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Dee EC, Pramesh CS, Booth CM, Rubagumya F, Mutebi M, Feliciano EJG, Eala MAB, Cerri GG, Ginsburg O, Gyawali B, Moraes FY. Growing the global cancer care system: success stories from around the world and lessons for the future. J Natl Cancer Inst 2024; 116:1193-1197. [PMID: 38663853 PMCID: PMC11308163 DOI: 10.1093/jnci/djae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 08/09/2024] Open
Abstract
Despite major biomedical advancements in various realms of oncology, the benefits of these developments are not equitably distributed, particularly in underresourced settings. Although much work has described the challenges and systemic barriers in global cancer control, in this article we focus on success stories. This article describes clinical care delivered at Rwanda's Butaro Cancer Center of Excellence, the cancer research collaborations under India's National Cancer Grid, and the efforts of Latin America's Institute of Cancer of São Paulo in advancing cancer care and training. These examples highlight the potential of strategic collaborations and resource allocation strategies in improving cancer care globally. We emphasize the critical role of partnerships between physicians and allied health professionals, funders, and policy makers in enhancing access to treatment and infrastructure, advancing contextualized research and national guidelines, and establishing regional and global collaborations. We also draw attention to challenges faced in diverse global settings and outline benchmarks to measure success in the fight against cancer.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C S Pramesh
- National Cancer Grid and Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, MH, India
| | - Christopher M Booth
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
| | - Fidel Rubagumya
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Erin Jay G Feliciano
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mt. Sinai, Queens, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Giovanni G Cerri
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
| | - Ophira Ginsburg
- Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
- Departments of Oncology and Public Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Fabio Ynoe Moraes
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
- Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON, Canada
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil
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Iskander GM, Cavazos A, Ejezie CL, Cox V, Cheng H, Perez S, Koong AC, Nguyen J, Herman J, Beddar S, Liao Z, Yeboa DN. Protocol-in-a-Day Workshop: Expediting IRB Approval for Junior and Senior Faculty. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02460-7. [PMID: 38914893 DOI: 10.1007/s13187-024-02460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/26/2024]
Abstract
Delays in research protocol development may be a single factor that hinders the career progression of academic faculty. Structured educational guidance during this phase proves crucial in mitigating setbacks in Institutional Review Board (IRB) approval and expediting trial implementation. To address this, the Protocol-in-a-Day (PIAD) workshop, a comprehensive 1-day event involving members from six critical facets of RO clinical trial implementation, was established, offering significant input to individual protocols. Efficacy and satisfaction of the PIAD workshop were assessed through a 5-question survey and the average time from submission to IRB initial approval. The normality of the data was analyzed using the Shapiro-Wilk Test. Nonparametric data was analyzed using a Mann-Whitney U test for significance. A total of 18 protocols that went through the PIAD workshop were activated. The mean time to IRB approval for protocols that went through PIAD was 39.8 days compared to 58.4 days for those that did not go through the PIAD workshop. Based on survey results, 100% of PIAD participants said the PIAD workshop was useful and 94% of participants stated that the PIAD workshop improved the overall quality of their protocol. Participant surveys further highlighted substantial improvements in trial quality, language, and statistical design and revealed that all participants found the workshop helpful. Therefore, both junior and senior faculty benefitted from this educational program during protocol development, as both groups demonstrated shorter times to IRB approval than non-participants. This acceleration not only fosters efficient trial implementation but also supports academic faculty in their career development.
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Affiliation(s)
- Geina M Iskander
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Adriana Cavazos
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Chinenye Lynette Ejezie
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Victoria Cox
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Hunter Cheng
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Shelby Perez
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Albert C Koong
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Jonathan Nguyen
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Joseph Herman
- Northwell Health Cancer Institute Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Sam Beddar
- Department of Radiation Physics, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 0097, Houston, TX, 77030-4009, USA.
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Nagar SD, Nagar SJ, Jordan V, Dawson J. Sympathetic nerve blocks for persistent pain in adults with inoperable abdominopelvic cancer. Cochrane Database Syst Rev 2024; 6:CD015229. [PMID: 38842054 PMCID: PMC11154857 DOI: 10.1002/14651858.cd015229.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Persistent visceral pain is an unpleasant sensation coming from one or more organs within the body. Visceral pain is a common symptom in those with advanced cancer. Interventional procedures, such as neurolytic sympathetic nerve blocks, have been suggested as additional treatments that may play a part in optimising pain management for individuals with this condition. OBJECTIVES To evaluate the benefits and harms of neurolytic sympathetic nerve blocks for persistent visceral pain in adults with inoperable abdominopelvic cancer compared to standard care or placebo and comparing single blocks to combination blocks. SEARCH METHODS We searched the following databases without language restrictions on 19 October 2022 and ran a top-up search on 31 October 2023: CENTRAL; MEDLINE via Ovid; Embase via Ovid; LILACS. We searched trial registers without language restrictions on 2 November 2022: ClinicalTrials.gov; WHO International Clinical Trials Registry Platform (ICTRP). We searched grey literature, checked reference lists of reviews and retrieved articles for additional studies, and performed citation searches on key articles. We also contacted experts in the field for unpublished and ongoing trials. Our trial protocol was preregistered in the Cochrane Database of Systematic Reviews on 21 October 2022. