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Alhajahjeh A, Hmeidan M, Abdulelah AA, Al-Nezaa I, Al-Abbadi F, Dobbs RW, Sater ZA, Al Awamlh BAH, Lee DI, Shahait M. Factors affecting the non-publication of clinical trials of prevalent urological cancer. World J Urol 2024; 42:426. [PMID: 39037516 DOI: 10.1007/s00345-024-05135-6] [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: 03/07/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVES Clinical trials (CTs) are critical in understanding and managing cancer. However, despite being completed, CT results are often unpublished, compromising the ability to glean useful information from them. This study aimed to evaluate factors influencing the non-publication of urological oncology clinical trials. METHODOLOGY We conducted a comprehensive search of ClinicalTrials.gov to identify CTs focused on urological cancers completed between 2000 and 2020. We used the National Clinical Trial (NCT) identifier number to check whether the trial was published. RESULTS 9,145 oncology CTs were conducted between 2000 and 2020, of which 8.39% (n = 767) focused on urological cancers, and 47.2% (n = 362) of these trials remained unpublished. Univariable analysis revealed that trials with a sample size of less than 50 and phase 4 were significantly associated with non-publication p < 0.001. In contrast, trials involving triple masking, a higher number of agents, and those conducted in High-Income Countries were associated with a higher likelihood of publication p < 0.05. Multivariable analysis demonstrated that trials enrolling more than 50 patients and employing three or more agents, along with triple and quadruple masking, had higher odds of being published (OR = 1.62; 95%CI (1.22-2.16), 1.89; 95%CI (1.10-3.27), 3.04; 95%CI (1.44-6.44), 5.62; 95%CI (1.72-18.37), and 5.41; 95%CI (1.76-16.67), p < 0.05, respectively). However, trials conducted in low-middle-income Countries had lower odds of publication (OR = 0.26; 95%CI (0.08-0.87), p = 0.02). CONCLUSION We found that almost one-half (47.2%) of all completed urologic oncology clinical trials are not published in a PubMed-indexed journal. This non-publication rate represents a significant loss of scientific knowledge and progress. We identified several key variables including sample size.
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Affiliation(s)
- Abdulrahman Alhajahjeh
- Department of Internal Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
- School of Medicine, University of Jordan, Amman, Jordan
| | | | - Ahmed A Abdulelah
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | | | - Faris Al-Abbadi
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | | | - Zahi Abdul Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- College of Public Health, Phoenicia University, Mazraat El Daoudiyeh, Lebanon
| | | | - David I Lee
- Department of Urology, University of California, Irvine Medical Center, Irvine, CA, UK
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Abdel-Wahab M, Coleman CN, Eriksen JG, Lee P, Kraus R, Harsdorf E, Lee B, Dicker A, Hahn E, Agarwal JP, Prasanna PGS, MacManus M, Keall P, Mayr NA, Jereczek-Fossa BA, Giammarile F, Kim IA, Aggarwal A, Lewison G, Lu JJ, Guedes de Castro D, Kong FMS, Afifi H, Sharp H, Vanderpuye V, Olasinde T, Atrash F, Goethals L, Corn BW. Addressing challenges in low-income and middle-income countries through novel radiotherapy research opportunities. Lancet Oncol 2024; 25:e270-e280. [PMID: 38821101 DOI: 10.1016/s1470-2045(24)00038-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: 11/15/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 06/02/2024]
Abstract
Although radiotherapy continues to evolve as a mainstay of the oncological armamentarium, research and innovation in radiotherapy in low-income and middle-income countries (LMICs) faces challenges. This third Series paper examines the current state of LMIC radiotherapy research and provides new data from a 2022 survey undertaken by the International Atomic Energy Agency and new data on funding. In the context of LMIC-related challenges and impediments, we explore several developments and advances-such as deep phenotyping, real-time targeting, and artificial intelligence-to flag specific opportunities with applicability and relevance for resource-constrained settings. Given the pressing nature of cancer in LMICs, we also highlight some best practices and address the broader need to develop the research workforce of the future. This Series paper thereby serves as a resource for radiation professionals.
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Affiliation(s)
- May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Lee
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ryan Kraus
- Department of Radiation Oncology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Ekaterina Harsdorf
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Becky Lee
- Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA; Department of Radiation Oncology, Summa Health, Akron, OH, USA
| | - Adam Dicker
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ezra Hahn
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, ON, Canada
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Keall
- Image X Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nina A Mayr
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiotherapy, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul, South Korea; Seoul National University, College of Medicine, Seoul, South Korea
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Grant Lewison
- Institute of Cancer Policy, King's College London, London, UK
| | - Jiade J Lu
- Shanghai Proton and Heavy Ion Centre, Fudan University School of Medicine, Shanghai, China
| | | | - Feng-Ming Spring Kong
- Department of Clinical Oncology, HKU-Shenzhen Hospital and Queen Mary Hospital, Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region, China
| | - Haidy Afifi
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Hamish Sharp
- Institute of Cancer Policy, King's College London, London, UK
| | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology and Nuclear Medicine, Korlebu Teaching Hospital, Accra, Ghana
| | | | - Fadi Atrash
- Augusta Victoria Hospital, Jerusalem, Israel
| | - Luc Goethals
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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3
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Petitt Z, Ordonez YT, Kelkar Y, Shakir M, Ott M, Patel Y, Agwu C, Khalafallah AM, Mullikin A, Tang A, Davis J, Ssembatya JM, Choi S, Deng DD, Headley J, Obiga O, Haglund MM, Fuller AT. A Mixed-Methods Assessment of the Feasibility of Conducting Neurosurgical Clinical Research in Uganda. World Neurosurg 2024; 183:e71-e87. [PMID: 38006934 DOI: 10.1016/j.wneu.2023.11.079] [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: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Clinical research is necessary to evaluate neurosurgical interventions, yet clinical trials are conducted less frequently in low- and middle-income countries. Because specific barriers, facilitating factors, and strategies for neurosurgical clinical research in Uganda have not been previously identified, this study evaluated neurosurgical providers' perspectives on clinical research and documentation patterns of neurosurgical variables at Mulago National Referral Hospital. METHODS Retrospective review of 166 neurosurgical patient charts assessed the frequency of documentation of key variables. Twenty-two providers working in neurosurgery participated in 6 focus group discussions with qualitative analysis utilizing the framework method. RESULTS Chart review showed that primary diagnosis (99.4%), pupil light response (97.6%), and computed tomography scan results (93.3%) were documented for most patients. Cranial nerve exam (61.5%), pupil size (69.9%), and time to neurosurgical intervention (45%) were documented less frequently. On average, Glasgow Coma Scale was documented for 86.6% of days hospitalized, while vital signs were documented for 12.3%. In most focus group discussions, participants identified follow-up, financing, recruitment, time, approval, and sociocultural factors as research barriers. Participants described how the current health workforce facilitates successful research. To improve research capacity, suggested strategies focused on research networks, data collection, leadership, participant recruitment, infrastructure, and implementation. CONCLUSIONS At Mulago National Referral Hospital, there was variability in the frequency of documentation of neurosurgical variables, which may impact data collection for future studies. While multiple barriers were identified, sociocultural, financing, and time barriers greatly impacted neurosurgical clinical research. Despite that, identified facilitating factors and strategies could be utilized to support neurosurgical research capacity growth.
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Affiliation(s)
- Zoey Petitt
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA; Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Yesel Trillo Ordonez
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Yuveer Kelkar
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA
| | - Muhammad Shakir
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Aga Khan University Hospital, Karachi, Pakistan
| | - Maura Ott
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Yash Patel
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Chibueze Agwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Pritzker School of Medicine, The University of Chicago Medical Center, Chicago, Illinois, USA
| | - Adham M Khalafallah
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Alexandria Mullikin
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA
| | - Alan Tang
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Jenna Davis
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Joseph Mary Ssembatya
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbararra, Uganda
| | - Shinbe Choi
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; TEACCH Autism Program, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Oscar Obiga
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA; Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA; Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
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Saidu Y, Nchinjoh SC, Adidja A, Besong AF, Netongo PM, Ndom P, Liebermann M. Anticipating and strategizing to address potential bottlenecks during clinical research projects in sub-Saharan Africa: a case for adapting approaches and tools used in the entrepreneurial and development sectors. Trials 2024; 25:105. [PMID: 38310290 PMCID: PMC10837968 DOI: 10.1186/s13063-023-07897-7] [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: 06/20/2023] [Accepted: 12/19/2023] [Indexed: 02/05/2024] Open
Abstract
Many research funders have invested billions of US dollars in building research capacity in sub-Saharan Africa (SSA). Despite these colossal investments, many well-intentioned and designed clinical research projects have either failed to kick off or ended abruptly. Although obstacles to clinical research in SSA are well known, there is limited information on frameworks and tools that can be used to anticipate and avert these systemic bottlenecks, particularly those related to socio-politics. In this paper, we leveraged lessons from entrepreneurs and development experts in harsh and uncertain business environments to develop a framework for anticipating and addressing potential bottlenecks to clinical research in SSA. More so, to illustrate and build a case for this framework, we shared our experience in supporting clinicians and regulators to adopt a point-of-use care tool, the "chemoPAD," to screen for the quality of anticancer medications rapidly and systematically in Cameroon despite resistance from some stakeholders. The critical steps in this framework involve identifying stakeholders, categorizing them based on their potential reactions to the study (adversary, supporters, and indifferents), and developing critical strategies to engage or deal with each stakeholder's reactions, starting with adversaries. This approach may be useful in complex research projects, especially clinical trials, which often involve many stakeholders with different interests and perceptions.
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Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative Inc, PO Box 2664, Yaoundé, Cameroon.
