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Ortiz AP, Hospedales CJ, Méndez-Lázaro PA, Hamilton WM, Rolle LD, Shepherd JM, Espinel Z, Gay HA, Nogueira LM, Shultz JM. Protecting Caribbean patients diagnosed with cancer from compounding disasters. Lancet Oncol 2024; 25:e217-e224. [PMID: 38697167 DOI: 10.1016/s1470-2045(24)00071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 05/04/2024]
Abstract
Caribbean small island developing states are becoming increasingly vulnerable to compounding disasters, prominently featuring climate-related hazards and pandemic diseases, which exacerbate existing barriers to cancer control in the region. We describe the complexities of cancer prevention and control efforts throughout the Caribbean small island developing states, including the unique challenges of people diagnosed with cancer in the region. We highlight potential solutions and strategies that concurrently address disaster adaptation and cancer control. Because Caribbean small island developing states are affected first and worst by the hazards of compounding disasters, the innovative solutions developed in the region are relevant for climate mitigation, disaster adaptation, and cancer control efforts globally. In the age of complex and cascading disaster scenarios, developing strategies to mitigate their effect on the cancer control continuum, and protecting the health and safety of people diagnosed with cancer from extreme events become increasingly urgent. The equitable development of such strategies relies on collaborative efforts among professionals whose diverse expertise from complementary fields infuses the local community perspective while focusing on implementing solutions.
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Affiliation(s)
- Ana Patricia Ortiz
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico; Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - C James Hospedales
- EarthMedic and EarthNurse Foundation for Planetary Health, Port of Spain, Trinidad and Tobago; Defeat-NCD Partnership Executive Committee Climate and Health, Healthy Caribbean Coalition, Geneva, Switzerland
| | - Pablo A Méndez-Lázaro
- Environmental Health Department, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
| | | | - LaShae D Rolle
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - J Marshall Shepherd
- Institute for Resilient Infrastructure Systems, Department of Geography, University of Georgia, Athens, GA, USA
| | - Zelde Espinel
- Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hiram A Gay
- Department of Radiation Oncology, School of Medicine, Washington University in St Louis, Saint Louis, MO, USA
| | | | - James M Shultz
- Protect & Promote Population Health in Complex Crises, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
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Riano I, Velazquez AI, Viola L, Abuali I, Jimenez K, Abioye O, Florez N. State of Cancer Control in South America: Challenges and Advancement Strategies. Hematol Oncol Clin North Am 2024; 38:55-76. [PMID: 37353378 DOI: 10.1016/j.hoc.2023.05.013] [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: 06/25/2023]
Abstract
Cancer is a major public health problem in South America. The cancer mortality burden is increasing in the region due to its presentation at later stages, which is related to limited access to cancer care. This results in a noticeable inequity in provisions of cancer care including specialized screening programs, as well as cancer-related treatments such as personalized medicine, radiation therapy, palliative care, and survivorship services. Consequently, South America faces many challenges for cancer control, most of them deriving from a lack of funding and unequal distribution of resources and cancer services, affecting mostly the underserved populations in the region.
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Affiliation(s)
- Ivy Riano
- Division of Hematology and Oncology, Dartmouth Cancer Center, Geisel School of Medicine Dartmouth, One Medical Drive, Lebanon, NH 03766, USA.
