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Ward ZJ, Gaba Q, Atun R. Cancer incidence and survival for 11 cancers in the Commonwealth: a simulation-based modelling study. Lancet Oncol 2024:S1470-2045(24)00336-X. [PMID: 39127064 DOI: 10.1016/s1470-2045(24)00336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND The number of new cancer cases in Commonwealth countries rose by 35% between 2008 and 2018, but progress in cancer control has been slow in many low-income and lower-middle-income member states. We aimed to examine cancer outcomes and priority areas in the Commonwealth to provide insight and guidance on prioritisation of efforts to improve cancer survival and make the best use of scarce resources. METHODS We adapted a previously developed microsimulation model of global cancer survival for 11 cancer sites (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate). All 56 Commonwealth countries were included and classified based on the 2020 World Bank Income groups (low-income, lower-middle-income, upper-middle-income, and high-income countries) and Commonwealth geographical areas. We modelled the number of incident cancer cases in each Commonwealth country in 2020, based on age group-specific estimates of incidence rates from GLOBOCAN 2020. We simulated 5-year net survival for each patient, accounting for the stage at diagnosis (I-IV), availability of specific treatment and imaging modalities, and quality of care (based on residual differences in expected versus observed survival after accounting for the availability and effectiveness of treatment and imaging modalities). We also simulated counterfactual policy scenarios, in which we scaled up various aspects of cancer care to the mean level of high-income countries to estimate the comparative effectiveness of different policies. FINDINGS Incident cancers in the Commonwealth accounted for an estimated 14·3% of global diagnosed cancer cases in 2020 among the 11 cancers modelled (1 610 000 Commonwealth cases [95% UI 1 556 000-1 674 000] of 11 227 000 global cases [11 069 000-11 406 000]) and are estimated to increase to 17·3% in 2050 due to population growth (3 330 000 [3 154 000-3 539 000] of 19 308 000 [18 706 000-19 911 000]). The 5-year net survival across 11 cancers combined in 2020 was 30·7% (95% UI 22·4-38·6) in Commonwealth countries, ranging from 4·1% (0·04-15·2) in low-income countries, 17·8% (3·7-30·9) in lower-middle-income countries, 33·1% (23·7-46·0) in upper-middle-income countries, to 59·0% (57·8-60·2) in high-income countries. Among single treatment policies, scaling up access to radiotherapy had the largest survival impact in low-income countries, surgery had the largest impact in lower-middle-income and upper-middle-income countries, and targeted therapy had the largest impact in high-income countries. By geographical area, improving radiotherapy availability was estimated to have the largest impact in Africa, surgery in Asia, targeted therapy in the Caribbean and the Americas and Europe, and quality of care in the Pacific Commonwealth countries. Comparing packages of scaling up the availability of all treatment modalities versus imaging modalities, expanding availability of imaging yielded the largest benefits in high-income countries, and in the Caribbean and the Americas, Europe, and the Pacific, whereas expanding treatment yielded larger benefits in all other income groups and geographical areas. INTERPRETATION We found large variation in 5-year net survival, with a nearly 15-times difference in cancer survival by country income group within the Commonwealth. Efforts to improve the availability of treatment and imaging modalities and quality of care will be crucial to reduce these disparities, with specific priorities of scale-up policies varying by setting. The Commonwealth could leverage a broad range of knowledge and resources and have an important role in supporting member countries with setting-specific priorities to improve cancer outcomes. FUNDING Harvard T H Chan School of Public Health.