- Institute for Global Health, University of Siena, Siena, Italy.
| | | | - Amani Adidja
- Faculté de Médecine Et de Sciences Biomédicales de L, Université de Yaoundé I (FMSB-UYI), Yaoundé, Cameroon
| | | | | | - Paul Ndom
- Faculté de Médecine Et de Sciences Biomédicales de L, Université de Yaoundé I (FMSB-UYI), Yaoundé, Cameroon
| | - Marya Liebermann
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, South Bend, IN, USA
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Halaseh SA, Al-Karadsheh A, Mukherji D, Alhjahaja A, Farkouh A, Al-Ibraheem A, Gheida IA, Al-Khateeb S, Al-Shamsi H, Shahait M. Prostate cancer clinical trials in low- and middle-income countries. Ecancermedicalscience 2023; 17:1629. [PMID: 38414940 PMCID: PMC10898911 DOI: 10.3332/ecancer.2023.1629] [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: 07/08/2023] [Indexed: 02/29/2024] Open
Abstract
Background Prostate cancer is the second most common form of cancer and a leading cause of cancer-related death in men. In an era of evidence-based medicine, clinical trials play a critical role, and adherence to best practices is crucial in managing complicated and non-communicable diseases, such as prostate cancer. For this reason, extrapolating research conducted in high-income countries (HICs) to low-middle-income countries (LMICs) may lead to incorrect findings or treatment plans for patients in these areas. Unfortunately, clinical trials in LMICs face several challenges in terms of design, funding and recruitment. This study aimed to examine clinical trials on prostate cancer in LMICs, including the scope of these trials, the type of interventions being tested and funding sources. Methods A search of the Cochrane Library Controlled Trials Registry was conducted between January 2010 and June 2021 using keywords including: 'prostate cancer', 'prostate adenocarcinoma' and 'prostate tumour'). The trials were classified into either HICs or LMICs based on the World Bank Atlas classification. A descriptive analysis was performed to determine the characteristics of the trials. Results A total of 3,455 clinical trials for prostate cancer have been conducted globally, with 542 (15.68%) conducted LMICs. Most of these trials (89%) were registered in upper-middle-income countries, with none being conducted in low-income countries. The majority of trials were prospective studies (98.1%), with 65.2% being randomised and 57% being phase III. Of the trials, 48.4% aimed to recruit fewer than 500 participants. The main source of funding was pharmaceutical companies in 78.1% of the cases, followed by institutional funds (16.1%) and public funds (5.8%). At the time of the search query, 74.6% of the trials were inactive, with 37% completed, 5% terminated due to insufficient funding and 75% terminated due to medical inefficacy or poor accrual. The majority of trials (88.2%) were interventional, with only 6% focusing on screening and prevention, and 2% designed for palliative care. Conclusion This study sheds light on the challenges faced in conducting clinical trials for prostate cancer in LMICs. The findings underline the need for improved support from international organisations and pharmaceutical companies to bridge the gaps in prostate cancer research and facilitate collaboration between researchers in LMICs and other countries.
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Affiliation(s)
- Sattam A Halaseh
- Urology Department, Torbay Hospital, Torbay and South Devon NHS Foundation Trust, Newton Rd, Torquay TQ2 7AA, UK
| | - Amro Al-Karadsheh
- General Medicine, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Greetwell Rd, Lincoln LN2 5QY, UK
| | - Deborah Mukherji
- Hematology/Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut 1107 2020, Lebanon
| | | | - Ala’a Farkouh
- American Center for Reproductive Medicine, Cleveland Clinic, 10681 Carnegie Ave, Cleveland, OH 44106, USA
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Centre, Queen Rania Al Abdullah Street, Amman 11941, Jordan
| | - Ibrahim Abu Gheida
- Cleveland Clinic Abu Dhabi LLC, Al Marayyah Island, PO Box 112412, Abu Dhabi, UAE
| | - Sultan Al-Khateeb
- King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia
| | - Humaid Al-Shamsi
- Burjeel Cancer Institute/VPS Oncology UAE, 28th Street, Mohammed Bin Zayed City Abu Dhabi, PO Box 92510, UAE
| | - Mohammed Shahait
- Surgery Department, Clemenceau Medical Center, Dubai Healthcare City Phase 2 - Al Jaddaf, Dubai, UAE
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Cobussen A, Petric P, Wulff CN, Buus S, Spejlborg H, Nielsen SK, Traberg A, Meisner B, Hokland S, Lindegaard JC. Clinical outcomes using a 3D printed tandem-needle-template and the EMBRACE-II planning aims for image guided adaptive brachytherapy in locally advanced cervical cancer. Acta Oncol 2023; 62:1470-1478. [PMID: 37594195 DOI: 10.1080/0284186x.2023.2246642] [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: 05/22/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Extensive local disease or narrow vagina may compromise brachytherapy (BT) in patients with cervical cancer. This is the first study to analyze long-term outcomes of using 3D printed vaginal tandem-needle templates (3DP TNT) for transvaginal insertion of needles in parallel (P) or parallel and oblique (P&O) direction to the tandem. MATERIAL AND METHODS All patients treated with BT using 3DP TNT from 2015-2020 were included. Decision to use a 3DP TNT and preplanning were made after 4-5 weeks of external beam radiotherapy, based on gynecological examination and MRI with a tandem-ring applicator in situ. The TNT was 3D-printed in house consisting of a circular template with P&O holes for guidance of plastic needles and a shaft fitting the uterine tandem. Thus, the radioactive source was never in direct contact with the 3DP TNT. The TNT was 3D printed in a standard or personalized configuration. Planning aims were based on the Embrace II protocol. RESULTS 101 patients (median age of 63 years) were included: 49 with P needles only and 52 with P&O needles. Personalized TNT was used in 19 patients in the P&O group. Performance status (WHO) was > 0 in 48%. FIGO2018 stage III-IV was present in 77%. T-score at diagnosis and BT was 9.1 and 6.3 respectively, with a significantly higher T-score in the P&O compared to P group. The mean high-risk CTV D90 was 93 Gy with no significant difference between the two groups. Three-year local control rates were 85%, 95%, 75% for the overall, P- and P&O group respectively and 68%, 80% and 56% for cancer specific survival. Grade ≥3 treatment related complications were observed in 10 (10%) patients. CONCLUSIONS 3DP TNT for BT in cervical cancer provides successful management of very extensive local disease and/or unfavorable anatomy with the possibility for treatment individualization.
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Affiliation(s)
- Anne Cobussen
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Radiation Oncology, MAASTRO clinic, the Netherlands
| | - Primoz Petric
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Radiation Oncology, Zürich University Hospital, Switzerland
| | | | - Simon Buus
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | | | - Anders Traberg
- Department of Oncology, Aarhus University Hospital, Denmark
| | - Bjarne Meisner
- Department of Oncology, Aarhus University Hospital, Denmark
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Molina-Aguilar C, Robles-Espinoza CD. Tackling the lack of diversity in cancer research. Dis Model Mech 2023; 16:dmm050275. [PMID: 37681401 PMCID: PMC10499025 DOI: 10.1242/dmm.050275] [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] [Indexed: 09/09/2023] Open
Abstract
Despite the clear benefit of studying biological samples from diverse genetic backgrounds and geographical locations, our current knowledge of disease is mostly derived from the study of European-descent individuals. In the cancer field, this is reflected in the poor representation of African and Amerindian/Latino samples in most large public data repositories. This lack of diversity is due to several reasons, but here we focus on (1) the lack of support for studies on non-European populations that are performed in low- and middle-income countries (LMICs), and (2) unequal partnerships between scientists in LMICs and those in high-income countries. We argue that expanding access to research funding, increasing the participation of underrepresented scientists in editorial boards and international conferences, facilitating the publication of studies conducted in these countries, and properly acknowledging LMIC researchers' contributions in publications and grant applications will promote equity for scientists working in LMICs. We envisage that this will translate to more impactful research in these countries, which will include more samples from diverse populations. For the cancer field, this will broaden our understanding of pathomechanisms and may help to improve the treatment of patients from all backgrounds.
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Affiliation(s)
- Christian Molina-Aguilar
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro 76230, Mexico
| | - C. Daniela Robles-Espinoza
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro 76230, Mexico
- Cancer, Ageing and Somatic Mutation, Wellcome Sanger Institute, Hinxton, Cambridgeshire CB10 1SA, UK
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8
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Warrell DA, Williams DJ. Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Lancet 2023; 401:1382-1398. [PMID: 36931290 DOI: 10.1016/s0140-6736(23)00002-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/26/2022] [Accepted: 12/18/2022] [Indexed: 03/16/2023]
Abstract
There is increasing recognition of the public health importance of snakebite envenoming. Worldwide annual incidence is likely to be 5 million bites, with mortality exceeding 150 000 deaths, and the resulting physical and psychological morbidity leads to substantial social and economic repercussions. Prevention through community education by trained health workers is the most effective and economically viable strategy for reducing risk of bites and envenoming. Clinical challenges to effective treatment are most substantial in rural areas of low-resource settings, where snakebites are most common. Classic skills of history taking, physical examination, and use of affordable point-of-care tests should be followed by monitoring of evolving local and systemic envenoming. Despite the profusion of new ideas for interventions, hyperimmune equine or ovine plasma-derived antivenoms remain the only specific treatment for snakebite envenoming. The enormous interspecies and intraspecies complexity and diversity of snake venoms, revealed by modern venomics, demands a radical redesign of many current antivenoms.
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Affiliation(s)
- David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Experimental Medicine Division, John Radcliffe Hospital, Headington, UK.
| | - David J Williams
- Regulation and Prequalification Department, World Health Organization, Geneva, Switzerland
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Burnazovic-Ristic L, Todic A, Maleskic Kapo S, Kusturica J, Kulo Cesic A, Loga-Zec S, Aganovic-Musinovic I, Rakanovic-Todic M. Are We Scared of Clinical Trials if Not Sufficiently Informed and Educated? ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1359-1366. [PMID: 36324330 PMCID: PMC9620834 DOI: 10.2147/amep.s375904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Educational interventions have already been shown to positively affect awareness of clinical trials (CTs) among medical students. We aimed to explore basic knowledge and attitudes about CTs among medical students in terms of educational interventions that should be reflected in their further involvement in performing CTs and their role in raising awareness about CTs. METHODS This cross-sectional, self-report anonymous online survey involved undergraduate medical students of the Medical Faculty University of Sarajevo enrolled in classes held within the Department of Pharmacology and Toxicology in the academic year 2015-2016. To include all accessible subjects for better representation of the whole population, consecutive sampling was applied. RESULTS Among 142 students who completed questionnaire, 50% of them expressed partial or full agreement with the questionnaire statement that they were satisfied with the available information on CTs. Only 38% said they would participate in a CT, 21% would not, while 41% were not sure. Positive correlations were detected for composite subscale scores of agreement with questionnaire statements conveying the student's knowledge about ethical and legal aspects of CTs and their perception about reliability/integrity and impact of CTs on medical practice. CONCLUSION Students have knowledge of the basic design and ethical aspects of CTs. Positive attitudes toward the impact of CTs on medical practice were shown in students of higher years of study, where educational intervention of additional knowledge of CTs was inserted and those students expressed better knowledge of CTs. However, no significant impact was detected between knowledge and willingness to participate in CTs, irrespective of years of study, reflecting the third of students that would participate in CTs. Changes in medical curricula led to the change in students' knowledge and attitudes regarding CTs as well as their involvement in CTs.
