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Riano I, Velazquez AI, Viola L, Abuali I, Jimenez K, Abioye O, Florez N. State of Cancer Control in South America: Challenges and Advancement Strategies. Hematol Oncol Clin North Am 2024; 38:55-76. [PMID: 37353378 DOI: 10.1016/j.hoc.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Cancer is a major public health problem in South America. The cancer mortality burden is increasing in the region due to its presentation at later stages, which is related to limited access to cancer care. This results in a noticeable inequity in provisions of cancer care including specialized screening programs, as well as cancer-related treatments such as personalized medicine, radiation therapy, palliative care, and survivorship services. Consequently, South America faces many challenges for cancer control, most of them deriving from a lack of funding and unequal distribution of resources and cancer services, affecting mostly the underserved populations in the region.
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Affiliation(s)
- Ivy Riano
- Division of Hematology and Oncology, Dartmouth Cancer Center, Geisel School of Medicine Dartmouth, One Medical Drive, Lebanon, NH 03766, USA.
| | - Ana I Velazquez
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. https://twitter.com/AnaVManana
| | - Lucia Viola
- Fundación Neumológica Colombiana, Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Cra. 13b #161 - 85, Bogotá, Colombia. https://twitter.com/LuciaViola9
| | - Inas Abuali
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. https://twitter.com/Inas_md
| | - Kathya Jimenez
- Universidad Evangelica de El Salvador, El Salvador. https://twitter.com/KathyaJimenezMD
| | - Oyepeju Abioye
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa. https://twitter.com/AbioyeOyepeju
| | - Narjust Florez
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA. https://twitter.com/NarjustFlorezMD
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Rojas-Concha L, Hansen MB, Petersen MA, Groenvold M. Symptoms of advanced cancer in palliative medicine: a longitudinal study. BMJ Support Palliat Care 2023; 13:e415-e427. [PMID: 34162585 DOI: 10.1136/bmjspcare-2021-002999] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/05/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed to examine the symptomatology of patients with advanced cancer at admittance to palliative care services and to investigate how the symptomatology changed during the first month, and whether these changes were associated with various patient characteristics. METHODS In a longitudinal study in Chile, outpatients with advanced cancer completed the questionnaires European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care and the Hospital Anxiety and Depression Scale. Prevalence and severity of symptoms and problems (S/Ps) at baseline were calculated. Differences in S/P scores from baseline to follow-up were calculated overall and according to patient characteristics. Multiple linear regression was used to study the associations between patient characteristics and changes in S/P scores. RESULTS At baseline, 201 patients answered the questionnaires and 177 completed the follow-up. Fatigue, pain and sleeping difficulties were the most prevalent S/Ps reported, and also had the highest mean scores at baseline. S/P scores at baseline varied significantly according to sex, age, civil status, residence, children, prior and current antineoplastic treatment. Emotional functioning, pain, sleeping difficulties, constipation and anxiety improved significantly during the first month of palliative care. Residence, cohabitation status, diagnosis and current antineoplastic treatment were associated with changes in S/P scores. CONCLUSIONS Patients reported moderate-to-severe levels of S/Ps at admittance to palliative care. Several S/Ps improved the first month. Certain patient characteristics were associated with changes in S/P scores. This information may guide clinicians to more effective interventions that can improve the quality of life of patients receiving palliative care.
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Affiliation(s)
- Leslye Rojas-Concha
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maiken Bang Hansen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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de Oliveira Avellar W, Ferreira ÉA, Vieira ACRA, de Melo AC, Aran V. Clinical Cancer Research in South America and Potential Health Economic Impacts. Healthcare (Basel) 2023; 11:1753. [PMID: 37372871 PMCID: PMC10298265 DOI: 10.3390/healthcare11121753] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Increased global cancer incidence rates have led to a growing demand for cancer diagnosis and treatment, as well as basic and clinical research on the subject. The expansion of clinical cancer trials beyond the borders of highly developed countries has aided the arrival of these assessments in South American countries. In this context, this study's objective is to highlight clinical cancer trial profiles developed and sponsored by pharmaceutical companies and conducted in South American countries from 2010 to 2020. METHODS This study comprises descriptive and retrospective research conducted following a search for clinical trials (phases I, II and III), registered at clinicaltrials.gov, carried out in Latin American countries and sponsored by pharmaceutical companies ("Argentina", "Brazil", "Chile", "Peru", "Colombia", "Ecuador", "Uruguay", "Venezuela", "Paraguay", "Bolivia"), registered between 1 January 2010 and 31 December 2020. A total of 1451 clinical trials were retrieved, of which 200 trials unrelated to cancer were excluded and 646 duplicates were removed, leading to a final total of 605 clinical trials employing qualitative and quantitative analyses. RESULTS A 122% increase in the number of clinical trial registrations from 2010 to 2020 was noted, with a prevalence of phase III studies (431 trials of a total of 605). Lung (119), breast (100), leukemia (42), prostate (39) and melanoma (32) were the main cancers tested for new drugs. CONCLUSIONS The data reported herein indicate the need for strategic basic and clinical research planning that considers South American epidemic cancer profiles.
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Affiliation(s)
- William de Oliveira Avellar
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rua André Cavalcanti 37, Bairro de Fátima, Rio de Janeiro 20231-050, Brazil; (W.d.O.A.)
| | - Édria Aparecida Ferreira
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rua André Cavalcanti 37, Bairro de Fátima, Rio de Janeiro 20231-050, Brazil; (W.d.O.A.)
| | - Ana Carolina Rodrigues Alves Vieira
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rua André Cavalcanti 37, Bairro de Fátima, Rio de Janeiro 20231-050, Brazil; (W.d.O.A.)
| | - Andreia Cristina de Melo
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute (INCA), Rua André Cavalcanti 37, Bairro de Fátima, Rio de Janeiro 20231-050, Brazil; (W.d.O.A.)
