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Gopalani SV, Qin J, Baksa J, Thompson TD, Senkomago V, Pordell P, Jeong Y, Reichhardt M, Palafox N, Buenconsejo-Lum L. Breast cancer incidence and stage at diagnosis in the six US-Affiliated Pacific Islands. Cancer Epidemiol 2024; 92:102611. [PMID: 38996557 DOI: 10.1016/j.canep.2024.102611] [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: 04/16/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Breast cancer is the most common cancer diagnosed among women globally and in the United States (US); however, its incidence in the six US-Affiliated Pacific Islands (USAPI) remains less characterized. METHODS We analyzed data from a population-based cancer registry using different population estimates to calculate incidence rates for breast cancer among women aged >20 years in the USAPI. Rate ratios and 95 % confidence intervals (CI) were calculated to compare incidence rates between the USAPI and the US (50 states and the District of Columbia). RESULTS From 2007-2020, 1118 new cases of breast cancer were diagnosed in the USAPI, with 66.3 % (n = 741) of cases reported in Guam. Age-standardized incidence rates ranged from 66.4 to 68.7 per 100,000 women in USAPI and 101.1-110.5 per 100,000 women in Guam. Compared to the US, incidence rates were lower in USAPI, with rate ratios ranging from 0.38 (95 % CI: 0.36, 0.40) to 0.39 (95 % CI: 0.37, 0.42). The proportion of late-stage cancer was significantly higher in the USAPI (48.7 %) than in the US (34.0 %), particularly in the Federated States of Micronesia (78.7 %) and Palau (73.1 %). CONCLUSIONS Breast cancer incidence rates were lower in the USAPI than in the US; however, late-stage diagnoses were disproportionately higher. Low incidence and late-stage cancers may signal challenges in screening, cancer surveillance, and health care access and resources. Expanding access to timely breast cancer screening, diagnosis, and treatment could reduce the proportion of late-stage cancers and improve survival in the USAPI.
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Affiliation(s)
- Sameer V Gopalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Jin Qin
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Janos Baksa
- John A Burns School of Medicine, University of University of Hawaii at Manoa, Honolulu, HI, United States
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paran Pordell
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Youngju Jeong
- John A Burns School of Medicine, University of University of Hawaii at Manoa, Honolulu, HI, United States
| | - Martina Reichhardt
- Yap State Department of Health Services, Yap, Federated States of Micronesia
| | - Neal Palafox
- John A Burns School of Medicine, University of University of Hawaii at Manoa, Honolulu, HI, United States
| | - Lee Buenconsejo-Lum
- John A Burns School of Medicine, University of University of Hawaii at Manoa, Honolulu, HI, United States.
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2
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Wee HL, Canfell K, Chiu HM, Choi KS, Cox B, Bhoo-Pathy N, Simms KT, Hamashima C, Shen Q, Chua B, Siwaporn N, Toes-Zoutendijk E. Cancer screening programs in South-east Asia and Western Pacific. BMC Health Serv Res 2024; 24:102. [PMID: 38238704 PMCID: PMC10797973 DOI: 10.1186/s12913-023-10327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/14/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The burden of cancer can be altered by screening. The field of cancer screening is constantly evolving; from the initiation of program for new cancer types as well as exploring innovative screening strategies (e.g. new screening tests). The aim of this study was to perform a landscape analysis of existing cancer screening programs in South-East Asia and the Western Pacific. METHODS We conducted an overview of cancer screening in the region with the goal of summarizing current designs of cancer screening programs. First, a selective narrative literature review was used as an exploration to identify countries with organized screening programs. Second, representatives of each country with an organized program were approached and asked to provide relevant information on the organizations of their national or regional cancer screening program. RESULTS There was wide variation in the screening strategies offered in the considered region with only eight programs identified as having an organized design. The majority of these programs did not meet all the essential criteria for being organized screening. The greatest variation was observed in the starting and stopping ages. CONCLUSIONS Essential criteria of organized screening are missed. Improving organization is crucial to ensure that the beneficial effects of screening are achieved in the long-term. It is strongly recommended to consider a regional cancer screening network.
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Affiliation(s)
- Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Karen Canfell
- The Daffodil Centre, A Joint Venture with Cancer Council NSW and the University of Sydney, Sydney, NSW, Australia
| | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Ilsandonggu, Goyang, Republic of Korea
| | - Brian Cox
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kate T Simms
- The Daffodil Centre, A Joint Venture with Cancer Council NSW and the University of Sydney, Sydney, NSW, Australia
| | - Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Institute of Cancer Control, National Cancer Center, Tokyo, Japan
- Teikyo University, Tokyo, Japan
| | - Qianyu Shen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Brandon Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Niyomsri Siwaporn
- Department of Medical Services, Ministry of Public Health, National Cancer Institute of Thailand, Bangkok, Thailand
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Toes-Zoutendijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2014, Rotterdam, CA, 3000, the Netherlands.
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3
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Qin RX, Zhang G, Lim MX, Waqainabete I, Tudravu J, Turagava J, Patel R, Ulufonua L, Herman J, Teapa D, May YY, Tarere-Lehi M, Leodoro B, Mekoll N, McLeod E, Park KB, Kafoa B, Maoate K, Tangi V. Assessment of essential surgical and anaesthesia care capacity: a cross-sectional study in five Pacific Island Countries. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100830. [PMID: 37484709 PMCID: PMC10362349 DOI: 10.1016/j.lanwpc.2023.100830] [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: 02/05/2023] [Revised: 05/11/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023]
Abstract
Background Pacific Island Countries (PICs) face unique challenges in providing surgical care. We assessed the surgical care capacity of five PICs to inform the development of National Surgical, Obstetric and Anaesthesia Plans (NSOAP). Methods We conducted a cross-sectional survey of 26 facilities in Fiji, Tonga, Vanuatu, Cook Islands, and Palau using the World Health Organization - Program in Global Surgery and Social Change Surgical Assessment Tool. Findings Eight referral and 18 first-level hospitals containing 39 functioning operating theatres, 41 post-anaesthesia care beds, and 44 intensive care unit beds served a population of 1,321,000 across the five countries. Most facilities had uninterrupted access to electricity, water, internet, and oxygen. However, CT was only available in 2/8 referral hospitals, MRI in 1/8, and timely blood transfusions in 4/8. The surgical, obstetric, and anaesthetist specialist density per 100,000 people was the highest in Palau (49.7), followed by Cook Islands (22.9), Tonga (9.9), Fiji (7.1), and Vanuatu (5.0). There were four radiologists and 3.5 pathologists across the five countries. Surgical volume per 100,000 people was the lowest in Vanuatu (860), followed by Fiji (2,247), Tonga (2,864), Cook Islands (6,747), and Palau (8,606). The in-hospital peri-operative mortality rate (POMR) was prospectively monitored in Tonga and Cook Islands but retrospectively measured in other countries. POMR was below 1% in all five countries. Interpretation Whilst PICs share common challenges in providing specialised tertiary services, there is substantial diversity between the countries. Strategies to strengthen surgical systems should incorporate both local contextualisation within each PIC and regional collaboration between PICs. Funding None.