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Affiliation(s)
- Lejla Burnazovic-Ristic
- Department of Pharmacology and Toxicology, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Sanita Maleskic Kapo
- Department of Pharmacology and Toxicology, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Jasna Kusturica
- Department of Pharmacology and Toxicology, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Aida Kulo Cesic
- Department of Pharmacology and Toxicology, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Svjetlana Loga-Zec
- Department of Pharmacology and Toxicology, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Maida Rakanovic-Todic
- Department of Pharmacology and Toxicology, Medical Faculty University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Randomised controlled trials in women's health in the last two decades: A meta-review. Eur J Obstet Gynecol Reprod Biol 2022; 278:11-15. [PMID: 36108449 DOI: 10.1016/j.ejogrb.2022.09.001] [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: 07/07/2022] [Revised: 08/22/2022] [Accepted: 09/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Obstetric and gynaecological conditions represent a significant burden of disease, requiring clinical research. We aimed to study trends in the publication of randomised controlled trials (RCTs) in women's health over the last two decades. The primary objective was to describe longitudinal trends in the geographical distribution of RCTs in obstetrics and gynaecology. We also described trends in trial funding, publication sources and separately published trial protocols. STUDY DESIGN RCTs were identified by searching the Web of Science alone, due to the large number of results and descriptive nature of analyses. Using the filter tool, only studies labelled as "Clinical trial" or "Article" were included; all other document types were excluded. Trial protocols were identified and analysed separately. Indexing data were extracted using the Web of Science selection tools. As we aimed simply to describe research trends using a single platform, we did not check for duplicates. No process for data pooling was necessary. Correlation of GDP, funding and number of RCTs was calculated using Pearson's r test. RESULTS We identified 39,071 RCTs. The number of annual publications globally increased from 1,406 in 2001 to 1,979 in 2020. The US (n = 12,479) and the UK (n = 3,745) were responsible for the most RCTs, followed by Italy (n = 2,676) and China (n = 2,338). The largest percentage increase in annual publications was seen in Iran (n = 5 to n = 113, +2,160 %) and the Western Pacific Region (n = 16 to n = 171, +968.8 %). GDP was significantly correlated with the number of published RCTs in 2019 for the 25 most prolific countries (p < 0.001), but not with the proportion of RCTs funded. CONCLUSIONS Despite growing contributions from the Western Pacific and Eastern Mediterranean regions, most RCTs are still produced in a small nucleus of high-income countries. Increased international collaboration may benefit both high- and low-income countries.
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11
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Solidum JGN, Rojo RD, Wo JY, Dee EC. Proton Beam Therapy for Esophageal Cancer. Cancers (Basel) 2022; 14:cancers14164045. [PMID: 36011037 PMCID: PMC9407004 DOI: 10.3390/cancers14164045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Early-stage esophageal cancer is managed surgically, with the addition of radiotherapy for locally advanced disease. Current photon-based radiotherapy results in a high treatment-related complications, due to proximal organ involvement. The anatomic location of the esophagus raises challenges due to the anatomical changes associated with diaphragmatic motion, weight loss, tumor changes, and set-up variability. These propelled the interest in proton beam therapy (PBT), which theoretically offers a reduction in the radiation exposure to healthy neighboring tissues with improvements in the therapeutic ratio. In this review, we present the role of PBT for esophageal cancer, including treatment planning, early clinical comparisons with photon-based techniques, ongoing trials, current challenges, toxicities, and issues of equity and health services. Abstract Early-stage esophageal cancer is often primarily managed surgically, with the addition of radiotherapy for locally advanced disease. However, current photon-based radiotherapy regimens and surgery results in a high incidence of treatment-related cardiac and pulmonary complications due to the involvement of proximal organs at risk. In addition, the anatomic location of the esophagus raises challenges for radiotherapy due to the anatomical changes associated with diaphragmatic motion, weight loss, tumor changes, and set-up variability. These challenges propelled the interest in proton beam therapy (PBT), which theoretically offers a reduction in the radiation exposure to healthy neighboring tissues with improvements in the therapeutic ratio. Several dosimetric studies support the potential advantages of PBT for esophageal cancer treatment however, translation of these results to improved clinical outcomes remains unclear with limited clinical data, especially in large populations. Studies on the effect on quality of life are likewise lacking. Here, we review the existing and emerging role of PBT for esophageal cancer, including treatment planning, early clinical comparisons of PBT with photon-based techniques, recently concluded and ongoing clinical trials, challenges and toxicities, effects on quality of life, and global inequities in the treatment of esophageal cancer.
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Affiliation(s)
- Jea Giezl N. Solidum
- College of Medicine, University of the Philippines Manila, Manila 1000, Metro Manila, Philippines
| | - Raniv D. Rojo
- College of Medicine, University of the Philippines Manila, Manila 1000, Metro Manila, Philippines
| | - Jennifer Y. Wo
- Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom St., Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Correspondence:
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12
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Dodkins J, Hopman WM, Wells JC, Lievens Y, Malik RA, Pramesh CS, Gyawali B, Hammad N, Mukherji D, Sullivan R, Parkes J, Booth CM, Aggarwal A. Is Clinical Research Serving the Needs of the Global Cancer Burden? An Analysis of Contemporary Global Radiation Therapy Randomized Controlled Trials. Int J Radiat Oncol Biol Phys 2022; 113:500-508. [PMID: 35151802 DOI: 10.1016/j.ijrobp.2022.01.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Randomized controlled trials (RCTs) are the cornerstone of delivering sustained improvements in cancer outcome. To inform radiation therapy research policy and prioritization, we analyze the radiation therapy RCT landscape including comparison with trials of systemic therapies over the same period, with a specific focus on funding and disparities across income settings. METHODS AND MATERIALS This retrospective cohort study identified all phase 3 RCTs evaluating anticancer therapies published from 2014 to 2017. RCTs were classified according to anticancer modality and country of origin. Descriptive statistics were used to compare key characteristics of radiation therapy RCT studies according to study design characteristics, tumor types evaluated, types of intervention appraised, treatment intent and main funding sources. RESULTS The study cohort included 694 RCTs of which 64 were radiation therapy RCTs (9%) compared with 601 systemic therapy RCTs (87%). Among all radiation therapy RCTs, 47% of them focused on 2 areas of evaluation: (1) combining radiation therapy with systemic agents (25%) and (2) changes in dose fractionation (22%). The most common cancers studied were head and neck (22%), lung (22%), and breast (14%), with cervical cancer trials representing only 3% of the cohort. Among the radiation therapy RCTs, 33% of them met their primary endpoint, and 62% assessed interventions in the curative setting compared with 31% in systemic therapy RCTs. For their country locations, 77% of radiation therapy RCTs took place in high-income countries, 13% in low-and-middle-income countries, and 11% in both high-income and low-and-middle-income countries. For funding, 17% of radiation therapy RCTs received funding from industry compared with 79% of systemic therapy RCTs. CONCLUSIONS This study highlights the need for greater investment in radiation therapy RCTs and the need to look at the disparities in conducting RCTs globally. The study emphases the urgent need for more capacity building for cancer clinical trials in low-and-middle-income countries and more sustainable funding sources.
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Affiliation(s)
- Joanna Dodkins
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | | | | | - Yolande Lievens
- Ghent University Hospital and Ghent University, Ghent, Belgium
| | - R A Malik
- University of Malaya, Kuala Lumpur, Malaysia
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | | | | | | | | | - Jeannette Parkes
- University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | - Ajay Aggarwal
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
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13
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Dee EC, Eala MAB, Small W, Gaffney DK, Tangco ED, Abdel-Wahab M, Grover S. Equity in Radiation Oncology Trials: from Knowledge Generation to Clinical Translation. Int J Radiat Oncol Biol Phys 2022; 113:511-512. [PMID: 35777396 PMCID: PMC10001240 DOI: 10.1016/j.ijrobp.2022.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - David K Gaffney
- Department of Radiation Oncology, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah
| | - Enrico D Tangco
- Department of Radiation Oncology, The Medical City, Pasig City, Philippines
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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14
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Owusu Sekyere S, Škrnjug-Yudov I, Pinz A, Meyer H, Conrad C. The Pivotal Role of Quality Technical Structures for Clinical Trials Oversight in the Achievement of Long-Term Capacity Strengthening Outcomes. Front Med (Lausanne) 2022; 9:772605. [PMID: 35308508 PMCID: PMC8924119 DOI: 10.3389/fmed.2022.772605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background Development of safe and efficacious medicines in many sub-Sahara African countries remains hampered due to fragmented health research infrastructure and ineffective regulatory oversight. To boost the latter in the area of Clinical Trials (CT) Oversight (CTO), many international programs and Regional Centers for Regulatory Excellence (RCORE) initiatives offer various trainings to help strengthen human resource capacity. Here, we aimed at evaluating the training outcomes (at home-institution level) of sponsored fellows for one of such capacity strengthening interventions; a measure that is less often reported and thus remains poorly understood. Method The Global Health Protection Programme's VaccTrain project sponsored nine regulatory staff from eight National Medicines Regulatory Authorities (NMRAs) in sub-Saharan Africa for the RCORE CT Training Fellowship by FDA Ghana in a particular year. Using a systematized evaluation framework based on the theory of change, we assessed the individual- and NMRA-level achievement of pre-defined training outcomes. For this purpose, data was collected at pre-training and at short- and long-term evaluation time-points using a survey instrument. Results At pre-training, our data revealed existence of differential expectations and orientations among the training participants, thus providing an early indication of potential distinctive patterns in achievement of desired training outcomes. In a short-term post-training follow-up evaluation, a two-group clustering of fellows based on the achievement of training outcomes where only one group (representing 44%) reported achievement of CTO-related outcomes was observed. At this time-point, achievement of training outcomes was associated with the vibrancy of CT activity and existence of a comprehensive technical structure for CTO. In a further long-term follow-up evaluation, our data revealed a successful achievement of CTO-related individual- and/or institutional-level outcomes in all but one fellow. Here again, availability of a robust technical structure for CTO (and perhaps fellow affiliation/selection)–but not CT vibrancy–showed a trend of temporal association with achievement of training outcomes. Conclusion Given the pivotal role operational structures of international standards at home institutions play in translating training-acquired knowledge into measurable CTO-related outcomes, we encourage that capacity strengthening projects aimed at achieving health-related targets of Sustainable Development Goals adopt an approach built on this foundation.
