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Oppong R, Yeboah D, Owusu-Ansah M, Salifu SP. Radiation Therapy for Breast Cancer in Africa. Adv Radiat Oncol 2024; 9:101488. [PMID: 38681886 PMCID: PMC11043849 DOI: 10.1016/j.adro.2024.101488] [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] [Received: 06/02/2023] [Accepted: 02/15/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Although radiation therapy is an effective treatment for breast cancer, it has a low rate of use in African countries. A systematic review was undertaken to investigate studies that used radiation therapy as a treatment modality for patients with breast cancer in Africa, focusing on survival outcomes, adverse effects, radiation therapy techniques, fractionation schedules, and effectiveness of radiation therapy. Methods and Materials We conducted a comprehensive literature search for studies that treated breast cancer with radiation therapy, using different electronic databases (PubMed, Scopus, and EBSCOhost) up to February 2023. The output was exported to a reference management system for analyses. Results The literature search primarily identified 3804 records from Scopus (2427), PubMed (982), and EBSCOhost (395). Based on the inclusion and exclusion criteria, 19 articles were finally included in this systematic review. Most of the studies published were conducted in North Africa (63%), followed by West Africa (21%) and Southeast Africa (16%). Most centers employed external beam radiation therapy to deliver radiation therapy to patients with breast cancer with the standard fractionation size of 50 Gy in 25 fractions. The long-term outcomes with regards to adverse effect suggests that radiation therapy was fairly tolerated among patients with breast cancer. Conclusions The reports provide substantial evidence that there are limited number of published studies on the use of radiation therapy for breast cancer treatment in Africa, as well as lower overall survival rate compared with developed countries. To improve breast cancer survivorship, it is necessary for government and other health care planners to provide more radiation therapy resources and implement training programs for personnels.
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Affiliation(s)
- Rita Oppong
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - David Yeboah
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | | | - Samson Pandam Salifu
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
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2
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Hu Y, Gordon N, Ogg K, Kraitchman DL, Durr NJ, Surtees B. Thermal Characterization and Preclinical Feasibility Verification of an Accessible, Carbon Dioxide-Based Cryotherapy System. Bioengineering (Basel) 2024; 11:391. [PMID: 38671812 PMCID: PMC11048087 DOI: 10.3390/bioengineering11040391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
To investigate the potential of an affordable cryotherapy device for the accessible treatment of breast cancer, the performance of a novel carbon dioxide-based device was evaluated through both benchtop testing and an in vivo canine model. This novel device was quantitatively compared to a commercial device that utilizes argon gas as the cryogen. The thermal behavior of each device was characterized through calorimetry and by measuring the temperature profiles of iceballs generated in tissue phantoms. A 45 min treatment in a tissue phantom from the carbon dioxide device produced a 1.67 ± 0.06 cm diameter lethal isotherm that was equivalent to a 7 min treatment from the commercial argon-based device, which produced a 1.53 ± 0.15 cm diameter lethal isotherm. An in vivo treatment was performed with the carbon dioxide-based device in one spontaneously occurring canine mammary mass with two standard 10 min freezes. Following cryotherapy, this mass was surgically resected and analyzed for necrosis margins via histopathology. The histopathology margin of necrosis from the in vivo treatment with the carbon dioxide device at 14 days post-cryoablation was 1.57 cm. While carbon dioxide gas has historically been considered an impractical cryogen due to its low working pressure and high boiling point, this study shows that carbon dioxide-based cryotherapy may be equivalent to conventional argon-based cryotherapy in size of the ablation zone in a standard treatment time. The feasibility of the carbon dioxide device demonstrated in this study is an important step towards bringing accessible breast cancer treatment to women in low-resource settings.
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Affiliation(s)
- Yixin Hu
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Naomi Gordon
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Katherine Ogg
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Dara L. Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Nicholas J. Durr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA;
| | - Bailey Surtees
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
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3
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Anandasabapathy S, Asirwa C, Grover S, Mungo C. Cancer burden in low-income and middle-income countries. Nat Rev Cancer 2024; 24:167-170. [PMID: 38332323 DOI: 10.1038/s41568-023-00659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 02/10/2024]
Affiliation(s)
| | | | - Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Chemtai Mungo
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
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4
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Court LE, Aggarwal A, Jhingran A, Naidoo K, Netherton T, Olanrewaju A, Peterson C, Parkes J, Simonds H, Trauernicht C, Zhang L, Beadle BM. Artificial Intelligence-Based Radiotherapy Contouring and Planning to Improve Global Access to Cancer Care. JCO Glob Oncol 2024; 10:e2300376. [PMID: 38484191 PMCID: PMC10954080 DOI: 10.1200/go.23.00376] [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: 10/03/2023] [Revised: 11/22/2023] [Accepted: 01/22/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Increased automation has been identified as one approach to improving global cancer care. The Radiation Planning Assistant (RPA) is a web-based tool offering automated radiotherapy (RT) contouring and planning to low-resource clinics. In this study, the RPA workflow and clinical acceptability were assessed by physicians around the world. METHODS The RPA output for 75 cases was reviewed by at least three physicians; 31 radiation oncologists at 16 institutions in six countries on five continents reviewed RPA contours and plans for clinical acceptability using a 5-point Likert scale. RESULTS For cervical cancer, RPA plans using bony landmarks were scored as usable as-is in 81% (with minor edits 93%); using soft tissue contours, plans were scored as usable as-is in 79% (with minor edits 96%). For postmastectomy breast cancer, RPA plans were scored as usable as-is in 44% (with minor edits 91%). For whole-brain treatment, RPA plans were scored as usable as-is in 67% (with minor edits 99%). For head/neck cancer, the normal tissue autocontours were acceptable as-is in 89% (with minor edits 97%). The clinical target volumes (CTVs) were acceptable as-is in 40% (with minor edits 93%). The volumetric-modulated arc therapy (VMAT) plans were acceptable as-is in 87% (with minor edits 96%). For cervical cancer, the normal tissue autocontours were acceptable as-is in 92% (with minor edits 99%). The CTVs for cervical cancer were scored as acceptable as-is in 83% (with minor edits 92%). The VMAT plans for cervical cancer were acceptable as-is in 99% (with minor edits 100%). CONCLUSION The RPA, a web-based tool designed to improve access to high-quality RT in low-resource settings, has high rates of clinical acceptability by practicing clinicians around the world. It has significant potential for successful implementation in low-resource clinics.
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Affiliation(s)
| | - Ajay Aggarwal
- Guy's and St Thomas Hospitals, London, United Kingdom
| | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | - Lifei Zhang
- University of Texas MD Anderson Cancer Center, Houston, TX
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5
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Ehret F, Kohlhase N, Eftimova D, Hofmann T, Fürweger C, Haidenberger A, Kufeld M, Muacevic A, Santacroce A. Self-Shielding Gyroscopic Radiosurgery: A Prospective Experience and Analysis of the First 100 Patients. Cureus 2024; 16:e56035. [PMID: 38606262 PMCID: PMC11008698 DOI: 10.7759/cureus.56035] [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] [Accepted: 03/10/2024] [Indexed: 04/13/2024] Open
Abstract
Background Stereotactic radiosurgery is a well-established treatment option for the management of various benign and malignant brain tumors. It can be delivered with several treatment platforms, usually requiring shielded radiation vaults to meet regulatory safety requirements. Recent technical advances have led to the first self-shielding platform enabling the delivery of gyroscopic radiosurgery (GRS). Given the limited number of GRS treatment platforms, the novelty of its characteristics, and the lack of available data, we report our prospective experience with the first 100 patients treated with GRS. Materials and methods Patients undergoing GRS for the treatment of intracranial tumors were enrolled in this prospective study. Patient and treatment characteristics, including patient satisfaction, were collected and analyzed. Results A total of 100 patients with 155 tumors were treated. The most commonly treated tumors comprised brain metastases (BM) (49%), vestibular schwannomas (31%), and meningiomas (14%). The median prescription dose for malignant and benign tumors was 20 and 13 Gy, respectively. The median prescription isodose line was 56%. Gross tumor volumes were small, with a median of 0.37 cc for BM and 0.92 cc for the other entities. The median total treatment time was 40 minutes. Dosimetric performance indices showed median values of 1.20 (conformity index), 1.24 (new conformity index), 1.74 (homogeneity index), and 3.13 (gradient index). Volumetric assessment of the treated tumors showed an overall decrease in size at the first available follow-up. Most patients were satisfied with the treatment experience. Conclusion Our first prospective experience of the use of GRS is favorable. Analyses of the dosimetric performance, treatment times, volumetric assessment, and patient satisfaction demonstrate its suitability for stereotactic treatments of intracranial tumors. Further prospective clinical and dosimetric analyses for GRS are pending.