| | - Veronica Aran
- Instituto Estadual do Cérebro Paulo Niemeyer (IECPN), Rua do Rezende, 156-Centro, Rio de Janeiro 20231-092, Brazil
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Long-term Mammography Utilization after an Initial Randomized Intervention Period by all Underserved Chilean Women in the Clinics. Cancers (Basel) 2022; 14:cancers14153734. [PMID: 35954397 PMCID: PMC9367461 DOI: 10.3390/cancers14153734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023] Open
Abstract
Chile has one of the highest rates of breast cancer in Latin America. Mammography rates among women, especially those of low socioeconomic status (SES), are thought to contribute to high breast cancer morbidity and mortality. A successful randomized controlled trial among women aged 50 to 70 in a low-SES primary care clinic in Chile led to a significant increase in mammography screening rates in a two-year intervention trial. This study assesses the sustainability of the intervention after ten years and identifies factors that might have been associated with a long-term effect using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The mammography rates among women aged 50 to 70 in the low-SES intervention clinic were compared to two populations of women aged 50 to 70 from middle-SES clinics and to national data. Qualitative data were used to answer questions of adoption, implementation, and maintenance, while quantitative data assessed the reach and effectiveness. After ten years, low-SES women at the intervention clinic maintained significantly higher mammography screening rates vs. middle-SES women at the comparison clinics (36.2% vs. 30.1% and 19.4% p < 0.0001). Women of a low SES at the intervention clinic also had significantly higher screening rates compared to women of a low SES at a national level (44.2% vs. 34.2% p < 0.0001). RE-AIM factors contributed to understanding the long-term difference in rates. Mailed contact, outreach interventions, and the integration of health promoters as part of the Community Advisory Board were important factors associated with the effects observed. This study provides information on factors that could contribute to reducing the social gap on breast cancer screening.
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Garlasco J, Nurchis MC, Bordino V, Sapienza M, Altamura G, Damiani G, Gianino MM. Cancers: What Are the Costs in Relation to Disability-Adjusted Life Years? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4862. [PMID: 35457733 PMCID: PMC9029428 DOI: 10.3390/ijerph19084862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/03/2023]
Abstract
Cancers currently represent a leading cause of morbidity and mortality, and precisely estimating their burden is crucial for evidence-based decision-making. This study aimed at understanding the average costs of cancer-related disability-adjusted life years (DALYs) and highlighting possible differences in economic estimates obtained with diverse approaches. We searched four scientific databases to identify all the primary literature simultaneously investigating cancer-related costs and DALYs. In view of the different methodologies, studies were divided into two groups: those estimating costs starting from DALYs, and those independently performing cost and DALY analyses. The latter were pooled to compute costs per disease-related DALY: meta-analytic syntheses were performed for total costs and indirect costs, and in relation to the corresponding gross domestic product (GDP) per capita. The quality of included studies was assessed through the Quality of Health Economic Studies instrument. Seven studies were selected. Total and indirect pooled costs per DALY were, respectively, USD 9150 (95% CI: 5560-15,050) and USD 3890 (95% CI: 2570-5880). Moreover, the cost per cancer-related DALY has been found to be, on average, 32% (95% CI: 24-42%) of the corresponding countries' GDP per capita. Costs calculated a priori from DALYs may lead to results widely different from those obtained after data retrieval and model building. Further research is needed to better estimate the economic burden of cancer in terms of costs and DALYs.
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Affiliation(s)
- Jacopo Garlasco
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (J.G.); (V.B.); (M.M.G.)
| | - Mario Cesare Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy;
| | - Valerio Bordino
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (J.G.); (V.B.); (M.M.G.)
| | - Martina Sapienza
- Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.A.)
| | - Gerardo Altamura
- Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.A.)
| | - Gianfranco Damiani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy;
- Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.A.)
| | - Maria Michela Gianino
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (J.G.); (V.B.); (M.M.G.)
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Cordova-Delgado M, Bravo ML, Cumsille E, Hill CN, Muñoz-Medel M, Pinto MP, Retamal IN, Lavanderos MA, Miquel JF, Rodriguez-Fernandez M, Liao Y, Li Z, Corvalán AH, Armisén R, Garrido M, Quiñones LA, Owen GI. A case-control study of a combination of single nucleotide polymorphisms and clinical parameters to predict clinically relevant toxicity associated with fluoropyrimidine and platinum-based chemotherapy in gastric cancer. BMC Cancer 2021; 21:1030. [PMID: 34525956 PMCID: PMC8444616 DOI: 10.1186/s12885-021-08745-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/22/2021] [Indexed: 12/22/2022] Open
Abstract
Background Fluoropyrimidine plus platinum chemotherapy remains the standard first line treatment for gastric cancer (GC). Guidelines exist for the clinical interpretation of four DPYD genotypes related to severe fluoropyrimidine toxicity within European populations. However, the frequency of these single nucleotide polymorphisms (SNPs) in the Latin American population is low (< 0.7%). No guidelines have been development for platinum. Herein, we present association between clinical factors and common SNPs in the development of grade 3–4 toxicity. Methods Retrospectively, 224 clinical records of GC patient were screened, of which 93 patients were incorporated into the study. Eleven SNPs with minor allelic frequency above 5% in GSTP1, ERCC2, ERCC1, TP53, UMPS, SHMT1, MTHFR, ABCC2 and DPYD were assessed. Association between patient clinical characteristics and toxicity was estimated using logistic regression models and classification algorithms. Results Reported grade ≤ 2 and 3–4 toxicities were 64.6% (61/93) and 34.4% (32/93) respectively. Selected DPYD SNPs were associated with higher toxicity (rs1801265; OR = 4.20; 95% CI = 1.70–10.95, p = 0.002), while others displayed a trend towards lower toxicity (rs1801159; OR = 0.45; 95% CI = 0.19–1.08; p = 0.071). Combination of paired SNPs demonstrated significant associations in DPYD (rs1801265), UMPS (rs1801019), ABCC2 (rs717620) and SHMT1 (rs1979277). Using multivariate logistic regression that combined age, sex, peri-operative chemotherapy, 5-FU regimen, the binary combination of the SNPs DPYD (rs1801265) + ABCC2 (rs717620), and DPYD (rs1801159) displayed the best predictive performance. A nomogram was constructed to assess the risk of developing overall toxicity. Conclusion Pending further validation, this model could predict chemotherapy associated toxicity and improve GC patient quality of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08745-0.