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Affiliation(s)
- Solomon Owusu Sekyere
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany.,RegTrain-VaccTrain of the Global Health Protection Programme (GHPP), Paul-Ehrlich-Institut, Langen, Germany
| | - Ivana Škrnjug-Yudov
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany.,RegTrain-VaccTrain of the Global Health Protection Programme (GHPP), Paul-Ehrlich-Institut, Langen, Germany
| | - Alexander Pinz
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Heidi Meyer
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany.,RegTrain-VaccTrain of the Global Health Protection Programme (GHPP), Paul-Ehrlich-Institut, Langen, Germany.,WHO Collaborating Centre for the Standardization and Evaluation of Vaccines, Paul-Ehrlich-Institut, Langen, Germany
| | - Christoph Conrad
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany.,RegTrain-VaccTrain of the Global Health Protection Programme (GHPP), Paul-Ehrlich-Institut, Langen, Germany.,WHO Collaborating Centre for the Standardization and Evaluation of Vaccines, Paul-Ehrlich-Institut, Langen, Germany
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15
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Shawahna R, Zaid L. Concentrations of antiseizure medications in breast milk of lactating women with epilepsy: A systematic review with qualitative synthesis. Seizure 2022; 98:57-70. [PMID: 35427849 DOI: 10.1016/j.seizure.2022.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Recent position papers and guidelines encourage women with epilepsy (WWE) to exclusively breastfeed their infants because the benefits to their infants outweigh the potential adverse effects caused by exposure to antiseizure medications (ASMs). OBJECTIVE The objectives of this review were: to evaluate concentrations of ASMs in breastmilk of lactating WWE, qualitatively synthesize evidence that can be used to estimate theoretical doses as estimated daily intake (EDI) and relative infant dose (RID) of ASMs, and to evaluate potential risks to infants as a result of exposure to ASMs from breastmilk. METHODS This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42020223645. The databases: MEDLINE/PubMed, EMBASE, CINAHL/EBSCO, COCHRANE, SpringerLink, ScienceDirect, Summon, WHO International Clinical Trials Registry Platform, and SCOPUS were systematically searched. A qualitative synthesis was adopted in this study. RESULTS A total of 15 records were included in this systematic review. The included studies reported levels of 8 ASMs in the breastmilk of WWE. The highest RIDs of carbamazepine, lamotrigine, primidone, phenobarbital, gabapentin, valproic acid, ethosuximide, levetiracetam, and topiramate were 3.70%, 36.33%, 4.96%, 3.15%, 4.37%, 1.90%, 31.49%, 12.50%, and 12.18%, respectively. Breastfeeding might be limited or even discontinued when signs of excessive sedation/drowsiness and/or poor weight gain are evident on infants exposed to primidone and phenobarbital, ethosuximide/primidone, or ethosuximide/phenobarbital. CONCLUSIONS Concentrations of ASMs can be detected in breastmilk of WWE and plasma/serum of infants exposed via breastmilk. Healthcare providers and WWE might use the findings of this study to make informed decisions on the safety of breastfeeding while taking ASMs.
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16
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Stanway S, Lodge M, Sullivan R, Diprose K, Young AM, Crisp N, Lewis P, Eden T, Aggarwal A, Nadin A, Chinegwundoh F, Sirohi B, Byrne G, Cowan R. The UK's contribution to cancer control in low-income and middle-income countries. Lancet Oncol 2021; 22:e410-e418. [PMID: 34478677 DOI: 10.1016/s1470-2045(21)00380-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
Cancer mortality rates in low-income and middle-income countries (LMICs) are unacceptably high, requiring both collaborative global effort and in-country solutions. Experience has shown that working together in policy, clinical practice, education, training, and research leads to bidirectional benefit for LMICs and high-income countries. For over 60 years, the UK National Health Service has benefited from recruitment from LMICs, providing the UK with a rich diaspora of trained health-care professionals with links to LMICs. A grassroots drive to engage with partners in LMICs within the UK has grown from the National Health Service, UK academia, and other organisations. This drive has generated a model that rests on two structures: London Global Cancer Week and the UK Global Cancer Network, providing a high-value foundation for international discussion and collaboration. Starting with a historical perspective, this Series paper describes the UK landscape and offers a potential plan for the future UK's contribution to global cancer control. We also discuss the opportunities and challenges facing UK partnerships with LMICs in cancer control. The UK should harness the skills, insights, and political will from all partners to make real progress.
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Affiliation(s)
| | - Mark Lodge
- UK Global Cancer Network, Manchester, UK; International Network for Cancer Treatment and Research, Oxford, UK
| | | | | | - Annie M Young
- UK Global Cancer Network, Manchester, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Nigel Crisp
- House of Lords, Houses of Parliament, London, UK
| | - Philippa Lewis
- Department of Clinical Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tim Eden
- World Child Cancer, London, UK; School of Medical Sciences, University of Manchester, Manchester, UK
| | - Ajay Aggarwal
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Ged Byrne
- Health Education England Global Engagement, London, UK; Department of Surgery, Manchester NHS Foundation Trust, Manchester, UK
| | - Richard Cowan
- UK Global Cancer Network, Manchester, UK; School of Medical Sciences, University of Manchester, Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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17
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Alghamdi MA, Alghamdi SM, Bahadur YA, Asiri MA, AlHussain HA, Alhebshi AS, Alothman MO, Al-Omair AS, Alghamdi AA, Qanat AS, Aqeeli MO, Alsuhaibani AA, Alshehri SM, Alotain IM, Mail NK, Alhashemi HH, Alassaf HA. Scholarly Activity of Radiation Oncologists in High-Income Developing Countries: Saudi Arabia as an Example. JCO Glob Oncol 2021; 7:378-383. [PMID: 33720748 PMCID: PMC8081503 DOI: 10.1200/go.20.00449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To examine the trends and quality metrics of publications by radiation oncologists in Saudi Arabia. METHODS PubMed was searched using names of all Saudi radiation oncologists to retrieve published articles between January 2010 and December 2019. International collaboration, journal impact factor and country of origin, and number of citations were collected. Each article was assessed for epidemiologic type and independently assigned a level of evidence (LOE) by two authors. The trend in publications was examined and compared in the first and second 5-year periods (2010-2014 and 2015-2019) using relevant parameters. RESULTS A total of 186 publications were found and included. The most common type of research was cohort studies followed by case reports and case series in 24%, 14%, and 13% of all publications, respectively. Dosimetry, clinical, and preclinical studies formed 7%, 8.6%, and 7.5% of the total publications, respectively. The LOE was I, II, III, IV, and not applicable in 8.6%, 22%, 25.8%, 29%, and 14.5% of the included publications, respectively. Comparing the first and second 5-year periods, there was an increase in international collaboration (P < .001) in the second period. The number of citations (P < .001) and journal impact factor (P = .028) were lower in the second period. LOE and publications in international journals were not statistically different between the two periods. CONCLUSION Although radiation oncology research activity in Saudi Arabia has gained momentum in terms of volume and international collaboration over time, the LOE has not improved. This calls for a national effort to make the contribution to the literature a priority, allocate adequate resources, and apply appropriate measures to enhance research productivity and quality.
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Affiliation(s)
- Majed A Alghamdi
- Department of Medicine, College of Medicine, Al Baha University, Al Baha, Saudi Arabia.,Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - Suliman M Alghamdi
- Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Yasir A Bahadur
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mushabbab A Asiri
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hussain A AlHussain
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Adnan S Alhebshi
- Radiation Oncology, Oncology Institute, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Majid O Alothman
- Radiation Oncology, Oncology Institute, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Ameen S Al-Omair
- Radiation Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Ahmed S Qanat
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed O Aqeeli
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah A Alsuhaibani
- Radiation Oncology, University Oncology Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Salem M Alshehri
- Radaition Oncology, Department of Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ibrahim M Alotain
- Radaition Oncology, Department of Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Noor K Mail
- Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Hashem H Alhashemi
- Department of Internal Medicine, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hossam A Alassaf
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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18
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Burt LM, McCormak M, Lecuru F, Kanyike DM, Bvochora-Nsingo M, Ndlovu N, Scott AA, Anorlu RI, Sharma V, Plante M, Nyongesa C, Tigeneh W, Fakie N, Suneja G, Gaffney DK. Cervix Cancer in Sub-Saharan Africa: An Assessment of Cervical Cancer Management. JCO Glob Oncol 2021; 7:173-182. [PMID: 33529076 PMCID: PMC8081497 DOI: 10.1200/go.20.00079] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Underdeveloped nations carry the burden of most cervical cancer, yet access to adequate treatment can be challenging. This report assesses the current management of cervical cancer in sub-Saharan Africa to better understand the needs of underdeveloped nations in managing cervical cancer. METHODS A pre- and postsurvey was sent to all centers participating in the Cervical Cancer Research Network's 4th annual symposium. The pre- and postsurvey evaluated human papillomavirus and HIV screening, resources available for workup and/or treatment, treatment logistics, outcomes, and enrollment on clinical trials. Descriptive analyses were performed on survey responses. RESULTS Twenty-nine centers from 12 sub-Saharan countries saw approximately 300 new cases of cervical cancer yearly. Of the countries surveyed, 55% of countries had a human papillomavirus vaccination program and 30% (range, 0%-65%) of women in each region were estimated to have participated in a cervical cancer screening program. In the workup of patients, 43% of centers had the ability to obtain a positron emission tomography and computed tomography scan and 79% had magnetic resonance imaging capabilities. When performing surgery, 88% of those centers had a surgeon with an expertise in performing oncological surgeries. Radiation therapy was available at 96% of the centers surveyed, and chemotherapy was available in 86% of centers. Clinical trials were open at 4% of centers. CONCLUSION There have been significant advancements being made in screening, workup, and management of patients with cervical cancer in sub-Saharan Africa; yet, improvement is still needed. Enrollment in clinical trials remains a struggle. Participants would like to enroll patients on clinical trials with Cervical Cancer Research Network's continuous support.