| | - Ana I Velazquez
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. https://twitter.com/AnaVManana
| | - Lucia Viola
- Fundación Neumológica Colombiana, Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Cra. 13b #161 - 85, Bogotá, Colombia. https://twitter.com/LuciaViola9
| | - Inas Abuali
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. https://twitter.com/Inas_md
| | - Kathya Jimenez
- Universidad Evangelica de El Salvador, El Salvador. https://twitter.com/KathyaJimenezMD
| | - Oyepeju Abioye
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa. https://twitter.com/AbioyeOyepeju
| | - Narjust Florez
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA. https://twitter.com/NarjustFlorezMD
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Buteau AC, Castelo-Loureiro A, Barragan-Carrillo R, Bejarano S, Kihn-Alarcón AJ, Soto-Perez-de-Celis E. Disparities in Cancer Control in Central America and the Caribbean. Hematol Oncol Clin North Am 2024; 38:35-53. [PMID: 37597998 DOI: 10.1016/j.hoc.2023.07.007] [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: 08/21/2023]
Abstract
Central America and the Caribbean is a highly heterogeneous region comprising more than 30 countries and territories with more than 200 million inhabitants. Although recent advances in the region have improved access to cancer care, there are still many disparities and barriers for obtaining high-quality cancer treatments, particularly for those from disadvantaged populations, immigrants, and rural areas. In this article, we provide an overview of cancer care in Central America and the Caribbean, with selected examples of issues related to disparities in access to care and suggest solutions and strategies to move forward.
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Affiliation(s)
| | - Alicia Castelo-Loureiro
- Medical Oncology Division, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Regina Barragan-Carrillo
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Vasco de Quiroga 15, Sección XVI, Tlalpan, Mexico City, Mexico
| | - Suyapa Bejarano
- Excelmedica, Liga Contra el Cancer Honduras, Condominios Médicos del Valle I Apt 318, San Pedro Sula, Honduras
| | - Alba J Kihn-Alarcón
- Research Department, Liga Nacional Contra el Cáncer & Instituto de Cancerología, 6a Avenida 6-58, Cdad. de Guatemala 01011, Guatemala
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, Mexico City, Mexico.
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Reece-Mills M, Bodkyn C, Baxter JAB, Allen U, Alexis C, Browne-Farmer C, Craig J, de Young S, Denburg A, Dindial K, Fleming-Carroll B, Gibson T, Gupta S, Knight-Madden J, Manley-Kucey M, Mclean-Salmon S, Ocho ON, Orrigio K, Read S, Sin Quee C, Smith B, Thame M, Wharfe G, Whitlock JA, Zlotkin S, Blanchette V. Developing a partnership to improve health care delivery to children <18 years with cancer and blood disorders in the English-speaking Caribbean: lessons from the SickKids-Caribbean Initiative (SCI). LANCET REGIONAL HEALTH. AMERICAS 2023; 26:100592. [PMID: 37727865 PMCID: PMC10506063 DOI: 10.1016/j.lana.2023.100592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
In 2013, the SickKids-Caribbean Initiative (SCI) was formalised among The Hospital for Sick Children in Toronto, Canada, the University of the West Indies, and Ministries of Health in six Caribbean countries (Barbados, The Bahamas, Jamaica, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago). The aim was to improve the outcomes and quality of life of children (<18 years) with cancer and blood disorders in the partner countries. Core activities included filling a human resource gap by training paediatric haematologists/oncologists and specialised registered nurses; improving capacity to diagnose and treat diverse haematology/oncology cases; developing and maintaining paediatric oncology databases; creating ongoing advocacy activities with international agencies, decision makers, and civil society; and establishing an integrated administration, management, and funding structure. We describe core program components, successes, and challenges to inform others seeking to improve health service delivery in a multidisciplinary and complex partnership.