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Affiliation(s)
- Miguel Cordova-Delgado
- Faculty of Chemical and Pharmaceutical Sciences, Universidad de Chile, 8380494, Santiago, Chile.,Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile.,Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330032, Santiago, Chile
| | - María Loreto Bravo
- Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330032, Santiago, Chile
| | - Elisa Cumsille
- Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile
| | - Charlotte N Hill
- Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, 8331150, Santiago, Chile
| | - Matías Muñoz-Medel
- Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330032, Santiago, Chile
| | - Mauricio P Pinto
- Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330032, Santiago, Chile
| | - Ignacio N Retamal
- Faculty of Dentistry, Universidad de Los Andes, 7620001, Santiago, Chile
| | - María A Lavanderos
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic and Clinical Oncology, Faculty of Medicine, Universidad de Chile, 8380494, Santiago, Chile.,Latin American Network for Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Madrid, Spain.,Escuela de Química y Farmacia, Facultad de Ciencias Médicas, Universidad Bernardo O'Higgins, Santiago, Chile
| | - Juan Francisco Miquel
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330032, Santiago, Chile
| | - Maria Rodriguez-Fernandez
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yuwei Liao
- Central Laboratory, Yangjiang People's Hospital, GuangDong Province, Yangjiang, China.,Center of Genome and Personalized Medicine, Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Zhiguang Li
- Center of Genome and Personalized Medicine, Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China.,National Institute on Aging, National Institute of Health, Baltimore, USA
| | - Alejandro H Corvalán
- Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330032, Santiago, Chile.,Advanced Center for Chronic Diseases (ACCDiS), 8330034, Santiago, Chile
| | - Ricardo Armisén
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, 7590943, Santiago, Chile
| | - Marcelo Garrido
- Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330032, Santiago, Chile
| | - Luis A Quiñones
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic and Clinical Oncology, Faculty of Medicine, Universidad de Chile, 8380494, Santiago, Chile. .,Latin American Network for Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Madrid, Spain.
| | - Gareth I Owen
- Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile. .,Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, 8330032, Santiago, Chile. .,Millennium Institute on Immunology and Immunotherapy, 8331150, Santiago, Chile. .,Advanced Center for Chronic Diseases (ACCDiS), 8330034, Santiago, Chile.
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Medical Cost of Cancer Care for Privately Insured Children in Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136746. [PMID: 34201571 PMCID: PMC8267683 DOI: 10.3390/ijerph18136746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 11/27/2022]
Abstract
Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007–2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients’ characteristics, type of cancer, and by service. Children with cancer had high annual medical costs, USD 32,287 on average for 2018. Costs were higher for the younger children in the sample. The vast majority of the cost was driven by inpatient hospital care for all types of cancer. The average total cost increased 20% in real terms over the period of study, while out-of-pocket expenses increased almost 29%. Private insurance beneficiaries faced a significant economic burden associated with medical treatment of a child with cancer. Interventions that reduce hospitalizations, as well as systemwide reforms that incorporate maximum out-of-pocket payments and prevent catastrophic expenditures, can contribute to alleviating the financial burden of childhood cancer.
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Boekstegers F, Marcelain K, Barahona Ponce C, Baez Benavides PF, Müller B, de Toro G, Retamales J, Barajas O, Ahumada M, Morales E, Rojas A, Sanhueza V, Loader D, Rivera MT, Gutiérrez L, Bernal G, Ortega A, Montalvo D, Portiño S, Bertrán ME, Gabler F, Spencer L, Olloquequi J, González Silos R, Fischer C, Scherer D, Jenab M, Aleksandrova K, Katzke V, Weiderpass E, Moradi T, Fischer K, Bossers W, Brenner H, Hveem K, Eklund N, Völker U, Waldenberger M, Fuentes Guajardo M, Gonzalez-Jose R, Bedoya G, Bortolini MC, Canizales S, Gallo C, Ruiz Linares A, Rothhammer F, Lorenzo Bermejo J. ABCB1/4 gallbladder cancer risk variants identified in India also show strong effects in Chileans. Cancer Epidemiol 2020; 65:101643. [PMID: 32058310 DOI: 10.1016/j.canep.2019.101643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The first large-scale genome-wide association study of gallbladder cancer (GBC) recently identified and validated three susceptibility variants in the ABCB1 and ABCB4 genes for individuals of Indian descent. We investigated whether these variants were also associated with GBC risk in Chileans, who show the highest incidence of GBC worldwide, and in Europeans with a low GBC incidence. METHODS This population-based study analysed genotype data from retrospective Chilean case-control (255 cases, 2042 controls) and prospective European cohort (108 cases, 181 controls) samples consistently with the original publication. RESULTS Our results confirmed the reported associations for Chileans with similar risk effects. Particularly strong associations (per-allele odds ratios close to 2) were observed for Chileans with high Native American (=Mapuche) ancestry. No associations were noticed for Europeans, but the statistical power was low. CONCLUSION Taking full advantage of genetic and ethnic differences in GBC risk may improve the efficiency of current prevention programs.