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Affiliation(s)
- Zachary J Ward
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Health Policy and Management, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Qassi Gaba
- Department of Biomedical Informatics, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Rifat Atun
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Faculty of Medicine, Imperial College London, London, UK
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Every A, Cuesta-Briand B, Hansell D, Burich S, Tofilua F, Crawford GB, Collier A. A qualitative study of Samoan cancer patients' experiences. Int J Palliat Nurs 2024; 30:380-388. [PMID: 39028314 DOI: 10.12968/ijpn.2024.30.7.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
METHODS This qualitative interview study was part of a larger study that interviewed19 participants recruited among patients with cancer registered with Samoa Cancer Society, or patients recently discharged from the main tertiary hospital in Samoa. Interview transcripts were reviewed, and the research team identified the key palliative-care-related themes. RESULTS Analysis led to the generation of the following key themes: living with pain; resource constraints; support from family and faith; and interactions with healthcare professionals. Most participants were experiencing unresolved pain as a result of poor health knowledge, lack of access to medications and practical issues, such as financial limitations and lack of transport. Participants also reported a lack of resources, including financial constraints, as a significant barrier to effective healthcare. Sources of support for patients with cancer were most commonly strong family relationships and religious faith. Although it was difficult for the participants to access care from healthcare professionals, they found that honest communication about their condition was comforting. However, they were frustrated if they felt communication was unsatisfactory. CONCLUSION This study provides much needed evidence on the issues that affect the quality of life patients with cancer receiving palliative care and their families in Samoa. It also highlights the intersectionality of these issues and how this compounds the patient experience. Practical recommendations for improving palliative care lie in a few key areas, including a need for improved access to opioids and support for family caregivers. However, from a systemic perspective, the way forward should lie in harnessing the strengths of Samoan culture, including the strong sense of family and the role of religion, to provide support and care for palliative patients.
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Affiliation(s)
- Alice Every
- Aged Care Rehabilitation and Palliative Care Division, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Beatriz Cuesta-Briand
- Rural Clinical School of Western Australia, University of Western Australia, Australia
| | - Dyxon Hansell
- World Health Organization, Samoa; National University of Samoa, Samoa
| | | | | | - Gregory B Crawford
- Aged Care Rehabilitation and Palliative Care Division, Northern Adelaide Local Health Network, Adelaide, Australia
- University of Adelaide, Australia
| | - Aileen Collier
- Aged Care Rehabilitation and Palliative Care Division, Northern Adelaide Local Health Network, Adelaide, Australia
- Flinders University, Adelaide, Australia
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Roberts C, Toohey K, Paterson C. The Experiences and Unmet Supportive Care Needs of Partners of Men Diagnosed With Prostate Cancer: A Meta-aggregation Systematic Review. Cancer Nurs 2024:00002820-990000000-00074. [PMID: 36480350 DOI: 10.1097/ncc.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Partners of men diagnosed with prostate cancer face their own emotional struggles as they navigate additional caregiver responsibilities while concurrently adjusting to the diagnosis and coping with greater illness uncertainty for their loved one. OBJECTIVE This qualitative systematic review examined the unmet supportive care needs of partners affected by prostate cancer. INTERVENTIONS/METHODS A meta-aggregation was conducted. Four electronic databases were searched using key words. The methodology followed the Joanna Briggs Institute for qualitative evidence synthesis. The review process followed a registered priori review protocol and was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Data extraction and quality assessment were conducted in parallel. RESULTS Twenty-one publications were included. A total of 239 findings and 32 categories were synthesized into 7 domains of unmet needs as experienced by partners. The domains of needs expressed by the participants included interpersonal/intimacy, physical/daily living, healthcare service, family-related, psychological/emotional needs, and spiritual and social needs. CONCLUSIONS There are gaps in clinical service support, despite routine clinical consultation with healthcare professionals. Partners may diminish their social networks to protect their husband at the cost to their own self-preservation and well-being. IMPLICATIONS FOR PRACTICE Cancer organizations, policy makers, healthcare care professionals, and researchers are slowly making progress to acknowledge the unique support needs of partners affected by cancer. Healthcare professionals should encourage partners to be included in models of prehabilitation to access timely support to address informational, intimacy, spiritual, and daily living needs support.