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Affiliation(s)
- Felix Ehret
- Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DEU
- Charité - Universitätsmedizin Berlin, German Cancer Consortium (DKTK) partner site Berlin, and German Cancer Research Center (DKFZ) Heidelberg, Berlin, DEU
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Nadja Kohlhase
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Dochka Eftimova
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Theresa Hofmann
- Radiation Oncology, European Radiosurgery Center Munich, Munich, DEU
| | - Christoph Fürweger
- Medical Physics, European Radiosurgery Center Munich, Munich, DEU
- Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, Cologne, DEU
| | | | - Markus Kufeld
- Radiosurgery, European Radiosurgery Center Munich, Munich, DEU
| | | | - Antonio Santacroce
- Radiosurgery, European Radiosurgery Center Munich, Munich, DEU
- Medicine, Faculty of Health, Witten/Herdecke University, Witten, DEU
- Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, DEU
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Anakwenze CP, Allanson E, Ewongwo A, Lumley C, Bazzett-Matabele L, Msadabwe SC, Kamfwa P, Shouman T, Lombe D, Rubagumya F, Polo A, Ntekim A, Vanderpuye V, Ghebre R, Kochbati L, Awol M, Gnangnon FHR, Snyman L, Fokom Domgue J, Incrocci L, Ndlovu N, Razakanaivo M, Abdel-Wahab M, Trimble E, Schmeler K, Simonds H, Grover S. Mapping of Radiation Oncology and Gynecologic Oncology Services Available to Treat the Growing Burden of Cervical Cancer in Africa. Int J Radiat Oncol Biol Phys 2024; 118:595-604. [PMID: 37979709 DOI: 10.1016/j.ijrobp.2023.10.036] [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: 04/15/2023] [Revised: 09/09/2023] [Accepted: 10/22/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To meet the demand for cervical cancer care in Africa, access to surgical and radiation therapy services needs to be understood. We thus mapped the availability of gynecologic and radiation therapy equipment and staffing for treating cervical cancer. METHODS AND MATERIALS We collected data on gynecologic and radiation oncology staffing, equipment, and infrastructure capacities across Africa. Data was obtained from February to July 2021 through collaboration with international partners using Research Electronic Data Capture. Cancer incidence was taken from the International Agency for Research on Cancer's GLOBOCAN 2020 database. Treatment capacity, including the numbers of radiation oncologists, radiation therapists, physicists, gynecologic oncologists, and hospitals performing gynecologic surgeries, was calculated per 1000 cervical cancer cases. Adequate capacity was defined as 2 radiation oncologists and 2 gynecologic oncologists per 1000 cervical cancer cases. RESULTS Forty-three of 54 African countries (79.6%) responded, and data were not reported for 11 countries (20.4%). Respondents from 31 countries (57.4%) reported access to specialist gynecologic oncology services, but staffing was adequate in only 11 countries (20.4%). Six countries (11%) reported that generalist obstetrician-gynecologists perform radical hysterectomies. Radiation oncologist access was available in 39 countries (72.2%), but staffing was adequate in only 16 countries (29.6%). Six countries (11%) had adequate staffing for both gynecologic and radiation oncology; 7 countries (13%) had no radiation or gynecologic oncologists. Access to external beam radiation therapy was available in 31 countries (57.4%), and access to brachytherapy was available in 25 countries (46.3%). The number of countries with training programs in gynecologic oncology, radiation oncology, medical physics, and radiation therapy were 14 (26%), 16 (30%), 11 (20%), and 17 (31%), respectively. CONCLUSIONS We identified areas needing comprehensive cervical cancer care infrastructure, human resources, and training programs. There are major gaps in access to radiation oncologists and trained gynecologic oncologists in Africa.
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Affiliation(s)
- Chidinma P Anakwenze
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emma Allanson
- Division of Obstetrics & Gynecology, King Edward Memorial Hospital for Women, Subiaco, Australia, and Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | | | - Christian Lumley
- Office of Global Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisa Bazzett-Matabele
- Department of Obstetrics & Gynecology, University of Botswana, Gaborone, Botswana, and Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Paul Kamfwa
- Gynecologic Oncology Unit, Cancer Diseases Hospital, Lusaka, Zambia
| | | | - Dorothy Lombe
- Cancer Screening, Treatment and Support Cluster, Health New Zealand, Palmerston North, New Zealand
| | - Fidel Rubagumya
- Rwanda Military Hospital, Kigali, Rwanda, and Division of Cancer Care and Epidemiology and Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Alfredo Polo
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | - Atara Ntekim
- Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
| | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology, and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology, and Women's Health and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Lofti Kochbati
- Department of Radiotherapy, Abderrahmen Mami Hospital, Tunis, Tunisia
| | - Munir Awol
- Department of Oncology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Freddy Houéhanou Rodrigue Gnangnon
- Department of Visceral Surgery, National Teaching Hospital of Cotonou, Cotonou, Benin, Department of Epidemiology of Chronic Diseases in the Tropical Zone, Institute of Epidemiology and Tropical Neurology, Limoges, France, and Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
| | - Leon Snyman
- Department Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Joël Fokom Domgue
- Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, and Faculty of Medicine and Biomedical Sciences, Department of Obstetrics and Gynecology, University of Yaoundé, Yaoundé, Cameroon
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe, and Department of Radiotherapy and Oncology, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Malala Razakanaivo
- Department of Radiotherapy, Joseph Ravoahangy Andrianavalona University Hospital, Antananarivo, Madagascar
| | - May Abdel-Wahab
- Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Kathleen Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hannah Simonds
- Department of Radiation Oncology, Stellenbosch University, Cape Town, South Africa, and Department of Oncology, University Hospitals Plymouth Trust, Plymouth, United Kingdom
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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DeBoer RJ, Ho A, Mutoniwase E, Nguyen C, Umutesi G, Bigirimana JB, Nsabimana N, Van Loon K, Shulman LN, Triedman SA, Cubaka VK, Shyirambere C. Ethical dilemmas in prioritizing patients for scarce radiotherapy resources. BMC Med Ethics 2024; 25:12. [PMID: 38297294 PMCID: PMC10829165 DOI: 10.1186/s12910-024-01005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Radiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles. METHODS Semi-structured interviews were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles. RESULTS Participants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier. CONCLUSIONS Multiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views.
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Affiliation(s)
- Rebecca J DeBoer
- Division of Hematology/Oncology, University of California, San Francisco, San Francisco, CA, USA.
| | - Anita Ho
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Cam Nguyen
- University of Colorado Cancer Center, Aurora, CO, USA
| | | | | | | | - Katherine Van Loon
- Division of Hematology/Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Lawrence N Shulman
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA
| | - Scott A Triedman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Joseph A, Akinsete AM, Lasebikan NN, Adeneye S, Awofeso OM, Oladipo AT, Ajose AO, Ojo O, Merrell K, Ngwa W, Puthoff DS, Onitilo AA. The Landscape of Pediatric Radiation Oncology in Nigeria. JCO Glob Oncol 2024; 10:e2300219. [PMID: 38207247 DOI: 10.1200/go.23.00219] [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: 06/30/2023] [Revised: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 01/13/2024] Open
Abstract
Radiation therapy (RT) is an essential part of the multidisciplinary treatment of pediatric cancer. Over the past five decades, significant advances have been made in the delivery of RT, with better dose delivery to disease targets while minimizing exposure to nearby organs at risk. These advances have led to improved treatment outcomes, increased survival, and reduced treatment-related toxicities. Advanced treatment techniques, however, require significant investment in infrastructural and personnel resources. This review documents what is currently available regarding expertise and infrastructure for pediatric radiation oncology practice in Nigeria. It was performed to serve as a foundation for the creation and design of tailored solutions (initiatives and policies) to increase pediatric radiation availability, accessibility, and equity in Nigeria and ultimately improve pediatric cancer treatment outcomes in the region.