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Affiliation(s)
- Felix Boekstegers
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Katherine Marcelain
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Chile
| | - Carol Barahona Ponce
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Germany; Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Chile
| | | | - Bettina Müller
- Servicio de Oncología Médica, Instituto Nacional del Cáncer, Santiago, Chile
| | - Gonzalo de Toro
- Servicio de Anatomía Patológica, Hospital de Puerto Montt, Puerto Montt, Chile
| | - Javier Retamales
- Servicio de Oncología Médica, Instituto Nacional del Cáncer, Santiago, Chile
| | - Olga Barajas
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Chile; Oncology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Monica Ahumada
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Chile; Oncology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Erik Morales
- Servicio de Anatomía Patológica, Hospital Regional, Talca, Chile
| | - Armando Rojas
- Biomedical Research Labs, Medicine Faculty, Catholic University of Maule, Talca, Chile
| | - Verónica Sanhueza
- Servicio de Anatomía Patológica, Hospital Padre Hurtado, Santiago, Chile
| | - Denisse Loader
- Servicio de Anatomía Patológica, Hospital Padre Hurtado, Santiago, Chile
| | | | - Lorena Gutiérrez
- Servicio de Anatomía Patológica, Hospital San Juan de Dios, Santiago, Chile
| | - Giuliano Bernal
- Laboratory of Molecular and Cellular Biology of Cancer (CancerLab), Department of Biomedical Sciences, Faculty of Medicine, Universidad Católica del Norte, Coquimbo, Chile
| | - Alejandro Ortega
- Servicio de Anatomía Patológica, Hospital Regional, Arica, Chile
| | | | - Sergio Portiño
- Oncology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - Fernando Gabler
- Servicio de Anatomía Patológica, Hospital San Borja Arriarán, Santiago, Chile
| | - Loreto Spencer
- Servicio de Anatomía Patológica, Hospital Regional Guillermo Grant Benavente, Concepción, Chile
| | - Jordi Olloquequi
- Laboratory of Cellular and Molecular Pathology, Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Rosa González Silos
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | | | - Dominique Scherer
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Mazda Jenab
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Krasimira Aleksandrova
- Nutrition, Immunity and Metabolism Senior Scientist Group, Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany; University of Potsdam, Institute of Nutritional Science, Potsdam, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Tahereh Moradi
- Division of Epidemiology, Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Krista Fischer
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Kristian Hveem
- The Nord-Trøndelag Health (HUNT) Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Norway
| | - Niina Eklund
- Genomics and biobank, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Uwe Völker
- Interfakultäres Institut für Genetik und Funktionelle Genomforschung, Universitätsmedizin Greifswald, Germany
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology and Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Rolando Gonzalez-Jose
- Instituto Patagónico de Ciencias Sociales y Humanas, Centro Nacional Patagónico, CONICET, Puerto Madryn, Argentina
| | - Gabriel Bedoya
- Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín, Colombia
| | - Maria C Bortolini
- Instituto de Biociências, Universidad Federal do Rio Grande do Sul, Puerto Alegre, Brazil
| | - Samuel Canizales
- Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Carla Gallo
- Unidad de Neurobiología Molecular y Genética, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andres Ruiz Linares
- Ministry of Education Key Laboratory of Contemporary Anthropology and Collaborative Innovation Center of Genetics and Development, School of Life Sciences and Human Phenome Institute, Fudan University, Shanghai 200433, China; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille 13007, France
| | | | - Justo Lorenzo Bermejo
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Germany.
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9
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Bravo-Linares D, Acevedo-Melo AM, Ruiz-Patiño A, Ricaurte L, Lucio-Arias D, Cardona AF. Scientific Productivity and Cancer-Related Mortality: A Case Study of a Positive Association in Colombia. J Glob Oncol 2020; 5:1-10. [PMID: 31433711 PMCID: PMC6733203 DOI: 10.1200/jgo.19.00164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Cancer morbidity represents an increasing public health issue; this worldwide phenomenon also is true for emerging upper-middle-income countries, such as Colombia. The main purpose of this study was to uncover the relationship between scientific productivity and cancer-related mortality in our setting. METHODS We conducted a temporal-trend ecologic study by means of bibliometric analysis from records of publications from SCOPUS database with Colombian institutional affiliations between 2000 and 2015. Productivity and overall mortality were estimated and compared using econometric modeling to identify potential correlations. Additional exploratory analyses per six most frequent cancer sites were performed. RESULTS Of 2,645 publication records retrieved, 1,464 (55.3%) met selection criteria to be classified as Colombian scientific production (interobserver agreement, 92.96%; κ = 0.859; 95% CI, 0.800 to 0.918). Overall, 79.6% of the records corresponded to original or in-press articles; furthermore, almost half (49.7%) embodied descriptive study designs. Selected records reported a median of five authors and three different affiliations per publication; 66% had been cited at least once up to September 2017. The most-studied cancer-specific locations were cervix (16.1%), breast (11.5%), and stomach (9.8%), but nonspecific locations had the largest combined participation (23.4%). An increasing trend in scientific productivity was correlated to decreasing trend in overall cancer mortality, which was reported as an inverse proportional relationship in the linear regression modeling (r = -0.958; P < .001). Graphic analyses per cancer-specific sites revealed heterogeneous behaviors of this relationship. CONCLUSION Colombian cancer-specific scientific productivity demonstrated a steady growth as opposed to a decreasing mortality trend in the recent years. The research output is predominantly descriptive with relatively low interinstitutional partnership and low impact in the international scientific community.
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Affiliation(s)
| | | | | | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia
| | | | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia.,Clínica del Country, Bogotá, Colombia.,Universidad El Bosque, Bogotá, Colombia
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10
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Vargas V, Leopold C, Castillo-Riquelme M, Darrow JJ. Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile. J Glob Oncol 2019; 5:1-17. [PMID: 31860377 PMCID: PMC6939746 DOI: 10.1200/jgo.19.00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The population of Chile has aged, and in 2017, cancer became the leading cause of death. Since 2005, a national health program has expanded coverage of drugs for 13 types of cancer and related palliative care. We describe the trends in public and private oncology drug expenditures in Chile and consider how increasing expenditures might be addressed. METHODS We analyzed total quarterly drug expenditures for 131 oncology drugs from quarter (Q)3 2012 until Q1 2017, including public and private insurance payments and patient out-of-pocket spending. The data were analyzed by drug-mix, sources of funding, growth, and intellectual property status. The Laspeyres Price Index was used to analyze expenditure growth. RESULTS We found 131 oncology drugs associated with 87,129 observations. Spending on drugs rose 120% from the first period, spanning from the first 3 quarters (Q3, Q4, Q1 2012-2013) to the last period (Q3, Q4, Q1 2016-2017), corresponding to an annualized rate of 19.2% and totaling US$398 million (in 2017 dollars). The public sector accounted for 84.2% of spending, which included 50 drugs in the official treatment protocols, whereas private insurance accounted for 7.3% in on-protocol drugs. The remaining 8.5% was paid out of pocket. In the public sector, more than 90% of growth resulted from increased use. Seven drugs, including 3 with nonexpired patents, accounted for 50% of total expenditures. CONCLUSION Increased use and access enabled by expanded public expenditures drove most of the growth in oncology drug expenditures. However, the rate of public expenditure growth may be fiscally unsustainable. Policies are urgently needed to promote the use of generic drugs, the appropriate mix of on-protocol versus off-protocol drugs, and the curbing of off-label prescribing.