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Affiliation(s)
- Lindsay M Burt
- Radiation Oncology Department, University of Utah, Huntsman Cancer Institute, Salt Lake City, UH
| | - Mary McCormak
- University College Hospital London, London, United Kingdom
| | | | | | | | - Ntokozo Ndlovu
- University of Zimbabwe College of Health Sciences, Parirenyatwa Hospital Harare, Harare, Zimbabwe
| | | | - Rose I Anorlu
- University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Vinay Sharma
- Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Park Town, South Africa
| | | | | | | | - Nazia Fakie
- University of Cape Town, Cape Town, South Africa
| | - Gita Suneja
- Radiation Oncology Department, University of Utah, Huntsman Cancer Institute, Salt Lake City, UH
| | - David K Gaffney
- Radiation Oncology Department, University of Utah, Huntsman Cancer Institute, Salt Lake City, UH
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19
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Ranganathan P, Chinnaswamy G, Sengar M, Gadgil D, Thiagarajan S, Bhargava B, Booth CM, Buyse M, Chopra S, Frampton C, Gopal S, Grant N, Krailo M, Langley R, Mathur P, Paoletti X, Parmar M, Purushotham A, Pyle D, Rajaraman P, Stockler MR, Sullivan R, Swaminathan S, Tannock I, Trimble E, Badwe RA, Pramesh CS. The International Collaboration for Research methods Development in Oncology (CReDO) workshops: shaping the future of global oncology research. Lancet Oncol 2021; 22:e369-e376. [PMID: 34216541 PMCID: PMC8328959 DOI: 10.1016/s1470-2045(21)00077-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
Low-income and middle-income countries (LMICs) have a disproportionately high burden of cancer and cancer mortality. The unique barriers to optimum cancer care in these regions necessitate context-specific research. The conduct of research in LMICs has several challenges, not least of which is a paucity of formal training in research methods. Building capacity by training early career researchers is essential to improve research output and cancer outcomes in LMICs. The International Collaboration for Research methods Development in Oncology (CReDO) workshop is an initiative by the Tata Memorial Centre and the National Cancer Grid of India to address gaps in research training and increase capacity in oncology research. Since 2015, there have been five CReDO workshops, which have trained more than 250 oncologists from India and other countries in clinical research methods and protocol development. Participants from all oncology and allied fields were represented at these workshops. Protocols developed included clinical trials, comparative effectiveness studies, health services research, and observational studies, and many of these protocols were particularly relevant to cancer management in LMICs. A follow-up of these participants in 2020 elicited an 88% response rate and showed that 42% of participants had made progress with their CReDO protocols, and 73% had initiated other research protocols and published papers. In this Policy Review, we describe the challenges to research in LMICs, as well as the evolution, structure, and impact of CReDO and other similar workshops on global oncology research.
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Affiliation(s)
- Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Durga Gadgil
- Research Administration Council, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Marc Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium; Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Chris Frampton
- Departments of Medicine and Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA
| | | | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ruth Langley
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Prashant Mathur
- National Centre for Disease Informatics and Research, Bengaluru, India
| | - Xavier Paoletti
- University of Versailles Saint-Quentin-en-Yvelines, Versailles, France; Department of Biostatistics, Institut Curie, Saint-Cloud, France; Department of Statistics for Precision Medicine, INSERM U900, Paris, France
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Douglas Pyle
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - Preetha Rajaraman
- US Department of Health and Human Services, Washington, DC, USA; US Embassy, New Delhi, India
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Ian Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Edward Trimble
- Office of the Director, National Cancer Institute, NIH, US Department of Health and Human Services, Washington, DC, USA
| | - Rajendra A Badwe
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - C S Pramesh
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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20
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Myers B, van der Westhuizen C, Pool M, Hornsby N, Sorsdahl KR. Responding to COVID-19 threats to trial conduct: lessons learned from a feasibility trial of a psychological intervention for South African adolescents. Trials 2021; 22:440. [PMID: 34243806 PMCID: PMC8267766 DOI: 10.1186/s13063-021-05400-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023] Open
Abstract
The COVID-19 pandemic has posed challenges to the conduct of clinical trials. Strategies for overcoming common challenges to non-COVID-19 trial continuation have been reported, but this literature is limited to pharmacological intervention trials from high-income settings. The purpose of this paper is to expand the literature to include a low- and middle-income country perspective. We describe the challenges posed by COVID-19 for a randomised feasibility trial of a psychological intervention for adolescents in Cape Town, South Africa, and lessons learned when implementing strategies to facilitate trial continuation in this context. We used a Plan-Do-Study-Act cycle method to explore whether our adaptations were having the desired effect on trial accrual and retention. We found that stakeholder engagement, trial coordination and team communication need to be intensified while testing these procedural changes. We learned that strategies found to be effective in high-income countries required significant adaptation to our resource-constrained setting. The detailed documentation of extraneous influences, procedural changes and trial process information was essential to guiding decisions about which adaptations to retain. This information will be used to examine the potential impact of these changes on study outcomes. We hope that these reflections will be helpful to other trialists from low- and middle-income countries grappling with how to minimise the impact of public health emergencies on their research. TRIAL REGISTRATION: The trial is registered with the Pan African Clinical Trials Registry (PACTR20200352214510). Registered 28 February 2020. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9795 .
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa. .,Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia. .,Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Claire van der Westhuizen
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Megan Pool
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nancy Hornsby
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa
| | - Katherine R Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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21
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Spierings ELH, Kärppä M, Ning X, Cohen JM, Campos VR, Yang R, Reuter U. Efficacy and safety of fremanezumab in patients with migraine and inadequate response to prior preventive treatment: subgroup analyses by country of a randomized, placebo-controlled trial. J Headache Pain 2021; 22:26. [PMID: 33863272 PMCID: PMC8052719 DOI: 10.1186/s10194-021-01232-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/15/2021] [Indexed: 01/03/2023] Open
Abstract
Background The FOCUS study evaluated the efficacy of migraine preventive medications across different countries within the same patient population, particularly for patients with difficult-to-treat migraine. These prespecified subgroup analyses evaluated efficacy by country in the FOCUS study of fremanezumab in adults with episodic migraine or chronic migraine and documented inadequate response to 2 to 4 migraine preventive medication classes. Methods Overall, 838 participants were enrolled in the FOCUS study, a randomized, double-blind, placebo-controlled, parallel-group, phase 3b study performed at 104 sites. For 12 weeks of double-blind treatment, patients were randomized (1:1:1) to quarterly fremanezumab, monthly fremanezumab, or matched placebo. The primary efficacy endpoint was the mean change from baseline in monthly average migraine days over 12 weeks of double-blind treatment, evaluated by country in these subgroup analyses. Results Of 14 countries contributing data, the Czech Republic (n = 188/838; 22%), the United States (n = 120/838; 14%), and Finland (n = 85/838; 10%) enrolled the most patients. Changes from baseline in monthly average migraine days over 12 weeks were significantly greater with fremanezumab versus placebo for patients in these countries: Czech Republic (least-squares mean difference versus placebo [95% confidence interval]: quarterly fremanezumab, − 1.9 [− 3.25, − 0.47]; P = 0.009; monthly fremanezumab, − 3.0 [− 4.39, − 1.59]; P < 0.001), the United States (quarterly fremanezumab, − 3.7 [− 5.77, − 1.58]; P < 0.001; monthly fremanezumab, − 4.2 [− 6.23, − 2.13]; P < 0.001), and Finland (quarterly fremanezumab, − 3.0 [− 5.32, − 0.63]; P = 0.014; monthly fremanezumab, − 3.9 [− 6.27, − 1.44]; P = 0.002). Results were comparable for the remaining 9 countries, with the least-squares mean difference versus placebo ranging from – 5.6 to – 2.4 with quarterly fremanezumab and from − 5.3 to − 1.5 with monthly fremanezumab. Incidences of serious adverse events and adverse events leading to discontinuation were low and comparable across countries and treatment groups. Conclusions Monthly and quarterly fremanezumab significantly reduced the monthly average number of migraine days versus placebo regardless of country and continent (North America versus Europe) in migraine patients with documented inadequate response to 2 to 4 migraine preventive medication classes. Trial registration ClinicalTrials.gov Identifier: NCT03308968. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01232-8.
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Affiliation(s)
| | - Mikko Kärppä
- Research Unit of Clinical Neuroscience, University of Oulu and Medical Research Center, Oulu University Hospital, P.O. Box 8000, Oulu, FI-90014, Finland
| | - Xiaoping Ning
- Teva Pharmaceutical Industries, Inc., 145 Brandywine Pkwy, West Chester, PA, 19380, USA
| | - Joshua M Cohen
- Teva Pharmaceutical Industries, Inc., 145 Brandywine Pkwy, West Chester, PA, 19380, USA
| | - Verena Ramirez Campos
- Teva Pharmaceutical Industries, Inc., 145 Brandywine Pkwy, West Chester, PA, 19380, USA
| | - Ronghua Yang
- Teva Pharmaceutical Industries, Inc., 145 Brandywine Pkwy, West Chester, PA, 19380, USA
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin, Charitépl. 1, 10117, Berlin, Germany
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22
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Wells JC, Sharma S, Del Paggio JC, Hopman WM, Gyawali B, Mukherji D, Hammad N, Pramesh CS, Aggarwal A, Sullivan R, Booth CM. An Analysis of Contemporary Oncology Randomized Clinical Trials From Low/Middle-Income vs High-Income Countries. JAMA Oncol 2021; 7:379-385. [PMID: 33507236 DOI: 10.1001/jamaoncol.2020.7478] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance The burden of cancer falls disproportionally on low-middle-income countries (LMICs). It is not well known how novel therapies are tested in current clinical trials and the extent to which they match global disease burden. Objectives To describe the design, results, and publication of oncology randomized clinical trials (RCTs) and examine the extent to which trials match global disease burden and how trial methods and results differ across economic settings. Design, Setting, and Participants In this retrospective cohort study, a literature search identified all phase 3 RCTs evaluating anticancer therapies published from 2014 to 2017. Randomized clinical trials were classified based on World Bank economic classification. Descriptive statistics were used to compare RCT design and results from high-income countries (HICs) and low/middle-income countries (LMICs). Statistical analysis was conducted in January 2020. Main Outcomes and Measures Differences in the design, results, and output of RCTs between HICs and LMICs. Results The study cohort included 694 RCTs: 636 (92%) led by HICs and 58 (8%) led by LMICs. A total of 601 RCTs (87%) tested systemic therapy and 88 RCTs (13%) tested radiotherapy or surgery. The proportion of RCTs relative to global deaths was higher for breast cancer (121 RCTs [17%] and 7% of deaths) but lower for gastroesophageal cancer (38 RCTs [6%] and 14% of deaths), liver cancer (14 RCTs [2%] and 8% of deaths), pancreas cancer (14 RCTs [2%] and 5% of deaths), and cervical cancer (9 RCTs [1%] and 3% of deaths). Randomized clinical trials in HICs were more likely than those in LMICs to be funded by industry (464 [73%] vs 24 [41%]; P < .001). Studies in LMICs were smaller than those in HICs (median, 219 [interquartile range, 137-363] vs 474 [interquartile range, 262-743] participants; P < .001) and more likely to meet their primary end points (39 of 58 [67%] vs 286 of 636 [45%]; P = .001). The observed median effect size among superiority trials was larger in LMICs compared with HICs (hazard ratio, 0.62 [interquartile range, 0.54-0.76] vs 0.84 [interquartile range, 0.67-0.97]; P < .001). Studies from LMICs were published in journals with lower median impact factors than studies from HICs (7 [interquartile range, 4-21] vs 21 [interquartile range, 7-34]; P < .001). Publication bias persisted when adjusted for whether a trial was positive or negative (median impact factor: LMIC negative trial, 5 [interquartile range, 4-6] vs HIC negative trial, 18 [interquartile range, 6-26]; LMIC positive trial, 9 [interquartile range, 5-25] vs HIC positive trial, 25 [interquartile range, 10-48]; P < .001). Conclusions and Relevance This study suggests that oncology RCTs are conducted predominantly by HICs and do not match the global burden of cancer. Randomized clinical trials from LMICs are more likely to identify effective therapies and have a larger effect size than RCTs from HICs. This study suggests that there is a funding and publication bias against RCTs led by LMICs. Policy makers, research funders, and journals need to address this issue with a range of measures including building capacity and capability in RCTs.