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Affiliation(s)
- Adedayo Joseph
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye M Akinsete
- Hematology & Oncology Unit, Department of Pediatrics, College of Medicine University of Lagos, Lagos, Nigeria
| | | | - Samuel Adeneye
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Opeyemi M Awofeso
- Psychosocial Oncology & Palliative Care, Dana Farber Cancer Institute, Boston, MA
| | - Aishat T Oladipo
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Azeezat O Ajose
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwatimileyin Ojo
- Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, NY
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - David S Puthoff
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
| | - Adedayo A Onitilo
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
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Li J, Lv Z, Guo Y, Fang J, Wang A, Feng Y, Zhang Y, Zhu J, Zhao Z, Cheng X, Shi H. Hafnium (Hf)-Chelating Porphyrin-Decorated Gold Nanosensitizers for Enhanced Radio-Radiodynamic Therapy of Colon Carcinoma. ACS NANO 2023; 17:25147-25156. [PMID: 38063344 DOI: 10.1021/acsnano.3c08068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
X-ray-induced radiodynamic therapy (RDT) that can significantly reduce radiation dose with an improved anticancer effect has emerged as an attractive and promising therapeutic modality for tumors. However, it is highly significant to develop safe and efficient radiosensitizing agents for tumor radiation therapy. Herein, we present a smart nanotheranostic system FA-Au-CH that consists of gold nanoradiosensitizers, photosensitizer chlorin e6 (Ce6), and folic acid (FA) as a folate-receptor-targeting ligand for improved tumor specificity. FA-Au-CH nanoparticles have been demonstrated to be able to simultaneously serve as radiosensitizers and RDT agents for enhanced computed tomography (CT) imaging-guided radiotherapy (RT) of colon carcinoma, owing to the strong X-ray attenuation capability of high-Z elements Au and Hf, as well as the characteristics of Hf that can transfer radiation energy to Ce6 to generate ROS from Ce6 under X-ray irradiation. The integration of RT and RDT in this study demonstrates great efficacy and offers a promising therapeutic modality for the treatment of malignant tumors.
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Affiliation(s)
- Jiachen Li
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Zhengzhong Lv
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Yirui Guo
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Jing Fang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Anna Wang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Yali Feng
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Yuqi Zhang
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Jinfeng Zhu
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, 00133 Roma, Italy
| | - Zhongsheng Zhao
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Xiaju Cheng
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
| | - Haibin Shi
- State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X) and Collaborative Innovation Centre of Radiation Medicine of Jiangsu Higher Education, Soochow University, Suzhou 215123, P. R. China
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10
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Hagos G, Hammad N, Stanway S, Yusuf A, Hailemariam T. Cancer care in Needle Hospital, Hargeisa, Somaliland. Ecancermedicalscience 2023; 17:1642. [PMID: 38414938 PMCID: PMC10898905 DOI: 10.3332/ecancer.2023.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Indexed: 02/29/2024] Open
Abstract
Somaliland is an autonomous region in the northern part of Somalia that declared its independence in 1991. It is a low-income country (LIC) with a population size of 5.7 million with a gross domestic product per capita of $775. Health services are delivered by public, private and non-governmental organisations. The public health care system in Somaliland is facing huge challenges. Seven percent of the population suffers from non-communicable diseases, but data on cancer incidence and mortality are not available. Much of the emphasis in public health has been placed on primary care and maternal and child health. There is still a large gap in cancer prevention, early detection and screening in the country. Additionally, there is no cancer registry or published data on cancer. Currently, there are a few private hospitals that provide chemotherapy services in Somaliland of which Needle Hospital is one. Services provided in this hospital include medical oncology for all solid tumours, palliative care, follow-up and cancer health education. The hospital provides services for patients from Somaliland and neighbouring countries including Djibouti, Somalia and Ethiopia. As a new oncology clinic in an LIC, the clinic is facing many challenges, like the absence of a multidisciplinary tumour board, presentation of patients at the advanced stage of tumours and poor cancer awareness in the general population.
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Affiliation(s)
| | - Nazik Hammad
- Saint Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Canada
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Elbanna M, Pynda Y, Kalinchuk O, Rosa A, Abdel-Wahab M. Radiotherapy resources in Latin America and the Caribbean: a review of current and projected needs based on International Atomic Energy Agency data. Lancet Oncol 2023; 24:e376-e384. [PMID: 37657478 DOI: 10.1016/s1470-2045(23)00299-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 09/03/2023]
Abstract
The inequitable access to radiotherapy globally is a complex undertaking that will require sustained work identifying gaps and mobilising efforts to resolve. The purpose of this review is to identify gaps and needs in radiotherapy in Latin America and the Caribbean. Data from 41 countries in Latin America and the Caribbean on teletherapy megavoltage units and brachytherapy resources were extracted from the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centers. These data were then matched to open-source data from GLOBOCAN and World Bank Data which included data on population size, gross national income per capita, cancer incidence, and mortality. These data were matched to current and projected cancer incidence and mortality (as estimated by the Global Cancer Observatory in 2020) to calculate current and projected gaps in external beam radiotherapy facilities. For brachytherapy, the analysis was focused on cervical cancer and included high dose rate and low dose rate machines. As of Oct 22, 2022, external beam radiotherapy was available in 32 (78%) of 41 countries, representing 742 radiotherapy centres and 1122 megavoltage units. Average coverage was 63%. LINACs accounted for 85% (955 of 1122) of megavoltage units and Cobalt-60 capacity decreased to 12% compared with in 2018. Median megavoltage units per 1000 cancer cases were 0·8 (IQR 0·54-1·03). Most countries clustered in the same range of gross national income per capita for teletherapy units per 1000 cases at a median of US$9380. The current deficit in megavoltage units is estimated at 668 units and is projected to be 2455 units by 2030. 28 (68%) of 41 countries had 279 installed brachytherapy services, both high dose rate and low dose rate, which could treat 108 420 patients with cervical cancer per year and meet the current needs, albeit with inequitable distribution of resources. Overall, this review indicated a 15% improvement in the current external beam radiotherapy capacity in Latin America and the Caribbean compared with 2018. However, there is still a current shortage of at least 668 extra units. By 2030, the need for megavoltage units will be double the current capacity. There is inequitable distribution of brachytherapy resources across the region primarily in the Caribbean. Adoption of hypofractionation can help overcome machine shortage; however, it will present technical challenges that need to be taken into account. Rays of Hope, is a novel IAEA initiative that is designed to mobilise global efforts to address radiotherapy gaps while ensuring the highest return on investment.
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Affiliation(s)
- May Elbanna
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Yaroslav Pynda
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Oleksandr Kalinchuk
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Arthur Rosa
- Department of Radiation Oncology, Oncoclinicas Salvador and Hospital Santa Izabel, Salvador, BA, Brazil
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
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Manson EN, Hasford F, Trauernicht C, Ige TA, Inkoom S, Inyang S, Samba O, Khelassi-Toutaoui N, Lazarus G, Sosu EK, Pokoo-Aikins M, Stoeva M. Africa's readiness for artificial intelligence in clinical radiotherapy delivery: Medical physicists to lead the way. Phys Med 2023; 113:102653. [PMID: 37586146 DOI: 10.1016/j.ejmp.2023.102653] [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] [Received: 05/12/2023] [Revised: 07/30/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND There have been several proposals by researchers for the introduction of Artificial Intelligence (AI) technology due to its promising role in radiotherapy practice. However, prior to the introduction of the technology, there are certain general recommendations that must be achieved. Also, the current challenges of AI must be addressed. In this review, we assess how Africa is prepared for the integration of AI technology into radiotherapy service delivery. METHODS To assess the readiness of Africa for integration of AI in radiotherapy services delivery, a narrative review of the available literature from PubMed, Science Direct, Google Scholar, and Scopus was conducted in the English language using search terms such as Artificial Intelligence, Radiotherapy in Africa, Machine Learning, Deep Learning, and Quality Assurance. RESULTS We identified a number of issues that could limit the successful integration of AI technology into radiotherapy practice. The major issues include insufficient data for training and validation of AI models, lack of educational curriculum for AI radiotherapy-related courses, no/limited AI teaching professionals, funding, and lack of AI technology and resources. Solutions identified to facilitate smooth implementation of the technology into radiotherapy practices within the region include: creating an accessible national data bank, integrating AI radiotherapy training programs into Africa's educational curriculum, investing in AI technology and resources such as electronic health records and cloud storage, and creation of legal laws and policies to support the use of the technology. These identified solutions need to be implemented on the background of creating awareness among health workers within the radiotherapy space. CONCLUSION The challenges identified in this review are common among all the geographical regions in the African continent. Therefore, all institutions offering radiotherapy education and training programs, management of the medical centers for radiotherapy and oncology, national and regional professional bodies for medical physics, ministries of health, governments, and relevant stakeholders must take keen interest and work together to achieve this goal.
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Affiliation(s)
| | | | | | | | | | | | - Odette Samba
- General Hospital of Yaoundé and University of Yaoundé I, Cameroon.
| | | | - Graeme Lazarus
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - Edem Kwabla Sosu
- School of Nuclear and Allied Sciences, University of Ghana, Ghana.