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Affiliation(s)
- Rennie X. Qin
- The Program in Global Surgery and Social Change, the Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, 22-30 Park Avenue, Auckland 1023, New Zealand
| | - Grace Zhang
- Notre Dame's Kellogg Institute for International Studies: Jenkins Hall, 1130, Notre Dame, IN 46556, USA
| | - Meghan X. Lim
- The Program in Global Surgery and Social Change, the Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
| | - Ifereimi Waqainabete
- Ministry of Health and Medical Services of Fiji, Dinem House, 88 Amy St, Suva, Fiji
| | - Jemesa Tudravu
- Ministry of Health and Medical Services of Fiji, Dinem House, 88 Amy St, Suva, Fiji
| | - Josese Turagava
- Ministry of Health and Medical Services of Fiji, Dinem House, 88 Amy St, Suva, Fiji
| | - Rajeev Patel
- Ministry of Health and Medical Services of Fiji, Dinem House, 88 Amy St, Suva, Fiji
| | | | - Josephine Herman
- Te Marae Ora - Cook Islands Ministry of Health, Rarotonga, Cook Islands
| | - Deacon Teapa
- Te Marae Ora - Cook Islands Ministry of Health, Rarotonga, Cook Islands
| | - Yin Yin May
- Te Marae Ora - Cook Islands Ministry of Health, Rarotonga, Cook Islands
| | | | - Basil Leodoro
- Northern Provincial Hospital, F5RM+CJ3, Luganville, Santo Island, Vanuatu
| | | | - Elizabeth McLeod
- Department of Neonatal and Paediatric Surgery, Royal Children's Hospital, 50 Flemington Rd, Melbourne, VIC 3052, Australia
| | - Kee B. Park
- The Program in Global Surgery and Social Change, the Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
| | - Berlin Kafoa
- Public Health Division, Secretariat of the Pacific Community, Suva, Fiji
| | - Kiki Maoate
- Department of Paediatric Surgery, Christchurch Hospital, University of Otago, 2 Riccarton Avenue, Christchurch 8011, New Zealand
| | - Viliami Tangi
- Ministry of Health, Taufa'ahau Roadd, Nuku'alofa, Tonga
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Wilson BE, Sullivan R, Peto R, Abubakar B, Booth C, Werutsky G, Adams C, Saint-Raymond A, Fleming TR, Lyerly K, Gralow JR. Global Cancer Drug Development-A Report From the 2022 Accelerating Anticancer Agent Development and Validation Meeting. JCO Glob Oncol 2023; 9:e2300294. [PMID: 37944089 PMCID: PMC10645408 DOI: 10.1200/go.23.00294] [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: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 11/12/2023] Open
Abstract
Rapidly expanding systemic treatment options, combined with improved screening, diagnostic, surgical, and radiotherapy techniques, have led to improved survival outcomes for many cancers over time. However, these overall survival gains have disproportionately benefited patients in high-income countries, whereas patients in low- and middle-income countries (LMICs) continue to experience challenges in accessing timely and guideline concordant care. In September 2022, the Accelerating Anticancer Agent Development and Validation workshop was held, focusing on global cancer drug development. Panelists discussed key barriers such as the lack of diagnostic services and human resources, drug accessibility and affordability, lack of research infrastructure, and regulatory and authorization challenges, with a particular focus on Africa and Latin America. Potential opportunities to improve access and affordability were reviewed, such as the importance of prioritizing investments in diagnostics, investing health infrastructure and work force planning, coordinated drug procurement efforts and streamlined regulatory processing, incentivized pricing through regulatory change, and the importance of developing and promoting clinical trials that can answer relevant clinical questions for patients in LMICs. As a cancer community, we must continue to advocate for and work toward equitable access to high-quality interventions for patients, regardless of their geographical location.
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Affiliation(s)
- Brooke E. Wilson
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
- Department of Oncology, Queen's University, Kingston, Canada
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
- Department of Oncology, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Richard Peto
- Department of Medical Statistics and Epidemiology, University of Oxford, Oxford, United Kingdom
| | - Bello Abubakar
- Department of Radiotherapy and Oncology, National Hospital Abuja, Abuja, Nigeria
| | - Christopher Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
- Department of Oncology, Queen's University, Kingston, Canada
| | - Gustavo Werutsky
- Department of Medical Oncology, Hospital São Lucas, Porto Alegre, Brazil
| | - Cary Adams
- Union for International Cancer Control, Geneva, Switzerland
| | - Agnes Saint-Raymond
- International Affairs Division, European Medicines Agency, Amsterdam, the Netherlands
| | | | - Kim Lyerly
- Departments of Surgery, Pathology, and Immunology, Duke University School of Medicine, Durham, NC
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Talia KL, van der Griend R. Supporting gynaecological pathology: volunteering at home and abroad. Pathology 2023; 55:591-595. [PMID: 37330339 DOI: 10.1016/j.pathol.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Karen L Talia
- Royal Children's Hospital, Royal Women's Hospital and Australian Centre for the Prevention of Cervical Cancer, Melbourne, Vic, Australia.