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Affiliation(s)
- Michelle Reece-Mills
- Faculty of Medical Sciences, Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Curt Bodkyn
- Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Jo-Anna B. Baxter
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Upton Allen
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Cheryl Alexis
- Haematology/Oncology Department, Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | - Jenna Craig
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Stephanie de Young
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Kevon Dindial
- Department of Paediatrics, Eric Williams Medical Sciences Complex, San Juan, Trinidad and Tobago
| | - Bonnie Fleming-Carroll
- Learning Institute, Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tracey Gibson
- Department of Pathology, The University of the West Indies, Mona, Jamaica
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Jennifer Knight-Madden
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | | | - Oscar Noel Ocho
- Faculty of Medical Sciences, School of Nursing, The University of the West Indies, St. Augustine, Trinidad and Tobago
- PAHO/WHO Collaborating Centre for Nursing and Midwifery Development in the Caribbean, School of Nursing, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Kadine Orrigio
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Stanley Read
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
| | - Corrine Sin Quee
- School of Clinical Medicine and Research, The University of the West Indies, Nassau, The Bahamas
| | - Brian Smith
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Minerva Thame
- Faculty of Medical Sciences, Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Gilian Wharfe
- Department of Haematology/Oncology, The University of the West Indies, Kingston, Jamaica
| | - James A. Whitlock
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Stanley Zlotkin
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Victor Blanchette
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
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Hackett AM, Adereti CO, Walker AP, Ozobu I, Petit J, Waldron KR, Rolle M. The impact of limited access to electronic medical records on neurosurgical care within the CARICOM countries: A survey and scoping review. BRAIN & SPINE 2023; 3:101747. [PMID: 37383430 PMCID: PMC10293305 DOI: 10.1016/j.bas.2023.101747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 06/30/2023]
Abstract
Introduction Global access to electronic medical records (EMRs) continues to grow, however many countries including those within the Caribbean Community (CARICOM) lack access to this system. Minimal research investigating EMR use in this region exists. Research question How does limited EMR access impact neurosurgical care within the CARICOM? Materials and methods The Cochrane Library, EMBASE, Scopus, PubMed/MEDLINE databases, and grey literature were queried for studies addressing this issue within the CARICOM and low- and/or middle-income countries (LMICs). A comprehensive search for hospitals within the CARICOM was performed and responses to a survey inquiring about neurosurgery availability and EMR access within each facility were recorded. Results 26 out of 87 surveys were returned leading to a response rate of 29.0%. Among the survey respondents, 57.7% stated neurosurgery was provided at their facility; however, only 38.4% admitted to using an EMR system. Paper charting was the primary means of record keeping for the majority of the facilities (61.5%). The most frequently reported barriers stalling EMR implementation were financial limitations (73.6%) and poor internet access (26.3%). A total of 14 articles were included in the scoping review. Results from these studies suggest that limited EMR access contributes to suboptimal neurosurgical outcomes within the CARICOM and LMICs. Discussion and conclusion This paper is the first to address the impact that limited EMR has on neurosurgical outcomes in the CARICOM. The lack of research addressing this issue also highlights the need for ongoing efforts to increase research output focused on EMR accessibility and neurosurgical outcomes in these countries.
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Affiliation(s)
- Ashia M. Hackett
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | - Johnnie Petit
- Ross University School of Medicine, Miramar, FL, USA
| | | | - Myron Rolle
- Department of Neurosurgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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Piñeros M, Laversanne M, Barrios E, Cancela MDC, de Vries E, Pardo C, Bray F. An updated profile of the cancer burden, patterns and trends in Latin America and the Caribbean. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:None. [PMID: 36189115 PMCID: PMC9483035 DOI: 10.1016/j.lana.2022.100294] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Cancer is a leading cause of disease and death in Latin America and the Caribbean (LAC). Contemporary data on the cancer burden aims to inform effective cancer policies; this article provides an update and benchmarking of national cancer incidence and mortality estimates for the year 2020, alongside recent mortality trends in the region. Methods The number of new cancer cases and deaths were extracted from the GLOBOCAN 2020 database developed by the International Agency for Research on Cancer (IARC), and mortality data over time from IARC's cancer mortality database, New cancer cases, deaths and corresponding age-standardized rates per 100,000 person-years are presented. Random fluctuations in mortality trends by country, sex and cancer site were smoothed using LOWESS regression. Findings An estimated total of 1.5 million new cancer cases and 700,000 deaths occur annually in LAC, with corresponding incidence and mortality rates of 186.5 and 86.6 per 100,000. The most common cancers in 2020 were prostate (15%), breast (14%), colorectal (9%), lung (7%) and stomach (5%). Lung cancer remained the leading cause of cancer death (12%), though rates varied substantially between countries. The mortality trends of infectious-related cancers tended to decline in most countries, while rates of cancer types linked to westernization were mainly increasing. Assuming rates remain unchanged, the cancer burden in LAC will increase by 67% reaching 2.4 million new cases annually by 2040. Interpretation The cancer patterns reflect important underlying sociodemographic changes occurring over the last decades. With an increasing burden anticipated over the next decades in this region, there is a need to plan oncological service provision accordingly. Funding No external funds received.