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) comparing any sympathetic nerve block targeting sites commonly used to treat abdominal pelvic pain from inoperable malignancies in adults to standard care or placebo. DATA COLLECTION AND ANALYSIS We independently selected trials based on predefined inclusion criteria, resolving any differences via adjudication with a third review author. We used a random-effects model as some heterogeneity was expected between the studies due to differences in the interventions being assessed and malignancy types included in the study population. We chose three primary outcomes and four secondary outcomes of interest. We sought consumer input to refine our review outcomes and assessed extracted data using Cochrane's risk of bias 2 tool (RoB 2). We assessed the certainty of evidence using the GRADE system. MAIN RESULTS We included 17 studies with 1025 participants in this review. Fifteen studies with a total of 951 participants contributed to the quantitative analysis. Single block versus standard care Primary outcomes No included studies reported our primary outcome, 'Proportion of participants reporting no worse than mild pain after treatment at 14 days'. The evidence is very uncertain about the effect of sympathetic nerve blocks on reducing pain to no worse than mild pain at 14 days when compared to standard care due to insufficient data (very low-certainty evidence). Sympathetic nerve blocks may provide small to 'little to no' improvement in quality of life (QOL) scores at 14 days after treatment when compared to standard care, but the evidence is very uncertain (standardised mean difference (SMD) -0.73, 95% confidence interval (CI) -1.70 to 0.25; I² = 87%; 4 studies, 150 participants; very low-certainty evidence). The evidence is very uncertain about the risk of serious adverse events as defined in our review as only one study contributed data to this outcome. Sympathetic nerve blocks may have an 'increased risk' to 'no additional risk' of harm compared with standard care (very low-certainty evidence). Secondary outcomes Sympathetic nerve blocks showed a small to 'little to no' effect on participant-reported pain scores at 14 days using a 0 to 10 visual analogue scale (VAS) for pain compared with standard care, but the evidence is very uncertain (mean difference (MD) -0.44, 95% CI -0.98 to 0.11; I² = 56%; 5 studies, 214 participants; very low-certainty evidence). There may be a 'moderate to large' to 'little to no' reduction in daily consumption of opioids postprocedure at 14 days with sympathetic nerve blocks compared with standard care, but the evidence is very uncertain (change in daily consumption of opioids at 14 days as oral milligrams morphine equivalent (MME): MD -41.63 mg, 95% CI -78.54 mg to -4.72 mg; I² = 90%; 4 studies, 130 participants; very low-certainty evidence). The evidence is very uncertain about the effect of sympathetic nerve blocks on participant satisfaction with procedure at 0 to 7 days and time to need for retreatment or treatment effect failure (or both) due to insufficient data. Combination block versus single block Primary outcomes There is no evidence about the effect of combination sympathetic nerve blocks compared with single sympathetic nerve blocks on the proportion of participants reporting no worse than mild pain after treatment at 14 days because no studies reported this outcome. There may be a small to 'little to no' effect on QOL score at 14 days after treatment, but the evidence is very uncertain (very low-certainty evidence). The evidence is very uncertain about the risk of serious adverse events with combination sympathetic nerve blocks compared with single sympathetic nerve blocks due to limited reporting in the included studies (very low-certainty evidence). Secondary outcomes The evidence is very uncertain about the effect of combination sympathetic nerve blocks compared with single sympathetic nerve blocks on participant-reported pain score and change in daily consumption of opioids postprocedure, at 14 days. There may be a small to 'little to no' effect, but the evidence is very uncertain (very low-certainty evidence). There is no evidence about the effect on participant satisfaction with procedure at 0 to 7 days and time to need for retreatment or treatment effect failure (or both) due to these outcomes not being measured by the studies. Risk of bias The risk of bias was predominately high for most outcomes in most studies due to significant concerns regarding adequate blinding. Very few studies were deemed as low risk across all domains for any outcome. AUTHORS' CONCLUSIONS There is limited evidence to support or refute the use of sympathetic nerve blocks for persistent abdominopelvic pain due to inoperable malignancy. We are very uncertain about the effect of combination sympathetic nerve blocks compared with single sympathetic nerve blocks. The certainty of the evidence is very low and these findings should be interpreted with caution.
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Affiliation(s)
- Sachin D Nagar
- Department of Hospital Palliative Care, North Shore Hospital, Te Whatu Ora - Waitemata, Auckland, New Zealand
| | - Sarah J Nagar
- Neurogenetics, Center for Brain Research, University of Auckland, Auckland, New Zealand
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jennifer Dawson
- Department of Hospital Palliative Care, Middlemore Hospital, Te Whatu Ora - Counties Manukau, Auckland, New Zealand
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Mankan AK, Shankar A, Limaye S, Ajaikumar BS, Nachane P, Singh N, Dawkhar S, Batra U, Bhosekar A, Ganguly S, Gawli P, Debnath K, Padalalu V, Reddy P, Sundaramoorthy S, Naveen KK, Bondarde S, Kumar P, Davis S, Ramkissoon SH, Chacko RT, Vidal L, Chico I, Hegedus A, Gupta S, Saini KS. Cancer Trials Ecosystem in India-Ready for Prime Time? JCO Glob Oncol 2024; 10:e2300405. [PMID: 38870438 DOI: 10.1200/go.23.00405] [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: 10/27/2023] [Accepted: 04/12/2024] [Indexed: 06/15/2024] Open
Abstract
Executing global clinical trials for cancer is a long, expensive, and complex undertaking. While selecting countries global studies, sponsors must consider several aspects including patient pool, quality of trained investigators, competing trials, availability of infrastructure, and financial investment versus returns. With a large, often treatment-naïve, and diverse patient pool, relatively low cost, good quality health care facilities in urban areas, and a robust and well-trained workforce, India offers several advantages for conducting oncology clinical trials. However, there remains challenges, including a shifting regulatory environment in recent decades. With the implementation of the New Drugs and Clinical Trial Rules in 2019, India's regulatory atmosphere seems to have stabilized. In this article, we present a review of the evolving clinical trial landscape in India, highlight the current regulatory scenario, and discuss the advantages and challenges of selecting India as a potential location for conducting global oncology clinical trials.
