1
|
Baumann M, Bacchus C, Aznar MC, Coppes RP, Deutsch E, Georg D, Haustermans K, Hoskin P, Krause M, Lartigau EF, Lee AWM, Löck S, Offersen BV, Thwaites DI, van der Heide UA, Valentini V, Overgaard J. Clinical research for global needs of radiation oncology. Radiother Oncol 2024; 190:110076. [PMID: 38157941 DOI: 10.1016/j.radonc.2023.110076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
| | - Carol Bacchus
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, United Kingdom
| | - Rob P Coppes
- Departments of Radiation Oncology and Biomedical Sciences of Cells & Systems, Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Eric Deutsch
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, France
| | - Dietmar Georg
- Division Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna/AKH, Wien, Austria
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Peter Hoskin
- Mount Vernon Cancer Centre and University of Manchester, United Kingdom
| | - Mechthild Krause
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany
| | - Eric F Lartigau
- Academic Department of Radiotherapy, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong - Shenzhen Hospital and University of Hong Kong, China
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - David I Thwaites
- Institute of Medical Physics, School of Physics, The University of Sydney, Australia; Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, United Kingdom
| | - Uulke A van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| |
Collapse
|
2
|
Mailhot Vega RB, Garcia Robles BE, Morris CG, Buss K, Mejia U, Poitevin A, Chilaca Rosas MF, Perez Villanueva H, Felix Leyva JA, Indelicato DJ, De la Mata D. Analysis of the Pediatric Radiotherapy Landscape in Mexico and a Subsequent Educational e-Contouring Intervention. JCO Glob Oncol 2023; 9:e2200372. [PMID: 37384858 PMCID: PMC10497300 DOI: 10.1200/go.22.00372] [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: 11/01/2022] [Revised: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE Mexico and Central America have the highest childhood cancer incidence in the West. Pediatric-specific oncology knowledge contributes to the disparity. We sought to (1) determine the self-identified treatment patterns and needs of Mexican pediatric radiation oncologists and (2) pilot a workshop to improve contouring accuracy. MATERIALS AND METHODS Partnering with local experts and the Sociedad Mexicana de Radioterapeutas (SOMERA), a 35-question survey was designed to ascertain pediatric radiotherapy capacity and distributed through the SOMERA listserv. The most challenging malignancies were selected for workshop. Participants received precontouring and postcontouring homework to assess improvement per the Dice metric. The Wilcoxon sign-rank test was used for comparative statistics. RESULTS Ninety-four radiation oncologists attempted and 79 completed the survey. Forty-four (76%) felt comfortable treating a pediatric patient, and 36 (62%) were familiar with national protocols for pediatric treatment. Most had access to nutrition, rehabilitation, endocrinology, and anesthesia; 14% had access to fertility services and 27% to neurocognitive support; 11% noted no support, and only one respondent had child-life support. The postsurvey contouring workshop was conducted for high-grade glioma, medulloblastoma, and Hodgkin lymphoma. Significant improvements were seen in all target volumes. CONCLUSION We present the first national survey of Mexico's pediatric radiotherapy capacity and Latin American e-contouring educational intervention with preworkshop and postworkshop Dice metrics, noting statistically significant improvement in all target volumes. Participation improved compared with prior experience through SOMERA partnership and Continuing Medical Education incentivization.
Collapse
Affiliation(s)
- Raymond B. Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | | | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - Kara Buss
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - Ulises Mejia
- Instituto Nacional de Cancerología, Hospital Infantil de México, Ciudad de México, México
| | | | | | | | | | - Daniel J. Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | | |
Collapse
|
3
|
Eriksen JG, Boldrini L, Gershkevitsh E, Guckenberger M, van der Heide U, Heijmen B, Joiner M, Nout R, Pruschy M, Rasch C, Tan LT, Verellen D, Vozenin MC, Palmu M, La Porta L, Gasparotto C. Postgraduate education in radiation oncology during the COVID-19 pandemic - What did we learn? Tech Innov Patient Support Radiat Oncol 2022; 24:73-77. [PMID: 36247369 PMCID: PMC9554011 DOI: 10.1016/j.tipsro.2022.09.008] [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: 06/24/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction During the COVID-19 pandemic the ESTRO School who provides international non-profit postgraduate education in Radiation Oncology and related disciplines, including Medical Physics and Radiation Technology, had to close down all live educational activities and turn online, although having only limited experience. The paper describes the experience, discusses the limitations and benefits of online education and suggests directions for the future. Materials and methods Data about format and feedback from attendees and faculty members from the course activities held in 2019, 2020 and 2021 were made available from the ESTRO School. Results In 2020, all but two out of thirty live courses that happened before the lockdown were canceled. Among the 18 courses scheduled in the second half of the year, seven went online with a short notice. Each course planned their activities quite differently, from compressed courses with consecutive full days online program to courses over several weeks with a few hours online a week. Both numbers of participants and different nationalities were higher than live courses in 2019 for the seven courses happening online, and courses were well evaluated by participants and faculties. Roughly-one-third of participants would prefer online courses in the future. Discussion Although online education was well received by the majority, pros and cons exist and especially the personal discussions and networking were missed. Online education and live education are not comparable but can complement each other. Careful balancing these activities in the future is important and strategies for online andragogy are needed.