| | - Rachael van der Griend
- Canterbury Health Laboratories, Te Whatu Ora, Waitaha Canterbury, Christchurch, New Zealand
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Lau B, Tominez P, Shing JZ, Vo JB, Pollom E, Taparra K. Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Patients with Cancer Who Refuse Recommended Radiation Therapy or Surgery. Cancers (Basel) 2023; 15:3358. [PMID: 37444468 DOI: 10.3390/cancers15133358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/11/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Despite radiation therapy (RT) and surgery being the curative treatments, prior work demonstrated that the aggregated Asian American (AA) and Native Hawaiian and Other Pacific Islanders (NHPI) population refuse RT and surgery at a higher rates than other races. Given that AA and NHPI are distinct groups, data disaggregation is necessary to understand racial and ethnic disparities for treatment refusal. We aimed to (1) compare RT and surgery refusal rates between AA and NHPI populations, (2) assess RT and surgery refusal on overall mortality, and (3) determine predictors of refusing RT and surgery using the United States (U.S.) National Cancer Database. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for treatment refusal were calculated using logistic regression. Adjusted hazard ratios (aHR) were calculated for overall survival using Cox proportional hazard models among propensity score-matched groups. The overall rate of RT refusal was 4.8% and surgery refusal was 0.8%. Compared to East AA patients, NHPI patients had the highest risk of both RT refusal (aOR = 1.38, 95%CI = 1.21-1.61) and surgery refusal (aOR = 1.28, 95%CI = 1.00-1.61). RT refusal significantly predicted higher mortality (aHR = 1.17, 95%CI = 1.08-1.27), whereas surgery refusal did not. Predictors of RT and surgery refusal were older patient age, high comorbidity index, and cancer diagnosis between 2011-2017. The results show heterogenous treatment refusal patterns among AA and NHPI populations, suggesting areas for targeted intervention.
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Affiliation(s)
- Brianna Lau
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, CA 94304, USA
| | - Paul Tominez
- School of Medicine, University of California, San Francisco, CA 94143, USA
| | - Jaimie Z Shing
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, CA 94304, USA
- Affiliated Physician, Palo Alto Veterans Affairs Hospital, Palo Alto, CA 94304, USA
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, CA 94304, USA
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7
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Lynch KA, Merdjanoff AA. Impact of Disasters on Older Adult Cancer Outcomes: A Scoping Review. JCO Glob Oncol 2023; 9:e2200374. [PMID: 37290025 PMCID: PMC10497294 DOI: 10.1200/go.22.00374] [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] [Accepted: 04/04/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE There is an urgent need to address the growing global cancer burden in the context of complex disaster events, which both disrupt access to oncology care and facilitate carcinogenic exposures. Older adults (65 years and older) are a growing population with multifaceted care needs, making them especially vulnerable to disasters. The objective of this scoping review is to characterize the state of the literature concerning older adult cancer-related outcomes and oncologic care after a disaster event. METHODS A search was conducted in PubMed and Web of Science. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, articles were extracted and screened for inclusion. Eligible articles were summarized using descriptive and thematic analyses. RESULTS Thirty-five studies met all criteria for full-text review. The majority focused on technological disasters (60%, n = 21), followed by climate-amplified disasters (28.6%, n = 10) and geophysical disasters (11.4%, n = 4). Thematic analysis classified the current evidence into three major categories: (1) studies concerned with carcinogenic exposure and cancer incidence related to the disaster event, (2) studies examining changes in access to cancer care and cancer treatment disruptions as a result of the disaster event, and (3) studies exploring the psychosocial experiences of patients with cancer affected by a disaster event. Few studies focused on older adults specifically, and most of the current evidence focuses on disasters in the United States or Japan. CONCLUSION Older adult cancer outcomes after a disaster event are understudied. Current evidence suggests that disasters worsen cancer-related outcomes among older adults by disrupting continuity of care and access to timely treatment. There is a need for prospective longitudinal studies following older adult populations postdisaster and studies focused on disasters in low- and middle-income country contexts.
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Affiliation(s)
- Kathleen A. Lynch
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY
| | - Alexis A. Merdjanoff
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY
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8
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Hyatt A, Chan B, Moodie R, Varlow M, Bates C, Foliaki S, Palafox N, Burich S, Aranda S. Strengthening cancer control in the South Pacific through coalition-building: a co-design framework. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100681. [PMID: 37181526 PMCID: PMC10166990 DOI: 10.1016/j.lanwpc.2022.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
Background Cancer is a significant problem for the South Pacific region due to a range of complex health challenges. Currently gaps in diagnosis, treatment and palliative care are significant, and while governmental commitment is strong, economic constrains limit health system strengthening. Alliances have been successful in strengthening non-communicable disease and cancer control policy and services in resource constrained settings. A regional coalition approach has therefore been recommended as an effective solution to addressing many of the challenges for cancer control in the South Pacific. However, evidence regarding the effective mechanisms for development of alliances or coalitions is scarce. This study aimed to 1) create a Coalition Development Framework; 2) assess the use of the Framework in practice to co-design a South Pacific Coalition. Methods Creation of the Coalition Development Framework commenced with a scoping review and content analysis of existing literature. Synthesis of key elements formed an evidence-informed step-by-step guide for coalition-building. Application of the Framework comprised consultation and iterative discussions with key South Pacific cancer control stakeholders in Fiji, New Caledonia, Papua New Guinea, Samoa and Tonga. Concurrent evaluation of the Framework utilising Theory of Change (ToC) and qualitative analysis of stakeholder consultations was undertaken. Findings The finalised Coalition Development Framework comprised four phases with associated actions and deliverables: engagement, discovery, unification, action and monitoring. Application of the Framework in the South Pacific identified overwhelming support for a Cancer Control Coalition through 35 stakeholder consultations. Framework phases enabled stakeholders to confirm coalition design and purpose, strategic imperatives, structure, local foundations, barriers and facilitators, and priorities for action. ToC and thematic consultation analysis confirmed the Framework to be an effective mechanism to drive engagement, unification and action in alliance-building. Interpretation A Coalition to drive cancer control has significant support among key Pacific stakeholders, and establishment can now be commenced. Importantly results confirm the effective application of the Coalition Development Framework in an applied setting. If momentum is continued, and a regional South Pacific Coalition established, the benefits in reducing the burden of cancer within the region will be substantial. Funding This work was completed for a Masters of Public Health project. Cancer Council Australia provided project funding.