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Affiliation(s)
- Cara Roberts
- Author Affiliations: Faculty of Health (Drs Paterson and Toohey and Ms Roberts) and Prehabilitation, Activity, Cancer, Exercise, and Survivorship (PACES) Research Group (Dr Paterson, Dr Toohey and Ms Roberts), University of Canberra, Bruce; and Canberra Health Services & ACT Health, SYNERGY Nursing and Midwifery Research Centre, ACT Health Directorate Level 3, Canberra Hospital, Garran (Dr Paterson), Australian Capital Territory, Australia; and Robert Gordon University, Aberdeen, Scotland, United Kingdom (Dr Paterson)
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Jia W, Huang Z, Zhou L, Liou YC, Di Virgilio F, Ulrich H, Illes P, Zhang W, Huang C, Tang Y. Purinergic signalling in cancer therapeutic resistance: From mechanisms to targeting strategies. Drug Resist Updat 2023; 70:100988. [PMID: 37413937 DOI: 10.1016/j.drup.2023.100988] [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: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
Purinergic signalling, consisting of extracellular purines and purinergic receptors, modulates cell proliferation, invasion and immunological reaction during cancer progression. Here, we focus on current evidence that suggests the crucial role of purinergic signalling in mediating cancer therapeutic resistance, the major obstacle in cancer treatment. Mechanistically, purinergic signalling can modulate the tumor microenvironment (TME), epithelial-mesenchymal transition (EMT) and anti-tumor immunity, thus affecting drug sensitivity of tumor cells. Currently, some agents attempting to target purinergic signalling either in tumor cells or in tumor-associated immune cells are under preclinical or clinical investigation. Moreover, nano-based delivery technologies significantly improve the efficacy of agents targeting purinergic signalling. In this review article, we summarize the mechanisms of purinergic signalling in promoting cancer therapeutic resistance and discuss the potentials and challenges of targeting purinergic signalling in future cancer treatment.
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Affiliation(s)
- Wenhui Jia
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, China
| | - Zhao Huang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, China
| | - Li Zhou
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, the Second Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Yih-Cherng Liou
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore 117573, Singapore; Department of Biological Sciences, Faculty of Science, National University of Singapore, 14 Science Drive 4, Singapore 117573, Singapore
| | | | - Henning Ulrich
- International Joint Research Centre on Purinergic Signalling, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | - Peter Illes
- International Joint Research Centre on Purinergic Signalling, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Rudolf-Boehm-Institut für Pharmakologie und Toxikologie, Universitaet Leipzig, Leipzig, Germany
| | - Wei Zhang
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Canhua Huang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, China; Institute of TCM-Based Stress Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Yong Tang
- International Joint Research Centre on Purinergic Signalling, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Acupuncture and Chronobiology Key Laboratory of Sichuan Province, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China.
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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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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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7
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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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Glasgow L, Lewis R, Charles S. The cancer epidemic in the Caribbean region: Further opportunities to reverse the disease trend. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100295. [PMID: 36777319 PMCID: PMC9903961 DOI: 10.1016/j.lana.2022.100295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cancer incidence has been rising in the Caribbean and is expected to have significant adverse implications for the health of people in the region and health systems in this decade. While developed countries, for the most part, enjoy the benefits of advanced technologies and adaptive systems in cancer control and management, a different experience confronts a large segment of the Caribbean population. The region has experienced some success in enhancing cancer services, however, there is a need to address gaps in several areas through nationally and regionally tailored initiatives. This Review complements previous publications on the challenges, actions, and progress towards cancer prevention and care in Caribbean countries but also further outlines potential positive impacts that can be derived from addressing gaps pertaining to cancer education, data management, screening and risk assessment, navigation services, gender factors, and resource development. The proposed approaches encapsulate concepts of health theories that are applicable across the ecological domains. When implemented in combination, the proposals may effectively contribute to reducing the cancer burden in the region.