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Affiliation(s)
- Marion Piñeros
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Enrique Barrios
- National Cancer Registry, Honorary Commission for the Fight against Cancer, Montevideo, Uruguay
| | | | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Constanza Pardo
- Cancer Surveillance Group, National Cancer Institute, INC Bogotá, Colombia
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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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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Khandwala YS, Ohanian A, Huang FW. Prostate Cancer in the Caribbean: A Baseline Assessment of Current Practices and Potential Needs. Cancer Control 2022. [PMCID: PMC8961354 DOI: 10.1177/10732748221082372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Afro-Caribbean men have a higher risk of prostate cancer than any other population of men
in the world. However, the Caribbean is composed of a heterogenous group of healthcare
systems located on small islands which makes population-based studies difficult to conduct
and interpret. The aim of this review is to compile previously published data on the state
of prostate cancer in Caribbean men and to highlight potential healthcare needs that can
be addressed by public health efforts. We reviewed three databases and identified relevant
papers that were subsequently searched by the authors. Peer-reviewed studies published in
the English language after 2010 with a focus on prostate cancer diagnosis, management, and
outcomes of Caribbean men were prioritized. Afro-Caribbean men were found to have a higher
incidence and mortality rate compared to their counterparts. Misperception about the
disease, lack of regional guidelines, and poor access to care are compounding factors that
result in worse outcomes for these men compared to high-income nations. Urologists and
oncologists in the region, while well-trained, are limited in number and in most cases do
not offer newer treatment modalities. Overall, only a few island nations have cancer
registries, and there remains a significant need for more population-based studies to
assess guideline adherence and outcomes. Until further research and investment in the
region is made, the disparity between the care received by Afro-Caribbean men and their
counterparts will likely remain.
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Affiliation(s)
- Yash S Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Alec Ohanian
- Division of Hematology and Oncology, University of California, San Francisco, CA, USA
| | - Franklin W Huang
- Division of Hematology and Oncology, University of California, San Francisco, CA, USA
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Gómez García WC, Rivas S, Paz G, Bustamante M, Castro G, Gutiérrez H, Ah Chu MS, Gassant PY, Larin Lovo R, Gamboa Y, Torres Núñez M, García Quintero X, Okhuysen-Cawley R. Pediatric Oncology Palliative Care Programs in Central America: Pathways to Success. CHILDREN 2021; 8:children8111031. [PMID: 34828744 PMCID: PMC8624815 DOI: 10.3390/children8111031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/17/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Palliative care offers children who have life-limiting and life-threatening oncologic illnesses and their families improved quality of life. In some instances, impeccable symptom control can lead to improved survival. Cultural and financial barriers to palliative care in oncology patients occur in all countries, and those located in Central America are no exception. In this article, we summarize how the programs participating in the Asociación de Hemato-Oncólogos Pediatras de Centro America (AHOPCA) have developed dedicated oncology palliative care programs. The experience in Guatemala, El Salvador, Costa Rica, Panama, Dominican Republic and Haiti is detailed, with a focus on history, the barriers that have impeded progress, and achievements. Future directions, which, of course, may be impacted by the COVID-19 pandemic, are described as well.