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Affiliation(s)
- Amelia Hyatt
- Cancer Control Policy, Cancer Council Australia, Sydney, NSW, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Rob Moodie
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Megan Varlow
- Cancer Control Policy, Cancer Council Australia, Sydney, NSW, Australia
| | - Chris Bates
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sunia Foliaki
- Research Centre for Hauora and Health, Massey University-Wellington Campus, Wellington, New Zealand
| | - Neal Palafox
- John A. Burns School of Medicine, University of Hawaii, University of Hawaii Cancer Center, Honolulu, United States
| | | | - Sanchia Aranda
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Nursing, University of Melbourne, Melbourne, VIC, Australia
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9
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Cancer Disparities among Pacific Islanders: A Review of Sociocultural Determinants of Health in the Micronesian Region. Cancers (Basel) 2023; 15:cancers15051392. [PMID: 36900185 PMCID: PMC10000177 DOI: 10.3390/cancers15051392] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
It is well appreciated that the social determinants of health are intimately related with health outcomes. However, there is a paucity of literature that explores these themes comprehensively for the indigenous people within Micronesia. Certain Micronesia-specific factors, such as transitions from traditional diets, the consumption of betel nut, and exposure to radiation from the nuclear bomb testing in the Marshall Islands, have predisposed certain Micronesian populations to an increased risk of developing a variety of malignancies. Furthermore, severe weather events and rising sea levels attributed to climate change threaten to compromise cancer care resources and displace entire Micronesian populations. The consequences of these risks are expected to increase the strain on the already challenged, disjointed, and burdened healthcare infrastructure in Micronesia, likely leading to more expenses in off-island referrals. A general shortage of Pacific Islander physicians within the workforce reduces the number of patients that can be seen, as well as the quality of culturally competent care that is delivered. In this narrative review, we comprehensively underscore the health disparities and cancer inequities faced by the underserved communities within Micronesia.
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10
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Zhou Y, Luo B, Sang J, Li C, Zhu M, Zhu Z, Dai J, Wang J, Chen H, Zhai S, Lu L, Liu H, Yu G, Ye J, Zhang Z, Huan J. A cloud-based consultation and collaboration system for radiotherapy: Remote decision support services for community radiotherapy centers. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107270. [PMID: 36516515 DOI: 10.1016/j.cmpb.2022.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE This study aimed to establish a cloud-based radiotherapy consultation and collaboration system, then investigated the practicability of remote decision support for community radiotherapy centers using the system. METHODS AND MATERIALS A cloud-based consultation and collaboration system for radiotherapy, OncoEvidance®, was developed to provide remote services of LINAC modeling, simulation CT data import/export, target volume and organ-at-risk delineation, prescription, and treatment planning. The system was deployed on a hybrid cloud. A federate of public nodes, each corresponding to a medical institution, are managed by a central node where a group of consultants have registered. Users can access the system through network using computing devices. The system has been tested at three community radiotherapy centers. One accelerator was modeled. 12 consultants participated the remote radiotherapy decision support and 77 radiation treatment plans had been evaluated remotely. RESULTS All the passing rates of per-beam dose verification are > 94% and all the passing rates of composite beam dose verification are > 99%. The average downloading time for one set of simulation CT data for one patient from Internet was within 1 min under the cloud download bandwidth of 8 Mbps and local network bandwidth of 100 Mbps. The average response time for one consultant to contour target volumes and make prescription was about 24 h. And that for one consultant to design and optimize a IMRT treatment plan was about 36 h. 100% of the remote plans passed the dosimetric criteria and could be imported into the local TPS for further verification. CONCLUSION The cloud-based consultation and collaboration system saved the travel time for consultants and provided high quality radiotherapy to patients in community centers. The under-staffed community radiotherapy centers could benefit from the remote system with lower cost and better treatment quality control.
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Affiliation(s)
- Yin Zhou
- Evidance Medical Technologies Inc, Suzhou, China.
| | - Binghui Luo
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Jiugao Sang
- Department of Radiation Oncology, Rudong County People's Hospital, Rudong, Nantong, China
| | - Cheng Li
- Homology Medical Technologies Inc. Ningbo, China
| | - Meng Zhu
- Evidance Medical Technologies Inc, Suzhou, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jianrong Dai
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhua Wang
- Ningbo Medical Center, Li Huili Hospital, Ningbo, China
| | - Haibo Chen
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Shuwei Zhai
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Lina Lu
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Hui Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Genhua Yu
- Department of Radiation Oncology, Zhebei Mingzhou Hospital, Huzhou, China
| | - Jin Ye
- Homology Medical Technologies Inc. Ningbo, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jian Huan
- Department of Radiation Oncology, the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China.
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11
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Young K, Bulosan H, Baksa J, Jeong Y, Buenconsejo-Lum LE, Birkeland AC. Oral Cancer Disparities in the Outer US-affiliated Pacific Islands. Laryngoscope 2022. [PMID: 36165583 PMCID: PMC10040458 DOI: 10.1002/lary.30419] [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: 07/06/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE/HYPOTHESIS Oral cancers in the US-affiliated Pacific Islands are poorly described despite disproportionately higher incidences in certain jurisdictions. This study attempts to better characterize the incidence, staging, and management of oral cancers in this region. STUDY DESIGN Retrospective Epidemiological Study. METHODS A retrospective review was conducted across the US-affiliated Pacific Islands between 2007 and 2019. Patient data were obtained for individuals with primary head and neck cancers from the Pacific Regional Central Cancer Registry database. All cohorts were age-adjusted to the 2000 US Standard Population. Further analysis was performed on oral cavity cancers due to their clear predominance within the sample. RESULTS A total of 585 patients with primary head and neck cancers were included. The average age was 54.5 ± 12.9 years, and most patients were male (76.8%). Oral cancer subsite analysis revealed the proportional incidence of buccal mucosa was higher in 5 of 9 jurisdictions when compared with the United States (p < 0.001). Tongue and lip cancers were not found to have significantly higher incidence proportions. Patients in the Pacific Islander group were less likely to be detected at earlier stages for cancers of the cheek and other mouth (p < 0.001), tongue (p < 0.001), and lips (p < 0.001) compared with the United States. CONCLUSIONS Many Pacific Island populations are burdened with higher incidences of oral cancer with later staging. Further investigation is recommended to evaluate oral cancer-related outcomes and mortality in this region. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Kurtis Young
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Hannah Bulosan
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Janos Baksa
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Youngju Jeong
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Lee E Buenconsejo-Lum
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Andrew C Birkeland
- Division of Otolaryngology, University of California Davis Medical Center, Sacramento, California, USA
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12
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Gallagher BD, Coughlin EC, Nair-Shalliker V, McCaffery K, Smith DP. Socioeconomic differences in prostate cancer treatment: A systematic review and meta-analysis. Cancer Epidemiol 2022; 79:102164. [DOI: 10.1016/j.canep.2022.102164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/18/2022] [Accepted: 04/16/2022] [Indexed: 11/02/2022]
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13
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Gifford H, Tautolo ES, McCool JP, Gartner CE, Edwards R, Maddox R. Getting there together: highlights, challenges and opportunities for tobacco control in the Oceania region. Tob Control 2022; 31:164-168. [PMID: 35241583 DOI: 10.1136/tobaccocontrol-2021-056542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/03/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The paper focuses on the geographical region of Oceania. We highlight the tobacco control leadership demonstrated in this region and describe the challenges and opportunities to achieving country-specific smoke-free goals. RESULTS Significant achievements include smoke-free nation goals, world-leading initiatives such as plain packaging, and a bold plan by New Zealand to reduce the retail availability of smoked tobacco products and remove virtually all the nicotine from cigarettes and rolling tobacco. There are significant challenges and opportunities before reaching smoke-free status including implementation pathways requiring strong governance and leadership and compliance monitoring and enforcement. CONCLUSIONS We conclude that achieving a smoke-free Oceania is possible through already existing bold country and regional smoke-free goals, excellent tobacco control leadership, experience and resources, and an understanding of how to work collectively. However, a commitment to focus tobacco control efforts regionally is required to achieve a smoke-free Oceania together.
