered when one option garnered between 50.0% and 74.9% of votes. Resource limitation was defined as any issues limiting access to qualified surgeons, contemporary imaging or radiation-oncology techniques, antineoplastic drugs, or funding for the provision of contemporary medical care. Results Consensus was reached for nine of 62 (14.5%) questions presented to the panel, whereas a majority vote was reached for 29 (46.7%) additional questions. For the remaining questions, there was considerable heterogeneity in the recommendations. Conclusion The development of guidelines focusing on areas of the world facing more severe resource limitations may improve medical practice and patient care.
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Affiliation(s)
- Fernando Cotait Maluf
- Hospital BP Mirante, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- *Correspondence: Fernando Cotait Maluf,
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Taylor P, Castilho MS, Marta GN. Cost containment analysis and access to treatment associated with adopting hypofractionated radiation therapy from the Brazilian perspective. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100292. [PMID: 36777322 PMCID: PMC9903585 DOI: 10.1016/j.lana.2022.100292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Estimates show that breast cancer, the leading cause of cancer death in females worldwide, will continue to increase in incidence, highlighting the need for increased treatment capacity. While postoperative radiation therapy (RT) is commonly used to reduce recurrence and mortality, research has shown that moderately hypofractionated radiation therapy (HFRT) and 5-fraction HFRT are equally safe and effective and can reduce treatment costs. This study aimed to compare the cost of conventional RT (50Gy/25), moderately HFRT (40.05Gy/15), and 5-fraction HFRT (26Gy/5) for breast cancer patients in Brazil. Methods The cost of each RT regimen was calculated using the International Atomic Energy Agency's Radiotherapy Cost Estimator Tool. The potential annual savings were then estimated by applying the cost of each regime to the 2020 Brazilian cancer incidence rates. Findings The average costs per patient for 25 fractions, 15 fractions, and 5 fractions are $2,699.20, $1,711.98, and $929.81, respectively. The annual cost savings associated with treating 70% of patients with 15 fraction HFRT and 30% of patients with 5 fraction HFRT as compared to treating all patients with 25 fraction RT is $72,929,315.40. The estimated annual productivity of 1 LINAC machine for 25 fractions, 15 fractions, and 5 fractions is 338, 647, and 1,310 patients, respectively. Interpretation The cost analysis revealed decreased patients' costs and potential for increased EBRT access associated with HFRT in the Brazilian perspective. Funding None.
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Affiliation(s)
- Prince Taylor
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Global Health, McMaster University, Hamilton, ON, Canada
| | - Marcus Simões Castilho
- Division of Radiotherapy, Radiocare - Hospital Felicio Rocho, Belo Horizonte, MG, Brazil
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, SP, Brazil
- Latin America Cooperative Oncology Group (LACOG), Brazil
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Peiris GS, Pawiro SA, Kasim MF, Sheehy SL. Failure modes and downtime of radiotherapy LINACs and multileaf collimators in Indonesia. J Appl Clin Med Phys 2022; 24:e13756. [PMID: 36001392 PMCID: PMC9859980 DOI: 10.1002/acm2.13756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND PURPOSE The lack of equitable access to radiotherapy (RA) linear accelerators (LINACs) is a substantial barrier to cancer care in low- and middle-income countries (LMICs). These nations are expected to bear up to 75% of cancer-related deaths globally by 2030. State-of-the-art LINACs in LMICs experience major issues in terms of robustness, with mechanical and electrical breakdowns resulting in downtimes ranging from days to months. While existing research has identified the higher failure frequency and downtimes between LMICs (Nigeria, Botswana) compared to high-income countries (HICs, the UK), there has been a need for additional data and study particularly relating to multileaf collimators (MLCs). MATERIALS AND METHODS This study presents for the first time the analysis of data gathered through a dedicated survey and workshop including participants from 14 Indonesian hospitals, representing a total of 19 LINACs. We show the pathways to failure of radiotherapy LINACs and frequency of breakdowns with a focus on the MLC subsystem. RESULTS This dataset shows that LINACs throughout Indonesia are out of operation for seven times longer than HICs, and the mean time between failures of a LINAC in Indonesia is 341.58 h or about 14 days. Furthermore, of the LINACs with an MLC fitted, 59 . 02 - 1.61 + 1.98 $59.02_{ - 1.61}^{ + 1.98}$ % of all mechanical faults are due to the MLC, and 57 . 14 - 1.27 + 0.78 $57.14_{ - 1.27}^{ + 0.78}$ % of cases requiring a replacement component are related to the MLC. CONCLUSION These results highlight the pressing need to improve robustness of RT technology for use in LMICs, highlighting the MLC as a particularly problematic component. This work motivates a reassessment of the current generation of RT LINACs and demonstrates the need for dedicated efforts toward a future where cancer treatment technology is robust for use in all environments where it is needed.