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Affiliation(s)
- Wendy Cristhyna Gómez García
- Oncology Unit, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo 10101, Dominican Republic
- Correspondence: (W.G.C.G.); (R.O.-C.)
| | - Silvia Rivas
- Palliative Care Program, Unidad Nacional de Oncología Pediátrica, Guatemala 01011, Guatemala; (S.R.); (G.P.); (M.B.)
| | - Gabriela Paz
- Palliative Care Program, Unidad Nacional de Oncología Pediátrica, Guatemala 01011, Guatemala; (S.R.); (G.P.); (M.B.)
| | - Marisol Bustamante
- Palliative Care Program, Unidad Nacional de Oncología Pediátrica, Guatemala 01011, Guatemala; (S.R.); (G.P.); (M.B.)
| | - Gerardo Castro
- Palliative Care, Hospital Escuela, Tegucigalpa 11101, Honduras;
| | - Hazel Gutiérrez
- Palliative Care, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José 10103, Costa Rica;
| | | | | | - Rolando Larin Lovo
- Palliative Care Program, Hospital Nacional de Niños Benjamín Bloom, San Salvador 1101, El Salvador;
| | - Yessika Gamboa
- Oncology Unit, Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José 10103, Costa Rica;
| | | | | | - Regina Okhuysen-Cawley
- Divisions of Critical Care Medicine and Palliative Care, Texas Children’s Hospital, Houston, TX 77030, USA
- Correspondence: (W.G.C.G.); (R.O.-C.)
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Boateng R, Petricca K, Tang B, Parikh S, SinQuee-Brown C, Alexis C, Browne-Farmer C, Reece-Mills M, Salmon SM, Bodkyn C, Gupta S, Maguire B, Denburg AE. Determinants of access to childhood cancer medicines: a comparative, mixed-methods analysis of four Caribbean countries. LANCET GLOBAL HEALTH 2021; 9:e1314-e1324. [PMID: 34416215 DOI: 10.1016/s2214-109x(21)00287-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Equitable access to essential medicines is a key facet of childhood cancer care, recognised by WHO as vital to improved childhood cancer outcomes globally. In the Caribbean, childhood cancer outcomes are poorer than those in most high-income countries. We aimed to generate in-depth comparative evidence of the current challenges and opportunities related to access to childhood cancer medicines in the Caribbean to identify context-sensitive health systems strategies to improve drug access and inform evidence-based paediatric cancer policies in the region. METHODS In this convergent, parallel, mixed-methods study, we mapped and analysed the determinants of access to childhood cancer medicines in four Caribbean countries (The Bahamas, Barbados, Jamaica, and Trinidad and Tobago). We analysed contextual determinants of access to medicines within and across study site jurisdictions, alignment of childhood cancer medicine inclusion between each country's national essential medicines list (NEML) and WHO's 2017 Essential Medicines List for Children, and availability and cost of chemotherapeutic agents at five tertiary care hospitals. We used a mixed-effects logistic regression model to analyse the association of medicine price, procurement efficiency (via median price ratio [MPR]), and site with drug availability. The fixed effect evaluated the effect of site and MPR on the probability of stockout in a given month. We assessed determinants of medicine access via thematic analysis of semi-structured qualitative interviews, literature, and policy documents. FINDINGS We collected and analysed data for 28 childhood cancer medicines from Barbados, 32 from The Bahamas, 30 from Trinidad and Tobago, and 31 from Jamaica. Despite stepwise inclusion of childhood cancer medicines in NEMLs, all four countries had frequent and recurrent stockouts for many cytotoxic medicines, showing no consistent relationship between NEML inclusion and availability. A mean MPR of greater than 3·0 in Trinidad and Tobago, The Bahamas, and Barbados suggests uniformly high procurement inefficiency, resulting in significant effects on drug stockout days. For each one unit increase in MPR the adjusted odds ratio (OR) of stockout increased by 10% (adjusted OR 1·10, 95% CI 1·04-1·16; p<0·01). These challenges in access to childhood cancer medicines stem from health system and policy dynamics at institutional, national, and supranational levels that cause price volatility and erratic medicine availability. Key challenges include disparate policy commitments (eg, among sites), inefficient procurement and supply chain management practices, and local effects of international market pressures. INTERPRETATION The Caribbean region exemplifies deficiencies in access to childhood cancer medicines that might be overcome by improved regional harmonisation of drug registration, pharmacovigilance, and procurement alongside national forecasting to strengthen global pharmaceutical planning and prioritisation. Focused political attention to address these challenges is required to ensure efficient, reliable, and sustained availability of cancer mediciness. FUNDING The SickKids-Caribbean Initiative.