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Affiliation(s)
- Heather Gifford
- Whakauae Research, Whakauae Research for Maori Health and Development, Whanganui, Manawatu-Whanganui, New Zealand
| | - El-Shadan Tautolo
- Centre for Pacific Health and Development, Auckland University of Technology, Auckland, New Zealand
| | - Judith P McCool
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Coral E Gartner
- School of Public Health, University of Queensland, Herston, Queensland, Australia
- Queensland Alliance for Environmental Health Sciences, University of Queensland Faculty of Health and Behavioural Sciences, Woolloongabba, Queensland, Australia
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Raglan Maddox
- Aboriginal and Torres Strait Islander Health Program, National Centre for Epidemiology and Public Health, Australian National University, Acton, Australian Capital Territory, Australia
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14
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Anjos EFD, Andrade KB, Martins PC, Paiva JAC, Prado NMDBL, Santos AMD. Atuação de profissionais de saúde e qualidade das ações no controle de câncer cervicouterino: um estudo transversal. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo avaliar o tempo de atuação de médicos e enfermeiros na Atenção Primária à Saúde (APS) e qualidade das ações desenvolvidas para controle do câncer cervicouterino (CC). Métodos estudo transversal, conduzido de janeiro a março de 2019 em região de saúde compreendida em 19 municípios localizada no estado da Bahia, Brasil. A amostra foi de 241 médicos e enfermeiros da APS. Utilizou-se a linha de cuidado do CC como condição traçadora. Elegeram-se o desfecho tempo de atuação na APS no mesmo município, categorizado em < 2 anos e ≥ 2 anos, e indicadores representativos da qualidade da APS. Os testes χ2 de Pearson e exato de Fisher foram empregados. Resultados a prevalência de tempo de atuação na APS foi 43,57% (IC95%: 37,40%; 49,94%) para < 2 anos e 56,43% (IC95%: 50,06%; 62,60%) para ≥ 2 anos. Observaram-se maiores prevalências, com diferença estatística significativa, dos indicadores de qualidade para o maior tempo de atuação. Conclusões e implicações para a prática a rotatividade profissional parece afetar o cuidado longitudinal de mulheres na linha de cuidado eleita. Sugere-se a ampliação do número e do papel dos enfermeiros, especialmente nos serviços de APS, para maior resolutividade e eficiência do sistema de saúde.
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15
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OUP accepted manuscript. Health Promot Int 2022:6554410. [DOI: 10.1093/heapro/daac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Palafox NA, Garcia MT, Chutaro E, Alailima C, Hixon AL, Silk I, Best B, Alik WC, Tufa AJ, Cash HL. COVID-19 Containment Ship Model: A Case Study for Pacific Island Response. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:102-109. [PMID: 34661133 PMCID: PMC8504318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Republic of the Marshall Islands, American Samoa, the Federated States of Micronesia, and the Republic of Palau have been without any COVID-19 community transmission since the beginning of the global pandemic. The Commonwealth of the Northern Mariana Islands has experienced modest community transmission, and Guam has had significant COVID-19 community transmission and morbidity. Although several of these United States Affiliated Pacific Island jurisdictions made difficult strategic choices to prevent the spread of COVID-19 which have been largely successful, the built environment and the population density in the urban areas of the Pacific remain inherently conducive to rapid COVID-19 transmission. Rapid transmission could result in devastating health and economic consequences in the absence of continued vigilance and long-term strategic measures. The unique COVID-19 vulnerability of islands in the Pacific can be modeled through examination of recent outbreaks onboard several United States Naval ships and other marine vessels. The environmental characteristics that pose challenges to infection control on an isolated naval ship are analogous to the environmental characteristics of these Pacific island communities. Considering a collection of case studies of COVID-19 transmission on ships and applying to Pacific Island environments, provides a heuristic, easily accessible epidemiologic framework to identify methods for interventions that are practical and reliable towards COVID-19 containment, prevention, and control. Using accessible evidence based public health policies, infection risk can be decreased with the objective of maintaining in-country health and social stability. These case studies have also been examined for their relevance to current discussions of health care infrastructure and policy in the Pacific Islands, especially that of vaccination and repatriation of citizens marooned in other countries. The need for aggressive preparation on the parts of territories and nations not yet heavily exposed to the virus is critical to avoid a rapid "burn-through" of disease across the islands, which would likely result in catastrophic consequences.
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Affiliation(s)
- Neal A. Palafox
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (NAP, ALH)
| | | | - Emi Chutaro
- Pacific Island Health Officers Association, Honolulu, HI (EC, HLC)
| | | | - Allen L. Hixon
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (NAP, ALH)
| | - Isabela Silk
- Republic of Marshall Islands Consulate, Honolulu, HI (IS)
| | - Bruce Best
- Kaiser Permanente, Honolulu, HI (BB, WCA)
| | | | | | - Haley L Cash
- Pacific Island Health Officers Association, Honolulu, HI (EC, HLC)
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17
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Amosa-Lei Sam F, Akinremi A, Mery L, Sarfati D, Stanley J, Gurney J. Cancer Incidence in Samoa: A 10-Year Retrospective Survey (2007-2016). Asia Pac J Public Health 2021; 33:700-706. [PMID: 33233921 DOI: 10.1177/1010539520975261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Samoa is not immune to the growing global incidence of cancer, which is disproportionately high in low- and middle-income countries. As a preliminary step to upscale our population-based cancer registry initiatives in Samoa, we conducted a 10-year survey of cancer incidences in Samoa from 2007 to 2016. We reviewed all laboratory and clinically confirmed cases of cancer from 2007 to 2016 covering both government and nongovernment facilities. Cancer incidence increased steadily from 2007 (28.5 per 100 000) to 2012 (67.1 per 100 000). The incidence rate decreased in 2013 (from 67.1 cases in 2012 to 51.4 cases per 100 000 in 2013); and in 2015 (from 65.1 cases in 2014 to 54.3 cases per 100 000 in 2015). From 2012 to 2016, the incidence rate fluctuates between 50 and 65 cases per 100 000. Cancers of female genitalia, breast, and digestive system were the most common types in female and males, respectively.