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Rosa AA, de Sousa CFPM, Pimentel LCF, Martins HL, Moraes FY, Marta GN, Castilho MS. Radiotherapy resources in Brazil (RT2030): a comprehensive analysis and projections for 2030. Lancet Oncol 2023; 24:903-912. [PMID: 37541272 DOI: 10.1016/s1470-2045(23)00284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The demand for radiotherapy in Brazil is unfulfilled, and the scarcity of data on the national network hampers the development of effective policies. We aimed to evaluate the current situation, estimate demands and requirements, and provide an action plan to ensure access to radiotherapy for those in need by 2030. METHODS The Brazilian Society for Radiation Oncology created a task force (RT2030) including physicians, medical physicists, policy makers, patient advocates, and suppliers, all of whom were major stakeholders involved in Brazilian radiotherapy care. The group was further divided into seven working groups to address themes associated with radiotherapy care in Brazil. From March 1, 2019, to Aug 3, 2020, there were monthly meetings between the group's leaders and the Central Committee and six general meetings. First, a comprehensive search of all different national databases was done to identify all radiotherapy centres. Questionnaires evaluating radiotherapy infrastructure and human resources and assing the availability, distribution, capacity, and workload of resources were created and sent to the radioprotection supervisor of each centre. Results were analysed nationally and across the country's regions and health-care systems. A pre-planned review of available databases was done to gather data on active radiation oncology centres and the distribution of radiotherapy machines (linear accelerators [LINACs]) across Brazil. We used national population and cancer incidence projections, recommended radiotherapy usage from the medical literature, and national working patterns to project radiotherapy demands in 2030. An action plan was established with suggestions to address the gaps and meet the demands. FINDINGS The database search yielded 279 centres with an active radiotherapy registry. After applying predefined exclusion criteria, 263 centres were identified that provided external beam radiotherapy machines with or without brachytherapy. All 263 operational centres answered the questionnaires sent on Dec 9, 2019, which were then returned between Jan 1 and June 30, 2020. There were 409 therapy machines, 646 radiation oncologists, 533 physicists, and 230 989 patients undergoing radiotherapy (150 628 [65·2%] in the public health-care system and 80 937 [35·0%] in private). The mean annual occupation rate was 566 patients per treatment machine (SD 250). The number of residents per treatment machine ranged from 258 333 to 1 800 000. Technology availability varied considerably among regions and systems. In 2030, 639 994 new cancer cases are expected, which will require 332 797 radiotherapy courses. Therefore, 530 LINACs, 1079 radiation oncologists, and 1060 medical physicists will be needed. INTERPRETATION The expected increase in cancer incidence in the coming years will probably increase the disparities in cancer care and the burden for Brazilian patients. We provide a roadmap of the current situation and the particularities of the Brazilian radiotherapy network, which can serve as a starting point for cancer policy planning to improve this scenario. FUNDING Accuray, BRAINLAB, Elekta, IBA, ONE medical solution, SUN NUCLEAR corporation, VARIAN, and ZIGMA.
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Affiliation(s)
- Arthur Accioly Rosa
- Grupo Oncoclínicas, Salvador, Bahia, Brazil; Latin America Cooperative Oncology Group, Porto Alegre, Brazil
| | | | | | | | - Fabio Ynoe Moraes
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
| | - Gustavo Nader Marta
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Rubagumya F, Mushonga M, Abdihamid O, Nyagabona S, Hopman W, Nwamaka L, Omar AA, Ndlovu N, Booth C, Aggarwal A, Brundage M, Vanderpuye V, de Moraes FY. Status of Peer Review in Radiation Oncology: A Survey of Cancer Centers in Sub-Saharan Africa. Int J Radiat Oncol Biol Phys 2023; 116:984-991. [PMID: 37453798 DOI: 10.1016/j.ijrobp.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and; Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Melinda Mushonga
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Omar Abdihamid
- Garissa Cancer Center-Garissa County Referral Hospital, Garissa, Kenya
| | - Sarah Nyagabona
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wilma Hopman
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Kingston Health Sciences Centre Research Institute, Kingston, Ontario, Canada
| | | | - Abeid Athman Omar
- Kenyatta University Teaching Research and Referral Hospital, Nairobi, Kenya
| | - Ntokozo Ndlovu
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Christopher Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and; Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and
| | | | - Fabio Ynoe de Moraes
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and
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Lin LL, Msadabwe SC, Chiao E. Improving Access to Radiation Therapy Globally To Meet World Health Organization Goals To Eliminate Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 116:459-462. [PMID: 37179093 PMCID: PMC10172026 DOI: 10.1016/j.ijrobp.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 05/15/2023]
Affiliation(s)
- Lilie L Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas.
| | | | - Elizabeth Chiao
- Departments of Epidemiology and General Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas
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Swain M, Budrukkar A, Rembielak A, Kron T, Agarwal JP. Challenges in the Sustainability of Brachytherapy Service in Contemporary Radiotherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00205-4. [PMID: 37302881 DOI: 10.1016/j.clon.2023.05.013] [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: 03/14/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Brachytherapy has a long history of delivering a highly conformal radiation dose to the target volume with sparing of adjacent normal tissue and has an irreplaceable role in certain cancers, such as cervical and prostate cancers. There have been futile attempts to replace brachytherapy with other radiation techniques. Despite that there are multifaceted challenges in preserving this dying art, from establishment, to a trained workforce, to maintenance of the equipment and source replacement costs. Here we focus on the challenges to access brachytherapy, the availability and distribution of care across the globe and appropriate training leading to proper implementation of the procedure. Brachytherapy holds a significant place in the treatment armamentarium of most common cancers, such as cervical, prostate, head and neck and skin cancers. However, there is an uneven distribution of brachytherapy facilities, not only across the globe, but also at a national level, with a larger proportion of facilities concentrated in certain regions, more so in low and low-middle income countries. The regions with the highest incidence of cervical cancer have the least access to brachytherapy facilities. Attempts to bridge the gap are essential and should be focused on uniform distribution and access to care, improving training of the workforce through specialised training programmes, reducing the cost of care, planning to reduce the recurring cost, generating evidence and research guidelines, renewing interest in brachytherapy through rebranding, use of social media and building an attainable long-term roadmap.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - T Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India.
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Feyisa JD, Woldegeorgis MA, Zingeta GT, Abegaz KH, Berhane Y. Cervical Cancer Progression in Patients Waiting for Radiotherapy Treatment at a Referral Center in Ethiopia: A Longitudinal Study. JCO Glob Oncol 2023; 9:e2200435. [PMID: 37216623 PMCID: PMC10497299 DOI: 10.1200/go.22.00435] [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: 12/23/2022] [Revised: 03/03/2023] [Accepted: 03/20/2023] [Indexed: 05/24/2023] Open
Abstract
PURPOSE Nonmetastatic cervical cancer is curable and can be treated with radiotherapy (RT). A delay in receiving treatment because of long waiting times results in upstaging of the disease stage and negatively affects the treatment outcomes. However, real-world evidence that progression occurs while waiting for treatment is scarce in low-income countries. We evaluated the impact of long waiting times for RT in patients with cervical cancer at a referral center in Ethiopia. METHODS A longitudinal study was conducted from January 5, 2019, to May 30, 2020, to address the objectives of this study. Patients with pathologically diagnosed cervical cancer with stage IIB to stage IVA were included in the study. We used Kaplan-Meier analysis to assess overall survival with time. Multivariate Cox regression analysis, using the backward likelihood ratio selection method, was used to fit the final model. RESULTS The median waiting time for radical RT after diagnosis was 477 days. Waiting for more than 51 days for RT results in disease progression. Of the 115 patients included in this study, 59 (51.3%) died during the study period. A delay in waiting (adjusted hazard ratio, 3; 95% CI, 1.7 to 4.9) was significantly associated with disease progression and decreased survival. CONCLUSION Waiting time to receive RT is very long. Urgent action is required to significantly reduce waiting times and improve the survival of patients with cervical cancer.