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Affiliation(s)
- J Connor Wells
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Shubham Sharma
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Joseph C Del Paggio
- Department of Oncology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Wilma M Hopman
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Department of Oncology, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Deborah Mukherji
- Department of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, United Kingdom.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Department of Oncology, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Ribeiro TB, Mazotti TA, Silva NADO, Stein AT, Diaz-Quijano FA, Melo DOD. Evaluation of the initial response in clinical trial efforts for COVID-19 in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 23:e200104. [PMID: 33439937 DOI: 10.1590/1980-549720200104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the methodological characteristics and good research practices of COVID-19 interventional studies developed in Brazil in the first months of the pandemic. METHODS We reviewed the bulletin of the National Research Ethics Committee - Coronavirus Special Edition (Comissão Nacional de Ética em Pesquisa - CONEP-COVID) (May 28, 2020) and the databases of the International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos - ReBEC) to identify interventional studies registered in Brazil that assessed drug type, biological therapy, or vaccines. We described their methodological characteristics and calculated their power for different effect magnitudes. RESULTS A total of 62 studies were included, 55 retrieved from the CONEP website, and 7 from registry databases. The most tested pharmacological interventions in these studies were: chloroquine/hydroxychloroquine, azithromycin, convalescent plasma, tocilizumab, sarilumab, eculizumab, vaccine, corticosteroids, anticoagulants, n-acetylcysteine, nitazoxanide, ivermectin, and lopinavir/ritonavir. Out of 22 protocols published on registry databases until May 2020, 18 (82%) were randomized clinical trials, and 13 (59%) had an appropriate control group. However, 9 (41%) of them were masked, and only 5 (24%) included patients diagnosed with a specific laboratory test (for example, reverse transcription polymerase chain reaction - RT-PCR). Most of these studies had power > 80% only to identify large effect sizes. In the prospective follow-up, 60% of the studies available at CONEP until May 2020 had not been published on any registry platform (ICTRP/ReBEC/ClinicalTrials) by July 21, 2020. CONCLUSION The interventions evaluated during the Brazilian research response reflect those of international initiatives, but with a different distribution and a large number of studies assessing hydroxychloroquine/chloroquine. Limitations in methodological design and sample planning represent challenges that could affect the research outreach.
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Affiliation(s)
- Tatiane Bomfim Ribeiro
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Talita Aona Mazotti
- Faculdade de Ciências Farmacêuticas, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Nayara Aparecida de Oliveira Silva
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo - Diadema (SP), Brasil
| | - Airton Tetelbom Stein
- Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | - Fredi Alexander Diaz-Quijano
- Departamento de Epidemiologia, Laboratório de Inferência Causal em Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Daniela Oliveira de Melo
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo - Diadema (SP), Brasil
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Mentorship and how to conduct research: A research primer for low- and middle-income countries. Afr J Emerg Med 2020; 10:S150-S153. [PMID: 33304799 PMCID: PMC7718449 DOI: 10.1016/j.afjem.2020.09.005] [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: 01/06/2020] [Revised: 07/31/2020] [Accepted: 09/05/2020] [Indexed: 11/24/2022] Open
Abstract
Development of a successful research program can seem daunting when looked at from the starting line. It will take years if not decades to succeed and become sustainable. It requires local partnerships and mentoring; it mandates the establishment of review boards; it requires national health policies to allow for protected time for research in salaries and for fund granting agencies to be set up; it requires training of researchers and support staff as well as a change in the mindset of clinical staff on the floor. It will almost inevitably require international support of some kind for low- and middle-income country researchers, be it university programs or other academic or private institutions. Success can occur; most likely it will occur by partnering with local research experts outside of emergency medicine in some combination with international networks and mentoring. Perhaps the most critical elements to success are intellectual curiosity and a burning flame of passion – and neither of those carry a financial cost.
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Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings. NPJ Prim Care Respir Med 2020; 30:52. [PMID: 33214560 PMCID: PMC7677536 DOI: 10.1038/s41533-020-00210-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022] Open
Abstract
Pulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.
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Addressing the burden of cervical cancer through IAEA global brachytherapy initiatives. Brachytherapy 2020; 19:850-856. [PMID: 32928684 PMCID: PMC7895316 DOI: 10.1016/j.brachy.2020.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/29/2020] [Accepted: 07/29/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE: Brachytherapy (BT) is an essential component of definitive therapy for locally advanced cervical cancer. Despite the advantages of the dose distribution with BT in cervical cancer, there is paucity of specific skills required for good-quality BT applications. Furthermore, replacing BT with other modern external beam techniques as a boost can lead to suboptimal results in cervix cancer. METHODS AND MATERIALS: Review of available IAEA resources, research and cooperation programs available from the IAEA was completed. These opportunities can be used to address challenges in Brachytherapy. The International Atomic Energy Agency (IAEA) provides support for BT through various means that includes education and training, both long term, short term and continuing medical education of professionals, providing expert visits to support implementation, development of curricula for professionals, e-learning through the human health campus, contouring workshops, 2D to 3D BT training, and virtual tumor boards. In addition, the IAEA provides support for implementing quality assurance in radiotherapy to its member states and provides guidelines for comprehensive audits in radiation therapy (QUATRO), and produces safety standards and training in radiation safety. In addition, mapping BT resources, making the case for investment and support for setting up BT services and radiotherapy centers are also available. The IAEA Dosimetry Laboratory provides calibration services to Secondary Standards Dosimetry Laboratories for well chambers used to confirm the reference air kerma rate of Co60 and Ir192 high-dose-rate BT sources, as well as for Cs137 low-dose-rate sources. Furthermore, the IAEA supports research and development in radiotherapy (and BT) through coordinated research activities that include controlled randomized clinical trials, Patterns of Care studies among others. Partnerships with professional organizations and funding bodies, as well as through the United Nations Joint Global Programme on Cervical Cancer Prevention and Control support radiotherapy activities, including BT in countries worldwide. CONCLUSION: The IAEA supports brachytherapy implementation, training and research and provides resources to professionals in the area.
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Monahan M, Jowett S, Pinkney T, Brocklehurst P, Morton DG, Abdali Z, Roberts TE. Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden. PLoS One 2020; 15:e0232960. [PMID: 32497086 PMCID: PMC7272045 DOI: 10.1371/journal.pone.0232960] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/24/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a worldwide problem which has morbidity, mortality and financial consequences. The incidence rate of SSI is high in Low- and Middle-Income countries (LMICs) compared to high income countries, and the costly surgical complication can raise the potential risk of financial catastrophe. OBJECTIVE The aim of the study is to critically appraise studies on the cost of SSI in a range of LMIC studies and compare these estimates with a reference standard of high income European studies who have explored similar SSI costs. METHODS A systematic review was undertaken using searches of two electronic databases, EMBASE and MEDLINE In-Process & Other Non-Indexed Citations, up to February 2019. Study characteristics, comparator group, methods and results were extracted by using a standard template. RESULTS Studies from 15 LMIC and 16 European countries were identified and reviewed in full. The additional cost of SSI range (presented in 2017 international dollars) was similar in the LMIC ($174-$29,610) and European countries ($21-$34,000). Huge study design heterogeneity was encountered across the two settings. DISCUSSION SSIs were revealed to have a significant cost burden in both LMICs and High Income Countries in Europe. The magnitude of the costs depends on the SSI definition used, severity of SSI, patient population, choice of comparator, hospital setting, and cost items included. Differences in study design affected the comparability across studies. There is need for multicentre studies with standardized data collection methods to capture relevant costs and consequences of the infection across income settings.
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Affiliation(s)
- Mark Monahan
- NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, England, United Kingdom
- Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Susan Jowett
- Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Thomas Pinkney
- Birmingham Surgical Trials Consortium, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Peter Brocklehurst
- NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, England, United Kingdom
- Birmingham Surgical Trials Consortium, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Dion G. Morton
- NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, England, United Kingdom
- Birmingham Surgical Trials Consortium, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Zainab Abdali
- Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
| | - Tracy E. Roberts
- NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, England, United Kingdom
- Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
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Vaidya A, Jain S, Sahu S, Jain PK, Pathak K, Pathak D, Kumar R, Jain SK. Anticancer Agents Based on Vulnerable Components in a Signalling Pathway. Mini Rev Med Chem 2020; 20:886-907. [DOI: 10.2174/1389557520666200212105417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/05/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023]
Abstract
Traditional cancer treatment includes surgery, chemotherapy, radiotherapy and immunotherapy
that are clinically beneficial, but are associated with drawbacks such as drug resistance and side
effects. In quest for better treatment, many new molecular targets have been introduced in the last few
decades. Finding new molecular mechanisms encourages researchers to discover new anticancer agents.
Exploring the mechanism of action also facilitates anticipation of potential resistance mechanisms and
optimization of rational combination therapies. The write up describes the leading molecular mechanisms
for cancer therapy, including mTOR, tyrosine Wee1 kinase (WEE1), Janus kinases, PI3K/mTOR
signaling pathway, serine/threonine protein kinase AKT, checkpoint kinase 1 (Chk1), maternal embryonic
leucine-zipper kinase (MELK), DNA methyltransferase I (DNMT1), poly (ADP-ribose) polymerase
(PARP)-1/-2, sphingosine kinase-2 (SK2), pan-FGFR, inhibitor of apoptosis (IAP), murine double minute
2 (MDM2), Bcl-2 family protein and reactive oxygen species 1 (ROS1). Additionally, the manuscript
reviews the anticancer drugs currently under clinical trials.