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Affiliation(s)
- Rhonda Boateng
- The SickKids-Caribbean Initiative, Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, ON, Canada
| | - Kadia Petricca
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, ON, Canada
| | - Brandon Tang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Supriya Parikh
- Biostatistics, Design, and Analysis, Hospital for Sick Children, Toronto, ON, Canada
| | - Corrine SinQuee-Brown
- Princess Margaret Hospital, University of the West Indies School of Clinical Medicine and Research, The Bahamas
| | | | | | - Michelle Reece-Mills
- University of the West Indies Hospital, University of the West Indies, Kingston, Jamaica
| | | | - Curt Bodkyn
- Child Health Unit, Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Sumit Gupta
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, ON, Canada; Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Bryan Maguire
- Biostatistics, Design, and Analysis, Hospital for Sick Children, Toronto, ON, Canada
| | - Avram E Denburg
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, ON, Canada; Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Stoltenberg M, Spence D, Daubman BR, Greaves N, Edwards R, Bromfield B, Perez-Cruz PE, Krakauer EL, Argentieri MA, Shields AE. The central role of provider training in implementing resource-stratified guidelines for palliative care in low-income and middle-income countries: Lessons from the Jamaica Cancer Care and Research Institute in the Caribbean and Universidad Católica in Latin America. Cancer 2021; 126 Suppl 10:2448-2457. [PMID: 32348569 DOI: 10.1002/cncr.32857] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
Individuals in low-income and middle-income countries (LMICs) account for approximately two-thirds of cancer deaths worldwide, and the vast majority of these deaths occur without access to essential palliative care (PC). Although resource-stratified guidelines are being developed that take into account the actual resources available within a given country, and several components of PC are available within health care systems, PC will never improve without a trained workforce. The design and implementation of PC provider training programs is the lynchpin for ensuring that all seriously ill patients have access to quality PC services. Building on the Breast Health Global Initiative's resource-stratified recommendations for provider education in PC, the authors report on efforts by the Jamaica Cancer Care and Research Institute in the Caribbean and the Universidad Católica in successfully developing and implementing PC training programs in the Caribbean and Latin America, respectively. Key aspects of this approach include: 1) fostering strategic academic partnerships to bring additional expertise and support to the effort; 2) careful adaptation of the curriculum to the local context and culture; 3) early identification of feasible metrics to facilitate program evaluation and future outcomes research; and 4) designing PC training programs to meet local health system needs.