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Affiliation(s)
- Jilcha D. Feyisa
- Department of Oncology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Girum T. Zingeta
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kedir H. Abegaz
- Department of Biostatistics & Health Informatics, Madda Walabu University, Robe, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Ige T, Lewis P, Shelley C, Pistenmaa D, Coleman CN, Aggarwal A, Dosanjh M, Zergoug I, Eduardo HM, Bvochora-Nsingo M, Fulu K, Ralefala T, Grover S, Maison-Mayeh AM, Ndi SR, Attalla E, Deiab N, Belay EY, Acquah GF, Amankwaa-Frempong E, Foy H, Ngigi E, Badi F, Elburi I, Harivony T, Kone A, Maiga S, Tolba A, Mootoosamy S, El-Boutayeb S, Momade A, Midzi W, Grobler M, Aruah SC, Kra J, Diagne M, Trauernicht C, Elbashir F, Ali NAE, Makwani H, Yusufu S, Farhat L, Mounir B, Awusi K, Azangwe G. Understanding the challenges of delivering radiotherapy in low- and middle-income countries in Africa. J Cancer Policy 2023; 35:100372. [PMID: 36512899 DOI: 10.1016/j.jcpo.2022.100372] [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: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Access to high quality radiotherapy (RT) continues to be a major issue across Africa with Africa having just 34% of its optimal capacity. METHODS We co-developed a survey with clinical, academic and policy stakeholders designed to provide a structured assessment of the barriers and enablers to RT capacity building in Africa. The survey covered nine key themes including funding, procurement, education and training. The survey was sent to RT professionals in 28 countries and the responses underwent qualitative and quantitative assessment. RESULTS We received completed questionnaires from 26 African countries. Funding was considered a major issue, specifically the lack of a ring fenced funds from the Ministry of Health for radiotherapy and the consistency of revenue streams which relates to a lack of prioritisation for RT. In addition to a significant shortfall in RT workforce disciplines, there is a general lack of formal education and training programmes. 13/26 countries reported having some IAEA support for RT for education and training. Solutions identified to improve access to RT include a) increasing public awareness of its essential role in cancer treatment; b) encouraging governments to simplify procurement and provide adequate funding for equipment; c) increasing training opportunities for all radiotherapy disciplines and d) incentivizing staff retention. CONCLUSION This survey provides unique information on challenges to delivering and expanding radiotherapy services in Africa. The reasons are heterogonous across countries but one key recommendation would be for national Cancer Control plans to directly consider radiotherapy and specifically issues of funding, equipment procurement, servicing and training. POLICY SUMMARY The study demonstrates the importance of mixed methods research to inform policy and overcome barriers to radiotherapy capacity and capability in LMICs.
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Affiliation(s)
- Taofeeq Ige
- National Hospital Abuja, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | | | - Charlotte Shelley
- The Royal Surrey County Hospital NHS Foundation trust, Guildford, UK
| | - David Pistenmaa
- ICEC, International Cancer Expert Corps, Washington, DC, USA
| | | | | | - Manjit Dosanjh
- ICEC, International Cancer Expert Corps, Washington, DC, USA; CERN, ATS-DO, Geneva, Switzerland; Department of Physics, University of Oxford, UK.
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Nadella P, Iyer HS, Manirakiza A, Vanderpuye V, Triedman SA, Shulman LN, Fadelu T. Geographic Accessibility of Radiation Therapy Facilities in Sub-Saharan Africa. Int J Radiat Oncol Biol Phys 2023; 115:557-563. [PMID: 36725167 DOI: 10.1016/j.ijrobp.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Access to radiation therapy in Sub-Saharan Africa (SSA) remains unacceptably low. Prior studies have focused on how many radiation therapy machines a country has but have not accounted for geographic accessibility, which is a known barrier to radiation therapy compliance. In this study, we describe accessibility measured as travel time by road to radiation therapy in SSA. METHODS AND MATERIALS This study used geographic information systems modeling techniques. A list of radiation therapy facilities was obtained from the Directory of Radiotherapy Centres. We obtained a 1 km2 surface of travel times using a least-cost-path algorithm implemented in Google Earth Engine (Google, Mountain View, CA). AccessMod 5 (World Health Organization, Geneva, Switzerland) was used to compute the percentage of each country's population with access to a radiation therapy facility within prespecified one-way travel time intervals. We then ranked countries using 3 measures of access: 2-hour geographic access, units per capita, and units per cancer case. RESULTS Only 24.4% of the population of SSA can access a radiation therapy facility within 2 hours of travel by road; access was 14.6% and 42.5% within 1 and 4 hours, respectively. More than 80% of Rwandans and South Africans were within 2 hours of radiation therapy, the highest in the region. Although countries with more radiation therapy units per capita tended to have higher 2-hour access, there was notable discordance between the 2 measures. Mauritania, Zambia, Sudan, and Namibia were among the top 10 countries ranked by machines per capita, but none ranked in the top 10 by 2-hour geographic access. There was similar discordance between 2-hour access and radiation therapy units per cancer case; Rwanda, Nigeria, Senegal, and Cote d'Ivoire ranked in the top 10 for the former but ranked worse using units per cancer case. CONCLUSIONS Prior measures of radiation therapy access provide an incomplete picture. Geographic location of radiation therapy centers is a crucial component of access that should be considered for future planning in SSA.
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Affiliation(s)
- Pranay Nadella
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Hari S Iyer
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology and Nuclear Medicine, Korlebu Teaching Hospital, Accra, Ghana
| | - Scott A Triedman
- Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts; Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Temidayo Fadelu
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Center for Global Cancer Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Christ SM, Willmann J. Measuring Global Inequity in Radiation Therapy: Resource Deficits in Low- and Middle-Income Countries Without Radiation Therapy Facilities. Adv Radiat Oncol 2023; 8:101175. [PMID: 37008253 PMCID: PMC10050474 DOI: 10.1016/j.adro.2023.101175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/05/2023] [Indexed: 03/05/2023] Open
Abstract
Purpose Although radiation therapy (RT) is an effective and inexpensive pillar of multidisciplinary cancer care, access to RT facilities remains highly inequitable globally. Numerous studies have documented this resource gap, yet many countries continue facing their raging cancer epidemics ill-equipped. In this study, we present an estimation of resource deficits in low- and middle-income countries (LMICs) without any RT facilities at all. Methods and Materials This study builds on publicly available data on country classification, population, cancer incidence, and RT requirements provided by the World Bank Group, the World Health Organization, and the International Atomic Energy Agency. Leveraging these data, we developed a capacity-planning model to estimate the current deficit of fundamental RT resources for LMICs with more than 1 million inhabitants and no active RT facilities. Results There were 23 LMICs with a population of more than 1 million inhabitants and without any active RT facilities, 78% of which were located in sub-Saharan Africa. The aggregate population of these countries was 197.3 million people. The largest countries without RT facilities were Afghanistan and Malawi, with a population of 38.0 million and 18.6 million inhabitants, respectively. Estimated cancer incidence for all countries under study totaled at 134,783 new cases per year, 84,239 (62.5%) of which would have required RT. There was an aggregate deficit of 188 megavoltage machines and 85 brachytherapy afterloaders, along with simulation equipment and human capital in the magnitude of approximately 3363 trained radiation oncology staff. Conclusions Hundreds of thousands of patients with cancer in LMICs continue to live in countries without access to RT in their own country. This extreme form of global health inequity requires urgent and decisive action, the success of which depends on the integration of international and local efforts.
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Affiliation(s)
- Sebastian M. Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Corresponding author: Sebastian M. Christ, MD, PhD
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
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Olatunji E, Swanson W, Patel S, Adeneye SO, Aina-Tofolari F, Avery S, Kisukari JD, Graef K, Huq S, Jeraj R, Joseph AO, Lehmann J, Li H, Mallum A, Mkhize T, Ngoma TA, Studen A, Wijesooriya K, Incrocci L, Ngwa W. Challenges and opportunities for implementing hypofractionated radiotherapy in Africa: lessons from the HypoAfrica clinical trial. Ecancermedicalscience 2023; 17:1508. [PMID: 37113724 PMCID: PMC10129374 DOI: 10.3332/ecancer.2023.1508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Indexed: 02/18/2023] Open
Abstract
The rising cancer incidence and mortality in sub-Saharan Africa (SSA) warrants an increased focus on adopting or developing approaches that can significantly increase access to treatment in the region. One such approach recommended by the recent Lancet Oncology Commission for sub-Saharan Africa is hypofractionated radiotherapy (HFRT), which can substantially increase access to radiotherapy by reducing the overall duration of time (in days) each person spends being treated. Here we highlight challenges in adopting such an approach identified during the implementation of the HypoAfrica clinical trial. The HypoAfrica clinical trial is a longitudinal, multicentre study exploring the feasibility of applying HFRT for prostate cancer in SSA. This study has presented an opportunity for a pragmatic assessment of potential barriers and facilitators to adopting HFRT. Our results highlight three key challenges: quality assurance, study harmonisation and machine maintenance. We describe solutions employed to resolve these challenges and opportunities for longer term solutions that can facilitate scaling-up use of HFRT in SSA in clinical care and multicentre clinical trials. This report provides a valuable reference for the utilisation of radiotherapy approaches that increase access to treatment and the conduct of high-quality large-scale/multi-centre clinical trials involving radiotherapy. Trial registration Not available yet.