Collapse
Affiliation(s)
- Jesper Grau Eriksen
- Corresponding author at: Dept of Experimental Clinical Oncology, Aarhus University Hospital, C108, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Yeoh K, Gray A. Health Economics and Cancer Care. Clin Oncol (R Coll Radiol) 2022; 34:e377-e382. [PMID: 35781405 DOI: 10.1016/j.clon.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/17/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- K Yeoh
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - A Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Willingness to pay for high-quality remote radiation oncology training in Latin America. Crit Rev Oncol Hematol 2021; 169:103546. [PMID: 34848367 DOI: 10.1016/j.critrevonc.2021.103546] [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: 06/30/2021] [Revised: 10/13/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
Access to high-quality continuing medical education, particularly in Radiation Oncology, can be challenging in some developing countries due to economic barriers. Despite the current offer of free-access self-educational material, end user training faces a backlog still difficult to overcome. The purpose of this investigation is to report the willingness-to-pay profile of practitioners in Latin America, as a surrogate of quality perception of remote educational resources. Related factors include professional experience and baseline practice confidence levels. Most of practitioners would cover their own expenses, while an increased tendency in less-experienced professionals was observed. However, baseline knowledge confidence levels were not influential in decision making. This report contributes to better know the profile of Latin American professionals, in order to design future educational interventions in the region and bridging the current accessibility gap.
Collapse
|
6
|
Ige TA, Jenkins A, Burt G, Angal-Kalinin D, McIntosh P, Coleman CN, Pistenmaa DA, O'Brien D, Dosanjh M. Surveying the Challenges to Improve Linear Accelerator-based Radiation Therapy in Africa: a Unique Collaborative Platform of All 28 African Countries Offering Such Treatment. Clin Oncol (R Coll Radiol) 2021; 33:e521-e529. [PMID: 34116903 DOI: 10.1016/j.clon.2021.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/22/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022]
Abstract
Radiation therapy is a critical component for curative and palliative treatment of cancer and is used in more than half of all patients with cancer. Yet there is a global shortage of access to this treatment, especially in Sub-Saharan Africa, where there is a shortage of technical staff as well as equipment. Linear accelerators (LINACs) offer state-of-the-art treatment, but this technology is expensive to acquire, operate and service, especially for low- and middle-income countries (LMICs), and often their harsh environment negatively affects the performance of LINACs, causing downtime. A global initiative was launched in 2016 to address the technology and system barriers to providing radiation therapy in LMICs through the development of a novel LINAC-based radiation therapy system designed for their challenging environments. As the LINAC prototype design phase progressed, it was recognised that additional information was needed from LMICs on the performance of LINAC components, on variables that may influence machine performance and their association, if any, with equipment downtime. Thus, a survey was developed to collect these data from all countries in Africa that have LINAC-based radiation therapy facilities. In order to understand the extent to which these performance factors are the same or different in high-income countries, facilities in Canada, Switzerland, the UK and the USA were invited to participate in the survey, as was Jordan, a middle-income country. Throughout this process, LMIC representatives have provided input on technology challenges in their respective countries. This report presents the method used to conduct this multilevel study of the macro- and microenvironments, the organisation of departments, the technology, the training and the service models that will provide input into the design of a LINAC prototype for a LINAC-based radiation therapy system that will improve access to radiation therapy and thus improve cancer treatment outcomes. It is important to note that new technology should be introduced in a contextual manner so as not to disrupt existing health systems inadvertently, especially with regards to existing staffing, infrastructure and socioeconomic issues. A detailed analysis of data is underway and will be presented in a follow-up report. Selected preliminary results of the study are the observation that LINAC-based facilities in LMICs experience downtime associated with failures in multileaf collimators and vacuum pumps, as well as power instability. Also, that there is a strong association of gross national product per capita with the number of LINACs per population.