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Affiliation(s)
- Lindonne Glasgow
- St. George's University, True Blue, St. George's, Grenada,Corresponding author at: Department of Public Health & Preventive Medicine, St. George's University, P.O. Box 7, True Blue, St. George, Grenada.
| | - Reeba Lewis
- St. George's University, True Blue, St. George's, Grenada
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Auguste A, Cox S, Oliver JS, Phillip D, Gabriel O, St. Catherine J, Radix C, Luce D, Barul C. Cancer Survivors in Saint Lucia Deeply Value Social Support: Considerations for Cancer Control in Under-Resourced Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116531. [PMID: 35682118 PMCID: PMC9180699 DOI: 10.3390/ijerph19116531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/09/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.
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Affiliation(s)
- Aviane Auguste
- Vaughan Arthur Lewis Institute for Research and Innovation (VALIRI), Sir Arthur Lewis Community College, Morne Fortune, Castries LC06 101, Saint Lucia;
- Correspondence:
| | - Shania Cox
- Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, 97100 Pointe-à-Pitre, France; (S.C.); (D.L.); (C.B.)
- Faculté de Médecine, Campus de Fouillole, Université des Antilles, 97157 Pointe-à-Pitre, France
| | - JoAnn S. Oliver
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL 35401, USA;
| | - Dorothy Phillip
- Faces of Cancer Saint Lucia, Tapion Ridge, Castries LC04 201, Saint Lucia;
| | - Owen Gabriel
- Department of Oncology, Owen King European Union Hospital, Millenium Highway, Castries LC04 201, Saint Lucia;
- Caribbean Association for Oncology and Hematology, Belmont, Port of Spain 150123, Trinidad and Tobago
| | - James St. Catherine
- Vaughan Arthur Lewis Institute for Research and Innovation (VALIRI), Sir Arthur Lewis Community College, Morne Fortune, Castries LC06 101, Saint Lucia;
| | - Carlene Radix
- Organisation of Eastern Caribbean States (OECS) Commission-Franck Johnson Avenue, Morne Fortune, Castries LC06 101, Saint Lucia;
| | - Danièle Luce
- Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, 97100 Pointe-à-Pitre, France; (S.C.); (D.L.); (C.B.)
| | - Christine Barul
- Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, 97100 Pointe-à-Pitre, France; (S.C.); (D.L.); (C.B.)
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Barak Y, Neehoff S, Glue P. Ageing badly: indicators of old-age structure in Australia and New Zealand. J Prim Health Care 2021; 12:272-276. [PMID: 32988449 DOI: 10.1071/hc19095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/26/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Until 2050, Australia and New Zealand will experience continuing increase in the population aged >65 years. Studying differences in indicators of old-age structure between these countries can inform policymakers. AIM To calculate and analyse indicators of old-age structure for Australia and New Zealand. METHODS Five indicators of old-age structure were calculated: centenarian ratio (number of centenarians per 100,000 people), longevity index (proportion of people aged ≥90 and ≥65 years in the population), longevity level (proportion of 80+/60+ years population), ageing tendency (proportion of people aged ≥60 years in the population) and centenarity index (ratio between the centenarians and the total population ≥90 years). RESULTS All indicators of old-age structure demonstrated an advantageous ageing structure in Australia compared with New Zealand. In addition, the New Zealand Māori and Australian Aboriginal indicators of old-age structure demonstrated a significant disadvantage to these ethnic groups compared with the general population. DISCUSSION Public health policy needs to target ageing in New Zealand as a major goal in advancing the 'Ageing Well' policy advocated by the government.