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Affiliation(s)
- Elizabeth Olatunji
- Co-first authors
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD 21205, USA
| | - William Swanson
- Co-first authors
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Saloni Patel
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD 21205, USA
| | - Samuel Olaolu Adeneye
- NSIA-LUTH Cancer Treatment Center, Lagos University Teaching Hospital, Lagos 100254, Nigeria
| | - Funmilayo Aina-Tofolari
- NSIA-LUTH Cancer Treatment Center, Lagos University Teaching Hospital, Lagos 100254, Nigeria
| | - Stephen Avery
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA 98121, USA
| | - Saiful Huq
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - Robert Jeraj
- Department of Medical Physics, University of Wisconsin, Madison, WI 53705, USA
- University of Ljubljana, Faculty of Mathematics and Physics, Ljubljana 1000, Slovenia
| | - Adedayo O Joseph
- NSIA-LUTH Cancer Treatment Center, Lagos University Teaching Hospital, Lagos 100254, Nigeria
| | - Joerg Lehmann
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW 2298, Australia
- Institute of Medical Physics, The University of Sydney, Sydney, NSW 2006, Australia
| | - Heng Li
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD 21205, USA
| | - Abba Mallum
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban 4091, South Africa
| | - Thokozani Mkhize
- Department of Radiotherapy and Oncology, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Oncology, Inkosi Albert Luthuli Central Hospital, Durban 4091, South Africa
| | - Twalib Athumani Ngoma
- Ocean Road Cancer Institute, Dar Es Salaam 3592, Tanzania
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, PO box 65001, Dar es Salaam, Tanzania
| | - Andrej Studen
- University of Ljubljana, Faculty of Mathematics and Physics, Ljubljana 1000, Slovenia
- Jožef Stefan Institute, Ljubljana 1000, Slovenia
| | - Krishni Wijesooriya
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Luca Incrocci
- Co-senior authors
- Department of Radiotherapy, Erasmus MC, Rotterdam, Netherlands
| | - Wilfred Ngwa
- Co-senior authors
- Johns Hopkins University School of Medicine, Baltimore, Maryland, MD 21205, USA
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
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22
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Okerosi S, Mokoh LW, Rubagumya F, Niyibizi BA, Nkya A, Van Loon K, Buckle G, Bent S, Ha P, Fagan JJ, Ng D, Aswani J, Xu MJ. Human Papillomavirus-Associated Head and Neck Malignancies in Sub-Saharan Africa: A Systematic Review. JCO Glob Oncol 2023; 9:e2200259. [PMID: 36730877 PMCID: PMC10166441 DOI: 10.1200/go.22.00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The proportion of head and neck cancers (HNCs) with human papillomavirus (HPV) positivity in sub-Saharan Africa (SSA) is poorly characterized. Characterizing this has implications in staging, prognosis, resource allocation, and vaccination policies. This study aims to determine the proportion of HPV-associated HNC in SSA. MATERIALS AND METHODS This systematic review included searches from PubMed, EMBASE, Web of Science, African Index Medicus, Google Scholar, and African Journals Online. All English publications reporting the proportion of HNC specimens from SSA patients who tested positive for HPV and/or p16 were included. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Case Series Studies. RESULTS In this systematic review of 31 studies and 3,850 patients, the overall p16 positivity was 13.6% (41 of 1,037 patients tested) with the highest proportion among oropharyngeal cancers (20.3%, 78 of 384 patients) and the overall HPV polymerase chain reaction positivity was 15.3% (542 of 3,548 samples tested) with the highest proportion among nasopharyngeal cancers (16.5%, 23 of 139 patients). Among the 369 HPV strains detected, the most common genotypes were HPV 16 (226 patients, 59.2%) and HPV 18 (78, 20.4%). CONCLUSION HPV was found to be associated with a significant proportion of HNC in SSA. The genotypes reported suggest that the nine-valent vaccine and gender-neutral vaccination policies should be considered. Given that these studies may not accurately capture prevalence nor causation of HPV in HNC subsites, additional research is needed to provide a more thorough epidemiologic understanding of HPV-associated HNC in SSA, including risk factors and clinical outcomes.
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Affiliation(s)
- Samuel Okerosi
- ENT, Kenyatta National Hospital, ENT Department, Nairobi, Kenya
| | | | - Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda.,Rwanda Cancer Relief, Kigali, Rwanda
| | | | - Aslam Nkya
- Department of Otorhinolaryngology, Muhimibili National Hospital, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Department of Medicine, University of California San Francisco, San Francisco, CA.,Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Geoffrey Buckle
- Department of Medicine, University of California San Francisco, San Francisco, CA.,Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Stephen Bent
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Patrick Ha
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA
| | - Johannes J Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Dianna Ng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joyce Aswani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | - Mary Jue Xu
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA
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23
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Ezenwankwo EF, Nnaji CA, Moodley J. Cancer service delivery and the impact of the COVID-19 pandemic in sub-Saharan Africa: a scoping review. Ecancermedicalscience 2022; 16:1485. [PMID: 36819808 PMCID: PMC9934970 DOI: 10.3332/ecancer.2022.1485] [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: 09/01/2022] [Indexed: 12/13/2022] Open
Abstract
Background The impact of the Coronavirus Disease 2019 (COVID-19) pandemic on health systems is widely reported worldwide. However, what remains unclear is the relative extent of the pandemic's effects on cancer management in sub-Saharan Africa (SSA). This review provides an up-to-date synthesis of the literature to inform post-pandemic policy and practice efforts in the region. Methods Sources searched for published research include MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, African Index Medicus, African Wide Information and Web of Science. Using predefined criteria, the retrieved citations were screened for primary research describing the direct and indirect impacts of the COVID-19 pandemic on the cancer care and service delivery landscape in SSA since March 2020. Evidence was summarised using narrative synthesis. Results Fourteen studies reporting findings from 19 SSA countries were included in this review. Studies were conducted mostly in the first wave of the pandemic (between March and July 2020) (10/14). The most commonly reported impact on cancer treatment (including surgery) were cancellations, delays and modifications (11/14). Half (7/14) of the studies reported on the impact of the pandemic on cancer care resource availability and service restructuring. Other notable impacts included temporary suspension, total cancellations or alterations in cancer screening (3/14) and diagnostic (3/14) services or programmes. Disruptions in cancer research and outreach activities were also reported (3/14). The availability and maintenance of cancer healthcare depended on multiple factors like availability of clinical supplies, existing oncology workforce, adequate supply of personal protective equipment and local pandemic mitigation measures. Notably, no studies reported on the impact of the pandemic on psychosocial support programmes, physiotherapy and other rehabilitation care for cancer patients. Conclusion Changes in cancer care and service delivery due to the COVID-19 pandemic varied considerably across countries in SSA. This review underscores the need for urgent actions to mitigate current setbacks while recommending evidence-based and contextualised approaches to revitalising cancer care in the post-pandemic era.
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Affiliation(s)
- Elochukwu F Ezenwankwo
- School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town 7925, Western Cape, South Africa,SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Chukwudi A Nnaji
- School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town 7925, Western Cape, South Africa,SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Jennifer Moodley
- School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town 7925, Western Cape, South Africa,SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
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24
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Downing J, Namisango E, Connor S, Batanda P, Irumba LC, Basemera B, Jatho A, Nakami S, Nalubega H, Kamate A, Basirika D, Zalwango J, Namuddu M, Chiyoka W, Kayondo F, Byaruhanga D, Rusanganwa E, Davis H, Watiti S, Gaolebale B, Ahern LN, Thomas L, Luyirika E. The Declaration on Palliative Care in a Pandemic: report of the African Ministers of Health Meeting and the 7th International African Palliative Care Conference, held from the 24th to 26th August 2022 in Kampala, Uganda and virtually. Ecancermedicalscience 2022; 16:1474. [PMID: 36819822 PMCID: PMC9934884 DOI: 10.3332/ecancer.2022.1474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Indexed: 11/24/2022] Open
Abstract
The 7th International African Palliative Care Conference and the 4th African Ministers of Health Meeting were held in Kampala from the 24th to 26th August 2022. The theme of the conference - Palliative Care in a Pandemic - reflected the reality of palliative care provision on the continent, and the experience of patients and providers over the past 2 years. It was hosted by the African Palliative Care Association and the Worldwide Hospice Palliative Care Alliance with co-sponsors being the International Children's Palliative Care Network, the International Association of Hospice and Palliative Care, Global Partners in Care and Palliative care in Humanitarian Aid Situations and Emergencies. The conference was held in Kampala as a hybrid event, with a mix of in-person, pre-recorded and virtual presentations. The African Ministers of Health Meeting held on the 24th August was attended by delegates from 25 Ministries of Health, with 92 participants in-person and 122 attending virtually. Hosted by the Minister of State for Primary Health Care in Uganda, the participants at the meeting endorsed a Declaration on Palliative Care in a Pandemic. The main conference, held on the 25th and 26th August, was attended by 334 delegates from 40 countries, 199 (60%) of whom attended in-person. Key themes discussed throughout the conference included: contagious compassion; building a business case and evidence for palliative care in Africa; palliative care policy, funding and sustainability; the importance of collaboration and global partnerships; palliative care for all ages, children through to the elderly, and all conditions; the need to be innovative and creative, embracing technology; and a feeling of hopefulness in the future of palliative care in the region as we go forward together. The impact of the pandemic has been significant on everyone. Despite this, and the limitations imposed by the pandemic, the African palliative care community has come through it stronger, is committed to continuing the development of palliative care across the region, working together and is hopeful for the future.