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Affiliation(s)
| | | | - Les Mery
- International Agency for Research on Cancer, Lyon, France
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18
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Cuesta-Briand B, Hansell D, Burich S, Loimata T. Delays in the Pathway to Cancer Diagnosis in Samoa: A Qualitative Study of Patients' Experiences. Asia Pac J Public Health 2021; 33:707-713. [PMID: 34075810 DOI: 10.1177/10105395211019857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cancer is a leading cause of death in Samoa, with cancer patients presenting late and experiencing poor outcomes. Barriers to early diagnosis are complex, and cultural factors play an important part. This qualitative study explored the barriers to cancer diagnosis in Samoa through semistructured interviews conducted with 19 Samoan patients. Thematic data analysis was informed by socioecological theory and yielded 4 themes: knowledge and beliefs about cancer; pain as a trigger for health care-seeking behavior; follow-up issues; and communication and trust. Cancer knowledge and attitudes toward pain were strongly influenced by culture and community beliefs. Lack of follow-up resulted in significant delays, and ineffective patient-doctor communication triggered feelings of uncertainty and mistrust in the health care system. Efforts to address knowledge gaps will not be effective unless they are accompanied by broader strategies addressing local health care capacity issues. Adopting a socioecological framework lens within a regional collaborative approach provides a way forward.
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Affiliation(s)
| | | | | | - Terri Loimata
- National University of Samoa, Apia, Samoa.,Samoa Cancer Society, Apia, Samoa
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19
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Anglade F, Milner DA, Brock JE. Can pathology diagnostic services for cancer be stratified and serve global health? Cancer 2021; 126 Suppl 10:2431-2438. [PMID: 32348564 DOI: 10.1002/cncr.32872] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/06/2020] [Accepted: 03/11/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Before initiating cancer therapy, a diagnostic tumor tissue sample evaluated within a pathology laboratory by a pathologist is essential to confirm the malignancy type and provide key prognostic factors that direct the treatment offered. METHODS Pathology evaluation includes multiple expensive reagents, complex equipment, and both laboratory and pathologist technical skills. By using breast cancer as an example, at a minimum, key tumor prognostic information required before the initiation of treatment includes subtype, tumor grade, tumor size, lymph node status when possible, and biomarker expression determined by immunohistochemistry for estrogen receptor. The additional determination of biomarker expression of progesterone receptor and human epidermal growth factor receptor (HER2) is the standard of care in high-resource settings, but assays may not be affordable in low-income and middle-income countries. RESULTS With positive tests, patients are eligible for either tamoxifen (for estrogen receptor-positive/progesterone receptor-positive cancers) or monoclonal antibody therapy (for HER2-positive cancers). For settings in which endocrine therapy and/or HER2-targeted therapy is unavailable, biomarker studies have no utility, and high-resource setting standards for pathology evaluation and reporting are unachievable. Resource-stratified pathology evaluation guidelines in cancer diagnosis have not been developed, in contrast to excellent comprehensive, resource-stratified clinical guidelines for use in low-income and middle-income countries, and these are long overdue. CONCLUSIONS The challenges of pathology evaluation in the context of global health are being met by innovative solutions, which may change the face of pathology practice.
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Affiliation(s)
- Fabienne Anglade
- Department of Pathology, Mirebalais Teaching Hospital, Mirebalais, Haiti
| | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois
| | - Jane E Brock
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
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20
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Naidu CK, Wiseman N, Harris N. Factors Associated with Low Screening Participation and Late Presentation of Cancer amongst Women in the Pacific Island Countries and Territories: A Systematic Review. Asian Pac J Cancer Prev 2021; 22:1451-1458. [PMID: 34048173 PMCID: PMC8408407 DOI: 10.31557/apjcp.2021.22.5.1451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objective: In most Pacific Island Countries and Territories (PICTs), cancer patients commonly present at very late stages and by the time the disease is diagnosed, it is often too late for treatment. This review examines the evidence on factors associated with low cancer screening participation and late presentation of cancer among women of the PICTs. Materials and Methods: Medline, PubMed, ProQuest and The Cumulative Index to Nursing and Allied Health Literature were searched to identify relevant studies for this review. Terms of medical subject headings was performed in combination with other key words such as “screening”, “delay”, “determinants”, “awareness”. Results: Eleven studies met the inclusion criteria of this review. Six factors were identified from these studies: resources and facilities, trust in the health care system, culture and tradition, modesty, awareness and socioeconomic status. Conclusion: Due to several barriers and factors, women in the PICTs are hindered from accessing cancer screening practices and often present late with cancer symptoms leading to advanced stage diagnosis. The findings of this study provide a foundation for future studies that could focus more in-depth to explain how these factors contribute to the presentation of cancer in late stages.
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21
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Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094770. [PMID: 33947123 PMCID: PMC8124473 DOI: 10.3390/ijerph18094770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19-86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.
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22
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Ward IG, Mel A, Soma A, Atalifo-Veu A, Karapetis CS, Yip D. A collaborative approach to meeting oncology challenges in island communities in the Asia-Pacific region. J Med Imaging Radiat Oncol 2021; 65:418-423. [PMID: 33666352 DOI: 10.1111/1754-9485.13160] [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: 09/30/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 12/24/2022]
Abstract
Treatment of cancer in small island communities is frequently challenged by the isolation and scattered nature of target populations, limited economic resources and overburdened healthcare systems. Strategies that have been successful in improving access to nonsurgical treatment in Fiji, Papua New Guinea, Solomon Islands and West Timor include balancing centralised location of scarce resources (particularly health professionals) with minimisation of patient travel, in-country training by teams of oncology professionals from high-income countries (HICs), sending health professionals to train in HICs, sharing and adaptation of treatment protocols, and telehealth initiatives. A common feature of successful initiatives is a collaborative approach. Cancer service design and implementation needs to be led by local health professionals with the collaboration of local health authorities and government. There is greater scope for collaboration between low- and middle-income countries and for the use of virtual meetings, distance learning, and remote technical support.