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Affiliation(s)
- Yoram Barak
- Department of Psychological Medicine, Dunedin School of Medicine, Otago University Dunedin, New Zealand; and Corresponding author.
| | - Shona Neehoff
- Department of Psychological Medicine, Dunedin School of Medicine, Otago University Dunedin, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, Dunedin School of Medicine, Otago University Dunedin, New Zealand
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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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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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Nagra S, Singh S, Kaur B, McCaig E, Tangi V, Guest G, Watters DA. How is surgery included in the Strategic Health Plans of the Pacific, Papua New Guinea and Timor-Leste? ANZ J Surg 2021; 91:795-801. [PMID: 33870624 DOI: 10.1111/ans.16651] [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: 02/03/2020] [Revised: 10/06/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Papua New Guinea, Pacific Island nations, and Timor-Leste represent a range of island nations with populations ranging from a few thousand to 8 million. They perform on average about 25% of the Lancet Commission of Global Surgery's target 5000 per 100 000 population and their health workforce have significant deficits of trained surgeons and anaesthetists. This study was conducted to determine how the current national health plans of these nations have included surgery and anaesthesia. METHODS The most recent (as of December 2018) published national health plans of 10 Pacific Island nations (Cook Islands, Fiji, Nauru, Federated States of Micronesia, Kiribati, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu), Papua New Guinea and Timor-Leste were reviewed for content and process, searching for key words and identifying themes related to surgery and anaesthesia. RESULTS There were 12 national health plans with a combined total of 478 pages. There was limited surgical and/or anaesthesia input within the planning process. Injuries, blindness, cancer and non-communicable diseases were included themes, but the potential role of surgical care in addressing these conditions was not well documented. The need for better information and registries was noted by several nations but possible surgical care delivery or outcome metrics were not included. CONCLUSION There is limited mention of surgical and anaesthesia care planning within current health plans in the Pacific, PNG and TL. There is a need for greater surgical and anaesthesia engagement in future plans with performance measured against World Health Organization core surgical indicators.
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Affiliation(s)
- Sonal Nagra
- Department of Surgery, Deakin University and Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Sheetal Singh
- Health System Improvement and Innovation, Ministry of Health, Wellington, New Zealand
| | - Balbindar Kaur
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | | | | | - Glenn Guest
- Department of Surgery, Deakin University and Epworth Hospital, University Hospital Geelong, Geelong, Victoria, Australia
| | - David A Watters
- Department of Surgery, Deakin University and Epworth Hospital, University Hospital Geelong, Geelong, Victoria, Australia
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Alleyne-Mike K, Sylvester P, Henderson-Suite V, Mohoyodeen T. Radiotherapy in the Caribbean: a spotlight on the human resource and equipment challenges among CARICOM nations. HUMAN RESOURCES FOR HEALTH 2020; 18:49. [PMID: 32680524 PMCID: PMC7367401 DOI: 10.1186/s12960-020-00489-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/07/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND There is limited data on access to radiotherapy services for CARICOM nations. METHODS This was a descriptive mixed-methods observational study which used data collected via survey from staff working in Radiation Oncology in 14 CARICOM countries. Benchmark recommendations from the International Atomic Energy Agency were compared to existing numbers. The Directory of Radiotherapy Centers, World Bank, and Global Cancer Observatory databases were all accessed to provide information on radiotherapy machines in the region, population statistics, and cancer incidence data respectively. Both population and cancer incidence-based analyses were undertaken to facilitate an exhaustive review. RESULTS Radiotherapy machines were present in only 50% of the countries. Brachytherapy services were performed in only six countries (42.9%). There were a total of 15 external beam machines, 22 radiation oncologists, 22 medical physicists, and 60 radiation therapists across all nations. Utilizing patient-based data, the requirement for machines, radiation oncologists, medical physicists, and radiation therapists was 40, 66, 44, and 106, respectively. Only four (28.6%) countries had sufficient radiation oncologists. Five (35.7%) countries had enough medical physicists and radiation therapists. Utilizing population-based data, the necessary number of machines, radiation oncologists, and medical physicists was 105, 186, and 96 respectively. Only one county (7.1%) had an adequate number of radiation oncologists. The number of medical physicists was sufficient in just three countries (21.4%). There were no International Atomic Energy Agency population guidelines for assessing radiation therapists. A lower economic index was associated with a larger patient/population to machine ratio. Consequentially, Haiti had the most significant challenge with staffing and equipment requirements, when compared to all other countries, regardless of the evaluative criteria. Depending on the mode of assessment, Haiti's individual needs accounted for 37.5% (patient-based) to 59.0% (population-based) of required machines, 40.1% (patient-based) to 59.7% (population-based) of needed radiation oncologists, 38.6% (patient-based) to 58.3% (population-based) of medical physicists, and 42.5% (patient-based) of radiation therapists. CONCLUSION There are severe deficiencies in radiotherapy services among CARICOM nations. Regardless of the method of comparative analysis, the current allocation of equipment and staffing scarcely meets 50% of regional requirements.