Collapse
Affiliation(s)
- T A Ige
- National Hospital Abuja, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | | | - G Burt
- University of Lancaster, Lancaster, UK
| | | | - P McIntosh
- STFC Daresbury Laboratory, Warrington, UK
| | - C N Coleman
- International Cancer Expert Corps, Washington, DC, USA
| | - D A Pistenmaa
- International Cancer Expert Corps, Washington, DC, USA
| | - D O'Brien
- International Cancer Expert Corps, Washington, DC, USA
| | - M Dosanjh
- University of Oxford, Oxford, UK; International Cancer Expert Corps, Washington, DC, USA; CERN, Geneva, Switzerland.
| |
Collapse
|
7
|
Ndlovu N, Ndarukwa S, Nyamhunga A, Musiwa-Mba P, Nyakabau AM, Kadzatsa W, Mushonga M. Education and training of clinical oncologists-experience from a low-resource setting in Zimbabwe. Ecancermedicalscience 2021; 15:1208. [PMID: 33912233 PMCID: PMC8057777 DOI: 10.3332/ecancer.2021.1208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 01/17/2023] Open
Abstract
As the burden of cancer increases worldwide, more so in low- and middle-income countries, one of the greatest challenges is human resource capacity development. Addressing this is critical in reducing the burden of cancer in the African continent. Other challenges include socio-economic demographics and disparities in the overall cancer care. Lack of sufficient numbers of qualified staff has been one of the obstacles in developing adequate and modern cancer treatment centres in Africa. Training in clinical oncology in Zimbabwe was established in 1990 through the collaboration between the Government of Zimbabwe and the WHO as a regional project. The training is offered by the University of Zimbabwe through the established Master of Medicine in Radiotherapy and Oncology (MMed Rad & Onco) postgraduate programme. Regional and local fellows have been trained, yielding more than 20 clinical oncologists over the years, who have initiated cancer treatment facilities in Africa and beyond. They have continued to train others, fulfilling the original WHO programme target of transfer of skills in sub-Saharan Africa. Collaborations with external partners have complemented efforts by the local faculty in addressing deficiencies in training, in areas where experts in the subject are lacking and in supporting nationals working abroad to come and teach newer technologies and techniques. The curriculum continues to evolve from knowledge-based training to competency-based training. However, there is a need to expand the current infrastructure to keep up with changing technology. Clinical oncology training in Zimbabwe continues and remains a regional resource. Emphasis on subspecialising seems to be the next natural step in progression. Strengthening of other disciplines, including surgical oncology and medical physics, would be complementary to the training. The programme is an example of a sustainable initiative born out of collaborative partnership and is sustained by local resources. The greater majority of qualified oncologists have remained in Africa.
Collapse
Affiliation(s)
- Ntokozo Ndlovu
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe.,Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Sandra Ndarukwa
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe.,Sally Mugabe Central Hospital, Harare, Zimbabwe
| | - Albert Nyamhunga
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe.,Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Patience Musiwa-Mba
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe.,Sally Mugabe Central Hospital, Harare, Zimbabwe
| | - Anna Mary Nyakabau
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe.,Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Webster Kadzatsa
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe.,Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | | |
Collapse
|
8
|
Donkor A, Luckett T, Aranda S, Vanderpuye V, Phillips J. Experiences of barriers and facilitators to establishing and sustaining radiotherapy services in low- and middle-income countries: A qualitative study. Asia Pac J Clin Oncol 2020; 16:e74-e85. [PMID: 32030881 DOI: 10.1111/ajco.13310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/07/2020] [Indexed: 01/08/2023]
Abstract
AIMS The factors contributing to the establishment of high-quality radiotherapy services in low- and middle-income countries (LMICs) are poorly understood. The aim was to identify and describe barriers and facilitators to establishing and sustaining high-quality and accessible radiotherapy services in LMICs based on the experience of successful and unsuccessful attempts. METHODS An exploratory-descriptive qualitative study using semistructured telephone interviews was undertaken. Purposive and snowball sampling techniques were used to recruit participants. The World Health Organization Innovative Care for Chronic Conditions Framework informed the interview guide. A constant comparative data analysis approach was adopted. FINDINGS Seventeen participants were interviewed. Ten were working permanently in nine LMICs and seven were permanently employed in four high-income countries. Three themes were developed: committing to a vision of improving cancer care; making it happen and sustaining a safe service; and leveraging off radiotherapy to strengthen integrated cancer care. Identified barriers included lack of political leadership continuity, lack of a coordinated advocacy effort, non-Member State of the IAEA, lack of reliable epidemiological data, lack of a comprehensive budget and lack of local expertise. Facilitators identified included strong political support, vision champion, availability of a regulator, costed cancer control plan, diversified sources of funding, responsible project manager, adoption of evidence-based practice, strategic partnerships, motivation to provide patient-centered care, and availability of supportive technology. CONCLUSIONS Assessing the level of readiness to establish and sustain a radiotherapy service is highly recommended. Future research is recommended to develop a readiness assessment tool for radiotherapy services implementation at LMICs.