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Affiliation(s)
- Iain Gordon Ward
- Canterbury Regional Cancer and Haematology Service, Christchurch Hospital, Christchurch, New Zealand
| | - Alfred Mel
- ANGAU Memorial General Hospital, Papua New Guinea National Cancer Centre, Lae, Papua New Guinea
| | - Andrew Soma
- NRH Oncology Unit, National Referral Hospital, Honiara, Solomon Islands
| | | | - Christos S Karapetis
- Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.,ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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23
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Wilson BE, Pokorny AMJ, Perera S, Barton MB, Yip D, Karapetis CS, Ward IG, Downes S, Yap ML. Australia and New Zealand's responsibilities in improving oncology services in the Asia-Pacific: A call to action. Asia Pac J Clin Oncol 2021; 18:133-142. [PMID: 33629530 DOI: 10.1111/ajco.13544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 12/16/2022]
Abstract
AIM To review the expected increasing demand for cancer services among low and middle-income countries (LMICs) in the Asia-Pacific (APAC), and to describe ways in which Australia and New Zealand (ANZ) can provide support to improve cancer outcomes in our region. METHODS We first review the current and projected incidence of cancer within the APAC between 2018 and 2040, and the estimated demand for chemotherapy, radiotherapy and surgery. We then explore potential ways in which ANZ can increase regional collaborations to improve cancer outcomes. RESULTS We identify 6 ways that ANZ can collaborate with LMICs to improve cancer care in the APAC through the ANZ Regional Oncology Collaboration Strategy: Increasing education and institutional collaborations in the APAC region through in-country training, twinning partnerships, observerships and formalised training programs in order to increase cancer care quality and capacity. Promoting and assisting in the establishment and maintenance of population-based cancer registries in LMICs. Increasing research capacity in LMICs through collaboration and promoting high quality global oncology research within ANZ. Engaging and training Australian and New Zealand clinicians in global oncology, increasing awareness of this important career path, and increasing health policy engagement. Increasing web-based endeavours through virtual tumour boards, web-based advocacy platforms and web-based teaching programs. Continuing to leverage for funding through professional bodies, government, industry, not-for-profit organisations and local hospital funds. CONCLUSION We propose the creation of an Australian and New Zealand Interest Group to provide formalised and sustained collaboration between researchers, clinicians and stakeholders.
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Affiliation(s)
- Brooke E Wilson
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South West Clinical School, University of New South Wales, Kensington, New South Wales, Australia.,Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Adrian M J Pokorny
- Department of Medical Oncology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sathira Perera
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South West Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Michael B Barton
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South West Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia.,ANU Medical School, Australian National University, Canberra, ACT, Australia
| | - Christos S Karapetis
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Iain G Ward
- Canterbury Regional Cancer and Haematology Service, Christchurch, New Zealand
| | - Simon Downes
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Mei Ling Yap
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South West Clinical School, University of New South Wales, Kensington, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Macarthur Cancer Therapy Centre, Western Sydney University, Campbelltown, New South Wales, Australia
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24
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Hiatt RA, Beyeler N. Cancer and climate change. Lancet Oncol 2020; 21:e519-e527. [PMID: 33152311 DOI: 10.1016/s1470-2045(20)30448-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/22/2022]
Abstract
The acute impact of climate change on human health is receiving increased attention, but little is known or appreciated about the effect of climate change on chronic diseases, particularly cancer. This Review provides a synopsis of what is known about climate change and the exposures it generates relevant to cancer. In the context of the world's cancer burden and the probable direction we could expect to follow in the absence of climate change, this scoping review of the literature summarises the effects that climate change is having on major cancers, from environmental exposures to ultraviolet radiation, air pollution, disruptions in the food and water supply, environmental toxicants, and infectious agents. Finally, we explore the effect of climate change on the possible disruption of health systems that have been essential to cancer control practice. We conclude with potential responses and opportunities for intervention.
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Affiliation(s)
- Robert A Hiatt
- Department of Epidemiology and Biostatistics and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - Naomi Beyeler
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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25
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Shafiq J, Gabriel GS, Barton MB. Radiotherapy service need in the Pacific Island countries. Asia Pac J Clin Oncol 2020; 17:e217-e225. [DOI: 10.1111/ajco.13437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/10/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Jesmin Shafiq
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE) Ingham Institute for Applied Medical Research University of New South Wales Sydney New South Wales Australia
| | - Gabriel Sam Gabriel
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE) Ingham Institute for Applied Medical Research University of New South Wales Sydney New South Wales Australia
| | - Michael B. Barton
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE) Ingham Institute for Applied Medical Research University of New South Wales Sydney New South Wales Australia
- Department of Radiation Oncology South Western Sydney Local Health District Sydney New South Wales Australia
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26
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Watters DA, Tangi V, Guest GD, McCaig E, Maoate K. Advocacy for global surgery: a Pacific perspective. ANZ J Surg 2020; 90:2084-2089. [DOI: 10.1111/ans.15972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022]
Affiliation(s)
- David A. Watters
- Department of Surgery Deakin University and Barwon Health Geelong Victoria Australia
- RACS Global Health Royal Australasian College of Surgeons Melbourne Victoria Australia
| | - Viliami Tangi
- Department of Surgery Ministry of Health Nuku'alofa Tonga
| | - Glenn D. Guest
- Department of Surgery Deakin University and Barwon Health Geelong Victoria Australia
- RACS Global Health Royal Australasian College of Surgeons Melbourne Victoria Australia
- Department of Surgery Epworth Geelong Geelong Victoria Australia
| | - Eddie McCaig
- Department of Surgery Fiji National University Suva Fiji
| | - Kiki Maoate
- Department of Surgery Epworth Geelong Geelong Victoria Australia
- Department of Surgery University of Otago Christchurch New Zealand
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27
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Mola GL, de Costa C. Cancer of the cervix – The view from Australia’s nearest neighbour. Aust N Z J Obstet Gynaecol 2020; 60:173-174. [DOI: 10.1111/ajo.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/02/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Glen L. Mola
- Department of Obstetrics and Gynaecology School of Medicine and Health Sciences University of Papua New Guinea Papua New Guinea
| | - Caroline de Costa
- Department of Obstetrics and Gynaecology James Cook University College of Medicine and Dentistry Cairns Australia
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Fordyce A, Vorias B, Taranto L, Soares A, Watters D, Saunders C. Breast disease in Timor-Leste. ANZ J Surg 2020; 90:1920-1924. [PMID: 32062871 DOI: 10.1111/ans.15720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/09/2020] [Accepted: 01/12/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgically treatable conditions are well documented in high-income countries. There is a gap in epidemiological understanding of breast pathology in many developing countries, Timor-Leste among them. This study was conducted to determine the burden of breast disease and to inform public health measures to address early detection, diagnosis and management. METHODS A retrospective quantitative case-control study was conducted at Guido Valadares National Hospital in Dili. Patients were included if they attended surgical outpatients or had a pathology specimen recorded between 1 September 2016 and 1 September 2017. RESULTS There were 444 female patients with a clinical diagnosis of breast disease over the 12-month period. The average age was 33.7 years. There were 188 (42.3% of total sample) cases of fibroadenoma and 122 (27.4% of total sample) diagnoses consistent with non-specific lumps. Of the 116 female patients presenting to Guido Valadares National Hospital who had a biopsy, 62.6% were malignant or hyperplastic in nature, and 86% of those with a malignant biopsy had clinically locally advanced disease. CONCLUSION Breast conditions including cancer in Timor-Leste are relatively common and occur in young women in the prime of their lives (37 years of age). Developing a national cancer registry and funding directed towards improving early presentation and good clinical care of breast cancer patients will be critical for reducing early morbidity and mortality and improving other patient outcomes including income loss, gender health inequality and the intergenerational effects of early parental death.