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Affiliation(s)
| | - Supriyanto Ardjo Pawiro
- Department of Physics, Faculty of Mathematics and Natural SciencesUniversitas IndonesiaDepok CityIndonesia
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Maitre P, Krishnatry R, Chopra S, Gondhowiardjo S, Likonda BM, Hussain QM, Zubizarreta EH, Agarwal JP. Modern Radiotherapy Technology: Obstacles and Opportunities to Access in Low- and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2100376. [PMID: 35839434 PMCID: PMC9812473 DOI: 10.1200/go.21.00376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Low- and middle-income countries (LMICs) have a large burden of cancer with differential population needs and outcomes compared to high-income countries. Access to radiotherapy, especially modern technology, is a major challenge. Modern radiotherapy has been demonstrated with better utility in overall cancer outcomes. We deliberate various challenges and opportunities unique to LMICs' set up for access to modern radiotherapy technology in the light of discussions and deliberations made during the recently concluded annual meeting of Tata Memorial Centre, India. We take examples available from various LMICs in this direction in our manuscript.
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Affiliation(s)
- Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India,Rahul Krishnatry, MD, Department of Radiation Oncology, Tata Memorial Hospital, Ernst Borges Rd, Parel, Mumbai 400012, India; e-mail:
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Soehartati Gondhowiardjo
- Department of Radiation Oncology, Faculty of Medicine of Indonesia,Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Beda Mnamala Likonda
- Bugando Medical Centre, Catholic University of Health Sciences, Nyamagana, Mwanza, Tanzania
| | | | - Eduardo H. Zubizarreta
- Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
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System-level capacity of high dose rate (HDR) brachytherapy for management of cervical cancer in an upper middle-income country: a case study from Brazil. Int J Radiat Oncol Biol Phys 2022; 114:545-553. [PMID: 35779808 DOI: 10.1016/j.ijrobp.2022.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/20/2022] [Accepted: 06/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ensuring optimal access to radiotherapy (RT) facilities is challenging for many countries. External beam RT and brachytherapy (BCT) are required to treat advanced cervical cancer. In this analysis, we evaluate the system-level capacity of brachytherapy in Brazil and its relationship with access to complete cervix cancer radiation treatment with both external beam radiotherapy and BCT. METHODOLOGY We used official government reports to compile data on BCT and Linear accelerator (LINAC) numbers, geographic distribution and coverage, cervical cancer annual incidence, and prevalence in Brazil. We also evaluated changes in national BCT capacity between 2001 and 2021. The 2020 relationship between cervical cancer cases for RT per BCT unit, LINAC per BCT unit, and the LINAC supply for each Brazilian state and region were evaluated. For comparison, the LINAC per BCT unit ratio in Brazil was compared with Europe using International Atomic Energy Agency data. RESULTS 85% (23/27) of Brazilian states have at least one brachytherapy unit; nationally, there are 117 cervical cancer cases for RT per BCT unit. Compared with the benchmark of 200 cervical cancer cases per BCT device per year, there are enough BCT units to fill capacity in Brazil nationally and regionally. The ratio of total cervix cancer cases per BCT unit decreased substantially over time from 142 in 2013 to 117 in 2021 (p<0.0001). Nationally, there are 252 LINAC units in the public system with a ratio of 1,985 new cancer cases/LINAC. Brazilian regions have a LINAC shortage ranging from 15 to 141 units. There were 2.55 LINACs per BCT unit in Brazil, compared with 3.25 in Europe (p=0.012). CONCLUSION Over 20 years, BCT capacity in Brazil has increased to meet the cervical cancer demand. However, the LINAC shortage has persisted over the decades, impacting the access to complete treatment and possibly the oncological outcomes. These data can help organize the patient treatment flow, avoid treatment delays, and improve survival.
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