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Affiliation(s)
- Veronica Vargas
- Department of Economics, Alberto Hurtado University, Santiago, Chile, and David Rockefeller Center for Latin America Studies, Harvard University, Boston, MA
| | - Christine Leopold
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Marianela Castillo-Riquelme
- Epidemiology Program, Institute of Population Health, School of Public Health, University of Chile, Santiago, Chile
| | - Jonathan J. Darrow
- Program on Regulation, Therapeutics, and Law, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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11
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High Proportion of Potential Candidates for Immunotherapy in a Chilean Cohort of Gastric Cancer Patients: Results of the FORCE1 Study. Cancers (Basel) 2019; 11:cancers11091275. [PMID: 31480291 PMCID: PMC6770659 DOI: 10.3390/cancers11091275] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022] Open
Abstract
Gastric cancer (GC) is a heterogeneous disease. This heterogeneity applies not only to morphological and phenotypic features but also to geographical variations in incidence and mortality rates. As Chile has one of the highest mortality rates within South America, we sought to define a molecular profile of Chilean GCs (ClinicalTrials.gov identifier: NCT03158571/(FORCE1)). Solid tumor samples and clinical data were obtained from 224 patients, with subsets analyzed by tissue microarray (TMA; n = 90) and next generation sequencing (NGS; n = 101). Most demographic and clinical data were in line with previous reports. TMA data indicated that 60% of patients displayed potentially actionable alterations. Furthermore, 20.5% were categorized as having a high tumor mutational burden, and 13% possessed micro-satellite instability (MSI). Results also confirmed previous studies reporting high Epstein-Barr virus (EBV) positivity (13%) in Chilean-derived GC samples suggesting a high proportion of patients could benefit from immunotherapy. As expected, TP53 and PIK3CA were the most frequently altered genes. However, NGS demonstrated the presence of TP53, NRAS, and BRAF variants previously unreported in current GC databases. Finally, using the Kendall method, we report a significant correlation between EBV+ status and programmed death ligand-1 (PDL1)+ and an inverse correlation between p53 mutational status and MSI. Our results suggest that in this Chilean cohort, a high proportion of patients are potential candidates for immunotherapy treatment. To the best of our knowledge, this study is the first in South America to assess the prevalence of actionable targets and to examine a molecular profile of GC patients.
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12
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de Oliveira Avellar W, de Melo AC, Ferreira da Silva C, Aran V. Cancer research in Brazil: Analysis of funding criteria and possible consequences. J Cancer Policy 2019. [DOI: 10.1016/j.jcpo.2019.100184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Martinez DA, Zhang H, Bastias M, Feijoo F, Hinson J, Martinez R, Dunstan J, Levin S, Prieto D. Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions. BMC Public Health 2019; 19:233. [PMID: 30808318 PMCID: PMC6390314 DOI: 10.1186/s12889-019-6526-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/08/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Most data on mortality and prognostic factors of universal healthcare waiting lists come from North America, Australasia, and Europe, with little information from South America. We aimed to determine the relationship between medical center-specific waiting time and waiting list mortality in Chile. METHOD Using data from all new patients listed in medical specialist waitlists for non-prioritized health problems from 2008 to 2015 in three geographically distant regions of Chile, we constructed hierarchical multivariate survival models to predict mortality risk at two years after registration for each medical center. Kendall rank correlation analysis was used to measure the association between medical center-specific mortality hazard ratio and waiting times. RESULT There were 987,497 patients waiting for care at 77 medical centers, including 33,546 (3.40%) who died within two years after registration. Male gender (hazard ratio [HR] = 1.17, 95% confidence interval [CI] 1.1-1.24), older age (HR = 2.88, 95% CI 2.72-3.05), urban residence (HR = 1.19, 95% CI 1.09-1.31), tertiary care (HR = 2.2, 95% CI 2.14-2.26), oncology (HR = 3.57, 95% CI 3.4-3.76), and hematology (HR = 1.6, 95% CI 1.49-1.73) were associated with higher risk of mortality at each medical center with large region-to-region variations. There was a statistically significant association between waiting time variability and death (Z = 2.16, P = 0.0308). CONCLUSION Patient wait time for non-prioritized health conditions was associated with increased mortality in Chilean hospitals.
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Affiliation(s)
- Diego A. Martinez
- Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Haoxiang Zhang
- Johns Hopkins University Whiting School of Engineering, 3400 N Charles St, Baltimore, MD 21218 USA
| | - Magdalena Bastias
- University of Chile School of Public Health, Av. Independencia 939, Independencia, Región Metropolitana Chile
| | - Felipe Feijoo
- Pontifical Catholic University of Valparaíso School of Engineering, Brasil, 2950 Valparaíso, Región de Valparaíso Chile
| | - Jeremiah Hinson
- Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Rodrigo Martinez
- University of Chile School of Public Health, Av. Independencia 939, Independencia, Región Metropolitana Chile
| | - Jocelyn Dunstan
- University of Chile School of Public Health, Av. Independencia 939, Independencia, Región Metropolitana Chile
| | - Scott Levin
- Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Diana Prieto
- Johns Hopkins University Carey School of Business, 100 International Drive, Baltimore, MD 21202 USA
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14
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Abstract
A lack of well-trained clinical oncologists can result in significant cancer health disparities. The magnitude of this problem around the world is poorly described in the literature. A comprehensive global survey of the clinical oncology workforce was conducted. Data on the number of clinical oncologists in 93 countries were obtained from 30 references. The mortality-to-incidence ratio was estimated by using data on incidence and mortality rates from the GLOBOCAN 2012 database; the ratio was > 70% in 26 countries (28%), which included 21 countries in Africa (66%) and five countries in Asia (26%). Eight countries had no clinical oncologist available to provide care for patients with cancer. In 22 countries (24%), a clinical oncologist would provide care for < 150 patients with a new diagnosis of cancer. In 39 countries (42%), a clinical oncologist would provide care for > 500 patients with cancer. In 27 countries (29%), a clinical oncologist would provide care for > 1,000 incident cancers, of which 25 were in Africa, two were in Asia, and none were in Europe or the Americas. The economic and social development status of a country correlates closely with the burden of cancer and the shortage of human resources. Addressing the shortage of clinical oncologists in regions with a critical need will help these countries meet the sustainable development goals for noncommunicable diseases by 2030.