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Affiliation(s)
| | - Abhishek Shankar
- Department of Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | | | | | | | - Navneet Singh
- PostGraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Ullas Batra
- Rajiv Gandhi Cancer Centre, New Delhi, India
| | | | | | | | | | | | | | | | | | | | | | - Sanish Davis
- Indian Society for Clinical Research, Mumbai, India
| | | | | | | | | | | | - Sudeep Gupta
- Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kamal S Saini
- Fortrea Inc, Durham, NC
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Brown K, Flores MJ, Haonga B, Chokotho LC, O'Marr JM, Rodarte P, Shearer D, Morshed S. Best Practices for Developing International Academic Partnerships in Orthopaedics. J Bone Joint Surg Am 2024; 106:924-930. [PMID: 37851955 DOI: 10.2106/jbjs.23.00626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
ABSTRACT Traumatic and nontraumatic orthopaedic conditions are major contributors to global morbidity and account for the majority of life-years lived with disability worldwide. Additionally, the burden of musculoskeletal injuries has increased substantially over the past 3 decades. Unfortunately, in low and middle-income countries (LMICs), access to orthopaedic care is limited, leading to a disproportionate burden of disease. The Lancet Commission on Global Surgery has emphasized the urgent need for unified international commitment and research collaboration to achieve universal access to safe and affordable surgical care. However, conducting high-quality orthopaedic research in LMICs remains challenging as a result of disparities in training, access to resources, infrastructure, and equipment availability. Partnerships between high-income countries (HICs) and LMICs have emerged in recent decades as an effective approach to combatting some of these challenges. These partnerships aim to bridge the gaps by facilitating collaborative research and knowledge exchange. The establishment of successful partnerships requires a collaborative and reciprocal approach that starts with a clear understanding of mutual research aims and the availability of resources. Despite the potential benefits, various factors can make establishing such partnerships difficult. However, these partnerships can have a substantial impact in delivering quality orthopaedic education and research training, thus improving access to care in resource-limited environments. This paper represents the collaborative effort of multiple international academic orthopaedic surgeons with extensive experience in HIC-LMIC partnerships. Our aims were to outline the best practices for conducting orthopaedic research within these relationships and to provide guidance for future successful collaborations.
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Affiliation(s)
- Kelsey Brown
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Michael J Flores
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Billy Haonga
- Muhimbili Orthopedic Institute, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Jamieson M O'Marr
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Patricia Rodarte
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - David Shearer
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Saam Morshed
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
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Gao P, Chen J, Hong Z, Choi M, Morgan A, Petushkov A, Lall R, Liu C, Muddu VK, Arroju V, Sunkavalli C, Kim G, Reddy BY. Landscape of cancer clinical trials in India - a comprehensive analysis of the Clinical Trial Registry-India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 24:100323. [PMID: 38756153 PMCID: PMC11096683 DOI: 10.1016/j.lansea.2023.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/12/2023] [Accepted: 10/30/2023] [Indexed: 05/18/2024]
Abstract
Background Cancer is one of the leading causes of morbidity and mortality in India. Clinical trials are critical for driving innovation in cancer therapy, diagnosis, and prevention. This study aims to depict the evolving landscape of cancer clinical trials in India by analysing the clinical trials registered in Clinical Trial Registry-India (CTRI). Methods We identified cancer trials registered in CTRI (between 2007 and 2021) using search terms adapted from the cancer types defined by the National Cancer Institute (USA). We then collated and analysed the publicly available information from CTRI (cancer subtypes, type of trial, treatment intent, type of intervention, sponsor type, recruitment countries) and used descriptive statistics to illustrate the overall as well as year-to-year trend. Findings In total, we identified 1988 cancer trials, the majority of which focused on treating cancer (63%) and rest of the trials aimed at optimising the operational aspects of surgery (19%), mitigating treatment-related toxicity (10.6%), or treating cancer-related symptoms (7.8%). Focusing on trials with the intent of treating cancer, we found that most were investigating solid tumours as opposed to haematological malignancies with the most prominent cancer subtypes being breast cancer (17%), head and neck cancer (9.8%), lung cancer (9.6%), and cervical cancer (6.6%). The number of trials conducted in a given cancer subtype from our analysis overall correlated to the incidence, mortality, and 5-year prevalence of the respective cancer subtype in India; however, head and neck cancer and cervical cancer were underrepresented in trials as compared with the disease burden. The most common type of intervention was investigational drugs. The most common sponsor types were global pharmaceutical industry (26%) and research institution and hospital (26%). Despite a relatively high cancer burden, the availability of cancer trials in the Northeastern states of India was limited. Interpretation There is a pressing need for clinical cancer research in India to be better aligned with the nation's healthcare needs and disease burden, focusing on prevalent and deadly cancers while ensuring the availability of clinical trials across geographic regions and underserved populations. Funding Pi Health USA, a fully owned subsidiary of BeiGene Ltd.
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Affiliation(s)
- Peng Gao
- Pi Health USA, Cambridge, MA, USA
| | | | | | | | | | - Anton Petushkov
- Pi Health USA, Cambridge, MA, USA
- College of Engineering, University of Michigan, Ann Arbor, USA
| | | | - Chao Liu
- Pi Health USA, Cambridge, MA, USA
| | - Vamshi K. Muddu
- Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, Telangana, India
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Melhem SJ, Nabhani-Gebara S, Kayyali R. Leveraging e-health for enhanced cancer care service models in middle-income contexts: Qualitative insights from oncology care providers. Digit Health 2024; 10:20552076241237668. [PMID: 38486873 PMCID: PMC10938624 DOI: 10.1177/20552076241237668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Background Global cancer research has predominantly favoured high-income countries (HICs). The unique challenges in low- and middle-income countries (LMICs) demand tailored research approaches, accentuated further by the disparities highlighted during the COVID-19 pandemic. Aim and objectives This research endeavoured to dissect the intricacies of cancer care in LMICs, with Jordan serving as a case study. Specifically, the study aimed to conduct an in-depth analysis of the prevailing cancer care model and assess the transformative potential of eHealth technologies in bolstering cancer care delivery. Methods Utilising a qualitative methodology, in-depth semi-structured interviews with oncology healthcare professionals were executed. Data underwent inductive thematic analysis as per Braun and Clarke's guidelines. Results From the analysed data, two dominant themes surfaced. Firstly, "The current state of cancer care delivery" was subdivided into three distinct subthemes. Secondly, "Opportunities for enhanced care delivery via e-health" underscored the urgency of digital health reforms. Conclusion The need to restrategise cancer care in LMICs is highlighted by this study, using the Jordanian healthcare context as a reference. The transformative potential of e-health initiatives has been illustrated. However, the relevance of this study might be limited by its region-specific approach. Future research is deemed essential for deeper exploration into the integration of digital health within traditional oncology settings across diverse LMICs, emphasising the significance of telemedicine in digital-assisted care delivery reforms.