Collapse
Affiliation(s)
- Andrew Donkor
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, New South Wales, Australia.,National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Korlebu, Ghana
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Sanchia Aranda
- Faculty of Health, University of Technology Sydney, New South Wales, Australia.,Union for International Cancer Control, Geneva, Switzerland.,Cancer Council Australia, New South Wales, Australia
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Korlebu, Ghana
| | - Jane Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Esho TO, Chung CV, Thompson JU, Dehghanpour M, Sutton JR, Shaitelman SF, Kisling KK, Court LE. Optimization of autogenerated chest-wall radiation treatment plans developed for postmastectomy breast cancer patients in underserved clinics. Med Dosim 2020; 45:102-107. [PMID: 31956001 DOI: 10.1016/j.meddos.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 11/27/2022]
Abstract
Over the past decade, several strides have been made to improve the management of breast cancer in developing countries; however, there are still obstacles present. In the area of radiation therapy, these hurdles include limited access to radiotherapy treatment and scarcity of oncology specialists. In an effort to reduce inequities in cancer care while improving patient outcomes, our research is focused on developing automated postmastectomy radiation therapy (PMRT) plans for breast cancer patients in these underserved communities that can be further improved upon through treatment planning system (TPS) specific optimization guidelines. The automated planning tool utilized algorithms integrated with Varian's Eclipse TPS. The tool created PMRT plans that used monoisocentric tangents and supraclavicular (SCV) fields with a mix of high and low energy photon beams along with field-in-field (FIF) segments. The completed autogenerated PMRT plans were imported into Phillip's Pinnacle 9.10 and Varian's Eclipse 13.6 TPSs to be further improved through manual optimization; the time required to complete this step was measured and assessed. A senior dosimetrist, physicist, and physician evaluated the optimized plans for clinical acceptability. Guidelines were developed for the planning systems that can be implemented by personnel with either limited experience in radiation treatment planning or those with limited time to produce treatment plans. The autogenerated plans in conjunction with our guidelines have shown to significantly reduce the time required to produce a clinically acceptable PMRT plan from approximately 120 ± 60 minutes to just 13 ± 11 (Pinnacle) and 12 ± 7 (Eclipse) minutes, reducing the total uninterrupted treatment planning time by an average of 108 ± 51 minutes. The results from this research indicate that the autogenerated PMRT plans along with the optimization guidelines are a viable option to provide quality and clinically acceptable PMRT plans that are more efficient and consistent for postmastectomy breast cancer patients in severely underserved communities.