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Affiliation(s)
- Mark Stoltenberg
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Massachusetts.,Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard Medical School, Boston, Massachusetts
| | - Dingle Spence
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Hope Institute Hospital, Kingston, Jamaica.,Department of Medicine, University of the West Indies, Mona Campus, Mona, Jamaica
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Massachusetts.,Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard Medical School, Boston, Massachusetts
| | - Natalie Greaves
- Department of Medical Sciences, University of the West Indies, Cave Hill Campus, Cave Hill, Barbados
| | - Rebecca Edwards
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
| | - Brittany Bromfield
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica
| | - Pedro E Perez-Cruz
- Palliative Medicine and Continuing Care Program, Faculty of Medicine, Pontifical Universidad Católica of Chile, Santiago, Chile.,Departament of Internal Medicine, Faculty of Medicine, Pontifical Universidad Católica of Chile, Santiago, Chile
| | - Eric L Krakauer
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - M Austin Argentieri
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
| | - Alexandra E Shields
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard Medical School, Boston, Massachusetts.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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12
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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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13
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Childhood cancer in Latin America: from detection to palliative care and survivorship. Cancer Epidemiol 2020; 71:101837. [PMID: 33121936 DOI: 10.1016/j.canep.2020.101837] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment options for childhood cancer have improved substantially, although in many low- and middle-income countries survival is lagging behind. Integral childhood cancer care involves the whole spectrum from detection and diagnosis to palliative and survivorship care. METHODS Based on a literature review and expert opinions, we summarized current practice and recommendations on the following aspects of childhood cancer in Latin America: diagnostic processes and time to diagnosis, stage at diagnosis, treatments and complications, survivorship programs and palliative care and end-of-life services. RESULTS Latin America is a huge and heterogeneous continent. Identified barriers show similar problems between countries, both logistically (time and distance to centers, treatment interruptions) and financially (cost of care, cost of absence from work). Governmental actions in several countries improved the survival of children with cancer, but difficulties persist in timely diagnosis and providing adequate treatment to all childhood cancer patients in institutions with complete infrastructure. Treatment abandonment is still common, although the situation is improving. Cancer care in the region has mostly focused on acute treatment of the disease and has not adequately considered palliative and end-of-life care and monitoring of survivors. CONCLUSIONS Decentralizing diagnostic activities and centralizing specialized treatment will remain necessary; measures to facilitate logistics and costs of transportation of the child and caretakers should be implemented. Twinning actions with specialized centers in high income countries for help in diagnosis, treatment and education of professionals and family members have been shown to work. Palliative and end-of-life care as well as childhood cancer survivorship plans are needed.
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14
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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: 7] [Impact Index Per Article: 1.8] [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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15
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Joachim C, Almont T, Drame M, Contaret C, Vestris M, Najioullah F, Aline-Fardin A, Escarmant P, Leduc N, Grossat N, Promeyrat X, Bougas S, Papadopoulou E, Vinh-Hung V, Sylvestre E, Veronique-Baudin J. International cooperation in public health in Martinique: geostrategic utility for cancer surveillance in the Caribbean. Global Health 2020; 16:20. [PMID: 32131844 PMCID: PMC7057621 DOI: 10.1186/s12992-020-00551-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background Cooperation in public health and in oncology in particular, is currently a major issue for the island of Martinique, given its geopolitical position in the Caribbean region. The region of Martinique shares certain public health problems with other countries of the Caribbean, notably in terms of diagnostic and therapeutic management of patients with cancer. We present here a roadmap of cooperation priorities and activities in cancer surveillance and oncology in Martinique. Main body The fight against cancer is a key public health priority that features high on the regional health policy for Martinique. In the face of these specific epidemiological conditions, Martinique needs to engage in medical cooperation in the field of oncology within the Caribbean, to improve skills and knowledge in this field, and to promote the creation of bilateral relations that will help to improve cancer management in an international healthcare environment. Conclusions These collaborative exchanges will continue throughout 2020 and will lead to the implementation of mutual research projects across a larger population basin, integrating e-health approaches and epidemiological e-cohorts.
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Affiliation(s)
- Clarisse Joachim
- , CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, UF 1441 Registre des cancers, Martinique, F-97200, France.