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Affiliation(s)
- Ankur Vaidya
- Pharmacy College Saifai, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), India
| | - Shweta Jain
- Sir MadanLal Institute of Pharmacy, Etawah (U.P.), India
| | - Sanjeev Sahu
- Department of Pharmaceutical Sciences, Lovely Professional University, Jalandhar, India
| | - Pankaj Kumar Jain
- Community Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), India
| | - Kamla Pathak
- Pharmacy College Saifai, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), India
| | - Devender Pathak
- Pharmacy College Saifai, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), India
| | - Raj Kumar
- Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (U.P.), India
| | - Sanjay Kumar Jain
- Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Vishwavidyalaya, Sagar, Madhya Pradesh, India
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Grover S, Zetola N, Ramogola-Masire D, Bvochora-Nsingo M, Schnader AF, Mick R, Gabaitiri L, Matlhagela K, Shen H, Chiyapo S, Balang D, Phaladze N, Nkomazana O, Friedman H, Jemmott J, Chilisa B, Robertson ES. Building research capacity through programme development and research implementation in resource-limited settings - the Ipabalele study protocol: observational cohort studies determining the effect of HIV on the natural history of cervical cancer in Botswana. BMJ Open 2019; 9:e031103. [PMID: 31892649 PMCID: PMC6955487 DOI: 10.1136/bmjopen-2019-031103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The global burden of cancer continues to increase in low- and middle-income countries, particularly in sub-Saharan Africa (SSA). Botswana, a middle-income country in SSA, has the second highest prevalence of HIV worldwide and has seen an increase in human papillomavirus (HPV)-associated cervical cancer over the last decade in the setting of improved survival of HIV-infected women. There is an urgent need to understand more clearly the causes and consequences of HPV-associated cervical cancer in the setting of HIV infection. We initiated the Ipabalele ('take care of yourself' in Setswana) programme to address this need for new knowledge and to initiate long-term research programme capacity building in the region. In this manuscript, we describe the components of the programme, including three main research projects as well as a number of essential cores to support the activities of the programme. METHODS AND PROCEDURES Our multidisciplinary approach aims to further current understanding of the problem by implementing three complementary studies aimed at identifying its molecular, behavioural and clinical determinants. Three participant cohorts were designed to represent the early, intermediate and late stages of the natural history of cervical cancer.The functional structure of the programme is coordinated through programmatic cores. These allow for integration of each of the studies within the cohorts while providing support for pilot studies led by local junior investigators. Each project of the Ipabalele programme includes a built-in capacity building component, promoting the establishment of long-lasting infrastructure for future research activities. ETHICS AND DISSEMINATION Institutional review board approvals were granted by the University of Pennsylvania, University of Botswana and Ministry of Health and wellness of Botswana. Results will be disseminated via the participating institutions and with the help of the Community Advisory Committee, the project's Botswana advisory group.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Nicola Zetola
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Allison F Schnader
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | - Rosemarie Mick
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lesego Gabaitiri
- Department of Statistics, University of Botswana, Gaborone, Gaborone, Botswana
| | - Keikantse Matlhagela
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Gaborone, Botswana
| | - Hao Shen
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sebathu Chiyapo
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | - Dawn Balang
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | | | - Oathokwa Nkomazana
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Gaborone, Botswana
| | - Harvey Friedman
- Botswana-UPenn Partnership, Gaborone, Botswana
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John Jemmott
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Erle S Robertson
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Mahantshetty U, Sturdza A, Naga CH P, Berger D, Fortin I, Motisi L, Schmid MP, Aravindakshan D, Ghadi Y, Swamidas JV, Chopra S, Gurram L, Nesvacil N, Kirisits C, Pötter R. Vienna-II ring applicator for distal parametrial/pelvic wall disease in cervical cancer brachytherapy: An experience from two institutions: Clinical feasibility and outcome. Radiother Oncol 2019; 141:123-129. [DOI: 10.1016/j.radonc.2019.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/28/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
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Zhao Y, Fitzpatrick T, Wan B, Day S, Mathews A, Tucker JD. Forming and implementing community advisory boards in low- and middle-income countries: a scoping review. BMC Med Ethics 2019; 20:73. [PMID: 31623624 PMCID: PMC6796331 DOI: 10.1186/s12910-019-0409-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/16/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Community advisory boards (CABs) have expanded beyond high-income countries (HICs) and play an increasing role in low- and middle-income country (LMIC) research. Much research has examined CABs in HICs, but less is known about CABs in LMICs. The purposes of this scoping review are to examine the creation and implementation of CABs in LMICs, including identifying frequently reported challenges, and to discuss implications for research ethics. METHODS We searched five databases (PubMed, Embase, Global Health, Scopus, and Google Scholar) for publications describing or evaluating CABs in LMICs. Two researchers independently reviewed articles for inclusion. Data related to the following aspects of CABs were extracted from included publications: time, country, financial support, research focus, responsibilities, and challenges. Thematic analyses were used to summarize textual data describing challenges. RESULTS Our search yielded 2005 citations, 83 of which were deemed eligible for inclusion. Most studies (65) were published between 2010 and 2017. Upper-middle-income countries were more likely to have studies describing CABs, with South Africa (17), China (8), and Thailand (7) having the greatest numbers. The United States National Institutes of Health was the main source of financial support for CABs. Many CABs (53/88, 60%) focused on HIV research. Thirty-four studies reported how CABs influenced the informed consent process for clinical trials or other aspects of research ethics. CAB responsibilities were related to clinical trials, including reviewing study protocols, educating local communities about research activities, and promoting the ethical conduct of research. Challenges faced by CABs included the following: incomplete ethical regulations and guidance; limited knowledge of science among members of communities and CABs; unstable and unbalanced power relationships between researchers and local communities; poor CAB management, including lack of formal participation structures and absence of CAB leadership; competing demands for time that limited participation in CAB activities; and language barriers between research staff and community members. Several challenges reflected shortcomings within the research team. CONCLUSIONS Our findings examine the formation and implementation of CABs in LMICs and identify several ethical challenges. These findings suggest the need for further ethics training among CAB members and researchers in LMICs.
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Affiliation(s)
- Yang Zhao
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
| | - Thomas Fitzpatrick
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
- University of Washington School of Medicine, Seattle, USA
| | - Bin Wan
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Suzanne Day
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Allison Mathews
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Ramaswami R, Paulino E, Barrichello A, Nogueira-Rodrigues A, Bukowski A, St Louis J, Goss PE. Disparities in Breast, Lung, and Cervical Cancer Trials Worldwide. J Glob Oncol 2019; 4:1-11. [PMID: 30241268 PMCID: PMC6223472 DOI: 10.1200/jgo.17.00226] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose As cancer burden has risen worldwide, physicians, patients, and their advocates have become aware that the clinical cancer trial research paradigm is not ubiquitous. Furthermore, the number and characteristics of trials that are registered in low- and middle-income countries (LMICs) compared with that in high-income countries (HICs) are unknown. Methods We collected retrospective data on trials for breast, lung, and cervical cancer registered in ClinicalTrials.gov or with the WHO International Clinical Trial Registry Platform between 2010 and 2017. The data were then classified as trials within LMICs or HICs using definitions from the World Bank. Results Included in these analyses were 6,710 trials, of which 3,164 (47%) were breast cancer trials, 3,283 (49%) were lung cancer trials, and 263 (4%) were cervical cancer trials. There were 1,951 (29%) trials from LMICs and 4,759 (71%) trials from HICs (P < .001). Although the proportion of phase III trials in HICs versus LMICs was similar (18% v 17%; P = .66), the number of phase I trials in LMICs was significantly lower than that of HICs (20% v 2%; P < .001). For several LMICs with the highest mortality-to-incidence ratios for breast, lung, or cervical cancer, there were no cancer trials registered in the registration data bases searched for this work. Conclusion There are differences in access to cancer clinical trials in LMICs compared with HICs. Several factors, such as excessive cost and a lack of infrastructure and expertise, may explain these differences.
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Affiliation(s)
- Ramya Ramaswami
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Eduardo Paulino
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Adriana Barrichello
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Angelica Nogueira-Rodrigues
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Alexandra Bukowski
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Jessica St Louis
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Paul E Goss
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
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Chopra S, Mittal P, Viswanathan A, Tharavichitkul E, Zubizarreta E, Nout RA, Yap ML, Grover S, Rodin D, Rai B, Gondhowiardjo S, Shrivastava SK. Global Collaborations for Cervical Cancer: Can the East-West Alliance Facilitate Treatment for all? Clin Oncol (R Coll Radiol) 2019; 31:529-538. [PMID: 31229379 DOI: 10.1016/j.clon.2019.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/11/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022]
Abstract
Despite the advances in the primary prevention of cervical cancer, there is an absolute increase in the incidence of cervical cancer as a result of an increase in world population. A vast majority of patients in low and low-middle income countries continue to present at a locally advanced stage, necessitating treatment with chemoradiation and brachytherapy. There is a dearth of equipment and trained professionals for the treatment of cervical cancer, especially in low and low-middle income countries. There is an urgent need to improve treatment availability and develop better treatments. Worldwide trends, however, reveal a low number of therapeutic and innovative research trials in cervical cancer. The present article elucidates the existing challenges and provides solutions to improve outcomes. The proposed strategies hinge on strengthening collaborations for global advocacy.
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Affiliation(s)
- S Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
| | - P Mittal
- Homi Bhabha National Institute, Mumbai, India; Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - A Viswanathan
- Department of Radiation Oncology, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - E Tharavichitkul
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - E Zubizarreta
- Division of Human Health, International Atomic of Energy Agency - Vienna International Centre, Vienna, Austria
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Center LUM, Leiden, the Netherlands
| | - M L Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, UNSW Sydney, Liverpool, New South Wales, Australia; Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia; School of Public Health, The University of Sydney, Camperdown, Australia
| | - S Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA; Botswana-UPENN Partnership, University of Botswana, Gaborone, Botswana
| | - D Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - B Rai
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gondhowiardjo
- Department of Radiotherapy, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - S K Shrivastava
- Department of Radiation Oncology, Apollo Hospital, Belapur, Navi Mumbai, India
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Morais A, Come J, Selemane C, Pires G, Tivane A, Cossa M, Tulsidás S, Antunes L, Costa MJ, Sidat M, Martins MDR, Carrilho C, Santos LL. Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge. Pan Afr Med J 2019; 32:83. [PMID: 31223374 PMCID: PMC6560991 DOI: 10.11604/pamj.2019.32.83.18126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/27/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital. METHODS To identify and characterize prevalent cancers, we performed a retrospective analysis of individual cancer patient registries of Maputo Central Hospital (MCH), Mozambique. Information was recorded into data collection sheets and analyzed with SPSS® 21. To assess MCH residents oncologic knowledge, we invited Twenty-six junior residents (49% of all residents) of different specialties to take a 30 item multiple choice written test used elsewhere in previous studies. The test focused on the domains of Basis of oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical Pathway. The test was administered anonymously and without prior notice. We analyzed the overall test and topic performance of residents. RESULTS The study covered a period of 3 years and 203 patients. The most prevalent malignant tumors treated by general and thoracic surgery in MCH cancer registry were esophageal (7%), female breast (6.5%) and colorectal cancer (2.8%). Globally these malignancies were diagnosed at an advanced stage of the disease and required a multimodal treatment. The mean percent correct score of residents was 37.3%. The dimension with the highest percent correct score were clinical management (46%) and surgical oncology (28%) showed the lowest correct score. CONCLUSION In Maputo, Mozambique esophageal, breast and colorectal cancer were the most prevalent malignancies treated, with surgery, by thoracic or general surgery in MCH. The test scores suggest that, among residents, the knowledge in oncology needs to be improved, rendering support to the need of a surgical oncology training tailored to suit the local needs. Specific training should take into account local cancer prevalence, resources, their quality and the support of surgical oncology services with volume and experience.