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Affiliation(s)
- Samar J Melhem
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, Surrey, UK
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Shereen Nabhani-Gebara
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, Surrey, UK
| | - Reem Kayyali
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, Surrey, UK
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Chintapally N, Nuwayhid M, Arroju V, Muddu VK, Gao P, Reddy BY, Sunkavalli C. State of cancer care in India and opportunities for innovation. Future Oncol 2023; 19:2593-2606. [PMID: 37675499 DOI: 10.2217/fon-2023-0047] [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: 09/08/2023] Open
Abstract
Cancer is one of the leading causes of morbidity and mortality in India. Despite recent medical and technological advances, the cancer burden in India remains high and continues to rise. Moreover, substantial regional disparities in cancer incidence and access to essential medical resources exist throughout the country. While innovative and effective cancer therapies hold promise for improving patient outcomes, several barriers hinder their development and utilization in India. Here we provide an overview of these barriers, including challenges related to patient awareness, inadequate infrastructure, scarcity of trained oncology professionals, and the high cost of cancer care. Furthermore, we discuss the limited availability of cancer clinical trials in the country, along with an examination of potential avenues to enhance cancer care in India. By confronting these hurdles head-on and implementing innovative, pragmatic solutions, we take an indispensable step toward a future where every cancer patient in the country can access quality care.
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Affiliation(s)
- Neha Chintapally
- Pi Health USA, Cambridge, MA, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | | | - Vamshi K Muddu
- Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, Telangana, India
| | - Peng Gao
- Pi Health USA, Cambridge, MA, USA
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9
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Rao KN, Arora RD, Dange P, Nagarkar NM. Standardizing the Head and Neck Cancer Treatment and Research. Indian J Surg Oncol 2023; 14:850-853. [PMID: 38187836 PMCID: PMC10766926 DOI: 10.1007/s13193-023-01789-7] [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: 05/17/2023] [Accepted: 06/22/2023] [Indexed: 01/09/2024] Open
Abstract
Head and neck cancer requires a multidisciplinary approach, with standardized care being essential for consistent, high-quality treatment. Standardization involves evidence-based guidelines and protocols, and collaboration is necessary for research and improving outcomes. However, collaboration can be challenging due to various barriers. Collaboration can improve care by facilitating sharing of knowledge, access to technology, clinical trials, data sharing, funding and education. To improve collaboration, a shared vision, communication channels, guidelines, centralized database, training programs, culture of collaboration and funding should be established.
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Affiliation(s)
- Karthik Nagaraja Rao
- MCh Head Neck Surgery and Oncology, Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India
| | - Ripu Daman Arora
- Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Prajwal Dange
- MCh Head Neck Surgery and Oncology, Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India
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Murthy SS, Are C. Inequities in cancer surgical research capacity in the global south and strategies to address them. J Surg Oncol 2023; 128:947-951. [PMID: 37804090 DOI: 10.1002/jso.27446] [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: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
Globally, cancer is a leading cause of premature mortality and incidence is rising rapidly. To mitigate the cancer burden establishing research programs that are country and/or region specific will inform evidence-based cancer control policies and programs. However inequities in surgical cancer research in the global south exist and in this article we discuss gaps and potential solutions through frameworks focusing on research training, building infrastructure, economic strategies, and research ethics.
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Affiliation(s)
- Shilpa S Murthy
- Department of Surgery, Division of Colon and Rectal Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Chandrakanth Are
- Department of Surgery, Division of Surgical Oncology, University of Nebraska, Omaha, Nebraska, USA
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Kapoor M, Nidhi Kaur K, Saeed S, Shannawaz M, Chandra A. Impact of COVID-19 on healthcare system in India: A systematic review. J Public Health Res 2023; 12:22799036231186349. [PMID: 37461400 PMCID: PMC10345816 DOI: 10.1177/22799036231186349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
Despite an extensive healthcare system in India, the COVID-19 Pandemic created havoc upon the existing Indian healthcare system by disrupting the supply of essential healthcare services to patients. It has also highlighted the significant-quality discrepancies of healthcare facilities between the rural-urban areas and between public and private healthcare providers. The not so advanced healthcare system of India was exposed through the lack of oxygen and essential drugs required for the treatment of COVID-19. Additionally, during the pandemic period there was a drastic decline in seeking non-COVID-19 disease related healthcare services. The objective of this systematic review is to determine whether COVID-19 has impacted the healthcare system in India.
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Affiliation(s)
- Megha Kapoor
- Laboratory of Disease Dynamics & Molecular Epidemiology, Amity Institute of Public Health, Amity University, Noida, Uttar Pradesh, India
| | - Karuna Nidhi Kaur
- Laboratory of Disease Dynamics & Molecular Epidemiology, Amity Institute of Public Health, Amity University, Noida, Uttar Pradesh, India
| | - Shazina Saeed
- Amity Institute of Public Health, Amity University, Uttar Pradesh, Noida, India
| | - Mohd Shannawaz
- Amity Institute of Public Health, Amity University, Uttar Pradesh, Noida, India
| | - Amrish Chandra
- Amity Institute of Public Health, Amity University, Uttar Pradesh, Noida, India
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12
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Chopra S, Gupta A, Aoyama H, Wu HG, Mahmood H, Tharavichitkul E, Khine A, Gandhi A, Faruque GM, Cruz M, Kodrat H, Xue X, Abeysinghe P, Ho GF, Minjgee M, Tey J, Gao X. Radiation Oncology Research in Asia: Current Status and a Peep Into the Future From the Federation of Asian Organizations for Radiation Oncology. JCO Glob Oncol 2023; 9:e2300002. [PMID: 37384859 PMCID: PMC10497287 DOI: 10.1200/go.23.00002] [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: 01/07/2023] [Revised: 03/05/2023] [Accepted: 03/18/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE This survey was conducted to assess the current research practices among the 14 members of the Federation of Asian Organizations for Radiation Oncology (FARO) committee, to inform measures for research capacity building in these nations. MATERIALS AND METHODS A 19-item electronic survey was sent to two research committee members from the 14 representative national radiation oncology organizations (N = 28) that are a part of FARO. RESULTS Thirteen of the 14 member organizations (93%) and 20 of 28 members (71.5%) responded to the questionnaire. Only 50% of the members stated that an active research environment existed in their country. Retrospective audits (80%) and observational studies (75%) were the most common type of research conducted in these centers. Lack of time (80%), lack of funding (75%), and limited training in research methodology (40%) were cited as the most common hindrances in conducting research. To promote research initiatives in the collaborative setting, 95% of the members agreed to the creation of site-specific groups, with head and neck (45%) and gynecological cancers (25%) being the most preferred disease sites. Projects focused on advanced external beam radiotherapy implementation (40%), and cost-effectiveness studies (35%) were cited as some of the potential areas for future collaboration. On the basis of the survey results, after result discussion and the FARO officers meeting, an action plan for the research committee has been created. CONCLUSION The results from the survey and the initial policy structure may allow facilitation of radiation oncology research in the collaborative setting. Centralization of research activities, funding support, and research-directed training are underway to help foster a successful research environment in the FARO region.