Collapse
Affiliation(s)
- Temiloluwa O Esho
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christine V Chung
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Juanita U Thompson
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mahsa Dehghanpour
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jordan R Sutton
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Kelly K Kisling
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Laurence E Court
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| |
Collapse
|
10
|
Mailhot Vega RB, Ishaq OF, Ahmed I, Rene L, Amendola BE, Hu KS. Novel Pilot Curriculum for International Education of Lymphoma Management Using E-Contouring. J Glob Oncol 2019; 4:1-9. [PMID: 30241149 PMCID: PMC6223383 DOI: 10.1200/jgo.2016.008755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The International Lymphoma Radiation Oncology Group (ILROG) published consensus guidelines on the management of Hodgkin disease (HD) and nodal non-Hodgkin lymphoma (NHL), which became the most downloaded articles from International Journal of Radiation Oncology, Biology, and Physics. E-contouring workshops allow for interactive didactic sessions, allowing participants to see case-based contouring in real time. A pilot 1-hour curriculum was developed with the objective of reviewing ILROG guidelines for HD and NHL management with incorporation of e-contouring tools. This represents the first international education intervention in Spanish using e-contouring with a pre- and postintervention questionnaire. METHODS A 1-hour presentation was prepared in Spanish reviewing the ILROG recommendations for HD and NHL. The review was followed by the author's demonstration of contour creation using patients with HD and NHL prepared for the American Society for Radiation Oncology's 2015 e-contouring lymphoma session. A five- question evaluation was prepared and administered before and after intervention. A two-tailed paired t test was performed to evaluate any significant change in test value before and after intervention. RESULTS A total of nine quizzes were collected before and after the intervention. The average test score before the intervention was 75.6%, and the average test score after the intervention was 86.7% ( P = .051). Four students scored 100% on both the pre- and postintervention evaluations, and no student had a decrease in score from pre- to postintervention evaluation. The topic with the lowest score tested dose consideration. CONCLUSION A substantial but nonsignificant improvement in test evaluation was seen with this pilot curriculum. This pilot intervention identified obstacles for truly interactive didactic sessions that, when addressed, can lead to fully developed interactive didactic sessions.
Collapse
Affiliation(s)
- Raymond B Mailhot Vega
- Raymond B. Mailhot Vega, Omar F. Ishaq, Inaya Ahmed, and Kenneth S. Hu, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY; Luis Rene, Centro de Radioterapia, Rosario, Argentina; and Beatriz E. Amendola, Innovative Cancer Institute, Miami, FL
| | - Omar F Ishaq
- Raymond B. Mailhot Vega, Omar F. Ishaq, Inaya Ahmed, and Kenneth S. Hu, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY; Luis Rene, Centro de Radioterapia, Rosario, Argentina; and Beatriz E. Amendola, Innovative Cancer Institute, Miami, FL
| | - Inaya Ahmed
- Raymond B. Mailhot Vega, Omar F. Ishaq, Inaya Ahmed, and Kenneth S. Hu, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY; Luis Rene, Centro de Radioterapia, Rosario, Argentina; and Beatriz E. Amendola, Innovative Cancer Institute, Miami, FL
| | - Luis Rene
- Raymond B. Mailhot Vega, Omar F. Ishaq, Inaya Ahmed, and Kenneth S. Hu, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY; Luis Rene, Centro de Radioterapia, Rosario, Argentina; and Beatriz E. Amendola, Innovative Cancer Institute, Miami, FL
| | - Beatriz E Amendola
- Raymond B. Mailhot Vega, Omar F. Ishaq, Inaya Ahmed, and Kenneth S. Hu, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY; Luis Rene, Centro de Radioterapia, Rosario, Argentina; and Beatriz E. Amendola, Innovative Cancer Institute, Miami, FL
| | - Kenneth S Hu
- Raymond B. Mailhot Vega, Omar F. Ishaq, Inaya Ahmed, and Kenneth S. Hu, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY; Luis Rene, Centro de Radioterapia, Rosario, Argentina; and Beatriz E. Amendola, Innovative Cancer Institute, Miami, FL
| |
Collapse
|
11
|
Dosanjh M, Aggarwal A, Pistenmaa D, Amankwaa-Frempong E, Angal-Kalinin D, Boogert S, Brown D, Carlone M, Collier P, Court L, Di Meglio A, Van Dyk J, Grover S, Jaffray D, Jamieson C, Khader J, Konoplev I, Makwani H, McIntosh P, Militsyn B, Palta J, Sheehy S, Aruah S, Syratchev I, Zubizarreta E, Coleman C. Developing Innovative, Robust and Affordable Medical Linear Accelerators for Challenging Environments. Clin Oncol (R Coll Radiol) 2019; 31:352-355. [DOI: 10.1016/j.clon.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/08/2018] [Accepted: 01/15/2019] [Indexed: 12/21/2022]
|
12
|
Swanson M, Ueda S, Chen LM, Huchko MJ, Nakisige C, Namugga J. Evidence-based improvisation: Facing the challenges of cervical cancer care in Uganda. Gynecol Oncol Rep 2018; 24:30-35. [PMID: 29892691 PMCID: PMC5993527 DOI: 10.1016/j.gore.2017.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/04/2017] [Accepted: 12/28/2017] [Indexed: 12/15/2022] Open