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Affiliation(s)
- Atílio Morais
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
- Department of Surgery of Faculty of Medicine, University of Eduardo Mondlane, Maputo, Mozambique
| | - Jotamo Come
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Carlos Selemane
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Germano Pires
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Adriano Tivane
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Matchecane Cossa
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Satish Tulsidás
- Medical Oncology Department, Maputo Central Hospital, Maputo, Mozambique
| | - Luís Antunes
- Epidemiology Service, Portuguese Institute of Oncology, Porto, Portugal
| | - Manuel João Costa
- Medical Education Unit, School of Medicine University of Minho, Portugal
| | - Moshin Sidat
- Department of Community Health, University of Eduardo Mondlane, Maputo, Mozambique
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Portugal
| | - Maria do Rosário Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Portugal
| | - Carla Carrilho
- Pathology Department, Maputo Central Hospital, Maputo, Mozambique
| | - Lúcio Lara Santos
- Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal
- Experimental Pathology and Therapeutics Research Group, Portuguese Institute of Oncology, Porto, Portugal
- ONCOCIR- Education and Care in Oncology, Lusophone, Africa
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Ranjan R, Agarwal NB, Kapur P, Marwah A, Parveen R. Factors Influencing Participation Of Healthy Volunteers In Clinical Trials: Findings From A Cross-Sectional Study In Delhi, North India. Patient Prefer Adherence 2019; 13:2007-2015. [PMID: 31819382 PMCID: PMC6890181 DOI: 10.2147/ppa.s206728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 10/21/2019] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To identify the specific motivations that drive healthy volunteers to consent for their participation in clinical studies. Additionally, the study aimed to document the socio-demographic determinants of participation in the trial related solely to the intention of securing financial gains. PATIENTS AND METHODS This cross-sectional study was conducted among subjects who participated as healthy volunteers in clinical trials conducted by Contract Research Organizations (CROs) of Delhi. Pre-tested, validated semi-structured questionnaires were used to collect baseline socio-demographic data, information about factors motivating participation in clinical trials, and pattern of utilisation of money received against participation in the trial. Logistic regression analysis was done to determine the factors that influenced participation in the trial related purely to the motive of securing financial gains. RESULTS A total of 400 participants were selected. The majority of the volunteers (77.5%) reported that their sole reason for participating in clinical trials was for monetary gain. Around a tenth of the volunteers participated with the intent to advance scientific knowledge and another 4.5% participated due to benefits of free medical check-ups. Participants in the age group of 29-38 years, those that were married, those residing in an urban slum, male participants, those with a high number of dependent family members (ie, 5 to 8), and those earning less than 5000 INR (71 USD) a month had higher odds of participating in a clinical trial purely for the financial benefits. Those educated till intermediate and above had lower odds of participation in the trial due to monetary benefits. CONCLUSION Our study shows that healthy volunteers in Delhi consider participation in clinical trials mainly because of the prospect of financial reward. More research is needed to inform judgments around the ethics of providing financial rewards and enrollment of healthy research volunteers.
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Affiliation(s)
- Rajesh Ranjan
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, New Delhi110062, India
- Department of Pharmaceutical Medicine, School of Pharmaceutical Education And Research, New Delhi110062, India
| | - Nidhi Bharal Agarwal
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, New Delhi110062, India
- Correspondence: Nidhi Bharal Agarwal Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi110062, IndiaTel +98 1833 4770Fax +91-11- 2605 9663 Email
| | - Prem Kapur
- Department of Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi110062, India
| | - Amit Marwah
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, New Delhi110062, India
| | - Rizwana Parveen
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, New Delhi110062, India
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Ramaswami R, Paulino E, Barrichello A, Nogueira-Rodrigues A, Bukowski A, St Louis J, Goss PE. Disparities in Breast, Lung, and Cervical Cancer Trials Worldwide. J Glob Oncol 2018. [PMID: 30241268 DOI: 10.1200/jgo.17.00226.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE As cancer burden has risen worldwide, physicians, patients, and their advocates have become aware that the clinical cancer trial research paradigm is not ubiquitous. Furthermore, the number and characteristics of trials that are registered in low- and middle-income countries (LMICs) compared with that in high-income countries (HICs) are unknown. METHODS We collected retrospective data on trials for breast, lung, and cervical cancer registered in ClinicalTrials.gov or with the WHO International Clinical Trial Registry Platform between 2010 and 2017. The data were then classified as trials within LMICs or HICs using definitions from the World Bank. RESULTS Included in these analyses were 6,710 trials, of which 3,164 (47%) were breast cancer trials, 3,283 (49%) were lung cancer trials, and 263 (4%) were cervical cancer trials. There were 1,951 (29%) trials from LMICs and 4,759 (71%) trials from HICs ( P < .001). Although the proportion of phase III trials in HICs versus LMICs was similar (18% v 17%; P = .66), the number of phase I trials in LMICs was significantly lower than that of HICs (20% v 2%; P < .001). For several LMICs with the highest mortality-to-incidence ratios for breast, lung, or cervical cancer, there were no cancer trials registered in the registration data bases searched for this work. CONCLUSION There are differences in access to cancer clinical trials in LMICs compared with HICs. Several factors, such as excessive cost and a lack of infrastructure and expertise, may explain these differences.
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Affiliation(s)
- Ramya Ramaswami
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Eduardo Paulino
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Adriana Barrichello
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Angelica Nogueira-Rodrigues
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Alexandra Bukowski
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Jessica St Louis
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
| | - Paul E Goss
- Ramya Ramaswami, Imperial College London, Hammersmith Hospital, London, United Kingdom; Eduardo Paulino, Adriana Barrichello, Angelica Nogueira-Rodrigues, Alexandra Bukowski, Jessica St. Louis, and Paul E. Goss, The Global Cancer Institute; and Massachusetts General Hospital, Boston, MA
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da Silva RE, Amato AA, Sousa TDR, de Carvalho MR, Novaes MRCG. The patient’s safety and access to experimental drugs after the termination of clinical trials: regulations and trends. Eur J Clin Pharmacol 2018; 74:1001-1010. [DOI: 10.1007/s00228-018-2474-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/02/2018] [Indexed: 11/25/2022]
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Vazquez M. Engaging Biomedical Engineering in Health Disparities Challenges. JOURNAL OF COMMUNITY MEDICINE & HEALTH EDUCATION 2018; 8:595. [PMID: 31223515 PMCID: PMC6585456 DOI: 10.4172/2161-0711.1000595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Health Disparities (HD) are community-based, biomedical challenges in need of innovative contributions from Science, Technology, Engineering and Math (STEM) fields. Surprisingly, STEM professionals demonstrate a persistent lack of HD awareness and/or engagement in both research and educational activities. This project introduced Health Disparities (HD) as technical challenges to incoming undergraduates in order to elevate engineering awareness of HD. The objective was to advance STEM-based, HD literacy and outreach to young cohorts of engineers. Engineering students were introduced to HD challenges in technical and societal contexts as part of Engineering 101 courses. Findings demonstrate that student comprehension of HD challenges increased via joint study of rising health care costs, engineering ethics and growth of biomedical-related engineering areas.
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Affiliation(s)
- Maribel Vazquez
- Department of Biomedical Engineering, City College of New York, USA
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Sapkota D, Baird K, Saito A, Anderson D. Interventions for domestic violence among pregnant women in low- and middle-income countries: a systematic review protocol. Syst Rev 2017; 6:254. [PMID: 29233167 PMCID: PMC5727941 DOI: 10.1186/s13643-017-0657-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Violence during pregnancy is a global problem, associated with serious health risks for both the mother and baby. Evaluation of interventions targeted for reducing or controlling domestic violence (DV) is still in its infancy, and the majority of findings are primarily from high-income countries (HICs). Therefore, there is an urgent need for generating evidence of DV interventions among pregnant women in low- and middle-income countries (LMICs). METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be employed to structure the review. A comprehensive search will be carried out via electronic databases including MEDLINE, CINAHL, Scopus, Embase, Web of Science, PsycINFO, and The Cochrane library. Gray literature will also be scrutinized for potential articles. An optimal search strategy has been developed following consultations with subject-matter experts and librarians. This search strategy will be adapted to the different databases. Experimental studies evaluating DV interventions among pregnant women from LMICs will be included in the review. The review will only include literature written in English. Two reviewers will independently screen and assess studies for inclusion in the review. A third author will resolve any discrepancies between the reviewers. Risk of bias will be assessed based on the Cochrane risk of bias assessment tool, and overall quality of the evidence will be judged using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Findings will be presented with the narrative synthesis, and if applicable, they will be further quantified using random-effects meta-analysis. Effect size, risk ratio for dichotomous variables, and standardized mean differences for continuous variables will be calculated for each outcome using Review Manager 5.3. DISCUSSION Systematic reviews to evaluate the efficacy of interventions to address DV within the perinatal context have been limited. Hence, no one intervention has emerged as substantially effective towards addressing perinatal DV and associated health consequences. The evidence generated from this systematic review will inform researchers and policy makers about the effectiveness of existing DV interventions among pregnant women in LMICs and provide recommendations for future research in this area. This in turn will contribute towards violence prevention in LMICs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017073938.
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Affiliation(s)
- Diksha Sapkota
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia. .,Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
| | - Kathleen Baird
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,Gold Coast University Hospital, Southport, QLD, Australia
| | - Amornrat Saito
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Debra Anderson
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,Women's Wellness Research Program, Menzies Health Institute Queensland, Brisbane, Australia
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Abstract
•Cervical cancer is the second most common cancer among women in LMIC.•Major efforts to improve research in gynecologic cancer in LMIC are needed.•GOR provides a platform featuring research and review of cancer care in LMIC.
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