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, India
| | - Ankita Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, India
| | - Hidefumi Aoyama
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Humera Mahmood
- Department of Clinical Oncology & Radiology, Atomic Energy Cancer Hospital, NORI, Islamabad, Pakistan
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Aung Khine
- Yangon General Hospital, Yangon, Myanmar
| | - Ajeet Gandhi
- Department of Radiation Oncology, Dr RML Institute of Medical Sciences, Lucknow, India
| | | | - Misael Cruz
- Cancer Institute Sacred Heart Medical Center, Angeles City, Philippines
| | - Henry Kodrat
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Xiaoying Xue
- Second Hospital of Hebei Medical University, Hebei, China
| | | | - Gwo Fuang Ho
- Department of Clinical Oncology, University of Malaya, Kuala Lumpur, Malaysia
| | - Minjmaa Minjgee
- Department of Radiation Oncology, Division of Non-surgical Oncology, National Cancer Centre, Ulaanbaatar, Mongolia
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), National University Health Systems (NUHS), Singapore, Singapore
| | - Xianshu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
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13
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Chufal KS, Ahmad I, Bajpai R, Miller AA, Chowdhary RL, Makker J, Batra U, Nathany S, Sharief MI, Umesh P, Sharma M, Amrith P, Pahuja AK, Sethi J, Antony V, Gairola M. Tri-modality therapy in advanced esophageal carcinoma: long-term results and insights from a developing world, institutional cohort. Br J Radiol 2023; 96:20220413. [PMID: 36541255 PMCID: PMC9975378 DOI: 10.1259/bjr.20220413] [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: 04/15/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate treatment outcomes in patients from a low-middle income country (LMIC) with esophageal carcinoma who underwent esophagectomy after neoadjuvant chemoradiation (NACRT/S). METHODS Between 2010 and 2020, 254 patients (median follow-up: 53 months) met our inclusion criteria. Out-of-field nodal regions were determined by reviewing individual radiotherapy plans. Cox regression modelling was performed to analyze overall survival (OS) and recurrence-free survival (RFS), while pathological complete response (pCR) prediction utilized Poisson regression. RESULTS The median OS was 71.4 months (interquartile range: 19.6-∞), RFS did not reach the median and pCR rate was 46%. On multivariable Cox regression, BMI [0.93 (0.89-0.98); 0.94 (0.89-0.99)] and absence of out-of-field node with extranodal extension (ENE)[0.22 (0.09-0.53); 0.30 (0.12-0.75)] influenced OS and RFS, respectively. Age [1.03 (1.01-1.06)], nodal stage [cN2-3 vs cN0: 2.67 (1.08-6.57)] and adventitial involvement [2.54 (1.36-4.72)] also influenced OS, while involved margins [3.12 (1.24-7.81)] influenced RFS. On multivariable Poisson regression, non-CROSS-chemotherapy regimens [0.65 (0.44-0.95)] and residual primary disease on pre-surgical imaging [0.73 (0.57-0.93)] were significantly associated with pCR. The most frequently involved in-field and out-of-field nodal regions were the periesophageal and perigastric (greater and lesser curvature) regions, respectively. CONCLUSION NACRT/S is feasible and effective in patients from LMIC. Out-of-field ENE merits further investigation as a prognostic factor since it significantly influenced both OS and RFS. ADVANCES IN KNOWLEDGE The results of clinical trials are replicable in LMICs. Out-of-field ENE is an independent prognostic factor for OS and RFS.
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Affiliation(s)
- Kundan Singh Chufal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Irfan Ahmad
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Ram Bajpai
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Alexis Andrew Miller
- Department of Radiation Oncology, Illawara Cancer Care Center, Wollongong, New South Wales, Australia
| | - Rahul Lal Chowdhary
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | | | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Shrinidhi Nathany
- Department of Molecular Diagnostics, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Muhammed Ismail Sharief
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Preetha Umesh
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Mansi Sharma
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Patel Amrith
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Anjali Kakria Pahuja
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Jaskaran Sethi
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Varghese Antony
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
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14
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Rubagumya F, Carson L, Mushonga M, Manirakiza A, Murenzi G, Abdihamid O, Athman A, Mungo C, Booth C, Hammad N. An analysis of the African cancer research ecosystem: tackling disparities. BMJ Glob Health 2023; 8:bmjgh-2022-011338. [PMID: 36792229 PMCID: PMC9933677 DOI: 10.1136/bmjgh-2022-011338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/30/2022] [Indexed: 02/17/2023] Open
Abstract
Disparities in cancer research persist around the world. This is especially true in global health research, where high-income countries (HICs) continue to set global health priorities further creating several imbalances in how research is conducted in low and middle-income countries (LMICs). Cancer research disparities in Africa can be attributed to a vicious cycle of challenges in the research ecosystem ranging from who funds research, where research is conducted, who conducts it, what type of research is conducted and where and how it is disseminated. For example, the funding chasm between HICs and LMICs contributes to inequities and parachutism in cancer research. Breaking the current cancer research model necessitates a thorough examination of why current practices and norms exist and the identification of actionable ways to improve them. The cancer research agenda in Africa should be appropriate for the African nations and continent. Empowering African researchers and ensuring local autonomy are two critical steps in moving cancer research towards this new paradigm.