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Affiliation(s)
- Julia Downing
- Makerere/Mulago Palliative Care Unit, Kampala, Uganda,International Children’s Palliative Care Network, Durban 3624, South Africa,African Palliative Care Association UK, London DA7 6AZ, UK
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Stephen Connor
- Worldwide Hospice Palliative Care Alliance, London WC1X 9JG, UK
| | | | | | | | | | | | | | | | | | | | - Mable Namuddu
- African Palliative Care Association, Kampala, Uganda
| | | | | | | | | | - Helena Davis
- Worldwide Hospice Palliative Care Alliance, London WC1X 9JG, UK
| | - Stephen Watiti
- Worldwide Hospice Palliative Care Alliance, London WC1X 9JG, UK
| | - Babe Gaolebale
- Worldwide Hospice Palliative Care Alliance, London WC1X 9JG, UK
| | - Lacey N Ahern
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN 46556, USA,Hospice Foundation/Global Partners in Care, Mishawaka, IN 46545, USA
| | - Lydia Thomas
- Hospice Foundation/Global Partners in Care, Mishawaka, IN 46545, USA
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25
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Drokow EK, Fangninou FF, Effah CY, Agboyibor C, Zhang Y, Arboh F, Deku MA, Xinyin W, Wang Y, Sun K. Cervical cancer survival times in Africa. Front Public Health 2022; 10:981383. [PMID: 36438301 PMCID: PMC9683338 DOI: 10.3389/fpubh.2022.981383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Accessibility to quality healthcare, histopathology of tumor, tumor stage and geographical location influence survival rates. Comprehending the bases of these differences in cervical cancer survival rate, as well as the variables linked to poor prognosis, is critical to improving survival. We aimed to perform the first thorough meta-analysis and systematic review of cervical cancer survival times in Africa based on race, histopathology, geographical location and age. Methods and materials Major electronic databases were searched for articles published about cervical cancer survival rate in Africa. The eligible studies involved studies which reported 1-year, 3-year or 5-year overall survival (OS), disease-free survival (DFS) and/or locoregional recurrence (LRR) rate of cervical cancer patients living in Africa. Two reviewers independently chose the studies and evaluated the quality of the selected publications, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-P). We used random effects analysis to pooled the survival rate across studies and heterogeneity was explored via sub-group and meta-regression analyses. A leave-one-out sensitivity analysis was undertaken, as well as the reporting bias assessment. Our findings were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-P). Results A total of 16,122 women with cervical cancer were covered in the 45 articles (59 studies), with research sample sizes ranging from 22 to 1,059 (median = 187.5). The five-year overall survival (OS) rate was 40.9% (95% CI: 35.5-46.5%). The five-year OS rate ranged from 3.9% (95% CI: 1.9-8.0%) in Malawi to as high as 76.1% (95% CI: 66.3-83.7%) in Ghana. The five-year disease-free survival rate was 66.2% (95% CI: 44.2-82.8%) while the five-year locoregional rate survival was 57.0% (95% CI: 41.4-88.7%). Conclusion To enhance cervical cancer survival, geographical and racial group health promotion measures, as well as prospective genetic investigations, are critically required.
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Affiliation(s)
- Emmanuel Kwateng Drokow
- Department of Radiation Oncology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangnon Firmin Fangninou
- State Key Laboratory of Pollution Control and Resource Reuse, Key Laboratory of Yangtze River Water, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, China
| | | | - Clement Agboyibor
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yunfeng Zhang
- Department of Obstetrics and Gynaecology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Francisca Arboh
- School of Management Science and Engineering, Jiangsu University, Zhenjiang, China
| | | | - Wu Xinyin
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Yue Wang
- Department of Obstetrics and Gynaecology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Sun
- Department of Hematology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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26
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Cancer burden and status of cancer control measures in fragile states: a comparative analysis of 31 countries. Lancet Glob Health 2022; 10:e1443-e1452. [DOI: 10.1016/s2214-109x(22)00331-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/20/2022] [Accepted: 07/20/2022] [Indexed: 12/25/2022]
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27
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Laskar SG, Sinha S, Krishnatry R, Grau C, Mehta M, Agarwal JP. Access to Radiation Therapy: From Local to Global and Equality to Equity. JCO Glob Oncol 2022; 8:e2100358. [PMID: 35960905 PMCID: PMC9470145 DOI: 10.1200/go.21.00358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The discipline of radiation oncology is the most resource-intensive component of comprehensive cancer care because of significant initial investments required for machines, the requirement of dedicated construction, a multifaceted workforce, and recurring maintenance costs. This review focuses on the challenges associated with accessible and affordable radiation therapy (RT) across the globe and the possible solutions to improve the current scenario. Most common cancers globally, including breast, prostate, head and neck, and cervical cancers, have a RT utilization rate of > 50%. The estimated annual incidence of cancer is 19,292,789 for 2020, with > 70% occurring in low-income countries and low-middle–income countries. There are approximately 14,000 teletherapy machines globally. However, the distribution of these machines is distinctly nonuniform, with low-income countries and low-middle–income countries having access to < 10% of the global teletherapy machines. The Directory of Radiotherapy Centres enlists 3,318 brachytherapy facilities. Most countries with a high incidence of cervical cancer have a deficit in brachytherapy facilities, although formal estimates for the same are not available. The deficit in simulators, radiation oncologists, and medical physicists is even more challenging to quantify; however, the inequitable distribution is indisputable. Measures to ensure equitable access to RT include identifying problems specific to region/country, adopting indigenous technology, encouraging public-private partnership, relaxing custom duties on RT equipment, global/cross-country collaboration, and quality human resources training. Innovative research focusing on the most prevalent cancers aiming to make RT utilization more cost-effective while maintaining efficacy will further bridge the gap. Improving global access to Radiotherapy: The current scenario and the road ahead
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Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Cai Grau
- Department of Radiation Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Minesh Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
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28
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Scott AA, Polo A, Zubizarreta E, Akoto-Aidoo C, Edusa C, Osei-Bonsu E, Yarney J, Dwobeng B, Milosevic M, Rodin D. Geographic Accessibility and Availability of Radiotherapy in Ghana. JAMA Netw Open 2022; 5:e2226319. [PMID: 35951324 PMCID: PMC9372791 DOI: 10.1001/jamanetworkopen.2022.26319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Radiotherapy is critical for comprehensive cancer care, but there are large gaps in access. Within Ghana, data on radiotherapy availability and on the relationship between distance and access are unknown. OBJECTIVES To estimate the gaps in radiotherapy machine availability in Ghana and to describe the association between distance and access to care. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional, population-based study of radiotherapy delivery in Ghana in 2020 and model-based analysis of radiotherapy demand and the radiotherapy utilization rate (RUR) using the Global Task Force on Radiotherapy for Cancer Control investment framework. EXPOSURES Receipt of radiotherapy and the number of radiotherapy courses delivered. MAIN OUTCOMES AND MEASURES Geocoded location of patients receiving external beam radiotherapy (EBRT); median Euclidean distance from the district centroids to the nearest radiotherapy centers; proportion of population living within geographic buffer zones of 100, 150, and 200 km; additional capacity required for optimal utilization; and geographic accessibility after strategic location of a radiotherapy facility in an underserviced region. RESULTS A total of 2883 patients underwent EBRT courses in 2020, with an actual RUR of 11%. Based on an optimal RUR of 48%, 11 524 patients had an indication for radiotherapy, indicating that only 23% of patients received treatment. An investment of 23 additional EBRT machines would be required to meet demand. The median Euclidean distance from the district centroids to the nearest radiotherapy facility was 110.6 km (range, 0.62-513.2 km). The proportion of the total population living within a radius of 100, 150 and 200 km of a radiotherapy facility was 47%, 61% and 70%, respectively. A new radiotherapy facility in the northern regional capital would reduce the median of Euclidean distance by 10% to 99.4 km (range, 0.62-267.7 km) and increase proportion of the total population living within a radius of 100, 150 and 200 km to 53%, 69% and 84%, respectively. The greatest benefit was seen in regions in the northern half of Ghana. CONCLUSIONS AND RELEVANCE In this cross-sectional study of geographic accessibility and availability of radiotherapy, Ghana had major national deficits of radiotherapy capacity, with significant geographic disparities among regions. Well-planned infrastructure scale-up that accounts for the population distribution could improve radiotherapy accessibility.