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Affiliation(s)
- Aju Mathew
- University of Kentucky, Lexington, KY; and Kerala Cancer Care, Kochi, India
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15
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Sirohi B, Chalkidou K, Pramesh CS, Anderson BO, Loeher P, El Dewachi O, Shamieh O, Shrikhande SV, Venkataramanan R, Parham G, Mwanahamuntu M, Eden T, Tsunoda A, Purushotham A, Stanway S, Rath GK, Sullivan R. Developing institutions for cancer care in low-income and middle-income countries: from cancer units to comprehensive cancer centres. Lancet Oncol 2018; 19:e395-e406. [PMID: 30102234 DOI: 10.1016/s1470-2045(18)30342-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 12/27/2022]
Abstract
Global cancer centres operate across different sizes, scales, and ecosystems. Understanding the essential aspects of the creation, organisation, accreditation, and activities within these settings is crucial for developing an affordable, equitable, and quality cancer care, research, and education system. Robust guidelines are scarce for cancer units, cancer centres, and comprehensive cancer centres in low-income and middle-income countries. However, some robust examples of the delivery of complex cancer care in centres in emerging economies are available. Although it is impossible to create an optimal system to fit the unique needs of all countries for the delivery of cancer care, we summarise what has been published about the development and management of cancer centres in low-income and middle-income countries so far and highlight the need for clinical and political leadership.
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Affiliation(s)
| | - Kalipso Chalkidou
- Imperial College London, London UK; Centre for Global Development, London, UK
| | | | | | - Patrick Loeher
- Indiana University Medical Center, Indianapolis, IN, USA
| | - Omar El Dewachi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | - Tim Eden
- University of Manchester, Manchester, UK
| | - Audrey Tsunoda
- Hospital Erasto Gaertner, Instituto de Oncologia do Paraná and Universidade Positivo, Curitiba, Brazil
| | - Arnie Purushotham
- Tata Trusts, Mumbai, India; King's Health Partners Comprehensive Cancer Centre and Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
| | | | - Goura K Rath
- All India Institute of Medical Sciences, New Delhi, India
| | - Richard Sullivan
- King's Health Partners Comprehensive Cancer Centre and Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
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16
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Owen GI, Pinto MP, Retamal IN, Fernádez MF, Cisternas B, Mondaca S, Sanchez C, Galindo H, Nervi B, Ibañez C, Acevedo F, Madrid J, Peña J, Bravo ML, Maturana MJ, Cordova-Delgado M, Romero D, de la Jara N, Torres J, Rodriguez-Fernandez M, Espinoza M, Balmaceda C, Freire M, Gárate-Calderón V, Crovari F, Jimenez-Fonseca P, Carmona-Bayonas A, Zwenger A, Armisen R, Corvalan AH, Garrido M. Chilean Gastric Cancer Task Force: A study protocol to obtain a clinical and molecular classification of a cohort of gastric cancer patients. Medicine (Baltimore) 2018; 97:e0419. [PMID: 29668600 PMCID: PMC5916646 DOI: 10.1097/md.0000000000010419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/23/2018] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer (GC) is the world's second-leading cause of neoplastic mortality. Genetic alterations, response to treatments, and mortality rates are highly heterogeneous across different regions. Within Latin America, GC is the leading cause of cancer death in Chile, affecting 17.6 per 100,000 people and causing >3000 deaths/y. Clinical outcomes and response to "one size fits all" therapies are highly heterogeneous and thus a better stratification of patients may aid cancer treatment and response.The Gastric Cancer Task Force is a Chilean collaborative, noninterventional study that seeks to stratify gastric adenocarcinomas using clinical outcomes and genomic, epigenomic, and protein alterations in a cohort of 200 patients. Tumor samples from the Pathology Department and the Cancer Center at UC-Christus healthcare network, Pontificia Universidad Católica de Chile will be analyzed using a panel of 143 known cancer genes (Oncomine Comprehensive Assay) at the Center of Excellence in Precision Medicine in Santiago, Chile. In addition, promoter methylation for selected genes will be performed along with tissue microarray for clinically relevant proteins (e.g., PD-L1, Erb-2, VEGFR2, among others) and Helicobacter pylori and Epstein-Barr virus status. Obtained data will be correlated to 120 clinical parameters retrieve from medical records, including general patient information, cancer history, laboratory studies, comorbidity index, chemotherapy, targeted therapies, efficacy, and follow-up.The development of a clinically meaningful classification that encompasses comprehensive clinical and molecular parameters may improve patient treatment, predict clinical outcomes, aid patient selection/stratification for clinical trials and may offer insights into future preventive and/or therapeutic strategies in patients from Latin America region. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03158571, Registered on May 18, 2017.