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Affiliation(s)
- Fidel Rubagumya
- Oncology, Rwanda Military Hospital, Kigali, Rwanda .,Oncology, Queen's University, Kingston, Ontario, Canada.,Research for Development (RD Rwanda), Kigali, Rwanda.,Oncology, University of Rwanda, Kigali, Rwanda
| | - Laura Carson
- Oncology, Queen's University, Kingston, Ontario, Canada
| | - Melinda Mushonga
- Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Gad Murenzi
- Oncology, Rwanda Military Hospital, Kigali, Rwanda,Research for Development (RD Rwanda), Kigali, Rwanda
| | - Omar Abdihamid
- Oncology, Garissa County Referral Hospital, Garissa, Kenya
| | - Abeid Athman
- Oncology, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Chemtai Mungo
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Nazik Hammad
- Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
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15
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Koczwara B, Chan A, Jefford M, Lam WWT, Taylor C, Wakefield CE, Bhoo-Pathy N, Gyawali B, Harvet G, Lou Y, Pramesh CS, Takahashi M, Ke Y, Chan RJ. Cancer Survivorship in the Indo-Pacific: Priorities for Progress. JCO Glob Oncol 2023; 9:e2200305. [PMID: 36749908 PMCID: PMC10166466 DOI: 10.1200/go.22.00305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA.,Department of Oncology Pharmacy, National Cancer Centre Singapore, Singapore
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Wendy W T Lam
- Jockey Club Institute of Cancer Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Centre for Psycho-oncology Research and Training, School of Public Health, The University of Hong Kong, Hong Kong, China
| | | | - Claire E Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics and Child Health, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bishal Gyawali
- Queen's Global Oncology Program, Department of Oncology, Queen's University, Kingston, Canada
| | - Gregory Harvet
- Department of Paediatrics, Centre Hospitalier Territorial, Nouméa, New Caledonia
| | - Yan Lou
- School of Nursing, Department of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Miyako Takahashi
- Japan Cancer Survivorship Network, Tokyo, Japan.,Iwate Medical University, Iwate, Japan
| | - Yu Ke
- Tokyo Jikei University School of Medicine, Tokyo, Japan
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
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16
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Poudyal BS, Dulal S, Shilpakar R, Gyawali B. Highlights from ecancer Choosing Wisely Nepal 2022: critical appraisal skills for evidence-based practice, 24th-25th September 2022, Kathmandu, Nepal. Ecancermedicalscience 2022; 16:1478. [PMID: 36819797 PMCID: PMC9934887 DOI: 10.3332/ecancer.2022.1478] [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: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
The ecancer Kathmandu 2022 workshop on the 24th-25th September 2022 was the first ecancer conference organised in Nepal, a Southeast Asian nation sandwiched between India and China. It was focused on critical appraisal skills for evidence-based practice and was organised in partnership with the Karnali Academy of Health Sciences and the Civil Service Hospital from Nepal, and the Queen's Global Oncology Program from Canada. The workshop emphasised the need for critical thinking in understanding clinical research, and also motivated the delegates to undertake meaningful clinical research relevant to the local setting. The sessions highlighted the features of a good clinical research, identify pitfalls in the reporting of clinical trials, implementation of the research into locally relevant practice and development of local clinical guidelines. Furthermore, the faculty also discussed how to write a good scientific paper, the do's and don'ts of a systematic review and meta-analysis, the role of peer-review and how to do one properly and what do editors look for in evaluating papers submitted for publication. The audience learned the importance of finding a good mentor and fostering local and international collaboration. The local faculty also highlighted their own personal journeys and how mentorship and global collaboration played an important role in their own academic career. The enthusiastic panel discussion was a highlight of the programme where the delegates learned about several important topics from the faculties, such as work-life balance, the role of mentorship in building careers and building networks.
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Affiliation(s)
- Bishesh Sharma Poudyal
- Clinical Hematology and Bone Marrow Transplant Unit, Department of Medicine, Civil Service Hospital, Kathmandu 44600, Nepal
| | - Soniya Dulal
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan 56700, Nepal
| | - Ramila Shilpakar
- Department of Clinical Oncology, National Academy of Medical Sciences, Bir Hospital, Kathmandu 44600, Nepal
| | - Bishal Gyawali
- Queen’s Global Oncology Program, Department of Oncology, Queen’s University, Kingston, ON K7L 3N6, Canada,Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, 10 Stuart Street, Level 2, Queen’s University, Kingston, ON K7L 3N6, Canada
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17
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Mutebi M, Lewison G, Aggarwal A, Alatise OI, Booth C, Cira M, Grover S, Ginsburg O, Gralow J, Gueye S, Kithaka B, Kingham TP, Kochbati L, Moodley J, Mohammed SI, Mutombo A, Ndlovu N, Ntizimira C, Parham GP, Walter F, Parkes J, Shamely D, Hammad N, Seeley J, Torode J, Sullivan R, Vanderpuye V. Cancer research across Africa: a comparative bibliometric analysis. BMJ Glob Health 2022; 7:bmjgh-2022-009849. [PMID: 36356985 PMCID: PMC9660667 DOI: 10.1136/bmjgh-2022-009849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/29/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Research is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals. METHODOLOGY Bibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009-2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed to understand multiple impact metrics and context relative outputs in comparison with the disease burden as well as the application of a funding thesaurus to determine funding resources. RESULTS African countries in total published 23 679 cancer research papers over the 12-year period (2009-2020) with the fractional African contribution totalling 16 201 papers and the remaining 7478 from authors from out with the continent. The total number of papers increased rapidly with time, with an annual growth rate of 15%. The 49 sub-Saharan African (SSA) countries together published just 5281 papers, of which South Africa's contribution was 2206 (42% of the SSA total, 14% of all Africa) and Nigeria's contribution was 997 (19% of the SSA total, 4% of all Africa). Cancer research accounted for 7.9% of all African biomedical research outputs (African research in infectious diseases was 5.1 times than that of cancer research). Research outputs that are proportionally low relative to their burden across Africa are paediatric, cervical, oesophageal and prostate cancer. African research mirrored that of Western countries in terms of its focus on discovery science and pharmaceutical research. The percentages of female researchers in Africa were comparable with those elsewhere, but only in North African and some Anglophone countries. CONCLUSIONS There is an imbalance in relevant local research generation on the continent and cancer control efforts. The recommendations articulated in our five-point plan arising from these data are broadly focused on structural changes, for example, overt inclusion of research into national cancer control planning and financial, for example, for countries to spend 10% of a notional 1% gross domestic expenditure on research and development on cancer.