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Affiliation(s)
- Andrew Fordyce
- Department of General Surgery, Alfred Health, Melbourne, Victoria, Australia.,Global Health Division, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Blake Vorias
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Lucas Taranto
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Alito Soares
- Department of Surgery, Guido Valadares National Hospital, Dili, Timor-Leste
| | - David Watters
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Christobel Saunders
- School of Surgery and Pathology, The University of Western Australia, Perth, Western Australia, Australia.,Department of Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Department of Surgery, St John of God Hospital, Perth, Western Australia, Australia
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29
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Sarfati D, Dyer R, Vivili P, Herman J, Spence D, Sullivan R, Weller D, Bray F, Hill S, Bates C, Foliaki S, Palafox N, Luciani S, Ekeroma A, Hospedales J. Cancer control in small island nations: from local challenges to global action. Lancet Oncol 2019; 20:e535-e548. [PMID: 31395475 PMCID: PMC7746435 DOI: 10.1016/s1470-2045(19)30511-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
Cancer is a leading cause of death in small island nations and is forecast to increase substantially over the coming years. Governments, regional agencies, and health services of these nations face daunting challenges, including small and fragile economies, unequal distribution of resources, weak or fragmented health services, small population sizes that make sustainable workforce and service development problematic, and the unavailability of specialised cancer services to large parts of the population. Action is required to prevent large human and economic costs relating to cancer. This final Series paper highlights the challenges and opportunities for small island nations, and identifies ways in which the international community can support efforts to improve cancer control in these settings. Our recommendations focus on funding and investment opportunities to strengthen cancer-related health systems to improve sharing of technical assistance for research, surveillance, workforce, and service development, and to support small island nations with policy changes to reduce the consumption of commodities (eg, tobacco and unhealthy food products) that increase cancer risk.
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Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Paula Vivili
- Public Health Division, Pacific Community, Noumea, New Caledonia
| | | | | | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - David Weller
- James Mackenzie Professor of General Practice, Usher Institute of Population Health, Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Sarah Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Christopher Bates
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, Melbourne, VIC, Australia
| | - Sunia Foliaki
- Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
| | - Neal Palafox
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Alec Ekeroma
- Obstetrics and Gynaecology, University of Otago, Wellington, Wellington, New Zealand; National University of Samoa, Le Papaigalagala Campus, To'omatagi, Samoa
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30
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Ekeroma A, Dyer R, Palafox N, Maoate K, Skeen J, Foliaki S, Vallely AJ, Fong J, Hibma M, Mola G, Reichhardt M, Taulung L, Aho G, Fakakovikaetau T, Watters D, Toliman PJ, Buenconsejo-Lum L, Sarfati D. Cancer management in the Pacific region: a report on innovation and good practice. Lancet Oncol 2019; 20:e493-e502. [PMID: 31395474 DOI: 10.1016/s1470-2045(19)30414-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022]
Abstract
Pacific island countries and territories (PICTs) face the challenge of a growing cancer burden. In response to these challenges, examples of innovative practice in cancer planning, prevention, and treatment in the region are emerging, including regionalisation and coalition building in the US-affiliated Pacific nations, a point-of-care test and treat programme for cervical cancer control in Papua New Guinea, improving the management of children with cancer in the Pacific, and surgical workforce development in the region. For each innovation, key factors leading to its success have been identified that could allow the implementation of these new developments in other PICTs or regions outside of the Pacific islands. These factors include the strengthening of partnerships within and between countries, regional collaboration within the Pacific islands (eg, the US-affiliated Pacific nations) and with other regional groupings of small island nations (eg, the Caribbean islands), a local commitment to the idea of change, and the development of PICT-specific programmes.
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Affiliation(s)
- Alec Ekeroma
- National University of Samoa, Le Papaigalagala Campus, To'omatagi, Samoa; Department of Obstetrics and Gynaecology, University of Otago, Wellington, Wellington, New Zealand.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Neal Palafox
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HA, USA; Population Sciences in the Pacific Program (Cancer Prevention in the Pacific), University of Hawaii Cancer Center, Honolulu, HA, USA
| | - Kiki Maoate
- Pacific Islands Programme, Royal Australasian College of Surgeons, Melbourne, VIC, Australia; Department of Paediatric Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Jane Skeen
- Starship Blood and Cancer Centre, Starship Children's Health, Auckland, New Zealand
| | - Sunia Foliaki
- Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
| | - Andrew J Vallely
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - James Fong
- Obstetrics and Gynaecology Unit, Colonial War Memorial Hospital, Ministry of Health, Suva, Fiji; Fiji National University, Suva, Fiji
| | - Merilyn Hibma
- Cervical Cancer Prevention in the Pacific Alliance, Dunedin, New Zealand; Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Glen Mola
- Department of Obstetrics, Gynaecology and Reproductive Health, Port Moresby General Hospital, Port Moresby, Papua New Guinea; School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - Martina Reichhardt
- Cancer Council of the Pacific Islands, Yap State Department of Health Services, Yap State, Federated States of Micronesia
| | - Livinston Taulung
- Cancer Council of the Pacific Islands, Kosrae State Department of Health Services, Kosrae State, Federated States of Micronesia
| | - George Aho
- Department of Paediatrics, Vaiola Hospital, Nuku'alofa Tonga
| | | | - David Watters
- Deakin University and Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Pamela J Toliman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lee Buenconsejo-Lum
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HA, USA
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
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