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Affiliation(s)
- Gareth I. Owen
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Department of Physiology, Faculty of Biological Sciences, PUC
- Biomedical Research Consortium of Chile
- Millennium Institute on Immunology and Immunotherapy, PUC
- Core Biodata, Advanced Center for Chronic Diseases, PUC
- Center UC Investigation in Oncology, PUC
| | | | - Ignacio N. Retamal
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
| | - María F. Fernádez
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
| | - Betzabe Cisternas
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
| | - Sebastian Mondaca
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
| | - Cesar Sanchez
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
| | - Hector Galindo
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
| | - Bruno Nervi
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
| | - Carolina Ibañez
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
| | - Francisco Acevedo
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
| | - Jorge Madrid
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
| | - José Peña
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
| | - Maria Loreto Bravo
- Department of Physiology, Faculty of Biological Sciences, PUC
- Biomedical Research Consortium of Chile
- Millennium Institute on Immunology and Immunotherapy, PUC
- Center UC Investigation in Oncology, PUC
| | - Maria Jose Maturana
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Core Biodata, Advanced Center for Chronic Diseases, PUC
| | - Miguel Cordova-Delgado
- Department of Physiology, Faculty of Biological Sciences, PUC
- Biomedical Research Consortium of Chile
| | - Diego Romero
- Department of Pathology, Faculty of Medicine, PUC
| | | | | | - Maria Rodriguez-Fernandez
- Department of Physiology, Faculty of Biological Sciences, PUC
- The Institute for Biological and Medical Engineering, PUC
| | - Manuel Espinoza
- Center of Clinical Research, Health Technology Assessment Unit, PUC
- Department of Public Health, PUC
| | - Carlos Balmaceda
- Center of Clinical Research, Health Technology Assessment Unit, PUC
- Department of Public Health, PUC
| | | | | | | | | | | | | | | | - Alejandro H. Corvalan
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Core Biodata, Advanced Center for Chronic Diseases, PUC
- Center UC Investigation in Oncology, PUC
| | - Marcelo Garrido
- Hematology and Oncology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile (PUC)
- Center UC Investigation in Oncology, PUC
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Sakellariou D, Rotarou ES. Utilisation of cancer screening services by disabled women in Chile. PLoS One 2017; 12:e0176270. [PMID: 28459874 PMCID: PMC5411071 DOI: 10.1371/journal.pone.0176270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/07/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research has shown that women with disabilities face additional challenges in accessing and using healthcare services compared to non-disabled women. However, relatively little is known about the utilisation of cancer screening services for women with disabilities. This study addresses this gap by examining the utilisation of the Papanicolaou test and mammography for disabled women in Chile. METHODS We used cross-sectional data, taken from a 2015 nationally-representative survey. Initially, we employed logistic regressions to test for differences in utilisation rates for the Papanicolaou test (66,281 observations) and the mammogram (35,294 observations) between disabled and non-disabled women. Next, logistic regressions were used to investigate the demographic, socioeconomic, and health-related factors affecting utilisation rates for cancer screening services for disabled women (sample sizes: 5,823 observations for the Papanicolaou test and 5,731 observations for the mammogram). RESULTS Disabled women were less likely to undergo screening tests than non-disabled women. For the Papanicolaou test and mammography, the multivariable regression models showed that living in rural areas, having higher education, being affiliated with a private health insurance company, giving a good health self-assessment score, and being under medical treatment for other illnesses were associated with higher utilisation rates. On the other hand, being single, inactive with regard to employment, and having a better income were linked with lower utilisation. While utilisation rates for both disabled and non-disabled women have increased since 2006, the utilisation disparity has slightly increased. CONCLUSIONS This study shows the influence of various factors in the utilisation rates of preventive cancer screening services for disabled women. To develop effective initiatives targeting inequalities in the utilisation of cancer screening tests, it is important to move beyond an exclusively single-disease approach and acknowledge the complexity of the patient population.
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Affiliation(s)
| | - Elena S Rotarou
- Department of Economics, University of Chile, Santiago, Chile
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18
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Are C, Ahmad H, Ravipati A, Croo D, Clarey D, Smith L, Price RR, Butte JM, Gupta S, Chaturvedi A, Chowdhury S. Global epidemiological trends and variations in the burden of gallbladder cancer. J Surg Oncol 2017; 115:580-590. [DOI: 10.1002/jso.24546] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 12/17/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology; Department of Surgery; University of Nebraska Medical Center; Omaha Nebraska
| | - Humera Ahmad
- Department of Surgery; Gundersen Medical Foundation; La Crosse Wisconsin
| | | | - Darren Croo
- Division of Surgical Oncology; Department of Surgery; University of Nebraska Medical Center; Omaha Nebraska
| | - Dillon Clarey
- Division of Surgical Oncology; Department of Surgery; University of Nebraska Medical Center; Omaha Nebraska
| | - Lynette Smith
- College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Ray R. Price
- University of Utah Health Care; Salt Lake City; Utah
| | - Jean M. Butte
- Department of Surgery; Instituto Oncológico Fundación Arturo López Pérez; Rancagua 878 Santiago Chile
| | - Sameer Gupta
- Department of Surgical Oncology; King George's Medical University; Lucknow India
| | - Arun Chaturvedi
- Department of Surgical Oncology; King George's Medical University; Lucknow India
| | - Sanjib Chowdhury
- Section of Gastroenterology; Department of Medicine; Boston University Medical Center; Boston Massachusetts
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19
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Taramasco C, Figueroa K, Lazo Y, Demongeot J. Estimation of life expectancy of patients diagnosed with the most common cancers in the Valparaiso Region, Chile. Ecancermedicalscience 2017; 11:713. [PMID: 28144287 PMCID: PMC5243132 DOI: 10.3332/ecancer.2017.713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Indexed: 12/18/2022] Open
Abstract
Background The 1000s of people who die from cancer each year have become one of the leading causes of death among the Chilean population, placing it as the second cause of death in the region of Valparaiso between 1997 and 2003. Statistics have provided different measures regarding the life expectancy of cancer patients which have resulted in being useful to establish courses of action for prevention and treatment plans to follow. Methods Data was extracted from the cancer module of the Epidemiology Assistance System (SADEPI for its initials in Spanish) which stores information about cancer cases in the provinces of Valparaiso and Petorca. The survival period is defined as the difference in days between the date of occurrence and the date of death of the patient by separating the data into quartiles. Results The more frequent cancers in the region of Valparaiso behave similarly to global behaviours of the disease. The majority of affected patients are around 65 years of age which progressively lowers its occurrence in younger adults under the age of 45. Conclusions Further efforts are required for early detection and timely access to treatment for cancer patients. Statistics are an important support in achieving this.