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Affiliation(s)
- Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Grant Lewison
- King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Olusegun Isaac Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - Christopher Booth
- Departments of Oncology & Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Miska Cira
- National Cancer Institute Center for Global Health, Rockville, Maryland, USA
| | - Surbhi Grover
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, Virginia, USA
| | - Serine Gueye
- Service d'urologie de l'Hopital General Idrissa Pouye, Dakar, Senegal
| | | | - T Peter Kingham
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lofti Kochbati
- Abderrahmen Mami Teaching Hospital, Ariana El Manar University, Tunis, Tunisia
| | | | | | | | - Ntokozo Ndlovu
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Groesbeck Preer Parham
- World Health Organization, Geneve, Switzerland,Department of Obstetrics and Gynecology, UTH-Women and Newborn Hospital, University of Zambia, Lusaka, Zambia
| | - Fiona Walter
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jeannette Parkes
- Department of Radiation Oncology, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Delva Shamely
- Faculty of Health Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Nazik Hammad
- Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Torode
- Global Oncology Group, King's College London, London, UK
| | | | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine and Korle Bu Teaching Hospital, Korle-Bu, Ghana
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18
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Jiwnani S, Penumadu P, Ashok A, Pramesh CS. Lung Cancer Management in Low and Middle-Income Countries. Thorac Surg Clin 2022; 32:383-395. [PMID: 35961746 DOI: 10.1016/j.thorsurg.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lung cancer is an increasing problem in the developing world due to rising trends in smoking, high incidence of air pollution, lack of awareness and screening, delayed presentation, and diagnosis at the advanced stage. Even after diagnosis, there are disparities in access to health care facilities and inequitable distribution of resources and treatment options. In addition, the shortage of trained personnel and infrastructure adds to the challenges faced by patients with lung cancer in these regions. A multi-pronged effort targeting tobacco cessation, health promotion and awareness, capacity building, and value-based care are the need of the hour.
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Affiliation(s)
- Sabita Jiwnani
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, India.
| | - Prasanth Penumadu
- Department of Surgical Oncology, Jawaharlal Institute of Medical Education and Research, JIPMER, 5343, 3rd Floor, SSB, Gorimedu, Pondicherry 605006, India
| | - Apurva Ashok
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Tata Memorial Hospital, 3rd Floor, Dr. E. Borges Road, Parel, Mumbai 400012, India
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Tata Memorial Hospital, Main Building, Ground Floor, Dr. E. Borges Road, Parel, Mumbai 400012, India
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19
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Rubagumya F, Hopman WM, Gyawali B, Mukherji D, Hammad N, Pramesh CS, Zubaryev M, Eniu A, Tsunoda AT, Kutluk T, Aggarwal A, Sullivan R, Booth CM. Participation of Lower and Upper Middle-Income Countries in Clinical Trials Led by High-Income Countries. JAMA Netw Open 2022; 5:e2227252. [PMID: 35980637 PMCID: PMC9389348 DOI: 10.1001/jamanetworkopen.2022.27252] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Many randomized clinical trials (RCTs) led by high-income countries (HICs) now enroll patients from lower middle-income countries (LMICs) and upper middle-income countries (UMICs). Although enrolling diverse populations promotes research collaborations, there are issues regarding which countries participate in RCTs and how this participation may contribute to global research. OBJECTIVE To describe which UMICs and LMICs participate in RCTs led by HICs. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study of all oncology RCTs published globally during January 1, 2014, to December 31, 2017, was conducted. The study cohort was restricted to RCTs led by HICs that enrolled participants from LMICs and UMICs. Study analyses were conducted in November 1, 2021, to May 31, 2022. MAIN OUTCOMES AND MEASURES A bibliometric approach (Web of Science 2007-2017) was used to explore whether RCT participation was proportional to other measures of cancer research activity. Participation in RCTs (ie, percentage of RCTs in the cohort in which each LMIC and UMIC participated) was compared with country-level cancer research bibliometric output (ie, percentage of total cancer research bibliometric output from the same group of countries that came from a specific LMIC and UMIC). RESULTS Among the 636 HIC-led RCTs, 186 trials (29%) enrolled patients in LMICs (n = 84 trials involving 11 LMICs) and/or UMICs (n = 181 trials involving 26 UMICs). The most common participating LMICs were India (42 [50%]), Ukraine (39 [46%]), Philippines (23 [27%]), and Egypt (12 [14%]). The most common participating UMICs were Russia (115 [64%]), Brazil (94 [52%]), Romania (62 [34%]), China (56 [31%]), Mexico (56 [31%]), and South Africa (54 [30%]). Several LMICs are overrepresented in the cohort of RCTs based on proportional cancer research bibliometric output: Ukraine (46% of RCTs but 2% of cancer research bibliometric output), Philippines (27% RCTs, 1% output), and Georgia (8% RCTs, 0.2% output). Overrepresented UMICs include Russia (64% RCTs, 2% output), Romania (34% RCTs, 2% output), Mexico (31% RCTs, 2% output), and South Africa (30% RCTs, 1% output). CONCLUSIONS AND RELEVANCE In this cross-sectional study, a substantial proportion of RCTs led by HICs enrolled patients in LMICs and UMICs. The LMICs and UMICs that participated in these trials did not match overall cancer bibliometric output as a surrogate for research ecosystem maturity. Reasons for this apparent discordance and how these data may inform future capacity-strengthening activities require further study.