| | - Thierry Almont
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, UF3636 INTERREG Surveillance du Cancer Oncofertilité, F-97200, Martinique, France
| | - Moustapha Drame
- CHU de Martinique, Direction de la Recherche, UF 3603, Unité de Soutien Méthodologique à la Recherche, Martinique, F-97200, France
| | - Cédric Contaret
- CHU de Martinique, Direction de la Recherche, UF 3163, Délégation de la Recherche et de l'innovation, Martinique, F-97200, France
| | - Mylène Vestris
- , CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, UF 1441 Registre des cancers, Martinique, F-97200, France
| | - Fatiha Najioullah
- CHU de Martinique, Pôle de Biologie, Laboratoire de Virologie, F-97200, Martinique, France
| | - Aude Aline-Fardin
- CHU de Martinique, Pôle de Biologie, Laboratoire d'anatomopathologie, F-97200, Martinique, France
| | - Patrick Escarmant
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, F-97200, Martinique, France
| | - Nicolas Leduc
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, F-97200, Martinique, France
| | - Nathalie Grossat
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, F-97200, Martinique, France
| | - Xavier Promeyrat
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, F-97200, Martinique, France
| | - Stefanos Bougas
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, F-97200, Martinique, France
| | - Eva Papadopoulou
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, F-97200, Martinique, France
| | - Vincent Vinh-Hung
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, F-97200, Martinique, France
| | - Emmanuelle Sylvestre
- CHU de Martinique, Centre de Données Cliniques, F-97200, Martinique, France.,CHU de Martinique, Pôle de Médecine, Service de Maladies Infectieuses, F-97200, Martinique, France.,INSERM, U1099, F-35000, Rennes, France.,Université de Rennes 1, LTSI, F-35000, Rennes, France
| | - Jacqueline Veronique-Baudin
- CHU de Martinique, Pôle de Cancérologie Hématologie Urologie, UF 3596 Recherche en Cancérologie Hématologie, F-97200, Martinique, France
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16
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Major A, Cox SM, Volchenboum SL. Using big data in pediatric oncology: Current applications and future directions. Semin Oncol 2020; 47:56-64. [DOI: 10.1053/j.seminoncol.2020.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022]
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17
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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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18
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Spence D, Dyer R, Andall-Brereton G, Barton M, Stanway S, Argentieri MA, Bray F, Cawich S, Edwards-Bennett S, Fosker C, Gabriel O, Greaves N, Hanchard B, Hospedales J, Luciani S, Martin D, Nimrod M, Ragin C, Simeon D, Tortolero-Luna G, Wharfe G, Sarfati D. Cancer control in the Caribbean island countries and territories: some progress but the journey continues. Lancet Oncol 2019; 20:e503-e521. [PMID: 31395473 DOI: 10.1016/s1470-2045(19)30512-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/24/2022]
Abstract
Cancer causes a fifth of deaths in the Caribbean region and its incidence is increasing. Incidence and mortality patterns of cancer in the Caribbean reflect globally widespread epidemiological transitions, and show cancer profiles that are unique to the region. Providing comprehensive and locally responsive cancer care is particularly challenging in the Caribbean because of the geographical spread of the islands, the frequently under-resourced health-care systems, and the absence of a cohesive approach to cancer control. In many Caribbean countries and territories, cancer surveillance systems are poorly developed, advanced disease presentations are commonplace, and access to cancer screening, diagnostics, and treatment is often suboptimal, with many patients with cancer seeking treatment abroad. Capacity building across the cancer-control continuum in the region is urgently needed and can be accomplished through collaborative efforts and increased investment in health care and cancer control.
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Affiliation(s)
- Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica; Jamaica Cancer Care and Research Institute, University of the West Indies, Mona, Jamaica.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | | | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, University of New South Wales, NSW, Australia
| | | | - M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK; Jamaica Cancer Care and Research Institute, University of the West Indies, Mona, Jamaica
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Shamir Cawich
- Department of Surgery, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | | | - Christopher Fosker
- Bermuda Cancer and Health Centre and Bermuda Hospitals Board, Hamilton, Bermuda
| | - Owen Gabriel
- Department of Oncology Victoria Hospital, Castries, Saint Lucia
| | - Natalie Greaves
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Barrie Hanchard
- Department of Pathology, University of the West Indies, Kingston, Jamaica
| | | | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Damali Martin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marisa Nimrod
- Caribbean Association for Oncology and Hematology, Port of Spain, Trinidad and Tobago
| | | | - Donald Simeon
- Caribbean Centre for Health Systems Research and Development, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Centre, Puerto Rico
| | - Gilian Wharfe
- Department of Pathology, University of the West Indies, Mona, Jamaica
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
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