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Affiliation(s)
- C Taramasco
- Escuela de Ingeniería Civil en Informática, Universidad de Valparaíso, 2362905, Chile
| | - K Figueroa
- Escuela de Ingeniería Civil en Informática, Universidad de Valparaíso, 2362905, Chile
| | - Y Lazo
- Escuela de Ingeniería Civil en Informática, Universidad de Valparaíso, 2362905, Chile
| | - J Demongeot
- Escuela de Ingeniería Civil en Informática, Universidad de Valparaíso, 2362905, Chile
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20
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Caglevic C, Silva S, Mahave M, Rolfo C, Gallardo J. The current situation for gastric cancer in Chile. Ecancermedicalscience 2016; 10:707. [PMID: 28105078 PMCID: PMC5221643 DOI: 10.3332/ecancer.2016.707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Indexed: 12/17/2022] Open
Abstract
Gastric cancer is a neoplasm with a high incidence and mortality rate in Chile where more than 3000 people die every year from this type of cancer. This study shows the clinical and epidemiological considerations of this disease, information about translational research on this pathology in Chile, the contribution of Chilean doctors to the development of gastric cancer management awareness and the general situation of gastric cancer in Chile.
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Affiliation(s)
- Christian Caglevic
- Cancer Drug Research Unit, Fundación Arturo López Pérez, Santiago, Chile; Instituto Oncológico Fundación Arturo López Pérez, Rancagua 878, Providencia Santiago, Chile
| | - Shirley Silva
- Radiation Oncology, University of Valparaíso, Valparaíso, Chile; Instituto Oncológico Fundación Arturo López Pérez, Rancagua 878, Providencia Santiago, Chile
| | - Mauricio Mahave
- Medical Oncology Service, Fundación Arturo López Pérez, Santiago, Chile; Instituto Oncológico Fundación Arturo López Pérez, Rancagua 878, Providencia Santiago, Chile
| | - Christian Rolfo
- Early Drug Development Unit - Phase I, University Hospital of Antwerp, Antwerp, Belgium; Instituto Oncológico Fundación Arturo López Pérez, Rancagua 878, Providencia Santiago, Chile
| | - Jorge Gallardo
- Fundación Chilena Desarrollo Oncología, SLAGO (Latin American Symposium on Oncological Gastroenterology), Santiago, Chile.; Instituto Oncológico Fundación Arturo López Pérez, Rancagua 878, Providencia Santiago, Chile
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21
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Amendola B, Quarneti A, Rosa AA, Sarria G, Amendola M. Perspectives on Patient Access to Radiation Oncology Services in South America. Semin Radiat Oncol 2016; 27:169-175. [PMID: 28325244 DOI: 10.1016/j.semradonc.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cancer represents a fast-growing challenge worldwide, and is being recognized as an emerging and critical issue in low- and middle-income countries, such most of South America. This subcontinent is unique for its geography, culture, and ethnical diversity. Most of its countries have large expanses of jungle and desert where underserved population groups including indigenous (native Indians), represent a challenge for cancer care. Many indigent patients have no access to preventive care nor early diagnosis. This results in late presentations with advanced disease and frequently incurable cancer. Prompt and coordinated action from local and international organizations is needed to support and guide local governments to avoid a global crisis. The critical role of education to improve awareness of the importance of radiation therapy, a cost-effective treatment modality, with the potential to help these patients at a relatively low cost is discussed.
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Affiliation(s)
| | - Aldo Quarneti
- Department of Radiation Oncology, School of Medicine of the University of the Republic of Uruguay, Montevideo, Uruguay
| | - Arthur Accioly Rosa
- Department of Radiation Oncology, Delfin Radioterapia Salvador, Bahía, Brazil
| | - Gustavo Sarria
- Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima Ica, Nazca, Peru
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22
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Sierra MS, Soerjomataram I, Forman D. Prostate cancer burden in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S131-S140. [PMID: 27678315 DOI: 10.1016/j.canep.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/24/2016] [Accepted: 06/27/2016] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVE The incidence of prostate cancer has increased in Central and South America (CSA) in the last few decades. We describe the geographical patterns and trends of prostate cancer in CSA. METHODS We obtained regional and national-level cancer incidence data from 48 population-based registries in 13 countries and nation-wide cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 person-years for 2003-2007 and the estimated annual percent change (EAPC) to describe time trends. RESULTS Prostate cancer was the most common cancer diagnosis and one of the leading causes of cancer deaths among males in most CSA countries. From 2003-2007, ASRs varied between countries (6-fold) and within countries (Brazil: 3-6-fold). French Guyana (147.1) and Brazil (91.4) had the highest ASRs whereas Mexico (28.9) and Cuba (24.3) had the lowest. ASMRs varied by 4-fold. Belize, Uruguay and Cuba (24.1-28.9) had the highest ASMRs while Peru, Nicaragua, and El Salvador (6.8-9.7) had the lowest. In Argentina, Brazil, Chile and Costa Rica prostate cancer incidence increased by 2.8-4.8% annually whereas mortality remained stable between 1997 and 2008. CONCLUSION The geographic and temporal variation of prostate cancer rates observed in CSA may in part reflect differences in diagnostic and registration practices, healthcare access, treatment and death certification, and public awareness. The incidence of prostate cancer is expected to increase given recent early detection activities and increased public awareness; however, the impact of these factors on mortality remains to be elucidated.
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Affiliation(s)
- Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
| | | | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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23
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Forman D, Sierra MS. Cancer in Central and South America: Introduction. Cancer Epidemiol 2016; 44 Suppl 1:S3-S10. [PMID: 27678321 DOI: 10.1016/j.canep.2016.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 11/22/2022]
Abstract
Central and South American countries (including Cuba) are experiencing rapid socio-demographic and epidemiologic changes and the nature of health problems are undergoing transition from infectious to chronic diseases, including cancer. Countries are poorly prepared to respond effectively to the subsequent challenges posed by the new patterns of disease. Existing data delineating the number of cancer cases and the distribution of cancer types from each country in the region are sparse due to limitations on health information systems for recording incidence and mortality despite improvements made in recent years. There is an urgent need for reliable statistics on cancer to inform governmental entities responsible for cancer control in the region. We attempted to obtain the best available cancer data from each country located in the region to provide an overview of current geographic patterns of cancer incidence and mortality in the 21st century.
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Affiliation(s)
- David Forman
- International Agency for Research on Cancer, Lyon Cedex 08, France.
| | - Monica S Sierra
- International Agency for Research on Cancer, Lyon Cedex 08, France
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