Abstract
There is significant disparity in the prevalence of cervical cancer globally, with low- and middle-income countries (LMICs) shouldering a disproportionate share of disease incidence and an even greater proportion of morbidity and mortality. Available resources for diagnosis, treatment and palliation of cervical cancer are inversely related to per capita income. While prevention and screening remain public health priorities, given the large number of women affected by cervical cancer, expanding treatment capacity should be included in any evidence-based intervention plan. Uganda, a country with a high incidence of cervical cancer, serves as a representative case study in terms of the challenges of diagnosis and access to treatment in sub-Saharan Africa. Providers and patients in Uganda are challenged by late presentation to care, limited training opportunities, cost-prohibitive diagnostic studies, insufficient access to gold-standard treatment, and under-utilized palliative care services. This review highlights the ways in which Uganda's experience is typical of the continent at large, as well as areas where Uganda is unique. We describe the ways in which a small but dedicated group of gynecologists carefully use limited evidence and available resources creatively to provide the best possible care for their patients. We show that improvisation, albeit evidence-based, is central to the nature and success of oncology care in Africa (Livingston, 2012). We argue that a "recalibrated global response" (Farmer et al., 2010), particularly stressing the expansion of radiotherapy capabilities, could dramatically improve cancer care and outcomes for women in Uganda as well as in LMICs globally.
Collapse
Affiliation(s)
- Megan Swanson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States
| | - Stefanie Ueda
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States
| | - Lee-may Chen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States
| | - Megan J. Huchko
- Department of Obstetrics and Gynecology, Duke Global Health Institute, United States
| | - Carol Nakisige
- Division of Gynaecologic Oncology, Uganda Cancer Institute, Makerere University College for Health Sciences School of Medicine, United States
| | - Jane Namugga
- Division of Gynaecologic Oncology, Mulago National Referral Hospital, Makerere University College for Health Sciences School of Medicine, Uganda
| |
Collapse
|
13
|
Parkes J, Hess C, Burger H, Anacak Y, Ahern V, Howard SC, Elhassan M, Ahmed S, Ghalibafian M, Abbasi AN, Qureshi BM, Zaghloul M, Zubizarreta E, Bey P, Davidson A, Bouffet E, Esiashvili N. Recommendations for the treatment of children with radiotherapy in low- and middle-income countries (LMIC): A position paper from the Pediatric Radiation Oncology Society (PROS-LMIC) and Pediatric Oncology in Developing Countries (PODC) working groups of the International Society of Pediatric Oncology (SIOP). Pediatr Blood Cancer 2017; 64 Suppl 5. [PMID: 29297617 DOI: 10.1002/pbc.26903] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023]
Abstract
Pediatric radiotherapy is a critical part of pediatric oncology protocols and the quality of the radiotherapy may determine the future quality of life for long-term survivors. Multidisciplinary team decision making provides the basis for high-quality care. However, delivery of high-quality radiotherapy is dependent on resources. This article provides guidelines for delivery of good quality radiation therapy in resource-limited countries based on rational procurement and maintenance planning, protocol development, three-dimensional planning, quality assurance, and adequate staff numbers and training.
Collapse
Affiliation(s)
- Jeannette Parkes
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Clayton Hess
- Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Hester Burger
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Yavuz Anacak
- Ege University School of Medicine, Izmir, Turkey
| | - Verity Ahern
- Crown Princess Cancer Center, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Scott C Howard
- University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Moawia Elhassan
- National Cancer Institute, University of Gezira, Wad Medani, Sudan
| | - Soha Ahmed
- Children's Cancer Hospital Egypt (CCHE), National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mithra Ghalibafian
- MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC), Tehran, Iran
| | | | | | - Mohamed Zaghloul
- Children's Cancer Hospital Egypt (CCHE), National Cancer Institute, Cairo University, Cairo, Egypt
| | | | | | - Alan Davidson
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Natia Esiashvili
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
14
|
Karim M, Nadeem Abbasi A, Ali N, Hafiz A, Qureshi B, Mir B. Postgraduate Training in a Low- and Middle-income Country: Sharing Experience from a Joint Commission International Accreditation-accredited University Hospital. Clin Oncol (R Coll Radiol) 2017; 29:636-637. [DOI: 10.1016/j.clon.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 04/25/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
|