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Affiliation(s)
- Aba Anoa Scott
- National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alfredo Polo
- International Atomic Energy Agency, Vienna, Austria
| | | | - Charles Akoto-Aidoo
- National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Clement Edusa
- Oncology Department, Sweden Ghana Medical Centre, Accra, Ghana
| | - Ernest Osei-Bonsu
- National Radiotherapy and Nuclear Medicine Centre, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Joel Yarney
- National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Bismark Dwobeng
- National Radiotherapy and Nuclear Medicine Centre, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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29
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Burger H, Rick T, Spies P, Cassel A, Vanderpuye V, Incrocci L. Testicular germ cell cancer in Africa: A survey on patterns of practice. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.4102/sajo.v6i0.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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30
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Maitre P, Krishnatry R, Chopra S, Gondhowiardjo S, Likonda BM, Hussain QM, Zubizarreta EH, Agarwal JP. Modern Radiotherapy Technology: Obstacles and Opportunities to Access in Low- and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2100376. [PMID: 35839434 PMCID: PMC9812473 DOI: 10.1200/go.21.00376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Low- and middle-income countries (LMICs) have a large burden of cancer with differential population needs and outcomes compared to high-income countries. Access to radiotherapy, especially modern technology, is a major challenge. Modern radiotherapy has been demonstrated with better utility in overall cancer outcomes. We deliberate various challenges and opportunities unique to LMICs' set up for access to modern radiotherapy technology in the light of discussions and deliberations made during the recently concluded annual meeting of Tata Memorial Centre, India. We take examples available from various LMICs in this direction in our manuscript.
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Affiliation(s)
- Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India,Rahul Krishnatry, MD, Department of Radiation Oncology, Tata Memorial Hospital, Ernst Borges Rd, Parel, Mumbai 400012, India; e-mail:
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Soehartati Gondhowiardjo
- Department of Radiation Oncology, Faculty of Medicine of Indonesia,Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Beda Mnamala Likonda
- Bugando Medical Centre, Catholic University of Health Sciences, Nyamagana, Mwanza, Tanzania
| | | | - Eduardo H. Zubizarreta
- Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
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Corry J, Ng WT, Ma SJ, Singh AK, de Graeff P, Oosting SF. Disadvantaged Subgroups Within the Global Head and Neck Cancer Population: How Can We Optimize Care? Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35439036 DOI: 10.1200/edbk_359482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the global head and neck cancer population, there are subgroups of patients with poorer cancer outcomes independent from tumor characteristics. In this article, we review three such groups. The first group comprises patients with nasopharyngeal cancer in low- and middle-income countries where access to high-volume, well-resourced radiotherapy centers is limited. We discuss a recent study that is aiming to improve outcomes through the instigation of a comprehensive radiotherapy quality assurance program. The second group comprises patients with low socioeconomic status in a high-income country who experience substantial financial toxicity, defined as financial hardship for patients due to health care costs. We review causes and consequences of financial toxicity and discuss how it can be mitigated. The third group comprises older patients who may poorly tolerate and not benefit from intensive standard-of-care treatment. We discuss the role of geriatric assessment, particularly in relation to the use of chemotherapy. Through better recognition and understanding of disadvantaged groups within the global head and neck cancer population, we will be better placed to instigate the necessary changes to improve outcomes and quality of life for patients with head and neck cancer.
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Affiliation(s)
- June Corry
- Division Radiation Oncology, GenesisCare Radiation OncologySt Vincent's Hospital, Melbourne, Australia.,Department of MedicineThe University of Melbourne, Parkville, Australia
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of MedicineThe University of Hong Kong, Hong Kong, China.,Clinical Oncology CentreThe University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Pauline de Graeff
- University Center for Geriatric MedicineUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Febbraro M, Gheware A, Kennedy T, Jain D, de Moraes FY, Juergens R. Barriers to Access: Global Variability in Implementing Treatment Advances in Lung Cancer. Am Soc Clin Oncol Educ Book 2022; 42:1-7. [PMID: 35427189 DOI: 10.1200/edbk_351021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Globally, lung cancer is the second most-diagnosed cancer and is the leading cause of cancer death. Advances in science and technology have contributed to improvements in primary cancer prevention, cancer diagnosis, and cancer therapy, leading to an increase in survival and improvement in quality of life. Many of these advances have been seen in high-income countries. Accessibility, availability, and affordability are key domains in barriers to access of care between countries and within countries. The impact of these domains, as they relate to molecular testing, radiation therapy, and systemic therapy, are discussed.
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Affiliation(s)
- Michela Febbraro
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Department of Medical Oncology, Juravinski Cancer Center, Hamilton, Ontario, Canada
| | - Atish Gheware
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Thomas Kennedy
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rosalyn Juergens
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Department of Medical Oncology, Juravinski Cancer Center, Hamilton, Ontario, Canada
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Kanmounye US, Karekezi C, Nyalundja AD, Awad AK, Laeke T, Balogun JA. Adult brain tumors in Sub-Saharan Africa: A scoping review. Neuro Oncol 2022; 24:1799-1806. [PMID: 35397473 PMCID: PMC9527516 DOI: 10.1093/neuonc/noac098] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sub-Saharan African (SSA) neuro-oncologists report high workloads and challenges in delivering evidence-based care; however, these reports contrast with modeled estimates of adult neuro-oncology disease burden in the region. This scoping review aimed to better understand the reasons for this discrepancy by mapping out the SSA adult brain tumor landscape based on published literature. METHODS Systematic searches were conducted in OVID Medline, Global Index Medicus, African Journals Online, Google Scholar, and faculty of medicine libraries from database inception to May 31 st, 2021. The results were summarized quantitatively and narratively. English and French peer-reviewed articles were included (title, abstract, and full text). RESULTS Of the 819 records identified, 119 articles by 24 SSA countries (42.9%) were included in the final review. Odeku published the first article in 1967, and nine of the ten most prolific years were in the 21 st century. The greatest contributing region was Western Africa (n=58, 48.7%) led by Nigeria (n=37, 31.1%). Central Africa had fewer articles published later than the other SSA regions (p=0.61). Most studies were non-randomized (n=75, 63.0%) and meningiomas (n=50, 42.0%) were the most common brain tumors reported. Less than 30 studies reported on adjuvant treatment or patient outcomes. CONCLUSIONS Most publications were hospital-based, and there was significant heterogeneity in the quality of evidence and reporting. This study highlights the need for rapid and sustainable investments and brain tumor research capacity in SSA.
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Affiliation(s)
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Arsene Daniel Nyalundja
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Ahmed K Awad
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tsegazeab Laeke
- Neurosurgery Unit, Surgery Department, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - James A Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Lombe D, M'ule BC, Msadabwe SC, Chanda E. Gynecological radiation oncology in sub-Saharan Africa: status, problems and considerations for the future. Int J Gynecol Cancer 2022; 32:451-456. [DOI: 10.1136/ijgc-2021-002461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/16/2021] [Indexed: 11/04/2022] Open
Abstract
Gynecological malignancies in Africa form a significant part of the burden of disease. The high prevalence of HIV in some countries creates a heightened risk for development of human papilloma virus related cancers such as cervical, vulval and vaginal cancers. Radiotherapy is an important modality of treatment for cancer and in Africa compensates for the lack of adequate surgical services for a large proportion of cancers as well as being a cornerstone of treatment for locally advanced cancers and palliation. In this review we look at the status of radiotherapy services in sub-Saharan Africa and critical factors that influence its delivery with a focus on gynecological malignancies. This unveils that radiotherapy for gynecological cancers in sub-Saharan Africa is a significant example of the need for a holistic development approach across different sectors of the economy and different disciplines of medicine. The complexity of its management continues to expose the underdevelopment of health and financial systems and the lack of universal health coverage and social systems as we continue to see unnecessary morbidity and mortality due to the lack of organization. More systematic and scientifically robust investigations tailored to the various sub-Saharan Africa countries need to be conducted to elicit disruptive local solutions to the status quo.
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