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Affiliation(s)
- Fidel Rubagumya
- Department of Clinical Oncology, Rwanda Military Hospital, Kigali, Rwanda
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
| | - Wilma M. Hopman
- Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
- Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Deborah Mukherji
- Department of Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nazik Hammad
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
| | - C. S. Pramesh
- Department of Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Mykola Zubaryev
- Department of Surgical Oncology, National Cancer Institute of Ukraine, Kyiv, Ukraine
| | - Alexandru Eniu
- Department of Oncology, Hopital Riviera-Chablais, Rennaz, Switzerland
| | - Audrey T. Tsunoda
- Department of Oncology, Hospital Erasto Gaertner e PUCPR, Curitiba, Paraná, Brazil
| | - Tezer Kutluk
- Department of Oncology, Hacettepe University Faculty of Medicine & Cancer Institute, Ankara, Turkey
| | - Ajay Aggarwal
- Institute of Cancer Policy, King’s College London, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Christopher M. Booth
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
- Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Diao K, Kizub DA, Ausat N, Mwaba CK, Anakwenze Akinfenwa CP, Cameron CA, Chiao EY, Lombe DC, Msadabwe SC, Lin LL. Perspectives of Zambian Clinical Oncology Trainees in the MD Anderson and Zambia Virtual Clinical Research Training Program (MOZART). Oncologist 2022; 27:e804-e810. [PMID: 35689473 PMCID: PMC9526501 DOI: 10.1093/oncolo/oyac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/15/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND African countries are underrepresented in cancer research, partly because of a lack of structured curricula on clinical research during medical education. To address this need, the MD Anderson and Zambia Virtual Clinical Research Training Program (MOZART) was developed jointly by MD Anderson Cancer Center (MDA) and the Cancer Diseases Hospital in Zambia (CDH) for Zambian clinical oncology trainees. We explored participant perspectives to provide insight for implementation of similar efforts. MATERIALS AND METHODS The MD Anderson and Zambia Virtual Clinical Research Training Program consisted of weekly virtual lectures and support of Zambian-led research protocols through longitudinal mentorship groups that included CDH faculty and MDA peer and faculty mentors. Participants were contacted via email to take part in semi-structured interviews, which were conducted via teleconference and audio-recorded, transcribed, and coded. Emergent themes were extracted and are presented with representative verbatim quotations. RESULTS Thirteen of the 14 (93%) trainees were interviewed. Emergent themes included (1) participants having diverse educational backgrounds but limited exposure to clinical research, (2) importance of cancer research specific to a resource-constrained setting, (3) complementary roles of peer mentors and local and international faculty mentors, (4) positive impact on clinical research skills but importance of a longitudinal program and early exposure to clinical research, and (5) challenges with executing research protocols. CONCLUSION To our knowledge, this is the first qualitative study of African clinical oncology trainees participating in a virtual clinical research training program. The lessons learned from semi-structured interviews with participants in MOZART provided valuable insights that can inform the development of similar clinical research training efforts and scale-up.
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Affiliation(s)
- Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Darya A Kizub
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Noveen Ausat
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Carrie A Cameron
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Y Chiao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dorothy C Lombe
- Department of Radiation Oncology, MidCentral District Health Board, Palmerston North, New Zealand
| | - Susan C Msadabwe
- Department of Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Lilie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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21
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Aggarwal A, Lievens Y, Sullivan R, Nolte E. What Really Matters for Cancer Care – Health Systems Strengthening or Technological Innovation? Clin Oncol (R Coll Radiol) 2022; 34:430-435. [DOI: 10.1016/j.clon.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
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22
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Sarode GS, Sarode SC. The CReDO workshop: a promising venture needing urgent reform. Lancet Oncol 2021; 22:e422. [PMID: 34592183 DOI: 10.1016/s1470-2045(21)00423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune 411018, Maharashtra, India
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune 411018, Maharashtra, India.
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23
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Mammarella E, Zampieri C, Panatta E, Melino G, Amelio I. NUAK2 and RCan2 participate in the p53 mutant pro-tumorigenic network. Biol Direct 2021; 16:11. [PMID: 34348766 PMCID: PMC8335924 DOI: 10.1186/s13062-021-00296-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 02/04/2023] Open
Abstract
Most inactivating mutations in TP53 gene generates neomorphic forms of p53 proteins that experimental evidence and clinical observations suggest to exert gain-of-function effects. While massive effort has been deployed in the dissection of wild type p53 transcriptional programme, p53 mutant pro-tumorigenic gene network is still largely elusive. To help dissecting the molecular basis of p53 mutant GOF, we performed an analysis of a fully annotated genomic and transcriptomic human pancreatic adenocarcinoma to select candidate players of p53 mutant network on the basis their differential expression between p53 mutant and p53 wild-type cohorts and their prognostic value. We identified NUAK2 and RCan2 whose p53 mutant GOF-dependent regulation was further validated in pancreatic cancer cellular model. Our data demonstrated that p53R270H can physically bind RCan2 gene locus in regulatory regions corresponding to the chromatin permissive areas where known binding partners of p53 mutant, such as p63 and Srebp, bind. Overall, starting from clinically relevant data and progressing into experimental validation, our work suggests NUAK2 and RCan2 as novel candidate players of the p53 mutant pro-tumorigenic network whose prognostic and therapeutic interest might attract future studies.
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Affiliation(s)
- Eleonora Mammarella
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Carlotta Zampieri
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Emanuele Panatta
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Gerry Melino
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Ivano Amelio
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, 00133 Rome, Italy
- School of Life Sciences, University of Nottingham, Nottingham, UK
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Choosing Wisely for COVID-19: ten evidence-based recommendations for patients and physicians. Nat Med 2021; 27:1324-1327. [PMID: 34226738 DOI: 10.1038/s41591-021-01439-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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