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Affiliation(s)
- Kellie Alleyne-Mike
- National Radiotherapy Centre, 112 Western Main Road, St. James, Port of Spain, Trinidad and Tobago.
| | - Pearse Sylvester
- National Radiotherapy Centre, 112 Western Main Road, St. James, Port of Spain, Trinidad and Tobago
| | - Vladimir Henderson-Suite
- National Radiotherapy Centre, 112 Western Main Road, St. James, Port of Spain, Trinidad and Tobago
| | - Thana Mohoyodeen
- Port of Spain General Hospital, 61 Charlotte Street, Port of Spain, Trinidad and Tobago
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Jackson MD, Tulloch-Reid MK, McCaw-Binns AM, Aiken W, Ferguson TS, Bennett NR, Harrison L, Badaloo A, McGrowder D, Grindley A, Walker E, Anderson SG. Central adiposity at diagnosis may reduce prostate cancer-specific mortality in African-Caribbean men with prostate cancer: 10-year follow-up of participants in a case-control study. Cancer Causes Control 2020; 31:651-662. [PMID: 32358695 DOI: 10.1007/s10552-020-01306-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/24/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE General and central adiposity are associated with the risk of developing prostate cancer (PCa), but the role of these exposures on PCa survival among men of African ancestry are less studied. This study aimed to investigate the association of anthropometry at diagnosis with all-cause and PCa-specific mortality and evaluate whether androgen deprivation therapy (ADT) modulated this risk. METHODS Associations between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) at diagnosis and mortality were examined in 242 men with newly diagnosed PCa enrolled between 2005 and 2007 and re-evaluated 10.9 years later. Multi-variable Cox proportional hazard models were used to examine associations of body size variables (using standard WHO cut-points and as continuous variables) with mortality, adjusted for sociodemographic characteristics, Gleason score, smoking, diabetes, primary treatment, and ADT therapy. RESULTS A total of 139 deaths (all-cause mortality 6.98/100 person-years) occurred (PCa-specific deaths, 56; other causes, 66; causes unknown, 17). In multi-variable analysis BMI, WC and WHR categories at diagnosis were not associated with all-cause mortality even after adjusting for ADT. While WHR (but not BMI or WC) when included as a continuous variable predicted lower PCa-specific mortality (multi-variable adjusted WHR per 0.1 difference: HR, 0.50; 95%CI 0.28, 0.93), the effect disappeared with ADT covariance and excluding deaths within the first 2 years. CONCLUSION Our study suggests that central adiposity as measured by WHR may improve long-term survival among men of African ancestry. Metabolic studies to understand the mechanism for this association are needed.
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Affiliation(s)
- Maria D Jackson
- Department of Community Health & Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica.
| | - Marshall K Tulloch-Reid
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Affette M McCaw-Binns
- Department of Community Health & Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - William Aiken
- Department of Surgery, Radiology, Anaesthesia, & Intensive Care, The University of the West Indies, Mona, Jamaica
| | - Trevor S Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Nadia R Bennett
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | | | - Asha Badaloo
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Donovan McGrowder
- Department of Chemical Pathology, The University of the West Indies, Mona, Jamaica
| | - Annielle Grindley
- Department of Community Health & Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Evelyn Walker
- Department of Community Health & Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Simon G Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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